CVP Pharm, RPE, Sternal Precautions Flashcards
CV Medication: Antihypertensive Drugs
Diuretics
Beta Blockers
ACE Inhibitors
Vasodilators
Calcium Channel Blockers
Diuretics act on:
kidneys =
increase sodium and water excretion
increase sodium and water excretion
Indications for diuretics =
hypertension
CHF
Diuretics - common types =
Lasix, Diuril, Aldactone
Adverse Effects, Rehab Concerns - diuretics =
Possible fluid depletion
Electrolyte Imbalance Na+, K+
Diuretics - what to watch for:
Orthostatic hypotension
Weakness, fatigue
Confusion, mood changes
Beta blocker functions =
Block effects of epinephrine and norepinephrine
Decrease HR (Epi) and contraction force (norepi)
General decrease in sympathetic response
Indications for beta blockers =
hypertension
angina
arrhythmias
heart failure
recovery from MI
Beta blocker - adverse effects, rehab concerns =
Bronchoconstriction
Decreased maximal exercise capacity
Orthostatic hypotension
Psychotropic effects = depression, lethargy, decreased libido
Beta blockers - common types =
Atenolol, metoprolol, pindolol, propranolol
What do Vasodilators act on?
Act directly on vascular smooth muscle to inhibit contraction
Indications for vasodilators =
hypertension
CHF
Vasodilators - common types =
Apresoline, Loniten
Vasodilators adverse effects =
tachycardia
orthostatic hypotension
dizziness
headaches
edema
fluid retention
Avoid systemic heat = true for all vasodilation drugs
Renin-Angiotensin Drugs fo what?
renin-angiotensin-aldosterone system (RAAS) = critical regulator of blood volume, electrolyte balance, and systemic vascular resistance
While thebaroreceptorreflex responds short term to decreased arterial pressure, the RAAS is responsible for acute and chronic alterations
Angiotensin Converting Enzyme Inhibitors (ACE) functions =
Inhibit angiotensin converting enzyme
Decrease formation of angiotensin II
Prevent acute vasoconstriction = decease BP
Prevent vascular hypertrophy = decrease long term effect on heart
Angiotensin Converting Enzyme Inhibitors (ACE) indications =
hypertension
CHF
common ACE Inhibitors =
Captopril
Enalapril
Fosinopril
Lisinopril
calcium channel blockers function =
Limit calcium entry into vascular smoot muscle and cardiac muscle
promote vasodilation
indications for calcium channel blockers =
hypertension
angina pectoris
arrhythmias
common calcium channel blockers =
Diltiazem, Verapamil, Nifedipine
calcium channel blockers - Adverse effects, Rehab concerns =
bilateral LE edema
orthostatic hypotension
abnormal HR
avoid systemic heat
Nitroglycerin function =
Dilate peripheral vasculature = venous and arterial dilation causing decreased cardiac preload & afterload = decreased cardiac workload & decreased oxygen demand
Nitroglycerin administration =
sublingual most common
Onset of action: 1-3 minutes
Duration of action: 30-60 minutes
Indications for nitroglycerin =
angina
Nitroglycerin Adverse effects, rehab concerns =
headache, dizziness
orthostatic hypotension
avoid systemic heat
Inadequate clotting:
hemorrhage
Excessive clotting:
thrombogenesis
Coagulation Meds =
Anticoagulants
Anticoagulants
Thrombolytics
Anticoagulants - used primarily in venous thrombosis =
Heparin
Warfarin
Heparin =
acts by increasing effects of anti clotting enzymes = rapid effect = administered parenterally (IV)
Warfarin (Coumadin) =
decrease synthesis of certain clotting factors = oral administration = 3-4 days for peak effect = long-term management
Anticoagulants - inhibit platelet activity, decrease platelet clots =
Aspirin
Aspirin =
prevents arterial thrombogenesis in MI, ischemic stroke
Thrombolytics =
initiate clot breakdown, restores blood flow, prevents/reverse damage during MI, ischemic stroke
Can decrease mortality by 50% if given within 1 hr after symptom onset; may be beneficial if administered within 3-12 hours after onset = must rule out hemorrhage first
Anticoagulant Drugs - Primary concern:
risk of hemorrhage
Ecchymosis?? - Use caution with manual techniques - bruise/contusion = occurs when blood vessels break and leak blood into the skin or mucous membranes, causing discoloration
Hyperlipidemia - Statins =
lipitor
lescol
mevacor
livalo
Hyperlipidemia - primary effects =
Decrease LDL and cholesterol
May increase HDL and lower triglycerides
Positive inotropic medication =
increase strength of heart muscle contraction
increase stroke volume
increase cardiac output
Pulmonary Medication Administration =
Oral or injections: not selective
Inhaled: selective
Respiratory Medication =
Antitussives
Antitussives function =
Opioids, suppress cough
Codeine, hydrocodone
Often combined with OTC meds
Antitussives side effects/rehab concerns =
sedation, dizziness, GI upset
Rehab Concerns: overuse, dependence, ineffective
Antihistamines function =
Block H1 receptors = decrease effects of histamine on upper respiratory tract
Used to treat coughing, sneezing, irritation
Antihistamines side effects/rehab concerns =
Side Effects: sedation, fatigue, incoordination, blurred vision
Rehab Concerns: sedative effects, dry-out respiratory tract, ineffective
Decongestant functions =
Administered locally when possible
Vasoconstrict nasal mucosa
Systemic administration = side effects
Decongestant side effects/rehab concerns =
Side Effects: headache, nausea, nervousness, CV stimulation
Rehab Concerns: dependence, overuse, abuse, cardiac palpitations, increase BP
Mucolytics:
breaks up & decreases viscosity of mucus; easier to mobilize secretions
Expectorants:
increase production of a thinner mucus; enhance effects of mucolytics
Mucolytics & Expectorants side effects/rehab concerns =
Side Effects: may have nausea, vomiting, irritation; usually well tolerated
Rehab Concerns: no major concerns
Beneficial during postural drainage, vibration, percussion
Bronchodilators function =
Stimulate beta-2 receptors on airway smooth muscle = smooth muscle relaxation = bronchodilation
Epinephrine, isoproterenol, albuterol, metaproterenol
Bronchodilators side effects/rehab concerns =
Side Effects: brochial irritation, cardiac stimulation
Rehab Concerns: use before postural drainage
Glucocorticoids function =
Powerful anti-inflammatory steroids
Systemic: increased number of side effects
Inhaled: more specific, decreased side effects
Glucocorticoids side effects =
Side Effects: catabolic effects muscle wasting, osteoporosis
Rating of perceived exertion (RPE) =
Borg’s = 6-11 ( very, very light to fairly light)
Modified borg = 0-3 (at rest to modified)
Borg’s = 12-15 ( somewhat hard to hard)
Modified borg = 4-6 (somewhat hard to hard)
Borg’s = 16-20 (very hard to very, very hard)
Modified borg = 7-10 (very hard to very, very hard)
Sternal Precautions =
Heavy lifting is contraindicated during the first 8 weeks per bone and tissue healing time
