Pharm Test Iii

Front 1

Fluid Therapy
Alterations in the Patient: (5)

Back 1

-Dehydration
-Hypovolemia
-Electrolyte imbalances (Na, K, Cl, Ca)
-Acid-Base Imbalances
-Hypoproteinemia

Front 2

Fluid Therapy
-Therapeutic Goals: (4)

Back 2

-Replace intravascular vol -> increase tissue perfusion
-Replace interstitial vol -> correct dehydration
-Meet Maintenance needs
-Replace ongoing losses

Front 3

To calculate fluids, need to know: (3)

Back 3

-Replacement - %Dehydrated x BW
-Maintenance - 40-60 ml/kg/day; 30 x kg + 70
-Ongoing losses - estimate from clinical observation

Front 4

4 Main categories of fluids:

Back 4

-Crystalloids
-Colloids
-Blood Products
-Parenteral Nutrition

Front 5

4 Main types of Crystalloids:

Back 5

-Replacement
-Maintenance
-Hypertonic
-Dextrose in H20

Front 6

Replacement Crystalloids are said to be similar to what? What % remains in IV space after 1hr

Back 6

Similar solutes to plasma water; 20-25%

Front 7

Replacement Crystalloids have a higer concentration of what ion compaired to maintenance?

Back 7

Na+

Front 8

What are the general tonicities of Replacement and Maintenance Crystalloids?

Back 8

Isotonic

Front 9

3 examples of Acidifying Replacement Crystalloids:

2 examples of Alkalinizing Replacement Crystalloids:

Back 9

-Ringer's
-0.9% saline
-LRS

-Norm-R
-Plasma-Lyte

Front 10

Maintenance Crystalloids are said to be similar to what?
What % remains in IV space after 1hr?

Back 10

similar solutes to ECF
-<10%

Front 11

What are 3 examples of Maintenance Crystalloids:

Back 11

ALL ARE ACIDIFYING:
-2.5% dextrose in 0.45% saline / KCl
-Norm-M w/ 5% dextrose
-Plasma-lyte M w/ 5% dextrose

Front 12

Which Crystalloid fluids have Ca2+

Back 12

-Any w/ LRS
-Plasma-lyte M w/ 5% dextrose

Front 13

Which Crystalloid fluids have Mg2+?

Back 13

Norm-R, Plasma-lyte A, Norm-M, Plasma-lyte M

Front 14

Alkalinizing fluids are associated w/ the presence of more ___, ____,& _____

Back 14

-Acetate
-Lactate,
-Gluconate

Front 15

Which Crystalloids are hypertonic? (2) + (4 additives)

Back 15

-Norm-M w/ 5% dextrose
-Plasma-Lyte M w/ 5% dextrose
***ADDITIVES***
*50% dextrose
*7.5% saline
*NaHCO3
*KCl

Front 16

What concentration of dextrose is isotonic?

Back 16

~5%

Front 17

What contains high MW compounds that stay in the IV space?

Back 17

Colloids

Front 18

What are the 5 listed categories of Colloids?
-what additional category is sometimes included? What are 2 specific examples?

Back 18

-Plasma
-Human Serum Albumin
-Hetastarch
-Dextrans
-Modified Gelatins
**Hemoglobin-based O2 Carrying compounds
-Oxyglobin
-Polyheme

Front 19

4 Examples of Blood Products used in Fluid Therapy?

Back 19

-Red Cells
-Plasma Proteins
-Platelets
-Coagulation Factors

Front 20

What are the 3 categories of Parenteral Nutrition & what % of basal metabolic need does each supply?

Back 20

-Supplement - amino acids/ electrolytes; up to 25% of basal metabolic needs
-PPN - 50%
-TPN - 100%

Front 21

What category of drug affects electrolyte & fluid imbalance?

Back 21

Mineralocorticoids

Front 22

What category of drug affects CHO metabolism (as opposed to its counterpart affecting electrolyte & fluid imbalance):

Back 22

Glucocorticoids

Front 23

Physiological Actions of Corticosteroids: (6)

Back 23

-Fluid Homeostasis - mineralocorticoids
-Increase Gluconeogenesis
-Decrease Protein Synth
-Increase Lipolysis w/ Release of Glycerol and free FAs
-Maintain microcirculation and normal vascular permeability
-Development of pulmonary surfactant in near-term fetus

Front 24

Indications for adminestration of GCCs: (2 main categories; 5 ex)

Back 24

1)Endocrine - Replacement Therapy (Addison's)
-Avg production 1mg/kg/day
2) Non-endocrine
-Shock & therapy - controversial
-Antiinflammatory & antiallergic indications
-Immunosuppressive therapy
*Immuner mediated DZs
-Chronic pallative therapy

Front 25

3 Indications not accepted for use of GCCs:

Back 25

-Laminitis
-Snake Bite
-Lack of Appetite

Front 26

Which mechanism is described as consisting of a cytosolic glucocorticoid receptor (cGCR) that translocates to the nucleus?
-3 major actions?

Back 26

Genomic mechanisms:
-Inhibits proinflamm transcription factors (NF-Kappa, B, STAT)
-Suppresses transcription of all inflamm genes (IL-2 & IL-1)
-Induces Transcription of immunosuppressive genes (Lipocortin 1)
* Inhibits AA Metabolism

Front 27

What are the Non-Genomic effects assoc w/ membrane-bound cGCRs?

Back 27

Non-specific effects caused by interactions w/ cellular membs

Front 28

3 Adverse Effects of GCC Therapy:

Back 28

-HPAA Suppression -> this is why we do EOD Tx, tapering, Short-term usage
-Think skin, potbelly, cushingoid appearance, fluid retention, wt gain, mm wasting, Na+ Retention, K+ Loss
-Can induce Parturition in last trimester, potential for congenital abnormailties

Front 29

What injection site is contraindicated b/c of fracture/infection?

Back 29

Joint Injection

Front 30

What are contraindications for all routes of admin:

Back 30

-Corneal ulcers
-GI ulcers
-Hyperadrenocorticism
-Infections (esp. w/ immunosuppressive doses)
--Uncontrolled bacterial, viral systemic mycotic, TB

Front 31

Which Corticosteroids have Mineralocorticoid effects (5)? What is the general duration of action?

Back 31

-Hydrocortisone (++)
-Cortisone (++)
-Prednisone
-Prednisolone
-Methylprednisolone
<24h

Front 32

Which corticosteroids have Alternate-day therapy possible?

Back 32

Mineralocorticoids (minus Hydrocortisone)
So:
-Cortisone
-Prednisone
-Prednisolone
-Methylprednisolone

Front 33

Which corticosteroid has an intermediate duration (24-48hr), and moderate HPAA Suppression?

Back 33

Triamcinolone

Front 34

Which corticosteriods have ultimate HPAA Suppression? (3)
-What is their duration of action?

Back 34

(drugs ending in "-asone")
-Flumethasone
-Dexamethasone
-Betamethasone
-Long acting >48h

Front 35

What are the 9 classical glucocorticoids and 3 new GCCs we are responsible for?

Back 35

-Hydrocortisone
-Cortisone
-Prednisone
-Prednisolone
-Methylprednisolone
-Triamclnolone
-Flumethasone
-Dexamethasone
-Betamethasone
*****NEW*****
*Budenoside - oral for BID
*Ciclesonide - uncommon
*Fluticasone - nasal spray

Front 36

Dose Respone vs therapeutic application with GCCs: (3)

Back 36

-Low - Replacement/low maintenance/ anti-inflamm
-High - Immunosuppressive
-Pulse/Shock Therapy - Immunosuppressive or inital lymphocytolytic (cancer therapy)

Front 37

Parenteral Preparations
-What GCCs are used in ER situations for shock and anaphylaxis? What is their onset and duration?

Back 37

Rapid Onset & Short duration
-Any GCC Sodium Succinate, Sodium Phosphate

Front 38

Parenteral Preparations
-Which GCCs are used In ER situations w/ Rapid Onset and Intermediate duration desired?

Back 38

-Dexamethasone SP
-or in propylene glycol

Front 39

Parenteral Preparations
-Which GCCS are used for Skin DZ, Arthritis, Topical & Intralesional TX? What is their onset/duration?

Back 39

-Slow Onset, Long Duration
-Triamcinolone
-Methylprednisolone acetate
or - Flumethasone

Front 40

Oral Preparations
-Which GCCs are used to TX acute and chronic conditions (alternate day therapy), replacement therapy?

Back 40

-Hydrocortisone
-Cortisone
-Prednisone
-Prednisolone
-Methylprednisone

Front 41

What is most common GCC used in Cattle? Indications?

Back 41

Dexamethasone
-anti-inflamm, induce abortion/parturition

Front 42

most common GCCs used in Cats?

Back 42

Methyl predisolone
Prednisolone

Front 43

most common GCCs used in Dogs?

Back 43

Prednisone

Front 44

Most common GCCs used in horses? Indications?

Back 44

-Dexamethasone
**used as anti-inflamm jt injections***********
**Methylprednisolone
**Triamcinolone

Front 45

Immunosuppresants
-Alteration in the patient:
-Ex (4)

Back 45

Immune mediated dz: inappropriate/overzealous immune response
-Ex. IMHA, IMT, Lupus, Pemphigus

Front 46

What r the 10 Immunosuppresive Drugs we covered?

Back 46

-Glucocorticoids
-Cyclosporine
-Tacrolimus
-Cyclophosphamide
-Chlorambucil
-Azathioprine
-Mycophenolate
-Dapsone
-Danazole
-Gold

Front 47

MOA of Cyclosporine?

ADE: (2)

Back 47

Calcineurin Inhibitor
=No NFAT=No cytokines such as IL-2 so inhibits normal Tcell signal transduction
ADE: GI effects, Gingival Hypersensitivity

Front 48

MOA of Tacrolimus

Back 48

Calcineurin Inhibitor
=No NFAT=No cytokines such as IL-2 so inhibits normal Tcell signal transduction

Front 49

MOA of cyclophosphamide & Chlorambucil?
-ADEs: (3)

Back 49

Cytotoxic & anti-proliferative
ADEs:
-Myelosuppression
-GI Effects
-poss teratogen

Front 50

MOA of Azathioprine & Mycophenolate?
ADEs: (2)

Back 50

Purine Antagonist to Decrease Lymphocyte Proliferation
ADEs:
-myelosuppression
-GI Effects

Front 51

Dapsone ADE:

Back 51

myelosuppression

Front 52

Gold ADE:

Back 52

Nephrotoxicity

Front 53

Glucocorticoids MOA:
ADE:

Back 53

affect neutrophil trafficiking, decrease macrophage fxn, decrease lymphocyte activity esp TCELLS
-ADEs:
-PU/PD, induction of parturition/abortion in 3rd trimester, hyperadrenocorticism, congenital anomalies

Front 54

What 7 Items are used as Immunostimulant Drugs?

Back 54

-Hyperimmune serum
-Other Abs
-Lysine
-CSFs
-Interferons
-Levamisole

Front 55

Primary toxicities of Antineoplastic Drugs: (3)

Back 55

-Bone marrow Suppression
-GI disturbances
-Alopecia

Front 56

What Antineoplastics are known to cause Extravasation (3)

Back 56

-Doxorubicin
-Vincristine
-Vinblastine

Front 57

Which 2 Antineoplastics are assoc w/ MILD bonemarrow suppression:

Back 57

-L-asparginase
-Vincristine

Front 58

Which 2 Antineoplastics are assoc w/ SEVER bone marrow suppression?

Back 58

-Carmustine
-Lomustine

Front 59

3 Acute Toxicities w/ Antineoplastics?

Back 59

-GI
-Allergic Rxns
-Anaphylaxis

Front 60

Delayed toxicities w/ Antineoplastics?

Back 60

-Myelosuppression
-Tissue Damage
*post extravasation
*alopecia

Front 61

6 reasons for Thearpeutic Failure when using Antineoplastics?

Back 61

-resistance
-incorrect dose
-wrong drug
-slow growing tumor
-inability to reach all cancer cells
-patient toxicity

Front 62

Specific Organ Toxicities w/ Antineoplastics:
--Renal:
--Cardiac:
--CNS:

Back 62

-Renal: Cisplatin
-Cardiac: Doxorubicin
-CNS: 5-fluorouracil (rare)

Front 63

7 reasons for resistance w/ antineoplastic therapeutic failure:

Back 63

-altered ADME
-Tumor blood flow
-low drug concentration
-drug inactivation
-changes in target receptor
-repair of drug induced damage
-increased drug efflux

Front 64

Which 2 Antineoplastics are considered Nitrogen Mustards? What is their MOA? ADE?

Back 64

-Cyclophosphamide
-Chlorambucil
*Non-cell cycle specific,
ADEs
-bone marrow suppression
-sterile hemorrhagic cystitis possible w/ cyclo

Front 65

Which 2 Antineoplastics are considered Nitrosourease alkylating agents? MOAs? ADE?

Back 65

-Lomustine
-Carmustine
*Non-cell cycle specific, CCNU (Lomustine) BCNU (Carmustine)
ADE: Sever bone marrow suppression

Front 66

Which 2 antineoplastics are considered Platinum coordination complexes/alkylating agents?
MOA?
ADE:

Back 66

-Ciplatin
-Carboplatin
*Non-cell cycle specific
ADE:
NEPROTOXIC , DONT use IN CATS (Ciplatin)
....Carboplatin is ok

Front 67

What are the 3 subclasses of Alkylating Agents as Antineoplastics?

Back 67

-Nitrogen Mustards
-Nitrosoureas
-Platinum Coordination Complexes

Front 68

What are the 6 Antineoplastic Alkylating Agents?

Back 68

-Cyclophosphamide
-Chlorambucil
_Lomustine
_Carmustine
-Cisplatin
-Carboplatin

Front 69

What are the 2 sub classes of antineoplastic anti-metabolites:

Back 69

-Folic Acid Analogs
-Pyrimidine Analogs

Front 70

Which antineoplastic is considered and anti-metabolite, floic Acid Analog?
MOA?
ADE:

Back 70

Methotrexate
**S PHASE specific; inhibits dihydrofolate reductase to inhib DNA synth, must be actively transported
ADE:
-Bone marrow suppression
-May precipitate in renal tubules at high doses

Front 71

What 2 antineoplastics are considered anti-metabolite Pyrimidine Analogs?
-MoA
-ADE:

Back 71

-Cytarabine
-5-fluorouracil

**S-phase specific, Inhibit DNA SYNTHESIS (Cytarabine)
inhib thymidilate synth & alter DNA & RNA synthesis ( 5-fluorouracil)
ADEs:
-bone marrow subbression (cytarabine)
-CNS toxicity in CATS (5-fluorouracil)

Front 72

What are the 3 sub catagories of Natural Products within Antineoplastic category?

Back 72

-Vinca Alkaloids
-Antibiotics
-Enzymes

Front 73

What are the 2 Antineoplastic Natural Products known as Vinca Alkaloids?
MoA?
ADE?

Back 73

-Vincristine
-Vinblastine

*M-Phase specific, inhib microtubule fxn
ADE:
-Extravasation, bone marrow suppression (higher with vinblastine), peripheral neuropathy rarely seen with Vincristine

Front 74

what is the lone anineoplastic natural product antibiotic?
-MOA:
ADE:

Back 74

-Doxorubicin

*Non cell cycle specific, ingibits topoisomerase fxn to prevent DNA relegation

ADE:
-dose related cardiotoxicity, extravasation

Front 75

What is the Antineoplastic natural product enzyme?
-MOA:
-ADE:

Back 75

-L-asparaginine

*G1 PHASE specific, catalyze hydrolysis of asparagine
-ADE
--Anaphylaxis
--mild bone marrow suppression

Front 76

What is the Cyclooxygenase Inhibitor Antineoplasitc?
MOA
ADE:

Back 76

Piroxicam
-non-cell cycle specific
ADE:
Apoptosis
GI Ulceration,
Subclinical renal papillar necrosis

Front 77

Anti-nausea, Anti-emetic GI Drugs (5)

Back 77

-Diphenydramine
-Acepromazine
-Maropitant
-Ondansetron
-Metoclopramide

Front 78

GI Drugs That increase GI motility? (5)

Back 78

-Metoclopramide
-Cisapride
-Bethanechol
-Lidocaine
-Domperidone

Front 79

GI Drugs, Acid Suppressants: (5)

Back 79

-Magnesium Hydroxide
-Cimetidine
-Ramitidine
-Famotidine
-Omeprazole

Front 80

2 GI Protective Drugs?

Back 80

-Misoprostol
-Sucralfate

Front 81

2 Drugs that Decrease GI Motility?

Back 81

-Atropine
-Glycopyrrolate

Front 82

2 Antidiarrheals?

Back 82

-Loperamide
-Diphenoxylate (contains atropine)

Front 83

What are the 6 Laxatives & Cathartics?

Back 83

-Wheat bran
-Mineral oil
-stimulant laxative (Bisacodyl
-Magnesium Sulfate
-Docusate

Front 84

What are the 3 GI drugs used for Appetite Stim?

Back 84

-BZDs
-Cyproheptadine
-Mirtazapine

Front 85

What are the 4 GI drugs used as EMETICS?

Back 85

-Apomorphine
-Xylazine
-3%H202
-Salt

Front 86

What GI drug is best known for Blocking HISTAMINE-1 receptors?

Back 86

Diphenydramine (phenothyazine)

Front 87

Which GI drug blocks D2 Receptors, is an alpha1 antagonist, and a muscarinic antagonist?

Back 87

Acepromazine

Front 88

What GI drug inhibits NK-1 receptoer in the vomiting center

Back 88

maropitant

Front 89

What GI drug is strictly a 5HT3 recepter antagonist?

Back 89

Ondansetron