ANS drugs
A patient taking metoprolol/Lopressor begins treadmill walking. Compared with an unmedicated patient, this medication is most likely to do this to the normal HR and BP rise during exercise.
What is depress or blunt the normal increase in HR and BP with exercise?
A patient with COPD uses albuterol/Ventolin before therapy. During gait training, the PT expects the medication’s primary desired effect to be this.
What is bronchodilation?
A patient taking lisinopril for hypertension begins a submaximal exercise test. Compared with beta blockers, ACE-I/ARBs generally do this to the BP response during exercise.
What is reduce SBP/DBP but not blunt or limit the normal BP response to exercise?
A patient with heart failure takes digoxin/digitalis. During exercise, the PT should know that this medication usually does this to regular HR/BP response
What is does not affect the regular HR/BP response to exercise?
A patient with COPD and hypertension takes tiotropium/Spiriva, albuterol/Ventolin, Breo, Lasix, and lisinopril. During walking, the patient becomes short of breath and lightheaded. Name one respiratory and one cardiovascular medication issue that could contribute.
What are COPD bronchospasm/dyspnea requiring bronchodilator support and Lasix-related volume reduction or BP medication-related lightheadedness?
A patient taking atenolol/Tenormin asks why they feel they can exercise longer before angina begins. This medication lowers myocardial oxygen demand by reducing this exercise-related value.
What is rate pressure product, or RPP?
A patient has both albuterol/Ventolin and tiotropium/Spiriva listed. The patient says, “I use one daily and one when I suddenly can’t breathe.” The rescue inhaler is this medication.
What is albuterol/Ventolin?
A patient taking an ACE inhibitor reports a persistent dry, nonproductive cough during therapy. This matters because it could be mistaken for this type of clinical problem during exercise
What is pulmonary limitation, respiratory disease symptom, or exercise-related dyspnea/cough?
A patient with heart failure taking digoxin/digitalis may demonstrate improved exercise tolerance because the drug can improve these two cardiac measures
What are ejection fraction and systolic blood pressure
A patient with emphysema is taking propranolol/Inderal and now needs albuterol/Ventolin more often during exercise. Identify the medication conflict.
What is a non-selective beta blocker may worsen bronchoconstriction in pulmonary disease, while albuterol is being used as a beta-2 agonist for bronchodilation?
A cardiac rehab patient taking carvedilol/Coreg has a low exercise HR even though they report moderate exertion. This is the PT’s best monitoring adjustment.
What is use additional intensity measures such as RPE, symptoms, workload, BP response, and clinical presentation rather than HR target zones alone?
A patient with emphysema takes tiotropium/Spiriva daily and uses albuterol/Ventolin for acute bronchospasm. During exercise, the PT should most closely monitor for these respiratory response changes.
What are shortness of breath, wheezing, bronchospasm, sputum/cough burden, oxygen saturation if indicated, and exercise tolerance?
A patient taking a calcium channel blocker such as diltiazem/Cardizem develops lower extremity swelling and a higher-than-expected HR during activity. This medication class can cause these two PT-relevant issues.
What are peripheral swelling/LE edema and reflexive tachycardia?
A patient in the ICU is receiving dobutamine. The student says, “We cannot mobilize because they are on this drug.” Give the better clinical reasoning answer.
What is dobutamine use is not automatically a contraindication to exercise or mobility, but the patient requires close physiologic monitoring and may have lower tolerance?
A patient with AECOPD is on albuterol nebulizer treatments, prednisone, Mucomyst, and an antibiotic. During bed mobility and transfer training, the patient has wheezing, productive cough, and poor endurance. The medication list suggests these active clinical problems.
What are acute COPD exacerbation, bronchospasm, airway inflammation, increased secretions/sputum, and infection?
A patient with a smoking history and mild emphysema is taking propranolol/Inderal. During bicycle exercise, the PT hears wheezing. This medication could contribute to the problem because it is this type of beta blocker.
What is a non-selective beta blocker?
A patient with COPD uses Breo, which contains fluticasone furoate and vilanterol. This combination addresses both airway inflammation and bronchodilation through these two medication types.
What are an inhaled corticosteroid and a LABA, or long-acting beta-2 agonist?
A patient with stable angina begins exercise but forgot their nitroglycerin tablets. This is the safest PT decision.
What is do not proceed with exertional therapy at the planned intensity; modify or hold exercise and follow facility procedures because the patient should have SL nitroglycerin available for exertional activities?
A patient taking digoxin/digitalis has ST depression during a stress test but no clear ischemic symptoms. This medication can create this testing issue.
What is a false-positive stress test result for myocardial ischemia?
A patient with hypertension and COPD is taking Lasix, lisinopril, tiotropium, and albuterol. After sit-to-stand training, they report dizziness. Identify two medication-related reasons this may occur and one PT action.
What are Lasix decreases volume, lisinopril lowers BP, and the PT should check BP/orthostatic response, modify activity, allow recovery, and monitor symptoms?
A patient with coronary artery disease and rhythm disturbances is taking a beta blocker. During exercise, the patient develops wheezing and shortness of breath. Identify the likely medication-related issue and a possible medication strategy the medical team may consider
What is bronchoconstriction related to a non-selective beta blocker, and the medical team may consider a medication with less bronchoconstrictive risk?
A patient admitted for AECOPD is receiving albuterol nebulizer treatments, acetylcysteine/Mucomyst, an antibiotic, and a tapered course of prednisone. Before mobility, the PT should connect this medication profile to these likely exercise-limiting problems.
What are acute bronchospasm, increased sputum/secretions, airway inflammation, infection/exacerbation, dyspnea, wheezing, and reduced exercise tolerance?
During exercise, a patient with angina uses sublingual nitroglycerin. The PT should anticipate this major hemodynamic effect and modify activity accordingly.
What is rapid vasodilation that can cause hypotension, including static, orthostatic, or exercise-related hypotension?
A patient is receiving milrinone/Primacor or inamrinone/Incor. These medications can support cardiac output during severe illness, but PT must recognize they are usually this level of medication and require this type of monitoring.
What are inpatient/ICU-level positive inotropic agents requiring close physiologic monitoring?
V.C. is a 63-year-old man with emphysema, hypertension, chronic smoking history, chronic productive cough, worsening shortness of breath, wheezing, and bronchospasm. He takes tiotropium/Spiriva, albuterol/Ventolin, Breo, Lasix, and lisinopril; during hospitalization for AECOPD, he receives Mucomyst, albuterol nebulizer treatments, antibiotic therapy, and a tapered course of prednisone. Identify at least four PT implications for exercise or mobility.
Monitor shortness of breath, wheezing, bronchospasm, and sputum production.
• Confirm availability/role of rescue inhaler albuterol/Ventolin.
• Recognize tiotropium/Spiriva as daily airway management, not acute rescue.
• Recognize Breo as combination respiratory medication supporting inflammation control and bronchodilation.
• Anticipate reduced exercise tolerance due to AECOPD.
• Monitor BP and orthostatic symptoms due to Lasix and lisinopril.
• Consider that Lasix decreases volume, contributing to dizziness or exercise intolerance.
• Monitor cough and breathing response; distinguish chronic/productive COPD cough from ACE-I dry nonproductive cough.
• Modify intensity, allow rest breaks, monitor symptoms and oxygen saturation if indicated.
• Communicate worsening dyspnea, wheezing, or poor response to activity to the medical team.