Bryan - Pharmacology Ii - Test 1 - Antiseizure And Liver - Winter 2Nd Year

Front 1

What three changes or alterations occur with seizures?

Back 1

Altered consciousness
altered behavior
altered motor function

Front 2

What are the types of generalized seizures? Which types involve uncontrolled movement?

Back 2

Tonic
Clonic
Tonic/Clonic
(any clonic seizure involves motion)

Front 3

What are the types of seizures (defined by region or degree of body involvement)?

Back 3

Generalized (total body)
Partial
Complex partial

Front 4

List some important differential diagnoses of seizures.

Back 4

Hypoglycemia
Hypocalcemia
Idiopathic epilepsy
Intracranial disease
Metabolic disease
Toxins/poisons

Front 5

What is the period between seizures known as?

Back 5

Interictal period

Front 6

Which breeds are predisposed to idiopathic epilepsy?

Back 6

German shepherds, golden retrievers

Front 7

Which drugs are "first line" therapy agents for seizures?

Back 7

Bromides
Phenobarbital

Front 8

Which antiseizure drug prevents seizures by hyperpolarizing the axonal membranes through competition with Cl ions?

Back 8

Bromides

Front 9

T or F:
Bromides are common first line therapy agents in many small animals.

Back 9

False!
They are first line in dogs; but 2nd or 3rd in cats (case respiratory effects in cats)

Front 10

What are common side-effects to bromide therapy? What additional side effects are seen in cats?

Back 10

sedation
vomiting
hyperkalemia
spurious hyperchloremia
respiratory effects (cats)

Front 11

Which drug is a common 1st choice antiseizure therapy for dogs and cats?

Back 11

Phenobarbital

Front 12

Choose bromides or phenobarbital...
...rapid elimination half-life.

Back 12

Phenobarbital

Front 13

Choose bromides or phenobarbital...
...long half life.

Back 13

Bromides

Front 14

Choose bromides or phenobarbital...
...activates cytochrome P450.

Back 14

Phenobarbital

Front 15

Choose bromides or phenobarbital...
...activity includes inhibition of Ach, NE, and Glutamate release.

Back 15

Phenobarbital

Front 16

What are examples of 2nd/3rd antiseizure agents? Which has questionable efficacy?

Back 16

Valproic acid (questionable)
Felbamate
Zonisamide

Front 17

Choose Valproic acid, Felbamate, or Zonisamide...
...expensive but shows promise as 2nd line drug.

Back 17

Zonisamide

Front 18

Choose Valproic acid, Felbamate, or Zonisamide...
...no additional sedative effect; induces liver enzymes.

Back 18

Felbamate

Front 19

Choose Valproic acid, Felbamate, or Zonisamide...
...GABA transaminase inhibitor.

Back 19

Valproic acid

Front 20

Choose Valproic acid, Felbamate, or Zonisamide...
...shares chemical properties with a large class of antibiotic drugs.

Back 20

Zonisamide

Front 21

A seizure lasting longer than 5 minutes is known as....

Back 21

...status epilepticus

Front 22

Why is status epilepticus severely life-threatening?

Back 22

Cerebral hypoxemia will develop;
Body temp also raises significantly

Front 23

What is the tiered treatment protocol for status epilepticus (ie first give this then another thing and if that doesn't work give this...)

Back 23

Treat w/diazepam up to 3x
Proceed to propofol therapy
Then, general anesthesia (pentobarb coma)

Front 24

2 or more seizures occurring in rapid succession with return to normal state in interictal period are called...

Back 24

...cluster seizures

Front 25

What is the common treatment for cluster seizures?

Back 25

Diazepam per rectum

Front 26

What liver disease is common in dogs? In cats?

Back 26

Dogs - chronic hepatitis
Cats - feline cholangitis

Front 27

What is a common signalment for chronic hepatitis?

Back 27

Middle aged dog

Front 28

What lesions are commonly seen with chronic hepatitis?

Back 28

Hepatocellular apoptosis/necrosis
Infiltration of mononuclear cells
Fibrosis (+/-)
Cirrhosis (+/-)

Front 29

What are the two forms of feline cholangitis? Which is more common?

Back 29

Neutrophilic
Lymphocytic (more common)

Front 30

Which drugs are commonly used for treatment of chronic hepatitis and feline cholangitis (hint...there are 3)? Which is used more in cats?

Back 30

Glucocorticoids
Azathioprine (don't give to cats!!!)
Chlorambucil (used in cats)

Front 31

What are some examples where glucocorticoids are contraindicated for hepatitis/cholangitis treatment?

Back 31

Acute processes
Infectious processes

Front 32

What specific form of glucocorticoid should be given to cats and dogs with severe liver disease and why?

Back 32

Prednisolone should be given (prednisone is metabolized to prednisolone in liver)

Front 33

Which drug is given to dogs when glucocorticoids fail? Why not cats?

Back 33

Azathioprine (causes bone marrow suppression in cats)

Front 34

Which drug is given to cats when glucocorticoids fail?

Back 34

Chlorambucil

Front 35

What substances trigger the release of bile salts from the gallbladder?

Back 35

Fat
CCK

Front 36

T or F:
Most bile is extracted from the blood by the liver in the first pass.

Back 36

True! over 95%

Front 37

Where in the GI tract is bile released? Where is it reabsorbed?

Back 37

Released - duodenum
Reabsorbed - ileum

Front 38

What pigment gives bile its color?

Back 38

Bilirubin

Front 39

In its unconjugated form, bilirubin is bound to which substance? What substance is it bound to when conjugated?

Back 39

Albumin (unconjugated)
Glucuronic acid (conjugated)

Front 40

Where is bilirubin conjugated?

Back 40

in the liver

Front 41

What naturally-occurring substance can be used as a drug to prevent damage from bile acid buildup? When is it contraindicated?

Back 41

Ursodeoxycholic acid (contraindicated with biliary obstruction)

Front 42

What drugs are commonly used to prevent oxidative stress in the liver?

Back 42

S-adenyl methionine
Vit E
Silymarin
Ursodeoxycholic acid

Front 43

Choose the antioxidant that...
...increases superoxide dismutase.

Back 43

Silymarin

Front 44

Choose the antioxidant that...
...protects against membrane peroxidation.

Back 44

Vitamin E

Front 45

What are the primary sources of free radicals in the liver?

Back 45

Mitochondria
cyt P450 enzymes
Kupffer cells

Front 46

Choose the antioxidant that...
...is the precursor for cysteine.

Back 46

SAMe (S Adenyl Methionine);
also N-acetylcysteine

Front 47

What are main causes of hepatic encephalopathy in dogs? in cats?

Back 47

dogs - severe liver dysfunction
dogs - portosystemic shunt
cats - anorexia (no arginine causes NH3 buildup)

Front 48

What are the three tiers to treatment of hepatic encephalopathy?

Back 48

fluid therapy
diet change (low protein)
decrease NH3 (lactulose adminstration)

Front 49

What are two main cellular routes leading to hepatic fibrosis?

Back 49

Inflammatory cells recruit fibroblasts
Activated Stellate (Ito) cells lead to fibrosis

Front 50

What is the most common antifibrotic treatment? What three things does this treatment decrease?

Back 50

Colchicine decreases amyloid, inflammatory mediators, and collagenase production

Front 51

How can portal hypertension lead to hepatic encephalopathy?

Back 51

Portal hypertension can lead to shunts and bridges in the liver, bypassing portal system

Front 52

What are the main therapies for portal hypertension?

Back 52

Na restriction
Fluid therapy
Diuretics (aldosterone antagonist - spirinolactone is best)

Front 53

What are two general therapies that reduce hepatic Cu levels?

Back 53

Chelators
Long term Zn administration

Front 54

Name some chelators that remove hepatic Cu.

Back 54

D-penicillamine
222 tetramine

Front 55

T or F:
The fastest way to remove hepatic Cu is to use the synergistic effect of a chelator and Zn.

Back 55

False!
The chelator will chelate Zn as well! Should not use them together!

Front 56

T or F:
Vitamin K is an effective long-term therapy treating the coagulopathy that often accompanies liver disease.

Back 56

False!
Vit. K should be used short-term (eg: before surgery)

Front 57

What are therapeutic strategies are used to combat hepatic lipidosis?

Back 57

Administer food
B-vitamins (Cobalamin and Thiamine)
Arginine
Carnitine
Taurine