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23 spring: med surg > Test 1: lecture 5 +6: CHF treatment > Flashcards

Test 1: lecture 5 +6: CHF treatment Flashcards

1
Q

what are some goals of CHF treatment

A

improve systolic and diastolic function

get rid of aggravating conditions: arrhythmia, HTN

control edema

avoid drug adverse effects

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2
Q

cat with HCM will have — hypertrophy with impaired —

A

concentric ventricular

Impaired diastolic relaxation
Increased myocardial stiffness (decreased compliance)
Normal systolic function

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3
Q

why does HCM cause congestion

A

big stiff LV requires more pressure to push blood out of heart

increased preload causes increased diastolic pressure → congestion

increased pressure leads to back up to the venous/capillaries causing edema

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4
Q

what drug to increase fluid excretion in cat

A

loop diuretics: lasix (furosemide)
1-2 mg/kg IV cat
0.5-1.0 mg/kg/day oral cat

natriuresis (increased sodium excretion)

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5
Q

two ways to decrease preload and congestion

A

increased fluid excretion → diuretics (Lasix)

increase venous capacitance→ venous vasodilators (Nitrates)

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6
Q

Nitrates will cause — and does what to preload

A

venous vasodilation

will decrease preload and congestion

nitroglycerine pasts: 1/8-1/4 inch cutaneoudly q6-8 hrs

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7
Q

what are some ACE inhibitors

A

—april

enalapril, benazepril, lisinopril ect

blocks angiotensin 1 from changing into angiotensin 2, prevents RAAS pathway

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8
Q

how does ACE inhibitor work

A

blocks angiotensin 1 from changing into angiotensin 2, prevents RAAS pathway

arterial vasodilation: will reduce afterload

decrease Na/H2O resorption: reduce preload

reduce angiotensin 2/ aldosterone myocardial hypertrophy

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9
Q

how will ACE inhibitor effect the preload/CO graph

A

will reduce preload ( decrease Na/H20 resorption) and reduce afterload (arterial vasodilation)

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10
Q

how to reduce myocardial work

A

myocardial oxygen demand (MVO2)= systolic BP x HR

can either decrease BP or decrease HR

can’t go to low on either but some wiggle room

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11
Q

what drugs are used to slow HR and increase diastolic filling time in cat

A

beta adrenergic receptor blockers (Atenolol)

Calcium channel blockers (Dilacor)

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12
Q

how do beta-adrenergic receptor blockers work

A

decrease sympathetic tone
decrease impulse to sinus node

will cause slow HR and increased diastolic filling time

Atenolol 6.25-12.5 mg/cat/day

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13
Q

how does caclium channel blockers work

A

decreased calcium dependent depolarization

slows impulse of SA node

slows HR and allows for increased diastolic filling time

Dilacor 30-60 mg/day cat

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14
Q

— olol drugs are for

A

beta blockers

slow HR

atenolol

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15
Q

side effects of diurectics

A

Hypovolemia
electrolyte abnormalities
pre-renal azotemia
acute kidney injury (increased BUN, Creat)

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16
Q

side effects of afterload reducers

A

hypotention

kidney injury

arterial vasodilators (ACE inhibitors) (enalapril)

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17
Q

side effect of beta blockers and Calcium blockers

A

bradycardia

beta blocker: atenolol
Ca blocker: dilacor

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18
Q

how to treat acute life threatening CHF in dogs

A

FOND

furosemide
oxygen
nitro
dobutamine, dopamine, digoxin

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19
Q

dose of Lasix in cat and dog

A

Lasix
Dog
2-4 mg/kg IV/IM q 2-3 hrs (has shorter 1/2 life in a dog)
2-3 mg/kg/day PO

Cat
1-2 mg/kg IV/IM (cat) q 2-3 hrs
0.5-1.0 mg/kg/day PO

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20
Q

how to monitor furosemide

A

short 1/2 life in dogs

monitor urine output, hydration status and renal function

could use constant rate infusion in dogs- reevaluate frequently

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21
Q

how does furosemide work

A

needs to be activly transported across PCT in the kidney from the blood into the tubule lumen

kidney needs to work for furosemide to work

receptor needs to be avilable - NSAIDs can block this transport

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22
Q

what happens to the dose of lasix needed over time

A

need more for same result
diminished response
Braking effect

kidney tries to go around lasix

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23
Q

what is Braking effect

A

kidneys response to diuretic

decrease in plasma volume will cause increase in RAAS

kidney gets angry and goes into over drive

24
Q

if low O2 what to do?

A

oxygen cage give 40% O2
intranasal give 100% O2
positive pressure ventilation: expensive

normal air O2=21%

25
Q

how to give nitroprusside

A

IV only
very short half life

CRI: 2-10 microgram/kg/minute for dog

protect from light, dilute with 5% detrose, degrades in plastic

will cause venous and arterial vasodilation: monitor for hypotension

26
Q

nitroprusside in a dog will cause

A

Venous vasodilation: reduce preload
Arterial vasodilation: reduce afterload

very short half life, IV only, CRI

27
Q

dobutamine effects —

A

sympathetic tone
will bind to B1 receptors on SA node and heart muscle to cause increased contractility

side effect: tachycardia

28
Q

name an inotrope used to treat CHF in a dog

A

dobutamine

will increase sympathetic tone
synthetic B1-agonist- increase calcium into the cell

increase contractility of the heart

digoxin, dobutamine, dopamine: increase Calcium in the cell

pimobendan- inodilator

29
Q

side effects of dobutamine

A

tachycardia

increase sympathetic function by increasing amount of Ca in the cell which increases contractility of the heart

very short half life: CRI: 5-15 microg/kg/min

30
Q

how does dopamine work

A

B-agonist: increase amount of calcium in the cell which increases HR and contractility

also binds to ⍺ receptors: cause vasoconstriction

side effects: tachycardia and vasoconstriction
monitor rate and rhythm

31
Q

what are some drugs to slow Afib in a dog

A

Ca channel blocker- decease Ca in SA node= decrease HR- dilacor

B-blocker- atenolol- decrease HR by decrease sympathetic impulse to SA node

Digoxin binds to and inhibits the sodium/potassium-ATPase (sodium pump) within the plasma membrane of cardiac myocytes- leads to more sodium= more calcium= increase contractality

32
Q

how to treat dog with low cardiac output, low contractility and hypotension

A

give fluids
inotropes- dobutamine to increase contractability of heart by increasing Ca in the cell by acting as B-agonist

33
Q

at home treatment for CHF in dog

A

Furosemide

Oxygen

Ace inhibitor-enalapril prevent RAAS pathway: arterial vasodilation(decrease afterload), decrease Na resporption (decrease preload), decrease angiotensin II mediated myocardial hypertrophy

Pimobendan- inodilator- increase contractlility(by increasing calcium sensitivity of actin and myosin), arterial vasodilator (phosphodiesterase inhibitor)

34
Q

how does pimobendan work

A

inodilator

increase contractlility(by increasing calcium sensitivity of actin and myosin)

arterial vasodilator (phosphodiesterase inhibitor)

better contractility without increasing workload of the heart

35
Q

compare energy requirment for Dobutamine vs Pimobendan

A

both act as positive inotropes: increase contractility inside the cell

Dobutamine works by increasing the amount of Calcium inside the cell (acts as B1-agonist, increases sympathetic impulse) = high energy expenditure

Pimobenden: makes actin and myosin more sensitive to calcium as well as acts as arterial vasodilator: low energy

36
Q

typically starting dose of lasix for dog and cat

A

Dog: 2mg/kg/day
Cat: 1-1.5mg/kg/day

can increase to
Dog: 1-3mg/kg q8-24hrs as needed
Cat: 1-2mg/kg q12-24hrs as needed

37
Q

what is an uncommon effect of ACE inhibitors

A

renal dysfunction

ace inhibitor can cause vasodilation of cells inside efferent blood vessels of glomerulus. This causes hypotension inside the kidney and decrease in function leading to hyperkalemia

38
Q

what is aldosterone escape

A

when you give ACE inhibitor

body finds a different way to make aldosterone

39
Q

how does spironolactone work?

A

aldosterone receptor antagonist

use in addition to ACE inhibtor to prevent aldosterone escape

prevents aldosterone from retaining sodium, causing myocardial damage

40
Q

aldosterone antagnosits are — sparing diuretics

A

potassium

spironolactone: work in DCT and collecting duct

41
Q

spironolactone is a —

A

aldosterone antagnoist

acts as a potassium sparing diuretic

anti-remodeling/hypertrophy effect rather than diuretic action

42
Q

side effects of spironolactone

A

dehydration, renal injury, hyperkalemia

aldosterone antagnoist: acts as potassium sparing diuretic

43
Q

chronic heart failure in dogs is treated with — drugs

A

FAPS

furosemide
ACE inhibitor
pimobendan
spironolactone

44
Q

digoxin works as a — inotrope

A

positive

increases contractility

45
Q

— has replaced digoxin in treatment of CHF

A

pimobendan

digoxin still used to slow ventricular HR (Afib)

46
Q

what is diurectic resistance

A

over time may need to increase or add new drug to get same diuretic effect

47
Q

how to treat refractory and end stage HF

A

make sure pet actually getting meds

increase meds: increase furosemide dose or increase dosing schedule for ACEI

remove excess fluid manually (tap the chest or abdomen)

48
Q

what are other diuretics you can use for refractory CHF

A

thiazide: works in DCT

Torsemide: works in loop

cause sequential nephron blockade: stop Na in multible areas of nephron

49
Q

— is a venous vasodilator, sorta like an oral nitro

A

isosorbide dinitrate

rapid development of tolerance

50
Q

what are some atrial vasodilators other then ACEI

A

amlodipine
hydralazine

limited by hypotension

51
Q

cats with — usually last 9-12 months ending with — and —

A

cardiomyopathy

thromboembolism, bradycardia

52
Q

dogs with — usually last 9 months with end signs of

A

mitral regurgitation

atrial fibrillation, pulmonary hypertension, atrial tears

53
Q

dogs with — last 6 months with end signs of

A

dilated cardiomyopathy

atrial fibrillation, ventricular arrhythmias

54
Q

goals of chronic CHF therapy are

A

  Prevent congestion
–  Interrupt maladaptive neurohormonal systems
–  Maintain hemodynamics
–  Avoid adverse side effects
–  Maintain high quality of life

55
Q

goals of acute CHF therapy are —

A

Alleviate congestion
Improve hemodynamics

23 spring: med surg (60 decks)

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