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Pharmacology > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q 
Thiazides, which are used in the treatment of hypertension, may require supplemental administration of:
Sodium
Chloride
Calcium
Potassium
A

Potassium

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2
Q 
Which of the following is a beta-adrenergic receptor agent used for the treatment of hypertension?
Prazosin (Minipress)
Clonidine (Catapres)
Atenolol (Tenormin)
Hydralazine (Apresoline)
Verapamil (Calan)
A

Atenolol (Tenormin)

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3
Q

What is the goal of cardiovascular pharmacology?

A

Decrease the workload on the heart–decrease oxygen demand from cardiac muscle

  • Blocked coronary arteries: decrease the available oxygen to cardiac tissues
  • Hypertension increases the afterload and preload of the heart
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4
Q

Describe how hypertension leads to congestive heart failure

A

Hyperlipidemia OR hypertension –> angina –> myocardial infarction –> arrhythmias OR congestive heart failure

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5
Q

Lisinopril (Zestril)

A

Class: Angiotensin Converting Enzyme (ACE) Inhibitors; Volume Regulator

Mechanism of action:

Indication:

  • Hypertension
  • Heart failure
  • MI

Pharmacological effects:

  • Decrease concentrations of ATII–> vasodilation
  • Increase bradykinin, a vasodilator
  • Decrease aldosterone

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Altered or reduced taste sensation
-Hypotension
-Bradykinin: cough in 20% of patients; angioedema of the face and mouth (more common in African American patients)

oContraindicated drugs:
-NSAIDs and ASA inhibit anti-HTN effects

oContraindications:

oWhich analgesic can the patient take:

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6
Q

Valsartan (Diovan)

A

Class: Angiotensin Receptor Antagonist; Volume Regulator

Mechanism of action:

Indication:

  • Heart failure
  • Hypertension
  • MI
  • Prevention of stroke

Pharmacological effects:

  • Inhibit vasoconstriction
  • Inhibit aldosterone secretion
  • Inhibit sodium retention

Comparison to ACE inhibitors:

  • Less adverse reactions (cough and angioedema)
  • Less effective vasodilation

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-GI upset

oContraindicated drugs:

  • Increase in anti-HTN effect with fluconazole and ketoconazole (we don’t want BP too low or pt could pass out)
  • Increase renal toxicity with NSAIDs

oContraindications:

oWhich analgesic can the patient take:

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7
Q

Angiotensin Receptor Antagonists

A 
Valsartan (Diovan)
Losartan (Cozaar)	
Irbesartan (Avapro)
Olmesartan (Benicar)
Candesartan (Atacand)
Telmisartan (Micardis)
Nisoldipine (Sular)
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8
Q

ACE Inhibitors

A 
Lisinopril
Captopril
Enalapril
Ramipril
Benazepril
Fosinopril
Perindopril
Quinapril
Trandolapril
Moexipril
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9
Q

Aldosterone

A

The cortical collecting duct cells
Mechanism:
-Binds to intracellular mineralocorticoid receptor
-Activation of the receptor
-Increases transcription of mRNAs that encode proteins involved in Na+ handling
-Control of sodium channel expression*

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10
Q

Spironolactone

A

Class: Aldosterone Antagonist; Potassium Sparing Diuretic; Volume Regulator

Mechanism of action:
-Potassium sparing diuretic
The cortical collecting duct cells
Mechanism
-Binds to intracellular mineralocorticoid receptor
-Activation of the receptor
-Control of sodium channel expression
Spironolactone is a aldosterone antagonist
-Binds to and prevents nuclear translocation of the mineralocorticoid receptor

Indication:

  • Hypertension
  • Edema states: Heart failure and Hepatic cirrhosis
  • Congestive Heart Failure
  • Hypokalemia
  • Male to female gender transformation

Pharmacological effects:

How this drug might effect dental treatment of patient
oAdverse effects you have to consider: 
Steroid structure
-Gynecomastia in men
-Menstrual irregularities in women
-Hyperkalemia

oContraindicated drugs:
-Decreased anti-HTN effect with NSAIDs

oContraindications:

oWhich analgesic can the patient take:

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11
Q

Nephron anatomy and sites of action of diuretics

A
  • Kidney reabsorbs 99 % of solutes and water that is filtered
  • Reabsorption of water is passive following osmotic gradients
  • Osmotic gradients are controlled by Na+ reabsorption by the nephrons
  • All diuretics act by inhibiting Na+ reabsorption
  • Less water reabsorbed: decrease CO
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12
Q

Hydrochlorothiazide (HCTZ)

A

Class: Thiazide Diuretic; Volume Regulator

Mechanism of action:

  • Binds to the Na+Cl- cotransporter in the distal tubule and inhibits turnover
  • Reduction in extracellular fluid volume
  • K+ is exchanged for Na+ leading to more K+ loss

Indication:

  • HTN
  • Edema: CHF, Hepatic cirrhosis, Renal dysfunction, Corticosteroid therapy

Pharmacological effects:

  • Reduction in NaCl reabsorption
  • Increase the reabsorption of Ca+

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Hypokalemia
-Hyponatremia
-Gout
-Dry mouth, lichenoid rxns, orthostatic hypotension

oContraindicated drugs:

  • NSAIDS decreases anti-HTN effects
  • Increase orthostatic hypotension with opiates

oContraindications:

oWhich analgesic can the patient take:

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13
Q

Furosemide (Lasix)

A

Class: Loop Diuretic; Volume Regulator

Mechanism of action:

  • Inhibition of NaCl reabsorption in the Loop of Henle by binding to the Cl- site of the cotransporter.
  • K+ secretion occurs in response to Na+ secretion
  • Reduce the extracellular fluid volume and BP with a greater magnitude than with thiazides

Indication:

  • HTN
  • Acute pulmonary edema
  • Edema: CHF, Hepatic cirrhosis, Renal dysfunction
  • Hyperkalemia
  • Hypercalcemia

Pharmacological effects:

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Same as those for thiazides with respect to hypokalemia and hyponatremia
-Same dental adverse effects
-Ototoxicity (hearing loss in the elderly)

oContraindicated drugs:
-NSAIDs decrease anti-HTN effects

oContraindications:

oWhich analgesic can the patient take:

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14
Q

Summary of Diuretics

A

Potency
-Loop, Thiazide, K sparing

Dosing
-Usually BID with 8 am and 4 pm administration times

Dental adverse effect

  • Dry mouth
  • Lichenoid reactions
  • Orthostatic hypotension
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15
Q

Organic Nitrate (Nitroglycerin)

A

Class: Direct-Acting Vasodilators; Vascular Tone

Mechanism of action:
Endothelial regulation of nitric oxide-mediated vascular smooth muscle relaxation
-Nitric Oxide Synthase catalyzes
-Arginine to nitric oxide and citrilline
-NO crosses freely through the cell membrane to convert guanylyl cyclase to the active form
-GMP goes to cGMP
Smooth muscle relaxes

Indication: 
Short-Acting  For acute episodes
-Sublingual Tablet 0.4 mg
-Oral Spray
Long-Acting  For Prophylaxis or ischemic heart disease
-Tablets
-Ointment
-Patch
At onset of chest pain
-1 tablet (spray) under tongue
-Can be repeated every 5 minutes for a total of 3 tablets (spray) in 15 minutes

Pharmacological effects:
Sites of action of organic nitrates
-Veins: decrease preload (main action); decreased myocardial O2 demand
-Ateries: decrease afterload; decrease myocardial O2 demand
-Heart: increased myocardial O2 supply bt dilating large epicardial arteries
Biotransformation of organic nitrates and sodium nitroprusside
-Development of tolerance: diminished response of peripheral tissues to nitrates after long term use

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Headache
-Orthostatic hypotension, stroke, dizziness, reflex tachycardia

oContraindicated drugs:
-Opiates ↑ the effects of nitric oxide

oContraindications:

oWhich analgesic can the patient take:

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16
Q

Amlodipine (Norvasc)

A

Class: Calcium Channel Blockers; Vascular Tone

Mechanism of action:

  • Block voltage dependent L-type Ca2+ channels
  • Different affinities for different conformation states of the channel
  • Differential tissue selectivity

Indication:

  • Angina
  • Coronary spasm
  • HTN

Pharmacological effects:
-Used with beta blockers in HTN

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Gingival hyperplasia

oContraindicated drugs:
-Azole antifungals decrease metabolism

oContraindications:

oWhich analgesic can the patient take:

17
Q

Diltiazem (Cardizem)

Verapamil (Calan)

A

Class: Calcium Channel Blockers; Vascular Tone

Mechanism of action:

  • Block voltage dependent L-type Ca2+ channels
  • Different affinities for different conformation states of the channel
  • Differential tissue selectivity

Indication:

  • HTN
  • Atrial fibrillation
  • Supraventricular tachycardia

Pharmacological effects:
-Used with nitroglycerin in HTN

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Gingival hyperplasia
-Verapamil-induced GH has appeared 11 months or more after subjects took daily doses of 240-360 mg.
-Severity : not dose dependent
-Gingivectomy is only successful if CCB therapy is discontinued
-GH regresses markedly 1 week after CCB discontinuance with all symptoms resolving in 2 months.

oContraindicated drugs:

  • Azole antifungals decrease metabolism
  • Beta blockers are contraindicated

oContraindications:

oWhich analgesic can the patient take:

18
Q

Site of action of calcium channel blockers

A
  • Act on myocardium and vascular smooth muscle

- Predominantly arteriolar dilators

19
Q

Doxazosin (Cardura)

A

Class: α1 Sympathetic Antagonist; Sympathetic Nervous System

Mechanism of action:

  • α1 receptor blockade
  • Smooth muscle relaxation
  • Decrease in TPR**

Indication:

Pharmacological effects:

How this drug might effect dental treatment of patient
oAdverse effects you have to consider: 
-Dry mouth
-Dizziness
-Orthostatic hypotension

oContraindicated drugs:

oContraindications:

oWhich analgesic can the patient take:

20
Q

Clonidine (Catapres)

A

Class: α2 Inverse Agonist (Sympathetic Agonist); Sympathetic Nervous System

Mechanism of action:

  • Inverse Agonist—
  • Binds to α2 medullary receptors in the brain
  • Inhibits sympathetic outflow to the body
  • Inhibition of α receptors in blood vessels

Indication:

Pharmacological effects:

How this drug might effect dental treatment of patient
oAdverse effects you have to consider: 
-Dry mouth
-Dizziness
-Orthostatic hypotension
-Abnormal taste

oContraindicated drugs:

oContraindications:

oWhich analgesic can the patient take:

21
Q

Metoprolol (Toprol XL)

A

Class: β blockers; Sympathetic Nervous System

Mechanism of action:
-Competitive inhibitor of epinephrine and norepi at β1

Indication:

  • Hypertension
  • Ischemic heart disease
  • Heart failure
  • β1 selective-usually for cardiac problems with other cardiac drugs

Pharmacological effects:
Reduce blood pressure in hypertensive patients
-CO decreases**
-HR decreases
-Peripheral resistance decreases
-Reduction in plasma renin activity
-Decrease CNS sympathetic outflow
-Alteration in baroreceptor responsiveness
↓ the force and rate of myocardial contraction
↓ O2 consumption of the heart
↓ of blood pressure in hypertensive patients

How this drug might effect dental treatment of patient
oAdverse effects you have to consider: 
-Altered taste**
-Lichenoid Reactions
-Orthostatic Hypotension
-Dry Mouth
oContraindicated drugs:
Antibiotics:
-Ampicillin causes ↓ levels of atenolol
-Allergic rxns to PCNs more severe because ↑ mediator release from mast cells
Epinephrine 
-↑ BP with bradycardia because of unopposed α stimulation
-No epi containing retraction cord
NSAIDs
-↓ antihypertensive effect
-Limit duration to 4 days

oContraindications:

oWhich analgesic can the patient take:

22
Q

Carvedilol (Coreg)

A

Class: α1/β blockers; Sympathetic Nervous System

Mechanism of action:

  • Antagonist at β1 and α1 receptors
  • Isomers bind to α or β receptors

Effects:

  • Decrease heart rate and contractility
  • Decrease blood pressure through alpha blockade

Indication:
-CHF

Pharmacological effects:

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:

oContraindicated drugs:

oContraindications:

oWhich analgesic can the patient take:

23
Q

Epinephrine use in cardiac patients

A

American Heart Association and the ADA:

  • “Vasoconstrictors should be used only when the procedure will be shortened or the analgesia rendered more profound. The minimum possible amount of vasoconstrictor should be used.”
  • Upper Limit: 0.04 mg total per procedure
24
Q

Pharmacology of cardiac contractility

A
  • Calcium enters the cell.
  • Increase in free calcium
  • Heart muscle contracts
  • Heart muscle relaxes calcium leaves the cell via the sodium gradient
  • Sodium pump keeps the heart muscle hyperpolarized
25
Q

Digoxin

A

Class: Positive Inotrope

Mechanism of action: 
Inhibition of the sodium-potassium ATPase
-↑ in available sodium
-↓ the rate of calcium-sodium exchange
-More calcium is available for contraction of cardiac muscle
-↑ force of contraction
-↓ rate of contraction
-Heart pumps more efficiently

Indication:

Pharmacological effects:

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:

oContraindicated drugs:

  • Antibiotics can kill off the bacteria in the gut that would metabolize some drug before absorption
  • Leads to Digoxin toxicity
  • Signs of toxicity: Excessive salivation, Headache, Fatigue and drowsiness, Abdominal pain, Visual disturbances, Yellow or green haze around objects

oContraindications:

oWhich analgesic can the patient take:

26
Q

Arrhythmias

A

Tachyarrhythmias

  • Stable: medical tx
  • Unstable: cardioversion
  • Need to slow the heart down
  • Why? - O2 consumption by myocardium is directly related to HR

Bradycardia/AV Blocks

  • 1st degree
  • 2nd degree
  • 3rd degree – pacemaker
  • Need to speed the heart up
  • Why?- BP is directly related to C.O. (BP=C.O.X PVR) then by definition, a HR increase will increase BP
27
Q

Atrial Fibrillation

A
  • Most common heart rhythm disturbance
  • 2 Major problems
    1. Atria firing at >350 impulses /min = no P wave (No effective atrial contraction = Risk of embolism from clot in atria – Rx: Coumadin)
    2. CV Risk is a fast ventricular rate, (increases myocardium O2 requirements)
  • Treatment: is to slow ventricular rate with Verapamil ,Beta blocker or Digoxin
  • If rate exceeds 150/min and pt is unstable must use cardioversion(synchronized shock) to get back into normal sinus rhythm
28
Q

Amiodarone

A

Class:

Mechanism of action:

  • Alteration of the lipid membrane in which channels and receptors are located
  • Lengthens the refractory period by inhibiting the potassium channels
  • Blocks sodium channels
  • Antagonizes α and β adrenergic recpetors
  • Calcium Channel Blocker

Indication:

Pharmacological effects:

How this drug might effect dental treatment of patient
oAdverse effects you have to consider:

oContraindicated drugs:

oContraindications:

oWhich analgesic can the patient take:

Pharmacology (15 decks)

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