Week 4 Flashcards
(213 cards)
1
Q
What is renin?
A
A proteolytic enzyme that is
released into the circulation primarily by the kidneys
2
Q
What stimulates the release of renin?
A
- Sympathetic nerve activation
(acting via β1-adrenoceptors) - Renal artery hypotension (caused by systemic hypotension or renal artery stenosis)
- Decreased sodium delivery to the distal tubules of the kidney.
3
Q
What is an essential/primary HTN?
A
HTN with no clear cause
4
Q
What is a secondary HTN?
A
Increase in BP due to a specific,
known cause (head trauma, cancer, renal, endocrine
disorders)
5
Q
What are the parameters for pharmacology and HTN?
A
• Start with one or more agents depending on the initial
BP readings
• Add additional agents or optimize doses if current
regimen is not successful
• Use agents with different mechanisms
6
Q
What is the BP target for HTN patients?
A
<140/90 for most patients
7
Q
What are the first line medications for HTN?
A
- Thiazide diuretics
- ACE inhibitors
- Angiotensin receptor blockers (ARBs)
- Calcium channel blockers (CCBs)
8
Q
What are the second and third line medications for HTN?
A
- Beta-blockers
- Aldosterone antagonists
- Loop diuretics
- Direct vasodilators, alpha-1 blockers, alpha-2 blockers
9
Q
What is the basic targets for treating HTN with direct cardiac agents?
A
Impact Heart rate (HR), contractility, conductivity
10
Q
What is the basic targets for treating HTN with peripheral
vascular agents?
A
Impact peripheral resistance, preload, vascular health,
vasodilation
11
Q
What is the basic targets for treating HTN with renal agents?
A
Impact fluid volume, metabolites
12
Q
What are the direct cardiac agents medications used to treat HTN?
A
- Beta Blockers
* Calcium Channel Blockers
13
Q
What are the peripheral
vascular agents medications used to treat HTN?
A
- Hydralazine
- Alpha 1 Antagonists
- Alpha 2 Agonists
14
Q
What are the renal agents medications used to treat HTN?
A
• ACE Inhibitors • Angiotensin 2 Inhibitors • Diuretics - Carbonic Anhydrase Inhibitors - Loop - Thiazide Diuretics - Aldosterone Antagonists - Potassium Sparing Diuretics
15
Q
What is the primary action and anti-HTN effects of antihypertensive drug category: diuretics?
A
- Primary actions: Kidneys
* Anti-HTN Effects: Decrease plasma fluid volume
16
Q
What is the primary action and anti-HTN effects of antihypertensive drug category: sympatholytics?
A
- Primary actions: Various sites within sympathetic nervous system
- Anti-HTN Effects: Decreased sympathetic influence on heart
17
Q
What is the primary action and anti-HTN effects of antihypertensive drug category: vasodilators?
A
- Primary actions: Peripheral vasculature
* Anti-HTN Effects: Lower vascular resistance
18
Q
What is the primary action and anti-HTN effects of antihypertensive drug category: Inhibition of ReninAngiotensin (ACEinhibitors)?
A
- Primary actions: Peripheral vasculature and certain involved organs
- Anti-HTN Effects: Various
19
Q
What is the primary action and anti-HTN effects of antihypertensive drug category: Calcium Channel Blockers?
A
- Primary actions: Vascular smooth muscle and cardiac muscle
* Anti-HTN Effects: Decreased contractility, cardiac force and rate
20
Q
What are the therapeutics uses of diuretics?
A
- Hypertension – thiazides are first line
- Heart Failure
- Edema (peripheral/pulmonary)
21
Q
What are the things to monitor on a patient taking diuretics?
A
- Blood Pressure
- Electrolytes (Na, K, Ca, Mg)
- Ins/Outs, Weights
22
Q
What are the side effects of diuretics?
A
- Hypotension
- Renal dysfunction
- Volume depletion
- Electrolyte disturbances
23
Q
What are the cautions/contraindications of diuretics?
A
- Sulfa allergy (loops)
- Anuric patients
- Concomitant use of other nephrotoxic agents
24
Q
What is the MOA of Thiazide Diuretic Agents?
A
Inhibition of Sodium/Cl reuptake
– Excretes sodium
– Loosely coupled with Potassium excretion
– Moderate diuresis & afterload reduction
25
___ is the 1st line medication option for an antihypertensive and its therapeutic value appears to be beyond diuresis
*Thiazide Diuretic Agents* is the 1st line medication option for an antihypertensive and its therapeutic value appears to be beyond diuresis
26
What are the common thiazides used?
```
– Hydrochlorothiazide (HCTZ)
– Chlorthalidone
– Metolazone
– Chlorthiazide
– Indapamide
```
27
What is the MOA of loop diuretic targets?
* Inhibit Na, K, Ca, Mg reabsorption in the loop of Henle
* Powerful diuresis and volume reduction
* Decreased afterload
28
What are the characteristics of loop diuretic targets?
• Not used much for BP reduction
• Useful in patients with edema and heart failure
• Most common is furosemide
(Lasix)
29
What is the MOA of Potassium Sparing Diuretics – Aldosterone Antagonists?
```
Inhibits aldosterone by inhibiting sodium-potassium exchange
site in the distal tubule
– Excretes sodium
– Excretes water
– Retains potassium
```
30
What are the characteristics of Potassium Sparing Diuretics – Aldosterone Antagonists?
```
• Used for resistant hypertension
• Also used to treat heart failure
• Aldosterone antagonists
– Spironolactone
– Eplerenone
```
31
What are the effects of ACE inhibitors as an antihypertensive?
• Inhibition of Angiotensin Converting Enzyme (ACE)
– Inhibition of the conversion of Angiotensin I to Angiotensin II
• Peripheral Vasodilation
– ATII causes peripheral vasoconstriction
• Reduced Antidiuretic Hormone (ADH) Production
– Reduced fluid volume
• Reduced Aldosterone Production
– Reduced fluid volume
• First line option
32
What are the therapeutic uses of ACE inhibitors?
* Hypertension
* Post MI (with LVSD) - remodeling
* Heart Failure
* Diabetic patients
33
What are the things to monitor in a patient taking an ACE inhibitor?
* BP
* K+
* Renal function (BUN/SCr)
34
What are the side effects of an ACE inhibitor?
* Angioedema
* Cough
* Orthostasis/hypotension
* Hyperkalemia
35
What are the cautions/contraindications of an ACE inhibitor?
* Acute kidney injury
* Bilateral renal artery stenosis
* Hypotension
* History of angioedema
36
What are the effects of an Angiotensin Receptor Blocker as an antihypertensive?
• Inhibition of Angiotensin II receptor
– Action of angiotensin II is blocked despite its production
• Peripheral Vasodilation
– ATII causes peripheral vasoconstriction
• Reduced Antidiuretic Hormone (ADH) Production
– Reduced fluid volume
• Reduced Aldosterone Production
– Reduced fluid volume
• First line option
– Should not be combined with ACE inhibitors
37
What are the therapeutic uses of Angiotensin Receptor Blockers?
* Hypertension
* Post MI (with LVSD) - remodeling
* Heart Failure
* Diabetic patients
38
What are the things to monitor on a patient taking Angiotensin Receptor Blockers?
* BP
* K+
* Renal function (BUN/SCr)
39
What are the side effects of an Angiotensin Receptor Blocker?
* Angioedema
* Orthostasis/hypotension
* Hyperkalemia
40
What are the contraindications/cautions of an Angiotensin Receptor Blocker?
* Acute kidney injury
* Bilateral renal artery stenosis
* Hypotension
* History of angioedema
41
What does a calcium channel blocker do as an antihypertensive?
Inhibition of sympathetic simulation of vascular smooth muscle
– That means reduced afterload, but also reduced cardiac muscle contractility
42
What is the mechanism of a calcium channel blocker as an antihypertensive?
Mechanism is by blocking calcium re-entry
– Reduced contractility, reduced HR
– Preserve renal function in those with HTN-related renal disease
43
What are some examples of a calcium channel blocker as an antihypertensive?
– Diltiazem
– Amlodipine
– Nicardipine
44
What are the characteristics of a calcium channel blocker as an antihypertensive?
• Vasodilation of vasculature
- dec BP
- Alleviate chest pain/spasm
• First line option for HTN
45
What are the therapeutic uses of calcium channel blocker as an antihypertensive?
* Hypertension
* Angina
* Atrial Fibrillation
* Subarachnoid hemorrhage
* Raynaud’s Phenomenon
46
What are the things to monitor in a patient taking calcium channel blocker as an antihypertensive?
BP, HR
47
What are the side effects of calcium channel blocker as an antihypertensive?
* Hypotension
* AV Block
* Reflex tachycardia (dihydropyridine agents)
* Headache, dizziness, flushing, drowsiness
* Edema
* Nausea
* Constipation
48
What are the primary functions of Sympatholytics – Beta Blockers?
– Inhibition of sympathetic cardiac stimulation of the SA node
– Inhibition of Renin secretion
49
What are the secondary functions of Sympatholytics – Beta Blockers?
Vasodilation of GI Vasculature
50
What is the place of Sympatholytics – Beta Blockers in therapy?
• Second line for hypertension when first line agents are optimized
• Can decrease exercise tolerance initially
• Important agent for Hypertension with other cardiovascular comorbidities
– Ischemic heart disease
– MI
– CHF
51
What are the effects of Beta 1 blockers?
– “Cardioselective”
– Inhibits sympathetic contractility, inotropy, and
conductivity of the heart
– Inhibits sympathetic renin secretion in the kidneys
52
What are the best tolerated beta 1 blockers?
– Atenolol
– Bisoprolol
– Metoprolol
– Nebivolol
53
What are the effects of Beta 2 blockers?
– Beta 2 receptors inhibit smooth muscle contractions in the lungs and GI tract
– Beta 2 blockade is useful for restricting hepatic blood flow
for patient with Liver Cirrhosis, but generally not a therapeutic effect for CVD
– Beta 2 blockade may cause bronchospasm
54
What are the commonly used beta 2 blockers?
– Propranolol
| – Nadolol
55
What is the effect of an Alpha 1 blockade?
Causes peripheral vasodilation
56
True or False
Combined alpha and nonselective betablockers lower blood pressure more than betablockers without alpha blockade
True
Combined alpha and nonselective betablockers lower blood pressure more than betablockers without alpha blockade
57
What is a commonly used combined alpha and nonselective beta-blockers?
– Carvedilol
| – Labetalol
58
What is the impact of hypertension management
| on rehabilitation?
• Primary concern is the presence of hypotension and postural related hypotension
• Reduced cardiovascular response to exercise, especially with Beta-Blockers and Calcium Channel Blockers
• Physical therapists can increase compliance through education
– Emphasize “silent killer” nature of hypertension
59
What are the non-pharmacological managements of hypertension?
```
• Diet modification(weight loss)
- Low fat
- Low sodium
- Omega-3 fatty acids
- Exercise
• Limit alcohol
• Smoking cessation
```
60
True or false
Non-pharmacological treatment strategies should be used
even if patient are being treated with pharmacological agent
True
Non-pharmacological treatment strategies should be used
even if patient are being treated with pharmacological agent
61
What are the special considerations for a PT, when treating a pt with HTN?
• Lots of patients with hypertension (both treated
and untreated), watch for:
- Orthostasis
- Hypotension
- Dizziness
- Fatigue
• Use caution when doing activities that may cause
vasodilation and further drops in blood pressure
• Be aware of the patient’s ability to exercise
• Help with compliance (pharm and non-pharm)
62
What is main problem in ischemic heart disease?
Cardiac Muscle has insufficient oxygen
63
What are the solutions to ischemic heart disease?
– Reduce cardiac Oxygen demand
| – Increase cardiac oxygen supply
64
What are the effects of reducing cardiac oxygen demand as a means of resolving ischemic heart disease?
* Decrease Preload
* Reduce Contractility
* Reduce Afterload
65
What are the effects of increasing cardiac oxygen supply as a means of resolving ischemic heart disease?
* Increase Coronary Flow
| * Increase Oxygen extraction
66
What is angina?
Chest pain due to ischemia
67
What is the MOA of angina?
Imbalance of O2 supply and demand to the myocardium
• EKG changes
• Increased lactate
• Wall motion abnormalities
68
What are the treatment options of angina?
• Nitrates - dec O2 demand
• Beta-blockers - dec O2 demand
• Calcium channel blockers - inc O2 supply & dec O2 demand
• Ranolazine – no effects on O2 supply or demand; mechanism
unknown
69
What are the characteristics of stable angina?
* O2 demand > O2 supply
| * Usually seen with physical exertion
70
What are the characteristics of prinzmetal’s angina (variant)?
* Can occur at rest
| * Caused by vasospasm which leads to a dec in O2 supply
71
What are the characteristics of unstable angina?
* Dec O2 supply (blocked artery) & O2 demand
| * Caused by atherosclerotic plaque rupture
72
What are the management methods of angina pectoris(?
* Organic Nitrates
* Beta Blockers
* Calcium Channel Blockers
* Ranolazine
These drugs help to restore
the balance between cardiac
oxygen supply and cardiac
oxygen demand.
73
What are the effects of beta blockers as a treatment method for ischemic heart disease?
Reduces Cardiac Oxygen Demand by limiting maximum
| stimulation (Heart Rate)
74
What are the characteristics of beta blockers and ischemic heart disease?
– First Line in therapy for stable angina
– Decreases morbidity (reduced symptoms)
– Decreases mortality (prolongs life)
75
What are the characteristics of organic nitrate as a treatment method for angina?
```
• Peripheral Vasodiation by promoting Nitric Oxide Release
1. Veins
2. Arteries
3. Arterioles
• Decrease Preload
```
76
When are organic nitrates used as a short acting first line in the treatment of angina?
Angina Attacks (nitroglycerin)
77
When are organic nitrates used as a long acting second line in the treatment of angina?
After beta blockers for symptom relief
78
What is the mechanism of calcium channel blockers for the treatment of angina?
Mechanism is by blocking calcium re-entry
– Reduced contractility, reduced HR
– Agent of choice for Prinzmetal angina
79
What are some examples of calcium channel blockers that are used as treatment for angina?
– Amlodipine
– Diltiazem
– Verapamil
80
What are the characteristics of ranolazine as a treatment method for angina?
* Blocks sodium channels but mechanism for treating angina is not fully known
* Does not impact blood pressure or heart rate
* Generally considered second line based on cost and potential side effect of arrhythmias
81
What are the non-pharmacological management options of angina?
```
• Underlying disease state needs to be addressed
- Hypertension
- CAD
- CHF
- Anemia
• Weight loss
• Smoking cessation
• Stress reduction
• PCI/CABG
```
82
What are the considerations to be kept in mind of angina's impact on rehabilitation?
• Ensure proximity and availability of drug during rehabilitation sessions
• Avoid over-challenging the heart during sessions
• Artificial increase in tolerance to exercise
• Guard against orthostatic
hypotension
83
What are the special considerations of angina for a PT?
• Therapy may disturb the myocardial oxygen balance
- Know the patients limitations and don’t overdo it
• Make sure patients with stable angina have SL nitro available (and be know how to use it)
• May have to adjust exercise based on patients medication regimen
• Be aware of hypotension and dizziness
• Use caution when doing activities that may cause
vasodilation and further drops in blood pressure
• Help with compliance (pharm and non-pharm)
84
What are the medications that all patients post MI should be on, unless contraindicated?
* Aspirin
* P2Y12 inhibitor for at least 12 months
* Beta blocker
* Statin
* +/- ACE inhibitor
85
What medical information should all patients post MI receive?
* Weight management
* Smoking cessation
* Exercise
86
What are the medication considerations for an acute coronary syndrome that a PT must keep in mind?
```
• Aspirin
- Antiplatelet agent may cause bruising
• P2Y12 inhibitors – also antiplatelet agents which may cause bruising
- Clopidogrel (Plavix®)
- Prasugrel (Effient®)
- Ticagrelor (Brilinta®)
• Statins
- Most common side effect is myopathy
```
87
What are the signs and symptoms that a PT must be on the look out for when treating a patient might be having an MI?
* Diaphoresis
* Chest pain (often radiates to jaw or arm)
* Shortness of breath (not necessarily with exertion)
88
What must a PT do when treating a patient that goes into an MI?
* Call 911
* Administer nitro if patient uses
* Administer 325mg of aspirin – chew and swallow
* If O2 available, administer via NC if O2 sat is <90%
* Hospital acronym: MONA(Morphine Oxygen Nitrate Aspirin)
89
What is the general gist of HF?
• Chronic overwork of the heart muscle causes hypertrophic
remodeling
• Reduced cardiac output
• Fluid retention
90
What does the treatment of CHF do?
* Decrease cardiac load
* Decrease resistance
* Increase contractility
91
What are the types of medications used to treat CHF?
* Cardiac Glycocides
* ACE Inhibitors
* Beta Blockers
* Aldosterone Antagonists
* Vasodilators
* Diurectics
92
What are the are the characteristics of cardiac glycoside (Digoxin) as a pharmacological treatment method for CHF?
* Positive inotrope – will increase contractility of heart
* No impact on mortality but can reduce hospitalizations
* Narrow therapeutic index medication
93
What are the signs and symptoms for cardiac glycoside (Digoxin) toxicity?
* Visual disturbances
* Bradycardia and heart block
* Anorexia
* Nausea and vomiting
94
What are the signs of CHF exacerbation?
* Dyspnea
| * Cough
95
What are the special considerations for a PT to know when treating patients with HF?
• Be aware of medication side effects, especially digoxin
• Be aware of hypotension and dizziness
• Use caution when doing activities that may cause
vasodilation and further drops in blood pressure
96
What is an arrhythmia?
Irregular heart rhythms
97
How are arrhythmias categorized?
* Can be categorized based on heart rate
| * Can be categorized based on origin of irregular electrical activity
98
What are the arrhythmias that are categorized based on heart rate?
* Bradyarrhythmia
| * Tachyarrhythmia
99
What are the arrhythmias that are categorized based on origin of irregular electrical activity?
* Supraventricular
| * Ventricular
100
What is the primary action of class I anti-arrhythmic drugs?
Drugs that block Na+ channels
101
What are some examples of class I anti-arrhythmic drugs?
* Procainamide
* Lidocaine
* Flecainide
102
What is the primary action of class II anti-arrhythmic drugs?
Beta Blockers
103
What are some examples of class II anti-arrhythmic drugs?
* Metoprolol
| * Atenolol
104
What is the primary action of class III anti-arrhythmic drugs?
Drugs that prolong repolarization
105
What are some examples of class III anti-arrhythmic drugs?
* Ibutilide
| * Amiodarone
106
What is the primary action of class IV anti-arrhythmic drugs?
Calcium Channel Blockers
107
What are some examples of class IV anti-arrhythmic drugs?
* Diltiazem
| * Verapamil
108
Why are non-pharmaceutical management of arrhythmias is common?
Many antiarrhythmic drugs can produce side-effects including increased arrhythmias.
109
What drug classification are anti-arrhythmics: class I drugs?
Sodium channel blockers
110
What are the characteristics of anti-arrhythmics: class IA drugs?
Slow phase 0 and AP propagation -> atrial of ventricular arrhythmias
• Increase time between AP’s
111
What are the characteristics of anti-arrhythmics: class IB drugs?
shorten repolarization (phase 2) -> ventricular arrhythmias
112
What are the characteristics of anti-arrhythmics: class IC drugs?
Slow phase 0 and conduction
| -> ventricular arrhythmias
113
What are some examples of anti-arrhythmics: class IA drugs?
* Procainamide (Pronestyl®)
* Disopyramide (Norpace®
* Quinidine (Cardioquin®)
114
What are the side effects of anti-arrhythmics class IA drugs: Procainamide (Pronestyl®)?
* GI
* Rash
* Dry mouth
* Decreased UOP
* CNS
115
What are the side effects of anti-arrhythmics class IA drugs: Disopyramide (Norpace®)?
* Decreased BP
* CHF
* Dry mouth
* Constipation
* Decreased UOP
116
What are the side effects of anti-arrhythmics class IA drugs: Quinidine (Cardioquin®)?
* Decreased BP
* Syncope
* TTP
* Lightheadedness
* Dizziness/syncope
* Headache
* GI
* Rash
117
What are some examples of anti-arrhythmics: class IB drugs?
* Lidocaine (Xylocaine®)
| * Mexiletine (Mexitil®)
118
What are the side effects of anti-arrhythmics class IB drugs: Mexiletine (Mexitil®)?
* Lightheadedness/dizziness
* Incoordination
* GI
* Headache
119
What are the side effects of anti-arrhythmics class IB drugs: Lidocaine (Xylocaine®)?
* Hypotension
* Headache
* Shivering
120
What are some examples of anti-arrhythmics: class IC drugs?
* Flecainide (Tambocor®)
| * Propafenone (Rythmol®)
121
What are the side effects of anti-arrhythmics class IC drugs: Flecainide (Tambocor®)?
* Dizziness
* Visual disturbances
* Dyspnea
* Headache
* Fatigue
* GI
* CHF
122
What are the side effects of anti-arrhythmics class IC drugs: Propafenone (Rythmol®)?
* Dizziness
* Fatigue
* Headache
* GI
123
What are the MOA of Anti-arrhythmics class II drugs: beta blockers?
• Decrease sympathetic outflow -> prolongs refractory
period -> slows HR
• Slow conduction through myocardium
• Best for supraventricular arrhythmias
124
What are some examples of anti-arrhythmics class II: beta blocker drugs?
* Atenolol (Tenormin®
| * Metoprolol (Lopressor®)
125
What are the side effects of anti-arrhythmics class II beta blocker drug: Atenolol (Tenormin®)?
* Decreased BP
* Decreased HR
* Fatigue
126
What are the side effects of anti-arrhythmics class II beta blocker drug: aMetoprolol (Lopressor®)?
* Decreased BP
* Decreased HR
* Fatigue
127
What are the characteristics of anti-arrhythmics: class III drugs?
* Delay repolarization -> increase time between AP’s -> slows HR
* Effects on K+ in and out of cells
* Use for ventricular and supraventricular arrhythmias
* Amiodarone could fit into all 4 classes
128
What are some examples of anti-arrhythmics class III drugs?
* Amiodarone (Cordarone®)
* Dofetilide (Tikosyn®)
* Sotalol (Betapace®)
* Dronedarone (Multaq®)
129
What are the side effects of anti-arrhythmics class III drug: Amiodarone (Cordarone®)?
```
• Decreased BP
• GI
• Dizziness
• Headache
• LFT’s
• Photosensitivity
• Hyper/hypothyroid
pulmonary toxicity
• Visual disturbances
```
130
What are the side effects of anti-arrhythmics class III drug: Dofetilide (Tikosyn®)?
* Headache
* Chest pain
* Dizziness
131
What are the side effects of anti-arrhythmics class III drug: Sotalol (Betapace®)?
* Decreased BP
* Decreased HR
* Fatigue
132
What are the side effects of anti-arrhythmics class III drug: Dronedarone (Multaq®)?
* Abdominal pain
* Diarrhea
* Nausea
* liver failure
* Decreased BP
* Decreased HR
133
What is the MOA of anti-arrhythmics class IV drugs: calcium channel blockers?
Inhibit calcium influx -> alter excitability (decreased SA node
discharge) and conduction (decreased AV node velocity)
134
What are the characteristics of anti-arrhythmics class IV drugs: calcium channel blockers?
* Used for supraventricular arrhythmias
| * No role for dihydropyridine agents
135
What are some examples of anti-arrhythmics class IV drug: calcium channel blockers?
* Diltiazem (Cardizem®)
| * Verapamil (Calan®)
136
What are the side effects of anti-arrhythmics class IV drug calcium channel blockers: Diltiazem (Cardizem®)?
* Decreased BP
* Decreased HR
* GI
137
What are the side effects of anti-arrhythmics class IV drug calcium channel blockers: Verapamil (Calan®)?
* Decreased BP
* Decreased HR
* constipation
138
What are the non-pharmacological management options of arrhythmias?
```
• Underlying source of the arrhythmia needs to be
addressed i.e. medications
• Procedures/devices
- Ablation
- AICD
- Pacemakers
```
139
What are the special considerations for a physical
| therapist when treating a patient with an arrhythmias?
* Be aware of medication side effects, especially dizziness and syncope
* Assess rate & rhythm by checking pulse
* Help with compliance
140
What are the primary drugs to treat angina?
* Organic nitrates
* Beta blockers
* Calcium channel blockers
141
___ drugs are used alone or in combination to treat or prevent the various forms of angina
*Antianginal* drugs are used alone or in combination to treat or prevent the various forms of angina
142
____ channel blockers, ___ blockers, and ___ channel blockers can prolong the cardiac action potential to treat arrhythmias
*Sodium channel blockers, beta blockers, and calcium channel blockers* can prolong the cardiac action potential to treat arrhythmias
143
___ and ____ treat congestive heart failure by decreasing the counterproductive changes that
increase cardiac workload in heart failure.
*ACE inhibitors and beta blockers* treat congestive heart
| failure by decreasing the counterproductive changes that increase cardiac workload in heart failure.
144
What are some examples of respiratory disorder: congestion?
* Common Cold
* Allergies
* Bronchitis
* Various Resp. infections
145
What are the types of medications used to treat congestion?
* Antitussives
* Decongestants
* Expectorants
* Mucolytics
* Antihistamines
146
What are some examples of respiratory disorder: obstruction?
* Asthma
* COPD
* Emphysema
147
What are the types of medications used to treat obstruction?
* Bronchodilators
* Glucocorticoids
* Other anti-inflammatory agents
148
What are some examples of the antitussives drugs used to treat congestion?
* Benzonatate
* Codeine
* Dextromethorphan
* Diphenhydramine
* Hydrocodone
149
What are the characteristics of the antitussives drugs used to treat congestion?
Used to suppress coughing, often in conjunction with Acetaminophen
• Short term use
• Efficacy is questionable, especially for non-prescription products
150
What are some examples of the decongestants drugs used to treat congestion?
* Ephedrine
* Oxymetazoline
* Phenylephrine
* Pseudoephedrine(Sudafed)
151
What are the characteristics of the decongestants drugs used to treat congestion?
• Alpha-1 Adrenergic agonists
• Stimulate nasal vasoconstriction
• Can cause CNS excitation (HA, dizziness, nervousness, HTN,
palpitations)
• May cause rebound congestion when used long term
152
What are some examples of the antihistamines drugs used to treat congestion?
* Diphenhydramine(Benadryl)
* Loratadine (Claritin)
* Fexofenadine(Allegra)
* Cetrizine(Zyrtec)
153
How many types of histamine receptors are there in the body?
4
154
In what type of patient population are antitussives most helpful?
In a patient who has a dry, non productive cough that keeps them awake at night
155
What are the side effects of decongestants?
* Headache
* Dizzy
* Nervous
* Palpitations
* HTN in patients with underlying cardiac sensitivity
* Inability to sleep when taken orally
156
In what form are decongestants commonly used?
Nasal spray
157
In what type of patient population are antihistamines most helpful?
Patients with:
• Significant nasal discharge
• Runny nose
• Watery eyes
158
What is the role of histamines in the body?
Regulates normal function: gastric secretion, CNS neural
| modulation, allergies
159
What is the mechanism of antihistamines?
Block H1 receptors(one of the 4 receptors in the body)
160
What does antihistamines do?
Decreases nasal congestion, mucosal irritation, and discharge (rhinitis, sinusitis), and conjunctivitis
161
How does an antihistamine cause sedation?
It is able to cross blood-brain barrier, but newer generation much improved with regards to CNS sedation
162
What are mucolytics?
Medications that help to break down mucus
163
What are expextorants?
Medications that are used to stimulate a cough and expel mucus
164
What is the primary mucolytic used to treat congestion?
Acetylcysteine
165
What is the role of acetylcysteine?
It breaks disulfide bonds of mucoproteins, forming less
| viscous secretion, so it is easier to expectorate.
166
How are mucolytic: acetylcysteine used?
Used in combination with other decongestants or antihistamines
167
What is the common expextorant used for congestion?
Guaifenesin
168
What is the role of guaifenesin?
Increases production of pulmonary secretions, encouraging the ejection of mucus and phlegm
169
What is the most common side effects of guaifenesin?
GI upset
170
What are obstruction diseases: asthma and COPD both characterized by?
* Bronchospams
* Airway inflammation
* Mucous plugging of the airways
171
What is the primary goal when treating: obstruction diseases: asthma and COPD?
Prevent or reverse broncho-constriction and the obstruction of the airways using bronchodilators and anti-inflammatories.
172
What are the types of bronchodilators used to treat obstruction?
* Beta-Adrenergic Agonists
* Anti-cholinergics
* Xanthine Derivatives
173
What are the types of anti-inflammatory used to treat obstruction?
* Glucocorticoids (corticosteroids)
* Cromones
* Leukotriene Inhibitors
174
What are the types of bronchodilator: beta-adrenergic agonists that are used to treat obstruction?
* Albuterol
* Formoterol
* Salmeterol
175
What is the role of bronchodilators: beta-adrenergic agonists?
Act on B-2 receptors on respiratory smooth muscle cells to cause relaxation and bronchodilation
176
How are bronchodilators: beta-adrenergic agonists usually administered?
Usually administered by inhalation (rapid acting)
177
How are other ways that bronchodilators: beta-adrenergic agonists can be administered?
Metered-dose inhalers (MDI), dry powder inhalers (DPI),
| nebulizers
178
What are the adverse effects of bronchodilators: beta-adrenergic agonists?
* Airway irritation
* Nervousness
* Restlessness
* Tremor
* Increased HR
179
What is the most effective method of bronchodilators: beta-adrenergic agonists administration?
Nebulizers
180
When are bronchodilators used?
As rescue medication
181
What is the action of bronchodilators: anti-cholinergics?
Block muscarinic cholinergic receptors to prevent
| acetylcholine-induced bronchoconstriction
182
What type of obstruction are bronchodilators: anti-cholinergics used to treat?
* COPD
| * Chronic bronchitis
183
How are bronchodilators: anti-cholinergics commonly used?
Inhaled for the treatment of respiratory disorders
184
What are the adverse effects of bronchodilators: anti-cholinergics?
* Dry mouth
* Constipation
* Urinary retention
* Confusion
* Blurred vision (less likely with inhaled versions)
185
What are bronchodilators: xanthine derivatives?
CNS stimulant for reversible airway obstruction (bronchitis,
| emphysema)
186
What do bronchodilators: xanthine derivatives do?
Works on smooth muscle cells to bronchodilate, but also has anti-inflammatory effect by inhibiting phosphodiesterase enzyme
187
How are bronchodilators: xanthine derivatives usually administered?
Orally
188
What is the common form of bronchodilators: xanthine derivatives?
Theophylline
189
What are the signs and symptoms of theophylline toxicity?
* Nausea
* Confusion
* Irritability
* Seizures
* Arrhythmias
190
What are the characteristics of theophylline toxicity?
* Serious, life-threatening effects may be the first sign of toxicity
* Avoid long-term use
* Not used frequently anymore
191
What are the most effective agents for controlling asthma?
Anti-inflammatory: Glucocorticoids
192
What is the MOA of anti-inflammatory: glucocorticoids
Induce anti-inflammatory effects via inhibition of the proinflammatory proteins and promotion of anti-inflammatory proteins, inhibit migration of neutrophils and monocytes
193
When are there decreased side effects of anti-inflammatory: glucocorticoids?
If inhaled (except for thrush)
194
What are the adverse of anti-inflammatory: glucocorticoids
* Thrush
* Catabolic effect on support tissues (osteoporosis, skin, muscle wasting)
* Aggravation of diabetes mellitus
* HTN
195
In what form should the prolonged use of anti-inflammatory: glucocorticoids be avoided?
Prolonged use orally
196
What are some examples of the common types of anti-inflammatory: glucocorticoids?
* Budesonide
* Cortisone
* Fluticasone
* Mometasone
* Prednisone
* Triamcinolone
197
What is the common use of anti-inflammatory: cromones?
Can be used prophylactically to prevent asthma, esp in children
198
What is the MOA of anti-inflammatory: cromones?
Inhibit inflammatory mediators (leukotriene, histamine) from
| pulmonary mast cells
199
In what form is anti-inflammatory: cromones usually administered?
Nasal spray, nebulizer
200
What are the adverse effects of anti-inflammatory: cromones?
Remarkably free of serious adverse effects
201
How often are anti-inflammatory: cromones used?
Infrequently used
202
What is the role of anti-inflammatory: leukotriene inhibitors?
Leukotrienes mediate airway inflammation by inhibiting lipoxygenase enzyme
203
For optimal COPD and asthma
| management, what can anti-inflammatory: leukotriene inhibitors be combined with?
Glucocorticoids
204
What are the averse effects of anti-inflammatory: leukotriene inhibitors?
Few adverse effects, mild liver impairment
205
What is the pathophysiology of asthma?
* Dual components of inflammation and bronchospasm
* Various triggers
* Inflammation of airway sensitize it to bronchospasms
206
What are the long-term management options for asthma?
• Shift recently to more anti-inflammatory drugs (inhaled
glucocorticoids)
• Long acting beta-blockers should not be used alone
• Combined preparations (glucocorticoid + bronchodilator). Example: Advair (Fluticasone + Sameterol)
• Rescue inhalers as backup
• Decreasing role of theophylline
• Non-pharm measures
207
What is the management philosophy of COPD?
• Prevent airflow restriction, maintain airway patency =
Anticholinergics/beta-adrenergic blockers
• Short-term: oral glucocorticoids
• Combined preparations
208
Exercise can exacerbate asthma
True or False
True
209
What are the side effects of bronchodilators?
* HR
* Arrhythmias
* Nervousness, confusion signs of toxicity
210
What should be done in the case that a patient is using glucocorticoids for a long time?
Make adjustments to tissue loading
211
Common cold, flu & allergy symptoms are controlled with ____
Common cold, flu & allergy symptoms are controlled with *antitussives, decongestants, antihistamines, mucolytics and expectorant*
212
Airway obstructions such as asthma, bronchitis & emphysema are treated with ___ and ____
Airway obstructions such as asthma, bronchitis & emphysema are treated with *bronchodilator agents and anti-inflammatory drugs*
213
Rehab can assist with ___ and ___ while also improving overall cardiorespiratory endurance
Rehab can assist with *respiratory hygiene and breathing exercises,* while also improving overall cardiorespiratory endurance
