Meds Flashcards

Question

When should nitroprusside not be used?

Answer 1

- compensatory hypertension eg AV shunts, coarctation of the aorta, cushing's reflex. - inadequate cerebral circulation or emergency surgery if the patient is near death - hypoT4 or low sodium - undiluted - geriatric, renal , liver.

Answer 2

Calcium channel blocker - benzothiazeprines Class IV antiarrhythmic weak negative ionotrope act on nodal cells to prolong refractory period and slow conduction.

Answer 3

- SVT (originate above the AV node), Afib - systemic hypertension - pulmonary hypertension

Answer 4

- hypothension - sinus node dysfunction - high grade AV block - sick sinus syndrome - pulonary congestion or oedema - acute myocardial infarction - old, liver, renal - use with care

Answer 5

Beta adrenergic inontrope direct B1 and mild B2 and alpha 1 adrenergic effects mild chronotropic, arrhtymogenic and vasodilatory effects. increase cardiac output and work.

Answer 6

- shock - CHF - hypotension during GA

Answer 7

- subaortic stenosis - insufficient blood volume - vent tachyarrhythmia or afib. use digoxin first for afib.

Answer 8

Adrenergic/dopaminergic ionotrope acts directly and indirectly on alpha and beta receptors lower dose = β1 effects, exerting positive cardiac inotropic activity (eg, increased contractility, cardiac output, heart rate); a CRI of 10 – 15 µg/kg/min IV will have both β1 and α1 effects,3-6 although α1 effects (eg, increased systemic and pulmonary vascular resistance, increased venous return) predominate in a dose-dependent fashion.

Answer 9

- correct hypotension assoc with low Cardiac output in patient with shock after adequate fluid replacement or peripheral vasodilation - CHF - hypotension under GA

Answer 10

- phaeo - V-fib - uncorrected tachyarrhythmia - occlusive vascular disease - oliguric AKI

Answer 11

Cardiac glycoside thought to increase the availability of Ca++ to myocardial fibers and inhibit Na+/K+ ATPAse withincrease intracallual Na+ and decreased K+ - increase myocardial contraction (+ve ionotrope) - decrease conduction velocity through AV node and prolong refractory period.

Answer 12

- CHF - Afib or flutter (+diltiazem) - SVT

Answer 13

- Vfib - digitalis intoxication - 3rd degree AV block +/- cats with HCM * don't give extravascular * care with complex arrhythmia and subaortic stenosis.

Answer 14

Antineoplastic - antitumour antibiotic. Binds DNA and inhibits both DNA and RNA synthesis via inhibition of RNA and DNA polymeraizses and topoisomerase II not cell phase specific, but most active in S-phase

Answer 15

- UCC/TCC and AGASAC - cardiac sparing/post max dose of doxorubicin - rescue lymphoma - mammary/renal adenocarcinoma - SCC - thyroid or prostate carcinoma - fibroid sarcoma

Answer 16

- myelosuppression | - infection

Answer 17

- Multiple myeloma

Answer 18

Alykylating agents: - melphalan - cyclophosphamide - Chlorambucil - meclorethamine (mustargen) - Ifosfamide covalent binding of alkyl groups to cellular macromolecules = > cross link DNA

Answer 19

Alykylating agent covalent binding of alkyl groups to cellular macromolecules = > cross link DNA

Answer 20

- Multiagent chemo for lymphoma - bone marrow abalation prior to BM transplantion - Sarcoma - Mammary carcinoma - metronomic chemo

Answer 21

Alykylating agents: - melphalan - cyclophosphamide - Chlorambucil - meclorethamine (mustargen) - Ifosfamide - CCNU - procarbazine - Dacarbazine (DTIC) - Streptozocin covalent binding of alkyl groups to cellular macromolecules = > cross link DNA

Answer 22

- sarcomas including feline injection site sarcoma

Answer 23

Alykylating agent + immunosuppressant covalent binding of alkyl groups to cellular macromolecules = > cross link DNA

Answer 24

- chronic lymphocytic leukaemia - T-cell lymphoma - Waldenstrom's macroglobulinaemia - Feline low grade/small cell GI lymphoma - metronomic chemo for bladder TCC - multiple myeloma - MCT - cutaneous plasmacytosis - Polycythemia vera - Ovarian adenocarcinoma. - HSA - immunosuppression for IBD, IMHA, non-erosive arthritis, immune med skin disease

Answer 25

Round tumours: - chronic lymphocytic leukaemia - T-cell lymphoma - Waldenstrom's macroglobulinaemia - Feline low grade/small cell GI lymphoma - multiple myeloma - MCT - cutaneous plasmacytosis - Polycythemia vera Other - metronomic chemo for bladder TCC - Ovarian adenocarcinoma. - HSA - immunosuppression for IBD, IMHA, non-erosive arthritis, immune med skin disease

Answer 26

Alykylating agent + immunosuppressant covalent binding of alkyl groups to cellular macromolecules = > cross link DNA

Answer 27

Nitrosourea - alkylating agent DNA-DNA or DNA to protein cross links.

Answer 28

Nitrosourea - alkylating agent Cell cycle non-specific DNA-DNA or DNA to protein cross links.

Answer 29

- CNS neoplasia - MCT - histocytic sarcoma - rescue lymphoma metronomic chemo

Answer 30

Nitrosourea - alkylating agent cell cycle non-specific DNA-DNA or DNA to protein cross links.

Answer 31

- insulinoma does have activity against gram +ve and gram -ve but cytotoxicity prevents this from being useful.

Answer 32

Alkylating agent methylates the O6 and N7 positions of guanine, thereby ceasing DNA replication elongation and causing DNA double-strand break not cell phase specific

Answer 33

- on own or + Dox or CCNU for relapsed lymphoproliferative disease - With dox +/- vinc for HSA - STS - Histiocytic sarcoma - melanoma

Answer 34

Alkylating agent inhibit protein, RNA, and DNA synthesis. Procarbazine is auto-oxidized into hydrogen peroxide, which may also directly damage DNA.

Answer 35

in combination therapy for lymphoma +/- relapse: - MOPP (mechlorethamine, vincristine, procarbazine, prednisone) - MPP (mechlorethamine, procarbazine, prednisone), - LOPP (lomustine, vincristine, procarbazine, prednisone), - BOPP (bendamustine, vincristine, procarbazine, prednisone)

Answer 36

Doxorubicin Mitoxantrone Actinomycin D Bleomycin DNA intercalation, interfering with topoisomerases, and other mechanisms. These drugs usually exhibit cross-resistance with others in their class and with drugs in some other classes, particularly mitotic inhibitors, and they are substrates for the multidrug resistance (MDR) pump

Answer 37

Antitumour antibiotic Inhibition of DNA synthesis, DNA-dependent RNA synthesis, and protein synthesis by inhibiting DNA and RNA polymerases and impairing topoisomerase II, as well as through generation of free radicals Doxorubicin alters transcription and replication by intercalating with DNA base pair

Answer 38

- lymphoma - HSA - OSA - histiocytic sarcoma - feline injection site sarcoma - mammary carcinoma - Thryoid carcinoma - Colonic adenocarcinoma

Answer 39

- anaphalaxis - extravasation (cold compress + dexrazonaxane) - cardiotoxicity with both acute and cumulative exposure => transient arrhythmia and DCM => CHF - nephrotoxicity in cats.

Answer 40

Antitumour antibiotic Bind DNA => inhibit transcription this inhibiting RNA and protien synthesis

Answer 41

Mulitagne protocol for dogs with lymphoma/lymphoprolif disease as relapse or dox substitute - bone and STS - Carcinomas - Gram +ve and gram -ve bacteria = some fungi - some immunosuppressant - some hypocalcaemic activity.

Answer 42

Bleomycin has both a DNA binding site and a site that binds to the ferrous form of iron. By serving as an electron acceptor from the ferrous ion to an oxygen atom in the DNA strand, bleomycin cleaves DNA and causes cellular apoptosis. Resistance to bleomycin can result from reduced cellular uptake of the drug, reduced ability to damage DNA, increased rates of DNA repair by the cell and drug inactivation by the enzyme bleomycin hydrolase

Answer 43

``` lymphomas, oral squamous cell carcinomas, teratomas, nonfunctional thyroid tumors acanthomatous ameloblastoma ``` may be used intralesional +/= electrophemealization. gram-negative and gram-positive bacteria and some fungi; however, its cytotoxicity to eukaryote cells prevents it from being clinically useful as an antimicrobial drug.

Answer 44

- Cytosine arabinoside - Methotrxate - Gemcitabine - 5-Fluorouracil - Rabacfosadine inhibit the use of cellular metabolities in the course of cell growth and division.

Answer 45

Antimetabolite and immunosuppressant. Competes with deoxycytidine triphosphate to inhibit DNA polymerase, resulting in inhibition of DNA synthesis. Specific to the S phase of the cell cycle (DNA synthesis) and blocks cell progress from the G1 phase to the S phase.

Answer 46

rescue lymphoma in DMAC protocol (dexamethasone, melphalan, actinomycin-D, Ara-C) lymphoreticular neoplasia leukaemia CNS lymphoma MUO

Answer 47

- DMAC: dexamethasone, melphalan, actinomycin-D, Ara-C) - MOPP: (mechlorethamine, vincristine, procarbazine, prednisone) - MPP: (mechlorethamine, procarbazine, prednisone), - LOPP: (lomustine, vincristine, procarbazine, prednisone), - BOPP: (bendamustine, vincristine, procarbazine, prednisone) - CHOP: (cyclophosphamide, doxo, vinc, pred) - COP: (cyclophosphamide, vinc, pred)

Answer 48

Antimetabolite folate analog that inhibits the enzyme dihydrofolate reductase, thus depleting reduced folate pools required for purine and thymidylate biosyn-thesis

Answer 49

rarely used. used to be for lymphoprolif neoplasia in multi agent protocols. Some immunosuppressant effect but limited.

Answer 50

Antimetabolite chemo inhibition of DNA synthesis through incorperationi into the DNA strand => inhibition of DNA polymerase => new DNA strand termination S-phase killing cells undergoing DNA synthesis and inhibiting cell progression to GA/S boundary

Answer 51

- radiosensitizer but not well tolerated. - with piroxicam in TCC no benefit noted in lymphoma, OSA, mammary carcinoma or hepatocellyar carinoma.

Answer 52

Antimetabolite chemo incorporated into RNA and DNA interfering with synthesis and function. The 5-FU metabolite FdUMP is an inhibitor of thymidylate synthetase, leading to depletion of thymidine 5′-monophosphate and thymidine 5′-triphosphate. The alterations in thymidine and deoxyuridine phosphate pools caused by thymidylate synthetase inhibition, effects on DNA synthesis and integrity, and effects on RNA synthesis and processing

Answer 53

- organ epithelial cell tumours - hepatic, pancreatic, renal, mammary + - GIT adenocarcinoma - AGASAC - nasal adenocarcionma - solar induced SCC - mammary tumours (+ doxo and cyclophosphamide) *** NOT CATS***

Answer 54

Antimetabolite chemo - guanine nucleotide analog => potent, chain-terminating inhibitor of the major deoxyribonucleic acid (DNA) polymerases inhibits proliferation of mitogen-stimulated lymphocytes and lymphoma/leukemia cell lines Inhibit DNA synthesis => S-phase arrest and apoptosis

Answer 55

single agent for - cutaneous T- cell, - relapsed B-cell, - multiple myeloma + dox => multicentric lymphoma (dog)

Answer 56

Paclitaxel Docetaxel Part of the vinc alkaloids interference with the polymerization or depolymerization of the microtubules that play critical roles in cell function and division => chromosome segregation during mitosis, leading to mitotic arrest.

Answer 57

Antimicrotuble agents. part of vinc alkaloids alteration in microtubule function causes an abnormal organization of spindle microtubules involved in chromosome segregation during mitosis, leading to mitotic arrest.

Answer 58

Mammary carcinoma | SCC

Answer 59

- vinblastine - vincristine - vindesine - vinorelbine bind to a distinct site on tubulin and inhibit microtubule assembly. This inhibition of microtubule function leads to a disruption in the mitotic spindle apparatus resulting in metaphase arrest and cytotoxicity.

Answer 60

Vinc alkaloid - antimicrotubule chemo bind to a distinct site on tubulin and inhibit microtubule assembly. This inhibition of microtubule function leads to a disruption in the mitotic spindle apparatus resulting in metaphase arrest and cytotoxicity.

Answer 61

- lymphoma rescue or instead of vinc if significant GI adverse effects - Carcinoma - MCT - splenic tumours - UCC/TCC

Answer 62

Vinc alkaloid - antimicrotubule chemo bind to b- tubulin and inhibit microtubule assembly. This inhibition of microtubule function leads to a disruption in the mitotic spindle apparatus resulting in metaphase arrest and cytotoxicity. + amino acid metabolism interference => purine synthesis CAC and urea formation

Answer 63

lymphoma/haematopoietic neoplasia (CHOP/COP) - however cats had less side effects with vinblastine so may use this instead of vinc for CHOP HSA - transmissible veneral tumours. some immuno suppressant activity + induces thrombocytosis => IMT

Answer 64

Vinc alkaloid - antimicrotubule chemo bind to b- tubulin and inhibit microtubule assembly. This inhibition of microtubule function leads to a disruption in the mitotic spindle apparatus resulting in metaphase arrest and cytotoxicity. + amino acid metabolism interference => purine synthesis CAC and urea formation

Answer 65

- bronchoalveolar or primary pulmonary carcinoma - histiocytic sarcoma - MCT - palliative rescue for TCC

Answer 66

Carboplatin Cisplatin (not in cats) Covalent binding of DNA through displacement reaction resulting in bifunctional lesion and inter or intrastrand crosslinks.

Answer 67

Sarcomas: - OSA melanoma Carcinomas: - SCC - AGASAC - intestinal - prostatic - mesothelioma - carcinomatosis - pulmonary - nasal - ovarian Radiation sensitization.

Answer 68

NOT CATS generally use carbo instead as less side effects. ``` OSA SCC TCC ovarian cacinoma nasal carcinoma Thyroid adenocarcinoma ``` intracavitary for neoplastic pulmonray effusion clsplatin impregnated beads for intralesional treatment with electrochemotherapy for MCT, sarcomas and injection site sarcoma in cats (injected into margins not given systemically).

Answer 69

intra- and interstrand DNA cross-linking that causes single- and double-stranded DNA breakage, impairs DNA replication, RNA transcription and protein synthesis, leading to cell death and inhibition of tumor growth

Answer 70

Antineoplastic interfere with DNA synthesis without interfering with RNA or protein synthesis S phase inhibitor and nay arrest cekks at G1-S border

Answer 71

- bone marrow disorders: - polycythaemia vera - granulocytic leukaemia - MCT - meningioma

Answer 72

anti-neoplastic depletion of circulating l-asparagine leads to inhibition of protein synthesis in tumor cells lacking l-asparagine synthetase, causing induction of apoptosis most effective in the post mitotic G1 cell phase.

Answer 73

initial induction or at relapse of lymphoprolif disorders. develops resistance.

Answer 74

Toceranib mastinib imatinib mesylate small-molecule inhibitors that block, receptor tyrosine kinases (RTKs) expressed on the cell surface by acting as competitive inhibitors of adenosine triphosphate (ATP) binding + anti-angiogenic effect through inhibition of VEGFR and PDGFR + KIt (Stem cell growth factor) induce cell cycle arrest and apoptosis in canine tumor cell lines expressing activating mutations in KIT.

Answer 75

Patniak grade II or III, recurrent cutaneous MCT +- regional LN mets. ``` - heart base tumours sarcoma - carcinoma - melaonma - multidrug resistant lymphoma - multiple mylepma ```

Answer 76

Class - glucocorticoid. induce killing of hematopoietic cancer cells through interaction with the glucocorticoid receptor328 and the induction of apoptosis.3

Answer 77

1) replacement or supplementation (eg, relative adrenal insufficiency associated with septic shock) for glucocorticoid deficiency secondary to hypoadrenocorticism, 2) anti-inflammatory agent, 3) immunosuppression, 4) antineoplastic agent

Answer 78

Cardiovascular system: - reduce capillary permeability and enhance vasoconstriction, increased blood volume=>increased blood pressure. Cells: inhibit fibroblast proliferation, macrophage response to migration inhibiting factor, sensitization of lymphocytes, and the cellular response to mediators of inflammation CNS: lower the seizure threshold, alter mood and behavior, diminish response to pyrogens, stimulate appetite, and maintain α-rhythm. Endocrine: - suppress the release of corticotropin (ACTH) - reduces release of TSH, FSH, prolactin, and LH + T3-T4 - increased PTH - reduce ADH effect on renal tubules => diuresis - inhibit osteoblast function. - inhibit insulin binding to insulin-receptors and the post-receptor effects of insulin. Fluid and electrolyte balance: - increase renal K+/Ca++ loss and NaCl reabsorption => increase ECF GI tract and hepatic system: - increase the secretion of gastric acid, pepsin, and trypsin. They alter the structure of mucin and decrease mucosal cell proliferation. - reduce Fe and Ca++ absorbed - increase fat absorbed. Hepatic: increased fat and glycogen deposits in hepatocytes and increased (ALT), (GGT) and (ALP). Hematopoietic system: - increase circ PLT, neutrophils, and RBCs, but platelet aggregation is inhibited. - Decreased amounts of lymphocytes (peripheral), monocytes, and eosinophils due to sequester these cells into the lungs and spleen - involution of lymphoid tissue. - inhibit neutrophil, macrophage, and monocyte migration; reduce production of interferon; and inhibit phagocytosis, chemotaxis, antigen processing, and intracellular killing. - antagonize the complement cascade - MCT reduced and histamine synthesis is suppressed. Metabolic effects: Glucocorticoids stimulate gluconeogenesis. Lipogenesis is enhanced in certain areas of the body (eg, abdomen), and adipose tissue can be redistributed away from the extremities to the trunk. Fatty acids are mobilized from tissues and their oxidation is increased. Plasma levels of triglycerides, cholesterol, and glycerol are increased. Protein is mobilized from most areas of the body (not the liver). Musculoskeletal: muscular weakness, atrophy, and osteoporosis. inhibited bone growth via growth hormone and somatomedin inhibition, increased calcium excretion, and inhibition of vitamin D activation. Resorption of bone can be enhanced. Fibrocartilage growth is also inhibited. Skin: Thinning and skin atrophy. Hair follicles can become distended and alopecia may occur.

Answer 79

Beta adrenergic blocker - relatively specific for B1 - Minimal B2 at recommended doses.

Answer 80

- ventricular hypertrophy - tachyarrhythmia including SVT, VPCs - HCM/OHCM + mexiletine for ARVC +/- systemic arterial hypertension, HCM and aortic/pulmonary stenosis

Answer 81

- brady arrhythmias with caution in patients with: - CHF, CKD and sinus node dysfunction as is a negative ionotrope - DM as can causes hyper/hypoglycaemia or mask signs of hyperT4 or hypoglycaemia.

Answer 82

B1 selective: - atenolol - esmolol - metoprolol nonselective B blockers: - carvediol, - propranolol - sotolol

Answer 83

Negative ionotrope negative chronotrope => reduced HR + slow AV conduction => reduced CO, BP and myocardial O2 demands.

Answer 84

bronchospasm | peripheral vasodilation => hypotension.

Answer 85

``` ultrashort acting Beta (1) blocker - class II antiarrhythmic. - neg ionotroph and chronotrope => reduce HR, work , CO and BP ``` increases sinus cycle length, slow av node conduction and prolongs sinus recovery time. For: - SVT - to see if Beta blocker therapy is needed - under GA and risk of hypertension. - hyperdynamic R vent outflow tract obstruction post balloon valvuloplasty for pulmonary valve stenosis.

Answer 86

- Overt CHF - second or 3rd degree AV blood - sinus bradycardia - cardiogenic shock - bronchoconstriction - DM

Answer 87

second generation, Beta 1 blocker used for: - SVT or Afib for rate control - VPC - systemic hypertension - HCM

Answer 88

- unstable/overt CHF - sensitive to beta blockers - second or third degree AV block - sinus bradycardia care in: - liver disease - bronchospasm - less than propranolol so used more. - CHF - hyperT4 - DM - sinus node dysfunction

Answer 89

nonselective B blocker selective alpha 1 blocker negative ionotrope Class II antiarrhythmic used fro : - DCM to attenuate pacing induced DCM - reduce Afib induction

Answer 90

- unstable/overt CHF - bronchial asthma - sensitive to beta blockers - second or third degree AV block - sick sinus syndrome (unless paced) - sinus bradycardia/severe brady cardia - cardiogenic shock

Answer 91

nonspecific B blocker selective alpha 1 blocker negative ionotrope Class II antiarrhythmic used fro : - short term management of thyrotoxicosis or phaeo - hypertension - B2 agonist toxicity (albuterol/terbutaline) generally use other ones

Answer 92

- unstable/overt CHF (unless secondary to tachyarrhythmia responsive to B blocker) - bronchial asthma - sensitive to beta blockers - second or third degree AV block - sick sinus syndrome (unless paced) - sinus bradycardia/severe bradycardia care in: - liver/renal disease - digitalis toxicity - DM - first degree AV blocks - sinus node dysfunction

Answer 93

``` Non selective B blocker Potassium channel blocker (class III antiarrhythmic) - prolongs repolarization and refractoriness without affecting conduction ``` used for: - long term oral management of ventricular tachycardia +/- mexiletine including ARVC, german shep with inherited arrhythmia and ventricular tachycardia that is refractory to IV antiarrhythmics. - supraventricular tachycardia inc accessory pathway mediated reciprocating tachycardia, atrial-flutter and a cat with SVT

Answer 94

- unstable/overt CHF (unless secondary to tachyarrhythmia responsive to B blocker) - bronchial asthma - sensitive to beta blockers - second or third degree AV block - sick sinus syndrome (unless paced) - sinus bradycardia/severe bradycardia - hypokalaemic bradycardia - long QT syndrome - cardiogenic shock care in: - liver/renal disease - digitalis toxicity - DM - first degree AV blocks - sinus node dysfunction

Answer 95

Class III antiarrhythmic (K+ channel inhibitor) + blocks Na+ and Ca++ channels + block B adrenergic receptors. => prolongs myocardial AP duration and refractory period. only used when less toxic compounds not available. - Cardioversion from Afib to sinus rhythm - refractory arrhythmia wiht systolic dysfucntion. + itraconazole => treat trypanosoma cruzi (Chagas) due to disruption of calcium homeostasis, sterol production, and blockade of the protease cruzipain

Answer 96

- unstable/overt CHF - second or third degree AV block - sick sinus syndrome - sinus bradycardia/severe bradycardia esp if syncope - cardiogenic shock - iodine sensitivity Care with thyroid disease - can cause hyper or hypothyroidism can cause histamine reactions, pulmonary fibrosis, corneal deposits, thrombocytopenis, hepatotoxic, coombs +ve

Answer 97

Class 1a antiarrhythmic Procainamide prolongs the refractory times in both the atria and ventricles, decreases myocardial excitability, and depresses automaticity and conduction velocity - negative inotrope but CO maintained. - some anticholinergic effects Used for - SVT with wide QRS complex - A-fib - VPC - V-tach - tachycardias that cannot be confirmed to be supraventricular or ventricular in origin due to wide QRS.

Answer 98

- myasthenia gravis - hypersensitivity - torsade de pointes - 2nd or 3rd degree AV block (unlesss paced) with caution in dogs with - cardiac glycoside intoxication - hepatic/renal disease - CHF - DCM - subaortic stenosis - patients susceptible to tachyarrhythmic -induced sudden death. - SLE?

Answer 99

K+ sparing diuretic - distal renal tubule, triamterene inhibits the reabsorption of sodium in exchange for hydrogen and potassium ions - doesn't competitively inhibit aldosterone - increases excretion of sodium, calcium, magnesium, and bicarbonate; urinary pH may be slightly increased. - Serum concentrations of potassium and chloride may be increased alternative to spironolactone infrequently used

Answer 100

- anuria - severe progressive renal disease - severe hepatic diseas - hypersensitivity - pre-exisiting hyperkalaemia - concurrent therapy with another potassium sparing agent - potassium supplementation.

Answer 101

K+ sparing diuretic - blocks epithelial sodium channel the late distal tubule, connecting tubule and collecting duct => reduced absorption of Na+ and reduced excretion of K+ alternative to spironolactone.

Answer 102

- acts through at least 5 different receptors (3 subtypes: V1, V2, V3; the oxytocin receptor; and the purinergic P2 receptor) to maintain serum osmolality. - V2 receptors, vasopressin promotes the renal reabsorption of solute-free water in the distal convoluted tubules and collecting duct - vasopressin V1 receptor stimulation and blockade of K+ -sensitive ATP channels can cause smooth muscle contraction = > vasoconstriction of capillaries and small arterioles in particular => decreased blood flow.

Answer 103

- diagnostics as part of water depreviation test. - treatment for central DI - CPR - can improve myocardial perfusion with no pulse. - increase BP SIRS/sepsis associated hypotension.

Answer 104

- vascular disease - seizure disorders - heart failure - asthma * * extravasation necrosis possible.

Answer 105

Similar to vasopressin but more antidiuretic and less vasopressor properties. + dose depending increase in vWF and factor VIII

Answer 106

- Diagnosis and treatment of central DI - peroperatively in dogs with type 1 vWF diseases to increase vWF - surgical adjunct to reduce LN involvement and mets of canine mammary carcinoma (controversoal)

Answer 107

- Hypersensitivity to it - nephrogenic DI - hyponaturaemia - Type IIb (=> PLT aggregation and thrombocytopenia) , type III (not efffective) or platelet-type (pseudo) vWF disease

Answer 108

- Sulfonylurea + antidiabetic agent. - antidiuretic activity: potentiating vasopressin’s effects on the renal tubules =/- increased ADH secretion - lowers BG but not sure how maybe by stimulating the beta cells in the pancreas to secrete additional endogenous insulin + increased peripheral sensitivity to insulin

Answer 109

Diabetes insipidus with partial ADH deficiency | possible DM?

Answer 110

- severe burns/trauma/infection - hypoglycaemia or diabetic coma - ketosis/ketoacidosis/other acidic condistion with care: - adrenal/pituitary insufficiency - thyroid, cardia, renal, hepatic function impairment. - fluid retention.

Answer 111

Selective, competitive ADH V2 antagonist | used to treat hyponatraemia assoc with CHD, cirrhosis and SIADH

Answer 112

Hormone - hypo-pituitary dwarfism - growth hormone responsive dermatosis/alopecia X

Answer 113

hypersenstivity to it | can cause DM and acromegaly.

Answer 114

Synthetic progrestin * adverse effects - consider others first - sexually dimorphic behaviour problems including roaming, inter-male aggression, spraying, mounting etc when castration is not effective/possible - feline psychogenic dermatitis - alopecia X - young german shepard dwarfs - short term treatment of benign prostatic hypertrophy

Answer 115

- puberty - pregnancy - pseudo pregnancy - dioestrus - prolonged cycle unless cystic ovarian disease is confirmed nad surgery, gnrh or hCG are not options - DM

Answer 116

Synthetic T4 Treatment of hypothryoidism

Answer 117

- acute myocardial infarction - thyrotoxicosis - untreated adrenal insufficiency (hypoA) care/lower dose with: - cardiac disease - DM - treated hypoA - geriatrics

Answer 118

Long acting stomatostatin analog - inhib synthesis and secretion of insulin, glucagon, secretin, GH, gastrin and motilin. used for: - gastrinoma - management of hyperinsulinaemia with insulinoma Not effective at reducing GH levels or enhancing insulin sensitivity in cats with acromegaly Use with caution in billary tract disorders.

Answer 119

Multireceptor ligand stomatostatin (growth hormone inhibitory hormone) analogue decreases IGF-1 and improves insulin sensitivity in cats

Answer 120

Ergot alkaloid-derived dopamine (D2) receptor agonist - Direct inhibitory effect on the secretion of prolactin from the anterior pituitary gland. - induces estrus by dopamine agonist effects on GnRH secretion rather than its effects on prolactin.

Answer 121

- pyometra - inducing and synchronizing oestrus - Primary or secondary anoestrus - Mastitis - Pseudopregnancy - pregnancy termination in the second half of pregnancy - prior to mammary tumour surgery - reduce post-spay aggression when spay occurs in the luteal phase.

Answer 122

- during pregnancy (unless a termination is wanted) - hypertension - hypersensitivity to it or bromocriptine - pregnant women or hepatic disease.

Answer 123

Monoamine oxidase inhibitor For hyperA: In the hypothalamus, corticotropin-releasing hormone (CRH) acts to stimulate the production of ACTH in the pituitary, and dopamine acts to inhibit the release of ACTH. As dogs age, there is a tendency for a decrease in dopamine production that can contribute to the development of PDH - dopamine is metabolized by monoamine oxidase-B (MAO-B) and selegiline irreversibly inhibits MAO-B, dopamine concentrations can be increased at receptor sites after selegiline administration.5 In theory, this allows the concentration of dopamine and CRH to be in balance in the hypothalamus, thereby reducing the amount of ACTH produced and, ultimately, cortisol

Answer 124

- Canine cognitive dysfunction - chronic anxiety or noise phobisa (+benzo or B-blocker) - maybe pituitary dependant hyperA but not really effective.

Answer 125

- HyperA that is not pituitary dependant - aggression - with some drugs => Serotonin syndrome

Answer 126

Monoamine oxidase inhibitors: - selegiline - amitraz - linezolid - methylene blue - SSRis inc fluoxetine - tricyclic antidespressants - clomipramine, amitryptyline - opioids - mirtazapine - tramadol - trazodone

Answer 127

Progesterone receptor antagonist - Synthetic steroid that competitively antagonizes progesterone at the P4 progesterone receptor - Progesterone is necessary for maintaining pregnancy, thus aglepristone binding to P4 receptors of the uterus, terminates pregnancy or induces parturition for pyometra => pening of the cervix and resumption of myometrial contractility Also binds to glucocorticoid receptors but without glucocorticoid activity

Answer 128

- pregnancy temination (+/- additional medication for cats) - induce partuition - pyometra - mammary hyperplasia in cats

Answer 129

During pregnancy unless for termination or induction of parturition. - unwell, Dm or liver/renal disease - hypoA - COPD or CV disease esp bacterial endocarditis.

Answer 130

- Carbimazole is the prodrug of methimazole - inhibits thyroid peroxidase and interferes with iodine incorporation into tyrosyl residues of thyroglobulin, thereby inhibiting thyroid hormone synthesis. - inhibits iodinated tyrosyl residues from coupling to form iodothyronine - doesn't effect already circ thyroid hormones Has antiVitamine K activity => increased risk of bleeding

Answer 131

- treatment of feline hyperthyroidism

Answer 132

- Hypersensitive to methimazole or carbimazole or PEG - autoimmune disease - primary liver disease - renal failure - haematological disorders or coagulopathies - DM

Answer 133

PTU inhibits the enzyme thyroperoxidase, which facilitating iodine's addition to tyrosine residues on the hormone precursor thyroglobulin, thus preventing Tg synthesis Also inhibits enzyme 5'-deiodinase (tetraiodothyronine 5' deiodinase), which converts T4 to the more active form T3 (methimazole doesn't do this) more side effects so not used any more.

Answer 134

1. Regular crystaline - IV - IM 4-6h - SC 6-8h 2. Lispro - IV 3. NPH/humulin - 6-12h 4. Lente/caninsulin - 8-14h 5. PZI - 10-16h 6. Glargine 8-16h 7. Detemir 8-16h

Answer 135

1. Regular crystaline - IV - IM 4-6h - SC 6-8h 2. Lispro - IV 3. NPH/humulin - 6-10h 4. Lente/caninsulin - 8-12h 5. PZI - 10-14h 6. Glargine 8-16h 7. Detemir 8-16h

Answer 136

If they are poorly controlled with a shorter acting insulin as PZI has a longer duration of effect.

Answer 137

If NPH/Humulin or Lente/Caninsulin have too short a duration of effect If detemir has too long a duration of effect Can be considered first line but generally not.

Answer 138

Glargine or maybe PZI | Lente/NPH often have too short duration of effect for q12h dosing

Answer 139

IV insulin such as regular crystaline or Lispro

Answer 140

long acting, higher dose glargine insulin | useful for difficult to manage or acromegalic diabetic cats.

Answer 141

Antidiabetic drug class. - lowers blood glucose concentrations in both diabetic and nondiabetic patients. - stimulate beta cells in the pancreas to secrete additional endogenous insulin + increase peripheral sensitivity to insulin and reduce the production of hepatic basal glucose.

Answer 142

Chlorpropamide Glimepiride Glipizide

Answer 143

sulfonylurea antidiabetic drug that increase existing pancreatic beta cell function and improves insulin sensitivity used in cats with type II diabetes provided there is existing beta cell function present. generally still recommended to use insulin concurrently or initially not in hypoglycaemia, DKA or other ketosis.

Answer 144

medium to long acting secretagogue sulfonylurea antidiabetic drug that increase existing pancreatic beta cell function and improves insulin sensitivity used in cats with type II diabetes (non-insulin dependent DM) provided there is existing beta cell function present. Less side effects than glipizide, generally still recommended to use insulin concurrently or initially not in hypoglycaemia, DKA or other ketosis or allergic to sulphonamides

Answer 145

sulfonylurea antidiabetic drug that increase existing pancreatic beta cell function and improves insulin sensitivity => used in cats with type II diabetes provided there is existing beta cell function present. + also has antidiuretic activity => potentiates ADH effects on renal tubules and may stimulate ADH release => for Diabetes insipidus

Answer 146

Anti-hyperglycaemia - increases insulin’s peripheral ability for cells to uptake glucose - decreases hepatic glucose production, - decrease intestinal absorption of glucose. does not stimulate insulin production or release from the pancreas and, therefore, does not cause hypoglycemia. Used in type II/non-insulin dependent DM, predominantly in cats but could also be used in dogs. not with iodinated contrast or acidosis

Answer 147

oral antidiabetic drugs. - Competitively inhibits pancreatic α-amylase and α-glucosidases found in the small intestine. => delays digestion of complex carbohydrates => glucose absorbed in lesser amounts lower in the GI tract. => decreases blood glucose and insulin requirements during the postprandial hyperglycemic phase may be used in non-insulin dependant DM (predom cats + dogs) +/- in Insulin dependent DM (type 1) as an adjunct treatment +/- used when insulin activity peaks too soon.

Answer 148

- glucagon-like peptide-1 (GLP-1)–receptor agonist, - incretin mimetic - increases glucose-dependent insulin synthesis and secretion, - increases pancreatic endocrine β-cell proliferation and survival, - inhibits glucagon secretion (without impeding glucagon secretion in response to hypoglycemia). - improves insulin sensitivity in muscles - reduces hepatic gluconeogenesis. requires adequate mass of functional pancreatic endocrine β cells.

Answer 149

Adjunctive treatment of uncomplicated DM in cats, esp newly diagnosed with glargine insulin

Answer 150

- DKA - monotherapy for type 1 DM - pancreatitis due to exenatide - drug induced IMT due to exenatide - hypersensitivity, - severe GI disease, - severe or end-stage renal disease, - medullary thyroid carcinoma, - multiple endocrine neoplasia syndrome type 2

Answer 151

Exenatide Liraglutide Activate GLP-1 receptors in the pancreas, which leads to enhanced insulin release and reduced glucagon release-responses that are both glucose-dependent-with a consequent low risk for hypoglycemia - increases glucose-dependent insulin synthesis and secretion, - increases pancreatic endocrine β-cell proliferation and survival, - inhibits glucagon secretion (without impeding glucagon secretion in response to hypoglycemia). - improves insulin sensitivity in muscles - reduces hepatic gluconeogenesis.

Answer 152

Direct vasodilator/hyperglycaemic vasodilatory effect on the smooth muscle in peripheral arterioles + reduces peripheral resistance and blood pressure. hyperglycemic: - inhibiting pancreatic insulin secretion, (decrease the intracellular release of ionized calcium, thus preventing release of insulin from beta cell insulin granules) - stimulating hepatic gluconeogenesis and glycogenolysis - stimulating the beta-adrenergic system to cause epinephrine release and inhibit tissue use of glucose.

Answer 153

hypoglycaemia secondary to hyperinsulin secretion (insulinoma) if refractory to pred and diet managment

Answer 154

functional hypoglycaemia hypoglycaemia secondary to insulin overdose Can cause Na++ and H2O retention - use with care

Answer 155

Anticonvulsant and anti-dysrhythmic Anticonvulsant actions: caused by the promotion of sodium efflux from neurons, thereby inhibiting the spread of seizure activity in the motor cortex. Antiarrhythmic - Group 1B: depresses phase 0 slightly and can shorten the action potential. Its principle cardiac use is in the treatment of digitalis-induced ventricular arrhythmias. - can inhibit insulin and vasopressin (ADH) secretion

Answer 156

Digoxin induced ventricular arrhythmia | not really used as an antiarrhythmic

Answer 157

- Cats - 2nd or 3rd degree heart block, - Sinoatrial block, - Adams-Stokes syndrome, - sinus bradycardia.

Answer 158

Adrenal Steroid Synthesis Inhibitor - competitive inhibitor of 3-β hydroxysteroid dehydrogenase - reduces synthesis of cortisol, aldosterone, and adrenal androgens. Inhibition is reversible and apparently dose dependent

Answer 159

- pituitary dependent hyperA - Adrenal dependant hyperA - Alopecia x dogs and cats

Answer 160

- hypoadrenocorticism care with - liver/renal disease - anaemia

Answer 161

Antineoplastic severe, progressive necrosis of the zona fasciculata and zona reticularis. adrenal cytotoxic agent, it apparently can also inhibit adrenocortical function without causing cell destruction Mostly spares zona glomerularis so generally aldosterone secretion is not significantly affected

Answer 162

- pituitary dependent hyperA | - palliative treatment of adrenal carcinoma

Answer 163

- cats - sick patients - addison's - patients without clinical and lab findings of pituitary dependent hyperA. care with - liver/renal disease - DM - potential for hypoA

Answer 164

imidazole antifungal - generally fungistatic but can be fungicidal inhibits a fungal cytochrome P450-dependent demethylation enzyme that produces ergosterol in the cell membrane Anti-inflam by inhibition of 5-lipooxygenase Suppress T-lymphocyte proliferation inhib Vit D activation steroid synthesis inc testosterone and cortisol is directly inhibited by blocking several P450 enzyme systems

Answer 165

``` Others usually recommended but Antifungal for: - Blastomyces dermatitidis, - Coccidioides immitis, - Cryptococcus neoformans, - Histoplasma capsulatum, - Microsporum spp, - Trichophyton spp. + higher doses for Aspergillus spp and Sporothrix ``` Historically for hyperA and prostatic carcinoma Reduce cost of other drugs that req CYP450 inc cyclosporine.

Answer 166

- Cats - hypersensitivity - liver disease - thrombocytopenia - stressful events - care with other drugs associated with CYP450 metabolism

Answer 167

Dopamine agonist/prolactin inhibitor. use cabergoline now. - acromgealy in cats - oestrus induction in dogs - treatment of pseudo pregnancy - pregnancy termination - pyometra

Answer 168

Pineal gland hormone

Answer 169

Hair loss: - alopecia X - canine pattern baldness - recurrent flank alopecia - post clipping alopecia - follicular disorders inc follicular dysplasia Brain assoc: - sleep cycle disorders - cognitive dysfunction - phobias and anxiety others: - idiopathic vaculolar hepatopathy - prologning interoestur period in queens - reversible reduction in sperm quantity and quality in male cats. * not for use in sexually immature animals.

Answer 170

Adrenal steroid inhibitor - inhibiting hydroxylation of 11-deoxycortisol to cortisol in the adrenal cortex. - suppress synthesis of aldosterone, and cause a mild natriuresis - ACTH production can increase as the negative feedback mechanism is inhibited but may be overridden in time.

Answer 171

- cats with hyperA prior to adrenalectomy + reduce insulin requirement. * need to monitor BGs

Answer 172

Cosyntropin is not as immunogenic as endogenous corticotropin (ACTH) due to difference in C-terminal. Both can be used for ACTH stim test but cosyntropin is more available. ACTH stimulates the adrenal cortex (principally the zona fasciculata) to stimulate the production and release of glucocorticoids/cortisol. ACTH release is controlled by corticotropin-releasing factor (CRF), activated in the hypothalamus via a negative feedback pathway, whereby either endogenous or exogenous glucocorticoids suppress ACTH release.

Answer 173

Mineralocorticoid + glucocorticoid Mineralocorticoids increase sodium reabsorption at the renal distal tubule and enhance potassium and hydrogen ion excretion in the collecting tubule

Answer 174

- systemic fungal infections risk of glaucoma/cataracts + immunosuppression Care with: - renal/cardiac disease (fluid retention + elyte imbalance + hypertension) - recent intestinal anastamosis, - GI ulcers - osteoporosis - Myasthenia gravis

Answer 175

DOCP - mineralocorticoid acts on the renal distal tubule, where it increases the reabsorption of sodium. Mineralocorticoids also enhance potassium and hydrogen ion excretion in the collecting tubules.

Answer 176

HypoA in dogs (limited info in cats) | more effective at reducing renin than fludrocortisone

Answer 177

- IV - hyperesensitivity to it - hypoA crisis that is not rehydrated - CHF - liver failure - oedema

Answer 178

Glucocorticoid with intermediate mineralocorticoid activity.

Answer 179

- Acute adrenal insufficiency/HypoA crisis | - critical illness assoc corticosteroid insufficiency

Answer 180

- systemic fungal infection unless used for replacement therapy for dogs with hypoA - idiopathic thrombocytopenia

Answer 181

- ACTH stim: do test before or 24h after last dose of hydrocortisone. * dex does not cross react - used for LDDST/HDDST - suppress TSH => reduced T3 and T4. - Reduces uptake of I131 - increase serum cholesterol + neuts - reudce serum potassium and lymphocytes.

Answer 182

- α-adrenergic Antagonist (nonselective), - Vasodilator - noncompetitively blocks the α-adrenergic response to circulating epinephrine or norepinephrine; - greater affinity for α1-receptors than α2-receptors. - increases cutaneous blood flow - block pupillary dilation, lid retraction, and nictitating membrane contraction

Answer 183

- urethral hypertonus - urethral obstrucion - hypertension associated with phaeo

Answer 184

- hypotension - glaucoma Caution with: - CHF/cardiac disease - renal disease - cerebral/coronary arteriosclerosis

Answer 185

Anti-hypertensive drug It inhibits the enzyme tyrosine hydroxylase and, therefore, catecholamine synthesis, => depletes the levels of the catecholamines dopamine, adrenaline and noradrenaline in the body. thus alleviate symptoms related to catecholamine excess, including hypertension, headache, tachycardia, constipation, and tremor - eg with pheochromocytoma.

Answer 186

IV bisphosphonate - inhibit bone resorption and do not inhibit bone mineralization via binding to hydroxyapatite crystals. - impede osteoclast activity, and induce osteoclast apoptosis

Answer 187

- hypercalcaemia inc - idiopathic, - assoc with malignancy - Vit D toxicicity - palliative pain management of osteolytic bone cancer

Answer 188

hypersensitivity to it, other bisphosphonates or mannitol care with reduced renal function, juvenile animals, healing bone fractures.

Answer 189

Osteoclast inhibiting hormone. - inhibiting osteoclastic bone resorption. - reduces tubular reabsorption thus increases excretion of calcium, phosphate, sodium, magnesium, potassium, and chloride, - increases jejunal secretion of water, sodium, potassium, and chloride (not calcium).

Answer 190

Control hypercalcaemia | pain that originates from the bone

Answer 191

Hypersensitivity - young animals - hypocalcaemia

Answer 192

Vit D3 analogue - enhance calcium absorption from the GI tract, - promote reabsorption of calcium by the renal tubules, - increase the rate of accretion and resorption of minerals in bone. Unlike other forms of vitamin D, calcitriol does not require renal activation for it to be effective.

Answer 193

+ oral calcium therapy for long term management of hypocalcaemia assoc with primary hypoPTH or secondary renal hypoPTH - CKD (dogs = survival benefit, cats = weak evidence) - MCT (may potentiate some chemo drugs) - refractory dermatopathies (primary idiopathic seborrhea)

Answer 194

- hypercalcaemia - vit D toxicity - sensitive to effects of Vit D - hyperphosphataemia (tissue mineralization) - CaOx urate producers - GIT disease with malabsorption.

Answer 195

Heavy metal chelator for lead and zinc toxicity. - The Calcium in CaEDTA can be displaced by divalent or trivalent metals to form a stable, water-soluble complex that is excreted in the urine (lead and zinc). - CaEDTA also binds cadmium, copper, iron, and manganese, but does not facilitate removal of those metals from the body. - CaEDTA is relatively ineffective for use in treating mercury, gold, or arsenic toxicities.

Answer 196

Bone resorption inhibitor - Binds to bone hydroxyapatite, inhibits osteoclast function and thereby reduces bone resorption. - promoting apoptosis and inhibiting osteoclastogenesis, angiogenesis, and cancer cell proliferation (in osteogenic tumours)

Answer 197

- refractory hypercalcemia inc idiopathic hyperCa++ - bone pain, - osteosarcoma treatment adjunct - feline tooth resorption

Answer 198

- hypocalcaemia - Upper GI effects inc oesophagitis/ulcers - query severe renal disease

Answer 199

Vit D2 req hydroxylation in liver to 25-hydroxyVit D, then activeted in kidneys to 1,25 -dihydroxyvit D - enhance calcium and phosphate absorption from the GI tract, - promote reabsorption of calcium by the renal tubules, - increase the rate of accretion and resorption of minerals in bone

Answer 200

Calcitriol recommended first | - hypocalcaemia assoc with hypoPTH (+ calcium)

Answer 201

- hypercalcemia, - vitamin D toxicity, - malabsorption syndrome, - abnormal sensitivity to the effects of vitamin D. * *hyperphosphatemia. - kidney dysfunction - may not be able to activate it.

Answer 202

Calcineurin inhibitor - selective immunosuppressant, primarily of CMI - binds to T-cell cyclophilin and blocks calcineurin-mediated T-cell activation. - inhibit cytokine production and release (including IL-2 and interferon-gamma => affect function of eosinophils, mast cells, granulocytes, and macrophages) - inhibit antigen-presenting functions of the dermal immune system. - increase thromboxane production.

Answer 203

- atopic dermatitis + other skin disease (eosinophilic, neutrophilic, ulcerative dermatosis of nose, alopecia areata etc) - perianal fistula/anal frunculosis off label: - IMHA + pure red cell aplasia (c) - IMT or thrombocytopenia purpura (c) - allograft transplant rejection - Chronic enteropathy/IBD - idiopathic chronic hepatitis - sebaceous adenitits - steroild nodular paniculitis - sterile granuloma/pyogranuloma complex, - refractory cases of juvenile sterile granulomatous dermatitis and lymphadenitis (ie, juvenile cellulitis) - vasculitis, - reactive histiocytic disorders, - pemphigus foliaceus (controversial results), - lupus erythematosus complex, - MUO - erythema multiforme, - uveodermatologic syndrome - chronic stomatitis (c) - feline asthma

Answer 204

- neoplasia - FIV/FeLV Caution: - infectious disease (only if benefit outweighs risk) - DM - renal disease - toxo - MDR1/ABCB1-1delta mutation? - Vaccination - reduced response = used killed.

Answer 205

selective Immunomodulator/immunosuppressant Pyramidine synthesis inhibitor - inhibits autoimmune T-cell proliferation and autoantibody production by B cell - prevents formation of (rUMP), => decreased DNA and RNA synthesis, inhibition of cell proliferation, and G1 cell cycle arrest primarily in lymphocytes - antiviral - tyrosine kinase inhibiting properties, - antiplatelet effect

Answer 206

- IMHA - IMT - Evans - pancytopenia - IMPA and rheumatoid arthritis - IBD/CE - systemic and cutaneous reactive histiocytosis - GME - vasculitis - transplant rejection

Answer 207

- hypersensitivity - liver/renal care with: - severe immunodeficiency - bone marrow dysplasia - active infection - with other immunosuppressants or durgs known to be hepatotoxic.

Answer 208

IVIG: "rapid" Pred: up to 1-2 weeks. generally reported less than 1 week Mycophenolate: 2 days to 2 weeks. Cyclosporine: 3-7 days. reported up to 2 weeks Leflunomide: 1-3 weeks Azathioprine: lag period of 1 week. up to 3-5 weeks for clinical immunosuppression

Answer 209

- Cyclosporine - mycophenolate - azathioprine INI with these - use leflunomide or IVIG (salvage option)

Answer 210

Immune serum B-cells produce IG, thus IVIG Abs act to: - antimicrobial or antitoxin neutralization - anti-idiotypic antibodies that neutralize autoantibodies; - negative feedback and down-regulation of antibody production; binding to CD5, IL-1a, IL-6, TNF-alpha, and T-cell receptors; - suppressing pathogenic cytokines and phagocytes.

Answer 211

Canine only - IMHA - IMT - Evans - Immune med dermatopathies (erythema multiforme, Steven-Johnson syndrome, toxic epidermal necrolysis, other cutaneous drug reactions) Not used as a first line - only in refractory.

Answer 212

- cats - prior hypersensitivity to human albumin Risks: - hypercoag state (eg IMHA) - renal dysfunction, AKI, osmotic nephrosis - increase BP - local reaction - Vol overload - anaphalaxis

Answer 213

Selective immunosuppressant (IMPDH inhibitor) => inhibits guanosine synthesis (purine) - noncompetitively, but reversibly, inhibits inosine monophosphate dehydrogenase (IMPDH) (Esp type 2 in activated lymphocytes) - lack of guanosine => proliferation of B and T cells is inhibited. + suppress Ab formation => inhibition of both CMI and humoral immune response

Answer 214

Dog +/- cats? - IMHA (D+C) - Aplastic anaemia - IMT - glomerulonephritis - myathenia gravis - MUO - pemphigus foliaceous/immune med skin disease

Answer 215

- SARDs (not effective) - maybe IBD due to GIT side effects - renal dysfunction care: - lymphoma - serious infections. - pappilomatosis

Answer 216

Non-specific immunosuppression. Purine antagonist - antagonizes purine metabolism => breaks in DNA and RNA => termination of the replication process. Cellular metabolism may become disrupted by the drug’s ability to inhibit coenzyme formation. - interferes with CD28 costimulation of T lymphocytes by converting the costimulatory signal from CD28 to trigger apoptosis - greater activity on delayed hypersensitivity and cellular immunity than on humoral antibody responses. - Clinical response to azathioprine may not be observed for up to 5 weeks.

Answer 217

used in combo with pred. - no large scale studies on its use - IMHA - other autoimmune diseases + cyclosporine to prevent renal allograft rejection in dogs

Answer 218

- cats (myelosuppression) - hypersensitivity, renal/liver disease => increased risk of infection or neoplasia

Answer 219

Antifungal - metabolite competes with uracil => interfere with pyrimidine metabolism => prevent RNA and protein synthesis. + inhibits thymidylate synthesis => inhibits DNA synthesis.

Answer 220

Cryptococcus Candida penetrates CNS - must be used with other antifungals as develops resistance quickly. - synergistic with amphotericin B

Answer 221

Must use with another antifungal as will develop resistance rapidly on own. Use extreme caution in: - dogs (drug assoc skin disease) - renal impairment - pre-exisiting BM depression - haematological diseases - those recieving bone marrow suppressants

Answer 222

``` Systemic antifungal (polyene macrolide antibiotic) Fungistatic => fungicidal ``` - binding to sterols (primarily ergosterol) in the fungal cell membrane and altering the permeability of the membrane, allowing intracellular potassium and other cellular constituents to leak out. - Mammals have cholesterol in their cells so can be affected but less so than ergosterol.

Answer 223

most severe systemic fungal disease including: - Blastomyces spp, - Aspergillus spp, - Paracoccidioides spp, - Coccidioides spp, Histoplasma spp, - Cryptococcus spp, - Mucor spp, - Sporothrix spp. - lipsomal form can be used to treat leishmaniasis (not recommended => resistance) and naegleria protozoa

Answer 224

- not severe, life-threatening, progressive disease that is unresponsive to other antifungals. - not indicated by antifungal susceptibility results. - renal disease

Answer 225

1. Amphotericin B deoxycholate (conventional formulation) 2. Amphotericin B lipid complex (ABLC, Abelcet), a suspension of amphotericin B complexed with two phospholipids. The most extensively evaluated in dogs, shown in one study to be safe and effective in dogs at a cumulative dosage of 8-12 mg/kg. 3. Amphotericin B cholesteryl sulfate complex (Amphotec). This is a colloidal dispersion, also called ABCD (amphotericin B colloidal dispersion). 4. Liposomal complex of amphotericin B encapsulated in a lipid bilayer (L-AmB, AmBisome) - lipid and cholesteryl formulations of amphotericin B are commonly used in people, but experience is limited in veterinary medicine due to cost. The advantage over traditional formulations is that these forms can be given at higher doses with greater efficacy and less toxicity.

Answer 226

Antifungal for dermatophytes only - disrupts the structure of the cell’s mitotic spindle, arresting the metaphase of cell division, and inhibiting nucleic acid synthesis. - concentrated in skin, hair, nails, fat, skeletal muscle, and the liver. only new hair/nail growht is resistant to dermatophytes

Answer 227

Dermatophytosis only: - Trichophyton, - Microsporum, - Epidermophyton concentrated in skin, hair, nails, fat, skeletal muscle, and the liver. only new hair/nail growht is resistant to dermatophytes

Answer 228

- Cats with FIV - kittens - liver failure - pregnancy

Answer 229

``` Ketoconazole Itraconazole Fluconazole Voriconazole Posaconazole ```

Answer 230

- inhibits a fungal CYP450-dependent demethylation enzyme that produces ergosterol in the fungal cell membrane. => weakened cellular membranes => increased membrane permeability, leakage of cellular contents and impairing uptake of purine and pyrimidine precursors. -high lipophilicity and poor solubility => limits GI absorption unless the medication is administered with food to stimulate stomach acids to aid in lipid dissolution. thus => Antacids, H2 blockers and PPIs can decrease GI absorption

Answer 231

tri-Azole antifungal - inhibits a fungal CYP450-dependent demethylation enzyme that produces ergosterol in the fungal cell membrane. => weakened cellular membranes => increased membrane permeability, leakage of cellular contents and impairing uptake of purine and pyrimidine precursors. ``` + Antifinlamf - suppression of Tlymph prolif, - inhib of Ca++-dependent inflam by Neut, - inhib of leukotriene B4 ```

Answer 232

- dermatophytosis in cats due to microsporium canis - non life threatening mycosis that DO NOT involve the CNS including: - aspergillosis, - cryptococcal meningitis - blastomycosis - coccidioidomycosis - sporotrichosis, - histoplasmosis - candida (+ terbinafine) can cross into the eye/brain if inflam but ?? better for crypto than others + - Trypanosoma cruzi (+amidarone) - fungal osteomyelitis, - onychomycosis, - Malassezia spp dermatitis adjunctive for: - pythiosis, - lagenidiosis, - zygomycosis, - phaeohyphomycosis, - hyalohyphomycosis.

Answer 233

- hypersensitivity to it or other azoles Caution with: - cardiac (slight neg ionotropic effect) - liver/renal - a/hypoclohydria - other meds that inhib cytochrome P450 pathway.

Answer 234

tri-Azole antifungal - inhibits a fungal CYP450-dependent demethylation enzyme that produces ergosterol in the fungal cell membrane. => weakened cellular membranes => increased membrane permeability, leakage of cellular contents and impairing uptake of purine and pyrimidine precursors. + Antifinlamf - reduce IL4 - inhib of leukotriene B4

Answer 235

- CNS fungal infections. - urinary fungal infections - blasto - histoplasmosis - skin/nail with candida, dermatophytes and malassezia (but ketoconazole or itraconazole may be better)

Answer 236

- hypersensitivity to it or other azoles - receiving drugs that both prolong the QT interval and are metabolized by cytochrome P450 3A4 Care with - hepatotoxicity - renal

Answer 237

Second gen triazole - inhibits a fungal CYP450-dependent demethylation enzyme that produces ergosterol in the fungal cell membrane. => weakened cellular membranes => increased membrane permeability, leakage of cellular contents and impairing uptake of purine and pyrimidine precursors. - also inhibits 24-methylene dehydrolanosterol demethylation in molds such as Aspergillus spp giving it more activity against these fungi

Answer 238

- CNS fungal infection - blasto - crypto - Aspergillus - Candida - Trchosporon - Fusarium

Answer 239

- cats (unless last resort for aspergillus) - given with food - hyperesnsitivity to it or other azoles - hepatic - arrhythmia prone

Answer 240

Second gen triazole - inhibits a fungal CYP450-dependent demethylation enzyme that produces ergosterol in the fungal cell membrane. => weakened cellular membranes => increased membrane permeability, leakage of cellular contents and impairing uptake of purine and pyrimidine precursors. - also inhibits 24-methylene dehydrolanosterol demethylation in molds such as Aspergillus spp giving it more activity against these fungi * delayed release tablets had better absorption than oral suspension

Answer 241

- cats - trypanosoma crusi - aspergillosis, - cryptococcus - sporotrichosis, - coccidioidomycosis, - blastomycosis, - histoplasmosis, - zygomycosis, - mucormycosis. - Candida

Answer 242

Not well known in animals but in people - hypersensitivity to the drug or any component in the suspension, - concomitant use with: - HMG-CoA reductase inhibitors (eg, atorvastatin, simvastatin), - sirolimus, - ergot alkaloids, - CYP3A4 substrates that can prolong QT interval (eg, pimozide, quinidine). + decrease dose with renal disease but not hepatic.

Answer 243

- fluconazole - flucytosine - Amphoteracin B - voriconazole

Answer 244

allylamine antifungal, - inhibits synthesis of ergosterol =>block enzyme squalene monooxygenase (ie, squalene 2,3-epoxidase), => inhibits the conversion of squalene to sterols (especially ergosterol) and causes accumulation of squalene. => both effects are antifungal. not mediated by cytrchorme P-450 enzs

Answer 245

Fungicidal - dermatophytes inc Microsporum spp, Trichophyton spp Fungistatic - yeasts (eg, Candida spp, malassezia - Aspergillus spp, - Blastomyces dermatitidis, - Coccidioidomyces immitis, - Histoplasma capsulatum, - Sporothrix schenckii, - Cryptococcus neoformans. - pythiosis (+ other antifungal)

Answer 246

- hypersensitive to it - liver disease - as sole drug for pythiosis

Answer 247

Macrolide antiparasitic - heartworm prevention - hoockworm - adult round worm (Toxocara and toxascaris) - whipworm (trichuris vulpis) - demodex and sarcoptes (off label) - angiostrongylus vasorum (+spinosad - dogs) - lungworm (Cats)

Answer 248

Avermectin antiparaciticide used for: - Heartworm prevention - larvae/microfilaricide (+doxycycline as an adulticide pretreatment. Can be used as slow kill but not recommended... maybe in cats to reduce worm burden) - hookworms - ectoparasites: demodex sarcoptes, cheyletiellosis, nasal mites, otodectes ***MDR1/ABCB1 risk of CNS toxicity

Answer 249

milbemycin-class, macrocyclic lactone antiparasitic - Prevention of heartworm inc circ microfilaria - + doxycycline => Slow kill for heartworm (not recommended) - hookworms (Ancylostoma caninum, Uncinaria stenocephala), - roundworms (Toxocara cati), - whipworms (Trichuris vulpis). + imidcloprid - fox lungworm (Crenosoma vulpis) - Feline aelurostrongylosis (Aelurostrongylus abstrusus) - Ocular Thelazia callipaeda (eyeworm) - Demodex ** safe for MDR1/ABCB1 mutation dogs

Answer 250

Avermectin atiparaciticide - fleas (Ctenocephalides felis), - prevention of heartworm disease (Dirofilaria immitis) but NOT adult HW or circulating microfilaria - ear mites (Otodectes cynotis) - sarcoptic mange (Sarcoptes scabiei) - tick infestations (Dermacentor variabilis). - nasal mites - cheletiellosis In cats: - hookworms (Ancylostoma tubaeforme) - roundworms (Toxocara cati) - ear mites

Answer 251

Arsenical antiparasitic - mechanism of action not known - 90% to 99% effective in killing adult and L5 larvae of Dirofilaria immitis - The 2-dose method kills only ≈90% of adult worms whereas the 3-dose method kills 98%

Answer 252

Stabilized class 1 (mild), 2 (moderate) and 3 (severe) heartworm disease caused by immature to mature adult infection for dirofilaria immitis.

Answer 253

Adulticide therapy - Macrocytic lactone Day 0, 30, 60, 90 + ongoing (prior to melarsomine) + exercise restriction (+/- antihistamine and pred tapering dose over the first month if symptomatic) - Doxycycline for 4 weeks (Day 1-30) then month break before melarsomine (eliminate Wolbachia) - Melarsomine - 3 doses: days 60, 90 and 91 post starting ML Caval syndrome: - surgical removal of worms first

Answer 254

- Cats - Class 4 (caval syndrome) heartworm disease - if can't be given via deep IM injection. *must exercise restrict afterwards.

Answer 255

Anticoagulant - acts on coagulation factors in both the intrinsic and extrinsic coagulation pathways. - combines with antithrombin, => inactivate factor Xa and prevent the conversion of prothrombin to thrombin. + inactivates factors IX, X, XI, XII Also - inactivates thrombin, - blocks fibrinogen to fibrin - prevents the formation of stable fibrin clots (inhib factor XIII). does not lyse clots but it can prevent the growth of existing clots

Answer 256

During treatment of: - immune-mediated hemolytic anemia (IMHA), - pulmonary thromboembolism, - other thromboembolic diseases, - occasionally during the hypercoagulable state of disseminated intravascular coagulation (DIC) (not recommended any more - blood products prefered) - reduce incidence of developing macrovascular thromboembolism in high-risk patients

Answer 257

- severe thrombocytopenia - factor depletion - uncontrolled bleeding - given IM (=> haematoma) - DIC???

Answer 258

-LMW (fractionated) heparin anticoagulant - binds to and accelerating antithrombin III, => enhance the inhibition of factor Xa and thrombin. More selective than unfractionated heparin => minimal impact on PT, TT and aPTT) enoxaprin has a shorter duration of action esp in cats (q6h dosing)

Answer 259

- prophylaxis or treatment of thromboembolic disease | - maybe angina

Answer 260

- hypersensitive to it, heparin, or pork products. - major bleeding - heparin-induced thrombocytopenia, - thrombocytopenia - renal dysfunction (drug accumulation) - those getting epidural anesthesia or with increased risk for hemorrhage. - give SC only (not IM/IV)

Answer 261

antiplatelet agent + NSAID - inhibits cyclooxygenase (COX-1, prostaglandin synthetase), thereby reducing prostaglandin and thromboxane (TXA2) synthesis. - platelets can't make more COX => irreversibile inhibition of platelet aggregation.

Answer 262

- offset cyclosporine-induced thromboxane synthesis - IMHA - Antiplatelet antithrombotic (long duration of action in cats) - not used as often as clopidogrel appears to be safer and more effective + - Analgesia - antipyretic - anti-inflam

Answer 263

- hypersensitivity reactions to aspirin or other salicylates - GI erosions and ulcerations - concurrent pred/NSAIDs - haemorrhagic disorders - asthma - renal insufficiency Care with: - cats - hypoalbuminaemia - liver/renal failure

Answer 264

a platelet aggregation inhibitor - metabolized and then selectively binds and irreversibly alters platelet surface ADP receptor, P2Y12, => reduced activation + inhibits full activation of the glycoprotein GPIIb/IIIa complex (which is responsible for platelet binding to fibrinogen and integration into clots)

Answer 265

preventio of thromboembolic disease - arterial TE - may improve pelvic limb circ after FATE Possibly in dogs with hypercoag conditions: - IMHA

Answer 266

- hypersensitive - actie bleeding - inherited thrombocytopathias - surgery (unless at high risk for thrombosis)

Answer 267

Factor Xa inhibitor - anticoagulant/antithrombotic - inhibitor of activated clotting factor X (FXa) and prothrombinase activity. - Unlike heparins, its anticoagulant effect does not require a cofactor. It indirectly inhibits platelet aggregation induced by thrombin.

Answer 268

prevent or treat thromboembolic disease in dogs and cats prefered over unfractionated heparin

Answer 269

- allergy - uncontrolled bleeding - renal/ hepatic disease +/- coagulopathy - bleeding disorders - coagulopathies - epidurals

Answer 270

- firinolytic/thrombolytic medication that breaks down clots. Stimulates conversion of plasminogen to plasmin=> degrades fibrin clots - needs to be used within 6h of clot formation. don't use if - uncontrolled bleeding - hypertension - prev intracranial haemorrhage or any other serious intracranial pathology.

Answer 271

- thrombolytic = break down clots catalyses conversion of plasminogen to plasmin=> degrades fibrin clots

Answer 272

Folic acid inhibitor/anti-protozoal drug - inhibits dihydrofolate reductase, which catalyzes the conversion of dihydrofolic acid to tetrahydrofolic acid. => reduced folic acid impairs protozoal production of proteins and nucleic acids. - binds to protozoal dihydrofolate reductase more than the mammalian enzyme. -has in vitro activity against T gondii; adding sulfadiazine can synergistically enhance activity

Answer 273

- Hepatozoon americanum - toxoplasma (+/- sulfonamides or clindmycin) - neospora

Answer 274

- pre-exisiting folate deficiency - hypersensitivity Care with cats, seizures, liver/renal

Answer 275

Protozoa: - Toxo - neospora - sarcocystis - amercan hepatozoonosis

Answer 276

Protozoa: (+ atovaquone) - Babesia - Cytauxzoonosis

Answer 277

Protozoa: (+ azithromycin) - Babesia - Cytauxzoonosis

Answer 278

Protozoa: - American hepatozoon - sarcocystisis

Answer 279

Protozoa: (+ atovaquone) - Babesia - Cytauxzoonosis

Answer 280

Protozoa: (+ azithromycin) - Babesia gibsoni/conradae - Cytauxzoonosis maybe toxo and pneumocystis

Answer 281

Protozoa: - Toxo - Neospora - Isospora

Answer 282

Protozoa: - Large babesia infections - Hepatozoon Can be used for small babesia and feline cytauxzoon but more effective agents are available.

Answer 283

Thiamine analogue Intestinal coccidiosis *can get CNS signs from thiamine deficiency

Answer 284

Triazine antiprotozoals - predominantly against apicomplexan coccidial infections. - in apicomplexan protozoa, act on a plastid-like chloroplast organelle (the apicoplast) that contains a small circular genome and operates key biochemical pathways. => may inhibit metabolic enzymes or decrease pyrimi-dine synthesis within the apicoplast. Protozoa: - Toxo - Neospora - Isospora

Answer 285

Triazine antiprotozoals - predominantly against apicomplexan coccidial infections. - in apicomplexan protozoa, act on a plastid-like chloroplast organelle (the apicoplast) that contains a small circular genome and operates key biochemical pathways. => may inhibit metabolic enzymes or decrease pyrimi-dine synthesis within the apicoplast. Protozoa: - Hepatozoon (as effective as TMS/clinda/pyrimethamine) - Isospora - Toxo - Neospora - Isospora

Answer 286

Nitroimidazole => causes free radical damageto parasite DNA. Parasitic/protozoa: - giardia (fenbendazole prefered)

Answer 287

5-nitroimidazole that has amoebicidal, giardicidal, trichomonicidal, and anaerobic bactericidal activity - Giardia

Answer 288

Nitroimidazole => causes free radical damageto parasite DNA. - Tritrichomonas foetus

Answer 289

Nitazoxanide is a nitrothiazolyl-salicylamide derivative - inhibits the pyruvate-ferredoxin/flavodoxin oxidoreductase enzyme-dependent electron transfer reaction needed for anaerobic metabolism - Cryptosporidium spp., - Giardia spp., - Sarcocystis neurona, - some anaerobic bacteria, - Helicobacter spp., - Campylobacter jejuni.

Answer 290

Aminoglycoside antibiotic Protozoa: - enteric est cryptosporidium * not in cats

Answer 291

Parasite/protozoa: | - combination treatment for babesia and HW/woolbacia

Answer 292

Antimony compound - selectively inhibit the leishmanial enzymes required for glycolytic and fatty acid oxidation. Leishmania * dont use in dogs with pre-existing cardiac arrhythmias, or significantly impaired renal function

Answer 293

Pentavalent Antimony compound - selectively inhibit the leishmanial enzymes required for glycolytic and fatty acid oxidation. Leishmania (+/- allopurinol = synnergy + reduced drug resistance) possibly in cats as well.

Answer 294

Purine analog + xanthine oxidase inhibitor. - stop urate and dissolve stones in dogs (not from PSS though) - treat leishmania +/- trypanosoma => inhibit the enzyme xanthine oxidase, which is responsible for the conversion of oxypurines (eg, hypoxanthine, xanthine) to uric acid thus treatment and prevention of recurrent uric acid and hyperuricosuiric CaOx stones in dogs (Esp dalmations). * doesn't dissolve urate uroliths in dogs with portovasc anomalies. Purine analogue => inhibits Leishmania spp activity by limiting available purines. => Allopurinol is taken up by the protozoa and metabolized into a toxic compound (4-amino-pyrazole-pyrimidine), which incorporates into the parasite’s RNA, causing death => treat Leishmania +/- trypanosomiasis