Science Quiz / Diuretics and Cardiac Drugs RonJon

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Diuresis refers to an increase in urine volume. Please give the specific term for the following?
Increased renal sodium excretion 
Increased renal chloride excretion 
Increased renal potassium excretion 
This class of diuretics works on the loop of henle?
The most commonly used class, especially in CHF cases. Includes furosemide, torsemide. 
This class of diuretic works on the distal tubule?
They include trichlormethiazide. They work by inhibiting the Na+/Cl- contransporter in the distal tubule. 
The collecting ducts and tubule are affected by these types of diuretics.
Including Spironolactone and Eplerenone. They block the effects of aldosterone in the collecting ducts. 
The early loop of henle and the proximal tubule are the target of ____ diuretics.
Including mannitol and glycerol. Freely filtered by the glomerulus, poorly absorbed from the tubule fluid. 
Which of the following is not an indication for the use of therapeutic diuretics?
a)specific ion imbalances b)severe renal disease with anuria c)edema or ascites d)acute renal failure with oliguia e)reduction in intraocular or intracranial pressure req'd 
Name a specific cause of mobilization of ECF stores causing edema or ascites and worthy of the use of diuretics?
 
What is not true regarding loop diuretics?
a)they are good for hypercalcemia b)they may cause ototoxicity, and should not be used with aminoglycosides c)digoxin is a recommended combination drug d)may cause hypotension e)may cause hypokalemia 
What is not true regarding Thiazide diuretics?
a)they are more potent than loop diuretics b)they decrease calcium excretion, and should be avoided in hypercalcemic patients c)they are sometimes combined with loop diuretics d)they are mainly used for parturient edema e)they cause a paradoxical decrease in urine output with nephrogenic diabetes inspidus 
What is not true regarding K+ sparing diuretics?
a)they are relatively weak diuretics b)they are often used in combination with other diuretics c)they should not be used if hyperkalemia is on the problem list d)all of the above are true 
What condition would contraindicate the use of mannitol to decrease intracranial pressure?
 
You might seek to prevent hypokalemia and ______ ______ by ensuring adequate K+ intake and/or adding a K+ sparing diuretic in conjunction?
 
Which of the following factors might limit diuretic response?
a)tolerance after long term use b)reduced renal blood flow c)proteinuria d)all of the above 
The only voluntary muscle involved in micturition (for which sympathetic nerves cause contraction rather than relaxation) is?
The voluntary striated muscle also causes contraction. 
True or false: Bethenechol or other cholinomimetics would be best to treat hypocontractile bladder due to neurological lesions?
 
Oxybutynin or propantheline (muscarinic antagonists, antispasmodic) or imipramine (tricyclic antidepressant that indirectly stimualtes adenergic receptors) treat this disorder?
Can be due to neurological causes, congenital disorders or tumours, but most commonly due to chronic inflammation due to infection which would also need to be addressed. 
What class do Phenoxybenzamine and Prazosin (treatments for hypertonic urethra) belong to?
Function is to decrease internal sphincter resistance, sometimes external sphincter too through centrally mediated effect. 
Match the following drugs to their adverse effects? prazosin, Imipramine, Oxybutynin
Drowsiness, constipation, urine retention 
Tremors, seizures, tachycardia 
Hypotension, reflex tachycardia, GI disturbance 
You might use this centrally acting striated muscle relaxant in a cat with a functional urethral obstruction?
 
This treatment for males with hypotonic urethra may cause aggression, perianal and prostatic disease?
 
This treatment for females with hypotonic urethra may cause bone marrow suppression, alopecia, induction of estrus.
 
Name a unisex treatment for patients with hypotonic urethras?
All of one class, may be associated with tachycardia, excitability and anorexia. 
The work or stress a heart faces at the end of diastole is generally termed?
 
The resistance against a heart must pump at systole is termed?
 
Which of the following drug types would not be a positive inotrope?
a)Na|K-ATPase blockers b)drugs that act to increase cAMP c)Beta adrenergic blockers d)calcium sensitizers 
Which of the following is a drug type that decreases afterload?
a)arteriodilators b)venodilators c)diuretics d)calcium sensitizers e)Ca2+ channel blockers 
Which of the following does not follow from the use of a positive inotrope to increase contractility?
a)increased cardiac output b)increased heart rate c)decreased TPR d)decreased afterload e)increased renal blood flow 
Name a condition that would contraindicate the use of positive inotropes?
They tend to increase MVO2 and can be arrhythmogenic... 
What is not true regarding beta agonists as positive inotropic agents?
a)they act to increase cellular cAMP and calcium ions b)dobutamine is only used for acute treatment of severe heart failure due to systolic dysfunction c)dopamine has the same function as dobutamine but is more arrhythmogenic d)dopamine in low doses causes increased vasoconstriction e)a medium dose (3-10micrograms/kg/min) is standard use of dopamine for inotropy increase 
This drug is an example of an Na/K-ATPase blocker used as a positive inotrope?
They act by increasing intracellular sodium, slightly decreasing calcium expulsion and increasing release by the SR during contraction. May also increase vagal activity. These days pimobendan has replaced this drug in the dog, but it is used in horses for heart failure, or to treat arrhythmias. It can be toxic and has a long half life. Avoid use with diuretics or hypokalemic patients. 
This group of drugs acts as positive inotropes by increasing sensitivity of myocyte contractile proteins.
They do not increase MVO2, but will block PDE III enzymes to cause some vasodilatory effects. Pimpobendin is an example. 
This drug acts as a venodilator to reduce preload?
High first pass effect, short duration, usually used as CRI. Development of tolerance overtime. Good in acute treatment of CHF. May be used in conjunction with furosemide. (An oral nitrate woudl be isosorbide) 
Aside from nitrate venodilators, what other general class of drugs would be useful to decrease preload?
 
Amlodipine is a calcium channel blocker _______ used to reduce ______.
Increases SV and decreases MVO2. Good for severe mitral regurgitation with chronic valvular disease. May also be used for hypertension. 
 
______ is another CCB arteriodilator that is more potent than amlodipine but has more reflex tachycardia and hypotension (due to negative inotropic effects)
This drug is preferable to amlodipine with severe regurgitation due to mitral or aortic insufficiency or VSD. Reserved for heart failure refractory to other dilators like ACE inhibitors. 
Enalapril, Benazapril, Imidapril are all ACE inhibitors, prodrugs that are converted into active form by the liver and act as ____ _____
Generally used as first line therapy in heart failure, blunt RAAS and SNS activity. 
This mixed vasodilator is limited in use for very short term CRI in fulminant heart failure. Causes release of NO once it enters VSM cells.
You need to start longer acting vasodilators concurrently due to rebound vasoconstriction. It may cuas ehypotension, cyanogen build up with prolonged treatment. 
Negative Inotropes and chronotropes decrease these two properties but increase ______
 
Which of the following conditions would you likely not treat with a negative inotrope?
a)hypertrophic cardiomyopathy b)dilated cardiomyopathy c)aortic stenosis d)subaortic stenosis e)arrhythmias 
This calcium channel blocker is used as a negative inotrope to increase distension?
It prefernetially affects myocytes. Main use in feline HCM. May caus ebradycardia, vasodilation, collapse with overdose.  
Beta adrenergic blockers reduce heart rate to indirectly enhance relaxation of myocytes. Name one?
 
This aldosterone receptor antagonist and potassium sparing diuretic may slow progression of heart failure, and is commonly combined with other drugs in treatment thereof?
 
This is an important and fairly frequent sequelus of feline myocardial disease, and may also follow hyperthyroidism and neoplasia.
Treated with aspirin most commonly, also could use clopidogrel (both antithrombotics) or anticoagulants like enoxaparin, warfarin or heparin. 
Arrhythmias, when classified by origin are either ______ or ______.
 
Arrhythmias, when classified by rate are either ____ or _____
 
Long term treatment for a bradyarrhythmia might be?
 
What is not true regarding Class I antiarrhythmics?
a)they work by blocking fast sodium channels b)they are most commonly used to treat ventricular tachyarrhythmias c)they may ameliorate atrial fibrillation or ventricular premature contractions d)Class 1A includes Quinidine and procainamide, class 1B includes Lidocaine and Mexiletine e)Class 1B is less profound in abnormal cardiac tissue than 1A 
Propanolol, atenolol, esmolol are all considered class ___ antiarrhythmic agents?
 
Class III antiarrhythmics are also called _____ ______ blockers, whcih act to prolong action potential duration and refractory period.
Safer than class I for preventing sudden death with ventricular arrhythmias. An example is solatol, which will act to slow heart rate as well. There is also amiodarone. 
Class IV antiarrhythmics are also called ______ ______ blockers, and include dilitiazem.
Decreased ventricular response to supra-ventricular tachyarrhythmias. 
This misc. antiarrhythmic agent is primarily indicated for supraventricular tachyarrhythmias including atrial fibrillation.
It increases parasympathetic nerve activity at the SA node, atria and AV node to decrease heart rate. It should be dosed based on lean body weight and used iwth caution for hypercalcemic or hypokalemic patients. Not for use with diuretics, or use VERY carefully. 
Anticholinergic bradyarrhythmia treatments include these two drugs?
For conditions with high vagal tone, use in sinus bradyarrhythmia and some 2nd degree heart blocks. 
Sympathomimetic bradyarrhythmia treatments include these two drugs. THey increase sinus node rate and AV conduction rate.
 

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