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Pharm II > Inotropic Agents > Flashcards

Inotropic Agents Flashcards

1
Q

Indications for digitalis

A

CHF Atrial arrythmias

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2
Q

MOA digitalis

A

Inhibits Na/Ka ATPase

  • Increase intracellular [Na]
    • Na exchanged for Ca via Na/Ca exchange*
    • Increased intracellular [Ca] —-> positive inotrope*
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3
Q

What effects does Digitalis have on: HR, conduction, contractibility, extiability, diuresis, and aqueous humor/CSF

A

HR: decreased

Conduction through AV: decreased

Contractability: increased (more Ca)

Excitability: increased (decrease K+ in cells)

Diuresis: increase (increased renal blod flow and GFR, decreased aldosterone)

Aqueous humor/CSF: decreased

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4
Q

Adverse effect of Digoxin in dogs

A

Vomiting (stimulates chemotrigger zone)

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5
Q

Oral bioavailability of Digoxin

A

High in elixir forms

Lower in horses

Very low in ruminants (microflora)

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6
Q

What is dose of Digoxin based on *

A

Lean body weight *

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7
Q

Distribution of digoxin

A

Plasma proteins –> wide distribution

  • Poor distribution in fat

Enterohepatic circulation

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8
Q

Excretion of Digoxin

A

Renal

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9
Q

Is Digitalis effective for ventricular arrythmias

A

No - only atrial arrythmias

Can cause ventricular arrythmias due to slow AV conduction

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10
Q

Dosings of digitalis

A
  1. LOADING DOSE (digitalization –> based on lean body weight)
  2. Slow methd –> mild cardiac failure. 5 dose/48h
  3. Rapid metod –> 3 dose/6hr
  4. Intensive –> emergencies. 1/2 dose, then 1/4 dose 6hours later and then 1/8 dose
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11
Q

T/F Digitalis is routinely used in cats

A

THEY ARE SENSITIVE! Only in emergencies

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12
Q

T/F Digitalis has a narrow safety margin

A

True

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13
Q

When monitoring Digitalis toxicity you need to routinely check serum K+ and Ca+. Why?

A

Potassium

Digitalis competes for a binding spot with K+

Hypokalemia = less K = increased binding sites for Digitalis —-> toxicity

Calcium

Hyper calcemia –> increased Ca for contraction –> increased toxicity

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14
Q

What can you give for Digitalis toxicity

A
  1. K+
  2. Cholestyramine
  3. Atropine
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15
Q

Important drug interaction with Digoxin

A

Quinidine: displaces Digoxin from tissues, increasing concentration 2x –> toxicity

Decrease Digoxin dose 6-8 days before giving Qunidine

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16
Q

T/F - Digoxin dose should be reduced in patients with kidney and liver disease

A

True

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17
Q

T/F Parenteral is a preferred route of administering Digitalis

A

False - it is irritating

18
Q

Two important effects of diuretics

A

1) Reduce edema
2) Reduce preload

19
Q

How do loop diuretics work? Give an example

A

Furosemide

  • Act on luminal membrane of ascending loop of Henle
  • Inhibits Na/K/Cl co-transport –> increased excretion
  • Also interferes with Mg and Ca resorption (due to reduction in transcellular voltage different)
20
Q

MOA of Thiazide diuretics

A
  1. Inhibit Na/Cl symporter in DT
  2. Na exchanged for K in CD –> hypokalemia
  3. Increased Ca resorption
21
Q

Which type of diuretic is slow onset

A

Potassium sparing diruetics

22
Q

What’s an aldosterone antagonist

A

Spirinolactone

23
Q

What are two Na-resoprtion inhibitors (potassium sparing diuretic)

A

1. Triamterence

2. Amiloride

24
Q

What’s a desirable combo with Spirinolactone

A

Hydroflumethiazide

25
Q

What can diuretics be given with to reduce edema

A

Digoxin

26
Q

Phosphodiesterase inhibitors

A
  • Inamrinome / Milrinone
  • Pimobendan
  • Aminophylline
27
Q

MOA phosphodiesterase inhibitors

A

Selective inhibition of phosphodiesterase isoenzyme III

(degrades cAMP. More cAMP = more contraction and vasodilaton)

28
Q

Which durg produces positive inotropic action without increasing myocardial O2 consumption

A

Inamrinone

Pimobendan

29
Q

Administration Inamrinome

A

IV

30
Q

Indications Inamrinome

A

Acute myocardial failure in dogs/cats

31
Q

Side effects Inamrinome

A

Tachycardia (humans)

32
Q

T/F phosphodiesterase inhibitors have positive inotropic effect without increasing myocardial O2 consumption

A

True!

33
Q

Which phosphodiesterase inhibitor is considered a safer alternative to Digitalis

A

Pimobendan

  • No effect on oxygen demand*
  • No arrythmia effects*
34
Q

Whats a B1 agonist used for its inotropic effects in acute conditions

A

Dobutamine

35
Q

Side effects Dobutamine

A

Arrythmias (with ischemic heart conditions)

Tachyphylaxis (chronic use)

36
Q

T/F Dobutamine has short half life

A

Yes – requires continuous IV administration

37
Q

Indications for Dobutamine in dogs and horses

A

Dogs

  • Dilated cardiomyopathy due to CHF
  • Cardiogenic shock (alternative to dopamine)

Horses

  • Hypotension during anesthesia
38
Q

MOA Aminophylline

A

Phosphodiesterase inhibitor (increased cAMP)

39
Q

Therapeutic uses Aminophylline

A

Acute pulmonary edema in CHF

40
Q

Primary effect aminophylline

A

Bronchodilation

(also weak inotrope, mild diuresis)

Used for acute pulmonary edema in CHF

Pharm II (16 decks)

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