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Pharm Final > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

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1
Q

Blood pressure that is contraindicated for dental tx is

A

Severe >180/110

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2
Q

At rest the normal heart rate is

A

50-100 bpm

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3
Q

Arrhythmias can be caused by

A

Diseased parts of the heart that can produce abnormal conduction pathways

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4
Q

Arrythmias can lead to thrombus formation and stroke so these are given

A

Anticoagulants

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5
Q

Automaticity is

A

The intrinsic rhythm of cardiac muscle cells

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6
Q

The most common arrythmia is

A

Atrial fibrillation

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7
Q

Atrial affects this many canadian

A

350,000

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8
Q

Symptoms of atrial fibrillation are

A

Irregular/fast heartbeat, heart palpitations, shortness of breath, chest discomfort, fatigue, dizziness, sweating, nausea, light-headed, fainting

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9
Q

Ischemic heart disease occurs when

A

Arteries do not supple enough oxygen to the myocardium due to atherosclerotic plaque

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10
Q

Cardiac symptom of ischemic heart disease

A

Angina or chest pain

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11
Q

Risk factors for ischemic heart disease are

A

Smoking, diabetes, lifestyle choices

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12
Q

Dental tx Contraindication of ischemic heart disease are

A

Unstable or progressive angina

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13
Q

This may be considered before treatment for those which ischemic heart disease

A

Prophylactic antibiotics

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14
Q

Heart failure is the

A

Inability to pump sufficient blood to meet metabolic needs of the body

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15
Q

The heart become ineffective in HF because

A

Blood accumulates in the failing ventricles, the ventricles enlarge

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16
Q

What is the difference between left side and right right side heart failure

A

Left: backs into pulmonary circulation leading to edema, dyspnea, and orthopnea
Right: causes systemic congestion leading to peripheral edema with fluid accumulation evidenced by pitting edema (pedal edema)

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17
Q

Common causes of HF are

A

Coronary artery disease and uncontrolled hypertension

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18
Q

Symptoms of HF are

A

Dyspnea, fatigue, and fluid retention

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19
Q

Medications for heart failure are for

A

The slowing of disease progression as there is no cure

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20
Q

Contraindication to those with HF during dental tx are

A

Symptomatic or decompensated heart failure

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21
Q

Considerations to those with heart failure during dental tx

A

They have difficulty lying flat, NSAIDs should be avoided, short stress free appts

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22
Q

Cardiovascular drugs are (9)

A

Beta blockers, calcium channel blockers, ACE inhibitors, Angiotensin Receptor Blockers (ARBs), Nitrates, Digoxin, Diuretics, Anti-platelets, anticoagulants

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23
Q

Beta blockers decrease

A

Heart rate and blood pressure

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24
Q

Uses of beta blockers

A

Hypertension, ischemic heart disease, heart attack, HF and arrythmias

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25
Beta blockers MoA
Block beta adrenergic receptors
26
in which receptors do beta 1 blockers block? Beta 2?
Myocardium. Lungs
27
Beta blocker meds ends in
-olol
28
There are two types of beta blockers
Selective and non selective
29
Selective beta blockers are? And the medications are?
Beta 1. Metoprolol, atenolol, bisoprolol, esmolol
30
Non selective beta blockers are? And the meds are?
Beta 1 and 2 - propranolol, sotalol, madolol | Beta 1 or 2 and alpha 1 - carvedilol and labetolol
31
The blocking of these receptors are stronger beta blockers.
The alpha receptors (under the non-selective subgroup)
32
The most common AAD (oral and IV)
AMIODARONE
33
Used to treat supraventricular and ventricular arrythmias
AMIODARONE
34
Possible oral adverse side effects of amiodarone are
Abnormal salivation and taste
35
When utilizing vasoconstrictor with amiodarone consider
Consult with MD before use
36
Toxic side effects of amiodarone are
Pulmonary fibrosis, liver toxicity, photosensitivity, thyroid dysfunction
37
Contraindications of beta blockers are
- heart rate <60 bpm (<50 absolute - systolic BP <100mmHg (relative) - moderate of severe LV failure (acute) - signs of peripheral hypoperfusion shock - PR interval >0.24 seconds (relative) - 2nd or 3rd degree AV block without fxning pacemaker - severe COPD/ asthma - severe PAD with Claudication
38
Adverse effects of Beta blockers
Fatigue, cold extremities, worsen depression, sleep disturbances, impotence Can mask symptoms of hypoglycemia Increase triglycerides Abrupt withdrawal symptoms may cause rebound hypertension, exacerbate angina, induce arrthymia, precipitate MI Lichenoid reactions and ortho hypotension
39
Consideration when using beta blockers and vasoconstriction (non selective vs cardioselective)
Non selective beta blockers with epi causing hypertension and reflex bradycardia = use with caution Selective = use vasoconstrictors normally
40
Calcium channel blockers MoA
Inhibits movement of extracellular calcium ions into cells
41
Calcium channel blockers produce and reverse
Vasodilation. Vasospasms
42
Systemic vasodilation reduces
After load on the hear and reduces the total peripheral resistance which lowers blood pressure
43
Decreasing myocardial contractility also
Decreases cardiac output
44
Different type of calcium channel blockers
Diphenylakylamines, benzothiazepines, dihydropyridines
45
Diphenhydramines are also known as
Verapamil
46
Benzothiazepines also known as
Diltiazem
47
Dihydropyridines also known
Nifedipine, amlodipine, felodipine
48
The least selective of any Ca channel blocker
diphenhydramine (verapamil)
49
A ca channel blocker for SVT and angina
Diphenhydramine (Verapamil)
50
Benzothiazepines (diltiazem) effects are
Cardiovascular and cardiac effects
51
These Ca Channel blockers have negative inotropic effect
Diphenylakylamines (verapamil) and benzothiazepines (diltiazem) - less that the first
52
Diphenylakylamines decreases BP but also
Migraines
53
Dihydropyridines (nifedipine, amlodipine, felodipine) effects are
Minimum effect on cardiac contractility, HR and CO but major effects on vasculature
54
Adverse effects of Ca channel blockers are
Dizziness, headache, fatigue, constipation, hypotension, bradycardia, and edema, flushing
55
Calcium channel blockers are used for treatment of
Ischemic heart disease (angina), hypotension, arrythmias
56
Calcium channel blockers dental implications are
Gingival enlargement, additional OHI and frequent hygiene appts
57
ACE inhibitors affects this system and it adjusts
Renin-angiotensin-aldosterone system. Adjusts the quantity of Na and H2O retained in the peripheral resistance (blood vessels)
58
Renin is released by the kidney when
It senses a decrease in BP or flow
59
Renin catalyze
The conversion of angiotensin to angiotensin 1
60
ACE converts.
Angiotensin 1 to 2
61
ACEIs block the enzyme
ACE
62
Angiotensin 2 produces ________ and the adrenal cortex is stimulated to release ______ which facilitates ________. Therefore blocking these events cause _________
Vasoconstriction, aldosterone, lower BP
63
ACEI stand for
Angiotensin conversion enzyme inhibitors
64
ACEIs meds end in
-Pril (perindropril - conversely, ramipril - Altace)
65
Adverse effects of ACE inhibitors are
Dry hacking cough, change in taste, andioedema of lip, face, or tongue, OH, burning mouth, lichenoid reactions
66
What are ARBs
Agiotensin Receptor Blockers
67
ARBs are used when
Patients are intolerant to ACE inhibitors
68
Where do ARBs attach
Angiotensin 2 receptor
69
ARBs end in
-tan
70
Losartan (Cozaar) is an ARB that has a high affinity and selectivity to which receptor
AT1
71
The affinity of losartan (Cozaar) has these effects on renin levels
An increase in renin
72
Adverse effects of ARBs
Fewer adverse rxns, OH, upper resp infections, diarrhea, muscle cramps (led and back pain), angioedema, teratogenicity(!)
73
Nitrates are used for
Prophylaxis and tx of angina
74
Nitrates dilates.
Coronary arteries
75
nitrates interact with these drugs
PDE5
76
Short acting nitrates and long acting nitrates are
Spray/tablets. | Patches with isosorbide dinitrate tablets
77
Adverse reactions of nitrates are
Dry mouth, OH, headache
78
How many doses of SL NTG and intervals for someone with an angina attack
3 tabs or doses of spray, 5 minutes apart.
79
When should the patient with an angina attack be taken to the emergency room
After three doses
80
digoxin is used for
Atrial fibrillation and HF
81
Digoxin MoA
Increases force and strength of contraction of the myocardium = positive inotropic effect
82
Digoxin effects
Automaticity, conduction velocity, and refectory periods of different parts of the heart in different ways
83
Digoxin directly suppresses __________ which increases _________ and decreases __________ leading to a decreased
AV node conduction, effective refractory period, conduction velocity, ventricular rate
84
Adverse effects of digoxin
Narrow therapeutic effects - can trigger toxic symptoms with slight change in dose increased gag reflex, anorexia, nausea, vomiting, copious salivation Arrythmias
85
Dental management of those who use digoxin
Watch for signs of OD, copious salivation, epi with caution, monitor for bradycardia
86
These medications increase digoxin levels
Erythromycin and tetracycline
87
The two types of diuretics are
Thiazides and loop diuretics
88
Loop diuretics vs. Thiazides
Thiazides: inhibit Na an Cl reabsorption in the distal tubule Loop diuretics: inhibits Cl reabsorption in thick ascending loop of Henle, high K+ loss in urine
89
Where are thiazides and loop diuretics used
T: hypertension LD: diuresis in HF
90
Adverse effects of diuretics
Dry mouth and OH
91
What are the different antiplatelets (4)
ASA/ aspirin, Clopidogrel (Plavix), Ticagrelor(Brilinta), Prasugrel (Effient)
92
How does ASA/aspirin work?
Antiplatelet: irreversibly inhibits COX-1, prevents formation of thromoxane 2 (induce plt aggregation)
93
Clopidogrel works by
Irreversible binding to ADP P2Y receptor in the plt surface
94
Ticagrelor works by
REVERSIBLY bind to ADP P2Y receptor on plt surface
95
Prasugrel works by
Irreversibly binding to ADP P2Y receptor in plt surface (same as Clopidogrel
96
Prasugrel is used
Post MI, PTCA (percutaneous transluminal coronary angioplasty) CABG (coronary artery bypass graft)
97
Anticoagulants are
Vitamin K agonists - which interferes with synthesis of Vit K dependent clotting factors (II, VII, IX, X)
98
Warfarin (coumadin) is
An anticoagulant
99
Management of those on anticoagulants
Bleeding time is prolonged, numerous drug interactions(abs), analgesics: aspirin is contraindicated unless taking 1 daily for anticoagulant effect
100
INR before dental work should be for a normal person Those on warfarin: Mechanical valve
<3.5 2-3 2.5-3.5
101
Dental implications of CVD
Contraindications, vasoconstrictor limits, cardiac pacemakers, perio and CVD, adverse effects of CV drugs
102
These CV drugs cause xerostomia
Beta blockers, Ca channel blockers and diuretics
103
These drugs cause gingival hyperplasia
Ca channel blockers
104
These drugs cause taste disturbance s
Ca channel blockers and ACE inhibitors
105
Angioedema is caused by these drugs
ACE inhibitors and ARBs (less likely)
106
Contraindications for dental tx
``` Uncontrolled bp (>180/110) MI within the past 6 months Unstable or progressive angina Uncontrolled/symptomatic HF Uncontrolled arrythmias ```
107
The cardiac limit dose of epi for severely affected patients (non-cardioselective beta blockers)
0.04mg

Pharm Final (12 decks)

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