Medications used in cardiology Flashcards
What diuretics are commonly used in heart failure
Furosemide, Spironolactone, hydrochlorothiazide
Furosemide (Lasix) How does this drug work?
Loop diuretic targeting theNa/K/2Cl cotransporter
Side Effects:
- activates the RAAS system (needs an Ace inhibitor) such as Enalapril/Benazepril
- azotemia
- hypokalemia
- metabolic alkalosis
- hypochloremia
This is the most effective diuretic causing increased urination. This drug has a high ceiling effect so you can increase the dose, increaseing the level of diuresis
Spironolactone - How does this drug work, and what are the side effects?
This is the 2nd line vs CHF
+ ionotrophy/blunts RAAS and SNS
Aldosterone antagonist/K+ sparing diuretic affecting the distal tubule/collecting duct
This drug is cardioprotective because it is bound by aldosterone. Aldosterone stimulates myocardial fibrosis and remodeling.
Side effects: azotemia, hyperkalemia, facial dermatitis
What diuretic is considered cardioprotective and why
spironolactone - binds to the aldosterone receptor. This prevents myocardial fibrosis and remodeling
Hydrochlorothiazide - How does this drug work and what are the side effects?
Thiazide diuretic targeting the distal tubule. This targets the Na/Cl cotransporter.
Side effects: azotemia, hypercalcemia, hypokalemia
this drug is the 3rd line in CHF. This can cause significant dehydration in our patients.
How do you decrease the afterload?
dilate the vessels
what drugs are options for vasodilating vessels
enalapril/benazepril
Hydralazine
Nitroprusside
Nitroglycerine
Amlodipine
Sildenafil
What is enalapril, and how does it work?
Enalapril is an ACE inhibitor and is considered a balanced vasodilator. It is indicated for treatment of Chronic CHF and proteinuria
Decreases glomerular hypertension as well by dilating the renal tubules
Side effects: azotemia, and hypotension
What is hydralazine ?
This drug is used in Acute Severe CHF conditions. This causes arteriodilation.
Side effects: hypotension
Generally used in the hospital
What is nitroprusside? How does it work, and what is it’s indicated use?
This drug is a balanced vasodilator used for treatment of acute severe CHF.
side effects: nitrate tolerance, cyanide toxicity, hypotension
this drug is used in the hospital with acute severe CHF cases
What drug is Nitroglycerine? how does it work and what is its indicated use?
This is a venodilator used for the treatement of Acute severe CHF
Side effect: nitrate tolerance, cyanide toxicity and hypotension
Generally used in the hospital vs acute severe CHF
what is Amlodipiine, and when is this drugs use indicated?
This drug is a calcium channel blocker. It is an arteriodilator
this drug is indicated with systemic hypertension, or severe chronic CHF
side effects: gingival hyperplasia or hypotension
May be given to a patient that is normotensive for afterload reduction
what is Sildenafil? How does this drug work and how is it used?
This drug is a PDE-v inhibitor.
this drug works as a pulmonary arteriodilator. This drug is indicated with pulmonary hypertension
Side effects: hypotension
What is the goal of using Inotropes?
increase the strengths of contraction
Increase the force and rapidity of the contraction
Need calcium to cause the crossbridge formation
Sensitize the Actin-Myosin receptors to Ca
What are the 3 inotropic drugs you can use/
Pimobendan
Dobutamine
Digoxin
What is Pimobendan? How does this drug work, and what are indications for its use?
Pimobendan causes Calcium sensitization and vasodilation
this drug is used as a first line drug for CHF
Side effects: anorexia, pro-arrhythmic (humans-only)
What is Dobutamine? How does this drug work and what are indications for its use?
B-adrenergic agonist- Binds to B1 receptor and causes more calcium to enter the cell
this drug is utilized in the hospital for cardiogenic shock.
Side effects: vasoconstriction (at high doses) and ventricular arrhythmias
What is digoxin? How does this drug work and what are situations that its use is indicated
This medication increases the intracellular calcium.
Its use is indicated in atrial fibrilation rate control in dogs only.
side effects: vomiting/diarrhea, ventricular arrhythmias, bradycardia
This is the only ionotrop that slows the heart rate
What does it mean to optimize the heart rate?
Treating the tachyarrhythmias or bradyarrhythmias that compromise the cardiac output.
- Rapid atrial fibrilation: negative chronotrope
Bradyarrhythmias: positive chronotrope (atropine, theophyline) or artificial pacing
What drug is Diltiazem and how does it work? What are indications for the use of this drug?
Calcium channel blocker slowing the conduction at the AV node. This decreases contractility.
Most effective at lowering the HR
Side effect: GI upset, bradycardia, hypotension
What drug is Atenolol, and how does it work? What situations is it indicated to use?
B-adrenergic blocker (slowing the conduction at the AV node) this decreases the contractility of the heart.
Only if started prior to CHF
Side effects: bradycardia, hypotension, bronchospasm
Negative ionotroph, negative chronotrope
do not gie to an animal in acute heart failure
Pharmacologic treatment of CHF in dogs
dietary Na+ restrictions
Ace inhibitors (Enalapril)
furosemide
(spironolactone)
pimobendan
-Sildenafil: if pulmonary hypertension
Diltiazem+ digoxin: if atrial fibrilation
how do you treat a dog with acute CHF?
Furosemide
Oxygen supplementation
Pimobendan
Sedation (butorphanol)
(Dobutamine), (Nitroprusside)
How do you treat a cat in acute CHF?
- furosemide
- oxygen supplementation
- pimobendan (caution with severe HOCM?)
- Sedation
+/- thoracocentesis with pleural effusion
(Dobutamine)
How do you treat a cat with chronic CHF?
dietary Na+ restrictions
Furosemide
Ace inhbitors
Clopidogrel
Pimobendan
Atenolol: if started before CHF
What are diet recommendations for patients with CHF?
moderate Na+ restrictions (especially treats)
protein/calories to avoid cachexia
Supplements such as fish oils, K+, Mg++, taurine, carnitine
What drugs are used in DCM cases to increase the inotropy and are cardioprotective?
pimobendan
Ace inhibitor
atneolol (do not give to an acute CHF patient)
What drugs are used in DCM cases to treat arrhythmias.
Sotalol, mexiletine for chronic Ventricular arrhythmias
Lidocaine for acute ventricular arrhythmias
Digoxin, diltiazem for atrial fibrillation
How do you treat a dog with acute CHF secondary to DCM?
FOPS
Furosemide
Oxygen
Pimobendan
Sedation (butorphanol)
-centesis: if pleural effusion/ascites
Dobutamine: if in cardiogenic shock and have poor CO
Lidocaine: if life-threatening VT
How do you treat a dog with chronic CHF secondary to DCM?
“Dogs Are For Special People”
Dietary Na+ restrictions
ACEi
Furosemide
Spironolactone
Pimobendan
-diltiazem/Digoxin: rate control in atrial fibrillation
Sotalol/Mexiletine: Ventricular arrhythmias
what are treatments for pericardial effusion
- if unstable/decreased BP IV fluids.
- if preparing for a pericardiocentesis, administer quarter shock bolus of IV crystalloids
- Pericardiocentesis
Where do you performa pericardiocentesis?
The right side of the chest ICS 3-5
in the intercostal space, go just cranial to the rib to avoid the neurovascular bundle that lies caudal to the rib
what medications are for the treatment of pulmonary hypertension in the presence of R-CHF?
R-CHF: furosemide, Pimobendan, enalapril
Pulmonary vasodilatior: Sildenafil
What is the treatment if pulmonary hypertension is due to chronic bronchopulmonary disease?
Bronchodilators (theophyline)
cough suppressants (hydrocodone)
antibiotics (doxycycline
Steroids (prednisone)
Treatment of pulmonary hypertension that is due to Left sided heart disease
enalapril, pimobendan, furosemide, spironolactone
How do you treat pulmonary hypertension due to pulmonary thromboembolic disease
Clopidogrel
Aspirin
Treatment of PLE/PLN/Cushing’s
How do you traet pulmonary hypertension due to heartworm disease?
heartworm preventative
doxycycline
Melarsomine protocol
what parasite is responsible for Heartworm disease
Dirofilaria immitis
describe the lifecycle of Dirofilaria immitis
Mosquito picks up the microfilaria. Microfilaria mature to L3. the L3 is infective and injected into the new host. The L3 matures to an L4 in the tissues. Adults are found in the pulmonary arteries. When both male and female are present they reproduce and form microfilaria.
What stage in the heartworm lifecycle does heartworm prevention kill?
L3 and Early L4
How do you proceed with treatment if an animal (dog) tests positive for heartworm disease?
- Begin HW preventative
- Doxyccyline 10mg/kg BID for 4 weeks
- 3 injection protocol of melarsomine
- injection 1 at day 60
- Injection 2 at day 90
- Injection 3 at day 91
- Prednisone taper with each melarsomine injection
Exercise restriction
What are complications for heartworm disease? How do you treat each
- eosinophilic pneumonitis -
- Prednisone
- Pulmonary vascular disease -> pulmonary hypertension
- Sildenafil
- Right sided CHF
- furosemide, pimobendan, enalapril, spironolactone
- Caval syndrome
- surgical HW extraction
What are complications for heartworm disease? How do you treat each
- eosinophilic pneumonitis -
- Prednisone
- Pulmonary vascular disease -> pulmonary hypertension
- Sildenafil
- Right sided CHF
- furosemide, pimobendan, enalapril, spironolactone
- Caval syndrome
- surgical HW extraction
What are side effects of Furosemide?
increased BUN and Creatinine
Decreased Cl/ increased bicarbonate
Decreased K
Decreased Mg
Decreased NA
What are side effects of using Enalapril, benazepril, spironolactone?
Incresaed BUN and creatinine
Increased K
How do you proceed with treatment if an animal (dog) tests positive for heartworm disease?
- Begin HW preventative
- Doxyccyline 10mg/kg BID for 4 weeks
- 3 injection protocol of melarsomine
- injection 1 at day 60
- Injection 2 at day 90
- Injection 3 at day 91
- Prednisone taper with each melarsomine injection
Exercise restriction
How is systemic hypertension treated?
The goal is to control the blood pressure.
- Enalapril, benazepril are ACE inhibitors that decrease the BP by 10-15 mmHg
- This decreases glomerular hypertension and proteinuria
- Inhibits RAAS system
- Telmisartan- decreases BP by 20-25mmHg, and inhibits RAAS system
- Amlodipine is a calcium channel blocker that decreases BP by 30-60mmHg. no effect on renal efferent arteriole
- Activates the RAAS system
What are negative prognostic indicators for a patient with H(O)CM?
left atrial enlargement, Severe LV hypertrophy, older age.
Asymptomatic cats have an average surgival rate of ~5 years
following left atrial enlargement: 3-6 months
What medications are known to decrease the chance of thrombosis?
Clopidogrel
Aspirin
Heparin
tPA
What medications are used to treat Stage B HCM patients
- Atenolol- LVOT obstruction, severe sinus tachycardia (more likely with HOCM) used to decrease the heart rate and potentially get rid of the outflow blockage
- Ace inhibitors - Severe LV/LA remodeling and fibrosis
- Clopidogrel (moderate-severe LA enlargement) decrease the chacne of thrombus formation
What medications are used to treat Stage C CHF with HOCM?
Acute: O@ supplementation +/- thoracocentesis
Furosemide
Ace inhibitors
pimobendan (may be a concern with HOCM cats)
Spironolactone
What medications are used to treat arterial thromboembolism
Analgesia
Clopidogrel
Heparin/low molecular weight heparin
Thrombolysis
the goal is to decrease additional thrombus formation
What are treatments for PDA?
interventional catheterization
Surgical ligation (thoracotomy)
treatment dramatically improves prognosis
what is the treatment for pulmonic stenosis
mild/moderate: atenolol
Severe : balloon valvuloplasty
Treatment for Subaortic stenosis
Atenolol if moderate/severe
No good procedure: baloon valvuloplasty is not effective
What are treatment methods for a VSD in cats?
small restrictive (loud murmur) no treatment required
Large/unrestrictive (softer murmur) treat CHF when it occurs. there is no corrective procedure in cats.
How do you treat Mitral and tricuspid valve dysplasia in cats?
you treat when CHF occurs
No corrective procedure is available
