Heartworm Disease III- CardioRush

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PHT increases RV pressure, flattens septumWhat causes septal flattening on echo?HWsWhat is the arrow pointing to?Enlarged PAWhat is the cursor pointing to?Pleural effusion (echo free space outside the cardiac wall)What are the arrows pointing to?Enlarged RV, pleural effusionWhat are the findings on this echo?Caval syndrome (when image plays, you can see the mass of worms moving between the RA and RV)What is this finding?Very sensitive to antigen, high risk of deathWhy should you not perform surgical extraction for caval syndrome in cats unless they are severely affected by the presence of the worm in the heart?False (it's really only dogs that we call caval syndrome, we don't always see the severe signs we see in caval syndrome with dogs)True or false: we always call HWs in the R heart caval syndrome when in the catHWWhat is the arrow pointing to?Macrocyclic lactonesWhat drug class is the mainstay of HWD prevention?Ivermectin, milbemycin, selamectin, moxidectinWhat are some examples of macrocyclic lactones used for HWD prevention?L3, L4What stage of the HW lifecycle is targeted by macrocyclic lactones?L3 and L4 target stages are around for more than a month, so when a single dose is missed, they can be killed with the next month doseWhat is the reachback effect referring to in HW prevention?Sterile, no larvae producedWhat is the effects of macrocyclic lactones of the reproduction of adult female worms?6-12mg/kgWhat is the dose of ivermectin given for HW prevention?False (the low dose is safe for any dog or any breed)True or false: the HW prevention dose of ivermectin is only safe in breeds without the MDR1 mutationTrueTrue or false: the HW prevention dose of ivermectin is safe for use in all dogs regardless of HW or microfilaria status, but the owner should monitor for the first 24 hours to look for signs of anaphylaxisDoxycyclineWhat drug can be paired with ivermectin to expedite the slow kill process for microfilaria control?50mg/kgWhat dose of ivermectin can be used extalabel to RAPIDLY kill microfilaria?Anaphylaxis risk highWhy shouldn't you give high dose ivermectin to kill off microfilaria rapidly?Rapidly microfilaricidal, may result in shockWhy isn't milbemycin oxime (interceptor, trifexis) recommended in microfilaremic dogs?Selamectin, moxidectinWhat HW preventative drugs can be used in cats and are easier to use because they are topical?MoxidectinWhat macrocyclic lactone is available as a 6 month slow release injectable?Heartgard, Triheart, iverhartWhat brandname HW preventative have ivermectin as the main ingredient?RevolutionWhat brandname HW preventative have selamectin as the main ingredient?Trifexis, interceptor, sentinelWhat brandname HW preventative have milbemycin oxime as the main ingredient?Advantage multi, proheart 6What brandname HW preventative have moxidectin as the main ingredient?Worm toxicity confined to L3 to L4 molt, had to give daily, could cause shockWhy isn't DEC used as a HW preventative anymore?8 weeksAt what age should you start a HW preventative in dogs?Give 1 month before anticipated HW season, continue for 3 months after transmission endsIf an owner only wants to give HW preventative seasonally, how should you give it?TrueTrue or false: rapidly microfilaricidal drugs, such as high dose ivermectin, should only be given to dogs that are known microfilaria negativeFalse (NOT protective)True or false: indoor only status is protective against HW in cats, so no prevention is required10-20% (more common than FeLV or FIV)What is the feline infection rate of HW in endemic areas compared to that of dogs?Kill Wolbachia, eliminate MF, kill adult worms, minimize pulmonary parenchymal and arterial pathology, treat RCHF and PHT is presentWhat are the goals of HW treatment?Prevent transmissionWhy is it important to eliminate microfilaria during HW treatment?Exercise restriction, corticosteroids for pneumonitisHow can we minimize pulmonary parenchymal and arterial pathology in HW treatment?Doxycycline and macrocyclic lactonesWhat is the recommended treatment for HW before adulticide is used?Confirm diagnosis, give doxy 10mg/kg BID and monthly HW preventative for 1 month, give melarsomine after 2 monthsWhat are the general recommendations for HW treatment?Kill WolbachiaWhat is the purpose of giving doxy for a month before adulticide treatment?Kill L3 to L4 stageWhat is the purpose of administering monthly HW preventative for 1-2 months before adulticide treatment?Susceptibility gapWhat is decreased by pretreating with macrocyclic lactones before adulticide treatment?Juvenile HW stage that isn't susceptible to either preventative or adulticideWhat is the susceptibility gap in HW treatment?Allows time for juvenile to become susceptible as adults, no new juveniles developHow does giving macrocyclic lactones for 2 months before adulticide treatment decrease the susceptibility gap?MelarsomineWhat is the mainstay of adulticide therapy for treatment of HW?Arsenical compoundWhat is is melarsomine made of?L5, adultsWhat life stages does melarsomine target?L4, early L5What life stage of HW is NOT susceptible to melarsomine?False (NEVER use any adulticide in a cat, it will kill them)True or false: only certain adulticide treatments for HW can be used in catsTrueTrue or false: Melarsomine is safer and more effective than Na carparsolate, but there are still severe side effectsSevere systemic disease, RCHF, pneumonitisWhat animals must be stabilized before adulticide treatment?Severe renal or hepatic diseaseWhat underlying diseases should you use caution in when giving adulticide treatment?Caval syndrome (stage 4)What stage of HWD can you NOT use adulticide treatment for in dogs?High die off increases risk of side effect, 10% may still remainWhy is the original dosing recommendation of 2 injections 24 hours apart no longer recommended?Initial single injection following in 1-3 months by 2 doses 24 hours apartWhat is the recommended adulticide therapy protocol?Symptomatic dogsWhat is the split dosing protocol required to treat?False (required for symptomatic dogs, recommended for all dogs needing adulticide)True or false: the split dosing protocol is only recommended for symptomatic dogsControlled, staged killing, lungs have time to recover before 2 doses, kills 98% of wormsWhat is the benefit of the split dosing protocol for HW adulticide treatment?Lengthier exercise restriction, increased cost of extra dose, increased total arsenical doseWhat are the cons of using the split dosing protocol for adulticide treatment?Correct dose, needle size for body weight, change needle between drawing and injecting, deep IM epaxial injection between L3-L5, firm pressure for 5 minutes at injection siteWhat aspects of giving melarsomine are extremely important to follow?False (some dogs require sedation or analgesia, which is fine)True or false: you should never give sedation or analgesia when administering melarsomine, it may interact with the adulticide therapyFalse (ALL animals get PTE accompanying worm die off, which is why we need to minimize risk)True or false: only some animals get PTE as a result of worm deathAbsolute cage rest for 6-8 weeks post treatment, tapering course of prednisoneHow can we minimize risk associated with worm die off after adulticide treatment?6 monthsHow long after HW adulticide treatment should we administer another antigen test?False (not all dogs are good candidates, some owners not interested)True or false: in practice, adulticide is a good option for all HW positive dogs and most owners are on board for treatmentLocal pain, inflammation, malaise, GI signs, reversible paralysis or neuro signs, pulmonary edema idiosyncratically, renal or hepatic tox, PTE, deathWhat are some possible side effects of adulticide therapy?Cough, hemoptysis, fever, dyspnea, sudden deathWhat are the signs of PTE in dogs following adulticide treatment?Geriatric dogs with low or high worm burdens, dogs with severe systemic disease, dogs who have adverse reaction to melarsomineWhat dogs are good candidates for the slow kill approach to HW treatment?Progressive pulmonary pathology occurs during long kill period (30 months), very prolonged exercise restrictionWhy would relying on the preventative dose of ivermectin for slow kill of adult worms be an unacceptable approach?Doxycycline 10-20mg/kg/dayWhat is given in combination with preventative doses of ivermectin in the slow kill approach to HW treatment?9-12 monthsHow long does the slow kill approach using ivermectin and doxycycline take to reduce the adult worm burden by 80-95%?Moxidectin/imidacloprid (Advantage multi)What is the preventative of choice to use with doxycycline in the slow kill approach?21 daysHow soon is after starting slow kill treatment is doxy combined with Moxidectin/imidacloprid microfilaricidal?96%What percentage of adult worms were kills after doxy and Moxidectin/imidacloprid use for 10 months?False (melarsomine is still considered the best option and slow kill is not recommended)True or false: the slow kill approach to adulticide treatment of HW is the standard of care recommended by the AHSSurgical extraction prior to melarsomineWhat is the recommended treatment for dogs with caval syndrome?Jugular venotomy, sedation or anesthesia, local blockWhat is required to surgically extract HWs in caval syndrome?IshiharaWhat forceps are used for HW extraction?False (risk of inflammation is greater, so steroids are used)True or false: the risk of hypercoagulability is greater than the risk of inflammation in HW, so corticosteroids are avoidedExercise restriction, doxycycline, ivermectin, corticosteroids, anticoagulants, O2, phosphodiesterase inhibitors for PHT, RCHF therapyWhat are the important ancillary therapies in HW treatment?CorticosteroidsWhat is the mainstay of treatment is a cat symptomatic from HW infection?10-20%What percentage of cats may die suddenly from HW infection?