Cardiac and Respiratory Pharmacology
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Questions and Answers

What effect does ketoconazole primarily have on cortisol synthesis?

  • Enhances cortisol synthesis
  • Inhibits cortisol synthesis (correct)
  • Has no effect on cortisol synthesis
  • Stimulates cortisol release

    • Which adverse effect is associated with the use of ketoconazole?

  • Anorexia and vomiting (correct)
  • Respiratory depression
  • Increased urinary retention
  • Muscle hypertrophy

    • Which of the following statements about itraconazole is true?

  • It has more adverse effects than ketoconazole
  • It is a cytochrome P450 inhibitor (correct)
  • It inhibits cortisol synthesis
  • It does not have potential drug interactions

    • What is a significant effect of amphotericin B on the fungal cell membrane?

    <p>Forms channels in the membrane</p> Signup and view all the answers

    Which of the following effects is NOT associated with ketoconazole?

    <p>Enhanced bone resorption</p> Signup and view all the answers

    What is one of the hematopoietic effects of amphotericin B?

    <p>Thrombocytosis</p> Signup and view all the answers

    What renal effect can ketoconazole cause?

    <p>Polyuria</p> Signup and view all the answers

    Which statement about the mechanism of action of amphotericin B is incorrect?

    <p>It has a high affinity for cholesterol</p> Signup and view all the answers

    What is a side effect of higher doses of narrow therapeutic index medications in cats?

    <p>Mydriasis</p> Signup and view all the answers

    Which statement is true regarding Milbemycin oxime?

    <p>It effectively prevents heartworms and treats L5 larvae.</p> Signup and view all the answers

    What is the proposed mechanism of action for Melarsomine?

    <p>Arsenical interactions with sulfhydryl groups in enzymes</p> Signup and view all the answers

    Which of the following is a contraindication for using Milbemycin oxime?

    <p>Class 4 heartworm disease</p> Signup and view all the answers

    What is a common side effect of Selamectin?

    <p>Pulmonary thromboembolism</p> Signup and view all the answers

    Which breed is noted for a higher incidence of toxicosis from narrow therapeutic index medications?

    <p>Collies</p> Signup and view all the answers

    What does Milbemycin oxime NOT treat?

    <p>Adult heartworms</p> Signup and view all the answers

    Which statement accurately describes the safety profile of heartworm preventative doses in collies?

    <p>It is reported to be safe.</p> Signup and view all the answers

    Which condition is contraindicated for the use of atenolol?

    <p>Myasthenia gravis</p> Signup and view all the answers

    What are the side effects of mexiletine?

    <p>GI upset</p> Signup and view all the answers

    Which type of arrhythmias is quinidine primarily indicated for?

    <p>Refractory ventricular arrhythmias</p> Signup and view all the answers

    What is a common side effect of sotalol?

    <p>Hypotension</p> Signup and view all the answers

    Which class of antiarrhythmics does mexiletine belong to?

    <p>Class I</p> Signup and view all the answers

    Which medication can cause a negative inotropic effect?

    <p>Esmolol</p> Signup and view all the answers

    What mechanism does Class III antiarrhythmics such as sotalol utilize?

    <p>Block potassium channels</p> Signup and view all the answers

    Which condition should not be treated with a drug that induces hypotension rapidly?

    <p>Hypertrophic heart disease</p> Signup and view all the answers

    What is a key benefit of using adrenergic signal transduction potentiators in cardiac treatment?

    <p>Increases myocardial contractility without increased oxygen consumption</p> Signup and view all the answers

    Which of the following is a contraindication for adrenergic agonists like albuterol?

    <p>Hypertension</p> Signup and view all the answers

    What is a common side effect associated with the use of nonselective beta-adrenergic agonists like epinephrine?

    <p>Tachycardia</p> Signup and view all the answers

    Which conditions can be indicated for the use of milrinone?

    <p>Arterial hypertension and CHF</p> Signup and view all the answers

    Which side effect is likely associated with terbutaline, a selective β-2 adrenergic receptor agonist?

    <p>Hyperglycemia</p> Signup and view all the answers

    What additional mechanism does pimobendan exhibit besides potentiating adrenergic signal transduction?

    <p>Increasing myocardial relaxation</p> Signup and view all the answers

    Which of the following statements about amrinone is incorrect?

    <p>It is a potent bronchodilator.</p> Signup and view all the answers

    What is a therapeutic use of albuterol?

    <p>Management of bronchospasm</p> Signup and view all the answers

    What is the main mechanism of action of Bethanechol?

    <p>Activation of muscarinic receptors</p> Signup and view all the answers

    Which of the following adverse effects is commonly associated with the use of Bethanechol?

    <p>SLUD symptoms</p> Signup and view all the answers

    Which beta-lactam antibiotic is specifically formulated to resist breakdown by beta-lactamases?

    <p>Clavulanate</p> Signup and view all the answers

    Which of the following statements accurately describes cephalosporins compared to penicillins?

    <p>Cephalosporins inhibit bacterial cell-wall synthesis.</p> Signup and view all the answers

    What distinguishes third-generation cephalosporins from first and second generations?

    <p>They often include coverage for Pseudomonas species.</p> Signup and view all the answers

    What are some common side effects of sulfonamides?

    <p>Idiosyncratic reactions and skin eruptions</p> Signup and view all the answers

    Which of the following is a contraindication for the use of certain beta-lactam antibiotics?

    <p>Hypotension</p> Signup and view all the answers

    What is the general spectrum of activity for standard penicillins?

    <p>Good activity against anaerobes and some gram-negative bacteria</p> Signup and view all the answers

    What is the primary action of endogenous catecholamines in relation to norepinephrine?

    <p>They act as a precursor for norepinephrine synthesis.</p> Signup and view all the answers

    Which medication is specifically indicated for short-term management of diabetics during hospitalization?

    <p>Regular insulin</p> Signup and view all the answers

    Which side effect is associated with the use of certain unspecified medications in the context discussed?

    <p>Polyuria</p> Signup and view all the answers

    What side effect is generally associated with higher doses of certain drugs mentioned?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is the effect of ACE inhibitors on the generation of angiotensin II?

    <p>They decrease its generation.</p> Signup and view all the answers

    In the context of renal function, which condition could be a contraindication for the use of certain medications discussed?

    <p>Pheochromocytoma</p> Signup and view all the answers

    Which type of insulin is characterized as having an intermediate action and is intended for maintenance therapy?

    <p>NPH insulin</p> Signup and view all the answers

    What is the secondary effect of ACE inhibitors besides decreasing angiotensin II production?

    <p>Reduction of proteinuria</p> Signup and view all the answers

    What mechanism of action does fenbendazole utilize to impair nematodes?

    <p>Binding to microtubules and inhibiting cell division</p> Signup and view all the answers

    Which adverse effect is most commonly associated with ivermectins in mammals?

    <p>Hyperexcitability followed by sedation</p> Signup and view all the answers

    Which of the following parasitic infections is fenbendazole effective against in cattle?

    <p>Haemonchus</p> Signup and view all the answers

    What is a key contraindication for the use of ivermectin in veterinary medicine?

    <p>Lactating dairy cows</p> Signup and view all the answers

    Which of the following statements is true regarding the efficacy of ivermectin?

    <p>It is ineffective against tapeworms</p> Signup and view all the answers

    What is a potential side effect following the administration of anthelmintic agents like ivermectin?

    <p>Local swelling and pruritus</p> Signup and view all the answers

    What condition is ivermectin NOT indicated for the treatment of in horses?

    <p>Tapeworms</p> Signup and view all the answers

    Which of the following is a mechanism by which ivermectin operates?

    <p>Potentiating the action of GABA</p> Signup and view all the answers

    What is a primary mechanism by which colchicine functions?

    <p>Microtubule inhibitor</p> Signup and view all the answers

    Which of the following side effects is associated with an overdose of a specific medication?

    <p>Tachycardia</p> Signup and view all the answers

    What is an important contraindication for the use of D-penicillamine?

    <p>Pregnancy</p> Signup and view all the answers

    What condition is trilostane primarily used to treat?

    <p>Hyperadrenocorticism</p> Signup and view all the answers

    Which of the following correctly describes a mechanism of action for mitotane?

    <p>Decreases glucocorticoid secretion</p> Signup and view all the answers

    What side effect is commonly associated with colchicine?

    <p>Peripheral neuropathy</p> Signup and view all the answers

    What is a significant side effect of high doses of D-penicillamine?

    <p>Hypocortisolemia</p> Signup and view all the answers

    Which indication is appropriate for using D-penicillamine?

    <p>Copper-associated hepatopathy</p> Signup and view all the answers

    What is the mechanism of action of Desoxycorticosterone pivalate (DOCP)?

    <p>It serves as a long-acting injectable mineralocorticoid.</p> Signup and view all the answers

    Which side effect is commonly associated with the use of mineralocorticoid supplementation?

    <p>Hyponatremia and hyperkalemia.</p> Signup and view all the answers

    Why might adjunct use of glucocorticoids be necessary with DOCP treatment?

    <p>To compensate for the lack of glucocorticoid activity in DOCP.</p> Signup and view all the answers

    What is the expected frequency of administration for Desoxycorticosterone pivalate in hypoadrenocorticism cases?

    <p>Every 25 to 28 days.</p> Signup and view all the answers

    What potential effect may occur when using drugs that decrease cortisol synthesis?

    <p>Adrenal enzyme inhibition.</p> Signup and view all the answers

    What is a notable characteristic of Glargine as an insulin formulation?

    <p>It provides a fairly flat glucose curve.</p> Signup and view all the answers

    Which of the following is a contraindication for using DOCP?

    <p>Inadequate glucocorticoid support.</p> Signup and view all the answers

    What is the relationship between glucagon and insulin as it pertains to blood glucose levels?

    <p>Glucagon increases blood glucose levels while insulin decreases them.</p> Signup and view all the answers

    What are the primary side effects associated with the rapid IV administration of a specific antiarrhythmic drug?

    <p>Hypotension and gastrointestinal upset</p> Signup and view all the answers

    Which of the following conditions is contraindicated for the use of atenolol in cats?

    <p>Second-degree AV block</p> Signup and view all the answers

    In what scenario is quinidine indicated for use?

    <p>Refractory ventricular arrhythmias</p> Signup and view all the answers

    What is a significant side effect of mexiletine that should be monitored?

    <p>Gastrointestinal upset</p> Signup and view all the answers

    Which statement accurately describes the primary pharmacological action of class III antiarrhythmics?

    <p>Blocking potassium channels to prolong the refractory period</p> Signup and view all the answers

    What is the main contraindication for using esmolol?

    <p>Bradyarrhythmias</p> Signup and view all the answers

    Which of the following best describes the mechanism of action for mexiletine?

    <p>It blocks sodium channels while prolonging the action potential</p> Signup and view all the answers

    What side effect is associated with class II and class III antiarrhythmics such as sotalol?

    <p>Negative inotropic effect</p> Signup and view all the answers

    What is the primary mechanism of action of methimazole?

    <p>Inhibits thyroid peroxidase and thyroid hormone synthesis</p> Signup and view all the answers

    Which of the following statements about lactulose is accurate?

    <p>It acts by trapping ammonia and reducing its absorption</p> Signup and view all the answers

    What is a significant contraindication for using radioiodine treatment?

    <p>Presence of underlying renal disease</p> Signup and view all the answers

    What is a commonly reported side effect of neomycin?

    <p>Bitter taste</p> Signup and view all the answers

    L-thyroxine is indicated for which of the following conditions?

    <p>Hypothyroidism</p> Signup and view all the answers

    Which statement best describes the side effects of metronidazole?

    <p>It leads to dose-dependent diarrhea</p> Signup and view all the answers

    Which of the following is a correct mechanism of action for drugs used in hepatic encephalopathy?

    <p>Convert to osmotically active acids in colon</p> Signup and view all the answers

    What is a key use of metronidazole besides treating hepatic encephalopathy?

    <p>It is used for anaerobic infections</p> Signup and view all the answers

    What is a potential risk associated with potassium supplementation?

    <p>Worsening of bradycardia</p> Signup and view all the answers

    Which two potential indications are associated with potassium citrate?

    <p>Reduction of calcium oxalate uroliths and interstitial cystitis</p> Signup and view all the answers

    Amitriptyline primarily acts by blocking which neurotransmitter reuptake?

    <p>Serotonin and norepinephrine</p> Signup and view all the answers

    Which side effect is commonly associated with amitriptyline?

    <p>Paradoxical hyperexcitability</p> Signup and view all the answers

    What is a contraindication for the use of amitriptyline?

    <p>Concomitant use of MAO inhibitors</p> Signup and view all the answers

    What is the primary mechanism of action of phenylpropanolamine?

    <p>Alpha-adrenergic agonist</p> Signup and view all the answers

    In which condition is phenylpropanolamine indicated?

    <p>Nasal congestion</p> Signup and view all the answers

    What effect does EPO (erythropoietin) have on blood cell production?

    <p>Stimulates erythropoiesis</p> Signup and view all the answers

    What is the primary mechanism of action of aminoglycosides?

    <p>Bind to ribosomal 30S subunit</p> Signup and view all the answers

    Which of the following statements regarding the side effects of fluoroquinolones is accurate?

    <p>They can lead to cartilage damage in growing animals</p> Signup and view all the answers

    What spectrum of activity do second-generation antibiotics provide?

    <p>Excellent gram-negative and gram-positive coverage but no anaerobes</p> Signup and view all the answers

    In terms of indications, which infection is metronidazole primarily used to treat?

    <p>Anaerobic infections</p> Signup and view all the answers

    Which specific side effect classifies aminoglycosides as requiring close monitoring?

    <p>Dose-dependent nephrotoxicity</p> Signup and view all the answers

    Which of the following is a significant concern when administering fluoroquinolones to growing animals?

    <p>Risk of cartilage damage</p> Signup and view all the answers

    Which of the following statements is true regarding the use of third-generation antibiotics?

    <p>They offer greatly extended gram-negative coverage</p> Signup and view all the answers

    Which of the following descriptions accurately reflects the indications for fluoroquinolones?

    <p>Used for several gram-negative infections</p> Signup and view all the answers

    Which antibiotic class is less sensitive to beta-lactamases and inhibits bacterial cell-wall synthesis?

    <p>Cephalosporins</p> Signup and view all the answers

    What is a common adverse effect associated with the use of standard penicillins?

    <p>Penicillin allergy</p> Signup and view all the answers

    Which of the following statements about third-generation cephalosporins is true?

    <p>They are classified but do not have an expanded spectrum.</p> Signup and view all the answers

    What is the main effect of Bethanechol on the bladder?

    <p>Increases bladder detrusor tone</p> Signup and view all the answers

    Which type of reactions can sulfonamides potentially cause?

    <p>Keratoconjunctivitis sicca (KCS)</p> Signup and view all the answers

    What clinical situation may indicate the use of extended-spectrum penicillins?

    <p>Infections involving Pseudomonas</p> Signup and view all the answers

    What condition is a contraindication for the use of certain beta-lactam antibiotics?

    <p>Equine colic</p> Signup and view all the answers

    Which of the following is NOT a side effect of Bethanechol?

    <p>Constipation</p> Signup and view all the answers

    What is the primary mechanism of action of fentanyl?

    <p>Full agonist at mu receptors</p> Signup and view all the answers

    Which indication is NOT commonly associated with the use of fentanyl?

    <p>Long-term chronic pain relief</p> Signup and view all the answers

    What is a potential side effect of fentanyl administration?

    <p>Respiratory depression</p> Signup and view all the answers

    How does hydromorphone compare in potency relative to morphine?

    <p>It is five times more potent than morphine</p> Signup and view all the answers

    Which of the following describes the duration of action of fentanyl?

    <p>20 to 30 minutes</p> Signup and view all the answers

    What is a significant property of transdermal fentanyl patches?

    <p>They can be used for more than 3 days.</p> Signup and view all the answers

    Which agent is characterized by a serotonergic effect that inhibits serotonin and norepinephrine reuptake?

    <p>Tramadol</p> Signup and view all the answers

    What side effect is typically associated with the use of hydromorphone?

    <p>Respiratory depression</p> Signup and view all the answers

    What is the primary mechanism of action for the opioid antidiarrheals mentioned?

    <p>They increase time available for water resorption.</p> Signup and view all the answers

    What is a side effect that is common to the use of opioids as antidiarrheal medications?

    <p>Constipation</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the anticholinergics used as antidiarrheals?

    <p>They have a mechanism of action that involves opioid receptors.</p> Signup and view all the answers

    What is a contraindication for using opioids as antidiarrheal agents?

    <p>Infectious diarrhea caused by organisms like Salmonella</p> Signup and view all the answers

    What form of constipation treatment is characterized as a bulk-forming agent?

    <p>Psyllium</p> Signup and view all the answers

    What is a potential negative effect of using mineral oil for treating constipation?

    <p>Impairment of water resorption in the colon</p> Signup and view all the answers

    What type of medication is bismuth subsalicylate classified as?

    <p>Antidiarrheal</p> Signup and view all the answers

    Which symptom is associated with side effects of cyclosporine?

    <p>Alopecia</p> Signup and view all the answers

    What is the primary mechanism of action of azole antifungals?

    <p>Blocks synthesis of ergosterol</p> Signup and view all the answers

    Which of the following is a side effect associated with glucocorticoids?

    <p>Gastrointestinal upset</p> Signup and view all the answers

    In which scenario is fluconazole primarily indicated?

    <p>Management of systemic mycoses</p> Signup and view all the answers

    What is a characteristic of griseofulvin when used alone?

    <p>Rapidly induces resistance</p> Signup and view all the answers

    Which of the following conditions demonstrates a contraindication for azole antifungals in cats?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is one of the significant actions of griseofulvin within the body?

    <p>Accumulates in developing keratinocytes</p> Signup and view all the answers

    What key aspect distinguishes ketoconazole from other azole antifungals?

    <p>Increased risk of gastrointestinal side effects in cats</p> Signup and view all the answers

    What component does the action of glucocorticoids mainly target within cells?

    <p>Intracellular glucocorticoid receptor</p> Signup and view all the answers

    What is a primary effect of ACE inhibitors on systemic vascular resistance?

    <p>Decrease systemic vascular resistance</p> Signup and view all the answers

    In what condition are β-blockers mainly indicated?

    <p>Congestive heart failure</p> Signup and view all the answers

    What is one of the mechanisms through which prazosin reduces afterload?

    <p>α1 adrenergic antagonism</p> Signup and view all the answers

    Which side effect is commonly associated with the use of ACE inhibitors?

    <p>Gastrointestinal upset</p> Signup and view all the answers

    What distinguishes Class I antiarrhythmics from β-blockers?

    <p>Effect on refractory periods</p> Signup and view all the answers

    What is a significant effect of hydralazine as a vasodilator?

    <p>Direct arterial dilation</p> Signup and view all the answers

    Which condition is specifically listed as a contraindication for prazosin?

    <p>Digoxin toxicity</p> Signup and view all the answers

    Which of the following best describes a primary action of lidocaine as an antiarrhythmic?

    <p>Stabilization of myocardial membranes</p> Signup and view all the answers

    What is the primary mechanism of action of Methimazole?

    <p>Inhibits thyroid peroxidase and thyroid hormone synthesis</p> Signup and view all the answers

    What is a notable side effect associated with Lactulose use?

    <p>Dose-dependent diarrhea</p> Signup and view all the answers

    Neomycin primarily functions by what mechanism?

    <p>Inhibits ammonia generation in colon</p> Signup and view all the answers

    Which condition can be unmasked by the treatment of Radioiodine?

    <p>Underlying renal disease</p> Signup and view all the answers

    What is the indication for prescribing L-thyroxine?

    <p>Hypothyroidism</p> Signup and view all the answers

    What potential adverse reaction is associated with Metronidazole?

    <p>Cerebellar toxicity</p> Signup and view all the answers

    What is the main indication for using Neomycin?

    <p>Hepatic encephalopathy</p> Signup and view all the answers

    The treatment with Lactulose is primarily aimed at reducing what substance?

    <p>Ammonia absorption</p> Signup and view all the answers

    What is the primary mechanism of action for heartworm adulticide Thiacetarsamide?

    <p>Organic arsenical action leading to disruption of parasite function</p> Signup and view all the answers

    Which of the following best describes the side effects associated with the use of Thiacetarsamide?

    <p>Severe vesicant, nephrotoxicity, and hepatotoxicity possible</p> Signup and view all the answers

    In which of the following scenarios is the use of heartworm adulticide Thiacetarsamide most indicated?

    <p>For heartworm infection in dogs without microfilaria</p> Signup and view all the answers

    Which of the following statements about organophosphates (OPs) is accurate?

    <p>They can cause permanent nerve damage upon phosphorylation</p> Signup and view all the answers

    What signs might indicate muscarinic toxicosis from organophosphate exposure?

    <p>Miosis, salivation, and frequent urination</p> Signup and view all the answers

    Which statement regarding the reactivation of phosphorylated AchE is correct?

    <p>Once aged, reactivation of the enzyme is not possible</p> Signup and view all the answers

    What is one of the main features of the combination product Imidacloprid plus permethrin?

    <p>Topical application effective against fleas and lice</p> Signup and view all the answers

    Which of the following is NOT a known side effect of organophosphates?

    <p>Severe nephrotoxicity</p> Signup and view all the answers

    Study Notes

    Antiarrhythmics

    • Lidocaine IV used to treat ventricular arrhythmias that are unresponsive to lidocaine
    • Atenolol is the drug of choice for feline ventricular arrhythmias
    • Mexiletine is an oral analog of lidocaine and is the drug of choice for ventricular arrhythmias in dogs
    • Quinidine prolongs the duration of the action potential and refractory period in both the atria and the ventricles
    • Sotalol is a combination class II and III antiarrhythmic

    Cardiac Drugs

    • Pimobendan is a positive inotrope that enhances cardiac contractility without increasing myocardial oxygen consumption
    • Amrinone and milrinone are used to treat CHF, dilated cardiomyopathy or valvular disease, and arterial hypertension

    Bronchodilators

    • Terbutaline and Albuterol are selective beta-2 adrenergic receptor agonists used to treat bronchospasm
    • Epinephrine is a nonselective beta-adrenergic agonist that stimulates beta-1, beta-2 and beta- adrenergic receptors and is used to treat allergic reactions and acute severe bronchospasm

    Anti-Inflammatory Drugs

    • Corticosteroids have a broad spectrum of anti-inflammatory effects including:
      • Inhibition of inflammatory cell mediator release
      • Stimulation of mucous secretion
      • Enhancement of mucociliary clearance
    • Corticosteroids can cause side effects:
      • Increased intraocular pressure
      • Inhibition of ejaculation

    Antibiotics

    • Penicillins inhibit bacterial cell wall synthesis
    • Cephalosporins inhibit bacterial cell wall synthesis and are less sensitive to beta-lactamases
    • Ketoconazole is a cytochrome P450 inhibitor and can cause:
      • Anorexia and vomiting
      • Increases in ALT
      • Inhibition of cortisol synthesis
      • Many potential drug interactions

    Anti-Fungal Drugs

    • Amphotericin B selectively binds ergosterol, a major component of fungal cell membranes, and alters fungal membrane permeability
    • Milbemycin oxime is effective as a heartworm preventative and microfilaricide in dogs as well as controlling infections with hookworms, roundworms and whipworms
    • Selamectin is a topical anti-parasitic widely used in cats and dogs

    Heartworm medications

    • Melarsomine is an organic arsenical used to treat adult heartworms and L5 larvae in dogs

    Class I Antiarrhythmics

    • Lidocaine is used intravenously for lidocaine-refractory ventricular arrhythmias
    • Atenolol is the drug of choice for feline arrhythmias
    • Mexiletine is an oral analog of lidocaine
    • Mexiletine is the oral drug of choice for ventricular arrhythmias in dogs
    • Quinidine prolongs the duration of the action potential and refractory period in both the atria

    Class II Antiarrhythmics

    • Beta-blockers decrease the heart rate and contractility
    • Propranolol and atenolol are commonly used in veterinary medicine
    • Esmolol is used intravenously only (short half-life)

    Class III Antiarrhythmics

    • Block potassium channels
    • Prolong the refractory period
    • Increase the duration of the action potential
    • Have the greatest effects in Purkinje fibers and ventricular muscle

    Sotalol

    • Combination class II and class III antiarrhythmic
    • Nonselective beta-adrenergic receptor antagonist
    • Potassium channel blocker

    Antiarrhythmic Side Effects and Contraindications

    • GI upset
    • Do not use with second- or third-degree AV block
    • Drug-induced arrhythmias
    • May cause hypotension with rapid IV administration
    • Contraindicated in myasthenia gravis
    • Negative inotropic effect
    • Hypotension
    • Lethargy
    • Diarrhea
    • Bradyarrhythmias
    • Drug-drug interactions
    • Negative inotropy
    • Proarrhythmic
    • Bronchovestibular neurologic signs with overdose
    • Anorexia, GI upset

    Colchicine (Anti-Fibrotics)

    • Microtubule inhibitor
    • Inhibits procollagen secretion
    • Used empirically for fibrotic liver disease with or without ascites
    • GI upset (dose dependent)
    • Peripheral neuropathy, myopathy, and bone marrow suppression less common

    Decoppering Agents

    • D-penicillamine chelates plasma copper to allow urinary excretion

    D-penicillamine Indications

    • Biopsy diagnosis of copper-associated hepatopathy

    D-penicillamine Side Effects

    • GI upset (common)
    • Contraindicated in pregnancy

    Zinc Mechanisms

    • Decreases copper absorption
    • Induces metallothionein synthesis by enterocytes, which binds intestinal copper and prevents absorption
    • May also have anti-fibrotic effects

    Zinc Indications

    • Biopsy diagnosis of copper-associated hepatopathy

    Drugs for Adrenal Disease

    • Mitotane is toxic to zona fasciculata and zona reticularis layers of the adrenal glands and decreases glucocorticoid secretion
    • Trilostane inhibits adrenal enzyme 3-beta-hydroxysteroid dehydrogenase and decreases cortisol and aldosterone secretion

    Antidiabetic Drugs

    • Regular insulin is the most rapid onset and shortest acting insulin
    • NPH, Lente, PZI, and Ultralente insulin types are intermediate-acting and can be given subcutaneously or intramuscularly

    Oral Hypoglycemic Drugs

    • Glipizide is commonly used for hyperglycemia.

    Drugs for Renal Disease

    • Dopamine is sometimes used for oliguric renal failure; efficacy is controversial
    • ACE inhibitors (e.g., enalapril, benazepril) inhibit ACE to decrease generation of angiotensin II and secondarily decrease elaboration of aldosterone and antidiuretic hormone (ADH)

    Anticonvulsant Drugs

    • Bromides are a class of anticonvulsant drugs
    • Mammals have GABA neurotransmission limited to the CNS, and ivermectins are excluded from the CNS in most mammals

    Heartworm, Flea, and Endoparasite Prevention

    • Ivermectin potentiates the action of the inhibitory neurotransmitter GABA and is used in both horse and cattle
    • Milbemycin oxime is effective against a wide range of internal and external parasites

    Antihypertensives

    • Angiotensin-converting enzyme (ACE) inhibitors (e.g., enalapril, benazepril) are potent arterial vasodilators
    • ACE inhibitors directly act on vascular smooth muscle to decrease contractility by modifying calcium metabolism
    • ACE inhibitors decrease systemic vascular resistance and afterload
    • ACE inhibitors are indicated for congestive heart failure (CHF) and severe or refractory hypertension
    • ACE inhibitors can cause hypotension, reflex tachycardia, and gastrointestinal upset
    • Hydralazine is a potent arterial vasodilator
    • Hydralazine directly acts on vascular smooth muscle to decrease contractility by modifying calcium metabolism
    • Hydralazine decreases systemic vascular resistance and afterload
    • Hydralazine is indicated for CHF and severe or refractory hypertension
    • Hydralazine can cause hypotension, reflex tachycardia, and gastrointestinal upset
    • Prazosin is a -1 adrenergic antagonist and a balanced vasodilator that reduces preload and afterload
    • Prazosin is indicated for CHF and refractory hypertension
    • Prazosin can cause gastrointestinal upset, syncope (first-dose effect), and development of drug tolerance

    Antiarrhythmics

    • Class I antiarrhythmics, such as lidocaine, quinidine, procainamide, and mexiletine, share similar mechanisms of action
    • Class I antiarrhythmics decrease sinus heart rate, increase the refractory period of the atrioventricular node, decrease myocardial oxygen demand, and decrease ventricular automaticity
    • Procainamide is a potent arterial vasodilator, has a direct action on vascular smooth muscle to decrease contractility by modifying calcium metabolism, and decreases systemic vascular resistance and afterload
    • Procainamide has anticholinergic effects
    • Procainamide is indicated for atrial fibrillation, refractory supraventricular tachycardias, and ventricular arrhythmias
    • Procainamide can cause gastrointestinal upset, hypotension, worsening of CHF, and atrioventricular block
    • Beta blockers (Class II antiarrhythmics) are adrenergic receptor antagonists
    • Beta blockers decrease sinus heart rate, increase the refractory period of the AV node, decrease myocardial oxygen demand, and decrease myocardial contractility
    • Beta blockers have the same indications as for Class I antiarrhythmics

    Antidiarrheals

    • Opioids, such as diphenoxylate (Lomotil) and loperamide (Immodium), are synthetic opiate agonists without CNS side effects
    • Opioids increase segmental contractions of the gut but decrease downstream movement
    • Opioids increase the time available for water resorption and decrease bowel movement frequency
    • Opioids are indicated for short-term (<48 hours) therapy of acute diarrheas in dogs
    • Opioids can cause constipation and are contraindicated for infectious diarrheas
    • Anticholinergics, such as aminopentamide (Centrine) and propantheline (Pro-Banthine), are anticholinergic agents labeled for use as an antispasmodic antidiarrheal
    • Anticholinergics can cause adverse effects and contraindications, as formulations may vary in content and potency

    Treatment of Constipation

    • Lubricants, such as petrolatum (Laxatone), are used for daily therapy for hairballs and may be sufficient for mild constipation in cats
    • Mineral oil may impair water resorption in the colon and has a risk of aspiration
    • Bulking agents include psyllium (Metamucil) and hemicellulose-containing seed extract
    • Bulking agents are insoluble fiber sources that adsorb water and swell, increasing fecal bulk
    • Osmotics, such as lactulose, are osmotic laxatives that are nonabsorbable disaccharides
    • Lactulose acts as an osmotic cathartic
    • Lactulose is indicated for hepatic encephalopathy and constipation
    • Lactulose can cause dose-dependent diarrhea

    Thyroid Disease

    • Methimazole is a medication that inhibits thyroid peroxidase and thyroid hormone synthesis
    • Methimazole is indicated for medical management of hyperthyroidism
    • Methimazole can cause gastrointestinal upset, idiosyncratic reactions, and may unmask underlying renal disease
    • Radioiodine is actively captured by thyroid glands and destroys active thyroid tissue via local beta irradiation
    • Radioiodine is indicated for hyperthyroidism
    • Radioiodine requires a short quarantine and can unmask underlying renal disease
    • L-thyroxine is a physiologic replacement of T4 and is indicated for hypothyroidism

    Antifungals

    • Azole antifungals, such as ketoconazole, itraconazole, fluconazole, and clotrimazole, block the synthesis of ergosterol, an important component of fungal cytoplasmic membrane
    • Ketoconazole and itraconazole are used for dermatophytes, Blastomyces, Coccidioides, Histoplasma, Candida, Malassezia, and Cryptococcus
    • Topical clotrimazole is used for nasal aspergillosis
    • Fluconazole is used for systemic mycoses, especially with ocular, prostate, urinary, or CNS involvement
    • Griseofulvin is a medication that enters fungi through an energy-dependent mechanism
    • Griseofulvin binds to polymerized microtubules and disrupts mitosis, accumulating in developing keratinocytes
    • Griseofulvin is indicated for dermatophytes (Microsporum and Trichophyton) and has no effect on yeast
    • Griseofulvin can cause gastrointestinal upset, bone marrow suppression, neurotoxicity, hepatotoxicity, and teratogenicity in cats, particularly kittens

    Glucocorticoids

    • Glucocorticoids bind intracellular glucocorticoid receptors and modify the expression profile of genes containing the glucocorticoid response element (GRE)
    • Glucocorticoids have catabolic effects on metabolism

    Heartworm Adulticides

    • Thiacetarsamide was an organic arsenical heartworm adulticide
    • Thiacetarsamide had no effect on microfilaria
    • Thiacetarsamide was a severe vesicant with potential for nephrotoxicity and hepatotoxicity

    Insecticides and Acaricides

    • Organophosphates (OPs), such as dichlorvos (DDVP), are highly toxic to mammals, birds, and fish
    • OPs are potent anticholinesterase agents that inhibit acetylcholinesterase (AchE) via enzyme phosphorylation
    • OPs are considered irreversible AchE inhibitors
    • OPs are used as insecticides and acaricides
    • Carbamates inhibit AchE via carbamylation, a reversible process
    • Imidacloprid is a topical adulticide that kills fleas
    • Imidacloprid has no known toxicity and is not recommended for use in sick or pregnant animals
    • Imidacloprid is available in combination products with other insecticides
    • Permethrin inhibits voltage-gated sodium channels in nerves
    • Permethrin is a topical adulticide and insecticide
    • Permethrin is a broad-spectrum insecticide that kills fleas and ticks

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