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Flashcards in 2Pharm I Deck (254):
1

Rank diuretics from most to least potent:

Loop

Thiazides

Carbonic anhydrase inhibitors (very mild)

Potassium sparing

2

What is the most common cardiovascular disease whose prevalence increases with age?

Hypertension

3

Individuals at 55 years old with NORMAL BP have a ___% lifetime risk for developing hypertension

90%

4

Hypertension contributes to what 2 categories of disease?

Coronary artery disease

Cerebral artery disease

*heart and brain

5

What are 3 categories of hypertension?

Essential (idiopathic - 90%)

Secondary (identifiable)

Malignant (5%, retinal/renal damage)

6

BP intervention LESS THAN 60 yrs:

BP intervention OVER 60:

140/90

150/90

7

AHA/ACC recommend lifestyle changes if Systolic is what range?

Diastolic?

140-159

90-99

8

What are the 3 basic ways to reduce overall blood pressure?

Reduce peripheral resistance

Reduce cardiac output

Reduce blood volume

9

How do most diuretics work?

Block Na+ reabsorption

(Which then blocks water)

10

In the US _____ are the first line of drugs in hypertension treatment

Diuretics

11

What was the first class of diuretics (no longer used b/c of toxicity)?

Mercurials

12

What is the first choice, and most commonly prescribed class of diuretic?

Thiazides (benzothiazides)

13

What do Thiazides block in the kidney?

(2 things)

Blocks Na+ reabsorption in Proximal and Distal tubules

Carbonic anhydrase (this decreases H+ availability for exchange with Na+)

14

With Thiazides, what is the problem in losing Na+ in the distal/proximal tubules?

K+ is also lost (hypokalemia)

15

When taking Thiazides, if sodium intake increases, ________ is exacerbated.

Potassium loss

16

Why are a lot of Diabetics not on Thiazides?

Hyperglycemia is side effect

17

Hypokalemia, Hyponatremia, Hypomagnesaemia, loss of carbonate, hyperuricemia, Hyperglycemia, elevated cholesterol, triglycerides, weakness, no boner.

What am I?

Thiazide diuretic

18

According to lectures, 2 thiazide drugs we need to know:

Hydrochlorothiazide (Microzide)

Chlorothiazide (Diuril)

19

What is the most powerful class of diuretic?

Loop

20

3 effects of Loop Diuretics

Major volume loss

Electrolyte imbalance (Na+ and K+ loss)

Ototoxicity

21

Loop diuretics block the _______ symporter

Na/K/Cl

22

Hyponatremia, hypokalemia, hyperglycemia, hypocalcemia, hyperuricemia, NEPHROTOXICITY, ototoxiciy, GI distress, CNS effect

What am I?

Loop diuretic

23

From lecture, 2 loop diuretics we need to know:

Ethacrynic acid (Edacrin)

Furosemide (Lasix)

24

What 2 classes of drugs cause the Lichenoid Drug Rxn?

Thiazide and Loop diuretics

25

What class of diuretic competes with aldosterone?

Where does that competition take place?

Potassium sparing diuretics

Distal renal tubules

26

Potassium sparing diuretics save K+ and ____.

They increase ___ and ____ excretion

H+

Na+ and Cl-

27

2 potassium sparing diuretics:

Spironolactone (Aldactone)

Triamterene (Dyrenium)

28

Adverse effects of Potassium sparing diuretics: Hyperkalemia, and what 4 other things?

Gynecomastia in males

Breast tenderness in young women

Menstrual irregularities

Decreased libido in males

29

What mild diuretic is now used mostly for glaucoma, and as an adjunctive therapy for congestive heart failure?

Carbonic anhydrase inhibitors

30

One carbonic anhydrase inhibitor we need to know:

Acetazolamide (Diamox)

31

What drug is used in emergencies to decrease blood volume?

Which to we need to know?

Osmotic diuretics

Urea (Ureaphil)

32

What diuretic is rarely used - but treats hypochloremic stated and metabolic alkalosis in the ER?

*produced a lot of chloride

What preparation do we need to know?

Acidifying Agents

Ammonium chloride

33

Caffeine is a _______ that inhibits tubular reabsorption of Na+ by inhibiting _______ in the ______

Xanthine

ADH

Bowman's capsule

34

Most diuretics cause ________ and many cause ______

Xerostomia

Aphthous stomatitis

35

T/F
Use of NSAIDS for greater than 3 weeks can decrease diuretic effectiveness

True

36

T/F
Many pts take potassium supplements to counteract the K+ loss from diuretics but this is contraindicated in case of severe renal impairment

True

37

Potassium supplements (salts) are contraindicated with what?

ACE Inhibitors

38

5 classes of drugs used to lower BP:

Diuretics

Sympathetic blockers (alpha, beta)

ACE inhibitors

Angiotensis II receptor blockers (ARB's)

Calcium channel blockers (CCB's)

39

T/F
Beta blockers decrease cardiac output even though constrict vessels via beta2

True

40

Beta blockers decrease _______ secretion

Renin

41

Cardioselective beta blockers block ______ only

Beta1

42

A beta2 agonist is used for ________

Asthma

43

Beta1 receptors are in the _____

Beta2 receptors are in the ______

Heart

Lungs

44

2 cardioselective Beta Blockers (blocks Beta1 only):

2 noncardioselective Beta Blockers (blocks beta1 and beta2):

Beta1:

Atenolol (Tenormin)

Metoprolol (Lopressor, Toprol)

Beta2:

Nadolol (Corgard)

Propranolol (Inderal)

45

What class of drugs has side effects consistent with over-activity of the parasympathetic nervous system?

Beta blockers

*GI upset, xerostomia, orthostatic hypotension, sexual dysfunction, etc

46

4 contraindications to beta blockers:

Congestive heart failure

Asthma

Heart block

Diabetes

47

What receptors are located postsynaptically and produce vasoconstriction, increasing peripheral resistance when stimulated?

Alpha1

48

Alpha1 blockers produce ________

peripheral vasodilation

49

T/F
Alpha1 blockers have big effects on cardiac output and renal blood flow

False

*little effect

50

T/F
Alpha1 blockers are more effective when used with diuretics and/or beta blockers

True

51

Other than decreasing peripheral resistance, what is another effect of Alpha1 blockers?

Decrease urinary resistance

*benign prostatic hypertrophy

52

Alpha1 blocker =

Old men

53

3 adverse effects of Alpha1 blockers:

Orthostatic hypotension

CNS effects

Cardiovascular effects

54

3 Alpha1 Receptor blockers:

doxazosin (Cardura)

prazosin (Minipress)

tamsulosin (Flomax)

55

Women shouldn't handle Flowmax, and its chief side effect in men is...

severe orthostatic hypotension

56

ACE inhibitors - inhibit Angiotensin Converting Enzyme how?

competitively

*prevents angiotensin I to angiotensin II conversion

57

Explain ACE Inhibitor pathway/mechanism:

blocks Angiotensin I - Angiotensin II

Low Angiotensin II increases Renin

Renin reduces Aldosterone secretion

58

Normally aldosterone does what in the kidneys?

retains Na+ and water

*so ACE Inhibitors will decrease Na/Water retention (pee free water)

59

What are the 2 primary beneficial effects of ACE Inhibitors?

Vasodilate

Decrease Blood Volume

60

What is the most widely prescribed ACE Inhibitor in the US?

lisinopril (Prinivil, Zestril)

61

2 ACE Inhibitors:

lisinopril (Prinivil, Zestril)

enalapril (Vasotec)

62

What are 2 side effects of ACE Inhibitors?

Chronic Dry Cough

Angioneurotic edema with first dose

63

What causes the Chronic Dry Cough associated with ACE Inhibitors?

Increased Bradykinin release in bronchial tree

64

Angiotensin Receptor Blockers, aka...

Angiotensin II Receptor Blockers

65

T/F
ARB's block vasoconstrictor and aldosterone-secreting effects of Angiotensin II

Resulting in...

True

increased Renin, vasodilation, decreased Na/Water retention, and reduction in BP

66

What is often preferred over ACE inhibitors b/c the action is at the receptor and there are fewer side effects

*better tolerated

ARB's

67

What may decrease the effectiveness of ARB's?

NSAIDS

68

CNS, Upper respiratory infections, GI effects, cramps, angioedema, teratogenicity - what am I?

ARB's

69

2 common ARB's:

losartan (Cozaar)

valsartan (Diovan)

70

What is the new, expensive class of drugs for Hypertension?

Renin Inhibitor

*binds to Renin, decreasing levels of Angiotensin I - II - Aldosterone

71

Calcium Channel Blockers prevent Ca++ from entering...

slow channels

(select voltage-sensitive areas)

72

T/F
Calcium Channel Blockers relax coronary vascular smooth muscle and cause coronary vasodilation, increasing myocardial oxygen delivery

True

73

Calcium Channel Blockers are used for what 3 CV purposes?

Hypertension

Angina

Arrhythmias

74

Calcium's role in muscle contraction - it binds ______

which turns on ______

which phospholrylates ________

so that it can better bind ______ and produce muscle contraction

calmodulin

myosin kinase

myosin

actin

75

3 Calcium Channel blockers:

amlodipine (Norvasc)

nifedipine (Adalat, Procardia)

verapamil (Calan)

76

verapamil (Calan) has major effects on the ______

nifedipine (Procardia) has more of an effect on _______

heart

blood vessels

77

What Calcium channel blocker is (most) associated with gingival hyperplasia?

What % have the responder gene that results in hyperplasia from this drug?

nifedipine (Procardia)

33%

78

T/F
Good oral hygiene will limit the extent and severity of a lesion due to a Calcium Channel Blocker

True

79

Why are Centrally Acting Antihypertensives used less often?

Less tolerated

80

clonidine (Catapres) is a centrally acting antihypertensive that is a ______ Agonist, that activates _____ neuron, which decreases _______

Alpha2

Inhibitory

Sympathetic outflow

81

Xerostomia, Parotid gland swelling/pain, Dysgeusia:

clonidine (Catapres)

*Centrally acting antihypertensive

82

What class of drug blocks granular uptake and storage of norepinephrine (decreasing sympathetic activity due to lack of neurotransmitter supply)

Catecholamine Release Blockers

83

2 Catecholamine Release Blockers:

reserpine (Serpasil)

guanethidine (Ismelin)

84

Antihypertensive meds react with general anesthetics and CNS depressants by enhancing _______

hypotention

85

Antihypertensive meds have a _____ response to vasoconstricting drugs

potentiated

*this why use epi w/ caution, take BP prior to locals

86

T/F
OTC sympathomimetics (like cold capsules) counteract antihypertensive therapy

True

87

Use of NSAIDS longer than _____ may decrease effectiveness of diuretics, beta blockers, and ACE inhibitors

3 weeks

88

T/F
Nicotine constricts blood vessels and increases BP

True

89

With Antihypertensive meds, prevent sudden changes in _____ with pts.

impregnated gingival retraction cord (vasopressors) is ______

Rebound hypertension develops when agents withdrawn, which happens often in men b/c ____ is severe

posture

contraindicated

impotence

90

Diuretics make you _____ potassium

ACE Inhibitors and ARB's make you ______ potassium

lose

gain (increase)

91

According to published guidelines, what 4 factors should be addressed when managing CV disease?

*HTN, obesity, and cholesterol...

Lifestyle

Obesity

Cholesterol

Risk assessment

92

The Risk Assessment portion of managing DV disease includes what 3 tiers?

Lifestyle changes

Drugs for under 60 140/90, over 60 150/90

Drugs for 160/100 + BP

93

The primary indication for diuretics is _______

(or life threatening edema (loop diuretics) or renal failure (osmotic diuretic - urea))

Hypertension

94

All Hypertension drugs have what 4 side effects?

Xerostomia

Weakness/fatigue

Sexual impotence/libido in men

Fake lichen planus

95

Antihypertensive meds have what drug interactions that are significant in dentistry?

(4 things)

Epinephrine

Vasoconstrictors

General anesthetics/CNS depressants

Prolonged analgesics, sedatives, and tranquilizers (CNS)

96

Use of NSAIDS longer than ____ weeks may decrease effectiveness of some diuretics, beta blockers, and ACEi

3 weeks

97

3 precautions to take during dental procedures when treating Hypertensive pts:

Fainters/Fallers (orthostatic hypotension)

Compliance

NSAID popping - diuretics don't work as well

98

What is the term for pain when the heart becomes Anoxic?

Angina

99

T/F
Angina is an ischemic heart disease, often involving the coronary arteries, and is greater if there is Hx of MI

True

100

Angina can be brought on by triggers, but absent that the pain occurs most often when?

Nighttime

101

Typical angina (exertional) is caused by the _____ arteries causing ischemia

coronary

102

If the demand exceeds available oxygen, then necrosis occurs =

myocardial infarction

103

Typical angina is ______

Atypical angina (variant), aka....

extertional

Prinzmetal's

104

Normally there are Beta2 receptors in coronary arteries, in Prinzmetal's angina there are more _____ receptors

Alpha 1

*causes vasoconstriction w/ epinephrine

105

Variant (Prinzmetal's) angina shows an elevated ______ segment on an EKG that is not present in normal angina

S-T

106

Nitrites and Nitrates work on endothelial cells to produce______ that cause ______ via _______

nitric oxide

***arterial/venous vasodilation

relaxation of all smooth muscle

107

T/F
Nitrates/NItrites produce vasodilation and increase venous return to the heart

False

*decrease venous return

108

Why do NItrates/Nitrites cause headache?

vasodilation is intense and fast

109

Other than headache, what are 5 side effects of Nitrites/Nitrates?

Postural hypotension and syncope

Flush/Rash

tachycardia/increased peripheral resistance (due to sympathetic reflex)

methemoglobin

decrease oxygen carrying in large doses

110

T/F
There is rapid onset to Nitrites/Nitrates and also rapid tolerance, which is why there is usually a 12 hrs on 12 hrs off schedule

True

111

What is the fastest onset Nitrite/Nitrate preparation?

Amyl nitrate snorted

112

Nitroglycerin is considered a "rescue" drug and is often in emergency kits

True

113

Why is nitroglycerine stored in a small brown vial?

Photosensitive

114

T/F
Nitroglycerin is very caustic and leaves a sublingual burn

True

115

What is the longer duration option for nitroglycerin?

Patch (up to 12 hours)

116

Two Nitrites/Nitrates we need to know:

Isosorbide dinitrate (Isordil)

Isosorbide mononitrate (Imdur)

117

Beta blockers decrease cardiac ______, which decreases oxygen demand and decreases Angina

output (afterload)

118

inotropic:

chronotropic:

force

timing

119

T/F
Beta blockers have negative chronotropic and inotropic effects

True

120

Pts with a history of MI will always be taking_______

beta blockers

121

Beta blockers cause vasodilation

False

122

Beta blockers are contraindicated for some forms of congestive heart failure and ________

Variant/Prinzemetal's Angina

123

Why are beta blockers often combined with diuretics?

Prevent sodium retention

124

Cardioselective agents are preferred for insulin-dependent diabetics and _______

Asthmatics

125

What does epinephrine do if the pt is taking a beta blocker?

Won't stimulate the heart

Will vasoconstrict Alpha1 receptors

126

Non-selective Beta blockers enhance what response to epinephrine?

What does this response entail? (2 things)

Pressor

hypertension, reflex bradycardia

127

T/F
It's ok to use epi with cardioselective beta blockers

True

128

T/F
Epinephrine dilates large vessels/muscles

Epinepherine constricts small vessels/muscles

True

129

If a pt is on heart meds, it's most likely a Beta blocker - what 2 things do you ask?

Are you a diabetic?

Asthma?

130

Inotropic effect of Calcium Channel blockers:

Negative

131

Some Ca++ channel blockers cause smooth muscle relaxation (vasodilation) where?

Coronary arteries

132

2 Calcium channel blockers that have a negative inotropic effect:

verapamil

diltiazem

133

Ca++ channel blocker that vasodilates coronary arteries:

amlodipine

134

Calcium channel blocker that vasodilates peripherally:

nifedipine

nicardipine

135

What 2 things to limit in visit from pt on anti-anginals?

Extent of procedures/visit

epinephrine

136

If a pt is on an Antianginal, consider local aneshtetics without _____

vasoconstrictor

137

What are the practical side effects of antiarhythmic drugs?

Arrhythmic manifestations

138

Most Antiarrhythmics prolong _______

others affect the ______ system

Prolong

electrical

139

Cardiac arrhythmias produce abnormalities of the heartbeat and all denote something wrong with the _________ system

They are caused by disease, cardiac injury, or drugs

electrophysiologic

140

Arrhythmias result from abnormal impulse ______, abnormal impulse ______, or a combination of the two

formation

conduction

141

The type of arrhythmia that begins at the nodal level can be Supraventricular, Vetricular, or ______

Ectopic foci (preempt SA/AV node)

142

When the His Purkinje system is cut in half and atria/ventricles work independently it is know as a....

Heart Block

143

Antiarrhythmic medications ____ parts of the heart that are beating abnormally

Depress

144

What are 3 pharmacologic effect of antiarrhythmic medications?

Change slope of depolarization

Raise threshold for depolarization

Alter conduction velocity

145

Antiarrhythmic meds work on one or more of the _____ transmembrane phases of the cardiac cycle

5

146

What are the 3 areas of the heart that have pacemaker activity?

SA node (main)

AV node

Purkinje fibers

147

The spontaneous opening and closing of K+ channels is what drives _______

automaticity

148

Where is Effective Refractory Period longer - pacemaker areas or myocardial cells?

*different arrhythmias require ERP be longer/shorter

Pacemaker areas

149

In what 2 situations would you want to induce an arrhythmia with epi, isoproterenol (beta agonist) or hypokalemic diuretics?

Ventricular arrhythmias due to AV node block

Temporary heart block until pacemaker insertion

150

4 contraindications for Antiarrhythmics

Complete AV heart block

Congestive heart failure

Hypotension

Known hypersensitivity to drug

151

A partial heart block is when the _______ is not in sync

atria/ventricles

152

T/F
Indications for antiarrhythmic drugs are arrhythmia, flutters, fibrillations, tachycardias, ectopic arrhythmia, or digoxin induced arrhythmia

True

153

What are 4 Contraindications to Antiarrhythmics?

Complete AV block

CHF

Hypotension

Known hypersensitivity to drug

154

What are the 4 classes of Antiarrhythmics?

!a, 1b, 1c

2

3

4

155

Class Ia Antiarrhythmics:

(3 drugs, 3 actions)

1a (medium) = quinidine, (***procainamide, Pronestryl), (**disopyramide, Norpace)

blocks Na conduction

Slows ERP

Slows AP

156

Class Ib Antiarrhythmics:

(1 drug, 2 actions)

FAST = lidocaine

blocks Na conduction

Decrease relative refractory period

157

Class Ic Antiarrhythmics:

(2 drugs, 2 actions)

***life threatening ventricular arrhythmias only

Slow = flecainide (Tambocor), propafenone (Rhythmol)

blocks Na conduction

conduction velocity

158

Quinidine can lead to what clinical manifestation?

Cinchonism

*from cinchona tree

159

Class II Antiarrhythmics:

(1 drug, 1 class)

propanolol

beta blockers

160

Class III Antiarrhythmics:

(3 drugs, mechanism)

amiodarone (Cordarone, Pacerone), bretyllium, sotalol

K+ channel blockers

***sotalol (Betapace) is nonselective beta crossover

161

Class IV Antiarrhthmics:

(5 drug, mechanism)

nifedipine, verapamil, diltiazem, adenosine, Digoxin (cardiac glycoside)

Calcium channel blockers

162

Describe cinchonism from quinidine:

nausea, vomiting, headache, TINNITIS

deafness, vertigo, visuals

FATAL arrhythmias

163

What is the site of action of cinchonism (quinidine)?

atrial tissues

164

If a patient is taking antiarrhythmics, what do we NOT give them?

What is ok to give them?

Atropine (may cause tachycardia)

Lidocaine solutions

***not the same lidocaine as anti-arrhythmic med

165

Prinzmetal angina is seen in ______ men most commonly

Japanese

166

Nitrites/Nitrates are _______ vasodilators

direct

167

T/F
CCB's block calcium channels so that calcium trickles more slowly, decreasing the rate and strength of contractions

True

168

What two side effects of taking NItrites/Nitrates is accentuated with alcohol?

Syncope

Postural hypotension

169

What is the fastest acting Nitrite/Nitrate and how long does it last?

What is the second fastest?

Vaporole - (snort) onset 1 minute, lasts 3-15 minutes

Nitroglycerin - onset 1-3 minutes, half life 10 minutes

170

A Transdermal pouch can last up to ___hrs

12

171

What are the 2 long acting nitrates?

(other than transdermal pouch)

Isosorbide dinitrate (4-6 hrs)

Isosorbide mononitrate (1/2 life 4 hrs)

172

procainamide (Pronestyl) is a class Ia antiarrhythmic that has reversible _____ like syndrome in ___% of pts

(nickname: novacaine)

lupus

25%

173

Class Ib antiarrhythmics (lidocaine, phenytoin, mexiletine, tocainide) are are used to treat ______ arrhythmias

ventricular

174

4 class Ib antiarrhythmics:

lidocaine

phenytoin (Dilantin)

mexiletine

tocainide

175

amiodarone (Cordarone, Pacerone) contains iodine causing blue skin and may cause _____ disease

*Class III antiarrhythmic

thyroid

176

Digoxin is a Class IV antiarrhythmic that increases _____ and ______

intracellular Ca

contractility

177

T/F
atropine and isoproteronol treat Bradyarrhythmias

True

178

T/F
Potassium and Magnesium treat Ectopic Pacemakers

True

179

T/F
The vagal blocking effects of anntiarrhythmic drugs (anticholinergics like atropine) can act synergistically to lead to tachycardia

True

180

Congestive heart failure is the inability of the heart to provide the necessary ______

output

181

What do drugs target in CHF?

Reflex sympathetic output

182

T/F
Right sided heart failure will manifest in fatigue and edema while left side will be more acute and result in pulmonary congestion

True

183

T/F
With CHF you want to slow the heart and increase the contractile force

True

184

What is the drug of choice in treatment of CHF?

digoxin (Digitek, Lanoxin)

aka Cardiac Glycosides

185

Digoxin inhibits __________, resulting in more ________ inside the cell.

This has a positive ______ effect

Na/K pump

Ca

inotropic

186

Digoxin has a positive inotropic effect and a negative ______ effect due to directly suppressing ______

chronotropic

AV node

187

Digoxin has 3 mechanisms of action: positive inotropic effect through increased Ca, negative chronotropic effect by suppressing the AV node, and what else?

Diuresis

*pee excessively, decreasing venous return

188

The increased vagal output caused by cardiac glycosides (digoxin) can be blockes by ________

Atropine

189

T/F
Digoxin has a low therapeutic index and can lead to uncoordinated arrhythmias

True

190

Few drugs cause sensory side effects - which causes a green/yellowish aura?

Digoxin

191

T/F
azole antifungals and macrolides like clindamycin and azythromycin could increase digoxin in the system and increase risk for toxicity

True

192

What posture would you not want to put a pt with CHF in?

don't recline fully - hard to breathe

193

T/F
It's ok to do general anesthesia in a dental setting with a pt with CHF

False

*hospital only

194

What are 3 preparations of Bile Acid Sequestrants?

chelestyramine resin

colesevelan

colestipol

195

What decreases liver triacylglycerol synthesis necessary for VLDL production?

(decreases plasma LDL's - used for MILDLY elevated cholesterol)

Nicotinic Acid (Niacin)

196

What is the side effect on Niacin?

facial flushing

197

What lowers plasma triglycerides and increases HDL by inhibiting cholesterol synthesis in the liver?

Fibric Acids

198

What are 3 Fibric Acids?

clofibrate

fenofibrate

gemfibrozil

199

The most popular/effective cholesterol inhibitors:

statins

HMG coA reductase inhibitors

200

HMG CoA reductase is the _____ step in the synthesis of ______

rate limiting

cholesterol

201

When can't you take a statin?

Liver disease

***HMG CoA reductase inhibitors alter liver function

202

What is a side effect of statins?

(HMG CoA reductase inhibitors)

myalgias

****rhabdomyolysis - disintegration of muscle tissue

203

What 2 types of drugs promote myalgias in pts taking statins?

Macrolide antibiotics (erythromycin)

Azole antifungals

204

2 statins are combined with a drug that decreases intestinal absorption (only drug in class), what is the drug, and what are the combos?

ezetimibe

Vytorin - simvastatin + ezetimibe

Liptruzet - atorvastatin + ezetimibe

205

The therapeutic dose for Digoxin is _____% of the toxic dose, which is why every pt needs to be _______

50-60%

Titrated

206

Cardiac glycosides are used for what 3 conditions?

CHF

A-fib

flutter

207

Cardiac glycosides (digoxin) can cause bradycardia/arrhythmia, _____ effects from stimulation of chemoreceptor zones and vagal nucleus (parasymphathetic effects)

*what other parasympathetic effects?

GI

*nausea, vomiting, increased saliation, anorexia, diarrhea, ab pain

208

Other than a Green/Yellow aura, what are 3 other CNS effects of Digoxin?

Headache - edema

fatigue

visual

209

Retraction cords and local anesthetics often have ________, which is contraindicated for pts with CHF

vasoconstrictors

210

T/F
General anesthesia is dangerous for pts with CHF

True

211

Statins should be used in pts with CV disease aged 40-75 and have a ______% or higher risk of having heart attack within 10 years

7.5%

212

T/F
You can't raise HDL without exercise

True

213

T/F
Statins shouldn't be combined with additional cholesterol lowering drugs like niacin or fibrates

True

*don't reduce heart attack/stroke risk

214

DVT =

deep vein thrombosis

215

What are 3 types of acute coronary syndromes caused by blood clots in coronary arteries?

Unstable angina

Non-ST elevated MI (incomplete blockage)

ST elevated MI (complete blockage)

216

T/F
Stroke reduction benefits of antiplatelets improve when used in combo with aspirin

True

217

Aspirin causes _______ platelet aggregation

irreversible

218

T/F
You should discontinue low dose aspirin therapy before dental treatment

False

*Stroke risk greater than bleeding

219

T/F
Discontinuing aspirin use Increases MI and adverse bleedings and has worse clinical outcomes than nonusers

True

220

Antiplatelet drugs used for short and long term stenting have ______ effects on platelets

Irreversible

221

4 antiplatelet drugs

ticlopidine (Ticlid) *canadian

clopidogrel (Plavix)

prasugrel (Effenet)

ticagrelor (Brilinta)

222

Aspirin blocks _____, which blocks ______

COX

Thromboxane A2

223

clopidogrel prevents binding of ____ to collagen receptors thereby preventing platelet aggregation

ADP

224

What is used with aspirin and heparin to treat acute coronary syndromes?

fibrinogen receptor inhibitors

(platelet glycoprotein IIb/IIIa receptor antagonists)

225

3 platelet glycoprotein IIb/IIIa receptor antagonists (Fibrinogen Receptor Inhibitors)

abciximab (ReoPro)

eptifibatide (Integrilin)

tirofiban (Aggrastat)

226

Thienopyridines prevent the binding of _____ to collagen receptors which prevents platelet aggregation.

It requires ____ to form the clot

ADP

Adenosine

227

Percutaneous coronary intervention (stents) combined with antiplatelet therapy has numerous dental advisory guidelines, one being _____ risk of premature discontinuation.

Consult the cardiologist, and defer any procedure with significant bleeding risks until ______

catastrophic

thienopyridine therapy conclusion

228

After a DES is placed, wait ___ months for major intervention

__ months for normal stent

12

1

229

Leading up to a procedure the pt can go off Plavix, but must stay on ______

Aspirin

*restart Plavix right after procedure

**keep pt on 1 antiplatelet

230

Heparin inhibits _____ and ______

produces _____ anticoagulant effect

Factor Xa and IIa thrombin

immediate

231

Warfarin interferes with liver synthesis of ______

produced effect in _____ days

vitamin K dependent clotting factors

4-5

232

Warfarin inhibits what 4 vitamin K dependent clotting factors?

What 2 proteins?

2, 7, 9, 10

C and S

233

6 drugs that alter the efficacy of warfarin:

Phenytoin

Phenobarbital

Any liver metabolism drug

Antibiotics

Vita K (spinach)

Tylenol (enhances coagulation)

234

3 antagonists to Heparin and Warfarin:

Vitamin K

Phenytoin

Phenobarbital

235

NSAIDS cause _____ effects on platelets

reversible

236

Heparin can cause profound bleeding, what is the antidote?

Protamine sulfate

237

T/F
Heparin and Warfarin can be overlapped 1-2 days

True

238

Warfarin has a mandatory blood test every 30 days b/c of low _____ indes

Therapeutic

239

Many things throw off coumadin, _____ being one

diet

*vita K

240

T/F
There is no need to discontinue warfarin use prior to routine dental procedures even though it is associated with increased gingival bleeding and mouth ulcers

True

241

5 tests used to assess the effects of Heparin and Warfarin:

INR

Bleeding time test

PT

aPTT

Intrinsic pathway

242

The International Normalized Ratio (INR) has a therapeutic range of ___ to ____

2-3

243

______ and warfarin significantly enhance anticoagulation

Acetaminophen

244

What causes the greatest number of drug interactions?

Warfarin

245

What is the direct Thrombin inhibitor?

dabigatran (Pradaxa)

*prodrug - converted in vivo to dabigatran

246

T/F
The advantages to dabigatron over warfarin is no monthly monitoring and less expensive

True

247

What is the antidote to dabigatran (Pradaxa)

idarucizumab (Praxbind)

248

Antithrombins drugs (not to be confused with Thrombin inhibitors) are _______ inhibitors

Factor Xa

249

What are 3 Factor Xa inhibitors (antithrombins)

apixaban (Eliquis)

fondaparinux (Arixtra)

rivaroxaban (Xarelto)

250

Hemorhage, no reversal agent, and loss of ____ function are the major risks to Factor Xa inhibitors (antithrombins)

kidney

251

When would Factor Xa inhibitors be used?

(antithrombins)

post op after total hip/knee

prevent stroke

252

Factor Xa inhibitors stop coagulation by preventing _____ mediated effects, including cleavage of fibrinogen to fibrin, and activation of what 4 factors?

thrombin

5, 8, 11, 13

253

2 thrombolytic clot busting drugs:

streptokinast (Streptase)

urokinase

254

What is the antidote for Tissue Plasminogen Activator (tPA)?

this is a clot forming IV drug = Retavase

Epsilon AminoCaproic Acid (Amicar)

*treats hemophilia, cerebral aneurysms

Decks in Tim's Cards Class (140):