Pharmacological Management of Heart and Vascular Disorders Flashcards
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
What are the indications for adrenergic antagonists agents?
- HTN
- BPH
What are the side effects of adrenergic antagonists agents?
dizziness
palpiations
orthostatic hypotension
drowsiness
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
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
What are the implications for ACE inhibitors?
HTN
CHF
What are the side effects of ACE inhibitors?
hypotension dizziness dry cough hyperkalemia hyponatremia
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
What do anticoagulant agents do?
inhibit platelet aggregation and thrombus formation
Ex: Heparin, Coumadin
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
What are the side effects of anticoagulant agents?
hemorrhage
increasd risk of bleeding
GI distress with oral version
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
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
What are the implications for antihyperlipidemia agents?
hyperlipidemia
atherosclerosis
prevent coronary events in pts with coronary diseases, diabetes, or PVD
What are the side effects of antihyperlipidemia agents?
HA
GI distress
myalgia
rash
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
What do antithrombotic (antiplatelet) agents do?
inhibit platelet aggregation and clot formation
Ex: aspirin, plavix
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
