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Pharmacology II
Lecture Review Questions: Endrocrine System
| Question | Answer |
|---|---|
| True or false: the respiratory system works in combination with the cardiovascular system and hematopoietic system to provide necessary gas exchange for the body. | True. Delivers oxygen to tissues. Removes carbon dioxide from tissues. |
| Respiratory Disease True or false: abnormalities in any portion of the respiratory tract may affect respiration or ventilation. Name six systems that can contribute to respiratory disease. | True. Upper airway. Lower airway. Diaphragm or other muscles. Immune system. Cardiovascular system. Neurologic system. |
| Clinical Signs: Upper Respiratory Name four. | Nasal discharge. Sneezing. Dry hacking, non-productive cough. Unusual respiratory sounds (wheezing, whistling, stridor). |
| Clinical Signs: Lower Respiratory Name seven. | "Deep" cough (may or may not be productive). Tachypnea. Dyspnea. Cyanosis. Abnormal (or absent) lung sounds. Nasal discharge. Abnormal body posture. |
| Evaluation of Respiratory Health Name six common tests. | RR/MM and effort. Pulse oximetry. Blood gas analysis. Radiographs. Culture. Cytology. |
| Evaluation of Respiratory Health Name three less common tests. | Bronchoscopy. Ultrasound. Biopsy. |
| Defense of the Respiratory System How do mucous secretion and mucociliary escalator help? | Mucous secretions help moisten the tissues and entrap bacteria and particulate matter than can then be eliminated. |
| Defense of the Respiratory System How do Lymphoid tissues help? | They are scattered throughout the respiratory tract. Either diffuse or follicular accumulations of lymphocytes. These are a part of 'mucosal' immunity and secrete IgA. |
| Defense of the Respiratory System What are three neurogenic reflex mechanisms? | Coughing. Sneezing. Gag. |
| The Cough Reflex: Cough Center True or false: Neurons in the brain stem (near the respiratory center) control the cough reflex. | True |
| The Cough Reflex: Cough Center Input from what three areas are triggered with irritation? | larynx, trachea, bronchi. |
| The Cough Reflex: Cough Center True of false: rapid muscle contraction mediated by the cough center causes sharp, forced expiration (cough). | True |
| Respiratory Drugs What are Antitussives? | They suppress coughs. May be centrally acting or locally acting. |
| Respiratory Drugs Name five centrally acting antitussives. | Butorphanol. Hydrocodone, Codeine. Dextromethorphan. Trimeprazine (in a combination product.) |
| Respiratory Drugs Which drug is an opioid (C-IV), suppresses cough centrally at low doses, and has minimal effect on respiratory & cardiovascular systems. | Butorphanol. |
| Respiratory Drugs True or false: all antitussives should be used only for non-productive coughs at the lowest dose possible to control signs. | True |
| Respiratory Drugs Which two drugs are an opioids (CIII) that usually have atropine added to decrease abuse potential in humans, and may cause slow GI motility/constipation? | Hydrocodone & Codeine. |
| Respiratory Drugs What drug is an opioid derivative, not controlled, and OTC that is weaker than other antitussives and a danger to animals when in mixed products with acetaminophen and ibuprofen. | Dextromethorphan |
| Respiratory Drugs True or false: mucolytics decrease the viscosity or thickness of respiratory secretions. Good hydration status of then patient should always be confirmed prior to utilizing these drugs. | True |
| Respiratory Drugs Name a mucolytic medication that is also used to treat acetaminophen toxicity. | acetylcysteine |
| Respiratory Drugs True or false: Expectorants increase the flow of respiratory secretions to allow material to be coughed up from the lungs. They increase the fluidity of mucus. | True |
| Respiratory Drugs Describe the action of Expectorants and name one drug. | Irritation of gastric mucosa and stimulation of parasympathetic nervous system. Guaifenesin. |
| Respiratory Drugs True or false: decongestants decrease the congestion of nasal passages by reducing swelling. | True |
| Respiratory Drugs True or false: decongestants should not be used in heart patients because it may cause dangerous arrhythmias. | True |
| Respiratory Drugs Decongestants should not be used more than __ days in a row due to possible "rebound" effect. | three |
| Respiratory Drugs Name two examples of Decongestant drugs. | Phenylephrine. Pseudoephedrine. |
| Respiratory Conditions ___ means narrowing of small airways due to smooth muscle contraction. May cause dyspnea. | Bronchoconstriction |
| Respiratory Conditions What are four possible causes of bronchoconstriction? | Parasympathetic nervous system stimulation. Irritants (dust, toxins, molds). Inflammation (histamine, prostaglandins). Drugs: B1 blockers. |
| Respiratory Drugs: Bronchodilators True or false: widen the lumen of the bronchi and counteract bronchoconstriction. Use caution in heart patients. | True |
| Respiratory Drugs: Bronchodilators True or false: cholinergic blocking agents (anticholinergics) such as atropine and glycopyrrolate are one example. | True |
| Respiratory Drugs: Bronchodilators Beta-2-adrenergic agonists, such as epinephrine, terbutaline, and albuterol, are an example. | True |
| Respiratory Drugs: Bronchodilators True or false: Methylxanthines such as aminophylline and theophylline are examples. | True |
| Bronchial Thickening Name four inflammatory cells involved. | Neutrophils. Eosinophils. Mast cells. Macrophages. |
| Bronchial Thickening What two cells are involved in hyperplasia? | Endothelial cells. Goblet cells. |
| Bronchial Thickening True or false: you will often see an increase in secretions. | True |
| Respiratory Drugs True or false: antihistamines prevent the release of histamine produced by mast cells (can not reverse the effect). | True |
| Respiratory Drugs True or false: antihistamine drug names usually end with -amine. | True |
| Respiratory Drugs What are two possible side effects of antihistamine use? | CNS depression. Anticholinergic effects such as dry mouth. |
| Respiratory Drugs Name two antihistamine drugs. | diphenhydramine. chlorpheniramine. |
| Histamine True or false: it is released form mast cells in response to antigen/IgE antibody activation. | True |
| Histamine activates inflammatory cytokines that result in what five clinical signs? | Swelling. Edema. Hyperemia. Pruritis. Pain. |
| True or false: histamine attracts eosinophils. | True |
| Respiratory Drugs True or false: corticosteroids (glucocorticoids) treat severe inflammation of airways. | True |
| Respiratory Drugs True or false: corticosteroids (glucocorticoids) stabilize mast cells, stopping histamine release. | True |
| Respiratory Drugs True or false: corticosteroids (glucocorticoids) stabilize capillary walls to decrease pulmonary edema of inflammation. | True |
| Respiratory Drugs What are five examples of corticosteroids (glucocorticoids)? | Prednisone. Prednisolone. Dexamethasone. Depo-medrol. Triamcinolone. |
| Respiratory Drugs: Corticosteroids Name three contraindications of their use. | Infectious disease may worsen due to decrease in cellular immunity. May mask clinical signs while infectious disease progresses. Heart disease will worsen due to sodium and water retention in the body. |
| Respiratory Drugs: Corticosteroids Name three indications for their use. | Allergic response. Immune-mediated lung disease. Chemical irritant (smoke inhalation). |
| Respiratory Drugs Describe the action of Diuretics. | They decrease water resorption by the kidneys, promoting increased urine volume and tissue dehydration. |
| Respiratory Drugs Name three indications for diuretic use. | Pulmonary edema due to heart failure. Hypoalbuminemia. Iatrogenic fluid administration. |
| Respiratory Drugs What is one contra-indication of diuretic use? | Pneumonia |
| Respiratory Drugs True or false: diuretics are ineffective for protein fluid accumulation in lungs (i.e. electrocution, vasculitis). | True |
| Respiratory Drugs: Antibiotics True or false: they are indicated for treatment of primary or secondary bacterial infections of airways (bronchitis) or alveoli (pneumonia). | True |
| Respiratory Drugs: Antibiotics True or false: they are ideally chosen based on culture from trachea, bronchus, or lung aspirate. Nasal or sputum cultures usually are not helpful in veterinary medicine. | True |
| Respiratory Drugs: Antibiotics What are four common antibiotics indicated in airway disease? | Clavamox. Baytril. Doxycycline. Metronidazole (anaerobic). |
| Respiratory Drugs True or false: respiratory stimulants stimulate the animal to increase its respirations. | True |
| Respiratory Drugs ___ is a CNS stimulant that acts at the respiratory center. May not improve blood oxygenation even though respiratory rate rises. It is used to revive neonates or anesthetic apnea. | Dopram |
| Respiratory Drugs ___ is used to stimulate respiration following narcotic overdose. | Naloxone |
| Respiratory Drugs ___ is used to reverse xylazine administration or overdose. | Yohimbine. |
| Respiratory Drugs Increasing environmental oxygen content may improve blood oxygenation by ___%. | 10% |
| Respiratory Drugs Oxygen therapy should be ___ to prevent drying of mucous membranes and decreased mucociliary function. | humidified |
| Respiratory Drugs __% oxygen delivered by intubation is toxic after __hours. | 100%. 24 hours. |
| Oxygen Delivery True of false: an oxygen cage is low stress but takes 40 minutes or more to fill the cage with oxygen so opening doors should be minimized. | True |
| Oxygen Delivery True or false: oxygen cage use is expensive, cage may become overly warm or humid, and should have CO2 absorption. | True |
| Oxygen Delivery True or false: intranasal oxygen is facilitated by placing a red rubber catheter in one or both nostrils to deliver oxygen. Sutured to the head. | True |
| Oxygen Delivery True or false: intranasal oxygen is an excellent choice for large breed dogs. | True |
| Oxygen Delivery True or false: Elizabethan collars are lidocaine nose drops may be needed to prevent sneezing and animal rubbing. | True |
| Oxygen Delivery True or false: an oxygen face mask is an excellent choice for delivery for short time periods. | True |
| Oxygen Delivery True or false: animals in respiratory distress dislike anything on the face. | True |
| Oxygen Delivery True or false: oxygen face masks usually require a staff member to hold the mask on or near the face. | True. Over large muzzle could be used to hold in place. |
| Oxygen Delivery True or false: an oxygen tent can be built from plastic bags or e-collars. | True |
| Oxygen Delivery When using an oxygen tent, it is very important that a slit be left open dorsally for CO2 to escape. | True |
| Oxygen Delivery Clear plastic is recommended to decrease animal ___. | anxiety |
| Respiratory Drug Delivery: Metered Dose Inhaler (MDI) True or false: the drug is aerosolized into microfine droplets for deposition into lower airways. | True |
| Respiratory Drug Delivery: Metered Dose Inhaler (MDI) Animal must breath ___ for this delivery to be effective. | deeply |
| Respiratory Drug Delivery: Metered Dose Inhaler (MDI) What is used to deliver this kind of medicine for animals? | A face mask and spacer |
| Respiratory Drug Delivery: Metered Dose Inhaler (MDI) True or false: a "puff" is a precise amount of medication and number of puffs is carefully prescribed and delivered. | True |
| Respiratory Drug Delivery: Nebulizer True or false: compressed air or oxygen is used to deliver saline or medication in saline in small droplets to lower airway. | True |
| Respiratory Drug Delivery: Nebulizer True or false: medication may cause irritation. | True |
| Respiratory Drug Delivery: Nebulizer True or false: pure saline nebulization and coupage are effective therapies to rehydrate mucous membranes and create a productive cough in pneumonia patients. | True |
| Nebulize and Coupage Pneumonia is best treated by ___ the productive cough. The lungs way of cleaning themselves. | encourage. |
| ___ exposes the animal to ultrafine water droplets to moisten small airways (humidifier is not as effective, water droplets are too large and land in nose). | Nebulize. 10-15 minutes. |
| ___ is a technique of slapping thorax with cupped hand over consolidated lung to encourage coughing and loosening debris; usually for 5-10 minutes after 10-15 min of nebulization. | Coupage 5-10 minutes. |
| The Electrical Heart True or false: muscle contraction of heart is carefully orchestrated by an electrical system. | True |
| The Electrical Heart Electrical activity moves across the heart from: | The Sinoatrial node (SA node), also called the pacemaker of the heart, to the Atrioventricular Node (AV node) which is commonly called the signal booster. |
| Each electrical wave results in heart muscle contraction. The P wave is related to ___ ___. | Atrial contraction |
| Each electrical wave results in heart muscle contraction. The QRS wave is related to ___ ___. | Ventricular contraction |
| Each electrical wave results in heart muscle contraction. The T wave is related to ___ ___. | Muscle relaxation |
| Basic Anatomy & Physiology The electrical impulses of the heartbeat originate in the ___. | Sinoatrial node (SA node) |
| Basic Anatomy & Physiology True or false: the heart rate is controlled primarily by the autonomic nervous system. | True |
| Basic Anatomy & Physiology Stimulation of the ___ nervous system slows the heart rate. | parasympathetic nervous system (rest and digest) |
| Basic Anatomy & Physiology Stimulation of the ___ nervous system increases heart rate. | sympathetic |
| Basic Anatomy & Physiology True or false: workload of the heart is divided into preload and afterload. | true |
| Basic Anatomy & Physiology ___ is the volume of blood entering the right side of the heart. | Preload |
| Basic Anatomy & Physiology ___ is the force needed to push blood out of the ventricles. | Afterload |
| Basic Anatomy & Physiology If the heart is not working properly, it can compensate by a few mechanisms. Name four: | Increase heart rate. Increase stroke volume. Increase efficiency. Enlarge itself. |
| Cardiac Output True or false: CO (Cardiac Output) = SV (Stroke Volume) x HR (Heart Rate). Vigorous exercise results in increased contractility, increased stroke volume, and increased heart rate. | True |
| Cardiovascular Disease What are the two categories? | Myocardial dysfunction. Circulatory Failure. |
| Cardiovascular Disease True or false: Myocardial dysfunction involves any heart disease that leads to "pump failure." | True |
| Cardiovascular Disease True or false: inadequate/ineffective circulating fluid volume and excess circulating pressure are lead to Circulatory Failure. | True |
| Cardiovascular Disease What are eight possible clinical signs? | Exercise intolerance or weakness. Tachypnea or Dyspnea. Coughing. Syncope (fainting). Abnormal heart rate or heart rhythm. Abnormal pulse quality or pulse deficit. Prolonged capillary refill time (CRT). Ascites. |
| Cardiovascular Drugs True or false: antiarrhythmic drugs control impulse formation and propagation in the heart. | True |
| Cardiovascular Drugs True or false: diuretic drugs change blood volume, ionic composition, and tissue hydration status. | True |
| Cardiovascular Drugs The goal is to decrease cardiac loading such as reduced blood volume and/or decrease peripheral resistance to cardiac outflow or increase cardiac pumping efficiency. | True |
| What is the Pacemaker Hierarchy: 1-4? | SA Node, AV Node, Bundle of His, then Ventricular Muscle. |
| Causes of Cardiac Arrhythmias Name four causes. | Autonomic nervous system disorders. Altered ionic permeability of cardiac membranes. Intrinsic cardiovascular disease. |
| Causes of Cardiac Arrhythmias What are six factors that lead to ionic permeability of cardiac membranes that results in partial or total depolarization in specific area (ectopic focus). | trauma. hypoxia. infection. metabolic disease. drugs. toxins. |
| Identifying Arrhythmias What are four ways this is accomplished? | Pulse deficit. ECG. Cardiac ultrasound. Holter Monitor. |
| Identifying Arrhythmias What is a Holter Monitor? | ECG worn by the patient in a "back pack" that is triggered to record when arrhythmias happen. Ideal for intermittent arrhythmias. |
| Treating Arrhythmias What is the first step? | Identifying the type of arrhythmia: Tachycardia vs Bradycardia or Atrial vs Ventricular. |
| Treating Arrhythmias After the type of arrhythmia is determined, what is the next step? | Finding the best anti-arrhythmic drug. It is chosen if the arrhythmia is dangerous to the patient. Not all arrhythmias require treatment. |
| Treating Arrhythmias What is the third step? | Treat any primary diseases that may be present. |
| Treating Arrhythmias What two things should be monitored? | Response to treatment and possible toxicities or side effects. |
| Treating Arrhythmias True or false: discontinue anti-arrhythmic drugs, if the underlying cause can be resolved such as electrolyte abnormalities, severe inflammation, and myocarditis. | True |
| Anti-arrhythmic Drugs True or false: they are used to correct variation in the normal beating of the heart (which can lead to reduced cardiac output). | True |
| Anti-arrhythmic Drugs What are five types? | local anesthetic, membrane stabilizers, beta-adrenergic blockers, action potential prolongation drugs, and calcium-channel blockers. |
| Anti-Arrhythmics: Mechanisms of Action True or false: they can either change gating properties of cardiac ion channels (Na, Ca, K+) directly, or change neuromodulary control of cardiac ion channel opening/closing. | True |
| Drugs that Inhibit Na+ Influx What three drugs decrease the flow rate of sodium into the cell? What does this accomplish? | Lidocaine, Procainamide, and Mexilitine. This slows depolarization of ectopic focus and allows SA node to work in normal manner. |
| Drugs that Inhibit Na+ Influx: Lidocaine, Procainamide, Mexilitine What two arrhythmias are these effective in treating? | PVC (Premature Ventricular Contractions) and Ventricular arrhythmias. |
| Drugs that Inhibit Na+ Influx: Lidocaine, Procainamide, Mexilitine ___ is given slow IV as a bolus then CRI. | Lidocaine |
| Drugs that Inhibit Na+ Influx: Lidocaine, Procainamide, Mexilitine What are two signs of toxicity? | Arrhythmias and Neurologic signs. |
| Drugs that Inhibit Na+ Influx: Lidocaine What is one precaution to remember when using Lidocaine in this way? | Be certain to use lidocaine without epinephrine. |
| Premature Ventricular Contractions True or false: the P wave is often not seen on the ECG tracing. | True |
| Premature Ventricular Contractions A wide, distorted or bizarre QRS complex is evident. | True |
| Premature Ventricular Contractions True or false: the beat preceding the PVC and the beat following are usually equal to the time of two normal beats. | True |
| Premature Ventricular Contractions True or false: they may be treated with IV lidocaine. | True |
| Ventricular Tachycardia is often referred to: | "Ghosts Holding Hands" This is a life-threatening arrhythmia. |
| Second Degree AV Block True of false: some atrial pulses are not conducted through the AV node and therefore do not cause depolarization of the ventricles. | True |
| What is Atrial Standstill? | SA node sends impulse but atria do not contract. No P waves seen. Hyperkalemia is most common cause, so decrease potassium. |
| What breed is especially susceptible? | English Springer Spaniel. Fibrous tissue take over myocardium and impairs its contractility. |
| True or false: If atrial standstill is not due to increased potassium, a pacemaker is warranted. | True |
| Beta Blockers (B blockers) True or false: B1 receptors are located in the heart as part of the sympathetic nervous system. | True |
| Beta Blockers (B Blockers) True or false: these drugs allow parasympathetic system dominance at SA nose to slow the heart rate. | True |
| Beta Blockers (B blockers) What drug is an antidote for beta blocker overdose or side-effect of bronchoconstriction? | Atropine |
| Beta Blockers (B blockers) Name three drugs in this class. | Propranolol. Atenolol. Metropolol. |
| Calcium Channel Blockers True of false: they block calcium channels of cardiac muscle cells, causing decreased automaticity. | True |
| Calcium Channel Blockers What two issues are they used to treat? | Atrial arrhythmias. Flutters. |
| Calcium Channel Blockers True or false: cats with hypertrophic cardiomyopathy are treated with these drugs. | True |
| Calcium Channel Blockers Name two drugs in this class: | Verapamil. Diltiazem. |
| Calcium Channel Blockers What drug is the number one choice for treating hypertension in cats? | Amlodipine. Very important in senior cats. |
| Calcium Channel Blockers In what situation is Amlodipine used? | If systolic blood pressure is >160 mmHg. Doppler used is gold standard, paw or tail works. |
| Calcium Channel Blockers True or false: vasodilators reduce afterload. | True |
| ___ ___ is a is a non-specific term referring to any heart disease that leads to very significant “heart pump” insufficiency and compensatory mechanisms of the body cause fluid to accumulate in the tissues. | Heart Failure |
| ___ side failure leads to free fluid accumulating in the pleural and abdominal cavity. | Right Side Failure |
| ___ side failure leads to fluid accumulation in the lungs. | Left Side Failure |
| Cardiovascular Drugs: Positive Ionotropes True or false: cardiac glycosides increase the strength of cardiac contractions, decrease heart rate, have an antiarrhythmic effect, and decrease signs of dyspnea. | True |
| Cardiovascular Drugs: Positive Ionotropes What are four side effects of Cardiac Glycosides. | anorexia. vomiting. diarrhea. cardiac arrhythmias. |
| Cardiovascular Drugs: Positive Ionotropes What are two examples of cardiac glycosides? | Digoxin and digitoxin |
| Cardiovascular Drugs: Positive Ionotropes True or false: Cardiac glycosides like digitoxin and digitoxin are very old drugs that are falling out of favor. | True |
| Digoxin Toxicity True or false: it has a narrow therapeutic range. | True |
| Digoxin Toxicity True or false: hypokalemia increases the risk of toxicity. | True |
| Digoxin Toxicity True or false: blood levels of digoxin and electrolytes should be monitored. | True |
| What are four clinical signs of Digoxin toxicity? | Arrhythmia. Vomiting/Diarrhea. Inappetance. Weakness. Especially cats and Dobermans. |
| Cardiovascular Drugs: Positive Ionotropes True or false: catecholamines increase the force and rate of myocardial contraction, constrict peripheral blood vessels, and increase blood glucose levels. | True |
| Cardiovascular Drugs: Positive Ionotropes What are four examples of Catecholamines? | Epinephrine. Dopamine. Dobutamine. Isoproterenol. |
| Cardiovascular Drugs: Positive Ionotropes True or false: Catecholamines are used for emergency cardiac support. | True |
| Cardiovascular Drugs: Positive Ionotropes True or false: Pimobendan (Vetmedin) is also a vasodilator and a negative chronotrope. | True |
| Cardiovascular Drugs: Positive Ionotropes True or false: Pimobendan (Vetmedin) is a relatively new drug used to treat chronic heart failure orally. It comes in a chewable tablet. It can worsen certain arrhythmias. | True |
| Cardiovascular Drugs: Positive Ionotropes True or false: Pimobendan (Vetmedin) may decrease appetite and cause vomiting. | True |
| Cardiovascular Drugs: Positive Ionotropes True or false: Pimobendan (Vetmedin) is being used in cats and dogs, but it is very dependent on the type of heart disease. | True |
| Cardiovascular Drugs: Vasodilators True or false: these drugs are used to dilate arteries and/or veins in an attempt to alleviate vessel constriction and improve cardiac output (decreases afterload). | True |
| Cardiovascular Drugs: Vasodilators True or false: they are used to treat hypertension. | True |
| Cardiovascular Drugs: Vasodilators What are two examples? | ACE-inhibitors and Nitroglycerine |
| Cardiovascular Drugs: ACE inhibitors What are they? | Angiotension-converting enzyme inhibitors |
| Cardiovascular Drugs: ACE inhibitors How do they work? | They block production of angiotensin and aldosterone. Blood vessels don't constrict and sodium is not retained leading to lower blood pressure or decreased afterload. |
| Cardiovascular Drugs: ACE inhibitors Name three examples. | Enalapril. Captopril. Benazepril. |
| Cardiovascular Drugs: ACE inhibitors True or false: nitroglycerin causes dilation of the veins, and is used as an emergency drug for volume overload of heart failure. | True |
| Cardiovascular Drugs: ACE inhibitors True or false: Nitroglycerin is a cream applied (wearing gloves) to the pinna of the ear every 8 hours by 1/4" increments. | True |
| Cardiovascular Drugs: ACE inhibitors When using Nitroglycerin cream, ears are alternated and marked. The previous dose is removed. | |
| Cardiovascular Drugs: AT Receptor Blocker Telmisartin is a brand new drug for veterinary medicine. The brand name is Semintra. What species is it used in? | Cats |
| Cardiovascular Drugs: AT Receptor Blocker True or false: Telmisartin affects a very specific receptor to treat hypertension. | true |
| Cardiovascular Drugs: AT Receptor Blocker Telmisartin comes in liquid form and is very expensive. | True |
| Cardiovascular Drugs: Diuretics True or false: they are drugs that increase the volume of urine excreted by the kidneys and thus promote the release of water from the tissues (lowers the fluid volume in tissues). | True |
| Cardiovascular Drugs: Diuretics True or false: they are used in the treatment of hypertension and volume overload of heart failure. | True |
| Cardiovascular Drugs: Diuretics' What is a Loop Diuretic? | They prevent reabsorption of Na+ from the Loop of Henle. |
| Cardiovascular Drugs: Loop Diuretics True or false: water remains in the urine. | True |
| Cardiovascular Drugs: Loop Diuretics What are two risks of using these drugs? | Patient dehydration. Hypokalemia with long-term use. |
| Cardiovascular Drugs: Loop Diuretics Furosemide is given ___ for emergency use, but is also given __, __, and __. | IV. SQ, IM, and PO. |
| Cardiovascular Drugs: Loop Diuretics What was the name Lasix chosen? | "lasts six hours" |
| In heart failure management, what is step I? | Avoid salted foods and educate. |
| In heart failure management, what is step II? | 'Senior' diet and ACE Inhibitor or Beta blocker. |
| In heart failure management, what is step III? | 'Heart' diet. ACE inhibitor, diuretic, digoxin, beta blocker, and rest. |
| In heart failure management, what is step IV? | Phase III drugs. Add diuretics or increase dose. Nitroprusside, Oxygen, Dobutamine, Centesis. |
| Anti-thromboembolics Name drugs is a platelet aggregation inhibitor prescribed to prevent clots (not treat them.) | Clopidorgrel (Plavix) |
| Anti-thromboembolics True or false: Aspirin is a Cox inhibitor that decreases platelet function. | True |
| Pain Management: Terminology True or false: analgesia is the absence of pain sensation. | True |
| Pain Management: Terminology True or false: distress is a physical or emotional display of physical or mental strain. | True |
| Pain Management: Terminology True or false: hyperesthesia is an increased sensitivity to non-noxious stimuli. | True |
| Pain Management: Terminology A ___ is a receptor that translates tissue damage to pain perception. | Nociceptor |
| Pain Management: Terminology What are three types of painful stimuli? | Mechanical: cut, stretch, crush, puncture. Temperature: Heat or Cold. Chemical: irritant, infection, inflammation. |
| Pain Management: Terminology What are the four steps in Nociception? | Transduction. Transmission. Modulation. Perception. |
| Pain Management: Terminology ___ is the translation of noxious stimuli into electrical activity at peripheral nociceptor. | Transduction |
| Pain Management: Terminology ___ is movement of nerve impulse through the nervous system. | Transmission |
| Pain Management: Terminology ___ is the change of pain perception by the efferent analgesic system (spinal cord). | Modulation |
| Pain Management: Terminology Where does Perception occur? | Cerebral cortex (Brain) |
| What are seven consequences of pain. | Decreased quality of life. Increased risk of infection. Delayed wound healing. Reduced food and water intake. Decreased sleep quality and quantity. Behavior changes. Mobility changes. |
| Recognizing Pain What are seven clinical signs to watch for if you suspect pain in your patients? | Increased blood pressure, heart rate, and respiratory rate. Stress leukogram (CBC). Vocalization. Hiding. Posture changes. |
| Pain Numerical Rating Scale True or false: there are many systems available. They should be different for each species. | True |
| Pain Numerical Rating Scale How should they be implemented in clinic? | Each veterinary hospital should adopt a pain scale system for every member of the veterinary team that is standard. Everyone uses the same scale. |
| Strategies of Pain Management What is preemptive analgesia? | Begun before the patient is exposed to noxious stimuli. |
| Strategies of Pain Management True or false: it minimizes the duration and intensity of animal discomfort. | True |
| Strategies of Pain Management True or false: it minimizes the amount of drug needed to control pain and decreases anesthetic drugs need. | True |
| What is "Wind Up?" | Repeated pain impulses to the brain leads to increased sensitivity to pain if it occurs over hours. |
| True or false: if pain stimulation is occurring during surgery, there will be a higher sensitivity to pain when the animal regains consciousness. That is why we give analgesia prior to surgery. | True |
| Strategies of Pain Management What is Multimodal Analgesia? | Simultaneous use of two or more analgesic drug classes or techniques. NSAID and Opiate. Local and Systemic Anesthesia. |
| Strategies of Pain Management Why do we use multimodal analgesia? | It interrupts transduction of pain at different sites along the pain pathway. |
| Mode of Delivery True or false: mode of delivery of a drug can make a major difference in effectiveness of therapy. | True |
| Mode of Delivery True or false: mode of delivery can make a major difference in time of onset of action. | True |
| Mode of Delivery Name five for Systemic Analgesia. | Oral (PO). Subcutaneous (SQ). Intravenous (IV). Constant Rate Infusion (CRI). Transdermal. |
| Transdermal Patches Describe the process of application. | Shave the patient without causing abrasion. Clean skin with water only. When dry apply patch to skin and hold with warm hand for 60 seconds. Apply bandage to maintain skin contact. Label bandage with date, time, dose, and initials. |
| Transdermal Patches True or false: never cut the patch. | True. If only half the patch is needed, leave backing on other half. |
| Transdermal Patches How long does ramp up time take? | 8 - 24 hours to reach systemically effective concentration. |
| What is CRI? | Constant Rate Infusion. A technique which can be used with many different types of drugs. |
| What types of drugs can be administered via CRI? | Electrolytes. Anti-nausea. Anti-arrhythmic. Insulin. Analgesia. |
| Constant Rate Infusion True or false: the dosage is given as a fixed amount per time. | True. Drug name, concentration/kg, hr |
| Constant Rate Infusion True or false: the dosage can be delivered in a buretrol at a rate independent of fluid support. | True |
| Mode of Delivery What are six means of delivering local and regional analgesia? | SQ. Topical. Epidural. Nerve blocks. Intra-articular. Pleural. |
| Intra-Articular Anaglgesia True or false: this is a sterile procedure. Shave and surgically scrub skin over joint. Sterile needle is guided into the joint. | True. Lidocaine. Bupivacaine. Morphine. |
| Drugs Used to Treat Pain Name five types. | NSAIDs. Opioids. a2 agonists. Local agonists. Adjuvant medications. |
| Non-steroidal Anti-inflammatory Drugs (NSAIDs) What is their mechanism of action? | Block prostaglandin synthesis. This decreases inflammation mediators, nociceptor sensitivity, and is effective for mild to moderate pain. |
| COX-1 prostaglandins are protective to homeostasis of: | kidneys, gastric mucosa, platelet function, macrophage function. |
| COX-2 prostaglandins are inflammatory mediators of: | swelling, pain, chemotaxis |
| Name three Non-specific NSAIDs. | Aspirin. Flunixin (Banamine). Bismuth subsalicylate |
| Name five COX-2 Inhibitor NSAIDs. | Carprofen (Rimadyl). Etodolac (Etogesic). Deracoxib (Deramaxx). Meloxicam (Metacam). Firocoxib (Previcox). |
| True or false: side effects of NSAID use include GI ulcers, renal and liver damage. | True |
| NSAID Side Effects and Contraindications True or false: GI ulcers especially with corticosteroid use. COX-1 targeting NSAIDs problematic. | True |
| NSAID Side Effects and Contraindications True or false: renal damage especially with hypotension, renal insufficiency, and in cats. | True |
| NSAID Side Effects and Contraindications True or false: liver damage is a special risk of Rimadyl in Labrador Retrievers. | True |
| NSAID Side Effects and Contraindications True or false: respiratory system affects include asthma like signs. Possibly due to leukotriene production. | True |
| NSAID Side Effects and Contraindications True or false: COX-1 inhibit platelet aggregation. NSAIDs may cause progression of heart failure in some patients (fluid retention). | True |
| Monitoring NSAID Use What are three ways we accomplish this? | Blood Chemistries before initiation, two weeks after, then periodically 3-6 months. Taper use to lowest effective dose (daily or EOD more effective than PRN). Decreased appetite, vomiting, melena reasons to immediately stop drug and re-evaluate the pet. |
| If GI Side-effects Occur with NSAID Use.... What should we do? (3) | Discontinue NSAID. Initiate Rx to treat ulcers, if present: Sucralfate (Carafate), Ranitidine (Zantac), Famotidine (Pepcid), and Misoprostol. Develop new pain control plan. |
| Opioids What is there mechanism of action? | Blocking synaptic receptors: OP1 (alpha), OP2 (beta), and OP3 (mu). Inhibits excitatory neurotransmitters. |
| Location of Opiate Receptors Name the three. | Brain: predominantly mu receptors. Spinal cord: Alpha, Beta, and Mu. Peripheral Receptors: receptors develop under certain inflammatory conditions. |
| Opioids What are five side effects/ Contraindications for this class of drugs? | Respiratory depression. Heart Rate depression. Vomiting. Hyperthermia (cats). Dysphoria (hallucinations) (esp. cats or elderly animals). |
| Opioid Synergy (Adjuvants) Enhanced effectiveness may occur when an opioid is combines with (4)? | NSAID. Alpha-2 agonist. Phenothiazine. Local anesthetic. |
| What is Neuroleptanalgesia? | An opioid plus a sedative are administered together. |
| Opioid Reversal What drugs are used? | Naloxone. Naltrexone. (Sometimes buprenorphine). Duration <2 hours |
| Opioid Reversal Why do we use them? | To arouse an animal when excessively sedated. May result in intense acute pain. Do not use for bradycardia alone (anticholinergic better choice). |
| Alpha 2 Agonists True or false: have moderate to excellent analgesia with moderate to profound sedation. | True |
| Alpha 2 Agonists True or false: they active a2 receptors in CNS and periphery. Cardiovascular side-effects can be profound (bradycardia). | True |
| Alpha 2 Agonists True or false: reversal agents are available. | True |
| Alpha 2 Agonists Name four Alpha 2 Agonist drugs. | Detomidine (Dormosedan). Medetomidine (Domitor). Romifinine (Sedivet). Xylazine (Rompun). |
| Alpha 2 Agonists Name two reversal agents. | Yohimbine (Yobine) and Atipamezole (Antisedan). |
| Alpha 2 Agonists True or false: bradycardia (AV blocks) are possible. | True |
| Alpha 2 Agonists True or false: respiratory depression parallels sedation. Upper airway relaxation can cause obstruction. | True |
| Alpha 2 Agonists True or false: vomiting common in dogs and cats. Bloat may occur. | True |
| Alpha 2 Agonists True or false: may be ideally used at very low doses as part of a multimodal pain care post-op. | True |
| Adjunctive Medications Name four. | Anxiolytics. Nutraceuticals. Sedatives. Antiemetics (Cerenia). |
| Chronic Pain Management How do we assess quality of life? | Clinical evaluation of veterinary staff. Owner questionnaires. Modified Karnofsky Score. |
| Chronic Pain Management What is the Modified Karnofsky Score? | Combines clinical evaluation and owner questionnaire to develop a quantitative score of normal life activities. |
| Chronic Pain Management True or false: the multimodal approach is ideal. | True |
| Chronic Pain Management What are 3 -6 options for a multimodal approach? | NSAIDs. Opioids. Adjunct medications. Acupuncture. PT and Exercise. Environmental modification (orthopedic beds, non-skid mats). |
| Chronic Pain Management True or false: daily to EOD therapy is more effective than "symptomatic" approach in maintaining high quality of life. | True |
| Treatment of DJD - Degenerative Joint Disease What are five options? | Decrease joint stress. Improve joint fluid quality. Decrease pain. Decrease inflammation. Complementary Medicine. |
| Treating DJD How do we decrease joint stress? | Weight loss. Modified exercise - low impact. Prevent slips and falls. |
| Treating DJD How do we improve joint fluid quality? | Glucosamine and Chondroitin. Adequan. |
| Treating DJD How do we decrease pain? | NSAIDs. Short term pain relievers. |
| Treating DJD How do we decrease inflammation? | NSAIDs. Omega 3 fatty acids. |
| Treating DJD Name four complementary medicine methods. | Acupuncture. Laser therapy. Massage. Treadmill. |
| Endocrine Function What are two functions? | Internal communication system utilizing chemicals called hormones. Feedback: communication moves from endocrine organ to target tissues and back to the endocrine organ. |
| ___ are chemical messengers produced by endocrine glands and secreted directly into blood vessels. | Hormones |
| ___ produce effects when they find their specific receptor in or on cells. | Hormones |
| A cell that has receptors for a particular hormone is referred to as a ___ of that hormone. | target |
| Name six endocrine organs: | pituitary gland, thyroid glands, parathyroid glands, adrenal glands, pancreas, and ovary/testes. |
| The ___ gland is referred to as the "Master Gland." | Pituitary gland |
| True or false: the pituitary gland gives directions to the other endocrine glands. Where is it located? | True. Ventromidline of the brain. |
| Basis Anatomy and Physiology Two types of feedback loops are involved in regulating the endocrine system. Name them. | Negative feedback loop. Positive feedback loop. |
| The ___ feedback loops are more common and work in response to low or high levels of hormone in the body. | Negative feedback |
| The ___ feedback loops occur when hormone levels continue to rise in response to stimuli. | Positive feedback |
| Where are they thyroid glands located? | Ventrolateral to trachea. Caudal to larynx. |
| The thyroid consists of two lobes. What do they secrete? | Thyroxine (T4). Calcitonin. |
| ___ (T3 and T4) is a iodine-containing hormone that adjusts metabolic rate in response to TSH from the pituitary. | Thyroxine |
| Control of Hormone Secretion - Negative Feedback True or false: When the level of a specific hormone drops below needed levels, the appropriate endocrine gland is stimulated to produce more hormone. | True |
| Control of Hormone Secretion - Negative Feedback True or false: once the proper hormone level is present in the bloodstream, stimulation of that endocrine gland is reduced and production of that hormone is reduced. | True |
| Diseases of the Thyroid Gland ___ is a common disease of dogs, but uncommon in cats. | Hypothyroidism |
| Diseases of the Thyroid Gland What are two etiologies behind hypothyroidism? | Thyroid atrophy. Thyroiditis. |
| Diseases of the Thyroid Gland What are four clinical signs of Hypothyroidism? | Weight gain on stable diet. Endocrine alopecia. Lethargy. Heat seeking. |
| Diseases of the Thyroid Gland What are two ways to diagnose Hypothyroidism? | Blood evaluation. Test of choice is fT4 and TSH. |
| Diseases of the Thyroid Gland True or false: T4 and clinical signs without thyroid panel might misdiagnose Euthyroid Sick. | True |
| Diseases of the Thyroid Gland What is a treatment option for Hypothyroidism? Monitoring? | Thyroid replacement hormones life-long. Dose should be monitored with blood tests. |
| Diseases of the Thyroid Gland A synthetic T4 drugs called ___, know by the brand name ___, is an iodine containing hormone most commonly used in veterinary medicine. The body will convert what it needs to active T3. | levothyroxine. Soloxine. |
| Diseases of the Thyroid Gland True or false: do not randomly change brands of levothyroxine (Synthetic T4) | True |
| Diseases of the Thyroid Gland True or false: you need to regularly check blood levels (more is not better) when prescribing Synthetic T4 (levothyroxine). | True |
| Diseases of the Thyroid Gland ___ is very common in senior cats, but extremely rare in dogs. | Hyperthyroidism |
| Diseases of the Thyroid Gland Describe the etiology of Hyperthyroidism. | Functional thyroid tumor (benign or cancerous, benigh much more common). |
| Diseases of the Thyroid Gland What are eight clinical signs of Hyperthyroidism? | Weight loss with good appetite (polyphagia). Vocalizing/behavior changes. Tachycardia. Thyroid nodule. Rough coat. Vomiting/diarrhea. Hypertension. Cranky. |
| Diseases of the Thyroid Gland What is one complication of hypertension in cats with Hyperthyroidism? | Retinal hemorrhage due to detached retina. |
| Diseases of the Thyroid Gland How is hyperthyroidism diagnosed (3)? | Elevated T4. Thyroid nodule. Thyroid scintigraphy. |
| Diseases of the Thyroid Gland What are four therapy options for animals with hyperthyroidism? | Surgery (curative - mostly), invasive surgery on senior cat. Methimazole. Radioactive Iodine. Iodine Depleted Diets. |
| Diseases of the Thyroid Gland: Hyperthyroidism ___ blocks the thyroid's ability to produce T3 & T4 by blocking utilization of iodine. | Methimazole |
| Diseases of the Thyroid Gland: Hyperthyroidism True or false: if methimazole treatment is stopped, signs of disease will immediately return. | True |
| Diseases of the Thyroid Gland: Hyperthyroidism What are four possible side effects of Methimazole treatment? | Vomiting and decreased appetite. Liver failure - rarely. Blood disorders - rarely. Skin eruptions. |
| Diseases of the Thyroid Gland: Hyperthyroidism True or false: animals receiving methimazole treatment should be monitored every 4-6 months for T4, CBC, and Chemistries. | True |
| Diseases of the Thyroid Gland: Radioactive Iodine True or false: it has a 98% cure rate (one time dose). | True |
| Diseases of the Thyroid Gland: Radioactive Iodine True or false: must be done at a licensed facility. | True |
| Diseases of the Thyroid Gland: Radioactive Iodine True or false: feces must have special handling for about 1 month after treatment. | True |
| Adrenal Glands They secrete what two substances? | Glucocorticoids (Cortisol). Mineralocorticoids (Aldosterone). |
| Adrenal Glands True or false: glucocorticoids are secreted due to ACTH signal from the pituitary? | True |
| Adrenal Glands What are some effects that glucocorticoids exhibit on the body? | Pro: anti-inflammatory, chronic stress. Con: decreased immune system, decreased muscle mass, hyperglycemia, polyuria/polydipsia. |
| Adrenal Glands True or false: aldosterone excreted by the adrenal cortex conserves Na+ and water in the kidneys to maintain blood pressure. Signaled by renin release by the kidney as part of a hormone cascade. | True |
| Adrenal Glands True or false: the adrenal medulla secretes epinephrine and norepinephrine due to signal from sympathetic nervous system. "Fight or flight" magnification. | True |
| Hypoadrenocorticism Is also called: | Addison's Disease |
| Hypoadrenocorticism What are two etiologies? | Insufficient production of: glucocorticoids and mineralocorticoids. |
| Hypoadrenocorticism What are five clinical signs (may be vague)? | Intermittent vomiting and diarrhea. Weakness. Polydypsia/Polyuria. Bradycardia. Endocrine coat pattern. |
| Hypoadrenocorticism What are three clinical signs of severe disease? | Collapse. Renal Failure. Megaesophagus. |
| Hypoadrenocorticism What are three treatment options for severe acute (emergency) disease? | IV fluids. Electrolyte correction. Glucocorticoids. |
| Hypoadrenocorticism What are two treatment options for chronic disease? | Mineralocorticoid replacement. Glucocorticoid replacement. |
| Hypoadrenocorticism What seven abnormalities might you see in blood test results? | Very low cortisol levels. Minimal response to ACTH stimulation. Increased potassium. Decreased sodium. Increased kidney values. Dilute urine. NA:K ratio <25 |
| Hypoadrenocorticism ___ is an oral mineralcorticoid with some glucocorticoid activity used in treatment. In cases of overdose, you might see PU/PD, Hypertension, Hypokalemia. | Fludrocortisone (Florinef). |
| Hypoadrenocorticism True or false: electrolytes and chemistries should be monitored every 3-4 months when treating an animal with Fludrocortisone (Florinef). | True |
| Hypoadrenocorticism: DOCP: Desoxycorticosterone ___ is a parenteral mineralcorticoid (IM); must shake vigorously prior to use. | Percorten-V |
| Hypoadrenocorticism: DOCP: Desoxycorticosterone Percorten-V (DOCP) is given every ___ days and is expensive. | 25 days |
| Hypoadrenocorticism: DOCP: Desoxycorticosterone True or false: animals receiving Percorten-V should be monitored for electrolytes and chemistries every 3-4 months. | True |
| Hypoadrenocorticism: DOCP: Desoxycorticosterone True or false: Percorten-V does not have corticosteroid effect and so prednisone is also needed. | True |
| Hypoadrenocorticism: DOCP: Desoxycorticosterone What three clinical signs might you see in an animal overdosed on Percorten-V? | PU/PD. Hypertension. Hypokalemia. |
| Hyperadrenocorticism What is another name? | Cushing's Syndrome |
| Hyperadrenocorticism Etiology: excess cortisol in the body. What are three caused of these abnormal levels? | Pituitary tumor (most common). Adrenal tumor. Iatrogenic. |
| Hyperadrenocorticism What are five clinical signs? | PU/PD (Urine sp. Gr. <1.015). Panting. Abdominal fat. Hair coat changes. Elevated AP. |
| Hyperadrenocorticism What is the gold standard for diagnosis? | Dexamethasone suppression test - 8 hour test |
| Hyperadrenocorticism - Endocrine Alopecia What are five attributes you might see in a Cushing's Animal? | Bilateral Symmetric Flank Alopecia. "Rat tail." Hyperpigmentation. Dry coat/Excess shedding. Loss of curl (Poodles). |
| Hyperadrenocorticism What are six common sequelae (consequences)? | Hypertension. Chronic infections. Pancreatitis. Diabetes Mellitus. Heart Failure. Cruciate Ligament Rupture. |
| Hyperadrenocorticism What are two therapy options? | Surgical: removal of adrenal or pituitary tumor, if present. Medical: chemotherapy to shrink hyperplasia of adrenals (Lysodren). Chemical interference with excess steroid production: Trilostane or Melatonin. |
| Hyperadrenocorticism True or false: Mitotane (o,p-DDD) is an adrenal cytotoxic agent that preferentially acts at corticosteroid level within 10 days of therapy (induction). Animal then put on a maintenance dose weekly. | True. Dose is increased until appetite loss is noted. |
| Hyperadrenocorticism What is a clinical signs of overdose of Mitotane (o,p-DDD) in these cases? Monitoring? | Hypoadrenocorticism. Monitoring with CBC, Chemistries, and ACTH stimulation very important. |
| Hyperadrenocorticism ___ (Vetoryl): the most common drug for HAC currently. Given as a daily dose or twice daily dose. Dose must be carefully tailored to the patient. Requires frequent monitoring with ACTH stimulation tests to ensure adequate dose. | Trilostane. Expensive. |
| Pancreas ___ ___ is defined as inadequate secretion or utilization of insulin resulting in a disorder of carbohydrate metabolism. | Diabetes mellitus |
| Diabetes mellitus What are six clinical signs? | PU/PD. Polyphagia. Weight loss. Lethargy/weakness. Plantigrade stance (Neuropathy). Sudden cataracts. |
| Diabetes mellitus: In Dogs Type I Diabetes is characterized by: | absolute lack of insulin production |
| Diabetes mellitus: In Dogs What are four predisposing factors? | Genetics. Pancreatitis. Endocrine disease. Obesity. |
| Diabetes mellitus: In Cats Type II Diabetes is characterized by: | Relative decrease in insulin (tissues are less sensitive). |
| Diabetes mellitus: In Cats What are four predisposing factors? | Pancreatitis. Certain medications. Obesity, obesity, obesity (sometimes reversible if weight corrected). Inappropriate diet. |
| Diabetes mellitus What are three ways to diagnose it? | Hyperglycemia with glycosuria. Elevated fructosamine. Glycated hemoglobin. |
| Diabetes mellitus: Therapy Goals Maintain blood glucose between __ and ___ mg/dl. Maintain ideal body weight. Resolution of neuropathies. General well-being of pet and owner. | 100 and 300 mg/dl. |
| Diabetes mellitus Are there oral hypoglycemics? | yes. Sulfonylurea drugs (glipizide, glimiperide). They directly stimulate B cells to produce insulin. |
| Diabetes mellitus True or false: Sulfonylurea drugs such as glipizide and glimiperide are not therapy options for dogs. | True |
| Diabetes mellitus True or false: Sulfonylurea drugs such as glipizide and glimiperide can cause adverse reactions such as liver damage in some cats. | True |
| Diabetes mellitus True or false: Sulfonylurea drugs generally do not work well in veterinary medicine. | True. Glipizide. Glimiperide. |
| Diabetes mellitus Insulin should always be identified by what three factors? | Species of origin (Humulin, Pork, Beef). Concentration. Duration of effect. |
| Diabetes mellitus: Insulin Handling True or false: All insulin should be carefully rolled in palms to re-suspend insulin crystals for accurate dosing. | True |
| Diabetes mellitus: Insulin Handling ___ can inactivate insulin due to damage of proteins. | Shaking |
| Diabetes mellitus: Insulin Handling ___ for maximum shelf-life, at room temperature insulin must be discarded after 7 days. | Refrigerate |
| Diabetes mellitus: Insulin Handling True or false: insulin must be kept in glass vial until ready to use because insulin sticks to plastic and will not dose accurately if "pre-drawn into syringes." | True |
| Diabetes mellitus: Insulin Handling Insulin syringes are one use only. Name three reasons why. | Sterility. Insulin crystals will clog needle. Fine needles are dull after one use. |
| Diabetes mellitus What are four means of monitoring glucose levels? | At home glucose checks. In clinic glucose curves. Fructosamine levels. Urine glucose strips. |
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