Cardiovascular (final exam) Flashcards
Cardiac stimulant drug groups
B1 agonists Methylxanthines Positive inotropes Inodilator “Other” cardiac stimulants
B1 agonists
Epinephrine Norepinephrine Isoproterenol Dopamine Dobutamine
Methylxanthines
Aminophylline
Theophylline
Positive inotropes
Digoxin
Dobutamine (B1 agonist)
Inodilator
Pimobendan
“Other” cardiac stimulants
Glucagon
Calcium salts
Congestive heart failure drugs
Positive inotropes Inodilators Vasodilators Diuretics Beta-blockers Adjunctives
Diuretics indicated in congestive heart failure
Mannitol Furosemide Hydrochlorothiazide Spironolactone Acetazolamide
Adjunctive treatments for congestive heart failure
Sodium-restricted diet
Exercise restriction
Oxygen therapy
Vasoconstrictor drug groups
a-antagonists
sympathomimetics
Vasodilator drug groups
a-antagonists ACE inhibitors Phosphodiesterase inhibitor Direct-acting vasodilators Calcium-channel blocker Angiotensin II antagonist
Antiarrhythmic drug classes
Class I - Na channel blockers Class II - B-blockers Class III - K channel blockers Class IV - Ca channel blockers Anticholinergics “Other” treatment
Non-selective a-antagonist vasoconstrictors
Epinephrine
Norepinephrine
Selective a1-antagonist vasoconstrictors
Dopamine (high dose)
Phenylephrine
Direct & indirect sympathomimetic vasoconstrictors
Vasopressin
Ephedrine
Pseudoephedrine
Phenylpropanolamine (B-hydroxy amphetamine) PPA
Non-selective a-antagonist vasodilator
Phenoxybenzamine
Selective a1-antagonist vasodilator
Prazosin
Other a1-antagonist vasodilator
Acepromazine
ACE inhibitor vasodilator
Enalapril
Benazepril
Phosphodiesterase inhibitor vasodilator
Sildenafil
Direct-acting vasodilators
Nitroprusside
Nitroglycerine
Hydralazine
Calcium-channel blocker vasodilator
Amlodipine
Angiotensin II antagonist vasodilator
Losartan
Class I antiarrhythmics
Quinidine
Procainamide
Lidocaine
Mexilitine
Class II antiarrhythmics
Propranolol Atenolol Esmolol Metoprolol Carvedilol
Class III antiarrhythmics
Sotalol
Amiodarone
Class IV antiarrhythmics
Diltiazem
Anticholinergic antiarrhythmics
Atropine
Glycopyrrolate
“Other” antiarrhythmic treatment
Magnesium sulfate
Drug of choice for calcium channel blocker toxicity
Glucagon
Treatment of choice for severe hyperkalemia
Calcium salts (IV calcium gluconate)
Methylxanthines mechanism of action
Phosphodiesterase inhibitors
Increase cAMP -> increase epinephrine release
Methylxanthines main use
Bronchodilation
Methylxanthines other effects
Induce diuresis (cardiac diuretic)
Methylxanthine precautions
Sever cardiac disease Hypertension Seizure disorders Gastric ulcers Hyperthyroidism Severe hypoxia Renal or hepatic dysfunction
Treatment of choice for congestive heart failure
Pimobendan
Most commonly used catecholamine for severe congestive heart failure due to myocardial failure:
Dobutamine (B1 agonist)
Which drug used to treat congestive heart failure increases intracellular calcium (positive inotropic effect)?
Digoxin
Inhibits Na/K ATPase = more Na available to exchange with Ca
Primary adverse effect of digoxin
GI signs #1
Tachyarrhythmias
Which drug used to treat congestive heart failure has a positive inotropic effect without increasing intracellular Ca?
Pimobendan
Pimobendan most commonly has what adverse effect? When is this drug contraindicated?
GI signs
Contraindicated in cases of aortic stenosis, augmented cardiac output
Define arrhythmia
Abnormalities in heart rate and rhythm
Three mechanisms of arrhythmias:
Abnormal automaticity
Abnormal conduction
Disturbance in both automaticity and impulse conduction
What is the drug of choice in treatment of supraventricular arrhythmias?
Diltiazem
What is the drug of choice in treatment of equine atrial fibrillation?
Quinidine
What is the drug of choice in ventricular arrhythmias?
Lidocaine IV
Class IA sodium channel blockers have what effect on myocardial contraction?
Prolong action potential
Class IB sodium channel blockers have what effect on myocardial contraction?
Shortens action potential
When are class II antiarrhythmics contraindicated?
Unstable heart failure
Class II = beta-blockers
Wean off drugs
Sotalol is a class III antiarrhythmic. When is it contraindicated?
Over or low output congestive heart failure
K channel blocker
K channel blocker mechanism of action
Prolong refractory period of cardiac action potentials
Amiodarone is used to treat what type of arrhythmia?
Ventricular arrhythmias in dogs
Diltiazem is a class IV antiarrhythmic contraindicated in what condition?
Pulmonary edema
Hypotension
“Other” antiarrhythmic treatments include:
Magnesium sulfate IV
Vagal maneuvers for supraventricular tachycardia
Cardioversion for supraventricular tachycardia
Magnesium sulfate IV can be used to treat what kind of arrhythmia?
Refractory ventricular arrhythmia
Drugs used to treat sinus bradycardia:
Atropine
Glycopyrrolate
Treatments used in atrioventricular block:
1st degree: monitor
2nd degree: atropine test, isoproterenol, theophylline, glucagon
3rd degree: pacemaker
Emergency treatments used in atrial standstill:
Often associated with severe hyperkalemia, recognize via ECG (absence of p-waves) IV calcium gluconate IV sodium bicarbonate Dextrose Regular insulin
Vasodilator drug groups
Angiotensin-converting enzyme (ACE) inhibitors
Phosphodiesterase inhibitors
Direct-acting vasodilators
Calcium channel blockers
ACE inhibitor mechanism of action
Inhibits of angiotensin converting enzyme
Inhibits angiotensin II synthesis
Inhibits aldosterone
Stimulates bradykinin (vasodilator) release
Stimulates renin
Benazepril pharmacokinetics
Long acting
Hepatic > renal clearance
Therapeutic indications for ACE inhibitors:
Congestive heart failure
Hypertension
Protein losing renal disease
ACE inhibitor contraindications
Hypotension
Risk of worsening azotemia
GI signs
Sildenafil mechanism of action
Stimulates nitric oxide production
Smooth muscle of pulmonary vasculature
Sildenafil therapeutic use
Treatment of pulmonary hypertension
Sildenafil contraindications
Systemic hypotension
Contraindicated for use with nitrates
Hypovolemia
Nitrates mechanism of action
Increased nitric oxide formation
Balanced direct arteriolar and venous vasodilation
Hydralazine mechanism of action
Increases local PGI2 concentration (alters Ca metabolism in smooth muscle)
Nitrates and Hydralazine therapeutic indications
Hypertensive crisis
Afterload reduction with severe congestive heart failure
Amlodipine mechanism of action
Inhibits influx of Ca in myocardial and smooth muscle cells
Inhibits myocardial contraction
Dilates coronary and systemic arteries
Amlodipine is primarily used to:
Decrease systemic blood pressure
What is the drug of choice in hypertensive cats?
Amlodipine
Amlodipine contraindications
Hypotension
Bradycardia
AV block
Which direct-acting vasodilator is contraindicated in renal disease?
Hydralazine
Hemostatic agents
Vitamin K1
Protamine sulfate
Aminocaproic acid
Desmopressin acetate
Vitamin K mechanism of action
Necessary for synthesis of coagulation factors II, VII, IX, X
What is the drug of choice for bleeding disorder associated with vitamin K deficiency?
Vitamin K. No shit.
Which drug is a specific antidote for anticoagulant rodenticide and warfarin induced hemorrhage?
Vitamin K
Vitamin K precaution
ONLY SQ injection
Risk of anaphylaxis if given IV
Protamine sulfate mechanism of action
Complexes with heparin to form inactive stable salt
What is the drug of choice for treating heparin induced hemorrhage?
Protamine sulfate
Protamine sulfate rapid IV administration may cause:
Hypotension Bradycardia Pulmonary hypertension Dyspnea Hypersensitivity
Aminocaproic acid mechanism of action
Antifibrinolytic
Inhibits fibrinolysis
Desmopressin acetate mechanism of action
Hormonal agent
Increases coagulation factor VIII and plasminogen factor
What is the drug of choice for bleeding due to vonWillebrand’s disease?
Desmopressin acetate
What is the drug of choice for treatment of central diabetes insipidus?
Desmopressin acetate
Anticoagulants
Heparin sodium
Dalteparin
Enoxaprin
Warfarin sodium
Heparin sodium mechanism of action
Prevents conversion of prothrombin to thrombin
Heparin sodium therapeutic indications
Treat some thromboembolic diseases
Prophylactic treatment to prevent thromboembolic disease development
Heparin sodium precautions
Monitor
Risk of bleeding
Induced thrombocytopenia has been reported
Dalteparin & enoxaparin mechanism of action
Inactivates coagulation factor Xa
Minimal impact on thrombin and clot times
Dalteparin & enoxaparin therapeutic indications
Prophylactic and treatment for thromboembolic diseases
Dalteparin & enoxaparin precautions
Administer SQ only
Hemorrhage possible
Warfarin sodium mechanism of action
Inhibits Vitamin K epoxide reductase
Inhibits synthesis of coagulation factors II, VII, IX, X
Warfarin sodium therapeutic indications
Used in dogs for thromboembolic disease, long term
Warfarin sodium precautions
Hemorrhage possible
Monitor PT
Teratogenic
Anti-thrombotics
Aspirin
Clopidogrel bisulfate
Thrombolytics
Streptokinase
Urokinase
Tissue plasminogen activator
Aspirin mechanism of action
Inhibit platelet aggregation
Inhibit thromboxane A2 (TXA2) synthesis
COX-1 inhibition
Aspirin therapeutic indications
Treat thrombotic disease
Feline aortic thromboembolism
IMHA
Aspirin is contraindicated in what conditions?
GI ulceration
Active GI bleeding
Clopidogrel bisulfate mechanism of action
Reduce platelet aggregation
Inhibits ADP receptor on platelets
Clopidogrel bisulfate therapeutic indications
Treatment of thrombotic disease
Feline aortic thromboembolism
IMHA
Clopidogrel bisulfate contraindication
GI ulceration
Active GI bleed
Thrombolytic drugs mechanism of action
Activate plasminogen for thrombolysis
Thrombolytic drugs therapeutic indications
Treat existing thrombus or thromboembolism
Not commonly used, high morbidity
Thrombolytic drug precautions
Life-threatening hemorrhage
IV administration only