2Pharm I Flashcards
1
Q
Rank diuretics from most to least potent:
A
Loop
Thiazides
Carbonic anhydrase inhibitors (very mild)
Potassium sparing
2
Q
What is the most common cardiovascular disease whose prevalence increases with age?
A
Hypertension
3
Q
Individuals at 55 years old with NORMAL BP have a ___% lifetime risk for developing hypertension
A
90%
4
Q
Hypertension contributes to what 2 categories of disease?
A
Coronary artery disease
Cerebral artery disease
*heart and brain
5
Q
What are 3 categories of hypertension?
A
Essential (idiopathic - 90%)
Secondary (identifiable)
Malignant (5%, retinal/renal damage)
6
Q
BP intervention LESS THAN 60 yrs:
BP intervention OVER 60:
A
140/90
150/90
7
Q
AHA/ACC recommend lifestyle changes if Systolic is what range?
Diastolic?
A
140-159
90-99
8
Q
What are the 3 basic ways to reduce overall blood pressure?
A
Reduce peripheral resistance
Reduce cardiac output
Reduce blood volume
9
Q
How do most diuretics work?
A
Block Na+ reabsorption
Which then blocks water
10
Q
In the US _____ are the first line of drugs in hypertension treatment
A
Diuretics
11
Q
What was the first class of diuretics (no longer used b/c of toxicity)?
A
Mercurials
12
Q
What is the first choice, and most commonly prescribed class of diuretic?
A
Thiazides (benzothiazides)
13
Q
What do Thiazides block in the kidney?
2 things
A
Blocks Na+ reabsorption in Proximal and Distal tubules
Carbonic anhydrase (this decreases H+ availability for exchange with Na+)
14
Q
With Thiazides, what is the problem in losing Na+ in the distal/proximal tubules?
A
K+ is also lost (hypokalemia)
15
Q
When taking Thiazides, if sodium intake increases, ________ is exacerbated.
A
Potassium loss
16
Q
Why are a lot of Diabetics not on Thiazides?
A
Hyperglycemia is side effect
17
Q
Hypokalemia, Hyponatremia, Hypomagnesaemia, loss of carbonate, hyperuricemia, Hyperglycemia, elevated cholesterol, triglycerides, weakness, no boner.
What am I?
A
Thiazide diuretic
18
Q
According to lectures, 2 thiazide drugs we need to know:
A
Hydrochlorothiazide (Microzide)
Chlorothiazide (Diuril)
19
Q
What is the most powerful class of diuretic?
A
Loop
20
Q
3 effects of Loop Diuretics
A
Major volume loss
Electrolyte imbalance (Na+ and K+ loss)
Ototoxicity
21
Q
Loop diuretics block the _______ symporter
A
Na/K/Cl
22
Q
Hyponatremia, hypokalemia, hyperglycemia, hypocalcemia, hyperuricemia, NEPHROTOXICITY, ototoxiciy, GI distress, CNS effect
What am I?
A
Loop diuretic
23
Q
From lecture, 2 loop diuretics we need to know:
A
Ethacrynic acid (Edacrin)
Furosemide (Lasix)
24
Q
What 2 classes of drugs cause the Lichenoid Drug Rxn?
A
Thiazide and Loop diuretics
25
What class of diuretic competes with aldosterone?
Where does that competition take place?
Potassium sparing diuretics
Distal renal tubules
26
Potassium sparing diuretics save K+ and ____.
They increase ___ and ____ excretion
H+
Na+ and Cl-
27
2 potassium sparing diuretics:
Spironolactone (Aldactone)
Triamterene (Dyrenium)
28
Adverse effects of Potassium sparing diuretics: Hyperkalemia, and what 4 other things?
Gynecomastia in males
Breast tenderness in young women
Menstrual irregularities
Decreased libido in males
29
What mild diuretic is now used mostly for glaucoma, and as an adjunctive therapy for congestive heart failure?
Carbonic anhydrase inhibitors
30
One carbonic anhydrase inhibitor we need to know:
Acetazolamide (Diamox)
31
What drug is used in emergencies to decrease blood volume?
Which to we need to know?
Osmotic diuretics
Urea (Ureaphil)
32
What diuretic is rarely used - but treats hypochloremic stated and metabolic alkalosis in the ER?
*produced a lot of chloride
What preparation do we need to know?
Acidifying Agents
Ammonium chloride
33
Caffeine is a _______ that inhibits tubular reabsorption of Na+ by inhibiting _______ in the ______
Xanthine
ADH
Bowman's capsule
34
Most diuretics cause ________ and many cause ______
Xerostomia
Aphthous stomatitis
35
T/F
| Use of NSAIDS for greater than 3 weeks can decrease diuretic effectiveness
True
36
T/F
Many pts take potassium supplements to counteract the K+ loss from diuretics but this is contraindicated in case of severe renal impairment
True
37
Potassium supplements (salts) are contraindicated with what?
ACE Inhibitors
38
5 classes of drugs used to lower BP:
Diuretics
Sympathetic blockers (alpha, beta)
ACE inhibitors
Angiotensis II receptor blockers (ARB's)
Calcium channel blockers (CCB's)
39
T/F
| Beta blockers decrease cardiac output even though constrict vessels via beta2
True
40
Beta blockers decrease _______ secretion
Renin
41
Cardioselective beta blockers block ______ only
Beta1
42
A beta2 agonist is used for ________
Asthma
43
Beta1 receptors are in the _____
Beta2 receptors are in the ______
Heart
Lungs
44
2 cardioselective Beta Blockers (blocks Beta1 only):
2 noncardioselective Beta Blockers (blocks beta1 and beta2):
Beta1:
Atenolol (Tenormin)
Metoprolol (Lopressor, Toprol)
Beta2:
Nadolol (Corgard)
Propranolol (Inderal)
45
What class of drugs has side effects consistent with over-activity of the parasympathetic nervous system?
Beta blockers
*GI upset, xerostomia, orthostatic hypotension, sexual dysfunction, etc
46
4 contraindications to beta blockers:
Congestive heart failure
Asthma
Heart block
Diabetes
47
What receptors are located postsynaptically and produce vasoconstriction, increasing peripheral resistance when stimulated?
Alpha1
48
Alpha1 blockers produce ________
peripheral vasodilation
49
T/F
| Alpha1 blockers have big effects on cardiac output and renal blood flow
False
*little effect
50
T/F
| Alpha1 blockers are more effective when used with diuretics and/or beta blockers
True
51
Other than decreasing peripheral resistance, what is another effect of Alpha1 blockers?
Decrease urinary resistance
*benign prostatic hypertrophy
52
Alpha1 blocker =
Old men
53
3 adverse effects of Alpha1 blockers:
Orthostatic hypotension
CNS effects
Cardiovascular effects
54
3 Alpha1 Receptor blockers:
doxazosin (Cardura)
prazosin (Minipress)
tamsulosin (Flomax)
55
Women shouldn't handle Flowmax, and its chief side effect in men is...
severe orthostatic hypotension
56
ACE inhibitors - inhibit Angiotensin Converting Enzyme how?
competitively
*prevents angiotensin I to angiotensin II conversion
57
Explain ACE Inhibitor pathway/mechanism:
blocks Angiotensin I - Angiotensin II
Low Angiotensin II increases Renin
Renin reduces Aldosterone secretion
58
Normally aldosterone does what in the kidneys?
retains Na+ and water
*so ACE Inhibitors will decrease Na/Water retention (pee free water)
59
What are the 2 primary beneficial effects of ACE Inhibitors?
Vasodilate
Decrease Blood Volume
60
What is the most widely prescribed ACE Inhibitor in the US?
lisinopril (Prinivil, Zestril)
61
2 ACE Inhibitors:
lisinopril (Prinivil, Zestril)
enalapril (Vasotec)
62
What are 2 side effects of ACE Inhibitors?
Chronic Dry Cough
Angioneurotic edema with first dose
63
What causes the Chronic Dry Cough associated with ACE Inhibitors?
Increased Bradykinin release in bronchial tree
64
Angiotensin Receptor Blockers, aka...
Angiotensin II Receptor Blockers
65
T/F
ARB's block vasoconstrictor and aldosterone-secreting effects of Angiotensin II
Resulting in...
True
increased Renin, vasodilation, decreased Na/Water retention, and reduction in BP
66
What is often preferred over ACE inhibitors b/c the action is at the receptor and there are fewer side effects
*better tolerated
ARB's
67
What may decrease the effectiveness of ARB's?
NSAIDS
68
CNS, Upper respiratory infections, GI effects, cramps, angioedema, teratogenicity - what am I?
ARB's
69
2 common ARB's:
losartan (Cozaar)
valsartan (Diovan)
70
What is the new, expensive class of drugs for Hypertension?
Renin Inhibitor
*binds to Renin, decreasing levels of Angiotensin I - II - Aldosterone
71
Calcium Channel Blockers prevent Ca++ from entering...
slow channels
| select voltage-sensitive areas
72
T/F
Calcium Channel Blockers relax coronary vascular smooth muscle and cause coronary vasodilation, increasing myocardial oxygen delivery
True
73
Calcium Channel Blockers are used for what 3 CV purposes?
Hypertension
Angina
Arrhythmias
74
Calcium's role in muscle contraction - it binds ______
which turns on ______
which phospholrylates ________
so that it can better bind ______ and produce muscle contraction
calmodulin
myosin kinase
myosin
actin
75
3 Calcium Channel blockers:
amlodipine (Norvasc)
nifedipine (Adalat, Procardia)
verapamil (Calan)
76
verapamil (Calan) has major effects on the ______
nifedipine (Procardia) has more of an effect on _______
heart
blood vessels
77
What Calcium channel blocker is (most) associated with gingival hyperplasia?
What % have the responder gene that results in hyperplasia from this drug?
nifedipine (Procardia)
33%
78
T/F
| Good oral hygiene will limit the extent and severity of a lesion due to a Calcium Channel Blocker
True
79
Why are Centrally Acting Antihypertensives used less often?
Less tolerated
80
clonidine (Catapres) is a centrally acting antihypertensive that is a ______ Agonist, that activates _____ neuron, which decreases _______
Alpha2
Inhibitory
Sympathetic outflow
81
Xerostomia, Parotid gland swelling/pain, Dysgeusia:
clonidine (Catapres)
*Centrally acting antihypertensive
82
What class of drug blocks granular uptake and storage of norepinephrine (decreasing sympathetic activity due to lack of neurotransmitter supply)
Catecholamine Release Blockers
83
2 Catecholamine Release Blockers:
reserpine (Serpasil)
guanethidine (Ismelin)
84
Antihypertensive meds react with general anesthetics and CNS depressants by enhancing _______
hypotention
85
Antihypertensive meds have a _____ response to vasoconstricting drugs
potentiated
*this why use epi w/ caution, take BP prior to locals
86
```
T/F
OTC sympathomimetics (like cold capsules) counteract antihypertensive therapy
```
True
87
Use of NSAIDS longer than _____ may decrease effectiveness of diuretics, beta blockers, and ACE inhibitors
3 weeks
88
T/F
| Nicotine constricts blood vessels and increases BP
True
89
With Antihypertensive meds, prevent sudden changes in _____ with pts.
impregnated gingival retraction cord (vasopressors) is ______
Rebound hypertension develops when agents withdrawn, which happens often in men b/c ____ is severe
posture
contraindicated
impotence
90
Diuretics make you _____ potassium
ACE Inhibitors and ARB's make you ______ potassium
lose
gain (increase)
91
According to published guidelines, what 4 factors should be addressed when managing CV disease?
*HTN, obesity, and cholesterol...
Lifestyle
Obesity
Cholesterol
Risk assessment
92
The Risk Assessment portion of managing DV disease includes what 3 tiers?
Lifestyle changes
Drugs for under 60 140/90, over 60 150/90
Drugs for 160/100 + BP
93
The primary indication for diuretics is _______
| or life threatening edema (loop diuretics) or renal failure (osmotic diuretic - urea)
Hypertension
94
All Hypertension drugs have what 4 side effects?
Xerostomia
Weakness/fatigue
Sexual impotence/libido in men
Fake lichen planus
95
Antihypertensive meds have what drug interactions that are significant in dentistry?
(4 things)
Epinephrine
Vasoconstrictors
General anesthetics/CNS depressants
Prolonged analgesics, sedatives, and tranquilizers (CNS)
96
Use of NSAIDS longer than ____ weeks may decrease effectiveness of some diuretics, beta blockers, and ACEi
3 weeks
97
3 precautions to take during dental procedures when treating Hypertensive pts:
Fainters/Fallers (orthostatic hypotension)
Compliance
NSAID popping - diuretics don't work as well
98
What is the term for pain when the heart becomes Anoxic?
Angina
99
T/F
| Angina is an ischemic heart disease, often involving the coronary arteries, and is greater if there is Hx of MI
True
100
Angina can be brought on by triggers, but absent that the pain occurs most often when?
Nighttime
101
Typical angina (exertional) is caused by the _____ arteries causing ischemia
coronary
102
If the demand exceeds available oxygen, then necrosis occurs =
myocardial infarction
103
Typical angina is ______
Atypical angina (variant), aka....
extertional
Prinzmetal's
104
Normally there are Beta2 receptors in coronary arteries, in Prinzmetal's angina there are more _____ receptors
Alpha 1
*causes vasoconstriction w/ epinephrine
105
Variant (Prinzmetal's) angina shows an elevated ______ segment on an EKG that is not present in normal angina
S-T
106
Nitrites and Nitrates work on endothelial cells to produce______ that cause ______ via _______
nitric oxide
***arterial/venous vasodilation
relaxation of all smooth muscle
107
T/F
| Nitrates/NItrites produce vasodilation and increase venous return to the heart
False
*decrease venous return
108
Why do NItrates/Nitrites cause headache?
vasodilation is intense and fast
109
Other than headache, what are 5 side effects of Nitrites/Nitrates?
Postural hypotension and syncope
Flush/Rash
tachycardia/increased peripheral resistance (due to sympathetic reflex)
methemoglobin
decrease oxygen carrying in large doses
110
T/F
There is rapid onset to Nitrites/Nitrates and also rapid tolerance, which is why there is usually a 12 hrs on 12 hrs off schedule
True
111
What is the fastest onset Nitrite/Nitrate preparation?
Amyl nitrate snorted
112
Nitroglycerin is considered a "rescue" drug and is often in emergency kits
True
113
Why is nitroglycerine stored in a small brown vial?
Photosensitive
114
T/F
| Nitroglycerin is very caustic and leaves a sublingual burn
True
115
What is the longer duration option for nitroglycerin?
Patch (up to 12 hours)
116
Two Nitrites/Nitrates we need to know:
Isosorbide dinitrate (Isordil)
Isosorbide mononitrate (Imdur)
117
Beta blockers decrease cardiac ______, which decreases oxygen demand and decreases Angina
output (afterload)
118
inotropic:
chronotropic:
force
timing
119
T/F
| Beta blockers have negative chronotropic and inotropic effects
True
120
Pts with a history of MI will always be taking_______
beta blockers
121
Beta blockers cause vasodilation
False
122
Beta blockers are contraindicated for some forms of congestive heart failure and ________
Variant/Prinzemetal's Angina
123
Why are beta blockers often combined with diuretics?
Prevent sodium retention
124
Cardioselective agents are preferred for insulin-dependent diabetics and _______
Asthmatics
125
What does epinephrine do if the pt is taking a beta blocker?
Won't stimulate the heart
Will vasoconstrict Alpha1 receptors
126
Non-selective Beta blockers enhance what response to epinephrine?
What does this response entail? (2 things)
Pressor
hypertension, reflex bradycardia
127
T/F
| It's ok to use epi with cardioselective beta blockers
True
128
T/F
Epinephrine dilates large vessels/muscles
Epinepherine constricts small vessels/muscles
True
129
If a pt is on heart meds, it's most likely a Beta blocker - what 2 things do you ask?
Are you a diabetic?
Asthma?
130
Inotropic effect of Calcium Channel blockers:
Negative
131
Some Ca++ channel blockers cause smooth muscle relaxation (vasodilation) where?
Coronary arteries
132
2 Calcium channel blockers that have a negative inotropic effect:
verapamil
diltiazem
133
Ca++ channel blocker that vasodilates coronary arteries:
amlodipine
134
Calcium channel blocker that vasodilates peripherally:
nifedipine
nicardipine
135
What 2 things to limit in visit from pt on anti-anginals?
Extent of procedures/visit
epinephrine
136
If a pt is on an Antianginal, consider local aneshtetics without _____
vasoconstrictor
137
What are the practical side effects of antiarhythmic drugs?
Arrhythmic manifestations
138
Most Antiarrhythmics prolong _______
others affect the ______ system
Prolong
electrical
139
Cardiac arrhythmias produce abnormalities of the heartbeat and all denote something wrong with the _________ system
They are caused by disease, cardiac injury, or drugs
electrophysiologic
140
Arrhythmias result from abnormal impulse ______, abnormal impulse ______, or a combination of the two
formation
conduction
141
The type of arrhythmia that begins at the nodal level can be Supraventricular, Vetricular, or ______
Ectopic foci (preempt SA/AV node)
142
When the His Purkinje system is cut in half and atria/ventricles work independently it is know as a....
Heart Block
143
Antiarrhythmic medications ____ parts of the heart that are beating abnormally
Depress
144
What are 3 pharmacologic effect of antiarrhythmic medications?
Change slope of depolarization
Raise threshold for depolarization
Alter conduction velocity
145
Antiarrhythmic meds work on one or more of the _____ transmembrane phases of the cardiac cycle
5
146
What are the 3 areas of the heart that have pacemaker activity?
SA node (main)
AV node
Purkinje fibers
147
The spontaneous opening and closing of K+ channels is what drives _______
automaticity
148
Where is Effective Refractory Period longer - pacemaker areas or myocardial cells?
*different arrhythmias require ERP be longer/shorter
Pacemaker areas
149
In what 2 situations would you want to induce an arrhythmia with epi, isoproterenol (beta agonist) or hypokalemic diuretics?
Ventricular arrhythmias due to AV node block
Temporary heart block until pacemaker insertion
150
4 contraindications for Antiarrhythmics
Complete AV heart block
Congestive heart failure
Hypotension
Known hypersensitivity to drug
151
A partial heart block is when the _______ is not in sync
atria/ventricles
152
T/F
Indications for antiarrhythmic drugs are arrhythmia, flutters, fibrillations, tachycardias, ectopic arrhythmia, or digoxin induced arrhythmia
True
153
What are 4 Contraindications to Antiarrhythmics?
Complete AV block
CHF
Hypotension
Known hypersensitivity to drug
154
What are the 4 classes of Antiarrhythmics?
!a, 1b, 1c
2
3
4
155
Class Ia Antiarrhythmics:
| 3 drugs, 3 actions
1a (medium) = quinidine, (***procainamide, Pronestryl), (**disopyramide, Norpace)
blocks Na conduction
Slows ERP
Slows AP
156
Class Ib Antiarrhythmics:
| 1 drug, 2 actions
FAST = lidocaine
blocks Na conduction
Decrease relative refractory period
157
Class Ic Antiarrhythmics:
(2 drugs, 2 actions)
***life threatening ventricular arrhythmias only
Slow = flecainide (Tambocor), propafenone (Rhythmol)
blocks Na conduction
conduction velocity
158
Quinidine can lead to what clinical manifestation?
Cinchonism
*from cinchona tree
159
Class II Antiarrhythmics:
| 1 drug, 1 class
propanolol
beta blockers
160
Class III Antiarrhythmics:
| 3 drugs, mechanism
amiodarone (Cordarone, Pacerone), bretyllium, sotalol
K+ channel blockers
***sotalol (Betapace) is nonselective beta crossover
161
Class IV Antiarrhthmics:
| 5 drug, mechanism
nifedipine, verapamil, diltiazem, adenosine, Digoxin (cardiac glycoside)
Calcium channel blockers
162
Describe cinchonism from quinidine:
nausea, vomiting, headache, TINNITIS
deafness, vertigo, visuals
FATAL arrhythmias
163
What is the site of action of cinchonism (quinidine)?
atrial tissues
164
If a patient is taking antiarrhythmics, what do we NOT give them?
What is ok to give them?
Atropine (may cause tachycardia)
Lidocaine solutions
***not the same lidocaine as anti-arrhythmic med
165
Prinzmetal angina is seen in ______ men most commonly
Japanese
166
Nitrites/Nitrates are _______ vasodilators
direct
167
T/F
| CCB's block calcium channels so that calcium trickles more slowly, decreasing the rate and strength of contractions
True
168
What two side effects of taking NItrites/Nitrates is accentuated with alcohol?
Syncope
Postural hypotension
169
What is the fastest acting Nitrite/Nitrate and how long does it last?
What is the second fastest?
Vaporole - (snort) onset 1 minute, lasts 3-15 minutes
Nitroglycerin - onset 1-3 minutes, half life 10 minutes
170
A Transdermal pouch can last up to ___hrs
12
171
What are the 2 long acting nitrates?
| other than transdermal pouch
Isosorbide dinitrate (4-6 hrs)
Isosorbide mononitrate (1/2 life 4 hrs)
172
procainamide (Pronestyl) is a class Ia antiarrhythmic that has reversible _____ like syndrome in ___% of pts
(nickname: novacaine)
lupus
25%
173
Class Ib antiarrhythmics (lidocaine, phenytoin, mexiletine, tocainide) are are used to treat ______ arrhythmias
ventricular
174
4 class Ib antiarrhythmics:
lidocaine
phenytoin (Dilantin)
mexiletine
tocainide
175
amiodarone (Cordarone, Pacerone) contains iodine causing blue skin and may cause _____ disease
*Class III antiarrhythmic
thyroid
176
Digoxin is a Class IV antiarrhythmic that increases _____ and ______
intracellular Ca
contractility
177
T/F
| atropine and isoproteronol treat Bradyarrhythmias
True
178
T/F
| Potassium and Magnesium treat Ectopic Pacemakers
True
179
T/F
The vagal blocking effects of anntiarrhythmic drugs (anticholinergics like atropine) can act synergistically to lead to tachycardia
True
180
Congestive heart failure is the inability of the heart to provide the necessary ______
output
181
What do drugs target in CHF?
Reflex sympathetic output
182
T/F
Right sided heart failure will manifest in fatigue and edema while left side will be more acute and result in pulmonary congestion
True
183
T/F
| With CHF you want to slow the heart and increase the contractile force
True
184
What is the drug of choice in treatment of CHF?
digoxin (Digitek, Lanoxin)
aka Cardiac Glycosides
185
Digoxin inhibits __________, resulting in more ________ inside the cell.
This has a positive ______ effect
Na/K pump
Ca
inotropic
186
Digoxin has a positive inotropic effect and a negative ______ effect due to directly suppressing ______
chronotropic
AV node
187
Digoxin has 3 mechanisms of action: positive inotropic effect through increased Ca, negative chronotropic effect by suppressing the AV node, and what else?
Diuresis
*pee excessively, decreasing venous return
188
The increased vagal output caused by cardiac glycosides (digoxin) can be blockes by ________
Atropine
189
T/F
| Digoxin has a low therapeutic index and can lead to uncoordinated arrhythmias
True
190
Few drugs cause sensory side effects - which causes a green/yellowish aura?
Digoxin
191
T/F
azole antifungals and macrolides like clindamycin and azythromycin could increase digoxin in the system and increase risk for toxicity
True
192
What posture would you not want to put a pt with CHF in?
don't recline fully - hard to breathe
193
T/F
| It's ok to do general anesthesia in a dental setting with a pt with CHF
False
*hospital only
194
What are 3 preparations of Bile Acid Sequestrants?
chelestyramine resin
colesevelan
colestipol
195
What decreases liver triacylglycerol synthesis necessary for VLDL production?
(decreases plasma LDL's - used for MILDLY elevated cholesterol)
Nicotinic Acid (Niacin)
196
What is the side effect on Niacin?
facial flushing
197
What lowers plasma triglycerides and increases HDL by inhibiting cholesterol synthesis in the liver?
Fibric Acids
198
What are 3 Fibric Acids?
clofibrate
fenofibrate
gemfibrozil
199
The most popular/effective cholesterol inhibitors:
statins
HMG coA reductase inhibitors
200
HMG CoA reductase is the _____ step in the synthesis of ______
rate limiting
cholesterol
201
When can't you take a statin?
Liver disease
***HMG CoA reductase inhibitors alter liver function
202
What is a side effect of statins?
| HMG CoA reductase inhibitors
myalgias
****rhabdomyolysis - disintegration of muscle tissue
203
What 2 types of drugs promote myalgias in pts taking statins?
Macrolide antibiotics (erythromycin)
Azole antifungals
204
2 statins are combined with a drug that decreases intestinal absorption (only drug in class), what is the drug, and what are the combos?
ezetimibe
Vytorin - simvastatin + ezetimibe
Liptruzet - atorvastatin + ezetimibe
205
The therapeutic dose for Digoxin is _____% of the toxic dose, which is why every pt needs to be _______
50-60%
Titrated
206
Cardiac glycosides are used for what 3 conditions?
CHF
A-fib
flutter
207
Cardiac glycosides (digoxin) can cause bradycardia/arrhythmia, _____ effects from stimulation of chemoreceptor zones and vagal nucleus (parasymphathetic effects)
*what other parasympathetic effects?
GI
*nausea, vomiting, increased saliation, anorexia, diarrhea, ab pain
208
Other than a Green/Yellow aura, what are 3 other CNS effects of Digoxin?
Headache - edema
fatigue
visual
209
Retraction cords and local anesthetics often have ________, which is contraindicated for pts with CHF
vasoconstrictors
210
T/F
| General anesthesia is dangerous for pts with CHF
True
211
Statins should be used in pts with CV disease aged 40-75 and have a ______% or higher risk of having heart attack within 10 years
7.5%
212
T/F
| You can't raise HDL without exercise
True
213
T/F
| Statins shouldn't be combined with additional cholesterol lowering drugs like niacin or fibrates
True
*don't reduce heart attack/stroke risk
214
DVT =
deep vein thrombosis
215
What are 3 types of acute coronary syndromes caused by blood clots in coronary arteries?
Unstable angina
Non-ST elevated MI (incomplete blockage)
ST elevated MI (complete blockage)
216
T/F
| Stroke reduction benefits of antiplatelets improve when used in combo with aspirin
True
217
Aspirin causes _______ platelet aggregation
irreversible
218
T/F
| You should discontinue low dose aspirin therapy before dental treatment
False
*Stroke risk greater than bleeding
219
T/F
| Discontinuing aspirin use Increases MI and adverse bleedings and has worse clinical outcomes than nonusers
True
220
Antiplatelet drugs used for short and long term stenting have ______ effects on platelets
Irreversible
221
4 antiplatelet drugs
ticlopidine (Ticlid) *canadian
clopidogrel (Plavix)
prasugrel (Effenet)
ticagrelor (Brilinta)
222
Aspirin blocks _____, which blocks ______
COX
Thromboxane A2
223
clopidogrel prevents binding of ____ to collagen receptors thereby preventing platelet aggregation
ADP
224
What is used with aspirin and heparin to treat acute coronary syndromes?
fibrinogen receptor inhibitors
| platelet glycoprotein IIb/IIIa receptor antagonists
225
3 platelet glycoprotein IIb/IIIa receptor antagonists (Fibrinogen Receptor Inhibitors)
abciximab (ReoPro)
eptifibatide (Integrilin)
tirofiban (Aggrastat)
226
Thienopyridines prevent the binding of _____ to collagen receptors which prevents platelet aggregation.
It requires ____ to form the clot
ADP
Adenosine
227
Percutaneous coronary intervention (stents) combined with antiplatelet therapy has numerous dental advisory guidelines, one being _____ risk of premature discontinuation.
Consult the cardiologist, and defer any procedure with significant bleeding risks until ______
catastrophic
thienopyridine therapy conclusion
228
After a DES is placed, wait ___ months for major intervention
__ months for normal stent
12
1
229
Leading up to a procedure the pt can go off Plavix, but must stay on ______
Aspirin
*restart Plavix right after procedure
**keep pt on 1 antiplatelet
230
Heparin inhibits _____ and ______
produces _____ anticoagulant effect
Factor Xa and IIa thrombin
immediate
231
Warfarin interferes with liver synthesis of ______
produced effect in _____ days
vitamin K dependent clotting factors
4-5
232
Warfarin inhibits what 4 vitamin K dependent clotting factors?
What 2 proteins?
2, 7, 9, 10
C and S
233
6 drugs that alter the efficacy of warfarin:
Phenytoin
Phenobarbital
Any liver metabolism drug
Antibiotics
Vita K (spinach)
Tylenol (enhances coagulation)
234
3 antagonists to Heparin and Warfarin:
Vitamin K
Phenytoin
Phenobarbital
235
NSAIDS cause _____ effects on platelets
reversible
236
Heparin can cause profound bleeding, what is the antidote?
Protamine sulfate
237
T/F
| Heparin and Warfarin can be overlapped 1-2 days
True
238
Warfarin has a mandatory blood test every 30 days b/c of low _____ indes
Therapeutic
239
Many things throw off coumadin, _____ being one
diet
*vita K
240
T/F
There is no need to discontinue warfarin use prior to routine dental procedures even though it is associated with increased gingival bleeding and mouth ulcers
True
241
5 tests used to assess the effects of Heparin and Warfarin:
INR
Bleeding time test
PT
aPTT
Intrinsic pathway
242
The International Normalized Ratio (INR) has a therapeutic range of ___ to ____
2-3
243
______ and warfarin significantly enhance anticoagulation
Acetaminophen
244
What causes the greatest number of drug interactions?
Warfarin
245
What is the direct Thrombin inhibitor?
dabigatran (Pradaxa)
*prodrug - converted in vivo to dabigatran
246
T/F
| The advantages to dabigatron over warfarin is no monthly monitoring and less expensive
True
247
What is the antidote to dabigatran (Pradaxa)
idarucizumab (Praxbind)
248
Antithrombins drugs (not to be confused with Thrombin inhibitors) are _______ inhibitors
Factor Xa
249
What are 3 Factor Xa inhibitors (antithrombins)
apixaban (Eliquis)
fondaparinux (Arixtra)
rivaroxaban (Xarelto)
250
Hemorhage, no reversal agent, and loss of ____ function are the major risks to Factor Xa inhibitors (antithrombins)
kidney
251
When would Factor Xa inhibitors be used?
| antithrombins
post op after total hip/knee
prevent stroke
252
Factor Xa inhibitors stop coagulation by preventing _____ mediated effects, including cleavage of fibrinogen to fibrin, and activation of what 4 factors?
thrombin
5, 8, 11, 13
253
2 thrombolytic clot busting drugs:
streptokinast (Streptase)
urokinase
254
What is the antidote for Tissue Plasminogen Activator (tPA)?
this is a clot forming IV drug = Retavase
Epsilon AminoCaproic Acid (Amicar)
*treats hemophilia, cerebral aneurysms
