Final Exam Cardio Flashcards
(102 cards)
1
Q
Beta Blockers (Suffix olol) what is there MOA?
A
Beta-blockers bind to beta-adrenoreceptors and block binding of norepinephrine and epinephrine to receptors;
2
Q
Beta1 receptor stimulation what would you use them for?
A
Cardiac stimulation
increase contraction and HR
Cardioselective beta blockers act on B1
3
Q
Beta2 receptor stimulation what would you use them for?
A
Lung stimulation
pheripheral vasculature
nonselective beta blockers act on B1 and B2
4
Q
Adverse reactions for cardio selective beta blockers
A
bradycardia
decreased exercise tolerance
cold extremities
depression
5
Q
Adverse reactions for non selective beta blockers
A
bradycardia
blocks symptoms of hypoglycemia
increased risk of hypoglycemia: blood glucose <70 mg/dl
Bronchospasm
decreased exercise tolerance
cold extremities
depression
6
Q
Angiotensin converting enzyme inhibitors what is there MOA?
A
inhibits enzyme responsible for conversion of angiotensin I –> angiotensin II
7
Q
Adverse reactions for ACE inhibitors?
A
‣ HYPERkalemia
‣ Lightheadedness
‣ Dry cough (20%)
‣ Angioedema: loss common but severe
8
Q
Angiotensin Receptor Blockers what is there MOA?
A
blocks angiotensin II receptor blockers and angiotensin mediated aldosterone secretion
9
Q
Adverse reactions of ARBS?
A
‣ HYPERkalemia
‣ Dry cough (less common)
10
Q
What is the mechanism of action for thiazide?
A
Inhibit the NaCl transporter in distal renal tubule
increase Na+ and H2O excretion
11
Q
Thiazide common adverse reactions?
A
- HYPOkalemia
- HYPOmagnesemia
- HYPERcalcemia
- HYPERglycemia
- HYPERuricemia
- Increased urination
12
Q
What is the mechanism of action for Loop Diuretics?
A
inhibit Na/K/Cl transporter in thick ascending limb
increasese Na + and H2O excretion
13
Q
Loop Diuretics adverse reactions?
A
- HYPOkalemia
- HYPOmagnesemia
- HYPOcalcemia
- HYPERuricemia
14
Q
What is the mechanism of action of potassium spring?
A
inhibit Na channel in collecting tubule and collecting duct
increases Na and H2O excretion
15
Q
What is the mechanism of action for aldosterone antagonists?
A
competes with aldosterone receptor sites in distal tubule
increases Na and H20 Excretion
16
Q
What is the mechanism of action for statins?
A
inhibits the enzyme HMG-CoA reductase, which plays a role in production of cholesterol in the liver,
thereby reducing cholesterol production
17
Q
What are the adverse reactions for statins?
A
‣ Myalgias ‣ Gas ‣ Diarrhea ‣ Dyspepsia: indigestion ‣ Increased liver enzymes
18
Q
What is normal WBC?
A
Normal: 5-10 x 10^9 / L
19
Q
What is HgB?
A
Normal: Males: 14-17 g/dL Females: 12-16 g/dL
20
Q
What is HCT?
A
Normal: Males: 42-53% Females 37-47%
21
Q
What is platelets?
A
Normal: 140-400k/uL
22
Q
What normal BNP?
A
Normal: <100pg/mL
23
Q
What is normal bicarbonate HCO3-?
A
Normal: 22-26 mEq/L
24
Q
What BUN normal?
A
Normal: 6-25 mg/dL
25
What is normal Bilirubin?
0.3 - 1 mg/dL
26
What is normal Hgb A1C?
Less than 5.7%
27
What is normal blood glucose?
Normal: 70-100 mg/dL
28
Are there normal responses of the autonomic nervous system?
▫ Temperature regulation
▫ Sensation of angina
▫ Baroreceptors & blood pressure regulation
29
Control of breathing: what is the function of the medulla?
contains respiratory rhythmicity centers
30
Controls of breathing: what is the function of the pons?
adjusts rate and depth in response to sensory
| stimuli, emotions, speech
31
What causes biots breathing?
Injury to the medulla
32
Description of Biots?
Irregular pattern of deep and shallow breaths. Deep breaths with occasional abrupt pauses in breathing.
33
What causes cheyne-stokes?
Heart failure or TBI
34
Description of cheyne-stokes?
Repeated cycle of deep breathing followed by shallow breathing and a short period of apnea
35
What causes kassmaul respiration?
metabolic acidosis and kidney failure
36
Description of kassmaul respiration?
Dyspnea with RR>20 br/m, increased depth of respiration, panting, air hunger
37
What causes asymmetrical or lateral costal breathing?
NM conditions and CVA
38
Descriptoin of asymmetrical or lateral costal breathing?
Asymmetrical breathing due to unilateral weakness of hemi- diaphragm or intercostals or significant scoliosis
39
What causes paradoxical breathing?
Asymmetric weakness (CVA), spasticity, flail chest, SCI
40
Description of paradoxical breathing?
All or some of the chest wall falls in during inspiration; can also see abdominal expansion during exhalation
41
Periodic breathing in infants is it normal or no?
Normal
Typically in first two weeks of life, but in some may extend to 5-6 months
Rapid breathing following by up to a 10 second pause
42
With a stroke what things are affected?
* Decreased power output
* Lower VO2 max
* Shifting of muscle fiber types
43
What types of interventions can help with brain repair?
Aerobic exercise can impact brain repair in the immediate post-stroke time period
Interacts with inflammatory cytokines
44
In multiple sclerosis: demyelination lesions in respiratory centers cause?
▫ Respiratory muscle weakness
▫ Abnormalities in the control of breathing
Sleep disordered breathing/sleep apnea
▫ Impaired matching of ventilation and perfusion
Increased dead space
45
Respiratory muscle weakness, decreased MIP and MEP?
Expiratory weakness more prevalent in those with
| UE weakness
46
Respiratory muscle impaired cough?
▫ Abdominal weakness
| ▫ Bulbar dysfunction and inability to close glottis
47
What are possible cardiac dysfunctions and MS?
* Higher risk for developing ischemic heart disease & heart failure
* Left ventricular dysfunction
• Altered cardiac/autonomic
control
• Impaired cardiovascular risk profile
48
Multiple sclerosis: CV & P issues?
Heat Sensitivity
49
MS: autonomic Dysregulation what should you look out for?
* Altered/abnormal BP and HR response
| * Altered sweating response
50
Tell me about Parkinson’s Disease?
* Rigidity and weakness of respiratory muscles
* Coordination of breathing is altered
* Decreased MIP and MEP
* Higher doses of levodopa can worsen breathing coordination
51
Patients tend to have orthostatic hypotension what asymptomatic things are you looking for?
▫ Baroreflex is abnormal
| ▫ Failure of adrenergic receptors on arterial muscles
52
What risk factors are you considering for metabolic syndrome?
```
3 or more of
the following risk factors
• Obesity
• Elevated triglyceride levels
• Low HDL
• HTN or on medication for HTN
• Elevated fasting blood glucose or on medication to treat high blood sugar
```
53
SCI and SV considerations for lack of direct sympathetic input?
▫ Blunted HR response to exercise
| ▫ Lower peak HR achieved
54
What are the causes of orthostatic hypotension?
▫ Venous pooling
▫ Loss of muscle pump
▫ Reduced plasma volume in people with SCI
▫ Deconditioning
55
What are the main pulmonary issues you will address?
```
▫ Secretion management
Weak or ineffective cough
▫ Atelectasis
Weak inspiratory effort
▫ Hypoventilation
Weak inspiratory effort
```
56
Diaphragm innervation:
C3-5
57
Diaphragm concentric contraction?
quiet and forceful
| inhalation
58
Diaphragm eccentric contraction?
controlled exhalation,
| speech, trunk stability
59
Diaphragm dependent upon intact abs for length tension and direction of pull of central tendon?
Creates negative pressure
Pull of central tendon helps to flare out lower ribs Concentric: inhalation
Eccentric: speech
60
The diaphragm is the main pressure regulator for what?
thoracic and abdominal regions
61
What do the intercostal muscles do?
Helps generate negative pressure
▫ Stability of thorax in the presence of negative pressure
Concentric: inhalation/exhalation Eccentric: speech
62
Intercostals innervation
(segmental): T1-T12
63
What do the abdominal muscles do?
▫ Helps provide tone so that diaphragm descends properly
▫ Helps align central tendon so ribs flare
▫ Provides concentric contraction to help with sneezing, laughing, high intensity exercise, coughing
64
Abdominal innervation
Innervation: T6-L1
65
The abdominal provide positive pressure for what?
diaphragm
66
Erector Spinae innervation
• Innervation: T1-S3
67
Serratus Anterior innervation
• Innervation: C5-C7
68
Erector Spinae Action
• Stabilizes thorax posteriorly
69
Serratus Anterior Action
• When insertion point (scapula) is fixed, origin point moves providing posterior expansion of the rib cage
70
Pectoralis Action
When insertion point is fixed (upper extremities), provides anterior and lateral expansion of the upper chest
71
Pectoralis innervation
C5-T1
72
Scalenes innervation
C3-8
73
Scalenes action
* Stabilizes upper chest during inhalation
| * Provides superior and anterior expansion of the upper chest and prevent collapse
74
Sternocleidomastoid innervation
C2-C3 and Spinal Accessory Cranial Nerve
75
Sternocleidomastoid actions
Stabilizes upper chest during inhalation
76
Trapezius Innervation
C2-C4 and Spinal Accessory Cranial Nerve
77
Trapezius Action
* Provides superior expansion of the upper chest
| * Least energy efficient accessory muscle (must lift the weight of the entire upper extremity to assist in inhalation)
78
Hyoid Muscles Innveration
C1-C3 and Trigeminal Cranial Nerve
79
Hyoid Muscles Actions
* Raises hyoid bone and steadies it during swallowing and speaking
* Depresses and elevates larynx
80
Activities of Ventilation inspiration
▫ Always concentric activity
81
Activities of Ventilation expiration
▫ Passive: during quiet breathing
▫ Eccentric: during quiet, controlled activities (ex. speech)
▫ Concentric: during forceful expulsion of air (ex. Yelling and coughing)
82
Why facilitate breathing?
To improve oxygen, facilitate the accessory muscles and diaphragm
83
Neurologic population: what will inhibit diaphragmatic breathing?
Cerebral palsy
CVA
Guillian Barre
Multiple Sclerosis
SCI
84
What issues do patients with cerebral palsy present with for inhibiting diaphragmatic breathing?
poor abdominal strength, contractures in lower extremities leading to poor pelvic alignment
85
What issues do patients with CVA present with for inhibiting diaphragmatic breathing?
muscle imbalance due to weakness on one side, neglect toward one side of body
86
What issues do patients with guillian barree present with for inhibiting diaphragmatic breathing?
Poor ab strength
87
What issues do patients with MS present with for inhibiting diaphragmatic breathing?
Poor ab strength
88
What issues do patients with SCI present with for inhibiting diaphragmatic breathing?
poor abdominal strength with impaired resting diaphragm position; lack of innervation; possible TLSO
89
Positioning to facilitate use of accessory muscles?
Shoulder flexion/abduction/ER
90
Positioning to facilitate diaphgramatic breathing?
Shoulder extension/adduction/IR
91
What issues do patients with SCI present with for inhibiting accessory muscle breathing?
cervical collar or halo, lack of muscle innervation, wheelchair prescription
92
What issues do patients with Parkinson's Disease present with for inhibiting accessory muscle breathing?
Stiff trunk lacking rotation, difficult to expand t. cage
93
What issues do patients with Guillian Barre present with for inhibiting accessory muscle breathing?
possibly have a tracheostomy due to poor airway clearance, muscle weakness, forward head posture
94
What issues do patients with CVA present with for inhibiting accessory muscle breathing?
forward head posture, muscle imbalance between the two sides, neglect toward one side of body
95
What issues do patients with CP present with for inhibiting accessory muscle breathing?
forward head posture, possible torticollis, contracted upper extremities with tightness in the pectoralis muscles
96
What is the purpose of the abdominal binder?
increased compliance of the abdominal wall in those that have limited or absent innervation effects:
▫ Diaphragm sits “lower” and loses length-tension and ability to generate force
▫ Line of pull of central tendon is not ideal
97
What is a P- Flex?
Inspiratory device
98
What is a threshold Device?
* Provides Threshold resistance based on MIP
| * RR has little effect on resistance provided
99
Normal pH:
7.35-7.45
100
Normal PaCO2
35-45 mmHg
101
Normal PaO2
80-100 mmHg
102
Normal HCO3
22-26 mEq/L
