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61 Cards in this Set
- Front
- Back
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amphotericin B facts (MOA, bioavailability)
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-produced by Streptomyces
-very effective, very toxic -fungicidal: causes altered permeability in ion channels, cell becomes acidified. -not orally available |
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amphotericin B spectrum, adverse events
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everything except dermatophyte
-esp good for aspergillus -reversible nephrotoxicity (80% patients, renal artery constriction and tubular permeability) -anaphylactoid reaction -thrombophlebitis (use catheter) |
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imidazole MOA, spectrum
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-Inhibits sterol synthesis (lag time), channel permeability
-variable bioavailabilities (better with gastric acid - give w/ food) -broad spectrum, no IV preps |
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imidazole adverse effects
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gastrointestinal
-drug interactions (inhibits enzymes and competes for P-glycoprotein) |
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griseofulvin origin, MOA, spectrum
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produced by Penicillium
-inhibits tubules for fungal mitosis -treats dermatophyte |
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griseofulvin availability, distribution, adverse effects
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ultra-microsize best for oral
-concentrates in keratin (lag time until growth) -potent inducer of hepatic metabolizing enzymes -teratogenic, allergic rxns in cats |
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allylamines
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-Tolnafate
-inhibits fungal cell wall -treats dermatophyte, aspergillus, sporothrix |
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iodides
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-treatment of choice for sporothrix
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2 antifungals that act synergistically
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amphotericin B and imidazoles
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3 methods of vasoconstriction during heart failure
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adrenal releases catecholamines
-neuronal vasoconstriction -juxtaglomerular cells release renin -- angiotensin II |
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aldosterone
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-steroid that causes reabsorbtion of sodium and secretion of potassium in distal tubules
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mechanism of increased after-load
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vasoconstriction, increased peripheral resistance
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mechanism of increased pre-load
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aldosterone
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mannitol uses
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treatment of intra-cellular swelling
-emergency treatment of glaucoma, cerebro-spinal swelling -contraindicated in ECF increases (pulmonary edema) |
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carbonic anhydrase inhibitors MOA, uses
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inhibit CA in proximal tubule
-kidney cannot reabsorb bicarb -causes loss of sodium and bicarb, retention of H+ -may cause metabolic acidosis -used for glaucoma |
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acetazolamide
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reversible carbonic anhydrase inhibitor
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carbonic anhydrase adverse events
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hepatic encephalopathy (increased urinary ammonia reabsorbed)
-hypothyroidism |
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sodium wasting drugs decrease pre/after load?
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pre-load
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loop diuretic MOA
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blocks kidney from reabsorbing electrolytes in ascending loop
-most likely to cause dehydration -some sodium (but not K+) reabsorbed in distal tubule -need good renal blood flow (dont use with NSAIDs) |
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furosemide adverse effects, drug interactions, major use
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dehydration, hypochloremic alkalosis
-don't use with digoxin, NSAIDs -synergism with thiazides -use for pulmonary edema, cardiac disease, renal disease, hypercalcemia |
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thiazide diuretic MOA, side effects
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inhibits reabsorption of Na, Cl in distal tubule
-wide safety margin -may need to supplement K+ |
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thiazide use and contraindications
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use for early CHF
-contraindicated in hypercalcemia, renal disease, diabetes mellitus |
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spironolactone (aldosterone antagonist) MOA
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-competitive antagonist
-causes sodium loss, K+ retention -active metabolite has longer half-life -enterohepatic circulation |
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spironolactone use
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CHF, liver disease
-use in combo with loop diuretic or thiazide -cardio-protectant in early CHF |
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3 potassium-sparing diuretics
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triamterene
-amiloride -spironolactone |
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pre-load vs after-load
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pre-load = venous return (emergency tmt)
after-load = arteries (long-term tmt) |
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cGMP causes contraction/relaxation?
cAMP? |
cGMP causes contraction
cAMP causes relaxation |
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hydralazine
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arterial vasodilator
-positive inotrope -effect is longer than half-life -use for CHF (decreases after-load) |
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calcium-channel blocker
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arterial vasodilator
amlodipinde used for feline hypertension, 2nd choice in dogs |
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2 types of calcium channels
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T (transient) - phase 4
L (long) - phase 0 |
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ACE inhibitors
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impacts aldosterone, angiotensin, bradykinin, ADH (vasopressin)
-decreases pre/after-load, positive inotrope -most are prodrugs -tissue ACE must be saturated |
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Enalapril, Benazepril
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ACE inhibitors
Enalapril for dogs, Benazepril for cats |
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ACE inhibitors contra-indications
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severe cardiac disease (kidneys can't constrict efferents, heart can't keep up, so GFR decreases - positive inotropes may help)
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ACE inhibitor use
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CHF, hypertension (helps kidneys), proteinuria
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organic nitrates MOA
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nitric oxide -- cGMP -- venous dilation
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nitroglycerin effects
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low dose - venous
high dose - also arteries -emergency venodilation |
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phases that calcium effects
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pace-maker: 0 and 4
non-pacemaker: 0 and 2 |
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Class I (Na+ blockers)
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block sodium channels
-phase 0: decreased upswing, velocity, prolonged RP, increased threshold |
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Class I (K+ blockers)
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-prolonged refractory period (RP)
-decrease of slope of phase 4 |
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quinidine effects and uses
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class I sodium blocker
-addition anti-vagal effect (paradoxical increased heart rate) -used for atrial arrhythmias (A-fib) |
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quinidine adverse effects/drug interactions
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-Don't use with digoxin (competition)
-paradoxical acceleration -GI upset -alpha-adrenergic blockade |
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procainamide MOA
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class IA
-targets open sodium channels (some K+ block by metabolite) -no anti-vagal effect -better for ventricular arrhythmias -less K+ block in dogs b/c acetylation deficiency (use higher dose) |
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procainamide uses and side effects
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GI upset, hypotension
-use for ventricular arrhythmias -can use IV, switch to oral |
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Lidocaine MOA
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Class IB
-targets open and inactive sodium channels (more prevalent in diseased, rapidly beating tissues) -causes prolonged RP -great for ventricular tachycardia |
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lidocaine preps, interactions
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-mexiletine is oral prep
-IV bolus is dangerous -direct chemical interaction with other drugs |
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lidocaine side effects
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-myocardial depression (cats more)
-contraindicated with heart block -IV bolus can cause seizures (dogs) |
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beta-blockers MOA, effects
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blocks calcium and K+
-negative chronotrope, inotrope -cardioprotection in early to middle CHF (outweighs neg. inotrope) |
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atenolol
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beta blocker used for hypertrophic cardiomyopathy
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Carvedilol
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beta-blocker
-also has some alpha blockade (reduces after-load) |
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beta blocker metabolism, clearance, side effects
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"flow limted" hepatic metabolism
-many different metabolites, isomers, affinities -difficult to predict response -bradycardia, decompensation in patients with low cardiac reserve |
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beta blocker uses
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negative chronotrope - atrial arrhythmias
-hyperthyroidism in cats -cardioprotective |
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Class IV - calcium channel blockers MOA
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negative chrono, inotrope
-targets slow calcium channels |
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Diltiazem metabolism, availability, side effects
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class IV (Calcium channel blocker)
-hepatic metabolism (acetylation) -variable availabilities -side effects same as B-blocker (hypotension, bradycardia) -inhibits metabolizing enzymes |
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digoxin effects
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negative chronotrope
-increases vagal tone (risk for A-fib), decreases symp. tone -hyperpolarize, increase RP |
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atropine effects
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-positive chronotrope
-short term tmt of bradycardias |
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digoxin targets
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-inhibits Na+/K+ pumps - direct (positive inotrope)
-vago-mimetic, sympatho-lytic - indirect (negative chronotrope) |
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digoxin use, preps, interactions
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-narrow therapeutic range
-renally excreted -other drugs cause increased conc. -treats A-fib |
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phosphodiesterase inhibitor effects
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Pimobendan
-increase myocardial calcium (positive inotrope) -cardioprotectant -peripheral vasodilation (decreases pre and afterload) -hepatic metabolite more active -use for CHF |
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dopamine
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used for diuresis (increases CO and dilate renal ateries) - low doses to prevent NE release
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dobutamine
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no release of NE, but also no renal dilation
-more effective inotrope -less arrhythmogenic -short term tmt for CHF |
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epinephrine
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most potent vesopressor
-positive inotrope, chronotrope -increase in cardiac oxygen demand |
