Final Exam Study Guide - Summer 2015 Flashcards
(322 cards)
1
Q
Appetite Stimulants…
A
NE, GABA, Dopamine, Benzodiazepines, Propofol, Serotonin Antagonists
2
Q
Benzodiazepines as appetite stimulants…
A
GABA agonists; Stimulate GABA –> Inhibit Satiety Center –> Increase appetite
3
Q
Appetite Inhibitor…
A
Serotonin
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
5
Q
Serotonin Antagonists that stimulate appetite…
A
Cyproheptadine (Cats) and Mirtazapine (Dogs)
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
7
Q
Mirtazapine..
A
Serotonin antagonist; used in dogs as an appetite stimulant; increases NE centrally; pharmacokinetics misunderstood; hard to dose in cats
8
Q
Glucocorticoids as an appetite stimulant…
A
Prednisone
9
Q
What is the side effect of concern when using Prednisone as an appetite stimulant?
A
polyphagia
10
Q
The purpose of using Emetics…
A
control of vomiting; act on the Emetic Center and CRTZ (outside the BBB)
11
Q
Peripherally acting Emetics…
A
Hydrogen Peroxide
12
Q
Hydrogen Peroxide as an Emetic…
A
reasonable for dogs; do not use in cats - severe hemorrhagic gastritis
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.
14
Q
Xylazine or Dexmedetomidine as Emetics…
A
alpha-2 agonists; more effective in cats than dogs
Cats have more alpha-2 receptors
15
Q
If you give a cat oral Diazepam, what will you potentially cause?
A
Idiosyncratic hepatotoxicity
16
Q
Repeated propofol administration in Cats can cause…
A
RBC injury and Heinz body anemia
17
Q
B-Vitamins an an appetite stimulant…
A
in cases of Vitamin deficiency
18
Q
Used as an appetite stimulant, Megestrol acetate is a…
A
synthetic progestin…use w/ caution!
19
Q
Anabolic steroids as an appetite stimulant…
A
Stanozolol…use w/ caution!
20
Q
CRTZ stands for…
A
chemoreceptor trigger zone
21
Q
What receptors stimulate the CRTZ to stimulate the emetic center and induce vomiting?
A
serotonin, neurokinin, alpha-2, dopamine, and histamine
22
Q
In the CRTZ, Cats have fewer receptors for…
A
histamine and dopamine
23
Q
In the CRTZ, Cats have more receptors for…
A
alpha-2 and serotonin
24
Q
Why should you not use hydrogen peroxide in cats to induce vomiting?
A
cats have a higher risk of mucosal damage
25
Centrally acting Emetics...
Apomorphine, Xylazine and Dexmedetomidine
26
What are Immunosuppressive drugs to consider?
High dose glucocorticoids, Antimetabolites, Azathiprine, Cyclosporine, Topical Tacrolimus
27
How do Antimetabolites work?
inhibit purine/pyrimidine synthesis --> inhibit DNA synthesis of lymphocytes --> block T-cell activation and response
28
Azathiprine...
Anti-metabolite Immunosuppressant; do NOT use in Cats; admin. orally; monitor CBC/Chem. for toxicities and side effects
29
If patients are able to tolerate Azathiprine, they show less side effects than when given...
Prednisone
30
Cyclosporine as an immunosuppressant...
- 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
31
Tacrolimus topical...
immunosuppressant; topically used to manage perianal fistula when Cyclosporine does not work (works on a different target)
-cytokine inhibitor
32
What is the most common adverse effect when administering chemo?
GI signs
33
If you see Adverse GI side effects in a pt. undergoing chemo, what do you do?
administer anti-emetics before/during treatment to decrease nausea
34
What are the adverse effects that can be seen when administering chemotherapy?
GI effects, Bone marrow suppression, Immunosuppression, Hair loss, Toxicity, Drug resistance/loss of efficacy, acute tumor lysis syndrome
35
When using Chemotherapeutic agents causing myelosuppression...what do you monitor?
CBC
36
Neutropenia is a common side effect of chemotherapy. What is the lowest neutrophil count called?
Nadir
37
What happens if you get severe neutropenia with chemotherapy?
prophylactic antibiotics may be started and/or you can delay the next chemo treatment
38
T/F - Animals undergoing chemo lose hair like humans do.
False. Hair loss is more common in breeds with continued hair growth; cats whiskers may fall out; shaved areas do not grow back well.
39
T/F - If you suspect extravasation when administering chemotherapeutic agents, immediately remove the catheter.
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.
40
What class of drugs potential provide analgesia?
Opioids and NSAIDs
41
The mechanism by which NSAIDs work...
Cyclooxygenase or COX-inhibitors
42
Why must you not use glucocorticoids and NSAIDs together?
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!
43
Pharmacokinetics of NSAIDs...
good absorption; IM and oral admin.; Hepatic metabolism (phase 1 and 2 reactions in the Liver)
44
Why do we not extrapolate dose rate or intervals of NSAIDs from 1 species to another?
Terminal-1/2 life carries between species
45
What are the Anti-Inflammatory effects of NSAIDs?
inhibit production of pro-inflammatory eicosanoids - concerned with COX-2
46
Tend to use NSAIDs in cases of...
acute inflammation and pain (NSAIDs have a greater affect on acute inflammation rather than chronic inflammation)
47
Some differences in using NSAIDs vs. Steroids...
no immunosuppression, no impaired wound healing, no delayed fibroblast functions with NSAIDs
48
How do NSAIDs result in Analgesia?
decrease prostaglandin sensitization of neurons
49
NSAIDs have Antipyretic effects but will not reduce...
NSAIDs reduce Fever but will not reduce hyperthermia or normal body temp.
50
How does Aspirin have anti-thrombotic effects?
irreversibly inhibit COX in platelets - increasing clotting time; TXA2 is a platelet aggregating agent (inhibited); PGI2 is an anti-aggregating agent (less inhibited)
51
COX-2 is expressed by a number of cancers. Using NSAIDs....
has been associated with improved outcomes. NSAID's have anti-neoplastic effects
52
What NSAID is often used in transitional cell carcinoma and osteosarcoma?
Piroxicam
53
Commonly used NSAIDs...
```
carprofen
meloxicam
deracoxib
firocoxib
robenacoxib
flunixin meglumine
phenylbutazone
aspirin
peroxicam
```
54
What are the indications for use of Ophthalmic drugs?
```
Mydriasis/Miosis
Decrease aqueous fluid production or IOP
Increase tear production
Decrease inflammation (glucocorticoids and NSAIDs)
Treat Infections
Analgesia
```
55
Why are topical preparations preferred for Ophthalmic drugs?
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
56
T/F - Ophthalmic drugs prepared as ointments have faster elimination.
False. Ophthalmic drugs prepared as ointments have SLOWER Elimination.
57
PSNS's effect of the eye....
Miosis - contracts the iris sphincter m.; contraction of the ciliary body; lens accommodation for near vision; increases uveoscleral aqueous outflow
Pupil constriction
58
SNS's effect on the eye...
Mydriasis - relaxation of the ciliary body; contraction of the iris dilator m.; aqueous humor formation; lens accommodation for far vision
Pupil dilation
59
When should you avoid using Miotic drugs?
Anterior uveitis or Anterior Lens Luxation
60
What are the Miotic drugs to know?
Parasympathomimetic Drugs...
Pilocarpine
Physostigmine and Demecarium
Echothiopate
61
Pilocarpine...
```
direct acting parasympathomimetic
short duration of action
miosis lasts 2-6hrs
Txt: glaucoma
diagnosis of parasympathetic lesions (CN III)
```
62
Physostigmine and Demecarium...
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)
63
Echothiophate...
indirect acting parasympathomimetic - irreversible
| long miosis duration - >12hrs
64
What are the Mydriatic drugs to know...
Parasympatholytic Drugs...
Atropine
Tropicamide
Phenylephrine
65
Atropine as an Ophthalmic drug...
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
66
What patients should you not use atropine as an ophthalmic drug in?
Do not use Atropine in patients with Primary Glaucoma!
67
What are the reasons to be cautious when using ophthalmic atropine?
primary glaucoma
bitter taste - will cause cats to froth/foam at the mouth
cycloplegia may cause panic in horses
68
When you need an Ophthalmic drug that will dilate the eye for long periods of time, you pick...
Atropine
69
Tropicamide...
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
70
Ophthalmic Phenylephrine...
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.
71
What does decreasing aqueous humor formation do for the animal?
decreases IOP and is used for managing glaucoma
72
What "classes" of drugs reduce aqueous humor formation of the eye act on?
alpha-agonists
beta-antagonists
carbonic-anhydrase inhibitors
prostaglandin analogs
73
What are the alpha-agonists that reduce aqueous humor formation?
Brimonidine (alpha-2 agonist)
| used in dogs for glaucoma txt
74
What are the beta-antagonists that reduce aqueous humor formation?
Timolol
minimal systemic bioavailability
used for glaucoma management - can cause a little miosis
75
What is Cosopt?
Timolol + Dorzolamide = Cosopt; gives a better control over aqueous humor
76
What are the carbonic anhydrase inhibitors that decrease aqueous humor formation?
Dorzolamide and Brinzolamide
77
Dorzolamide...
carbonic anhydrase inhibitor
| used to treat glaucoma
78
Brinzolamide...
reversible inhibition of carbonic anhydrase which decreases aqueous humor formation
sulfonamide derivative!
79
What prostaglandin analog is used to decrease aqueous humor formation?
```
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
```
80
Natural tear film is 3 layered, made out of...
mucin, water, lipid
81
Lacrimomimetic agents provide...
lubrication but do not perfectly replicate natural tears
82
Why do we prefer ointments to drops for artificial tear production?
ointments have prolonged contact time, less dilution, a slower breakdown by tears/enzymes and less drainage via the nasolacrimal duct
83
What are the lacrimogenics we need to know?
Cyclosporine (optimmune)
| Tacrolimus
84
Lacrimogenic Cyclosporine...
used in the txt of canine keratoconjunctivitis sicca
BID topical application is required; lifelong
monitored by Schirmer's tear test
causes local immunosuppression
85
The purpose of lacrimogenics is to...
increase tear production
86
Lacrimogenic Tacrolimus...
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
87
The purpose of Topical Corticosteroids used to treat eye issues...
manage inflammation and immune-mediated conditions (Non-infectious keratitis, uveitis)
88
What are the 2 topical corticosteroids used for eye issues...
Prednisolone and Dexamethasone
| there is little systemic absorption with local application
89
When do you grab Topical NSAIDs for eye issues?
when a higher local concentration and lower systemic concentration is desired
90
Topical NSAIDs are used in...
management of uveitis and some keratitis; use to manage inflammation associated with cataracts (diabetic pts.)
91
What are the contraindications of topical NSAIDs?
corneal ulcers, glaucomas, or coagulopathies
92
What are the 2 topical NSAIDs mentioned from class?
Flurbiprofen and Diclofenac
93
What are the topical antimicrobial agents for eyes?
Polymyxcin and aminoglycosides
94
What are the uses of topical antimicrobial agents for eyes?
treat conjunctival and corneal infectious diseases
| typically require frequent administration
95
What could be damaging to the eyes when using antibiotics?
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
96
What drug is the local anesthetic for eyes?
Proparacaine
97
MOA for Proparacaine...
blocks Na+ channels to prevent axonal depolarization
98
What is Proparacaine used to treat?
used to decrease corneal sensation to allow diagnostic evaluation (tonometry) by "freezing" the eye or decreasing pain in the eye
99
What are the classes of respiratory drugs?
expectorants, mucolytics, and decongestants
100
Respiratory drugs improve...
clearance of material from the airways by stimulating cough and breaking up mucous
101
What expectorant has been used in equine med?
Guaifenesin
102
What decongestant has been used to relieve nasal congestion in horses?
Phenylephrine - causes local vasoconstriction in upper airways
103
T/F - In respiratory infections, you are most likely treating a pneumonia.
True
104
What Respiratory drugs have good concentration in the epithelial lining fluid?
macrolides, tetracyclines, fluoroquinolones
105
What respiratory drugs achieve good concentration in the interstitial space?
Beta-lactams and aminoglycosides
106
If you suspect a fungal respiratory infection by Blastomycosis, what drug do you treat with?
Itraconconazole
107
Respiratory fungal infections caused by coccidioidomycosis is often treated w/...
fluconazole
108
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.
True.
109
Using antiviral drugs to treat respiratory infections are uncommon. What viral conditions may you treat for?
conjunctivitis and feline herpes
110
What anti-inflammatory drugs are used for treating respiratory issues?
```
Glucocorticoids
Prednisone or Prednisolone (orally)
Fluticasone
Leukotriene inhibitors
NK1 antagonists - Maropitant (Cerenia)
```
111
The purpose of Antitussives...
cough suppressant
112
What are some antitussive drugs to know?
Opioids
Hydrocodone
Butorphanol
Codeine and dextromethorphan
113
How do Opioids function as antitussives?
reduce the sensitivity of the cough-center to afferent stimuli (like irritation, stretch) via opioid receptors
114
What may Hydrocodone have in it that vets should be aware of?
may be formulated w/ homatropine or acetaminophen
115
Butorphanol has a (high/low) first-pass effect, causing it to have (higher/lower) oral bioavailability.
Butorphanol has a HIGH first-pass effect, causing it to have LOWER oral bioavailability.
116
What are the side effects of antitussives?
sedation, constipation or nausea
117
What classes of drugs are bronchodilators?
beta-adrenergic agonists
methylxanthine derivatives
anticholinergics
118
Where do bronchodilators work?
bronchioles
119
Bronchodilating drugs are not commonly used in treatment of...
pneumonia and pleural disease
120
What are the non-selective beta-adrenergic agonists of the bronchodilator drugs?
Epinephrine and Isoproterenol
121
Epinephrine and Isoproterenol bronchodilator drugs...
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
122
Selective Beta-2 agonist bronchodilator drugs...
```
Albuterol
Salmeterol
Clenbuterol
Terbutaline
AeroKat, AeroDawg, AeroHippus
```
123
Albuterol...
Selective beta-2 agonist bronchodilator
inhalational route
rapid response (5 min.); can last hrs.
124
Clenbuterol...
selective beta-2 agonist bronchodilator
oral syrup used in horses to manage chronic airway disease (COPD)
not permitted in food production animals
125
Terbutaline...
human approved product used in animals to manage asthma
oral or injectable available
*Almost ZERO oral absorption in horses.
126
What are the metered-dose inhaler drugs?
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!
127
What are the primary effects of selective beta-2 agonists?
bronchodilation, may also stabilize mast cells and increase mucociliary clearance
less apparent effects: smooth ms. relaxation, hyperglycemia, hypokalemia, tachycardia, tremors or ms. cramps
128
With chronic use of selective beta-2 agonists, you may start to see resistance..then what?
increase dose, change drugs or use environmental management
129
When using Phosphodiesterase inhibitors you get...
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
In patients with pulmonary hypertension, treat w/...
Sildenafil (Viagra) - a vascular smooth ms. relaxant
131
What respiratory drug is an analeptic and central respiratory stimulant?
Doxapram - used to assist with laryngeal examination in dogs/cats
132
In premature animals, Doxapram will...
increase surfactant secreted shortly after birth.
133
What is the overall goal in Endocrine Pharmacology?
regaining normal homeostasis
134
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
Dextrose (hypoglycemia)
Calcium gluconate (hypo calcemia)
Levothyroxine (hypothyroid)
DOCP/Fludrocortisone and Prednisone (hypoadrenocorticism - Addison's)
135
If you have hypocalcemia from low PTH, which drug do you choose?
Calcitriol/Vitamin D
| -calcitriol is INDIRECT replacement
136
In instances where the target for drug action is HYPER (hypercalcemia, carcinoma, adenoma, etc.) you have 4 options...
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
In Endocrine Pharmacology, when you want to inhibit the production of the excess substance - particularly for hyperthyroidism, what drug do you choose?
Methimazole - will not affect the mass but will inhibit its production of thyroid hormone
138
What drug works to inhibit the production of excess substances from the adrenal gland?
Trilostane
139
If you want to rid the body of excess calcium...
saline diuresis is your method!
140
What are the therapeutic goals on Endocrine Pharmacology?
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
Goal of Hypothyroid treatment...
decrease T3 and T4 production by the thyroid gland
142
Levothyroxine Sodium generic names...
Soloxine, Synthroid
143
Levothyroxine AKA Soloxine...
preferred drug for txt of hypothyroidism in all species
oral or injectable
injectable is only for treating myxedema coma (rare)
144
Hypothyroidism is way more common in....
dogs!
145
Hyperthyroidism is way more common in...
cats!
146
Antithyroid Drugs...GO!
Thiourylenes like:
| Methimazole (Tapazole - human approved)
147
Methimazole...
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
Mild side effects of Methimazole...
transient or mild GI signs - inappetence, vomiting
lethargy
mild, transient hematologic changes
149
Major side effects of Methimazole...
idiosyncratic reactions: facial excortiation, hepatopathy and significant hematologic changes - agranulocytosis and thrombocytopenia
150
Methimazole is available in a transdermal formulation...tell me about it!
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
T/F - Using transdermal Methimazole eliminated the chances of idiosyncratic reactions and GI upset in hyperthyroid treatment.
FALSE!
152
What is the goal in treating periparturient hypocalcemia?
Just replacing lost calcium.
153
In primary hypothyroidism, calcium replacement therapy is short term and replacement of BLANK is initiated for long-term management.
Vitamin D!
154
What is weird about the dosing of Levothyroxine?
dose it in mg/m^2
155
Why is the dosing for Levothyroxine weird?
to reduce the risk of over supplementation or thyrotoxicosis (excessive T4 levels)
156
How do you monitor Levothyroxine levels?
Check/Measure their T4 levels
157
What are drugs that could interfere with T4 levels?
Phenobarbital, glucocorticoids (pred. and dex.), phenylbutazone, zonisamide and quinidine
158
What CS would you expect in acute hypocalcemia?
hyperesthesia/pawing at face, flaccid paralysis, seizures, hyperthermia, bradycardia
159
Periparturient hypocalcemia is AKA...
Milk Fever or eclampsia
160
Treatment of Acute hypocalcemia, what are you parenteral options?
Ca Gluconate and Ca Chloride
161
Because Ca Chloride is more caustic, it should never be given...
SC/IM or extravasated when given IV
162
Rapid IV administration of Ca can cause...
arrhythmias or cardiac arrest
163
Oral formulations of Calcium are...
Ca Carbonate and Ca Proprionate
164
In regards to Calcium...
Bones..
Kidneys...
Gut...
Bones STORE Ca
Kidneys EXCRETE Ca
Gut ABSORBS Ca
165
Hypocalcemia from HypoPTH...how do we treat?
Short-term: parenteral Ca - Ca Carbonate and Ca Proprionate
| Long-Term: Replace Vitamin D via Calcitriol
166
T/F - Calcitriol is the most potent form of Vit D.
Truth!
167
Giving calcitriol works how?
significantly increases Ca reabsorption in the Gut and decreases kidney excretion of Ca
168
What is Milk Fever?
periparturient hypocalcemia - sudden increase in Ca usage for which the pt. cannot adapt rapidly enough --> associated with birth and lactation
Milk...YUMMM
169
What is the lifelong treatment for hypoparathyroidism?
VITAMIN D!!!
170
What do you do when you feel hypoglycemic?
EAT!!!! Particularly, eat small meals more often! FEED THE NEURONS!
171
You have a hypoglycemic patient...who do you call on for help?
Dextrose 50%
172
How do you give Dextrose 50%?
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
What is the most commonly used emergency therapy drug for hypoglycemia?
Dextrose 50%
174
What happens if you give Dextrose 50% SubQ?
Tissue Irritation
175
Glucagon treats what?
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
What is the most common disease causing clinically significant hyperglycemia?
Diabetes Mellitus
177
Diabetes Mellitus is...
a chronic metabolic disorder that is characterized by high blood glucose caused by insulin deficiency and/or resistance
178
What can cause transient hyperglycemia?
stresssssss like finals!!!!
179
Treatment of Hyperglycemia from Diabetes Mellitus involves...
a combo of diet, exercise and meds! (either oral hypoglycemic agents or injectable insulin)
180
Tell me about oral hypoglycemic drugs in cats...
only work in about 20-30% of cats
| Side effects: hypoglycemia, GI effects - vomiting, elevated liver enzymes
181
Glipizide...
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
Hellur, I have hyperglycemia, what drug do I need?
Insulin!
183
What are the 2 preparations of insulin approved for veterinary use by the US FDA?
PROZINC
| VETSULIN
184
Veterinary preparations of Insulin come as...
40 IU/mL concentration or "U40"
185
Human preparations of Insulin come as...
100 IU/mL concentration of "U100"
186
T/F - When using veterinary preparations of Insulin, it is ok to use human insulin syringes.
FALSE! Special syringes are required if U40 insulin is used!
187
What's so special about Detemir?
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
What are the short-acting insulins?
Regular Insulin AKA Humulin-R
189
Tell me about Humulin-R...
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
What are the intermediate-acting insulins?
NPH/Vetsulin and Humulin-N
191
What are the "good K9 starting insulins"?
NPH/Vetsulin and Humulin-N
192
Isophane or Neutral Protamine Hagedorn is complexed w/...
protamine
193
Vetsulin/Caninsulin is kinda cool...why?
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
What is the long-acting insulin?
Prozinc (protamine zinc insulin), Glargine, and Detemir
195
Prozinc...
FDA approved insulin for cats
pharmacokinetics are shorter than expected in felines
only given Subq
shortest of the long-acting insulins
196
Glargine...
long effect due to acidic pH - gradual absorption
more used in cats
Only given SubQ
precipitants form - get longer absorption
197
Detemir...
more commonly used in canine pts.
also used in some cats
4x higher potency in canine pts.
198
What drugs act on the adrenal cortex?
glucocorticoids and mineralcorticoids
199
How do glucocorticoids exert their effects?
genomic and non-genomic mechanisms
200
What do genomic effects involve?
the binding of glucocorticoid to a receptor which alters gene expression through transactivation or transrepression; in the cytoplasm
201
What do non-genomic effects involve?
interaction w/ receptors within the lipid membranes of cells and can cause more rapid changes; in the membrane
202
Do you use glucocorticoids in diabetic patients?
No ma'am/sir you do NOT! They are antagonistic to Insulin!
203
What are the most common side effects of glucocorticoids?
PU/PD...decrease serum calcium (decrease GI absorption, increase renal excretion), decrease ADH secretion....increases GFR
204
How do glucocorticoids affect the musculoskeletal system?
loss of muscle mass and gaining abdominal body fat
| muscle wasting and polyphagia
205
How do glucocorticoids affect the reproductive system?
potential teratogens
| can inhibit spermatogenesis and ovulation
206
How do glucocorticoids affect the GI/Hepatic system?
can cause GI ulcerations by increasing acid secretion and decreasing mucus secretion
cause fatty liver (increased fat absorption and deposition into the liver)
207
Do glucocorticoids cause pancreatitis?
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
What are the immunosuppressive effects of glucocorticoids?
may have an impact on healing when given at higher doses and for long-term therapy
209
What are the clinical uses for glucocorticoids?
anti-inflammatory, immunosuppression and neoplasia
210
The most common ways to use glucocorticoids is...
in allergy patients...atopic dermatitis, asthma, etc.
211
Higher doses of glucocorticoids are used...
longer term for immune-mediated and autoimmune conditions like immune-mediated thrombocytopenia (IMT) and inflammatory bowel disease (IBD)
212
Glucocorticoids have an effect on certain WBCs, making them useful adjuncts or palliative treatment for...
neoplasms, particularly round cell neoplasias: lymphomas, multiple myeloma and mast cell tumors
213
Steroids that require hepatic activation may show reduced..
potency in individuals w/ liver dysfunction
214
The duration of action of glucocorticoids is determined by...
the base steroid
215
What are the short-acting steroids?
hydrocortisone, prednisone, prednisolone, methylprednisolone
216
What time frame are short-acting steroids working with?
217
What time frame is Triamcinolone working with?
24-48hrs
218
What are the long-acting steroids?
Betamethasone and dexamethasone
219
What time frame are the long-acting steroids working with?
> 48hrs
220
Repeated dosing of Dexamethasone would result in...
accumulation.
221
What is the formulation of glucocorticoids?
salt esters and insoluble esters
222
What are the salt esters we should know?
Na phosphate and Na succinate
223
What are the Insoluble esters we should know?
acetate, acetonide, pivvulate
224
What is so special and cool about salt esters?
It allows for IV injection of larger volumes.
225
Dexamethasone sodium phosphate is an example of...
| In practice, it is commonly referred to as...
a salt ester...
| Dex SP
226
T/F - Insoluble esters may be administered IV, IM, SubQ, Intralesional, and Intraarticular.
False! Insoluble esters are NOT FOR IV use!
227
What are 2 examples of insoluble ester drugs?
Methylprednisolone acetate (Depo-Medrol) and Triamcinolone acetonide (Vetalog)
228
T/F - Glucocorticoids may be given orally or parenterally and are highly plasma protein bound.
True!
229
Prednisone must be hydrolyzed to BLANK to release the steroid base.
Prednisolone
230
Cortisone must be hydrolyzed to BLANK to release the steroid base.
Cortisol
231
Methylprednisone must be hydrolyzed to BLANK to release the steroid base.
Methylprednisolone
232
Glucocorticoids should NEVER EVER be used with...
NSAIDs
233
What happens when you use Glucocorticoids and NSAIDs together?
Increase the risk of GI Ulcers - potentially fatal complication
234
What are the side effects of short-term therapy wi†˙ glucocorticoids?
PU/PD/PP (polyphagia), stress leukogram
| more sever effects are seen in pregnant animals - fetal abnormalities and abortion
235
What are the side effects of long-term therapy of glucocorticoids?
immunosuppression and increased susceptibility to infection, collagen disease - cruciate injuries, dermatologic changes, hypertension, thromboembolic disease, delayed wound healing, Addisonian signs
236
What do you risk with acute withdrawal of long-term glucocorticoid therapy?
Iatrogenic Addisons
237
What is the endogenous mineralocorticoid?
Aldosterone
238
Aldosterone is regulated through the...
Renin Angiotensin-Aldosterone system
239
What drugs do we use to treat hypoadrenocorticism?
```
Desoxycorticosterone Pivalate (DOCP)
Fludrocortisone
```
240
T/F - DOCP has no anti-inflammatory component.
Truth!
241
What is the most commonly used mineralocorticoid?
DOCP
242
How is DOCP administered in canines?
Given IM every 25 days
243
How do you monitor DOCP/Hypoadrenocorticism?
Checking Serum Na+ and K+ levels
244
How is Fludrocortisone different from DOCP?
more potent w/ mild anti-inflammatory/glucocorticoid effects
| given orally BID
245
How do you monitor Fludrocortisone/Hypoadrenocorticism?
Checking serum Na+ and K+ levels
246
Bromide cause BLANK in cats..
ASTHMA
247
If you give Propofol to a seizing pt. you must also...
intubate
248
Anti-epileptics that must be loaded...
Phenobarbital, Leveteracetum, or Bromide
249
Zonisamide...
rapidly enters the CNS
250
MOA of Phenobarbital...
potentiates GABA; Cytochrome p450 induction
251
MOA of Bromide...
competes with a Chloride transporter
252
Bromide...
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
Bromism toxicosis SE's..
blindness, paresis, coma, megaesophagus; give fluids w/. furosemide
254
Leveteracetum...
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
Which epileptic can be given as CRI?
Midazolam
256
MOA of Zonisamide...
potentiates GABA...
257
Zonisamide...
sulfa; induces Liver enzymes - double the dose in pts. who are on Phenobarb
258
Opioids metabolized by the liver...
lidacaine, bupivacaine, mepivicaine, ropivacaine
259
Opioids Metabolized by plasma pseudocholinesterases...
procaine, and proparacaine
260
Increase dose by adding...
volume
261
Increase potency by adding...
lipid and water
262
Onset of analgesia is contributed to...
placement, concentration and drug factors
263
Local infiltration...
peripheral nerve block, intra-articular, epidural/intrathecal
264
Adverse effects of analgesics..
CNS stimulation, CNS depression, Cardiovascular depression, local irritation, methemoglobinemia (benzocaine and prilocaine), Histamine release (procaine and proparacaine)
265
Procaine...
esther; slow onset/short duration; metabolized to Paba; poor penetration to MM; TOXIC TO HORSES
266
General Lidocaine...
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
Systemic Lidocaine...
class 1B anti arrhythmic; CRI anti-inflammatory for post-op ileus; in MLK drips
268
Local Lidocaine...
injs. are 1-2% solutions; can mix with bicarb to reduce irritation; topically is 4% soon. in gels, sprays and patches
269
EMLA cream...
2.5% lidocraine and 2.5% prilocaine; methemoglobinemia is possible but w/ lower toxicity
270
Bupivacaine...
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
Mepivacaine...
liver metabolism; used more in nerve blocks
272
Proparacaine...
Liver metabolism; 30 s onset/20 min. duration; topical; used in eye exams
273
Which NSAID is COX-1 selective?
Aspirin - does not do anti-inflammatory
274
COX-2 selective NSAID?
Peroxicam
275
3, nonselective NSAIDs..do both COX-1 and CPX-2
flunexin meglumine (the only one approved in cattle - more for visceral pain)
phenylbutazone (used for musculoskeletal pain)
ketoprofen
276
COX-2 preferential NSAIDs..
carprofen, meloxicam (only given once in cats), deracoxib
277
COX-2 selective NSAIDs are the best...who are they?
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
Aspirin...
COX-1 selective and anti-thrombotic
279
Flunexin meglumine...
bovine respiratory and mastitis
280
what NSAIDs do you not give IM in horses...
Flunexin meglumine or phenylbutazone
281
NSAID to treat Musculoskeletal pain in horses...
phenylbutazone...
282
NSAID administered IV or PO only...
phenylbutazone
283
Other anti-inflammatories...
Tramadol (opioid, weak mu agonist)
Chondroprotectives - glucosamine, omega 3 fatty acids, etc.
Omantidine (adjunct)
Cerenia
284
Which antitussive has a high first pass effect...
butorphanol
285
2 anti-congestants in horses...
Guaifenesin and Phenylephrine
286
2 Non-selective beta adrenergic agonists...
Epinephrine and Isoproterenol
287
Clenbuterol...
oral syrup used to treat COPD in horses
288
Albuterol or Salmeterol...
inhalant that is rapid and that lasts hrs.
289
Terbutaline...
small animal asthma drug
290
Methylzanthine derivatives are used to manage...
respiratory distress
| Aminophylline and Theophylline
291
What drug is a respiratory stimulant to assist in pharyngeal exam...
Doxapram
292
Selective Beta 2 agonists...
-erols
293
Non-selective Beta adrenergic agonists...
Epi and Isoproterenol
294
Respiratory Anti-Inflamm. Steroids...
Pred. Prednisolone Fluticazone
295
The only direct acting parasympathomimetic...
Pilocarpine
296
Both parasympatholytic ophthalmic drugs are direct/indirect...
direct-acting
297
For fundic exams, choose...
Tropicamide
298
Sympathomimetic ophthalmic alpha-1 agonist...
Phenylephrine...indirect-acting; used in Horner's diagnosis; cardio effects
299
Non-selective beta antagonist that treats and prevents glaucoma...decreasing aqueous humor production
timolol
300
carbonic anhydrase inhibitor...decreasing aqueous humor production
dorzolamide (be careful w/ sulfa allergies)
301
increases aqueous outflow...
latanoprost
302
cyclosporine is use in what species?
dogs only!
303
anti-inflammatory used to treat the back of the eye and immune-mediate keratitis/uveitis...
dexamethasone and prednisolone
304
topical NSAIDs that can be used for diabetic cataracts...
flurbiprofen and diclofenac
305
Levothyroxine reacts w/..
phenobarbital, zonisamide, sulfonamide, glucocorticoids, phenylbutazone, quinidine, etc.
306
You never give Ca Chloride...
SubQ or IM
307
It is best if you give Ca Gluconate...
IV...if you give it IV, dilute it!
308
When giving Ca Chloride/Gluconate, monitor w/....
EKG
309
Hypocalcemia due to HypoPTH give...
Ca Propionate and Ca Carbonate and may have to give calcitriol
310
What is the only oral hypoglycemic drug?
Glipizide
311
Endogenous glucocorticoid...
cortisol (made in zona fesiculata of adrenal gland)
312
Glucocorticoid protein transporter...
transcortin (preferentially bind to this instead of albumin)
313
Base steroid...
Prednisone
314
Salt esters...
make it more soluble....onset is faster, duration is the same
315
Insoluble esters...
onset slower and duration slower and cannot give it IV
316
Glucocorticoids (5)
Triamcinolone, Pred., Prednisolone, Dexamethasone, Methylprednisolone
317
A patient on glucocorticoid will have bloodworm w/...
decreased thyroid, stress leukogram
318
Where is aldosterone produced?
zona glomerulosa
319
Aldosterone....
Na-Retention! H2O-Retention!
320
First line of drugs for immunosuppression...
glucocorticoids
321
When do you use body-surface dosing?
Chemo and Levothyroxine
322
Metronomic...
lower doses for longer periods (more owner risk involved)
