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140 Cards in this Set
- Front
- Back
- 3rd side (hint)
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4 Species that have a poorly developed emetic center
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Horses
Ruminants Rodents Rabbits |
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These hormones can act on the CRTZ to trigger the Emetic Pathway
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Dopamine D2
Serotonin 5-HT Histamine H1 A-2 Adredergic |
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What percentage of the Stomach contents are emptied with emesis?
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40-60%
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Name 3 peripherally-acting emetics
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Salt water (unreliable)
Hydrogen peroxide orally Syrup of ipecac (emetine) |
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What's the problem with syrup of ipecac?
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If they don't vomit, you have to get that out, too. Emetine is nephro and cardiotoxic.
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Name 2 Centrally-acting emetics
and how they work. |
Apomorphine (dopamine agonist - works on the CRTZ)
Xylazine (a-2 agonist - works on the CRTZ) |
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What's something you need to know about Apomorphine vs. Xylazine?
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Apomorphine won't work in cats, but xylazine will. Also, Apomorphine at high doses will act as a CNS depressant and shouldn't be given repeatedly if emesis fails. Xylazine can cause hypotension, respiratory depression and cardiac arrythmias, but can be reversed.
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Contraindications of Anti-emetics
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Epilepsy
GI Infections GI Obstructions Systemic Hypotension |
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Name classes of Anti-emetic agents
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Anti-dopaminergic
Seratonin Antagonists NK-1 receptor Antagonists Anti-histamine Agents (H1 antagonists) |
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Name the Anti-dopaminergic Agents
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Phenothiazines
Metaclopramide |
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Phenothiazine specifics
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-D2 at CRTZ AND acts at emetic center
-Side effects include: hypotension, sedation, and extrapyramidal signs. |
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Metaclopramide specifics
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-D2 at CRTZ and seratonin (5HT3) antagonist
-Peripheral Cholinergic effect Side effects: Increased GI motility, depression, aggression, hyperactivity, seizures USE SPECIFICALLY FOR: |
Metabolic disease
Acid-base imbalances Vomiting due to delayed gastric emptying Gastroesophageal reflux Post-op ileus |
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Name the Seratonin antagonists
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Ondansetron
Dolasetron Metoclopramide Cisapride Work on: |
Vagal nerve and Gut
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Ondasetron/Dolasetron specifics
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-S3 receptor in CRTZ (ond)
-5HT receptor (Dol) -$$$ -No extrapyramidal effects -Great for pancreatitis or parvo |
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Cerenia specifics
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-Acts on NK-1 receptors found in emetic center, CRTZ, Intestinal epithelium
-Blocks Substance P -Rapid onset -No side effects -dose OID |
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Antihistamine Specifics
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-Benadryl, meclizine, Promethazine
-Sedation |
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Name the H2 Receptor blockers and what they do
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Famotidine
Ranitidine Cimetidine Nizatidine |
They reversibly inhibit Histamine action in the GI, decreasing Proton pump activity, thereby reducing the release of H+ ions.
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Potency of H2 Receptor Blockers
And Primary uses |
Famotidine>Ranitidine>Cimetidine
Cimetidine inhibits P450, and may slow metabolism of some drugs. |
GI and duodenal ulcers
Gastritis Gastric erosions |
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Omeprazole specifics
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-Dose OID
-more potent than H2 Blockers -inactive at neutral pH -$$$ - Irreversibly binds to proton pumps |
-use with MCT
Gastrinoma Gastroduodenal ulcers gastric erosions gastric acid unresponsive to H2s FDA approved in horses |
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Antacid specifics
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Antacids including:
Sodium Bicarbonate Calcium carbonate Magnesium Hydroxide Aluminum Hydroxide |
- Increases pH of GI lumen
- Al stimulates mucosal defenses with pepsin and PG |
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Sucralfate specifics
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Stimulates mucosal defenses
Protects against ulcers by making a gel over potential ulcer areas |
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Misoprostol specifics
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Use with:
Ulcers from NSAIDs May cause abortions |
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Primary Ulcer treatment plan
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Famotidine
Famotidine + Sucralfate Omeprazole if unresponsive (or ranitidine in larger animals) |
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Anti-ulcer drugs
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Antacids
Misoprostol H2 Antagonists |
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Name the Prokinetic drugs including Benzamides and others
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Metaclopramide
Cisapride Domperidone Erythromycin Lidocaine Ranitidine |
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Cisapride specifics
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Increases motility
Good for dogs, cats, horses CNS effects Can cause fatal arrhythmias when combined with -conazoles. More potent than metoclopramide |
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Erythromycin specifics
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motilin antagonist
Stomach and SI motility |
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Ranitidine Specifics
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Preferred in Large animal
Increases ACH release Good for increasing GI motility |
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Cisapride Uses and contraindications
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Uses:
Chronic constipation, Post-op ileus, esophageal reflux, delayed gastric emptying |
Contraindications:
GI obstruction Cardiac drug interactions |
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Drugs affecting the GI
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Opioids
-paregoric -diphenoxalate -Loperamide Bismuth Subsalicylate Sulfasalzine Antimicrobials Glucocorticoids Clonicine NSAIDs |
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Opioids GI specific effects
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Uses:
-bind to mu and delta receptors -prolong transit -Inhibit secretion -stimulate reabsorption Contraindications: |
Contraindications:
-GI infections -Head injuries -Respiratory disease -Hepatic disease -Small dogs -Collies |
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Bismuth Subsalicylate GI Specific effects
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Antibacterial (helicobacter)
Turns stool black Toxicosis in cats Binds toxins |
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What drugs can cause an imbalance between absorption and secretion?
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Opioids (diphenoxalate, loperamide)
Bismuth Sulfasalazine antimicrobials |
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Sulfasalazine mechanism/use
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5-Amino salicylic adic inhibits leukotrienes
LI inflammation |
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Name two GI drugs to avoid in cats
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Bismuth
Sulfasalazine |
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Bismuth Subslicylate mechanism/use
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metabolized to bismuth/salicylate
bismuth binds toxins, salicylate blocks PG |
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GI Stimulants
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Phenolphthalein and bisacodyl
Castor Oil |
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Osmotic Agents for GI stimulation
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Mg
Na Salts PEG Sugar alcohols Lactulose Synthetic disaccharides |
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Bulk forming Agents for GI stimulation
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bran, whole grains, psyllium
linseed, wheat bran, pumpkin |
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Lubricating/surface acting agents for GI stimulation
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Mineral oil
Docusates |
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What drugs can typically cause interactions with Anti-epileptics?
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Chloramphenicol
Metoclopramide Enrofloxacin Pen G |
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Phenobarbital mechanism/metabolism
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Stabilizes the post-synaptic neurons by increasing Cl- conductance and decreaseing Ca+2 influx into cell
Potentiates GABA |
Liver - induces some drugs including itself
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Phenobarbital specifics
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Well absorbed
Widely distributed Slow into CNS |
Test trough at
14-21 d 45 90 180 360 |
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Potassium Bromide mechanism/metabolism
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Stabilizes the neuronal cell membranes via hyperpolarization
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Kidney
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KBr Specifics
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Only contraindicated in renal failure
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Monitor at 3 mos, then yearly
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Diazepam/ Primidone (mylepsin) mechanism/metabolism
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Increases the action of GABA on Nerve
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Liver
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Diazepam specifics
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THE drug for status epilepticus
Rapid CNS penetration Tolerance develops in dogs |
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Drugs to avoid in animals
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vigabatrin
lamotrigine tiagabine oxcarbaxepine topiramate phenytoin carbamazepine valproate ethosuximide |
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Name the second generation Anti-epileptic drugs and their mechanism of action
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Felbamate (Felbatol)
Gabapentin (Neurontin) Zonisamide (Zonegran) Levetiracetam (Keppra) |
Felbamate -
Gabapentin - increases [GABA]; inhibits Na and Ca channels Zonisamide - multi-faceted Levetiracetam - binds to synaptic vesicle |
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Felbamate specifics
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70% eliminated in urine
Does not cause sedation May cause liver dysfunction |
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Gabapentin specifics
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70% urine elimination
No induction of hepatic enzymes |
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Zonisamide specifics
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Eliminated by liver
Very safe |
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Levetiracetam specifics
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100% bioavailability
Mostly urine elimination Extremely safe in dogs May develop tolerance Good for cats |
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In case of Status Epilepticus...
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Give Diazepam IV
or... |
pentobarb, phenobarb
Propofol Etomidate Levetiracetam |
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Name the benzodiazepines
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diazepam
lorazepam midazolam Alprazolam oxazepam Name the reversal |
flumazenil
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Name the phenothiazines
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Acepromazine
Chlorpromazine |
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Name the Butyrophenones
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azaperone
Droperidol |
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Name the A-2 Agonists
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xylazine
Detomidine Dexmedetomidine Romifidine Name the reversals |
yohimbine
Atipamazole Tolazoline |
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Benzodiazepines mechanism
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promote binding of GABA to the GABA receptors leading to hyperpolarization of the post-synaptic membrane
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Mechanism of Phenothiazines
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Inhibits dopaminergic receptors
Antagonist of seratonin receptors Blocks A-1 receptors peripherally |
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Phenothiazine Specifics
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May cause ileus.
May cause hypotension Reflex tachycardia Sinus bradycardia and 2nd degree heart block Extrapyramidal signs Sedation Hyperglycemia Antiemetic Decreased hematocrit (sequestration of blood in spleen) Hyper/hypothermia No analgesia |
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Butyrophenones
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Azaperone
Droperidol Mechanism: |
Antagonist of:
dopamine receptors seratonin receptors A-1 receptors Also, antihistaminic effect. |
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Butyrophenones effects
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Mild respiratory depression
CV depression Hypotension Reflex tachycardia Extrapyramidal signs Neuroleptic Dysphoria Antithrobotic effect No Analesia Contraindications |
painful
Hypotensive Cardiac arrythmias Coma Dobermans |
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A-2a Receptors in the ___ ____ are the primary site of action of A-2 agonists
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Locus Coeruleus
What's the mechanism for that? |
Gets into the post-synapse and prevents Influx of Ca+2
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Peak sedation with an A-2 is at ____ minutes
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~5 IV
~12 IM |
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Phases of CV effects by A-2s are
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1. Hypertension/Bradycardia
2. Hypotension/bradycardia Those further breakdown into: |
1. Peripheral vasoconstriction>increased BP>Reflex bradycardia
2. Vasodilation>Hypotension>decreased Cardiac output |
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A-2 specifics
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Cows
require 10% of horse dose Brahman-influenced Highly sensitive Sheep May activate PIMs |
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Name the 4 mechanisms of Heart failure
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Systolic - Pump
Diastolic - Filling Volume Overload - Preload Pressure Overload - Afterload |
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Name 5 types of Systolic Failure
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DCM
Muscular dystrophy Taurine Deficiency Myocarditis Arrhythmias |
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Name 4 types of Diastolic Failure
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HCM
Pericardial effusion Pericarditis Lymphosarcoma |
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Name the 2 types of Volume overload
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Chronic valvular disease
-L: Mitral, aortic -R: Pulmonary, tricuspid AV Shunting |
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Name the 2 types of Pressure Overload
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Left ventrical
-systemic arterial hypertension -Aortic stenosis Right ventrical -Pulmonary hypertension -Pulmonic stenosis |
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Explain the pathophysiology of Cardiohypertrophy
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myocytes degnerate>low contractility>low stroke volume>triggers RAAS>high afterload>overworked muscles>huge muscles
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Explain the pathophysiology of Cardiodilation
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myocytes degnerate>low contractility>low stroke volume>triggers RAAS>high preload>Stretched muscles>weak muscles
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These drugs are used to relieve edema/effusion/preload
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Diuretics and aldosterone antagonists
ACE Inhibitors and ARBs Venodilators |
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These drugs are used to decrease cardiac workload/afterload
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ARBs
Ca channel blockers Arteriolar dilators Pulmonary hypertension reducers |
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These drugs improve short-term contractility
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catecholamines IV
Phosphodiesterase inhibitors IV |
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These drugs improve long-term contractility
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Digitalis glycosides
Oral phosphodiesterase inhibitors |
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These drugs improve diastolic filling by reducing HR
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Beta blockers
Calcium channel blockers |
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These drugs improve diastolic filling by improving early relaxation
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Calcium channel blockers
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Name the loop diuretics
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Furosemide
Ethacrynic acid |
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Name the Thiazide diuretics
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hydrochlorothiazide
chlorothiazide |
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Name the potassium sparing diuretics
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Spironolactone
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Name the ACE Inhibitors
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enalapril
captopril benazepril lisinopril ramipril And what was it that those do? |
block production of AT-2
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3 facts about Enalapril
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decreases filling pressure;increases output
<24hr duration in dogs Renal elimination |
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3 facts about Captopril
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have to administer TID
Bioavailability 4>3 with food |
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2 facts about lisinopril
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Not affected by feeding
lasts longer than captopril |
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Possible side effects of ACEIs
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vomiting
diarrhea hyperkalemia azotemia |
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How do Digitalis Glycosides work?
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increase myocardial contraction
increase vagal tone Increase diuresis (blocks renin) decreases SNS tone NARROW therapeutic range |
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Where would you NEVER use Digitalis Glycosides?
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Sinus AV node
HCM Diastolic dysfunction |
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4 facts about Digoxin
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BID in dogs; SID in cats
Base dose on lean mass HIGHLY VARIABLE Renal elimination Toxicity is common (cats) - GI, arrhythmias |
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4 facts about Digitoxin
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TID dosing
Hepatic elimination 95% Oral availability 95% bound to albumin |
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4 facts about hydralazine
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arteriolar dilator
significant 1st pass hepatic metabolism Alternative to ACEI for mitral regurg. |
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5 facts about nitroglycerin
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venodilator
variable dose takes effect in 15 minutes Pre-load reducer improves circulation, reduces O2 demand |
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4 facts about Nitroprusside
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potent, balanced vasodilator
Afterload AND preload reducer Fast acting/shortlived - CRI that shit start @ low dose work up DOC for emergency arterial BP reduction |
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4 facts about Prazosin
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A-1 receptor blocker
artery/venodilator Tolerance Use when hydralazine prohibited |
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What do positive inotropes do?
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Increase contractility
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4 facts about Inamrinone
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+inotrope
balaced vasodilation (low preload, afterload) SHORT TERM TREATMENT OF SEVERE HF OR MYOCARDIAL DEPRESSION WHEN CONVENTIONAL THERAPY FAILS Hypotension, arrhythmia, GI upset common (Overdose) |
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3 facts about milrinone
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+inotrope
~35x more potent than inamrinone with fewer side effects |
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3 facts about pimobendan
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+inotrope
Artery/venodilator Reduces plasma NE, cytokines |
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3 facts about catecholamines
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act on A and B adrenergic receptors
increase contractility, HR, BP, CO Increase workload and O2 demand DOC for cardiac arrest |
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What are the dose ranges for Dopamine?
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low - ARF
High - Cardiogenic shock |
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Dobutamine is reserved for what
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cases of sever intractable HF by myocardial failure
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Non-selective Antiarrhythmics
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propanolol - avoid if asthma
carvedilol - also vasodilates sotalol - K blocker |
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Selective (B-1) Antiarrhythmics
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Altenolol
Metoprolol Esmolol (IV) |
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Antiarrhythmics in general
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improve diastolic performance
negative inotropes negative chronotropes |
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Calcium channel Antiarrhythmics
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Diltiazem - HCM
Verapamil - HCM Amlodipine - peripheral vasodilator |
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Tx for acute DCM (dog)
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furosemide
dobutamine nitroglycerin lidocaine O2 |
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Tx for chronic DCM (dog)
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furosemide
digoxin ACEI Maybes: |
Taurine
antiarrhythmics |
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Tx for chronic HCM (cat)
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furosemide
ACEI diltiazem low dose aspirin (thrombi) |
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Name the 4 classes of Anti-arrhythmic drugs
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I - Sodium channel blockers
II - B-blockers III - K blockers IV - Ca blockers |
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Class I Anti-arrhythmics do what?
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slow phase 0
increase threshold inhibit misfire |
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Class Ia Anti-Arrhythmics do what?
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Depress phase 0
depress conduction slow repolarization Those drugs are: |
quinidine
procainamide Disopyramide |
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3 facts about Quinidine
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Oral use only
cardiac, GI, and dermal side effects negative inotrope |
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What's the deal with Diopryamide?
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potent negative inotrope reserved for when the other drugs stop working.
DO NOT USE WITH CHF! |
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Class Ib Anti-arrhythmics do what?
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shorten AP
Shorten repolarization increase fibrillation threshold (goes from Batman to Batman running) Those drugs are: |
lidocaine - IV only
tocainide - ARF in dobies Mexiletine - 80% urine elim. |
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Class II Anti-Arrhythmics do what?
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Negative inotropic, chronotropic, dromotropic
Decrease heart O2 needs Which makes them good for? |
Supraventricular tachycardias
Atrial fibrillation Refractory ventricular tachyarrhythmias HCM |
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Class III Anti-Arrhythmic drugs do what?
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inhibit K channel
prolong AP Prolong refractory period increase threshold And those drugs are? |
Amiodarone
Sotalol - Neg Inotrope |
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Class IV Anti-Arrhythmic drugs do what?
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Ca channel blockers
depress contractility reduce CO That drug is? |
diltiazem - atrial fib, HCM, supraventricular arrhythmias
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These drugs are for acute supraventricular arrhythmias
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Diltiazem
esmolol Procainamide (IM) These are for chronic |
Digoxin and beta blockers/calcium blockers/procainamide
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These drugs are for acute ventricular tachycardias
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lidocaine
Procainamide These are for chronic |
Mexiletine and altenolol/procainamine/sotalol
Procainamide and altenolol |
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This is absorbed in the PCT
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bicarb
sodium water |
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This is absorbed in the DLOH
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Water
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This is absorbed in the ALOH
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Na
Later, K, Cl, Na NOT WATER. |
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This is absorbed in the DCT
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Na
This gets tweeked |
H
K Na |
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This is altered in the CD
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water out
Na out K in |
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Name the 5 types of diuretics
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Osmotic
Thiazide Loop K sparing Carbonic Anhydrase Inhibitors |
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These drug classes work at the PCT
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CAI
Osmotic |
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These drug classes work at ALOH
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Loop
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These drug classes work at the Early DCT
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thiazide
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These drug classes work at Late DCT
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Potassium Sparing
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These drug classes work at the CD
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Potassium sparing
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Osmotic diuretics are used for
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Oliguric RF
Cerebral edema Acute glaucoma well-hydrated But contraindicated for |
Pulmonary edema
HF dehydration DM hemorrhage |
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Thiazide diuretics work by
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blocking Cl, the cotransport for Na. This prevents Na resorption
This causes loss of |
Na
Cl K (due to aldosterone) Mg But Ca is retained. |
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2 Facts about Thiazide diuretics
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can cause arrhythmias when given with cardiac glycosides
diminish effects of insulin And particular uses |
edema
NDI prevention of Ca stones (largely replaced by Loop diuretics) |
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Loop diuretics work by
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blocking Cl resorption in the LOH
so you lose |
Na (~30%)
Cl K (due to aldosterone) |
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Loop diuretics are great for
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edema (all)
Congestive HF Ascites Hepatic fibrosis EIPH in horses |
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K sparing diuretics work by
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blocking the production of Na/K pumps
The two types are: |
Na channel - miloride, triamterene
Ald antagonists - sprionolactone |
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K sparing diuretics specific uses
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edema (liver disease, adrenal tumors)
Hyperald cirrhosis Don't use with |
hyperkalemic
ACEI |
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CAI drugs
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Acetazolamide
Methazolamide Mainly used to reduce IOP They work by |
preventing the formation of bicarb in PCT, reducing H ions, thus less NA reabsorbed
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