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23 spring: pharm > Test 3: 33 cardio drugs > Flashcards

Test 3: 33 cardio drugs Flashcards

1
Q

how do vasodilators effect arterial blood pressure

A

decreases total peripheral resistance (arterial vascular smooth muscle tone →vasodilation = ↓afterload)

↓ venous return to the heart = ↓preload

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2
Q

how do positive inotropic drugs effect arterial blood pressure

A

change myocardial contraction which changes stroke volume → changes cardiac output

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3
Q

— are some common ace inhibitors

A

benazepril
enalapril

type of vasodilator

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4
Q

— is a type of ARB

A

telmisartan

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5
Q

— are two inotropes used in vet med

A

digoxin and pimobendan

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6
Q

arteriodilators can decrease mitral regurgitation in dogs with DCM by

A

increasing the size of the aorta= decrease afterload

will cause more blood out through the aorta and less going backwards into the atrium

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7
Q

— is a venous dilator medication

A

nitroglycerin

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8
Q

— are balanaced vasodilators

A

ACE inhibitors (enalapril)
Nitrates (nitroprusside)

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9
Q

— are arteriodilators

A

hydralazine
amlodipine

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10
Q

goal of ACE inhibition

A

stop angiotensin II which causes

fluid and Na retention
vasoconstriction
increased thirst
vascular and myocardial fibrosis and pathologic tissue remodeling
increases aldosterone

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11
Q

which ACE inhibitor is less toxic in patients with exisiting renal disease

A

Benazepril

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12
Q

what is an ARB

A

angiotensin II receptor blocker
telmisartan

bind to AT1 receptors which cause hypertension and vasocontriction

does not bind to AT2 receptors which cause good things: vasodilation and Natriuretic

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13
Q

side effects of ACE inhibitors

A

hypotension
renal impairment (need to check renal function after starting meds)
↑ potassium
anorexia, diarrhea, vomiting
cough?

enalapril

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14
Q

if patient gets cough on ACE inhibitor then can start —

A

ARB (telmisartan)

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15
Q

what are the three main nitrates used

A

nitroglycerin
isosorbide (mono-, di-) nitrate
nitroprusside

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16
Q

how do nitrates work

A

exact mechanism not known but nitrates cause the release of NO which will cause vasodilation by the formation of cGMP

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17
Q

why do paitents become tolerant to nitrates

A

↓ sulfhydryl(SH) groups

can prevent tolerance by staggered therapy- give for 5 days, give weekend off

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18
Q

Isosorbide mononitrate is metabolized where

A

not the liver

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19
Q

how do arteriodilators reduce myocardial workload

A
  • reduce systemic BP
  • reduce afterload and myocardial wall stress
  • unloads the failing heart
20
Q

what happens with high dose IV nitroprusside

A

toxic

coverts to methemoglobin which pushed curve to the left: RBC won’t let go of O2

nitroprusside: balanced vasodilator: both arteriodilator and venodilator

21
Q

when to use nitroprusside

A

bad cases of CHF that are not responding to normal therapy

HTN crisis

does not need SH to release NO → vasodilation
balanced vasodilation: both arterio and venodilator

22
Q

adverse effects of nitroprusside

A

hypotension
reflex tachycardia

does not need SH to release NO → vasodilation
balanced vasodilation: both arterio and venodilator

23
Q

how does hydralazine work?

A

unknown

increases cGMP → vasodilation= ↓afterload

24
Q

adverse effects of hydralazine

A

hypotension
reflex tachycardia
GI: vomiting and anorexia

25
Q

— is a dihdropyridine calcium channel blockers

A

amlodipine

treat ↑BP with no effect on heart rate or inotropic state

26
Q

— are non-dihydropyridine calcium channel blockers

A

verapamil
diltiazem

will ↓BP and control HR (antiarrhthymic)

27
Q

side effect of amlodipine in dogs

A

gingival hyperplasia

amlodipine: dihdropyridine calcium channel blocker that ↓ BP without effecting HR

28
Q

— are naturally occurring catecholamines

A

sympathomimetics

epinephrine
norepinephrine
dopamine

29
Q

what 4 receptors are effected by beta agonist in the heart

A

L type Ca channel
phospholamban
Troponin I
RYR2

30
Q

— drugs work on the beta adrenergic receptor in the heart

A

dopamine
dobutamine

31
Q

— is a phosphodiesterase inhibitor

A

pimobendan (balanced vasodilator)

32
Q

— drugs works on the Na/K ATP pump in the heart

A

digoxin

33
Q

compare effect of dopamine nad dobutamine on systemic vascular resistance and cardiac output

A
34
Q

how does pimobendan work

A

increases binding of Ca to troponin in the cardiac cell = ↑ myocardial contractility

does not increase the amount of Ca in a cell and does not increase energy demand of the cell

inhibits phosphodiesterase

will also cause arterio and venodilation

35
Q

compare pimobendan and digoxin

A

primobendan increases contractility of heart by increasing troponins sensitivity to Ca that is already there= no increase in Ca into the cell and no increase in energy demand of the cell

digoxin will inrease the amount of Ca into a cell to cause increased contraction

36
Q

if you give pimodendan to dog with asymptomatic heart disease what will happen

A

reduces onset of CHF for average of 15 months

37
Q

how does digoxin effect HR

A

slows conduction by SA node
slows conduction through AV node
increases refractory period in the AV node

used to treat Afib

38
Q

what happens with digoxin toxicity

A

narrow therapeutic window

cause cardiac arrhythmias (AV block, ventricular bigeminy)
Vomiting, diarrhea, anorexia and weight loss
depression

39
Q

how to prevent digoxin toxicity

A

start at low dose
dose on body surface area
check a serum level after 5-7 days

40
Q

how to treat digoxin toxicity

A

stop drug
treat symptoms

can give antibody Digibind

if symptoms resolve can restart at lower dose

41
Q

dopamine at low dose

A

B receptor: increases HR and contactility, cause vasodilation

at high dose: binds to alpha adrenergic receptors and causes vasoconstrictiona and ↑HR

42
Q

dopamine at high dose

A

act on Alpha 1 receptors

cause vasoconstriction and ↑HR

at low dose: B receptors: ↑HR and contractility
sopaminergic receptors cause vasodilation

43
Q

— is primary ⍺1 agonist vs — is primary β1 agonist

A

dopamine (cause vasoconstriction and ↑HR)

dobutamine ( inotropic agent= increases intracellular Ca= increase contraction with minimal effect on heart rate)

44
Q

what does a B1 adrenergic agonist do

A

dobutamine

increases contraction of the heart without effecting HR

does not increase O2 demand of the heart

45
Q

dopamine or dobutamine should be given to treat CHF

A

dobutamine: B1 receptor= + inotropic drug= increases contraction of the heart

dopamine is a vasopressor= alpha 1 receptor= cause vasocontraction and increases systemic vascular resistance = used to treat sepsis

46
Q

— increase myocardial contractility and are used in the setting of heart failure.

A

Positive inotropic agents

(catecholamines/dobutamine, digoxin→increase Ca into a cell)

(pimobendan →increase binding of Ca to myosin)

23 spring: pharm (46 decks)

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