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Clin Pharm > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Define; Ionotropy, Chronotropy, Preload, Afterload, Congestive Heart Failure (CHF)

A

Inotropy
- Intrinsic property of sarcomere to shorten (Actin-Myosin interaction) or to contract

Chronotropy
- affecting the heart rate. Constant flux between sympathetic and parasympathetic tone. Congestive heart failure increases sympathetic tone

Preload
- pressure that stretches the right or left ventricles prior to contraction (systole). Both pressure and volume dependent. Increased Preload elicits the Frank-Starling mechanism (increases force of contraction)

Afterload
- force that opposes ventricular ejection. Afterload ≠ Blood pressure. But we often use as clinical surrogate. Afterload can also be “fixed” as in an obstruction such as pulmonic stenosis.

Congestive heart failure
- fluid accumulation in tissues (lungs or cavities) as decompensation from the blood volume augmenting affects of the RAAS system trying to maintain C.O. Often referred to as backward failure

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2
Q

How to achieve Positive Ionotropy, & drugs

A

How
○ Increase quantity of intracellular Ca
○ Increase sensitivity of contractile proteins to Ca
○ OR both

Positive Ionotropes
○ Pimobendan
○ Digoxin

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3
Q

Pimobendan MOA, dose, use in dogs, use in cats

A

MOA
■ Phosphodiesterase inhibitor ->
■ decrease degradation of cAMP ->
■ Increases intracellular Ca+
■ Ca sensitizer
■ PDE III inhibitor -> vasodilation

Dose
■ 0.25 - 0.3mg/kg PO BID

Uses in dogs
■ Systolic dysfunction
■ CHF
■ Pre-clinical valve dz w/ cardiomegaly

Use in Cats
■ Not usually used for HCM
■ May use end stage HCM or refractory CHF
■ Use for dilated & restrictive cardiomyopathy

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4
Q

Pimobendan Cautions, Adverse Effects

A

Cautions
■ Contraindicated in ventricular hypertrophy or obstruction
■ Not stable as liquid compound

Adverse Effects
■ GI
■ Hypotension w/ tachycardia
■ CNS stimulation

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5
Q

Mitral Valve Endocardiosis Staging & Therapy

A

A
■ Breeds at risk w/ no murmur
■ Monitor yearly

B1
■ Minimal to no atrial enlargement
■ Monitor q6-12mo

B2
■ Moderate-severe atrial enlargement
■ Pimobendan +/- enalapril

C
■ Severe cardiomegaly and/or CHF
■ Pimobendan + enalapril + Furosemide + diet

D
■ Refractory CHF
■ Pimobendan + enalapril + Furosemide + diet + additional diuretics

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6
Q

Digoxin MOA, Dose, Use, Caution, Adverse Effects

A

MOA
■ Inhibits Na/K ATPase ->
■ Increase cellular Na ->
■ Decrease activity of Na/Ca exchanger ->
■ Increase Ca in cell
■ Decrease sympathetic tone
■ Decrease ALD

Dose
■ 0.0025 - 0.005 mg/kg PO BID

Uses
■ DCM
■ A fib (to slow heartrate)

Caution
■ VERY narrow therapeutic window
■ Pro-arrhythmic effect
■ Renal excretion

Adverse Effects
■ GI
■ CNS
■ Arrhythmias

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7
Q

What increases Pre-load & drugs to decrease preload

A

What Increases Preload
○ Fluid therapy
○ anemia
○ hyperthyroidism
○ Heart dz leading to fluid volume retention

Preload Reducers
○ Furosemide
○ Spironolactone

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8
Q

Spironolactone MOA

A

■ Antagonize ALD
■ K sparing
■ Slows myocardial fibrosis

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9
Q

What increases Afterload & drugs to decrease afterload

A

What increases Afterload
○ Systemic hypertension
○ Systemic vasoconstriction w/ RAAS & CHF
○ Pulmonary hypertension
○ Pulmonic stenosis
○ Subaortic stenosis
○ L ventricular outflow obstruction

Afterload Reducers
○ ACE Inhibitors
○ Amlodipine
○ Pimobendan

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10
Q

Ace Inhibitors; Drugs, Dose, Use, Adverse Effects, Interactions

A

Enalapril, Benazepril

Dose
■ 0.25-0.5 mg/kg PO BID

Use
■ Pre CHF & CHF
■ Systemic hypertension
■ Glomerular hypertension

Adverse Effects
■ Dehydration & azotemia
■ Hyperkalemia
■ Hyponatremia
■ GI
■ Renal injury

Drug Interactions
■ NSAIDs
■ Cisplatin
■ Aminoglycoside

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11
Q

Amlodipine; MOA, Dose, Use, Adverse Effects

A

MOA
■ Dihydropyridine Ca channel Blocker

Dose
■ 0.1-0.2 mg/kg PO SID-BID

Use
■ Systemic hypertension

Adverse Effects
■ Dehydration
■ GI
■ Hypotension
■ Gingival hyperplasia

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12
Q

Nitrates / Nitroglycerin

A

○ Increase nitric oxide production
○ Venodilator -> preload reducer

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13
Q

Class 1 (1a) Antiarrhythmic; Drugs, MOA, Use

A

Drugs
● quinidine (usually large animal)

MOA
■ Na channel blocker
■ Mb stabilizers

■ Slows conduction
■ 1a - Decrease upstroke & prolong AP

Use
● atrial & ventricular arrhythmias
● EQ atrial fibrilation

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14
Q

Class 1 (1b) Antiarrhythmic; Drugs, MOA, Use

A

Drugs
● lidocaine
● mexiletine

MOA
■ Na channel blocker
■ Mb stabilizers

■ Slows conduction
■ 1b - shortens AP

Use
● ventricular arrhythmias

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15
Q

Class 2 Antiarrhythmic; Drugs, MOA, Use

A

Drugs
■ Atenolol

MOA
■ Beta-blocker
■ Slows SA & AV node

■ Slows conduction of
 ectopic beats

■ Depresses contractility

Use
■ Atrial & ventricular arrhythmias
■ Diastolic dysfunction (hypertrophy)
■ Slow HR & promote ventricular filling

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16
Q

Class 3 Antiarrhythmic; Drugs, MOA, Use

A

Drugs
■ Sotalol

MOA
■ K+ channel blocker
■ Prolongs AP

■ Decrease excitability
■ Multimodal class

Use
■ Atrial & ventricular arrhythmias (esp. severe/refractory)
■ multimodal

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17
Q

Class 4 Antiarrhythmic; Drugs, MOA, Use

A

Drugs
■ Diltiazem

MOA
■ Ca channel blocker
■ Inhibit L- Ca++

■ Decrease SA node firing
■ Slows AV conduct
■ Mild decrease in contractility

Use
■ Atrial arrhythmia
■ Atrial fib
■ Promote filling in diastolic dz

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18
Q

Quinidine Adverse Effects

A

○ GI
○ Arrhythmia
○ Hypotension
○ CNS excitation
○ Dose 3-4 times per day

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19
Q

Lidocaine Adverse Effects

A

○ Very short T1/2
○ CNS excitation
○ Cats very sensitive (use 1/10th dose)

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20
Q

Mexiletine Adverse Effects

A

○ Very long T1/2 must give 3x per day
○ GI

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21
Q

Atenolol Adverse Effects

A

○ Destabilize patients w/ poorly controlled DCM or CHF
○ bronchiol constriction
○ Bradycardia / hypotension
○ GI

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22
Q

Sotalol Adverse Effects

A

○ Arrhythmias

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23
Q

Diltiazem Adverse Effects

A

○ Bradycardia / hypotension
○ GI

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24
Q

Indications for Anti-hemostatic Drugs

A

Prevention of feline aortic thromboembolism
• HCM
• restrictive cardiomyopathy

Treatment of feline aortic thromboembolism

Prevention of pulmonary thromboembolism
• Hyperadrenocorticism
• IMHA
• DIC
• Protein losing enteropathy/nephropathy
• Heartworm dz

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25
Q

Types of Anti-hemostatic Drugs

A

Anticoagulants
• Interfere with clotting cascade to prevent clotting

Thrombolytics

• Breakdown thrombi that have already formed

Antithrombotics

• Interfere with platelet activation/aggregation

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26
Q

Heparin MOA, Caution, Monitor

A

MOA
• Works w/ antithrombin III
• Inhibits thrombin & some Xa

Caution
• High dose need to be effective
• Can cause excessive bleeding

Monitor
• ACT
• aPTT

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27
Q

Low-molecular weight heparin (LMWH) MOA, Better than?

A

MOA
• Higher affinity for antithrombin III than heparin
• Inactivate Xa but not thrombin

Better than Heparin?
• Tendancy for bleeding less than heparin
• No monitoring necessary

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28
Q

Aspirine, MOA, Caution

A

MOA
• Irreversibly inhibits COX enzymes ->
• Platelets can’t synthesize more COX
->
• Blocks TXA2 production for life of platelet

Caution
• Exacerbate GI & renal dz

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29
Q

Clopidigrel; MOA, Better than?

A

MOA
• ADP Antagonist, cant bind to P2Y12 receptor
• Activation of platelet is inhibited


Better than aspirin?
• More effective & less side effects

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30
Q

Thrombolytics; MOA, Drugs, Indications

A

MOA
• Conversion of plasminogen to plasmin ->
• Plasmin cleaves fibrin, breaks clot

Drugs:

• Tissue plasminogen activator
• Urokinase

• Streptokinase

Indications:
• Acute clotting, coronary artery disease
• Not good for chronic, large clots (most veterinary patients)

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31
Q

Drugs for Ruminat Esophageal Obstruction

A

o Acepromazine
o Xylazine or detomidine

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32
Q

Drugs for Ruminotorics

A

o Mineral oil
o Dioctyl sodium sulfosuccinate

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33
Q

Antifoaming Agents in Ruminants

A

o Poloxalene
o Polymerized methyl silicone

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34
Q

Modulators of Ruminoreticular Motility

A

o Neostigmine and bethanechol

o N-butylscopolammonium bromide
o Atropine

o Xylazine
o Metoclopramide

o Erythromycin lactobionate

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35
Q

Proton Pump Inhibitors for Large Animals; Drugs, MOA, Indications, Toxicity

A

o Omeprazole
o Gastroguard & Ulcerguard FDA approved for horses

MOA
• prodrug activated in acidic environment ->
• binds irreversibly to the proton pump. ->
• acid production resumes only after the new proton pumps are synthetized in the parietal cells.
• 30% of maximal effect within the first 24 hs
• maximal effect 2-4 days.

Indications
• Prevention of ulcers in horses (give 1 hr prior to meal)

Toxicity
• Rebound hyperacidity
• Chronic use -> bacterial overgrowth
• Can alter absorption of antifungals & mycophenolate
• Metabolized by P450

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36
Q

Prokinetic Cholinergic – NEOSTIGMINE in large animals; Clinical Use, Adverse Effects,

A

Clinical Use
• Enhance cecal emptying in healthy ponies
• Promote passage of gas in foals w/ abdominal distension
• Enhance gastric emptying in horses

Adverse Effects
• SLUD
• Bradycardia
• Colic
• Increased gastric acid secretion

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37
Q

When to Use Appetite Stimulants in Small Animals

A

• When a feeding tube cannot be placed
• When the underlying cause of anorexia/hyporexia has been removed but patient is still not eating
• Short term during diagnostic phase
• When secondary to behavioral or environmental factors
• To overcome food aversion
• In chronically ill or palliative cases when a feeding tube cannot be placed

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38
Q

Cyproheptadine; MOA, Use, Adverse Effects

A

MOA
• 5HT3 antagonist
• decrease serotonin -> increase opiates -> stimulate apetite

Use
• appetite stimulant for cats

Adverse Effects
• Sedation
• Dry mucous membranes

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39
Q

Mirtazapine; MOA, Use, Adverse Effects

A

MOA
• 5HT3 antagonist decrease serotonin -> increase opiates -> stimulate apetite
• alpha adrenergic receptor antagonist
• histamine receptor antagonist

Use
• Appetite stimulant for dogs PO
• Appetite stimulant cats PO or pinna

Adverse Effects
• Sedation
• Behaviior changes
• GI upset
• Pinna irritation

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40
Q

Capromorelin; MOA, Use, Adverse Effects

A

MOA
• Ghrenlin receptor agonist
• Signals hypothalamus

Use
• Appetite stimulant for dogs & cats PO

Adverse Effects
• Increased salivation
• GI upset

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41
Q

Diazepam; MOA, Use

A

MOA
• GABAminergic inhibition of satiety center

Use
• Short term appetite stimulant in cats IV

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42
Q

Apomorphine; MOA, Use, Adverse Effects

A

MOA
• Stimulates D2 dopamine receptor in CRTZ

Use
• Emetic of choice for dogs

Adverse Effects
• Ocular irritation
• Lethargy
• Prolonged nausea/vomiting

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43
Q

Ropinerole; MOA, Use, Adverse Effects

A

MOA
• Stimulates D2 dopamine receptor in CRTZ

Use
• Emetic for dogs given opthalmic

Adverse Effects
• Inhibits prolactin -> don’t use during pregancy/lactation
• Ocular irritation
• Prolonged nausea/vomiting

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44
Q

Xylazine; MOA, Use, Adverse Effects

A

MOA
• Alpha-2 agonist

Use
• Previous emetic of choice for cats (IM or IV)

Adverse Effects
• Sedation
• Reveresed w/ yohimbine

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45
Q

Dexmedetomidine; MOA, Use, Adverse Effects

A

MOA
• Alpha-2 agonist

Use
• Emetic of choice for cats (IM or IV)

Adverse Effects
• Sedation
• Reveresed w/ atipamezole

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46
Q

Hydrogen Peroxide; MOA, Use, Adverse Effects

A

MOA
• Generates water & gas ->
• Expansion of stomach ->
• Stimulate GI nerve endings

Use
• Last shot emetic in dogs

Adverse Effects
• Do not give more than 45ml
• Gastritis, esophagitis
• GI ulceration / perforation

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47
Q

Metoclopramide; MOA, Use, Adverse Effects

A

MOA
• Serotonin antagonist
• Antidopaminergic
• enhances ACh release

Use
• Antiemetic in dogs
• prokinetic in proximal GI
• ileus
• GDV
• delayed gastric emptying
• gastroesophageal reflux
• Treat postoperative ileus, gastric dilatation-volvulus, idiopathic gastroparesis in LA
• Relax pyloric sphincter to promote gastric emptying in LA

Adverse Effects
• Change in mentation
• Do not use in gi obstruction or perforation
• Constipation

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48
Q

Maropitant; MOA, Use, Adverse Effects

A

MOA
• Neurokinin-1 receptor antagonist

Use
• Antiemetic for cats & dogs

Adverse Effects
• Few
• Pain at site of injection

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49
Q

Ondanestron or Dolasetron; MOA, Use, Adverse Effects

A

MOA
• Serotonin antagonist

Use
• Antiemetic for chemo induced nausea

Adverse Effects
• May cause neuro issue is MDR1 mutation dogs

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50
Q

Antacids; Drug, MOA, Considerations

A

Drugs
o Aluminum Hydroxide
o Mg Hydroxide
o Ca carbonate

MOA
o Neutralize acid

Considerations
o Super sort-term
o Not palatable

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51
Q

H2 Antagonists; Drugs, MOA, Use

A

• Famotidine (bradycardia; hemolysis in cats)
• Ranitidine (No longer available)
• Nizatidine

MOA
o Inhibition of acetylcholinesterase activity

Use
o Uremia
o Mast cell tumors
o ileus
o gastroesophageal reflux
o delayed gastric emptying
o constipation

52
Q

Erythromycin in LAs; MOA, Use, Adverse Effects

A

MOA
• Stimulates motilin receptor ->
• Promotes gastric & proximal intestinal motility

Use
• 2nd choice prokinetic after lidocaine
• cecal impactions
• given IV

Adverse Effects
• CRI high doses decreases motilin
• GI dz may decrease efficacy

53
Q

Lidocaine as Prokinetic in LAs; MOA, Use, Adverse Effects

A

MOA
• Prevents inhibition of bowel motility

Use
• Prophylactically avoid post operative ileus
• Bolus dose followed by CRI

Adverse Effects
• Cardiac arrhythmia
• Muscle fasciculations
• Ataxia seizures

54
Q

Hyoscine butylbromide; Use, Adverse Effects

A

Use
o Equine colic
o Calf scours

Adverse Effects
o Dry mouth
o Constipation
o Urinary retention
o Tachycardia

55
Q

Opioids in LAs; Drugs, Use,

A

Loperamide
o Slow marker passage
o Decrease fecal water/weight
o Anti-diarrheal in foals

Butorphanol
• Combined w/ Xylazine, suppress duodenal motility in horses

56
Q

Alpha-2 Agonists in LAs; Drugs, Use

A

Xylazine & Detomidine

Use
• Disrupt blood flow & motility on equine pelvic flexure
• Reduce motility in cecal muscle
• Decrease cecal blood flow

57
Q

Phenoxybenzamine in LAs; Use

A

• Treat severe nonresponsive Ds in horses

58
Q

Protectants & Absorbents in LAs; Drugs, Precautions

A

o Mg Sulfate
o Bismuth
o Activated Charcoal

Precautions
• Bismuth should not be given to patients on NSAIDs

59
Q

Laxatives in LAs; Drugs, use

A

Mineral oil

Surfactants (DSS)
• Questionable efficacy
• Can cause colic & severe Ds in horses

Psyllium Hydrophilic Mucilloid
• May be useful for sand impaction in horses

60
Q

Cathartic in LAs; Drug, Use

A

Lactulose
• Stimulates deffication

61
Q

Using Motility Modulators in Cows

A

o Controversial
o Little efficacy
o Correct underlying issue instead

62
Q

Treatment of Neonatal Ds in Ruminants

A

o Parenteral admin of antimicrobials
o Meloxican & flunixin meglumine
o Do not use probitics, protectants, absorbants, motility modifiers

63
Q

Proton Pump Inhibitors Drugs, MOA, Adverse Effects

A

o Omeprazole
o Pantoprazole (drug of choice)

MOA
o Inhibit gastic H-K-ATPase pump ->
o Reduce gastric acid secretion

Adverse Effects
o Increase gastrin levelse & rebound hyperacidity
o Inhibits CYP 450 (not Pantoprozole)

64
Q

Misoprostol; MOA, Use, Adverse Effects

A

MOA
o Prostaglandin E1 analog
o Inhibit gastric acid secretion
o Increase bicarbonate & mucus secretion
o Increase gastric blood flow

Use
o Treatment and prevention of aspirin (and maybe other NSAID) induced ulcers
• NSAID associated R dorsal colitis in horses

Adverse Effects
o GI distress
o Uterine contractions (abortion)

65
Q

Sucralfate; MOA

A

• Combined with acid -> sucrose octasulfate+aluminum hydroxide
• Coats cells & protects
• Doesn’t work great, use PPIs instead

66
Q

Insulin Similar to Endogenous Canine and Feline Insulin

A

Canine Insulin
o Same as porcine insulin
o 1 amino acid from human
o 3 amino acids from bovine

Feline Insulin
o 1 amino acid from bovine
o 3 amino acids from porcine
o 4 amino acids from human

67
Q

5 Insulin Formulations

A

Regular
• Recombinant human insulin
• Onset & duration same as endogenous
• IV, IM, SQ

NPH
• Combined w/ protamine to delay absorption
• SQ only

PZI
• Combined w/ protamine & zinc
• Greater delay in absorption than NPH
• SQ only

Lente/Ultralente
• Molucules into crystals
• Small crystals – short delay in absorption
• Large crystals – ong delay in absorption
• SQ only

Synthetic/Analogs
• Chemical modification of human insulin
• Amino acids added
• Slow absorption & degredation

68
Q

Humulin R & Novalin R; basics, syringe size

A

o Recombinant human insulin
o Insulin of choice for DKA, hyperkalemia
o Shortest acting (1-2 hours)
o Used in dogs and cats
o Must refrigerate

Syringe
• U-100

69
Q

Vetsulin; basics, syringe size

A

o Porcine lente insulin
o best for dogs
o also approved for cats
o Must refrigerate

Syringe
• U-40

70
Q

Novalin-N & Humulin-N; basics, syringe size

A

o NPH inslulin from human
o Often used in dogs
o Refrigerate & Do Not shake

Syringe
• U-100

71
Q

Detemir; basics, syringe size

A

o Human recombinant/analog
o Used in dogs
o More potent
o DO not shake

Syringe
• U-100

72
Q

Glargine; basics, syringe size

A

o Human recombinant/analog
o Used in cats
o Long-acting
o Refrigerate & Do Not shake
o Pens can last 1mo out of fridge

Syringe
• U-100

73
Q

Prozinc; basics, syringe size

A

o PZI human insulin
o Approved for cats
o Intermediate duration
o Refrigerate & Do Not shake

Syringe
• U-40

74
Q

Acarbose; MOA, Use, Adverse Effects

A

MOA
• Alpha-glucosidase inhibitor ->
• Inhibitis intestinal enzymes that convert starches to simple sugars ->
• Slows digestion of carbs and delays glucose absorption.

Use
• Dogs w/ poor glycemic control w/ no cause
• Maybe in cats that won’t eat a low carb diet

Adverse Effects
• GI signs
• Hypoglycemia
• Must give immediately before meal

75
Q

Glipizide MOA, Use, Adverse Effects

A

MOA
• Sulfonylurea antidiabetic agent ->
• Stimulates beta cell secretion of insulin
• May take 1-2 mo to see effects

Use
• Cats w/ non-insulin dependent diabetes
• If insulin can’t be given or if only small amount of nsulin needed to control DM

Adverse Effects
• GI signs
• Elevated liver enzymes & jaundice
• Hypoglycemia (rare)
• Increased amyloid deposition

76
Q

Cisapride; MOA, Use, Adverse Effects

A

MOA
• Enhances acetylcholine release

Use
• Targets smooth msucle from esophagus thru colon
• Megaesophagus & megacolon in cats
• Gastroesophageal reflux
• Delayed gastric emptying
• Ileus

Adverse Effects
• Metabolized by CYP 450 so affected by drugs that inhibit this enzyme
• Minimal; maybe V/D

77
Q

Erythromycin; ; MOA, Use, Adverse Effects

A

MOA
• Macrolide Ab w/ motilin like activity

Use
• Delayed gastric emptying
• Gastroesophageal reflux
• Decreased colonic motility in dogs

Adverse Effects
• Inhibits CYP 450
• MDR1 mutants may react

78
Q

Bethanechol; MOA, Use, Adverse Effects

A

MOA
• Cholinergic

Use
• Usually to improve bladder contractility
• May use to increase LES tone in megaesophagus
• Treat delayed gastric emptying in LA
• Increase contraction of cecum & R ventral colon in LA

Adverse Effects
• SLUD
• Bradycardia
• Increased gastric acid & pancreatic secretion

79
Q

Diphenoxylate; MOA, Use, Adverse Effects

A

MOA
• Opioid binds to enteric opioid receptors & inhibits GI motility

Use
• Anti-diarrheal

Adverse effects
• Constipation, bloat, sedation in dogs
• Excitatory to cats (not recommended)

80
Q

Loperamide; MOA, Use, Adverse Effects

A

MOA
• Opioid binds to enteric opioid receptors & inhibits GI motility

Use
• Anti-diarrheal

Adverse Effects
• Constipation, bloat, sedation in dogs
• Excitatory to cats (not recommended)
• Reaction in MDR1 mutants

81
Q

Kaolin/Pectin; MOA, Use, Adverse Effects

A

MOA
• Demulcent/Protectant
• Adsorbs some potential toxicants (Poor efficacy)

Use
• Relieves irritation during Ds by lining mucosal surface

Adverse Effects
• GI upset if given w/o food

82
Q

Bismuth/Charcoal; MOA, Use, Adverse Effects

A

MOA
• Adsorbant

Use
• may absorb toxins during Ds (poor efficacy)

Adverse Effects
• Black stool
• GI upset if given w/o food

83
Q

Metronidazole; MOA, Use, Adverse Effects

A

MOA
• Disrupts bacterial DNA synthesis
• Effective against certain protozoal species and anaerobic bacteria

Use
• antibiotic responsive diarrhea or GI dysbiosis
• chronic enteropathy, exocrine pancreatic insufficiency, hepatic encephalopathy
• Giardia or Clostridium
• anaerobic infections (Ex: hepatitis)

Adverse Effects
• Hepatotoxicity
• GI upset
• Neurotoxicosis
• Reduced olfactory function in dogs
• Can cause multi-drug resistance

84
Q

Tylosin; MOA, Use, Adverse Effects

A

MOA
• Macrolide antibiotic
• Inhibits 50s subunit of bacterial ribosomes to inhibit protein synthesis, mainly bacteriostatic

Use
• antibiotic responsive diarrhea or GI dysbiosis
• chronic enteropathy, exocrine pancreatic insufficiency

Adverse Effects
• Few and mild

85
Q

3 Types of Laxatives & MOA

A

Fiber
• Absorb water, soften stool, add bulk
• Preferred treatment due to safety, tolerance, and efficacy
• Psyllium, wheat dextrin, pumpkin

Osmotic
• Attract fluid into lumen to soften stool
• Lactulose

Lubricants
• Mineral oil, petroleum, paraffins
• Not generally advised due to risk of aspiration

86
Q

Treatment for Megacolon

A

• Laxatives – Lactulose or Fiber
• Cisapride
• High fiber, low residue diet
• Enemas
• Surgery – subtotal colectomy

87
Q

Treatment for Megaesophagus

A

• Upright feedings
• Change diet consistency - meatballs, slurry, etc.
• Sildenafil
• Treat secondary esophagitis w/ Omeprazole & Sucralfate
• metoclopramide, cisapride, bethanacol (in cats)

88
Q

Sildenafil; MOA, Use, Adverse Effects

A

MOA
• Phosphodiesterase-5 inhibitor -> relaxes smooth muscle -> vasodilation.
• short time ~20-60 mins
• dogs & cats

Use
• Megaesophagus
• LES dysfunction
• Pulmonary hypertension

Adverse Effects
• Maybe hypotension

89
Q

EPI Treatment

A

Viokase, Pancreazyme, etc
• Dried extracts of bovine or porcine pancreas
• Powdered form is preferred

Vit B12 (Cyanocobalamin)

90
Q

Vit B12; MOA, Use

A

MOA
• Absorbed in Ileum

Use
• EPI
• Chronic enteropathy
• Pancreatitis (especially cats)

91
Q

Chronic Enteropathy Treatment

A

Immunosuppressants such as:
• Steroids (dogs or cats)
• Cyclosporine (dogs or cats)
• Mycophenolate (mostly dogs)
• Chlorambucil (dogs and especially cats)
• Azathioprine (dogs only)
• Leflunomide (mostly dogs)

92
Q

Ursodeoxycholic acid or ursodiol; MOA, Use, Adverse Effects

A

MOA
• Deceases hepatic synthesis/secretion of cholesterol and intestinal absorption of cholesterol.
• Increases bile flow
• May protect hepatic cells from toxic bile
• In patients with chronic hepatitis, may reduce hepatocellular inflammatory changes and fibrosis.

Use
• Cholestasis
• Gallbladder sludge

Adverse Effects
• None

93
Q

Hepatoprotectants

A

Denamarin + Denosyl

S-adenosyl methionine (SAMe)
o Normally produced in the liver and needed for several metabolic pathways in the liver

Silymarin (milk thistle)
o Free radical scavenger/antioxidant
o Inhibits TNF
o Prevents toxin penetration into hepatocytes

94
Q

Hepatic Encephalopathy Treatment; Drugs & MOAs

A

Lactulose
o Increases osmotic pressure drawing water into the bowel ->
o Metabolized by bacteria into acid metabolites ->
o The acidification causes ammonia NH3 (ammonia) to migrate from the blood into the colon where it is trapped as [NH4]+ ->
o expelled w/ the feces

Neomycin (Amoxicillin, metronidazole)
o Aminoglycoside
o Reduce ammonia producing bacteria in GI

95
Q

Furosemide; MOA & Use

A

MOA
• Inhibit Na+-K+-2Cl- symporter
• Inhibits Ca reabsorption in the thick ascending limb of the loop of Henle

Use
• Hypercalcemia
• Fast acting

96
Q

Bisphosphonates; MOA, Drugs & Adverse Effects

A

MOA
• Inhibits osteoclast activity and bone resorption
• Promotes apoptosis and inhibits osteoclastogenesis, angiogenesis, and cancer cell proliferation
• slow acting

Alendronate PO
• GI
• esophagitis

Pamidronate – injectable
• Renal tox
• Electrolyte abnormalities

Zoledronate – injectable
• Maybe renal tox

97
Q

Cinacalcet; MOA

A

• Calcimimetic agent,
• increases sensitivity of Ca-sensing receptors to activation by extracellular Ca.
• negative feedback and suppression of PTH release

98
Q

Calcium Gluconate; MOA, Use, Adverse Effects

A

MOA
• Direct replacement of Ca

Use
• Emergency hypoclacemia

Adverse Effects
• Arrhythmias or arrest if given too fast IV

99
Q

Calcium Carbonate; MOA, Use

A

MOA
• Direct replacement of Ca
• Binds dietary phosphate

Use
• chronic hypoclacemia

100
Q

Calcitriol; MOA, Use, Adverse Effects

A

MOA
• Activated Vit D
• Replaces Vit D

Use
• Hypoparathyroidism
• Renal secondary hyperparathyroidism

Adverse Effects
• Hypercalcemia
• Tissue mineralization
• Ca oxalate uroliths

101
Q

DDAVP; MOA, Use, Adverse Effects

A

MOA
• Synthetic anolog of vasopressin (ADH)
• Replaces ADH

Use
• Central diabetes insipidus
• Differentiate Central diabetes insipidus from nephrogenic

Adverse Effects
• Uncommon ocular irritation

102
Q

Thiazide Diuretics; MOA, Use

A

MOA
• inhibit Na-Cl cotransporter in early distal tubule
• enhanced excretion of Na and water

Use
• reduce clinical PU/PD in diabetes insipidus

103
Q

Synthetic Levothyroxine; Drugs, MOA, Use, Adverse Effects

A

Drugs
• Thyro-tabs
• Sythroid

MOA
• Direct T4 replacement

Use
• Treatment of choice for hypothyroidism

Adverse Effects
• Increases myocardial O2 demand
• Start with ½ dose in dogs w/ cardiac disease
• Development of hyperthyroidism with overdose
• Food decreases bioavailability

104
Q

Synthetic Liothyronine; MOA, Use, Adverse Effects

A

MOA
• Directly replaces T3

Use
• Use when levothyroxine has poor GI absorption

Adverse Effects
• Not recommended
• Does not increase T4
• T3 produced by T4 so may overdose T3 in some tissues

105
Q

Thyroid Extracts or Dessicated Thyroid

A

o Not recommended
o Potential for allergies/sensitivities
o Too much variability

106
Q

Methimazole; MOA, Use, Adverse Effects

A

MOA
• Inhibits thyroid peroxidase
• Inhibits iodide binding tyrosine

Use
• Drug of choice for hyperthyroidism

Adverse Effects
• GI
• Neutropenia
• Thrombocytopenia
• Facial excoriation
• Hepatotoxicity
• May unmask underlying renal dz

107
Q

I-131; MOA

A

MOA
• I-131 concentrated in hyperfunctional thyroid cells ->
• β-particles destroy hyperfunctional tissue ->
• normal thyroid tissue is suppressed and not producing hormone so it is preserved

108
Q

Synthetic Adrenocorticotropic Hormone (ACTH) Use

A

• ACTH Stimulation Test
• Evaluates the maximal response of the adrenal glands to ACTH
• diagnosis of hyperadrenocorticism, hypoadrenocorticism, and iatrogenic Cushing’s

109
Q

Dexamethasone; Use in Testing, Adverse Effects

A

Use
• Dexamethasone suppression test
• diagnosing and differentiating between pituitary and adrenal dependent Cushing’s

Adverse Effects:
• Single low dose no significant side effects
• GI ulcer if given w/ NSAIDs

110
Q

Trilostane; MOA, Use, Adverse Effects

A

MOA
• Competitive enzyme inhibitor that blocks formation of cortisol
• Inhibits 3β-hydroxysteroid dehydrogenase
• Also some effect on aldosterone and androgen synthesis

Use
• Hyperadrenocorticism

Adverse Effects
o Idiosyncratic adrenal necrosis
o hyperkalemia, hyponatremia
o GI signs, lethargy, hypovolemia
o Ketoconazole may potentiate its effects

111
Q

Mitostane; MOA, Use, Adverse Effects

A

MOA
• Adrenolytic/adrenal cytotoxic

Use
• Less useful for hyperadrenocorticism

Adverse Effects
• Addisonian state (GI signs, lethargy)
• Liver changes – congestion, centrolobular atrophy, fatty degeneration
• Phenobarbital & spironolactone decrease efficacy

112
Q

Ketoconazole; MOA, Use, Adverse Effects

A

MOA
• Inhibits steroid biosynthesis
• Interferes with the imidazole ring and cytochrome p-450 enzyme systems

Use
• Hyperadrenocorticism
• Not Recommended

Adverse Effects
• GI signs
• Hepatotoxicity
• Thrombocytopenia
• Suppression of sex hormone

113
Q

Selegiline; MOA, Use

A

MOA
• Enhances dopamine mediated inhibition of ACTH release from the pars intermedia of the pituitary

Use
• Hyperadrenocorticism
• Not Recommended

114
Q

Metyrapone; MOA, Use

A

MOA
• Enzyme inhibitor that blocks formation of cortisol

Use
• Short-term feline hyperadrenocortcism (Cushing’s)

115
Q

Prednisone; MOA, Use, Adverse Effects

A

MOA
• Direct glucocorticoid replacement

Use
• Hypoadrenocorticism

Adverse Effects:
• Should be minimal to non-existent at proper dose
• If steroid side effects are seen the dose may need to be decreased

116
Q

Desopxycorticosterone pivalate (DOCP); MOA, Use, Adverse Effects

A

MOA
• Direct mineralcorticoid replacement

Use
• Hypoadrenocorticism

Adverse Effects:
• Irritation at the injection site
• GI signs
• PU/PD, fluid retention, edema

117
Q

Fludrocortisone; MOA, Use, Adverse Effects

A

MOA
• Direct gluco and mineralcorticoid replacement

Use
• Hypoadrenocorticism

Adverse Effects:
• PU/PD,
• hypertension,
• edema,
• hypokalemia

118
Q

Glucocorticoids as Immunosuppressants; MOA, Drugs, Indications, Adverse Effects

A

MOA
• Lipocortin -> PLA2
• Rapid onset
• Affect innate & acquired immunity

Drugs
• Pednisone/prednisolone
• Dexmethasone (better bioavailability)

Indications
• First-line in inflammatory & immune dz
• Immune-mediated anemia & polyarthritis
• IBD

Adverse Effects
• GI ulceration, especially in dogs treated with high doses or for long durations.
• Iatrogenic hyperadrenocorticism
• Adrenal gland suppression
• Insulin resistance and secondary diabetes mellitus (esp cats)
• Muscle catabolism

• Delayed wound healing

• Opportunistic infections

• behavior changes

119
Q

Glucocorticoids as Immunosuppressants; Hemopoietic Effects, Anti-inflammatory Effects

A

Effects on Hemopoietic system
• Decrease proliferation, differentiation, and survival of inflammatory cells (T lymphocytes and macrophages)
• High doses kill lymphocytes
• Reduced size of thymus, spleen, and lymph nodes
• Neutrophils, platelets, & RBCs increased
• eosinophils decreased

Anti-inflammatory Effects
• inhibit release of cell adhesion molecules reducing recruitment of inflammatory cells
• Prevent release and actions of IL-1, IL-2, TNF-
• Prevent release of histamine, serotonin, and lyzosomal enzymes from mast cells

120
Q

Calcineurin Inhibitors; Drugs, MOA, Indications, Adverse Effects, Drug Interactions

A

Drugs
• Cyclosporine
• Tacrolimus

MOA
• bind to a cytoplasmic receptor protein ->
• complex then binds and inhibits calcineurin ->
• decreased expression of IL-2 and other cytokines necessary for T-cell activation

Indications
• First line for perianal fistulas & Keratoconjunctivitis (ophthalmic drops)
• 2nd line or add-on drug for other immune-mediated diseases such as IMHA, IBD

Adverse Effects
• Variable patient-patient reactions & poor bioavailability
• Immunosuppression

• Gingival hyperplasia (Less likely)

• Hepatotoxicity
• Thromboembolism
• Self-limiting GI upset

Drug Interactions
• Efficacy diminished when administered w/ azoles & phenobarbital(cats)

121
Q

Janus Kinase Inhibitor; Drug, MOA, Indications, Adverse Effects

A

Drug
• Oclactinib

MOA
• Inhibit proinflammatory cytokines (IL-31)

Indications
• hypersensitivity induced cutaneous pruritis in dogs > 12 months of age
• 1st choice fast relief

Adverse effects
• vomiting, diarrhea, lethargy, anorexia, and bloodwork changes
• can’t use in pregnant/lactating dogs

122
Q

Caninized monoclonal antibody against interleukin-31; Drug, Indications

A

Drugs
• Cytopoint

Indications
• Management of allergic puritis flares
• Injection w/ long lasting effect

123
Q

Antimetabolites; Drug, MOA, Indications, Pharmacokinetics, Adverse Effects

A

Drugs
• Azathioprine

MOA
• Interfere with incorporation of purines or pyrimidines into DNA
• Prodrug metabolized to a purine analog (6-mercapto purine)

Indications
• Immune-mediated diseases such as IBD, hemolytic anemia, etc.
• decrease dose of Glucocorticoids while maintaining remission.

Pharmacokinetics
• delayed several days to weeks so monotherapy with azathioprine should not be the initial treatment for immune-mediated diseases
• PO
• Metabolized in liver by TPMT

Adverse Effects
• Contraindicated in cats & horses due to lack of TPMT
• Bone marrow suppression
• Hepatotoxicity
• GI

124
Q

Alkylating Agents; Drug, MOA, Indications, Adverse Effects

A

Drugs
• Cyclophosphamide
• Chlorambucil

MOA
• Alkylate DNA ->
• chemical cross-links in DNA ->
• interfere w/ DNA replication

Indications
• Chlorambucil - Second-line immunosuppressive in cats

Adverse Effects
• Cyclophosphamide – BAG & neutropenia

125
Q

Mycophenolate mofetil; MOA, Indications, Adverse Effects

A

MOA
• inhibits type II isoform of inosine-5’-monophosphate dehydrogenase ->
• no synthesis of guanosine nucleotides

Inidications
• 2nd or 3rd line immunosuppressive agents in dogs
• immune-mediated anemia, thrombocytopenia, polyarthritis, glomerulonephritis, skin dz
• myasthenia gravis
• meningoencephalomyelitis
• may be usable w/ prednisolone in cats

Adverse Effects
• GI
• Don’t use in pregnant patients

126
Q

Antihistaminic Drugs for Immunosuppression; Drugs, MOA, Efficacy

A

Drugs
• Dipenhydramine

MOA
• inverse agonist (H1) ->
• reverses effects of histamine on capillaries ->
• reduces allergic reaction symptoms

Efficacy
• Limited research to show efficacy

Clin Pharm (8 decks)

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