Medications and Exercise Testing

Anti-depressants | Beta-Blockers | Bronchodialators/Antihistamines | Calcium Channel Blockers | Digitalis | Diuretics | Thyroid Medication

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Medications and Exercise

ANTI-DEPRESSANTS

  • Mechanism of Action:
    • Block uptake of norepinephrine into the central nervous system synapses.
  • Treatment:
    • Depression.
  • Effect at Rest:
    • Increase HR, may cause hypotension.
  • Effects during Exercise:
    • Increase HR, decrease BP or stable, increase risk for arrhythmias.
  • Caution:
    • Careful with cardiac rehab.

Common Drugs
Generic Name Brand Name
Fluoxetine Prozac
Doxepin Sinequan
Tofranil Tofranil
Elavil Elavil
Desipramine Norpramin

BETA BLOCKERS

  • Mechanism of action:
    • Blocks beta-receptors of the sympathetic nervous system. Some agents act primarily on beta receptors in the heart. These are called cardioselective. Beta- blockage results in decreased heart rate, blood pressure, and contractility of the heart. Therefore, reducing the demand for oxygen by the heart.
  • Treatment:
    • Angina pectoris, hypertension, previous MI patients, arrhythmias, migraine headaches.
  • Effect at rest:
    • Decreased HR, decreased BP, decreased arrhythmias.
  • Effect during exercise:
    • Increased exercise capacity in patients with angina, exercise capacity decreased in patients without angina, decreased exercise ischemia, decreased HR, decreased BP.

Common Drugs
Generic Name Brand Name
Propranolol Inderal
Metoprolol Lopressor
Nadolol Corgard
Atenolol Norpramin

BRONCHODIALATORS / ANTIHISTAMINES

  • Mechanism of action:
    • Inhibit bronchial smooth muscle constriction in patients with asthma or COPD.
  • Treatment:
    • Asthma, Chronic Obstructive Pulmonary Disease (COPD).
  • Effect at Rest:
    • May produce arrhythmia, bronchodilators may increase HR or BP, effect will vary.
  • Effect during Exercise:
    • May produce PVC's and dysrrhythmias, bronchodilators may increase HR or BP.

Common Drugs
Generic Name Brand Name
Aminophylline = B Aminophyllin, Phyllocontin, Somophyllin, Truphylline
Isoproterenol = B Isuprel
Theophylline = B Theo-Dur, Theo-24, Uniphyl, Elixophyllin

Note the decongestant Pseudoephedrine (sometimes combined with certain antihistamines) can increase heart rate and blood pressure. This effect may become attenuated after continued use.

CALCIUM CHANNEL BLOCKERS

  • Mechanism of Action:
    • Inhibits trasmembrane calcium influx in cardiac and vascular smooth muscle. This causes vasodilation and lower resting blood pressure.
  • Treatment:
    • Angina pectoris, coronary artery spasm, arrhythmias, hypertension.
  • Effect at Rest:
    • Nifedipine/Procardia:
      • Increased HR, increased BP.
    • Other Calcium Channel Blockers:
      • decreased HR, decreased BP, decreased Ischemia. Check individual medication!
  • Effects during Exercise:
    • Same at rest, may increase exercise capacity.

Common Drugs
Generic Name Brand Name
Diltiazem Cardizem
Nifedipine Procardia
Verapamil Isoptin, Calan

DIGITALIS

  • Mechanism of Action:
    • Improves myocardial contraction by altering the calcium utilization of the myocardial cell.
  • Treatment:
    • (CHF) Congestive Heart Failure, Atrial fibrillation, atrial flutter.
  • Effects at Rest:
    • May decrease HR.
  • Effects during Exercise:
    • May decrease HR, will improve exercise capacity only in patients atrial fibrillation or CHF.

Common Drugs
Generic Name Brand Name
Digoxin Lanoxin
Digitoxin Crystodigin
Digitalis Digitortis

DIURETICS

  • Mechanism of Action:
    • Most diuretics alter renal function, causing an increase in the excretion of fluid.
    • CAUTION - Sodium and potassium levels may be depleted. Calcium supplements may also be necessary.
  • Treatment:
    • Hypertension, edema (swelling) increase/decrease
  • Effect at Rest:
    • Decrease of blood pressure.
  • Effects during Exercise:
    • May decrease BP, may affect CHF patients. May induce arrhythmias.

Common Drugs
Generic Name Brand Name
Furosemide Lasix
Triamterene Furoside
Chlorothiazide Dyazide
Hydrochlorothiazide Hydro-Diuril

THYROID MEDICATION (Only Levothyroxine)

  • Mechanism of Action:
    • Hormonal regulation
  • Treatment:
    • To correct abnormal and irregular release of hormones, due to thyroid dysfunction.
  • Effect at Rest:
    • Increase HR, increase BP, may increase ischemia.
  • Effects during Exercise:
    • Same effects at rest, may be exaggerated.

Common Drugs
Generic Name Brand Name
Thyroxine Synthrox


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