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Pharmacology Test 3 > Exercise and Drug Interactions > Flashcards

Exercise and Drug Interactions Flashcards

1
Q

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

A

decrease HR, CO, and BP

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2
Q

Beta-blockers impact on thermoregulation

A

increase sweating by 10% during exercise

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3
Q

Beta-blockers +exercise consideration

A

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

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4
Q

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

A

BORG RPE

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5
Q

Calcium channel blockers suffix

A

-dipine

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6
Q

Calcium channel blockers drugs

A
  1. Dihydropyridines
  2. Benzothiazepines
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7
Q

impact of Dihydrpyridines (amlodipine) on cardiac function?

A
  1. increased HR at rest and during exercise
  2. can leadto angina due to increased myocardial O2 consumption
  3. coronary steal phenomenon
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8
Q

what is coronary steal phenomenon?

A

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

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9
Q

Benzothiazepine (diltiazem) cardiac effects

A
  1. reduce HR at rest and during exercise
  2. more effective for treating exertional angina
  3. less likely to cause reflex tachycardia
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10
Q

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

A

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

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11
Q

general guidelines for CCBs and Beta-Blockers and exercise prescription

A
  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
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12
Q

all antithromotics have a risk of _______

A

causing bleeding –> so monitor/prevent for falls!

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13
Q

antithrombotics we covered

A
  1. Heparin
  2. Warfarin
  3. LMWH
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14
Q

how does Heparin work?

A

prevents conversion of fibrinogen to fibrin

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15
Q

Heparin risks/notes

A
  1. increased risk for HIT
  2. increased risk for osteoporosis
  3. requires monotoring of aPTT
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16
Q

how does Warfarin work?

A

decreaes Vitamin K stores which stops production of coagulation factors

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17
Q

Warfarin Notes

A
  1. monitor INR (increased INR = less clotting factors = increased risk of bleeding)
  2. many drug & food inreactions
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18
Q

how does LMWH work?

A

increases inhibition of FXa (more specific than Heparin)

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19
Q

LMWH notes

A
  1. simpler dosing than Heparin and requires no lab monitoring
  2. decreased risk of HIT and osteoporosis
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20
Q

PT notes for Antithrombotics

A
  1. avoid soft tissue mobilization
  2. avoid pressure
  3. avoid cutting ot tissue (sharp debridement)
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21
Q

what are Nitrates used to treat?

A

Angina (exertional, variant, and unstable)

*may be used in conjunction with CCB and BB

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22
Q

how do Nitrates work?

A
  1. decrease intracellular Ca to work directly on heart smooth muscle
  2. this decresaes preload/afterload and decreases O2 demand
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23
Q

how are Nitrates administered?

A

IV

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

topical (transderm patches)

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24
Q

Nitrates dosing/storage info

A

up to 3 doses in 15 minutes

store in dark, brown glass bottle

good for 6 months unopened and only 3 months once opened

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25
Q

Goal of Antiarrhythmic Drugs

A

restore normal rhythm or control abnormal

26
Q

how are antiarrhythmic drugs classified?

A
  1. origin = ventricular/atrial (supraventricular)
  2. pattern/rhythm = fibrillation or flutter
  3. speed/rate = brady or tachycardia
27
Q

Classes of Antiarrhythmic drugs

A

Class II

Class III

Class IV

28
Q

Antiarrhythmic Drug

Class II

A

beta-blocker

try to control rate

29
Q

Antiarrhythmic Drug

Class III

A

Amiodarone

controls rhythm (works by blocking K+ channles to lengthening AP)

**remember blue man

30
Q

what would Amidoarone be used to treat?

A

recurrent V-tachycardia

31
Q

Antiarrhythmic Drugs

Class IV

A

verapril and diltiazem (CCBs) - used for atria

*used to control origin

NOT for pts w/HFrEF

32
Q

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

A
  1. smoking cessation
  2. long-term O2 therapy
33
Q

main pharmacology trx for COPD

A

Bronchodilators

34
Q

how are bronchodilators helpful in pts with COPD?

A

increased exercise capacity which can improve QOL

35
Q

Types of Bronchodilators

A
  1. beta 2 agonists
  2. muscarinic antagonists
36
Q

Beta 2 Agonists types

A

SABA

LABA

37
Q

SABA info

A

drug = albuterol

used for acute exacerbations

onset 5 min

duration 4-6 hrs

38
Q

LABA info

A

drug = salmeterol

used to maintenance, daily use

duration = 12-24 hrs

39
Q

what do both SABAs and LABAs treat?

A

bronchospasms

40
Q

Common AE for Beta 2 agonists?

A
  1. tremor
  2. tachycardia
  3. hypokalemia (when taken w/thiazide)
41
Q

types of muscarinic antagonists (antimuscarinics)

A

SAMA
LAMA

42
Q

SAMA info

A

drug = ipratropium

used w/nebulizer

onset = 15-20 min

duration = 6-8 hrs

43
Q

LAMA info

A

drug = tiotropium

used for maintenance, daily use

duration = 12-24 hrs

44
Q

Common muscarinic antagonists AE

A

ABCDs

*specifically dry mouth

45
Q

what is used to treat severe COPD?

A

PDE-4 Inhibitors

46
Q

how do PDE-4 inhibitors work?

A

decrease cyclic AMP breakdown = decreased inflammation

47
Q

PDE-4 Inhibitors AE

A
  1. nausea
  2. diarrrhea
  3. weight loss
48
Q

Treatments for Cystic Fibrosis

A
  1. CFTR Modulators
  2. Bronchodilators
  3. Mucolytics
49
Q

how do CFTR Modulators work?

A

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

50
Q

CFTR Modulators AE

A
  1. GI
  2. HA
  3. *Orkambi = hypotension
51
Q

which mucolytics are primarily used in treating CF?

A

hypertonic saline

dornase alfa

52
Q

Hypertonic Saline notes

A

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

53
Q

Dornase alfa notes

A

1-2x daily

amost all pts

work by cleveing DNA = decreased viscosity of mucus

AE: chest pain

54
Q

Pulmonary medications Exercise Consideration

A
  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)
55
Q

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

A

Diabetic Autonomic Neuropathy

56
Q

what are the signs of Diabetic Autonomic Neuropathy?

A
  1. exercise intolerance (BP and HR response blunted)
  2. orthostatic hypotension
  3. Silent MI
  4. hypoglycemima unawareness
57
Q

what is silent MI?

A

delay in recognizing angina

unexplained fatigue, condusion, dyspnes, N/V, hemoptysis, diaphoresis, dysrrhthmias, edema

58
Q

T1DM Exercise Considerations

A

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

59
Q

T1DM + insulin

Exercise Consideration

A
  1. monitor blood glucose with exercise
    • before
    • during
    • after (2 hrs after, possibly middle of night)
  2. make changes in insulin and carb consumption
60
Q

Overall Diabetes Exercise Considerations

A
  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

Pharmacology Test 3 (10 decks)

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