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Clinical Pharmacology > Equine Resp Pharmacology > Flashcards

Equine Resp Pharmacology Flashcards

1
Q

non infectious cough– TTW or BAL

A

BAL- cells in lower airways
(TTW- more diffuse, infectious)
case example- saw neutrophils and Curshman’s Spirals

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2
Q

RAO vs IAD

A

RAO over 25% neutrophils

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3
Q

Cough reflex- anatomy

A

Involuntary reflex

Sensory receptors in airway epithelia –> larynx to resp bronchioles.

Nerve fibers conduct afferent impulses within vagal, glossopharyngeal, trigeminal, phrenic nerves

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4
Q

do horses have more receptors in upper or lower airways

A

upper airways

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5
Q

Horses are ____ sensitive to upper airway cough receptors than other species

A

Less

Ex. pass stomach tube…into trachea-..more or may not cough

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6
Q

Anti-tussives in horses- indicated when

A

Persistent coughing, fatiguing, non productive cough

Not used often in horse

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7
Q

which anti-tussives are used infrequently in horses

A

Opiate agonists: Hydrocodone, Butorphanol

Non opioids: dextromethorphan

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8
Q

Anti tussives MOA

A

Direct suppression of cough center

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9
Q

Bronchodilators: methylxanthines (theophylline) MOA

A

Competitive non selective phosphodiesterase inhibitor (increases cAMP, protein kinase A, inhibits TNF-alpha and leukotriene synthesis)

Non selective adenosine receptor antagonist: Antagonization of A1, A2, A3 receptors + cardiac effects

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10
Q

Methylxantines- side effects

A

CNS excitation
arrhythmias
narrow safety margin

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11
Q

theophylline- effects on dexamethasone

A

Theophylline didn’t potentiate the effects of low dose Dexamethasone in horses with RAO

Didn’t improve lung fxn

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12
Q

MOA of Beta 2 adrenergic agonists (see map)

A

Bronchodilation, Decreased: plasma exudation, cholinergic neurotransmission, Bacterial adherence (good), Neutrophil fxn (not so good)
Increases: MC clearance

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13
Q

What are some selective Beta 2 agonists

A

Albuterol
Clenbuterol
Salmeterol

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14
Q

What are some non selective Beta 2 agonists

A

Very short acting (emergencies!)
Epinephrine
Isoproteranol

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15
Q

Can you use albuterol as a rescue drug

A

No– you get TOLERANCE (down regulation) and Tachypylaxis possibly

Uncoupling of adenylate cyclase

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16
Q

Toxicity/side effects of Beta 2 agonists: non selective Rescue drugs

A

Epi –> tachycardia, muscle fasiculations, sweating, hypertension
Isoproteranol –> tachycardia

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17
Q

Toxicity/side effects: Selective drugs (which ones are shorter/longer acting)

A

Albuterol- shorter acting
clenbuterol- longer acting
salmeterol- longer acting

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18
Q

Toxicity/side effects: Selective drugs

A

All have tachycardia, sweating, muscle fasiculations, excitation

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19
Q

3 indications for beta-2 agonist use

A

1) emergency therapy in horses w/marked airway obstruction or anaphylaxis (duration under 1 hr)
e. g. Epi and Iso

2) before exercise- relieves mild to moderate airway obstruction
3) before administration of aerosol corticosteroid preparations

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20
Q

why give beta 2 agonist before aerosol corticosteroid preparations

A

To improve pulmonary distribution of these surface active agents

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21
Q

Most common beta 2 agonist used in the horse

A

Clenbuterol- oral

Partial beta 2 agonist approved for use in horses

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22
Q

Clenbuterol tolerance? bioavailability? fat? inflammation?

A

tolerance can develop! start at low dose

excellent F of 87%
anti inflammatory properties

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23
Q

Tocolytic effect of clenbuterol

A

Slows progress of labor in dystocias

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24
Q

Inhaled drugs vs systemic drugs

A

Particles >10 micrometer– won’t go far

10 to 6 –> into cardiac inlet

5 to 1 –> into lungs

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25
Q

Particles as large as ____ suspended in gas and administered as aerosol

but only SMALL particles reach distal airways effectively

A

50 micrometers

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26
Q

Particle size of ___ are thetherapueitc aerosol that are maximally deposited in ___ airways

A

1-5 micrometers

lower airways

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27
Q

When does maximal deposition of inhaled drug occurs

A

when patients take slow, deep breaths with large tidal volumes

but difficult to control breathing patterns of aimals

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28
Q

Albuterol- bioavailability in horses

A

Poor F in horses, give with devices such as Aerohippus or Nebulization instead

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29
Q

Albuterol- how long does it take to work

A

5 min

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30
Q

Salmeterol- how long does it last?

A

8-12 hours in severe asthma horses (long acting)

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31
Q

salmeterol- anti inflammatory properties

A 
inhibits leukotriene and histamamine release from mast cells
reduces eosinohils (esp with RAO)
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32
Q

when is salmeterol recommended

A

maintenance in therapy and pre-exercise administration

mild to mod airway obstruction

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33
Q

Anti cholinergics- MOA

A

Parasymp system= dominant in the pulmonary ANS in mammals

PS innervation throughout tracheobronchial tree of horse

Use Muscarinic antagonist to block M3 receptor –> blocks PS

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34
Q

where is the greatest effect of anti cholinergics

A

Large central airways

35
Q

where are muscarinic receptors

A

abundant in airway smooth muscle –> smooth muscle contraction and bronchoconstriction

36
Q

M3 receptors is ___ mediated

A

vagally mediated, cholinergic stimulation

37
Q

What is the primary mechanism of bronchospasm in severe equine asthma?

A

vagally mediated cholinergic stimulation of M3 receptors

38
Q

Atropine

A

Non selective M1M2M3 antagonist

39
Q

What does atropine decrease

A

release of intracellular Ca2+ from SR –> smooth muscle relaxation

Rapid bronchodilation in horses

40
Q

Atropine duration

A

short (.5 to 2 hours)

41
Q

Atropine use in horses

A

limited- except as rescue

42
Q

Atropine side effects!!

A

Ileus

Impaired MC clearance
Increased mucus viscosity

CNS toxicity

Tachycardia

43
Q

Ipatromium bromide

A

Synthetic anticholinergic compound

Non selective muscarinic antagonist

44
Q

Ipatromium bromide usage

A

Leads to bronchodilation, inhibits cough

Nebulized or inhaler

45
Q

Ipatromium bromide effect and lasts how long

A

usually in 15-30 min

Lasts 4-6 hours

46
Q

N butylscopalammonium bromide AKA buscopan

A

Anticholinergic
Quatenary ammonium compound used for gas/spasmodic colic in horses
Potent bronchodilator

47
Q

Buscopan adverse effects

A

minimal–

TRANSIENT tachycardia, decreased borborygmi, pupillary dilation

48
Q

Buscopan maximum effect

A

10 min after IV

usually effect within a few min! good response

49
Q

Buscopan dissipation

A

1 hour after admin

50
Q

Buscopan as a rescue drug?

A

Excellent rescue drug! AND excellent for determining if bronchostriction is involved!!!

51
Q

Cromolyn Sodium Intal uses

A

Nebulized or used with inhaler

52
Q

Cromolyn MOA

A

Inhibits mast cell degranulation

Interferes with Ca tarnsport across cell membrane

53
Q

Cromolyn – bronchodilation?

A

NO BRONCHODILATORY EFFECTS (must combine with another drug)

54
Q

Cromolyn uses

A

limited uses, except in horse with known “triggers”

55
Q

Cromolyn administration

A

Given prior to allergen exposure

56
Q

Bronchconstriction is a PORTION of the problem, while ____ is a huge component

A

INFLAMATION

57
Q

Glucocorticoids for anti inflammation, what is MOA

A

Increases beta 2 adrenergic mediated bronchial smooth muscle
May prevent down regulation of beta receptors
DECREASES inflammatory mediators

58
Q

Corticosteroids indications

A

severe asthma and some cases of IAD or mild/mod asthma

horses with severe diffuse airway dz need SYSTEMIC CS

59
Q

Corticosteroids pros

A

improves pulmonary fxn, reduces inflammation

60
Q

systemic vs inhaled CS

A

Inhaled– won’t get distributed when severely affected horse (need systemic CS)

61
Q

CS onset and dosing

A

within hours

increasing dose does NOT help in human or equine med

62
Q

conservative dosing – why is it recommended with CS

A

increasing dose doesnt help

NOT DOSE DEPENDENT

63
Q

CS: systemic

Dexamethasone – watch out for what

A

LAMINITIS

athough never proven, always worry about CS use and laminitis

64
Q

CS: prednisolone vs prednisone

A

Prenisolone- doesn’t decrease airway inflammation obstruction, as well as Dexamethasone does

Predinisone- DOES NOT WORK!

65
Q

why doesnt prednisone work

A

poor absorption
rapid excretion
hepatic failure of converting it to Prednisolone

66
Q

CS: inhaled

effective when

A

horses with mild to moderate airway obstruction

67
Q

CS: pros of aerosolized drug

A

reduces total therapeutic dose

allows direct delivery to lower resp tract

68
Q

CS: 3 formulas

A

Fluticasone
Beclomethasone
Flunisolide

69
Q

Which of the 3 inhaled CS is most potent?

A

Fluticasone

70
Q

Fluticasone vs beclomethasone vs Flunisolide in terms of potency and $

A

FBF
Fluticasone = most potent and $$
Beclomethasone= moderate, similar $
Flunisolide= less potent but less $

71
Q

corticosteroids and HPA

A

inhaled steroids can suppress HPA

up to 65% with fluticasone

72
Q

CS and HPA– effects gone within ___ days

A

1-2 days

73
Q

Immunomodulatory drug

A

IFN alpha

74
Q

IFN alpha

A

endogenous immunostimulant
Antiviral
Immunomodulatory
Anti proliferative activity

75
Q

IFN alpha ADMINISTRATION

A

ORAL!! for horses with mild asthma/IAD

this activates natural defense system in oropharynx associated with lymphoid tissue

76
Q

Mucolytics uses (human med vs equine)

A

human med (COPD and cystic fibrosis)N

typically we don;t use with equine asthma! use more with broncho or pleural pneumonia cases

77
Q

Mucolytic benefits

A

decreases viscosity, enhances clearance of bronchial exudates, productive cough

78
Q

N acetylcysteine- mucomyst MOA

A

breaks disulfide bonds –> lowers viscosity

79
Q

mucomyst uses

A

nebulizer, 20-50 mL of 10% solution q6

80
Q

respiratory stimulants: Doxapram

Uses

A

stimulates resp center in emergency situations

neonates , anesthetic emergencies, overdose of benzodiazepines, opiates

81
Q

Doxapram MOA

A

General CNS stimulant

Stimulates carotid and aortic chemoreceptors

82
Q

Doxapram contraindications

A

Cerebral hemorrhage

Increased cerebral pressure

83
Q

Resp stimulant: Caffeine

MOA

A

enhances ventilatory response (adenosine receptor A1 A2 antagonist)

Increases respiratory drive

Clinical Pharmacology (7 decks)

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