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Pharm > Cardiac Conditions > Flashcards

Cardiac Conditions Flashcards

1
Q

Ischemic Heart disease

A

•Cardiac Muscle has insufficient oxygen
•Two Solutions
–Reduce cardiac Oxygen demand•Decrease Preload•Reduce Contractility•Reduce Afterload
–Increase cardiac oxygen supply•Increase Coronary Flow•Increase Oxygen extraction

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2
Q

Angina

A 
•Chest pain due to ischemia
•Imbalance of O2supply and demand to the myocardium
•EKG changes
•Increased lactate
- wall motion abnormalities
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3
Q

Angina treatments

A
  • Nitrates- decrease O2 demand
  • Beta-blockers- decrease O2 demand
  • Calcium channel blockers -­ increase O2 supply & decrease O2 demand
  • Ranolazine–no effects on O2 supply or demand; mechanism unknown
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4
Q

Stable angina

A
  • O2 demand> o2 supply

- usually seen with physical exertion

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5
Q

Prinzmetal’s angina (variant)

A
  • can occur at rest

- caused by vasospasm -> decreased o2 supply

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6
Q

unstable angina

A
  • decreased O2 supply (blocked artery) and increased O2 demand
  • caused by atherosclerotic plaque rupture
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7
Q

management of angina pectoris

A
  • Organic Nitrates
  • Beta Blockers
  • Calcium Channel Blockers
  • Ranolazine
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8
Q

Organic nitrates

A

•Peripheral Vasodiation by promoting Nitric Oxide Release
1.Veins
2.Arteries
3.Arterioles
•Decrease Preload
•Short acting first line for Angina Attacks (nitroglycerin)
•Long acing second line after Beta Blockers for Symptom Relief

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9
Q

Nonpharmacologic management of angina

A
  • Weight loss
  • Smoking cessation
  • Stress reduction
  • PCI/CABG
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10
Q

Angina pectoralis impact on rehab

A
  • 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
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11
Q

Myocardial infarction

A
  • All patients post MI should be on the following medications unless contraindicated:•Aspirin •P2Y12inhibitor for at least 12 months •Beta blocker •Statin •+/-ACE inhibitor
  • In addition they should receive information regarding: •Weight management •Smoking cessation •Exercise
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12
Q

PT considerations for MI

A
  • Signs/symptoms to look for: •Diaphoresis •Chest pain (often radiates to jaw or arm) •Shortness of breath (not necessarily with exertion)
  • What to do: •Call 911 •Administer nitro if patient uses •Administer 325mg of aspirin –chew and swallow •If O2 available, administer via NC if O2sat is <90% •Hospital acronym: MONA
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13
Q

CHF

A
  • Chronic overwork of the heart muscle causes hypertrophic remodeling
  • Reduced cardiac output
  • Fluid retention
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14
Q

CHF Treatment

A

Treat to: decrease cardiac load, decrease resistance, increase contractility

cardiac glycocides
ace inhibitors
beta blockers
aldosterone antagonists
vasodilators
diuretics
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15
Q

Cardiac glycoside

A
  • Positive inotrope –will increase contractility of heart
  • No impact on mortality but can reduce hospitalizations
  • Narrow therapeutic index medication
  • Signs/symptoms of toxicity: •Visual disturbances •Bradycardia and heart block •Anorexia •Nausea and vomiting
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16
Q

PT and CHF

A
  • Know signs of CHF exacerbation: •Dyspnea •Cough
  • 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
17
Q

Arrhythmias

A
  • Irregular heart rhythms
  • Can be categorized based on heart rate •Bradyarrhythmia •Tachyarrhythmia
  • Can be categorized based on origin of irregular electrical activity •Supraventricular •Ventricular
18
Q

Anti-arrhythmics Class 1

A

sodium channel blockers

19
Q

Anti-arrhythmics Class 2

A

beta blockers

20
Q

Anti-arrhythmics class 3

A

drugs that prolong polarization

21
Q

anti-arrhythmics class 4

A

ccN

22
Q

non-pharmacological management of arrhythmias

A

ablation
aicd
pacemakers

23
Q

PT and arrhythmias

A
  • Be aware of medication side effects - Especially dizziness and syncope
  • Assess rate & rhythm by checking pulse
  • Help with compliance
24
Q

KEY POINTS

A
  • Organic nitrates, beta blockers, and calcium channel blockers are the primary drugs to treat angina
  • Antianginal drugs used alone or in combination to treat or prevent the various forms of angina
  • Sodium channel blockers, beta blockers, and calcium channel blockers can prolong the cardiac action potential to treat arrhythmias.
  • ACE inhibitors and beta blockers treat congestive heart failure by decreasing the counterproductive changes that increase cardiac workload in heart failure.
  • Rehabilitation providers need to monitor these patients closely during exercise and help educate patients on cardiac risk factors and symptoms related to CV disease

Pharm (15 decks)

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