Therapy of Heart Failure Flashcards
What are the factors that go into deciding appropriate tx for heart failure
Severity
facilities
cost
outpt vs inpt
What is the 1st & MOST important thing to remember about heart failure animals?
Handle with Care!
these pts are inherently stressed and we have to minimize any additional stress. (e.g. no excitement ⇒ incr. catecholamine release ⇒ VPDs etc)
Medications to decr pt anxiety:
Butorphenol (IM) +/- hubful of Acepromazine
no longer recomd morphine (downside= vomiting)
diazepam (doesn’t work as well as butorphenol)
What is 2nd thing we do to help heart failure pts?
Enhance oxygenation
-pleural fluid/froth (thoracocentesis may be needed)
What is the precaution with using 100% O2 supplementation?
can cause free radical formation with extended use
you want to have environment of 30-50% O2 and remember to humidify it!
what is best way to deliver O2 to patient?
Nasal catheter
@50-100 ml/kg/min
What may a pt need when in resp. distress?
ventilatory support
if PaCO22 >60 mm (=hypercapnic)
3rd thing for heart failure therapy
reduce edema
caused by RAAS trying to compensate by incr. preload
use diuretics!
Furosemide
FONS
Which drug causes arrythmias
digoxin!
FONS is heart failure tx mneumonic for
Furosemide
Oxygen
Nitroprusside
Sedation
How to use furosemide in heart failure
Use as bolus (q1-2 hrs)/CRI in emergency to decr. pulmonary edema
(dose is sl. lower in cats d/t incr sensitivity to it)
then as RR decr 25-50% (animal doesn’t need so much resp effort) try to lower dose (po tid), HR will decr., Pulses improve
+ enalapril (ACE inhibitor) & decr Na diet
maintenance goal = lowest furosemide dose needed & highest ACE inhibitor dose
spironolactone (aldosterone antagonist)
how to further decr preload?
venodilators
Nitroprusside (not only venodilator but also arteriodilator also!)
must be CRI due to potency!
ACE inhibitoris - weak & slow but! work well for maint & slow progression of failure, lower furosemide dose, prolong lives
problems with ACE inhibitors?
can cause hypotension
azotemia (can decr GFR due to dilation of efferent arteriole in glomerulus)
escape (Angiotensen Receptor Blockers)
What other drug can be used to help HF pts
Pimobenden ((+) inotrope main activity)
phosphodiesterase inhibitor (aterio/venodilator slight)
How to decr afterload in HF pt?
ACE inhibitors
arteriodilators:
hydralazine (1/3 dogs have GI issues when using it - no bueno)
amlodipine- Ca channel blocker (causes periph vasodilation- no evidence says it works in dogs)
How to incr contractility if depressed?
- *Pimobendan**
- phosphosiesterase & Ca sensitizer
inodilator
