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SAM 1 > Heart Failure Treatment > Flashcards

Heart Failure Treatment Flashcards

1
Q

MOA: calcium sensitization and phosphodiesterase 3 inhibition

A

pimobendan (ca > + inotrope, phosph > vasodilation)

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2
Q

what drug indirectly causes vasodilation?

A

ACE inhibitors

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3
Q

name two potent arteriodilators

A

sodium nitroprusside and hydralazine

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4
Q

name two major ACE inhibitors

A

benazepril and enalapril

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5
Q

digoxin slows conduction through the AV node and is used in conjunction with what drug to control HR in AF and other SVTs?

A

diltiazem

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6
Q

what antiarrhythmic is a cardiac glycoside?

A

digoxin

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7
Q

pimobendan is what…

A

an inodilator

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8
Q

what drug is used to treat HR control in AF and SVTs (converting some SVTs > sinus rhythm)

A

diltiazem

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9
Q

dobutamine is what?

A

a synthetic catecholamine

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10
Q

why might a clinician choose to use spironolactone?

A

for it’s potassium-sparing and cardioprotective (anti-fibrotic) effects

i.e. patients on furosemide that are hypokalemic

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11
Q

T/F: thoracocentesis is common in dogs while abdominocentesis is common in cats

A

FALSE, opposite

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12
Q

T/F: patients with HF may develop cardiac cachexia

A

TRUE

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13
Q

what is the ER dose of diltiazem for cats and dogs?

A

0.1 mg/kg IV SLOW over 5 min

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14
Q

MOA: inhibit conversion of angiotensin I to ang II

A

ACE inhibitors

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15
Q

T/F: if your HF patient develops azotemia you should consider a protein-restricted diet

A

FALSE, protein restriction is CONTRAINDICATED in HF

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16
Q

what is increased in excretion in HCTZ and not loop diuretics?

A

phosphate, iodide, bromide

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17
Q

what is the ER dose of furosemide for dogs and cats?

A

dogs: 2-4 mg/kg IV or IM boluses +/- CRI
cats: 1-3 mg/kg IV or IM boluses +/- CRI

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18
Q

diltiazem, digoxin, lidocaine, mexiletine, sotalol, and amiodarone are all what type of drug?

A

antiarrhythmic

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19
Q

what drugs are used for chronic management of VT and other complex ventricular ectopy?

A

mexilitine and sotalol (both PO)

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20
Q

MOA: increase production of NO

A

nitrates (nitroglycerin and nitroprusside)

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21
Q

what are the chronic deleterious effects of chronic sympathetic stimulation on cardiac muscle?

A

fibrosis, apoptosis, necrosis

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22
Q

MOA: inhibits phosphodiesterase 5

A

sildenafil

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23
Q

what are the potential adverse effects of ACE inhibitors?

A

systemic hypotension, impaired renal function, GI upset

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24
Q

MOA: interferes w/ cellular calcium metabolism in smooth muscle

A

hydralazine

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25
Q

what drug class is amiodarone?

A

class III (class I, II, and IV effects)

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26
Q

what type of heart failure matches the clinical signs below?

exercise intolerance, weakness and/or collapse, lethargy, depressed mentation, pallor, hypothermia

A

low output HF (poor perfusion, hypotension)

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27
Q

what vasodilator is a pulmonary arteriodilator?

A

sildenafil

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28
Q

pimobendan, dobutamine, and digoxin are what types of drugs?

A

positive inotropes

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29
Q

what type of diet is suggested for patients with HF?

A

complete and balanced w/ high quality protein and moderate sodium restriction (AAFCO standards)

30
Q

T/F: angiotensin I stimulates the SNS causing vasoconstriction leading to increased afterload therefore causing problems for myocardium

A

FALSE, angiotensin II (conversion inhibited in ACE inhibitors)

31
Q

which of the following antiarrhythmic drugs are given PO?

a) diltiazem
b) digoxin
c) lidocaine
d) mexilitine
e) sotalol
f) amiodarone

A

diltiazem (also IV), digoxin, mexiletine, sotalol, amiodarone

32
Q

what two types of patients would you be cautious in using ACE inhibitors?

A

renal disease and concurrent NSAID use

33
Q

when are beta blockers contraindicated?

A

acute HF…careful in ventricular systolic dysfunction!

34
Q

what drug is both an anti-arrhythmic and positive inotrope?

A

digoxin

35
Q

MOA: calcium channel blocker (specific to vascular smooth muscle)

A

amlodipine

36
Q

what type of azotemia is relatively common in patients with CHF?

A

mild and pre-renal (from diuretic and/or decreased CO)

37
Q

which of the following is not a diuretic?

a) benazepril
b) furosemide
c) hydrochlorothiazide
d) hydralazine
e) spironolactone
f) sildenafil

A

a), d), f)

38
Q

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

A

L-CHF: 1

R-CHF: 2

Dogs similar except + exercise intolerance

39
Q

what are the major expected side effects of furosemide?

A

PU/PD

40
Q

what are the three main goals of HF therapy?

A

1) relieve congestion
2) improve CO
3) prevent progression (“cardioprotection”)

41
Q

dobutamine (CRI) is used to treat what?

A

severe HF and cardiogenic shock

42
Q

hydrochlorothiazide (HCTZ) is what type of drug?

A

diuretic

43
Q

when providing supplemental O2 FiO2 should be what %?

A

40%

44
Q

what drug class is lidocaine?

A

class I (sodium channel blocker)

45
Q

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?

A

furosemide

46
Q

Name major vasodilators

A

nitrates, hydralazazine, amlodipine, sildenafil, pimobendan

47
Q

MOA: inhibit Na/K/2Cl cotransporter in thick (ascending) loop > increased renal excretion of Na, K, Cl, Mg, Ca, H, ammonium, bicarb, and water

A

loop diuretics (furosemide, torsemide)

48
Q

what is the ER dose of lidocaine for cats and dogs?

A

dogs: 2 mg/kg IV SLOW over 2-3 min
cats: 0.2 mg/kg IV SLOW

49
Q

name two loop diuretics

A

furosemide (lasix) and torsemide (demadex)

50
Q

MOA: strong beta1 receptor agonist

A

dobutamine

51
Q

what drug is used to suppress VPCs and ventricular tachycardia?

A

lidocaine

52
Q

what drug would you discontinue if your patient with HF has moderate/severe azotemia or shows evidence of renal disease?

A

ace inhibitor

53
Q

what drug is both a vasodilator and positive inotrope?

A

pimobendan

54
Q

what drug class is mexiletine?

A

class I (sodium channel blocker)

55
Q

what drug is a weak + inotrope and antiarrhythmic?

A

digoxin

56
Q

what are three ways to decrease ventricular filling pressure (big picture)?

A

decrease blood volume (preload), decrease venous return to heart (preload), increase forward flow

57
Q

what is the most common presenting complaint in cats with CHF?

A

dyspnea

58
Q

what vasodilator is mostly used chronic treatment of systemic hypertension in cats and dogs

A

amlodipine

59
Q

when are ACE inhibitors contraindicated?

A

dehydrated (or hypotensive) patients

60
Q

what two types of drugs reduce deleterious effects of RAAS?

A

ACEi and aldosterone antagonists

61
Q

when should reevaluation of HF occur?

A

w/in 1 week of starting a medication or increasing the dose

62
Q

name the major cardioprotective drugs

A

beta blockers, ACEi, aldosterone antagonists

63
Q

What drug is routinely used in canine HF due to DVD or DCM and more recently used in feline HF and stage B2 DMVD?

A

pimobendan (inodilator)

64
Q

what drug class is diltiazem?

A

IV (calcium channel blocker)

65
Q

T/F: coughing is a common indication for congestive heart failure in cats

A

FALSE, uncommon…dogs>cats

66
Q

what drug is used to treat post-cardioversion of AF and refractory ventricular tachycardia?

A

amiodarone (PO)

67
Q

furosemide routes of administration include PO, IV, IM, and SC

A

true BUT SC is off label, MOST COMMONLY used=furosemide (torsemide is newer product, better bioavailability and longer duration)

68
Q

MOA: aldosterone receptor antagonist

A

spironolactone

69
Q

what is the difference between nitroglycerin and nitroprusside?

A

nitroglycerin: predom. vasodilator (acute treatment of CHF, available topically)
nitroprusside: potent rapidly-acting ARTERIO-dilator (severe/life-threatening pulmonary edema)

70
Q

what drug class are beta blockers?

A

antiarrhythmic (class II)

71
Q

MOA: inhibit Na/Cl cotransporter in distal tubule > increased renal excretion of Na, Cl, and water

A

diuretic

SAM 1 (19 decks)

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