Heart Failure Treatment Flashcards
MOA: calcium sensitization and phosphodiesterase 3 inhibition
pimobendan (ca > + inotrope, phosph > vasodilation)
what drug indirectly causes vasodilation?
ACE inhibitors
name two potent arteriodilators
sodium nitroprusside and hydralazine
name two major ACE inhibitors
benazepril and enalapril
digoxin slows conduction through the AV node and is used in conjunction with what drug to control HR in AF and other SVTs?
diltiazem
what antiarrhythmic is a cardiac glycoside?
digoxin
pimobendan is what…
an inodilator
what drug is used to treat HR control in AF and SVTs (converting some SVTs > sinus rhythm)
diltiazem
dobutamine is what?
a synthetic catecholamine
why might a clinician choose to use spironolactone?
for it’s potassium-sparing and cardioprotective (anti-fibrotic) effects
i.e. patients on furosemide that are hypokalemic
T/F: thoracocentesis is common in dogs while abdominocentesis is common in cats
FALSE, opposite
T/F: patients with HF may develop cardiac cachexia
TRUE
what is the ER dose of diltiazem for cats and dogs?
0.1 mg/kg IV SLOW over 5 min
MOA: inhibit conversion of angiotensin I to ang II
ACE inhibitors
T/F: if your HF patient develops azotemia you should consider a protein-restricted diet
FALSE, protein restriction is CONTRAINDICATED in HF
what is increased in excretion in HCTZ and not loop diuretics?
phosphate, iodide, bromide
what is the ER dose of furosemide for dogs and cats?
dogs: 2-4 mg/kg IV or IM boluses +/- CRI
cats: 1-3 mg/kg IV or IM boluses +/- CRI
diltiazem, digoxin, lidocaine, mexiletine, sotalol, and amiodarone are all what type of drug?
antiarrhythmic
what drugs are used for chronic management of VT and other complex ventricular ectopy?
mexilitine and sotalol (both PO)
MOA: increase production of NO
nitrates (nitroglycerin and nitroprusside)
what are the chronic deleterious effects of chronic sympathetic stimulation on cardiac muscle?
fibrosis, apoptosis, necrosis
MOA: inhibits phosphodiesterase 5
sildenafil
what are the potential adverse effects of ACE inhibitors?
systemic hypotension, impaired renal function, GI upset
MOA: interferes w/ cellular calcium metabolism in smooth muscle
hydralazine
what drug class is amiodarone?
class III (class I, II, and IV effects)
what type of heart failure matches the clinical signs below?
exercise intolerance, weakness and/or collapse, lethargy, depressed mentation, pallor, hypothermia
low output HF (poor perfusion, hypotension)
what vasodilator is a pulmonary arteriodilator?
sildenafil
pimobendan, dobutamine, and digoxin are what types of drugs?
positive inotropes
what type of diet is suggested for patients with HF?
complete and balanced w/ high quality protein and moderate sodium restriction (AAFCO standards)
T/F: angiotensin I stimulates the SNS causing vasoconstriction leading to increased afterload therefore causing problems for myocardium
FALSE, angiotensin II (conversion inhibited in ACE inhibitors)
which of the following antiarrhythmic drugs are given PO?
a) diltiazem
b) digoxin
c) lidocaine
d) mexilitine
e) sotalol
f) amiodarone
diltiazem (also IV), digoxin, mexiletine, sotalol, amiodarone
what two types of patients would you be cautious in using ACE inhibitors?
renal disease and concurrent NSAID use
when are beta blockers contraindicated?
acute HF…careful in ventricular systolic dysfunction!
what drug is both an anti-arrhythmic and positive inotrope?
digoxin
MOA: calcium channel blocker (specific to vascular smooth muscle)
amlodipine
what type of azotemia is relatively common in patients with CHF?
mild and pre-renal (from diuretic and/or decreased CO)
which of the following is not a diuretic?
a) benazepril
b) furosemide
c) hydrochlorothiazide
d) hydralazine
e) spironolactone
f) sildenafil
a), d), f)
match L-CHF and R-CHF in cats with the following signs:
1) tachypnea, dyspnea, lethargy or hiding, syncope or pre-syncope, cough, decreased appetite, wt loss, vomiting
2) tachypnea, dyspnea, lethargy or hiding, abdominal distension, syncope or pre-syncope, decreased appetite, wt loss, V/D
L-CHF: 1
R-CHF: 2
Dogs similar except + exercise intolerance
what are the major expected side effects of furosemide?
PU/PD
what are the three main goals of HF therapy?
1) relieve congestion
2) improve CO
3) prevent progression (“cardioprotection”)
dobutamine (CRI) is used to treat what?
severe HF and cardiogenic shock
hydrochlorothiazide (HCTZ) is what type of drug?
diuretic
when providing supplemental O2 FiO2 should be what %?
40%
what drug class is lidocaine?
class I (sodium channel blocker)
volume depletion & pre-renal azotemia, electrolyte imbalances (hypokalemia), renal failure, otoxicity, and dermal ulcerations (at SC injection sites) are all potential adverse effects of what drug?
furosemide
Name major vasodilators
nitrates, hydralazazine, amlodipine, sildenafil, pimobendan
MOA: inhibit Na/K/2Cl cotransporter in thick (ascending) loop > increased renal excretion of Na, K, Cl, Mg, Ca, H, ammonium, bicarb, and water
loop diuretics (furosemide, torsemide)
what is the ER dose of lidocaine for cats and dogs?
dogs: 2 mg/kg IV SLOW over 2-3 min
cats: 0.2 mg/kg IV SLOW
name two loop diuretics
furosemide (lasix) and torsemide (demadex)
MOA: strong beta1 receptor agonist
dobutamine
what drug is used to suppress VPCs and ventricular tachycardia?
lidocaine
what drug would you discontinue if your patient with HF has moderate/severe azotemia or shows evidence of renal disease?
ace inhibitor
what drug is both a vasodilator and positive inotrope?
pimobendan
what drug class is mexiletine?
class I (sodium channel blocker)
what drug is a weak + inotrope and antiarrhythmic?
digoxin
what are three ways to decrease ventricular filling pressure (big picture)?
decrease blood volume (preload), decrease venous return to heart (preload), increase forward flow
what is the most common presenting complaint in cats with CHF?
dyspnea
what vasodilator is mostly used chronic treatment of systemic hypertension in cats and dogs
amlodipine
when are ACE inhibitors contraindicated?
dehydrated (or hypotensive) patients
what two types of drugs reduce deleterious effects of RAAS?
ACEi and aldosterone antagonists
when should reevaluation of HF occur?
w/in 1 week of starting a medication or increasing the dose
name the major cardioprotective drugs
beta blockers, ACEi, aldosterone antagonists
What drug is routinely used in canine HF due to DVD or DCM and more recently used in feline HF and stage B2 DMVD?
pimobendan (inodilator)
what drug class is diltiazem?
IV (calcium channel blocker)
T/F: coughing is a common indication for congestive heart failure in cats
FALSE, uncommon…dogs>cats
what drug is used to treat post-cardioversion of AF and refractory ventricular tachycardia?
amiodarone (PO)
furosemide routes of administration include PO, IV, IM, and SC
true BUT SC is off label, MOST COMMONLY used=furosemide (torsemide is newer product, better bioavailability and longer duration)
MOA: aldosterone receptor antagonist
spironolactone
what is the difference between nitroglycerin and nitroprusside?
nitroglycerin: predom. vasodilator (acute treatment of CHF, available topically)
nitroprusside: potent rapidly-acting ARTERIO-dilator (severe/life-threatening pulmonary edema)
what drug class are beta blockers?
antiarrhythmic (class II)
MOA: inhibit Na/Cl cotransporter in distal tubule > increased renal excretion of Na, Cl, and water
diuretic
