PHARM 2 Flashcards
The intrinsic property of sarcomere to shorten (actin myosin interaction) and contract is known as (inotropy/ chronotropy)
Inotropy
Chronotropy has a constant flux of parasympathetic and sympathetic tone. With CHF there is more (sympathetic/ parasympathetic)
Sympathetic
What are the two main mechanisms to increase inotropy (contractility)
Increasing the quantity of intracellular calcium
Increasing the sensitivity of contractile proteins to calcium
Combo
All of the following are drugs used in heart disease and failure as positive inotropes. Which are the major drugs used in general practice? A. Dopamine B. Pimobendan C. Digoxin D. Dobutamine E. Milrinone
B
C
Which drugs increase Ca concentration via B adrenergic agonism. They increase cAMP via adenylate cyclase, increasing Ca A. Dopamine B. Pimobendan C. Milrinone D. Dobutamine E. Digoxin
A
D
Phosphodiesterase inhibitors decrease degradation of cAMP, thus increasing Intracellular Ca. Which drugs are these
A. Dopamine B. Pimobendan C. Milrinone D. Dobutamine E. Digoxin
B
C
Pimobendan works by decreasing degradation of cAMP, being a calcium sensitizer (troponin C), and is a phosphodiesterase 3 inhibitor What does phosphodiesterase do
Is in smooth muscle causes vasodilation if arteries and vein
When is pimobendan used
Systolic dysfunction (DCM)
Congestive heart failure
Pre-clinical valve disease with cardiomegaly
Which of the following are contraindications or adverse effects of pimobendan? A. Ventricular hypertrophy B. Sub-aortic stenosis (obstruction) C. Can only be used as a liquid solution D. GIT effects E. Hypotension
A B- don’t use in these C- only pills (incorrect) D- most common SE E. Hypotension may occur as SE
In which of the follow cases can pimobendan be used in cats
A. Hypertrophic Cardiomyopathy (LV hypertrophy)
B. End stage HCM or refractory CHF
C. Dilated and restrictive cardiomyopathy
C is most used
B- can or cannot be used
A- not used
What is digoxin’a primary MOA
Inhibits Na/ K ATPase= increases cellular Na then decreased Na/ Ca exchanger
Which is false regarding digoxin? A. Used in DCM B. Used for atrial fibrillation C. Wide therapeutic window D. Monitored blood concentrations up to 10 days E. Excreted from kidney F. SE include arrhythmias G. Can have digibind (drug Ab)
C- very narrow
What can increase preload
Fluid therapy
High output state (anemia, hyperthyroid)
Heart dz= fluid retention
All of the following are preload reducers (diuretics) Which are used the most for general practice A. Furosemide B. Torsemide C. Bumetanide D. Spironolactone
A
D- K sparing But questionable efficacy in survival
Other 2 are more potent
What increases after load
Hypertension (LV) Vasoconstriction (RAAS and CHF- LV after load) Pulmonary hypertension (RV)
What are 2 prominent drugs used in heart dz and failure to increase forward output
ACE inhibitors (Enalapril (renal) benazepril (renal and hepatic) lisinopril) Amlodipine
Nitrates- nitroglycerin
Pimobendan
Telemisartin
Vasodilators
Ace inhibitors can be used for what
Pre CHF
CHF
Systemic and glomerular hypertension
T/ F ACE inhibitors can cause GIT upset, renal injury (azotemia with furosemide)
True
When would you not want to use ACE inhibitors (contraindication)
Dehydration Azotemia Hyperkalemia Hyponatremia Interacts with NSAID Cisplatin Aminoglycosides
Amlodipine is an after load reducer that can treat
Systemic hypertension
Glomerular hypertension
Vasoconstriction in CHF
T/F. Amlodipine should be used in patients with hypertension that are dehydrated
False- contraindication if dehydrated or hypotension
Can cause GIT upset, hypotension, gingival hyperplasia what resolves with disuse
Nitrates such as Nitroglycerin (increase/ decrease) nitric oxide production
Increase. Is a venodilator
Match 1. Electric depol of ventricle 2. Repol (ventricular recovery) 3. Atrial depol A. P wave B. QRS C. T wave
B
C
A
Antiarrhythmic drugs Class 1 (Na channel block) are associated with atrial and ventricular arrhythmias. Class 1a drugs which decrease upstroke and prolonged AP include _________. Class 1b which shortens AP include _________.
1a- quinidine procainamide
1b- lidocaine mexiletine
T/F lidocaine can cause CNS excitation in both cats and dogs
True. Especially cats
Is class 1b
Cats=1/10 dose (normally prefer ventricular arrhythmias)
Mexiletine is similar
Atenolol can destabilize patients with poor systolic function or poor output. Is to be used with caution or at all with bronchial disease or asthma. What class is it in
2
Sotalol is a class 3 drug with some class 2 effects. T/f
True. It prolongs AP
Diltiazem side effects include
Bradycardia. Hypotension weakness. GIT
What can anti- hemostatic drugs prevent in cats
Feline aortic thromboembolism
Also a tx
Prevents pulmonary thromboembolism from hyper adrenocorticism, IMHA, DIC, nephropathy, HTWM
(Thrombolytics/ anticoagulants/ antithrombotics) interfere with the clotting cascade. (Thrombolytics/ anticoagulants/ antithrombotics) breakdown thrombi that already formed. (Thrombolytics/ anticoagulants/ antithrombotics) interfere with platelet aggregation.
Anticoagulant
Thrombolytics
Antithrombotics
When using heparin as an anticoagulant drug what should be monitored frequently
ACT
aPTT
Acts on antithrombin 3
Low molecular weight heparin needs (less/more) monitoring than unfractionated heparin.
Less- risk for bleeding is less
Aspirin does all of the following except.
A. Reversibly inhibits COX enzymes
B. Causes platelets to not synthesize more COX
C. Blocks TXA2 production for life of platelet
D. Exacerbates GIT or renal dz
A- irreversible
Clopidigreo is a ADP antagonist but cannot bind to the P2Y12 receptor. The platelet activation is inhibited but it is (more/less) effective than aspirin
More. With less side effects
Used in fat cats
What is the MOA of Thrombolytics
Enhance conversion of plasminogen to plasmin
Cleaves fibrin and breaks clot
(Tissue plasminogen activator, urokinase, streptokinase)- used for acute clotting and coronary artery dz. (not for chronic clots)
What drug can be used to block Na/K pump leading to increase of intracellular Ca concentrations?
Digoxin
What are the two types of GI contractions and how long do they last
Phasic- rhythmic. Seconds
Tonic- minutes to hours
What is the largest endocrine organ in the body
GIT
T/F the enteric nervous system can function independently of the CNS
True- affeeent sensory neurons, inter neurons and efferent secretomotor neurons
What is the main neurotransmitter in parasympathetic postganglionic fibers that innervate the SM and secretory cells
Acetylcholine
Also serotonin dopamine vasoactive intestinal peptide ATP nitric oxide
These stimulate motor and secretory activity
Sympathetic (inhibits/ stimulates) motor and secretory activity, and (inhibits/stimulates) sphincter and blood vessel contraction.
Inhibits
Stimulates
What are some gastrointestinal reflexes
Peristalsis Enterogastric reflex (distention of SI suppresses secretion and motor activity of stomach -ENS) Intestino-intestinal (distention of bowel is one segment inhibits activity elsewhere in bowel- ENS)
Postoperative ileus occurs when increased concentrations of circulating ________ from surgical stress cause parasympathetic _______ and thus resection and anastomosis (physical disruption of ENS)
Catecholamines
Hypo-activity ( depression)
What electrolyte imbalances can cause POI
Ca and Mg
What is most of intestine innervated by
Vagus
Prokinetic drugs (similar to parasympathomimetics) increase acetylcholine by
Stimulating release or preventing degradation
Sympathetic NS on the GIT uses what nerve to inhibit contraction and what neurotransmitter
Splanchnic
Norepinephrine
What does lidocaine increase SM contractions?
Duodenum only
What systems are most sensitive to lidocaine toxicosis
Nervous and skeletal
Other species = CV
When is lidocaine contraindicated
Reduced liver function
Low protein
Neonates
Decreased cardiac output
What are some signs of lidocaine toxicity (hours after tx)
Muscle fasciculations
Ataxia
Collapse
Resolve quickly (minutes)
_______ is a muscarinic receptor agonist and mimics the action of acetylcholine. It is also resistant to degradation by acetylcholiesterase. It acts on the duodenum, jenunum, cecum and pelvic flexure
Bethanacol
Cholinergic agents’s primary side effect is
Excessive salivation
Used mainly with gastric and duodenal ulcers
Neostigmine inhibits the activity of what
Acetylcholinesterase- reduces gastric emptying and jejuenal motility Acts in large colon +LC impactions (not for SI ileus or gastric reflux)
Can also be used for foals to pas gas with ab distention
What should be checked before giving neostigmine
If displaced or torsion of colon
Can make impaction colic signs worse
What do 5- hydroxytryptamine receptor agonists bind to and what does that binding cause
Serotonin- 5-HT4
Peristalsis and secretion in myenteric plexus, ileum and pelvic flexure
Metoclopramide stimulates motility by binding to ______ receptors and is an antagonist to _____ receptors (perception of pain and nausea)
5-HT4
5-HT3
Dopamine antagonist too (dopamine inhibits acetylcholine release and reduces SM contraction)
What can metaclopramide not be administered with in the same IV line
Calcium gluconate
Erythromycin
IV CRI to reduce side effects
What are metoclopramide’s side effects and why so we see them?
Extrapyramidal wffects - dopamine inhibition in CNS= sedation and excitement, restless and muscle spasms
What should be given is metoclopramide side effects are seen
Diphenhydramine
Sedatives make it worse!
Coda pride has (less/more) side effects when compared to metaclopramide (also a 5-HT4 agonist and 5-HT3 antagonist)
Less because no anti- dopamine
What do motilin agonists bind to?
Receptors in enteric nerves= release of acetylcholine
Macrolide antibiotics mimic these= motilide
What is the most widely used motilide
Erythromycin
1 for cecal impaction
Stimulates migrating myoelectric complexes
Best IV. Oral = colitis
Where are motilin receptors predominantly found
Duodenum and jejunum (thus erythromycin increased gastric emptying with jejunal contraction)
Also found in pelvic flexure and cecum
Which is true about H2 Antagonists A. Irreversibly bound B. Competitive antagonist C. Highly Bioavailable D. Cimetidine is better than ranitidine
B
A- reversible
C- poor
D- ranitidine> cimetidine (TID) neither great
What do H2 antagonists do
Block gastric and Ach stimulated acid
Some pepsin secretion also inhibited
What is the common denominator for gastric acid secretion regardless of stimulus
Proton pump (H K ATPase pump)
How many days does it take to get a steady state of a proton pump inhibitor
3 (omeprazole)
Sucralfate binds to _______ then create a physics barrier to protect mucus from stomach acid
Ulcers- albumin or fibrinogen
promotes bicarbonate Buffer with corporate tube properties
What is false regarding sucralfates MOA
A. Acts in acidic environment
B. Stimulates production of prostaglandin E
C. Reacts with hydrochloride acid in stomach
D. Acts up to 4 hours
D- up to 8
Rank the following prokinetics A. Metoclopramide B. Erythromycin C. Neostigmine D. Lidocaine
D
A
B
C
Dogs have only what type of muscle in their esophagus
Skeletal
Skeletal 2/3 for cat SM distal 1/3
Adrenergic receptors (inhibit/enhance) motility
Inhibit. Cholinergic enhance
Metaclopramide MOA includes what 2 actions
Serotonin antagonist
Antidopaminergic
Proximal GIT distal is less responsive
What drug can be used post GDV to enhance motility
Metoclopramide
Also ileus reflux
Cisapride enhances acetylcholine release from intrinsic cholinergic neurons. Where is it’s sit of action
Muscle of esophagus to colon
Cisapride can be used in all of the following except A. Mega esophagus (cats) B. Megacolon (cats) C. Ileus D. Reflux E. Megaeaophagus (dog)
E- skeletal muscle only (needs SM)
What is cisapride metabolized by
CYP 450
SE: vomiting diarrhea ab discomfort
Nizatidine is a H2 receptor blocker and inhibits acetylcholinesterase activity. What can it be used in
Delayed gastric emptying
Consitpation
Pseudo obstruction
Reflux
Erythromycin works beat in what part of the GIY
Proximal (motilin receptors)
Erythromycin can be used to decrease colonic activity in what species
Dogs
What drugs shouldn’t be given to MDR1 mutation dogs
Erythromycin
Loperamide
When is a drug that suppresses motility contraindicated when a dog has diarrhea
If infectious cause
Diphenoxylate is an opioid that leads to decreased GI motility. What species can it not be given to
Cats- excitatory SE
Same with loperamide (opioid too)
Protectants/ adsorbants (pectin, kaolin, charcoal, bismuth) absorb fluid and toxics but aren’t effective in binding what toxin
E. coli enterotoxin
Which is false about metronidazole A. Disrupts bacterial DNA synthesis B. Effective agonist protozoan species C. Effective against anaerobic bacteria D. Minimally metabolized by liver due to its retention in the GIT
D- extensive hepatic metabolism- lower dose is decreased liver function
What are some adverse effects of metronidazole
GIT upset Hepatotoxicity Neurotoxicosis Hyposmia Doesn’t work for hemorrhagic diarrhea AB resistant species maker Disrupts microbiome for months
Tylosin is a macrolide antibiotic that alerts GI microbes. When is it usually used
Chronic enteropathy Exocrine pancreatic insufficiency GI dysbiosis
Can be given chronically with few side effects
Laxatives such as parrafins, surfactants and fiber work by
Increasing hydration of fecal mass and lubricate
What enema cannot be used in cats
Phosphate enemas
Ursodeoxycholic acid or ursodiol (actigall) decrease hepatic synthesis of cholesterol and intestinal absorption of cholesterol. When is this used
Cholestasis
GB sludge
Mucoceles (but can expand and cause GB rupture so only if Sx not possible)
Name some hepatoprotectants
S-adenosyl (deficient in liver dz)
Silymarin- inhibits TNF and prevents toxin penetration into hepatocytes
Denamarin denosyl
What is a non absorbable disaccharide what is used to treat hepatic encephalopathy by drawing water into the colon, metabolizes bacteria into acid metabolites (thus ammonia migrated from blood to colon to be excreted)
Lactulose
Neomycin only works locally in the GIT to reduce the number of ammonia producing bacteria therefore it can be given lifelong. What is its MOA
Aminoglycosides AB
Name possible drugs that can be used for perinatal fistulas
Cyclosporine (immunosuppressive against T cell)
Tacrolimus- calcineurin inhibitor (topical)
Niacinamide (vitamin b) and doxycycline (tetracycline AB)
Exocribe pancreatic insufficiency can be caused by pancreatic acinar atrophy or chronic pancreatitis It leads to diarrhea, malnutrition and cobalamin deficiency What is the treatment
Replace my pancreatic enzymes
Viokase pancreazyme
Cobalamin (B12) absorbed in ileum
How do we treat a horse with insulin dysregulation, overweight, laminitis, elevated GGT AST (EMS)
Diet
Exercise
Levithyroxine
Metformin
What are thyroid hormones controlled by
TSH feed back system
What happens when there are increased levels of ATP
Increased metabolism
Increased HR
increased GI motility
Increased sensitivity to catacholamine (increased sympathetic tone)
T/F levithyroxine (artificial T4/ thyroxine) is regularly used in horses
False. Other species
What is levithyroxine’s MOA
Converted to T3. Bind to thyroid receptor proteins of the cell Nucleus Metabolic effects by control of DNA transcription and pt. Synthesis
What does Levothyroxine do for horses with EMS
Accelerates weight loss Increases metabolic rate Increases insulin sensitivity Mild hyperthyroidism state 3-6 months max and slowly weaned off
Metformin inst that bioavailable to horses but it’s MOA is
Decreases GI absorption of glucose and limits post prandial insulin concentrations
Given 1 hr before eating then check insulin 2 hours post eating. In first day and 7th day
SGLT2 causes what to occur
Glucose loss through kidney = weight decreas BP decrease
Canaglidlozin and velagliflozin are new to EMS treatment but
Research looks good
Which is true about Cushings (PPID) in horses
A. Generally involves the Anterior lobe of the pituitary
B. Generally involves the adrenal gland
C. Older horses >14
D. Generally involves an excess of dopamine
C. Intermediate lobe and lack of dopamine
How is PPID diagnosed in horses
Endogenous ACTH concentrations- not always accurate if early dz, increased in summer and fall
Thyrotropin releasing hormone stimulation test- better in early stages, causes intermediate lobe to increase ACTH
Prascend is a long acting dopamine receptor agonist that stimulates dopamine receptors thus it inhibits
Production of POMC ACTH MSH
May disrupt repro function
What are some side effects of prascend
Sweating Inapp. Anorexia Lethargy CNS Colic Diarrhea
When should ACTH levels be checked after starting prascend
4-6 weeks
Increase dose if no improvement
Cyproheptadine is a serotonin receptor blocking agent. It is used with what to help with clinical signs if PPID
Pergolide (used when prascend is at max dose)
What are side effects of cyprohepatadine
Sedation
Dry MM
tachycardia
Which are steroid hormone? A. Aldosterone B. Thyroxine C. Insulin D. ACTH E. Cortisol F. Androgens
A E F. Others are peptides
Acarbose (alpha glycosidase inhibitor) treats what disease by preforming what action
Diabetes by inhibiting intestinal enzymes that convert start healthy to sugar (slows glucose absorption)
Only used with poor glycemic control dogs or cats that won’t eat low carb diets
What are some adverse effects of acarbose
GI- weight loss diarrhea flatulence
Hypoglycemia if used in combo with insulin
Takes 2 weeks for effect
Won’t work with ad libitum
Glipizide. Which is true A. Sulfonylurea anti diabetic agent B. Stimulates alpha cells C. Used in dogs with insulin dependent diabetes D. Given with insulin
A
B- beta
C- cats with non insulin dependent
D- only if insulin cannot be given or dose is too small
How effective is glipizide
20-30%
BID with meals
What adverse effect of Glipizide can make diabetes worse
Increases amyloid deposition (compared to insulin) which worsens beta cell function further
Elevated liver enzymes- monitor first 1-2 weeks
Many drug interactions and takes 1/2 months to see effect
T/F in general oral hypoglycemic agents are recommended for use to treat diabetes
False. Usually not
(Dogs/Cats) can tolerate more differences and are less likely to form antibodies against insulin medications.
Cats
What is not a possible adverse effect of insulin A. Hypoglycemia B. Somogyi effect C. Diarrhea D. Injection site reaction
C
Many drug interactions so check before use
Which is a recombinant human insulin which no chemical modification? A. Regular B. NPH C. PZI D. Lente/Ultralente E. Synthetic insulin
A
SQ IV IM
Which of the following insulin’s are combined with protamine and zinc.
A. Regular B. NPH C. PZI D. Lente/Ultralente E. Synthetic insulin
C
SQ Only
Which formulation is combined with protein to delay absorption
A. Regular B. NPH C. PZI D. Lente/Ultralente E. Synthetic insulin
B
SQ
Which formulation is combined into small and large crystals for delayed absorption
A. Regular B. NPH C. PZI D. Lente/Ultralente E. Synthetic insulin
D
SQ
Which of the following formulations is altered to slow absorption and degradation A. Regular B. NPH C. PZI D. Lente/Ultralente E. Synthetic insulin
E
What uw the insulin of choice for DKA and Hyperkalemia
Regular human insulin Shortest acting (1-2 hrs) Dog or cat Hyperkalemia = with dextrose U100
What is the insulin of choice for dogs
Vetsulin- lente
Lasts for 12 hours
U40
Shake
Novolin-N and Humulin N are what type of insulin formulations
NPH
Dog if not vetsulin
Cats = less effective
U100
Detemir is a potent insulin that should not be used in ___
Cats- so potent that dose is very low
U100
What is the most used insulin in cats
Glargine
Human recombinant U100
Long acting (up to 24 hours)
Prozinc is a PZI that is a human recombinant insulin. What U is it
U40
FDA for animals
2nd choice for cats
What fluids are given to a patients with hypercalcemia
Physiologic saline diuresis Correct dehydration Decreases renal tubular calcium reabsorption = calcium excreted IV or SQ Fast
Furosemide inhibits _____ in the thick ascending loop of henle in order to inhibit calcium reabsorption
Na K Cl symporter
Must be hydrated
Fast
Glucocorticoids are used to treat hypercalcemia. What do they do
Reduce bone resorption
Increase renal excretion
Decrease absorption
Cytotoxic good neoplastic lymphocytes
Include pred and dexamethasone
T/F Glucocorticoids are not useful in treating primary hyper parathyroidism caused hypercalcemia or non hematologic neoplasia
True
T/F Bisphosphates are used to treat chronic hypercalcemia by inhibiting osteoclasts activity and bone resorption
True
Slow acting
Included alendronate (oral) and pamidronate IV and zoledronate (IV)
Alendronate is used in (cats/dogs) more
Cats
Can cause GI and esophagitis
Not given with food but give with water to prevent SE
Pamidronate is given over how long to prevent renal toxicity and electrolyte abnormalities
2-4 hrs
Dogs and cats
Zoledronate has to be given how often
Every 28 days
Possible renal to city
Is a bisphosphonate
What drug is generally not recommended for hypercalcemia because it has to be given every 2 hours for effectiveness, hypersensitivity, poor efficacy and promotes excretion of Ca, ph, and other electrolytes
Calcitonin
What is calcium gluconate’s MOA
Direct replacement
Must administer slowly -cardiac arrest and hypotension IV only
Monitor with ECG
Chronic therapy if hypocalceniq due ti hypoparathyroidism combines these two treatments
Direct Ca supplement and vitamin D
Calcium carbonate (tums)- bind phosphate too
Calcitriol (vitamin D) also for renal secondary hyperparathyroid
When should calcitriol not be given
Hyperphosphatemic animals it with Ca/phos > 70
Can cause tissue mineralization and hypercalcemia and calcium oxalate stone
TSH (thyrotropin Alfa) MOA is increases ________ uptake by the thyroid glands and (increases/ decreases) production of thyroid hormones
Iodine
Increases
Is the gold standard for Dx hypothyroidism
What is a adverse effect if TSH
Hypersensitivity (human product)
Synthetic levithyroxine is the treatment of choice for hypothyroid and it’s MOA is
Direct hormone replacement
Don’t exceee 0.8 mg/dog a day
What concurrent diseases should levothyroxine be used with caution
Hyperadrenocorticism
Cardiac disease
DM
(Dose reduction)
T/F levothyroxine should be given with food to prevent nausea
False. Food decreases bioavailability
Why is synthetic liothyronine not recommended to treat hypothyroid
Is T3 and can cause and over dose
More expensive
No increase of T4
Only used when there in poor T4 GI absorption
T/F thyroid extracts/desiccated thyroid contain both T3 and T4
True in a 4:1 ratio (more t4)
Is not recommended due to allergies
What are hormones for diagnoses of hyperthyroid
Synthetic liothyronine (active thyroid) T3 suppression test (t3 should inhibit tsh)- should be suppressed <50%
What drug is used to treat hyperthyroid
Methimazole
Inhibits thyroid peroxidase (inhibits iodide binding to tyrosine)
Why would methimazole be given transdermally
Fewer GI side effects- wear gloves
What should be monitored on a CBC when giving methimazole
Neutropenia thrombocytopenia
Discontinue if seen
What are side effects of methimazole
Facial excoriation- discont Pruritis- discont Hepatotoxicity- discont Renal decompensation- if had before (reduce dose) Takes 1-3 week for sustained suppression
I-131 is concentrated in hyper functional thyroid cells to treat
Hyperthyroid
T/F cats treated with I-131 must be quarantined for a minimum of 8 days
True
DDAVP (desmopressin acetate) mechanism of action is
Synthetic analog of vasopressin (ADH) Central DI (or differential central from nephrogenic)
How is DDAVP given
Eye drop or SQ
What diuretic is given to stop PU PD in diabetic patients
Thiazides cholorothiazide (in early distal tubule) Many drug interactions
What drug is used to diagnosed hyperadrenocorticism (cushings)
Synthetic adrenocorticoteopic hormones (ACTH cosyntropin, corticotropin) Dexamethasone suppression (not with NSAIDS)
What is the MOA of trilostane (vetoryl) and what does it treat
Cushings
Is a synthetic steroid analog- competitive enzyme inhibitor that blocks formation of cortisol
Monitor ACTH stim tests in 2+4 weeks
What are possible adverse effects of trilostane
Idiosyncratic adrenal necrosis
Electrolyte abnormalities (hyper K, hypo Na)
Addisons- reversible (GI Leth hypovolemia)
What might be a reason not to use trilostane
Drug interactions - ketoconazole and mitotane, ACE inhibitor and K sparing Diuretics make hyper K worse
Compounding - 40-150% deviation from label
What chemotherapeutic drug can be used to treat cushings (but is less used since trilostane)
Mitotane- adrenolytic/adrenal cytotoxic
Make addisons
Ketoconazole is no longer used for cushings
Selegiline is a monoamine oxidase inhibitor thus causes dopamine in the pars intermedia to (increase/ decrease)
Increase and thus inhibit ACTH (cushings tx)
Not useful since most cushings are pars distalis
What drug is used in feline cushings
Metyrapone It’s an enzyme inhibitor that blocks formation of cortisol
Short term tax before adrenalectomy
Synthetic ACTH diagnoses what
Cushings. Addisons
A glucocorticoid replacement drug is common in addisons patients. What drug is this
Prednisone- direct hormone supplement
Wait 24 hours to perform cortisol testing
A aldosterone replacement drug is common in addisons patients. What drug is
Desoxycorticosterone pivalate (DOCP)
Long acting mineralcorticoid (may cause irritation GI PU PD)
Not given if atypical!
A glucocorticoid and aldosterone replacement drug is common in addisons patients. What drug is
Fludrocortisone- steroid with both glucocorticoid and mineralcorticoid
(May not need pred) not with atypical!
PU OD hypertension and edema and hypokalemia possible
