5. Cardiovascular Drugs Flashcards
What are ace inhibitors and angiotensin 2 inhibitors used for? (2)
- Mechanism?
- Hypertension and congestive heart failure
2. Suppression of renin-angiotensin-aldosterone system
ACE inhibitor - example
- Mechanism
Lisinopril
- Blocks synthesis of angiotensin 2 and allows for vasodilatory effect of bradykinin
(Angiotensin 2 causes direct vasoconstriction and increases aldosterone which increases fluid retention)
Angiotensin 2 blocker - example
- Mechanism
Valsartan
- Blocks action of angiotensin 2 (limiting direct vasoconstriction)
ACE inhibitors / Angiotensin 2 blockers - Side effects (4)
- Persistent cough
- Dizziness, fatigue
- Dry mouth, dysgeusia
- Oral ulcerations
ACE inhibitors / Angiotensin 2 blockers - Interactions
ASA & NSAIDs interact to decrease antihypertensive effects
ACE inhibitors / Angiotensin 2 blockers - Dental considerations (3)
- Oral ulcers, persistent cough
- Orthostatic hypotension
- Assess patient’s salivary flow
Ca++ channel blockers
- Uses (5)
- Mechanism
- Angina, HTN, coronary vasospasm, MI, CHF
- Decrease Ca++ influx in cardiac and smooth muscle, decrease myocardial contractility and O2 demand, dilate coronary arteries
CA++ channel blockers - Side effects (4)
- Dizziness, headache
- Dry mouth
- Bradycardia
- Gingival hyperplasia
Ca++ channel blockers
- Interactions (3)
- Protein-bound drugs (ASA, NSAIDs)
- Grapefruit juice
- Erythromycin (5x sudden death risk)
Ca++ channel blockers - Dental considerations (5)
- Orthostatic hypotension
- Assess salivary flow
- Gingival enlargement
- Use NSAID with caution
- Avoid Erythromycin
Beta blockers - which are selective and which are non-selective
- Metoprolol, atenolol, propanolol
Selective: Metoprolol and atenolol (A-M)
Non-selective (N-Z): Propanolol
Beta blockers - Uses
- Mechanism
Use: Angina, HTN, MI
Mechanism: Blockage of B-1 receptors, slowing HR and depress renin secretion
Beta blockers - Side effects (5)
- Dizziness, fatigue
- Dry mouth
- Hypotension
- Bradycardia
- Asthmatic issues if non-selective
Beta blockers - interactions (2)
Epinephrine and NSAIDs
Beta blockers - Dental considerations
- Monitor vital signs
- Minimize stress
- Orthostatic hypotension
- Monitor salivary flow
- Use epi/NSAIDs with caution
Vasodilators - Nitrates
- Mechanism
- Side effects
Decrease cardiac preload by increasing venous capacitance
Headache, postural hypotension, dry mouth, tolerance
Vasodilators - Nitroglycerine - Mechanism
- Metabolized where?
Causes vascular smooth muscle relaxation and vasodilation
- Metabolized in liver
Vasodilators - Alpha 1 blockers
- Mechanism
Blockage of catecholamine binding sites on vascular alpha-1 adrenoreceptors, causing decrease in arteriolar resistance
Cardiac glycosides - Digoxin
- Mechanism
- Uses? (2)
Inhibits Na-K ATPase to increase Calcium and contractility (increases CO/EF)
Increase PS tone to heart, reducing SA firing and conduction velocity through AV node
Uses: A-fib and CHF
Cardiac glycosides - digoxin - What are the dangers? (3)
Very narrow therapeutic index and may result in worsening CHF or increased mortality with a-fib
Diuretics - Uses (2)
- Mechanism?
HTN and edema
Inhibits reabsorption of Na+ and Cl- in distal tubule/loop of Henle
Diuretics
- Side effects
Hypokalemia and hypotension
Diuretics - Dental considerations
- Oral ulcers
- Assess patient’s salivary flow
- K+ supplementation
Coumadin - Uses
- Mechanism
Peripheral thrombi, a-fib, pulmonary embolism, MI, prosthetic heart valves
Mechanism: Inhibit synthesis of Vital K dependent coagulation factors (II, VII, IX, X)
Coumadin - Side effects (1)
- Interactions (3)
Hemorrhage
- Salicylates, NSAIDs
- Acetaminophen
- Cephalosporins, Cipro, antibiotics
Coumadin - Dental considerations (4)
- Lab test (check PT/INR)
- Local hemostasis measures
- Provide OHI
- Many drug interactions
Plavix - Use and MoA
- Treatment and prophylaxis of atherothrombotic events
2. Inhibits platelet aggregation by inactivating receptors linked to ADP pathways
Plavix - side effects and interactions
Hemorrhage
- Salicylates
- Proton Pump Inhibitors
Plavix - Dental Considerations
- Local hemostasis measures / increased risk of intra-operative bleeding
- Provide OHI
Pradaxa - Use and complications
Reduction of ischemic stroke risk; a-fib
Bleeding complication
Xarelto - Use and complications
DVT prophylaxis TJR surgery. Ischemic stroke prevention, A-fib
Antilipid agents (HMG CoA reductase inhibitor) - Use and mechanism (3)
Hypercholesterolemia and hyperlipidemia
MoA: Inhibit HMB COA reductase (statins), modify lipoproteins, interfere with cholesterol absorption
HMG CoA Reductase inhibitors - Side effects
- Nausea, ab pain, diarrhea
- Liver enzyme elevation
- Dysgeusia
HMG CoA Reductase inhibitors - Interactions and Dental considerations (1)
Interacts with erythromycin, so avoid erythromycin
