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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
what are some reasons to test for microflaria?
identify reservoir host, identify dogs that may have a hypersensitivity reaction with preventatives, & confirming your diagnosis
26
what tests can be done for identifying microfilaria?
direct smear & modified knott test
27
why may you get a false negative heartworm antigen test in dogs & cats?
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
T/F: an antibody heartworm test may be positive for cats when their antigen test was negative
true
29
what are some examples of when you should antigen test dogs for heartworms?
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
what is the historical therapy for microfilaricide?
single dose of ivermectin
31
what is the current therapy for microfilaricide?
macrocyclic lactone + doxycycline
32
how does ivermectin work for treating microfilaria?
takes several months to completely clear them but reduces potential adverse effects of fast kill
33
how does milbemycin work for treating microfilaria?
initial fast kill but takes several months to clear them out - pretreat with steroids & antihistamine
34
what is the FDA approved drug for microfilaricide?
topical moxidectin
35
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
true
36
T/F: adulticide therapy is contraindicated in cats
true
37
when are adverse effects seen from adulticide therapy? what are the side effects?
7-10 days after the injection tenderness at injection site, fever, cough, hemoptysis, anorexia
38
what drug is used for adulticide therapy?
melarsomine - split 3 doses
39
what is the split adulticide therapy protocol?
1 IM injection followed in 4-6 weeks by 2 IM injections 24 hours apart
40
what is the potential benefit of the split protocol for adulticide therapy?
slower kill results in less damage to pulmonary arteries
41
what is the potential benefit of the standard protocol for adulticide therapy?
lower cost for 2 injections & less time confined
42
what is the standard protocol for adulticide therapy?
2 IM injections 24 hours apart
43
when may slow kill be used instead of adulticide therapy?
dogs with co-morbidities preventing immiticide therapy & dogs that can't be confined
44
what are the disadvantages of slow kill for adulticide therapy?
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
what is slow kill adulticide therapy?
heartgard plus - negative test after 3-4 year period advantage multi + doxycycline - negative test after > 206 days
46
can you give 3 immiticide innjections 1 month apart so there is a lower probability of adverse effects? why?
no - 2 injections 24 hours apart are required to kill the female worms
47
in the split protocol, do the second set of injections have to be exactly 1 month after the first injection?
no - not if the dog had a reaction to the first injection
48
what is the potential benefit of using corticosteroids in heartworm treatment?
may help reduce pulmonary inflammation - pred at 0.5 mg/kg every 12 hours tapered over 3-4 weeks following each injection
49
what is wolbachia?
symbiotic intracellular parasite found in heartworms that has a surface protein that induces an inflammatory response in the host's lungs & kidneys
50
what is the role of doxycycline in heartworm treatment?
eliminates wolbachia - 10mg/kg/day for 30 days, gets rid of them for 3-4 months
51
what is the benefit of combining doxycycline & monthly ivermectin for heartworm treatment?
sterilizes & damages the female worms, microfilaria removed from circulation in 9-12 weeks, & dogs had significantly less pulmonary arterial lesions & thrombi
52
what are the current recommendations for doxycycline in heartworm treatment?
doxycycline for 30 days prior to immiticide, macrocyclic lactone preventative at the time of diagnosis, & corticosteroids
53
T/F: there may be resistant microfilaria
true - but may be a lack of compliance or under-dosing, or re-infection
54
______ _____ is a differential diagnosis in dogs with exercise intolerance, cough, dyspnea, ascites, & dark colored urine
heartworm disease
55
what does a systolic right-sided heart murmur in a heartworm positive dog suggest? what diagnostic is required?
caval syndrome, pulmonary hypertension echo is required to definitively diagnose
56
what should you consult for the most up to date information on heartworm disease?
american heartworm society
57
T/F: prevention is better than therapy for heartworm disease
true
58
what is the treatment for caval syndrome?
heartworm extraction & proceed with adulticide therapy
59
what is the prognosis of caval syndrome?
good if caught early poor if: heart failure, renal failure, coagulopathy
60
what are the clues of caval syndrome?
evidence of hemolysis - anemia, dark red (port wine) colored urine systolic right-sided heart murmur - tricuspid regurgitation
61
if an owner won't confine their heartworm positive dog, what therapy are you less likely to pursue?
immiticide
62
what is the most important aspect of client education when doing immiticide therapy?
STRICT exercise restriction - all positive dogs for 4 weeks following each injection
63
why is strict exercise restriction required in all heatworm positive dogs especially those getting immiticide?
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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