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ACVIM.Pharm > Pharm > Flashcards

Pharm Flashcards

1
Q

Bethanechol drug class

A

cholinergic

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2
Q

bethanechol indications

A

used primary to inc bladder contractility
–acute & partial detrusor atony secondary to acute bladder overdistension and partial neurogenic lesions

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3
Q

Bethanechol alternative indications in horses

A

adjunctive prokinetic agent for tx of equine gastric ulcer syndrome (EGUS)

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4
Q

Bethanechol altnerative indication in ruminants

A

INC abomasum and duodenum contractility with healthy dairy cattle and those with left displacement of the abomasum (LDA)

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5
Q

Bethanechol pharmacology/actions

A

stimulates cholinergic receptors
**effects principally muscarinic negligible nicotinic activity

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6
Q

Bethanechol pharmacologic effects

A
  • INC esophageal persistalsis and lower esophageal sphincter tone
  • INC sphincter tone
  • INC tone & peristatic activity of stomach and intestines
  • INC gastric and pancreatic secretions
  • INC tone of detrusor mm of bladder
  • DEC bladder capacity
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7
Q

Bethanechol at high doses

A

INC bronchial secretions & constriction

  • lacrimation
  • salivation
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8
Q

Bethanechol contraindications

A
  • GI or urinary tract obstructions
  • bladder wall integrity is in question
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9
Q

Bethanechol adverse effects in horses

A

Salivation

lacrimation

abdominal pain (colic)

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10
Q

bethanechol if used IM/IV can cause

A

Severe cholinergic reactions

  • salivation, tearing & sweating, bronchoconstriciton, bradycardia, inc GI motility, diarrhea
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11
Q

Metoclopramide drug class

A

GI prokinetic agent

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12
Q

Metoclopramide indications

A
  • Stimulates upper GI motility & has anti-emetic properties
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13
Q

Metoclopramide pharmacological effect

A

(not completely known)

Sensitizes upper GI smooth mm effects of acetylcholine

–anti-cholinergic drugs will negate metoclopramides effects

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14
Q

Metoclopramide in CNS effects

A

Antagonizes dopamine (D3) at receptor sites

– weak inhibitor of 5-HT3– agonist of 5HT4 receptors

–> sedative, central anti-emetic, extrapyramidal and prolactin secretion stimulation effects

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15
Q

Metoclopramide contraindications

A

GI hemorrhage

obstruction or perforation

hypersensitivity

**relatively contraindicated: seizure disorders, pheochromocytoma

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16
Q

Metoclopramide adverse effects

A

Severe CNS effects

–>Alternating periods of sedation & excitement, beahvioral changes & abdominal pain

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17
Q

Omeprazole drug class

A

Proton pump inhibitor

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18
Q

Omeprazole pharmacological actions

A

Benzimidazole gastric acid (proton) pump inhibitor

  • –> activated to sulphenamide derivative that binds at secretory surface of parietal cells to the enzyme, H-K ATPase
  • inhibits strnasport of H ions into stomach
  • reduces acid secretion
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19
Q

Omeprazole inhibits what enzyme?

A

Hepatic cytochrome P-450 mixed function oxidase system

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20
Q

Omeprazole is metabolized by what organ?

A

IN the liver

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21
Q

Sucralfate Drug Class

A

GI mucosal protectant

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22
Q

Sucralfate indications

A

Tx of oral, esophageal, gastric & duodenal ulcers

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23
Q

Sucralfate MOA

A

**Exact mechanism unknown

  • local effect
  • reacts with hydrochloric acid in stomach to form paste-like complex that will bind to proteinaceous exudates found at ulcer sites
  • insoluble complex forms a barrier at site & protects ulcer from further damage caused by pepsin, acid or bile
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24
Q

Misoprostal drug class

A

Prostaglandin E1 Analog

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25
Q

Misoprostol indications

A

Treating or preventing gastric ulcers

Uterine contractibility & cervical softening/opening (pregnancy termination)

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26
Q

Misoprostol pharmacology actions

A

Direct action on parietal cells

  • inhibits basal & nocturnal gastric acid secretion
  • pepsin secretion decreased
  • cytoprotective effect on gastric mucosa–> INC production of gastric mucus & bicarbonate, INC turnover & blood supply of gastric mucosal cells

Uterine contractions

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27
Q

Misoprostol contraindications

A

Pregnancy & nursing others

Caution: sensitivty to prostaglandins & prostaglandin analogues; pts with cerebral or coronary vascular dz

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28
Q

Misoprostol adverse effects

A

GI distress (diarrhea, adbom pain, vomiting/flatulence)

**pregnant women should handle with caution**

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29
Q

Cisapride drug class

A

Pro-motility agent

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30
Q

Cisapride indications

A

Oral GI prokinetic– used in several spp for GI stasis, reflux esophagitis & constipation/megacolon (cats)

**no longer commerically available**

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31
Q

Cisapride contraindications

A

Hypersensitivity

GI perforation or obstruction

Hemorrhage

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32
Q

Cisapride pharmacology actions

A

INC lower esophageal peristalsis & sphincter pressure

accelerates gastric emptying

–> enhances release of acetylcholine at myenteric plexues (does not induce myenetric plexus, but does not induce nicotinic or muscarinic receptor stim)

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33
Q

Naloxone drug class

A

Antidote: opiate antagonist

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34
Q

Naloxone pharmacologic actions

A

** exact mech unknown

  • competitive antagonist by binding to the mu, kappa & sigmoid opioid receptor sites
  • high affinity for mu receptor
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35
Q

Naloxone effect on horses:

A

low end of dosing range: limit opioid induced locomotor actiivty

Upper end of dosing range: may stimulate colonic propulsion

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36
Q

Flunixin meglumine drug class

A

Non-steroidal anti-inflammatory agent

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37
Q

Flunixin meglumine use caution in:

A

GI ulcers, renal, hepatic or hematologic dzes

–horses with colic– may mask behavioral & cardiopulmonary signs assoc with endotoxemia or intesitnal devitalization

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38
Q

Flunixin meglumine pharmacology/actions:

A

potent inhibitor of cyclooxygenase

– analagesic, anti-inflammatory & antipyretic activity

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39
Q

Phenylbutazone drug class

A

Non-steroidal anti-inflammatory agent

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40
Q

Phenylbutazone contraindications

A

known hypersensitivity

history of or pre-existing hematologic or bone marrow abnormalities pre-existing GI ulcers

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41
Q

Phenylbutazone pharacologic actions

A

inhibition of cyclooxygenase– reducing prostaglandin synthesis

Other effects: reduced renal blood flow, dec GFR, dec plt aggregation, gastric mucosal damage

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42
Q

Phenylbutazone adverse effects in horses

A

oral & GI erosions & ulcers

hypoalbuminemia

diarrhea

anorexia

renal effects

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43
Q

Administration of phenylbutazone intrmauscular can cause

A

irritating: swelling ot necrosis & sloughing

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44
Q

Fenbendazole indicated for removal of following parasites in horses:

A

large strongyles (S. edentatus, S. equinus, S. vulgaris)

Small strongyles (Cyathostomum spp., Cyclicocylus spp., Cyclicostephanus spp., Triodontroophorus spp.)

Pin worms (oxyuris equi)

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45
Q

Fenbendazole indicating for following parasites in cattle:

A

Haemonchus contortus, Ostertagia ostertagi, Trichostorngylus axei, Brunostomum phelbotomum, Nematodirus helvetianus, Cooperia spp., Trichostrongylus colubriformis, Oesophagostomum radiatum, Dictyocaulus viviparus

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46
Q

Acetylcystein indications

A

mucolytic

treatment for acetaminophen tox or other hepatotoxic conditions were glutathione syntehsis is inhibited or oxidative stress occurs

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47
Q

Acetylcysteine used in horses for what indication

A

Strangles– acetylcysteine instilled into guttural pouch used ot help break up chondroids & avoid the need for surgical removal

Meconium impaciton– foals: break up meconium refractory to repeated enemas

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48
Q

Acetylcystein MOA as a mucolytic

A

Reduces viscosity of purulent & nonpurulent secretions & expedites removal of secretions via coughing, suction or postural drainage

  • free sulfhydryl group on drug reduces disulfide linkages in mucoproteins
  • pronounced action at pH from 7-9
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49
Q

Acetylcysteine actions on liver d/t acetominophen toxicity

A
  • reduce extent of liver injury or methemoglobemia after ingestion of acetaminophen or phenol
  • provides an alterante substrate for conjugations with reactive metabolite of acetaminophen– maintaining or restoring glutathione level s
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50
Q

Acetylcysteine advers effect when administered into pulmonary tract

A

hypersensitivity

chest tightness

bronchoconstriction

bronchial or tracheal irritation

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51
Q

S-Adenosyl-methionine drug class

A

Hepatoprotectant

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52
Q

S-Adenosyl-methionine Pharacological action

A

Endogenous molecuels synthesized by cells throughout the body

  • formed from amino acid methionine
  • SAMe– essenital part of 3 major biochemical pathways
  • beneficial effects: inc liver & rbc glutahtione levels &/or prevent its depletion; inhibts apoptosis secondary to acohol or bile acids in hepatocytes
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53
Q

Pentoxifylline pharmacological actions

A
  • INC RBC flexibility by inhibiting rbc phosphodiesterase & dec rbc viscosity by dec plasma fibrinogen
  • INC fibrinolytic activity
  • horses– potent inihibitor of matrix metalloproteinase-9 & 2
  • dec negative endotoxic effects of cytokine medators via phosphodiesterase inhibition
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54
Q

Pentoxifylline contraindications:

A

retinal or cerebral hemorrhage

intolerance or hypersensitivity to xanthines

Caution: severe hepatic or enal impairment or at risk for hemorrhage

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55
Q

Pentoxifylline adverse effects

A

GI tract (vomiting/inappetance) most common

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56
Q

Isoflupredone acetate uses/indications

A

potent glucocorticoid– anti-inflammatory or immunosuppressive effects:

  • labelled indications: adjucntive in bovine ketosis, alleviating pain & lameness assoc with msc conditions, acute hypersenstiivity rxns, adjunctive tx of overwhelming infections with sevre tox, shock, supportive therapy in stress, dystocia, retained palcement, inflamm., ocular conditions, sneakbite & parturient paresis
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57
Q

Isoflupredone acetate pharmacological actions

A

17x more potent anti-inflammatory than hydrocotisone (cortisol)

10x more potent than prednisolone

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58
Q

Isoflupredone acetate adverse effects

A

Hyperadrenocroticism

dairy cattle–hypokalemia

potential adverse effects: dec milk production, delayed wound healing, GI ulceration, INC infection rates, diabetes mellitus exacerbation/hyperglycemia, pancreatitis, hepatopathy, renal dysfunction, osteoporosis, laminitis, hypothyroidism, hyperlipidemia

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59
Q

Dexamethasone drug class

A

Glucocorticoid

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60
Q

Glucocorticoids: 3 braod uses/indications

A
  1. Replacement of glucocorticoid activity in patients with adrenal insuffiency
  2. anti-inflammatory agent
  3. immunosuppressive
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61
Q

Glucocorticoids effects on cardiovascular system

A
  • Dec capillary permeability
  • enhance vasoconstriction
  • POS ionotropic (mild) (inc BP)
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62
Q

Glucocorticoids effects on cells

A
  • inhibit fibroblast proliferation
  • macro response to migration inhibiting factor
  • sensitization of lymphocytes and cellular response to mediators of inflammation
  • stabilize lysosomal membranes
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63
Q

Glucocorticoids effect on CNS/autonomic nervous sytem

A
  • Lower seizure threshold
  • alter mood and behavior
  • diminish response to pyrogens
  • stim appetite
  • maintain alpha rhythm
  • glucocorticoids necessary for normal adrenergic receptor sensitivity
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64
Q

Glucocorticoids effect on endocrine system

A
  • suppress release of ACTH from anterior pituitary–> dec release of endogenous corticosteroids
  • inihibit osteoblast function
  • reduced ADH (vasopressin) activity at renal tubules & diuresis may occur
  • inhibits insulin binding to insulin receptors & post-recept effects of insulin
  • reduced: TSH, FSH, prolactin & LH at pharmacological doses
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65
Q

Glucocorticoids effect on hematopoietic system

A
  • INC number of circulating neuts & rbcs
  • plt aggregation inhibited
  • dec amts of lymphocytes (peripheral), monos & eos
  • removal of old red cells diminished
  • can cause involution of lymphoid tissue
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66
Q

Glucocorticoids effects on immune system

A
  • dec circulating levels of T lymphs
  • inhibit lymphokines
  • inhibit neuts, macro & mono migration
  • reduce production of interferon
  • inhibit phagocytosis & chemotaxis
  • ag processing
  • diminish intracellular killing
  • antagonize complement cascade & mask clinical signs of infection
  • mast cells decreased in number & histamine suppressed
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67
Q

Glucocorticoid effects on metabolism

A
  • stimulate gluconeogenesis
  • lipogenesis enhance in certain areas of body
  • adipose tissue can be redistrubted away from extremities to trunk
  • fatty acids are mobilized from tissues & their oxidation increased
  • plasma triglycerides, cholesterol & glycerol increased
  • protein mobilize from most areas of body
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68
Q

Glucocorticoid effects on musculoskeletal sys

A
  • may cause muscular weakness, atrophy, osteoporosis
  • bone growht inhibited via growth hormoen & somatomedin inihibition
  • increased Ca excretion
  • inhibition of Vit D activation
  • resorption of bone can be enhanced
  • fibrocartilage growth inhibited
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69
Q

Ophthalmic effects of Glucocorticoids

A

prolonged use (systemic/topical)–> INC intraocular pressure & glaucoma, cataracts & exopathalmus

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70
Q

Glucocorticoid effects on renal, fluid & electrolytes

A
  • INC potassium & Ca excretion
  • Na & Cl reabsorption
  • extracellular fluid volume
  • rare: hypokalemia/hypocalcemia
  • diuresis
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71
Q

Glucocorticoid effects on skin

A
  • thinning of dermal tissue & skin atrophy
  • hair follicles can become distended & alopecia may occur
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72
Q

Propylene glycol base injectable production administration rapidly can cause

A

Hypotension

Collapse

Hemolytic Anemia

**most drug formualtions use sodiu mphosphate when givin drug intravenously**

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73
Q

Triamcinolone Acetonide intraarticular injeciton in horses shown to cause

A
  • improvement clinical lamenss
  • reduce articular protein, inflammatory cell infiltraiton, animal hyperplasia & subintimal fibrosis
  • synovial levels of hyaluronan & glycosaminoglycan can be increased
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74
Q

Ivermectin is approved for control of what parasites in horses

A
  • Large adult strongyles: strongylus vulgaris, S. Edentatus, S. Equinus Triodontophorus spp
  • Small strongyles
  • pinworms (adults & 4th stage larva)
  • ascarids (adults)
  • hair worms (adults)
  • large mouth stomach worms (adults)
  • beck threadworms (microfilaria)
  • bots (oral & gastric stages)
  • lungworms (adults & 4th stage larva0
  • intestinal threadworms (adults)
  • summer sores (cutaneous 3rd stage larva) econdary to Hebronema or Draschia spp.
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75
Q

Ivermectin is labeled for control of what parasites in cattle

A
  • roundworms (adults & 4th stage larva)
  • lungworms (adults & 4th stage larva)
  • cattle grubs (parasitic stages)
  • sucking lice
  • mites (scabies)
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76
Q

Ivermectin pharmacological actions

A
  • enhances release of GABA at pre-synpatic neurons
  • blocks postsynaptic stim of adjacent neuron in nematodes or mm fiber in athropods
  • causes paralysis of parasite & eventual death
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77
Q

Ivermectin is ineffective against liver flukes & tapeworms because

A

Do not use GABA as pierpheral nerve transmitter

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78
Q

Amphotericin B pharmacologic actions

A

acts by binding sterols (primarily ergosterol) in cell membrane & alters permeability of membrane allowing intraclelular K & other cellular constituents to leak out

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79
Q

Amphotericin B is ineffective against rickettsia & bacteria because

A

has no activity against these organisms

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80
Q

Amphotericin B in vitro activity against what fungal organisms

A
  • blastomyces
  • aspergillus
  • paracoccidioides
  • coccidioides
  • histoplasma
  • cryptococcus
  • mucor
  • sporothrix
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81
Q

Amphotericin adverse effects in hroses

A

tachycardia

tachypnea

lethargy

fever

restlessness

fever

anorexia

anemia

phlebitis

polyuria

collapse

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82
Q

Amphotericin B nephrotoxicity

A

renal vasoconstriction wiht subsequent reduction in GFR

**monitor renal values aggressively during therapy**

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83
Q

Acyclovir tx in horses

A

investigated in EHV-5, lymphoma, EHV-1 myelonencephalopathy

**poor bioavailability is an issue

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84
Q

Acyclovir adverse effects

A

thrombophlebitis

acute renal failure

encephelopathologic changes (rare)

GI disturbances– oral or parenteral therapy

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85
Q

Class 1 Antiarrythmic agents

A

Na channel blockers

– block voltage gated sodium channels of myocardium

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86
Q

Class 1a antiarrhythmic agetns

A

block fast sodium channels

– prolong action potential activity– lengthening the effective refractory period

potentially proarrythmic– QT interval prolongation (promoting reentry)

Tx of supraventricular & ventricular tachyarrythmias

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87
Q

Class 1a antiarrhythmic agents examples

A

Quinidine

procainamide

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88
Q

Quinidine indications

A

atrial fibrillation

(quinidine gluconate): ventricular tachycardia (VT-) discontinued in 2017

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89
Q

Quinidine pharmacological actions

A

slow impulse conduction

prolong effective reractor period

vagolytic activity–accelerated AV nodal conudction

alpha adrenoreceptor antagonist effects: hypotension & reflex INC in sympathetic outflow (poteniates proarrhythmic effects)

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90
Q

Quinidine adverse effects in horses

A
  • inappetance
  • depression
  • swelling of nasal mucosa
  • ataxia
  • diarrhea
  • colic
  • hypotension
  • rarely: laminitis, paraphimosis & development of urticarial wheels; cardiac arrthmias: AV block, circulatory collapse & sudden death
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91
Q

Procainamide indications

A

acute management of VT (& VPCs)

acute onset AF in horses

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92
Q

Procainamide action

A
  • Prolongs refractory times in both atria & ventricles
  • decreases myocardial excitability
  • depresses automaticity and conduction velocity
  • some anticholinergic effects
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93
Q

Procainamide contraindicated

A
  • myasthenia gravis
  • hyerpsensitivity to drug, procaine or other chemically related drugs
  • torsade de pointes
  • 2nd or 3rd degree heart block (unless artificially paced)
  • EXTREME CAUTION: cardiac glycoside intoxication, systemic lupus
  • CAUTION: signficant hepatic, renal dz or CHF
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94
Q

Procainamide adverse effects

A
  • Reported in the dog: GIT effects: anorexia, vomiting & diarrhea
  • CV: weakness, hypotension, neg inotropism, widened WRS complex & QT intervals, AV block, multiform ventricular tachycardia
  • profound hypotension if injected too rapidly
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95
Q

Class 1b anti-arrhythmic agents used for management of

A

Ventricular arrhythmias

  • shorten action paotenial without causing QT prolongation
  • preferentially bind to Na channels– act primarily on damaged mycoardial cells ot prevent reentry pathways
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96
Q

Class 1b anti-arrhythmic agents examples

A

lidocaine

phenytoin (diphenylhydantoin)

tocaindide

mexiletine

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97
Q

Lidocaine indications

A

ventricular tachycardia

**less effective in hypokalemia

PIVA–partial intravenous anesthesia– analgesic, antiiinflammatory & prokinetic effects

–> prevention of post-op ileus and reperfusion injury & adjunctive tx of endotoxemia

98
Q

Lidocaine pharmacologic actions

A
  • phase 4 diastolic depolarization attenutation
  • decreased automaticity
  • decrease or no change in membrane responsiveness and excitability

–>lidocaine acts by combining with fast sodium channels when inactive which inhibits recovery after repolarization

99
Q

phenytoin indications

A

acute tx of cardiac glycoside induced arrthymias

**rarely used in USA

100
Q

Class 1c antiarrythmic agents MOA

A

potent inhibitors of fast sodium channels with differential blocked within the Purkinje fibers with little impact on surrounding myocardium

101
Q

Class 1c antiarrythmic drugs should not be used in

A

pateitns with documented structural heart disease or myocardial damage

102
Q

Examples of Class 1c antiarrhythmic drugs

A

flecainide

propafenone

103
Q

Flecainide indications

A

researched in the management of afib & vtch– cannot be recommended in hrose b/c narrow safety profile

104
Q

Propafenone indication

A

treatment of sustained supraventricular tachycardia, VT, Ventricular premature complexes in humans

**under investigation in veterinary spp**

105
Q

Class II antiarrhythmic agents MOA

A

Beta-adrenoceptor antagonists (beta blockers)

  • prolong phase 4 of cardiac action potential– suppressing SA pacemaker activity & AV nodal conduction–> slowing heart rate
  • negative inotropic & anti-arrythmic effects
106
Q

3 subtypes of beta-adrenoreceptors in teh heart

A
  1. beta1: affects force & rate of cardiac contraction, automaticity of the pacemaker sites & conduction through AV node
  2. Beta2: located in SA & AV nodes–activations leads to increased automaticity & AV nodal conduction–> INC rate
  3. Beta3: human & canine myocardium– not identified in equine myocardium
107
Q

Examples of class II anti-arrythmic agents

A

propanolol

sotalol

atenolol

esmolol

108
Q

Propanolol MOA

A
  • non-specific beta adrenoreceptor antagonists acting on both Beta1 and Beta2 adrenoreceptors
  • dose depednet suppression of myocardial contractility
  • CV effects: dec heart rate, depressed AV conduction, diminished CO, dec mycoardial O2 demand, dec hepatic & renal blood flow, dec blood pressure, inhibition of isoproterenol induced tachycardia
109
Q

Propanolol indications

A

supraventricular & ventricular (refractory to other therapies) tachycardias

110
Q

Propanolol contraindications

A
  • heart failure
  • hypersensitivity to this class of agents
  • greater than 1st degree heart block
  • sinus bradycardia
  • CHF
  • CAUTION: significant renal or hepatic insufficiency, sinus node dysfunction, labile diabetic patients, digitalized or digitalis intoxication
111
Q

Propanolol adverse effects

A
  • bradycardia
  • lethargy
  • depression
  • impaired AV conduction
  • CHF or worsening heart failure
  • hypotension
  • syncope
  • diarrhea
  • hypoglycemia
  • bronchoconstriction
112
Q

Class III anti-arrythmic agents MOA

A

K channel blockers– suppress inward potassium current– prolonging phase 3 of action potential & refractory period

113
Q

Class III antiarrhythmic examples

A

amiodarone

114
Q

Amiodarone indications

A

treatment of AF in hroses (lots of adverse effects) and VT resistant to other meds

115
Q

Amiodarone adverse effects

A

GI

nuerologic

cardiac

derm signs

116
Q

Class IV anti-arrhythmic agents function

A

Calcium channel blockers– act on phase 2 of cardiac potential

  • primarily act on nodal tissues
117
Q

Class IV anti-arrythmic indications

A

supraventricular arrythmias in humans & dogs, have not be eval in horses

118
Q

Diltiazem indication in horses

A

in combination with quinidine to tx atrial fibrillation in horses

119
Q

Magnesium sulfate indications

A
  • terminating refractory ventricular arrhythmias
  • –> reduce occurrence of ventricular atopy and VT in human patients with CHF
  • tx of choice for quinidine induced torsades de pointeses
120
Q

Magnesium sulfate can potentiate the effects of:

A

lidocaine: through its effects on na/K atpase transporters in patients with hypokalemia

121
Q

Anticholinergic agents effective in controlling (cardiovascular)

A

Vagal mediated bradyarrhythmias

–> competitively inhibit binding of acetylcholine to the postganglionic synapses in teh heart– blocking vagally induced slowing of heart rate predom used to tx or prevent life-trheatning drug-induced bradycardia

122
Q

Class II anti-arrhythmic indication

A

tx of supraventricular arrythmias in humans & dogs– not critically evaluated in horses

123
Q
A
124
Q

Atropine indications

A
  • tx sinus bradycardia, sinoatrial arrest, incomplete AV block
  • differentiate vagally-mediated bradycardia for other causes
  • antidote for overdoses of cholinergic agents (eg, physostigmine, etc.)
  • antidote for organophosphate, carbamate, muscarinic mushroom, blue-green algae intoxciation
  • hypersialism: reduce secretions
  • tx (adjunctive) of bronchosontrictive dz
125
Q

Atropine pharmacological actions

A

Antimuscarinic agents– competitively inhibits acetylcholine or other cholinergic stimualtes at postganglionic parasympathetic neuroeffector sites

dose related effects:

  • low: salivation, bronchial secretions & sweating (no horses) are inhibited
  • moderate: atoprine dilates & inhibits accomodation of pupil, INC heart rate
  • high: dec GI & urinary tract motility, inhibit gastric secretion
126
Q

Atropine contraindicated:

A
  • Narrow-eyed glaucoma
  • synechia (adhesions) between iris & lens
  • hyeprsensitivity to anticholinergic drugs
  • tachycardias secondary to thyrotoxicosis or cardiac insufficiency
  • myocardial ischemia
  • unstable cardiac status during acute hemorrhage
  • GI obstructive dz
  • paralytic ileus
  • severe ulcerative colitis
  • obstructive uropathy
  • myastehnia gravis (unless used to reverse adverse muscarinic effects secondary to therapy

Extreme caution: autonomic neuropathy

127
Q

Atropine GI effects

A
  • Dry mouth (xerostomia)
  • increased viscosity of secretions
  • dysphagia
  • constipation
  • vomiting
  • thirst
  • urinary retention
128
Q

Atropine CNS effects

A
  • stimulation
  • drowsiness
  • ataxia
  • seizures
  • respiratory depression
129
Q

Atropine ophthalmic effects

A
  • Blurred vision
  • pupil dilation
  • cycloplegia
  • photophobia
130
Q

Atropine cardiovascular effects

A
  • Sinus tachycardia (at higher doses)
  • increased myocardial work & O2 consumption
  • bradycardia (initially or at very low doses)
  • hypertension
  • arrhythmias (ectopic complexes)
  • circulatory failure
131
Q

Physostigmine drug class

A

cholinesterase inhibitor (reversal for atropine)

132
Q

physostigmine indications

A
  • detect ivermectin tox in dogs
  • provacative gent for dx of narcolepsy in dogs & horses
  • tx of anticholinergic tox
133
Q

Phystostigmine pharmacological actions

A
  • reversibility inhibits destruction of acetylcholine by acetylcholinesterase– increasing acetylcholine at receptor sites
  • cross BBB and inhibits acetylcholiensterase both centrally and peripherally
  • miosis, bronchial constriction, hypersalivation, mm wekaness, sweating
134
Q

Physostigmine at higher dosages can cause

A

cholinergic crisis: seizures, bradycardia/tachycardia, asystole, nausea, vomiting, diarrhea, depolarizing neuromuscular block, pulmonary edema & respiratory paralysis

135
Q

Glycopyrrolate drug class

A

anticholinergic

136
Q

Glycopyrrolate indications

A
  • Sinus bradycardia (use in life-threatening cases d/t GI side effects)
  • sinoatrial arrest
  • incomplete AV blockade
137
Q

Glycopyrrolate is similar to atropine, except for what effects seen with atropine, not seen with glycopyrrolate

A

does not cross appreciably into the CNS

**CNS effects are not exhibited to the same effect as atropine

138
Q

N-butylscopolamine bromide drug class

A

quaternary ammonium antispasmodic and anticholinergic

139
Q

N-butylscopolamine bromide indications

A
  • control of abdominal pain assoc with spasmodic colic, flatulent colic & simple impactions in horses
  • esophageal obstruction
  • bradycardia
  • acute RAO

**shorter acting than atropine

140
Q

N-butylscopolamine bromide pharmacological actions

A

Dec peristalsis & rectal pressure via:

  • anti-cholinergic actions by competitively inhibiting muscarinic receptors on smooth mm
  • bronchodilatory and chronotropic effects in horses
141
Q

Mannitol drug class

A

osmotic diuertic

142
Q

Mannitol indications

A
  • diuresis in acute oliguric renal failure
  • reduce intraocular and intracerebral pressures
  • enhance urinary excretion of some toxins (eg, aspirin, some barbiturates, bromides, ethylene glycol)
  • conjunction with other diuretics to reduce edema or ascites
143
Q

Mannitol pharmacological actions

A
  • free filtered at glomerulus and poorly reabsorbed in the tubule
  • increased osmotic pressure prevents water from being reabsorbed at the tubule
144
Q

For mannitol to be effective what must be intact

A

sufficient renal blood flow and filtraiton for mannitol to reach the tubules

145
Q

Increased excretion of Mannitol promotes excretion of what other substances

A

sodium, other electrolytes, uric acid & urea

146
Q

Mannitol contraindications

A

Anuria secondary to renal disease

Severe dehydration

Severe pulmonary congestion or pulmonary edema

147
Q
A
148
Q

Mannitol adverse effects

A
  • Fluid and electrolyte imbalances
  • GI (nausea, vomiting)
  • cardiovascular (pulmonary edema, CHF, tachycardia)
  • CNS effects (dizziness, headache, etc.)
149
Q

Furosemide drug class

A

loop diuretic

150
Q

Furosemide indication

A

Congestive cardiomyopathy

pulmonary edema

udder edema

hypercalcuric nephropathy

uremia

hyperkalemia (adjunctive therapy)

EIPH- racehorses

151
Q

Furosemide pharmacological actions

A

Transient increases in GFR

  • aLOH: reduces absorption of electrolytes (dec reabsorption of both sodium and chloride)
  • distal renal tubule: increases excretion of potassium
  • proximal tubule: directly effects electrolyte transport
152
Q

Furosemide contraindicated in:

A
  • anuria
  • hypersensitivity
  • seriously depleted electrolytes
  • CAUTION: patients with pre-existing electrolyte or water balance abnormalities, paired hepatic function & diabetes mellitus
153
Q

Thiazide diuretics MOA

A

inhibit the sodium/chloride symporter in renal epithelial cell of the distal convoluted tubule

  • increases loss of sodium, chloride & water
154
Q

Drugs to reduce preload on the heart

A

Loop diuretics: furosemide

Thiazide diuretics: amioloride

155
Q

Drugs to reduce afterload on the heart

A

inhibitors of RAAS

ACE inhibitors (spirinoloactone)

direct acting vasodilators (hydralazine, nitrates/nitroglycerine, acepromazine)

156
Q

ACE inhibitors indications

A

Effective in managing CHF & delaying progression of both symptomatic & asymptomatic heart disease

  • hypertension
  • heart failure
  • chronic renal failure
  • protein losing glomerulonephropathies in dogs & cats
157
Q

Benazepril pharmacological actions

A
  • after metabolism to benazeprilate– drug inhibits of angiotensin I to angiotensin II by inhibiting angiotensin convertin enzyme (ACE)
  • angiotensin II acts as a vasoconstrcitors & stim production of aldosterone in adrenal cortex
  • by blocking angiotensin II formation– generally dec blood pressure in hypertesnive patients & vascular resistance in patietns with CHF
158
Q

Benazepril contraindicated in:

A

acute kidney injury

CAUTION: patients with INC Crea, hyponatremia, coronary or cerebrovascular insufficiency, SLE, hematologic disorders

159
Q

Acepromazine causes vasodilation in horses via

A

alpha adrenoreceptor and 5 hydroxtryptamine (serotonin)receptor antagonist

160
Q

Antibiotics that are bactericidal

A
  • Penicillins (PPG, Kpenn)
  • cephalosporins (Naxcel/Excede)
  • Aminoglycosides (Gent, Amikacin)
  • Fluoroquinolones (Enrofloxacin)
  • Metronidazole
  • Rifampin
161
Q

Antibiotics that are bacteirostatic

A

potentiated sulfonamides (TMS)

Tetracyclines (Oxytet, Doxy, Mino)

Chloramphenicol

Macrolides

162
Q

Bacteriostatic vs bacteriocidal

A

bactericidal– kills bacteria

bacteriostatic– inhibits bact growth

163
Q

Time dependent antibiotics MOA

A

time spent above MIC for duration of dosing interval

164
Q

Examples of time dependent antibitoics

A

Pencillins (PPG, Kpenn)

Cephalosporins (Naxcel, Excede)

Potentiated sulfonamides (TMS)

Tetracyclines (oxy, doxy, mino)

Chloramphenicol

Macrolides (erythromycin, azithromycin, chlarithromycin)

165
Q

Concentraiton dependent antibitoics mechanism of action

A

maximize plasma concentration

166
Q

Concentration depdent antibiotics examples

A

Aminoglycosides (gent, Amikacin)

Fluoroquinolones (Enrofloxacin)

167
Q

MOA: Beta-lactams

A

inhibit cell wall synthesis–> by acting on penicillin binding proteins (PBPs) responsible for building the cell wall

168
Q

MOA: Aminoglycosides

A

inhibit protein (30 s ribosomal subunit) synthesis

**synergism with beta-lactams**

169
Q

MOA: Tetracyclines

A

Binds to 30s ribosomal subunit to interfere with bact protein synthesis

170
Q

MOA: flouroquinolones

A

inhibit bacterial DNA gyrase (topoisomeraseII)

171
Q

MOA: potentiated sulfonamides

A

sulfonamide: inhibit bact dihydropoteroate synthetase (DPS)in folic acid pathway

Trimethoprim: inhibits dihydrofolate reductase in next step of folic acid pathway (inihibiting bact nucleic acid synthesis)

172
Q

MOA: rifampin

A

inhibits DNA-dependent RNA polymerase to suppress RNA synthesis

173
Q

MOA: Macrolides

A

bind 50-s ribosomal subunit to inhibit protein synthesis

174
Q

MOA: phenicols

A

Inhibit protein synthesis by binding 50-s ribosomal subunit

175
Q

MOA: metronidazole

A

inhibit protein synthesis by binding 50-s ribosomal subunit

176
Q

Antibiotics spectrum of activity: gram positive

A

Penicillins

macrolides (some pasteurella & histopholus)

cephalosporins

rifampin

177
Q

Antibiotics spectrum of activity: gram negative

A

Aminoglycosides

Fluoroquinolones (intracellular organisms)

178
Q

Antibiotics gram positive & negative coverage

A

Tetracyclines (intracellular organisms)

chloramphenicol

Cephalosporins (some negative)

Rifampin (some neg)

179
Q

Antibiotics with anaerobic bacterial coverage

A

Penicillin- except beta-lactams producing Bacteroides spp

Cephalosporin– excluding Bacteroides

Chloramphenicol

Metronidazole

180
Q

Using MIC to direct antibiotic therapy

A

=: can use this antibiotic against the cultured bacteria

181
Q

Antibiotics eliminated by the kidney

A

penicillins

cephalosporins

amingglycosides

TMS

Tetracyclines

Fluoroquinolones

Chloramphenicol

Metronidazole

Rifampin

182
Q

Antibiotics eliminated by the liver

A

Tetracyclines (enterohepatic circulation)

TMS

Fluoroquinolones (first pass heaptic metabolism)

Chloramphenicol

Metronidazole

Rifampin

Macrolides (w/ bile excretion)

183
Q

Adverse effects of penicillins

A

IMHA: type 2 hypersensitivity– resolves with d/c therapy

anaphylaxis: T. 1 hypersensitivity– d/t previous exposure to penicillin

184
Q

CNS excitement in procaine reactions

A

procaine hydrolyzed by plasma esterases to nontoxic metabolites PABA & diethlaminoethanol

185
Q

Aminoglycoside nephrotoxicity mech

A

enter renal tubule after filtration from glomerulus

  • bind anionic phospholipids on PCT cells
  • taken into cell by carrier medaited pinocytosis & translocated into cytoplasmic vacuoles which fuse with lysosomes
  • overloaded lysosomes swell and rupture– disrupte PCT cells and cause cell death
186
Q

Disease processes do not want to use the aminoglycosides

A

dzes that cause neuromuscular blocake (ie. Botulism)

–because can block acetylcholine at nicotinic cholinergic receptors & can precipitate neuromuscular blockade

187
Q

Chloramphenicol can decreased clearance of medications through which process

A

chloramphenicol is metabolized by same cytochome P450 enzymes

Other drugs: phenytoin, phenobarb, phenylbutazone, xylazine, cyclophosphamide

188
Q

Chloramphenicol use is not recommended with fllouroquinolones because of what metabolism

A

inhibition of protein synthesis by interfering with production fo autolysins necessary for cell lysis after fluoroquinolones interfere with DNA supercoiling

189
Q

Bacteria that are resistant to TMS and through which mechanism

A
  • Pseudomonas spp., Bacteroides spp., enterococci
  • mediated by chromosomal mutations–> bact hyperproduction of PABA, overcomes competitive substitution of sulfonamides or mediated by plasmids –> bypass of drug sensitivity step by production of later forms of DPS enzyme with lower affinity of sulfonamides
190
Q

Bacteria that overproduce what enzyme, will make it impenetrable to TMS

A

excessive bact production of dihydrofolate reductase (DHFR) and reduction in ability of drug to penetrate bact cell wall

191
Q

TMS what can cause what form of anemia

A

folate antagonism anemia (folate def /t inhibition of folate prdouction by GIT and inhibition of its ocnversion to tetrahydrofolate & dihydrofolate)

192
Q

Tetracyclines can cause cardiovascular collapse through which mechanism

A

IV chelation of calcium, DEC bp or BOTH

–> tachycardia, arrhythmias, systemic arterial hypertension, collapse & deaht d/t chelation of intracellular Ca

193
Q

Tetracycline mediated flexor tendon relaxation

A

inhibition of collagen gel contraction by equine myofibroblasts– inhibition of noraml collagen organization

194
Q

Fluoroquinolones negative CNS side effect

A

GABA antagonism

195
Q

Macrolides can cause CNS excitement, particuarly in foals at what dose

A

cumulative 60 mg/kg

196
Q

Major food animal species

A

Cattle

pigs

chickens

turkeys

197
Q

Drugs with no allowable extralabel uses in any food producing animal species

A

chloramphenicol

clenbuterol

diehtlstilbestereol (DES)

fluoroquinolone-class antibiotics

glycopeptides– all agents, including vancomycin

medicated feeds

nitroimidazoles– all agents including dimethridazole, iproindazole, metronidazole

nitrofurans– all agents, indlucign furazolindine, nitrofurazone & others

198
Q

Adamantane and nueraminidase inhibitors extra label drug are prohibited in:

A

chickens

turkeys

ducks in USA

**used in other countries for prevention of avian influenza**

199
Q

Cephalosporin ELDU is

A

restricted in the USA

200
Q

Cephalosporin difference in major & minor species

A

Major species: only fo rtherapeutic indicaitons & is prohibited in all of the following situations: no deviation form dose, duration frequency of admin route, outside of intended use of product in an unapproved major spp., cannot be sued for purpose of dz prevention

Minor species: ELDU permitted in these species

201
Q

Genitian violet use in Food animals is:

A

Prohibited

202
Q

Phenylbutazone use in Food animals is:

A

strictle prohibited in female diary cattle greater than 20 months of age

203
Q

Sulfonamide class antibiotic use in food animals

A

prohibited in lactating dairy cattle, except for aprpoved uses of sulfadimethoxine, sulfabromotheazine, sulfaethoxypyridazine

204
Q

Oxytetracycline is labeled for:

A

Beef and dairy cattle for treatment of:

  • pneumonia & shipping fever complex assoc with pasteruella & haemophilus
  • infectious bovine keratoconjunctivitis (pink eye) caused by morazella bovis
205
Q

Excede (cefiotfur crystalline free acid) label in food animal

A

Tx of:

  • bovine respiratory disease (BRD)
  • foot rot
  • control of resp dz in cattle at high risk for BRD
206
Q

Excenel (ceftiofur hydrochloride) label in food animal

A

Treatment of:

  • bovine resp disease (BRD, shipping fever, pneumonia)
  • foot rot
  • acute metritis in cattle
  • swine bacterial resp disease (SRD) in swine
207
Q

Enrofloxacin label in food animal

A

Beef and non-lactating dairy cattle

  • BRD- mannheimia haemolytica, pasterella multocida, histophilus somni & mycoplasma bovis

Swine:

  • SRD- actinobacillus pleuropneumoniae, pasterella multocida, haemophilus parasuis, strep suis
208
Q

Nuflor (florfenicol) label in food animal

A

Cattle

  • BRD
  • foot rot
209
Q

Draxxin (tulatrhomycin) label for use in food animals

A
  • BRD/SRD
  • infectious bovine keratoconjunctivitis (IBK)
  • foot rot
210
Q

Clenbuterol use in food animals

A
  • illegal/prohibited d/t tissue residue
211
Q

Chlorotetracycline use in food animals

A

can only use label for Anaplasma

212
Q

If giving concurrent with theophylline, what drug concentration needs to be decreased?

A
  • Enrofloxacin: bronchodilator– tx asthma & other lung problems

–flouroquinolones inhibit CYPIA2 mtabolism of theophylline

**in dogs INC theophyline concentrations

213
Q

Erythromycin is usually bacteriostatic except for

A

At high concentrations

** bactericidal (time-dependent) activity**

214
Q

Prokinetic effects of erythromycin are seen at sub-antimicorbial doses due to its action:

A

effects of motilin or 5-hydroxytryptophan3 (5-HT3)

can stimulate migraitng motility complexes

& antegrade peristalsis

215
Q

Adverse effects of erythromycin

A

avoid if preexisting liver dysfunction

enterocolitis (adult horses)

hyperthermia (foals)

216
Q

At what age should erythromycin be used cautiously in foals?

A

>4 months old

217
Q

Low concentrations of heparin MOA

A

comb with ATIII inactivate factor Xa and prevent conversion of prothrombin to thrombin

218
Q

Higher concentrations of heparin:

A

inactivates thormbin

blocks conversion of fibrinogen ot fibrin

when combinated with antirhombin III inactivates factors IX, X, X1, XII

219
Q

By inhibiting factor XIII heparin prevents what:

A

formation of stable fibrin clost

**does not lyse clots but prevents growth of existing clots

220
Q

heparin causes increases release of what protein?

A

lipoprotein lipase– increasing clerance of circulating lipids & boosting plasma levels of free fatty acids

221
Q

When should heparin not be administered?

A

thrombocytopenia

uncontrollable bleeding (other than DIC)

222
Q

What is the most common adverse effects of heparin in horses?

A

anemia

**likley d/t erythroycte agglutination

other AE: hemorrahge, thrombocytopenia & pain at injection sites

223
Q

Clopidogrel uses/indications

A

platelet aggregation inhibitor

224
Q

Clopidogrel MOA

A

metabolized to active highly unstable thiol compound that is responible for its inhibitory plt aggregation activity (primary and seconadry aggregation)

binds selectively to plt surface low affinity ADP receptors & inhibits ADP binding to the site therapy reducingplt aggregation

225
Q

How long is the mechanism of clopidogrel?

A

Clopidogrels active metabolite irreverisbyl alters the ADP receotr

**platelet is altered for its lifespan

226
Q

How is the mechanism of Clopidogrel different from Aspirin?

A

Aspirin acetylates and ianctivates COX-1 on plts, thereby preventing formation of thromboxane A2

227
Q

Is clopridogrel safe to be used with heparin?

A

yes

**both unfractionated and LMW

228
Q

Aspirin mechanism of action

A

inhibits cyclooxygenase (COX-1, prostaglandin synthetase), reducing the syntehsisi of prostalgandins & thormboxanes (TXA2)

229
Q

Aspirin administration is contraindicated in:

A

bleeding ulcers

hemorrahgic disorders

asthma

renal insufficiency

hypoalbuminemia (lower dosages to prevent C/S of tox)

230
Q

Most common adverse effect of aspirin administration

A

gastric (nausea, anorexia, vomiting) or intestinal irritation

231
Q

Neostigmine is what kind of drug?

A

parasympathomimetic (cholinergic)

232
Q

What is neostigmine labeled for?

A

rumen atony

initiating peristalysis

emptying the bladder

sitmulating skeletal mm contractions

233
Q

neostigmine MOA

A

compets with actylcholine for actylhcolinesterase– hydrolyzed at a sloweer rate than acetylcholine-enzyme complex

**acetylcholine willa ccumulate with a restulant exaggeration & prolongation of effects–> INC ton e of itnesinal & skeletal mm, stim of salivary & sweat glands, rbonchoocnstriction, urter constriciton, miosis & bradycardia

234
Q

Neostigmine is contraindicated in patients with:

A

peritonitis

mechanical intestinal or urinary tract obstructions

late stages of pregnancy

235
Q

Adverse effects of neostigmine

A

cholinergic in nature & dose related

(nause, vomiting, diarrhea, excessive salivation& drooling, sewating, miosis, lacrimation, inc bronchial secretions, bradycardia or tachycardia, cardiospasm, bronchospasm, hypotension, mm cramps & weakness, agitation,r estlessness or parlaysis)

236
Q

Dantrolene sodium indication

A

skeletal mm relaxation

**horses: post anesthesia myositis/acute rhabdomyolysis

**malignant hyperthermia

237
Q

Dantrolene sodium MOA

A

**exact mech not well understood

acts on skeelta mm by interfering wiht release of calcium from sarcoplasmic reticulum

238
Q

Dantrolene sodiuma adverse effects

A

weakness

sedation

increased urinary frequency

GI effects

hepatotoxicity (esp with chronic use)

239
Q

Methocarbamol primary indication?

A

muscle relaxant

IV in horses: adjunctive therapy of acute inflammatory & traumatic aconditions of skeletal mm to reduce mm spasms & effect stirated mm relaxation

240
Q

Methocarbamol MOA

A

**Exact MOA unknown

**has no direct relaxant effects on striated mm, nerve fibers or motor endplate (not direclty relax contracted skeletal mm)

241
Q

What is a minor metabolite of the methocarbamol?

A

quaifenesin

** may have racing regulatory ramifications & little clinical effect

242
Q

Methocarbamol adverse effects

A
  • sedation
  • salivation
  • emesis
  • lethargy
  • weakness
  • ataxia
  • sedation– horses

ACVIM.Pharm (4 decks)

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