3Rd Pharmacology Exam - Positive Inotropes Cardiac Drugs

Front 1

name the classes of drugs that are cardiac inotropic drugs?

Back 1

sympathomimetic drugs, digitalis glycosides, phophodiesterase III inhibitors, phosphodiesterase III inhibitors/calcium sensitizers

Front 2

name some sympathomemetic drugs that are cardiac inotropes?

Back 2

epinephrine, isoproterenol, dobutamine

Front 3

name some digitalis glycosides that are cardiac inotropes?

Back 3

digoxin, digitoxin, ouabain

Front 4

name some phosphodiesterase III inhibitors?

Back 4

milrinone, amrinone

Front 5

name some phosphodiesterase III inhibitors/calcium sensitizers?

Back 5

pimobendan

Front 6

what acronym do we follow to manage cardiac arrest?

Back 6

ABCDEF

Front 7

how do we manage cardiac arrest?

Back 7

airway, breathing, CPR (chest compression), drugs, ECG (monitor rate and rhythm), fluids

Front 8

what is the action/organ that alpha1 receptors affect?

Back 8

contract pilomotor smooth muscles, gluconeogenesis in liver, secretion of sweat glands, increase tone of urethra smooth muscles, and constrict peripheral & splanchnic vessels (with alpha2)

Front 9

what is the action/organ that beta2 receptors affect?

Back 9

dilate skeletal muscle vessels, relax bronchial smooth muscles, stabilize respiratory mast cells

Front 10

what is the action/organ that beta1 receptors affect?

Back 10

increase heart rate and contraction

Front 11

what is the action/organ that alpha2 receptors affect?

Back 11

constrict peripheral and splanchnic vessels (with alpha1)

Front 12

what receptors does norepinephrine affect?

Back 12

a1 (+++), a2 (+++), B1 (++)

Front 13

what receptors does epinephrine affect?

Back 13

a1 (+++), A2(++), B1 (+++), B2 (+++)

Front 14

what receptors does dobutamine affect?

Back 14

a1 (+), B1 (+++), B2 (+)

Front 15

what receptors does dopamine affect?

Back 15

a1 (+), B1 (+++), DA (+++)

Front 16

what receptors does isoproterenol affect?

Back 16

B1 (+++), B2 (+++)

Front 17

freebie

Back 17

freebie

Front 18

freebie

Back 18

freebie

Front 19

what reaction does epinephrine cause and at what receptors?

Back 19

a1 & a2 = vasoconstriction, B2 = bronchodilation & vasodilation, B1 = increased heart rate & increased contractility & increased conduction

Front 20

what are the primary receptors affected by epinephrine?

Back 20

B1, B2 & a1

Front 21

what are the primary receptors affected by norepinephrine?

Back 21

B1, a1

Front 22

what are the primary receptors affected by isoproterenol?

Back 22

potent B1 & B2

Front 23

what type of agent is epinephrine?

Back 23

sympathomimetic agent

Front 24

what type of agent is norepinephrine?

Back 24

sympathomimetic agent

Front 25

what type of agent is isoproterenol?

Back 25

sympathomimetic agent

Front 26

what drug, besides epinephrin, is used to treat cardia arrest?

Back 26

vasopression (argine vasopressin, AVP)

Front 27

what does vasoppresin do at what receptors?

Back 27

acts at V1, V2, V3 receptors, pressor effect mediated by V1 receptors on vascular smooth muscle

Front 28

what drugs would we use to treat acute cardiogenic pulmonary edema?

Back 28

positive inotropic agent (dobutamine) diuretics (furosemide), vasodilators (nitroprusside: maintain mean arterial pressure > 70 mmHg), oxygen therapy (supplemental O2)

Front 29

what does dobutamin hydrochloride do at what receptors in treating acute cardiogenic pulmonary edema?

Back 29

B1 is cardioselective, a1 & B2 have minor effects: positive cardiac inotrope, minimum increase in heart rate

Front 30

what determines the dosage of dobutamine hydrochloride for treating acute cardiogenic pulmonary edema?

Back 30

half life = 2-3 min, CRI; adjust infusion rate by clinical response

Front 31

what adverse reactions may occur when using dobutamine hydrochloride to treat acute cardiogenic pulmonary edema?

Back 31

high doses will cause increased heart rate and arrhythmias. Do NOT mix with alkalinizing solutions.

Front 32

what are the effects of low dose dopamine?

Back 32

stimulates DA1 receptors & increase renal perfusion

Front 33

what are the cardiovascular effects of moderate dose dopamine?

Back 33

stimulates B1-receptors on heart & positive inotropic and chronotropic effect

Front 34

what are the cardiovascular effects of high dose dopamine?

Back 34

stimulates a1 vascular receptors & increases vascular resistance & decreases renal perfusion (tachycardai, vasoconstriction, tissue necrosis if administered outside vein)

Front 35

what is the non-cardiac uses of dopamine?

Back 35

acute renal failure: via action on DA1 & DA2 receptors proposed to increase renal perfusion; no clinical evidence of benefit

Front 36

what are the components addressed in management of heart failure?

Back 36

treat valvular insufficiency with a positive iotrope which decreased contractility and decreased cardiac output which results in renin-angiotensin -aldosterone imbalance which is treated with diuretic, ACE-inhibitor. The decreased cardiac output causes increased sympathetic tone which leads to tachycardia that is treated with negative chronotrope and vasoconstriction that is treated with a vasodilator

Front 37

what cardiac inotropic drugs can be used to treat heart failure?

Back 37

digitalis glycosides (digoxin, digitoxin, ouabain), phosphodiesterase III inhibitors/calcium sensitizers (pimobendan), & NOT LONG TERM: phosphodiesterase III inhibitors (mitrinone, amrinone) sympathomimetic drugs (epinephrine, isoproterenol, dobutamine)

Front 38

what are the direct effects of digoxin?

Back 38

(1) inhibit NA+/K+ ATPase (2) increasese exchange of Na+ for Ca++ (3) increases intracellular Ca++ (4) more intracellular Ca++ available for contraction

Front 39

what are the neuroendocrine effects of digoxin?

Back 39

increase (restores) baroreceptor reflex sensitivity, decreases sympathetic tone, increased vagal tone

Front 40

what are the clinical effects of digoxin?

Back 40

slowed sinus rate & decreased AV conduction

Front 41

what needs to be monitored with digoxin?

Back 41

concentration due to narrow therapeutic index

Front 42

what affects the therapeutic concentration of digoxin?

Back 42

oral absorption rates (tablet 60% absorption, elixer 85% absorption), clearance impaired with renal disease, collect samples 4 and 12 hours after last dose

Front 43

what are the clinical uses of digoxin?

Back 43

increase force of contraction, slow heart rate, decrease conduction through AV-node

Front 44

what diseases are treated with digoxin?

Back 44

heart failure, cardiomyopathy, atrial fibrillation

Front 45

what are the adverse affects of digitalis?

Back 45

GI (anorexia, nausea, vomiting, diarrhea), cardiovascular (heart block, arrhythmias)

Front 46

how does digitalis interact with electrolytes?

Back 46

low K+ enhances toxicity, high K+ reduces digoxin effects, high Ca++ may increase effects

Front 47

name phosphodiesterase III inhibitors?

Back 47

milrinone, amrinone (not available in vet med), pimbendan (also a calcium sensitizer), levosimndan (also a calcium sensitizer)

Front 48

what are the effects of pimobendan?

Back 48

weak effects in myocardium & peripheral effects of vasodilation

Front 49

what is an inodilator?

Back 49

a drug that causes positive inotropic effects (calcium sensitizer) and vasodilation (PDE III inhibitor)

Front 50

what drug is an inodilator?

Back 50

pimobendan

Front 51

what is the direct affect of pimobendan?

Back 51

increases sensitivity to tropinin C to intracellular Ca++, increases contraction without increasing energy expenditure, may have additional cardiac effect (restore baroreceptor sensitivity, modulates cytokines associated with heart failure)

Front 52

compared to ACE inhibitors, what is the efficacy of pimobendan?

Back 52

with furosemide (for both drugs), pimobendan supports longer survival, improved clinical signs, and few adverse effects

Front 53

what are the adverse affects of pimobendan?

Back 53

early treatment of heart disease may cause adverse cardiac effects; worsening mitral valve disease, increase in cardiac lesions