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RUSVM Pharmacology > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the catecholamine B1- agonists?

A 
Epinephrine 
Norepinephrine 
Dopamine 
Dobutamine 
Isoproterenol
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2
Q

What two drugs are methylxanthines?

A

Aminophylline

Theophylline

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3
Q

What is the MOA of aminophylline ?

A

Phosphodiesterase (PDE) inhibition -> increase the amount of cAMP-> increase release of endogenous epinephrine

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4
Q

What is the main effect of aminophylline and theophylline?

A

Bronchodilation

  • direct relaxation of smooth muscle in bronchi and pulmonary vasculature
  • some centrally mediated respiratory stimulation

Weak chronotrope and inotrope
(Usually considered a side effect)

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5
Q

What are precautions to treating with aminophylline/theophylline?

A

Patient with cardiac disease or hypertension
->tachycardia

Seizure disorder 
Gastric ulcer 
Hyperthyroidism 
Severe hypoxia 
Renal or hepatic dysfunction
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6
Q

What are used in the treatment of congestive heart failure ?

A 
Positive inotrope 
Vasodilator 
Inodilator (both positive inoptropic  and vasodilator effects) 
Diuretics 
Beta blockers
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7
Q

What is the body’s normal compensatory mechanisms for congestive heart failure?

A

In response to decreased blood pressure:

  • Increase sympathetic tone
  • ADH secretion
  • RAAS activation

Myocardial remodeling

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8
Q

What to drugs are positive inotropes?

A

Digoxin

B-1agonsit (eg Dobutamine)

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9
Q

What is the MOA of digoxin?

A

Inhibit Na/K/ATPase in the myocardial cell membrane to increase sodium available for exchange for calcium

-> increase intracellular calcium -> positive inotropic effect

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10
Q

Digoxin is administered ________ most commonly, but is also available in _________

A

Orally; IV formulation

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11
Q

How is digoxin metabolized and excreted?

A

Small amount in liver
Enterohepatic recirculation

Dog and horse - renal excretion

Cat- renal and hepatic excretion

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12
Q

What drug has positive inoptropic effects but will reduce sinus rate/nodal conduction?

A

Digoxin

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13
Q

What should you see on a ECG of a patient on digoxin ???

A

Prolonged PR interval

-negative chronotropic/dromotropic effects

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14
Q

What are secondary effects/precautions of digoxin?

A

Renal- diuretic effect due to increase CO (cardiac diuretic)

GI irritation
Vomiting, nausea, anorexia
Diarrhea

Alter serum potassium
Acute-> hyperkalemia
Chronic-> hypokalemia

Tachycardia

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15
Q

What is the number one adverse effect of digoxin???

A

GI signs

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16
Q

What are factors that predispose a patient to digoxin-induced tachyarrhythmias?

A

HYPO kalemia / magnnesemia

HYPER calcemia / natremia

HYPER or HYPO thyroidism

Hypoxemia

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17
Q

How do you treat Digoxin toxicity???

A

Potassium supplementation

Anti-arrhythmic drugs as indicated

Cholestyramine -> decrease enterophepatic recirculation

Digibind -> specific antidote of a digoxin immune Fab

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18
Q

What are the clinical uses of digoxin?

A

Atrial fibrillation/flutter

Congestive heart failure -> not first line anymore

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19
Q

Pimobendan in a ________ type of drug

A

Inodilator

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20
Q

What is the MOA of primobendan?

A

Sensitize myocardial contractile apparatus to calcium-> result in positive inotropic effect

-Enhance interaction between calcium and troponin complex

Phosphodiesterase (PDE)III inhibitor -> result in vasodilator effect

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21
Q

How is pimobendan administered?

A

Oral absorption is rapid with 60% oral bioavailability

NO IV formulation

Dosed BID or TID

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22
Q

How is pimobendan excreted?

A

Feces

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23
Q

What is the most common side effect of pimobendan?

A

GI signs

-vomiting, inappetence, diarrhea

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24
Q

What are side effects associated with pimobendan??

A

GI signs
Seizure
PU/PD/
Arrhythmia (but less than digoxin)

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25
Q

When is use of pimobendan contraindicated?

A

Aortic stenosis or any condition where augmentation of cardiac output is inappropriate for function or anatomic reasons

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26
Q

What is considered the drug of choice for treatment of congestive heart failure?

A

Pimobendan

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27
Q

T/F: pimobendan is an inodolator by increasing intracellular calcium available for exchange with sodium

A

F

Inodilator through myocardial sensitization to calcium and PDE III inhibitor

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28
Q

Digoxin should not be used concurrently with ___________

A

Furosemide

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29
Q

_____________ is an abnormality in heart rate and rhythm

A

Arrhythmia

Anything that is not a normal sinus rhythm

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30
Q

What is a normal sinus rhythm?

A

Normal physiological pattern of SA node to AV node

You see a Pwave followed by QRS complex and Twave at regular intervals and rate

31
Q

What are the three mechanisms of arrhythmia ?

A

Abnormal automaticity
Abnormal conduction
Disturbance in both automaticity and impulse conduction

32
Q

What is the MOA of class I antiarrhythmic drugs

A

Sodium channel blockage

Membrane stabilization -> slowed conduction, decreased excitability and automaticity

33
Q

What is the MOA of class II antiarrythmic drugs?

A

B adrenergic blockage (B blockers)

Reduces effect of sympathetic stimulation

34
Q

What is the MOA of class III antiarrhythmic drugs?

A

Potassium channel blockade -> prolong AP duration and refractory period

Anti-adrengergic effects

Prolonged Q-t interval

35
Q

What is the MOA of class IV antiarrythmic drugs?

A

Calcium channel blockage

Greatest effects on SA and AV node

36
Q

What drugs is a Class IA antiarrythmic ?

A

Quinidine

Procainamide

37
Q

What is a Class IB antiarrythmic ?

A

Lidocaine

Mexilitine (oral formulation)

38
Q

What is the drug of choice for treatment of atrial fibrillation in horses?

39
Q

What are the uses of procainamide

A

Heart - second line antiarrhythmic, more effective for ventricular arrhythmias than atrial arrhythmias

40
Q

What is the drug of choice for treatment of ventricular tachycardia in dogs?

41
Q

What are the Class II beta-blockers?

A 
Propranolol 
Esmolol 
Atenolol 
Metoprolol 
Carvediol
42
Q

What is a Non-selective B blocker?

A

Propranolol

43
Q

What are the selective B blockers?

A

Esmolol
Atenolol
Metoprolol

44
Q

What drugs is most indicated in a cat that has hypertrophic cardiomyopathy (HCM) secondary to hyperthyroidism?

A

Propranolol

Preferred over selective B blockers because of its ability to inhibit T4 to T3 conversation

45
Q

What drug would be used for short term treatment of SVT to determine if a beta blocker is effective at controlling the arrhythmia?

A

Esmolol (ultra short acting)

CRI

46
Q

What is the best treatment option for treatment of SVT in patients with bronhcoconstrictive disease?

A

Selective B1 antagonism

Atenolol (most selective for B1)

47
Q

What is the main clinical use of metoprolol?

A

Systemic hypertension

Can be used for SVT or VPC (less common)

48
Q

What drug has antiarrythmic properties but also reduces afterload through alpha 1 adrenergic receptor antagonism

A

Carvediol

Useful in some cases of dilated cardiomyopathy in dogs

49
Q

When is B blocker used contraindicated ?

A

Unstable or overt heart failure is present

50
Q

What are adverse effects of B blockers ?

A

Most common in geriatric or unstable patients

Hypotension
Lethargy and depression
Syncope
Worsening CHF

51
Q

When taking a patient off of B blockers, you should… ?

A

Wean of drug gradually

B receptors are upregulated, if you remove B blocker completely you risk sympathetic storm

52
Q

What are the Class III potassium channel blockers? What is the main effect of these drugs?

A

Sotalol (also non selective B blocker)

Amiodarone

Prolong the effective refractory period of cardiac action potential without decreasing conduction velocity (slow HR, covert back to normal sinus rhythm)

53
Q

What is the main sed of sotalol?

A

Oral formulation useful for ongoing management of ventricular tachyarrythmia

54
Q

Sotalol use is contraindicated with ?

A

Overt or low output CHF

55
Q

____________ is often a 2nd or 3rd line treatment for antiarrythmia

A

Amiodarone

56
Q

What are adverse effects of amiodarone ?

A

GI (most common)

Bone marrow suppression and hepatotoxicity (to be most concerned about)

Type I hypersensitivity

57
Q

What are the Class IV calcium channel blockers? What is the main action of these drugs

A

Diltiazem

Calcium entry blockade

58
Q

What is the drug of choice for treatment of supraventricular tachycardia (SVT)

59
Q

What is the drug of choice to decrease ventricular response rate in treatment of atrial fibrillation?

60
Q

What are precautions to using diltiazem?

A

Pulmonary edema
IV- Give VERY slowly

Oral extended release capsules- must open capsule and give a single tablet (associated with overdose/lethal toxicity)

61
Q

What two drugs are used in combination to treat atrial fibrillation in horses ?

A

Quinidine and diltiazem

62
Q

____________ is a cofactors in variety of enzyme systems and may be used in treatment of refractory ventricular arrhythmias

A

Magnesium sulfate IV

63
Q

What are vagal maneuvers ? What do they treat?

A

Treat SVT

Increase pressure by carotid sinus massage and ocular pressure –> simulation to decrease HR

64
Q

What is a fluid-responsive tachycardia?

A

Tachycardia due to severe dehydration -> hypovolemia

65
Q

Analgesic-responsive tachycardia is usually due to ??

A

Painful condition

  • trauma
  • acute abdominal signs
  • post op
66
Q

How can sinus bradycardia be treated?

A

Do nothing
Atropine
Glycopyrrolate
Reversal agent (if indicated)

67
Q

An absence of a p-wave is called ___________

A

Atrial standstill

68
Q

What is atrial standstill most commonly caused by?

A

Severe hyperkalemia

69
Q

What is emergency treatment of atrial standstill caused by severe hyperkalemia?

A

IV calcium gluconate

Maybe :
IV sodium bicarbonate
Dextrose
Insulin with dextrose

70
Q

What are negative effects of chronic nervous system activation?

A 
Tachycardia 
Tachyarrythmia 
Activate RAAS 
Down regulate B blockers 
Induce myocyte necrosis 
Altered myocyte energy substrate and calcium ion handling
71
Q

What is the drug of choice for treatment of ventricular tachycardia?

72
Q

What is the drug of choice for treatment of atrial fibrillation with a high ventricular response rate?

73
Q

Mexilitine, sotalol, and amiodarone can all be used for ???

A

Treatment of ventricular arrhythmia

RUSVM Pharmacology (18 decks)

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