Kaylee's Cardiac And Respiratory Drugs

Front 1

How can the heart compensate for heart disease?

Back 1

- increasing heart rate

- increase the force of contraction

- enlargement (muscle)

- increase efficiency

Front 2

what is the goal of treatment for heart disease?

Back 2

- increase and maintan cardiac output

- decrease resistance

- relieve fluid accumulation

- increase strength/ force of contraction

- fix arrhythmias

Front 3

what can be done for end stage heart disease?

Back 3

ansilary treatment:

- asprin- prophilaxis to prevent clots

- stage 4: narcotics/ sedatives

- low doses of acepromazine

- oxygen in hospital

Front 4

how can resistance to the heart be decreased?

Back 4

treating hypertension:

- dilate arteries (to reduce afterload)

- dilate veins (to reduce preload)

Front 5

What can be done to relieve fluid accumulation in the heart?

Back 5

- diuretics (better at relieving fluid accumulation: use in dire/emergency situations)

- ACE inhibitors (better at preventing fluid accumulation)

- diet: low sodium

Front 6

List the ACE inhibitors

Back 6

Benazapril

Enalapril

Caphepril

Front 7

List some diuretics

Back 7

lasix

spironolactone

Front 8

What is the goal of treatment in end stage heart failure

Back 8

improve oxygenation and make the animal comfortable/ less anxious

Front 9

four ways cardiac drugs effect the system

Back 9

1. chronotrope

2. inotrope

3. stroke volume

5. cardiac output

Front 10

define chronotrope

Back 10

affects the rate of the heart beat

- postive chronotrope: increase heart rate

- negative chronotrope: decreases heart rate

Front 11

define inotrope

Back 11

affects the strength of the heart contraction

Front 12

what are the two parts of stroke volume that are affected in cardiac disease?

Back 12

- Preload: quantity of blood filling chambers during diastole

- afterload: arterial resistance the heart must pump agains (worse with arteriole stenosis)

Front 13

define cardiac output

Back 13

the amount of blood the heart is capable of pumping per minute

Front 14

how do you calculate cardiac output

Back 14

stroke volume x beats per minute

Front 15

what are the four heart valves?

Back 15

- tricuspid

- mitral

- pulmonic

- aortic

Front 16

What are the factors that determine the treatment

Back 16

- the patient

- type of disease

- the response to the drugs tried

Front 17

Why does the body increase water absorbtion with heart disease?

Back 17

to try to increase blood volme and therefore cardiac output

Front 18

What are the three general categories of cardiac drugs?

Back 18

1. Inotropes

2. antiarrhythmics

3. vasodilators

Front 19

List some positive inotropes

Back 19

- glycosides

- catecholamines

- mixed dilators

Front 20

when are positive inotropes used?

Back 20

as a last resort in late stage 3 or 4 cardiac diseases

Front 21

name a cardiac glycoside

Back 21

digitalis (digoxin)

Front 22

what do cardiac glycosides do?

Back 22

- increase strength of contraction

- decrease heart rate (allowing chambers to fill)

- stabilize rhythm

- decrease dyspnea

Front 23

how can digoxin be administered

Back 23

injection

tablets/ capsules

oral elixer

Front 24

where does digitalis/ digoxin come from

Back 24

from the digitalis plant

Front 25

what are the down sides to digitalis glycosides

Back 25

small therapeutic window/ margin of safety

dosed on lean body weight

variable bioavailability = blood monitoring

*multiple adverse drug reactions (especially lasix)

Front 26

adverse side effects to digitalis glycosides

Back 26

(seen at hight or toxic serum levels)

- decreased appetite, anorexia

- vomiting and diarrhea

- cats are more sensitive

Front 27

What are cardiac glycosides used for?

Back 27

- cardiac heart failure

- atrial fibrillation and atrial tachycardia

Front 28

What are the sympathetic receptors

Back 28

Alpha1

alpha 2

beta 1

beta 2

Front 29

what do Alpha 1 receptors control?

Back 29

- vasoconstriction (particularly atrial system)

- ureter constriction

- urethral constriction

Front 30

what do Alpha 2 receptors control

Back 30

- insulin release

- glucagon release

- sphincters of the GI tract constrict

Front 31

what do beta 1 receptors control?

Back 31

(only really the heart)

- increase heart rate

- increase force of contraction

Front 32

what do beta 2 receptors control

Back 32

- dilate bronchi

- dilate bronchioles

- reduce GI motility

- stimulate insulin release

- inhibit histamine

Front 33

which are stronger alpha 1 or beta 2?

Back 33

Alpha 1, often overrule beta 2

Front 34

where are beta 2 receptors located

Back 34

in the smooth muscle of the heart

Front 35

what are catecholamines?

Back 35

- Positive inotropes and chronotropes

- sympathemimetic drugs

Front 36

what do catecholamines do?

Back 36

- cause vasoconstriction

- increase the rate and strength of contraction

- elevate blood glucose

- stimulate beta 1 receptors in the heart

Front 37

when are catecholamines used?

Back 37

since they have a short half life they are often reserved for severe heart failure (stage D)

Front 38

List some catecholamines

Back 38

- Epinephrine

- Dopamine

- dobutamine

Front 39

What is it important to remember when using epinephrine

Back 39

comes in two forms

human use does not need to be refrigerated

veterinary use may

Front 40

what are the side effects of epinephrine

Back 40

- hypertension

- arrhythmia

- anxiety

- excitability

Front 41

what is epinephrine used for?

Back 41

cardiac resuscitation and anaphylaxis

Front 42

what is dopamine used for?

Back 42

acute heart failure

oliguric renal failure

shock

Front 43

what are the side effects of dopamine?

Back 43

- vomiting

- tachycardia

- dyspnea

- blood pressure abnormalities

Front 44

What is it important to remember about dobutamine

Back 44

human only- requires dilution

Front 45

Why can't catecholamines be used long term?

Back 45

can contribute to the development of arrhythmias and increase the workload of the heart

Front 46

List an inotropic mixed dilator

Back 46

pimobendan (vetmedin)

Front 47

what do inotropic mixed dilators do?

Back 47

- increase calcium sensitivity of myofibrils

- inhibits enzyme phosphodiestrase

- dilates both veins and arteries

- increase force of contraction

Front 48

What are inotropic mixed dilators (pimobendan) used for?

Back 48

- mital and tricuspid acquired murmurs

- Dilated cardio myopathies

Front 49

what is the contraindications of inotropic mixed dilators (pimobendan)

Back 49

not for use with Hypertrophic cardiomyopathy or aortic stenosis

Front 50

How is pimobendan administered, and who is it approved for?

Back 50

oral, chewable tablets

labeled for dogs, used in both dogs and cats

Front 51

what are the adverse side effects of inotropic mixed dilators (pimobendan)

Back 51

- anorexia

- lethargy

- diarrhea

- allergic reactions

Front 52

What are the two scenarios that cause arrhythmias?

Back 52

- a problem with impulse generation

- a problem with impulse conduction (abnormal route)

Front 53

What is an arrhythmia

Back 53

poorly coordinated pumping activity results in decreased cardiac output

Front 54

what does the p in the pqrst represent

Back 54

atrial contraction

Front 55

what does the qrs in the pqrst represent

Back 55

ventricle contraction

Front 56

what does the t in the pqrst represent

Back 56

repolarization

Front 57

what are the factors that predispose an animal to cardiac disease?

Back 57

- hypoxemia

- electrolyte imablance

- increased levels of/sensitivity to catecholamines

- drugs: anesthetics (halothane, xylazine, digitalis)-

- cardiac trauma/myocardial disease

Front 58

how are arrhythmias classified?

Back 58

- tachy vs. brady

- tachy:

- atrial vs. ventricular

Front 59

what is another name for atrial

Back 59

supraventricular

Front 60

How are antiarrhythmic drugs classified?

Back 60

Class 1: a-c

Class 2

Class 3

Class 4

Front 61

List some class 1a antiarrhythmic drugs

Back 61

- quinidine

- procainamide

- quinidine

Front 62

list some class 1b antiarrhythmic drugs

Back 62

- lidocaine

- tocainide

- mexiletine

Front 63

list some class 2 antiarrhythmic drugs

Back 63

- beta-adrenergic blockers:

- propranolol

- atenolol

Front 64

list some class 4 antiarrhythmic drugs

Back 64

calcium channel blockers

- verapamil

- nifedipine

- amlodipine

- diltiazem

Front 65

how are quinidine and procainamide (class 1A antiarrhythmics) administered?

Back 65

oral and injectable

Front 66

what are quinidine and procainamide (class 1a antiarrhythmics) used for?

Back 66

- depress myocardial excitability

- prolong refractory time

- increase conduction times

- antrial and vntricular arrhythmais

* can be used long term

Front 67

what is quinidine used to treat?

Back 67

- atrial and ventricular arrhythmias

Front 68

what are the side effects of quinidine?

Back 68

- anorexia

- vomiting and diarrhea

- weakness

- laminitis

Front 69

where does quinidine come from?

Back 69

cinchona plant

Front 70

What class of antiarrhythmics will we see the most

Back 70

Class 1B

Front 71

Who are class 1 B antiarrhythmics labeled for

Back 71

humans only. all extralabel use

not labeled for use as an antiarrhythmic

Front 72

What do class 1B antiarrhythmics do to treat arrhythmia?

Back 72

stabilize myocardial cell membranes by blocking sodium channels

Front 73

List some class 1B antiarrhythmics

Back 73

- Lidocaine

- Tocainide

- Mexiletine

Front 74

side effects of class 1B antiarrhythmics

Back 74

all are rare!

- drowsiness

- depression

- ataxia

- muscle tremmors

usually dose dependent

cats are more sensitive to systemic use

Front 75

How is lidocaine administered?

Back 75

IV injectable

Front 76

how is tocainide and mexiletine administered

Back 76

oral dosing

Front 77

List the class 2 antiarrhythmics

Back 77

Beta-adrenergic blockers

- Propanolol

- atenolol

- Sotalol

Front 78

What receptors do each of the beta blockers work with

Back 78

Propanolol- non selective B1+ B2

Sotalol (betapace)- non selective B1 + B2

Atenolol- selective B1 only

Front 79

How do class 2 antiarrhythmics work with the heart?

Back 79

reduce automaticity of cardiac condition

block B1\B2 receptors or both

- lower blood pressure

- slow heart rate

- decrease cardiac conduction leading to reduced cardiac output

Front 80

Adverse side effects of Class 2 antiarrhythmics

Back 80

- bradycardia

- hypotension

- aggravation of CHF

- bronchospasm/constriction

- lethargy

- depression

Front 81

which of the beta blockers is the newest and also a potassium channel blocker?

Back 81

Sotalol (betapace)

Front 82

Which beta blocker is best for animals prone to bronchiospasm?

Back 82

atenolol

Front 83

What do class 4 antiarrhythmics do?

Back 83

block calcium channels at cardiac membranes

- depresses contractile mechanism in myocardial and smooth muscle cells

Front 84

What are class4 antiarrhythmics used to treat?

Back 84

- super ventricular tachyarrhythmias

- atrial fibrilation/flutter

- feline hypertrophic cardiomyopathy

Front 85

Who are3 class 5 antiarrhythmics (calcium channel blockers) labeled for use in?

Back 85

humans

extralabel use in animals

Front 86

Name some Class 4 antiarrhythmics

Back 86

diltiazem (cardizem)

amlodipine (norvasc)

Front 87

what is amlodipine (norvasc) used to treat?

Back 87

hypertension associated with renal failure

Front 88

what is diltiazem (cardizem) used to treat?

Back 88

feline hypertrophic cardio myopathy

Front 89

which has more smooth muscle, arteries or veins?

Back 89

arteries

Front 90

what does ACE stand for

Back 90

angiotensin converting enzyme

Front 91

what do vasodilator drugs do?

Back 91

dilate arteries, veins or both

Front 92

why would we want to use a vasodilator? what is the body doing that we need to stop?

Back 92

with heart disease causing a lowered blood pressure, afterload is increased and the heart must work harder.

The kidney tells the body (via the renin angiotensin system) that it needs more blood.

the RAS expands circulating blood volume and causes vasoconstriction

good in the short term, bad in the long term

Front 93

What are the three ways vasiodilators dilate their targets?

Back 93

- directly on the smooth muscle of arteries

- vie blocking sympathetic nervous system stimulation

- prevention of conversion of angiotensin 1- angiotensin 2

Front 94

List the vasodilaor drugs

Back 94

- Hydralazine

- nitroglycerin ointment

- prazocin (minipress)

- ACE inhibitors

Front 95

list the ACE inhibitors

Back 95

- Captopril

- Benazapril

- enalapril (enacard)

Front 96

what does hydralazine do

Back 96

arteriole dilator

used for mitral valve insufficiency

Front 97

what does nitroglcerine ointment do?

Back 97

- venodilator (topical)

improves cardiac output while reducing pulmonary edema

reduces swelling and treats laminitis

Front 98

what does prazocin (minipress) do

Back 98

dilates both veins and arteries

used to treat:

- CHF

- DCM

- systemic/pulmonary edema

Front 99

what do ACE inhibitors do?

Back 99

- prevent the conversion of angiotensin 1 to angiotensin 2

- treat stage B,C,D heart failure

- treat hypertension from congestive renal failure or hypertrophic cardio myopathy

Front 100

side effects of ace inhibitors

Back 100

- hypotension (monitor blood pressure)

- azotemia (worstening of BUN+creatinine)

- vomiting and diarrhea

- hyperkalemia

Front 101

what is it important to do when giving ACE inhibitors

Back 101

monitor blood pressure and kidney levels

Front 102

What are diuretics used for?

Back 102

- to reduce preload via diuresis

- decreases the symptoms of fluid retention

Front 103

List the diuretics

Back 103

- furosemide (salix/lasix)

- spironolactone

Front 104

what does furosemide (salix/lasix) do?

Back 104

- reduces reabsorption of potassium by kidney tubules

- called a loop diuretic (works in the loop of henle)

Front 105

what is it important to do when giving furosemide (salix/lasix)

Back 105

monitor electrolyte levels (potassium) look for ehydration weakness and shockk

Front 106

What are the effects of spironolactone

Back 106

- a potassium sparing diuretic

- blocks aldosterone

- more common in human medicine

Front 107

List the ancillary treatments for heart failure

Back 107

- bronchodilators

- oxygen therapy

- sedation

- asprin

- thoraccocentesis/abdominocentesis

- low sodium diet

Front 108

when are ancillary treatments for heart failure usually used

Back 108

usually for later stages of heart failure

Front 109

What are the three general categories of cardiac drugs?

Back 109

1. inotropes (changes the force of contraction)

2. antiarrhythmics

3. vasodilators

Front 110

who do you have to be careful with when administering lidocaine IV

Back 110

cats

ruminants- especially goats

Front 111

where are beta 1 receptors located

Back 111

in the heart

Front 112

where are beta 2 receptors located

Back 112

in the lungs

stimulation = bronchodilation

Front 113

What are the causes of respiratory disease?

Back 113

- allergy

- aspiration

- infection

- congenital defects

- neoplasia

- parasites

- trauma

- neurologic conditions

Front 114

what factors do you use to determine the treatment method of respiratory disease

Back 114

etiology and what symptoms need support

Front 115

what are the body's respiratory defense mechanisms?

Back 115

- reflexes (coughing, sneezing, bronchioconstriction)

- mucus production (to clear mucociliary)

- inflamation

Front 116

What is the goal of respiratory treatment?

Back 116

- control secretion (decrease production/increase elimination)

- control reflexes (suppression of non productive cough)

- maintain normal airflow through the bronchioles (decrease inflamation and assist ventilation)

Front 117

List the respiratory treatments (8, not including the misc category)

Back 117

- inhalation therapy

- expectorants

- mucolytics

- antitussives (narcotic+ non narcotic)

- bronchodilators

- antihistamines

- decongestants

- corticosteroids

Front 118

What is inhalation therapy?

Back 118

- aerosolization (nebulization) of drugs

- minimizes the amount of drug in the blood

Front 119

how is the efficacy of inhalation therapy determined?

Back 119

- dose of drug

- distribution

- airway size, shape and pattern

- animal's breathing pattern

- airway pathology

- nebulizer vs. meter dose inhaler

Front 120

what is the difference between a nebulizer and a metered dose inhaler

Back 120

- nebulizer is usually in house and effects the lower airway

- metered dose inhaler is at home and effects the upper airway

Front 121

define expectorant

Back 121

liquefies and dilutes viscous secretions (mucus)

Front 122

how are expectorants administered

Back 122

orally

Front 123

when do you use an expectorant

Back 123

used when the animal has a productive cough

Front 124

List some expectorants

Back 124

Guaifenesin (glyceral guaiacolate)

- robitussin

- mucinex

Front 125

when are expectorants (guaifenesin) used in horses

Back 125

during general anesthesia

Front 126

what are expectorants usually combined with?

Back 126

an antitussive

Front 127

define mucolytics

Back 127

crease the viscosity of respiratory secretions- alter the chemical composition of mucus by breaking down the disulfide bonds

Front 128

how are mucolytics administerd

Back 128

via nebulization

Front 129

name a mucolytic

Back 129

acetylcysteine

Front 130

what are antitussives

Back 130

drugs that inhibit or suppress coughing

Front 131

how are antitussives categorized

Back 131

- centrally acting vs. peripherally acting

- narcotic vs. non narcotic

Front 132

what does it mean when an antitussive is centrally acting

Back 132

ct on the cough control center of the brain

Front 133

what does it mean when an antitussive is peripherally acting

Back 133

- depress cough receptors in the airways

- response to irritation in the larynx

- not often used in vet medicine

- ex. honey

Front 134

List the narcotic antitussives

Back 134

- butorphanol tartrate (torbutrol/torbugesic)

- hydrocodone bitatrate

- codeine

Front 135

list the non narcotic antitussives

Back 135

- dextromethorphan (robitussin DM, Dimetapp)

- temaril-P

Front 136

what do you have to be careful with when using non narcotic antitussives

Back 136

most come in a combination with tylenol, find one without!

Front 137

what are the side effects of butorphanol

Back 137

sedation and ataxia

Front 138

what are the side efects of hydrocodone bitatrate

Back 138

constipation, sedation and GI upset

Front 139

what are the side effects of codeine

Back 139

sedation and constipation

Front 140

what is temaril P?

Back 140

a non narcotic antitussive

combination of trimeprazine + prednisolone

anti tussive and antipuritic

Front 141

side effects of temaril-p

Back 141

- sedation

- depression

- hypotension

- minor CNS symptoms

Front 142

what are the three mechanisms that cause bronchoconstriction (decreasing of the size of the lumen of bronchiole)

Back 142

- increased parasympathetic stimulation

- release of histamine

- blockage of beta 2 receptors by drugs

Front 143

define broncho constriction

Back 143

a decrease in the size of the lumen of the bronchioles

Front 144

aht are the four categories of bronchodilators?

Back 144

- cholinergic blockers

- antihistamines

- beta 2 adrenergics

- methylxanthines

Front 145

how do cholinergic blockers prevent bronchioconstriction?

Back 145

block acetylcholine

Front 146

how do beta 2 adrenergics stop bronchioconstriction?

Back 146

- cause relaxation of the smooth muscle

- stabilize mast cells

Front 147

what are the side effects of beta 2 adrenergics

Back 147

hypertension and mild tachycardia

Front 148

list the beta 2 adrenergic drugs

Back 148

- epinepherine (emergencies)

- albuterol and clenbuterol (horses)

- terbutaline (brethine)

- salmeterol (serevent)

Front 149

how do methylxanthines prevent bronchioconstriction

Back 149

- inhibit phosphodiesterase: a bronchioconstricting chemical

Front 150

side effects of methylxanthines

Back 150

- gi tract upset

- ataxia

- cns signs (nervousness + excitability)

Front 151

list the methylxanthine bronchiodilators

Back 151

- theophylline (theo-dur, slo-bid)

- aminophylline

Front 152

How do antihistamines prevent bronchoconstriction?

Back 152

- prevent mast cell degranulation

- block H1 receptors on smooth muscle cells

Front 153

list the antihistamines

Back 153

- diphenhydramine

- clemastine

- hydroxyzine

- cyproheptadine

- doxylamine

Front 154

How can antihistamines be administered?

Back 154

- inhaled

- oral

- injectable

Front 155

What are decongestants?

Back 155

drugs that reduce the swelling of the mucus membranes of the nasal cavity

Front 156

list the decongestants and how they are administered

Back 156

- ephedrine + pseudoephedrine (orally)

- oxymetazoline (nasally)

- phenylephrine (nasally)

Front 157

how are decongestants sometimes used specifically in cats?

Back 157

ocasionally used to treat feline URI

Front 158

What respiratory conditions can corticosteroids be used to treat?

Back 158

allergic respiratory conditions

controls the signs not the cause

Front 159

name some allergic respiratory conditions

Back 159

- equine chronic obstructive pulmonary disease

- feline asthma

- acute respiratory distress syndrome

- allergic and chroic bronchitis

Front 160

list some corticosteroids used for respiratory conditions

Back 160

- prednisolone (Temaril-P)

- prednisolone sodium succinate (solu-delta-cortef)

- dexmethasone (azium)

- triamcinolone (vetalog)

Front 161

list the miscellaneous respiratory drugs

Back 161

- respiratory stimulants (cns)

- yohimbine (antidote for respiratory depression from xylazine)

- naloxone (antidote for respiratory depression from narcotic overdose)

- doxapram hydrochloride/dopram (stimulates respiratory center of cns)

- cromolyn

- montelukast sodium (singular)

- zafirlukast (accolate)

Front 162

Preload

Back 162

- quantity of blood filling chambers during diastole

Front 163

Preload

Back 163

- quantity of blood filling chambers during diastole

Front 164

Afterload

Back 164

arterial resistance the heart must pump agains (worse with arteriole stenosis)