vascular system rx Flashcards by Caleb Houghton

Q

pul HTN med classes

A

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

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Q

Endothelin receptor antagonists names

A

Ambrisentan
Bosentan
Macitentan
all available as PO form

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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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Q

ADRs of ERA’s

A

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

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Q

dental implacation of ERA’s

A

gum bleeding

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Q

PDE5 inhibitor names

available as?

A

Sildenafil
Tadalafil
Available: PO

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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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Q

PDE5 inhibitors ADRs

A

Flushing
Headache
Dyspepsia
Skin rash

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Q

PDE5 inhibitors dental

A

Avoid nitrate use

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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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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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Q

prostacyclin analogues ADRs

A

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

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Q

prostacyclin analogue dental

A

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

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Q

Soluble guanylate cyclase stimulator
name and form?

A

Riociguat
Available: PO

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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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Q

Soluble guanylate cyclase stimulator ADRs

A

Hypotension
Dyspepsia
Headache
Edema

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Q

Soluble guanylate cyclase stimulator dental

A

Increased risk of bleeding=
Risk of unanticipated bleeding during procedure

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Q

prostacyclin receptor agonist name/form

A

Selexipag
Available: PO

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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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Q

Prostacyclin receptor agonist ADRs

A

Jaw pain
Flushing
Headache
Skin rash
Diarrhea

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Q

prostacyclin receptor agonist dental

A

Jaw pain (~1 in 4 patients)

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Q

Direct Acting Vasodilators names/ forms?

A

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

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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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Q

Minoxidil ADRs

A

Hair Growth
Edema
Photosensitivity (rare)
Hypotension

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Minoxidil dental

ortho hypo

Na nitroprusside MOA

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

Na nitroprusside ADRs

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.

Hydralazine MOA

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

Hydralazine ADRs

Hypotension Headache Palpitations GI disturbances Facial flushing (rare)

Hydralazine dental

ortho hypo

direct renin inhibitor name/ form

Aliskerin (Tekturna) Available: PO

Aliskerin moa

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

aliskerin adrs

Diarrhea, dyspepsia, hypotension

aliskerin dental

ortho hypo

ACEi names?

all end in -pril

Angiotensin receptor blockers (ARBs) names

all end in -sartan

ARBs moa

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

ARBs adrs | do not cause what adrs?

Orthostatic hypotension Headache Dizziness Hyperkalemia **Should not cause cough or angioedema**

ARBs dental

ortho hypo

Angiotensin Receptor Neprilsyn Inhibitor (ARNI) name/ form

Sacubitril/Valsartan (Entresto) Available: PO

Sacubitril/Valsartan MOA

Sacubitril: inhibits neprilysin resulting in elevated levels of B-type natriuretic peptide (BNP) Valsartan: blocks the angiotensin II AT1 receptor of angiotensin II

Sacubitril/Valsartan ADRs

Hypotension Hyperkalemia Angioedema (more than ACE inhibitors)

Sacubitril/Valsartan dental

hypo

Aldosterone antagonists names/forms

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

aldo antag moa

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

aldo antag ADRs

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

aldo antag dental

Monitor of dry mouth due to diuretic effect

Dihydropyridine Rx's

all end in -pine

Amlodipine (Norvasc) MOA

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

amlodipine ADRs

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

Dihydropyridine Rx's dental implications

Monitor of gingival hyperplasia, usually resolves upon discontinuation

Clevidipine (Cleviprex) Only available as?

IV form

clevidipine MOA

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

clevidipine ADrs

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

felidipine MOA

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

felodipine ADRs

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

Isradipine (DynaCirc CR) MOA

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

isradipine ADRs

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

Nicardipine (Cardene) Available in?

PO and IV formulations

nicardipine MOA

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

nicardipine ADRs

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

nicardipine dental implications

Xerostomia (normal salivary flow resumes upon discontinuation) Monitor of gingival hyperplasia, usually resolves upon discontinuation

Nifedipine MOA

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

nifedipine ADRs

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

nifedipine ADR

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

nimodipine MOA

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

nimodipine ADR

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

nimodipine dental implications

Possibly gingival hyperplasia- although no known cases

nisoldipine MOA

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

nisoldipine ADRs

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

nisoldipine dental

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

Non-Dihydropyridine Rx

selective for myocardium Diltiazem and vermapril

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

diltiazem ADRs

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

diltiazem dental

gingival hyperplasia usually resolves upon discontinuation

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

verapamil ADRs

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

verapamil dental

gingival hyper