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Small animal Medicine- Cardiology > Medications used in cardiology > Flashcards

Medications used in cardiology Flashcards

1
Q

What diuretics are commonly used in heart failure

A

Furosemide, Spironolactone, hydrochlorothiazide

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2
Q

Furosemide (Lasix) How does this drug work?

A

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

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3
Q

Spironolactone - How does this drug work, and what are the side effects?

A

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

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4
Q

What diuretic is considered cardioprotective and why

A

spironolactone - binds to the aldosterone receptor. This prevents myocardial fibrosis and remodeling

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5
Q

Hydrochlorothiazide - How does this drug work and what are the side effects?

A

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.

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6
Q

How do you decrease the afterload?

A

dilate the vessels

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7
Q

what drugs are options for vasodilating vessels

A

enalapril/benazepril

Hydralazine

Nitroprusside

Nitroglycerine

Amlodipine

Sildenafil

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8
Q

What is enalapril, and how does it work?

A

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

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9
Q

What is hydralazine ?

A

This drug is used in Acute Severe CHF conditions. This causes arteriodilation.

Side effects: hypotension

Generally used in the hospital

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10
Q

What is nitroprusside? How does it work, and what is it’s indicated use?

A

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

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11
Q

What drug is Nitroglycerine? how does it work and what is its indicated use?

A

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

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12
Q

what is Amlodipiine, and when is this drugs use indicated?

A

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

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13
Q

what is Sildenafil? How does this drug work and how is it used?

A

This drug is a PDE-v inhibitor.

this drug works as a pulmonary arteriodilator. This drug is indicated with pulmonary hypertension

Side effects: hypotension

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14
Q

What is the goal of using Inotropes?

A

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

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15
Q

What are the 3 inotropic drugs you can use/

A

Pimobendan

Dobutamine

Digoxin

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16
Q

What is Pimobendan? How does this drug work, and what are indications for its use?

A

Pimobendan causes Calcium sensitization and vasodilation

this drug is used as a first line drug for CHF

Side effects: anorexia, pro-arrhythmic (humans-only)

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17
Q

What is Dobutamine? How does this drug work and what are indications for its use?

A

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

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18
Q

What is digoxin? How does this drug work and what are situations that its use is indicated

A

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

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19
Q

What does it mean to optimize the heart rate?

A

Treating the tachyarrhythmias or bradyarrhythmias that compromise the cardiac output.

  • Rapid atrial fibrilation: negative chronotrope

Bradyarrhythmias: positive chronotrope (atropine, theophyline) or artificial pacing

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20
Q

What drug is Diltiazem and how does it work? What are indications for the use of this drug?

A

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

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21
Q

What drug is Atenolol, and how does it work? What situations is it indicated to use?

A

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

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22
Q

Pharmacologic treatment of CHF in dogs

A

dietary Na+ restrictions

Ace inhibitors (Enalapril)

furosemide

(spironolactone)

pimobendan

-Sildenafil: if pulmonary hypertension

Diltiazem+ digoxin: if atrial fibrilation

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23
Q

how do you treat a dog with acute CHF?

A

Furosemide

Oxygen supplementation

Pimobendan

Sedation (butorphanol)

(Dobutamine), (Nitroprusside)

24
Q

How do you treat a cat in acute CHF?

A
  • furosemide
  • oxygen supplementation
  • pimobendan (caution with severe HOCM?)
  • Sedation

+/- thoracocentesis with pleural effusion

(Dobutamine)

25
Q

How do you treat a cat with chronic CHF?

A

dietary Na+ restrictions

Furosemide

Ace inhbitors

Clopidogrel

Pimobendan

Atenolol: if started before CHF

26
Q

What are diet recommendations for patients with CHF?

A

moderate Na+ restrictions (especially treats)

protein/calories to avoid cachexia

Supplements such as fish oils, K+, Mg++, taurine, carnitine

27
Q

What drugs are used in DCM cases to increase the inotropy and are cardioprotective?

A

pimobendan

Ace inhibitor

atneolol (do not give to an acute CHF patient)

28
Q

What drugs are used in DCM cases to treat arrhythmias.

A

Sotalol, mexiletine for chronic Ventricular arrhythmias

Lidocaine for acute ventricular arrhythmias

Digoxin, diltiazem for atrial fibrillation

29
Q

How do you treat a dog with acute CHF secondary to DCM?

A

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

30
Q

How do you treat a dog with chronic CHF secondary to DCM?

A

“Dogs Are For Special People”

Dietary Na+ restrictions

ACEi

Furosemide

Spironolactone

Pimobendan

-diltiazem/Digoxin: rate control in atrial fibrillation

Sotalol/Mexiletine: Ventricular arrhythmias

31
Q

what are treatments for pericardial effusion

A
  • if unstable/decreased BP IV fluids.
    • if preparing for a pericardiocentesis, administer quarter shock bolus of IV crystalloids
  • Pericardiocentesis
32
Q

Where do you performa pericardiocentesis?

A

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

33
Q

what medications are for the treatment of pulmonary hypertension in the presence of R-CHF?

A

R-CHF: furosemide, Pimobendan, enalapril

Pulmonary vasodilatior: Sildenafil

34
Q

What is the treatment if pulmonary hypertension is due to chronic bronchopulmonary disease?

A

Bronchodilators (theophyline)

cough suppressants (hydrocodone)

antibiotics (doxycycline

Steroids (prednisone)

35
Q

Treatment of pulmonary hypertension that is due to Left sided heart disease

A

enalapril, pimobendan, furosemide, spironolactone

36
Q

How do you treat pulmonary hypertension due to pulmonary thromboembolic disease

A

Clopidogrel

Aspirin

Treatment of PLE/PLN/Cushing’s

37
Q

How do you traet pulmonary hypertension due to heartworm disease?

A

heartworm preventative

doxycycline

Melarsomine protocol

38
Q

what parasite is responsible for Heartworm disease

A

Dirofilaria immitis

39
Q

describe the lifecycle of Dirofilaria immitis

A

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.

40
Q

What stage in the heartworm lifecycle does heartworm prevention kill?

A

L3 and Early L4

41
Q

How do you proceed with treatment if an animal (dog) tests positive for heartworm disease?

A
  • 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

42
Q

What are complications for heartworm disease? How do you treat each

A
  • eosinophilic pneumonitis -
    • Prednisone
  • Pulmonary vascular disease -> pulmonary hypertension
    • Sildenafil
  • Right sided CHF
    • furosemide, pimobendan, enalapril, spironolactone
  • Caval syndrome
    • surgical HW extraction
43
Q

What are complications for heartworm disease? How do you treat each

A
  • eosinophilic pneumonitis -
    • Prednisone
  • Pulmonary vascular disease -> pulmonary hypertension
    • Sildenafil
  • Right sided CHF
    • furosemide, pimobendan, enalapril, spironolactone
  • Caval syndrome
    • surgical HW extraction
44
Q

What are side effects of Furosemide?

A

increased BUN and Creatinine

Decreased Cl/ increased bicarbonate

Decreased K

Decreased Mg

Decreased NA

45
Q

What are side effects of using Enalapril, benazepril, spironolactone?

A

Incresaed BUN and creatinine

Increased K

46
Q

How do you proceed with treatment if an animal (dog) tests positive for heartworm disease?

A
  • 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

47
Q

How is systemic hypertension treated?

A

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
48
Q

What are negative prognostic indicators for a patient with H(O)CM?

A

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

49
Q

What medications are known to decrease the chance of thrombosis?

A

Clopidogrel

Aspirin

Heparin

tPA

50
Q

What medications are used to treat Stage B HCM patients

A
  • 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
51
Q

What medications are used to treat Stage C CHF with HOCM?

A

Acute: O@ supplementation +/- thoracocentesis

Furosemide

Ace inhibitors

pimobendan (may be a concern with HOCM cats)

Spironolactone

52
Q

What medications are used to treat arterial thromboembolism

A

Analgesia

Clopidogrel

Heparin/low molecular weight heparin

Thrombolysis

the goal is to decrease additional thrombus formation

53
Q

What are treatments for PDA?

A

interventional catheterization

Surgical ligation (thoracotomy)

treatment dramatically improves prognosis

54
Q

what is the treatment for pulmonic stenosis

A

mild/moderate: atenolol

Severe : balloon valvuloplasty

55
Q

Treatment for Subaortic stenosis

A

Atenolol if moderate/severe

No good procedure: baloon valvuloplasty is not effective

56
Q

What are treatment methods for a VSD in cats?

A

small restrictive (loud murmur) no treatment required

Large/unrestrictive (softer murmur) treat CHF when it occurs. there is no corrective procedure in cats.

57
Q

How do you treat Mitral and tricuspid valve dysplasia in cats?

A

you treat when CHF occurs

No corrective procedure is available

Small animal Medicine- Cardiology (3 decks)

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