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Possible meds for blockage and bradycardia

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  • luanne.pelletier@servicecanada.gc.ca
    Hi guys, Sorry for all the Spencer posts but I m trying to find as much info as I can so I can talk things over with my vet in regards to the atenolol and
    Message 1 of 3 , Nov 30, 2005
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      Hi guys,

      Sorry for all the Spencer posts but I'm trying to find as much info as I can so I can talk things over with my vet in regards to the atenolol and other alternatives.

      I've been searching the 'net to try to find out how to treat a cat with a 3rd degree blockage and bradycardia (since that's his main problem now) but there's not a whole lot about that on the 'net. I found a few places where they mentioned Atropine (I'm not sure how safe that is for cats) but some say it's useful for a 2nd degree blockage but not for a 3rd degree blockage. It's supposed to abolish the bradycardia.

      I found atropine as well as glycopyrrolate, isoproterenol, and terbutaline mentioned in a few places.

      Here's a few sources that mention those meds:

      http://vetgo.com/cardio/concepts/concsect.php?conceptkey=20071#20071

      Treat the underlying cause of the bradycardia
      Atropine will abolish the bradycardia (atropine - 0.04 mg/kg IV)

      Atropine: (altho it says it's not usu effective in 3rd degree but ok for 2nd degree)
      *dog: 0.01-0.04 mg/kg (IV,IM); 0.02-0.04 mg/kg TID- QID (SQ, PO)
      *cat: 0.02-0.04 mg/kg (IV,IM), QID (SQ)
      Glycopyrrolate:
      *dog: 0.005-0.01 mg/kg (IV,IM); 0.01-0.02 mg/kg BID-TID (SQ)
      *cat: 0.005-0.01 mg/kg (IV,IM); 0.01-0.02 mg/kg (SQ)
      Isoproterenol:
      *dog: 0.04-0.09 ug/kg/min (CRI)
      *cat: 0.04-0.09 ug/kg/min (CRI)
      Terbutaline:
      (Brethine)
      *dog: 2-5 mg BID (PO)
      *cat: unknown

      **********
      http://en.wikibooks.org/wiki/Veterinary_Board_Review:_A-Z_List:_C
      Sinus bradycardia - Caused by increased vagal tone. Treat with atropine, glycopyrrolate, isoproterenol, artificial pacemaker.


      **********
      http://vetpda.ucdavis.edu/boards/CardioOverview.htm
      3rd degree AV block - there is no association between the P waves and the QRS complexes. The supporting rhythm may be a junctional or ventricular escape rhythm. It is usually not responsive to atropine and usually requires permanent pacemaker implantation.

      **********
      http://rems.vaems.org/Protocols/Part5.HTML#ATROPINE
      (human site but good info)

      ATROPINE SULFATE
      THERAPEUTIC EFFECTS By blocking parasympathetic (vagal) action on the heart, atropine:
      * Increases the rate of discharge by the sinus node.
      * Enhances conduction through the atrioventricular (AV) junction.
      * Accelerates the heart rate, thereby improving cardiac output.
      In addition, by speeding up a slow heart to a normal rate, atropine reduces the chances of ectopic activity in the ventricles and thus of ventricular fibrillation. Atropine is most effective in reversing bradycardia due to increased parasympathetic tone, morphine, or organophosphate; it is less effective in treating bradycardia due to actual damage to the AV or sinoatrial (SA) node.
      INDICATIONS
      * SINUS BRADYCARDIA when accompanied by premature ventricular contractions (PVCs) or hypotension.
      * SECOND- and THIRD-DEGREE HEART BLOCK when accompanied by bradycardia.
      * In some cases of ASYSTOLE.
      * As an antidote in ORGANOPHOSPHATE POISONING.
      CONTRAINDICATIONS None when used for life-threatening emergencies. Use with caution in patients with:
      * Atrial flutter or atrial fibrillation when there is a rapid ventricular response.
      * Glaucoma.
      * Chronic obstructive pulmonary disease.
      SIDE EFFECTS The patient should be warned that he or she may experience some of the following side effects and that these side effects are part of the drug's usual and expected actions:
      * Blurred vision, headache, pupillary dilation.
      * Dry mouth, thirst.
      * Flushing of the skin.
      Paradoxical bradycardia may occur if a dose less then 0.5 mg is given or if even the correct dose is given too slowly.

      *********

      http://www.petplace.com/article.aspx?id=5190

      Overview
      Isoproterenol (also called isoprenaline) is a drug that traditionally has been used to treat certain heart problems, circulatory disorders, and bronchospasm.
      Isoproterenol increases the heart rate, relaxes muscles in the airways and stomach, and dilates blood vessels. These actions make it easier for the heart to pump oxygen-rich blood throughout the body.
      Isoproterenol is a prescription drug and can only be obtained from a veterinarian or by prescription from a veterinarian.

      Uses of Isoproterenol
      Isoproterenol is used in the treatment of bronchospasm.
      Isoproterenol is also used to treat some types of abnormal heart rhythm.
      Occasionally, isoproterenol has been used to dilate airways in the treatment of acute feline allergic bronchitis (asthma).

      **********

      I know that Atropine and Glycopyrrolate are also used as anesthesia agents but the write up for atropine does sound like it would be worthwhile trying, as long as it's a safe med for cats.

      Does anyone have any thoughts or experience using atropine or any of the other mentioned meds? Are they safe for cats?

      Thanks,
      Luanne
    • Susan
      Luanne, VetGo Cardiology Concepts is my favorite. I think you are on the right path. I also search NIH s PubMed:
      Message 2 of 3 , Nov 30, 2005
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        Luanne,

        VetGo Cardiology Concepts is my favorite. I think you
        are on the right path. I also search NIH's PubMed:

        http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed

        I do not limit myself to vet articles. I also read
        human and animal research to benefit humans including
        dogs since they are used for research more than cats.

        There is one pacemaker/feline abstract on PubMed BTW

        Also this:
        Noninvasive transthoracic temporary cardiac pacing in
        dogs.

        http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14529132&query_hl=6

        Susan



        --- luanne.pelletier@... wrote:

        > Hi guys,
        >
        > Sorry for all the Spencer posts but I'm trying to
        > find as much info as I can so I can talk things over
        > with my vet in regards to the atenolol and other
        > alternatives.
        >
        > I've been searching the 'net to try to find out how
        > to treat a cat with a 3rd degree blockage and
        > bradycardia (since that's his main problem now) but
        > there's not a whole lot about that on the 'net. I
        > found a few places where they mentioned Atropine
        > (I'm not sure how safe that is for cats) but some
        > say it's useful for a 2nd degree blockage but not
        > for a 3rd degree blockage. It's supposed to abolish
        > the bradycardia.
        >
        > I found atropine as well as glycopyrrolate,
        > isoproterenol, and terbutaline mentioned in a few
        > places.
        >
        > Here's a few sources that mention those meds:
        >
        >
        http://vetgo.com/cardio/concepts/concsect.php?conceptkey=20071#20071
        >
        > Treat the underlying cause of the bradycardia
        > Atropine will abolish the bradycardia (atropine -
        > 0.04 mg/kg IV)
        >
        > Atropine: (altho it says it's not usu effective
        > in 3rd degree but ok for 2nd degree)
        > *dog: 0.01-0.04 mg/kg (IV,IM); 0.02-0.04 mg/kg TID-
        > QID (SQ, PO)
        > *cat: 0.02-0.04 mg/kg (IV,IM), QID (SQ)
        > Glycopyrrolate:
        > *dog: 0.005-0.01 mg/kg (IV,IM); 0.01-0.02 mg/kg
        > BID-TID (SQ)
        > *cat: 0.005-0.01 mg/kg (IV,IM); 0.01-0.02 mg/kg (SQ)
        >
        > Isoproterenol:
        > *dog: 0.04-0.09 ug/kg/min (CRI)
        > *cat: 0.04-0.09 ug/kg/min (CRI)
        > Terbutaline:
        > (Brethine)
        > *dog: 2-5 mg BID (PO)
        > *cat: unknown
        >
        > **********
        >
        http://en.wikibooks.org/wiki/Veterinary_Board_Review:_A-Z_List:_C
        > Sinus bradycardia - Caused by increased vagal tone.
        > Treat with atropine, glycopyrrolate, isoproterenol,
        > artificial pacemaker.
        >
        >
        > **********
        > http://vetpda.ucdavis.edu/boards/CardioOverview.htm
        > 3rd degree AV block - there is no association
        > between the P waves and the QRS complexes. The
        > supporting rhythm may be a junctional or ventricular
        > escape rhythm. It is usually not responsive to
        > atropine and usually requires permanent pacemaker
        > implantation.
        >
        > **********
        > http://rems.vaems.org/Protocols/Part5.HTML#ATROPINE
        > (human site but good info)
        >
        > ATROPINE SULFATE
        > THERAPEUTIC EFFECTS By blocking parasympathetic
        > (vagal) action on the heart, atropine:
        > * Increases the rate of discharge by the sinus node.
        >
        > * Enhances conduction through the atrioventricular
        > (AV) junction.
        > * Accelerates the heart rate, thereby improving
        > cardiac output.
        > In addition, by speeding up a slow heart to a normal
        > rate, atropine reduces the chances of ectopic
        > activity in the ventricles and thus of ventricular
        > fibrillation. Atropine is most effective in
        > reversing bradycardia due to increased
        > parasympathetic tone, morphine, or organophosphate;
        > it is less effective in treating bradycardia due to
        > actual damage to the AV or sinoatrial (SA) node.
        > INDICATIONS
        > * SINUS BRADYCARDIA when accompanied by premature
        > ventricular contractions (PVCs) or hypotension.
        > * SECOND- and THIRD-DEGREE HEART BLOCK when
        > accompanied by bradycardia.
        > * In some cases of ASYSTOLE.
        > * As an antidote in ORGANOPHOSPHATE POISONING.
        > CONTRAINDICATIONS None when used for
        > life-threatening emergencies. Use with caution in
        > patients with:
        > * Atrial flutter or atrial fibrillation when there
        > is a rapid ventricular response.
        > * Glaucoma.
        > * Chronic obstructive pulmonary disease.
        > SIDE EFFECTS The patient should be warned that he or
        > she may experience some of the following side
        > effects and that these side effects are part of the
        > drug's usual and expected actions:
        > * Blurred vision, headache, pupillary dilation.
        > * Dry mouth, thirst.
        > * Flushing of the skin.
        > Paradoxical bradycardia may occur if a dose less
        > then 0.5 mg is given or if even the correct dose is
        > given too slowly.
        >
        > *********
        >
        > http://www.petplace.com/article.aspx?id=5190
        >
        > Overview
        > Isoproterenol (also called isoprenaline) is a drug
        > that traditionally has been used to treat certain
        > heart problems, circulatory disorders, and
        > bronchospasm.
        > Isoproterenol increases the heart rate, relaxes
        > muscles in the airways and stomach, and dilates
        > blood vessels. These actions make it easier for the
        > heart to pump oxygen-rich blood throughout the body.
        > Isoproterenol is a prescription drug and can only
        > be obtained from a veterinarian or by prescription
        > from a veterinarian.
        >
        > Uses of Isoproterenol
        > Isoproterenol is used in the treatment of
        > bronchospasm.
        > Isoproterenol is also used to treat some types of
        > abnormal heart rhythm.
        > Occasionally, isoproterenol has been used to
        > dilate airways in the treatment of acute feline
        > allergic bronchitis (asthma).
        >
        > **********
        >
        > I know that Atropine and Glycopyrrolate are also
        > used as anesthesia agents but the write up for
        > atropine does sound like it would be worthwhile
        > trying, as long as it's a safe med for cats.
        >
        > Does anyone have any thoughts or experience using
        > atropine or any of the other mentioned meds? Are
        > they safe for cats?
        >
        > Thanks,
        > Luanne
        >




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      • luanne.pelletier@servicecanada.gc.ca
        Hi Susan, Thanks for your reply! http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed That link
        Message 3 of 3 , Nov 30, 2005
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          Hi Susan,

          Thanks for your reply!

          http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed

          That link doesn't work for me...

          >>>There is one pacemaker/feline abstract on PubMed BTW

          I did find a couple of abstracts about that in PubMed. One of the recommendations after Spencer's last ECG was a pacemaker but considering Spencer's age (he's almost 17) and his stress level when he's at the vet and everything else, we didn't think he would be a good candidate for that. The specialist also said that it's a very challenging procedure in a cat.

          >>>Also this:
          Noninvasive transthoracic temporary cardiac pacing in
          dogs.
          http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14529132&query_hl=6

          Interesting. Thanks for the links!

          Luanne
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