Dr. Kramer On: New Cardiac Drugs
By Dr. George Kramer, DACVIM (Cardiology)
Atlantic Coast Veterinary Specialists
The standard of care for treating heart failure over the last 20 years has consisted of balanced vasodilation with an ACE-inhibitor, diuretic therapy and, if indicated, positive inotropic therapy and/or antiarrhythmia therapy. This usually has translated into enalapril, furosamide, possibly digoxin, and a variety of antiarrhythmic treatments.
Recently, there have been a number of new drugs added to our pharmacologic armamentarium to use in the treatment of congestive heart failure. The purpose of this article is to give some background information on the drug and guidance to those who have never used them.
- Pimobendan (Vetmedin): This drug has received much press since its FDA licensing. However, as a cardiologist in private practice, I see many cases where the drug is being used inappropriately. The prescribing veterinarian should be fully aware of the mechanism of action, indications for use, and adverse effects that can be seen with the drug prior to using it in a therapeutic protocol.
Pimobendan is a benzimidazole pyridazinone derivative. It is classified as an inodilator and has a dual mode of action. It causes vasodilation through phosphodiesterase III inhibition and it causes an increase in cardiac contractility through increased Ca++ sensitization of the cardiac myofilaments. There is also mild inhibition of phosphodiesterase V activity. The increase in contractility is achieved by increasing the efficiency within the cardiac myofibrils without an increase in myocardial energy requirements. This is a very important distinction from .
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Owners Unaware That Dog May Be Suffering
From Serious Heart Disease
Recently released global research shows that over 50% of dog owners are unaware that their dog may be at risk of heart failure. Heart disease affects one in four dogs over seven years of age, yet the lack of knowledge about this serious, life-threatening condition calls for better education among dog owners on how to recognize the disease, and how to maintain their dogs’ heart health. New data were also presented at the 29th World Veterinary Congress that show that dogs with congestive heart failure that is due to a condition called myxomatous mitral valve disease live longer when treated with pimobendan (Vetmedin) compared with a commonly used ACE inhibitor. The results of the QUEST trial, the largest international study of its kind to be conducted among dogs with congestive heart failure, are due to be published in the “Journal of Veterinary Internal Medicine” later this year.
Veterinarians Keep An Eye On The Economy
Home foreclosures. Rising fuel prices. Rising food prices. Job losses. Losses in the stock market. In the current economic climate, small animal practitioners may fear that pet owners have less discretionary income or are less willing to spend on veterinary care. Practices also must account for some of the same cost increases as households. Although statistics on practice revenues and expenses in 2008 are generally not available yet, veterinarians with expertise in economics believe most small animal practitioners are weathering the slowdown or downturn — varying by community. “I think there’s no question that there’s an impact on veterinary practices from the economic issues the country is facing,” said Dr. Karen E. Felsted, CEO of the National Commission on Veterinary Economic Issues. “But it’s not clear-cut that every practice is feeling the same pinch.” Dr. Felsted said veterinarians historically have been fortunate to be in a generally recession-proof industry, and they have done reasonably well when the economy has been weak in the past. She said the impact could be more dramatic this time, however. Complete story.
FDA Issues Safety Warning On
Comfortis-Ivermectin Interaction
Veterinarians who use high, extralabel doses of ivermectin to treat dogs with nonresponsive demodectic mange and other conditions should be aware that the FDA’s Center for Veterinary Medicine has received reports of some dogs developing signs of ivermectin toxicosis when ivermectin is used concurrently with Comfortis (spinosad). The clinical signs of these adverse reactions are consistent with ivermectin toxicosis. Elanco Animal Health, a division of Eli Lilly and Company, manufactures Comfortis. The drug is a monthly oral, chewable tablet for the prevention and treatment of flea infestations on dogs. The FDA and Elanco Animal Health are advising veterinarians that dogs receiving extralabel doses of ivermectin should not receive concurrent treatment with Comfortis. Download a technical bulletin on “Spinosad and the Extra-Label Use of High Dose Ivermectin for the Treatment of Generalized Demodicosis in Dogs.”
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QUIZ : What’s Your Diagnosis?
A 12-yr, M/N, DSH presented for poor appetite and limited drinking for 2-3 days. He had vomited once and seemed lethargic to the owners. He normally fights when being put into his carrier, but tonight he did not care. His vaccination and retro status were unknown. There has been no recent weight loss, c/s/d.
On physical exam, he was depressed but responsive and was 7% dehydrated. Abnormal findings consisted of a rectal temperature of 96.6 degrees F, a grade II/VI SHM, a large left cranial abdominal mass, small and smooth kidneys, hematuria when bladder was expressed, and weak ambulation.
The lungs were clear and the patient was eupneic. Palpation of the abdomen was not painful.
CHALLENGE: What is your radiographic interpretation and plan?
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Funny Bone
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Events Calendar
Thursday, September 11
Long Island Veterinary Medical Association (LIVMA)
Monthly Meeting
7:30-10:30 PM; Holiday Inn in Plainview
http://livma.org/
September 18-21
Intl. Veterinary Emergency & Critical Care Symposium 2008 (IVECCS)
Phoenix, Arizona
Dr. Kramer on:
9/18, 8 AM “Cardiac Imaging In The ICU”
9/18, 9:15 AM “New Cardiac Drugs”
9/18, 11 AM “Arterial Thromboembolism In Cats”
9/20, 1:30 PM “Diagnosis & Treatment Of Arrhythmias In The ICU”
Click here for other state, national, and global veterinary events in September.
October 2-5
NYSVMS Veterinary Conference
www.nysvms.org/
Thursday, October 16
Long Island Veterinary Medical Association (LIVMA)
Monthly Meeting
http://livma.org/
Click here for other state, national, and global veterinary events in October.
Thursday, November 13
Long Island Veterinary Medical Association (LIVMA)
Monthly Meeting
http://livma.org/
Click here for other state, national, and global veterinary events in November.
Thursday, December 4
Long Island Veterinary Medical Association (LIVMA)
Monthly Meeting
http://livma.org/
Click here for other state, national, and global veterinary events in December.
About Atlantic Coast
Veterinary Specialists
At Atlantic Coast Veterinary Specialists, our commitment is to provide you — the referring veterinarian — and your clients, the best and the latest in modern veterinary medicine.
Whether it is through our mobile ultrasound service or through our referral and emergency services available, Atlantic Coast Veterinary Specialists is here to work with you as a partner on those difficult and challenging cases. We look forward to hearing from you.
Please feel free to call any member
of our Board Certified staff for help and assistance.
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