Block 3 Flashcards
(496 cards)
1
Q
When should you treat an arrhythmia?
A
When is leads to a hemodynamic instability (tachy or brady)
2
Q
Do all arrhythmias need treated?
A
NO! Most do not!!
3
Q
Can antiarrhythmic drugs be pro-arrhythmic/
A
YES!
Do no harm!!
4
Q
How do we classify anti arrhythmic drugs?
A
Vaughan-Williams
5
Q
How is the Vaughan-Williams classified?
A
By which channels are blocked
6
Q
What are the 4 classes of Vaughan-Williams?
A
Class 1: Na channel blockers
Class 2: Beta-adrenergic blockers
Class 3: K channel blockers
Class 4: Ca channel blockers
7
Q
What is phase 0 of the cardiac cycle?
A
Rapid depolarization in cardiac muscle cells
8
Q
What do sodium channel blockers od?
A
Slows the rapid depolarization in cardiac muscle cells (Phase 0)
9
Q
What sodium blockers are used to treat ventricular arrhythmias?
A
Lidocaine, procainamide, mexiletine
10
Q
What sodium blocker is used to treat atrial fibrillations in horses
A
Quinidine
11
Q
What does vagolytic mean?
A
Increase heart rate
12
Q
What is quinidine used for?
A
Converts A-fib to sinus rhythm in horses with lone a-fib
13
Q
What is procainamide used for?
A
Therapy for ventricular arrhythmia
14
Q
How is lidocaine given for treatment of arrhythmias?
A
IV
15
Q
What type of treatment is lidocaine used for (chronic or acute)
A
Acute
16
Q
What type of arrhythmias does lidocaine treat?
A
Ventricular arrhythmias
17
Q
How is mexiletine adminsitered?
A
Orally “oral lidocaine”
18
Q
What is mexiletine used for?
A
Chronic therapy of ventricular arrhythmias
19
Q
What do beta-blockers do?
A
Slows the Ca in phase 2
20
Q
What are beta blockers for?
A
Negative inotropes (reduce HR)
21
Q
What phase do beta blockers inhibit?
A
Phase 2
22
Q
A
23
Q
A
24
Q
When should you treat arrhythmias?
A
Can lead to hemodynamic instability (tachyarrhythmias or bradyarrhythmias)
25
What are 2 examples of tachyarrhythmias?
Ventricular arrhythmias
Supreventricular arrhythmias
26
What are typical bradyarrhytmias?
AV blocks or persistent atrial standstill
27
Seems like tachyarrhmias are ventricular and bradyarrhymias are atrial
28
Do ALL arrhythmias need treated?
NO!! Many do not!
29
What can anti-arrhyhic drugs cause?
They can potentially be pro-arrhythmic
30
What does A-fib drive?
Congestive heart failure
31
What is the most common drug classification called?
Vaughan-Williams
32
How does the Vaughan William classification classify drugs?
Which channels/currents the drugs block
33
What is class 1 of the Vaughan Williams?
Na channel blockers
34
What is class 2 of the Vaughan Williams?
Beta-adrenergic blockers
35
What is class 3 of the Vaughan Williams?
K channel blockers
36
What is class 4 of the Vaughan Williams?
Ca channel blockers
37
What are the 4 phases of heart depolarization and depolarization?
Stage 0 - Depolarize with Na channels open
Stage 1 - Initial depolarization. Na channels close and K channels open
Stage 2 - Plateau. K stay open and Ca open
Stage 3 - Rapid repolarization. Ca close and slow K open
Stage 4 - Resting. High K permeability
38
What phase do class 1 drugs block?
Stage 0
Slows rapid depolarization of cardiac cells
39
What are the 4 class 1 drugs we need to know?
Quinidine
Procainamide
Lidocaine
Mexiletine
40
What does quinidine do?
convert A-fib to sinus rhythm in HORSES w/ lone a-fib
41
What is a side effect of quinidine?
Vagolytic (can increase HR)
42
What does procainamide do?
Therapy of ventricular arrhythmias
43
How is lidocaine given for arrhythmias?
IV
44
What is lidocaine given for?
ACUTE treatment of life-threathening arrhythmias
45
How is mexiletine given?
Orally
46
What is mexiletine for?
Chronic therapy of ventricular arrhythmias
47
What are class 2 vaughan williams?
Beta blockers
48
What phase of depolarization block?
Phase 2
49
What is the purpose of class 2 beta blockers
blocks funny currents (nodal cells)
50
What do beta blockers do?
Negative inotrope
Reduce contractility (slows Ca intake)
51
What is the biggest beta blocker that is used?
Atenolol
52
How does atenolol help?
Cardioprotective
53
What beta is atenolol most selective for?
Beta 1 specific
54
What is atenolol used for?
Obstructive lesion (SAS, PS, HOCM)
55
What chamber does atenolol mostly act on?
Atrial arrhythmias
Occasionally ventricular arrhythmias
56
What's the biggest side effect of atenolol?
Bradycardia (negative ionotrope)
57
What phase does class 3 block?
Stage 3
Potassium repolarization
58
What are the 2 main class 3 drugs?
Sotalol
Amiodarone
59
What is something else sotalol acts on besides potassium blockers?
Beta blocker
60
***What is the most common drug used for chronic management of ventricular arrhythmias?
Sotalol
61
What are 2 side effects of sotalol?
Pro-arrhythmia
Negative inotrope
62
What properties does amiodarone have?
Has properties from all vaughan Williams classes
63
What is amiodarone used for?
Refractory ventricular arrhythmias
64
What is a concern of amiodarone?
Has many side effects
Likely because it acts on so many different channels
65
What stage does class 4 Ca blockers act on?
Stage 2 (plateau)
66
What is the main goal of class 4 drugs?
Block the AV node
67
What is the main class 4 drug?
Diltiazem
68
What does diltiazem do?
Treats atrial arrhythmias through blocking AV node
69
What is the first line drug for rate control of atrial fibrillation?
Diltiazem
70
What are the side effects of diltiazem?
Negative inotrope
Hypotension
71
What are 2 downsides to the Vaughan-Williams scheme?
Doesn't explain all mechanisms of each drug
Doesn't include all antiarrhytmic drugs
72
Explain Digoxin
positive inotrope
Slows conduction of AV node
Controls A fib
Slows NA/K ATPase
73
What needs to be monitored with digoxin?
Pro-arrhythmic
GI side effects
74
What does torsade de pointe mean?
Turning around the point
Common arrhythmia in horses
75
What is used to treat to torsade de point?
Magnesium sulfate
76
What type of arrhythmia is torsade de pointe?
Refractory ventricular arrhythmia
77
What is the acronym for aims of treatment of heart disease?
D - delay of disease progression
I - Improve quality of life
P - Prolong survival
P - Prevent catastrophic event
78
How can you help determine if a cat's murmur is present?
Stress test
79
When using atenolol, what are the 3 questions that you should ask?
1. Is disease clinically relevant or prognostically important
2. Can I follow-up?
3. Is treatment safe?
80
what are drugs that affect ventricular pumping?
Inotropes
81
what needs to be used in conjunction with diuretics?
Sodium restriction
ACE-inhibitors
82
In refractory heart disease with chronic fluid retention, what is a good diuretic to use?
Torasemide
83
What diuretic is used in acute cases?
Furesemide
84
What diuretic is used in chronic cases?
Torasemide
85
What is a weak diuretic that is also a cardio protectant?
Spironolactone
86
What is spironolactone used in conjunction with sometimes?
Furosemide
87
What is a diuretic that is not a loop diuretic that can be used in conjunction with torasemide or furosemide?
Hydrochlorothiazide
88
What are the 5 diuretics?
Furesemide
Torasemide
Spironolactone
Hydrochlorothiazide
89
Why must an ACE inhibitor be used with diuretics?
Use of diuretics will initiate a strong RAAS response
90
What should DCM in cats always be treated with?
Taurine
91
What is the only nutraceutical that has been shown to help cardiac cachexia
Omega-3 fatty acids
92
What are the 4 ACE-inhibitors?
Benazepril
Enalapril
Lisinopril
Ramipril
93
What do ACE-inhibitors do?
Inhibit RAAS system be decreasing effectivity of Angiotensin II
94
What are 2 nitro-vasodilators?
nitroglycerine ointment and sodium nitroprusside
95
What is a non-nitro-vasodilator?
Hydralazine
96
What drugs help to treat pulmonary hypertension?
Phosphodiesterase-5 inhibitors
97
What is a phosphodiesterase-5 inhibitor?
Sildenafil (viagra)
98
What is the drug of choice for systemic hypertension?
Amlodipine
99
Amlodipe is a calcium channel blocker
100
What do angiotensin receptor blocking agents do?
Block RAAS
101
What is a common RAAS?
Telmisartan
102
When should you not treat HCM?
When there is low risk / asymptomatic
103
When should you consider an anticoagulant/antiplatelet?
With severe left atrial diameter (will throw a clot) >20mm
104
Risk factors for HCM are LA enlargement, LV diastolic dysfunction
105
What should be considered with LV diastolic dysfunction?
Furosemide
106
What should be considered with LV remodeling (regional wall thickening)
ACE inhibition and Plavix (anticoagulation)
107
What should be considered with LV systolic dysfunction?
Pimobendan
Furosemide
ACE inhibition
Plavix
108
What should be considered with extreme LV hypertrophy?
Diltiazem
Atenolol
109
What should be considered with Ventricular ectopy?
Sotalol
Atenolol
Amiodarone
110
What should be considered with A fib?
DILTIAZEM
111
What is the acute treatment of heart disease acronym?
F - furosemide
O - oxygen
N - nitroglycerine paste
S - sedation
T - tap (pleural effusion)
112
What do antiarrhythmics do?
Cardio-depressive
113
What is a sign of CHF?
Pericardial effusion
114
What are the main aims of ATE?
Pain management
Induction of hypo coagulable state
Prevention of thrombus expansion
115
What should be given for pain in ATE?
Full mu opioid
116
What can be given to prevent thrombus expansion?
Heparin
117
What can be given to inhibit platelet aggregation?
Plavix
118
Besides plavix, what can be added to help with ATE management/prevention?
Aspirin or rivaroxaban
119
What is B1 stage of most cardiac diseases?
Normal LA/LV size or mild enlargement
120
Where will MMVD be auscultated?
Left apical systolic murmur
121
Should you treat a B1 MMVD?
No
122
What should you do about a B1 MMVD?
Monitor with auscultation and imaging
123
What does B1 MMVD not meet?
EPIC criteria
124
What was the result of the EPIC study?
15 month benefit if given pimobendan
125
What puts a dog in B2 for EPIC?
LA:Ao > 1.6
VHS > 10.5
126
What if a patient can't have an echo to grade B1 or B2?
Chest rads
127
What do the chest rads need to be to categorize B1 or B2?
VHS < 10.5 = B1, no pimo
VHS > 11.5 = B2, pimo
VHS between is grey zone
128
What does categorization into B2 mean?
B2 = Start Pimobendan!
129
What does the C in the grading scale stand for
C = CHF (left sided in DMVD)
130
What should usually be done when presented with a potential cardiac case?
Blood pressure!!
131
What is the prevention for all stages of the EPIC rankings?
None (no way to prevent)
132
What does stage D mean of DMVD?
Refractory / end stage
133
Mini Schnauzers are very susceptible to MMVD
134
What can you also consider if a dog is in the "grey zone" with VHS?
VLAS
135
What is VLAS?
Vertebral left atrial size
136
What does VLAS usually need to be over for B2?
2.4 (or 3.0)
137
What should you add on to pimobendan in "very advanced" B2?
RAAS inhibitor
138
What is the mechanism of ACE inhibitors?
Block enzyme that turns angiotensin I into angiotensin II
139
When should you recheck B2 dogs?
every 6-12 months
140
Will giving furosemide kill a dog?
No, give it if suspicious
141
What effect does nitroglycerine have?
Vasodilator
142
What is the chronic treatment for MMVD acronym?
P - pimobendan
A - ACE inhibitor
S - spironolactone
F - Furosemide
E - Exercise restriction
143
What 2 things does pimobendan do to help CHF?
Vasodilator
Positive inotrope
144
What is the median survival time after stage C onset?
CHF = 1 year
145
Will all dogs with MMVD develop CHF?
No only 25-30%
146
What is lasix?
Brand name of furosemide
147
How do you treat pulmonary hypertension associated with DMVD?
Diuretics to reduce LA pressure
148
What are the 3 potential DMVD complications?
Pulmonary hypertension
Arrhythmias
Left atrial tear
149
What type of arrhythmias can be seen with DMVD?
A-fib
150
Does MMVD occur in cats?
No
151
Degenerative valve disease occurs in horses but not a common cause of mortality!
No proven treatment but if CHF develops, poor prognosis
152
***What types of drugs treat secondary Afib?
"Rate control drugs"
153
What is the most common shunt?
VSD
154
What are the 3 most common shunts?
PDA, VSD, ASD
155
What is clinical hallmark of PDA?
Loud continuous heart murmur (machine murmur)
156
What are the 2 different managements for PDA?
Interventional occlusion and surgical ligation
157
The interventional occlusion is the coils and stuff
158
What is the weird pear shaped coil called?
ACDO
159
Is PDA curable?
Yes!
160
Can you do PDA in really small animals?
No
161
What is the disadvantage to surgical ligation of PDA?
Rupture can happen and kill dog
162
Is PDA heritable?
Yes
163
What does a reverse PDA look like?
Pink oral mm
Cyanotic vaginal mm
164
What is there to be done about a reverse PDA?
Not much
Potentially repeated phlebotomy
165
Where is the murmur herd on a VSD?
On the right (systolic)
166
What is the most common VCD?
Perimembranous
167
If there is a small VSD, what is the lifespan of the dog?
Normal lifespan
168
What is Eisenmenger's complex
shunt reversal
169
Is VSD heritable?
Yes!
170
How to treat VSD?
Can add device
Start on enalapril and spironolactone
171
Are there murmurs with ASDs?
No
172
Where is the dilation associated with ASD?
In RA and RV
173
Is ASD heritable?
Yes
174
What are the treatment options for most ASDs?
No therapy, just watch
175
What are treatment options for large ASDs?
Medical, surgery, interventional
176
What is medical treatment of ASD?
Enalapril and spironolactone
177
How can you treat ToF?
Exercise limitation
Propranolol (beta blocker)
Potentially phlebotomy
178
What is cause of sinus bradycardia?
NO Treatment
Find underlying cause
179
What is a first degree AV block?
Prolonged PR interval
No blocked P wave
180
What is a 2nd degree AV block?
Blocked P wave
181
What is a 2nd degree Mobitz type I AV block?
Gradual prolongation of the PR interval then a blocked P wave
182
What is a 2nd degree Mobitz type II AV block?
Consistent blocked P wave, consistently high grade (more than 2 dropped P in a row)
183
What is a 3rd degree AV block?
Complete AV dissociation
184
What of the blocks are a result of high vagal tone?
1st and 2nd degree type 1 Mobitz
185
What of the blocks are a result of conduction disease?
2nd degree type II Mobitz and 3rd degree
186
Are the high vagal tone blocks treatable?
NO!
187
What should you do if you are uncertain if the disease is related to high vagal tone or if its a conduction disease?
Atropine response test
188
If the animal becomes tachycardia off the atropine response test, what does this mean?
Positive test
189
What is the treatment for the 2nd and 3rd degree AV blocks?
Artificial pacemaker
190
What are the 4 things seen in an atrial standstill de to hyperkalemia?
Absent P waves
Bradycardia
Tented T waves
Widened QRS
191
How do you treat hyperkalemia?
Calcium gluconate
192
What is sinus arrest?
Sinus node fails to fire resulting in pauses of the rhythm
Sick sinus syndrome = idiopathic degeneration of sinus node
193
How do you treat sinus arrest?
High vagal tone likely doesn't need treatment but atropine / glycopyrrolate if needed
194
What is sick sinus syndrome?
Fibrotic changes to the SA node
Causes syncope
195
What is treatment for sick sinus syndrome?
Pacemaker
Chronotropic drugs may help
196
Which sex gets sick sinus syndrome more?
Females!!
197
What is the medical treatment for sick sinus syndrome?
Theophylline
Propantheline
Terbutaline
Hyoscyamine
198
What is atrioventricular block caused by in cats?
Older cats - idiopathic fibrosis - usually asympomatic
199
Are pacemakers a good treatment for AV blocks?
Treats syncope but doesn't change survival time
200
What are the 2 differentials for absent P waves?
A fib
Atrial standstill
201
What is heart speed of a fib patients?
Tachy
202
What is heart speed of atrial standstill patients?
Brady
203
What is atrial standstill patients usually associated with?
Hyperkalemia
204
What are the 4 target organs of hypertension?
Brain
Eyes
Kidneys
Heart
205
At what BP will organ damage begin for the eyes?
>160
206
What are 2 signs of damage to the eyes?
Blindness
Medriasis
207
What is a result to the heart of systemic hypertension/
LV hypertrophy
208
How should you treat systemic hypertension?
Take 2-5 days to reduce below 160. Need to give time to equilibrate to it
209
Should you hospitalize a systemically hyerptensive patient
No, too stressful
210
What drug should be given to treat systemic hypertension?
Amlodipine
211
How long after starting amlodipine should there be a recheck?
3 months
212
What are 2 drugs that can be used as add-ons to amlodipine?
Telmisartan
Benazepril
213
What is the goal of a hypertensive emergency (<200 + organ damage)
Reduce by 10% in first hour then 15% over next 3 hours
214
What is a drug that can be used in a hypertensive emergency?
Fenoldopam
215
What are 2 other drugs that can be used in hypertensive emergencies?
Hydralazine and sodium nitroprusside
216
What is pulmonary hypertension?
>40mmHg
217
What is cor pulmonale?
Enlargement of right side of heart due to high pressure in lungs
218
What are 3 overarching treatment goals of pulmonary hypertension?
Correct underlying cause
Decrease pulmonary vascular resistance
Increase RV cardiac output
219
How do you decrease pulmonary vascular resistance?
Vasodilators
-oxygen acutely
PDE-5 inhibitors (Viagra, cialis, sildenafil)
220
How can you increase RV output?
Pimobendan
221
What do you NOT give in pulmonary hypertension?
Ferosimide
222
What is type A in pulmonary stenosis?
Fusion
223
What is type B in pulmonary stenosis?
Dysplasia
224
Is there a treatment for type A pulmonary stenosis?
Yes
225
Is there a treatment for type B pulmonary stenosis?
No
226
What is the most common consequence of pulmonary stenosis?
Sudden death
227
What can be done for pulmonary stenosis?
Exercise restriction
Selective B blockers (atenolol)
Balloon angioplasty (surgery)
228
Is pulmonary stenosis hereditary
yes
229
What is the number that determines the severity of sub aortic stenosis?
Pressure to open aortic valve
120/10 -> 200/25
230
What can happen commonly with a sub aortic stenosis?
Infective endocarditis
231
What can be done for sub aortic stenosis?
Exercise restriction
Beta blocker (atenolol)
Prophylactic antibiotics to reduce risk of infectious endocarditis
232
Does canine sub aortic stenosis balloon valvuplasty work well?
Not really
233
What can be done about semilunar valve stenosis?
Exercise intolerance
Atenolol (prevent tachycardia)
Drugs to manage CHF (Ferosemide, pimobendan, emalapril, spironolactone)
234
When does cyanosis occur?
Pa02 < 40mmHg
235
What muscle is called the "heave line" that is a result of chronic respiratory distress?
External Oblique
236
Where is a tracheotomy inserted?
Ventral neck and a horizontal incision between tracheal rings. In the upper third of the neck
237
What 2 main things are needed for respiratory emergencies in the field?
Tracheostomy tube
Ultrasound
238
How do you know when to add a tracheostomy?
In the case of respiratory distress with noise
239
What is another reason for needing a tracheostomy?
Tracheal collapse
Esophageal obstruction (choke)
240
What type of horse is at an increased risk for needing a tracheostomy?
Horses that are homozygous for HYPP leading to pharyngeal pathology
241
Name the 3 most common lower respiratory conditions in horses
Pneumonia / pleuropneumonia
Pulmonary edema
Equine asthma
242
What is pulmonary edema usually secondary to?
Cardiogenic
243
What are symptoms of a horse with pulmonary edema?
Fluid from nose (clear to pink)
Cough
244
How do you treat pulmonary edema?
Oxygen and lasix
245
How do you diagnose pneumothorax?
M-mode ultrasound
Use kitchen cling wrap to pack it? idk
246
How do you diagnose hemothorax?
Swirling on ultrasound
247
What happens to body weight of horses with asthma?
Lose weight quickly
248
What 2 drugs are added as medical treatment of equine asthma?
Bronchodilator
Steroid (dex)
249
Nonrespiratory causes of respiratory distress?
Anemia
Red maple toxicity (O2 exchange)
Pain
Hyperthermia
Anhidrosis
250
What should you NOT do with horses that are in respiratory compromise?
AVOID SEDATION (alpha 2)
251
How do you determine if respiratory compromise is coming from upper vs lower tract?
Upper = noise
Lower = no noise
252
What is the cutoff for hypoxia?
<96%
253
What is the difference between stridor and stertor?
Stridor = high pitched
Stertor = low pitched
254
What sound is made with obstruction?
Stridor
255
What is lar par also called?
GOLPP
256
What is the definition of hypoxia?
Oxygen in tissue is low
257
What is the definition of hypoxemia?
Low oxygen in arterial blood
258
What is a greater respiratory response, hypercapnia or hypoxemia?
Hypercapnia
259
What should you do first with a respiratory patient?
Hands-off non invasive approach and assess them in an O2 cage
260
What should be first step in treatment of respiratory case?
Oxygen
261
What should be second step in treatment of respiratory case?
Sedation
Butorphanol or ace
262
How do you distinguish rhinitis from other nasopharyngeal differentials?
It is bilateral (most others are unilateral)
263
What can you do for laryngeal treatment?
Dexamethasone
Ice pack
Slow wake up with sedation
264
What is something important that you should minimize with laryngeal disease?
Barking
265
What will a tracheal respiratory disease sound like?
Cough is dry/honking
266
If cough is on inspiration:
Extra-thoracic tracheal disease
267
If cough is on expirationL
Intra-thoracic tracheal disease
268
What is herd on auscultation of a bronchial disease?
Expiratory wheeze
269
What do you see with bronchial disease?
Abdominal effort
270
What are top 2 differentials for bronchial disease?
Asthma
Bronchitis (infectious / inflammatory)
271
What are 2 bronchodilators that can be used for bronchial treatment?
Albuterol
Terbutaline
272
How many B lines must you see in a plane for it not to be normal?
>3
273
When do you see paradoxical breathing?
Diaphragmatic pathology
274
What is paradoxical breathing?
Inspiration = abdomen sucks in
Expiration = abdomen distends
275
What should you do with diaphragmatic pathology?
Elevated position
276
Thoracocentesis is life saving
277
What is NIPD?
Non-infectious pulmonary disease
278
What are NIPDs?
Inflammatory or fibrotic
279
How does an NIPD occur?
Reaction to an environmental factor or abnormal response to injury
280
What are the 4 NIPDs?
Canine chronic bronchitis
Feline asthma
Eosinophilic bronchopneumonopathy
Idiopathic pulmonary fibrosis
281
What are the 4 goals for CCB?
Reduce inflammation
Control cough
Improve exercise tolerance
Slow progression
282
How can you reduce inflammation?
Environmental cleaning (smoke, aerosols)
283
What is a medical way to reduce inflammation for the chronic inflammation
Prednisone - cheap
Fluticasone - Inhaled but expensive
284
How do you control cough in the chronic bronchitis?
Hydrocodone
285
What is a side effect of hydrocodone?
Sedation
286
What is the number one way to improve exercise tolerance for CCB?
Manage obesity
287
How can you slow progression of CCB?
Prednisone and fluticasone
288
What is the prognosis of CCB?
Its progressive. Goal is to slow it, manage client expectation
289
What likely causes feline bronchial disease/? Aka feline asthma
likely allergen induced
290
Can you stop treatment of feline asthma if asymptomatic?
No!!
291
What are 3 goals of feline asthma?
Reduce inflammation
Slow progression and remodeling
Control bronchoconstriction
292
How do you reduce inflammation of feline asthma?
Environmental management
Glucocorticoids (fluticasone and pred)
293
***What is a side effect of pred on cats?
Diabetes mellitus in fat cats
294
Slowing progression and airway remodeling is same treatment as reducing inflammation
295
How can you control bronchoconstriction acutely for feline asthma?
Albuterol
SQ terbutaline
296
What is EBP?
Eosinophilic bronchopenumonopathy
297
What is EBP tho?
Idiopathic inflammatory disease in DOGS
298
How do you treat EBP?
Immunosuppressive steroids
299
What species gets ICPF?
West Highland White Terriers
300
What is ICPF?
Idiopathic canine pulmonary effusion
301
How do you treat ICPF?
No effective treatment
Can try steroids to reduce cough
Terminal
302
What is relapse rate of EBP?
30%
303
What can eosinophilic bronchopneumonopathy look like?
Lung worms
Give antithelmitic on top of steroids just in case
304
What is the cutoff for transudate?
<2.5
305
What is the cutoff for modified transudate?
2.5-7.0
306
What is the cutoff for exudate?
>7.0
307
What is the first thing you do if your patient comes in with fluid in its chest?
Stabilize - oxygen and sedation
308
What do you do after stabilization?
Thoracocentesis (maybe imaging next)
309
Where is the first place you should look if the fluid is a modified transudate?
Heart
310
If it is a pyothorax in a cat, what is the most likely etiology?
Cat bite (pasteurella multocida)
311
If it is a pyothorax in a dog, what is the most likely etiology?
Inhaled plant piece (nocardia asteroids)
312
What is the medical treatment for pyothorax?
Broad spectrum antibiotics
(Amoxi + Clav) for 4-6 weeks
313
What is a surgical thing you can do for pyothorax?
Placement of chest tube
Also removal of FB in dog
314
What is the cutoff for chylothorax?
Triglycerides 2x serum or >100mg/dL
315
What is treatment for chylothorax?
Treat underlying cause
Chyle is very irritating to pleura
316
What is a Medical approach to chylothorax?
Low fat diet
317
What should you always ask before tapping a hemothorax?
Any rodenticide exposure
318
What should you always check before tapping a hemothorax?
Check PT/PTT BEFORE tapping chest if hemothorax is suspected
319
What are the BIG 5 parasites?
Nematode
Protozoa
Cestode
Trematode
Ectoparasite
320
What drug class works for giardia?
Benzimidazole (fenbendazole)
321
What drug class works for blood suckers and burrowing ectoparasites?
Macrocyclic lactones
322
Do tetrahydropyrimidines work against heart worm?
NO!!
323
Within microcytic lactones, what are 2 classes?
Avermectin and milbemycins
324
What drug class is within avermectin
ivermectin
eprinomectin
selamectin
325
What are 2 drugs within benzimidazole?
Fenbendazole
Albendazole
326
Do benzimidazoles more against HW?
NO!!
327
What are 2 drug classes within tetrahydropyrimidines?
Pyrantel
Strongid
328
What do preventative for HW act on?
L3 and early L4
329
What do mosquitos pick up from host?
microfilaria
330
What stage does microfilaria get to in mosquito?
L3
331
How long does going from microfilaria to L3 take?
10-14 days
332
What is the medical term for HW?
Dirofilaria immitis
333
What is tracheal collapse most commonly seen in?
Middle-aged to older toy and miniature breeds
334
When does the trachea collapse? Inspiration or expiration?
Expiration
335
What is the classic sound of a tracheal collapse?
Goose honking
336
what is the medical treatment for tracheal collapse?
Anxiolytic drugs, sedation
Cough suppressants (hydrocodone) and anti-inflammatory steroids (prednisone if needed)
337
What does a positive intrope do?
Makes heart beat stronger
338
When are 5 times to use a positive inotrope?
Impaired systolic function
Dilated cardiomyopathy
Heart failure (cardiogenic shock)
Critical care patients (septic shock)
General anesthesia
Drug overdoses
339
What type of drug is anesthesia?
Negative inotrope (postive inotrope helps to combat this)
340
What is the mechanism of action of positive inotrope?
Increase Ca influx into myocytes
341
What is the mechanism of action of digitalis catecholamine positive inotopes
Inhibit Na/K ATPase, activating Na/Ca
342
What is the mechanism of action of catecholamine positive inotropes
Stimulate beta-adrenoreceptors
343
Give an example of digitalis glycosides?
Digoxin
344
Give an example of catecholamines
Dobutamine
345
What is the mechanism of action of calcium sensitizers (PDE III inhibitors)?
Sensitive contractile filaments to Ca
346
Give an example of calcium sensitizers
Pemobendan
347
What is the drug of choice for cardiogenic check?
Dobutamine
348
What nerve type does norepinephrine work on?
Alpha 1
349
What does norepinephrine (alpha1) cause?
Vasoconstriction
350
What is the drug of choice for cardiac arrest?
Epinephrine
351
What does pimopendan do to the vessels?
Vaso dilator (both arterial and venous)
352
What type of "trope" is pimopendan
Strong positive inotrope + mixed vasodilator
353
How does pimobendan compare to dobutamine?
Pimobendan is longer and stronger but takes longer to kick in than dobutamine
354
When do you use pimobendan?
In dogs with congestive heart failure
355
How does the vasodilation aspect of pemobendan help with CHF??
Vasodilation helps to unload the failing ventricles but also helps increase contractility of heart
356
What is the mechanism of action of digoxin (review)
Plugs Na/K ATPase channel leaving more intracellular sodium for Na/Ca to utilize (increasing intracellular calcium)
357
What are 2 other effects of digoxin (digitalis glycosides)?
Baroreceptor (Increase vagal tone)
Antiarrhythmic
358
What is the major indication for digoxin?
Control A fib
359
When are the "trough levels" of digoxin?
8-12 hr post pill
360
***What factor can induce digoxin toxicity?
Hypokalemia
361
Where is digoxin primarily excreted?
Kidneys (not liver)
362
What drug do you need with increased preload?
Diuretics
Get that shit outta here
363
What is the main indication for diuretics?
CHF
364
What is the main loop diuretic to know?
Furosemide
365
What type of diuretic is hydrochlorothiazide?
Thiazide
366
What is the mechanism of action of thiazide?
Inhibit Na and H2O in distal tubules
367
What is the best/fastest/easiest diuretic?
Furosemide
368
What is an important beneficial aspect of spironolactone?
Spares potassium
Cardioprotective
369
Why might you eventually need to add an additional diuretic?
Eventually there will be a diuretic resistance that develops
370
What are the beta blockers known as?
The lols
371
What do beta blockers do?
Decrease contractility (negative inotrope)
Decrease myocardial oxygen demand
372
What beta receptors do atenolol (**) and metoprolol target?
Beta 1
373
What beta receptors does propranolol target
Beta 1 and 2
374
What are the side effects of beta blockers?
Bradycardia
Hypotension
Decreased systolic function
375
What are 3 indications for beta blockers?
Hypertrophic obstructive cardiomyopathy
Pulmonary/aortic stenosis
Antiarrhythmic effects
376
What beta blocker is preferred in cats?
Atenolol
377
What beta blocker is preferred in dogs?
Sotalol
378
If cannot do echocardiography, do not use beta blockers
Never use beta blockers in a "wet" patient - CHF
379
What is another negative inotrope and vasodilator?
Calcium channel blockers
380
What is the major effect of non-dihydropyridines? (Calcium channel blocker)
Nodal tissues
381
What non-dihydropyridine is most commonly used?
Diltiazem
382
What dihydropyridine is most commonly used?
Amlodipine
383
What is amlodipine mostly used for?
Treatment of systemic arterial hypertension
384
When do you use calcium channel blockers?
Atrial tachycardias (A fib!) or systemic hypertension
385
What are 4 drugs used for cardio protection?
ACE inhibitors
Beta blockers
Spironolactones
Fish oils
386
What is the main trigger for ACE inhibition?
Reduced cardiac output
387
What are the ACE inhibitors?
The -prils
Enalapril
388
What do ACE inhibitors do?
RAAS inhibitors and mixed vasodilators
Lower blood pressure!
389
What are the angiotensin receptor blockers?
The -tans
Telmisartan
390
What is telmisartan primarily used for?
Cats with proteinuria and systemic hypertension
391
What are angiotensin receptor blockers used for?
Lower blood pressure
392
What are prothrombin drugs used for?
Cats at risk of feline arterial thromboembolism
393
What does a cat have that may show rick of FATE?
Smoke
394
What are 2 FATE drugs?
Aspirin and Plavix
395
Is pemobendan used in cats?
Rarely
396
What are 2 drugs that can be used for treatment of Afib?
Digoxin
Diltiazem
397
Sorry - What are 6 dietary modifications to be recommended to CHF patients?
Sodium restriction
Fatty acids
Taurine (cats ony)
L-carnatine
CoQ10
Avoid BEG diets
398
Where should you not give fluids in a shock patient?
SQ or enteral
399
What fluid should you never give a shock patient?
Hypotonic fluids!
400
When do you give hypertonic solution?
In severe shock
401
What is the physical exam point that is the "last to go, first to come back"?
Blood pressure
402
What do you do if there is no response with shock fluids?
Consider a positive inotrope
Maybe issue is cardiogenic
403
What 2 dogs get DCM the most?
Boxer
Doberman
404
What are 3 drugs for treatment of DCM?
Pimobendan
Enalapril (cardioprotective)
Spironolactone (cardioprotective)
405
When do you add furosemide?
In CHF. DCM is not CHF
406
What are seen commonly in dogs with DCM?
Ventricular premature complexes (VPCs)
407
What drug is given to reduce arrhythmias in arrhythmegonic RV cardiomyopathies?
Sotalol
408
How do you determine if something is in CHF and not just DCM>
Has ascites and or a respiratory component
409
What do you give the patient that has DCM with CHF?
Furosemide
On top of everything else
410
What can you try with a patient that has lone Afib?
Electrical cardioverion (electric shock thing)
411
What are 2 drugs to correct Afib
Diltiazem
Digoxin
412
Besides Afib, what other disease do you see an absence of P waves?
Atrial standstill
413
What is given for a dog with atrial standstill?
Need a pacemaker
414
What other drugs do you give a dog with atrial standstill?
Still pimobendan
Enalapril (cardioprotectant)
Spironolactone (cardioprotectant)
415
What is the most important congenital pericardial disorder?
Peritoneaopericardial diaphragmatic Hernia (PPDH)
416
Do PPDH always need treated?
No, often incidental finding
417
What is treatment for PPDH?
surgical
418
What is the number 1 differential diagnosis for pericardial effusion in dogs?
Neoplastic
419
What type of fluid is in pericardium of heart failure patients?
Transudate
420
What is the most common cause of pericardial effusion in cats?
CHF
421
How do you treat pericardial effusion from CHF in cats?
No pericardiocentesis
Just use diuretics
422
What are the top 2 neoplasias that cause pericardial effusion in dogs?
Hemangiosarcoma
Chemodectoma
423
***What is treatment of cardiac tamponade?
PERICARDIOCENTESIS
424
Where do you approach for a pericardiocentesis?
Right side in cardiac notch
425
What will happen if you dont perform the pericardiocentesis?
The dog will die
426
What should you NOT give in pericardiocentesis?
Furosemide! NOOOOO
427
What should you give during preparation for pericardiocentesis of a cardiac tamponade case?
IV fluids
Maintain BP while prepping.
Also opioid for sedation (butorphenol)
428
What surgery can be done to treat continued cardiac tamponade?
Pericardectomy
429
In horses, what 2 places can you palpate for peripheral pulses in a shock patient?
Facial artery
Transverse facial artery
430
What happens to lactate with decrease lactate?
Increase lactate
431
What happens to lactate with strangulating lesions?
Higher base lactate than horses but lactate doesn't change with strangulation lesions
432
What are the 6 catergories of shock?
Metabolic
Hypoxemic
Cardiogenic
Hypovolemic
Obstructive
Mal(distributive)
433
What is the most common type of shock?
Hypovolemic
434
How do you treat a guttural pouch mycosis?
Intra-arterial coil embolization
435
What can you give during maldistributive shock?
Epinephrine to cause vasodilation
436
What is number one reason for cardiogenic shock?
CHF
437
You basically give fluids to all types of shock in horses. What type do you NOT GIVE FLUIDS?
Cardiogenic!
438
How do you (not) give fluids during shock
Only IV
Not enteric, SQ, rectal
439
Treating shock, how much do you initially bolus with isotonic crystalloids?
10-20mL over 20-30 min then reassess
440
Treating shock, how much do you initially bolus with hypertonic saline?
2-4mL/kg
441
How much blood volume is required to require shock resuscitation in a horse?
>30%
442
What drug classes are bronchodilators?
Sympathomimetics (beta agonists)
CNS stimulants
Adenosine antagonists
443
Bronchodilators occur due to which agonist?
Beta 2 agonism
444
What drug helps with lar par?
None, its a surgical disease
445
When should you administer oxygen to a patient in respiratory distress?
Always
446
What is persistent pulmonary hypertension?
Failure of fetus to make respiratory and cardiac transition to extra-uterine life
Persistent hypercapneic hypoxia
447
How is PPH mediated?
NO
448
What is an antitussive?
Drug that decreases cough
449
What are antitussive drugs?
Opioids
450
What is the primary antitussive drug we use?
Hydrocodone
Codeine
451
What is the mechanism of action of antitussives?
Opioids depress cough center in medulla
452
What are the side effects of antitussive drugs?
Sedation
Constipation
Bradycardia
453
What class of respiratory drugs relax bronchiole smooth muscle?
Bronchodilators
454
What class of drugs are bronchodilators?
Beta - 2 agonists
455
What are 3 beta-2 agonists?
Terbutaline
Albuterol
Clenbuterol
456
What is a bronchodilator that is not a beta-2 agonist
epinephrine
457
What is the mechanism of beta-2 agonists?
Smooth muscle in bronchioles are relaxed by innervation of the beta-2 nerves
458
What are bronchodilators used to treat?
Asthma
459
What of the beta 2 agonists are prohibited in food animals?
Clenbuterol
460
What are 2 side effects of beta 2 agonists?
Tachycardia
Muscle tremors
461
What are methylxanthines used for?
BronchodilatorsWh
462
What are 3 methylxanthines?
Caffeine
Theobromine
Theophylline
463
What is the mechanism of action of methylxanthines?
CNS stimulant
464
What are side effects of methylxanthines?
GI signs
Cardiac stimulation
Seizures
465
How often are methylxanthines used?
Not as often due to side effects
466
What species are methylxanthines more often used on?
Horses
467
What drug class is used to treat airway inflammation?
GlucocorticoidsW
468
What are 2/3 glucocorticoids?
Prednisone/prednisolone
Fluticasone
469
What is the mechanism of action of glucocorticoids?
Bind to receptors on cells and inhibit transcription of genes that produce mediators of inflammation
470
Many side effects with glucocorticoids, try to keep dosage low
470
What are glucocorticoids used to treat?
Bronchitis
Asthma
Recurrent airway obstruction
471
What is definition of hypoxemia?
SpO2<90%
PaO2<60
471
What is the single most important therapy for hypoxemia?
Oxygen
472
What are the 2 ways oxygen can exist?
Carried on hemoglobin
Dissolved in blood
473
What type of hypoxemia is from pneumonia?
V/Q mismatch
473
What are the 4 major causes of bacterial pneumonia?
Community acquired
Aspiration pneumonia
Foreign body
Immune dysfunction
473
What are some side effect of oxygen?
Tunnel vision, tinnitus, seizures
473
What is type 2 oxygen toxicity?
Penumocytes proliferate
474
What is type 1 oxygen toxicity?
Pneumocyte degenerate
475
What is a respiratory stimulant?
Doxapram
475
What is the mechanism of action of doxapram?
Inhibits potassium channels on carotid body cells (chemoreceptors) resulting in increased sensitivity to CO2
475
***What are the 5 causes of hypoxemia?
Reduced Fi02
Hypoventilation
V/Q mismatch
Right to left shunt
Diffusion impairment
476
When is doxapram used?
Neonatal resuscitation (not first line)
Reversal of anesthetic-induced patients
477
477
Which lung lobe is most likely to harbor aspiration pneumonia?
Right middle
477
How can you diagnose pneumonia in dogs and cats?
Tracheal wash
477
Should you culture/do cytology of nasal discharge?
NO
477
What 2 antibiotic options are available for bacterial pneumonia in dogs and cats?
Amoxicillin and doxycycline
478
What to do if moderate+ signs with pneumonia?
Dual therapy. For Gram + and -
478
In a critical patient, what should consider in terms of antibiotics?
Parental administration
479
When shouldn't you consider providing antibiotics within 10 day duration for feline acute upper respiratory tract infection
No symptoms but has serous or mucopurulent discharge
479
How long do you treat the pneumonia past resolution of sings?
5-7 days
479
When should you consider providing antibiotics within 10 day duration for feline acute upper respiratory tract infection
Symptomatic WITH mucopurulent discharge
480
If there is no improvement in 7-10 days, what should your next steps be?
Additional diagnostics or different antimicrobial therapy
480
What is something to keep in mind when doing hydration of a pulmonary patient.
Really dont want to over hydrate
480
What is a large side effect of doxycycline in cats?
Esophageal stricture
