deck_8853870

Question 1

how do Beta-blockers impact the heart during rest and exercise?

Answer 1

decrease HR, CO, and BP

Question 2

Beta-blockers impact on thermoregulation

Answer 2

increase sweating by 10% during exercise

Question 3

Beta-blockers +exercise consideration

Answer 3

beware of premature fatigue – espeically around 90 min after meds are taken

Question 4

how should you gauge exercise tolerance in a patient on beta-blockers?

Answer 4

BORG RPE

Question 5

Calcium channel blockers suffix

Answer 5

-dipine

Question 6

Calcium channel blockers drugs

Answer 6

1. Dihydropyridines
2. Benzothiazepines

Question 7

impact of Dihydrpyridines (amlodipine) on cardiac function?

Answer 7

1. increased HR at rest and during exercise
2. can leadto angina due to increased myocardial O2 consumption
3. coronary steal phenomenon

Question 8

what is coronary steal phenomenon?

Answer 8

shunting of blood from ischemic to normally perfused areas of myocardium

all the vessels are dilated reducing any gradient that would drive blood towards ischemic regions

Question 9

Benzothiazepine (diltiazem) cardiac effects

Answer 9

1. reduce HR at rest and during exercise
2. more effective for treating exertional angina
3. less likely to cause reflex tachycardia

Question 10

if a patient is on CCB or beta-blockers medication should be readily available to them?

Answer 10

nitroglycerin (Nitrates) if they were prescribed to them, make sure it is available during PT

Question 11

general guidelines for CCBs and Beta-Blockers and exercise prescription

Answer 11

1. 3-5 days/week, 20-60 min duration
2. limit HR increases to 20 bpm above RHR when pt. misses dose or has a dose adjustment

Question 12

all antithromotics have a risk of _______

Answer 12

causing bleeding –> so monitor/prevent for falls!

Question 13

antithrombotics we covered

Answer 13

1. Heparin
2. Warfarin
3. LMWH

Question 14

how does Heparin work?

Answer 14

prevents conversion of fibrinogen to fibrin

Question 15

Heparin risks/notes

Answer 15

1. increased risk for HIT
2. increased risk for osteoporosis
3. requires monotoring of aPTT

Question 16

how does Warfarin work?

Answer 16

decreaes Vitamin K stores which stops production of coagulation factors

Question 17

Warfarin Notes

Answer 17

1. monitor INR (increased INR = less clotting factors = increased risk of bleeding)
2. many drug & food inreactions

Question 18

how does LMWH work?

Answer 18

increases inhibition of FXa (more specific than Heparin)

Question 19

LMWH notes

Answer 19

1. simpler dosing than Heparin and requires no lab monitoring
2. decreased risk of HIT and osteoporosis

Question 20

PT notes for Antithrombotics

Answer 20

1. avoid soft tissue mobilization
2. avoid pressure
3. avoid cutting ot tissue (sharp debridement)

Question 21

what are Nitrates used to treat?

Answer 21

Angina (exertional, variant, and unstable)

*may be used in conjunction with CCB and BB

Question 22

how do Nitrates work?

Answer 22

1. decrease intracellular Ca to work directly on heart smooth muscle
2. this decresaes preload/afterload and decreases O2 demand

Question 23

how are Nitrates administered?

Answer 23

IV

sublingual (used for acute attacks, tingle means its working)

topical (transderm patches)

Question 24

Nitrates dosing/storage info

Answer 24

up to 3 doses in 15 minutes

store in dark, brown glass bottle

good for 6 months unopened and only 3 months once opened

Question 25

Goal of Antiarrhythmic Drugs

Answer 25

restore normal rhythm or control abnormal

Question 26

how are antiarrhythmic drugs classified?

Answer 26

1. origin = ventricular/atrial (supraventricular) 2. pattern/rhythm = fibrillation or flutter 3. speed/rate = brady or tachycardia

Question 27

Classes of Antiarrhythmic drugs

Answer 27

Class II Class III Class IV

Question 28

Antiarrhythmic Drug Class II

Answer 28

beta-blocker try to control rate

Question 29

Antiarrhythmic Drug Class III

Answer 29

Amiodarone controls rhythm (works by blocking K⁺ channles to lengthening AP) \*\*remember blue man

Question 30

what would Amidoarone be used to treat?

Answer 30

recurrent V-tachycardia

Question 31

Antiarrhythmic Drugs Class IV

Answer 31

verapril and diltiazem (CCBs) - used for atria \*used to control origin NOT for pts w/HFrEF

Question 32

what are 2 types of non-pharmacological trxs that increase survival from COPD?

Answer 32

1. smoking cessation 2. long-term O2 therapy

Question 33

main pharmacology trx for COPD

Answer 33

Bronchodilators

Question 34

how are bronchodilators helpful in pts with COPD?

Answer 34

increased exercise capacity which can improve QOL

Question 35

Types of Bronchodilators

Answer 35

1. beta 2 agonists 2. muscarinic antagonists

Question 36

Beta 2 Agonists types

Answer 36

SABA LABA

Question 37

SABA info

Answer 37

drug = albuterol used for acute exacerbations onset 5 min duration 4-6 hrs

Question 38

LABA info

Answer 38

drug = salmeterol used to maintenance, daily use duration = 12-24 hrs

Question 39

what do both SABAs and LABAs treat?

Answer 39

bronchospasms

Question 40

Common AE for Beta 2 agonists?

Answer 40

1. tremor 2. tachycardia 3. hypokalemia (when taken w/thiazide)

Question 41

types of muscarinic antagonists (antimuscarinics)

Answer 41

SAMA LAMA

Question 42

SAMA info

Answer 42

drug = ipratropium used w/nebulizer onset = 15-20 min duration = 6-8 hrs

Question 43

LAMA info

Answer 43

drug = tiotropium used for maintenance, daily use duration = 12-24 hrs

Question 44

Common muscarinic antagonists AE

Answer 44

ABCDs \*specifically dry mouth

Question 45

what is used to treat severe COPD?

Answer 45

PDE-4 Inhibitors

Question 46

how do PDE-4 inhibitors work?

Answer 46

decrease cyclic AMP breakdown = decreased inflammation

Question 47

PDE-4 Inhibitors AE

Answer 47

1. nausea 2. diarrrhea 3. weight loss

Question 48

Treatments for Cystic Fibrosis

Answer 48

1. CFTR Modulators 2. Bronchodilators 3. Mucolytics

Question 49

how do CFTR Modulators work?

Answer 49

increase chloride transport = increased regulation of Na⁺ and water = mucous thinning

Question 50

CFTR Modulators AE

Answer 50

1. GI 2. HA 3. \*Orkambi = hypotension

Question 51

which mucolytics are primarily used in treating CF?

Answer 51

hypertonic saline dornase alfa

Question 52

Hypertonic Saline notes

Answer 52

2-4x daily almost all pts use them work by increases salt which increases water in airway = water down mucus = increased function of mucociliary elevator

Question 53

Dornase alfa notes

Answer 53

1-2x daily amost all pts work by cleveing DNA = decreased viscosity of mucus AE: chest pain

Question 54

Pulmonary medications Exercise Consideration

Answer 54

1. time PT w/meds 2. watch for paradoxial breathing 3. B-agonists and methylxanthines = Increase RHR 4. watch for R vent failure 5. pts should always carrier rescue inhaler (especially during PT sessions)

Question 55

what is the most serious complication that can occur from Diabetes?

Answer 55

Diabetic Autonomic Neuropathy

Question 56

what are the signs of Diabetic Autonomic Neuropathy?

Answer 56

1. exercise intolerance (BP and HR response blunted) 2. orthostatic hypotension 3. Silent MI 4. hypoglycemima unawareness

Question 57

what is silent MI?

Answer 57

delay in recognizing angina unexplained fatigue, condusion, dyspnes, N/V, hemoptysis, diaphoresis, dysrrhthmias, edema

Question 58

T1DM Exercise Considerations

Answer 58

exercise does not increase glucose uptake, possibly due to increased free fatty acids

Question 59

T1DM + insulin Exercise Consideration

Answer 59

1. monitor blood glucose with exercise * before * during * after (2 hrs after, possibly middle of night) 2. make changes in insulin and carb consumption

Question 60

Overall Diabetes Exercise Considerations

Answer 60

1. Proper footwear is essential 2. avoid high impact activitees for older adults 3. keep fast acting CHO nearby 4. no exercise if glucose \>300 mg/dL 5. injest CHO if glucose \<70 mg/dL prior to activity 6. avoid insuling injection sites 7. illness can increase glucose levels