Drugs Acting on the Cardiovascular System

1. Drugs affecting the blood

• Hematinic/Anti-Anemic Drugs

• Hemostatics

• Anti-Hemostatic

2. Drugs Affecting the Heart

• Inotropes/Inotropics/Positive Inotropes

• Anti-Arrhythmics

3. Drugs Affecting the Blood Vessels

• Vasoactive Drugs

• Inodilators

• New/Experimental Drugs

topic outline

1. Hematinic/Anti-Anemic Drugs

2. Hemostatics

3. Anti-Hemostatic

Drugs Affecting the Blood

Hematinic/Anti-Anemic Drugs

• Increases the hemoglobin content of the blood thus increasing the red blood cell of the body

• Hemoglobin carries oxygen, which is carried by the RBC

• Increase in hemoglobin also increases RBC

Hematinic/Anti-Anemic Drugs

• _____________ of the blood thus _______________of the body

• Hemoglobin carries ____, which is carried by the ______

• Increase in hemoglobin also increases RBC

Anemia

Hematinic/Anti-Anemic Drugs

• Disorders that lack RBC/Hemoglobin

1. Iron

2. B12 (Cobalamin)

3. B9 (Folic acid)

4. Erythropoietic co-factors

5. Anabolic Steroids

Hematinic/Anti-Anemic Drugs

• examples

Hematinic/Anti-Anemic Drugs examples

Iron

• Iron's primary function in erythropoiesis is to serve as a core component of hemoglobin, the protein in red blood cells responsible for oxygen transport

• Inject iron on day 3 (with or without bleeding)

• Piglets are prone to baby pig anemia

Hematinic/Anti-Anemic Drugs examples

Iron

• Iron's primary function in erythropoiesis is to __________________________________, the protein in red blood cells responsible for _______________

• For Iron deficiency anemia in piglets?

• Piglets are prone to ______________

hemoglobin

the protein in red blood cells responsible for oxygen transport

Hematinic/Anti-Anemic Drugs examples

Iron

• Iron deficiency anemia in menstruating women

• Ferritin - An enzyme from iron helps in the hemoglobin content of RBC

Hematinic/Anti-Anemic Drugs examples

Iron

• ______________ in menstruating women

• _______ - An enzyme from iron helps in the hemoglobin content of RBC

Hematinic/Anti-Anemic Drugs examples

Iron

• Erythrogenesis (RBC Formation)

• Reticuloendothelial System (Mainly the bone marrow; liver, kidneys, spleen)

• Erythrocyte contains Hemoglobin

• Heme - provides color to the blood

• Globin - contains iron

• Hemoglobin is composed of 1 heme and 4 globin (1 globin is composed of 1 amino acid, protein)

  
  

Hematinic/Anti-Anemic Drugs examples

Iron

• ____________ (RBC Formation)

• _______________ (Mainly the bone marrow; liver, kidneys, spleen)- iron recycling

• _________ contains Hemoglobin

• Heme - provides ___________

• Globin - contains ____

• Hemoglobin is composed of _______ and _______ (1 globin is composed of 1 amino acid, protein)

  
  

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Used for RBC maturation

• without Vitamin B12 or Folic Acid, red blood cells die much earlier than their normal 120-day lifespan (human)

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Used for ___________

• without Vitamin B12 or Folic Acid, ______________________ than their normal 120-day lifespan (human)

• Chicken – 28–45 days

• Rabbit – 50–60 days

• Cat – 65–76 days

• Pig – 80–90 days

• Dog – 110–120 days

• Goat – ~125 days

• Cattle – 130–160 days

• Horse – 140–150 days

• Sheep – ~150 days

  
  

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• RBC lifespan in animals

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Maturation failure anemia

  • The RBCs die before reaching 72–120 days

  • Spleen is known as the graveyard organ

  • Lower RBC circulating results to anemic blood

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• _______________

  • The RBCs die before reaching 72–120 days

  • Spleen is known as the graveyard organ

  • Lower RBC circulating results to anemic blood

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Maturation failure anemia

  • The RBCs die before reaching 72–120 days

  • Spleen is known as the graveyard organ

  • Lower RBC circulating results to anemic blood

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Maturation failure anemia

  • The RBCs ______________

  • ______ is known as the graveyard organ

  • _______________ results to anemic blood

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Pernicious anemia

  • Abundance of B12, but the small intestines lack the intrinsic factor, which allows absorption of B12

  • This makes it under the maturation failure anemia because the RBC will not last longer, resulting to anemia

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• ___________________

  • Abundance of B12, but the small intestines lack the intrinsic factor, which allows absorption of B12

  • This makes it under the maturation failure anemia because the RBC will not last longer, resulting to anemia

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Pernicious anemia

  • Abundance of B12, but the small intestines lack the intrinsic factor, which allows absorption of B12

  • This makes it under the maturation failure anemia because the RBC will not last longer, resulting to anemia

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Pernicious anemia

  • ____________ , but the small intestines _______________, which allows _________________

  • This makes it ________________ because the_______________, resulting to anemia

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Cobalamin is a vital cofactor for enzymes involved in DNA synthesis. This process is crucial for cell division, especially in the rapid production of new red blood cells within the bone marrow.

• Folic acid is essential for erythrogenesis because it is converted to its active form, tetrahydrofolic acid, which is a crucial coenzyme in the synthesis of DNA and RNA. This process allows erythroblasts, the precursors to red blood cells, to proliferate and differentiate properly

Hematinic/Anti-Anemic Drugs examples

Cobalamin B12 and Folic acid (B9)

• Cobalamin is a ________________ involved in DNA synthesis. This process is crucial for____________, especially in the ____________________________.

• Folic acid is essential for ________________ because it is converted to its active form,_______________________, which is a crucial coenzyme in the synthesis of DNA and RNA. This process ______________, the precursors to red blood cells, to _________________________

Hematinic/Anti-Anemic Drugs examples

Erythropoietic co-factors

• Allows bone marrow to produce more RBCs (helpers)

• No direct effect on bone marrow, but rather aids the bone marrow to produce RBCs

• Copper and Cobalt - Lack of these cofactors slows down erythropoiesis

  
  

Hematinic/Anti-Anemic Drugs examples

Erythropoietic co-factors

• ___________________________ (helpers)

• ___________________ on bone marrow, but rather _____ the bone marrow to produce RBCs

• ______ and ______ - Lack of these cofactors slows down erythropoiesis

  
  

Hematinic/Anti-Anemic Drugs examples

Erythropoietic co-factors

1. Cobalt

• Cobalt is needed to produce B12. B12 is also needed by chromosomes, DNA, and the nervous system

• Cobalt directly stimulates the production of the erythropoietin (EPO) hormone by stabilizing hypoxia-inducible factor (HIF), which promotes red blood cell generation

• It is responsible in aiding the hemoglobin with oxygen-carbon dioxide exchange and synthesis (faster division of cells)

Hematinic/Anti-Anemic Drugs examples

Erythropoietic co-factors

1. Cobalt

• Cobalt is _____________. B12 is also needed by __________, ______, and the _____________

• Cobalt __________________ by stabilizing hypoxia-inducible factor (HIF), which ___________________

• It is responsible in ______________ with __________________ and _______ (faster division of cells)

Hematinic/Anti-Anemic Drugs examples

Erythropoietic co-factors

2. Copper

• Copper helps mitochondria maintain adequate energy production

• Copper influences erythropoiesis by facilitating iron metabolism, absorption, and transfer, ensuring the iron needed for hemoglobin synthesis is available for red blood cell formation.

Hematinic/Anti-Anemic Drugs examples

Erythropoietic co-factors

2. Copper

• Copper helps mitochondria ______________________

• Copper influences erythropoiesis by _____________________________, ensuring the ____ needed for hemoglobin synthesis is_______________________________.

Increases the oxygen intake of muscles

Hematinic/Anti-Anemic Drugs examples

Anabolic Steroids

• ?

Hemostatics

• Hemo = blood

• Static = stagnant

Hemostatics

• Hemo = _____

• Static = ______

Hemostatics

• Controls bleeding or hemorrhages

• Prevents blood loss anemia

• Topical and Systemic

Hemostatics

• Controls ______ or ______

• Prevents ___________

• 2 types?

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Stops bleeding coming from small and superficial blood vessels

• Apply pressure (clamp during surgery) to seal off (platelets) ruptured blood vessels due to laceration, abrasion, and incision.

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Stops bleeding coming from_________________

• ______________________________________ due to laceration, abrasion, and incision.

Hematinic/Anti-Anemic Drugs examples

Hemostatics

• Abrasion - Superficial wound caused by scraping or rubbing against a rough surface

• Laceration - Irregular, torn wound usually caused by blunt trauma; has jagged edges (serrated)

• Incision - Clean, straight wound usually made by a sharp object (e.g., scalpel); has well-defined edges (smooth)

  
  

Hematinic/Anti-Anemic Drugs examples

Hemostatics

• Abrasion - Superficial wound caused by _______________________

• Laceration - ________________ usually caused by __________; has jagged edges (______)

• Incision - _____________ usually made by a_________ (e.g., scalpel); has well-defined edges (_____)

  
  

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• If the bleeding does not stop, give drugs

• Normal enzymes in the blood used by the companies to manufacture drugs: they get these from specific pathogen-free animals

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• If the _____________ , give drugs

• Normal enzymes in the blood used by the companies to manufacture drugs: they get these ___________________

1. Thrombin

2. Thromboplastin

3. Fibrin

4. Fibrinogen

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Normal enzymes in the blood used by the companies to manufacture drugs: they get these from specific pathogen-free animals

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Thrombin/Thromboplastin/Fibrin/Fibrinogen

  • Makes oxidized cellulose

  • Oxidized Cellulose - Gauze-like, for small particles

  • Gelatin Sponge - Gauze-like, for larger bleeding

  • Contains thrombin, thromboplastin, fibrin, and fibrinogen

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Thrombin/Thromboplastin/Fibrin/Fibrinogen

  • Makes _____________

  • Oxidized Cellulose __________ for______________

  • Gelatin Sponge - __________ , for____________

  • Contains ___________________________

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Epinephrine

  • (vasoconstriction in small blood vessels, drug of choice for epistaxis)

  • Acts on epistaxis

  • Used in surgery

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• __________

  • (vasoconstriction in small blood vessels, drug of choice for epistaxis)

  • Acts on epistaxis

  • Used in surgery

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Epinephrine

  • (vasoconstriction in small blood vessels, drug of choice for epistaxis)

  • Acts on epistaxis

  • Used in surgery

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Epinephrine

  • (___________ in _______ blood vessels, drug of choice for ________)

  • Acts on _______

  • Used in ______

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Fibrinogen

  • Makes gelatin sponge (for larger bleeding)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• __________

  • Makes gelatin sponge (for larger bleeding)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Fibrinogen

  • Makes gelatin sponge (for larger bleeding)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Fibrinogen

  • Makes ___________ (for _______ bleeding)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Styptics

  • A general term for all minerals/chemicals that cause clamping of platelets and thereby seal off ruptured blood vessels

  • Liquid or in powder form

  • Applied to blood vessels

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Styptics

  • A general term for all minerals/chemicals that ______________________ and thereby ________________

  • _____ or in _______ form

  • Applied to _____________

• Iodine (Povidone Iodine)

• Silver nitrate (wound spray)

• Ferric sulfate (wound spray)

• Tannic acid

• Styptic Power (Hemostop)

  
  

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic

• Styptics

  • Examples

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Stops bleeding coming from large and deep blood vessels

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• __________________ coming from ________________

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Blood transfusion

  • Used commonly in emergency cases

  • Also used in dogs

  • Contains platelets for the normal clotting mechanism

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• ________________

  • Used commonly in emergency cases

  • Also used in dogs

  • Contains platelets for the normal clotting mechanism

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Blood transfusion

  • Used commonly in emergency cases

  • Also used in dogs

  • Contains platelets for the normal clotting mechanism

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Blood transfusion

  • Used commonly in ______________

  • Also used in ____

  • Contains______________________

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Vitamin K

  • K1 = Phylloquinone (plants)

  • K2 = Menaquinone (gram-positive bacteria)

  • K3 = Menadione (synthetic)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Vitamin K

  • K1 = ___________ (plants)

  • K2 = _____________ (gram-positive bacteria)

  • K3 = ____________ (synthetic)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Vitamin K

  • Fastest way to stop bleeding (Fast acting)

  • Necessary for hepatic synthesis of coagulation factors II, VII, IX, and X

  • Acts on the liver to produce clotting factors

  • Commonly available

  • Causes allergic reaction

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Vitamin K

  • ___________ (Fast acting)

  • Necessary for ________________ of coagulation factors _____________

  • Acts on the __________________

  • ____________

  • Causes ______________

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Protamine sulfate

  • A protein found in the sperm of some fish

  • For the normal clotting mechanism

  • Harder to find

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• _______________

  • A protein found in the sperm of some fish

  • For the normal clotting mechanism

  • Harder to find

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Protamine sulfate

  • A protein found in the sperm of some fish

  • For the normal clotting mechanism

  • Harder to find

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Protamine sulfate

  • A ________ found in the _____________

  • For the _______________

  • ________ to find

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Anti-Fibrinolytic

  • New classification which is similar to the action of Vitamin K

  • Increases the action of fibrin, faster clotting

  • Advantage: No allergic reactions

  • Disadvantage: Slower reaction to Vitamin K (4 clotting factor vs 1 clotting factor)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• ____________

  • New classification which is similar to the action of Vitamin K

  • Increases the action of fibrin, faster clotting

  • Advantage: No allergic reactions

  • Disadvantage: Slower reaction to Vitamin K (4 clotting factor vs 1 clotting factor)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Anti-Fibrinolytic

  • New classification which is similar to the action of Vitamin K

  • Increases the action of fibrin, faster clotting

  • Advantage: No allergic reactions

  • Disadvantage: Slower reaction to Vitamin K (4 clotting factor vs 1 clotting factor)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Anti-Fibrinolytic

  • New classification which is ________________

  • _______________, faster clotting

  • Advantage:____________

  • Disadvantage: ______________ to Vitamin K (4 clotting factor vs 1 clotting factor)

• Tranexamic Acid

• Aminocaproic Acid

• Aprotinin

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic

• Anti-Fibrinolytic examples

Criza TAA

• Blood transfusion

• Vitamin K

• Protamin Sulfate

• Anti-Fibrinolytic

Hematinic/Anti-Anemic Drugs examples

Hemostatics

2. Systemic Hemostatic examples

• Thrombin/Thromboplastin/Fibrin/Fibrinogen

• Epinephrine

• Fibrinogen

• Styptics (Iodine, Silver Nitrate, Ferric sulfate, Tannic Acid and Styptic Power)

Hematinic/Anti-Anemic Drugs examples

Hemostatics

1. Topical Hemostatic examples

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

• Blood found in blood vessels should be liquid and circulating

• A blood clot stops circulation

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

• Blood found in blood vessels should be____________

• A blood clot______________

  
  

  
  

1. Anticoagulants

2. Fibrinolytics/Thrombolytics

3. Antithrombotic/Antiplatelets

Anti-Hemostatics

• types

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

1. Anticoagulants

• Interferes with the clotting cascade

• Stops the clotting mechanism, prevents blood coagulation

• There are 2 types of anticoagulants:

  • In vitro

  • in vivo

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

1. Anticoagulants

• Interferes with the ___________

• _________________, prevents blood coagulation

• There are 2 types of anticoagulants:

  • ______

  • _______

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

1. Anticoagulants

• In vitro

  • Collect blood from a living organism to subjecting it to lab tests/uses

  • Vitro = test tube

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

1. Anticoagulants

• In vitro

  • Collect blood from a_________________

  • Vitro = ______

• Heparin

• Acid Citrate Dextrose (ACD)

• Sodium Citrate

• Ca EDTA

• Oxalate

• Double Oxalate

  
  

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

1. Anticoagulants

• In vitro

  • Examples

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

1. Anticoagulants

• In vivo

  • Collect blood from one living organism to another living organism

  • Blood transfusion

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

1. Anticoagulants

• In vivo

  • Collect blood from __________ to __________

  • ___________

• Heparin (most common)

• Acid Citrate Dextrose (ACD)

• Sodium Citrate

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

1. Anticoagulants

• In vivo

  • Examples

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

2. Fibrinolytics/Thrombolytics

• Increases the activity of plasma and fibrinolysin which are responsible for dissolving clots

• Breakdown fibrin

• From platelet → rrhexis → platelet plug → fibrin clot → blood clot → thrombus (to achieve anastomoses) → emboli

  • Emboli are broken down

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

2. Fibrinolytics/Thrombolytics

• ___________ the activity of _______ and ______ which are _______________

• _____________

• From ________________________________

  • Emboli are ___________

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

2. Fibrinolytics/Thrombolytics

• Decreases the activity of the plasmid or fibrinolysin which is responsible for dissolving the blood clot

• Examples (Enzymes from streptococcus)

  • Streptokinase - Tissue-type plasminogen activator

  • Streptodornase

  • Urokinase

  • Alteplase

  • Reteplase

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

2. Fibrinolytics/Thrombolytics

• ________ the activity of the ______ or _______ which is _____________________________

• Examples (Enzymes from ________)

  • Streptokinase - Tissue-type plasminogen activator

  • Streptodornase

  • Urokinase

  • Alteplase

  • Reteplase

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

2. Fibrinolytics/Thrombolytics

• Examples (Enzymes from streptococcus)

  • Streptokinase - Tissue-type plasminogen activator

  • Streptodornase

  • Urokinase

  • Alteplase

  • Reteplase

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

2. Fibrinolytics/Thrombolytics

• Examples (Enzymes from streptococcus)

  • ___________ - Tissue-type plasminogen activator

  • ____________

  • ___________

  • __________

  • _________

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

3. Antithrombotic/Antiplatelets

• Affects the function of the platelets

• Used in cases when there is no problem in the blood vessel, but there is a clot formation due to Disseminated Intravascular Coagulation (DIC)

  • Normal blood vessel, but has the presence of platelets that stick together

  • This causes viscosity of the blood, which makes the blood flow slow and eventually, clot

  • Stroke, Diabetes (thick blood)

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

3. Antithrombotic/Antiplatelets

• Affects the ___________

• Used in cases when there is _____________, but there is a clot formation due to ___________________

  • Normal blood vessel, but has the ______________________

  • This causes ________ of the blood, which makes the __________ and eventually, ____

  • _____, _______ (thick blood)

They stop bleeds, repair tissues, fight microbes, and maintain leak-proof pipes.

platelet function

Anti-Hemostatics

3. Antithrombotic/Antiplatelets

• TEME – thromboembolic meningoencephalitis in cattle (Histophilus somni)

Anti-Hemostatics

3. Antithrombotic/Antiplatelets

• TEME –____________________ in cattle (Histophilus somni)

• Aspirin - Inhibits blood clot

• Non-steroidal anti-inflammatory drug (NSAID)

• Dipyridamole

• Clopidogrel

• Triclopidine

Hematinic/Anti-Anemic Drugs examples

Anti-Hemostatics

3. Antithrombotic/Antiplatelets

• examples

Clopidogrel

• Prevents platelets (a type of blood cell) from sticking together and forming a dangerous blood clot

• Used as a blood thinner for diabetics

Clopidogrel

• Prevents platelets (a type of blood cell) ______________________

• Used as a __________________

1. Inotropes/Inotropics/Positive Inotropes

2. Anti-Arrhythmics

Drugs Affecting the Heart

Inotropes/Inotropics/Positive Inotropes

• Increase the strength of cardiac muscle contraction

Inotropes/Inotropics/Positive Inotropes

• ______________________________

1. Cardiac Glycosides

2. Phosphodiesterase Inhibitors

3. β-Adrenergic Agonist

4. Angiotensin-Converting Enzyme Inhibitors

Inotropes/Inotropics/Positive Inotropes

• examples

Inotropes/Inotropics/Positive Inotropes

1. Cardiac Glycosides

• MOA: Inhibition of the membrane bound Na-K-ATPase pump

• Examples

  • Digitalis from foxglove (Digitalis purpurea, Digitalis lanata, Strophanthus gratus, and Strophanthus kombe)

Inotropes/Inotropics/Positive Inotropes

1. Cardiac Glycosides

• MOA: ________ of the _________________

• Examples

  • _______________ (Digitalis purpurea, Digitalis lanata, Strophanthus gratus, and Strophanthus kombe)

• Digitalis purpurea

• Digitalis lanata

• Strophanthus gratus

• Strophanthus kombe

Digitalis from foxglove species

DDSs

Inotropes/Inotropics/Positive Inotropes

1. Cardiac Glycosides

• Digitalis

  • Has a negative chromotropic effect due to a decrease in conduction velocity in the A.V. node

  • Also potentiates vagal activity in the heart

explanation:

• Pumps Harder (+ Inotrope): Traps calcium inside heart muscle cells $\rightarrow$ every squeeze is much stronger.

• Beats Slower (- Chronotrope / - Dromotrope): Slams the brakes on the electrical highway (AV node) so a racing heart calms down.

• Vagal Tone: Boosts the "rest and digest" nerve (vagus nerve) to tell the heart to chill out.

• Digoxin vs. Digitoxin:

  • Digoxin exits through the Kidneys. Bad kidneys? It piles up and poisons the animal.

  • Digitoxin exits through the Liver. Use this one if the kidneys are failing.

• Cats are Sensitive: Cats suck at processing this drug in their liver/kidneys, so tiny amounts can easily overdose them.

• "Diuretic" Effect: It does not act on the bladder/kidney tubules directly. It just pumps blood so much better that the kidneys wake up, filter fluid, and make the animal pee away excess fluid/edema.

Inotropes/Inotropics/Positive Inotropes

1. Cardiac Glycosides

• Digitalis

  • Has a __________________ due to a _________________ in the A.V. node

  • Also _________________ in the heart

Inotropes/Inotropics/Positive Inotropes

1. Cardiac Glycosides

• Digoxin

  • Most commonly used

  • Drug of choice except in animals with renal disease (digitoxin should be used)

  • Cats are more sensitive than dogs

  • Has diuresis effect

Inotropes/Inotropics/Positive Inotropes

1. Cardiac Glycosides

• Digoxin

  • ____________ used

  • Drug of choice except in animals with _______________ (________ should be used)

  • _____________ than dogs

  • Has _______ effect

Inotropes/Inotropics/Positive Inotropes

1. Cardiac Glycosides

• Digitalis preparation

  • Digitalis purpurea: Digitoxin, Gitoxin, Gitalin

  • Digitalis lanata: Digitoxin, Gitoxin, Digoxin

  • Strophanthus gratus and Strophanthus kombe: Strophantidin and Oubain

Inotropes/Inotropics/Positive Inotropes

1. Cardiac Glycosides

• Digitalis preparation

  • Digitalis purpurea: ______________

  • Digitalis lanata: ____________________

  • Strophanthus gratus and Strophanthus kombe: ___________

Inotropes/Inotropics/Positive Inotropes

1. Phosphodiesterase Inhibitors

• Also known as Non-Glycoside or Non-Catecholamine

• Phosphodiesterase is used to combat asthma

• MOA:Inhibit the breakdown of cAMP and therefore increase the intracellular cAMP, resulting in an increase in heart contractilitya

Inotropes/Inotropics/Positive Inotropes

1. Phosphodiesterase Inhibitors

• Also known as __________ or _______________

• Phosphodiesterase is used to ___________

• MOA: _________ the ________________ and therefore_____________ resulting in an ________________

Inotropes/Inotropics/Positive Inotropes

1. Phosphodiesterase Inhibitors

• Aminophylline

  • Used in down regulation effect

  • This inhibitor causes an accumulation of cAMP, leading to bronchodilation.

  • It also improves diaphragmatic contractility

Down-Regulation

Rule: Too much stimulation $\rightarrow$ cell destroys/hides receptors to protect itself $\rightarrow$ target becomes less sensitive (tolerance/resistance).

The Correlation to "Down-Regulation":

• Chronic use of standard bronchodilators (like beta-2 agonists / Albuterol) causes target cells to hide/destroy their receptors (down-regulation), making those inhalers stop working.

• Aminophylline acts inside the cell past the receptor level by directly trapping cAMP; it bypasses the exhausted surface receptors, restoring bronchodilation even when beta-receptors have been completely down-regulated.

Inotropes/Inotropics/Positive Inotropes

1. Phosphodiesterase Inhibitors

• Aminophylline

  • Used in _____________

  • This inhibitor causes an _______________, leading to _____________.

  • It also improves __________________

Inotropes/Inotropics/Positive Inotropes

1. Phosphodiesterase Inhibitors

• Milrinone

  • Drug of choice in dogs with congestive heart failure

  • Used as an alternative of refractory to digitalis

Inotropes/Inotropics/Positive Inotropes

1. Phosphodiesterase Inhibitors

• Milrinone

  • Drug of choice in dogs with _____________________

  • Used as an alternative of ______________

Inotropes/Inotropics/Positive Inotropes

2. Phosphodiesterase Inhibitors

• Sildenafil

  • It has a vasodilation effect (dilation of blood vessels) and is used for pulmonary hypertension

Pulmonary hypertension is high blood pressure in the arteries that carry blood from your heart to your lungs, forcing the right side of your heart to work harder than normal.

Inotropes/Inotropics/Positive Inotropes

2. Phosphodiesterase Inhibitors

• Sildenafil

  • It has a ______________ effect (dilation of blood vessels) and is used for__________________

Inotropes/Inotropics/Positive Inotropes

3. β-Adrenergic Agonist

• Stimulates beta receptors

• MOA:

  • Increase heart contractility by stimulating adenyl cyclase and increasing cAMP

Inotropes/Inotropics/Positive Inotropes

3. β-Adrenergic Agonist

• Stimulates________________

• MOA:

  • ____________ by _____________________

• Dopamine

• Dobutamine

• Epinephrine

• Isoproterenol

• Glucagons

Inotropes/Inotropics/Positive Inotropes

3. β-Adrenergic Agonist

• Examples:

Dobutamine

Used for the treatment of low-output cardiac failure

Epinephrine

Only used for emergency treatment of cardiac arrest

Isoproterenol

DOC for heart block

Inotropes/Inotropics/Positive Inotropes

4. Angiotensin-Converting Enzyme Inhibitors

• Aside from its use in heart disease, this group of drugs is also beneficial for chronic renal failure

  • Starts with hypovolemia (plasma fluid is decreased) thus slower blood flow from the heart

  • The juxtaglomerular apparatus releases renin

  • Renin enters the blood and stimulates/activates the enzyme angiotensin I (inactive) → angiotensin II (active)

  • It then enters the adrenal gland and releases aldosterone

  • Aldosterone increase thirst to increase plasma of blood

  • It also inhibits diuresis (retention of electrolyte and water)

Inotropes/Inotropics/Positive Inotropes

4. Angiotensin-Converting Enzyme Inhibitors

• Aside from its ____________________, this group of drugs is also _____________________

  • Starts with ______________ (plasma fluid is decreased) thus s__________________

  • The juxtaglomerular apparatus releases ____

  • Renin__________ and ________________ (inactive) → angiotensin ___ (active)

  • It then______________ and releases _______

  • Aldosterone ____________ to increase ________ of blood

  • It also _________________ retention of electrolyte and water)

• Captopril

• Enalapril

• Benazepril

• Ramipril

Inotropes/Inotropics/Positive Inotropes

4. Angiotensin-Converting Enzyme Inhibitors

• examples

4pril

Benazepril

Labeled for dogs already but unavailable in the Philippines

1. Cardiac Glycosides - Inhibition of the membrane bound Na-K-ATPase pump

2. Phosphodiesterase Inhibitors - Inhibit the breakdown of cAMP and therefore increase the intracellular cAMP, resulting in an increase in heart contractility

3. β-Adrenergic Agonist - Increase heart contractility by stimulating adenyl cyclase and increasing cAMP

4. Angiotensin-Converting Enzyme Inhibitors - Aside from its use in heart disease, this group of drugs is also beneficial for chronic renal failure

Differentiate MOAs of the 4 types of inotropes

Anti-Arrhythmics

• Drugs that combat arrhythmia (without heartbeat, irregular)

Anti-Arrhythmics

• Drugs that combat __________ (_________________)

• Horse – 28–40 bpm

• Ox – 36–60 bpm

• Cattle (Dairy cow) – 48–84 bpm

• Sheep – 70–80 bpm

• Goat – 70–80 bpm

• Pig – 70–120 bpm

• Dog – 70–120 bpm

• Cat – 120–140 bpm

• Rabbit – 180–350 bpm

• Chicken (adult) – 250–300 bpm

• Chicken (chick) – 350–450 bpm

Beats per minute for specific species:

Anti-Arrhythmics

• An arrhythmia is a problem with the rate of rhythm of the heartbeat

• Heart beats too quickly, too slowly, or with an irregular pattern

• When the heart beats faster than normal, it is called tachycardia

• When the heart beats too slowly, it is called bradycardia

• The most common type of arrhythmia is atrial fibrillation, which causes an irregular and fast heartbeat

  
  

Anti-Arrhythmics

• An arrhythmia is a problem with the _____________

• Heart beats too _____, too _____, or with an ______ pattern

• When the heart beats faster than normal, it is called _________

• When the heart beats too slowly, it is called ___________

• The most common type of arrhythmia is ____________, which causes an __________________

  
  

Anti-Arrhythmics

1. Class 1

• Membrane-stabilizing drugs

• MOA:

  • Selectively blocks the fast Na channel, which is responsible for nerve impulses from the brain to the muscle for contraction

Anti-Arrhythmics

1. Class 1

• _______________ drugs

• MOA:

  • ________________________ , which is responsible for nerve impulses from the brain to the muscle for contraction

• Quinidine

• Procainamide

• Lidocaine

Anti-Arrhythmics

1. Class 1

• examples

Anti-Arrhythmics

2. Class 2

• β-adrenergic receptor blocking drugs

Anti-Arrhythmics

2. Class 2

• _________________________

Anti-Arrhythmics

2. Class 2

• Propranolol

  • Most commonly used

  • Beneficial in cats with hypertrophic cardiomyopathy

  • Irregular heartbeats may be caused by enlargement of the cardiac muscles

  • Should be avoided in cats with respiratory diseases

Anti-Arrhythmics

2. Class 2

• Propranolol

  • ___________ used

  • Beneficial in ___ with ________________

  • Irregular heartbeats may be caused by _______________________

  • Should be avoided in ______________

1. Propranolol

2. Timolol

3. Nadolol

4. Alprenolol

5. Metroprolol

Anti-Arrhythmics

2. Class 2 examples

olol

Anti-Arrhythmics

2. Class 3

• MOA

  • Prolong the cardiac action potential and refractory production

Anti-Arrhythmics

2. Class 3

• MOA

  • __________ the _______________________

• Bretylium

• Amiodarone

• Sotalol

nti-Arrhythmics

2. Class 3

• Examples

Angina pectoris

chest pain

Amiodarone

Most commonly used that has anti anginal action

Sotalol

• The Problem: The Boxer has scar tissue in its heart that causes wild, super-fast electrical misfires (ventricular tachycardia).

• The Fainting (Syncope): The heart beats so ridiculously fast that it pumps zero blood to the brain $\rightarrow$ lights out, dog collapses.

• The Drug (Sotalol):

  1. Resets the rhythm: Blocks potassium channels to break the electrical short-circuit.

  2. Blocks adrenaline: Acts as a beta-blocker so excitement or running won't trigger another attack.

Ventricular tachyarrhythmia and syncope (fainting) in a boxer DOC

Anti-Arrhythmics

4. Class 4

• Calcium channel blocking drugs

• Most commonly used

• Has vasodilation and an ionotropic effect

Anti-Arrhythmics

4. Class 4

• _______________

• ______________ used

• Has __________ and an ___________ effect

• Verapamil

• Diltiazem

• Nifedipine

• Amlodipine (for humans)

Anti-Arrhythmics

4. Class 4

• examples

Amlodipine

Drug of choice for hypertension in cats

Diltiazem

• What it is: The heart muscle walls (mainly the left ventricle) become abnormally thick and stiff, growing inward (concentric hypertrophy).

• The Main Problem (Diastolic Failure): Because the walls are so thick, the inside chamber becomes tiny and rigid. The heart cannot relax or fill with enough blood between beats.

Drug of choice for hypertrophic cardiomyopathy

1. Vasoactive Drugs

2. Inodilators

3. New/Experimental Drugs

Drugs Affecting the Blood Vessels

Vasoactive Drugs

• Drugs that act on the blood vessels

• Ideally, blood vessels should be dilated

Vasoactive Drugs

• Drugs that act on the ____________

• Ideally, blood vessels should be __________