Cardiovascular Drugs Flashcards
(50 cards)
What drugs are used to prevent further CV disease
Anti platelet drugs Statins Anti-arrhythmics Anticoagulants Diuretics Ace-inhibitors Beta-Adrenergic Blockers
What drugs are used to reduce symptoms of current CV disease
Diuretics
Anti-arrhythmics
Nitrates
Calcium channel blockers
Give examples of anti platelet drugs
Aspirin
Clopidogrel
Dipyridamole
What is the function of Aspirin
Inhibits platelet aggregation, alters balance between Throboxane A2 and Prostacyclin
What is the function of Clopidogrel
Inhibits ADP induced platelet aggregation
What is the function of Dipyridamole
Inhibits platelet phosphodiesterase
What are other functions of anti platelets
Significantly reduce the chance of heart attack and stroke in the at risk population
Prolong the bleeding time following dental extraction
Give examples of new antiplatelet drugs and when are they used
Prasugrel, Ticagrelor
Only used in conjunction with aspirin
Only licensed for ACS
Give examples of oral anticoagulants
Warfarin Rivaroxiban Apixaban Dabigatran Edoxaban
Describe how oral anticoagulants work
By reducing the activation of the clotting cascade, they reduce the amount of fibrin formed and therefore clot stability
Once platelet has formed it will not stabilise properly as fibrin will not be deposited on the surface
Describe the bleeding pattern with oral anticoagulants
Typical bleeding pattern is to stop bleeding as normal but bleeding will continue after a few hours
Does not affect bleeding time
Describe how warfarin works
Inhibits synthesis of vitamin K dependent clotting factors
Factor 2,7,9,10 slow over 2 days as the supplies stored from liver are still in circulation
Immediate effect on protein C and S as it inhibits their function - they will not inhibit the inhibition of clotting
What is the outcome of using warfarin
Produces hypercoagulation then over a few days, as clotting factors are consumed and no replacements are made, patient will becomes anticoagulated
How can warfarin be used for an immediate coagulation effect
In combination with heparin
What type of drug is warfarin
Coumarin based anticoagulant
How long until warfarin loses its effect
Once stabilised will take 2-3 days to lose effect if drug is stopped
Why must warfarin be monitored regularly
Heavily bound to plasma proteins and metabolised in the liver so other medications can interfere with the warfarin action and change the degree of coagulation
What is INR
International Normalised Ratio
A ratio of healthy volunteers prothrombin time (time to convert prothrombin to thrombin) measured against the patient
What is a therapeutic INR range and how does it affect dental care
2-4
If within the range - no attention needed for dental care
If out of range - refer for medical advice
What should be given to patients on warfarin during dental treatment
Apply measures to area of surgery to help with bleeding - fibrinogen activator, suture or LA with a vasoconstrictor which will slow blood flow through the area
What drugs should be avoided in dental care if a patient is on warfarin
Avoid analgesics
Give examples of NOACs as well as how often they should be taken and what they inhibit
Rivaroxaban - once daily (aXi)
Apixaban - twice daily (aXi)
Dabigatran - twice daily (dTi)
Edoxaban - once daily (aXi)
Describe the properties of NOACs
Do not require monitoring and have predictable bioavailability so amount of drug absorbed and metabolised each day is the same and other drugs rarely interfere with their action
Short half live so their effect is rapidly lost
Give examples of beta-adrenergic blockers and what receptors do they act on
Atenolol - selective - B1 only
Propranolol - non selective - B1 and B2
Many others ending in -olol
