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Pharmacology 2 > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

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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
What are 3 inodilators?
Pimobendan Inamrinone Milrinone
26
Why are Inamrinone and milrinone only used in emergencies?
Because they also produce tachycardias.
27
What is an inodilator?
Substance at is both a positive inotrope and a vasodilator.
28
By what mechanism does Pimobendan work?
Sensitizes the cardiac contractile apparatus to Ca
29
What is balanced vasodilation?
Vasodilation in both arteries and veins.
30
How does Pimobendan cause balanced vasodilation?
Inhibition of PDE III and V in blood vessels.
31
What are 3 uses of Pimobendan?
- 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
32
What side effects can you see with Pimobendan? (4 things)
V&D Inappetence Seizures PU/PD
33
Which is less arrhythmogenic, Digitalis or Pimobendan?
Pimobendan
34
When is Pimobendan contraindicated?
Hypertrophic cardiomyopathy | Conditions where increase of cardiac output is not physically possible
35
How is Pimobendan given?
Orally
36
What is the bioavailability of Pimmobendan?
60%
37
What are the pharmacokinetics of Pimobendan?
Activated in the liver | Excreted in feces
38
What is the half-life of Pimobendan?
2 hours
39
T/F: Pimobendan is bound to protein.
True
40
What 4 dilators do you use for CHF?
ACE Inhibitors Hydralazine Nitrates Prazosin
41
What 3 types of diuretics are used in CHF?
Loop Thiazide K-sparing
42
What 2 types of B-blockers are used in CHF?
Carvedilol | Metoprolol or Atenolol
43
What stage do you use Carvedilol to treate CHF?
Early stage CHF
44
What is the mechanism of action of Carvedilol?
Nonselective B-blocker and a1-blocker Antioxidant Inhibits endothelial release
45
What are 4 other agents used to treat CHF?
Oxygen Morphine sulfate (very small dose) Aminophylline Nebulization of ethanol (20%)
46
What is an arrhythmia?
Abnormality in heart rate.
47
What are 3 mechanisms of arrhythmia?
Abnormal automaticity Abnormal conduction Disturbances in both
48
What are the 2 types or arrhythmias?
Tachyarrhythmias | Bradyarrhythmias
49
How many classes are there of drugs that treat tachyarrhythmias?
4
50
What are the 4 classes of drugs that treat tachyarrhythmias?
Class I: Sodium channel blockers Class II: B-blockers Class III: Potassium channel blockers Class IV: Ca channel blockers
51
What do class IA drugs do?
Prolongs action potential
52
What drugs are under Class IA? (3 drugs)
Quinidine Procainamide Disopyramide
53
What do Class IB drugs do?
Shortens action potential
54
What drugs are under Class IB? (5 drugs)
Lidocaine (75% or more undergoes first pass) Phenytoin Tocainide Mexiletine (similar to lidocaine, but oral) Aprinidine
55
What do Class IC drugs do?
No effect on action potential
56
What drugs are under Class IC? (3 drugs)
Flecainide Encainide Lorcainide
57
What are Class II drugs?
B-blockers
58
What drugs are under Class II?
All the "-lol"s
59
What are Class III drugs?
K-channel blockers
60
What 3 drugs are under Class III?
Bretylium Amiodarone Sotalol (nonselective B-blocker)
61
What are Class IV drugs?
Calcium channel blockers
62
What 2 drugs fall under Class IV?
Verapamil | Diltiazem
63
What is Quinidine used for? (2 things)
Ventricular arrhythmias | A fib in horses (drug of choice), cattle and large breed dogs
64
What is Procainamide used for?
Ventricular arrhythmias
65
What is Lidocaine used for?
IV drug of choice for ventricular arrhythmias d/t GA, sx, ischemia or trauma Digitalis-induced arrhythmias
66
What is Phenytoin used for?
Digitalis-induced arrhythmias in dogs only (NOT CATS)
67
What is Propranolol used for? (3 things)
Supraventricular tachycardia Digitalis-induced tachyarrhythmias Arrhythmias due to inhalation anesthesia
68
What is Bretylium used for?
Refractory and recurrent tachyarrhythmias
69
What are Verapamil and Diltiazem used for?
Supraventricular tachyarrhythmias | Myocardial hypertrophy
70
What 3 drugs can you use to treat atrial tachycardia in dogs?
Digoxin Procainamide, propranolol Quinidine, Phenytoin
71
What 2 drugs can you use to treat atrial flutter in dogs?
Digoxin | Quinidine, Procainamide, Propranolol
72
What 3 drugs can you use to treat atrial fibrillation in dogs?
Digoxin Propranolol Quinidine, Procainamide
73
What 3 drugs can you use to treat ventricular premature complexes in dogs?
Quinidine, Procainamide, Lidocaine Phenytoin Propranolol
74
What 3 drugs can you use to treat ventricular tachycardia in dogs?
Procainamide, Lidocaine Quinidine, Phenytoin Propranolol
75
What can you use to treat tachyarrhythmias in cats?
B-blockers are the drug of choice
76
What are the 3 antiarrhythmic drugs used for Bradyarrhythmias?
Atropine Isoproterenol Epinephrine
77
What 2 drugs do you use to treat a sinus bradycardia?
Atropine | Isoproterenol
78
What 3 drugs do you use to treat an second-degree AV block?
Atropine Isoproteranol Glucagon
79
What drugs can you use to treat cardia asystole (cardiac resuscitation)?
Epinephrine
80
What 2 types of drugs act on the blood vessels?
Vasoconstrictors | Vasodilators
81
What are 3 types of vasoconstrictors?
Nonselective a-agonists Selective a1-agonists Direct and indirect sympathomimetics
82
What 2 nonselective a-agonists are vasocontrictors?
Epinephrine | Norepinephrine
83
What selective a1-agonist vasoconstricts?
Phenylephrine
84
What 3 direct and indirect acting sympathomimetics vasoconstrict?
Ephedrine Pseudoephedrine Phenylpropanolamine (PPA)
85
What are 5 types of vasodilators?
``` Sympatholytics ACE Inhibitors Angiotensin II antagonists Direct-acting vasodilators Calcium channel blockers ```
86
What 7 types of sympatholytic vasodilators are there?
``` Non-selective a-blockers Selective a1-blockers Presynaptic a2-agonist Nonselective B-blockers Selective B1-blockers B1 and a1-blockers Indirect sympatholytics ```
87
What are the 4 ACE inhibitors?
Captopril Enalapril Benazepril Lisinopril
88
How do ACE inhibitors work?
- Inhibits Angiotensin-converting enzyme which prevents AT II synthesis - Inhibits Aldosterone - Produces a reflex increase in renin and increased bradykinin levels (vasodilators)
89
What are the 3 therapeutic uses for ACE inhibitors?
CHF (Mild cases, combined with other drugs for more severe cases) Hypertension in dogs Chronic renal insufficiency in cats
90
How are ACE inhibitors given?
Enalapril is given orally and parenterally | All others are oral
91
What is the important to remember when giving Captopril (ACE inhibitors) orally?
Food reduces intestinal absorption.
92
Between Enalapril and Captopril in dogs, which has slower onset and longer duration?
Enalapril
93
Which 2 ACE inhibitors are are long acting?
Benazepril and Lisinopril
94
Which 2 ACE inhibitors are activated in the liver?
Enalapril and Benazepril
95
Which ACE inhibior is least likely to need dosage modification in renal failure patients and why?
Benazepril, because 50% is excreted in bile
96
What are the adverse effects of ACE inhibitors? (3 things)
Hypotension Lower intraglomerular pressure decreasing GFR Captopril may cause idiosyncratic glomerular disease in some dogs
97
What adverse side effects do you see with Captopril? (2 things)
Captopril has more GI side effects than enalapril | Captopril may cause neutropenia, proteinuria and skin rash in some humans
98
What do we not worry about in dogs and cats on ACE inhibitors?
Coughing
99
What Angiotensin II antagonist do we use?
Losartan
100
How do Angiotensin II antagonists work?
Competitive antagonist of AT II receptors
101
What do we use angiotensin II antagonists to treat?
Hypertensive (Losartan is an antihypertensive)
102
What are the two direct acting vasodilators?
Hydralazine | Nitrates
103
What 3 types of nitrates are used?
Sodium nitroprusside Nitroglycerin Isosorbide dinitrate
104
How does hydralazine work?
Increases local concentration of PGI2 | May inhibit Ca influx into smooth muscle of arteries
105
Hoe do nitrates work?
Reactive radical nitric oxide (NO) activates guanylyl cyclase, increases cGMP and dephosphorylates myosin light chains to relax smooth muscle of blood vessels
106
What are the 3 classes of calcium channel blockers?
Diphenyl alkylamines (Class IV) (Verapamil) Benzodiazepines (Class IV) (Diltiazem) Dihydropyridines (Amlodipine, Nifedipine)
107
How do calcium channel blockers work?
Inhibit influx of extracellular calcium across myocardial and smooth muscle cell, inhibiting contraction resulting in dilation of coronary and systemic arteries
108
What effects do calcium channel blockers have on the hearts? (4 things)
Negative inotrope Negative chronitrope Increased O2 delivery to myocardial tissue Decreased afterload
109
What effects do calcium channel blockers have on blood vessels ? (2 things)
Decrease peripheral resistance | Decreased systemic blood pressure
110
What are 4 therapeutic uses from calcium channel blockers?
Antiarrhythmic (Class IV) Antihypertensive Myocardial hypertrophy Antianginal (ischemic heart disease)
111
What are antiarrhythmics are calcium channel blockers? (2 things)
Verapamil | Diltiazem
112
What are antihypertensives are calcium channel blockers? (1 thing)
Amlodipine
113
What drug is used to treat myocardial hypertrophy in cats?
Diltiazem
114
What is the drug of choice for hypertensive cats (as long as the cause isn't hyperthyroidism)?
Amlodipine
115
What would you use in a hypertensive cat with hyperthyroidism?
A beta-blocker is used
116
What are the adverse effects of calcium channel blockers? (4 things)
Bradycardia and AV block Hypotension GI side effects Elevated liver enzymes (temporary)
117
What 4 classes of drugs are used to treat hypertension?
Diuretics Beta blockers Vasodilators Calcium channel blockers
118
What are 4 ways to treat emergency hypertension?
Hydralazine or sodium nitroprusside IV Propranolol or Acepromazine IV Phentolamine IV Oral calcium channel blockers, prazosin or ACE inhibitors
119
What is the drug of choice in treating a pheochromocytoma-induced hypertension?
Phenoxybenzamine

Pharmacology 2 (9 decks)

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