Pharmacology Flashcards
(12 cards)
What are beta-blockers and their use? what are their effects on exercise?
“lols”
receptor antagonists (block receptors and prevent natural agonists from binding) that block receptor sites for norepinephrine and epinephrine.
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cardiac effects:
- decrease HR
- decrease contractility (reduces myocardial contractability and CO, suppresses formation of ventricular arrhythmia)
- decrease conduction velocity (slows ventricular response to atrial fibrillation and atrial cardia)
- lowers BP by dilating artery
vascular effects:
- smooth muscle contraction
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used for angina, following an MI, HF, irregular heart rhythms and hypertension
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- reduces resting HR and exercise HR (EHR 20-30%)
- reduces resting and exercise BP
- reduces VO2max with acute administration
- increases exercise capacity with chronic administration (particularly in angina and CVD)
- use of HR predictive equations likely invalid
- can still use HR to monitor exercise intensity provided taking medication at time of testing
- RPE should be used as an adjunct to HR to monitor intensity
- monitor for symptoms of hypotension or bradycardia
- mask symptoms of hypoglycemia - BG monitored in diabetic patients initially
- in asthmatics can trigger asthma attack
What are ACE inhibitors and their use? What are their effects on exercise?
“prils”
ACE inhibitors prevent conversion of angiotensin I to II. The vasodilation causes a decrease in BP. They also break down bradykinin (vasodilator substance)
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cardiorenal effect:
- vasodilation
- decrease blood volume
- depress sympathetic activity
- inhibit cardiac and vascular hypertrophy associated with chronic hypertension
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Used for heart failure, hypertension, acute and chronic MI
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- decreases resting and exercise BP
- increases exercise tolerance in patients with CHF
- monitor for symptoms of hypotension
- encourage gradual cool down post exercise
What are ARBs and their use? What are their effects on exercise?
“sartans”
similar effects to ACE inhibitors
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Stops vasoconstriction and fluid retention
- used to treat hypertension
- typically used instead of ACE-I in patients who do not tolerate ACE-I
What are calcium channel blockers (CCB) and their use? What are their effects on exercise?
DHPS - “pines”
CCB bind to L-type channels (located on cascular mooth muscle) slow movement of calcium into cardiac and vascular smooth muscle cells
- slow HR and decrease BP
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cardiac effects:
- decrease contractility
- decrease HR
- decrease conduction velocity
vascular effects:
- smooth muscle relaxation (vasodilation)
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used to treat hypertension, angina and arrhythmias
there are 3 classes of CCBs which differ in selectivity toward cardiac and vascular L-type channels
1. dihydropyridines (DHPs)
- for HTN
2. non-dihydropyridines (non-DHPs)
- verapamil (angina, arrhythmias)
- diltiazem (both cardiac and vasodilatory mechanisms)
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DHPS
- decrease resting and exercise BP
non-DHPs
- decrease resting and exercise HR & BP
What are diuretics and their use? What are their effects on exercise?
increase urine output (diuresis) by inhibiting re-absorption of Na+
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used for patients with edema, HTN, HF, and certain kidney disorders
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- decreases resting and exercise BP
- increases exercise tolerance in HF with preserved EF
- dehydration and electrolyte depletion lead to hypokalemia and some cardiac arrhythmias
What are nitrates and their use?
“nitro/nitrate”
nitric oxide and nitrates increases cGMP which inhibits calcium entry into cell causing smooth muscle relaxation/vasodilation. This vasodilation of blood vessels leads to a decrease in resistance and increase in blood supply to tissues
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used to treat angina, congestive HF and HTN
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there is short and long acting nitrates
- chronic usage results in intolerance and may cause endothelial damage
What are antilipemic agents (statins) and their use? What are their effects on exercise?
“statin”
Used in primary and secondary prevention of CVD to reduce risk of CV events and mortality
- shown to decrease risk of major vascular events by 10%
- higher doses elicit better results
- modify the lipid profile to “stabilise” arteries
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- target cholesterol production in the liver
- decrease conversion of HMG-CoA to mevalonic acid
- enhance LDL receptor activity and remove LDL from the blood stream
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- decreases exercise capacity in those with muscular fatigue
What are anticoagulants and their use? What are their effects on exercise?
“blood thinners”
- decrease clotting ability of blood and reduce clot formation
- used to prevent and treat thromboembolic (blood clot formation) disorders
- decrease risk of deep vein thrombosis (DVT) and pulmonary embolism (blockage in artery in lung (usually blood clot))
- prevent stroke in those with: 1. atrial fibrillation 2. valvular heart disease 3. artificial heart valves
What are antiplatelet agents and their use? What are their effects on exercise?
Inhibit activation or aggregation of platelets in the bloodstream.
- can be used in primary prevention, but mostly secondary prevention (MI, unstable angina, ischemic stroke, TIA)
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Dual antiplatelet therapy (DAPT)
ACS, CABG, PCI prescribed two antiplatelet agents (DAPT) to decrease re-occlusion or re-stenosis of treated vessels
- DAPT decreases recurrent events compared with aspirin alone
What are inhaled corticoids and their use? What are their effects on exercise?
first line treatment for asthma
suppresses airway inflammation by:
- activating anti-inflammatory gene expression
- inhibiting inflammatory cells
- increasing B2 receptor expression and function
- leads to reduced inflammation and less symptoms
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in patients with asthma, combination therapy with b-agonist can help better manage symptoms
What are bronchodilators and their use? What are their effects on exercise?
Used to treat asthma and COPD
- relaxes walls of the bronchi allowing airflow to increase
two main classes of bronchodilators:
- muscarinic receptor antagonists (control smooth muscle tone, mucus secretion, vasodilation and inflammation.
inhibits antagonist inhibits the effect of ACh from binding to muscarinic receptors. sinus tachycardia can occur. while rare, cases of angina, SVT and AF have also been reported.)
- beta-agonists (act on B2 adrenergic receptor pathway/ stimulate smooth muscle that line the bronchi initiating relaxation and dilation. relieve acute symptoms of asthma and manage COPD. sinus tachycardia and palpitations are the effects on exercise response)
