Thursday, June 24, 2010

Curing HD with DRUG therapy

There seems to be a lot of problem for owners of dog with HD. By arranging your dog diet it can be helpful, since reducing weight the correct way will reduce the risk as well.

check this Therapy Also

This is an articel of a vet, explaining about HD treatment for dogs.

Heart disease drugs, Cushing's and Medication

Q: Dear Dr. Mike:

I have a few questions:

1. Would 500mg per day of Lysodren (for Cushing's) cause heart disease or heart failure in a 30 pound Lhasa Apso?

2. If he already has heart disease, would that dosage of Lysodren make his heart disease worse?

3. Does Rimadyl reduce the ability of Vasotec (aka Enalapril) to treat heart disease or heart failure?

4. Are there any circumstances under which diuretic furosemide should not be used with Vasotec to treat heart disease or heart failure?

5. Under which circumstances should any of the following drugs be used, either alone or with any other drug or drugs, to treat either heart disease or heart failure: Amrinone Captopril Digitalis Glycosides Digoxin Dobutamine Hydralazine Intravenous Furosemide Milrinone Morphine Nitroglycerine Nitroprusside Procainamide Propranolol Quinidine Theophylline

What ever advice you can offer will be much appreciated, because, as a layman, I cannot understand the veterinary articles on this subject.

Gregory

A: Gregory-

Lysodren is the brand name for a mitotane. This is a medication chemically related to DDT (the insecticide). It is useful in the treatment of hyperadrenocorticism (Cushing's disease) because it selectively kills adrenal tissue. Most of the adverse effects of mitotane are related to its effect on the adrenal gland because it can cause signs of hypoadrenocorticism (Addison's disease) if it is overdosed. It is very easy for small dogs to be overdosed with mitotane because it is only available in 300mg tablets. Initially dogs are given about 25mg/lb of bodyweight twice a day. (so about 1 tablet per 12 lbs). This dosage is continued until the symptoms of Cushings disease subside or for 10 days to 2 weeks. At that time the medication is usually used on a once per week or twice per week schedule, using somewhere between 10 and 30mg/lb of body weight, based on the clinician's evaluation of the initial response to treatment.

When Lysodren is overdosed most of the problems seen are due to the medication causing hypoadrenocorticism. The signs of this are vomiting, diarrhea, weakness, depression, shock and even death. Once in a while these symptoms will appear really rapidly with Lysodren use but usually they are seen after a week to 10 days. Since the object of using Lysodren is to kill adrenal cells and decrease production of adrenal hormones the effects of the medication must be closely monitored, especially during the period when it is being used everyday. Lysodren can cause liver damage that is unrelated to its effect on the adrenal gland and hypersensitivity (allergy) reactions have been reported to it, as well. I am not aware of any reported effects on the heart function. Addison's disease can lead to heart failure due to high potassium levels that occur as a result of the disease and inhibit cardiac function but this effect is supposed to be uncommon with the use of mitotane because it isn't as effective at killing the adrenal cells that control potassium levels as it is at killing adrenal cells that are involved in corticosteroid production. So there would be a small chance of heart effects due to overdosage of Lysodren but they would be an indirect effect.

I have written the word "overdosage" in relation to the use of Lysodren several times in this note and I think that it needs to be explained a little. Many medications are used according to specific guidelines, such as 5mg/lb of bodyweight. Lysodren is used "to effect", which means that it is dosed daily until it has done its job and then a guess is made as to how much is needed on a maintenance basis. There are no easy guidelines for Lysodren use and it is very very easy to overdose the medication despite doing a good job of monitoring its use.

Question 2: A lot of dogs with Cushing's disease have some degree of heart failure, because Cushing's disease causes muscular weakness and the heart is basically a specialized muscle group and because most dogs with Cushing's disease are older animals likely to have heart failure independently of the Cushing's disease. Lysodren should help this situation in most cases. As far as I know heart failure as a specific reaction to Lysodren is not reported to be a problem.

Question 3: It is very likely that carprofen (Rimadyl Rx) will decrease the effectiveness of enalapril (Enacard Rx, Vasotec Rx) because other non-steroidal anti-inflammatory medications are reported to have this effect. I do not have a package insert from Rimadyl with me (I'm on the road this weekend) but I will try to check and see if this effect was studied during the drug approval process for carprofen.

Question 4: Furosemide is a diuretic which has some effect on blood pressure (lowering it). Enalapril also lowers blood pressure. Using both medications at the same time may cause the blood pressure to get too low (hypotension). If this happens it is probably better to reduce the amount of furosemide being given than to reduce the amount of enalapril. It is a good idea to be very cautious when using either furosemide or enalapril in patients with low sodium levels. Enalapril and potassium sparing diuretics, such as spironolactone, can be a bad combination, leading to excessively high potassium levels.

Question 5: There are a lot of different causes of heart failure and different medications are used based on they type of problem present. I will try to give you an idea of the circumstances medications are used in but not in great detail. If you need more information on any of these, let me know.

Amrinone: This medication is used in low output heart failure. I have not ever used it and have no personal experience with it but low output heart failures are situations in which the heart is too weak or too damaged to pump blood effectively or when blood volume is too low for the heart to work properly.

Captopril: Captopril is closely related to enalapril and it is used in the same circumstances. Both are in the "ACE inhibitor" class of medications which are used to treat chronic heart failure. Prior to the availability of enalapril (Enacard Rx) as an approved medication for use in dogs captopril was commonly prescribed.

Digitalis Glycosides: this is a group of medications which include digoxin and digitoxin. In humans digoxin is the digitalis glycoside of choice. In dogs digitoxin may be safer and more effective. These medications increase the strength of the heart beat and help to control arrythmias. There has always been a lot of controversy over the effectiveness of digitalis glycosides but currently they seem to be in favor again.

Digoxin: see above

Dobutamine: Dobutamine is supposed to be a heart strengthening medication (positive ionotrope) but I haven't seen much written on its use in veterinary medicine.

Hydralazine: Hydralazine is a rapidly acting venous dilator. It can be used in an emergency situation to reduce the workload on the heart prior to initiating therapy with enalapril or other ACE inhibitors since they are slower to exert their beneficial effects.

Intravenous Furosemide: Intravenous furosemide is used when it seems unlikely that a pet would be able to properly absorb oral furosemide (severe heart failure symptoms) or when oral administration is not advisable (gastro-intestinal disease).

Milrinone: I have not used milrinone but it is supposed to be helpful in low output heart failure, which is when the heart is too weak or the valve function too poor for the heart to pump enough blood.

Morphine: Low dose morphine usage is supposed to be helpful in controlling anxiety associated with severe heart failure. It may also be useful if pain is the cause of an arrythmia, such as might occur with trauma or difficulty delivering puppies.

Nitroglycerine: Nitroglycerine is used in situations in which rapid lowering of pulmonary venous pressure may be beneficial. This situation doesn't arise as often in the dog as it does in cats. It also has the advantage of being absorbed across intact skin which means that it can be applied to cats in severe respiratory or cardiac distress without hassling the cat too much.

Nitroprusside: I think that nitroprusside is also probably used more in the cat than in the dog but am not certain of this. It is also a potent vasodilator, affecting both arterial and venous blood pressure. It is possible to lower the blood pressure beyond what is good for the patient using this medication so it is best to monitor its use carefully. In cats this medication is sometimes credited with real life-saving ability in severely ill cats and it is possible that it may be similarly effective in dogs.

Procainamide: This medication is used to control ventricular (large heart chamber) arrhythmias. It is sometimes associated with sudden death, which may be an effect of the medication or might just be due to the situations it is used in, since these dysrhythmias seem to occur in stressful situations.

Propranolol: Propranolol is used to treat ventricular arrhythmias and atrial tachycardia (too rapid beating of the atrium). It is a "beta blocker" and has a rapid but short-lived effect. Despite this it may be recommended for long term use in atrial tachycardia in some cases

Quinidine: Quinidine is an antiarrhythmia medication that is similar in effect to procainamide. It enhances the effect of digitalis glycosides and must be used with caution when also using those medications.

Theophylline: Theophylline is used in dogs with heart failure because it is has a slightly positive effect on heart strength and because it is a bronchodilator, which may make it easier for a pet to breathe if it has pulmonary congestion secondary to the heart failure. Personally, I don't think this medication works well enough to make much use of it. It can be hard to distinguish lung problems from heart problems early in either disease and theophylline may benefit either one, so I think it is used sometimes in an effort to cover all possibilities.

In chronic heart failure in dogs, there are three commonly used groups of medications: "ACE Inhibitors" which decrease blood pressure and make it easier for the heart to work; diuretics which also lower blood pressure and make it easier for the heart to work; digoxin or digitoxin, which increase the strength of the heart muscle and control arrythmias. Cough suppressants can be beneficial in dogs in which cough persists despite medications for the heart problems.


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source : http://www.vetinfo.com/dogmed.html

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