Test 2 Review Flashcards
Anti-arrhythmic and beta-blocker antiarrhythmic are two categories of cardiovascular drugs. What are the other 3 categories?
Positive Inotropic Agents
Vasodilators and ACE inhibitors
Aspirin
Aspirin is technically a miscellaneous cardiovascular drug. Why is this?
It is used as a blood thinner although this is not its primary effect.
Cardiovascular drugs don’t just effect the heart, but also the ____________
circulatory system
What are some responses you can expect when provoking the SYMPATHETIC nervous system?
Increase in force of contraction
Increase in blood pressure
increase in heart rate
Construction of all peripheral blood vessels out of the extremedies
Decrease blood flow to non essential tissues and decrease activity of the gastrointestinal tract
The Sympathetic Nervous System primes our bodies for “Fight or Flight” mode. What mode does the Parasympathetic Nervous System prepare our bodies for?
“Rest and Restore” by doing the exact opposite of what a provoked Sympathetic system will do.
To effect the heart rate, which nervous system do we provoke?
You can provoke either the sympathetic or the parasympathetic nervous system as long as they are balanced
To increase heart rate, you can either increase _________ or decrease ___________
Sympathetic Nervous System
Parasympathetic Nervous System
The Sympathetic Nervous System is also known as the
Adrenergic system
The Sympathetic System contains which cardiac-function related receptors? There is 4
Alpha-1
Alpha-2
Beta-1
Beta-2
Which two neurotransmitters does the Sympathetic or Adregeneric system use?
Adrenaline (Epinephrine) and Noradrenalin (Norepinephrine)
If the neurotransmitter connects with the Alpha-1 or Alpha-2 receptors we get increased Heart Rate. If the NT connects with Beta-1 or Beta-2, what would happen?
We see increased Heart Rate but not to the same extent
Some Beta receptors are found in the _________
bronchioles
Do Beta Blocking medications effect the Beta receptors that are located in the bronchioles?
yes
The Parasympathetic Nervous System is also known as the
Cholinergic system
Which neurotransmitter does the Parasympathetic or Cholinergic nervous system use?
Acetylcholine
What are the basic objectives of treatment? (Cardiovascular drugs)
Control rhythm disturbance Maintain or increase cardiac output Relieve fluid accumulation Increase oxygenation of blood Ancillary treatment
What is the difference between an Arteriolar dilatory and Venodilators?
Arteriolar dilator: increase the afterload on the heart
Venodilator: increase the preload on the heart
Which cardiovascular drug type helps relieve fluid accumulation?
diuretics
cardiovascular system is linked closely to ________ function
kidney
Antiarrhythmic drugs don’t tell the heart how to beat but rather ______
Allow the heart to calm down and slow
Define supraventricular
above the ventricle
What is the most common Antiarrhytmic drug we use?
Lidocaine
Which drug is often used for immediate ventricular tachycardia?
lidocaine
Why isn’t Lidocaine used as a long term antiarrhythmic drug?
it has a very short half life and doesn’t last long
In order for proper heart function we need proper balances of what 3 elements?
calcium
sodium
potassium
What two Sodium channels are in the heart?
Fast (helps heart muscle contract faster)
Slow (helps heart muscle contact slower)
Lidocaine is a _______ stabilizing drug
membrane
Beta Blockers are used for what purpose
to re-establish a rhythm or slow the heart rate
Beta Blockers block the Beta receptors in the heart and allow the heart rate to slow down and re-establish rhythm. True or False?
True
What two types of Beta Blockers are there? What concerns come with each? (If any)
Selective: targets beta-1 or beta-2
Non-Selective: targets both, but will also block the beta receptors in the bronchioles causing Reflex Broncho-Restriction or a minor cough.
What is an important Beta Blocker to know?
“Inderal” or “Atenolol” active drug is Propranolol
Why do we start on a low dose of Beta Blockers and gradually increase?
A sudden decrease in dose of Beta Blockers will cause upregultion, all of the Beta receptors are opened at once resulting in an accelerated heart rate which is potentially lethal
Positive Inotropic Agents main purpose is to:
increase the strength of contraction in a weakened heart
How do Positive Inotropic Agents work?
They make more Calcium available to the contractile proteins in the muscle cell
The body has natural positive inotropes called:
catecholamines
Positive Inotropic Agents can also be called Adrenerhic or Sympathimimetic. Why?
They mimic the sympathetic system
Lanoxin and Cardoxin are brand names for what Positive Inotropic Agent drug?
Digoxin
What is the drug of choice for long term positive inotropic effects?
digoxin
Vasodilators are used to relieve some of the cardiac workload. How?
Opening constricted sphincters
Decreasing resistance to flow
Making it easier for the heart to pump through the vessels
True or false: Reducing the workload on the heart has no long term benefits
False. It means the heart will last longer.
The broad term for cardiac disease is:
heart failure
Vasoconstriction means _______ blood flow (increase or decrease)
decrease
Vasoconstriction causes decreased renal perfusion. The kidney detects this and produces a hormone called _________
Renin
Renin combines with ________ which is produced in the liver and creates a substance called ___________
Angiotensinogen
Angiotensin-1
Angiotensin-1 combines with Angiotensin-Converting-Enzyme (ACE) and converts it to Angiotensin-2. What is this system called?
Renin Aldosterone Angiotensin System (RAAS)
“Enacard” is an important brand name for what drug? What type of drug is it?
Enalapril, a vasodilator
“Vetmedin” (Pimobendan) is technically an ________ because it increases force of contraction and has some dialating effects
Inodilator
“Prilium” contains what active drug?
Imidapril hydrochloride
Nitroglycerin relaxes the primary blood vessels on the _______ side of the cardiovascular system and helps dilate the coronary arterioles
venous side
Aspirin is a brand name for what active drug?
Acetylsalicylic acid
Aspirin is a blood thinner. How?
Reduces the aggregation of platelets
What is the first clinical sign you’d see when blood thinning is occurring?
Peticiation on gums or easy bruising
As a blood clot approaches the vessel bifurcation, the clot becomes occluded into the hind end of the cat and immediately creates inflammation. This is a life threatening condition called:
Saddle Thrombus (cats only)
Symptoms of Saddle Thrombus include:
paralysis, pain, lameness, screaming or howling
How can the owner help their cat suffering from Saddle Thrombus on the way to the vet?
Give them a baby aspirin to thin the blood
Morphine does not work for Saddle Thrombus pain control. Why?
The dose needed to control such a large amount of pain will stop the lungs
Urinary system drugs can be used for two reasons: What are they?
Management of renal disease
Urinary system disorders
True or false: Some drugs work by influencing urine production and electrolyte balance whereas some maintain blood pressure and reduce urinalysis system disease
True
Before you see signs of kidney disease, what percentage of nephrons are already dead or non functional?
80-90%
Once you see signs of kidney disease, it is easy to treat. True or False.
False. There is no reversing kidney damage.
The ______ is critical in maintaining blood pressure
kidney
What are the four types of renal/urinary drugs?
Diuretics
Blood Pressure Lowering
Urolith treatment
Urinary incontinence
Diuretics lower blood pressure by:
making animal excrete water more
Urolith treatment drugs do not get rid of crystals but rather they:
Change the pH in the environment of the bladder to disintegrate it
True or false: Diuretics mainly increase urine formation and promote water loss from tissues
true
“Where _______ goes, water molecules will follow.”
Sodium molecules
Diuretics block the reabsorption of sodium and chloride ions. What purpose does this serve?
Sodium has nowhere to go but out of the kidneys and into the bladder, drawing water with it and therefore flushing it
Diuretics is defined as
increased urine production that is provoked
What is the strongest type of Diuretics we have?
Loop Diuretics
Loop Diuretics work in what two ways:
Prevent reabsorption of Sodium and Potassium from the renal tubules
OR
Enhance the secretion of Sodium and Potassium into the tubules from the loop of Henle
Define hypokalemia
decreased potassium in the blood
Diuretics increase the secretion of Sodium into the Loop of Henle which excretes out. The body recognizes this quick loss of sodium and makes a last minute switch in the distal convoluted tubule from sodium to _________ because it doesn’t draw as much water
potassium
Furosemide is the active drug and the most commonly used as a Loop Diuretic. What brand name is it sold under?
Lasix
Loop diuretics given orally have an onset of action in ________ minutes whereas parenteral administration has an onset of action in _________
30-60 mins
5 mins
Furosemide cannot be used in patients with what two conditions?
Hypovolemic (not enough volume in blood system)
Hypotension (low blood pressure)
Mannitol 20% increases blood flow to the _________
renal medulla
Glycerin “Osmoglyn” is an example of an Osmotic diuretic. True or false.
True
Osmotic Diuretics should not be used in patients with heart failure. why?
because it causes water to move out of cells and into vascular space which causes a circulatory overload
Carbonic Anhydrase Inhibitors can cause a metabolic _______
acidosis
Caffeine and Theobromide can be considered as which type of renal drug?
Methylxanthines
Cholingeric Agonists are primarily used to treat “Spinal Cord Bladder”. What does this term mean?
There has been damage to the nerves that control relaxation of the urinary bladder outflow sphincters
Although they need it most, which species has a compromised mucociliary clesrance?
equine
We want to control the reflex of coughing. Why?
It can cause permanent damage
the inside of the nares are called ______ and they are lined with _______ for protection
turbinates
cilia
Respiratory reflexes include what 3 symptoms all with the purpose of expelling foreign particles?
Cough
Sneeze
Reverse Sneeze
There are three respiratory therapeutic principles. What are they?
control secretions
control reflexes
maintain normal airflow to alveoli
What is the purpose of an Expectorant respiratory drug?
To liquefy and dilute secretions so that they can easily be eliminated
Expectorants are used with productive coughs. Why?
Because they liquefy secretions so they can be easily expelled (vs a non productive cough where nothing is being coughed up)
Why would we use an Expectorant and not a Cough Suppressant?
You want the animal to cough up any mucus or secretions that are in the way, you don’t want to suppress a productive cough
What is the risk of using a Cough Suppressant on a Productive cough?
Pushing mucus lower and risking pneumonia
What is the example of Expectorant drugs we are focusing on?
“Guaifenesin” active drug is Glyceryl Guaiacolate
Guaifenesin is an Expectorant drug. What else is it used for?
As a general anaesthetic in equines or to help maintain a general anaesthetic
What does a Mucolytic do?
Breaks up mucus, decreasing the viscosity so that the cilia can clear it out
What is the common Mucolytic we use?
“Mucomyst” or “Mucosil-10” active drug is Acetylcysteine
Acetylcysteine, a mucolytic, is given via PO or nebuluzation. What does this mean?
You place a mask on the animal that is attached to a motorized machine. The drug is in a reservoir and warmed and vaporized by the machine. It is released through the airways. (Like an inhaler)
Acetylcysteine, a mucolytic, is also used commonly for what emergency situation?
As an antidote for acetaminophen toxicity in felines
Which category of respiratory drug is designed to reduce swelling in the mucus membranes via vasoconstriction of the nasal blood vessels
Decongestant
Propagest or Pro-in are brand names of what active drug? What type of drug is it?
Phenylpropanolamine
Decongestant
Antitussives can be used in what two ways?
Centrally (cough centres)
Peripherally (sensory nerves)
Butorphanok Tartrate is a narcotic we use as an Antitussive. What is it’s common brand name?
Torbugesic “Torb”
Torbugesic is used for non productive coughs. Why?
It sedated and suppresses the respiratory tract, this is best for chronic and unproductive coughs to prevent damage to respiratory tissues. It is also a pain reliever.
In a low dose, Torbugesic becomes a ________ drug while at high doses it becomes a ___________ drug
Antitussive
Narcotic
Dextromethorphan is sold under the brand name Robitussin. It is different than a Antitussive. How?
Antitussives suppress the cough, Dextromethorphan raises the reflex threshold so that the patient does not need to cough
Hydrocodone Bitrate is a narcotic used for non productive coughs. True or false.
True
Dextromethorphan is a narcotic cough suppressant.
False, it is non narcotic
Analeptic is a respiratory stimulant. How does this work?
Acts on the central nervous system to stimulate the respiratory centre of the brain
Dopram-V is a brand name for which Respiratory Stimulating drug?
Doxapram Hydrochloride
Doxapram Hydrochloride is good in what emergency situation?
After C sections to get neonates to breathe on their own.
How is Dopram-V administered to neonates to stimulate breathing?
Sublingual drops
How do Antihistamines work?
Blocks the effects of Histamine
How is Histamine produced?
After an allergic reaction, Histamine is released from Mast Cells
True or False. Antihistamines are given in higher doses after a longer duration of allergic reaction to reverse any Histamine that was released before the patient was seen.
False. Histamine cannot be reversed, only prevented.
What is the most important Antihistamine we cover?
“Benadryl” active drug Diphenhydramine
What is Bronchidilation via Cholinergic Blockers?
Combined with acetylcholine receptors on the smooth muscle fibres and prevent the bronchoconstricting effects of acetylcholine
Ventipulmin is an important brand name for what active drug?
Clenbuterol which is a Beta-2-Adregeneric Agonist
There are 3 Gastrointestinal Drug Categories. Name them and their effected systems.
Gastric drugs: stomach
Enteric drugs: Intestines
Colonic drugs: Cecum/Colon
Name the order in which Ruminant Digestion occurs
Esophagus Reticulum Rumen Mouth Rumen Omasum Abomasum (true stomach)
How does the Parasympathetic Nervous System effect the Gastrointestinal System when provoked?
Increases digestive secretions
Increase blood flow to GI tract
acetylcholine increases stomach______
acidity
What does an Emetic do? Why is it used?
Induced vomiting, used for toxicity or drug overdose
How does the Emetic work to induce vomiting?
Stimulates the vagus nerve
Stimulates the nerves of the inner ear
The Emetic Center of the brain is protected by the:
Blood Brain Barrier
There is a specialized area of receptors in the Central Nervous System that is capable of detecting toxic substances in the blood and cerebralspinal fluid. What is this called?
Chemoreceptor Trigger Zone
If burns on the oral mucosa are observed in an animal that has ingested an unknown substance, the ingested compound should be assumed to be ______ unless proven otherwise
corrosive
When inducing vomiting be sure to give an Emetic and stimulate the gag reflex
False. Never stimulate the gag reflex.
Emetics can be Centrally Acting or Locally Acting. Name one of each.
Central: apomorphine
Local: Ipecac
True or false. Ipecac Syrup is Hepatotoxic
False. It is Cardiotoxic
Activated Charcoal is is given before Syrup of Ipecac to induce vomiting. True or false.
False, it is given after
Antiemetic work by blocking dopamine receptors in CRTZ and emetic centre. What are two drugs in this category?
“Reglan” active drug Metoclopramide
Antihistamines are also used as Antiemetics. What three drugs?
“Benadryl” Diphenhydramine
“Dramamine” dimenhydrinate
“Phenergan” Promethazine
What is a common Antiemetic we use?
Convenia
Laxatives are also called _______ or _________
Cathartics
Purgatives
What are some reasons why we might use Laxatives?
Chronic constipation
Empty colon for radiographs
Famotidine, Ranitidine and Cimetidine are all examples of what Gastrointestinal drug?
Antacids (systemic)
Why might we use caution when giving Antitussives for therapy?
They are mostly narcotic based so they cause ataxia, sedation and addiction. There are reversal agents but these aren’t 100% effective.
Explain the order of administration for Syrup of Ipecac and Activated Charcoal.
Syrup of Ipecac is administered first. This is because you must allow time for the Ipecac to pass into the intestines to produce the local irritant effect. If you were to give Charcoal first, since it is absorbant it will absorb Ipecac and render it useless.
Why is Apomorphine administered via the conjunctival sac?
It is safer. Apomorphine is an opioid which stimulates the CRTZ but also suppresses CNS, which includes the emetic centre.
What does upregulation mean?
Beta Blockers inhibit Beta receptors and allow the heart rate to slow down. The body recognizes the blockage and produces more receptors to compensate. If the drug was stopped cold turkey, all of these receptors would begin to tell the heart to beat fast atthe same time.
Xylazine, an emetic drug, works best in cats. Why?
They have more Alpha 2 receptors
Apomorphine, an emetic drug, works best in canines. Why?
They have more dopamine receptors
Hypersomolar laxative:
draws water to themselves to the bowel, where the pressure of the water causes a bowel movement
Locally Acting Emetic:
Irritants that vet on a certain muscle reflex to get the animal to vomit
Antibloat Medication:
Causes gas within animal to coalesce (join) for easier expulsion
Why might Propanolol, an antiarrhythmic drug, contribute to difficulty breathing in animals with respiratory disease?
It is non selective which means it also blocks the Beta receptors in the Bronchioles causing a minor cough
Vasoconstriction stimulates RAAS and produces __________
renin
Renin and Angiotensinogen combine to make:
Angiotensin-1
Angiotensin-1 combines with ACE (angiotensin converting enzyme) to create:
Angiotensin-2
What caution should be used when using Nitroglycerin
wear gloves, don’t let chicken or other pets touch it
