Pharmacological Management of Heart and Vascular Disorders Flashcards by Elizabeth Dernell

What do alpha adrenergic antagonists agents do?

Reduce peripheral vascular tone by blocking alpha-1-adrenergic receptors
-Causes dilation of arterioles and veins and decrease BP
Examples: Cardura, Minipress

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What are the indications for adrenergic antagonists agents?

- BPH

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What are the side effects of adrenergic antagonists agents?

dizziness
palpiations
orthostatic hypotension
drowsiness

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What are the implications for PT when patients are on adrenergic antagonists agents?

Be careful during position changes b/c orhtostatic or dizzy

closely monitor patient during exercise

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What do angiotensin-converting enzyme (ACE) inhibitor agents do?

-Decrease BP and afterload (forces that impede blood out of the heart)
-suppresses enzyme that converts angiotensin I to angiotensin II
Ex: Capoten, Vasotec

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What are the implications for ACE inhibitors?

HTN

CHF

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What are the side effects of ACE inhibitors?

hypotension
dizziness
dry cough
hyperkalemia
hyponatremia

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What are the implications for PT if a pt is taking ACE inhibitors?

Avoid sudden changes in posture (fainting from hypotension and dizziness)
Pts with heart failures should avoid rapid increases in physical activity

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What do anticoagulant agents do?

inhibit platelet aggregation and thrombus formation

Ex: Heparin, Coumadin

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What are the indications for anticoagulant agents?

post coronary angioplasty and coronary bypass graft

- prevention of venous thromboemboism and cardioembolic events in pts with Afib and prosthetic heart valves

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What are the side effects of anticoagulant agents?

hemorrhage
increasd risk of bleeding
GI distress with oral version

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What are the implications for PT if pt is on anticoagulants?

Avoid injury secondary to the risk of excessive bleeding or bruising
Pt education on side effects is also indicated to protect the pt

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What do antihyperlipidemia agents do?

-5 different categories: most common is statins
-inhibit enzyme action in cholesteroal synthesis
-break down LDL
-Decrease Triglyceride levels
-increase HDL levels
Ex: Lipitor, Zocor

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What are the implications for antihyperlipidemia agents?

hyperlipidemia
atherosclerosis
prevent coronary events in pts with coronary diseases, diabetes, or PVD

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What are the side effects of antihyperlipidemia agents?

HA
GI distress
myalgia
rash

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What are the implications for PT if pt is on antihyperlipidemia agents?

Aerobic exercise can increase HDLs and maximize effect of drug therapy
-pts on these can and would benefit from exercise

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What do antithrombotic (antiplatelet) agents do?

inhibit platelet aggregation and clot formation

Ex: aspirin, plavix

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What are the indications for antithrombotic (antiplatelet) agents?

post MI
Afib
prevent arterial thrombus formation

What are the side effects of antithrombotic (antiplatelet) agents?

hemorrhage
thrombocytopenia (deficiency of platelets)
potential liver toxicity with use of aspirin
GI distress

What are the implications for PT if pt is on antithrombotic (antiplatelet) agents?

Avoid injury- risk for excessive bleeding

Pt education regarding common side effects indicated to protect pt

What do beta blockers (Beta-Adrenergic Blocking) agents do?

decrease myocardial oxygen demands by decreasing HR and contractility by blocking beta adrenergic receptors
Ex: Tenormin, Lopressor, Inderal

What are the indications for beta blockers (Beta-Adrenergic Blocking) agents?

HTN
Angina
arrhythmias
HF
migrains
essential tremor

What are the side effects of beta blockers (Beta-Adrenergic Blocking) agents?

bradycardia
cardiac arrthymias
fatigue
depression
dizziness
weakness
blurred vision

What are the implications of PT if pt is on beta blockers (Beta-Adrenergic Blocking) agents?

HR and BP response to exercise will be diminished
RPE may be used to monitor exercise intensity
closely monitor pts during position changes b/c at increased risk for hypotension

What do calcium channel blockers do?

Decrease entry of calcium into vascular smooth muscle cells resulting in diminished myocardial contraction, vasodilation, and decreased oxygen demands of the heart Ex: Procardia, Cardizem

What are the indications of calcium channel blockers?

HTN angina pectoris arrhythmias CHF

What are the sideffects of calcium channel blockers?

dizziness HA hypotension peripheral edema

What are the implications for PT if pt is on calcium channel blockers?

HR and BP response to exercise will be diminished Watch for dizziness and orthostatic hypotension observe pts for s/s of CHF worsening: worsening peripheral edema, dyspnea, or weight gain

What are diuretic agents do?

increase the excretion of sodium and urine causes reduction of plasma volume which decreases BP Classifications: thiazide, loop, and potassium sparing agents Ex: Diuril, Lasix

What are the indications for diuretics?

HTN Edema associated with HF pulmonary edema glaucoma

What are the side effects of diuretics?

``` dehydration hyoptesnion electrolyte imbalance polyuria increased LDL arrhythmias ```

What are the implications if pt is on diuretics

be careful with position changes | monitor pts closely for s/s of electrolyte imbalance and muscle weakness or cramping

What do nitrate agents do?

decrease ischemia through smooth muscle relaxation and dilation of peripheral vessels ex: nitrostat, nitorglycerin

What are the indications for nitrates?

angina pectoris

What are the side effects of nitrates?

``` HA dizziness orthostatic hyoptension reflex tachycardia nausea vomiting ```

What are the implications for PT if a pt uses nitrates?

pts must be educated to come to a standing positions slowly | sublingual (under the tounge) administration is the preferred method during acute angina attack

What do positive inotropic agents do?

increase the force and velocity of myocardial contraction slow HR decrease conduction velocity through the AV node decrease the degree of activation of the sympathetic NS Ex: Digoxin

What are the indications for positive inotropic agents?

HF | Afib

What are the side effects of positive inotropic agents?

cardiac arrhythmias GI distress dizziness blurred vision

What are the implications for PT if pt is on positive inotropic agents?

- Monitor HR during activity | - Teach pt and family to take the pts pulse and seek health care provider's advice for HR less than 60 or more than 100

What do thrombolytic agents do?

-facilitate clot dissolution through conversion of plasminogen to plasmin -plasmin breaks down clots and allows occluded vessels to reopen to maintain blood flow Ex: Urokinase, Activase

What are the indications of thrombolytic agents?

Acute MI Pulmonary embolism Ischemic stroke Arterial or venous thrombosis

What are the side effects of thrombolytic agents?

hemorrahge (specifically intracranial in certain populations) allergic reaction cardiac arrhythmia

What are the implications for PT if pt using thromboloytic agents?

Avoid situations that may cause trauma due to the altered clotting activity