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Drugs Acting on the Heart Flashcards

0
Q

What are 4 examples of cardiac stimulants?

Big Pretty Gray Cats

A
  • B1 agonists
  • Phosphodiesterase inhibitors
  • Glucagon
  • Calcium salts
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1
Q

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

CAD

A
  • Cardiac stimulants
  • Drugs used in the treatment of CHF
  • Antiarrhythmic drugs
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2
Q

What are 4 examples of B1 agonists?

DINE

A
  • Isoproterenol
  • Epinephrine
  • Norepinephrine
  • Dopamine
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3
Q

What is an example of phosphodiesterase inhibitor?

A

Aminophylline

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4
Q

What is the most potent B1 agonist?

A

Isoproterenol

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5
Q

What is the most commonly used B1 agonist?

A

Epinephrine

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6
Q

When do you not use epinephrine?

A

With an incomplete AV block.

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7
Q

What are 2 examples of non-drug therapy treatments of CHF?

A
  • Restricted salt diet

- Restricted exercise

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8
Q

What are 6 classes of drugs used in the treatment of CHF?

VIP BOD

A
  • Positive inotropic drugs
  • Inodilators
  • Vasodilators
  • Diuretics
  • B blockers
  • Other agents
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9
Q

What are 2 examples of positive inotropic drugs?

B positive, Do Good

A
  • Digitalis glycosides

- B1 agonists

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10
Q

Which B1 agonist is more likely to cause reflex bradycardia?

Brady in New England

A

Norepinephrine

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11
Q

What are 3 examples of digitalis glycosides?

DOD

A
  • Digitoxin
  • Digoxin
  • Ouabain
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12
Q

What is the mechanism of action for digoxin?

A
  • Inhibition of Na+/K+ ATPase in the myocardial cell membrane increases sodium available for exchange with calcium.
  • Result is increase in intracellular calcium which results in a positive inotropic effect.
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13
Q

What are 5 cardiovascular effects of digoxin?

RIPPN

A
  • Positive inotropic effects
  • Reduction in sinus rate and slowing AV conduction
  • Prolonged PR intervals in ECG
  • Increased mechanical efficiency of the failing heart
  • Normalization of blood pressure and peripheral resistance
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14
Q

What effect does digoxin have on the kidneys?

A

Diuretic effects mainly secondary to increased cardiac output.

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15
Q

What 2 effects does digoxin have on the GI tract?

not Very Good

A
  • GI irritation

- Vomiting

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16
Q

How can digoxin be administered?

A

Orally and slowly by IV in emergency

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17
Q

What is the bioavailability for digoxin in the elixir form and the tablet form?

A

Elixir- 75%

Tablet- 60%

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18
Q

What is the average half-life of digoxin?

What plays a role in determining the half-life of digoxin?

A
  • 24 hours

- Depends on the species

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19
Q

Is digoxin metabolized in the liver?

A

Yes, a small amount.

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20
Q

T/F: Digoxin undergoes enterohepatic recycling.

A

True

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21
Q

In what 2 species is the excretion of digoxin mainly renal?

In what species is excretion renal and hepatic?

A
  • Dogs, horses

- Cats

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22
Q

What are 2 examples of therapeutic uses of digoxin?

AC

A
  • Congestive heart failure

- Atrial arrhythmias in dogs

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23
Q

What are 3 examples of adverse effects of digoxin?

CDC

A
  • Digitalis has a narrow safety margin
  • Cats are more sensitive than dogs
  • Cardiac - tachyarrhythmia
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24
What are 7 predisposing factors for tachyarrhythmias with digoxin? (Hypo-4, Hyper-3)
- Hypokalemia - Hypomagnesemia - Hypothyroidism - Hypoxemia - Hypercalcemia - Hypernatremia - Hyperthyroidism
25
What are 5 ways to treat tachyarrhythmia due to digoxin? | C PADD
- Drug withdrawal - Potassium IV - Antiarrhythmic drugs - Cholestyramine - Digoxin immune Fab (Digibind)
26
What are 3 examples of antiarrhythmic drugs that can be used to treat tachyarrhythmia caused by dioxin? (PLP)
- Lidocaine - Phenytoin - Propranolol
27
What are 2 possible treatments for bradyarrhythmias caused by digoxin? (AD)
- Drug withdrawal | - Atropine
28
What are 3 clinical signs that can be seen in the GI due to digoxin use? What are 2 treatment options?
- Anorexia, vomiting, diarrhea | - Drug withdrawal, fluid therapy
29
Digoxin alters serum potassium in what 2 ways?
- Acute: causes hyperkalemia | - Chronic: causes hypokalemia
30
What are 2 examples of B1 agonists? | Double D
- Dopamine | - Dobutamine
31
What are 3 examples of inodilators? | PIM
- Pimobendan - Inamrinone - Milrinone
32
What kind of drug is Pimobendan?
An inodilator (positive inotrope and balanced vasodilator)
33
What is the mechanism of action for Pimobendan?
- In failing heart, acts primarily by sensitization of the cardiac contractile apparatus to calcium by enhancing interaction between calcium and troponin C complex. - Has potential to increase intracellular calcium and increase myocardial oxygen consumption because it inhibits PDE III and probably V but this effect is minimal at therapeutic doses in dogs with CHF.
34
Pimobendan's inhibition of PDE III and V in blood vessels causes balanced vasodilation in both arteries and veins which leads to what?
Reduction in both cardiac preload and afterload.
35
What are 3 uses for Pimobendan?
- Approved to treat CHF in dogs. - Effective as adjunctive therapy in improving quality and length of life in dogs with heart failure due to both dilated cardiomyopathy (DCM) and chronic degenerative valvular disease (CVD). - Can be used with furosemide, spironolactone or ACE in heart failure patients.
36
What are 5 possible side effects that can be seen with Pimobendan? (D VIPS)
- Diarrhea - Vomiting - Inappetence - Seizures - Polyuria/polydipsia
37
Is Pimobendan more or less arrhythmogenic than digitalis?
Less
38
What are 2 contraindications for Pimobendan?
- Should not be used in hypertrophic cardiomyopathy. | - Clinical conditions where an increase of cardiac output is not physically possible.
39
How is Pimobendan administered?
Orally
40
What is the bioavailability of Pimobendan?
60%
41
T/F: Pimobendan is metabolically activated in the liver.
True
42
How are the metabolites of Pimobendan excreted? | What is the half-life?
- In feces | - 2 hours
43
Is the half-life of Digoxin shorter or longer in cats compared to dogs?
Longer
44
Is the half-life of Digoxin in horses shorter or longer compared to dogs?
Shorter
45
Is Pimobendan bound to plasma proteins?
Yes
46
What are 4 examples of vasodilators that can be used for CHF? (HAPN)
- ACE inhibitors - Hydralazine - Nitrates - Prazosin
47
What are 4 examples of ACE inhibitors? | BLEC the prils
- Captopril - Enalapril - Lisinopril - Benazepril
48
What are 4 examples of nitrates? | DINS
- Sodium nitroprusside - Nitroglycerin - Isosorbide - Dinitrate
49
What are 3 types of diuretics that can be used in CHF? | TPL
- Loop diuretics - Thiazide diuretics - Potassium-retaining diuretics
50
What type of a diuretic is Furosemide?
Loop diuretic
51
What type of a diuretic is Hydrochlorothiazide?
Thiazide diuretic
52
What type of a diuretic is chlorothiazide?
Thiazide diuretic
53
What type of a diuretic is Spironolactone?
Potassium-retaining diuretic
54
What type of a diuretic is Triamterene?
Potassium-retaining diuretic
55
What type of a diuretic is Amiloride?
Potassium-retaining diuretic
56
What type of a drug is Carvedilol?
Beta blocker
57
What is the mechanism of action for carvedilol? | Put A1 on all the Beef
- Nonselective B blocker and A1 blocker - Antioxidant - Inhibits endothelin (ET) releasee
58
When is carvedilol used? | Why?
- In early treatment of CHF due to dilated cardiomyopathy. | - To blunt the harmful effects of the sympathetic nervous system on the heart.
59
What are 2 other beta blockers that can be used? | AM
- Metoprolol | - Atenolol
60
What are 4 examples of other agents that can be used in CHF? | MOAN
- Oxygen therapy - Morphine sulfate (very small dose) - Aminophylline - Nebulization of ethanol (20%)
61
What is the definition for arrhythmias?
Abnormalities in heart rate and rhythm (any rhythm that is not normal sinus rhythm).
62
What are the mechanisms of action of arrhythmias? | DAA
- Abnormal automaticity - Abnormal conduction (re-entry) - Disturbances in both automaticity and impulse conduction
63
What are 3 examples of causes of arrhythmias?
- Imbalances of sympathetic and parasympathetic - Changes in serum potassium, calcium or magnesium - Hypoxemia
64
What are 6 other causes of arrhythmias? | MMM CAD
- Acidosis - Mechanical trauma - Myocardial disease - Cardiac ischemia - Myocardial infarction - Drugs
65
What are 2 types of arrhythmias? | TB
- Tachyarrhythmias | - Bradyarrhythmias
66
What are the 4 classifications of antiarrhythmic drugs used for tachyarrhythmias?
- Class I: Sodium channel blockers - Class II: B-blockers - Class III: Agents that prolong action potential duration (potassium channel blockers) - Class IV: Ca2+ channel blockers
67
What are 3 examples of Class IA sodium channel blockers?
- Quinidine - Procainamide - Disopyramide
68
What do Class I sodium channel blockers do to the action potential?
Prolong the action potential.
69
What are 5 examples of Class IB drugs?
- Lidocaine - Phenytoin - Tocainide - Mexiletine - Aprinidine
70
What effect do Class IB drugs have on action potentials?
Shortens the action potential.
71
What are 3 examples of Class IC drugs?
- Flecainide - Encainide - Lorcainide
72
What effect do Class IC drugs have on an action potential?
No effect on action potential.
73
What are 8 examples of Class II B-blockers?
- Propranolol - Timolol - Pindolol - Oxyprenolol - Alprenolol - Atenolol - Esmolol - Metroprolol
74
What are 3 examples of Class III potassium channel blockers?
- Bretylium - Amiodarone - Sotalol (nonselective B-blocker)
75
What are 2 examples of Class IV calcium channel blockers?
- Verapamil | - Diltiazem
76
What are 2 therapeutic uses for Quinidine?
- Ventricular arrhythmias | - Atrial fibrillation in horses (drug of choice), cattle and large breed dogs.
77
What is a therapeutic use for Procainamide?
More effective for ventricular arrhythmias than atrial arrhythmias.
78
What are 2 examples of therapeutic uses for lidocaine?
- Intravenous drug of choice for ventricular arrhythmias due to general anesthetics, surgery, ischemia and trauma. - Digitalis-induced arrhythmias.
79
What is a therapeutic use for Phenytoin?
Digitalis-induced arrhythmias in dogs only.
80
What are 3 therapeutic uses for propranolol?
- Paroxysmal supra-ventricular tachycardia - Digitalis-induced tachyarrhythmias - Arrhythmias due to inhalation anesthesia
81
What is a therapeutic use for Bretylium?
Refractory and recurrent tachyarrhythmias
82
What are 2 therapeutic uses for verapamil and diltiazem?
- Supraventricular tachyarrhythmias | - Myocardial hypertrophy
83
What are 3 forms of supraventricular tachyarrhythmias?
- Atrial tachycardia - Atrial flutter - Atrial fibrillation
84
What are 5 drugs that can be used to treat atrial tachycardia in dogs?
- Digoxin - Procainamide - Propranolol - Quinidine - Phenytoin
85
What are 4 drugs that can be used to treat atrial flutter in dogs?
- Digoxin - Quinidine - Procainamide - Propranolol
86
What are 4 drugs that can be used to treat atrial fibrillation in dogs?
- Digoxin - Propranolol - Quinidine - Procainamide
87
What are 2 types of ventricular tachyarrhythmias?
- Ventricular premature complexes | - Ventricular tachycardia
88
What are 5 examples of drugs that can be used to treat ventricular premature complexes in dogs?
- Quinidine - Procainamide - Lidocaine - Phenytoin - Propranolol
89
What are 5 examples of drugs used for ventricular tachycardia in dogs?
- Procainamide - Lidocaine - Quinidine - Phenytoin - Propranolol
90
What type of drug is the drug of choice for both supraventricular and ventricular tachyarrhythmias?
Beta blockers
91
What are 3 examples of antiarrhythmic drugs that can be used for bradyarrhythmias?
- Atropine - Isoproterenol - Epinephrine
92
What are 2 examples of drugs used to treat sinus bradycardia?
- Atropine | - Isoproterenol
93
What are 3 drugs that can be used with a second-degree AV block?
- Atropine - Isoproterenol - Glucagon
94
What is an example of a drug that can be used with cardiac asystole (cardiac resuscitation)?
Epinephrine
95
Which type of a vasoconstrictor is epinephrine?
Non-selective alpha-agonist
96
Which type of a vasoconstrictor is Norepinephrine?
Non-selective alpha-agonist
97
Which type of vasoconstrictor is Phenylephrine?
Selective alpha 1-agonist
98
What are 3 examples of direct and indirect sympathomimetics that cause vasoconstriction?
- Ephedrine - Pseudo-ephedrine - Phenylpropanolamine (PPA)
99
What are 5 categories of vasodilators?
- Sympatholytic drugs - ACE inhibitors - Angiotensin II antagonists - Direct-acting vasodilators - Calcium channel blockers
100
Phentolamine is what type of sympatholytic vasodilator?
Non-selective alpha-blocker
101
Phenoxybenzamine is what type of sympatholytic vasodilator?
Non-selective alpha-blocker
102
Prazosin is what type of sympatholytic vasodilator?
Selective alpha 1-blocker
103
Terazosin is what type of sympatholytic vasodilator?
Selective alpha 1-blocker
104
Doxazosin is what type of a sympatholytic vasodilator?
Selective alpha 1-blocker
105
Clonidine is what type of sympatholytic vasodilator?
Presynaptic alpha 2-agonist
106
Propranolol is what type of sympatholytic vasodilator?
Non-selective beta-blocker
107
Atenolol is what type of sympatholytic vasodilator?
Selective beta 1-blocker
108
Carvedilol is what type of sympatholytic vasodilator?
Beta and alpha 1-blocker
109
Bretylium is what type of sympatholytic vasodilator?
Indirect sympatholytic
110
What are 4 examples of ACE inhibitors?
- Captopril - Enalapril - Benazepril - Lisinopril
111
What are 3 things that ACE inhibitors inhibit?
- Angiotensin-converting enzyme (kininase) - Angiotensin II synthesis - Aldosterone
112
A reflex increase in renin can be seen with what category of drug?
ACE inhibitors
113
Increased bradykinin levels can be seen with which category of drug?
ACE inhibitors
114
Where in the body are there local tissue specific renin-angiotensin systems (RASs)?
Heart, kidney, brain, adrenal and other tissues.
115
T/F: The local RASs in these tissues may be more important than the systemic RAS.
True
116
What are 3 therapeutic uses for ACE inhibitors?
- Congestive heart failure - Hypertension - Chronic renal insufficiency in cats
117
Which ACE inhibitor is available both orally and parenterally? In which form are the others available?
- Enalapril | - Oral only
118
Food reduces intestinal absorption of which ACE inhibitor?
Captopril
119
Enalapril has a slower onset and longer duration of actin than which other ACE inhibitor in the dog?
Captopril
120
Which 2 ACE inhibitors are long-acting and can be administered once daily?
- Benazepril | - Lisinopril
121
Which 2 ACE inhibitors are activated in the liver?
- Enalapril | - Benazepril
122
Which ACE inhibitor is least likely to require dosage modification in renal failure patients because of significant excretion in bile (50%)?
Benazepril
123
What are 2 examples of adverse effects that can be seen in ACE inhibitors in general?
- Hypotension | - May lower intraglomerular pressure decreasing GFR in animals with systemic hypertension and azotemia.
124
What are 3 examples of adverse effects seen specifically with Captopril?
- May cause idiosyncratic glomerular disease in some dogs. - Has more GI side effects than enalapril. - (-SH group) may cause neutropenia, proteinuria and skin rash in some humans.
125
Which drugs in an angiotensin II antagonist?
Losartan
126
What is the mechanism of action for angiotensin II antagonists?
Competitive antagonist of angiotensin II receptors.
127
What is a clinical use for an angiotensin II antagonist?
Anti-hypertensive
128
What are 2 examples of direct-acting vasodilators?
- Hydralazine (arteriolar vasodilator) | - Nitrates
129
What are 3 examples of nitrates?
- Sodium nitroprusside - Nitroglycerin - Isosorbide dinitrate
130
What does Hydralazine increase?
Local concentrations of PGI2
131
What might Hydralazine inhibit?
Calcium influx into smooth muscles of arteries.
132
Nitrates cause the formation of what that activates what?
Formation of the reactive radical nitric oxide (NO) which activates guanylyl cyclase.
133
What do nitrates increase?
Cyclic GMP
134
What do nitrates stimulate?
GMP-dependent protein kinase
135
What do nitrates cause the alteration of?
Phosphorylation of proteins in smooth muscle and dephosphorylation of myosin light chain.
136
What do nitrates cause the relaxation of?
Smooth muscle of blood vessels.
137
What are 3 classifications of calcium channel blockers (CCBs)?
- Diphenyl alkylamines - Benzodiazepines - Dihydropyridines
138
What is an example of a diphenyl alkylamine?
Verapamil
139
What is an example of a Benzodiazepine?
Diltiazem
140
What are 2 examples of Dihydropyridines?
- Amlodipine | - Nifedipine
141
What do calcium channel blockers inhibit?
The influx of extracellular calcium across myocardial and smooth muscle cell membranes.
142
A decrease in intracellular calcium inhibits what?
Myocardial contraction and results in dilation of the coronary and systemic arteries.
143
What are 4 effects calcium channel blockers have on the heart?
- Negative inotropic effect - Negative chronotropic effect - Increase oxygen delivery to the myocardial tissue - Decrease afterload
144
What are 2 effects calcium channel blockers have on blood vessels?
- Decrease peripheral resistance | - Decrease systemic blood pressure
145
What are 4 therapeutic uses of calcium channel blockers?
- Anti-arrhythmic (ClassIV) - Antihypertensive - Myocardial hypertrophy - Antianginal (ischemic heart disease)
146
What are 2 examples of calcium channel blockers that are used in the treatment of supraventricular tachyarrhythmias?
- Verapamil | - Diltiazem
147
Which calcium channel blocker is recommended as the first-line antihypertensive in cats unless the cause is hyperthyroidism, in that cause which drug is used?
- Amlopdipine | - Beta-blocker
148
What is the drug of choice for cats with myocardial hypertrophy?
Diltiazem
149
What are 4 adverse effects that can be seen with calcium channel blockers?
- Bradycardia and AV block - Hypotension - GI side effects - Elevated liver enzymes (temporary)
150
What are 4 categories of antihypertensive drugs?
- Diuretics - Beta blockers - Vasodilators - Calcium channel blockers
151
What are 2 examples of diuretics that can be used as antihypertensive drugs?
- Hydrochlorothiazide | - Furosemide
152
What are 4 examples of vasodilators that can be used as antihyhpesensitive drugs?
- ACE inhibitors - Angiotensin II antagonists - Hydralazine - Alpha blockers
153
What are 4 types of drugs that can be used in the emergency treatment of hypertension?
- Hydralazine or sodium nitroprusside IV - Propranolol or acepromazine IV - Phentolamine IV - Oral calcium channel blockers, prazosin or ACE inhibitors
154
What is the drug of choice form pheochromocytoma-induced hypertension?
Phenoxybenzamine

Pharmacology 2 (10 decks)

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