heart meds Flashcards
(170 cards)
1
Q
Nitroglycerin MOA
A
Forms free nitric oxide (NO) which activate guanylate cyclase (GC) to increase cGMP resulting in smooth muscle relaxation. Aldehyde dehydrogenase-2 (ALDH2) is the enzyme that releases the NO from organic nitrates. This enzyme can get depleted resulting in “nitrate tolerance” requiring nitrate holiday
2
Q
NG ADR
A
Headache, syncope, hypotension, reflex tachycardia,
methemoglobinemia (increased affinity of hemoglobin for ferric iron versus ferrous iron)
3
Q
NG dental implications
A
Xerostomia- normal salivary flow resumes upon discontinuation
Monitor for orthostatic hypotension
4
Q
Isosorbide mononitrate
(ISMN) (Imdur) MOA
A
Forms free nitric oxide (NO) which activate guanylate cyclase (GC) to increase cGMP resulting in smooth muscle relaxation. Aldehyde dehydrogenase-2 (ALDH2) is the enzyme that releases the NO from organic nitrates. This enzyme can get depleted resulting in “nitrate tolerance” requiring a nitrate holiday.
long acting oral formulation
5
Q
Isosorbide mononitrate ADRs
A
Headache, syncope, hypotension
6
Q
Isosorbide mononitrate dental implications
A
none
7
Q
Isosorbide dinitrate
(ISDN/Isodril) MOA
A
Forms free nitric oxide (NO) which activate guanylate cyclase (GC) to increase cGMP resulting in smooth muscle relaxation. Aldehyde dehydrogenase-2 (ALDH2) is the enzyme that releases the NO from organic nitrates. This enzyme can get depleted resulting in “nitrate tolerance” requiring a nitrate holiday. Intermediate-acting oral formulation
8
Q
Isosorbide dinitrate ADRs
A
Headache, syncope,
hypotension
9
Q
Isosorbide dinitrate dental implications
A
Xerostomia- normal salivary flow resumes
upon discontinuation
10
Q
Sodium Nitroprusside
(Nitropress)
Only available in what form
A
IV form
11
Q
Sodium Nitroprusside
(Nitropress) MOA
A
Direct donates a NO molecule, which activate guanylate cyclase (GC) to increase cGMP resulting in smooth muscle relaxation. Does not require ALDH2.
Does not exhibit tolerance
12
Q
Sodium Nitroprusside
(Nitropress) ADRs
A
Severe hypotension, flushing, reflex tachycardia, methemoglobinemia, thiocyanate toxicity.
Thiocyanate can form in the parenteral fluid due to
exposure to light, product MUST BE PROTECTED form
light. This is more common with higher doses and longer durations of administration
13
Q
Sodium Nitroprusside
(Nitropress) dental implications?
A
none
14
Q
Ranolazine (Ranexa) MOA
A
Inhibition of late inward sodium current (Ina). Does not affect heart rate or blood pressure
15
Q
Ranolazine (Ranexa) ADRs
A
QT prolongation, torsade de pointes, bradycardia,
hypotension, xerostomia
Usually does not affect hemodynamic parameters
16
Q
Ranolazine (Ranexa) dental implications
A
Xerostomia- normal salivary flow resumes
upon discontinuation
17
Q
Ivabradine (Corlanor) approval in US?
A
Not approved for angina in the United
States- only approved for HF
18
Q
Ivabradine (Corlanor) MOA
A
Inhibited the If (funny) channel in the SA node resulting in a reduction in heart rate, without a change in blood pressure
19
Q
Ivabradine (Corlanor) ADRs
A
Bradycardia, atrial fibrillation, phosphenes
20
Q
Ivabradine (Corlanor) dental implications
A
none
21
Q
b1 selective blockers
A
acebutolol
esmolol
atenolol
betaxolol
metopolol
nebivolol
22
Q
Acebutolol (Sectral) MOA
exhibits what activity?
A
Competitively blocks β1 adrenergic receptors with little
to no effect on β2 adrenergic receptors.
Exhibits intrinsic sympathomimetic activity
23
Q
Acebutolol (Sectral) ADRs
A
Bradycardia, hypotension, dizziness
24
Q
B1 specific blockers dental implications
A
Cardio selective beta-blockers do not interact with local anesthetics.
NSAIDs can reduce antihypertensive effects of beta-blockers. Short-term use of NSAIDs (i.e. 3 days) is safe
25
Atenolol
(Tenormin) MOA
Competitively blocks β1
adrenergic receptors with little
to no effect on β2 adrenergic
receptors
26
atenolol ADRs
Bradycardia,
hypotension,
dizziness,
AV node block,
fatigue,
Raynaud’s phenomenon,
impotence
27
betaxolol MOA
Competitively blocks β1
adrenergic receptors with little
to no effect on β2 adrenergic
receptors
28
betaxolol ADRs
Bradycardia, hypotension, dizziness, AV node block, fatigue, impotence
29
Esmolol (Brevibloc)
Only available as?
Only available IV:
Short acting (t1/2= 5 mins
30
esmolol MOA
Competitively blocks β1
adrenergic receptors with little
to no effect on β2 adrenergic
receptors
31
esmolol ADRs
Hypotension, bradycardia,
infusion site reaction
32
metoprolol forms
(Lopressor)- immediate release
(Toprol XL)- extended release
33
metoprolol MOA
Competitively blocks β1
adrenergic receptors with little
to no effect on β2 adrenergic
receptors at doses < 100mg
daily
34
metoprolol ADRs
Bradycardia,
hypotension,
dizziness,
AV node block,
fatigue,
impotence
35
Nebivolol (Bystolic) MOA
also produces what effect?
Competitively blocks β1 adrenergic receptors with little to no effect on β2 adrenergic receptors.
**Also produces nitric oxide dependent vasodilation **
36
nebivolol ADRs
Bradycardia, hypotension,
dizziness, fatigue,
impotence
37
non selective B blockers
carteolol
penbutolol
pindol
propranolol
timolol
38
Carteolol
(Ocupress) only formulation
opthalmalic
39
carteolol MOA
Blocks both β1 and β2 adrenergic
receptors. Reduces intraocular
pressure
40
carteolol ADRs
Conjunctival hyperemia
(no systemic ADRs noted)
41
carteolol dental implications
none
42
Penbutolol
(Levatol) MOA
Blocks both β1 and β2 adrenergic receptors.
**Exhibits mild intrinsic sympathomimetic activity
43
penbutolol ADRs
Bradycardia,
hypotension,
fatigue,
dizziness,
impotence
44
penbutolol dental implcations
Xerostomia- normal salivary flow resumes upon discontinuation
Non-selective beta blockers may enhance the pressor response to epinephrine resulting in hypertension and bradycardia.
NSAIDs can reduce antihypertensive effects of beta-blockers. Short-term use of NSAIDs (i.e. 3 days) is safe.
45
pindolol MOA
Blocks both β1 and β2 adrenergic receptors.
**Exhibits mild intrinsic sympathomimetic activity **
46
pindolol ADRs
Bradycardia,
hypotension,
fatigue,
dizziness,
impotence
47
pindolol dental implications
Non-selective beta blockers may enhance the pressor response to epinephrine resulting in hypertension and bradycardia.
NSAIDs can reduce antihypertensive effects of beta blockers. Short-term use of NSAIDs (i.e. 3 days) is safe
48
Propranolol (Inderal LA)/ (Hemangeol) MOA
can work where else? how?
Blocks both β1 and β2 adrenergic receptor
Reduce portal pressure by producing splanchnic vasoconstriction
49
propranolol ADRs
Bradycardia,
hypotension,
fatigue,
dizziness,
impotence
50
propranolol dental implications
Non-selective beta blockers may enhance the pressor response to epinephrine resulting in hypertension and bradycardia.
NSAIDs can reduce the antihypertensive effects of beta-blockers. Short-term use of NSAIDs (i.e. 3 days)
is safe
51
timolol formulations
(Timoptic)- ophthalmic formulation
(Betimol)
52
timolol MOA
Blocks both β1 and β2 adrenergic
receptors.
Reduces intraocular pressure
53
timolol ADRs
Ophthalmic- burning eyes
Bradycardia,
hypotension,
fatigue,
dizziness,
impotence
54
timolol dental implications
Xerostomia- normal salivary flow resumes upon discontinuation
Non-selective beta blockers may enhance the pressor response to epinephrine resulting in hypertension and bradycardia
55
carvediolol formulations
(Coreg)- immediate release
(Coreg CR)- extended release
56
carvediolol MOA
Blocks both β1 and β2 adrenergic receptors.
Also blocks α1 adrenergic receptors.
57
Non-selective beta blockade with alpha blocking (β1 = β2 ≥ α1 > α2)
carvediolol and labetolol
58
carvediolol ADRs
Bradycardia,
hypotension,
fatigue,
dizziness,
impotence
59
carvediolol dental implications
Orthostatic hypotension, use caution when changing position.
NSAIDs can reduce antihypertensive effects of beta-blockers. Short-term use of NSAIDs (i.e. 3 days) is safe
60
Labetalol
(Trandate) MOA
Blocks both β1 and β2 adrenergic receptors.
Also blocks α1 adrenergic receptors.
The ratio of alpha to beta blockade is 1:3 following
oral administration
61
labetalol ADRs
Bradycardia,
hypotension,
fatigue,
dizziness,
impotence
62
labetalol dental implications
Taste disorder
NSAIDs can reduce antihypertensive effects of beta-blockers. Short-term use of NSAIDs (i.e. 3 days) is safe
63
Dihydropyridine Rx's
all end in -pine
64
Amlodipine (Norvasc) MOA
Inhibits calcium ions influx through L-type or “slow”
calcium channels”
Selective for vascular smooth muscle
**same as all -pine Rx**
65
amlodipine ADRs
Reflex tachycardia, flushing, hypotension,
peripheral edema, gingival hyperplasia
66
Dihydropyridine Rx's dental implications
Monitor of gingival
hyperplasia, usually
resolves upon
discontinuation
67
Clevidipine
(Cleviprex)
Only available as?
IV form
68
clevidipine MOA
Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle
69
clevidipine ADrs
Reflex tachycardia,
flushing,
hypotension,
peripheral edema
**Gingival hyperplasia not reported probably due to shorter duration of administration**
70
felidipine MOA
Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle
71
felodipine ADRs
Reflex tachycardia,
flushing,
hypotension,
peripheral edema,
gingival hyperplasia
72
Isradipine
(DynaCirc CR) MOA
Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle
73
isradipine ADRs
Reflex tachycardia,
flushing,
hypotension,
peripheral edema
Information is sparse as to whether isradipine causes
gingival hyperplasia
74
Nicardipine
(Cardene)
Available in?
PO and IV
formulations
75
nicardipine MOA
Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle
76
nicardipine ADRs
Reflex tachycardia,
flushing,
hypotension,
peripheral edema,
gingival hyperplasia
77
nicardipine dental implications
Xerostomia (normal salivary flow resumes upon discontinuation)
Monitor of gingival hyperplasia, usually resolves upon discontinuation
78
Nifedipine MOA
Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle
79
nifedipine ADRs
Reflex tachycardia,
flushing,
hypotension,
peripheral edema,
gingival hyperplasi
80
nifedipine ADR
Gingival hyperplasia (10%
incidence with doses of
30-100mg/day). Effects
present after 1-9 months
of treatment. Usually
resolves upon
discontinuation
81
nimodipine MOA
Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle
82
nimodipine ADR
Reflex tachycardia,
flushing,
hypotension,
peripheral edema
No reports of gingival hyperplasia with nimodipine
83
nimodipine dental implications
Possibly gingival
hyperplasia- although no
known cases
84
nisoldipine MOA
nhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle
85
nisoldipine ADRs
Reflex tachycardia,
flushing,
hypotension,
peripheral edema
Information is sparse as to whether nisoldipine causes
gingival hyperplasi
86
nisoldipine dental
Xerostomia (normal salivary flow resumes upon discontinuation)
Possibly gingival hyperplasia- information is sparse
87
Non-Dihydropyridine Rx
selective for myocardium
Diltiazem and vermapril
88
Diltiazem MOA
inhibits calcium ions influx through L-type or “slow” calcium channels”
Selective for myocardial calcium channels
Slows impulse conduction through the AV node
89
diltiazem ADRs
Constipation,
dizziness,
lightheadedness,
hypotension,
bradycardia,
gingival hyperplasia
90
diltiazem dental
gingival hyperplasia
usually resolves
upon discontinuation
91
Verapamil MOA
where are impulses slowed in the cardiac conduction?
inhibits calcium ions influx through L-type or “slow”
calcium channels”
Selective for myocardial calcium channels
Slows impulse conduction through the AV node
92
verapamil ADRs
Constipation,
dizziness,
lightheadedness,
hypotension,
bradycardia,
gingival hyperplasia
93
verapamil dental
gingival hyper
94
class Ia anti-arrhytmatics
moderate sodium channel blockers
95
Quinidine MOA
moderate na channel block
96
quinidine ADRs
abdominal pain and cramps, nausea, vomiting, diarrhea
Cinchonsim- “overdose” (symptoms include: ringing in ears, blurred vision, hearing loss)
Cardiac- QT prolongation
97
quinidine dental
May consider semisupine
chair position to minimize
GI distress if occurs
98
procainamide MOA
moderate Na blocker
99
procainamide ADRs
Lupus-like syndrome
Skin rash
QT prolongation
100
procainamide dental
dysguesia
101
dysopyramide MOA
moderate na blocker
102
dysopyramide ADRs
Anticholinergic-Dry mouth, constipation, urinary hesitancy
Cardiac- QT prolongation
103
dysopryamide dental
xerostomia- done with discontinuation
104
class Ib agents
weak na blockers
lidocaine
tocanide
mexilitine
phenytoin
105
lidocaine mech
weak na block
106
lido ADRS
Neuro- Agitation, anxiety, hallucinations, seizures
(toxic)
Bradycardia
107
lido dental
metalic taste
108
tocainide MOA
weak na block
109
mexilitine MOA
weak na block
110
mexilitine ADRs
GI- nausea, vomiting, heartburn
Neuro- dizziness, light-headedness, tremors, convulsion (toxic
111
mexitiline dental
Xerostomia- normal salivary flow resumes upon discontinuation
112
phenytoin MOA
weak na blocker
113
phenytoin ADRs
Ataxia, cardiovascular side
effects with IV
administration
114
phenytoin dental
Gingival hyperplasia is
common during the first 6
months of treatment
115
class Ic
strong na block
moricizine
flecainide
propafenone
116
moricizine moa
strong na block
117
flecainidea moa
strong na block
118
flecainide ADRs
Dizziness and visual disturbances
119
flecainide dental;
none
120
Propafenone moa
strong na block
121
propafenone ADRs
Unusual taste (3-23%)
Nausea/vomiting
Blurred vision (1-6%)
Dizziness
122
propafenone dental
unusual taste, also xerostomia a possibility
123
class III antiarrhytmatics
amiodarone
donfetilide
dronedarone
ibutilide
satalol
| K channel block
124
amiodarone moa
K+ channel blocker
Also blocks Na+ and Ca2+
channels, B receptors
125
amiodarone adrs
eyes- blurred vision
Lungs- pulmonary fibrosis
Heart- hypotension (IV formulation)
Thyroid-hypo/hyperthyroidism
Liver- elevated LFTs
GI- nausea and vomiting
Skin-photosensitivity/blue skin
126
amiodarone denta;l
abnormal salivation and taste
127
donfetilide moa
k channel blocker
128
donfetilide adr
QT prolongation/Torsades de pointes
Minimal other ADRs
129
dronedarone moa
K+ channel blocker
Also blocks Na+ and Ca2+
channels, B receptors
Similar to Amiodarone
130
dronedarone adr
QT prolongation/Torsades de pointes
Elevations in serum creatinine
Acute hepatic failure inpost-marketing
131
ibutilide moa
k channel block
132
ibutilide adr
QT prolongation/Torsades
de pointes
133
salatol moa
K+ channel blocker
Also blocks both β1 and β2
adrenergic receptors
134
salatol adr
QT prolongation/Torsades de pointes
Bradycardia, hypotension, fatigue, dizziness
135
salatol dental
Related to beta blocking activity.
Non-selective beta blockers may enhance the pressor response to epinephrine resulting in hypertension and bradycardia
NSAIDs can reduce antihypertensive effects of beta-blockers. Short-term use of NSAIDs (i.e. 3 days) is safe.
136
positive ionotropic meds
digoxin
dobutamine
milrinone
levosemnderin
137
digoxin moa for HF and SV arrhythmias
**Heart failure**: inhibition of the sodium/potassium ATPase pump in myocardial cells resulting in an increase of intracellular sodium which promotes calcium influx via the sodium-calcium exchange pump
leading to increased contractility
**Supraventricular arrhythmias**: direct suppression of the AV node conduction to increase effective refractory period and decrease conduction velocity
138
digoxin adr
nausea, vomiting, diarrhea, bradycardia, heart block, visual disturbances
139
digoxin dental
increased gag reflex may make dental procedures, such as taking radiographs or impressions difficult
Avoid dental light in patient’s eye/offer dark glasses
140
dobutamine moa
Stimulates myocardial B1-adrenergic receptor. Results in increased contractily
141
dobutamine adr
increased heart rate and blood pressure,
arrhythmias, chest pain, localized phlebitis
142
milrinone moa
Selective phosphodiesterase -3
inhibitor (PDE3) in cardiac and
vascular tissue, resulting in
vasodilation and increased
contractility
143
milrinone adr
Decreased blood pressure,
arrhythmias, chest pain
144
levosimendan moa
Sensitize troponin to Ca2+
(inotropy) and KATP channel
activation in smooth muscle
(vasodilation
145
levosimendan uses
none, not available here
146
what adrs can we see with all nitrates
headache, syncope, hypotension
147
which nitrates can cause methemoglob
NG and Na nitroprusside
148
which nitrate can cause thioocyante toxicity
Na nitroprusside
149
which nitrates can cause xero
NG, iso dinitrate, ranolazine
150
which Rx can cause phosphenes
ivabradine
151
common adrs of all b blocks
hypo, dizzy, fatique
152
which b block can cause raynauds
atenolol
153
which b blockers can cause AV block
atenolol, betaxolol, metoprolol
154
which b blockers do not cause impotence?
acebutolol, esmolol, carteolol
155
which b blockers can cause xero
penbutolol, timolol
156
which b blocker can cause taste disorder?
labetalol
157
which b blocker can cause NO dependent vasodialtion
nebivolol
158
which b blocker exhibit mild intrinsic sympathomeitic activity
penbutolol, pindolol
159
which b blocker reduces portal pressure
propranolol, causes splanchnic vasoconstriction
160
dihydropyradine common adrs
reflex tachy, flushing, hypo, edema, ging hyper (usually)
161
which dihydropyradines may not have ging hyper
clevidipine, isradipine, nimodipine, nislodipine
162
which dihydropyradines may cause xero
nicardipine and nislodipine
163
what are the common adrs of non-dihydropyradines
constipation, lightheaded, dizzy, hypoten, bradycardia, ging hyper
164
which Rx may increase gag
digoxin
165
what rx should you avoid light in eyes
dogoxin and amiodarone
166
which class 3 drugs also block other channels/receptors
amiodarone and dronedarone
167
which class 3 drugs can cause QT prolong and TdP?
donfetilide, dronedarone, ibutilide, sotalol
168
which Rx can cause acute hepatic failure
dronedarone
169
which class I agents may alter taste
procainamide
lidocaine
propafenone
170
which class I Rx's may cause xero?
disopyramide, mexilitine, propafenone
