Shokry exam 1 Flashcards
Type of anemia seen in piglets if they don’t have access to soil
microcytic anemia
This mineral is necessary for iron absorption
copper
In order for iron to get to bloodstream it must attach to
transferrin
In order for iron to get through the epithelial cell it must attach to
ferritin
Do heavy metals cross the BBB?
NO
Which drug given for microcytic anemia must by given PO?
ferrous
Which is less irritating, organic or inorganic iron?
organic is LESS irritating
Which is less irritating and astringent, ferrous or ferric?
ferrous is LESS irritating and astringent
What is the antidote for an overdose in microcytic anemia drugs?
chelating agent to bind to Fe and make an inactive glob
What drugs are used for microcytic anemia?
Iron carbohydrate complexes (iron dextran), ferrous chloride/phosphate/sulfate, copper sulfate, copper glycinate
What must be given with drugs for microcytic anemia and what is its side effect?
carbohydrate, can cause anaphylactic reaction
What drug is used for macrocytic anemia?
cobalt supplement in horses
What drugs are used for normocytic anemia?
erythropoetin(DOC) and epogen, give iron supplement, anabolic steroids possible but not suggested
What is one major side effect of epogen?
hypersensitivity, hypertension and increased BP
What drugs are used in immune mediated hemolytic anemia?
supportive treatment, blood transfusion, immunosuppressives, IV gamma globulin
What is often used in blood transfusions for animals suffering immune mediated hemolytic anemia?
hemoglobin glutamer - 200 bovine (oxyglobine)
What are the CSF drugs?
filgrastim (G-CSF) and sargramostim (GM-CSF)
Which CSF only stimulates neutrophils?
filgrastin
What is a side effect of using CSFs?
bone pain
How is epinephrine given as a local hemostatic?
topically only
What are the local hemostatic vasoconstrictor drugs?
epinephrine and clot-it-plus
What are the local hemostatic astringent drugs?
tannic acid and ferric chloride
What are the local hemostatic surgical drugs?
oxidized cellulose, gelatin sponge, and collagen
What are the local hemostatic physiological drugs?
thromboplastin, thrombin, fibronogen, and fibrin foam
A soft clot is made out of
fibrin
A hard clot is made out of
cross linked fibrin
Removes the thrombus
plasmin
Side effect of epinephrine and the reason you don’t want to use systemically
tachycardia
Method of action for Clot-it-plus
acts on a1 receptors and ester conformation of benzocaine (makes numb)
Application of astringents is
topical
Method of action for surgical hemostatics
speeds up clotting process by stimulating clotting process
Why do you not use physiological hemostatics systemically?
causes intravascular thrombosis
What are the systemic hemostatic drugs?
blood transfusion, FFF, vit K, protamine sulfate, aminocaproic acid, desmopressin (DDAVP)
What is the other name for vit K1 and where does it come from?
phytonadione from plant origin
What is the other name for Vit K2 and where does it come from?
menaquinone from bacteria in GI tract
What is the other name for vit K3 and where does it come from?
menadione, synthetic - weakest
What is the MOA of vit K?
stimulates formation of factors 2,7,9,10
What is vit K1 an antidote for?
warfarin poisoning but takes 24 hours to act
What is important for Vit K tx to be effective?
a functioning liver
What Vit can you not use in horses?
K3 causes renal failure
Is protamine sulfate acidic or basic?
strongly basic
What is protamine sulfate an antidote for?
heparin to prevent bleeding by chemical antagonism
What are symptoms of overdose in protamine sulfate?
increased bleeding
What are some important uses of aminocaproic acid?
antagonism of the fibrinolytic actions of thrombolytic agents, tx of degenerative myelopathy in german shepherds
What is a clinical use for desmopressin?
control bleeding in dobermans w/ VWD but only lasts 2 hours
What are the anticoagulant drugs?
heparin and warfarin
What is the method of action of heparin?
activates antithromin III resulting in inhibition of factors II, 9, 10, 11, 12
How id heparin administered?
IV or SC ONLY
Does heparin cross the placenta or get excreted in milk?
NO
Is heparin used in vivo or vitro?
BOTH
What is heparin’s safety margin like?
narrow, bleeding is main toxic effect
What is the MOA of warfarin?
inhibition of activation of factor 2,7,9,10 AND competitive antagonist of Vit K by inhibiting Vit K epoxide reductase
How long does it take warfarin to activate?
48hrs, given PO so slow absorption
How much warfarin binds to PP?
99%, loosely bounf to albumin, easily replaced
Does warfarin cross the placenta or get excreted in milk?
YES
Is warfarin used in vivo or in vitro?
in vivo only
Which drugs decrease the response of warfarin?
enzyme inducers like phenobarbitol
What are the thrombocytic agent drugs?
streptokinase, urokinase, tPA, anistreplase
What is the MOA of thrombolytic agents?
activate conversion of plasminogen to plasmin for fibrinolysis
Which thrombolytic agent is most effective?
tPA because it binds specifically to plasminogen bound to fibrin to dissolve a thrombus
What is an antagonist for thrombolytic agents?
aminocaproic acid
What are the anti platelet drugs?
aspirin, dipyridamole, abciximab, lepirudin, clopidogrel
What does low doses of aspirin do?
inhibit synthesis of TXA2 by irreversibly inhibiting cyclooxygenase - antitplatelet
What does high doses of aspirin do?
inhibits PG12 and TXA2 and can form a clot
Which anti platelet drug is used in cats to prevent thromboembolism?
clopidogrel (plavix)
What is the definition of diuretics?
drugs that increase rate of urine flow and rate of Na excretion (not cause urination)
What are the physiological diuretics?
water, sodium chloride
What are the cardiovascular diuretics?
digitalis, phosphodiesterase inhibitors, methylxanthine derivatives (caffeine/threobromine), NB
What are the osmotic diuretics?
mannitol, urea, glycerin/isosorbide
How is mannitol administered?
IV ONLY
What is the MOA of osmotic diuretics?
act on both LOH and PCT
What are osmotic diuretics used for?
cerebral edema, acute glaucoma, acute renal failure - NEVER R CHF or systemic edema
Which diuretics are most effective? Least effective?
most = loop diuretics(aLOH), least = K sparing diuretics (CD & DCT)
What are the loop or high ceiling diuretics?
furosemide (lasix), bumetanide, ethacrynic acid
What are the thiazide diuretics?
hydrochlorothiazide, chlorothiazide
Do loop diuretics work under conditions w/ decreased renal blood flow?
YES
Do thiazide diuretics work under conditions w/ decreased renal blood flow?
NO
Where do thiazide diuretics work?
on DCT - 2nd most effective
How are thiazide diuretics administered?
PO
How are loop diuretics administered?
PO or IV
What is the MOA for loop diuretics?
inhibit Na K2Cl symport on luminal membrane of aLOH inhibits paracellular reabsorption
What is the MOA of thiazide diuretics?
inhibits the NaCl symporter in the DCT to inhibit tubular reabsorption of Na/Cl/K/Mg - also increases reabsorption of Ca
What are loop diuretics used for?
acute pulmonary edema, pulmonary congestion, generalized edema associated w/ CHF,chronic renal failure, and liver cirrhosis
Which diuretics would be used with an isotonic saline for hypercalcemia?
loop diuretics
Which drug is used for exercise induced pulmonary hemorrhage in horses?
furosemide
What are thiazide diuretics used for?
edema of CHF, liver cirrhosis, nephrogenic syndrome, acute glomerular nephritis, hypertension, nephrogenic DI, calcium nephroliathiasis, udder edema
What are some side effects of loop diuretics?
hypokalemia and systemic alkalosis, stimulates renin - angiotensin aldosterone system, hyperglycemia, systemic alkalosis
What are the carbonic anhydrase inhibitor drugs?
acetazolamide, dorzolamide, methazolamide, brinzolamide
What are the potassium sparing diuretics?
spironolactone (aldactone), triamterene, amiloride
Which potassium sparing drug is an aldosterone antagonist?
spironolactone
What is the MOA of carbonic anhydrase inhibitors?
reversible inhibition of carbonic anhydrase, inhibits exchange of H for Na in PCT, lowers IOP
How is acetazolamide administered?
PO
How are dorzolamide and brinzolamide administered?
topically, opthalmic
Which carbonic anhydrase inhibitor is used in udder edema?
acetazolamide
Which carbonic anhydrase inhibitor is used in chronic glaucoma?
dorzolamide
What is the MOA for spironolactone?
competitively blocks aldosterone receptors in DCT and CD causing excretion of Na/Cl and retention of K/H - acidosis
How is spironolactone administered?
given PO,
When is spironolactone contraindicated?
metabolized in liver - don’t use in liver failure
What is spironolactone used for?
as a diuretic but not commonly on its own, not used in emergencies
What is the MOA for triamterene/amiloride?
blocks luminal Na channels of principle cells of late DCT & CD, excretes Na and retains K/H
When is triamterene contraindicated?
metabolized in liver - don’t use in liver failure
When are triamterene and amiloride used?
tx of hypokalemia and hypomagnesia
What is a side effect of carbonic anhydrase inhibitors and potassium sparing diuretics?
systemic acidosis
What is natural ADH (pitressin) used for?
diagnosis of diabetes insipidus - short DOA
What drugs are used to treat nephrogenic diabetes insipidus?
thiazide diuretics
What drugs are used to treat central diabetes insipidus?
vasopressin (ADH), desmopressin (DDAVP), thiazide diuretics, chlorpropamide, restrict nacl intake
What is desmopressin?
synthetic vasopressin (ADH)
What are the B1 agonist drugs?
isoproterenol, epinephrine, norepinephrine, dopamine
Which B1 drug is most potent as a cardiac stimulant?
isoproterenol
Which B1 cardiac stimulant works on all adrenergic receptors?
epinephrine
Which B1 agonist cardiac stimulant is indicated for vasodilation?
isoproterenol
Which B1 agonist cardiac stimulant is the DOC for anaphylaxis?
epinephrine
Which B1 agonist cardiac stimulant is indicated in vasoconstriction and decrease bleeding?
norepinephrine
What is the MOA of dopamine?
increases blood flow to kidneys, vasoconstriction
What is the DOC as a cardiac stimulant when the heart is not contracting? Why?
dopamine (less tachycardias and arrhythmias)
What are two types of non-drug therapy for heart failure patients?
restricted salt diet, restricted exercise
What are the positive ionotropic drugs?
cardiac glycosides = digitalis glycosides (foxglove), digitoxin, digoxin, oaubain catecholamines = dopamine, dobutamine
What is the MOA of cardiac glycosides?
inhibits NaKATPase in myocardial cell membrane increasing Na available to exchange with Ca resulting in increase in intracellular Ca, + ionotropic effect, increases contractility, decreases HR
How are cardiac glycosides administered?
PO
What are the therapeutic uses for cardiac glycosides?
CHF, atrial arrhythmias in dogs
What is the most commonly used cardiac glycoside?
digoxin
What must be done to prevent digoxin toxicity?
monitor blood levels
Which positive ionotropic drugs are used only in emergencies?
dopamine and dobutamine
What effect do cardiac glycosides have at the kidney?
diuretic effect, increased CO = increase in GFR
What are the short term and long term side effects of cardiac glycosides?
acute = hyperkalemia leading to bradycardia chronic = hypokalemia leading to tachycardia
What drug is used to treat cardiac glycoside induced bradyarrhythmias?
atropine
What drug is used to treat cardiac glycoside induced tachyarrhythmias?
potassium IV slow or digoxin immune FAB
What are the indicator drugs?
pimobendan, inamrinone, milrinone
What is the classification for inodilators?
+ ionotropes and vasodilators at both veins and arteries
What is the MOA of inodilators?
sensitization of cardiac contractile apparatus to Ca by enhancing interaction of Ca and troponin C
What are inodilators used for?
tx of CHF in dogs, or dilated cardiomyopathy
When are inodilators contraindicated?
hypertrophic cardiomyopathy
What are the ACE inhibitor drugs?
captopril, lisinopril, benazepril, enalapril
Which ACE inhibitor is excreted in bile?
benazepril
What is the MOA for ACE inhibitors?
inhibits angiotension converting enzyme preventing conversion of AT1->AT2 which is needed for aldosterone, vasodilator so heart is less stressed
What is the DOC of ACE inhibitors?
enalapril
What are the beta blocker drugs?
carvedilol, metoprolol, atenolol
What is the MOA of beta blockers?
decrease contractility of heart so doesn’t pump as hard, nonselective B blocker and A1 blocker, inhibits endothelia release
What are beta blockers used for?
mild CHF, blocks harmful SNS can use in hypertrophic cardiomyopathy
Class 1A
prolongs AP- sodium channel blocker
Class 1B
shortens AP- sodium channel blocker
Class 2
B blocker
Class 3
K channel blocker
Class 4
Ca channel blocker
What drugs are in class 1A?
quinidine, procainamide, disopyramide
What is the DOC for atrial fibrillation in horses?
quinidine - also in cattle and lg breed dogs
Which 1A drug is more effective for ventricular arrhythmias?
procainamide
What drugs are in class 1B?
lidocaine, phenytoin, mexiletine, aprinidine
How is mexiletine administered?
PO
What is the IV DOC for ventricular arrhythmias in dogs?
lidocaine
What class 1B drug is used to treat digitalis-induced arrhythmias?
lidocaine and phenytoin
What class 1B drug is used in supra ventricular and ventricular arrhythmias?
phenytoin
What effect do class 1C drugs have on the action potential?
none
What is the DOC for hypertension and tachycardia in cats with hyperthyroidism?
beta blockers
When is propranolol contraindicated?
asthma patients
How is timolol applied?
topical to eye only
Which drugs are used to treat refractory ventricular tachycardia?
potassium channel blockers
Why are potassium channel blockers not commonly used?
narrow safety margin, can cause bradycardia
Which potassium channel blocker is a non-selective beta blocker?
sotalol
What are Ca channel blockers used to treat?
supraventriclar tachycardia and myocardial hypertrophy