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Treatment > Block 3 > Flashcards

Block 3 Flashcards

1
Q

When should you treat an arrhythmia?

A

When is leads to a hemodynamic instability (tachy or brady)

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2
Q

Do all arrhythmias need treated?

A

NO! Most do not!!

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3
Q

Can antiarrhythmic drugs be pro-arrhythmic/

A

YES!
Do no harm!!

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4
Q

How do we classify anti arrhythmic drugs?

A

Vaughan-Williams

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5
Q

How is the Vaughan-Williams classified?

A

By which channels are blocked

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6
Q

What are the 4 classes of Vaughan-Williams?

A

Class 1: Na channel blockers
Class 2: Beta-adrenergic blockers
Class 3: K channel blockers
Class 4: Ca channel blockers

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7
Q

What is phase 0 of the cardiac cycle?

A

Rapid depolarization in cardiac muscle cells

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8
Q

What do sodium channel blockers od?

A

Slows the rapid depolarization in cardiac muscle cells (Phase 0)

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9
Q

What sodium blockers are used to treat ventricular arrhythmias?

A

Lidocaine, procainamide, mexiletine

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10
Q

What sodium blocker is used to treat atrial fibrillations in horses

A

Quinidine

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11
Q

What does vagolytic mean?

A

Increase heart rate

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12
Q

What is quinidine used for?

A

Converts A-fib to sinus rhythm in horses with lone a-fib

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13
Q

What is procainamide used for?

A

Therapy for ventricular arrhythmia

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14
Q

How is lidocaine given for treatment of arrhythmias?

A

IV

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15
Q

What type of treatment is lidocaine used for (chronic or acute)

A

Acute

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16
Q

What type of arrhythmias does lidocaine treat?

A

Ventricular arrhythmias

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17
Q

How is mexiletine adminsitered?

A

Orally “oral lidocaine”

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18
Q

What is mexiletine used for?

A

Chronic therapy of ventricular arrhythmias

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19
Q

What do beta-blockers do?

A

Slows the Ca in phase 2

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20
Q

What are beta blockers for?

A

Negative inotropes (reduce HR)

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21
Q

What phase do beta blockers inhibit?

A

Phase 2

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22
Q
A
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23
Q
A
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24
Q

When should you treat arrhythmias?

A

Can lead to hemodynamic instability (tachyarrhythmias or bradyarrhythmias)

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25
Q

What are 2 examples of tachyarrhythmias?

A

Ventricular arrhythmias
Supreventricular arrhythmias

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26
Q

What are typical bradyarrhytmias?

A

AV blocks or persistent atrial standstill

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27
Q

Seems like tachyarrhmias are ventricular and bradyarrhymias are atrial

A
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28
Q

Do ALL arrhythmias need treated?

A

NO!! Many do not!

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29
Q

What can anti-arrhyhic drugs cause?

A

They can potentially be pro-arrhythmic

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30
Q

What does A-fib drive?

A

Congestive heart failure

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31
Q

What is the most common drug classification called?

A

Vaughan-Williams

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32
Q

How does the Vaughan William classification classify drugs?

A

Which channels/currents the drugs block

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33
Q

What is class 1 of the Vaughan Williams?

A

Na channel blockers

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34
Q

What is class 2 of the Vaughan Williams?

A

Beta-adrenergic blockers

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35
Q

What is class 3 of the Vaughan Williams?

A

K channel blockers

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36
Q

What is class 4 of the Vaughan Williams?

A

Ca channel blockers

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37
Q

What are the 4 phases of heart depolarization and depolarization?

A

Stage 0 - Depolarize with Na channels open
Stage 1 - Initial depolarization. Na channels close and K channels open
Stage 2 - Plateau. K stay open and Ca open
Stage 3 - Rapid repolarization. Ca close and slow K open
Stage 4 - Resting. High K permeability

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38
Q

What phase do class 1 drugs block?

A

Stage 0

Slows rapid depolarization of cardiac cells

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39
Q

What are the 4 class 1 drugs we need to know?

A

Quinidine
Procainamide
Lidocaine
Mexiletine

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40
Q

What does quinidine do?

A

convert A-fib to sinus rhythm in HORSES w/ lone a-fib

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41
Q

What is a side effect of quinidine?

A

Vagolytic (can increase HR)

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42
Q

What does procainamide do?

A

Therapy of ventricular arrhythmias

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43
Q

How is lidocaine given for arrhythmias?

A

IV

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44
Q

What is lidocaine given for?

A

ACUTE treatment of life-threathening arrhythmias

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45
Q

How is mexiletine given?

A

Orally

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46
Q

What is mexiletine for?

A

Chronic therapy of ventricular arrhythmias

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47
Q

What are class 2 vaughan williams?

A

Beta blockers

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48
Q

What phase of depolarization block?

A

Phase 2

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49
Q

What is the purpose of class 2 beta blockers

A

blocks funny currents (nodal cells)

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50
Q

What do beta blockers do?

A

Negative inotrope

Reduce contractility (slows Ca intake)

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51
Q

What is the biggest beta blocker that is used?

A

Atenolol

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52
Q

How does atenolol help?

A

Cardioprotective

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53
Q

What beta is atenolol most selective for?

A

Beta 1 specific

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54
Q

What is atenolol used for?

A

Obstructive lesion (SAS, PS, HOCM)

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55
Q

What chamber does atenolol mostly act on?

A

Atrial arrhythmias

Occasionally ventricular arrhythmias

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56
Q

What’s the biggest side effect of atenolol?

A

Bradycardia (negative ionotrope)

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57
Q

What phase does class 3 block?

A

Stage 3
Potassium repolarization

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58
Q

What are the 2 main class 3 drugs?

A

Sotalol
Amiodarone

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59
Q

What is something else sotalol acts on besides potassium blockers?

A

Beta blocker

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60
Q

***What is the most common drug used for chronic management of ventricular arrhythmias?

A

Sotalol

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61
Q

What are 2 side effects of sotalol?

A

Pro-arrhythmia
Negative inotrope

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62
Q

What properties does amiodarone have?

A

Has properties from all vaughan Williams classes

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63
Q

What is amiodarone used for?

A

Refractory ventricular arrhythmias

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64
Q

What is a concern of amiodarone?

A

Has many side effects

Likely because it acts on so many different channels

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65
Q

What stage does class 4 Ca blockers act on?

A

Stage 2 (plateau)

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66
Q

What is the main goal of class 4 drugs?

A

Block the AV node

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67
Q

What is the main class 4 drug?

A

Diltiazem

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68
Q

What does diltiazem do?

A

Treats atrial arrhythmias through blocking AV node

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69
Q

What is the first line drug for rate control of atrial fibrillation?

A

Diltiazem

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70
Q

What are the side effects of diltiazem?

A

Negative inotrope
Hypotension

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71
Q

What are 2 downsides to the Vaughan-Williams scheme?

A

Doesn’t explain all mechanisms of each drug
Doesn’t include all antiarrhytmic drugs

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72
Q

Explain Digoxin

A

positive inotrope
Slows conduction of AV node
Controls A fib
Slows NA/K ATPase

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73
Q

What needs to be monitored with digoxin?

A

Pro-arrhythmic
GI side effects

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74
Q

What does torsade de pointe mean?

A

Turning around the point
Common arrhythmia in horses

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75
Q

What is used to treat to torsade de point?

A

Magnesium sulfate

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76
Q

What type of arrhythmia is torsade de pointe?

A

Refractory ventricular arrhythmia

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77
Q

What is the acronym for aims of treatment of heart disease?

A

D - delay of disease progression
I - Improve quality of life
P - Prolong survival
P - Prevent catastrophic event

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78
Q

How can you help determine if a cat’s murmur is present?

A

Stress test

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79
Q

When using atenolol, what are the 3 questions that you should ask?

A
  1. Is disease clinically relevant or prognostically important
  2. Can I follow-up?
  3. Is treatment safe?
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80
Q

what are drugs that affect ventricular pumping?

A

Inotropes

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81
Q

what needs to be used in conjunction with diuretics?

A

Sodium restriction
ACE-inhibitors

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82
Q

In refractory heart disease with chronic fluid retention, what is a good diuretic to use?

A

Torasemide

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83
Q

What diuretic is used in acute cases?

A

Furesemide

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84
Q

What diuretic is used in chronic cases?

A

Torasemide

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85
Q

What is a weak diuretic that is also a cardio protectant?

A

Spironolactone

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86
Q

What is spironolactone used in conjunction with sometimes?

A

Furosemide

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87
Q

What is a diuretic that is not a loop diuretic that can be used in conjunction with torasemide or furosemide?

A

Hydrochlorothiazide

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88
Q

What are the 5 diuretics?

A

Furesemide
Torasemide
Spironolactone
Hydrochlorothiazide

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89
Q

Why must an ACE inhibitor be used with diuretics?

A

Use of diuretics will initiate a strong RAAS response

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90
Q

What should DCM in cats always be treated with?

A

Taurine

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91
Q

What is the only nutraceutical that has been shown to help cardiac cachexia

A

Omega-3 fatty acids

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92
Q

What are the 4 ACE-inhibitors?

A

Benazepril
Enalapril
Lisinopril
Ramipril

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93
Q

What do ACE-inhibitors do?

A

Inhibit RAAS system be decreasing effectivity of Angiotensin II

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94
Q

What are 2 nitro-vasodilators?

A

nitroglycerine ointment and sodium nitroprusside

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95
Q

What is a non-nitro-vasodilator?

A

Hydralazine

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96
Q

What drugs help to treat pulmonary hypertension?

A

Phosphodiesterase-5 inhibitors

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97
Q

What is a phosphodiesterase-5 inhibitor?

A

Sildenafil (viagra)

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98
Q

What is the drug of choice for systemic hypertension?

A

Amlodipine

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99
Q

Amlodipe is a calcium channel blocker

A
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100
Q

What do angiotensin receptor blocking agents do?

A

Block RAAS

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101
Q

What is a common RAAS?

A

Telmisartan

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102
Q

When should you not treat HCM?

A

When there is low risk / asymptomatic

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103
Q

When should you consider an anticoagulant/antiplatelet?

A

With severe left atrial diameter (will throw a clot) >20mm

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104
Q

Risk factors for HCM are LA enlargement, LV diastolic dysfunction

A
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105
Q

What should be considered with LV diastolic dysfunction?

A

Furosemide

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106
Q

What should be considered with LV remodeling (regional wall thickening)

A

ACE inhibition and Plavix (anticoagulation)

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107
Q

What should be considered with LV systolic dysfunction?

A

Pimobendan
Furosemide
ACE inhibition
Plavix

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108
Q

What should be considered with extreme LV hypertrophy?

A

Diltiazem
Atenolol

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109
Q

What should be considered with Ventricular ectopy?

A

Sotalol
Atenolol
Amiodarone

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110
Q

What should be considered with A fib?

A

DILTIAZEM

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111
Q

What is the acute treatment of heart disease acronym?

A

F - furosemide
O - oxygen
N - nitroglycerine paste
S - sedation
T - tap (pleural effusion)

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112
Q

What do antiarrhythmics do?

A

Cardio-depressive

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113
Q

What is a sign of CHF?

A

Pericardial effusion

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114
Q

What are the main aims of ATE?

A

Pain management
Induction of hypo coagulable state
Prevention of thrombus expansion

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115
Q

What should be given for pain in ATE?

A

Full mu opioid

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116
Q

What can be given to prevent thrombus expansion?

A

Heparin

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117
Q

What can be given to inhibit platelet aggregation?

A

Plavix

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118
Q

Besides plavix, what can be added to help with ATE management/prevention?

A

Aspirin or rivaroxaban

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119
Q

What is B1 stage of most cardiac diseases?

A

Normal LA/LV size or mild enlargement

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120
Q

Where will MMVD be auscultated?

A

Left apical systolic murmur

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121
Q

Should you treat a B1 MMVD?

A

No

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122
Q

What should you do about a B1 MMVD?

A

Monitor with auscultation and imaging

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123
Q

What does B1 MMVD not meet?

A

EPIC criteria

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124
Q

What was the result of the EPIC study?

A

15 month benefit if given pimobendan

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125
Q

What puts a dog in B2 for EPIC?

A

LA:Ao > 1.6
VHS > 10.5

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126
Q

What if a patient can’t have an echo to grade B1 or B2?

A

Chest rads

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127
Q

What do the chest rads need to be to categorize B1 or B2?

A

VHS < 10.5 = B1, no pimo
VHS > 11.5 = B2, pimo

VHS between is grey zone

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128
Q

What does categorization into B2 mean?

A

B2 = Start Pimobendan!

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129
Q

What does the C in the grading scale stand for

A

C = CHF (left sided in DMVD)

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130
Q

What should usually be done when presented with a potential cardiac case?

A

Blood pressure!!

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131
Q

What is the prevention for all stages of the EPIC rankings?

A

None (no way to prevent)

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132
Q

What does stage D mean of DMVD?

A

Refractory / end stage

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133
Q

Mini Schnauzers are very susceptible to MMVD

A
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134
Q

What can you also consider if a dog is in the “grey zone” with VHS?

A

VLAS

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135
Q

What is VLAS?

A

Vertebral left atrial size

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136
Q

What does VLAS usually need to be over for B2?

A

2.4 (or 3.0)

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137
Q

What should you add on to pimobendan in “very advanced” B2?

A

RAAS inhibitor

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138
Q

What is the mechanism of ACE inhibitors?

A

Block enzyme that turns angiotensin I into angiotensin II

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139
Q

When should you recheck B2 dogs?

A

every 6-12 months

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140
Q

Will giving furosemide kill a dog?

A

No, give it if suspicious

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141
Q

What effect does nitroglycerine have?

A

Vasodilator

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142
Q

What is the chronic treatment for MMVD acronym?

A

P - pimobendan
A - ACE inhibitor
S - spironolactone
F - Furosemide
E - Exercise restriction

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143
Q

What 2 things does pimobendan do to help CHF?

A

Vasodilator
Positive inotrope

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144
Q

What is the median survival time after stage C onset?

A

CHF = 1 year

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145
Q

Will all dogs with MMVD develop CHF?

A

No only 25-30%

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146
Q

What is lasix?

A

Brand name of furosemide

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147
Q

How do you treat pulmonary hypertension associated with DMVD?

A

Diuretics to reduce LA pressure

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148
Q

What are the 3 potential DMVD complications?

A

Pulmonary hypertension
Arrhythmias
Left atrial tear

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149
Q

What type of arrhythmias can be seen with DMVD?

A

A-fib

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150
Q

Does MMVD occur in cats?

A

No

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151
Q

Degenerative valve disease occurs in horses but not a common cause of mortality!

A

No proven treatment but if CHF develops, poor prognosis

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152
Q

***What types of drugs treat secondary Afib?

A

“Rate control drugs”

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153
Q

What is the most common shunt?

A

VSD

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154
Q

What are the 3 most common shunts?

A

PDA, VSD, ASD

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155
Q

What is clinical hallmark of PDA?

A

Loud continuous heart murmur (machine murmur)

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156
Q

What are the 2 different managements for PDA?

A

Interventional occlusion and surgical ligation

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157
Q

The interventional occlusion is the coils and stuff

A
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158
Q

What is the weird pear shaped coil called?

A

ACDO

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159
Q

Is PDA curable?

A

Yes!

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160
Q

Can you do PDA in really small animals?

A

No

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161
Q

What is the disadvantage to surgical ligation of PDA?

A

Rupture can happen and kill dog

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162
Q

Is PDA heritable?

A

Yes

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163
Q

What does a reverse PDA look like?

A

Pink oral mm
Cyanotic vaginal mm

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164
Q

What is there to be done about a reverse PDA?

A

Not much
Potentially repeated phlebotomy

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165
Q

Where is the murmur herd on a VSD?

A

On the right (systolic)

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166
Q

What is the most common VCD?

A

Perimembranous

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167
Q

If there is a small VSD, what is the lifespan of the dog?

A

Normal lifespan

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168
Q

What is Eisenmenger’s complex

A

shunt reversal

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169
Q

Is VSD heritable?

A

Yes!

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170
Q

How to treat VSD?

A

Can add device
Start on enalapril and spironolactone

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171
Q

Are there murmurs with ASDs?

A

No

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172
Q

Where is the dilation associated with ASD?

A

In RA and RV

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173
Q

Is ASD heritable?

A

Yes

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174
Q

What are the treatment options for most ASDs?

A

No therapy, just watch

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175
Q

What are treatment options for large ASDs?

A

Medical, surgery, interventional

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176
Q

What is medical treatment of ASD?

A

Enalapril and spironolactone

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177
Q

How can you treat ToF?

A

Exercise limitation
Propranolol (beta blocker)
Potentially phlebotomy

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178
Q

What is cause of sinus bradycardia?

A

NO Treatment
Find underlying cause

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179
Q

What is a first degree AV block?

A

Prolonged PR interval
No blocked P wave

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180
Q

What is a 2nd degree AV block?

A

Blocked P wave

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181
Q

What is a 2nd degree Mobitz type I AV block?

A

Gradual prolongation of the PR interval then a blocked P wave

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182
Q

What is a 2nd degree Mobitz type II AV block?

A

Consistent blocked P wave, consistently high grade (more than 2 dropped P in a row)

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183
Q

What is a 3rd degree AV block?

A

Complete AV dissociation

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184
Q

What of the blocks are a result of high vagal tone?

A

1st and 2nd degree type 1 Mobitz

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185
Q

What of the blocks are a result of conduction disease?

A

2nd degree type II Mobitz and 3rd degree

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186
Q

Are the high vagal tone blocks treatable?

A

NO!

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187
Q

What should you do if you are uncertain if the disease is related to high vagal tone or if its a conduction disease?

A

Atropine response test

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188
Q

If the animal becomes tachycardia off the atropine response test, what does this mean?

A

Positive test

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189
Q

What is the treatment for the 2nd and 3rd degree AV blocks?

A

Artificial pacemaker

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190
Q

What are the 4 things seen in an atrial standstill de to hyperkalemia?

A

Absent P waves
Bradycardia
Tented T waves
Widened QRS

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191
Q

How do you treat hyperkalemia?

A

Calcium gluconate

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192
Q

What is sinus arrest?

A

Sinus node fails to fire resulting in pauses of the rhythm

Sick sinus syndrome = idiopathic degeneration of sinus node

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193
Q

How do you treat sinus arrest?

A

High vagal tone likely doesn’t need treatment but atropine / glycopyrrolate if needed

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194
Q

What is sick sinus syndrome?

A

Fibrotic changes to the SA node
Causes syncope

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195
Q

What is treatment for sick sinus syndrome?

A

Pacemaker

Chronotropic drugs may help

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196
Q

Which sex gets sick sinus syndrome more?

A

Females!!

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197
Q

What is the medical treatment for sick sinus syndrome?

A

Theophylline
Propantheline
Terbutaline
Hyoscyamine

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198
Q

What is atrioventricular block caused by in cats?

A

Older cats - idiopathic fibrosis - usually asympomatic

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199
Q

Are pacemakers a good treatment for AV blocks?

A

Treats syncope but doesn’t change survival time

200
Q

What are the 2 differentials for absent P waves?

A

A fib
Atrial standstill

201
Q

What is heart speed of a fib patients?

A

Tachy

202
Q

What is heart speed of atrial standstill patients?

A

Brady

203
Q

What is atrial standstill patients usually associated with?

A

Hyperkalemia

204
Q

What are the 4 target organs of hypertension?

A

Brain
Eyes
Kidneys
Heart

205
Q

At what BP will organ damage begin for the eyes?

A

> 160

206
Q

What are 2 signs of damage to the eyes?

A

Blindness
Medriasis

207
Q

What is a result to the heart of systemic hypertension/

A

LV hypertrophy

208
Q

How should you treat systemic hypertension?

A

Take 2-5 days to reduce below 160. Need to give time to equilibrate to it

209
Q

Should you hospitalize a systemically hyerptensive patient

A

No, too stressful

210
Q

What drug should be given to treat systemic hypertension?

A

Amlodipine

211
Q

How long after starting amlodipine should there be a recheck?

A

3 months

212
Q

What are 2 drugs that can be used as add-ons to amlodipine?

A

Telmisartan
Benazepril

213
Q

What is the goal of a hypertensive emergency (<200 + organ damage)

A

Reduce by 10% in first hour then 15% over next 3 hours

214
Q

What is a drug that can be used in a hypertensive emergency?

A

Fenoldopam

215
Q

What are 2 other drugs that can be used in hypertensive emergencies?

A

Hydralazine and sodium nitroprusside

216
Q

What is pulmonary hypertension?

A

> 40mmHg

217
Q

What is cor pulmonale?

A

Enlargement of right side of heart due to high pressure in lungs

218
Q

What are 3 overarching treatment goals of pulmonary hypertension?

A

Correct underlying cause
Decrease pulmonary vascular resistance
Increase RV cardiac output

219
Q

How do you decrease pulmonary vascular resistance?

A

Vasodilators
-oxygen acutely
PDE-5 inhibitors (Viagra, cialis, sildenafil)

220
Q

How can you increase RV output?

A

Pimobendan

221
Q

What do you NOT give in pulmonary hypertension?

A

Ferosimide

222
Q

What is type A in pulmonary stenosis?

A

Fusion

223
Q

What is type B in pulmonary stenosis?

A

Dysplasia

224
Q

Is there a treatment for type A pulmonary stenosis?

A

Yes

225
Q

Is there a treatment for type B pulmonary stenosis?

A

No

226
Q

What is the most common consequence of pulmonary stenosis?

A

Sudden death

227
Q

What can be done for pulmonary stenosis?

A

Exercise restriction
Selective B blockers (atenolol)
Balloon angioplasty (surgery)

228
Q

Is pulmonary stenosis hereditary

A

yes

229
Q

What is the number that determines the severity of sub aortic stenosis?

A

Pressure to open aortic valve
120/10 -> 200/25

230
Q

What can happen commonly with a sub aortic stenosis?

A

Infective endocarditis

231
Q

What can be done for sub aortic stenosis?

A

Exercise restriction
Beta blocker (atenolol)
Prophylactic antibiotics to reduce risk of infectious endocarditis

232
Q

Does canine sub aortic stenosis balloon valvuplasty work well?

A

Not really

233
Q

What can be done about semilunar valve stenosis?

A

Exercise intolerance
Atenolol (prevent tachycardia)
Drugs to manage CHF (Ferosemide, pimobendan, emalapril, spironolactone)

234
Q

When does cyanosis occur?

A

Pa02 < 40mmHg

235
Q

What muscle is called the “heave line” that is a result of chronic respiratory distress?

A

External Oblique

236
Q

Where is a tracheotomy inserted?

A

Ventral neck and a horizontal incision between tracheal rings. In the upper third of the neck

237
Q

What 2 main things are needed for respiratory emergencies in the field?

A

Tracheostomy tube
Ultrasound

238
Q

How do you know when to add a tracheostomy?

A

In the case of respiratory distress with noise

239
Q

What is another reason for needing a tracheostomy?

A

Tracheal collapse
Esophageal obstruction (choke)

240
Q

What type of horse is at an increased risk for needing a tracheostomy?

A

Horses that are homozygous for HYPP leading to pharyngeal pathology

241
Q

Name the 3 most common lower respiratory conditions in horses

A

Pneumonia / pleuropneumonia
Pulmonary edema
Equine asthma

242
Q

What is pulmonary edema usually secondary to?

A

Cardiogenic

243
Q

What are symptoms of a horse with pulmonary edema?

A

Fluid from nose (clear to pink)
Cough

244
Q

How do you treat pulmonary edema?

A

Oxygen and lasix

245
Q

How do you diagnose pneumothorax?

A

M-mode ultrasound

Use kitchen cling wrap to pack it? idk

246
Q

How do you diagnose hemothorax?

A

Swirling on ultrasound

247
Q

What happens to body weight of horses with asthma?

A

Lose weight quickly

248
Q

What 2 drugs are added as medical treatment of equine asthma?

A

Bronchodilator
Steroid (dex)

249
Q

Nonrespiratory causes of respiratory distress?

A

Anemia
Red maple toxicity (O2 exchange)
Pain
Hyperthermia
Anhidrosis

250
Q

What should you NOT do with horses that are in respiratory compromise?

A

AVOID SEDATION (alpha 2)

251
Q

How do you determine if respiratory compromise is coming from upper vs lower tract?

A

Upper = noise
Lower = no noise

252
Q

What is the cutoff for hypoxia?

A

<96%

253
Q

What is the difference between stridor and stertor?

A

Stridor = high pitched
Stertor = low pitched

254
Q

What sound is made with obstruction?

A

Stridor

255
Q

What is lar par also called?

A

GOLPP

256
Q

What is the definition of hypoxia?

A

Oxygen in tissue is low

257
Q

What is the definition of hypoxemia?

A

Low oxygen in arterial blood

258
Q

What is a greater respiratory response, hypercapnia or hypoxemia?

A

Hypercapnia

259
Q

What should you do first with a respiratory patient?

A

Hands-off non invasive approach and assess them in an O2 cage

260
Q

What should be first step in treatment of respiratory case?

A

Oxygen

261
Q

What should be second step in treatment of respiratory case?

A

Sedation
Butorphanol or ace

262
Q

How do you distinguish rhinitis from other nasopharyngeal differentials?

A

It is bilateral (most others are unilateral)

263
Q

What can you do for laryngeal treatment?

A

Dexamethasone
Ice pack
Slow wake up with sedation

264
Q

What is something important that you should minimize with laryngeal disease?

A

Barking

265
Q

What will a tracheal respiratory disease sound like?

A

Cough is dry/honking

266
Q

If cough is on inspiration:

A

Extra-thoracic tracheal disease

267
Q

If cough is on expirationL

A

Intra-thoracic tracheal disease

268
Q

What is herd on auscultation of a bronchial disease?

A

Expiratory wheeze

269
Q

What do you see with bronchial disease?

A

Abdominal effort

270
Q

What are top 2 differentials for bronchial disease?

A

Asthma
Bronchitis (infectious / inflammatory)

271
Q

What are 2 bronchodilators that can be used for bronchial treatment?

A

Albuterol
Terbutaline

272
Q

How many B lines must you see in a plane for it not to be normal?

A

> 3

273
Q

When do you see paradoxical breathing?

A

Diaphragmatic pathology

274
Q

What is paradoxical breathing?

A

Inspiration = abdomen sucks in
Expiration = abdomen distends

275
Q

What should you do with diaphragmatic pathology?

A

Elevated position

276
Q

Thoracocentesis is life saving

A
277
Q

What is NIPD?

A

Non-infectious pulmonary disease

278
Q

What are NIPDs?

A

Inflammatory or fibrotic

279
Q

How does an NIPD occur?

A

Reaction to an environmental factor or abnormal response to injury

280
Q

What are the 4 NIPDs?

A

Canine chronic bronchitis
Feline asthma
Eosinophilic bronchopneumonopathy
Idiopathic pulmonary fibrosis

281
Q

What are the 4 goals for CCB?

A

Reduce inflammation
Control cough
Improve exercise tolerance
Slow progression

282
Q

How can you reduce inflammation?

A

Environmental cleaning (smoke, aerosols)

283
Q

What is a medical way to reduce inflammation for the chronic inflammation

A

Prednisone - cheap
Fluticasone - Inhaled but expensive

284
Q

How do you control cough in the chronic bronchitis?

A

Hydrocodone

285
Q

What is a side effect of hydrocodone?

A

Sedation

286
Q

What is the number one way to improve exercise tolerance for CCB?

A

Manage obesity

287
Q

How can you slow progression of CCB?

A

Prednisone and fluticasone

288
Q

What is the prognosis of CCB?

A

Its progressive. Goal is to slow it, manage client expectation

289
Q

What likely causes feline bronchial disease/? Aka feline asthma

A

likely allergen induced

290
Q

Can you stop treatment of feline asthma if asymptomatic?

A

No!!

291
Q

What are 3 goals of feline asthma?

A

Reduce inflammation
Slow progression and remodeling
Control bronchoconstriction

292
Q

How do you reduce inflammation of feline asthma?

A

Environmental management
Glucocorticoids (fluticasone and pred)

293
Q

***What is a side effect of pred on cats?

A

Diabetes mellitus in fat cats

294
Q

Slowing progression and airway remodeling is same treatment as reducing inflammation

A
295
Q

How can you control bronchoconstriction acutely for feline asthma?

A

Albuterol
SQ terbutaline

296
Q

What is EBP?

A

Eosinophilic bronchopenumonopathy

297
Q

What is EBP tho?

A

Idiopathic inflammatory disease in DOGS

298
Q

How do you treat EBP?

A

Immunosuppressive steroids

299
Q

What species gets ICPF?

A

West Highland White Terriers

300
Q

What is ICPF?

A

Idiopathic canine pulmonary effusion

301
Q

How do you treat ICPF?

A

No effective treatment
Can try steroids to reduce cough
Terminal

302
Q

What is relapse rate of EBP?

A

30%

303
Q

What can eosinophilic bronchopneumonopathy look like?

A

Lung worms
Give antithelmitic on top of steroids just in case

304
Q

What is the cutoff for transudate?

A

<2.5

305
Q

What is the cutoff for modified transudate?

A

2.5-7.0

306
Q

What is the cutoff for exudate?

A

> 7.0

307
Q

What is the first thing you do if your patient comes in with fluid in its chest?

A

Stabilize - oxygen and sedation

308
Q

What do you do after stabilization?

A

Thoracocentesis (maybe imaging next)

309
Q

Where is the first place you should look if the fluid is a modified transudate?

A

Heart

310
Q

If it is a pyothorax in a cat, what is the most likely etiology?

A

Cat bite (pasteurella multocida)

311
Q

If it is a pyothorax in a dog, what is the most likely etiology?

A

Inhaled plant piece (nocardia asteroids)

312
Q

What is the medical treatment for pyothorax?

A

Broad spectrum antibiotics
(Amoxi + Clav) for 4-6 weeks

313
Q

What is a surgical thing you can do for pyothorax?

A

Placement of chest tube

Also removal of FB in dog

314
Q

What is the cutoff for chylothorax?

A

Triglycerides 2x serum or >100mg/dL

315
Q

What is treatment for chylothorax?

A

Treat underlying cause
Chyle is very irritating to pleura

316
Q

What is a Medical approach to chylothorax?

A

Low fat diet

317
Q

What should you always ask before tapping a hemothorax?

A

Any rodenticide exposure

318
Q

What should you always check before tapping a hemothorax?

A

Check PT/PTT BEFORE tapping chest if hemothorax is suspected

319
Q

What are the BIG 5 parasites?

A

Nematode
Protozoa
Cestode
Trematode
Ectoparasite

320
Q

What drug class works for giardia?

A

Benzimidazole (fenbendazole)

321
Q

What drug class works for blood suckers and burrowing ectoparasites?

A

Macrocyclic lactones

322
Q

Do tetrahydropyrimidines work against heart worm?

A

NO!!

323
Q

Within microcytic lactones, what are 2 classes?

A

Avermectin and milbemycins

324
Q

What drug class is within avermectin

A

ivermectin
eprinomectin
selamectin

325
Q

What are 2 drugs within benzimidazole?

A

Fenbendazole
Albendazole

326
Q

Do benzimidazoles more against HW?

A

NO!!

327
Q

What are 2 drug classes within tetrahydropyrimidines?

A

Pyrantel
Strongid

328
Q

What do preventative for HW act on?

A

L3 and early L4

329
Q

What do mosquitos pick up from host?

A

microfilaria

330
Q

What stage does microfilaria get to in mosquito?

A

L3

331
Q

How long does going from microfilaria to L3 take?

A

10-14 days

332
Q

What is the medical term for HW?

A

Dirofilaria immitis

333
Q

What is tracheal collapse most commonly seen in?

A

Middle-aged to older toy and miniature breeds

334
Q

When does the trachea collapse? Inspiration or expiration?

A

Expiration

335
Q

What is the classic sound of a tracheal collapse?

A

Goose honking

336
Q

what is the medical treatment for tracheal collapse?

A

Anxiolytic drugs, sedation
Cough suppressants (hydrocodone) and anti-inflammatory steroids (prednisone if needed)

337
Q

What does a positive intrope do?

A

Makes heart beat stronger

338
Q

When are 5 times to use a positive inotrope?

A

Impaired systolic function

Dilated cardiomyopathy
Heart failure (cardiogenic shock)
Critical care patients (septic shock)
General anesthesia
Drug overdoses

339
Q

What type of drug is anesthesia?

A

Negative inotrope (postive inotrope helps to combat this)

340
Q

What is the mechanism of action of positive inotrope?

A

Increase Ca influx into myocytes

341
Q

What is the mechanism of action of digitalis catecholamine positive inotopes

A

Inhibit Na/K ATPase, activating Na/Ca

342
Q

What is the mechanism of action of catecholamine positive inotropes

A

Stimulate beta-adrenoreceptors

343
Q

Give an example of digitalis glycosides?

A

Digoxin

344
Q

Give an example of catecholamines

A

Dobutamine

345
Q

What is the mechanism of action of calcium sensitizers (PDE III inhibitors)?

A

Sensitive contractile filaments to Ca

346
Q

Give an example of calcium sensitizers

A

Pemobendan

347
Q

What is the drug of choice for cardiogenic check?

A

Dobutamine

348
Q

What nerve type does norepinephrine work on?

A

Alpha 1

349
Q

What does norepinephrine (alpha1) cause?

A

Vasoconstriction

350
Q

What is the drug of choice for cardiac arrest?

A

Epinephrine

351
Q

What does pimopendan do to the vessels?

A

Vaso dilator (both arterial and venous)

352
Q

What type of “trope” is pimopendan

A

Strong positive inotrope + mixed vasodilator

353
Q

How does pimobendan compare to dobutamine?

A

Pimobendan is longer and stronger but takes longer to kick in than dobutamine

354
Q

When do you use pimobendan?

A

In dogs with congestive heart failure

355
Q

How does the vasodilation aspect of pemobendan help with CHF??

A

Vasodilation helps to unload the failing ventricles but also helps increase contractility of heart

356
Q

What is the mechanism of action of digoxin (review)

A

Plugs Na/K ATPase channel leaving more intracellular sodium for Na/Ca to utilize (increasing intracellular calcium)

357
Q

What are 2 other effects of digoxin (digitalis glycosides)?

A

Baroreceptor (Increase vagal tone)
Antiarrhythmic

358
Q

What is the major indication for digoxin?

A

Control A fib

359
Q

When are the “trough levels” of digoxin?

A

8-12 hr post pill

360
Q

***What factor can induce digoxin toxicity?

A

Hypokalemia

361
Q

Where is digoxin primarily excreted?

A

Kidneys (not liver)

362
Q

What drug do you need with increased preload?

A

Diuretics

Get that shit outta here

363
Q

What is the main indication for diuretics?

A

CHF

364
Q

What is the main loop diuretic to know?

A

Furosemide

365
Q

What type of diuretic is hydrochlorothiazide?

A

Thiazide

366
Q

What is the mechanism of action of thiazide?

A

Inhibit Na and H2O in distal tubules

367
Q

What is the best/fastest/easiest diuretic?

A

Furosemide

368
Q

What is an important beneficial aspect of spironolactone?

A

Spares potassium
Cardioprotective

369
Q

Why might you eventually need to add an additional diuretic?

A

Eventually there will be a diuretic resistance that develops

370
Q

What are the beta blockers known as?

A

The lols

371
Q

What do beta blockers do?

A

Decrease contractility (negative inotrope)
Decrease myocardial oxygen demand

372
Q

What beta receptors do atenolol (**) and metoprolol target?

A

Beta 1

373
Q

What beta receptors does propranolol target

A

Beta 1 and 2

374
Q

What are the side effects of beta blockers?

A

Bradycardia
Hypotension
Decreased systolic function

375
Q

What are 3 indications for beta blockers?

A

Hypertrophic obstructive cardiomyopathy

Pulmonary/aortic stenosis

Antiarrhythmic effects

376
Q

What beta blocker is preferred in cats?

A

Atenolol

377
Q

What beta blocker is preferred in dogs?

A

Sotalol

378
Q

If cannot do echocardiography, do not use beta blockers

A

Never use beta blockers in a “wet” patient - CHF

379
Q

What is another negative inotrope and vasodilator?

A

Calcium channel blockers

380
Q

What is the major effect of non-dihydropyridines? (Calcium channel blocker)

A

Nodal tissues

381
Q

What non-dihydropyridine is most commonly used?

A

Diltiazem

382
Q

What dihydropyridine is most commonly used?

A

Amlodipine

383
Q

What is amlodipine mostly used for?

A

Treatment of systemic arterial hypertension

384
Q

When do you use calcium channel blockers?

A

Atrial tachycardias (A fib!) or systemic hypertension

385
Q

What are 4 drugs used for cardio protection?

A

ACE inhibitors
Beta blockers
Spironolactones
Fish oils

386
Q

What is the main trigger for ACE inhibition?

A

Reduced cardiac output

387
Q

What are the ACE inhibitors?

A

The -prils

Enalapril

388
Q

What do ACE inhibitors do?

A

RAAS inhibitors and mixed vasodilators

Lower blood pressure!

389
Q

What are the angiotensin receptor blockers?

A

The -tans

Telmisartan

390
Q

What is telmisartan primarily used for?

A

Cats with proteinuria and systemic hypertension

391
Q

What are angiotensin receptor blockers used for?

A

Lower blood pressure

392
Q

What are prothrombin drugs used for?

A

Cats at risk of feline arterial thromboembolism

393
Q

What does a cat have that may show rick of FATE?

A

Smoke

394
Q

What are 2 FATE drugs?

A

Aspirin and Plavix

395
Q

Is pemobendan used in cats?

A

Rarely

396
Q

What are 2 drugs that can be used for treatment of Afib?

A

Digoxin
Diltiazem

397
Q

Sorry - What are 6 dietary modifications to be recommended to CHF patients?

A

Sodium restriction
Fatty acids
Taurine (cats ony)
L-carnatine
CoQ10
Avoid BEG diets

398
Q

Where should you not give fluids in a shock patient?

A

SQ or enteral

399
Q

What fluid should you never give a shock patient?

A

Hypotonic fluids!

400
Q

When do you give hypertonic solution?

A

In severe shock

401
Q

What is the physical exam point that is the “last to go, first to come back”?

A

Blood pressure

402
Q

What do you do if there is no response with shock fluids?

A

Consider a positive inotrope
Maybe issue is cardiogenic

403
Q

What 2 dogs get DCM the most?

A

Boxer
Doberman

404
Q

What are 3 drugs for treatment of DCM?

A

Pimobendan
Enalapril (cardioprotective)
Spironolactone (cardioprotective)

405
Q

When do you add furosemide?

A

In CHF. DCM is not CHF

406
Q

What are seen commonly in dogs with DCM?

A

Ventricular premature complexes (VPCs)

407
Q

What drug is given to reduce arrhythmias in arrhythmegonic RV cardiomyopathies?

A

Sotalol

408
Q

How do you determine if something is in CHF and not just DCM>

A

Has ascites and or a respiratory component

409
Q

What do you give the patient that has DCM with CHF?

A

Furosemide
On top of everything else

410
Q

What can you try with a patient that has lone Afib?

A

Electrical cardioverion (electric shock thing)

411
Q

What are 2 drugs to correct Afib

A

Diltiazem
Digoxin

412
Q

Besides Afib, what other disease do you see an absence of P waves?

A

Atrial standstill

413
Q

What is given for a dog with atrial standstill?

A

Need a pacemaker

414
Q

What other drugs do you give a dog with atrial standstill?

A

Still pimobendan
Enalapril (cardioprotectant)
Spironolactone (cardioprotectant)

415
Q

What is the most important congenital pericardial disorder?

A

Peritoneaopericardial diaphragmatic Hernia (PPDH)

416
Q

Do PPDH always need treated?

A

No, often incidental finding

417
Q

What is treatment for PPDH?

A

surgical

418
Q

What is the number 1 differential diagnosis for pericardial effusion in dogs?

A

Neoplastic

419
Q

What type of fluid is in pericardium of heart failure patients?

A

Transudate

420
Q

What is the most common cause of pericardial effusion in cats?

A

CHF

421
Q

How do you treat pericardial effusion from CHF in cats?

A

No pericardiocentesis
Just use diuretics

422
Q

What are the top 2 neoplasias that cause pericardial effusion in dogs?

A

Hemangiosarcoma
Chemodectoma

423
Q

***What is treatment of cardiac tamponade?

A

PERICARDIOCENTESIS

424
Q

Where do you approach for a pericardiocentesis?

A

Right side in cardiac notch

425
Q

What will happen if you dont perform the pericardiocentesis?

A

The dog will die

426
Q

What should you NOT give in pericardiocentesis?

A

Furosemide! NOOOOO

427
Q

What should you give during preparation for pericardiocentesis of a cardiac tamponade case?

A

IV fluids

Maintain BP while prepping.

Also opioid for sedation (butorphenol)

428
Q

What surgery can be done to treat continued cardiac tamponade?

A

Pericardectomy

429
Q

In horses, what 2 places can you palpate for peripheral pulses in a shock patient?

A

Facial artery
Transverse facial artery

430
Q

What happens to lactate with decrease lactate?

A

Increase lactate

431
Q

What happens to lactate with strangulating lesions?

A

Higher base lactate than horses but lactate doesn’t change with strangulation lesions

432
Q

What are the 6 catergories of shock?

A

Metabolic
Hypoxemic
Cardiogenic
Hypovolemic
Obstructive
Mal(distributive)

433
Q

What is the most common type of shock?

A

Hypovolemic

434
Q

How do you treat a guttural pouch mycosis?

A

Intra-arterial coil embolization

435
Q

What can you give during maldistributive shock?

A

Epinephrine to cause vasodilation

436
Q

What is number one reason for cardiogenic shock?

A

CHF

437
Q

You basically give fluids to all types of shock in horses. What type do you NOT GIVE FLUIDS?

A

Cardiogenic!

438
Q

How do you (not) give fluids during shock

A

Only IV
Not enteric, SQ, rectal

439
Q

Treating shock, how much do you initially bolus with isotonic crystalloids?

A

10-20mL over 20-30 min then reassess

440
Q

Treating shock, how much do you initially bolus with hypertonic saline?

A

2-4mL/kg

441
Q

How much blood volume is required to require shock resuscitation in a horse?

A

> 30%

442
Q

What drug classes are bronchodilators?

A

Sympathomimetics (beta agonists)
CNS stimulants
Adenosine antagonists

443
Q

Bronchodilators occur due to which agonist?

A

Beta 2 agonism

444
Q

What drug helps with lar par?

A

None, its a surgical disease

445
Q

When should you administer oxygen to a patient in respiratory distress?

A

Always

446
Q

What is persistent pulmonary hypertension?

A

Failure of fetus to make respiratory and cardiac transition to extra-uterine life

Persistent hypercapneic hypoxia

447
Q

How is PPH mediated?

A

NO

448
Q

What is an antitussive?

A

Drug that decreases cough

449
Q

What are antitussive drugs?

A

Opioids

450
Q

What is the primary antitussive drug we use?

A

Hydrocodone
Codeine

451
Q

What is the mechanism of action of antitussives?

A

Opioids depress cough center in medulla

452
Q

What are the side effects of antitussive drugs?

A

Sedation
Constipation
Bradycardia

453
Q

What class of respiratory drugs relax bronchiole smooth muscle?

A

Bronchodilators

454
Q

What class of drugs are bronchodilators?

A

Beta - 2 agonists

455
Q

What are 3 beta-2 agonists?

A

Terbutaline
Albuterol
Clenbuterol

456
Q

What is a bronchodilator that is not a beta-2 agonist

A

epinephrine

457
Q

What is the mechanism of beta-2 agonists?

A

Smooth muscle in bronchioles are relaxed by innervation of the beta-2 nerves

458
Q

What are bronchodilators used to treat?

A

Asthma

459
Q

What of the beta 2 agonists are prohibited in food animals?

A

Clenbuterol

460
Q

What are 2 side effects of beta 2 agonists?

A

Tachycardia
Muscle tremors

461
Q

What are methylxanthines used for?

A

BronchodilatorsWh

462
Q

What are 3 methylxanthines?

A

Caffeine
Theobromine
Theophylline

463
Q

What is the mechanism of action of methylxanthines?

A

CNS stimulant

464
Q

What are side effects of methylxanthines?

A

GI signs
Cardiac stimulation
Seizures

465
Q

How often are methylxanthines used?

A

Not as often due to side effects

466
Q

What species are methylxanthines more often used on?

A

Horses

467
Q

What drug class is used to treat airway inflammation?

A

GlucocorticoidsW

468
Q

What are 2/3 glucocorticoids?

A

Prednisone/prednisolone
Fluticasone

469
Q

What is the mechanism of action of glucocorticoids?

A

Bind to receptors on cells and inhibit transcription of genes that produce mediators of inflammation

470
Q

Many side effects with glucocorticoids, try to keep dosage low

A
470
Q

What are glucocorticoids used to treat?

A

Bronchitis
Asthma
Recurrent airway obstruction

471
Q

What is definition of hypoxemia?

A

SpO2<90%
PaO2<60

471
Q

What is the single most important therapy for hypoxemia?

A

Oxygen

472
Q

What are the 2 ways oxygen can exist?

A

Carried on hemoglobin
Dissolved in blood

473
Q

What type of hypoxemia is from pneumonia?

A

V/Q mismatch

473
Q

What are the 4 major causes of bacterial pneumonia?

A

Community acquired
Aspiration pneumonia
Foreign body
Immune dysfunction

473
Q

What are some side effect of oxygen?

A

Tunnel vision, tinnitus, seizures

473
Q

What is type 2 oxygen toxicity?

A

Penumocytes proliferate

474
Q

What is type 1 oxygen toxicity?

A

Pneumocyte degenerate

475
Q

What is a respiratory stimulant?

A

Doxapram

475
Q

What is the mechanism of action of doxapram?

A

Inhibits potassium channels on carotid body cells (chemoreceptors) resulting in increased sensitivity to CO2

475
Q

***What are the 5 causes of hypoxemia?

A

Reduced Fi02
Hypoventilation
V/Q mismatch
Right to left shunt
Diffusion impairment

476
Q

When is doxapram used?

A

Neonatal resuscitation (not first line)

Reversal of anesthetic-induced patients

477
Q
A
477
Q

Which lung lobe is most likely to harbor aspiration pneumonia?

A

Right middle

477
Q

How can you diagnose pneumonia in dogs and cats?

A

Tracheal wash

477
Q

Should you culture/do cytology of nasal discharge?

A

NO

477
Q

What 2 antibiotic options are available for bacterial pneumonia in dogs and cats?

A

Amoxicillin and doxycycline

478
Q

What to do if moderate+ signs with pneumonia?

A

Dual therapy. For Gram + and -

478
Q

In a critical patient, what should consider in terms of antibiotics?

A

Parental administration

479
Q

When shouldn’t you consider providing antibiotics within 10 day duration for feline acute upper respiratory tract infection

A

No symptoms but has serous or mucopurulent discharge

479
Q

How long do you treat the pneumonia past resolution of sings?

A

5-7 days

479
Q

When should you consider providing antibiotics within 10 day duration for feline acute upper respiratory tract infection

A

Symptomatic WITH mucopurulent discharge

480
Q

If there is no improvement in 7-10 days, what should your next steps be?

A

Additional diagnostics or different antimicrobial therapy

480
Q

What is something to keep in mind when doing hydration of a pulmonary patient.

A

Really dont want to over hydrate

480
Q

What is a large side effect of doxycycline in cats?

A

Esophageal stricture

Treatment (8 decks)

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