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PHARM > vascular system rx > Flashcards

vascular system rx Flashcards

1
Q

pul HTN med classes

A

endothelin receptor antag
PDE5 inhibitors
prostacyclin analogues
Soluble guanylate cyclase stimulator
Prostacyclin receptor agonist

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2
Q

Endothelin receptor antagonists names

A

Ambrisentan
Bosentan
Macitentan
all available as PO form

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3
Q

Endothelin receptor antagonists MOA

A

Block the ETA and ETB receptors- but have a high affinity for ETA

Ambrisentan
Bosentan
Macitentan

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4
Q

ADRs of ERA’s

A

Peripheral Edema
Headache
Dyspepsia
Flushing
Liver dysfunction (more common with bosentan)

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5
Q

dental implacation of ERA’s

A

gum bleeding

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6
Q

PDE5 inhibitor names

available as?

A

Sildenafil
Tadalafil
Available: PO

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7
Q

PDE5 inhibitors MOA

A

Inhibits action of phosphodiesterase 5 (PDE5), increasing intracellular cGMP concentrations, lowering
the intracellular Ca++ concentrations, resulting in vascular smooth muscle relaxation

Sildenafil
Tadalafil

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8
Q

PDE5 inhibitors ADRs

A

Flushing
Headache
Dyspepsia
Skin rash

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9
Q

PDE5 inhibitors dental

A

Avoid nitrate use

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10
Q

Prostacyclin analogue names

and forms

A

Epoprostenol: Available: IV
Iloprost: Available: Inhalation (Inh)
Treprostinil: Available: PO, Inh, IV, and SQ

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11
Q

prostacyclin analogues MOA

A

Binds to prostacyclin receptor (IP), stimulate
activity of adenylate cyclase (AC), increases intracellular cyclic AMP levels, lowering the intracellular Ca++ concentration, resulting in vascular smooth muscle relaxation

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12
Q

prostacyclin analogues ADRs

A

Jaw Pain (dose limiting)
Platelet inhibition (increased bleeding)
Headache
Flushing
Hypotension
Infusion site pain

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13
Q

prostacyclin analogue dental

A

Increased risk of bleeding due to platelet inhibition
Jaw pain (dose related ADR)

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14
Q

Soluble guanylate cyclase stimulator
name and form?

A

Riociguat
Available: PO

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15
Q

Soluble guanylate cyclase stimulator moa

A

Sensitizes guanylyl cyclase to nitric oxide but also
directly activates guanylyl cyclase, increasing intracellular cGMP concentration, lowering the intracellular Ca++ concentration, resulting in vascular smooth muscle relaxation

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16
Q

Soluble guanylate cyclase stimulator ADRs

A

Hypotension
Dyspepsia
Headache
Edema

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17
Q

Soluble guanylate cyclase stimulator dental

A

Increased risk of bleeding=
Risk of unanticipated bleeding during procedure

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18
Q

prostacyclin receptor agonist name/form

A

Selexipag
Available: PO

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19
Q

Prostacyclin receptor agonist moa, name?

A

Selective IP receptor agonist, stimulate activity of adenylate cyclase (AC), increases intracellular cyclic AMP levels, lowering the intracellular Ca++ concentration, resulting in vascular smooth muscle relaxation

Selexipag

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20
Q

Prostacyclin receptor agonist ADRs

A

Jaw pain
Flushing
Headache
Skin rash
Diarrhea

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21
Q

prostacyclin receptor agonist dental

A

Jaw pain (~1 in 4 patients)

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22
Q

Direct Acting Vasodilators names/ forms?

A

Minoxidil (PO)
Sodium Nitroprusside (IV only)
Hydralazine (IV and PO)

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23
Q

Minoxidil MOA

A

Causes smooth muscle relaxation by opening KATP channels. Primary effects on arteriolar smooth muscle,
with little to no effects on veins.

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24
Q

Minoxidil ADRs

A

Hair Growth
Edema
Photosensitivity (rare)
Hypotension

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25
Q

Minoxidil dental

A

ortho hypo

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26
Q

Na nitroprusside 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

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27
Q

Na nitroprusside 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.

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28
Q

Hydralazine MOA

A

Direct acting vasodilator thru interference with action of IP3 on calcium release from sarcoplasmic reticulum.
Primary effects on arteriolar smooth muscle, with little to no effects on veins

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29
Q

Hydralazine ADRs

A

Hypotension
Headache
Palpitations
GI disturbances
Facial flushing (rare)

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30
Q

Hydralazine dental

A

ortho hypo

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31
Q

direct renin inhibitor name/ form

A

Aliskerin (Tekturna)
Available: PO

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32
Q

Aliskerin moa

A

Decreases plasma renin activity
and inhibits the conversion of
angiotensinogen to angiotensin I

33
Q

aliskerin adrs

A

Diarrhea, dyspepsia, hypotension

34
Q

aliskerin dental

A

ortho hypo

35
Q

ACEi names?

A

all end in -pril

36
Q

Angiotensin receptor blockers (ARBs) names

A

all end in -sartan

37
Q

ARBs moa

A

Blocks the AT1 receptor of
angiotensin II, preventing
vasoconstriction and
aldosterone secretion

38
Q

ARBs adrs

do not cause what adrs?

A

Orthostatic hypotension
Headache
Dizziness
Hyperkalemia
Should not cause cough or angioedema

39
Q

ARBs dental

A

ortho hypo

40
Q

Angiotensin Receptor Neprilsyn Inhibitor (ARNI) name/ form

A

Sacubitril/Valsartan
(Entresto)
Available: PO

41
Q

Sacubitril/Valsartan MOA

A

Sacubitril: inhibits neprilysin resulting in elevated levels
of B-type natriuretic peptide (BNP)

Valsartan: blocks the angiotensin II AT1 receptor
of angiotensin II

42
Q

Sacubitril/Valsartan ADRs

A

Hypotension
Hyperkalemia
Angioedema (more than ACE inhibitors)

43
Q

Sacubitril/Valsartan dental

A

hypo

44
Q

Aldosterone antagonists names/forms

A

Eplerenone (Inspra) Available: PO
Spironolactone (Aldactone) Available: PO

45
Q

aldo antag moa

A

Competitively inhibits the action of aldosterone at
mineralocorticoid receptors. Reducing blood pressure in a dose-dependent manner and preventing myocardial and vascula fibrosis

46
Q

aldo antag ADRs

A

Hyperkalemia (16%)
Renal insufficiency
Gynecomastia (9% of males- spironolactone)
Dry mouth (rare

47
Q

aldo antag dental

A

Monitor of dry mouth due
to diuretic effect

48
Q

Dihydropyridine Rx’s

A

all end in -pine

49
Q

Amlodipine (Norvasc) MOA

A

Inhibits calcium ions influx through L-type or “slow”
calcium channels”
Selective for vascular smooth muscle
same as all -pine Rx

50
Q

amlodipine ADRs

A

Reflex tachycardia, flushing, hypotension, peripheral edema, gingival hyperplasia

51
Q

Dihydropyridine Rx’s dental implications

A

Monitor of gingival
hyperplasia, usually
resolves upon
discontinuation

52
Q

Clevidipine
(Cleviprex)
Only available as?

A

IV form

53
Q

clevidipine MOA

A

Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle

54
Q

clevidipine ADrs

A

Reflex tachycardia,
flushing,
hypotension,
peripheral edema
Gingival hyperplasia not reported probably due to shorter duration of administration

55
Q

felidipine MOA

A

Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle

56
Q

felodipine ADRs

A

Reflex tachycardia,
flushing,
hypotension,
peripheral edema,
gingival hyperplasia

57
Q

Isradipine
(DynaCirc CR) MOA

A

Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle

58
Q

isradipine ADRs

A

Reflex tachycardia,
flushing,
hypotension,
peripheral edema
Information is sparse as to whether isradipine causes
gingival hyperplasia

59
Q

Nicardipine
(Cardene)
Available in?

A

PO and IV
formulations

60
Q

nicardipine MOA

A

Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle

61
Q

nicardipine ADRs

A

Reflex tachycardia,
flushing,
hypotension,
peripheral edema,
gingival hyperplasia

62
Q

nicardipine dental implications

A

Xerostomia (normal salivary flow resumes upon discontinuation)

Monitor of gingival hyperplasia, usually resolves upon discontinuation

63
Q

Nifedipine MOA

A

Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle

64
Q

nifedipine ADRs

A

Reflex tachycardia,
flushing,
hypotension,
peripheral edema,
gingival hyperplasi

65
Q

nifedipine ADR

A

Gingival hyperplasia (10%
incidence with doses of
30-100mg/day). Effects
present after 1-9 months
of treatment. Usually
resolves upon
discontinuation

66
Q

nimodipine MOA

A

Inhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle

67
Q

nimodipine ADR

A

Reflex tachycardia,
flushing,
hypotension,
peripheral edema
No reports of gingival hyperplasia with nimodipine

68
Q

nimodipine dental implications

A

Possibly gingival
hyperplasia- although no
known cases

69
Q

nisoldipine MOA

A

nhibits calcium ions influx
through L-type or “slow”
calcium channels”
Selective for vascular smooth
muscle

70
Q

nisoldipine ADRs

A

Reflex tachycardia,
flushing,
hypotension,
peripheral edema
Information is sparse as to whether nisoldipine causes
gingival hyperplasi

71
Q

nisoldipine dental

A

Xerostomia (normal salivary flow resumes upon discontinuation)
Possibly gingival hyperplasia- information is sparse

72
Q

Non-Dihydropyridine Rx

A

selective for myocardium
Diltiazem and vermapril

73
Q

Diltiazem MOA

A

inhibits calcium ions influx through L-type or “slow” calcium channels”
Selective for myocardial calcium channels
Slows impulse conduction through the AV node

74
Q

diltiazem ADRs

A

Constipation,
dizziness,
lightheadedness,
hypotension,
bradycardia,
gingival hyperplasia

75
Q

diltiazem dental

A

gingival hyperplasia
usually resolves
upon discontinuation

76
Q

Verapamil MOA
where are impulses slowed in the cardiac conduction?

A

inhibits calcium ions influx through L-type or “slow”
calcium channels”
Selective for myocardial calcium channels
Slows impulse conduction through the AV node

77
Q

verapamil ADRs

A

Constipation,
dizziness,
lightheadedness,
hypotension,
bradycardia,
gingival hyperplasia

78
Q

verapamil dental

A

gingival hyper

PHARM (15 decks)

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