Cardiovascular Drugs Flashcards
Blood pressure that is contraindicated for dental tx is
Severe >180/110
At rest the normal heart rate is
50-100 bpm
Arrhythmias can be caused by
Diseased parts of the heart that can produce abnormal conduction pathways
Arrythmias can lead to thrombus formation and stroke so these are given
Anticoagulants
Automaticity is
The intrinsic rhythm of cardiac muscle cells
The most common arrythmia is
Atrial fibrillation
Atrial affects this many canadian
350,000
Symptoms of atrial fibrillation are
Irregular/fast heartbeat, heart palpitations, shortness of breath, chest discomfort, fatigue, dizziness, sweating, nausea, light-headed, fainting
Ischemic heart disease occurs when
Arteries do not supple enough oxygen to the myocardium due to atherosclerotic plaque
Cardiac symptom of ischemic heart disease
Angina or chest pain
Risk factors for ischemic heart disease are
Smoking, diabetes, lifestyle choices
Dental tx Contraindication of ischemic heart disease are
Unstable or progressive angina
This may be considered before treatment for those which ischemic heart disease
Prophylactic antibiotics
Heart failure is the
Inability to pump sufficient blood to meet metabolic needs of the body
The heart become ineffective in HF because
Blood accumulates in the failing ventricles, the ventricles enlarge
What is the difference between left side and right right side heart failure
Left: backs into pulmonary circulation leading to edema, dyspnea, and orthopnea
Right: causes systemic congestion leading to peripheral edema with fluid accumulation evidenced by pitting edema (pedal edema)
Common causes of HF are
Coronary artery disease and uncontrolled hypertension
Symptoms of HF are
Dyspnea, fatigue, and fluid retention
Medications for heart failure are for
The slowing of disease progression as there is no cure
Contraindication to those with HF during dental tx are
Symptomatic or decompensated heart failure
Considerations to those with heart failure during dental tx
They have difficulty lying flat, NSAIDs should be avoided, short stress free appts
Cardiovascular drugs are (9)
Beta blockers, calcium channel blockers, ACE inhibitors, Angiotensin Receptor Blockers (ARBs), Nitrates, Digoxin, Diuretics, Anti-platelets, anticoagulants
Beta blockers decrease
Heart rate and blood pressure
Uses of beta blockers
Hypertension, ischemic heart disease, heart attack, HF and arrythmias
Beta blockers MoA
Block beta adrenergic receptors
in which receptors do beta 1 blockers block? Beta 2?
Myocardium. Lungs
Beta blocker meds ends in
-olol
There are two types of beta blockers
Selective and non selective
Selective beta blockers are? And the medications are?
Beta 1. Metoprolol, atenolol, bisoprolol, esmolol
Non selective beta blockers are? And the meds are?
Beta 1 and 2 - propranolol, sotalol, madolol
Beta 1 or 2 and alpha 1 - carvedilol and labetolol
The blocking of these receptors are stronger beta blockers.
The alpha receptors (under the non-selective subgroup)
The most common AAD (oral and IV)
AMIODARONE
Used to treat supraventricular and ventricular arrythmias
AMIODARONE
Possible oral adverse side effects of amiodarone are
Abnormal salivation and taste
When utilizing vasoconstrictor with amiodarone consider
Consult with MD before use
Toxic side effects of amiodarone are
Pulmonary fibrosis, liver toxicity, photosensitivity, thyroid dysfunction
Contraindications of beta blockers are
- heart rate <60 bpm (<50 absolute
- systolic BP <100mmHg (relative)
- moderate of severe LV failure (acute)
- signs of peripheral hypoperfusion shock
- PR interval >0.24 seconds (relative)
- 2nd or 3rd degree AV block without fxning pacemaker
- severe COPD/ asthma
- severe PAD with Claudication
Adverse effects of Beta blockers
Fatigue, cold extremities, worsen depression, sleep disturbances, impotence
Can mask symptoms of hypoglycemia
Increase triglycerides
Abrupt withdrawal symptoms may cause rebound hypertension, exacerbate angina, induce arrthymia, precipitate MI
Lichenoid reactions and ortho hypotension
Consideration when using beta blockers and vasoconstriction (non selective vs cardioselective)
Non selective beta blockers with epi causing hypertension and reflex bradycardia = use with caution
Selective = use vasoconstrictors normally
Calcium channel blockers MoA
Inhibits movement of extracellular calcium ions into cells
Calcium channel blockers produce and reverse
Vasodilation. Vasospasms
Systemic vasodilation reduces
After load on the hear and reduces the total peripheral resistance which lowers blood pressure
Decreasing myocardial contractility also
Decreases cardiac output
Different type of calcium channel blockers
Diphenylakylamines, benzothiazepines, dihydropyridines
Diphenhydramines are also known as
Verapamil
Benzothiazepines also known as
Diltiazem
Dihydropyridines also known
Nifedipine, amlodipine, felodipine
The least selective of any Ca channel blocker
diphenhydramine (verapamil)
A ca channel blocker for SVT and angina
Diphenhydramine (Verapamil)
Benzothiazepines (diltiazem) effects are
Cardiovascular and cardiac effects
These Ca Channel blockers have negative inotropic effect
Diphenylakylamines (verapamil) and benzothiazepines (diltiazem) - less that the first
Diphenylakylamines decreases BP but also
Migraines
Dihydropyridines (nifedipine, amlodipine, felodipine) effects are
Minimum effect on cardiac contractility, HR and CO but major effects on vasculature
Adverse effects of Ca channel blockers are
Dizziness, headache, fatigue, constipation, hypotension, bradycardia, and edema, flushing
Calcium channel blockers are used for treatment of
Ischemic heart disease (angina), hypotension, arrythmias
Calcium channel blockers dental implications are
Gingival enlargement, additional OHI and frequent hygiene appts
ACE inhibitors affects this system and it adjusts
Renin-angiotensin-aldosterone system. Adjusts the quantity of Na and H2O retained in the peripheral resistance (blood vessels)
Renin is released by the kidney when
It senses a decrease in BP or flow
Renin catalyze
The conversion of angiotensin to angiotensin 1
ACE converts.
Angiotensin 1 to 2
ACEIs block the enzyme
ACE
Angiotensin 2 produces ________ and the adrenal cortex is stimulated to release ______ which facilitates ________. Therefore blocking these events cause _________
Vasoconstriction, aldosterone, lower BP
ACEI stand for
Angiotensin conversion enzyme inhibitors
ACEIs meds end in
-Pril (perindropril - conversely, ramipril - Altace)
Adverse effects of ACE inhibitors are
Dry hacking cough, change in taste, andioedema of lip, face, or tongue, OH, burning mouth, lichenoid reactions
What are ARBs
Agiotensin Receptor Blockers
ARBs are used when
Patients are intolerant to ACE inhibitors
Where do ARBs attach
Angiotensin 2 receptor
ARBs end in
-tan
Losartan (Cozaar) is an ARB that has a high affinity and selectivity to which receptor
AT1
The affinity of losartan (Cozaar) has these effects on renin levels
An increase in renin
Adverse effects of ARBs
Fewer adverse rxns, OH, upper resp infections, diarrhea, muscle cramps (led and back pain), angioedema, teratogenicity(!)
Nitrates are used for
Prophylaxis and tx of angina
Nitrates dilates.
Coronary arteries
nitrates interact with these drugs
PDE5
Short acting nitrates and long acting nitrates are
Spray/tablets.
Patches with isosorbide dinitrate tablets
Adverse reactions of nitrates are
Dry mouth, OH, headache
How many doses of SL NTG and intervals for someone with an angina attack
3 tabs or doses of spray, 5 minutes apart.
When should the patient with an angina attack be taken to the emergency room
After three doses
digoxin is used for
Atrial fibrillation and HF
Digoxin MoA
Increases force and strength of contraction of the myocardium = positive inotropic effect
Digoxin effects
Automaticity, conduction velocity, and refectory periods of different parts of the heart in different ways
Digoxin directly suppresses __________ which increases _________ and decreases __________ leading to a decreased
AV node conduction, effective refractory period, conduction velocity, ventricular rate
Adverse effects of digoxin
Narrow therapeutic effects - can trigger toxic symptoms with slight change in dose
increased gag reflex, anorexia, nausea, vomiting, copious salivation
Arrythmias
Dental management of those who use digoxin
Watch for signs of OD, copious salivation, epi with caution, monitor for bradycardia
These medications increase digoxin levels
Erythromycin and tetracycline
The two types of diuretics are
Thiazides and loop diuretics
Loop diuretics vs. Thiazides
Thiazides: inhibit Na an Cl reabsorption in the distal tubule
Loop diuretics: inhibits Cl reabsorption in thick ascending loop of Henle, high K+ loss in urine
Where are thiazides and loop diuretics used
T: hypertension
LD: diuresis in HF
Adverse effects of diuretics
Dry mouth and OH
What are the different antiplatelets (4)
ASA/ aspirin, Clopidogrel (Plavix), Ticagrelor(Brilinta), Prasugrel (Effient)
How does ASA/aspirin work?
Antiplatelet: irreversibly inhibits COX-1, prevents formation of thromoxane 2 (induce plt aggregation)
Clopidogrel works by
Irreversible binding to ADP P2Y receptor in the plt surface
Ticagrelor works by
REVERSIBLY bind to ADP P2Y receptor on plt surface
Prasugrel works by
Irreversibly binding to ADP P2Y receptor in plt surface (same as Clopidogrel
Prasugrel is used
Post MI, PTCA (percutaneous transluminal coronary angioplasty) CABG (coronary artery bypass graft)
Anticoagulants are
Vitamin K agonists - which interferes with synthesis of Vit K dependent clotting factors (II, VII, IX, X)
Warfarin (coumadin) is
An anticoagulant
Management of those on anticoagulants
Bleeding time is prolonged, numerous drug interactions(abs), analgesics: aspirin is contraindicated unless taking 1 daily for anticoagulant effect
INR before dental work should be for a normal person
Those on warfarin:
Mechanical valve
<3.5
2-3
2.5-3.5
Dental implications of CVD
Contraindications, vasoconstrictor limits, cardiac pacemakers, perio and CVD, adverse effects of CV drugs
These CV drugs cause xerostomia
Beta blockers, Ca channel blockers and diuretics
These drugs cause gingival hyperplasia
Ca channel blockers
These drugs cause taste disturbance s
Ca channel blockers and ACE inhibitors
Angioedema is caused by these drugs
ACE inhibitors and ARBs (less likely)
Contraindications for dental tx
Uncontrolled bp (>180/110) MI within the past 6 months Unstable or progressive angina Uncontrolled/symptomatic HF Uncontrolled arrythmias
The cardiac limit dose of epi for severely affected patients (non-cardioselective beta blockers)
0.04mg
