deck_8853870 Flashcards
how do Beta-blockers impact the heart during rest and exercise?
decrease HR, CO, and BP
Beta-blockers impact on thermoregulation
increase sweating by 10% during exercise
Beta-blockers +exercise consideration
beware of premature fatigue – espeically around 90 min after meds are taken
how should you gauge exercise tolerance in a patient on beta-blockers?
BORG RPE
Calcium channel blockers suffix
-dipine
Calcium channel blockers drugs
- Dihydropyridines
- Benzothiazepines
impact of Dihydrpyridines (amlodipine) on cardiac function?
- increased HR at rest and during exercise
- can leadto angina due to increased myocardial O2 consumption
- coronary steal phenomenon
what is coronary steal phenomenon?
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
Benzothiazepine (diltiazem) cardiac effects
- reduce HR at rest and during exercise
- more effective for treating exertional angina
- less likely to cause reflex tachycardia
if a patient is on CCB or beta-blockers medication should be readily available to them?
nitroglycerin (Nitrates) if they were prescribed to them, make sure it is available during PT
general guidelines for CCBs and Beta-Blockers and exercise prescription
- 3-5 days/week, 20-60 min duration
- limit HR increases to 20 bpm above RHR when pt. misses dose or has a dose adjustment
all antithromotics have a risk of _______
causing bleeding –> so monitor/prevent for falls!
antithrombotics we covered
- Heparin
- Warfarin
- LMWH
how does Heparin work?
prevents conversion of fibrinogen to fibrin
Heparin risks/notes
- increased risk for HIT
- increased risk for osteoporosis
- requires monotoring of aPTT
how does Warfarin work?
decreaes Vitamin K stores which stops production of coagulation factors
Warfarin Notes
- monitor INR (increased INR = less clotting factors = increased risk of bleeding)
- many drug & food inreactions
how does LMWH work?
increases inhibition of FXa (more specific than Heparin)
LMWH notes
- simpler dosing than Heparin and requires no lab monitoring
- decreased risk of HIT and osteoporosis
PT notes for Antithrombotics
- avoid soft tissue mobilization
- avoid pressure
- avoid cutting ot tissue (sharp debridement)
what are Nitrates used to treat?
Angina (exertional, variant, and unstable)
*may be used in conjunction with CCB and BB
how do Nitrates work?
- decrease intracellular Ca to work directly on heart smooth muscle
- this decresaes preload/afterload and decreases O2 demand
how are Nitrates administered?
IV
sublingual (used for acute attacks, tingle means its working)
topical (transderm patches)
Nitrates dosing/storage info
up to 3 doses in 15 minutes
store in dark, brown glass bottle
good for 6 months unopened and only 3 months once opened