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Equine > PHARM 2 > Flashcards

PHARM 2 Flashcards

1
Q

The intrinsic property of sarcomere to shorten (actin myosin interaction) and contract is known as (inotropy/ chronotropy)

A

Inotropy

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2
Q

Chronotropy has a constant flux of parasympathetic and sympathetic tone. With CHF there is more (sympathetic/ parasympathetic)

A

Sympathetic

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3
Q

What are the two main mechanisms to increase inotropy (contractility)

A

Increasing the quantity of intracellular calcium
Increasing the sensitivity of contractile proteins to calcium
Combo

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4
Q 
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
A

B

C

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5
Q 
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

A

D

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6
Q

Phosphodiesterase inhibitors decrease degradation of cAMP, thus increasing Intracellular Ca. Which drugs are these

A. Dopamine
B. Pimobendan
C. Milrinone
D. Dobutamine 
E. Digoxin
A

B

C

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7
Q

Pimobendan works by decreasing degradation of cAMP, being a calcium sensitizer (troponin C), and is a phosphodiesterase 3 inhibitor What does phosphodiesterase do

A

Is in smooth muscle causes vasodilation if arteries and vein

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8
Q

When is pimobendan used

A

Systolic dysfunction (DCM)
Congestive heart failure
Pre-clinical valve disease with cardiomegaly

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9
Q 
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 
A
B- don’t use in these
C- only pills (incorrect)
D- most common SE
E. Hypotension may occur as SE
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10
Q

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

A

C is most used
B- can or cannot be used
A- not used

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11
Q

What is digoxin’a primary MOA

A

Inhibits Na/ K ATPase= increases cellular Na then decreased Na/ Ca exchanger

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12
Q 
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)
A

C- very narrow

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13
Q

What can increase preload

A

Fluid therapy
High output state (anemia, hyperthyroid)
Heart dz= fluid retention

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14
Q 
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

A
D- K sparing But questionable efficacy in survival

Other 2 are more potent

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15
Q

What increases after load

A 
Hypertension (LV)
Vasoconstriction (RAAS and CHF- LV after load)
Pulmonary hypertension (RV)
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16
Q

What are 2 prominent drugs used in heart dz and failure to increase forward output

A 
ACE inhibitors (Enalapril (renal) benazepril (renal and hepatic) lisinopril)
Amlodipine

Nitrates- nitroglycerin
Pimobendan
Telemisartin
Vasodilators

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17
Q

Ace inhibitors can be used for what

A

Pre CHF
CHF
Systemic and glomerular hypertension

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18
Q

T/ F ACE inhibitors can cause GIT upset, renal injury (azotemia with furosemide)

A

True

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19
Q

When would you not want to use ACE inhibitors (contraindication)

A 
Dehydration
Azotemia
Hyperkalemia
Hyponatremia
Interacts with NSAID Cisplatin Aminoglycosides
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20
Q

Amlodipine is an after load reducer that can treat

A

Systemic hypertension
Glomerular hypertension
Vasoconstriction in CHF

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21
Q

T/F. Amlodipine should be used in patients with hypertension that are dehydrated

A

False- contraindication if dehydrated or hypotension

Can cause GIT upset, hypotension, gingival hyperplasia what resolves with disuse

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22
Q

Nitrates such as Nitroglycerin (increase/ decrease) nitric oxide production

A

Increase. Is a venodilator

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23
Q 
Match
1. Electric depol of ventricle
2. Repol (ventricular recovery)
3. Atrial depol
A. P wave
B. QRS
C. T wave
A

B
C
A

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24
Q

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 _________.

A

1a- quinidine procainamide

1b- lidocaine mexiletine

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25
Q

T/F lidocaine can cause CNS excitation in both cats and dogs

A

True. Especially cats
Is class 1b
Cats=1/10 dose (normally prefer ventricular arrhythmias)
Mexiletine is similar

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26
Q

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

A

2

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27
Q 
Sotalol is a class 3 drug with some class 2 effects.
T/f
A

True. It prolongs AP

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28
Q

Diltiazem side effects include

A

Bradycardia. Hypotension weakness. GIT

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29
Q

What can anti- hemostatic drugs prevent in cats

A

Feline aortic thromboembolism
Also a tx
Prevents pulmonary thromboembolism from hyper adrenocorticism, IMHA, DIC, nephropathy, HTWM

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30
Q

(Thrombolytics/ anticoagulants/ antithrombotics) interfere with the clotting cascade. (Thrombolytics/ anticoagulants/ antithrombotics) breakdown thrombi that already formed. (Thrombolytics/ anticoagulants/ antithrombotics) interfere with platelet aggregation.

A

Anticoagulant
Thrombolytics
Antithrombotics

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31
Q

When using heparin as an anticoagulant drug what should be monitored frequently

A

ACT
aPTT
Acts on antithrombin 3

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32
Q

Low molecular weight heparin needs (less/more) monitoring than unfractionated heparin.

A

Less- risk for bleeding is less

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33
Q

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

A- irreversible

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34
Q

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

A

More. With less side effects

Used in fat cats

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35
Q

What is the MOA of Thrombolytics

A

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)

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36
Q

What drug can be used to block Na/K pump leading to increase of intracellular Ca concentrations?

A

Digoxin

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37
Q

What are the two types of GI contractions and how long do they last

A

Phasic- rhythmic. Seconds

Tonic- minutes to hours

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38
Q

What is the largest endocrine organ in the body

A

GIT

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39
Q

T/F the enteric nervous system can function independently of the CNS

A

True- affeeent sensory neurons, inter neurons and efferent secretomotor neurons

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40
Q

What is the main neurotransmitter in parasympathetic postganglionic fibers that innervate the SM and secretory cells

A

Acetylcholine
Also serotonin dopamine vasoactive intestinal peptide ATP nitric oxide
These stimulate motor and secretory activity

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41
Q

Sympathetic (inhibits/ stimulates) motor and secretory activity, and (inhibits/stimulates) sphincter and blood vessel contraction.

A

Inhibits

Stimulates

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42
Q

What are some gastrointestinal reflexes

A 
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)
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43
Q

Postoperative ileus occurs when increased concentrations of circulating ________ from surgical stress cause parasympathetic _______ and thus resection and anastomosis (physical disruption of ENS)

A

Catecholamines

Hypo-activity ( depression)

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44
Q

What electrolyte imbalances can cause POI

A

Ca and Mg

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45
Q

What is most of intestine innervated by

A

Vagus

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46
Q

Prokinetic drugs (similar to parasympathomimetics) increase acetylcholine by

A

Stimulating release or preventing degradation

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47
Q

Sympathetic NS on the GIT uses what nerve to inhibit contraction and what neurotransmitter

A

Splanchnic

Norepinephrine

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48
Q

What does lidocaine increase SM contractions?

A

Duodenum only

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49
Q

What systems are most sensitive to lidocaine toxicosis

A

Nervous and skeletal

Other species = CV

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50
Q

When is lidocaine contraindicated

A

Reduced liver function
Low protein
Neonates
Decreased cardiac output

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51
Q

What are some signs of lidocaine toxicity (hours after tx)

A

Muscle fasciculations
Ataxia
Collapse
Resolve quickly (minutes)

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52
Q

_______ 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

A

Bethanacol

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53
Q

Cholinergic agents’s primary side effect is

A

Excessive salivation

Used mainly with gastric and duodenal ulcers

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54
Q

Neostigmine inhibits the activity of what

A

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

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55
Q

What should be checked before giving neostigmine

A

If displaced or torsion of colon

Can make impaction colic signs worse

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56
Q

What do 5- hydroxytryptamine receptor agonists bind to and what does that binding cause

A

Serotonin- 5-HT4

Peristalsis and secretion in myenteric plexus, ileum and pelvic flexure

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57
Q

Metoclopramide stimulates motility by binding to ______ receptors and is an antagonist to _____ receptors (perception of pain and nausea)

A

5-HT4
5-HT3
Dopamine antagonist too (dopamine inhibits acetylcholine release and reduces SM contraction)

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58
Q

What can metaclopramide not be administered with in the same IV line

A

Calcium gluconate
Erythromycin

IV CRI to reduce side effects

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59
Q

What are metoclopramide’s side effects and why so we see them?

A

Extrapyramidal wffects - dopamine inhibition in CNS= sedation and excitement, restless and muscle spasms

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60
Q

What should be given is metoclopramide side effects are seen

A

Diphenhydramine

Sedatives make it worse!

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61
Q

Coda pride has (less/more) side effects when compared to metaclopramide (also a 5-HT4 agonist and 5-HT3 antagonist)

A

Less because no anti- dopamine

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62
Q

What do motilin agonists bind to?

A

Receptors in enteric nerves= release of acetylcholine

Macrolide antibiotics mimic these= motilide

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63
Q

What is the most widely used motilide

A

Erythromycin
1 for cecal impaction
Stimulates migrating myoelectric complexes
Best IV. Oral = colitis

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64
Q

Where are motilin receptors predominantly found

A

Duodenum and jejunum (thus erythromycin increased gastric emptying with jejunal contraction)
Also found in pelvic flexure and cecum

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65
Q 
Which is true about H2 Antagonists
A. Irreversibly bound
B. Competitive antagonist 
C. Highly Bioavailable 
D. Cimetidine is better than ranitidine
A

B
A- reversible
C- poor
D- ranitidine> cimetidine (TID) neither great

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66
Q

What do H2 antagonists do

A

Block gastric and Ach stimulated acid

Some pepsin secretion also inhibited

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67
Q

What is the common denominator for gastric acid secretion regardless of stimulus

A

Proton pump (H K ATPase pump)

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68
Q

How many days does it take to get a steady state of a proton pump inhibitor

A

3 (omeprazole)

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69
Q

Sucralfate binds to _______ then create a physics barrier to protect mucus from stomach acid

A

Ulcers- albumin or fibrinogen

promotes bicarbonate Buffer with corporate tube properties

70
Q

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

A

D- up to 8

71
Q 
Rank the following prokinetics
A. Metoclopramide 
B. Erythromycin
C. Neostigmine 
D. Lidocaine
A

D
A
B
C

72
Q

Dogs have only what type of muscle in their esophagus

A

Skeletal

Skeletal 2/3 for cat SM distal 1/3

73
Q

Adrenergic receptors (inhibit/enhance) motility

A

Inhibit. Cholinergic enhance

74
Q

Metaclopramide MOA includes what 2 actions

A

Serotonin antagonist
Antidopaminergic
Proximal GIT distal is less responsive

75
Q

What drug can be used post GDV to enhance motility

A

Metoclopramide

Also ileus reflux

76
Q

Cisapride enhances acetylcholine release from intrinsic cholinergic neurons. Where is it’s sit of action

A

Muscle of esophagus to colon

77
Q 
Cisapride can be used in all of the following except
A. Mega esophagus (cats)
B. Megacolon (cats)
C. Ileus
D. Reflux
E. Megaeaophagus (dog)
A

E- skeletal muscle only (needs SM)

78
Q

What is cisapride metabolized by

A

CYP 450

SE: vomiting diarrhea ab discomfort

79
Q

Nizatidine is a H2 receptor blocker and inhibits acetylcholinesterase activity. What can it be used in

A

Delayed gastric emptying
Consitpation
Pseudo obstruction
Reflux

80
Q

Erythromycin works beat in what part of the GIY

A

Proximal (motilin receptors)

81
Q

Erythromycin can be used to decrease colonic activity in what species

A

Dogs

82
Q

What drugs shouldn’t be given to MDR1 mutation dogs

A

Erythromycin

Loperamide

83
Q

When is a drug that suppresses motility contraindicated when a dog has diarrhea

A

If infectious cause

84
Q

Diphenoxylate is an opioid that leads to decreased GI motility. What species can it not be given to

A

Cats- excitatory SE

Same with loperamide (opioid too)

85
Q

Protectants/ adsorbants (pectin, kaolin, charcoal, bismuth) absorb fluid and toxics but aren’t effective in binding what toxin

A

E. coli enterotoxin

86
Q 
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
A

D- extensive hepatic metabolism- lower dose is decreased liver function

87
Q

What are some adverse effects of metronidazole

A 
GIT upset
Hepatotoxicity
Neurotoxicosis
Hyposmia
Doesn’t work for hemorrhagic diarrhea
AB resistant species maker
Disrupts microbiome for months
88
Q

Tylosin is a macrolide antibiotic that alerts GI microbes. When is it usually used

A

Chronic enteropathy Exocrine pancreatic insufficiency GI dysbiosis
Can be given chronically with few side effects

89
Q

Laxatives such as parrafins, surfactants and fiber work by

A

Increasing hydration of fecal mass and lubricate

90
Q

What enema cannot be used in cats

A

Phosphate enemas

91
Q

Ursodeoxycholic acid or ursodiol (actigall) decrease hepatic synthesis of cholesterol and intestinal absorption of cholesterol. When is this used

A

Cholestasis
GB sludge
Mucoceles (but can expand and cause GB rupture so only if Sx not possible)

92
Q

Name some hepatoprotectants

A

S-adenosyl (deficient in liver dz)
Silymarin- inhibits TNF and prevents toxin penetration into hepatocytes
Denamarin denosyl

93
Q

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)

A

Lactulose

94
Q

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

A

Aminoglycosides AB

95
Q

Name possible drugs that can be used for perinatal fistulas

A

Cyclosporine (immunosuppressive against T cell)
Tacrolimus- calcineurin inhibitor (topical)
Niacinamide (vitamin b) and doxycycline (tetracycline AB)

96
Q

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

A

Replace my pancreatic enzymes
Viokase pancreazyme

Cobalamin (B12) absorbed in ileum

97
Q

How do we treat a horse with insulin dysregulation, overweight, laminitis, elevated GGT AST (EMS)

A

Diet
Exercise
Levithyroxine
Metformin

98
Q

What are thyroid hormones controlled by

A

TSH feed back system

99
Q

What happens when there are increased levels of ATP

A

Increased metabolism
Increased HR
increased GI motility
Increased sensitivity to catacholamine (increased sympathetic tone)

100
Q

T/F levithyroxine (artificial T4/ thyroxine) is regularly used in horses

A

False. Other species

101
Q

What is levithyroxine’s MOA

A

Converted to T3. Bind to thyroid receptor proteins of the cell Nucleus Metabolic effects by control of DNA transcription and pt. Synthesis

102
Q

What does Levothyroxine do for horses with EMS

A 
Accelerates weight loss
Increases metabolic rate
Increases insulin sensitivity 
Mild hyperthyroidism state
3-6 months max and slowly weaned off
103
Q

Metformin inst that bioavailable to horses but it’s MOA is

A

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

104
Q

SGLT2 causes what to occur

A

Glucose loss through kidney = weight decreas BP decrease

105
Q

Canaglidlozin and velagliflozin are new to EMS treatment but

A

Research looks good

106
Q

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

A

C. Intermediate lobe and lack of dopamine

107
Q

How is PPID diagnosed in horses

A

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

108
Q

Prascend is a long acting dopamine receptor agonist that stimulates dopamine receptors thus it inhibits

A

Production of POMC ACTH MSH

May disrupt repro function

109
Q

What are some side effects of prascend

A 
Sweating 
Inapp.
Anorexia
Lethargy
CNS
Colic
Diarrhea
110
Q

When should ACTH levels be checked after starting prascend

A

4-6 weeks

Increase dose if no improvement

111
Q

Cyproheptadine is a serotonin receptor blocking agent. It is used with what to help with clinical signs if PPID

A

Pergolide (used when prascend is at max dose)

112
Q

What are side effects of cyprohepatadine

A

Sedation
Dry MM
tachycardia

113
Q 
Which are steroid hormone?
A. Aldosterone
B. Thyroxine
C. Insulin
D. ACTH
E. Cortisol 
F. Androgens
A

A E F. Others are peptides

114
Q

Acarbose (alpha glycosidase inhibitor) treats what disease by preforming what action

A

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

115
Q

What are some adverse effects of acarbose

A

GI- weight loss diarrhea flatulence
Hypoglycemia if used in combo with insulin
Takes 2 weeks for effect
Won’t work with ad libitum

116
Q 
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

A
B- beta
C- cats with non insulin dependent
D- only if insulin cannot be given or dose is too small

117
Q

How effective is glipizide

A

20-30%

BID with meals

118
Q

What adverse effect of Glipizide can make diabetes worse

A

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

119
Q

T/F in general oral hypoglycemic agents are recommended for use to treat diabetes

A

False. Usually not

120
Q

(Dogs/Cats) can tolerate more differences and are less likely to form antibodies against insulin medications.

A

Cats

121
Q 
What is not a possible adverse effect of insulin
A. Hypoglycemia 
B. Somogyi effect 
C. Diarrhea
D. Injection site reaction
A

C

Many drug interactions so check before use

122
Q 
Which is a recombinant human insulin which no chemical modification?
A. Regular
B. NPH
C. PZI
D. Lente/Ultralente
E. Synthetic insulin
A

A

SQ IV IM

123
Q

Which of the following insulin’s are combined with protamine and zinc.

A. Regular
B. NPH
C. PZI
D. Lente/Ultralente
E. Synthetic insulin
A

C

SQ Only

124
Q

Which formulation is combined with protein to delay absorption

A. Regular
B. NPH
C. PZI
D. Lente/Ultralente
E. Synthetic insulin
A

B

SQ

125
Q

Which formulation is combined into small and large crystals for delayed absorption

A. Regular
B. NPH
C. PZI
D. Lente/Ultralente
E. Synthetic insulin
A

D

SQ

126
Q 
Which of the following formulations is altered to slow absorption and degradation 
A. Regular
B. NPH
C. PZI
D. Lente/Ultralente
E. Synthetic insulin
A

E

127
Q

What uw the insulin of choice for DKA and Hyperkalemia

A 
Regular human insulin 
Shortest acting (1-2 hrs)
Dog or cat
Hyperkalemia = with dextrose 
U100
128
Q

What is the insulin of choice for dogs

A

Vetsulin- lente
Lasts for 12 hours
U40
Shake

129
Q

Novolin-N and Humulin N are what type of insulin formulations

A

NPH
Dog if not vetsulin
Cats = less effective
U100

130
Q

Detemir is a potent insulin that should not be used in ___

A

Cats- so potent that dose is very low

U100

131
Q

What is the most used insulin in cats

A

Glargine
Human recombinant U100
Long acting (up to 24 hours)

132
Q

Prozinc is a PZI that is a human recombinant insulin. What U is it

A

U40
FDA for animals
2nd choice for cats

133
Q

What fluids are given to a patients with hypercalcemia

A 
Physiologic saline diuresis
Correct dehydration 
Decreases renal tubular calcium reabsorption = calcium excreted 
IV or SQ
Fast
134
Q

Furosemide inhibits _____ in the thick ascending loop of henle in order to inhibit calcium reabsorption

A

Na K Cl symporter
Must be hydrated
Fast

135
Q

Glucocorticoids are used to treat hypercalcemia. What do they do

A

Reduce bone resorption
Increase renal excretion
Decrease absorption
Cytotoxic good neoplastic lymphocytes

Include pred and dexamethasone

136
Q

T/F Glucocorticoids are not useful in treating primary hyper parathyroidism caused hypercalcemia or non hematologic neoplasia

A

True

137
Q

T/F Bisphosphates are used to treat chronic hypercalcemia by inhibiting osteoclasts activity and bone resorption

A

True
Slow acting
Included alendronate (oral) and pamidronate IV and zoledronate (IV)

138
Q

Alendronate is used in (cats/dogs) more

A

Cats
Can cause GI and esophagitis
Not given with food but give with water to prevent SE

139
Q

Pamidronate is given over how long to prevent renal toxicity and electrolyte abnormalities

A

2-4 hrs

Dogs and cats

140
Q

Zoledronate has to be given how often

A

Every 28 days
Possible renal to city
Is a bisphosphonate

141
Q

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

A

Calcitonin

142
Q

What is calcium gluconate’s MOA

A

Direct replacement
Must administer slowly -cardiac arrest and hypotension IV only
Monitor with ECG

143
Q

Chronic therapy if hypocalceniq due ti hypoparathyroidism combines these two treatments

A

Direct Ca supplement and vitamin D
Calcium carbonate (tums)- bind phosphate too
Calcitriol (vitamin D) also for renal secondary hyperparathyroid

144
Q

When should calcitriol not be given

A

Hyperphosphatemic animals it with Ca/phos > 70

Can cause tissue mineralization and hypercalcemia and calcium oxalate stone

145
Q

TSH (thyrotropin Alfa) MOA is increases ________ uptake by the thyroid glands and (increases/ decreases) production of thyroid hormones

A

Iodine
Increases

Is the gold standard for Dx hypothyroidism

146
Q

What is a adverse effect if TSH

A

Hypersensitivity (human product)

147
Q

Synthetic levithyroxine is the treatment of choice for hypothyroid and it’s MOA is

A

Direct hormone replacement

Don’t exceee 0.8 mg/dog a day

148
Q

What concurrent diseases should levothyroxine be used with caution

A

Hyperadrenocorticism
Cardiac disease
DM
(Dose reduction)

149
Q

T/F levothyroxine should be given with food to prevent nausea

A

False. Food decreases bioavailability

150
Q

Why is synthetic liothyronine not recommended to treat hypothyroid

A

Is T3 and can cause and over dose
More expensive
No increase of T4
Only used when there in poor T4 GI absorption

151
Q

T/F thyroid extracts/desiccated thyroid contain both T3 and T4

A

True in a 4:1 ratio (more t4)

Is not recommended due to allergies

152
Q

What are hormones for diagnoses of hyperthyroid

A 
Synthetic liothyronine (active thyroid)
T3 suppression test (t3 should inhibit tsh)- should be suppressed <50%
153
Q

What drug is used to treat hyperthyroid

A

Methimazole

Inhibits thyroid peroxidase (inhibits iodide binding to tyrosine)

154
Q

Why would methimazole be given transdermally

A

Fewer GI side effects- wear gloves

155
Q

What should be monitored on a CBC when giving methimazole

A

Neutropenia thrombocytopenia

Discontinue if seen

156
Q

What are side effects of methimazole

A 
Facial excoriation- discont
Pruritis- discont
Hepatotoxicity- discont
Renal decompensation- if had before (reduce dose)
Takes 1-3 week for sustained suppression
157
Q

I-131 is concentrated in hyper functional thyroid cells to treat

A

Hyperthyroid

158
Q

T/F cats treated with I-131 must be quarantined for a minimum of 8 days

A

True

159
Q

DDAVP (desmopressin acetate) mechanism of action is

A 
Synthetic analog of vasopressin (ADH)
Central DI (or differential central from nephrogenic)
160
Q

How is DDAVP given

A

Eye drop or SQ

161
Q

What diuretic is given to stop PU PD in diabetic patients

A 
Thiazides  cholorothiazide (in early distal tubule)
Many drug interactions
162
Q

What drug is used to diagnosed hyperadrenocorticism (cushings)

A 
Synthetic adrenocorticoteopic hormones (ACTH cosyntropin, corticotropin) 
Dexamethasone suppression (not with NSAIDS)
163
Q

What is the MOA of trilostane (vetoryl) and what does it treat

A

Cushings
Is a synthetic steroid analog- competitive enzyme inhibitor that blocks formation of cortisol
Monitor ACTH stim tests in 2+4 weeks

164
Q

What are possible adverse effects of trilostane

A

Idiosyncratic adrenal necrosis
Electrolyte abnormalities (hyper K, hypo Na)
Addisons- reversible (GI Leth hypovolemia)

165
Q

What might be a reason not to use trilostane

A

Drug interactions - ketoconazole and mitotane, ACE inhibitor and K sparing Diuretics make hyper K worse
Compounding - 40-150% deviation from label

166
Q

What chemotherapeutic drug can be used to treat cushings (but is less used since trilostane)

A

Mitotane- adrenolytic/adrenal cytotoxic
Make addisons
Ketoconazole is no longer used for cushings

167
Q

Selegiline is a monoamine oxidase inhibitor thus causes dopamine in the pars intermedia to (increase/ decrease)

A

Increase and thus inhibit ACTH (cushings tx)

Not useful since most cushings are pars distalis

168
Q

What drug is used in feline cushings

A

Metyrapone It’s an enzyme inhibitor that blocks formation of cortisol
Short term tax before adrenalectomy

169
Q

Synthetic ACTH diagnoses what

A

Cushings. Addisons

170
Q

A glucocorticoid replacement drug is common in addisons patients. What drug is this

A

Prednisone- direct hormone supplement

Wait 24 hours to perform cortisol testing

171
Q

A aldosterone replacement drug is common in addisons patients. What drug is

A

Desoxycorticosterone pivalate (DOCP)
Long acting mineralcorticoid (may cause irritation GI PU PD)
Not given if atypical!

172
Q

A glucocorticoid and aldosterone replacement drug is common in addisons patients. What drug is

A

Fludrocortisone- steroid with both glucocorticoid and mineralcorticoid
(May not need pred) not with atypical!
PU OD hypertension and edema and hypokalemia possible

Equine (10 decks)

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