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122 Cards in this Set

  • Front
  • Back
What is dehydation?
loss of body water from ICF, ECF or both
caused by diarrhea, vomiting, polyuria,
thirdspacing due to vasculitis, low protein and or increased hydrostatic pressure
What is water loss?
animal losing fluid whether it be due to hypertonic, isotonic or hypotonic origin

Blood loss (vascular) resulting in hypovolemia

can see hypovolemia and dehydration in a vomiting patient
What is hypovolemeia?
loss of fluid from the vascular space

caused by severe dehydration, hemorrhage, inability to maintain vascular volume
-vasculitis
-low protein
What are crystalloids?
Fluids used for maintainence, replacements and dextrose solution

Non-buffered
Isotonic saline (0.9)*
Ringers Solution
* = HCO3- wasting


Buffered Sodium lactate (lactated ringers)
Sodium gluconate and acetate** solution (Normasol R and plasmalyte**

** = decreases acidosis
What are side effects of crystalloids?
dilutional coaguopathy
hypoproteinemia
Fluids overload (pulmonary edema)
Careful with LRS and liver disease
What is dextrose?
Maintenance solution that re rapidly converted to free water and allows it to be given without decreasing the osmolality of the solution

-patients with free water loss benefit from dextrose because it decreases the sodium in these hypernatremic patients

-used to increase glucose

does not me nutritional requirements of patient
What are Colloids?
Solutions that pull water into the vascular space from other compartments

During shock restore the vascular volume resulting in decreased after load while maintaining preload, bp and blood flow to tissues

-used in hypovolemic shock (shock doses are less than crystalloid)
-albumin


Hypertonic saline:
-hydroxethyl starch
-pentastarch
-Dextians
-Concentrated Albumin
-Fresh Frozen Plasma
What are side effects of Colloids?
Fluid overload- pulmonary edema
Synthetic coaguopathy
Renal failure
Allergic reactions to albumin in dogs from human source
What is vasodilatory shock?
due to poor vascular tone and caused a decrease in vascular resistance and pooling of blood and decreased preload

decreased preload results in a decrease in cardiac output, decreased blood flow despite the decrease in vascular resistance
What are causes of vasodilitary shock?
Drugs (acepromazine)
Toxins
Inflammation
Trauma
What are the clinical signs of vasodilatory shock?
-increased heart rate (can be decreased in septic or cardiac patients)
-decreased CRT (due to vasodilation)
-increase CRT (in septic shock due to excessive vasodilation)
-bounding pulses initially and later weak
-cool extremities or hypothermia
-weak, dull, lethargic
What are the treatments for vasodilatory shock?
Fluids (help increase preload)
-Crystalloid
-Colloid
-Hypertonic saline

Vasopressures
-excessive vasoconstriction decreases blood flow to less vital organs (GI)

Treatment of other forms of shock
When are steroids used in shock?
used in the treatment of renal insufficiency and anaphylactic shock
What are treatments for anaphylactic shock?
Fluids
Antihistamines
Steroids
Epinephrine
What is a treatment for adrenal insufficiency?
Steroids necessary for vascular tone

otherwise contraindicated
What are vasopressors?
drugs that restore the tone which increases preload and increase cardiac output

peripheral resistance will increase blood pressure and blood flow
What are examples of vasopressors?
Dopamine
Norepinephrine
Epinephrine
Ephedine
Phenylephedrine
Vasopressin
Nalaxone
What are the uses for low doses of Dopamine?
dopamine receptor activation

causes vasodilation and improves GFR
What are the uses of mild doses of Dopamine?
Beta 1 and 2 receptor activation

results in increase in cardiac contractility and vasocilation
What are the uses of high doses of Dopamine?
Beta 1 and 2 receptors
Alpha 1 receptore

increases contractility of the heart
causes vasoconstriction

improves vascular resistance in vasodilitory shock and therefore blood pressure and blood flow

increases preload
What are the therapeutic uses of dopamine?
cardiogenic shock
renal failure

given IV
wide distribution but does not cross BBB
eliminated by plasma lover and kidney
What are the adverse effects of Dopamine?
ventricular arrhythmias
Sinus side effects
excessive vasocontriction
vomiting and diarrhea
extravascular administration can cause skin necrosis and sloughing
What are the effects of Norepiephrine?
Alpha 1 and 2 receptor activation
Beta 1 receptor

causes vasoconstriction, increased contractility
can causes reflex bradycardia

given IV
What are adverse effects of Norepinephrine?
arrhythmias
no beta 2 activation = excessive vasoconstriction to non vital organs
-can lead to GI ulcers
What are the effects of Phenylephrine?
Alpha receptor activation

in vasocilatory shock this will increase resistance and therefore blood pressure and blood flow

give IV
metabolised in liver
What are the uses of Phenylephrine?
treatment for vasodilitary shock
competes with Acepromazine (potent vasodilator)
What are drugs that should not be used in the reversal of acepromazine?
Dopamine
Epinephrine

use phenylephrine
What are the adverse effects of Phenylephrine?
hypertension
reflex bradycardia
CNS stimulation
Excessive Vasoconstriction (no Beta 2)
skin necrosis and skin sloughing at injection site
What are the actions of ephedrine?
Alpha and Beta receptor activator

direct
indirect - norepinephrine release
long acting- given bolus
What are the effects of vasopressin?
V1 receptor activation
causes vasoconstriction

used in the treatment of vasodilatory shock and cardiac arrest
What are the uses of Naloxone?
prevents exogenous opioid mediated vasodilation and used experimentally
Tachyarrhythemias are the results of giving what vasoconstrictors?
Isoproterenol
Epinephrine
What are the uses of Epiephrine?
used in cardiac arrest and to increase vascular tone

works on both alpha and beta receptors 1 and 2
What is the order of beta 1 effects in vasoconstrictors?
Isoproterenol > Epinephtine > norephinephrine > Dopamine/Dobutamine
What is heart failure?
impaired pumping that decreases ventricular ejection and impedes venous return
What is systolic failure?
inability of the hear to eject blood properly and results in lethergy and exercise intolerace

See stenosis, decrease contractility and decreased heart rate

known as cardiogenic Shock
decreased O2 delivery
Volumre overload
What is diastolic failure?
inadequate ventricular filling resulting in congestion

see stenosis, hypertrophy and increased heart rate?

known as congestive heart failure
pressure overload
What are causes of hear failure?
pressure overload
-left =aortic stenosis, systeming hyeprtension
-right = heartworm, pumonic stenosis, pulmonary hypertension

Volume overload
-valvular insufficiency, PDA

Primary Myocardial Disease
-DCM, HCM, Myocarditis

Myocardial infarction
Pericardial disease
Arrhythmias

*cause determines treatment
What do you see with pressure overload changes on the heart?
hypetrophy
-first helpful the harmful due to increased chamber size
diastolic failure
What do you see with volume overload changes on the heart?
results in eecentric hypertrphy and small amount of concentric hypertrphy
may improve diastolic function initially - later harmful due to increased stress and inadequate O2 delivery causing systolic function to worsen
What are primary myocardial failure changes?
Poor contractility will reduce cardiac output and decrease atrial blood pressure and atrial blood flow
Usually associated with concentric hypertrophy – DCM
Maybe due to decreased sympathetic tone or direct myocardial depression
-drugs
-toxins
-inflammation
What are the compensation mechanisms for heart failure?
Increase cardiac output
-hypertrophy
-frank starlings law
-increased heart rate and contractility
Volume loss
-ANP
-BNP
Volume gain
-ADH
-RAAS
Vasoconstriction
-Sympathetic stimulation
-RAAS
-Vasopressin
What is neurohormonal compensation for heart failure?
-good initially
increasing preload via venous constriction will increase contractility resulting in increase arterial pressure

not helpful in hypovolemia shock because volume is not the main problem
What is the effect of excessive venoconstriction?
increase preload to the point that it hinders heart contractility

see congestion
What is the effect on sympathetic stimulation in heart failure?
Norephinephrine may induce

-Apoptosis in cardiac myocytes
-Myocyte hypertrophy
-Ca overload in cardiac myocyte
-Altered arterial baroreceptor reflex
-Down regulation of Beta 1
-Decrease Ca uptake during diastole can result in decrease contractility due to decreased contractility die to decreased release of Ca during systole
-Increased Norepilevels (CHF)
-decrease heart rate variability is associated with a poor prognosis
What does chronic exposure to angiotensin II cause?
Eccentric ventricular hypertrophy
Myocarial inflammation
Myocardial necrosis

Aldosterone may be involved
-baroreceptor dysfuction
-indiction of coronary inflammation
-cardiac hypertrophy
-cardiac fibrosis

**renin active has been in some studies to be of prognosic value in heart failure
What are the consequences of stress and inflammation on the heart?
TNF-alpha mabe produced by cardiac myocytes during heart failure due to hypoxia and mechanical stress and oxidative stress
-decrease cardiac contractility
-ventricular hypertrophy
-apoptosis

IL-1, IL-2, IL-6 may also produced
-inflammation
-ventricular hypertrophy
-Decreased contractility
What are clinical signs of diastolic heart failure?
right sided
-organomegaly (distended abdomen)
-Pleural effusion
-Distended vessels

Left sided
-pulmonary edema
-pleural effusion
What are clinical signs of systolic heart failure.
Similar to other forms of shock
-similar to other forms of shick
-exercise in tolerence
-weak pulses
-cold lips/hypothermia
-increased CRT
-pale/blue mucous membrane
-decreased urination
-weakness
What is the treatment for heart failure?
supportive failure since mostlikely can not reverse the cause

fluids = hypovolemia
vasopressors = for vasofilitory shock
Positive inotropes are not always used in cardiogenic shock
-HCM
-valvular
-Stenosis
-DCM

drugs are used to maintain blood flow by blood pressure
What are drugs used in emergency management of heart failure?
Oxygen
Diuretics
Vasodilators
Postitive Inotropes
What diuretic is used in emergency heart failure?
Furosemide
inhibits Na-K 2Cl symporter in aLOH
decreases preoload and decreases hydrostatic pressure

used of congestive heart failure
What are adverse effects of Furosemide?
cardiac arrhythmias
hyperglycemia
ototoxicty
GI disturbance
Anemia
Leukopenia
What vasodilators are used in emergency heart failure?
Nitroglycerin
Nitroprusside
Hydralazine
Isorbide dinitrate
What are the effects of arterial dilators? venous vasodilators
Decrease afterload
Decrease preload
What is Nitroglycerin?
Drug used in emergency heart failure
Venous vasodilator by NO formation

decreases preload
What is Nitroprusside?
Drug used in emergency heart failure
arterial and venous vasodilator

short acting
decreases preload and afterload
What is Hydralazine
Drug used in emergency heart failure

Arterial vasodilator
decreases afterload

can be combined with Nitroglycerin (venous vasodilator)
What is Isorbate dinitrate?
drug used in emergency heart failure
venous dilator

decrease preload
What are the intropes?
Druge used in emergency cardiac failure
Dubutamine
Dopamine
Bipyridines
-Amrinine
-Milrinone
What is dubutamine?
an inotrope used in emergency heart failure

1st line agent in heart disease and acts on Beta 1 receptors

useful in cardiogenic shock due to decreased sympathetic tone, -decreased myocardial -contractility from toxins or inflammatory mediators

Used when systolic function is poor - DCM
not recommended for HCM (mare worsen diastolic function)

increase mitral or tricuspid valvular regurgitation

least likely of the cateholamines to cause arrhythmias

may worsen the heart disease in the long term by increasing myocardial oxygen demand
What are the the Bipyridines?
Milrinone (most potent)
Amrinone
What are mechanism of action of Bipyridines?
they are phosphodiesterace inhibitors

- increase cAMP = cardiac contractility
-increase Ca in cardiac Myocytes
-increase cAMP in small muscle decreases calcium
What are the effects of Milrinone and amnrinone?
phosphodiesterase inhibitors that increase contractility by increasing cAMP levels

work with heart disease associated with systolic function

may cause arrhythmias and may worsen long term prognosis due to increase myocardiac work
What are drugs used in management of stable heart failure?
loop diuretics
Thiazide diuretics
Potassium sparing diuretics

vasodilators
-angiotensin converting enzyme inhibitors
-angiotensin antagonists
-Hydralozine
What beta blockers are used in the treatment of heart failure?
Metoprolol
Carvediol
Atenolol
What are examples of ACE inhibitors? effects?
Enalapril
Lisinopril
Bensepril
Capropril

vasodilation
results in afterload reduction and may reduce preload in a colume overloaded heart

decreases angiotensin II and bradykinin

decreases aldosterone release
used in congestive heart failure, glomerulonephritis, hypertension and chronic renal failure
What are adverse effects of ACE inhibitors?
in renal disease there is a decrease in intraglomerular pressure resulting in decrease in GFR = azotemia

diuretics
can cause idiosyncratic glomeruloar disease in cats (captopril)
can cause GI irritation

not recommended in patients win which decreased resistance does not improve heart function and worsens blood pressure
Whatus Hydralazine?
a vasodilator that works on arteries and results in a decrease in afterload
What is Losartan?
angiotensin II antagonistv(competitive)
block agiotensin II formed by non ACE dependant pathways
What is Amlodipine?
Ca channel blocker that causes arterial vasodilation resulting in discreased afterload

may be beneficial in heart disease based on some human studies but not clear
What are digitalis glycoside?
positive inotropes such as
-Digoxin
-Digitoxin
-Ouabain
What are the effects of digitalis glycosides?
contractility from Na/K ATPase in the myocardial cell membraine increases sodium available for exchanve with calcium

results in increased intracellular calcium which results in a positive inotropic effect

kidney- improves GFR by increasing cardiac output
-inhibition of renin release due to increased delivery of sodium to the distal tubule
What are the adverse effects of Digitalis Glycosides?
don't treat it systolic function is normal - may worsen heart disease

Narrow safety margin and cats are often evaluated to if toxicity likely

GI issues

Bradyarrhythmias - parasympathetic tone

tachyarrhythmias - intracellular Ca

cardiac toxicity
What is Pimobendan?
Inodilator used to increase contractility

causes vasodilation by inbihiting inhibiting phosphodiesterase III

sensitizes troponin C complex to intracellular Ca

treatment of systolic failure beneficial in heart disease due to systolic failure (DCM)
How do beta blockers help in early heart failure?
blunts the harmful effects of the sympatheitic nervous system and RAAS on the heart

may reverse cardiac remodeling and improve systolic function when given over a long period

*dogs with DCM may not live long enough to see the benefit
What does Metoprolol and atenolol block?
Beta 1 receptors
What does Carvedilol block?
Beta 1 and 2 and alpha 1
What is an arrhythmia?
cardiac disturbance in rate, rhythum or both

rate abnormalities
-Bradycardia
-Tachycardia

Rhythm
-regular
-regularly irregular
-irregularly irregular
What are causes of arrhythmias?
disorders on conduction
disorders of impulse formation (pacemaker)
What are causes of conduction bradycardia?
Block of SA node
-may not be seen if conducction is slow, see drop in P QRS or skipped beat
-AV node may take over if complete

Block of AV Node
-1st degree porlonged beat or drop P QRS
-2nd degree sometimes conduction is blocked
3rd degree - conduction is always blocked

Blocked perkenji fibers
-normal rate and regularity
-change in ECG appearance
What are causes of condution tachycardia?
due to premature excitation cells depolarizing the cell that deporlarize them
What are the causes of impulse bradycardia?
decrease in normal automaticity

decrease of discharge from autonomic SA node
-parasympathetic stimulation
-hyperkalemia
-disease of node
What are the causes of impulse tachycardia?
increased rate of firing from autonomic site
-increased sympathetic tone

abnormal automaticity
-cells normally autonomic are
-cells normally slow are fast
--myocardial ischeima
--hypoxia - change in membrane portential

abnormal early depolarization
-increased sympathetic tone
-electrolyte imbalance
-drugs
What is sinus bradycardia?
due to slowing of the SA node impulse formation

-increased vagal tone
-sick sinus syndrome
-drugs that change autonomic tone
What is a sinus arrhythmia?
decrease in normal automaticity due to increase vagal tone during expiration

positive pressure during expiration increase BP there by activating baroreceptors
What is sinoatrial block?
due to conduction clock in the SA node

may see skipped beats
no P QRS seen
Bradyarrhythmias
What is sinus arrest?
due to cessation of sinus activity for more than two RR intervals
maybe due ti increase vagal tone or sinus node
may see escape beats
What is atrial standstill?
resembles sinus arrest due to depressed normal automaticity
causes include hyperkalemia, disease of the SA node
no P wave
may see QRS generated from other cells
What is an AV block?
due to clock of conduction at AV node
may be due to increase vagal tone or decreased AV nide

see P waves with no QRS
can be 1st, 2nd, or 3rd degree
What are the cause of tachyarrhythmias?
due to enhanced normal automaticity
often via increased sympathetic tone
What is a supracentricular premature depolarization?
originates in the AV node
often due to re-entry, abnormal automaticity or triggered activity
What is Preexcitation syndrome?
due to abnormal communication between the atria and ventricles that can cause reentry
What is Atrial flutter?
often due to reentry loops
no P waves see F waves
What is atrial fibrillation?
often due to multiple re-entry loops
irregularly irregular rhythm
no P waves
What is ventricular fibrillation?
impulse originates form ventricle
due to multiple re entry loops
will see no PQRS just undulating base line
What are treatment considerations when treating arrythmias?
antiarrhythmias change action potential and conduction of impulse

change may convert a rhythm
-re-entry
-tissue may be refractory when loop comes around

May offer rate control by decrease conduction
-decrease AV conduction in atrial fibrillation

may arrythmias so not need to treated with antiarrhythmics
-side effects out weigh benefits
-idoventricular rhythm
-sinus tachycardia

sometimes can obtain rate control in dogs with DCM
What are the class IA drugs?
drugs used to treat tachyarrhythmias by blocking sodium blockers

-prolong action potential

Quinidine
Procainamide
What are the class IB drugs?
Drugs used to treat tachyarrhythmias
sodium channel blockers

shortens action potential
-lidocaine
-phenytoin
-Mexieltine
What are the class II drugs?
Beta blockers

-propranolol
-timolol
-pindolol
-Atenolol
-Asmolol
-Metoprolol
-carevedilol
What are the class III drugs?
Bretylium
Amiodarone
Sotalol

K channel blockers
What are class IV drugs?
Verapamil
Diltiazem
What is the treatment of supracentriular arrhytmias?
drugs that decrease rate or decrease arrythmias

-Digoxin
-Beta Blocker
-Calcium Channel Blocker
What is the treatment of atrial tachycardia, atrial flutter and atrial fibrillation?
Diltiazem (class IV)
Digixin
Beta Blockers (class II)

Quindine and procainamide can be tried it other drugs are ineffective in emergency or chronic therapy
What is the treatment of ventricular prematire complexes?
often do not require treatment or at least not emergency treatment
What can you use to treat ventricular tachycardia in an emergency setting?
Lidocaine
Procainamide if lidocaine doesn't work
beta blockers
Amiodarone if lidocaine doesn't work
How do you treat tachyarrhythmias in cats?
betablockers

cats are sensitive to lidocaine- do not use systemically
What is Procainamide?
a class Ia drug
sodium channel blocker
prolongs the action potential
-decrease velocity
-decrease automaticity
-decrease myocardial excitability

Prokinetic
What is Quinidine?
drug of choice for atrial fibrillation in the horse

class Ia sodium channel blocker
-prolongs the action potential
What is lidocaine?
local anesthetic that is the drug of choice for life threatening ventricular arrhythmias in dogs

class IB sodium channel blocker

Shortens action potential

increases motility in horses

do not use in cats systemically
What is Phenytoin?
used to help tachycarrhythmias caused by digitalis glycosides in dogs

used for seizure prevention

class II with an action similar to lidocaine
What is Mexiletine?
similar to lidocaine but given orally

used for ventricular arrhythmias
What flecainide?
a drug that blocks sodium channels

does not effect action proteinal ot refractory
results in the strongest repression at the O phase
-decrease impulse conduction
-suppression of cardiac contractility

can be antiarrhythmiac or proarrythmic
What are arrhythmias are beta blockers used for in cats?
Supracetricular and ventricular arrhythmias
What are examples of non selective beta blockers?
Propranolol
Timolol
Pindolol

-used for supraventricular arrythmias
-anesthesmia induced, digitalis induced arrythimias
-glaucoma
-hypertension
-hyoperthyrodism
What are adverse effects of beta blockers?
Sinus bradycardia
and decrease contractility
tachycardia because of sudden withdrawal

-hypoglycemia
-Bronchospasm
-hyperkalemia
-GI side effects
-sedation
-seizures at toxic doses
What are selective beta 1 blockers?
Metoprolol, Esmolol, Atenolol

used in patients with asthma, diabetes and peripheral vascular disease

-no beta 2 blockade

Atenolol is used in cats to reduce heart rate in heart disease
What is sotolol?
a drug that acts as a non selective class II drug at low doses

acts as a class III drug at high doses (K channel blocker)

often used for ventricular arrythmias
What drugs are Ca channel blockers?
Diltiazem (anti arrhythmic)
Verapamil (anti arrhythmic)

used for supraventricular arrhythmias

inhibits slow inward Ca during action potential resulting in decreased intracellular calcium
-control supraventricular arrhythmias
-interrupt arrhythmias triggered by automaticity
-slows subus rate, negative inotropes, decrease AV conduction
What is the treatment for cardiac asystole?
epinephrine
vasopressin
What is the cause of hypertension in animals?
usually secondary due to:

-renal disease
-daibetes
-hyperthyroid
-Pheochromocytoma
Drugs used in the treatment of hypertension work by what mechanism?
vasodilation
decrease cardiac contractility and rate
decrease blood volume

use vasodilators
beta blockers