DRUGS ACTING ON THE CARDIOVASCULAR SYSTEM

HEMATINICS

• Drug that increases the hemoglobin (Hgb) content of the blood
• Hemoglobin is carried by RBC. When Hgb is increased, in a way, RBC also increases.
  • Anemia - when there is not enough RBC

Iron

• Bone marrow produces RBC via the process erythrogenesis.
• MOA: When the bone marrow is producing the erythrocyte (RBC), it needs the ferritin, a blood protein that contains iron. The iron that we ingest will go to the enzyme ferritin, which will then go to the bone marrow, to make RBC.

B12

• Maturation failure anemia - the lifespan of the RBC is lessen
• needed for the maturation of the RBC.
• B12 deficiency -> pernicious anemia

Folic acid

• It is needed for the maturation of the RBC.

Erythropoietic co factors

• Cobalt and Copper
• Helps the bone marrow to create RBC faster.

Anabolic steroids

• For those who builds muscles.

HEMOSTATICS

Controls or stops the bleeding

TOPICAL/LOCAL

Drugs that stops bleeding if it comes from small or superficial blood vessels, like incision or abrasion.

Oxidized cellulose/Gelatin sponge

• Gauze-like pad that is placed on top of the bleeding to absorb it, and close the blood vessel.
• This sponge contains the normal contents of blood that makes it clot, such as thrombin, thromboplastin, fibrin and fibrinogen.

Epinephrine

• Used for epistaxis

Styptics

• These are the powders, liquids, and spray that is used on the wound to stop the bleeding.
• In some cases, iodine is applied on the wound.
• Spray contents includes: methylene blue, silver nitrate and gentian violet.
• Powder contents include: ferric sulfate and tannic acid

SYSTEMIC

Drugs that stops bleeding from large and deep internal blood vessels. Other cases include: stabbed or run over

Blood transfusion

• It is performed when a lot of blood is gone

Vitamin K

• It is given during surgery during a large blood vessel is cut.
• MOA: Vitamin K is needed by the hepatic system (in the liver), to produce clotting factors like II, VII, IX and X.

Protamine sulfate

• Protein found in the sperm of some fishes.

ANTI-HEMOSTATICS

In physio, as long as blood is inside the vein, it is still liquid

ANTICOAGULANT

Interfere with clotting cascade.

In vitro - “test tube”

• For laboratory tests
• All of the anticoagulants can be used.

In vivo - “life”

• It is when you collect blood and would give it someone alive

For blood transfusion

• Not all anticoagulants can be used. Only Heparin, Sodium citrate, and ACD.
• Example: Heparin, Calcium EDTA, Calcium oxalate, Sodium oxalate, Sodium citrate, and ACD (acid citrate dextrose)

FIBRINOLYTIC

Increase the activity of plasma or fibrinolysin, which is responsible for dissolving clots

1. Streptokinase
2. Streptodornase

ANTITHROMBOTIC/ANTIPLATELET

Affecting platelets activity.

• Similar to fibrinolytic, except it is not used on damaged area of blood vessels.

1. Aspirin and other NSAID
2. Dipyrimadole

INOTROPES

Increases the strength of heart muscle contraction

CARDIAC GLYCOSIDE

• Comes from plants, foxglove (scientific name: digitalis purpurea)
  • As a group, it is called digitalis
• MOA: inhibition of the membrane bound N-K-AT base pump
• There are 2 digitalis that is commonly used:

1. Digoxin
   1. Cats are more sensitive to digoxin than dogs
   2. Digoxin is the drug of choice, except in animal with renal disease (digitoxin should be used)
   3. Has diuresis effect
2. Digitoxin
   1. Has a negative chromotropic affect due to decrease conduction velocity in the AV node
   2. Potentiates vagal activity in the heart

PHOSHODIESTRASE INHIBITORS OR NON-GLYCOSIDE, NON-CATECHOLAMINE

• Inhibits phosphodiesterase

1. Theophylline
2. Aminophylline
3. Amrinone
4. Milrinone
5. Sildenafil

• Milrinone is the drug of choice in dogs with congestive heart failure
• Milrinone is use as alternative of refractory to digitalis

B-ADRENERGIC AGONIST

Example:

1. Dopamine
2. Dobutamine
   1. For low output cardiac failure
3. Epinephrine
   1. Used for emergency treatment of cardiac arrest
4. Isoproterenol
   1. For heart block
5. Glucagon

ANTI-ARRHYTHMICS

Drugs that treat arrythmia; irregular heartbeat.

CLASS I

• MOA: blocks the sodium channel so it will return to a normal heartbeat
• Example:

1. Quinidine
2. Procainamide
3. Lidocaine

CLASS II

• Acts as B-adrenergic receptor blocking drugs
• Example:

1. Propranolol
2. Timolol
3. Nadolol
4. Alprenolol
5. Metoprolol

• Propranolol is beneficial in cats with hypertrophic cardiomyopathy. It should be avoided in cats with respiratory disease

CLASS III

• Prolong the cardiac action potential and refractory production
• Example:
  1. Beryllium
  2. Amiodarone – has anti-anginal action to treat angina pectoris (chest pain)
  3. Sotalol - ventricular tachyarrhythmic and syncope in boxer

CLASS IV

• Blocks the calcium channel
• Example: Verapamil, Erapamil, and Diltiazem

VASOACTIVE DRUGS

Causes dilation of blood vessels

ARTERIAL DILATORS

• After load reducer
• Example:
  • Captopril - is the commonly used arterial dilator in dogs and cats

VENOUS DILATORS

• Preload reducer
• Example:

1. Nitroglycerin
2. Nitroprusside
3. Prazosin

• Both Nitroglycerin and Nitroprusside have anti-anginal action.

DRUG ACTING ON THE DIGESTIVE SYSTEM

DRUGS AFFECTING APPETITE

1. APPETITE STIMULANT
   1. B vitamin - anti stress
   2. Steroids - gives a feeling of euphoria; feeling of being energetic
      1. Glucocorticoids
      2. Anabolic steroids
   3. Minerals
      1. Zinc - promotes taste acuity
   4. Benzodiazepines - affects the hunger center and satiety center of the brain (hypothalamus).
      1. diazepam
   5. Cycloheptadiene - same as Benzodiazepines.
   6. Ways to increase appetite:
      1. Warming of food
      2. Providing small quantities for food
2. APPETITE SUPPRESSANT - to prevent obesity.
   1. Apetamin - suppress the hunger center and satiety center of the brain.
   2. No particular effect/use in vet med.

DRUGS AFFECTING THE MOUTH, PHARYNX AND ESOPHAGUS

- functions: chewing (mastication)

- saliva has an enzyme called ptyalin or salivary amylase that functions as digestion of carbohydrates

1. SIALAGOGUES
   1. Drug that increases volume and fluidity of the saliva
   2. Use: Tx of hypoptyalism (inadequate saliva) and xerostomia (dry mouth cavity)
   3. Example: Alkaloids from plants like Gentian, Quassia, and Nux vomica
      1. Strychnos nux-vomica - you can get 2 alkaloids: strychnine, used as CNS stimulant; and nux-vomica, which increases the saliva in the mouth because it is bitter.
   4. Example: Cholinergic drugs
      1. Increases the saliva
      2. Includes:
         1. Choline esters (acetylcholine, methacholine, carbachol, bethanechol),
         2. cholinomimetic alkaloids (muscarine, pilocarpine, cevimeline),
         3. cholinesterase inhibitors (neostigmine, physostigmine)
2. ANTI-SIALAGOGUES
   1. Drugs that decrease the flow and fluidity of saliva
   2. Example:
      1. Atropine - used as preanesthetic. Decreases that salivation during pre-anesthetic med.
      2. Glycopyrrolate
3. ALIMENTARY DEMULCENT
   1. Coat, lubricate and mechanically protect irritated or abraded mucous membrane
      1. It coats whatever food or medicine that have a bitter taste. Thus, it masks unpleasant taste.
   2. Act as suspending agent
   3. Most often used as lubricants for stomach tube
   4. Example: syrup, gum, glycerol, egg, albumin, starch, mineral, oil
4. BUCCOPHARYNGEAL ANTISEPTIC
   1. Drugs that mechanically cleanse and decrease bacterial growth in the oral cavity.
   2. Use: Tx of halitosis (bad breath), periodontal diseases (tartar buildup, plaque), gingivitis (swollen gums), stomatitis (swollen mouth cavity) and sore throat
   3. Example: mouthwash (pinole, bactidol, hexidine, chlorhexidine), lozenges (dequadin, dequalinium, strepsils)

DRUGS AFFECTING THE GASTRIC FUNCTION

EMETIC

Induces vomition

Use:

• when poison is ingested, and the poison is still in the stomach (for non-corrosive poisoning only)
• when foreign bodies are eaten that can clog the intestine
• during emergency surgeries
• Commonly employed in dogs and cats
• Rarely in pigs and exotic spp.; not in horse and cattle
• Types:
  • Peripherally acting
    • Warm water is saturated with: CuSo4 or ZnSO4
    • Ipecac (production of toxic emetine)
    • Mustard seed
  • Centrally acting
    • Apomorphine (don’t use in cats)
    • Xylazine (less effective in dogs)
    • Ipecac

ANTI-EMETIC

Control vomition

Types:

• Peripherally acting - reduce vomition associated with pharynhitis, gastritis, esophagitis, gastritis, esophagitis, gastric ulcer, gastroenteritis
  • Glycopyrrolate
  • Propantheline
  • Methscopolamine
  • Isopropamide
  • Metoclopramide - mostly used in veterinary practice
  • Domperidone
• Locally acting - in the mucous membrane of the stomach. Provide protective coating on inflamed mucosal surface.
  • Antacids
  • Kaolin
  • Pectin
  • Bismith subsalicylate
• Centrally acting - action is in the brain (hypothalamus); the vomiting center
  • Metoclopramide – sedative (barbiturate)
    • Metoclopramide is advocated for the control of persistent vomiting caused parvoviral infection.
  • Labyninthine – anxiolytics (diazepam)
  • Meclizine (teratogenic)
  • Dimenhydramine
  • Diphenhydramine
  • Cyclizine (teratogenic)
  • Promethazine

STOMACHIC

• Promote the function activity of stomach by increasing motility and secretion
• Examples: Bethanechol, Neostigmine, Bicarbonate, Pentagastrin, Betazole and Histamine acid phosphate

ANTI-STOMACHIC

• Used when there is fast peristaltic movement
• Also known as gastric sedatives
• Rarely used in animals
• Examples: Atropine and Glycopyrrolate

ANTACID

• When there is too much acid, it would result to hyperacidity
• This drug decrease and control hydrochloric acid in the stomach
• Types:
  • Neutralized the hydro chloric acid - binds with alkaline drugs
    • Sodium bicarbonate
    • Sodium citrate
    • Calcium carbonate
    • Aluminum hydroxide
    • Magnesium hydroxide
    • Magnesium carbonate
  • H2 blocker - when there is now a wound due to too much hydrochloric acid
    • Cimetidine
    • Ranitidine
    • Famotidine
    • Nizatidine
  • Proton pump inhibitor - when there is ulcer and too much pain
    • Dexlansoprazole
    • Esomeprazole magnesium
    • Lansoprazole
    • Omeprazole - most commonly used
      • Omeprazole magnesium
      • Omeprazole and sodium bicarbonate
    • Pantoprazole sodium
    • Rabeprazole sodium

CARMINATIVES

• Promote expulsion of gas from the stomach
• Anti-flatulence
• Example: Alcohol ether, Chloroform, Ginger oil, Peppermint oil, Anise oil, and Eucalyptus oil

ANTIZYMOTIC

• • Depress ruminal fermentation, which leads to gas pockets or gas bubbles.
    • Ruminants have a disease called bloat. It has 2 types: free gas bloat and frothy bloat.
  • Examples: Turpentine oil, Formalin, and Poloxalene

DRUGS AFFECTING THE INTESTINAL FUNCTION

LAXATIVES AND PURGATIVES - induces defecation.

1. Laxatives (aperients) - promotes elimination of soft, formed feces
2. Purgatives (cathartics) - promotes elimination of watery feces
3. Types:
   1. Lubricant and emollient laxative - makes it slippery
      1. Fecal softness
      2. Example: Mineral oil, Docusate sodium (dioctyl sodium succinate, DSS), and Polaxazol
   2. Simple bulk laxative (bulk = fiber)
      1. Fiber eaten will absorb water and would cause swelling, which would turn into emollient gel. Thus, it will make the poop slippery
      2. Example: Methylcellulose, Agar, Plantago seed, Wheat bran, Prunes and Cilium
   3. Osmotic cathartics/hyperosmotic - attract water, increase the volume and stretch the intestinal mucosa
      1. Example: magnesium sulfate, magnesium hydroxide, magnesium citrate, sodium sulfate (Glauber’s salt), sodium phosphate, potassium sodium tartrate (Rochelle salt), and lactulose
   4. Irritant cathartics/stimulant - causes irritation of the villi of the mucous membrane. When the villi is irritated, peristaltic movement will become faster, thus, leading to defecation.
      1. Indirect - the drug will only be active once it passes the liver
         • Castor oil - ricinoleates
         • Linseed oil - linoleates
         • Olive oil – olineates
      2. Direct - there is action already
         • Bisacodyl
         • Phenolphthalein
   5. Neuromuscular purgatives
      1. Uses: constipation, move foreign bodies, removal of toxin
      2. Examples: neostigmine, physostigmine, bethanechol, and carbachol

ENEMA - solution/suppositories introduce into the rectum to initiate defecation

• Also called enemata
• Faster than laxatives and purgatives
• Example: Soapy water, Glycerol, Sorbitol, Isotonic saline, Mineral oil, Vegetable oil, Docusate sodium

SPASMOLYTIC/ANTISPASMODIC/MOLULATORS OF INTESTINAL MOTILITY - drugs that modulate or decrease the peristaltic movement, decreasing the chance of having diarrhea.

• Example: Opioid analgesic and anticholinergics

GIT PROTECTANT AND ADSORBENT -

• Example: Activated charcoal, Attapulgite, Kaolin, Pectin, and Bismuth salt

DIGESTANTS

- increases the digestion of nutrients

1. ACIDIFIER - given when there is not enough hydrochloric acid, which makes it hard to digest protein.
   1. Example: formic acid, butyric acid, propionic acid
2. ENZYME - there are times when enzymes are enough to digest (fats = lipase; protein = proteases; carbohydrates = amylase).
3. PROBIOTIC - good, live, microorganism that will help in the digestion.
   1. Example: lactobacillus, bacillus, saccharomyces
4. PREBIOTIC - nutrients that support the growth of good bacteria.
   1. Example: bifidum, inulin, fructooligosaccharides

DRUGS AFFECTING LIVER

- largest organ in the body

- functions: digestion, bio transforms drug and toxins for detoxification

1. CHOLAGOGUES - drugs that increase the production of bile.
   1. Causes the contraction of the gall bladder to release bile
   2. Example: magnesium sulfate, ceruletide
2. CHOLERETIC - drugs that increase the production of bile directly from the hepatocytes
   1. Example: bile salts, clanobutin, chenodiol, tocamphyl
3. LIVER PROTECTANTS
   1. Example: choline, methionine, betaine, lecithin, B12, vitamin E, selenium, sorbitol, glucose, fructose, silymarin

DRUGS ACTING ON THE RESPIRATORY SYSTEM

TYPES OF COUGHING:

• Productive coughing - there is phlegm in the cough
• Non-productive - there has no phlegm in the cough

MUCOKINETIC

• Dilute airway mucus after aerosol or system administration.
  • When mucus is watery, it will flow down. If it hardens, it can’t go out.
• Example:

1. Saline solution (PO, IV)
2. Water vapor (steaming)
3. Nebulization
4. Propylene glycol
5. NaHCO3
6. Glycerin

ANTITUSSIVE

- against tuspirina (cough)

- useful for non-productive coughing

- decrease frequency of coughing

• Locally acting
  • There is only a particular area where the cough comes from; like larynx and pharynx
  • Example:
  1. Syrup
  2. Glycerin
  3. Honey
• Centrally acting
  • Narcotic - can cause drowsiness
    • Morphine
    • paregoric,
    • hydromorphone,
    • hydrocodone
    • codeine
  • Non-narcotic - does not cause drowsiness
    • Dextromethorphan
    • Noscapine
    • Diphenhydramine

EXPECTORANT

• Drugs that causes expulsion of phlegm
• Useful for productive coughing
• Examples:
  1. K iodine
  2. Guaifenesin
  3. Ammonium chloride
  4. Guaiacol

MUCOLYTIC

• Drugs that causes expulsion of sticky phlegm
• Examples:

1. Acetylcysteine
2. Carbocysteine
3. Bromhexine
4. Dembrexine

DECONGESTANT

• Decrease swelling and edema in the upper respiratory tract thru vasoconstriction
• Examples:
  1. Ephedrine
  2. Pseudoephedrine
  3. Phenylephrine
  4. Phenylpropanolamine

BRONCHODILATORS

• The reason for coughing is the entrance of oxygen is blocked due to the bronchus getting constricted = Bronchial asthma
• Drugs that causes dilation of bronchus; relaxation of bronchus
• Receptor agonist (clenbuterol and salbutamol)
  • Mostly used
  • Accompanied by anti-histamine (H1 blocker) which are anti-allergy
• Xanthine (Caffeine, theophylline and Theobromine)
• Anticholinergic (atropine and glycopyrrolate)

ANTI-INFLAMMATORY

• Has no direct effect on respiratory diseases but can help in the respiratory tract (like in sinusitis and bronchitis)
• Helps in the swelling
• Example:

1. Glucocorticoids
2. NSAID (no-steroidal anti-inflammatory drugs)

ANTIFOAMING AGENT

• Tx pulmonary Edema = when there is watering in the lungs due to bronchitis or pneumonia
• Foaming occurs when there is water in the lungs, thus, making it hard to breath
• Examples:
  1. Ethyl alcohol
  2. Propylene glycol
  3. Glycerol
• Once the foam is gone, water will still be there, so it should be followed by diuretics

RESPIRATORY STIMULANTS/ANALEPTICS

• Also known as CNS stimulants
• Example:

1. Doxapram
2. Nikethamide
3. Xanthines
4. CO/CO2
5. Strychnine
6. Bemegride