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Pharmacology 2 > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

What are 3 types of drugs that act on the heart?

A

Cardiac stimulants
Treatment of CHF
Antiarrhythmics

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2
Q

What are 4 classes of drug that are cardiac stimulants?

A

B1-agonists
Phosphodiesterase inhibitors
Glucagon
Calcium salts

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3
Q

What are two non-drug treatments of CHF?

A

Restricted salt diet

Restricted exercise

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4
Q

When treating CHF with drugs, does the drug depend on the degree of the disease?

A

Yes

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5
Q

What 5 types of drugs are used to treat CHF?

A 
Positive inotropic drugs
Inodilators
Vasodilators
Diuretics
B-blockers
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6
Q

What 2 drugs are positive inotropes?

A 
Digitalis glycosides (Digitoxin Digoxin*, Ouabain)
B1-agonists
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7
Q

How does digoxin work?

A

Inhibits Na/K ATPase, increasing intracellular calcium = positive inotropic effect

NOTE: Drug can kill by this mechanism

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8
Q

What 5 CV effects does digoxin have?

A 
Positive inotrope
Slows AV conduction (reduces sinus rate)
Prolongs PR intervals
Increases mechanical efficiency of the failing heart (increase contractility, not O2 demand)
Normalization of BP
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9
Q

What other organs does digoxin affect?

A

Kidney (diuretic)

GIT (irritation, vomiting)

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10
Q

How is Digoxin given?

A 
Orally
Slow IV (emergency)
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11
Q

What is the bioavailability of digoxin in the elixer vs. tablet?

A

75% vs. 60%

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12
Q

Is any digoxin metabolized in the liver?

A

Yes, a small amount.

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13
Q

T/F: Digoxin doesn’t undergo enterhepatic recycling.

A

False.

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14
Q

Where is digoxin excreted?

A

Renal in dogs and horses

Renal and hepatic in cats

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15
Q

What are 2 therapeutic uses for digoxin?

A

CHF

Atrial arrhythmias in dogs

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16
Q

What kind of safety margin does digoxin have?

A

Narrow

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17
Q

What adverse effects do you see with digoxin?

A

Cardiac

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18
Q

What species is more sensitive to digoxin?

A

Cats

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19
Q

How do you treat a tachyarrhythmia caused by digoxin? (5 things)

A 
Drug withdrawal
Potassium IV
Antiarrhythmic drugs (lidocaine, phenytoin, propranolol)
Cholestyramine
Digibind
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20
Q

How you do treat a bradyarrhythmia caused by digoxin? (2 things)

A

Drug withdrawal

Atropine

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21
Q

What clinical signs do you see with digoxin affecting the GI? (2 things)

A

Anorexia

V&D

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22
Q

How do you treat adverse GI reactions to digoxin? (2 things)

A

Drug withdrawal

Fluid therapy

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23
Q

What 2 B1-agonists would you use to treat serious heart failure?

A

Dopamine

Dobutamine

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24
Q

Why would you not use (nor)epi or isoproteranol to treat serious heart failure?

A

Because they produce tachycardia which can be a problem.

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25
Q

What are 3 inodilators?

A

Pimobendan
Inamrinone
Milrinone

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26
Q

Why are Inamrinone and milrinone only used in emergencies?

A

Because they also produce tachycardias.

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27
Q

What is an inodilator?

A

Substance at is both a positive inotrope and a vasodilator.

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28
Q

By what mechanism does Pimobendan work?

A

Sensitizes the cardiac contractile apparatus to Ca

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29
Q

What is balanced vasodilation?

A

Vasodilation in both arteries and veins.

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30
Q

How does Pimobendan cause balanced vasodilation?

A

Inhibition of PDE III and V in blood vessels.

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31
Q

What are 3 uses of Pimobendan?

A
  • Treat CHF
  • Adjunct to help improve quality and length of life in dogs with both dilated cardiomyopathy (DCM) and chronic degenerative valvular disease (CVD)
  • Used with furosemide, spironolactone or ACE in heart failure patients
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32
Q

What side effects can you see with Pimobendan? (4 things)

A

V&D
Inappetence
Seizures
PU/PD

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33
Q

Which is less arrhythmogenic, Digitalis or Pimobendan?

A

Pimobendan

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34
Q

When is Pimobendan contraindicated?

A

Hypertrophic cardiomyopathy

Conditions where increase of cardiac output is not physically possible

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35
Q

How is Pimobendan given?

A

Orally

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36
Q

What is the bioavailability of Pimmobendan?

A

60%

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37
Q

What are the pharmacokinetics of Pimobendan?

A

Activated in the liver

Excreted in feces

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38
Q

What is the half-life of Pimobendan?

A

2 hours

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39
Q

T/F: Pimobendan is bound to protein.

A

True

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40
Q

What 4 dilators do you use for CHF?

A

ACE Inhibitors
Hydralazine
Nitrates
Prazosin

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41
Q

What 3 types of diuretics are used in CHF?

A

Loop
Thiazide
K-sparing

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42
Q

What 2 types of B-blockers are used in CHF?

A

Carvedilol

Metoprolol or Atenolol

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43
Q

What stage do you use Carvedilol to treate CHF?

A

Early stage CHF

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44
Q

What is the mechanism of action of Carvedilol?

A

Nonselective B-blocker and a1-blocker
Antioxidant
Inhibits endothelial release

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45
Q

What are 4 other agents used to treat CHF?

A

Oxygen
Morphine sulfate (very small dose)
Aminophylline
Nebulization of ethanol (20%)

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46
Q

What is an arrhythmia?

A

Abnormality in heart rate.

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47
Q

What are 3 mechanisms of arrhythmia?

A

Abnormal automaticity
Abnormal conduction
Disturbances in both

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48
Q

What are the 2 types or arrhythmias?

A

Tachyarrhythmias

Bradyarrhythmias

49
Q

How many classes are there of drugs that treat tachyarrhythmias?

A

4

50
Q

What are the 4 classes of drugs that treat tachyarrhythmias?

A

Class I: Sodium channel blockers
Class II: B-blockers
Class III: Potassium channel blockers
Class IV: Ca channel blockers

51
Q

What do class IA drugs do?

A

Prolongs action potential

52
Q

What drugs are under Class IA? (3 drugs)

A

Quinidine
Procainamide
Disopyramide

53
Q

What do Class IB drugs do?

A

Shortens action potential

54
Q

What drugs are under Class IB? (5 drugs)

A

Lidocaine (75% or more undergoes first pass)
Phenytoin
Tocainide
Mexiletine (similar to lidocaine, but oral)
Aprinidine

55
Q

What do Class IC drugs do?

A

No effect on action potential

56
Q

What drugs are under Class IC? (3 drugs)

A

Flecainide
Encainide
Lorcainide

57
Q

What are Class II drugs?

A

B-blockers

58
Q

What drugs are under Class II?

A

All the “-lol”s

59
Q

What are Class III drugs?

A

K-channel blockers

60
Q

What 3 drugs are under Class III?

A

Bretylium
Amiodarone
Sotalol (nonselective B-blocker)

61
Q

What are Class IV drugs?

A

Calcium channel blockers

62
Q

What 2 drugs fall under Class IV?

A

Verapamil

Diltiazem

63
Q

What is Quinidine used for? (2 things)

A

Ventricular arrhythmias

A fib in horses (drug of choice), cattle and large breed dogs

64
Q

What is Procainamide used for?

A

Ventricular arrhythmias

65
Q

What is Lidocaine used for?

A

IV drug of choice for ventricular arrhythmias d/t GA, sx, ischemia or trauma
Digitalis-induced arrhythmias

66
Q

What is Phenytoin used for?

A

Digitalis-induced arrhythmias in dogs only (NOT CATS)

67
Q

What is Propranolol used for? (3 things)

A

Supraventricular tachycardia
Digitalis-induced tachyarrhythmias
Arrhythmias due to inhalation anesthesia

68
Q

What is Bretylium used for?

A

Refractory and recurrent tachyarrhythmias

69
Q

What are Verapamil and Diltiazem used for?

A

Supraventricular tachyarrhythmias

Myocardial hypertrophy

70
Q

What 3 drugs can you use to treat atrial tachycardia in dogs?

A

Digoxin
Procainamide, propranolol
Quinidine, Phenytoin

71
Q

What 2 drugs can you use to treat atrial flutter in dogs?

A

Digoxin

Quinidine, Procainamide, Propranolol

72
Q

What 3 drugs can you use to treat atrial fibrillation in dogs?

A

Digoxin
Propranolol
Quinidine, Procainamide

73
Q

What 3 drugs can you use to treat ventricular premature complexes in dogs?

A

Quinidine, Procainamide, Lidocaine
Phenytoin
Propranolol

74
Q

What 3 drugs can you use to treat ventricular tachycardia in dogs?

A

Procainamide, Lidocaine
Quinidine, Phenytoin
Propranolol

75
Q

What can you use to treat tachyarrhythmias in cats?

A

B-blockers are the drug of choice

76
Q

What are the 3 antiarrhythmic drugs used for Bradyarrhythmias?

A

Atropine
Isoproterenol
Epinephrine

77
Q

What 2 drugs do you use to treat a sinus bradycardia?

A

Atropine

Isoproterenol

78
Q

What 3 drugs do you use to treat an second-degree AV block?

A

Atropine
Isoproteranol
Glucagon

79
Q

What drugs can you use to treat cardia asystole (cardiac resuscitation)?

A

Epinephrine

80
Q

What 2 types of drugs act on the blood vessels?

A

Vasoconstrictors

Vasodilators

81
Q

What are 3 types of vasoconstrictors?

A

Nonselective a-agonists
Selective a1-agonists
Direct and indirect sympathomimetics

82
Q

What 2 nonselective a-agonists are vasocontrictors?

A

Epinephrine

Norepinephrine

83
Q

What selective a1-agonist vasoconstricts?

A

Phenylephrine

84
Q

What 3 direct and indirect acting sympathomimetics vasoconstrict?

A

Ephedrine
Pseudoephedrine
Phenylpropanolamine (PPA)

85
Q

What are 5 types of vasodilators?

A 
Sympatholytics
ACE Inhibitors
Angiotensin II antagonists
Direct-acting vasodilators
Calcium channel blockers
86
Q

What 7 types of sympatholytic vasodilators are there?

A 
Non-selective a-blockers
Selective a1-blockers
Presynaptic a2-agonist
Nonselective B-blockers
Selective B1-blockers
B1 and a1-blockers
Indirect sympatholytics
87
Q

What are the 4 ACE inhibitors?

A

Captopril
Enalapril
Benazepril
Lisinopril

88
Q

How do ACE inhibitors work?

A
  • Inhibits Angiotensin-converting enzyme which prevents AT II synthesis
  • Inhibits Aldosterone
  • Produces a reflex increase in renin and increased bradykinin levels (vasodilators)
89
Q

What are the 3 therapeutic uses for ACE inhibitors?

A

CHF (Mild cases, combined with other drugs for more severe cases)
Hypertension in dogs
Chronic renal insufficiency in cats

90
Q

How are ACE inhibitors given?

A

Enalapril is given orally and parenterally

All others are oral

91
Q

What is the important to remember when giving Captopril (ACE inhibitors) orally?

A

Food reduces intestinal absorption.

92
Q

Between Enalapril and Captopril in dogs, which has slower onset and longer duration?

A

Enalapril

93
Q

Which 2 ACE inhibitors are are long acting?

A

Benazepril and Lisinopril

94
Q

Which 2 ACE inhibitors are activated in the liver?

A

Enalapril and Benazepril

95
Q

Which ACE inhibior is least likely to need dosage modification in renal failure patients and why?

A

Benazepril, because 50% is excreted in bile

96
Q

What are the adverse effects of ACE inhibitors? (3 things)

A

Hypotension
Lower intraglomerular pressure decreasing GFR
Captopril may cause idiosyncratic glomerular disease in some dogs

97
Q

What adverse side effects do you see with Captopril? (2 things)

A

Captopril has more GI side effects than enalapril

Captopril may cause neutropenia, proteinuria and skin rash in some humans

98
Q

What do we not worry about in dogs and cats on ACE inhibitors?

A

Coughing

99
Q

What Angiotensin II antagonist do we use?

A

Losartan

100
Q

How do Angiotensin II antagonists work?

A

Competitive antagonist of AT II receptors

101
Q

What do we use angiotensin II antagonists to treat?

A

Hypertensive (Losartan is an antihypertensive)

102
Q

What are the two direct acting vasodilators?

A

Hydralazine

Nitrates

103
Q

What 3 types of nitrates are used?

A

Sodium nitroprusside
Nitroglycerin
Isosorbide dinitrate

104
Q

How does hydralazine work?

A

Increases local concentration of PGI2

May inhibit Ca influx into smooth muscle of arteries

105
Q

Hoe do nitrates work?

A

Reactive radical nitric oxide (NO) activates guanylyl cyclase, increases cGMP and dephosphorylates myosin light chains to relax smooth muscle of blood vessels

106
Q

What are the 3 classes of calcium channel blockers?

A

Diphenyl alkylamines (Class IV) (Verapamil)
Benzodiazepines (Class IV) (Diltiazem)
Dihydropyridines (Amlodipine, Nifedipine)

107
Q

How do calcium channel blockers work?

A

Inhibit influx of extracellular calcium across myocardial and smooth muscle cell, inhibiting contraction resulting in dilation of coronary and systemic arteries

108
Q

What effects do calcium channel blockers have on the hearts? (4 things)

A

Negative inotrope
Negative chronitrope
Increased O2 delivery to myocardial tissue
Decreased afterload

109
Q

What effects do calcium channel blockers have on blood vessels ? (2 things)

A

Decrease peripheral resistance

Decreased systemic blood pressure

110
Q

What are 4 therapeutic uses from calcium channel blockers?

A

Antiarrhythmic (Class IV)
Antihypertensive
Myocardial hypertrophy
Antianginal (ischemic heart disease)

111
Q

What are antiarrhythmics are calcium channel blockers? (2 things)

A

Verapamil

Diltiazem

112
Q

What are antihypertensives are calcium channel blockers? (1 thing)

A

Amlodipine

113
Q

What drug is used to treat myocardial hypertrophy in cats?

A

Diltiazem

114
Q

What is the drug of choice for hypertensive cats (as long as the cause isn’t hyperthyroidism)?

A

Amlodipine

115
Q

What would you use in a hypertensive cat with hyperthyroidism?

A

A beta-blocker is used

116
Q

What are the adverse effects of calcium channel blockers? (4 things)

A

Bradycardia and AV block
Hypotension
GI side effects
Elevated liver enzymes (temporary)

117
Q

What 4 classes of drugs are used to treat hypertension?

A

Diuretics
Beta blockers
Vasodilators
Calcium channel blockers

118
Q

What are 4 ways to treat emergency hypertension?

A

Hydralazine or sodium nitroprusside IV
Propranolol or Acepromazine IV
Phentolamine IV
Oral calcium channel blockers, prazosin or ACE inhibitors

119
Q

What is the drug of choice in treating a pheochromocytoma-induced hypertension?

A

Phenoxybenzamine

Pharmacology 2 (9 decks)

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