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Cardio Unit 4 - Emily > Week 13 > Flashcards

Week 13 Flashcards

(59 cards)

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1
Q

What do diuretics do?

A

Act on kidneys to increase sodium and water excretion
Decrease fluid in the vascular system

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2
Q

How do diuretics help the cardiovascular system?

A

They take the load off the cardiovascular system so there’s not as much pressure and the heart doesn’t have to work as hard to move excess fluid

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3
Q

Indications for diuretics

A

Hypertension
Congestive heart failure

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4
Q

Diuretics adverse effects

A

Possible fluid depletion (excess fluid loss)
Electrolyte imbalance - due to too much sodium and water loss

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5
Q

Diuretics rehab concerns

A

Orthostatic hypotension
Weakness, fatigue
Confusion, mood changes - dehydration symptoms

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6
Q

What are sympatholytics?

A

Beta blockers

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7
Q

What do beta blockers do?

A

Bind to the heart and block the effects of epinephrine and norepinephrine
Decrease heart rate and contraction force
Can also produce more general decrease in sympathetic response

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8
Q

Cardiovascular indications for beta blockers

A

Hypertension
Angina
Arrhythmias
Heart Failure
Recovery from MI

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9
Q

Other indications for beta blockers

A

Migraine
Raynaud’s
Situational anxiety

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10
Q

What is the main impact of beta blockers?

A

It’s mainly impacting sympathetic discharge - it has a quiet effect on the sympathetic nervous system

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11
Q

Beta blockers adverse effects and rehab concerns

A

Bronchoconstriction
Orthostatic hypotension
Psychotropic effects (depression, lethargy, decreased libido - esp. in older men)
Decreased MAXIMAL exercise capacity

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12
Q

How many beats per minute will beta blockers reduce maximal heart rate?

A

About 20 to 30 beats per minute

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13
Q

Your patient with hypertension was recently prescribed a beta blocker to help improve cardiac function. During an aerobic exercise session, she begins to wheeze and have difficult, labored breathing (dyspnea). What is likely true?

A

It is likely she has some form of Bronchoconstriction disease, and she is taking a non selective beta blocker that affects her lungs as well as her heart.

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14
Q

Why are diuretics useful in HTN and heart failure?

A

They decrease excess fluid in the cardiovascular system, thus reducing stress on the heart and vasculature

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15
Q

What effect do beta blockers have on the sympathetic nervous system?

A

They directly decrease SNS simulation on the heart
Have general “quieting” effect on SNS activity throughout the body

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16
Q

What do vasodilators do?

A

Act directly on vascular smooth muscle

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17
Q

How do vasodilators help decrease pressure?

A

They inhibit contraction of the smooth muscle at the arterial level, it will relax and allow more blood to flow through the arterial, thus decreasing pressure

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18
Q

Indications for vasodilators?

A

Hypertension
Heart failure

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19
Q

Adverse effects of vasodilators

A

Reflex tachycardia
Orthostatic hypotension
Dizziness, headaches
Edema, fluid retention

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20
Q

How do vasodilators cause reflex tachycardia?

A

Drugs cause dilation and BP is going to go down - the heart response by increasing the heart rate

You can use beta blockers to help decrease heart rate that’s increasing due to vasodilators

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21
Q

What do you want to avoid with vasodilators?

A

Systemic heat since you’d essentially be doubling up on the dilating effect

** True for all drugs that cause vasodilation **

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22
Q

What is the renin angiotensin system (RAS)?

A

Neuroendocrine response that helps control BP and other physiological reactions in various tissues

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23
Q

What do excessive or inappropriate RAS responses cause?

A

Increased BP
Damage to CV system and kidneys

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24
Q

What options are available to prevent harmful effects of angiotensin II?

Study These Flashcards
A

ACE inhibitors
Angiotensin II receptor blockers
Direct renin inhibitors

25
Angiotensin converting enzyme (ACE) inhibitors
Inhibit angiotensin converting enzyme (ACE) - keep it from going from angiotensin I to angiotensin II Decrease formation of angiotensin II Normalizes and doesn’t allow excessive formation of angiotensin II
26
What do ACE inhibitors do?
Prevent acute vasoconstriction from ANG II - decrease BP Prevent vascular hypertrophy from ANG II - decrease long term detrimental effects on heart and vasculature
27
Indications for ACE inhibitors
Hypertension Heart failure
28
Ang II receptors blockers
Block angiotensin II receptors Prevent detrimental effects of Ang II on heart and vasculature May be as effective as ACE inhibitors, but fewer side effects
29
Direct renin inhibitors - newest option
Prevents production of precursor to Ang II (this can’t form as easily) Aliskiren (Tekturna) - inhibits renin’s ability to convert angiotensinogen to Ang I
30
RAS Drugs: Adverse effects and rehab concerns
Generally well tolerated - some nausea, dizziness Possible allergic reaction (rash, angioedema) ACE inhibitors: dry cough (due to increased bradykinin)
31
Excessive renin-angiotensin activity should be controlled because increased production of _____ causes ______.
Angiotensin II Vasoconstriction and vascular smooth muscle hypertrophy
32
Calcium channel blockers
Limit calcium entry into vascular smooth muscle and cardiac muscle Promote vasodilation, stabilize HR
33
Indications for calcium channel blockers
Hypertension Angina pectoris Arrhythmias
34
Calcium channel blockers adverse effects and concerns
Swelling in feet, ankles Orthostatic hypotension Altered heart rate Avoid systemic heat
35
What is the traditional route of anti-anginals: organic nitrates?
Sublingual
36
What are the transdermal administration for anti-anginals: organic nitrates?
Creams Patches
37
What is the primary indication for anti-anginals
Angina pectoris
38
Nitrates: primary effects
Dilate peripheral vasculature Result: decreased cardiac workload, decreased O2 demand
39
What does dilating peripheral vasculature cause?
Venous dilation causes decreased cardiac preload (blood returning to heart, heart doesn’t have to work as hard) Arterial dilation causes decreased afterload (pressure heart pumps against, heart doesn’t have to work as hard pushing blood into the arterial system)
40
How do you prevent nitrate tolerance?
Daily nitrate free intervals (e.g., patch 12 hr on, 12 hr off)
41
Nitrates: adverse effects, rehab concerns
Headache, dizziness Orthostatic hypotension Increased vasodilation - exaggerated response to systemic heat Sublingual doses: check drug viability; have drug ready before rehab session
42
Nitrates such as nitroglycerin help decrease symptoms of angina Pectoris because they _____ myocardial oxygen demand by vasodilating the _____.
Decrease; peripheral vasculature
43
Treatment of cardiac arrhythmias: 4 Drug “Classes”
1. Sodium channel blockers 2. Beta blockers 3. Drugs that prolong repolarization 4. Calcium channel blockers
44
Class II: beta blockers
Decrease excessive sympathetic stimulation of heart
45
Class IV: Ca++ channel blockers
Limit Ca++ excitation of SA, AV nodes
46
Class I: Sodium Channel Blockers
Inhibit (abnormal) Na+ channel opening in cardiac cells - stabilize excitability [normalize sodium entry]
47
What are the three subclasses depending on effects for Class I: Sodium channel blockers?
IA, IB and IC
48
IA Sodium channel blockers
Moderate slowing of depolarization and action potential conduction; prolong repolarization
49
IB: Sodium Channel Blockers
Shorten cardiac repolarization
50
IC: Sodium channel blockers
Marked slowing of depolarization and action potential conduction
51
Class III: Drugs that prolong repolarization
Lengthen time interval before next action potential can be generated — want hear to have time to rest between beats to allow to refill - no time to refill adequately, it can’t continue to pump blood adequately
52
Class III: Drugs that prolong repolarization - how do they probably work?
Probably by decreasing K+ efflux (exit) during repolarization — slow it down so heart doesn’t go back to normal as quickly
53
Class I (Na+ channel blockers): Primary clinical indications
Various arrhythmias - especially PVCs and VTach
54
Class II (Beta blockers): primary clinical indications
A fib and VTach
55
Class III (amiodarone): primary clinical indications
A Fib VTach V Fib
56
Class IV (CCBs): Primary clinical indications
A fib Supraventricular tachycardias
57
Anti-arrhythmics: rehab concerns; problems
Various side effects depending on class Monitor HR and symptoms, especially during exercise
58
Primary rehab concerns/problems for anti-arrhythmics
Change in type of arrhythmia
59
What is the proarrhythmic effect?
Drug fixing one arrhythmia may cause a different arrhythmia or unmask a different arrhythmia

Cardio Unit 4 - Emily (3 decks)

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