Common Cardiac Drugs- CardioRush

CHF, arrhythmias
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Terms in this set (79)
CHF, arrhythmias
What are the 2 main categories of disease cardiac drugs are used to treat?
False (some are used to slow the onset of signs associated with CHF)
True or false: all drugs used to treat CHF should NOT be used in cases of asymptomatic heart disease, as they may speed onset of CHF
Furosemide, spironolactone, ACE inhibitor, pimobendan
What are the 4 types of drugs used to treat CHF?
All CHF, both acute emergency setting and chronic daily control
What are the indications of furosemide?
Pulmonary edema
What type of fluid imbalance occurs most frequently with left sided CHF?
Effusions
What type of fluid imbalance occur most frequently with right sided CHF?
True
True or false: once an animal presents in an emergency setting and needs furosemide, they will likely need it chronically for daily use for the rest of their life
Inhibits Na/K/2Cl transports in thick ascending limb of LOH, causes diuresis
What is the MOA of furosemide?
True
True or false: furosemide has a "high ceiling" for use, meaning there is a wide range of doses and the higher the dose, the more the effect
Normally 1%, can induce up to 25% loss
What percentage of natriuresis of filtered Na load is normal vs. what furosemide can induce?
Excessive dosageWhat are the side effects of furosemide mostly associated with?Azotemia, weakness, dehydration, lethargy, electrolyte depletion, hypotensionWhat are the side effects of furosemide associated with excessive dosage?GI upset, pancreatitis, deafness if given rapidly IVWhat are some less common side effects of furosemide?False (should NOT restrict access to water)True or false: furosemide will induce an increase in thirst and urination, and you should restrict access to water in animalsEnalapril, lisinopril, benazeprilWhat are specific examples of ACE inhibitors?CHF in cats and dogs, protein losing nephropathy, systemic hypertension, sometimes prevention of cardiac remodeling before CHF onsetWhat are the indications for ACE inhibitors?False (mainly used to chronically manage CHF, not for acute episodes)True or false: ACE inhibitors are commonly used in an emergency setting for treatment of acute CHFInhibit angiotensin converting enzymeWhat is the MOA of ACE inhibitors?Low BP, low renal blood flow, decreased NaCl to macula densa, SNS stimulationWhat triggers renin release?Thirst, vasoconstriction, Na reabsorption, cell proliferation/remodeling, aldosterone releaseWhat are the effects associated with angiotensin II release?Na reabsorption, K excretion, water retentionWhat are the effects associated with aldosterone release?Inhibits ACE, production of angiotensin II, decreases aldosterone secretion and angiotensin II mediated vasoconstrictionWhat are the direct effects of ACE inhibitors?TrueTrue or false: RAAS is inappropriately activated in CHF, and intra cardiac RAAS may play a role in cardiac remodelingHypotension, azotemia (esp with concurrent diuretic), renal failure, GIWhat are the side effects of ACE inhibitors?False (only in humans, not in animals)True or false: Cough is a common side effect of ACE inhibitors in both humans and animalsFirst onset of CHF or refractory CHF, usually used in addition to furosemideWhat are the indications for spironolactone use?HydrochlorothiazideWhat other medication can come in a combo pill with spironolactone?Aldosterone antagonist, prevents Na/H2O retention and K excretion, results in K sparingWhat is the MOA of spironolactone?WeakWhat is the strength of spironolactone as a diuretic?Inhibits aldosterone, which is part of RAAS, which contributes to remodelingHow is it thought that spironolactone may decrease myocardial and perivascular fibrosis?GI upset, hyperkalemia, azotemiaWhat are the side effects of spironolactone?Dog CHF in almost all cases, advanced heart disease to slow onset of CHF, some cases of CHF in catsWhat are the indications for pimobendan?False (only in dogs this is true, not cats)True or false: In cats, pimobendan is used in almost all cases of CHF, so it is alright to start them on it before an echo to confirm diagnosisCa sensitizer, PDE3 inhibitorWhat is the MOA of pimobendan?Increase interaction between Ca and troponin C, which increases actin and myosin cross binding, leads to positive inotrope (increased force of contraction)How does Ca sensitizer contribute to pimobendan MOA?PDE3 usually breaks down cAMP, when inhibited cAMP can increase, which mediated peripheral vasodilationHow does PDE3 inhibition contribute to pimobendan MOA?InodilatorWhat is the term used for pimobendan because it is a vasodilator and inotrope?Proven to improve outcome with large studiesWhy do we use pimobendan in CHF?Uncommon, but may cause excitability, GI upset, or arrhythmiaWhat are the side effects of pimobendan?TrueTrue or false: antiarrhythmic medications have less clear guidelines for when to use compared to drugs used to treat CHFNa channel blockersWhat are class I antiarrhythmics?Procainamide, quinidine, lidocaine, mexiletineWhat are examples of class I antiarrhythmics?Primarily ventricular arrhythmias, given IV in ER setting to dogs (cats tend to react poorly)What are the indications for lidocaine and procainamide?Primarily conversion of atrial fibrillation in horsesWhat are the indications for quinidine?Ventricular arrhythmiaWhat are the indications for mexiletine?SotalolWhat drug is oral mexiletine often given in combination with?Block fast Na channels found in cardiac myocytes, leading to slower ventricular action potentialsWhat is the MOA of class I antiarrhythmics?GI upset, esp vomiting, neuro signs in horses and cats, quinidine in horses cause tachycardia, sweating, hives, colicWhat are the side effects of class I antiarrhythmics?Beta blockersWhat type drugs are class II antiarrhythmics?Propranolol, atenolol, carvedilol, metoprolol, esmololWhat are specific examples of drugs in class II antiarrhythmics?Primarily ventricular arrhythmia, sometimes supraventricular, outflow tract obstruction, sometimes CHFWhat are the indications for class II antiarrhythmics?Block Beta adrenergic receptors and block SNS stimulationWhat is the MOA of class II antiarrhythmics?TrueTrue or false: some class II antiarrhythmics specifically block either B1 or B2 receptors, while others block bothBradycardia, AV block, hypotension, weakness, fatigue, dizziness, bronchospasm, worsening of CHFWhat are the side effects associated with class II antiarrhythmics?Negative inotropeWhy can class II antiarrhythmics result in worsened CHF?Potassium channel blockersWhat are class III antiarrhythmics?Sotalol, amiodaroneWhat are specific examples of drugs that are class III antiarrhythmics?Primarily ventricular arrhythmia, but also supraventricularWhat are the indications for sotalol?Supraventricular and ventricular arrhythmiasWhat are the indications for amiodarone?Block K channels, result in prolonged action potential propagation and extended QT intervalWhat is the MOA of class III antiarrhythmics?Class IISotalol has properties of what other class of antiarrhythmics?TrueTrue or false: Amiodarone has some properties of all 4 classes of antiarrhythmicsFalse (it is a very strong anti-arrhythmic, used in serious and dangerous arrhythmias)True or false: Because Amiodarone has properties of all 4 classes of antiarrhythmics, it is not a great drug for serious arrhythmiasNegative inotrope may cause CHF worsening, hypotensionWhat are the side effects of sotalol use?Hepatotoxicity (reversible), thyroid abnormalitiesWhat are the side effects of amiodarone?Very long halflifeWhy do the side effects of amiodarone take a long time to resolve after discontinuing use of the drug?Ca Channel blockersWhat type of drugs are class IV antiarrhythmics?Diltiazem, amlodipineWhat are 2 specific drugs that are class IV antiarrhythmics?Supraventricular artrhythmiaWhat are the indications for diltiazem?Systemic hypertensionWhat are the indications for amlodipine?Blocks Ca channels in SA and AV node, slows conduction and HRWhat is the MOA of diltiazem?Selective vascular Ca channel blocker, results in vasodilationWhat is the MOA of amlodipine?Bradycardia, AV block, hypotension, weakness, lethargy, worsen CHFWhat are the side effects of diltiazem?HypotensionWhat are the side effects of amlodipine?Supraventricular arrhythmia, refractory CHF, vasovagal syncopeWhat are the indications for digoxin?Vagomimetic slows HR, AV node conductionWhat MOA of digoxin is the drug most commonly used for?Na/K ATPase inhibitor, restores baroreceptor functionWhat 2 other MOAs for digoxin are mostly secondary?Increases intracellular Na, cell uses Na/Ca exchanger instead, results in higher intracellular Ca and enhanced myocardial contraction (weak positive inotrope)What is the effect of Na/K ATPase inhibition due to digoxin?Narrow therapeutic window, GI upset, can cause any arrhythmia, depression or neuro signsWhat are the side effects of Digoxin?