Respiratory Pharmacology

Question 1

__________ and _________ are part of the normal pulmonary defenses
- should not be suppressed unless they are _________, _____ or _________ debilitating to the animal

Answer 1

Coughing and sneezing are part of the normal pulmonary defenses
- should not be suppressed unless they are excessive, dry or physically debilitating to the animal

Question 2

Cough reflex
____________ arc of the cough reflex receives input from sensory nerves in the __________ and ________ airways
→ activate the cough center in the __________ _________.
* ________ material or ________ amounts of mucus on surface of the airways can stimulate the cough reflex.

Answer 2

Cough reflex
Afferent arc of the cough reflex receives input from sensory nerves in the bronchial and
tracheal airways
→ activate the cough center in the medulla oblongata
* Foreign material or excessive amounts of mucus on surface of the airways can stimulate the cough reflex

Question 3

Antitussives: opioids
They directly depress the cough center in the _________
→ The site of action may be either ___ or _____ opiate receptors:
* Butorphanol (Torbutrol®) → _____-receptor _____
* Codeine → ____-receptor ______
* Opioids are administered _____ to surgery to provide a ______ effect, _______ and may facilitate ________
→ Inhibition of the cough reflex may decrease ________ spasms and ______ associated with intubation

Answer 3

Antitussives: opioids
They directly depress the cough center in the medulla
→ The site of action may be either mu or kappa opiate receptors
* Butorphanol (Torbutrol®) → kappa-receptor agonist
* Codeine → mu-receptor agonist
* Opioids are administered prior to surgery to provide a sedative effect, analgesia and may facilitate intubation
→ Inhibition of the cough reflex may decrease laryngeal spasms and coughing associated with intubation

Question 4

Antitussives: opioids
Codeine
* Occasional use in _______
* It is available as 15, 30, 60 mg tablets and oral syrups (2mg/ml)
* Codeine oral absorption in dogs is _____ and __________

Answer 4

Antitussives: opioids
Codeine
* Occasional use in dogs
* It is available as 15, 30, 60 mg tablets and oral syrups (2mg/ml)
* Codeine oral absorption in dogs is low and inconsistent

Question 5

Antitussives: opiods
____________: Tussigon®, Hycodan®
* It is similar to codeine (______) → ____ potent
*This drug is combined with an ____________ drug → Hycodan®
→ ____________ is added to discourage abuse rather than for a respiratory indication
* It is also combined with ___________
* Oral doses administered to dogs: 0.22 – 0.25 mg/Kg q 6 – 8 h

Answer 5

Antitussives: opiods
Hydrocodone: Tussigon®, Hycodan®
* It is similar to codeine (MOA) → more potent
* This drug is combined with an anticholinergic drug → Hycodan®
→ homatropine is added to discourage abuse rather than for a respiratory indication
* It is also combined with acetaminophen
* Oral doses administered to dogs: 0.22 – 0.25 mg/Kg q 6 – 8 h

Question 6

Antitussives: opioids
_____________: Torbutrol®, Torbugesic®
* The oral bioavailability is ____ because of the _____ pass metabolism
→ in dogs the ______ doses are higher than _________ doses
* After oral administration, the maximum effects were observed ~ __ h but persisted up to ___ h
→ Codeine’s effect in dogs is much ________
* Butorphanol is available as 1, 5, and 10 mg tablets and as an injectable solution

Answer 6

Antitussives: opioids
Butorphanol: Torbutrol®, Torbugesic®
* The oral bioavailability is low because of the first pass metabolism
→ in dogs the oral doses are higher than parenteral doses
* After oral administration, the maximum effects were observed ~ 4 h but
persisted up to 10 h
→ Codeine’s effect in dogs is much shorter
* Butorphanol is available as 1, 5, and 10 mg tablets and as an injectable solution

Question 7

β-adrenergic receptor agonists
* They have a beneficial effect in the treatment of some airway diseases
* β –agonist are commonly used for the treatment of _____ in people
* In animals they are used for:
➢ _________ disease
➢ Allergic ________
➢ Feline ________
➢ ________ (“heaves”)
➢ ____________ airway disease (IAD) in horses

Answer 7

β-adrenergic receptor agonists
* They have a beneficial effect in the treatment of some airway diseases
* β –agonist are commonly used for the treatment of asthma in people
* In animals they are used for:
➢ Airway disease
➢ Allergic bronchitis
➢ Feline asthma
➢ Recurrent airway obstruction (RAO) (“heaves”)
➢ Inflammatory airway disease (IAD) in horses

Question 8

β-adrenergic receptor agonists –> MOA
* Bronchial smooth muscle is innervated by ____-_____________ receptors
* The stimulation of these receptors leads to ↑ activity of ________ _______ and thus ↑ intracellular cAMP

Answer 8

β-adrenergic receptor agonists –> MOA
* Bronchial smooth muscle is innervated by β2-adrenergic receptors
* The stimulation of these receptors leads to ↑ activity of adenylate cyclase and thus ↑ intracellular cAMP

Question 9

β-adrenergic receptor agonists MOA cont.
* Stimulation of β-receptor activity on mast cells decreases release of __________
mediators
* There is _____ effect on other inflammatory cells
* β-adrenergic agonists increase mucociliary ________ in the respiratory tract

Answer 9

β-adrenergic receptor agonists MOA cont.
* Stimulation of β-receptor activity on mast cells decreases release of inflammatory
mediators
* There is little effect on other inflammatory cells
* β-adrenergic agonists increase mucociliary clearance in the respiratory tract

Question 10

β-adrenergic receptor agonists
Clinical use
* β-receptor agonists should be used for short-term relief of ____________.
* Repeated administrations may ________ the response (when drugs are administered
regularly for several ______).
→ Change in ______: avoid ____-term use -
1. ______________ (drug tolerance)
2. Allow drug-_____ breaks in treatment

Answer 10

β-adrenergic receptor agonists
Clinical use
* β-receptor agonists should be used for short-term relief of bronchospasm
* Repeated administrations may diminish the response (when drugs are administered
regularly for several weeks
→ Change in receptor: avoid long-term use :
1. Desensitization (drug tolerance)
2. Allow drug-free breaks in treatment

Question 11

B-adrenergic receptor agonists

–> ______-acting _________ bronchodilators
- Epinephrine (________) is considered the drug of choice for the emergency treatment of life- threatening ___________.
→ anaphylactic reaction
Dosage: 10 μg/Kg IV or IM (it can be repeated in 15 min)

Answer 11

B-adrenergic receptor agonists

–> Short acting nonspecific bronchodilators
- Epinephrine (adrenaline) is considered the drug of choice for the emergency treatment of life- threatening bronchoconstriction
→ anaphylactic reaction
Dosage: 10 μg/Kg IV or IM (it can be repeated in 15 min)

Question 12

Question 13

β-adrenergic receptor agonists
–> _______-acting β__-specific drugs
___________: Brethine® Bricanyl®
* It is similar to _____________, but it is ______ acting (6 to 8 h)
* This drug may be injected ____ to relieve an acute episode of _____________
Dosage: → 2.5 mg q 8 h for dogs
→ 0.625 mg q 12 h for cats
→ 0.01 mg/Kg IV or IM in cats (acute case)
* It has been used in horses to treat ______. _______ preparations must be used.

Answer 13

β-adrenergic receptor agonists
–> longer-acting β2-specific drugs
Terbutaline: Brethine® Bricanyl®
* It is similar to isoproterenol, but it is longer acting (6 to 8 h)
* Terbutaline may be injected SC to relieve an acute episode of bronchoconstriction
Dosage: → 2.5 mg q 8 h for dogs
→ 0.625 mg q 12 h for cats
→ 0.01 mg/Kg IV or IM in cats (acute case)
* It has been used in horses to treat recurrent airway obstruction (RAO). Injectable preparations must be used

Question 14

β-adrenergic receptor agonists
–> ______-acting β2-specific drugs
A. ________ (______): Proventil® Ventolin®
* It is similar to _________
- This drug has has 2 isoforms: → ___-isoform
→ ___-isoform: Broncho-________ and
_____-inflammatory properties

Answer 14

β-adrenergic receptor agonists
–> Longer-acting β2-specific drugs
A. Albuterol (salbutamol): Proventil® Ventolin®
* It is similar to terbutaline
Albuterol has 2 isoforms: → R-isoform
→ S-isoform Broncho-constrictive and
pro-inflammatory properties

Question 15

Answer 15

Albuterol (Torpex®)
→ the nasal bulb is inserted into the horse’s
nostril and is activated when the horse inhales

Question 16

β-adrenergic receptor agonists
________-acting β2-specific drugs
A. ____________: Ventipulmin®
* It is approved for use in horses as a _____________ (______)
* This drug has ________ clinical efficacy compared to other β-agonists (__________)
→ Partial agonist
* It is available as a syrup (100 ml and 33 ml bottles, 72.5 μg/ml) → Ventipulmin®syrup
for horses
A study in rats showed that _______-regulation of β2 receptors occurs after ten days
of treatment → 45% _______

Answer 16

β-adrenergic receptor agonists
longer-acting β2-specific drugs
A. Clenbuterol: Ventipulmin®
* It is approved for use in horses as a bronchodilator (RAO)
* Clenbuterol has lower clinical efficacy compared to other β-agonists (terbutaline)
→ Partial agonist
* It is available as a syrup (100 ml and 33 ml bottles, 72.5 μg/ml) → Ventipulmin®syrup
for horses
A study in rats showed that down-regulation of β2 receptors occurs after ten days
of treatment → 45% decrease

Question 17

β-adrenergic receptor agonists
Adverse effects from β-agonists
* The most common adverse effects involve the __________ system and _______ muscle
→ _________
→ muscle __________
* This kind of effects can be prominent with β___-________ and can be produced by
β___-________ at high doses
* These drugs have been abused in humans and animals for the muscle-_________
properties

Answer 17

β-adrenergic receptor agonists
Adverse effects from β-agonists
* The most common adverse effects involve the cardiovascular system and skeletal muscle
→ tachycardia
→ muscle tremors
* This kind of effects can be prominent with β1-agonists and can be produced by
β2-agonists at high doses
* These drugs have been abused in humans and animals for the muscle-building
properties

Question 18

_______ (________): Intal®
* It is used occasionally to stabilize _____ cells → ___________ airways
* This drug has no intrinsic _________ action
* This drug inhibits _____ cells release of histamine, __________ from sensitized cells
* It has been administered via inhalation ____ daily for 1 – 4 days (80 mg) to treat ____ in horses
* To be effective, it must be administered _______ the horse is exposed to the allergen → ___________ therapy

Answer 18

Cromolyn
Cromolyn (sodium cromoglycate): Intal®
* It is used occasionally to stabilize mast cells → hypersensitive airways
* Cromolyn has no intrinsic bronchodilator action
* Cromolyn inhibits mast cells release of histamine, leukotrienes from sensitized cells
* It has been administered via inhalation once daily for 1 – 4 days (80 mg) to treat RAO in horses
* To be effective, it must be administered before the horse is exposed to the allergen → prophylactic therapy

Question 19

Answer 19

Cromolyn
Cromolyn (sodium cromoglycate): Intal®
* It is used occasionally to stabilize mast cells → hypersensitive
airways
* Cromolyn has no intrinsic bronchodilator action
* Cromolyn inhibits mast cells release of histamine, leukotrienes
from sensitized cells
* It has been administered via inhalation once daily for 1 – 4 days
(80 mg) to treat RAO in horses
* To be effective, it must be administered before the horse is
exposed to the allergen → prophylactic therapy

Question 20

Anticholinergic Drugs - Parasympatholytic/ antimuscarinic drugs
* Atropine and glycopyrrolate are effective ___________
*_______ (______ injectable) is an effective agent for horses
MOA: Cholinergic stimulation causes _______
➢ Anticholinergic drugs ____ vagal-mediated cholinergic smooth muscle tone
➢ Asthmatic patients have _____ stimulation of cholinergic receptors

Answer 20

Anticholinergic Drugs - Parasympatholytic/ antimuscarinic drugs
* Atropine and glycopyrrolate are effective bronchodilators
* N-butylscopolamine bromide (NBB) (Buscopan injectable) is an effective agent for
horses
MOA: Cholinergic stimulation causes bronchoconstriction
➢ Anticholinergic drugs inhibit vagal-mediated cholinergic smooth muscle tone
➢ Asthmatic patients have excessive stimulation of cholinergic receptors

Question 21

A study compared the effects of atropine, isoproterenol, and theophylline in horses with RAO. _______ at dose of 0.02 mg/Kg IV was better at relieving some signs.
________ > ________ > ______

Answer 21

A study compared the effects of atropine, isoproterenol, and theophylline in horses with RAO. Atropine at dose of 0.02 mg/Kg IV was better at relieving some signs.
Atropine > isoproterenol > theophylline

Question 22

Parasympatholytic/antimuscarinic drugs
* Atropine is acceptable for _____-term use. 5 mg IV dose has been used as a ______ test in horses
* If anticholinergic drugs are administered, __________ ______ such as glycopyrrolate (Robinul-V®), propantheline (ProBanthine®) should be used

Answer 22

Parasympatholytic/antimuscarinic drugs
* Atropine is acceptable for short-term use. 5 mg IV dose has been used as a response test in horses
* If anticholinergic drugs are administered, quaternary amines such as glycopyrrolate (Robinul-V®), propantheline (ProBanthine®) should be used

Question 23

“topical form of atropine”:
___________ _________ (Atrovet®) a _______ amines is administered as an ________ to horses for treatment of RAO → 180 mcg aerosol/horse.

–> _________ effects

Answer 23

“topical form of atropine”:
Ipratropium bromide (Atrovet®) a quaternary amines is administered as an aerosol to horses for treatment of RAO → 180 mcg aerosol/horse.

–> Adverse effects

Question 24

Methylxanthines (Xanthines)
Methylxanthines: Theophylline
* Methylxanthines (theophylline) have been used as ___________ (therapy of human asthma)
* In small animals, theophylline is _____ tolerated, and _____ dosing is convenient
* In horses it is restricted by _______- effects. Theophylline is a _________ substance in
equine sports.

—> Pharmacological effects
Methylxanthines ______ bronchial smooth muscle

Nonrespiratory effects
* CNS _________ (caffeine)
* ________ (mild)
* Cardiac _________ (mild)
* Gastric ____________
* __________ reflux

Answer 24

Methylxanthines (Xanthines)
Methylxanthines: Theophylline
* Methylxanthines (theophylline) have been used as bronchodilators (therapy of human asthma)
* In small animals, theophylline is well tolerated, and oral dosing is convenient
* In horses it is restricted by adverse effects. Theophylline is a prohibited substance in
equine sports

—> Pharmacological effects
Methylxanthines relax bronchial smooth muscle

Nonrespiratory effects
* CNS stimulation (caffeine)
* Diuresis (mild)
* Cardiac stimulation (mild)
* Gastric hypersecretion
* Gastroesophageal reflux

Question 25

Methylxanthines: Theophylline
Mode of action
1. Theophylline inhibits _________ enzyme
➢ This enzyme catalyzes ________
→ Horses with _______
2. Theophylline is a potent ________ of ________ receptors, ___ and ____ but less effective against ___ receptors
➢ Adenosine constricts airways of asthmatic patients via the release of _______ and _________ from mast cells

Answer 25

Methylxanthines: Theophylline
Mode of action
1. Theophylline inhibits phosphodiesterase enzyme
➢ This enzyme catalyzes cyclic AMP (cAMP)
→ Horses with recurrent airway obstruction

2. Theophylline is a potent inhibitor of adenosine receptors, A1 and A2 but
   less effective against A3 receptors
   ➢ Adenosine constricts airways of asthmatic patients via the release
   of histamine and leukotrienes from mast cells

Question 26

Methylxanthines: Theophylline Pharmacokinetics
* After oral administration, theophylline is ______ and _________ absorbed
➢ Systemic availability
* 91% in ____
* 96-100% in ______
* 100% in ______
* 90% ______
* Theophylline is metabolized primarily by the _______ in all species (P450). Only 10% of the doses is eliminated _________ in the urine

Answer 26

Methylxanthines: Theophylline
Pharmacokinetics
* After oral administration, theophylline is rapidly and completely absorbed
➢ Systemic availability
* 91% in dogs
* 96-100% in cats
* 100% in horses
* 90% People
* Theophylline is metabolized primarily by the liver in all species (P450). Only 10% of the doses is eliminated unchanged in the urine

Question 27

Corticosteroids
* Glucocorticoids decrease __________ associated with _________ pulmonary diseases
E.g:
* Feline _________ (“feline _______”)
* ________ bronchitis
* _____ and _____ in horses
* Asthma in ________

Answer 27

Corticosteroids
* Glucocorticoids decrease inflammation associated with inflammatory pulmonary diseases
E.g:
* Feline tracheobronchitis (“feline asthma”)
* Allergic bronchitis
* RAO and IAD in horses
* Asthma in people

Question 28

Glucocorticoids (GCs) Mechanism of action
* GCs bind to receptors on cells and ______ the transcription of genes to produce mediators (_________ and _________) involved in airway inflammation: ____, ___________, and _______.
* GCs have a more pronounced effect on _________ and _______ than _______ cells
* GCs also enhance the action of ________ ________ receptors → _________ of down-regulation

Answer 28

Glucocorticoids (GCs) Mechanism of action
* GCs bind to receptors on cells and inhibit the transcription of genes to produce
mediators (cytokines and chemokines) involved in airway inflammation PGs, leukotrienes, and platelet-activating factor
* GCs have a more pronounced effect on neutrophils and eosinophils than mast cells
* GCs also enhance the action of β2 agonists receptors
→ prevention of down-regulation

Question 29

Clinical Use Glucocorticoids
➢ In dogs
* Oral _________ or _________: 0.5 – 1.0 mg/Kg
* Metered-dose inhaler: ________ at a dose of 110 mcg twice daily

Answer 29

Clinical Use Glucocorticoids
➢ In dogs
* Oral prednisolone or prednisone: 0.5 – 1.0 mg/Kg
* Metered-dose inhaler: fluticasone at a dose of 110 mcg twice daily

Question 30

Clinical Use Glucocorticoids
➢ In cats: treatment options for feline _______
* ______________ 1-2 mg/Kg q 12 h initially, then taper to lower dose
* _____________ _____ (Depo Medrol) 10-20 mg IM every 4-8 weeks
* Metered-dose inhaler: ________ at a dose of 110 mcg/puff a day

Answer 30

Clinical Use Glucocorticoids
➢ In cats: treatment options for feline asthma
* Prednisolone 1-2 mg/Kg q 12 h initially, then taper to lower dose
* Methylprednisolone acetate (Depo Medrol) 10-20 mg IM every 4-8 weeks
* Metered-dose inhaler: fluticasone at a dose of 110 mcg/puff a day

Question 31

When asthmatic cats are administered inhaled corticosteroids _____ a day and allowed __ to __ breaths (___ sec) from the chamber, it ________ the need for oral ____________

Answer 31

When asthmatic cats are administered inhaled corticosteroids twice a day and allowed 5 to 7 breaths (10 sec) from the chamber, it reduces the need for oral prednisolone

Question 32

The best results are obtained when GCs administration is combined with ?

Answer 32

The best results are obtained when GCs administration is combined with environmental control

Question 33

Clinical use of GC’s
➢ In horses
* Corticosteroids are important for the management of _____ and ____. _________ and _________ had beneficial effects
* Oral corticosteroids are used in horses → there are no convenient _____ formulations developed specifically for horses
* ___________ tablets: 2 mg/Kg oral once a day then tapered to 1 mg/Kg
* Oral __________: 0.165 mg/Kg per day decreased to 0.04 mg/Kg (over a course of 21 days)
* _____________ injection: 0.06 – 0.1 mg/Kg IM, then tapered to 0.02- 0.05 mg/Kg
once daily

Answer 33

Clinical use of GC’s
➢ In horses
* Corticosteroids are important for the management of RAO and IAD. Prednisolone and dexamethasone had beneficial effects
* Oral corticosteroids are used in horses → there are no convenient dose formulations developed specifically for horses
* Prednisolone tablets: 2 mg/Kg oral once a day then tapered to 1 mg/Kg
* Oral dexamethasone: 0.165 mg/Kg per day decreased to 0.04 mg/Kg (over a course
of 21 days)
* Dexamethasone injection: 0.06 – 0.1 mg/Kg IM, then tapered to 0.02- 0.05 mg/Kg
once daily

Question 34

Glucocorticoids (GCs)
Clinical use
➢ Inhaled corticosteroids in horses
One of the limitations for the use is the _______ of the metered-dose inhaler products
* ________ is frequently used: 2,000 mcg twice daily initially then 2,000 mcg once a day

Answer 34

Glucocorticoids (GCs)
Clinical use
➢ Inhaled corticosteroids in horses
One of the limitations for the use is the expense of the metered-dose inhaler products
* Fluticasone is frequently used: 2,000 mcg twice daily initially then 2,000 mcg
once a day

Question 35

Question 36

Leukotrienes:, 4?
Leukotrienes contribute to airway inflammation by:
* Increasing migration of _________
* Producing ___________
* Increasing airway wall ________
* _______ rather than other leukotrienes may contribute to airway obstruction in horses with RAO
* It hasn’t been demonstrated if leukotrienes are important mediators in feline ______

Answer 36

Leukotrienes:, LTB4, LTD4, LTC4, LTE4
Leukotrienes contribute to airway inflammation by:
* Increasing migration of eosinophils
* Producing bronchoconstriction
* Increasing airway wall edema
* LTB4 rather than other leukotrienes may contribute to airway obstruction in
horses with RAO
* It hasn’t been demonstrated if leukotrienes are important mediators in feline
asthma

Question 37

________________ inhibitor: Zileuton (Zyflo®)
* Zileuton is a drug for treating _______ in people. It inhibits the enzyme _____________
and thereby _________ synthesis of inflammatory leukotrienes
* The dose used in people (600 mg q 6h, oral) has been extrapolated to animals for some
studies

Leukotriene receptor blockers (LRAs): ?
* These oral drugs have been used for treating asthma
➢ The _______ leukotriene receptors → ?

Answer 37

Lipoxygenase inhibitor: Zileuton (Zyflo®)
* Zileuton is a drug for treating asthma in people. It inhibits the enzyme 5-lipoxygenase
and thereby inhibits synthesis of inflammatory leukotrienes
* The dose used in people (600 mg q 6h, oral) has been extrapolated to animals for some
studies
Leukotriene receptor blockers (LRAs): Zafirlukast (Accolate®), montelukast (Singulair®)
* These oral drugs have been used for treating asthma
➢ The cysteinyl leukotriene receptors → LTD4, LTC4, LTE4 but not LTB4

Question 38

__________ and ________ Drugs have been used to increase the output of bronchial secretions.
➢ Some of these drugs have a “traditional use” in veterinary medicine but their efficacy
has not been established.

Saline expectorants: ammonium _______, ammonium _______, ________ iodide,
_______ iodide, and ______.
* These drugs are promoted to _______ bronchial mucus via a ______-mediated reflex
action on the _______ mucosa.
→ Stimulating the __________ appears to trigger a reflex that stimulates bronchial secretions
* Guaifenesin (glyceryl guaiacolate) → Mucinex® and acetylcysteine (NAC,
Mucomyst®)

Answer 38

Expectorants and Mucolytic Drugs have been used to increase the output of bronchial secretions.
➢ Some of these drugs have a “traditional use” in veterinary medicine but their efficacy
has not been established
Saline expectorants: ammonium chloride, ammonium carbonate, potassium iodide,
calcium iodide, and ethylenediamine dihydroiodide (EDDI)
* These drugs are promoted to stimulate bronchial mucus via a vagal-mediated reflex
action on the gastric mucosa
→ Stimulating the stomach appears to trigger a reflex that stimulates bronchial
secretions
* Guaifenesin (glyceryl guaiacolate) → Mucinex® and acetylcysteine (NAC,
Mucomyst®)

Question 39

Decongestants
Decongestants are used to “dry up” mucus membranes when ________ occurs
* Decongestants are __________ drugs → stimulate ___-receptors in mucus membranes
➢ Local __________ is produced which results in a decongestant effect

Topical decongestants
* Short-acting topical agents: ________ and _________ (OTC nasal sprays)
➢ _____ bleeding associated with some surgical procedures in horses and dogs
* Long-acting topical agents: 2?
The administration of topical agents for nasal problems can be difficult and inconvenient

Answer 39

Decongestants
Decongestants are used to “dry up” mucus membranes when rhinorrhea occurs
* Decongestants are sympathomimetic drugs → stimulate α-receptors in mucus membranes
➢ Local vasoconstriction is produced which results
in a decongestant effect
Topical decongestants
* Short-acting topical agents: phenylephrine and phenylpropanolamine (OTC nasal sprays)
➢ ↓ bleeding associated with some surgical procedures in horses and dogs
* Long-acting topical agents: Oxymetazoline (Afrin®) and xylometazoline (Dristan®)
The administration of topical agents for nasal problems can be difficult and inconvenient

Question 40

Systemic decongestants
* The systemic use of _______ ________ as decongestants has been a common practice
in medicine
* OTC formulations for colds and allergies have contained:
→ __________
→ ______________ (Sudafed®)
→ _______________ (____) Proin®
* Side effects from the orally administration include ___________ and ________ blood
pressure

Answer 40

Systemic decongestants
* The systemic use of adrenergic agonists as decongestants has been a common practice
in medicine
* OTC formulations for colds and allergies have contained:
→ Ephedrine
→ Pseudoephedrine (Sudafed®)
→ Phenylpropanolamine (PPA) Proin®
* Side effects from the orally administration include vasoconstriction and increased blood
pressure

Question 41

Respiratory _________
___________ (Dopram®) stimulates respiration by _______ stimulation of the _______
respiratory center and activation of the ______ and ________ chemoreceptors
→ These receptors are sensitive to changes in _______ ______
* This drug is used primarily in _________ → during anesthesia
* In horses it is used for the treatment of respiratory ________ in ______
* The syndrome of _______-_______ (?) is common in neonatal foals
→ Dose: 0.5 mg/Kg IV followed bay a CRI of 0.03 or 0.08 mg/Kg/min for 20 min
* Doxapram is also used to increase suckling activity in neonatal foals
This Photo by Unknown Author is licensed under CC BY-NC

Answer 41

Respiratory Stimulants
Doxapram (Dopram®)
Doxapram stimulates respiration by direct stimulation of the medullary
respiratory center and activation of the aortic and carotid
chemoreceptors
→ These receptors are sensitive to changes in carbon dioxide
* Doxapram is used primarily in emergencies → during anesthesia
* In horses is used doxapram for the treatment of respiratory acidosis in foals
* The syndrome of hypoxic-ischemic encephalopathy (perinatal asphyxia) is
common in neonatal foals
→ Dose: 0.5 mg/Kg IV followed bay a CRI of 0.03 or 0.08 mg/Kg/min for 20 min
* Doxapram is also used to increase suckling activity in neonatal foals
This Photo by Unknown Author is licensed under CC BY-NC