Test 3 Flashcards
- Volume of distribution definition/equation
V= amount of drug in the body / concentration measured in plasma.
A hypothetical volume of body fluid that would be required to dissolve the total amount of drug needed to achieve the same concentration as that found in the blood.
- Cephalosporins:
Metabolism:
Elimination:
Legalities:
- Cephalosporins:
Metabolism: ONLY CEFTIOFUR IS METABOLIZED (ceftiofur is not active until metabolized).
Elimination: Most are eliminated by the kidney as the parent drug. Good for urinary tract infections.
Legalities: (excluding Cephapirin) Illegal for extralabel (except for EL purpose) use in cattle, swine, poultry
Drugs in 2nd Generation Cephalosporins
Cefoxitin
Drugs in 3rd Generation Cephalosporins
Cefotaxime
Ceftiofur
Cefpodoxime
Cefovecin
Drugs in 4th Generation Cephalosporins
Cefepime
Drugs in Group 7 Cephalosporins
Cefepime
Drugs in Group 5 Cephalosporins
Cefpodoxime
Drugs in Group 4 Cephalosporins
Cefotaxime
Ceftiofur
Cefovecin
Drugs in Group 3 Cephalosporins
Cefoxitin
Drugs in Group 2 Cephalosporins
Cephalexin
Drugs in Group 1 Cephalosporins
Cephapirin
Cefazolin
1st Generation Cephalosporins
MOA: AE: CI: Legal: What do they Treat?
MOA: Inhib cell wall synth
AE: Allergies, bleeding problems
CI: not for animals allergic to beta lac, rec. warfarin anticoag.
Legal: Cephapirin = withdrawal for milk/cattle
TX: Gram+,
cephapirin used for mastitis
2nd generation cephalosporins
MOA:
AE:
CI:
TX:
- MOA: inhib cell wall synth.
- AE: allergies, agg. bldg problems
- Not for animals allegic to beta lac./rec. warfarin anticoag.
- TX: enterobac, anaerobes
3rd generation cephalosporins
list them: MOA: AE: CI: TX: Legal:
List: Cefotaxime, Cefpodoxime, Ceftiofur, Cefovexin
MOA: inhib. cell wall synth
AE: allergies, agg. bldg problems
- Ceftiofur: BM suppression, thrombocytopenia, anemia, diarrhea in horses
- Cefovecin: vomit/dia in dogs/cats, inj. site irr. and edema, long half life at site of inj. GI upset
CI: allergies and warfarn normal but:
- Ceftiofur - don’t give IV, High doses, don’t combine formulations
TX: NOT Staph. aureus, pseudomonas, Gram - Anaerobes
Legal: Ceftiofur withdrawal, Cefovecin not for FA
4th Generation Cephalosporins
List them: MOA: AE: CI: TX:
List: Cefepime (grp7)
MOA: inhib. cell wall synth.
AE: allergies, bldg disorders, vomit/dia
CI: nor for Blactam allergic, reduce to less intervals w/patients w/renal failure
TX: Respiratory, Enterobacteriacea, Pseudomonas
Carpabenems
List them
Imipenem
Meropenem
Imipenem
MOA:
AE:
CI:
TX:
MOA: binds PBP-1 and weakens cell wall faster than other beta lactams
AE: allergies, rapid infusion = neurotox., nephrotox, vomit, nausea, IM painful
CI: use caution in animals prone to seizure. DRUG OF LAST RESORT.
TX: Everything (not mycoplasma, spirochetes)
Meropenem
MOA:
AE:
CI:
TX:
MOA: binds PBP-1 which weakens cell wall faster than other beta lactams
AE: less prone to seizures than imipenem, allergies, SQ injections may experience hair loss
CI: yellow discoloration when reconstituted, dark indicates loss of potency. DRUG OF LAST RESORT.
TX: Everything (not spyro or myco)
Metronidazole
- MOA:
- AE:
- CI:
- TX:
- Legal:
- MOA: reduced in anaerobic environment, (electron sink) to toxic intermediate.
- AE: CNS Toxicity via inhib. of GABA; mutagen, vomiting, anorexia, benzoic acid toxic to cats, Type II idiopathic
CI: caution w/seizure animals esp. w/renal failure
TX: Anaerobes, protozoa
legal: ILLEGAL FOR EXTRALABEL USE IN FA
Polymixins
MOA:
AE:
TX:
MOA: interfere w/bacterial cell membrane function, inhib. formation and prot. synth
AE: narrow therapeutic index, renal injury at long/high doses, hydrate or kidney dmg, doesn’t work w/puss/detergents
TX: Enterobacteriacea
Bacitracin
MOA:
AE:
TX:
MOA: interferes with bacterial cell membrane function.
AE: Nephrotox, hypersens. rxns
TX: most Gram -
Nitrofurans
MOA: AE: CI: TX: Legal:
MOA: Urinary antiseptic, thera conc. reached only in urine, inhib. bac. DNA/RNA
AE: naus, vomit, dia, urine turns rust yellow/brwn,
CI: not while prego, can cause hemoly. anemia in newborn, not for neonates
TX: UTI’s
Legal: Illegal in FA
Rifampin
MOA:
AE:
TX:
MOA: inh. bac. RNA synth
lipid sol. can enter cells and conc. in leuko to inhib intracell. bac.; complexes w/beta subunit of DNA dependant RNA polymerase to inactivate it.
AE: people - hypersens/flu like symptoms
- hepatotox in dogs, elevated liver enzymes, urine orange to red/organge, may discolor saliva, teaers, feces, sclera and mucousm., ubpalatable, pancreatitis
- INDUCES CytP450 so may increase met. of other drugs
TX: Gram+, used w/macrolides
Amphoteracin B
Class of Drug: MOA: AE: CI: Effect:
CoD: Antifungal
MOA: binds to ergosterol in cell membrane causing loss of integrity, leaking, cell death
AE: Dose dep. nephrotox., fever phlebitis, tremors, renal potassium wasting, CHECK FOR CASTS, BUN, CREATINE, Nyastatin - PU/PD, V/D
CI: NOT FOR PTNTS W/RENAL DZ OR IN DEHYDRATED
Effect: fungicidal drug for systemic fungi, some protozoa
Caspofungin
MOA;
AE:
CI:
Effect:
MOA: inhib. Glucan in fungal cell wall; inhib. cell wall synth
AE: hepatic sens, GI symptoms, increased liver enzymes
CI: acts w/cyclosp. cause elevated liver enz and tacrolimus
Effect: Fungicidal
Flucytosine
MOA:
AE:
CI:
Effect:
MOA: converted to flurorouracil, acts as antimetabolite, pen. fungal cell wall
AE: anemia, thrombocytopenia, cutaneous and mucocutaneous eruptions in dogs
CI: Not for dogs
Effect: tx cryptococcal meningitis often in combo w/Amphoteracin
Griseofulvin
Class of drug: MOA: AE: CI: TX: Legal:
Class: Antifungal
MOA: inhib mitosis of fungal cells, kills them
AE: teratogen, anemia, leukopenia, anorexia, depression, v/d, FIV-marrow toxicosis w/irrevers. pancytopenia
CI: not for prego cats, caution if have FIV
TX: DOC for systemic dermatophyte treatment
Legal: not for for FA as it’s teratogenic
Terbinafine
COD: MOA: AE: CI: TX
COD: Allylamin antifungal
MOA: targets squalene epoxidase to inhibit ergosterol synth.
AE: Vomit, nausea, anorexia, increased liver enzymes, facial puritis, hapatotoxic
CI: none; note, stays longer in hair than does systemic
TX: used for dermatophyte and Malazzezia yeast infections
Flucanoazole
COD: MOA: AE: CI: TX: Legal:
COD: Azole antifungal
MOA: inhib ergosterol synth. in cell membrane
AE: hepatopathy, increased liver enzyme, endocrine dysfunction
CI: caution in prego animals, fetal abnormalities in lab animals
TX: works on dermatophytes, systemic fungi and yeasts (candida, coccidiodes and cryptococcus)
Legal: none
Itraconazole
COD: MOA: AE: CI: TX:
COD: Azole antifungal
MOA: inhib ergosterol synth. in cell membrane
AE: hepatotoxicity, INC. LIVER ENZYMES, NO endocrine dysf., vaculitis and skin lesions in dogs, vomiting in cats, anemia
CI: caution w/liver dz and prego, fetal abnormalities in lab animals.
TX: works on dermatophytes, systemic fungi, blastomyces, histoplasma, coccidiodes
ketoconazole
COD: MOA: AE: CI: TX: Legal:
COD: Azole antifungal
MOA: inhib ergosterol synth. in cell membrane, INHIBITS CYT. P450 enzyme in fungi
AE: hepatotox, increased liver enzyes, endocrine dys., low cortisol and testosterone, V/D, hepatic injury, lighter hair, cataracts, lower hormone synthesis
CI: not for prego, embryotoxic and fetal abnormalities in lab animals
TX: works on dermatophytes, systemic fungi and histoplasma, blastomyces, coccidiodes, malassezia
Legal: NA
Posaconazole
COD MOA AE CI TX Legal
COD: Azole antifungal
MOA: inhib ergosterol synth. in cell membrane
AE: headache, diarrhea, nausea, increased liver enzymes, neuronal vacuolation
CI: not prego, lab abnormalities
TX: works on dermatophytes, systemic fungi and yeasts (as do all azoles)
Legal: NA
Voriconazole
COD: MOA AE CI TX Legal
COD: Azole antifungal
MOA: inhib ergosterol synth. in cell membrane (prev. P450 enzyme)
AE: neurotox in cats, vomit, hepatotox, ocular problems in ppl; CNS signs that resolve after disuse
CI: prego, lab animal abnormal., use PO form in animals with renal issues
TX: works on dermatophytes, systemic fungi, yeasts
Miconazole
used for:
Class of drug:
OTC topical (vag cream) COD: antifungal
Nystatin
how administered:
MOA:
AE:
CI:
- Topical only
- MOA: binds ergosterol in cell membrane causing leaking, cell death
- AE: NEPHROTOXIC, fever, phlebitis, tremors, renal K wasting, PU/PD, V/D
- CI: not for ptnts w/renal dz or dehydrated animals
Drugs in 1st Generation Cephalosporins
- Cefazolin
- Cephapirin
- Cefalexin
assume these adverse effects with all of the -azole antifungals
- Increased liver enzymes
- possible liver disease (hepatopathy)
- inhibit P450 enzyme
Bethanechol
Class of Drug: Effect: MOA: AE: CI:
- COD: Promote Urination
- Effect: Muscarinic Cholinergic agonist
- MOA: stimulates gastric/intestinal motility and contraction of urinary bladder ; resists acetylcholinesterase
- AE: Increase GI mot resulting in diarrhea, circulatory depression
- CI: not w/obstruction
Phenoxybenzamine
- Class of Drug:
- Effect:
- MOA:
- AE:
- CI:
- COD: Promote urination
- Effect: adrenergic antagonist (relax urethral sm. mm), vasodilator
- MOA: alpha 1 antagonist
- AE: hypotension, tachycardia, weakness, syncope, diarrhea in horses
- CI: not with heart problems, not if dehydrated
Phenylpropanolamine
COD: Effect: MOA: AE: CI:
COD: Reduce incontinence
Effect: adrenergic agonist (const. sm. mm)
MOA: nonselective adrenergic agonist (A&B)
AE: tachycardia, cardiac effects, CNS excitement, restlessness, appetite stimulation, increased BP, stroke
CI: not with cardiovasc. dz
Diethylstilbestrol
COD: Effect: MOA: AE: CI:
COD: reducing incontinence
Effect: synthetic estrogen
MOA: synth estrogen, increases sens. of alpha receptors in urinary sphincter
AE: increased risk of pyometra, estrogen sens. tumors, rarely bone marrow depression and anemia
CI: risk of cancer in humans
Estriol
COD: Effect: MOA: AE: CI:
COD: Reduce Incontinence Effect: estrogen hormone MOA: estrogen, increases sens. to alpha 1 receptors in urinary sphincter AE: NONE CI: not for prego animals or FERRETS
Ammonium Chloride
COD: Effect: MOA: AE: CI:
COD: Reduce urinary calculi
Effect: urine acidifier (manages crystal calc. and chronit UTI’s)
MOA: induces acidic urine
AE: bitter taste in food, aacidemia in high doses
CI: not w/systemic acidemia or renal dz
Potassium Citrate
COD: Effect: MOA: AE: CI:
- COD: reduce urinary calculi
- Effect: urine alkalinizer (brks up urinary calculi)
- MOA: alkalinizes urine and increases urine citric acid which decreases urinary calcium oxalate crystallization
- AE: toxicity, hyperkalemia leading to cardiovasc tox., muscular weakness, nausea, stomach irritation
- CI: renal dz, not with other K drugs
Acronym for Diuretics:
FMASH
F - Furosemide M - Mannitol A - Acetazolamide S - Spiranolactone H - Hydrochlorothiazide
Acetazolamide
Effect: COD: MOA: AE: CI:
- COD: Diuretic
- Effect: Carbonic anhydrase inhibitor diuretic (used to lower intra-ocular pressure)
- MOA: carbonic anhydrase inhibitor; inhibits uptake of bicarb in PROXIMAL renal tubule, which resuts in loss of bicarb, water, and alkaline urine
- AE:hypokalemia, bicarb loss, REP RXN due to RESP ACIDOSIS
- CI: not w/acidemia or those sensitive to sulfonamides
Mannitol
COD: Effect: MOA: AE: CI:
- COD: Diuretic
- Effect: osmotic Diuretic (increases osm. of plasm that dec. edema, intracranial and intra-ocular pressures)
- MOA: filtered in glomerulus (PROX TUBULE, LOH) but not reabsorbed, increases osmolarity of urine, leads to inhibition of reabsorption
- AE: fluid loss, electrolyte imbalance, rapid infusion = excessive ECF expansion
- CI: not dehydrated or w/intracranial bldg
Furosemide
COD: Effect: MOA: AE: CI:
- COD: Diuretic
- Effect: Loop Diuretic (used for edema)
- MOA: Na/K/Cl symporter inhibitor
- AE: hyponatremia more common than hypokalemia in dogs, tolerance and activation of RAAS with repeated admin.
- CI: caution w/RAAS inhib. to decrease risk of azotemia (elev. BUN/cr)
Hydrochlorothiazide
COD: Effect: MOA: AE: CI:
- COD: Diuretic
- Effect: thiazide diuretic (decrease Na and water reabsorption, not a strong diuretic as occurs so late in the process)
- MOA: inhibits Na reabsorption in DISTAL TUBULE (incr. Na, K and Water, decreases Ca excretion)
- AE: Hypokalemia
- CI: not w/high serum calcium (prevents Ca excretion)
Spironolactone
COD: Effect: MOA: AE: CI:
- COD: Diuretic
- Effect: Aldosterone antagonist diuretic
- MOA: potassium sparing diuretic, inhib. aldosterone; interferes w/ Na reabsorption in DISTAL TUBULE
- AE: hyperkalemia, high doses have steroid like effects, facial dermatitis in cats
- CI: not if dehydrated, Gi problems, NSAIDS interfere, don’t give w/K supp.
Most Diuretics cause K to be high or low?
Low (all but Spironolactone)
put these in order of importance when using diuretics:
Hyponatremia, Dehydration, Hypokalemia
- Dehydration
- Hypokalemia
- Hyponatremia
most common alteration in patients relating to fluid balance:
- acid/base imbalance
- electrolyte imbalance
- water imbalance (dehydration, Hypovolemia)
- hypoproteinemia
Therapeutic Goals for fluid therapy alterations:
water imbalance
hypoproteinemia
electrolyte imbalance, etc.
- Improve tissue perfusion by replacing intravascular volume
- meet maintenance needs
- correct dehydration by replacing interstitial volume
- replace on going losses
Water accounts for what % of total body weight?
ECF ICF Blood Plasma Interstitial
Water: 60%
ECF: 20% Plasma: 5% of ECF interstitial: 15% of ECF ICF: 40% Blood: 7% of ICF
what’s Higher in ECF vs. ICF
Na
K
Cl
Ca
Inside:
- K
Outside:
- Na
- Cl
- Ca
Drug (fluid therapy) options less commonly used for physio alterations resulting in the need for use of therapy include:
- hemoglobin based oxygen carrying compounds
- blood products
- parenteral nutrition
drug (fluid therapy) options most commonly used for physio alterations resulting in fluid therapy:
colloids
crystalloids
main difference between maintenance and replacement crystalloid fluids:
Na concentration
Lesser importance: generally higher conc of K in maintenance
maintenance fluids have Na content that resembles:
ECF or ICF
Replacement fluid Na conc resembles ECF conc of Na
ICF, Na is lower.
replacement fluids would be higher in Na while Maintenance fluids would be lower in Na
what % remains in the IV space after 1 hour?
- Replacement Crystalloids
- Maintenance Crystalloids
If concerned about volume, what should you do? (not answered on card)
- Replacement: 25%
- Maintenance: 10%
Commonly used colloids:
distinguishing characteristic of colloids from crystalloids?
- plasma
- albumen
- synthetic colloids
- oncotic (colloid osmotic properties)
parameters to be monitored during fluid therapy:
- normal bronchiovesicular lung sounds (pulm. edema w/fluids)
- PCV (diluted w/fluids)
- total protein (decreases)
- electrolytes (change)
- arterial pH
- arterial pCO2
- Urine Output (increase)
- Hemodynamics (hypervolemia)
Fluids that contain Mg:
Plasma Lyte-M
Plasma Lyte-A
Normosol M
Normosol R
Fluids that contain Calcium:
- Lactated Ringers
- Ringers
- Plasma Lyte M
Replacement Fluids
which are acidic
Which are alkalinic
Acidic: - ringers - Normal Saline Alkalinic: - Lactated Ringers - Normosol R - Plasma Lyte-A
Maintenance fluids:
List them
Are they acidic or alkalinic
- Normosol M
- Plasma Lyte-M
- Acid
Volume increasing fluids:
List them:
- Hypertonic Saline
- Hetastarch
Hetastarch
COD: Therapeutic Goal: MOA: AE: CI:
- COD: Fluids
- TG: decrease dehydration, correct hypovolemia (expander circ. shock)
- MOA: Colloid-like, expander; maint. vascular volume w/circulatory shock (synthetic starch molecule)
- AE: allergic rxn, hyperosmotic renal dysfunction, dec function of platelets
- CI: not for bldg patients, or coagulopathies