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Pharma 1 > cardiovascular and respiratory system > Flashcards

cardiovascular and respiratory system Flashcards

1
Q

Respiratory antiinflammatory groups

A
  1. Inhalational glucocorticoids
  2. Chromones
  3. Leukotriene antagonists
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2
Q

Inhalation glucocorticoids:

  • effects
  • Other aplication
  • examples
A

Most effective antiinflammatories

  • Inhibition of the expression of several genes decreasing citokine production: IL 4, IL 5!
  • Decreased mucous production! Increasing diameter
  • Systemic application possible but: several side effects (HTHP axis, stomach, liver etc.)

beclomethasone, fluticasone

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3
Q

chromones are:

how to administer?

A

mast cell stabilizers

Per os, inhalation, nasal spray, eye drop

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4
Q

Leukotriene synthesis inhibitor

A

zileuton , (fenleuton)

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5
Q

Leukotriene antagonists

A

zafirlukast, montelukast (afainst feline asthma)

pranlukast

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6
Q

Peripherial antitussives

A

mucolytics, expectorants
bronchodilators
coating substances
local anesthetics

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7
Q

Central antitussive

A

morphine derivatives

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8
Q

antitussitives

- drugs

A

Codeine, morphine
Dihydrocodeine (more effective, Ø cat!*)
Hydrocodone
Butorphanol (most effective, but ….sedation)
Tramadol
Dextrometorphan (safe also in cats)

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9
Q

Mucolytic — expectorant:

- indications

A

bronchitis, bronchopneumonia, tracheitis, rhinitis,

sinusitis, RAO as adjunctive therapy

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10
Q

Mucolytics

  • drugs
  • effects
  • admin
A 
N Acetylcysteine (breaks disulphide bonds of the mucoproteins) bad taste and odour
- Given per os or inhalation

Carbocystein

  • similat action
  • oral absorption a little better
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11
Q

Antidote for parecetamol

A

N Acetylcysteine

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12
Q

Expectorants:

  • effects
  • drugs
A
  • directly on the mucous membrane of airways , or indirectly by stimulating gastric mucous membrane
Bromhexin
Ambroxol
Dembrexine (Eq longer half-life)
Guaifenesin (Can be combined with antitussives)
Ipecacuanha
volatile oils
Salts (pl. NH 4 Cl, NaI)
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13
Q

Drug groups used for immunosupression:

-examples

A
  • Antimetabolites (Azathioprine, mycophenolate
    mofetil, Methotrexate)
  • Alkylating agents (Cyclophosphamide)
  • Glucocorticoids
  • Cytokine gene expression inhibitors
  • Calcineurin (Cyclosporin and tacrolimus)
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14
Q

Cyclosporin use

A 
per os or oral admin
- Autoimmune diseases pemphigus , lupus , AIHA,
  KCS= keratoconjunctivitis sicca
- Atopic dermatitis
- IBD
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15
Q

causes arrythmia, dysrythmia:

A 
Ectopic impulse! (impulse...)
Cardiomyopathy
Re-entry
Drugs
Electrolite imbalances
Primary cause
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16
Q

Quinidine effects

  • admin
  • side effects
A
  • Vagal effect (+direct effect!)
  • Negative inotropic (heart failure!)
  • Dog (GI and CV side effects), cat (short t1/2) ??
  • Horse IV. or PO.
  • frequent side effects
  • supraventricular arrhytmias
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17
Q

Sodium channel blockers

A 
Quinidine
Procainamide
lidocaine
Mexiletine
Carvedilol
flecainide
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18
Q

Procainamide:

- side effects

A

Side effect (IV.)

  • negative inotropic, arrhytmogenic
  • Unfavorable pharmacokinetics (short t1/2)
  • Ventricular arrhytmias IV.: if refractory to lidocaine
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19
Q

Lidacaine:

  • use
  • side effects
  • admin
A
  • Immediate treatment of life threatening ventricular arrhytmias!
  • NO Supraventricular effect
  • Advantages
    Short t1/2
    Damaged cells  normal cells
    hypocalemia reduces effect
  • side effects in cats!
    - Use diazepam against CNS side effects
    Ø negative inotropic effect, hypotension, conductance failure = safe to use
  • given IV
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20
Q

Oral substitute for lidocaine

A

Mexiletine
= treatment of ventricular arrhytmias at home
given oraly
- Frequently combined with β-blockers (atenolole, sotalole)

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21
Q

Beta blockers:
1st generation:
2nd generation:
3rd generation:

A
  1. Beta 1+2 (Propranolol)
  2. Beta 1 (Metoprolol, Atenolol, esmolol)
    • Ca: in combo with mexiletine
  3. Beta 1+ peripheral+++ (Carvedilol)
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22
Q

Contraindications for beta blockers

A

severe bradycardia, AV block

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23
Q

K channel blockers:

  • use
  • drugs
A

ERP increases!
excellent in re entry!
Sotalol (boxer cardiomyopathy)
Amiodarone (supraventricular, ventricular)

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24
Q

Ca channel blockers:

  • effect
  • types of drugs
A

SA and AV node—-> bradycardia
mainly supraventricular
Decreased Ca2+-influx: decreased contraction and vasodilatation!!
- reducing afterlad

Dihydropyridine type (vessels): amlodipine, nifedipine
Non-dihydropyridine type (heart): verapamil, diltiazem
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25
Q

Treatment for Congestive heart failure (CHF):

  • types of treatment
  • example drugs
A
  1. Increasing frequency: only in life threatening cases!
    e.g. epinephrine: positive inotropic, chronotropic
    increases myocardial oxygen demand
  2. Increasing contractility: digitalis glycosides
  3. Decreasing preload and afterload: ACE inhibitors
  4. Inodilators (2+3): PDE inhibitors
  5. Vasoactive substances (arterial and venous vasodilators): e.g. nitroglycerine
  6. Diuretics: decrease preload
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26
Q

What is Pimobendan?

contraindications:

A

PDE inhibitor
Ca2+ sensitizer —> positive inotropic effect
PDE inhibition —> arterial and venous vasodilation
= „INODILATOR”

  • Extensive protein binding!
  • outflow obstruction
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27
Q

Most important ACE inhibitor:

A

Benazepril (excreted in urine and bile = good for kidney damage pateints)

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28
Q

Name the ACE inhibitors:

A 
captopril 
Enalapril
Ramipril
Benazepril
Lisinopril
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29
Q

Angiotensin II receptor antagonists

A

Losartan, valsartan, telmisartan

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30
Q

Types of diuretics:

A
  1. Cardial diuretics
    Digoxin
    Xanthine derivatives (coffeine, theophyllin, theobromine)
    ACE inhibitors
  2. Osmotic diuretics
  3. Natriuretics
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31
Q

Osmotic diuretics:

  • drug
  • indications
  • admin
A
  • Mannitol (mannit)
    only IV as it cant cross menbranes
    retains blood in bloodvessels and drain tissues

Indications:
life threatening edemas
acute renal failure (oliguria, anuria)
gleucoma

0,5-1 mg/kg IV. (4-6 h)

  • Glycerine
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32
Q

Natriuretics groups:

  • Functions
  • Examples
A
  1. Carboanhydrase inhibitors (inhibit Na/H pump)
    - against glaucoma (aquous humor is formed)
    - Acetolamide orally, dorsolamide eye drops
  2. Loop diuretics (Na/K pump is inhibited)
    - MOST EFFECTIVE DIURETIC!
    - Mg2+ and Ca2+ excretion increased
    - FUROSEMIDE (oedema! give also if mannitol is not working), torsemide, etacrinic acid
  3. Thiazides
    NCCT inhibition –>Na+ and water excretion
    K+ excretion increased, Ca2+ excretion decreased!
    - Chlorothiazide, Hydrochlorothiazide
    - can be given in combo with furosemine to enhance it
4. Potassium sparing diuretics
(ENaC and Na/K-ATP-ase protein expression)
A. Amiloride, triamterene
B. Aldosterone antagonists	
	*competitive antagonists
        * increased Na+ excretion (mild), K+ excretion (mild)
	*very mild diuretics!!!
-Spironolactone
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33
Q

Which treatment can you use against allergic conjunctivitis?

A
  1. Mast cell stabilizers
  2. Vasoconstrictors
  3. Antihistamines (together with 1)
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34
Q

Mast cell stabilizers:

A

Sodium chromoglycate , lodoxamide, nedocromil

35
Q

Vaoconstrictos used for allergic conjunctivitis:

A

Tetryzoline HCl

36
Q

Antihistamines:

A

Azelastine, olopatadine , epinastine , emedastine

antazoline

37
Q

Which drug can be used against the CNS symptoms in lidocaine treatment?

A

Diazepam

38
Q

Beta-blockers

  • indications
  • contraindications
A

Indications
1. Supraventricular and ventricular arrhytmias
preventing sudden death
2. HCM (too thick heart muscle, = hypertrophic cardiovascular myopathy)
3. Hyperthyroidism, methylxanthine poisoning

Contraindications: severe bradycardia, AV-block

39
Q 
Vaughan-Williams conductance groups: 
1.
2. 
3.
4.
5.
A

Antiarrythmia drugs:
1. Na-channel blockers (“membrane-stabilizers”) Quinidine, Procainamide, lidocaine, Mexiletine
2. Beta receptor blockers
Propranolol, Metoprolol, Atenolol, esmolol, Carvedilol
3. Potassium channel blockers
Sotalol, Amiodarone
4. Calcium channel blockers
amlodipine, nifedipine, verapamil, diltiazem
5. Other substances
- Digoxin, atropine

40
Q

ERP=?

A

ERP= effective refractory period

The amount of time in which the cell cannot respond to a new conducted stimulus

41
Q

Congestive heart failure (CHF):

types and causes:

A

Acute heart failure
cause: sudden deterioration of heart pump function (e.g. myocardial infarction, ventricular fibrillation)

Chronic heart failure
cause: gradual and slow deterioration in heart pump function and performance

42
Q

Cardiotonics

-used in case of? drug examples

A 
Positive inotropic drugs, cardiotonics
In acute heart failure
Epinephrine 
Dobutamine
Dopamine

In chronic heart failure
Digitalis glycosides
Pimobendan

43
Q

Cardiotonics

-Pharmacological effects

A 
1. direct cardiac action
		positive inotropic: cardiac output increase
		improves RBF: water and Na+ excretion
	2. increases vagal tone
		negative chronotropic
		negative dromotropic
44
Q

Digoxin

pharmacokinetics

A 
Digoxin
	pharmacokinetics
		orally
		protein binding: interactions! 
		accumulation in myocytes
		measuring plasma levels after 3-5 days
		excretion via kidney
	small therapeutic index (hypokalaemia!)
45
Q

Digoxin side effects:

A

cardiac: arrhythmias, bradycardia, hypokalaemia!
extracardial: GI-signs (vomiting)

46
Q

Digoxin

  • Usage
  • contraindications
A

Digoxin usage:
prolong survival time in heart failure
supraventricular tachyarrhytmias

Contraindication
	outflow obstruction (HCM, stenosis)
47
Q

PDE inhibitors =Phosphodiesterase inhibitors

- effects

A
  • Pimobendan
48
Q

Pimobendan

  • effect
  • contraindications
  • bioavailability
  • side effects
A

Pimobendan:

  • positive inotropic effect
  • Ca2+ sensitizer: positive inotropic effect
  • PDE inhibition: arterial and venous vasodilation

Contraindications: outflow obstruction
Side effects: Gastrointestinal: diarrhea and appetite
depresion

  • give it with feed—> good bioavailability
49
Q

ACE inhibitors

- indications

A

Indications
heart failure (species!)
hypertension
proteinuria

50
Q

ACE inhibitors

- side effects

A

azotaemia
hypotension: tiredness, faintness!
GI-disturbances: anorexia, vomiting, diarrhea
Ho: dry cough

51
Q

Angiotensin II receptor antagonists

  • advantages
  • examples of drugs
A

Advantages
more effective
no bradykinin activation

Losartan, valsartan, telmisartan

52
Q

Nitroglycerin :

  • effect
  • Application
A
  • Pronounced arterial and venous dilation
  • dilation of mesenterial veins: „shift” from pulmonary circulation
  • Decreased preload, afterload, myocardial O2 consumption!!
  • Dilates coronary arteries

-Application: first pass effect orally
IV., sublingual, transdermal patch, ointment—> quick effect —> acute heart failure of decompensated chronic heart failure

53
Q

Asthma is a complex disease characterized by:

A
  • airway inflammation which leads to airway
    hyperresponsiveness which causes symptomatic
    bronchoconstriction

=obstructive lung disease and inflammatory disease

54
Q

COPD is caused by:

A

an abnormal inflammatory response to an inhaled
environmental insult

- divided into two frequently overlapping
diseases emphysema (=alveolar
enlargement) and chronic bronchitis (=chronic cough)
55
Q

Drugs Acting on the Respiratory System:

A
  • Bronchodilatators
  • Respiratory antiinflammatory drugs
  • Antitussives
  • Mucolytics, expectorants
56
Q

Bronchodilators indications:

A
  • anaphylaxis
  • allergic bronchitis
  • asthma (Fe), RAO (horse)
  • pulmonary edema
  • pneumonia
  • pleural effusion
  • pneumothorax
  • tracheal collapse and hypoplasia?
57
Q

Bronchodilator groups:

- examples

A

= Act mainly on β 2 adrenergic receptors

  1. Sympathomimetics
    - non specific: Adrenaline, Isoproterenol, Ephedrine
    - specific: salbutamol, terbutaline, clenbuterole, salmeterol (= β 2 receptor agonists)
  2. Anticholinergic substances
  3. Xanthine derivatives
58
Q

β 2 agonists characteristics:

  • side effects
  • contraindications
  • action time
A
  • Bronchodilators at β 2 receptors (+ variable β 1 receptorial effect)
  • SE: tachycardia, restlessness, tremors, decreased uterine contraction
  • contraindications: congestive heart failure
  • decreased mast cell degranulation
Short acting (1 4 hours)
Long acting (6 12 hours)
59
Q

salbutamol:

- admin

A

Short acting β 2 agonist

  • significant veterinary experience
  • given per os or inhalation
60
Q

terbutaline:

  • Specificity
  • admin
  • used in:
A

Long acting β 2 agonists

  • less specific
  • subcutaneous, intravenous injection, inhalation
  • feline asthma, organophosphate toxicosis, horse ROA
61
Q

clenbuterole:

  • Specificity
  • used in:
A

Long acting β 2 agonists

  • less specific
  • less effective in companion animals
  • frequently in horse (Ø meat producing animals)
62
Q

salmeterol:

  • specificity
  • duration
A

Long acting β 2 agonists
•most specific (50000:1)
- longest duration
- most expensive

63
Q

Side effects of bronchodilators:

A
  • β 1: Tachychardia, arrhythmias from ephedrine, isoproterenol
  • β 2: skeletal muscle tremor
  • α: vasoconstriction and hypertension
  • tachyphylaxis
64
Q

Acetylcholine antagonists (M3 receptors)

  • effects
  • indications:
A

Acetylcholine antagonists (M3 receptors)
- bronchodilation + decreased mucous secretion
side effects: tachycardia, mydriasis, decreased
„mucociliary clearence”, paralytic ileus (Eq)

indications:
asthma (Fe!)
horse RAO
organophosphate toxicosis

65
Q

Bronchodilators, Parasympatholytics:

name the drugs:

A
  • Atropine (in organophosphate toxicosis++)
  • Glycopyrrolate (longer action, much safer)
  • Ipratropium (quaternary amin, only inhalasol= safe,
    does not cross BBB)
    -
66
Q

Methylxanthine derivatives:

  • names
  • effects
  • pharmacokinetics
  • side effects
  • indications, administration
A

Caffeine, theobromin

theophyllin:
1. phosphodiesterase inhibitor (bronchodilation)
2.Various pharmacological effects!
3.Pharmacokinetics : good absorption, enterohepatic circulation
4.Side effects : small therapeutic index! (CV, GI, diuresis)
5. Indications, dosage:bronchitis, pneumonia etc.
IV., PO (retard tablets)

67
Q

Derivatives of theophyllin=

A
  • aminophyllin
  • propentophyllin:
    • –> bronchodilator
    • –> vasodilator: brain, muscles, kidney
  • pentoxyfillin
68
Q

Methylxanthines:

  • Therapeutic uses
  • Side effects:
A
  • Treat acute or chronic asthma that is unresponsive to
    β-adrenoceptor agonists
  • Treat COPD and emphysema
  • Side effects:
    arrhythmias , nervousness , vomiting and
    gastrointestinal bleeding
69
Q

In case of digoxin overdose you can give:

A

Lidocaine

70
Q

Inodilator definition

A

inodilators are agents with inotropic effects that also cause vasodilation leading to decreased systemic and/or pulmonary vascular resistance

71
Q

Positive inotropic effect definition

A

Positively inotropic agents increase the strength of muscular contraction

72
Q

Positive chronotropic definition

A

Positive chronotropes increase heart rate; negative chronotropes decrease heart rate

73
Q

Why do you take blood samples after 1 week of ACE inhibitor treatment?

A

To look for azotaemia

=characterized by abnormally high levels of nitrogen-containing compounds

74
Q

Carboanhydrase inhibitors

  • Indications
  • side effects
A

Indications
congestive heart failure
glaucoma (systemic  local)
alkalizing urine! (cystine stones)

Side effects
metab. acidosis, other uroliths
Acetazolamide, dorsolamide

75
Q

Furosemide

  • indications
  • side effects
A

Indications
heart failure (primary drug!)
edemas
oliguria, anuria (rehydration!)

Side effects
hypokalemia, hypomagnesemia, metabolic alkalosis, hypotension (Fe), ototoxicity
Indications
1-5 mg/kg iv., im., po.
give 3 times a day against any type of oedemas
Human dosage =much lower!
Combinations –> „aldosteron escape “ NB remodeling, so give together with aldosterone antagonist

76
Q

Hydrochlorothiazide

  • indications
  • side effects
A 
Indications
	heart failure, hypertension
	Ca oxalate urolithiasis
	diabetes insipidus
Side effects
	hypokalemia, metabolic alkalosis
77
Q

Spironolactone

  • indications
  • side effects
A

Indications
antagonising aldosterone in CHF!
preventing diuretic induced „aldosteron-escape”
hyperaldosteronism

Side effects
hyperkalemia: don’t use!

78
Q

Combined treatment of CHF

  • dog
  • cat
A

Dog
Pimobendan+furosemide+spironolactone
ACE inhibitor+furosemide+spironolactone

Cat:
- Furosemide
Treating hypertension
Amlodipine+ACE inhibitor

79
Q

Receptors for bronchocontriction

- cause of bronchoconstrinction

A

Express muscarinic receptors,especially the excitatory M3 subtype of muscarinic receptors. Upon stimulation, these receptors induce bronchoconstriction.

Acutely, mast cell degranulation produces
bronchoconstriction and airway inflammation
- Mast cells also release leukotriene C 4 (LTC 4) which is
subsequently converted into LTD 4 and LTE 4 —> Bronchoconstriction

80
Q

Bronchodilation and constriction drugs:

A

Dilation:
cAMP
(β 2 agonists, xanthine derivatives)

Constriction:
Acetylcholine

81
Q

Treatment of allergic bronchitis, RAO and
feline asthma:
- Horse treatment combinations

A 
1. Glucocorticoids
•continously
- beclomethasone, fluticasone
2. Bronchodilators
continously or occasionally advantage!
  • Other agents in feline asthma:
    1. Antihistamines
    •cyproheptadine
    2. Na chromoglycate
    3. Leukotriene antagonists

E.g. HORSE
beclomethasone+salmeterol
beclomethasone+ipratropium

CAT
fluticasone + salbutamol/etc.

82
Q

Codeine vs morphine:

A 
better bioavailability orally
10 times lower analgesic potency
similar antitussive
rare side effects
- cat!: excitation, convulsions, sedation, constipation
83
Q

Bromhexin

  • actions
  • indications
  • admin
A 
= Expectorant
3 actions:
1. breaking up mucopolysaccharides, dissolving mucus
2. increasing secretion of serous glands
3. enhancing ciliary movement
Enhancing permeation of Igs and AB s!
IgA, IgG levels increased
- Indications: rhinitis, sinusitis, tracheobronchitis (but: purulent discharge!)
  • Side effects: nausea, rash, vomiting, diarrhea,
  • per os, sc . BID

Pharma 1 (15 decks)

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