Diuretics/Beta Blockers
How do Diuretics work? What can they treat?
Act on kidneys to increase sodium and water excretion and decrease fluid in vascular system
Indications: Hypertension, Congestive Heart Failure
What are some cardioselective Beta Blockers called and what are some nonselective ones?
Cardioselective: suffix "-olol"
- Atenolol (Tenormin)
- Metoprolol (Lopressor)
Nonselective
- Pindolol (Visken)
- Propranolol (Inderal)
How do Vasodilators work? What are they used for? What are some examples?
They act directly on the vascular smooth muscle to inhibit contraction
Used to treat: hypertension and HF (heart failure)
Ex: hydralazine (Apresoline), minoxidil (Loniten)
What are some adverse effects/rehab concerns for RAS drugs?
Need to look out for allergic rxns (rash, angioedema)
ACE inhibitors: can cause dry cough
What are some adverse effects of Nitrates? What do we need to ensure when patient takes sublingual dose?
HA, dizziness, orthostatic hypotension, increased vasodilation--> AVOID systemic heat
If patient is taking sublingual dose- check drug viability and make sure they have the drug ready before the rehab session if they need it
What are some examples of Diuretics?
Thiazides: chlorothiazide (Diuril)
Loop diuretics: furosemide (Lasix)
Potassium sparing agents: spironolactone (Aldactone)
What are some adverse effects and rehab concerns when a patient is taking Beta Blockers?
Bronchoconstriction, orthostatic hypotension, psychotropic effects (depression, lethargy ect.), decreased MAX. exercise capacity
What are some adverse effects of Vasodialators?
Reflex tachycardia, orthostatic hypotension, dizziness, HA, edema/fluid retention
AVOID SYSTEMIC HEAT- all drugs that cause vasodilation
How do calcium channel blockers work? What can they treat?
Limits calcium entry into vascular smooth muscle and cardiac muscle, promotes vasodilation and stabilizes HR
Used to treat: hypertension, angina pectoris, arrhythmias
What are the 4 drug classes to treat cardiac arrythmias?
1: sodium channel blockers
2: Beta blockers
3: drugs that prolong repolarization
4: calcium channel blockers
What are the main adverse effects and rehab concerns for diuretics?
Possible fluid depletion, electrolyte imbalance
We need to watch for:
- orthostatic hypotension
- weakness, fatigue
- confusion/mood changes
Alpha blockers
Presynaptic adrenergic inhibitors
Centrally acting agents
Ganglionic blockers
ONLY USED when high BP is difficult to control or is poorly managed, these are very strong drugs
How do ACE inhibitors work? What are they used to treat?
They inhibit the angiotensin converting enzyme (ACE) and decreases formation of angiotensin II
Prevents vasoconstriction form Ang. II- decrease BP
Also decreases long term detrimental effects on the heart
Used to treat: hypertension and HF
Give some examples of calcium channel blockers. What are some adverse effects?
Diltiazem, Verapamil, Nifedipine
Look out for: swelling in feet/ankles, orthostatic hypotension, altered HR, AVOID systemic heat!!!
How does class 1: sodium channel blockers work to treat arrhythmias? What are some examples
inhibits abnormal Na+ channel opening in cardiac cells- stabilizes excitability
Examples: disopyramide, lidocaine, flecainide
What is the main sympatholytic? What is their role?
Beta Blockers
Binds to heart and blocks effects of norepinephrine and epinephrine
Also decreases HR and contraction force and decreases sympathetic responses
What is the renin angiotensin system (RAS)?
It is a neuroendocrine response that helps control BP and other physiological reactions
What is the common suffix for ACE inhibitors? Name some examples of ACE inhibitors.
"-pril"
captopril, enalapril, lisinopril ect.
What is the primary Antianginal medication? How is it typically administered? When is it mostly used?
Nitroglycerin- sublingually
Used mostly for angina pectoris (chest pain)
How do class 3: drugs that prolong repolarization work to treat arrythmias? What are some examples?
Lengthens the time before next AP can be generated
Ex: amiodarone (Cordarone), dofetilide (Tikosyn) ect.
When can beta blockers be used (cardiac and non cardiac)?
Cardiovascular: hypertension, angina, arrhythmias, HF, recovery from MI
Non-cardiac: migraine, situational anxiety, raynauds
What are the 3 ways to prevent harmful effects of angiotensin II?
ACE inhibitors
Angiotensin II receptor blockers
Direct renin inhibitors: inhibits renins ability to convert angiotensinogen into Ang II
How do Ang II receptor blockers work? How do they differ from ACE inhibitors? What is the common suffix for these drugs?
Blocks Ang II receptors, prevents detrimental effects of Ang II on heart
May be as effective as ACE inhibitors but with less side effects
"-sartan" drugs- losartan (Cozaar), eprosartan (Teveten)
How do Nitrates affect the heart?
Decreases cardiac workload and O2 demand
What are the primary indications for each drug class in treatment of arrhythmias?
What is the primary rehab concern?
Class 1: various arrhythmias- esp PVCs and Vtach
Class 2: Afib, V Tach
Class 3 (amiodarone): Afib, Vtach, Vfib
Class 4: Afib, supraventricular tachyc.
Primary concern: change in type of arrhythmia (proarrhythmic effect)