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Small Animal Internal Medicine > Drugs for Heart Failure > Flashcards

Drugs for Heart Failure Flashcards

1
Q

List 5 drug options to decrease preload.

A
  1. Furosemide
  2. Spironolactone
  3. Hydrochlorothiazide
  4. Nitroprusside
  5. Nitroglycerine
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2
Q

List 3 drug options to increase ionotope.

A
  1. Pimobendan
  2. Dobutamine
  3. Digoxin
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3
Q

List 5 drug options to decrease afterload.

A
  1. Nitroprusside
  2. Enalopril
  3. Amlodipine
  4. Hydralazine
  5. Sildenafil
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4
Q

What are the 5 drug options to optimize heart rate?

A
  1. Digoxin
  2. Diltiazem
  3. Atenolol
  4. Atropine
  5. Theophylline
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5
Q

What are the 3 drug options to block RAAS/SNS?

A
  1. Enalopril
  2. Atenolol
  3. Spironolactone
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6
Q

Where do thiazide diuretics work?

A

Distal convoluted tubule

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7
Q

Where do loop diuretics work?

A

Ascending loop of henle

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8
Q

Which transporter do loop diuretics effect?

A

Na+/K+/2Cl- transporter

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9
Q

What transporter do thiazide diuretics effect?

A

Na+/Cl- transporter

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10
Q

Where do K+ sparing diuretics work?

A

Late DCT and collecting duct

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11
Q

What is the 1st line of defense for CHF?

A

Furosemide

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12
Q

What class of diuretic is Furosemide?

A

Loop diuretic

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13
Q

Where is the nephron does Furosemide work?

A

Ascending loop of henle

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14
Q

On which transporter does Furosemide work?

A

Na+/K+/2Cl- cotransporter

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15
Q

With Furosemide, what electrolyte values would be abnormal within the urine?

A
  1. Increased sodium
  2. Increased chloride
  3. Increased potassium
  4. Increased calcium
  5. Increased magnesium
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16
Q

What are the 5 adverse side effects associated with Furosemide?

A
  1. Azotemia
  2. Metabolic alkalosis
  3. Hypochloridemia
  4. Hypomagnesemia
  5. Hypokalemia
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17
Q

What is the 2nd line of defense for CHF?

A

Spironolactone

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18
Q

What type of diuretic is Spironolactone?

A

K+ sparing diuretic

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19
Q

Where in the nephron does Spironolactone work?

A

Late DCT and collecting duct

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20
Q

On which specific receptor/transporter does Spironolactone bind?

A

Aldosterone/Na-H antiporter

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21
Q

What are the 3 adverse side effects associated with Spironolactone?

A
  1. Azotemia
  2. Hyperkalemia
  3. Facial dermatitis (cats)
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22
Q

What is the 3rd line of defense for CHF?

A

Hydrochlorothiazide

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23
Q

What type of diuretic is Hydrochlorothiazide?

A

Thiazide

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24
Q

Where is the nephron does Hydrochlorothiazide work?

A

DCT

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25
Q

On which transporter does Hydrochlorothiazide bind?

A

Na+/Cl- cotransporter

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26
Q

What are the 3 adverse side effects associated with Hydrochlorothiazide?

A
  1. Azotemia
  2. Hypercalcemia
  3. Hypokalemia
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27
Q

What drug class does Enalopril fit in?

A

ACE inhibitor

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28
Q

What are 2 indications for using Enalopril?

A
  1. Chronic CHF

2. Proteinuria

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29
Q

What are the 2 side effects associated with Enalopril?

A
  1. Azotemia

2. Hypotension

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30
Q

What 3 factors determine stroke volume?

A
  1. Preload
  2. Afterload
  3. Inotrope
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31
Q

What 1 reason would cause left sided heart failure due to too much afterload?

A

Systemic hypertension

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32
Q

What 1 reason would cause left sided heart failure due to too much preload?

A

Valvular disease (mitral, aortic)

33
Q

What 2 reasons would cause left sided heart failure due to not enough contractility?

A
  1. DCM

2. Myocarditis

34
Q

What 1 reason would cause left sided heart failure due to not enough relaxation/filling?

A

HCM

35
Q

What 1 reason would cause right sided heart failure due to too much afterload?

A

Pulmonary hypertension

36
Q

What 1 reason would cause right sided heart failure due to too much preload?

A

Valvular disease (tricuspid)

37
Q

What 2 reasons would cause right sided heart failure due to not enough contractility?

A
  1. DCM

2. Myocarditis

38
Q

What 1 reason would cause right sided heart failure due to not enough relaxation/filling?

A

Neoplasia

39
Q

What are the clinical signs of low output heart failure?

A
  1. Syncope
  2. Prerenal azotemia
  3. Cyanosis
  4. Pallor
  5. Hypokinetic pulses
40
Q

What are the clinical signs of congestive heart failure?

A
  1. Pulmonary edema
  2. Pleural effusion
  3. Pericardial effusion
  4. Ascites
  5. Hepatomegaly
  6. Splenomegaly
41
Q

With low output heart failure, what structure in the kidney recognizes the decreased renal perfusion?

A

Juxtaglomerular apparatus

42
Q

What are the long-term effects of the neurohormonal compensatory system in response to heart failure?

A
  1. Myocardial remodeling
  2. Myocardial fibrosis
  3. Renal sclerosis
  4. Aortic sclerosis
43
Q

With low output heart failure, what within the SNS recognizes the low blood pressure?

A

Baroreceptors

44
Q

Of the drugs discussed, which 6 are vasodilators?

A
  1. Enalopril
  2. Amlodipine
  3. Hydrazaline
  4. Sildenafil
  5. Nitroprusside
  6. Nitroglycerine
45
Q

Name one indication to use Hydralazine (vasodilator).

A

Acute severe CHF

46
Q

Name one indication to use Nitroprusside (vasodilator).

A

Acute severe CHF

47
Q

Name one indication to use Nitroglycerine (vasodilator).

A

Acute severe CHF

48
Q

Name two indications to use Amlodipine (vasodilator).

A
  1. Systemic hypertension

2. Severe chronic CHF

49
Q

Name one indication to use Sildenafil (vasodilator).

A

Pulmonary hypertension

50
Q

What is Pimobendan’s effect on the heart rate?

A

NO effect

51
Q

What is Dobutamine’s effect on the heart rate?

A

Increase

52
Q

What is Digoxin’s effect on the heart rate?

A

Decrease

53
Q

What is the ONE specific indication for Pimobendan?

A

1st line CHF

54
Q

What is the ONE specific indication for Dobutamine?

A

Cardiogenic shock

55
Q

What is the ONE specific indication for Digoxin?

A

Atrial fibrillation

56
Q

What is the ONLY positive inotrope that slows heart rate?

A

Digoxin

57
Q

Does Diltiazem increase or decrease contractility?

A

Decrease

58
Q

Does Digoxin increase or decrease contractility?

A

Increase

59
Q

Does Atenolol increase or decrease contractility?

A

Decrease

60
Q

What are the 3 NEGATIVE CHRONOTROPES discussed?

A
  1. Diltiazem
  2. Digoxin
  3. Atenolol
61
Q

What is a consistent adverse effect of all the negative chronotropes?

A

Bradycardia

62
Q

What are the 3 adverse effects of the negative chronotrope Diltiazem?

A
  1. Bradycardia
  2. GI upset
  3. Hypotension
63
Q

What are the 3 adverse effects of the negative chronotrope Digoxin?

A
  1. Bradycardia
  2. V/D
  3. Ventricular arrhythmias
64
Q

What are the 3 adverse effects of the negative chronotrope Atenolol?

A
  1. Bradycardia
  2. Bronchospasm
  3. Hypotension
65
Q

What are the acute (in hospital) pharmacological treatments of CHF in dogs?

A

“FOPS”

  1. Furosemide
  2. Oxygen
  3. Pimobendan
  4. Sedation
66
Q

What are the chronic (at hone) pharmacological treatments of CHF in dogs?

A

“DOG’S ARE FOR SPECIAL PEOPLE”

  1. Dietary Na+ restriction
  2. ACE inhibitor
  3. Furosemide
  4. Spironolactone
  5. Pimobendan
67
Q

What are the acute (in hospital) pharmacologic treatments for CHF in the cat?

A

” FOPS +/- T”

  1. Furosemide
  2. Oxygen
  3. Pimobendan
  4. Spironolactone
  5. Thoracocentesis
68
Q

What are the chronic (in home) pharmacologic treatments for CHF in cats?

A

“DON’T FORGET ABOUT CATS, PLEASE”

  1. Dietary Na+ restriction
  2. ACE inhibitor
  3. Furosemide
  4. ACE inhibitor
  5. Clopidogrel
  6. Pimobendan
69
Q

What is the mechanism of action of class I antiarrhythmic drugs?

A

Block Na+ channels

70
Q

What is the mechanism of action of class II antiarrhythmic drugs?

A

Beta-adrenergic blockers

71
Q

What is the mechanism of action of class III antiarrhythmic drugs?

A

Block repolarizing K+ channels, prolonging action potentials

72
Q

What is the mechanism of action of class IV antiarrhythmic drugs?

A

Block Ca2+ channels

73
Q

What is the “go-to” acute treatment for ventricular tachyarrhythmias?

A

IV lidocaine

74
Q

In controlling ventricular tacharrhythmias, what are your 3 longer-term oral options?

A
  1. Sotalol
  2. Mexiletine
  3. Amiodarone
75
Q

What is the “go-to” acute treatment for supraventricular tachyarrhythmias?

A

IV diltiazem

76
Q

What are your 3 oral options for controlling supreventricular tachyarrhythmias long-term?

A
  1. Diltiazem
  2. Beta blocker
  3. +/- Digoxin
77
Q

What is the “go-to” acute treatment for bradyarrhythmias?

A

IV atropine

78
Q

What is a normal VHS in most dog breeds?

A

8.5 - 10.5

79
Q

What is a normal VHS in cats?

A

7.5 (

Small Animal Internal Medicine (36 decks)

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