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Dentistry Human Disease > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

What is the function of anti-platelet drugs?

A

Medication that prevents platelets from sticking together and forming clots

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2
Q

What is the function of lipid-lowering drugs (statins)?

A

Used to lower the level of lipids and lipoproteins, such as cholesterol, in the blood

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3
Q

What is the function of anti-arrhythmics drugs?

A

Prevents and treats abnormal heartbeats

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4
Q

What is the function of anticoagulant drugs?

A

Medicines that help prevent blood clots

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5
Q

What is the function of duiretic drugs?

A

Medicines that help reduce fluid buildup in the body, they are anti-hypertensive as reducing plasma volume reduces cardiac workload.

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6
Q

What is the function of ACE-inhibitors?

A

Medicines that help relax veins and arteries to lower blood pressure

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7
Q

What is the function of nitrate drugs?

A

Medication that causes vasodilation by donating nitric oxide

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8
Q

What is the function of calcium channel blockers?

A

Medication that disrupts movement of calcium through calcium channels in order to decrease blood pressure

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9
Q

what are the three main anti-platelet drugs you will come across in dental practice? (In order of use)

A
  1. Aspirin
  2. Clopidogrel
  3. Dipyridamole
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10
Q

If you wish to carry out a dental procedure that has risk of bleeding, how long before the procedure would aspirin medication need to be halted and why?

A

A week before the procedure. This is because platelet life in the plasma is about 7 days.

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11
Q

How does aspirin inhibit platelet aggregation?

A

By altering the balance between throboxane A2 and Prostacyclin

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12
Q

how does clopidogrel inhibit platelet aggregation?

A

Through ADP inhibition

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13
Q

Combinations of anti-platelet drugs can be given together, and are more effective than an individual drug acting alone. True or false?

A

True, if a more intense action is required, combination of the drugs is suitable and more effective.

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14
Q

If a patient is on a combination of anti-platelet drugs, what is the main concern?

A

They may have a more significant bleeding problem upon dental procedures

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15
Q

What are the two new anti-platelet drugs that are only prescribed in conjunction with aspirin, and only licensed for acute coronary syndromes?

A

Prasugrel and Ticagrelor

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16
Q

What is the most commonly used oral anti-coagulant in dental practice?

A

Warfarin

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17
Q

What type of drug would be expected to cause immediate bleeding after dental extractions?

A

Anti-platelets

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18
Q

What type of drug would be expected to cause delayed post treatment bleeding (most likely a few hours after treatment)?

A

Anticoagulants

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19
Q

Other than warfarin, name 4 new oral anticoagulants (NOAC).

A
  1. Rivaroxaban
  2. Apixaban
  3. Dabigatran
  4. Edoxaban
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20
Q

What type of base does the anti-coagulant warfarin have?

A

Coumarin

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21
Q

How does warfarin inhibit coagulation?

A

Inhibits synthesis of vitamin K dependant clotting factors: 2,7,9,10, and protein C and S.

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22
Q

If a patient requires to be anti-coagulated immediately, what medication should they be placed on?

A

Warfarin in conjunction with heparin (another anticoagulant)

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23
Q

How many days does it take for warfarin to take affect?

A

2-3 days

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24
Q

What anticoagulant is heavily bound to plasma proteins and metabolised in the liver?

A

Warfarin

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25
Q

How is warfarin action tested?

A

Monitored with INR test

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26
Q

What is the INR test?

A

INR = international normalised ratio

This is the ratio of a healthy volunteer’s prothrombin time measured against the patient.

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27
Q

What is meant by “prothrombin time”?

A

The time taken for prothrombin to be converted to thrombin

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28
Q

In most clinical situations, a patient taking warfarin should have what range of INR in order to not alter medication before treatment?

A

2-4

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29
Q

Give examples of local haemostatic measures

A
  1. Fibrinogen activator
  2. Suture
  3. Local anaesthetic (with vasoconstrictor)
30
Q

when would you use local haemostatic measures?

A

Where there is a higher risk of bleeding following dental care

31
Q

It is acceptable for a patient who takes warfarin and has haemophilia to be given an ID block. True or false?

A

False. Giving an ID nerve block is acceptable for a patient on warfarin, however completely contraindicated if the patient has haemophilia.

32
Q

When taking warfarin, what group of drugs should be avoided?

A

NSAID analgesics

33
Q

Which of the NOAC works as a direct thrombin inhibitor?

A

Dabigatran

34
Q

What are the two main advantages of NOAC in dentistry?

A
  1. They do not require anticoagulant test before treatment (bioavailability is predictable)
  2. They have a short half-life (effect of drug is rapidly lost if its not administered to its normal schedule)
35
Q

How is the short-half life of NOAC’s advantageous for dental procedures to take place?

A

Because it can be possible to carry out a procedure just before the dose of the drug is due and the effect in the blood will be at its lowest. This will allow maximum chance for a blood clot to form, reducing post-op bleeding.

36
Q

What is the full name for “statins”?

A

HMG coA reductase inhibitors

37
Q

What is the specific role of statins?

A

To inhibit cholesterol synthesis in the liver

38
Q

what are the main side effect of taking statins?

A

myositis (inflammation in the muscles)

39
Q

What group of medication is contraindicated for use alongside statins?

A

Anti-fungals

40
Q

give an example of a selective beta-adrenergic blocker?

41
Q

Give an example of a non selective beta-adrenergic blocker?

A

Propranolol

42
Q

What does it mean if a beta blocker is selective?

A

Only works on beta 1

43
Q

what does it mean if a beta blocker is non-selective?

A

works on beta 1 and 2

44
Q

A patient with asthma can take the beta blocker propranolol. True or false?

A

False, propranolol is a non selective beta blocker, meaning that it acts upon beta 1 and 2. Beta 2 receptors are involved in management of asthma, therefore if a patient were to take a beta 2 blocker, it will prevent the action of their salbutamol inhaler.

45
Q

What is the function of beta-blockers?

A

They reduce heart muscle excitability and stop arrhythmias (ventricular fibrillation) leading to cardiac arrest

46
Q

Why should a patient on beta-blockers stand up slowly when getting out of the dental chair?

A

Because beta blockers cause postural hypotension, if they stood up too quickly they could collapse

47
Q

What is an inatrope?

A

A drug which improves cardiac function

48
Q

why are beta-blockers considered as negative inatropes?

A

Because they reduce cardiac efficiency

49
Q

what are the two most common types of diuretics?

A

Thiazide and loop diuretics

50
Q

what is a side effect of taking diuretics?

A

Sodium/potassium ion imbalance

51
Q

what is a main side effect of diuretics in the elderly?

52
Q

What drugs are used for the emergency treatment of angina or for long term prevention of angina?

53
Q

Give an example of a short acting nitrate used for emergency management of angina pectoris

A

Glyceryl trinitrate (GTN)

54
Q

Give an example of a long acting nitrate used for prevention of angina pectoris

A

Isosorbide mononitrate

55
Q

How is GTN administered?

A

Usually as a spray, it is extensively metabolised on first pass metabolism when administered sublingually

56
Q

how is Isosorbide mononitrate administered?

A

Via dermal transcutaneous patch

57
Q

which vessels do nitrates primal act upon?

58
Q

calcium channel blockers are used in the treatment of what conditions?

A

Hypertension and/or migraine

59
Q

What oral side effect can arise from calcium channel blocker use?

A

Gingival hyperplasia

60
Q

What calcium channel blockers are more active on peripheral blood vessels?

A

Nifedipine and amlodipine

61
Q

Which calcium channel blocker is more active on heart muscle and blood vessels in brain?

62
Q

give three examples of ACE inhibitors?

A
  • enalapril
  • ramapril
  • lisinopril
63
Q

What is the action of ACE inhibitors?

A

They inhibit the conversion of angiotensin 1 to angiotensin 2, therefore preventing aldosterone dependant re absorption of salt and water.

64
Q

What are the oral reactions associated with taking ACE inhibitors?

A
  1. Angio-oedema
  2. Lichenoid reaction
65
Q

What is the ending of all ACE inhibitor drugs?

66
Q

What is the ending of all angiotensin II blockers?

67
Q

what is the ending of all beta-blockers?

68
Q

What classes of drugs are anti-hypertensive?

A
  1. ACE inhibitors
  2. Angiotensin II blockers
  3. Calcium channel blockers
  4. Diuretics
69
Q

Why should NSAID’s be avoided when a patient is taking ACE inhibitors?

A

Because NSAIDs reduce the anti-hypertensive effect of ACE inhibitors and increase the risk of acute renal injury

70
Q

What anti-fungal, in particular has a severe reaction with statins?

A

Fluconazole

Dentistry Human Disease (29 decks)

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