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SA DX & TX I > Exam 4 - Heartworm Disease > Flashcards

Exam 4 - Heartworm Disease Flashcards

1
Q

what makes up adulticide therapy?

A

doxycycline for 1 month, macrocyclic lactone preventative for 3 months, & then 3 dose regimen of melarsomine + tapering steroids

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2
Q

what is the one state that may not have heartworms?

A

alaska

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3
Q

when is peak heartworm transmission?

A

july & august

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4
Q

what is the particular climate required for transmission of heartworms?

A

temperature with sustained heat for maturation of mosquito larvae

humidity

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5
Q

what habitats are required for mosquitos that have allowed heartworm disease to become so wide spread?

A

water sources, urban sprawl/heat islands, irrigation

mosquitos need water

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6
Q

what is the definitive host of heartworms? what are some less suitable hosts that can still become infected?

A

dogs!!!

cats & ferrets

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7
Q

can microfilaria become adults in a dog?

A

no - requires mosquitos

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8
Q

when should heartworm prevention be started? maintained?

A

puppies - 8 weeks old

standard prevention dose of macrocyclic lactones has been shown to be safe in all breeds, prevention recommended year round

multimodal prevention - mosquito control

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9
Q

T/F: there have been studies that have shown that repelling & killing mosquitoes is effective in prohibiting microfilariae transmission from dogs to mosquitoes

A

true

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10
Q

what is the difference in longevity in dogs vs cats with heartworm infections?

A

cats: 2-3 years

dogs: 5-7 years

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11
Q

T/F: there is no approved treatment for heartworms in cats & when treated, there is a high rate of complications

A

true

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12
Q

what makes up staging in a heartworm positive patient?

A

history - clinical signs, any preventative administered, activity level

physical exam - respiratory signs, ascites/abdominal distension, & right-sided heart murmur

diagnostics - rads & labwork

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13
Q

what are some mild signs of canine heartworm disease?

A

asymptomatic or cough

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14
Q

what are some moderate signs of canine heartworm disease?

A

cough, exercise intolerance, abnormal lung sounds

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15
Q

what is caval syndrome?

A

sudden onset of severe lethargy & weakness accompanied by hemoglobinemia & hemoglobinuria

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16
Q

what pathology to heartworms cause in the host?

A

primary damage to the pulmonary arteries & lungs, inflammation & fibrosis (eosinophilic pneumonitis), pulmonary embolization, pulmonary hypertension, right-sided heart failure, & potential glomerulonephritis from antigen/antibody complexes

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17
Q

do dead or live heartworms cause damage to the host?

A

both

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18
Q

what are some signs of right-sided heart failure?

A

ascites, jugular venous distension, & positive hepatojugular reflex

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19
Q

what are some differentials for a systolic right-sided heart murmur in a heartworm positive dog?

A

**

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20
Q

what may be seen on thoracic radiographs supportive of heartworm disease?

A

enlarged peripheral pulmonary arteries that are larger than the corresponding vein (unless there is concurrent venous distension), enlarged main pulmonary artery, & enlarged right atrium/ventricle

may have a bronchointerstitial pulmonary pattern

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21
Q

when would you potentially use an echo in a heartworm positive animal?

A

useful for patients with signs of right-sided heart failure, syncope, suspect pulmonary hypertension, or suspect caval syndrome

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22
Q

what may be seen on a CBC of a heartworm positive animal?

A

non-regenerative anemia, neutrophilia/eosinophilia/basophilia, thrombocytopenia, & microfilaria

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23
Q

what may be seen on a chem panel of a heartworm positive animal?

A

hyperglobulinemia, hypoalbuminemia, & pre-renal/renal azotemia

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24
Q

what may be seen on a urinalysis of a heartworm positive animal?

A

proteinuria

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25
Q

what are some reasons to test for microflaria?

A

identify reservoir host, identify dogs that may have a hypersensitivity reaction with preventatives, & confirming your diagnosis

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26
Q

what tests can be done for identifying microfilaria?

A

direct smear & modified knott test

27
Q

why may you get a false negative heartworm antigen test in dogs & cats?

A

may be an all male infection, prepatent period (too early to detect), lone worm burdens (only a few females), & antigen & antibody are bound tightly

28
Q

T/F: an antibody heartworm test may be positive for cats when their antigen test was negative

A

true

29
Q

what are some examples of when you should antigen test dogs for heartworms?

A

newly acquired puppy - 6/7 months of age
adult dog of unknown origin - test today & in 6/7 months
following adulticide - 6/7 months after the last injection
if the owner was late or missed a preventative dose - test in 6/7 months

30
Q

what is the historical therapy for microfilaricide?

A

single dose of ivermectin

31
Q

what is the current therapy for microfilaricide?

A

macrocyclic lactone + doxycycline

32
Q

how does ivermectin work for treating microfilaria?

A

takes several months to completely clear them but reduces potential adverse effects of fast kill

33
Q

how does milbemycin work for treating microfilaria?

A

initial fast kill but takes several months to clear them out - pretreat with steroids & antihistamine

34
Q

what is the FDA approved drug for microfilaricide?

A

topical moxidectin

35
Q

T/F: if a heartworm positive animal has more worms and gets adulticide therapy, there is a higher risk of complications because there is more pathology caused by the infection

A

true

36
Q

T/F: adulticide therapy is contraindicated in cats

A

true

37
Q

when are adverse effects seen from adulticide therapy? what are the side effects?

A

7-10 days after the injection

tenderness at injection site, fever, cough, hemoptysis, anorexia

38
Q

what drug is used for adulticide therapy?

A

melarsomine - split 3 doses

39
Q

what is the split adulticide therapy protocol?

A

1 IM injection followed in 4-6 weeks by 2 IM injections 24 hours apart

40
Q

what is the potential benefit of the split protocol for adulticide therapy?

A

slower kill results in less damage to pulmonary arteries

41
Q

what is the potential benefit of the standard protocol for adulticide therapy?

A

lower cost for 2 injections & less time confined

42
Q

what is the standard protocol for adulticide therapy?

A

2 IM injections 24 hours apart

43
Q

when may slow kill be used instead of adulticide therapy?

A

dogs with co-morbidities preventing immiticide therapy & dogs that can’t be confined

44
Q

what are the disadvantages of slow kill for adulticide therapy?

A

ongoing damage to the heart & lungs, patients can develop caval syndrome, dogs can develop false negative antigen tests, & it’s not typically recommended as the primary therapy

45
Q

what is slow kill adulticide therapy?

A

heartgard plus - negative test after 3-4 year period

advantage multi + doxycycline - negative test after > 206 days

46
Q

can you give 3 immiticide innjections 1 month apart so there is a lower probability of adverse effects? why?

A

no - 2 injections 24 hours apart are required to kill the female worms

47
Q

in the split protocol, do the second set of injections have to be exactly 1 month after the first injection?

A

no - not if the dog had a reaction to the first injection

48
Q

what is the potential benefit of using corticosteroids in heartworm treatment?

A

may help reduce pulmonary inflammation - pred at 0.5 mg/kg every 12 hours tapered over 3-4 weeks following each injection

49
Q

what is wolbachia?

A

symbiotic intracellular parasite found in heartworms that has a surface protein that induces an inflammatory response in the host’s lungs & kidneys

50
Q

what is the role of doxycycline in heartworm treatment?

A

eliminates wolbachia - 10mg/kg/day for 30 days, gets rid of them for 3-4 months

51
Q

what is the benefit of combining doxycycline & monthly ivermectin for heartworm treatment?

A

sterilizes & damages the female worms, microfilaria removed from circulation in 9-12 weeks, & dogs had significantly less pulmonary arterial lesions & thrombi

52
Q

what are the current recommendations for doxycycline in heartworm treatment?

A

doxycycline for 30 days prior to immiticide, macrocyclic lactone preventative at the time of diagnosis, & corticosteroids

53
Q

T/F: there may be resistant microfilaria

A

true - but may be a lack of compliance or under-dosing, or re-infection

54
Q

______ _____ is a differential diagnosis in dogs with exercise intolerance, cough, dyspnea, ascites, & dark colored urine

A

heartworm disease

55
Q

what does a systolic right-sided heart murmur in a heartworm positive dog suggest? what diagnostic is required?

A

caval syndrome, pulmonary hypertension

echo is required to definitively diagnose

56
Q

what should you consult for the most up to date information on heartworm disease?

A

american heartworm society

57
Q

T/F: prevention is better than therapy for heartworm disease

A

true

58
Q

what is the treatment for caval syndrome?

A

heartworm extraction & proceed with adulticide therapy

59
Q

what is the prognosis of caval syndrome?

A

good if caught early

poor if: heart failure, renal failure, coagulopathy

60
Q

what are the clues of caval syndrome?

A

evidence of hemolysis - anemia, dark red (port wine) colored urine

systolic right-sided heart murmur - tricuspid regurgitation

61
Q

if an owner won’t confine their heartworm positive dog, what therapy are you less likely to pursue?

A

immiticide

62
Q

what is the most important aspect of client education when doing immiticide therapy?

A

STRICT exercise restriction - all positive dogs for 4 weeks following each injection

63
Q

why is strict exercise restriction required in all heatworm positive dogs especially those getting immiticide?

A

dead heartworms will embolixe the pulmonary vasculature - risk of sudden respiratory distress, pneumothorax, or sudden death is minimized when activity is limited

SA DX & TX I (59 decks)

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