Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Small Animal Medicine > Cardio - Treatment of HF > Flashcards

Cardio - Treatment of HF Flashcards

1
Q

What pathophysiological parameters can we alter pharmacologically to treat HF?

A

Increase inotropy, decrease preload, decrease afterload, optimize HR, blunt RAAS, blunt SNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the top 3 drugs we can use to decrease preload?

A

Furosemide, Spironolactone, Hydrochlorothiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the trade name for furosemide?

A

Lasix or Salix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the trade name for Spironolactone?

A

Aldactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the trade name for Pimobendan?

A

Vetmedin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What drugs are considered diuretics?

A

Furosemide, Spironolactone, Hydrochlorothiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drug class are weak diuretics and why?

A

Carbonic anhydrase inhibitors - weak due to increased Na resorption distally (PCT)

(Not really used as diuretics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where do loop diuretics act?

A

Ascending Loop of Henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the mechanism behind loop diuretics?

A

Act on the Na/K/2Cl co-transporter to block it, therefore allowing electrolytes to remain in the lumen and be excreted in the urine along with water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where do thiazide diuretics act?

A

DCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the mechanism behind thiazide diuretics?

A

They block resorption of the Na/Cl co-transporter, causing loss of Na and Cl into the lumen - they are excreted out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where do K+ sparing diuretics act?

A

Distal tubule/Collecting duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the mechanism behind K+ sparing diuretics?

A

They block aldosterone, so you get less of the Na/H antiporter; Na is excreted and K+ is kept (“spared”) in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of diuretic is furosemide?

A

It is a loop diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of diuretic is hydrochlorothiazide?

A

thiazide diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of diuretic is spironolactone?

A

K+ sparing diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In what order would you choose a diuretic in the face of CHF?

A

Furosemide > Spironolactone > Hydrochlorothiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are potential side effects of furosemide?

A

Activates RAAS (need ACEi), azotemia, hypokalemia, metabolic alkalosis, hypochloremia, hypomagnesemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are potential side effects of spironolactone?

A

Azotemia, hyperkalemia, facial dermatitis (cats)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the side effects of hydrochlorothiazide?

A

Azotemia, hypokalemia, hypercalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What diuretic is the most effective at diuresis?

A

Furosemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What diuretic activates RAAS and which one blocks RAAS?

A

Furosemide activates RAAS

Spironolactone blocks RAAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the 5 drug options we have to decrease afterload?

A

Enalapril/Benazepril, nitroprusside, amlodipine, hydralazine, sildenafil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the general mechanism of drugs that decrease afterload?

A

They are vasodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What drug class are enalapril/benazepril in?
ACE inhibitors
26
What drug class is hydralazine in?
They increase cGMP
27
What drug class are nitroprusside and nitroglycerine in?
They are nitrates
28
What drug class is amlopidine in?
Ca channel blocker
29
What drug class is sildenafil in?
PDE-V inhibitor
30
What is the selectivity of vasodilation of enalapril/benazepril?
Balanced vasodilator (dilates arteries and veins to some degree)
31
What is the selectivity of vasodilation of hydralazine?
Arteriodilator
32
What is the selectivity of vasodilation of nitroprusside?
balanced vasodilator
33
What is the selectivity of vasodilation of nitroglycerine?
venodilator
34
What is the selectivity of vasodilation of amlopidine?
arteriodilator
35
What is the selectivity of vasodilation of sildenafil?
pulmonary arteriodilator
36
What is the indication for use of enalapril/benazepril?
chronic CHF (always), proteinuria
37
What is the indication for use of hydralazine?
Acute severe CHF
38
What is the indication for use of nitroprusside?
Acute severe CHF (CRI)
39
What is the indication for use of nitroglycerine?
Acute severe CHF (topical paste)
40
What is the indication for use of amlopidine?
Systemic hypertension or severe chronic CHF
41
What is the indication for use of sildenafil?
Pulmonary hypertension **ONLY**
42
What are side effects of enalapril/benazepril?
Azotemia/AKI, hypotension
43
What are side effects of hydralazine?
Hypotension
44
What are side effects of nitroprusside/nitroglycerine?
Nitrate tolerance, cyanide toxicity, hypotension
45
What are side effects of amlopidine?
Gingival hyperplasia (dogs), hypotension
46
What are side effects of sildenafil?
Hypotension, inguinal/ear tip flushing
47
What 2 vasodilators are given mainly in the hospital setting?
nitroprusside and nitroglycerine
48
What 3 drugs are used to increase inotropy?
Pimobendan, Dobutamine, Digoxin
49
What mechanism does Dobutamine utilize?
It is a ß-adrenergic agonist; binds to ß1 receptor, causing a cascade that results in PKA causing Ca influx into the cell
50
What mechanism does Pimobendan utilize?
It is a Ca sensitizer, positive inotrope, and vasodilator; It inhibits phosphodiesterase III to increase cAMP, and sensitizes actin/myosin to Ca --\> increase inotropy
51
What mechanism does Digoxin utilize?
It increases IC Ca by acting on 2 different pumps: 1. Binds Na/K ATPase (normally 3Na out, 2K in) and paralyzes it so that it can no longer send Na out of the cell 2. Works on the Na/Ca exchanger; Na buildup powers this exchanger, sending excess Na out and bringing Ca in --\> extra Ca binds actin/myosin
52
Digoxin is used only in CHF with _____ \_\_\_\_\_.
atrial fibrillation
53
What generally does Digoxin do to the heart, other than increasing inotropy?
Decreases HR
54
What inotrope is used in the 1st line for CHF?
Pimobendan
55
What effect does Pimobendan have on HR?
No change
56
What are the side effects of Pimobendan?
Anorexia (rare), pro-arrhythmic (humans)
57
What effect does Dobutamine have on HR?
Mild increase
58
What is the indication for using Dobutamine and how is it administered?
Cardiogenic shock - IV CRI **only**
59
What are the side effects of Dobutamine?
Vasoconstriction (high doses), ventricular arrhythmias
60
What effect does Digoxin have on HR?
decreases it
61
What is the specific indication of use of Digoxin and in what species?
atrial fibrillation rate control in dogs only
62
What are the side effects of Digoxin?
Vomiting/diarrhea, ventricular arrhythmias, bradycardia
63
The therapeutic index of Digoxin is \_\_\_\_\_.
low
64
What 3 drugs can be used to optimize HR?
Digoxin, Diltiazem, Atenolol
65
What HR is used to optimize CO in dogs?
~150 - 160 bpm
66
What HR/pattern do most dogs that are in heart failure have?
Sinus tachycardia ~160 bpm
67
What eventually happens when the HR in dogs goes above 160?
The heart is beating so fast that they are no longer increasing CO
68
What does optimization of HR in HF mean?
Treating tachyarrhythmias (or bradyarrhythmias) that compromise CO
69
What drug *type* would you use to treat rapid atrial fibrillation?
negative chronotrope
70
What drug type (and give the names) would you use to treat bradyarrhythmias?
Positive chronotrope; Atropine, theophylline, or artificial pacing
71
What are the negative chronotropes?
Diltiazem, Digoxin, Atenolol
72
What is the MOA of Diltiazem?
Ca channel blocker (slow conduction at AV node)
73
What effect does Diltiazem have on contractility?
Mild decrease
74
What is the specific indicatino for using diltiazem?
It is most effective at lowering HR
75
What are the side effects of diltiazem?
GI upset, bradycardia, hypotension
76
What is the MOA of Digoxin?
Vagomimetic (slow conduction at AV node)
77
What is the MOA of Atenolol?
B-adrenergic blocker (slow conduction at AV node)
78
What effect does Digoxin have on contractility?
Mild increase
79
What effect does Atenolol have on contractility?
Decreases it
80
What is the specific indication for Digoxin?
It is a good drug to use in the setting of CHF
81
What is the specific indication for Atenolol?
ONLY if started prior to CHF
82
What are side effects of Digoxin?
Vomiting/diarrhea, ventricular arrhythmias, bradycardia
83
What are side effects of atenolol?
Bradycardia, hypotension, bronchospasm
84
What are the 3 drugs that blunt RAAS/SNS?
Enalapril/benazepril, Spironolactone, Atenolol
85
What stimulates renin release?
Decreased renal perfusion, increased sympathetic tone, decreased Na to macula densa
86
What 2 aspects of RAAS are we blocking with drugs?
1. Angiotensin II (aldosterone release, SNS stim, hypertrophy of heart/vessels) 2. ACE
87
Angiotensin II, aldosterone, and SNS stimulation are _____ (AKA **bad**) because they cause _____ and \_\_\_\_\_.
CARDIOTOXIC, fibrosis, remodeling
88
What is the order of choice for neurohormonal modulators?
Enalapril/benazepril = always in chronic CHF Spironolactone = usually in chronic CHF Atenolol = ONLY if started prior to CHF
89
What is the acronym for treatment of ACUTE CHF in dogs?
**FOPS** Furosemide, Oxygen, Pimobendan, Sedation (+/- dobutamine and nitroprusside if doing very poorly)
90
What is the acronym for ACUTE CHF in cats?
**FOPS +/- T** Furosemide, Oxygen, Pimobendan, Sedation, +/- Thoracocentesis (+/- dobutamine)
91
Why would you want to perform a thoracocentesis in a cat with acute CHF?
Because it probably has pleural effusion
92
What is the acronym for CHRONIC CHF in dogs?
**Dogs Are For Special People** Dietary Na restriction, ACEi, Furosemide, Spironolactone, Pimobendan (+/- Sildenafil if pulmonary hypertension) (+/- Diltiazem+Digoxin if atrial fibrillation)
93
What is the acronym for CHRONIC CHF in cats?
**Don't Forget About Cats, Please** Dietary Na restriction, Furosemide, ACEi, Clopidogrel, Pimobendan (+/- Atenolol if started before CHF)
94
Why would you consider clopidogrel as part of your treatment of chronic CHF in cats?
Because of possible clot formation (HOCM)
95
What is the frequency of tx of HF meds?
BID-TID
96
What diet changes should be condiered for patients in HF?
Moderate Na restriction (50-80mg per 100kcal), protein/calories to avoid cachexia, supplements such as fish oil, K, mg, taurine, carnitine
97
What exercise/activity modifications should be considered in patients in HF?
Allow pets to self-regulate and avoid strenuous activity
98
What are the 2 goals of HF tx?
Quantity of life (survival) and Quality of life

Small Animal Medicine (100 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions