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Pharmacology Final > Final Exam Study Guide - Summer 2015 > Flashcards

Final Exam Study Guide - Summer 2015 Flashcards

1
Q

Appetite Stimulants…

A

NE, GABA, Dopamine, Benzodiazepines, Propofol, Serotonin Antagonists

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2
Q

Benzodiazepines as appetite stimulants…

A

GABA agonists; Stimulate GABA –> Inhibit Satiety Center –> Increase appetite

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3
Q

Appetite Inhibitor…

A

Serotonin

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4
Q

Propofol as an appetite stimulant…

A

GABA agonist; indicated for short term use; caution in cats - Heinz body anemia is possible if used for >5 days

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5
Q

Serotonin Antagonists that stimulate appetite…

A

Cyproheptadine (Cats) and Mirtazapine (Dogs)

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6
Q

Cyproheptadine…

A

Serotonin antagonist; use in cats as an appetite stimulant; orally admin. - well absorbed (takes 2-3 days); side effects: sedation

Blocks serotonin –> Inhibits Satiety Center –> Increase Appetite

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7
Q

Mirtazapine..

A

Serotonin antagonist; used in dogs as an appetite stimulant; increases NE centrally; pharmacokinetics misunderstood; hard to dose in cats

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8
Q

Glucocorticoids as an appetite stimulant…

A

Prednisone

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9
Q

What is the side effect of concern when using Prednisone as an appetite stimulant?

A

polyphagia

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10
Q

The purpose of using Emetics…

A

control of vomiting; act on the Emetic Center and CRTZ (outside the BBB)

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11
Q

Peripherally acting Emetics…

A

Hydrogen Peroxide

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12
Q

Hydrogen Peroxide as an Emetic…

A

reasonable for dogs; do not use in cats - severe hemorrhagic gastritis

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13
Q

Apomorphine as an Emetic…

A

opioid - reversing the opioid does not reverse the vomiting; side effects: sedation and respiratory depression; effective for dogs - Do NOT use in Cats
Can be given in all routes including the conjunctival sac - can flush the eye to get rid of some of it.

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14
Q

Xylazine or Dexmedetomidine as Emetics…

A

alpha-2 agonists; more effective in cats than dogs

Cats have more alpha-2 receptors

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15
Q

If you give a cat oral Diazepam, what will you potentially cause?

A

Idiosyncratic hepatotoxicity

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16
Q

Repeated propofol administration in Cats can cause…

A

RBC injury and Heinz body anemia

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17
Q

B-Vitamins an an appetite stimulant…

A

in cases of Vitamin deficiency

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18
Q

Used as an appetite stimulant, Megestrol acetate is a…

A

synthetic progestin…use w/ caution!

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19
Q

Anabolic steroids as an appetite stimulant…

A

Stanozolol…use w/ caution!

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20
Q

CRTZ stands for…

A

chemoreceptor trigger zone

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21
Q

What receptors stimulate the CRTZ to stimulate the emetic center and induce vomiting?

A

serotonin, neurokinin, alpha-2, dopamine, and histamine

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22
Q

In the CRTZ, Cats have fewer receptors for…

A

histamine and dopamine

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23
Q

In the CRTZ, Cats have more receptors for…

A

alpha-2 and serotonin

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24
Q

Why should you not use hydrogen peroxide in cats to induce vomiting?

A

cats have a higher risk of mucosal damage

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25
Q

Centrally acting Emetics…

A

Apomorphine, Xylazine and Dexmedetomidine

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26
Q

What are Immunosuppressive drugs to consider?

A

High dose glucocorticoids, Antimetabolites, Azathiprine, Cyclosporine, Topical Tacrolimus

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27
Q

How do Antimetabolites work?

A

inhibit purine/pyrimidine synthesis –> inhibit DNA synthesis of lymphocytes –> block T-cell activation and response

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28
Q

Azathiprine…

A

Anti-metabolite Immunosuppressant; do NOT use in Cats; admin. orally; monitor CBC/Chem. for toxicities and side effects

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29
Q

If patients are able to tolerate Azathiprine, they show less side effects than when given…

A

Prednisone

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30
Q

Cyclosporine as an immunosuppressant…

A
  • reduces T cell activation and response
  • topically treats KCS (eyes)
  • systemically treats perianal fistula
  • used as an adjunct w/ glucocorticoids to treat IMHA
  • cytokine inhibitor
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31
Q

Tacrolimus topical…

A

immunosuppressant; topically used to manage perianal fistula when Cyclosporine does not work (works on a different target)
-cytokine inhibitor

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32
Q

What is the most common adverse effect when administering chemo?

A

GI signs

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33
Q

If you see Adverse GI side effects in a pt. undergoing chemo, what do you do?

A

administer anti-emetics before/during treatment to decrease nausea

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34
Q

What are the adverse effects that can be seen when administering chemotherapy?

A

GI effects, Bone marrow suppression, Immunosuppression, Hair loss, Toxicity, Drug resistance/loss of efficacy, acute tumor lysis syndrome

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35
Q

When using Chemotherapeutic agents causing myelosuppression…what do you monitor?

A

CBC

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36
Q

Neutropenia is a common side effect of chemotherapy. What is the lowest neutrophil count called?

A

Nadir

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37
Q

What happens if you get severe neutropenia with chemotherapy?

A

prophylactic antibiotics may be started and/or you can delay the next chemo treatment

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38
Q

T/F - Animals undergoing chemo lose hair like humans do.

A

False. Hair loss is more common in breeds with continued hair growth; cats whiskers may fall out; shaved areas do not grow back well.

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39
Q

T/F - If you suspect extravasation when administering chemotherapeutic agents, immediately remove the catheter.

A

False. Leave that sucker in! You need to try and remove as much of the drug as possible. You can also locally infuse with saline +/- other substances and administer hot/cold packs.

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40
Q

What class of drugs potential provide analgesia?

A

Opioids and NSAIDs

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41
Q

The mechanism by which NSAIDs work…

A

Cyclooxygenase or COX-inhibitors

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42
Q

Why must you not use glucocorticoids and NSAIDs together?

A

Glucocorticoids work to reduce and influence the cyclooxygenase pathway like the NSAIDs do. Using these drugs together will increase the risk of adverse effects - GI Ulcers!

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43
Q

Pharmacokinetics of NSAIDs…

A

good absorption; IM and oral admin.; Hepatic metabolism (phase 1 and 2 reactions in the Liver)

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44
Q

Why do we not extrapolate dose rate or intervals of NSAIDs from 1 species to another?

A

Terminal-1/2 life carries between species

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45
Q

What are the Anti-Inflammatory effects of NSAIDs?

A

inhibit production of pro-inflammatory eicosanoids - concerned with COX-2

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46
Q

Tend to use NSAIDs in cases of…

A

acute inflammation and pain (NSAIDs have a greater affect on acute inflammation rather than chronic inflammation)

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47
Q

Some differences in using NSAIDs vs. Steroids…

A

no immunosuppression, no impaired wound healing, no delayed fibroblast functions with NSAIDs

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48
Q

How do NSAIDs result in Analgesia?

A

decrease prostaglandin sensitization of neurons

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49
Q

NSAIDs have Antipyretic effects but will not reduce…

A

NSAIDs reduce Fever but will not reduce hyperthermia or normal body temp.

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50
Q

How does Aspirin have anti-thrombotic effects?

A

irreversibly inhibit COX in platelets - increasing clotting time; TXA2 is a platelet aggregating agent (inhibited); PGI2 is an anti-aggregating agent (less inhibited)

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51
Q

COX-2 is expressed by a number of cancers. Using NSAIDs….

A

has been associated with improved outcomes. NSAID’s have anti-neoplastic effects

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52
Q

What NSAID is often used in transitional cell carcinoma and osteosarcoma?

A

Piroxicam

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53
Q

Commonly used NSAIDs…

A 
carprofen
meloxicam
deracoxib
firocoxib
robenacoxib
flunixin meglumine
phenylbutazone
aspirin
peroxicam
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54
Q

What are the indications for use of Ophthalmic drugs?

A 
Mydriasis/Miosis
Decrease aqueous fluid production or IOP
Increase tear production
Decrease inflammation (glucocorticoids and NSAIDs)
Treat Infections
Analgesia
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55
Q

Why are topical preparations preferred for Ophthalmic drugs?

A

high local concentration, low systemic absorption; drugs reach the anterior chamber and less get into the posterior chamber; systemic drugs may not reach parts of the eye in sufficient concentrations

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56
Q

T/F - Ophthalmic drugs prepared as ointments have faster elimination.

A

False. Ophthalmic drugs prepared as ointments have SLOWER Elimination.

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57
Q

PSNS’s effect of the eye….

A

Miosis - contracts the iris sphincter m.; contraction of the ciliary body; lens accommodation for near vision; increases uveoscleral aqueous outflow
Pupil constriction

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58
Q

SNS’s effect on the eye…

A

Mydriasis - relaxation of the ciliary body; contraction of the iris dilator m.; aqueous humor formation; lens accommodation for far vision
Pupil dilation

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59
Q

When should you avoid using Miotic drugs?

A

Anterior uveitis or Anterior Lens Luxation

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60
Q

What are the Miotic drugs to know?

A

Parasympathomimetic Drugs…
Pilocarpine
Physostigmine and Demecarium
Echothiopate

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61
Q

Pilocarpine…

A 
direct acting parasympathomimetic
short duration of action
miosis lasts 2-6hrs
Txt: glaucoma
diagnosis of parasympathetic lesions (CN III)
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62
Q

Physostigmine and Demecarium…

A

indirect acting parasympathomimetic (reversible cholinesterase inhibitor - narrower therapeutic index)
Physostigmine crosses the BBB
increases uveoscleral drainage up to 48 hrs
Demecarium is usually used as preventative in the contralateral eye (preventative care for glaucoma)

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63
Q

Echothiophate…

A

indirect acting parasympathomimetic - irreversible

long miosis duration - >12hrs

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64
Q

What are the Mydriatic drugs to know…

A

Parasympatholytic Drugs…
Atropine
Tropicamide
Phenylephrine

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65
Q

Atropine as an Ophthalmic drug…

A

direct acting parasympatholytic
onset in 1 hr; duration last 120+ hrs
causes cycloplegia - be careful in horses!
Indications: mydriatic-cycloplegia to reduce pain associated w/ corneal or iris disease (uveitis); can break up synechiaee (adhesions of the iris to the cornea or lens)
minimal systemic absorption

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66
Q

What patients should you not use atropine as an ophthalmic drug in?

A

Do not use Atropine in patients with Primary Glaucoma!

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67
Q

What are the reasons to be cautious when using ophthalmic atropine?

A

primary glaucoma
bitter taste - will cause cats to froth/foam at the mouth
cycloplegia may cause panic in horses

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68
Q

When you need an Ophthalmic drug that will dilate the eye for long periods of time, you pick…

A

Atropine

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69
Q

Tropicamide…

A

direct acting parasympatholytic
onset of action in 15-30 min.; duration 6-12 hrs
indications: dilate the pupil for ophthalmic (funduscopic) exam, used to prevent adhesions after cataract surgery

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70
Q

Ophthalmic Phenylephrine…

A

alpha 1 agonist
contract the iris dilator m. - mydriasis
perioperative use in cataract surgery - reduces post-synechiae formation
more often used to help diagnosis and txt of Horner’s syndrome
cardiovascular side effects
In cats and horses it is unlikely to cause adequate mydriasis alone.

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71
Q

What does decreasing aqueous humor formation do for the animal?

A

decreases IOP and is used for managing glaucoma

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72
Q

What “classes” of drugs reduce aqueous humor formation of the eye act on?

A

alpha-agonists
beta-antagonists
carbonic-anhydrase inhibitors
prostaglandin analogs

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73
Q

What are the alpha-agonists that reduce aqueous humor formation?

A

Brimonidine (alpha-2 agonist)

used in dogs for glaucoma txt

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74
Q

What are the beta-antagonists that reduce aqueous humor formation?

A

Timolol
minimal systemic bioavailability
used for glaucoma management - can cause a little miosis

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75
Q

What is Cosopt?

A

Timolol + Dorzolamide = Cosopt; gives a better control over aqueous humor

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76
Q

What are the carbonic anhydrase inhibitors that decrease aqueous humor formation?

A

Dorzolamide and Brinzolamide

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77
Q

Dorzolamide…

A

carbonic anhydrase inhibitor

used to treat glaucoma

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78
Q

Brinzolamide…

A

reversible inhibition of carbonic anhydrase which decreases aqueous humor formation
sulfonamide derivative!

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79
Q

What prostaglandin analog is used to decrease aqueous humor formation?

A 
Latanoprost
emergency drug for acute glaucoma txt
helps drain the pressure in the eye
increases uveoscleral outflow by stimulating FP receptors in the eye
reduces IOP
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80
Q

Natural tear film is 3 layered, made out of…

A

mucin, water, lipid

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81
Q

Lacrimomimetic agents provide…

A

lubrication but do not perfectly replicate natural tears

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82
Q

Why do we prefer ointments to drops for artificial tear production?

A

ointments have prolonged contact time, less dilution, a slower breakdown by tears/enzymes and less drainage via the nasolacrimal duct

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83
Q

What are the lacrimogenics we need to know?

A

Cyclosporine (optimmune)

Tacrolimus

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84
Q

Lacrimogenic Cyclosporine…

A

used in the txt of canine keratoconjunctivitis sicca
BID topical application is required; lifelong
monitored by Schirmer’s tear test
causes local immunosuppression

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85
Q

The purpose of lacrimogenics is to…

A

increase tear production

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86
Q

Lacrimogenic Tacrolimus…

A

decreases T-cell activation
used in pts. that do not respond to cyclosporine
**potential link to cancer - wear gloves
**can be used topically to treat perianal fistulas

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87
Q

The purpose of Topical Corticosteroids used to treat eye issues…

A

manage inflammation and immune-mediated conditions (Non-infectious keratitis, uveitis)

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88
Q

What are the 2 topical corticosteroids used for eye issues…

A

Prednisolone and Dexamethasone

there is little systemic absorption with local application

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89
Q

When do you grab Topical NSAIDs for eye issues?

A

when a higher local concentration and lower systemic concentration is desired

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90
Q

Topical NSAIDs are used in…

A

management of uveitis and some keratitis; use to manage inflammation associated with cataracts (diabetic pts.)

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91
Q

What are the contraindications of topical NSAIDs?

A

corneal ulcers, glaucomas, or coagulopathies

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92
Q

What are the 2 topical NSAIDs mentioned from class?

A

Flurbiprofen and Diclofenac

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93
Q

What are the topical antimicrobial agents for eyes?

A

Polymyxcin and aminoglycosides

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94
Q

What are the uses of topical antimicrobial agents for eyes?

A

treat conjunctival and corneal infectious diseases

typically require frequent administration

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95
Q

What could be damaging to the eyes when using antibiotics?

A

damaging to epithelial cells or inhibitory to keratocytes and impair corneal healing or worsen deep corneal ulcers
-these drugs are often use to treat secondary infections

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96
Q

What drug is the local anesthetic for eyes?

A

Proparacaine

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97
Q

MOA for Proparacaine…

A

blocks Na+ channels to prevent axonal depolarization

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98
Q

What is Proparacaine used to treat?

A

used to decrease corneal sensation to allow diagnostic evaluation (tonometry) by “freezing” the eye or decreasing pain in the eye

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99
Q

What are the classes of respiratory drugs?

A

expectorants, mucolytics, and decongestants

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100
Q

Respiratory drugs improve…

A

clearance of material from the airways by stimulating cough and breaking up mucous

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101
Q

What expectorant has been used in equine med?

A

Guaifenesin

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102
Q

What decongestant has been used to relieve nasal congestion in horses?

A

Phenylephrine - causes local vasoconstriction in upper airways

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103
Q

T/F - In respiratory infections, you are most likely treating a pneumonia.

A

True

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104
Q

What Respiratory drugs have good concentration in the epithelial lining fluid?

A

macrolides, tetracyclines, fluoroquinolones

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105
Q

What respiratory drugs achieve good concentration in the interstitial space?

A

Beta-lactams and aminoglycosides

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106
Q

If you suspect a fungal respiratory infection by Blastomycosis, what drug do you treat with?

A

Itraconconazole

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107
Q

Respiratory fungal infections caused by coccidioidomycosis is often treated w/…

A

fluconazole

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108
Q

T/F - When treating respiratory fungal infections, it is common to see the patients get worse before getting better because the drugs work to slowly kill the infectious agents.

A

True.

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109
Q

Using antiviral drugs to treat respiratory infections are uncommon. What viral conditions may you treat for?

A

conjunctivitis and feline herpes

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110
Q

What anti-inflammatory drugs are used for treating respiratory issues?

A 
Glucocorticoids
Prednisone or Prednisolone (orally)
Fluticasone
Leukotriene inhibitors 
NK1 antagonists - Maropitant (Cerenia)
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111
Q

The purpose of Antitussives…

A

cough suppressant

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112
Q

What are some antitussive drugs to know?

A

Opioids
Hydrocodone
Butorphanol
Codeine and dextromethorphan

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113
Q

How do Opioids function as antitussives?

A

reduce the sensitivity of the cough-center to afferent stimuli (like irritation, stretch) via opioid receptors

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114
Q

What may Hydrocodone have in it that vets should be aware of?

A

may be formulated w/ homatropine or acetaminophen

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115
Q

Butorphanol has a (high/low) first-pass effect, causing it to have (higher/lower) oral bioavailability.

A

Butorphanol has a HIGH first-pass effect, causing it to have LOWER oral bioavailability.

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116
Q

What are the side effects of antitussives?

A

sedation, constipation or nausea

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117
Q

What classes of drugs are bronchodilators?

A

beta-adrenergic agonists
methylxanthine derivatives
anticholinergics

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118
Q

Where do bronchodilators work?

A

bronchioles

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119
Q

Bronchodilating drugs are not commonly used in treatment of…

A

pneumonia and pleural disease

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120
Q

What are the non-selective beta-adrenergic agonists of the bronchodilator drugs?

A

Epinephrine and Isoproterenol

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121
Q

Epinephrine and Isoproterenol bronchodilator drugs…

A

urgent, injectable drugs (not given orally)
used for short-term treatment of life-threatening bronchoconstriction (as in acute anaphylaxis)
will have beta-1 cardiac effects

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122
Q

Selective Beta-2 agonist bronchodilator drugs…

A 
Albuterol
Salmeterol
Clenbuterol
Terbutaline
AeroKat, AeroDawg, AeroHippus
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123
Q

Albuterol…

A

Selective beta-2 agonist bronchodilator
inhalational route
rapid response (5 min.); can last hrs.

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124
Q

Clenbuterol…

A

selective beta-2 agonist bronchodilator
oral syrup used in horses to manage chronic airway disease (COPD)
not permitted in food production animals

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125
Q

Terbutaline…

A

human approved product used in animals to manage asthma
oral or injectable available
*Almost ZERO oral absorption in horses.

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126
Q

What are the metered-dose inhaler drugs?

A

AeroKat, AeroDawg and AeroHippus
have a spacer and a specialized mask!
used more in treatment of chronic respiratory disease in cats and horses because they are weird!

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127
Q

What are the primary effects of selective beta-2 agonists?

A

bronchodilation, may also stabilize mast cells and increase mucociliary clearance

less apparent effects: smooth ms. relaxation, hyperglycemia, hypokalemia, tachycardia, tremors or ms. cramps

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128
Q

With chronic use of selective beta-2 agonists, you may start to see resistance..then what?

A

increase dose, change drugs or use environmental management

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129
Q

When using Phosphodiesterase inhibitors you get…

A

bronchodilation, inhibition of mast cell degranulation and improvement of muciliary clearance; adverse effects may include respiratory stimulation resulting in increased heart rate, increased contractility, GI upset, skeletal ms. twitching and PU/PD

130
Q

In patients with pulmonary hypertension, treat w/…

A

Sildenafil (Viagra) - a vascular smooth ms. relaxant

131
Q

What respiratory drug is an analeptic and central respiratory stimulant?

A

Doxapram - used to assist with laryngeal examination in dogs/cats

132
Q

In premature animals, Doxapram will…

A

increase surfactant secreted shortly after birth.

133
Q

What is the overall goal in Endocrine Pharmacology?

A

regaining normal homeostasis

134
Q

If our target for drug action is HYPO and we are wanting to replace endogenous substances what drugs do we consider?

For example: hypoglycemia, hypocalcemia, hypothyroidism, hypoadrenocorticism

A

Dextrose (hypoglycemia)
Calcium gluconate (hypo calcemia)
Levothyroxine (hypothyroid)
DOCP/Fludrocortisone and Prednisone (hypoadrenocorticism - Addison’s)

135
Q

If you have hypocalcemia from low PTH, which drug do you choose?

A

Calcitriol/Vitamin D

-calcitriol is INDIRECT replacement

136
Q

In instances where the target for drug action is HYPER (hypercalcemia, carcinoma, adenoma, etc.) you have 4 options…

A
  1. destroy the abnormal tissue to get rid of the source
  2. inhibit the production of the substance
  3. increase elimination of the substance
  4. inhibit function of the substance
137
Q

In Endocrine Pharmacology, when you want to inhibit the production of the excess substance - particularly for hyperthyroidism, what drug do you choose?

A

Methimazole - will not affect the mass but will inhibit its production of thyroid hormone

138
Q

What drug works to inhibit the production of excess substances from the adrenal gland?

A

Trilostane

139
Q

If you want to rid the body of excess calcium…

A

saline diuresis is your method!

140
Q

What are the therapeutic goals on Endocrine Pharmacology?

A
  1. determining if the homeostatic change was abrupt or slow and then reversing the change in a similar fashion
  2. establishing the urgency of correction
  3. ALWAYS LOOK AT THE PATIENT

(lol I think I am losing my mind at this point in making my Study Guide)

141
Q

Goal of Hypothyroid treatment…

A

decrease T3 and T4 production by the thyroid gland

142
Q

Levothyroxine Sodium generic names…

A

Soloxine, Synthroid

143
Q

Levothyroxine AKA Soloxine…

A

preferred drug for txt of hypothyroidism in all species
oral or injectable
injectable is only for treating myxedema coma (rare)

144
Q

Hypothyroidism is way more common in….

145
Q

Hyperthyroidism is way more common in…

146
Q

Antithyroid Drugs…GO!

A

Thiourylenes like:

Methimazole (Tapazole - human approved)

147
Q

Methimazole…

A

treats hyperthyroidism in cats
dose SID - BID
stable clinical effects achieved after 2-4 wks
stops de novo production of thyroid hormones - does not affect pre-formed hormone

148
Q

Mild side effects of Methimazole…

A

transient or mild GI signs - inappetence, vomiting
lethargy
mild, transient hematologic changes

149
Q

Major side effects of Methimazole…

A

idiosyncratic reactions: facial excortiation, hepatopathy and significant hematologic changes - agranulocytosis and thrombocytopenia

150
Q

Methimazole is available in a transdermal formulation…tell me about it!

A

made by compounder; applied to inner ear - ear pinna
useful in badass cats who hate taking meds…so ALL cats!
or in cats who have GI disease….these cats are probably still evil

151
Q

T/F - Using transdermal Methimazole eliminated the chances of idiosyncratic reactions and GI upset in hyperthyroid treatment.

152
Q

What is the goal in treating periparturient hypocalcemia?

A

Just replacing lost calcium.

153
Q

In primary hypothyroidism, calcium replacement therapy is short term and replacement of BLANK is initiated for long-term management.

A

Vitamin D!

154
Q

What is weird about the dosing of Levothyroxine?

A

dose it in mg/m^2

155
Q

Why is the dosing for Levothyroxine weird?

A

to reduce the risk of over supplementation or thyrotoxicosis (excessive T4 levels)

156
Q

How do you monitor Levothyroxine levels?

A

Check/Measure their T4 levels

157
Q

What are drugs that could interfere with T4 levels?

A

Phenobarbital, glucocorticoids (pred. and dex.), phenylbutazone, zonisamide and quinidine

158
Q

What CS would you expect in acute hypocalcemia?

A

hyperesthesia/pawing at face, flaccid paralysis, seizures, hyperthermia, bradycardia

159
Q

Periparturient hypocalcemia is AKA…

A

Milk Fever or eclampsia

160
Q

Treatment of Acute hypocalcemia, what are you parenteral options?

A

Ca Gluconate and Ca Chloride

161
Q

Because Ca Chloride is more caustic, it should never be given…

A

SC/IM or extravasated when given IV

162
Q

Rapid IV administration of Ca can cause…

A

arrhythmias or cardiac arrest

163
Q

Oral formulations of Calcium are…

A

Ca Carbonate and Ca Proprionate

164
Q

In regards to Calcium…
Bones..
Kidneys…
Gut…

A

Bones STORE Ca
Kidneys EXCRETE Ca
Gut ABSORBS Ca

165
Q

Hypocalcemia from HypoPTH…how do we treat?

A

Short-term: parenteral Ca - Ca Carbonate and Ca Proprionate

Long-Term: Replace Vitamin D via Calcitriol

166
Q

T/F - Calcitriol is the most potent form of Vit D.

167
Q

Giving calcitriol works how?

A

significantly increases Ca reabsorption in the Gut and decreases kidney excretion of Ca

168
Q

What is Milk Fever?

A

periparturient hypocalcemia - sudden increase in Ca usage for which the pt. cannot adapt rapidly enough –> associated with birth and lactation
Milk…YUMMM

169
Q

What is the lifelong treatment for hypoparathyroidism?

A

VITAMIN D!!!

170
Q

What do you do when you feel hypoglycemic?

A

EAT!!!! Particularly, eat small meals more often! FEED THE NEURONS!

171
Q

You have a hypoglycemic patient…who do you call on for help?

A

Dextrose 50%

172
Q

How do you give Dextrose 50%?

A

In IV boluses diluted 1:4
For extended IV use, you must dilute to a 5% solution or lower to prevent phlebitis
Can be given as CRI

173
Q

What is the most commonly used emergency therapy drug for hypoglycemia?

A

Dextrose 50%

174
Q

What happens if you give Dextrose 50% SubQ?

A

Tissue Irritation

175
Q

Glucagon treats what?

A

Hypoglycemia as well! But, it is given IV and is used to treat insulin-induced hypoglycemia in dogs (but dextrose is more commonly used)

176
Q

What is the most common disease causing clinically significant hyperglycemia?

A

Diabetes Mellitus

177
Q

Diabetes Mellitus is…

A

a chronic metabolic disorder that is characterized by high blood glucose caused by insulin deficiency and/or resistance

178
Q

What can cause transient hyperglycemia?

A

stresssssss like finals!!!!

179
Q

Treatment of Hyperglycemia from Diabetes Mellitus involves…

A

a combo of diet, exercise and meds! (either oral hypoglycemic agents or injectable insulin)

180
Q

Tell me about oral hypoglycemic drugs in cats…

A

only work in about 20-30% of cats

Side effects: hypoglycemia, GI effects - vomiting, elevated liver enzymes

181
Q

Glipizide…

A

only useful in Type II diabetes
work by direct stimulation insulin secretion by the beta cells
only used in cats (20-30%) - stimulates pancreatic insulin secretion
adverse effects: significant Hypoglycemia

182
Q

Hellur, I have hyperglycemia, what drug do I need?

183
Q

What are the 2 preparations of insulin approved for veterinary use by the US FDA?

A

PROZINC

VETSULIN

184
Q

Veterinary preparations of Insulin come as…

A

40 IU/mL concentration or “U40”

185
Q

Human preparations of Insulin come as…

A

100 IU/mL concentration of “U100”

186
Q

T/F - When using veterinary preparations of Insulin, it is ok to use human insulin syringes.

A

FALSE! Special syringes are required if U40 insulin is used!

187
Q

What’s so special about Detemir?

A

Deter could be DETRIMENTAL to Dogs! It is significantly more potent in the canine! Canine insulin receptors are 4x more sensitive to this insulin than other insulins.

188
Q

What are the short-acting insulins?

A

Regular Insulin AKA Humulin-R

189
Q

Tell me about Humulin-R…

A

it is the ONLY insulin that can be given IV and as a CRI
-also given as intermittent IM inj. - - do NOT give a bolus
it is soluble/crystalline/neutral insulin
most commonly used for management of critical care pts (DKA, hyperosmolar, etc)

190
Q

What are the intermediate-acting insulins?

A

NPH/Vetsulin and Humulin-N

191
Q

What are the “good K9 starting insulins”?

A

NPH/Vetsulin and Humulin-N

192
Q

Isophane or Neutral Protamine Hagedorn is complexed w/…

193
Q

Vetsulin/Caninsulin is kinda cool…why?

A

There is an insulin pen for cats that allows you to give 0.5IU increments.
it contains porcine lent insulin in a zinc suspension

194
Q

What is the long-acting insulin?

A

Prozinc (protamine zinc insulin), Glargine, and Detemir

195
Q

Prozinc…

A

FDA approved insulin for cats
pharmacokinetics are shorter than expected in felines
only given Subq
shortest of the long-acting insulins

196
Q

Glargine…

A

long effect due to acidic pH - gradual absorption
more used in cats
Only given SubQ
precipitants form - get longer absorption

197
Q

Detemir…

A

more commonly used in canine pts.
also used in some cats
4x higher potency in canine pts.

198
Q

What drugs act on the adrenal cortex?

A

glucocorticoids and mineralcorticoids

199
Q

How do glucocorticoids exert their effects?

A

genomic and non-genomic mechanisms

200
Q

What do genomic effects involve?

A

the binding of glucocorticoid to a receptor which alters gene expression through transactivation or transrepression; in the cytoplasm

201
Q

What do non-genomic effects involve?

A

interaction w/ receptors within the lipid membranes of cells and can cause more rapid changes; in the membrane

202
Q

Do you use glucocorticoids in diabetic patients?

A

No ma’am/sir you do NOT! They are antagonistic to Insulin!

203
Q

What are the most common side effects of glucocorticoids?

A

PU/PD…decrease serum calcium (decrease GI absorption, increase renal excretion), decrease ADH secretion….increases GFR

204
Q

How do glucocorticoids affect the musculoskeletal system?

A

loss of muscle mass and gaining abdominal body fat

muscle wasting and polyphagia

205
Q

How do glucocorticoids affect the reproductive system?

A

potential teratogens

can inhibit spermatogenesis and ovulation

206
Q

How do glucocorticoids affect the GI/Hepatic system?

A

can cause GI ulcerations by increasing acid secretion and decreasing mucus secretion
cause fatty liver (increased fat absorption and deposition into the liver)

207
Q

Do glucocorticoids cause pancreatitis?

A

They were just removed from the pancreatitis list. It is not believed that they predispose patients to pancreatitis but do NOT directly cause it.

208
Q

What are the immunosuppressive effects of glucocorticoids?

A

may have an impact on healing when given at higher doses and for long-term therapy

209
Q

What are the clinical uses for glucocorticoids?

A

anti-inflammatory, immunosuppression and neoplasia

210
Q

The most common ways to use glucocorticoids is…

A

in allergy patients…atopic dermatitis, asthma, etc.

211
Q

Higher doses of glucocorticoids are used…

A

longer term for immune-mediated and autoimmune conditions like immune-mediated thrombocytopenia (IMT) and inflammatory bowel disease (IBD)

212
Q

Glucocorticoids have an effect on certain WBCs, making them useful adjuncts or palliative treatment for…

A

neoplasms, particularly round cell neoplasias: lymphomas, multiple myeloma and mast cell tumors

213
Q

Steroids that require hepatic activation may show reduced..

A

potency in individuals w/ liver dysfunction

214
Q

The duration of action of glucocorticoids is determined by…

A

the base steroid

215
Q

What are the short-acting steroids?

A

hydrocortisone, prednisone, prednisolone, methylprednisolone

216
Q

What time frame are short-acting steroids working with?

217
Q

What time frame is Triamcinolone working with?

218
Q

What are the long-acting steroids?

A

Betamethasone and dexamethasone

219
Q

What time frame are the long-acting steroids working with?

220
Q

Repeated dosing of Dexamethasone would result in…

A

accumulation.

221
Q

What is the formulation of glucocorticoids?

A

salt esters and insoluble esters

222
Q

What are the salt esters we should know?

A

Na phosphate and Na succinate

223
Q

What are the Insoluble esters we should know?

A

acetate, acetonide, pivvulate

224
Q

What is so special and cool about salt esters?

A

It allows for IV injection of larger volumes.

225
Q

Dexamethasone sodium phosphate is an example of…

In practice, it is commonly referred to as…

A

a salt ester…

Dex SP

226
Q

T/F - Insoluble esters may be administered IV, IM, SubQ, Intralesional, and Intraarticular.

A

False! Insoluble esters are NOT FOR IV use!

227
Q

What are 2 examples of insoluble ester drugs?

A

Methylprednisolone acetate (Depo-Medrol) and Triamcinolone acetonide (Vetalog)

228
Q

T/F - Glucocorticoids may be given orally or parenterally and are highly plasma protein bound.

229
Q

Prednisone must be hydrolyzed to BLANK to release the steroid base.

A

Prednisolone

230
Q

Cortisone must be hydrolyzed to BLANK to release the steroid base.

231
Q

Methylprednisone must be hydrolyzed to BLANK to release the steroid base.

A

Methylprednisolone

232
Q

Glucocorticoids should NEVER EVER be used with…

233
Q

What happens when you use Glucocorticoids and NSAIDs together?

A

Increase the risk of GI Ulcers - potentially fatal complication

234
Q

What are the side effects of short-term therapy wi†˙ glucocorticoids?

A

PU/PD/PP (polyphagia), stress leukogram

more sever effects are seen in pregnant animals - fetal abnormalities and abortion

235
Q

What are the side effects of long-term therapy of glucocorticoids?

A

immunosuppression and increased susceptibility to infection, collagen disease - cruciate injuries, dermatologic changes, hypertension, thromboembolic disease, delayed wound healing, Addisonian signs

236
Q

What do you risk with acute withdrawal of long-term glucocorticoid therapy?

A

Iatrogenic Addisons

237
Q

What is the endogenous mineralocorticoid?

A

Aldosterone

238
Q

Aldosterone is regulated through the…

A

Renin Angiotensin-Aldosterone system

239
Q

What drugs do we use to treat hypoadrenocorticism?

A 
Desoxycorticosterone Pivalate (DOCP) 
Fludrocortisone
240
Q

T/F - DOCP has no anti-inflammatory component.

241
Q

What is the most commonly used mineralocorticoid?

242
Q

How is DOCP administered in canines?

A

Given IM every 25 days

243
Q

How do you monitor DOCP/Hypoadrenocorticism?

A

Checking Serum Na+ and K+ levels

244
Q

How is Fludrocortisone different from DOCP?

A

more potent w/ mild anti-inflammatory/glucocorticoid effects

given orally BID

245
Q

How do you monitor Fludrocortisone/Hypoadrenocorticism?

A

Checking serum Na+ and K+ levels

246
Q

Bromide cause BLANK in cats..

247
Q

If you give Propofol to a seizing pt. you must also…

248
Q

Anti-epileptics that must be loaded…

A

Phenobarbital, Leveteracetum, or Bromide

249
Q

Zonisamide…

A

rapidly enters the CNS

250
Q

MOA of Phenobarbital…

A

potentiates GABA; Cytochrome p450 induction

251
Q

MOA of Bromide…

A

competes with a Chloride transporter

252
Q

Bromide…

A

requires loading; used in dogs; if dog on high salt diet, you need a higher dose/double dose; higher Cl- levels in bloodworm; ok for pts. with RENAL disease

253
Q

Bromism toxicosis SE’s..

A

blindness, paresis, coma, megaesophagus; give fluids w/. furosemide

254
Q

Leveteracetum…

A

hydrolyzed in serum and other tissues - safe in Liver diseased pts.; given IV for status epileptics; gets into CNS rapidly; tid or qid dosing; HONEYMOON effect!

255
Q

Which epileptic can be given as CRI?

256
Q

MOA of Zonisamide…

A

potentiates GABA…

257
Q

Zonisamide…

A

sulfa; induces Liver enzymes - double the dose in pts. who are on Phenobarb

258
Q

Opioids metabolized by the liver…

A

lidacaine, bupivacaine, mepivicaine, ropivacaine

259
Q

Opioids Metabolized by plasma pseudocholinesterases…

A

procaine, and proparacaine

260
Q

Increase dose by adding…

261
Q

Increase potency by adding…

A

lipid and water

262
Q

Onset of analgesia is contributed to…

A

placement, concentration and drug factors

263
Q

Local infiltration…

A

peripheral nerve block, intra-articular, epidural/intrathecal

264
Q

Adverse effects of analgesics..

A

CNS stimulation, CNS depression, Cardiovascular depression, local irritation, methemoglobinemia (benzocaine and prilocaine), Histamine release (procaine and proparacaine)

265
Q

Procaine…

A

esther; slow onset/short duration; metabolized to Paba; poor penetration to MM; TOXIC TO HORSES

266
Q

General Lidocaine…

A

lrg. animal; metabolized by the liver; onset is 5 min/lasts an hr.; Sheep are most sensitive; cats more sensitive than dogs; 4mg/kg

267
Q

Systemic Lidocaine…

A

class 1B anti arrhythmic; CRI anti-inflammatory for post-op ileus; in MLK drips

268
Q

Local Lidocaine…

A

injs. are 1-2% solutions; can mix with bicarb to reduce irritation; topically is 4% soon. in gels, sprays and patches

269
Q

EMLA cream…

A

2.5% lidocraine and 2.5% prilocaine; methemoglobinemia is possible but w/ lower toxicity

270
Q

Bupivacaine…

A

metabolized in liver; 0.5% soln for inj.; 20 min. onset/ 8 hr duration; more potent than Lidocaine; 2mg/kg; more cardiodepression w/ diazepam

271
Q

Mepivacaine…

A

liver metabolism; used more in nerve blocks

272
Q

Proparacaine…

A

Liver metabolism; 30 s onset/20 min. duration; topical; used in eye exams

273
Q

Which NSAID is COX-1 selective?

A

Aspirin - does not do anti-inflammatory

274
Q

COX-2 selective NSAID?

275
Q

3, nonselective NSAIDs..do both COX-1 and CPX-2

A

flunexin meglumine (the only one approved in cattle - more for visceral pain)
phenylbutazone (used for musculoskeletal pain)
ketoprofen

276
Q

COX-2 preferential NSAIDs..

A

carprofen, meloxicam (only given once in cats), deracoxib

277
Q

COX-2 selective NSAIDs are the best…who are they?

A

Robenacoxib (used in cats for 3 days), firocoxib (for dogs but ppl use it in horses bc it’s much cheaper and really good!)

278
Q

Aspirin…

A

COX-1 selective and anti-thrombotic

279
Q

Flunexin meglumine…

A

bovine respiratory and mastitis

280
Q

what NSAIDs do you not give IM in horses…

A

Flunexin meglumine or phenylbutazone

281
Q

NSAID to treat Musculoskeletal pain in horses…

A

phenylbutazone…

282
Q

NSAID administered IV or PO only…

A

phenylbutazone

283
Q

Other anti-inflammatories…

A

Tramadol (opioid, weak mu agonist)
Chondroprotectives - glucosamine, omega 3 fatty acids, etc.
Omantidine (adjunct)
Cerenia

284
Q

Which antitussive has a high first pass effect…

A

butorphanol

285
Q

2 anti-congestants in horses…

A

Guaifenesin and Phenylephrine

286
Q

2 Non-selective beta adrenergic agonists…

A

Epinephrine and Isoproterenol

287
Q

Clenbuterol…

A

oral syrup used to treat COPD in horses

288
Q

Albuterol or Salmeterol…

A

inhalant that is rapid and that lasts hrs.

289
Q

Terbutaline…

A

small animal asthma drug

290
Q

Methylzanthine derivatives are used to manage…

A

respiratory distress

Aminophylline and Theophylline

291
Q

What drug is a respiratory stimulant to assist in pharyngeal exam…

292
Q

Selective Beta 2 agonists…

293
Q

Non-selective Beta adrenergic agonists…

A

Epi and Isoproterenol

294
Q

Respiratory Anti-Inflamm. Steroids…

A

Pred. Prednisolone Fluticazone

295
Q

The only direct acting parasympathomimetic…

A

Pilocarpine

296
Q

Both parasympatholytic ophthalmic drugs are direct/indirect…

A

direct-acting

297
Q

For fundic exams, choose…

A

Tropicamide

298
Q

Sympathomimetic ophthalmic alpha-1 agonist…

A

Phenylephrine…indirect-acting; used in Horner’s diagnosis; cardio effects

299
Q

Non-selective beta antagonist that treats and prevents glaucoma…decreasing aqueous humor production

300
Q

carbonic anhydrase inhibitor…decreasing aqueous humor production

A

dorzolamide (be careful w/ sulfa allergies)

301
Q

increases aqueous outflow…

A

latanoprost

302
Q

cyclosporine is use in what species?

A

dogs only!

303
Q

anti-inflammatory used to treat the back of the eye and immune-mediate keratitis/uveitis…

A

dexamethasone and prednisolone

304
Q

topical NSAIDs that can be used for diabetic cataracts…

A

flurbiprofen and diclofenac

305
Q

Levothyroxine reacts w/..

A

phenobarbital, zonisamide, sulfonamide, glucocorticoids, phenylbutazone, quinidine, etc.

306
Q

You never give Ca Chloride…

A

SubQ or IM

307
Q

It is best if you give Ca Gluconate…

A

IV…if you give it IV, dilute it!

308
Q

When giving Ca Chloride/Gluconate, monitor w/….

309
Q

Hypocalcemia due to HypoPTH give…

A

Ca Propionate and Ca Carbonate and may have to give calcitriol

310
Q

What is the only oral hypoglycemic drug?

311
Q

Endogenous glucocorticoid…

A

cortisol (made in zona fesiculata of adrenal gland)

312
Q

Glucocorticoid protein transporter…

A

transcortin (preferentially bind to this instead of albumin)

313
Q

Base steroid…

A

Prednisone

314
Q

Salt esters…

A

make it more soluble….onset is faster, duration is the same

315
Q

Insoluble esters…

A

onset slower and duration slower and cannot give it IV

316
Q

Glucocorticoids (5)

A

Triamcinolone, Pred., Prednisolone, Dexamethasone, Methylprednisolone

317
Q

A patient on glucocorticoid will have bloodworm w/…

A

decreased thyroid, stress leukogram

318
Q

Where is aldosterone produced?

A

zona glomerulosa

319
Q

Aldosterone….

A

Na-Retention! H2O-Retention!

320
Q

First line of drugs for immunosuppression…

A

glucocorticoids

321
Q

When do you use body-surface dosing?

A

Chemo and Levothyroxine

322
Q

Metronomic…

A

lower doses for longer periods (more owner risk involved)

Pharmacology Final (1 decks)

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