BS2 Exam5: Cardiovascular, cholesterol, and lipid pharm 10/29 ASYNCH

Diuretic

Respiratory infections

What do diuretics do?

- act on the kidneys

- increases excretion of sodium and water to decrease the volume of fluid on the vascular system

- "water pill"

hypertension, congestive heart failure

Diuretics are use by pts with

Thiazides, loop, and potassium-sparing diuretics

What are the classifications of diuretics?

Thiazide diuretics

- inhibits sodium reabsorption thus retaining more water in the nepheron

- used to treat hypertension

Loop diuretics

- act on loops of henle

- inhibit reabsorption of sodium and chloride from the nephron and the water that follows these electrolytes

Potassium sparing diuretics

- not as strong as thiazide and loop

- prevent the secretion of postassium into the distal tubule

What are the ADRs of diuretics?

- fluid depletion (decrease in the blood volume, causes increase in CO)

- electrolyte imbalance (hyponatremia: low sodium; lypokalemia: low potassium

- thiazides are a common cause of erectile dysfunction

What are the rehab considerations for pts taking diuretics?

- monitor vital signs

- check for weakness, fatigue, confusion, moodchanges

- encourage med compliance

Sympatholytic; increase

Beta blockers are a ____ agents. They inc/dec sympathetic activity

Beta blockers act on the:

Heart by binding to receptors on heart to decrease HR and force of contraction of the heart

beta blockers

________ are used by pts who have:

- hypertension

- arrhythmias

- angina perctoris

- heart failure

- recovery from MI

Classification of beta blockers (2)

- Cardioselective (binds to B1 receptors)

- Nonselective (binds B1 and B2)

Beta blockers - cardioselective ADR

- orthostatic hypotension

- decreased maximal exercise capacity (20-30bpm)

- psychotropic effects (depression, lethargy, decreases libido)

- erectile dysfunction

Beta blockers - nonselective ADR

- bronchoconstriction in patients with asthma and other respiratory conditions

What are the rehab consideration for patients taking beta blockers?

- monitor vital signs

- decreased maximal exercise capacity: use RPE! (1-10 haw hard the patient is working)

- encourage med compliance

*Will a BP reading at the beginning of a PT session be accurate if the patient is taking Atenolol?

Yes! BUT IF, the pt is doing aerobic exercise, monitoring HR and BP will not provide an accurate measure of how hard the person is working as the response is blunted. Use an RPE scale to get an accurate assesment of how hard a person is workinf to keep them in the safe zone.

Beta blockers

*-olol ending drugs are:

What are vasodilators?

- acts directly on smooth muscle of blood vessels

- vasodialation decreases peripheral vascular resistance

- usually added when first line meds fail

hypertension, heart failure

Vasodilators are use by pts with:

- hydralazine (apresoline)

- minoxidil (loniten)

What are the types of vasodilators used for hypertension?

What are the types of vasodilators use in emergencies?

- hydralazine (apresoline)

- diazoxide (hyperstat)

- nitroprusside (nipride, nitropress)

Vasodilators ADR

- reflex tachycardia (incerased HR)

- orthostatic hypotension

- dizziness

- headache

- weakness

- fluid retention

- minoxidil (hair growth on face, ears, forhead)

What are the rehab considerations for pts taking vasodilators?

- monitor vital signs (orthostatic hypotension, tachycardia)

- monitor for other side effects

- avoid systemic heat such as a large whirlpool or hot tub (can cause excessive hypotension)

- exercises can cause vasodilation

Angiotensin-converting enzyme (ACE) inhibitors

- act on regin-angiotensin system

- inhibit angiotensin converting enzyme which decreases the formation of angiotensin II

- prevents angio I from converting to angio II!!

hypertension, heart failure

ACE inhibitors are use by pts with

ACE inhibitor

*-pril

ACE inhibitors ADR

- allergic skin rash

- dry cough, persistent

- nausea

- dizziness

Angiotensin II Receptor Blockers (ARB)

- block angiotensin II receptors (blocks the harmful affects when angio I turns to angio II)

- fewer side effects that ACE inhibits

- just as effective

Angiotensin II Receptor Blocker

*-sartan

Rehab considerations for pts taking ACE inhibitors and angiotensin II blockers (ARB)

- monitor vital signs

- encourage med compliance

B. Lisinopril

Which of the following drugs prevents angiotensin I from converting to angiotensin II?

A. Propranolol

B. Lisinopril

C. Losartan

D. Minoxidil

Calcium channel blockers

- blocks calcium into vascular smooth muslce cells and cardiac muscle

- promotes vasodialation and stabilize heart rate

hypertension, angina pectoris, arrhythmias

Calcium channel blockers are used by pts who have:

Calcium channel blockers

*-ipine

Calcium channel blockers ADR

- swelling in feet and ankles

- orthostatic hypotension

- altered HR, too fast, too slow, irregular

- dizzines, headache, nausea

- increased risk of heart attacks (sudden change in BP)

Rehab considerations of pt taking calcium cancel blockers

- monitor vital signs

- avoid systemic heat (hot tub, whirlpool - may cause dizziness)

- encourage meducation complicance

- exercises can cause vasodialtion in skeletal muscle

Organic nitrates

- dialate perioheral vasculature

- venous dilation causes decreases cardiac preload

- arterial dilation causes decrease afterload

- resulrs in decreases cardiac workload and decreases cardiac oxygen demand

Angina pectoris (chest pains)

Organic nitrates are used by pts who have:

Nitrates ADR

- headache

- dizziness

- orthostatic hypotenison

- nausea

Rehab consideration for patients taking nitrates

- monitor vital signs

- have meds avalible during therapy sessions (with an increase in activity level, angina occurs chest pain, need to take at first sign)

- encourage med compliance

- avoid heat/ hot tubs

- exercise can cause vasodialtaion

Positive inotropes -Digitalis

- inhibits sodium postassium pump in cardiac cells

- sodium accumulates in cell, more calcium in cell, increases actin myosin binding = STENGTHEN CONTRACTION OF HEART

derived from foxglove plant

- digoxin (lanoxin)

- digitoxin (digitaline)

- usually parental route

Congestive heart failure

Positive inotropes - digitalis are used by pts with

Digitalis ADR

- digitalis toxicity (common)

- can be fatal

- GI signs (nausea, vomiting, diarrhea)

- CNS problems

- cardiac arrhythmias

- indications: heart failure

What are other positive inotropes?

Dopamine (Intropin) and Dobutamine (Dobutrex)

Rehab considerations for pts taking positive inotropes?

- monitor vital signs

- observe for early sign of digitalis toxicity

C. Calcium channel blockers such as Nifedipine

Which type of drug has a side effect of swelling in the feet and ankles?

A. Organic nitrates such as nitroglycerin

B. Positive inotropes such as digitalis

C. Calcium channel blockers such as Nifedipine

D. Beta blockers such as Metoprolol

Hyperlipidemia

*-statin

Organic nitrate

*Nitroglycerin

Hyperlipidema

- high concentration of lipids in the blood stream

- plaque on the walls leading to thrombis or infarction

- primary cause of cardiovascular disease

High density lipoproteins (HDL); Low density proteins (LDL) and VLDL (very low)

The goal is to increase______ and lower _____ and ______

Statin drugs inhibit

- Inhibit HMG-CoA reductase

- inhibits the creation of cholesterol! Good!

- decrease choledterol sytehsis, increase hepatic LDL breakdown, decrease VLDL synthesis

- CAUSE MUSCLE PAIN

primary effects of Statin

- decrease LDL, VLDL, and triglycerides

- increase HDL

Fibril acids

- decrease triglycerides

- decrease VLDL

Antihyperlipidema drugs ADR

*see pic

Rehab considerations for pts taking antihyperlipedmia drugs

- statin induced myopathy

- usually reversible

- encourage med compliance

- encouage lifestyle chages (diet, weight loss)

- exercise perscription

A. Atorvastatin

Which drug is MOST likely to cause muscle pain?

A. Atorvastatin

B. Niacin

C. Gemfibrozil

D. Fenofibrate