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Cardio > Final Exam Cardio > Flashcards

Final Exam Cardio Flashcards

1
Q

Beta Blockers (Suffix olol) what is there MOA?

A

Beta-blockers bind to beta-adrenoreceptors and block binding of norepinephrine and epinephrine to receptors;

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2
Q

Beta1 receptor stimulation what would you use them for?

A

Cardiac stimulation

increase contraction and HR

Cardioselective beta blockers act on B1

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3
Q

Beta2 receptor stimulation what would you use them for?

A

Lung stimulation

pheripheral vasculature

nonselective beta blockers act on B1 and B2

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4
Q

Adverse reactions for cardio selective beta blockers

A

bradycardia

decreased exercise tolerance

cold extremities

depression

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5
Q

Adverse reactions for non selective beta blockers

A

bradycardia

blocks symptoms of hypoglycemia

increased risk of hypoglycemia: blood glucose <70 mg/dl

Bronchospasm

decreased exercise tolerance

cold extremities

depression

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6
Q

Angiotensin converting enzyme inhibitors what is there MOA?

A

inhibits enzyme responsible for conversion of angiotensin I –> angiotensin II

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7
Q

Adverse reactions for ACE inhibitors?

A

‣ HYPERkalemia
‣ Lightheadedness
‣ Dry cough (20%)
‣ Angioedema: loss common but severe

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8
Q

Angiotensin Receptor Blockers what is there MOA?

A

blocks angiotensin II receptor blockers and angiotensin mediated aldosterone secretion

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9
Q

Adverse reactions of ARBS?

A

‣ HYPERkalemia

‣ Dry cough (less common)

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10
Q

What is the mechanism of action for thiazide?

A

Inhibit the NaCl transporter in distal renal tubule

increase Na+ and H2O excretion

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11
Q

Thiazide common adverse reactions?

A
  • HYPOkalemia
  • HYPOmagnesemia
  • HYPERcalcemia
  • HYPERglycemia
  • HYPERuricemia
  • Increased urination
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12
Q

What is the mechanism of action for Loop Diuretics?

A

inhibit Na/K/Cl transporter in thick ascending limb

increasese Na + and H2O excretion

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13
Q

Loop Diuretics adverse reactions?

A
  • HYPOkalemia
  • HYPOmagnesemia
  • HYPOcalcemia
  • HYPERuricemia
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14
Q

What is the mechanism of action of potassium spring?

A

inhibit Na channel in collecting tubule and collecting duct

increases Na and H2O excretion

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15
Q

What is the mechanism of action for aldosterone antagonists?

A

competes with aldosterone receptor sites in distal tubule

increases Na and H20 Excretion

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16
Q

What is the mechanism of action for statins?

A

inhibits the enzyme HMG-CoA reductase, which plays a role in production of cholesterol in the liver,
thereby reducing cholesterol production

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17
Q

What are the adverse reactions for statins?

A 
‣ Myalgias
‣ Gas
‣ Diarrhea
‣ Dyspepsia: indigestion
‣ Increased liver enzymes
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18
Q

What is normal WBC?

A

Normal: 5-10 x 10^9 / L

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19
Q

What is HgB?

A

Normal: Males: 14-17 g/dL Females: 12-16 g/dL

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20
Q

What is HCT?

A

Normal: Males: 42-53% Females 37-47%

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21
Q

What is platelets?

A

Normal: 140-400k/uL

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22
Q

What normal BNP?

A

Normal: <100pg/mL

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23
Q

What is normal bicarbonate HCO3-?

A

Normal: 22-26 mEq/L

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24
Q

What BUN normal?

A

Normal: 6-25 mg/dL

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25
Q

What is normal Bilirubin?

A

0.3 - 1 mg/dL

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26
Q

What is normal Hgb A1C?

A

Less than 5.7%

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27
Q

What is normal blood glucose?

A

Normal: 70-100 mg/dL

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28
Q

Are there normal responses of the autonomic nervous system?

A

▫ Temperature regulation
▫ Sensation of angina
▫ Baroreceptors & blood pressure regulation

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29
Q

Control of breathing: what is the function of the medulla?

A

contains respiratory rhythmicity centers

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30
Q

Controls of breathing: what is the function of the pons?

A

adjusts rate and depth in response to sensory

stimuli, emotions, speech

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31
Q

What causes biots breathing?

A

Injury to the medulla

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32
Q

Description of Biots?

A

Irregular pattern of deep and shallow breaths. Deep breaths with occasional abrupt pauses in breathing.

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33
Q

What causes cheyne-stokes?

A

Heart failure or TBI

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34
Q

Description of cheyne-stokes?

A

Repeated cycle of deep breathing followed by shallow breathing and a short period of apnea

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35
Q

What causes kassmaul respiration?

A

metabolic acidosis and kidney failure

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36
Q

Description of kassmaul respiration?

A

Dyspnea with RR>20 br/m, increased depth of respiration, panting, air hunger

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37
Q

What causes asymmetrical or lateral costal breathing?

A

NM conditions and CVA

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38
Q

Descriptoin of asymmetrical or lateral costal breathing?

A

Asymmetrical breathing due to unilateral weakness of hemi- diaphragm or intercostals or significant scoliosis

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39
Q

What causes paradoxical breathing?

A

Asymmetric weakness (CVA), spasticity, flail chest, SCI

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40
Q

Description of paradoxical breathing?

A

All or some of the chest wall falls in during inspiration; can also see abdominal expansion during exhalation

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41
Q

Periodic breathing in infants is it normal or no?

A

Normal

Typically in first two weeks of life, but in some may extend to 5-6 months

Rapid breathing following by up to a 10 second pause

42
Q

With a stroke what things are affected?

A
  • Decreased power output
  • Lower VO2 max
  • Shifting of muscle fiber types
43
Q

What types of interventions can help with brain repair?

A

Aerobic exercise can impact brain repair in the immediate post-stroke time period

Interacts with inflammatory cytokines

44
Q

In multiple sclerosis: demyelination lesions in respiratory centers cause?

A

▫ Respiratory muscle weakness
▫ Abnormalities in the control of breathing
Sleep disordered breathing/sleep apnea
▫ Impaired matching of ventilation and perfusion
Increased dead space

45
Q

Respiratory muscle weakness, decreased MIP and MEP?

A

Expiratory weakness more prevalent in those with

UE weakness

46
Q

Respiratory muscle impaired cough?

A

▫ Abdominal weakness

▫ Bulbar dysfunction and inability to close glottis

47
Q

What are possible cardiac dysfunctions and MS?

A
  • Higher risk for developing ischemic heart disease & heart failure
  • Left ventricular dysfunction

• Altered cardiac/autonomic
control

• Impaired cardiovascular risk profile

48
Q

Multiple sclerosis: CV & P issues?

A

Heat Sensitivity

49
Q

MS: autonomic Dysregulation what should you look out for?

A
  • Altered/abnormal BP and HR response

* Altered sweating response

50
Q

Tell me about Parkinson’s Disease?

A
  • Rigidity and weakness of respiratory muscles
  • Coordination of breathing is altered
  • Decreased MIP and MEP
  • Higher doses of levodopa can worsen breathing coordination
51
Q

Patients tend to have orthostatic hypotension what asymptomatic things are you looking for?

A

▫ Baroreflex is abnormal

▫ Failure of adrenergic receptors on arterial muscles

52
Q

What risk factors are you considering for metabolic syndrome?

A 
3 or more of
the following risk factors
• Obesity
• Elevated triglyceride levels
• Low HDL
• HTN or on medication for HTN
• Elevated fasting blood glucose or on medication to treat high blood sugar
53
Q

SCI and SV considerations for lack of direct sympathetic input?

A

▫ Blunted HR response to exercise

▫ Lower peak HR achieved

54
Q

What are the causes of orthostatic hypotension?

A

▫ Venous pooling
▫ Loss of muscle pump
▫ Reduced plasma volume in people with SCI
▫ Deconditioning

55
Q

What are the main pulmonary issues you will address?

A 
▫ Secretion management
 Weak or ineffective cough
 ▫ Atelectasis
 Weak inspiratory effort
 ▫ Hypoventilation
 Weak inspiratory effort
56
Q

Diaphragm innervation:

A

C3-5

57
Q

Diaphragm concentric contraction?

A

quiet and forceful

inhalation

58
Q

Diaphragm eccentric contraction?

A

controlled exhalation,

speech, trunk stability

59
Q

Diaphragm dependent upon intact abs for length tension and direction of pull of central tendon?

A

 Creates negative pressure
 Pull of central tendon helps to flare out lower ribs  Concentric: inhalation
 Eccentric: speech

60
Q

The diaphragm is the main pressure regulator for what?

A

thoracic and abdominal regions

61
Q

What do the intercostal muscles do?

A

Helps generate negative pressure
▫ Stability of thorax in the presence of negative pressure
 Concentric: inhalation/exhalation  Eccentric: speech

62
Q

Intercostals innervation

A

(segmental): T1-T12

63
Q

What do the abdominal muscles do?

A

▫ Helps provide tone so that diaphragm descends properly
▫ Helps align central tendon so ribs flare
▫ Provides concentric contraction to help with sneezing, laughing, high intensity exercise, coughing

64
Q

Abdominal innervation

A

Innervation: T6-L1

65
Q

The abdominal provide positive pressure for what?

A

diaphragm

66
Q

Erector Spinae innervation

A

• Innervation: T1-S3

67
Q

Serratus Anterior innervation

A

• Innervation: C5-C7

68
Q

Erector Spinae Action

A

• Stabilizes thorax posteriorly

69
Q

Serratus Anterior Action

A

• When insertion point (scapula) is fixed, origin point moves providing posterior expansion of the rib cage

70
Q

Pectoralis Action

A

When insertion point is fixed (upper extremities), provides anterior and lateral expansion of the upper chest

71
Q

Pectoralis innervation

A

C5-T1

72
Q

Scalenes innervation

A

C3-8

73
Q

Scalenes action

A
  • Stabilizes upper chest during inhalation

* Provides superior and anterior expansion of the upper chest and prevent collapse

74
Q

Sternocleidomastoid innervation

A

C2-C3 and Spinal Accessory Cranial Nerve

75
Q

Sternocleidomastoid actions

A

Stabilizes upper chest during inhalation

76
Q

Trapezius Innervation

A

C2-C4 and Spinal Accessory Cranial Nerve

77
Q

Trapezius Action

A
  • Provides superior expansion of the upper chest

* Least energy efficient accessory muscle (must lift the weight of the entire upper extremity to assist in inhalation)

78
Q

Hyoid Muscles Innveration

A

C1-C3 and Trigeminal Cranial Nerve

79
Q

Hyoid Muscles Actions

A
  • Raises hyoid bone and steadies it during swallowing and speaking
  • Depresses and elevates larynx
80
Q

Activities of Ventilation inspiration

A

▫ Always concentric activity

81
Q

Activities of Ventilation expiration

A

▫ Passive: during quiet breathing
▫ Eccentric: during quiet, controlled activities (ex. speech)
▫ Concentric: during forceful expulsion of air (ex. Yelling and coughing)

82
Q

Why facilitate breathing?

A

To improve oxygen, facilitate the accessory muscles and diaphragm

83
Q

Neurologic population: what will inhibit diaphragmatic breathing?

A

Cerebral palsy

CVA

Guillian Barre

Multiple Sclerosis

SCI

84
Q

What issues do patients with cerebral palsy present with for inhibiting diaphragmatic breathing?

A

poor abdominal strength, contractures in lower extremities leading to poor pelvic alignment

85
Q

What issues do patients with CVA present with for inhibiting diaphragmatic breathing?

A

muscle imbalance due to weakness on one side, neglect toward one side of body

86
Q

What issues do patients with guillian barree present with for inhibiting diaphragmatic breathing?

A

Poor ab strength

87
Q

What issues do patients with MS present with for inhibiting diaphragmatic breathing?

A

Poor ab strength

88
Q

What issues do patients with SCI present with for inhibiting diaphragmatic breathing?

A

poor abdominal strength with impaired resting diaphragm position; lack of innervation; possible TLSO

89
Q

Positioning to facilitate use of accessory muscles?

A

Shoulder flexion/abduction/ER

90
Q

Positioning to facilitate diaphgramatic breathing?

A

Shoulder extension/adduction/IR

91
Q

What issues do patients with SCI present with for inhibiting accessory muscle breathing?

A

cervical collar or halo, lack of muscle innervation, wheelchair prescription

92
Q

What issues do patients with Parkinson’s Disease present with for inhibiting accessory muscle breathing?

A

Stiff trunk lacking rotation, difficult to expand t. cage

93
Q

What issues do patients with Guillian Barre present with for inhibiting accessory muscle breathing?

A

possibly have a tracheostomy due to poor airway clearance, muscle weakness, forward head posture

94
Q

What issues do patients with CVA present with for inhibiting accessory muscle breathing?

A

forward head posture, muscle imbalance between the two sides, neglect toward one side of body

95
Q

What issues do patients with CP present with for inhibiting accessory muscle breathing?

A

forward head posture, possible torticollis, contracted upper extremities with tightness in the pectoralis muscles

96
Q

What is the purpose of the abdominal binder?

A

increased compliance of the abdominal wall in those that have limited or absent innervation effects:
▫ Diaphragm sits “lower” and loses length-tension and ability to generate force
▫ Line of pull of central tendon is not ideal

97
Q

What is a P- Flex?

A

Inspiratory device

98
Q

What is a threshold Device?

A
  • Provides Threshold resistance based on MIP

* RR has little effect on resistance provided

99
Q

Normal pH:

A

7.35-7.45

100
Q

Normal PaCO2

A

35-45 mmHg

101
Q

Normal PaO2

A

80-100 mmHg

102
Q

Normal HCO3

A

22-26 mEq/L

Cardio (5 decks)

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