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FITNESS EXAM 3
Pharmacology, Cardiac Rehab, Exercise Rx, Management of Weight loss, & Rx for the Pulmonary Disease Patient
158
Fitness
Undergraduate 3
04/01/2015

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Term
of the 9 million people in the US with angina, _____ are actually being treated.
Definition
5 million
Term
what is the cause of angina?
Definition
an imbalance between oxygen supply and demand
Term
how could you distinguish heart burn and angina?
Definition
angina occurs when you are exerting yourself and can be subtle
Term
what is VO2? is myocardial VO2 high at rest?
Definition
the body's ability to extract and get oxygen

near max even at rest
Term
what do medications have a general affect on the body's oxygen supply and demand?
Definition
increase supply and reduce demand
Term
what is angiogenesis? when will this occur? are there drugs that can help?
Definition
sprout new blood vessels that will bypass a blockage

takes years to occur

making drugs that will induce this
Term
with coronary blood flow, what causes chest pain?
Definition
70% of greater blockage
Term
with coronary vascular resistance, how do drugs help relieve chest pain?
Definition
enhancing vasodilation
Term
what is diastolic filling time? how can you increase this? what kind of drug?
Definition
the time it takes for the left ventricle to fill with blood

increase diastole by decreasing HR

beta-blockers
Term
what effect does increasing HR have on oxygen demand?
Definition
increases demand
Term
what are the four features of myocardial blood flow?
Definition
1)5% of cardiac output
2)diastolic flow greatest
3)extraction of oxygen about 75% at rest
4)flow controlled by autoregulation
Term
what are the four determinants of oxygen supply?
Definition
1)coronary blood flow
2)vascular resistance
3)collateral blood flow
4)diastolic filling time
Term
what are the four determinants of oxygen demand?
Definition
1)heart rate
2)contractility
3)afterload
4)preload
Term
if you ____ preload, you will _____ oxygen demand.
Definition
decrease

decrease
Term
what are the three different types of angina?
Definition
vasospastic angina
exertional angina
partially occlusive transient platelet thrombus
Term
explain vasospastic angina.
typical or atypical?
is this associated with exertion?
can drugs help this?
Definition
spastic contraction of SMC that clamps down on the coronary artery and reduces blood flow

atypical

no

yes
Term
explain exertional angina.
will drugs help this angina?
Definition
slow progressive narrowing of the blood vessel due to atherosclerosis which causes a reduction in blood flow that results in typical angina during exertion

yes
Term
explain partially occlusive transient platelet thrombus angina.
will anti-anginal drugs help this? if not, what will?
Definition
plaque will throw a clot, which causes pain and then the clot breaks up

no, but a blood thinner will
Term
what are treatment strategies for angina?
Definition
behavior modification
nitrates
calcium channel blockers
beta-blocking agnets
surgical (angioplasty, CABG)
Term
what is nitroglycerine's effect on the arteries?
what won't it affect?
what are the side effects?
Definition
dilation

the 10-15% of the population that already have dilated arteries

headaches
Term
Nitrates are exclusively used for angina, they dilate the veins and arteries, which causes what? and then what?
Definition
reduction in preload-> lowers oxygen demand
decreased blood pressure->reduces oxygen demand
increase c-GMP->relaxation of SMC
decreased contractility->lowers oxygen demand
Term
T/F in 85%-90% of people nitrates cause vasodilation, which increases oxygen supply.
Definition
true
Term
T/F nitrates decrease blood pressure, which decrease oxygen demand and ultimately decrease heart work.
Definition
true
Term
T/F nitrates increase filing pressure, which decreases heart work.
Definition
false
decreases filling pressure to decrease heart work
Term
if a healthy individual were to take a nitrate, what would happen?
Definition
it would reduce ability and performance
Term
in relation to exercise, what do nitrates do for someone with angina?
Definition
allow the individual to workout longer and harder before the onset of angina
increase exercise performance
Term
what are the side effects of nitrates? what is the cause of each side effect?
Definition
headaches by dilation of the blood vessels in the brain
dizziness by orthostatic hypotension
reflex tachycardia by reflex activation of the sympathetic neurons in a response to a drop in BP
Term
what is orthostatic hypotension?
Definition
less blood is pumped to the brain which can cause fainting
Term
any medication that decreases HR or systolic blood pressure will _____ oxygen demand.
Definition
decrease
Term
nitrates affect oxygen supply by:
____coronary blood flow,
____vascular resistance,
____collateral blood flow, and
____diastolic filling time.
Definition
increase
decrease
increase
decrease
Term
nitrates affect oxygen demand by:
___heart rate,
___contractility,
___afterload, and
___preload.
Definition
increase
increase
decrease
decrease
Term
what is the major affect of nitrates?
Definition
reduction of preload
Term
nitrates dilate the coronary arteries which causes___?
Definition
an increase in the blood supply
Term
what are the two beneficial effects of nitrates for treatment of vasospastic angina?
Definition
1)relaxation of the coronary artery spasm which increases the blood flow to the heart muscle
2)reductions in preload and afterload
Term
what are nitrates prescribed for?
Definition
angina
Term
what are the major uses of calcium channel blockers?
Definition
angina
hypertension
arrhythmias
Term
what does the heart use make a more forceful contraction?
Definition
extracellular calcium
Term
what is the mechanism of action of calcium channel blockers?
Definition
inhibit the movement of calcium from the extracellular fluid into the intracellular fluid by blocking the channels
Term
what affect does calcium channel blockers have on vascular smooth muscle?
Definition
cause relaxation
Term
what affect do calcium channel blockers have on cardiac muscle? what can too much do?
Definition
slow down electrical signal to the AV node and decrease the contrail state of the atrial and ventricular muscles

cause cardiac depression
Term
calcium channel blockers affect oxygen supply by:
___coronary blood flow and
___vascular resistance.
Definition
increase
decrease
Term
calcium channel blockers affect oxygen demand by ____ after load and contractility?
Definition
decreasing
Term
what are the side effects of calcium channel blockers?
Definition
dizziness
headache
cardiac depression (rare)
Term
T/F it is commonly seen for pair a calcium channel blocker with a beta blocker.
Definition
true
Term
how do beta blockers work?
Definition
block the beta receptor for sympathetic nerves, specifically beta1
Term
what would be the effect if you were to block the Beta2 receptors on the veins and arteries?
Definition
there would be little to no effect because the Alpha1 receptor is important on the blood vessels
Term
what are non-selective beta blockers?
Definition
block both beta 1 and 2 receptors
Term
what are selective beta blockers?
Definition
just target the beta1 receptors
Term
what are the major uses of beta blockers?
Definition
angina
arrhythmias
hypertension
Term
T/F blocking the beta-receptors within the heart leads to an increase in heart rate and contractility.
Definition
false
decrease
Term
Beta blockers _____ the work load and thus the demand for oxygen by the heart.
Definition
decrease
Term
T/F if you decrease HR, you will increase diastolic filling time, and increase oxygen supply.
Definition
true
Term
how do beta-blockers help with exercise?
Definition
higher exercise levels can be attained before the patient experiences angina
Term
T/F it is uncommon for beta-blockers to be paired with nitrates.
Definition
false
common
Term
what do beta blockers decrease your risk of?
Definition
decrease sympathetic activity which decreases arrhythmias
may reduce congestive heart failure
Term
if you just have high blood pressure and you are taking a beta blocker what will this increase your risk for?
Definition
stroke
Term
what are the side effects of beta-blockers?
Definition
headache
orthostatic hypotension
erectile dysfunction
increase triglycerides
decrease HDL levels
bronchiospasm
masks symptoms of hypoglycemia
cause differential AV block
Term
what are the uses of diuretics?
Definition
edema
hypertension
Term
what is the action of diuretics?
Definition
altering renal function resulting in an increased excretion of electrolytes and fluid
Term
Diuretics help individuals with coronary artery disease because of what?
Definition
reduction of blood pressure and venous return which reduces the work of the heart and ultimately reduces oxygen demand
Term
T/F diuretics help exercise.
Definition
false
they do not influence the exercise capacity but rather produce a toxic affect that may show on the EEG.
Term
vasodilators are primarily used for the treatment of ____.
Definition
hypertension
Term
vasodilators cause the relaxation of SMC which causes what?
Definition
reduction of blood pressure
Term
what are ACE inhibitors used for?
Definition
treatment of hypertension
Term
what controls long term blood pressure regulation?
Definition
kidneys
Term
explain how angiotensinogen becomes active.
Definition
-renin is released when the sympathetic nerves are active, which cuts angiotensinogen into angiotensin 1 (inactive)
-as angiotensin 1 circularities ACE changes angiotensin 1 to angiotensin 2 (active)
-angiotensin 2 binds to the blood vessels and causes vasoconstriction, which increases blood pressure
-angiotensin 2 also causes adrenal glands to secrete aldosterone which causes the kidneys to retain sodium, which increases blood pressure
Term
what three drugs affect the Renin Angiotensin Aldosterone System?
Definition
ace inhibitor
angiotensin 2 binding blockers
aldosterone receptor blockers
Term
how do ACE inhibitors work?
Definition
block conversion of angiotensin 1 to angiotensin 2
Term
how do angiotensin 2 binding blockers work?
Definition
blocks the binding of angiotensin 2 to the blood vessel
Term
how do aldosterone receptor blockers work?
Definition
block aldosterone receptors in the kidneys
Term
in a patient that has had a heart transplant, why would a longer warm up be appropriate?
Definition
the nerves are cut therefore HR will take longer to increase to meet demands because hormones take longer to exhibit effect
Term
if your goal is to calculate net calories what should you do?
Definition
leave off the 3.5 from the beginning equation when calculating VO2
Term
1 watt is equal to ___kgm/min
Definition
6
Term
what are the mechanism of action for nitrates? (Hint:3)
Definition
reduces venous return and end-diastolic volume
dilates the coronary arteries
reduces SBP
Term
T/F ACE inhibitors are not effective in decrease BP when paired with a calcium channel blocker.
Definition
false
are effective
Term
elevated levels of aldosterone are associated with what?
Definition
vasotoxicity
CHF
renal disease
Term
what are the primary uses of Digitalis?
Definition
increase myocardial contractility
reduces supraventricular arrhythmias
Term
T/F the correct dosage of digitalis is easy to find.
Definition
false
Term
how does digitalis work?
Definition
opens calcium channels in people with weak hearts
Term
what is the issue with anti-coagulants?
Definition
you could potentially bleed to death
Term
how does aspirin work?
Definition
anti-inflammatory
anti-coagulant
Term
how do statins work?
Definition
reduce intraplaque lipids
stabilize atherosclerotic plaque
improve vasomotor function
anti-inflammatory
Term
how do you find a percent of VO2R?
Definition
resting Vo2= 3.5 ml/kg/min
subtract resting from max is the VO2R
then multiply by %
Term
what are the goals of a cardiac rehabilitation program?
Definition
1)increase caloric expenditure
2)improve aerobic fitness
3)maintain or improve functional ability
4)increase muscular strength
5)improve vocational or recreational performance
6)optimize ability to perform ADLs
7)MAINTAIN INDEPENDENCE
Term
T/F initial exercise Rx for a cardiac rehab patient should be based on risk stratification.
Definition
true
Term
a graded exercise test should be performed when dealing with patients with cardiac disease in order to:
Definition
assess functional capacity to aid in risk stratification
identify problems and effectiveness
evaluate medications
provide the basis for the exercise Rx
Term
a patient in cardiac rehab should start at ___ METS and progress ___ MET per stage.
Definition
1-2

1
Term
what is the recommended frequency for a patient in cardiac rehab?
Definition
3 days, but there is no reason they cannot do more, insurance will only pay for 3 days a week, multiple day sessions is ideal
Term
what is the recommended duration for patient in cardiac rehab?
Definition
minimum of 15 minutes
most patients exercise 20-40 minutes
Term
the warm up for a cardiac rehab patient has been shown to___.
Definition
increase the time to the onset of angina
Term
explain the intensity for someone in cardiac rehab?
what if there was no GXT?
Definition
should start at 40/50% HRR
should start +20-30 beats above resting HR
Term
what are some important points for intensity for a patient in cardiac rehab?
Definition
1)workload on the heart is determined by the product of the HR and SBP
2)HR & BP can vary greatly between different modes of exercise
3)inadequate warm-up may result in patient experiencing angina at lower HR than normal
Term
what are the limitations of using RPE to assess intensity for a patient in cardiac rehab?
Definition
HR, BP and other may vary drastically between different modes of exercise at the same RPE

patients figure out very quickly what happens when they report a lower RPE
Term
what can be used to set the upper limit for a patient in cardiac rehab?
Definition
1)onset of angina
2)plateau or decrease in SBP
3)>1mm ST-segment
4)radionucleide evidence of left ventricular dysfunction
5)increase frequency of arrhythmias
6)significant EEG disturbances
7)other signs and symptoms that limit exercise (non cardiac related)
Term
how would you progress an individual in cardiac rehab?
Definition
if the patient cannot do 15 minutes of continuous exercise progress to 20-30 minutes

increase duration 10-30% per week
Term
why does chest pain delay with exercise?
Definition
decreased HR
Term
T/F you can increase duration and intensity in the same week.
Definition
false
duration should be increased before intensity
Term
why is a prolonged cool down recommended?
Definition
to minimize risks of post-exercise hypotension and arrhythmias, not to mention DOMS
Term
can someone in cardiac rehab do strength training?
Definition
only very light resistance
teach them to how the machines work
Term
what is the titration method?
Definition
add small amounts at the a time
Term
what are some ways to make strength training safer for patients in cardiac rehab?
Definition
spot the person at the beginning as well as end of the lift
don't take the set to fatigue
perform exercise with one limb at a time
don't grip too tightly
Term
what are some examples of COPD?
Definition
asthma
bronchitis
emphysema
Term
COPD is characterized by___.
Definition
expiratory flow limitations
Term
T/F 30 million people are diagnosed with COPD.
Definition
true
Term
T/F COPD is the 2nd leading reason for "at home" care after CHF.
Definition
false
3rd leading cause after CHF and stroke
Term
T/F COPD patients are more likely to be admitted into the hospital compared with age and gender matched patients with other illnesses.
Definition
true
Term
T/F in 2011 was the 11th consecutive year in which men exceeded woman in he number of deaths due to COPD.
Definition
false
women exceeded men
Term
T/F women are twice as likely to be diagnosed with chronic bronchitis than men.
Definition
true
Term
what is the estimated total economic cost of COPD in 2010?
Definition
49.9 billion
Term
what is the leading cause of hospitalization in our aged population?
Definition
COPD
Term
T/F 51% of individuals say that their COPD limits their ability to do work.
Definition
true
Term
asthma and EIA are characterized by reactivity to various stimuli such as:

reaction to these stimuli cause what?
Definition
pollen or other allergens
pollution
cold or dry air
exercise or emotional stress

bronchospasm
excessive mucus production
Term
explain asthma.
onset?
usual etiology?
course?
airflow limitation?
clinical features?
inflammatory cell?
responses to steroids?
Definition
onset: anytime
usual etiology: immunologic stimuli, family history
course: usually intermittent
airflow limitation: largely reverse able
clinical features: wheeze, chest tightness, couch, dyspnea
inflammatory cell: marcophages
responses to steroids: inhibits inflammation
Term
what is bronchitis characterized by?
Definition
chronic cough
excessive mucus production
enlargement of mucus glands
thickening of airway walls
Term
what is emphysema characterized by?
Definition
loss of lung tissue
increased proteolytic activity
loss of lung elasticity
expiratory flow limitations
increase in Vd and impaired gas diffusion
Term
restrictive lung diseases are characterized by____.
Definition
decreased inspiratory flow or capacity
Term
give examples of restrictive diseases that effect the ribcage and the spine.
Definition
kyphoscoliosis
anklyosing spondylitis
Term
give examples of restrictive diseases that effect the respiratory muscle and nerves.
Definition
SCI
stroke
neuromuscular disorders
Term
give examples of restrictive lung diseases that effect the pleura.
Definition
effusion
chronic pleuritis
pleural fibrosis
Term
give examples of restrictive lung diseases that effect the alveoli and parenchyma.
Definition
interstitial fibrosis
alevolitis
Term
T/F obesity has an effect on the lungs as a restrictive disease.
Definition
true
Term
spirometry of someone with COPD would have:
___TLC,
___FVC,
___RLV,
___IC,
___FEV1,
___FEV1/FVC ratio, and
___MVV.
what is the dead give away?
Definition
normal or increased
modestly decreased
increased
decreased
markedly decreased
decreased
markedly decreased

DECREASED FEV1/FVC RATIO
Term
spirometry of someone with restrictive lung disease would have:
___TLC,
___FVC,
___IC,
___FEV1,
___FEV1/FVC ratio, and
___MVV.
what is the dead give away?
Definition
markedly decrease
markedly decrease
markedly decrease
modestly decreased
normal or above normal
modestly decreased

INCREASED FEV1/FVC RATIO
Term
someone with COPD would have ____ Ve, Ve/CO2 and Ve/O2 at rest and during exercise.
Definition
elevated
Term
T/F someone with COPD may reach the upper limits of MVV.
Definition
true
Term
someone with restrictive disease would have ____ Ve, Ve/CO2 and Ve/O2 at rest and during exercise.
Definition
elevated
Term
T/F someone with restrictive disease may reach the upper limits of IC.
Definition
true
Term
what are some commonly prescribed medications for someone with COPD?
Definition
bronchodilator-theophylline
albuterol; prevents bronchospasm and symptoms of EIA,
cromolyn sodium: prevents chemical mediators from triggering asthma
corticosteroids: anti-inflammatories
Term
what medications protect patients in the late-phase COPD?
Definition
bronchodilators
phosphodiesterase-4 inhibitors
Term
what medications protect patients in early-phase COPD?
Definition
inflammatory mediators
antioxidants
antiproteases
retinoids
Term
what is Tiotropium? what does it do?
Definition
new-generations anticholinergic agent
slows dissociation from the muscarinic receptor found on the bronchial smooth muscle
Term
what does a patient assessment include? (Hint: 10)
Definition
1)patient interview
2)medical history
3)physical exam
4)diagnostic test
5)symptom assessement
6)musculoskeletal and exercise assessment
7)nutritional assessment
8)educational assessment
9)psychosocial assessment
10)goal development
Term
what are recommended tests for potential lung issues?
Definition
spirometry
O2 saturation at rest and walking
chest radiograph
ECG
field test of exercise capacity
screening assessment of anxiety and depression
CBC
Term
what kind of exercise test would you put someone with lung issues though?
Definition
mostly cycle test are performed but the test should look like everyday activities
GXTs
constant work rate tests
Term
what are the advantages of a simple walking test? disadvantage?
Definition
simple and reproducible

learning effect must be controlled for
limited ability to measure physiological variables
Term
what are the advantages of GXT for someone with lung issues? disadvantages?
Definition
the measurement of any physiological variable
more reliable

influenced by patient motivation
may be of limited use in severely disabled patients
Term
what are the advantages of constant work rate tests? disadvantages?
Definition
allows for the measurement of physiological variables under the same conditions
useful as an adjunct to GXT

learning effect is a limitation
Term
T/F malnutrition is a problem in 20-30% of moderate to severe COPD patients.
Definition
true
Term
what BMI is associated with an increase overall mortality, independent of the degree of airway obstruction?
Definition
<20BMI
Term
hypoxia and hypercapnia, in relation to COPD____.
Definition
related to severe COPD and linked with malnutrition
Term
T/F overweight and even obesity are related to improved survival of patients with severe COPD.
Definition
true
Term
higher body weight correlates to better what?
Definition
exercise capabilities and diffusion capacity
Term
T/F obesity relates to a low FEV1.
Definition
true
Term
what are the points to goal development?
Definition
establish short term and long term goals
realistic goals
involve significant others
assess goals frequently and change as needed
document progress to goals each session
Term
explain the mode for exercise Rx for patients with lung issues.
Definition
aerobic exercise involving large muscle groups
strength training may help to maintain or increase muscle mass as well as improve strength and endurance
Term
T/F exercise involving upper body for patients with lung issues is ok.
Definition
false
may increase respiratory demands/ distress
Term
what is the recommended frequency for patients with lung issues?
Definition
3-5 days a week
Term
what is the recommended duration for patients with lung issues?
Definition
progression to 20-30 minutes total exercise time using intermittent/interval training techniques
Term
what is the recommended intensity for patients with lung issues?
Definition
no clear consensus
moderate intensity has shown improvements
Term
what is the best way to determine intensity in a patient with lung issues?
Definition
ratings of dyspnea
O2 saturation
Term
explain what each level on the dyspnea scale means.
1?
2?
3?
4?
Definition
1-mild, noticeable to patient, not to observer
2-some difficulty, noticeable to observer
3-moderate difficulty, but can continue
4-severe difficulty patient cannot continue
Term
what should be incorporated into an exercise program for someone with lung issues?
Definition
controlled breathing techiques
Term
when would supplemental oxygen be necessary?
Definition
if a patient is desaturating
Term
what does CPAP stand for? what is it? what does it help to prevent?
Definition
continuous positive airway pressure
reduces excessive elastic recoil associated with hyperinflation

reduces mechanical load on breathing muscles
prevents collapse of smaller airways
Term
what can pursed lip breathing help?
Definition
the maintenance of positive airway pressure
Term
what does UBRT stand for? what is it? are the results consistent?
Definition
upper body resistance training
ADLs involving the upper body

no
Term
what does RIMT stand for? what cases has it been successful?
Definition
resistive inspiratory muscle training

patients who don't respond to other therapy
patients with decreased respiratory muscle strength
absence of severe hyperinflation
Term
what are the benefits and goals of exercise training with someone with lung issues?
Definition
improved aerobic capacity
increased muscle strength
improved ventilatory muscle strength
improved neuromuscular coordination
desensitization to dyspnea
reduced respiratory symptoms
achieve some degree of independence and significantly improve their quality of life
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