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Pharmacology I > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

Drugs used to tx CHF

A 
\+ inotropes
vasodilators
inodilators
diuretics
B blockers
Other agents in emergency
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2
Q

Positive inotropic drugs

A

Digitalis glycosides

B1 agonists

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3
Q

Mechanism of Action for Digitalis and B1 Agonists

A

Inhibition of NaKAtpase in myocardial cell membrane increases Na available for exchange with Ca
Results in increase in intracellular Ca which results in a + inotropic effect

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4
Q

Cardiovascular effect of Digitalis/B-1 Agonists

A

+ inotropic effect
Reduction in sinus rates/slow AV conduction
Prolonged PR in ECG
Increased mechanical efficiency of the failing heart
Normalization of blood pressure and peripheral resistance

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5
Q

Pharmacokinetics of Digitalis and B-1 Agonists

A

oral or slow IV in emergency
oral bioavailbitiy is more for elixir 75% than tablet 60%
half life depends on species, avg ~ 24 hrs
Small amount metabolized in liver
Undergoes enterohepatic recyclin
Excretion- renal in dogs and horses, renal and hepatic in cats

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6
Q

Theraputic uses of Digoxin and B-1 agonists

A

CHF

Atrial arrhythmias only in dogs

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7
Q

Toxcitiy with Digitalis/B-1 agonists

A 
Digitalis has a narrow safety margin
Cats more sensitive than dogs
Cardiac toxicity
GI toxcity
Other toxicity: hyperkalemia, chronic=hypokalemia
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8
Q

What are the ACE inhibitor drugs?

A

Captopril, enalipril, lisinopril, benzapril

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9
Q

How do ACE inhibitors work?

A

Block RAAS leading to vasodilation

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10
Q

What are the Inodilator drugs?

A

Pimobenden

Phosphodiesterase inhibitors- amrione, milrinone

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11
Q

How does Pimobenden work?

A

Sensitizes cardiac contractile apparatus to Ca by enhancing interaction between Ca and troponin C complex
May increase cardiac contractility and causes vasodilation by inhibiting PDE III and

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12
Q

What are the B blocker drugs ?

A

Carvediol

Metoprolol and Atenolol

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13
Q

What is the mechanism of action for Carvedilol? When is it used?

A

nonselective B blocker and a-1 blocker

used in early tx of CHF due to dilated cardiomyopathy to blunt the harmful effects of the SNS on the heart

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14
Q

Other agents to tx CHF?

A

Oxygen therapy
Morphine sulfate
Aminophylline-single dose inodilator
nebulization of ethanol (20%) antifrothing

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15
Q

Cardiac Stimulants

A

B1 agonists-epi/norepi, isoprotenerol, dopamine
Phosphodiesterase inhibitos- aminophylline
Glucagon
Ca salts

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16
Q

Pimobenden uses

A

tx CHF dogs
adjunctive therapy for dogs with dilated cardiomyopathy and chronic degenerative valvular dz
Can be used with furosemide, spironolactone or ACE in heart failure patients

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17
Q

Side effects of Pimobenden

A

Les arrhythmogenic than digitalis but may cause diarrhea, vomiting, inappetence, seizures and pu/pd

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18
Q

Pimobenden contraindications

A

don’t use in hypertrophic cardiomyopathy or clinical conditions where increase of cardiac output is not physically possible

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19
Q

Pharmacokinetics of Pimobenden

A

rapid oral absorption, 60% bioavailability
metabolically activated in liver
metabolites are excreted in feces with a half life of 2 hours
bound to plasma protiens

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20
Q

Vasodilators used for CHF

A

ACE inhibitors (drug of choice- Enalapril)
Hydralazine
Nitrates
Prazosin

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21
Q

Diuretics used in CHF

A

Furosemide
Hydrochlorothiazide, chlorothiazide
Spironolacton, tramterene, amiloride

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22
Q

Classification of Antiarrhythmic drugs

A

Class I- Na channel blockers
Class II- B blockers
Class III- Agents that prolong action potential duration (potassium channel blockers)
Class IV- Ca++ channel blockers

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23
Q

Drugs in Class IA

A

Quinidine

Procinamide

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24
Q

What is the drug of choice to tx atrial fibrulation in horses?

A

Quinidine

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25
Q

What is the drug of choice to tx ventricular tachycardia/tachyarrhythmias in dogs?

A

Lidocaine

26
Q

What do Class I B drugs do and what are they?

A

Class I B drugs shorten action potential and are only ventricular
Lidocaine
Phenytoin
Mexiletine

27
Q

Class II B blockers

A

Propanalol

Atenolol

28
Q

What are Class IV Antiarrythymics and what do they do?

A

Verapamil
Diltiazem
Ca channel blockers, only supraventricular

29
Q

Therapeutic use of Procainamide?

A

more effective for ventricular arrhythmias than atrial

30
Q

What is the drug of choice for ventricular arrhythmias due to general anesthetics, sx, ischemia, and trauma? What species? Why can’t you give it orally?

A

Lidocaine IV
Only in dogs
Systemic first pass effect

31
Q

Why would you give Phenytoid IV

A

Digitalis-induced arrhythmias in dogs only

32
Q

What drugs would you give to tx SVTs- atrial tachycardia in dogs?

A

Digoxin
Procainamide, propanolol
Quinidine, phenytoin

33
Q

What drugs would you give to tx SVTs, atrial flutter in dogs?

A

Digoxin

Quinidine, procanimide, propanolol

34
Q

What drugs would you give to tx SVT, atrial fibrillation in dogs?

A

Digoxin
Propanalol
Quinidine, procainamide

35
Q

What is the drug of choice for both supraventricular and ventricular tachyarrhythmias in cats?

A

B blockers

36
Q

Tx of ventricular tachyarrhythmias, VPCs in dogs?

A

Quinidine, procainamide, lidocaine
phenytoin
propanolol

37
Q

Drugs that tx Ventricular tachycardia in dogs?

A

procinamide, lidocaine
quinidine, phenytoin
propranolol

38
Q

Antiarrhythimic drugs for brady arrhythmias

A

Atropine
Isoproterenol
Epinephrine

39
Q

Tx of Sinus bradycardia

A

atropine

isoproterenol

40
Q

Tx for 2nd degree AV block?

A

Atropine
Isoproterenol
Glucagon

41
Q

Drug of choice to tx incomplete AV block

A

atropine

42
Q

Drug to tx cardiac asystole (cardiac resuscitation)

A

Epinephrine

43
Q

Vasoconstrictors

A

nonselective a agonists: epinephrine, norepinephrine
selective a1 agoinist: phenylephrine
direct and indirect sympathomimetics: ephedrine, pseudoephedrine, PPA

44
Q

Vasodilators

A 
sympatholytic
ACE inhibitos
Angiotensin II antagonists
Direct acting vasodilators
Ca channel blockers
45
Q

Prazosin is a

A

selective a1 blocker, sympatholytic vasodilator

46
Q

What are the ACE inhibitor drugs?

A

Enalapril

Benazepril

47
Q

MoA for Ace Inhibitors

A

Inhibition of angiotensin converting enzyme
Inhibition of angiotensin II synthesis
Inhibition of aldosterone
Reflex increase in renin
Increased bradykinin level (vasodilator and stimulated PGs- also vasodilators)

48
Q

Therapeutic uses of ACE inhibitors

A

CHF- drug of choice
Hypertension- drug of choice in dogs
Chronic renal insufficiency in cats

49
Q

ACE inhibitor Pharmacokinetics

A

Enalapril oral and parenterally but others only oral
enalapril slow onset and long duration (compaired with captopril)
benazepril long acting
enalapril activatd in the liver
benazeprili least likely to require dosage modification in renal failure patients because of significan excretion in bile 50%

50
Q

Adverse effects of ACE inhibitors

A

hypotension

lower intraglomerular pressure decreasing GFR with animals with systemic hypertension and azotemia

51
Q

Direct acting vasodilator

A

Hydralazine

52
Q

MoA of Hydralazine

A

increases local conctrations of PGl2
May be inhibiting Ca influx into smooth muscles of arteries
alteration of phosphorylation of proteins in smooth muscle and dephosphorylation of myosin light chain
relaxation of smooth muscle of blood vessels

53
Q

Amlodipine what is at and MoA?

A

Ca channel blocker
Inhibits influx of extracellular Ca across myocardial and smooth muscle cell membranes
The decrease in intracellular Ca inhibits myocardial contraction and results in dilation of the coronary and systemic arteries

54
Q

Ca Channel block pharmacological effects on the heart

A 
neg inotrope
neg chronotrope
increase o2 delivery to myocardial tissue
decrease afterload
coronary vasodilation
55
Q

Ca channel blockers affect on blood vessels

A

decrease peripheral resistance

decrease systemic blood pressure

56
Q

Ca Channel Blockers Therapeutic uses

A

Antiarrthymic
Antihypertensive
Myocardial hypertrophy
Antianginal

57
Q

Adverse effects of Ca Channel blockers

A

bradycardia and av block
hypotension
GI side effects
elevated liver enzymes

58
Q

Drug of choice for hypertension in
dogs
cats
hyperthyroid cats

A

ACE inhibitors
Anopholine
B blockers

59
Q

Emergency tx of Hypertension

A

hydralazine or Na nitroprusside IV
Propraolol or acepromazine IV
Phentolamine IV
Oral Ca channel blockers, prazosine, or ACE inhibitors

60
Q

Drug of choice for Pheochromocytoma induced hypertension?

A

Phenoxybenzamine

Pharmacology I (16 decks)

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