drugs acting on vascular tone Flashcards
groups of drugs acting on vasoregulation
organic nitrates Ca channel blockers alpha1 agonists Hydralazin PDE inhibitors RAA system blockers
name an organic nitrate
nitroglycerin
effects of nitroglycerin
pronounced arterial and venous dilation - dilation of mesenterial veins -> shift from pulmonary circulation
what does nitroglycerine do to the preload and afterload
decreases them
what does nitroglycerine do to the coronary arteries
dilates them
nitroglycerine admin route
first pass effect orally -> Iv and sublingual
transdermal patch, ointment -> quick effect->acute heart failure or decompensated heart failure
nitroglycerine half life
short
nitroglycerin habituation
quick
two groups of Ca channel blockers
dihyropyridines
non-dihydropyridines
which Ca channel blockers can be used to affect vasodilation
amlodipine
diltiazem, verapemail
amlodipine effect
arterial vasodilation
amlodipine admin route
orally
amlodipine indications
cat hypertension
diltiazem, verapamil indications
antiarrhythmic drugs that also have some effect on hypertension, but low vessel/heart selectivity
name two alpha1 antagonists that can be used to affect vasodilation
prazosin, doxasozin
hydralazin effect
arterial vasodilator
hydralazin admin route
orally
PDE inhibitors that could be used as vasodilators
pimobendan, sildenafil
three groups of diuretics
cardial diuretics
osmotic diuretics
natiuretics
cardial diuretics
digoxin
xanthine derivatives
ACE inhibitors
four types of natiuretics
carboanyhydrase inhibitors
loop diuretics
thiazides
potassium sparing diuretics
which type of natiuretic has the best effect
loop diuretics - the loop of henle is where 80% of H2O is excreted
osmotic diuretics list
mannitol
glycerine
how is mannitol administered
IV
does mannitol penetrate across membranes
no
is mannitol reabsorbed
no, just filtration
mannitol indications
life threatening oedemas
acute renal failure
opthalmology - glaucoma
carbanhydratase inhibitors mechanism of action
they block the Na-H pump - H in cells and Na in urine -> acidosis in cells and alkalosis in urine
where do carbanyhydratase inhibitors have their action
proximal tubule
carbanyhydratase inhibitors indications
heart failure
glaucoma
alkalising urine
carbanyhydratase inhibitors side effects
metabolic acidosis, other uroliths
carbanhydratase inhibitors for systemic use against glaucoma
acetolamide
carbanhydratase inhibitors for local use against glaucoma
dorzolamide, brinzolamide
loop diuretics mechanism of action
NKCC2 inhibition -> Na and K excretion
Mg and Ca excretion increased
where do loop diuretics have their effect
loop of henle
name two loop diuretics
furosemide, torsemide
furosemide half life
very short, must be applied very frequently
furosemide indications
heart failure
oedemas
oliguria, anuria
furosemide side effects
hypokalaemia, metabolic alkalosis, hypotension, ototoxicity
why should furosemide be used in combinations
aldosterone escape
can we combine furosemide with aminoglycoside ABs
no autotoxicity
why should we adjust the dose of furosemide when combined with ACE inhibitors
bc they decrease the blood pressure
something important to check before administering furosemide in the case of acute renal failure
must make sure animal is well hydrated
thiazides mechanism of action
NCCT inhibition -> Na and water excretion
K excretion incr, Ca excretion decr
where do thiazides have their effect mostly
distal tubule
do we use thiazides in the case of Ca oxalate urolithiasis
yes, rarely
do we use thiazides in combo
yes rarely
name two thiazides that can be used as diuretics
chlorothiazide, hydrochlorothiazide
potassium sparing diuretics list
amiloride, triameterine
aldosterone antagonists
what kind of antagonists are aldosterone antagonists
competitive
aldosterone antagonists mechanism of action
ENaC and Na/K ATPase protein expression decr, incr Na excretion, K excretion unchanged
name the main aldosterone antagonist
spironolactone
spirinolactone indications
antagonising aldosterone in CHF
preventing diuretic induced aldosterone escape
hyperaldosteronism
spirinolactone side effects
hyperkalamia - not very severe
spirinolactone dosage Car
1-2mg/kg PO
options for combined treatment of CHF in dogs
pimobendan+furosemide+spirinolactone
ACE inhibitor+furosemide+spironolactone
Pimobendan+ACE inhbitor
option for combined treatment of CHF in cats
furosemide
combined treatment for hypertension
amlodipine+ACE inhibitor+AT-II antagonist
name the four phases of blood clotting
local vasoconstriction
platelet aggregation
coagulation cascade
thrombolysis
two groups of antiplatelet agents
cyclooxygenase inhibitors
ADP receptor inhibitors
antiplatelet COX inhibitors
acetylsalicylic acid
acetylsalicilylic acid species
dog, human
acetylsalicilylic acid duration
long
antiplatelet ADP receptors
clopidorgel
clopidogrel side effects
less frequent, inappetance, GI -> give food if GI symptoms
clopidogrel is a prodrug, in which organ is it metabolised
liver
clopidogrel half life
SID, half life huge
anticoagulants
VitK antagonist, warfarin
heparin
what does warfarin inhibit by antagonising vit K
ii, vii, ix, x clotting factor activation
warfarin onset of action
18-24 hours
warfarin admin route
orally, iv, im
warfarin, does it have protein binding
extensive, interactions
warfarin side effects
bleedings
pregnancy - malformations, neg effects on development
where is heparin produced
mast cells
heparin is acidic?
yes
two forms of heparin as a drug
heterogenic substance btwn 1-30kDa
low molecular weight heparin
which of the two forms of heparin is the safest
low molecular weight heparin
why is the LMWH safer to use
inhibition of thrombin is based on molecular weight
has better selectivity
larger therapeutic index
which bleeding parameter is the most important to check when adjusting the dose of heparin
APTT
heparin mechanism of action
antithrombin - thrombin, vii, is, x and xii clotting factors inactivation
non fractionated heparin substances
Na heparin, Ca heparin
LMWH substances
dalteparin
fraxiparin
enoxaparin
can heparin be given orally
no, give as inj
heparin indications
feline HCM thromboembolism
DIC
heartworm
thrombolytic agents
streptokinase
where is streptokinase produced
by streptococcus sp
possible side effects of streptokinase
immune response, anaphylaxis
non selective for thrombi - bleedings
reperfusion
due to the anaphylaxis how many times should we apply streptokinase
only once or twice at most
how should streptokinase be applied
parenterally
whats protamine
chemical antagonist of heparin
on which type of heparin does protamine have a greater effect
standard
protamine dosage
50% of heparin dosage
how should protamine be administered
iv, slow infusion
effects of etamsylat
decr bleeding time, but PT and APTT stay the same
etamyslat side effects
rare, large therapeutic index
etamyslat admin route
po, im, iv