Cardiovascular Flashcards

1
Q

Formula for BP

A

BP = CO X TPR

CO: cardiac output
TPR: total peripheral resistance to blood flow

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2
Q

Most important factor determining TPR

A

Blood vessel diameter

Volume and viscosity of blood also factors

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3
Q

Hypertension

A

140/90

“Silent killer”. Often asymptomatic.

Major risk factor for heart disease.

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4
Q

Average resting HR

A

70-72 bpm

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5
Q

Rapid heart rate …

A

Reduces the time frame in which the heart wall itself can be perfused with fresh blood.

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6
Q

Five functional categories of cardiovascular meds:

A
  1. Improve heart function
  2. Increase blood vessel diameter
  3. Alter blood coagulation mechanisms
  4. Reduce blood volume
  5. Lower blood lipid levels
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7
Q

Drugs that improve heart function:

A

Beta blockers

Cardiac glycosides

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8
Q

Beta blockers

A

Act on beta-adrenergic receptors in the surface of the heart (NE, epinephrine).

Metoprolol, atenolol, propranolol, labetolol.

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9
Q

Beta blockers: Mechanism

A

Hypertension: reduce cardiac output –> reduce BP

Ischemic heart disease: reduces HR and CO –> reduces workload

Heart failure: can reduce peripheral resistance and workload of heart

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10
Q

Beta blockers: Adverse effects

A

GI: nausea, trots

Resp: bronchospasm

Cardio: hypotension, bradycardia, heart failure

Endocrine: hypoglycaemia

CNS: fatigue, dizziness, depression

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11
Q

Beta blockers: massage guidelines

A

Be careful of hypotension.

Tx:Caution lying down.

Hydro: Don’t increase cardiac workload

Ex: ditto. Also fatigue.

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12
Q

Cardiac glycosides

A

Digitalis
Digoxin

Used to manage congestive heart failure; treatment and prevention of dysrhythmias.

Increases contractility of heart while decreasing heart rate.

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13
Q

Digoxin: mechanism

A

Reduces heart rate

Increases strength of contraction

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14
Q

Digoxin: adverse effects

A

Toxicity: fatigue, nausea, vomiting, visual disturbances, headache

Bradycardia

Hypotension

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15
Q

Digoxin: massage

A

Be aware of dysrhthmias, dyspnea, angina

General guidelines for heart failure.

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16
Q

Drugs that increase blood vessel diameter

A

Vasodilators
Alpha receptor
Calcium channel blockers
ACE inhibitors

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17
Q

Vasodilators

A

Nitrate-related compounds (nitroglycerine)

Used to manage angina, hypertension, congestive heart failure.

Can be administered via oral spray, sublingually, transdermally, IV
* almost complete first pass metabolism

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18
Q

Nitroglycerine: mechanism

A

Vasodilation of coronary arteries

Improves blood flow to heart; decreases preload and afterload (this decreasing workload to heart)

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19
Q

Nitroglycerine: adverse effects

A

Hypotension

Headache

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20
Q

Nitroglycerine: massage

A

Ischemic heart disease guidelines

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21
Q

Alpha receptor drugs

A

Found in smooth muscle of BV walls

Alpha-1 and Alpha-2

NE, epinephrine (adrenergic) receptors

Hypertension, congestive heart failure, reynauds

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22
Q

Alpha-2 receptor agonist: mechanism

A

Hypertension: acts on CNS to cause peripheral vasodilation

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23
Q

Alpha 1-receptor antagonist

A

Alpha 1 receptors in vascular smooth muscles. Cause vasoconstriction

Antagonists (ie Prazosin, doxazosin) cause vasodilation

Hypertension
Angina

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24
Q

Alpha 2 receptor agonist

A

Alpha 2 receptors in CNS –> decrease SNS –> peripheral vasoconstriction

Agonists (clonidine) –> vasodilation

Hypertension

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25
Q

Alpha 1 receptor antagonist: mechanism

A

Hypertension: vasodilation and reduces force of heart contraction

Angina: reduces workload of the heart by reducing contractility

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26
Q

Alpha 2 agonist: adverse effects

A

CNS: fatigue, drowsiness, sedation

Cardio: hypotension (orthostatic and otherwise)

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27
Q

Alpha 1 receptor antagonist: adverse effects

A

Cardio: edema, bradycardia, congestive heart failure, hypotension, dizziness

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28
Q

Alpha Receptor Drugs: Massage

A

Postural hypotension
(Alpha 1 antagonist: edema)

Systemic heat risks hypotension and syncope

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29
Q

Calcium channel blockers

A

Acts on smooth muscle tone in BV walls

Verapamil, nifedipine, ditiazem

Used to treat hypertension and tachycardia and to prevent migraines and vascular spasm after brain hemorrhages.

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30
Q

Calcium channel blockers: mechanism

A

Hypertension: vasodilation, reduction of force of heart contraction

Angina: reduces contractility so reduces workload

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31
Q

Calcium channel blockers:

Adverse effects

A

Edema, bradycardia, congestive heart failure, hypotension, dizziness

32
Q

Calcium channel blockers: massage

A

Hypotension, edema, syncope

33
Q

ACE Inhibitors

A

Vasodilation by interrupting action of enzyme in RAA system. –> reduces angiotensin II production

Long term BP control
Hypertension
Congestive heart failure

Lisinopril
Captopril
enalapril

34
Q

ACE inhibitors: mechanism of action

A

Vasodilation

Reduced blood volume

35
Q

ACE inhibitors: adverse effects

A

Dizziness, hypotension

Cough

Hyperkalemia (excess circulating K+)

36
Q

ACE inhibitors: massage

A

Positional hypotension. Maybe not lying down.

Syncope

37
Q

Three categories of drugs that affect coagulation.

A
  1. Anticoagulants
  2. Antithrombics
  3. Thrombolytics
38
Q

Blood coagulant affecting drugs are used to treat:

A

DVT

Thromboembolic and circulatory disorders (heat attack, surgery, pulmonary embolism,TOA)

39
Q

Anticoagulants: mechanism

A

Heparin: activation of anti thrombin II, decreased thrombin activity

Warfarin: Vit K antagonist

40
Q

Which drug is easily affected by food, resulting in over/under dose?

A

Coumadin (warfarin)

41
Q

Anticoagulants: adverse effects

A

Hemorrhage

Ecchymosis

42
Q

Anticoagulants: massage

A

Don’t bruise ‘em

43
Q

Antithrombotics

A

AKA antiplatelet drugs.
Aspirin

Used to prevent thrombosis
Inhibit formation of thromboxanes (aspirin specifically)

44
Q

Thrombolytics

A

Promote disintegration of clots

Increase plasmin formation (enzyme that breaks down thrombi)

Used to treat arterial and venous thrombi, prevent after strokes and heart attacks, and to clear IVs etc

45
Q

Streptokinase

A

Enzyme delivered as drug that combines with plasminogen to facilitate plasmid formation –> break up thrombi b

46
Q

Cardiovascular response to heightened tissue demand:

A
  1. Increase blood pressure
    2 increase heart rate
  2. Redirect blood flow to prioritize tissues under stress
47
Q

Diuretics

A

Drugs that reduce blood volume.
Hydrochlorithiazide, furosamide

First drug of choice for hypertension and heart disease.

Act directly on kidneys to reduce total blood volume.

48
Q

Diuretics are used to manage

A

Primary hypertension

Edema due to congestive heart failure, liver disease

Pulmonary edema

Diabetes insipidus

49
Q

Diuretics: mechanism of action

A

Decrease absorption of water at kidney tubules –> increased urine output –> decreased blood volume and CO –> decreased BP

50
Q

Diuretics: adverse effects

A

Hypotension
Dizziness
Hypokalemia

51
Q

Diuretics: massage

A

Hypotension considerations.

Muscle cramps and weakness, heart palpitations, may be a sign of potassium problems.

52
Q

Diabetes medications work by:

A
  1. Replacing insulin
  2. Increase insulin sensitivity
  3. Increase insulin secretion.
53
Q

Symptoms of hypoglycemia

A

=> insulin shock

Stomach pains
Hunger 
Sweating
Weakness
Headache
Tachycardia
Concussion
Moist pale skin
Convulsions.
54
Q

Symptoms of hyperglycaemia

A

=> diabetic coma.

Thirst
Polyuria
Fatigue confusion reduced consciousness. 
Headache 
Blurred vision 
Constipation 
Dehydration
55
Q

Normal blood glucose level

A

80-90 mg /100 ml

56
Q

Insulin

A

SubQ injection

Toronto, NPH, Lente, ultralente.

57
Q

Insulin: mechanism of action

A

Allows glucose to enter cells, decreasing blood sugar.

Inserts GLUT transporters into cell membrane.

58
Q

Insulin: adverse effect

A

Hypoglycemia

59
Q

Insulin: massage

A

Be wary of injection site, implant.

Possible peripheral neuropathy

60
Q

Oral hypoglycemia drugs

A

Sulfonylureas
Biguanides
Alpha-glucosidase inhibitors
Thiazilodinedione

61
Q

Sulfonylureas

A

Oral hypoglycemic (for diabetes)

Only for Type 2

Glipizide, glyburide

62
Q

Sulfonylureas: mechanism of action

A

Increase insulin secretion by pancreas

63
Q

Sulfonylureas: adverse effects

A

Hypoglycemia

Rarely: paresthesias and rashes

64
Q

Sulfonylureas: massage

A

Implants and injection sites.

Hypoglycemia
(Can be increased by NSAIDS).

65
Q

Biguanides

A

Hypoglycemic med (for diabetes)

Metformin

Type 2 only

66
Q

Biguanides: mechanism of action

A

Decrease release of glucose by liver

Decrease intestinal absorption of glucose

Increase insulin sensitivity in peripheral tissue

67
Q

Biguanides: adverse effects

A

Fatigue and weakness

Nausea and barf

Bruising, flatulence, lactic acidosis

68
Q

Biguanides: massage

A

Avoid deep tissue work (bruising)

Short Tx because of fatigue

Diabetic neuropathy

69
Q

Thiazolidinediones

A

Hypoglycemic drug (diabetes)

Rosiglitazone
Pioglitazone

Type 2 only

70
Q

Thiazolidinediones: mechanism of action

A

Increases sensitivity to insulin

Beneficial CHO lipid profiles

71
Q

Thiazolidinediones: adverse effects

A

Edema
Headache
Anemia
Fatigue.

72
Q

Thiazolidinedioles: massage

A

Peripheral edema and headache may not respond well to massage

73
Q

Alpha-glucosidase inhibitors

A

Hypoglycemic meds (for diabetes)

Precose

74
Q

Alpha-glycosidase inhibitors: mechanism of action

A

Decrease glucose absorption by intestine

75
Q

Alpha-glucosidase inhibitors: adverse effects

A

Flatulence

76
Q

Alpha-glucosidase inhibitors: massage

A

Be wary of GI issues: diarrhea, bloating, gas