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Cardiovascular > Therapuetics NOT COMPLETE > Flashcards

Therapuetics NOT COMPLETE Flashcards

0
Q

4 stages of treatment of CV disease

A
  1. Correctly ID underlying disease
  2. Stage severity of disease (which Tx and aims?)
  3. Apply EBVM
  4. Absence of best-evidence - make an informed and rational decision on basis of type of signs shown and type of therapy most effective
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1
Q

Which species are commonly treated for heart failure?

A

Cats and dogs

- limited literature on treatement of other species

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2
Q

Egs. of classification systems for staging severity of heart disease?

A
  • New york heart association
  • INternational small animal cardiac health council
  • ACC (american college of caridology)
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3
Q

What are the simple stages of CV disease?

A
  1. disease no compensiation
  2. disease and compensation
  3. congestive heart failure with clinical signs of this
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4
Q

How may heart failure be characterised by pathophysiology?

A
  • ^ preload (^ retention of fluid)
  • ^ afterload (vasoconstriciton or narrowing of OFT)
  • impaired inotropy
  • impaired luisotropy
  • abnormalities of rate and rhythm
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5
Q

Which drugs have good evidence for their use?

A

> MVD dogs - pimobendan, ACEI, sprionolactone
DCM - pimobendan, ACEI
HCM cats - ACEI

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7
Q

Classes of diuretic - which are most commonly used?

A 
> loop diuretics
- frusemide (commonest) 
- torasemide (end stage only if refractory to frusemide) 
> thiazides
- chlorothiazide
- hydrochlorothiazides
> K+ sparing
- spironolactone
- amiloride
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8
Q

What is he site of action of various diuretics?

A
  • CA inhibitors: PCT
  • Frusemide: loop
  • Thiazides: DCT
  • K+ sparing: collecting duct
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9
Q

How is diuretic tx starte and progressed?

A
  • start single agent - frusemide 1-2mg/kg oral BID/TID
  • administer at higher doses and IV
  • Introduce 2nd diuretic - sequential blockade (spironolactone)
  • swap to torasemide
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10
Q

What are the risks of diuresis?

A 
> hypovolaemia
- excessive diuresis
> Hypotension
- reduction of cardiac output 
> Electrolyte disturbances 
- K, Mg, Na 
> Stimulation of RAAS
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11
Q

How does response in Na gain change over time with diuretic tx?

A

Returns to equilibrium (ie. has less effect over time)

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12
Q

Eg of venodilators?

A

glyceryl trinitrate

- percutaneous

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13
Q

Eg. of balanced vasodilators?

A
  • ACEI
  • Pimobendan
  • Nitroprusside
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14
Q

What is afterload? How is afterload reduction acheived?

A

Peak ventricular wall tension during systole
- determined by resistance to ejection from the ventricle
- ^ systemic vascular resistance
- obstruction of outflow tracts associated with high resistance to ejection (AS/PS)
> arteriodilators (unless fixe obstruction)

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15
Q

How can afterload affect mitral regurgitant fraction??

A

decreased afterload decreased regurgitant fraction

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16
Q

Risks of afterload reduction?

A

Under perfusion of CNS, coronary circulation and renal blod flolw

17
Q

Agents for afterload reduction?

A
  • ACEI
  • Pimobendan
  • Others
    > Ca channel blockers eg. Amlodipine
    > xanthines
    > alphablockers
  • Ateriodilators eg. hydralazine
18
Q

What are patients described as cold or wet?

A
  • cold = v output
  • wet = congested
    > we want patient to be warm and dry!
19
Q

Which drugs can convert a patient from cold to warm?

A
  • inotropes
  • afterload reduction
  • anti-arrythmics
20
Q

Which drugs can convert a patient from wet to dry?

A
  • diuretics (excrete Na)

- preload reduction

21
Q

What is the most common, main tx of congestive heart failure?

A

Diuretics

22
Q

What effects does spironolactone have?

A
  • blocks aldosterone R

- v fibrosis through other mechanisma

23
Q

How do diruetics work and what effect does this have on their use clinically?

A
  • multiple regions of kidney
  • will become refractory to drugs as further downstream adaptations occour, and sodium levels will return to a close to previous level after initial major drop
    > diuretics must be maintained infinitely
    > sequential bockade usage of diuretics strting with PCT -> loop -> DCT -> collecting duct based drugs
24
Q

How can treatment of cardiac disease be managed?

A
  • v preload (v fluid volume, v venous tone)
  • v afterload (arterial tone)
  • imprve systolic function or diastolic function
  • optimise cardiac rate or rhythm
25
Q

Give a specific disease where afterload reduction is particularly useful

A

Mitral valve disease (will v regurgitation fraction)

26
Q

Which diseases will benefit from improving systolic fucntion?

A
  • DCM

- late stage MVD

27
Q

When would imprived diastolic function benefit the patient?

A
  • hypertrophic cardiomyopathies

- fibrosis

28
Q

What kind of drugs can assist with diastolic function?

A
  • hasten relaxation (calcium channel blockers)
  • slow heart rate (b blockers)
  • reduce fibrosis (ACEI)
29
Q

See lecture for table of preload/afterload/systolic/diastolic/rate and rhythm/blot clot prevention drugs

A

Cardiovascular (11 decks)

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