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Pharm Final > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

Blood pressure that is contraindicated for dental tx is

A

Severe >180/110

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2
Q

At rest the normal heart rate is

A

50-100 bpm

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3
Q

Arrhythmias can be caused by

A

Diseased parts of the heart that can produce abnormal conduction pathways

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4
Q

Arrythmias can lead to thrombus formation and stroke so these are given

A

Anticoagulants

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5
Q

Automaticity is

A

The intrinsic rhythm of cardiac muscle cells

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6
Q

The most common arrythmia is

A

Atrial fibrillation

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7
Q

Atrial affects this many canadian

A

350,000

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8
Q

Symptoms of atrial fibrillation are

A

Irregular/fast heartbeat, heart palpitations, shortness of breath, chest discomfort, fatigue, dizziness, sweating, nausea, light-headed, fainting

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9
Q

Ischemic heart disease occurs when

A

Arteries do not supple enough oxygen to the myocardium due to atherosclerotic plaque

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10
Q

Cardiac symptom of ischemic heart disease

A

Angina or chest pain

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11
Q

Risk factors for ischemic heart disease are

A

Smoking, diabetes, lifestyle choices

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12
Q

Dental tx Contraindication of ischemic heart disease are

A

Unstable or progressive angina

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13
Q

This may be considered before treatment for those which ischemic heart disease

A

Prophylactic antibiotics

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14
Q

Heart failure is the

A

Inability to pump sufficient blood to meet metabolic needs of the body

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15
Q

The heart become ineffective in HF because

A

Blood accumulates in the failing ventricles, the ventricles enlarge

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16
Q

What is the difference between left side and right right side heart failure

A

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)

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17
Q

Common causes of HF are

A

Coronary artery disease and uncontrolled hypertension

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18
Q

Symptoms of HF are

A

Dyspnea, fatigue, and fluid retention

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19
Q

Medications for heart failure are for

A

The slowing of disease progression as there is no cure

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20
Q

Contraindication to those with HF during dental tx are

A

Symptomatic or decompensated heart failure

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21
Q

Considerations to those with heart failure during dental tx

A

They have difficulty lying flat, NSAIDs should be avoided, short stress free appts

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22
Q

Cardiovascular drugs are (9)

A

Beta blockers, calcium channel blockers, ACE inhibitors, Angiotensin Receptor Blockers (ARBs), Nitrates, Digoxin, Diuretics, Anti-platelets, anticoagulants

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23
Q

Beta blockers decrease

A

Heart rate and blood pressure

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24
Q

Uses of beta blockers

A

Hypertension, ischemic heart disease, heart attack, HF and arrythmias

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25
Q

Beta blockers MoA

A

Block beta adrenergic receptors

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26
Q

in which receptors do beta 1 blockers block? Beta 2?

A

Myocardium. Lungs

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27
Q

Beta blocker meds ends in

A

-olol

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28
Q

There are two types of beta blockers

A

Selective and non selective

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29
Q

Selective beta blockers are? And the medications are?

A

Beta 1. Metoprolol, atenolol, bisoprolol, esmolol

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30
Q

Non selective beta blockers are? And the meds are?

A

Beta 1 and 2 - propranolol, sotalol, madolol

Beta 1 or 2 and alpha 1 - carvedilol and labetolol

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31
Q

The blocking of these receptors are stronger beta blockers.

A

The alpha receptors (under the non-selective subgroup)

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32
Q

The most common AAD (oral and IV)

A

AMIODARONE

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33
Q

Used to treat supraventricular and ventricular arrythmias

A

AMIODARONE

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34
Q

Possible oral adverse side effects of amiodarone are

A

Abnormal salivation and taste

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35
Q

When utilizing vasoconstrictor with amiodarone consider

A

Consult with MD before use

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36
Q

Toxic side effects of amiodarone are

A

Pulmonary fibrosis, liver toxicity, photosensitivity, thyroid dysfunction

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37
Q

Contraindications of beta blockers are

A
  • 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
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38
Q

Adverse effects of Beta blockers

A

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

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39
Q

Consideration when using beta blockers and vasoconstriction (non selective vs cardioselective)

A

Non selective beta blockers with epi causing hypertension and reflex bradycardia = use with caution
Selective = use vasoconstrictors normally

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40
Q

Calcium channel blockers MoA

A

Inhibits movement of extracellular calcium ions into cells

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41
Q

Calcium channel blockers produce and reverse

A

Vasodilation. Vasospasms

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42
Q

Systemic vasodilation reduces

A

After load on the hear and reduces the total peripheral resistance which lowers blood pressure

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43
Q

Decreasing myocardial contractility also

A

Decreases cardiac output

44
Q

Different type of calcium channel blockers

A

Diphenylakylamines, benzothiazepines, dihydropyridines

45
Q

Diphenhydramines are also known as

A

Verapamil

46
Q

Benzothiazepines also known as

A

Diltiazem

47
Q

Dihydropyridines also known

A

Nifedipine, amlodipine, felodipine

48
Q

The least selective of any Ca channel blocker

A

diphenhydramine (verapamil)

49
Q

A ca channel blocker for SVT and angina

A

Diphenhydramine (Verapamil)

50
Q

Benzothiazepines (diltiazem) effects are

A

Cardiovascular and cardiac effects

51
Q

These Ca Channel blockers have negative inotropic effect

A

Diphenylakylamines (verapamil) and benzothiazepines (diltiazem) - less that the first

52
Q

Diphenylakylamines decreases BP but also

A

Migraines

53
Q

Dihydropyridines (nifedipine, amlodipine, felodipine) effects are

A

Minimum effect on cardiac contractility, HR and CO but major effects on vasculature

54
Q

Adverse effects of Ca channel blockers are

A

Dizziness, headache, fatigue, constipation, hypotension, bradycardia, and edema, flushing

55
Q

Calcium channel blockers are used for treatment of

A

Ischemic heart disease (angina), hypotension, arrythmias

56
Q

Calcium channel blockers dental implications are

A

Gingival enlargement, additional OHI and frequent hygiene appts

57
Q

ACE inhibitors affects this system and it adjusts

A

Renin-angiotensin-aldosterone system. Adjusts the quantity of Na and H2O retained in the peripheral resistance (blood vessels)

58
Q

Renin is released by the kidney when

A

It senses a decrease in BP or flow

59
Q

Renin catalyze

A

The conversion of angiotensin to angiotensin 1

60
Q

ACE converts.

A

Angiotensin 1 to 2

61
Q

ACEIs block the enzyme

A

ACE

62
Q

Angiotensin 2 produces ________ and the adrenal cortex is stimulated to release ______ which facilitates ________. Therefore blocking these events cause _________

A

Vasoconstriction, aldosterone, lower BP

63
Q

ACEI stand for

A

Angiotensin conversion enzyme inhibitors

64
Q

ACEIs meds end in

A

-Pril (perindropril - conversely, ramipril - Altace)

65
Q

Adverse effects of ACE inhibitors are

A

Dry hacking cough, change in taste, andioedema of lip, face, or tongue, OH, burning mouth, lichenoid reactions

66
Q

What are ARBs

A

Agiotensin Receptor Blockers

67
Q

ARBs are used when

A

Patients are intolerant to ACE inhibitors

68
Q

Where do ARBs attach

A

Angiotensin 2 receptor

69
Q

ARBs end in

A

-tan

70
Q

Losartan (Cozaar) is an ARB that has a high affinity and selectivity to which receptor

A

AT1

71
Q

The affinity of losartan (Cozaar) has these effects on renin levels

A

An increase in renin

72
Q

Adverse effects of ARBs

A

Fewer adverse rxns, OH, upper resp infections, diarrhea, muscle cramps (led and back pain), angioedema, teratogenicity(!)

73
Q

Nitrates are used for

A

Prophylaxis and tx of angina

74
Q

Nitrates dilates.

A

Coronary arteries

75
Q

nitrates interact with these drugs

A

PDE5

76
Q

Short acting nitrates and long acting nitrates are

A

Spray/tablets.

Patches with isosorbide dinitrate tablets

77
Q

Adverse reactions of nitrates are

A

Dry mouth, OH, headache

78
Q

How many doses of SL NTG and intervals for someone with an angina attack

A

3 tabs or doses of spray, 5 minutes apart.

79
Q

When should the patient with an angina attack be taken to the emergency room

A

After three doses

80
Q

digoxin is used for

A

Atrial fibrillation and HF

81
Q

Digoxin MoA

A

Increases force and strength of contraction of the myocardium = positive inotropic effect

82
Q

Digoxin effects

A

Automaticity, conduction velocity, and refectory periods of different parts of the heart in different ways

83
Q

Digoxin directly suppresses __________ which increases _________ and decreases __________ leading to a decreased

A

AV node conduction, effective refractory period, conduction velocity, ventricular rate

84
Q

Adverse effects of digoxin

A

Narrow therapeutic effects - can trigger toxic symptoms with slight change in dose
increased gag reflex, anorexia, nausea, vomiting, copious salivation
Arrythmias

85
Q

Dental management of those who use digoxin

A

Watch for signs of OD, copious salivation, epi with caution, monitor for bradycardia

86
Q

These medications increase digoxin levels

A

Erythromycin and tetracycline

87
Q

The two types of diuretics are

A

Thiazides and loop diuretics

88
Q

Loop diuretics vs. Thiazides

A

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

89
Q

Where are thiazides and loop diuretics used

A

T: hypertension
LD: diuresis in HF

90
Q

Adverse effects of diuretics

A

Dry mouth and OH

91
Q

What are the different antiplatelets (4)

A

ASA/ aspirin, Clopidogrel (Plavix), Ticagrelor(Brilinta), Prasugrel (Effient)

92
Q

How does ASA/aspirin work?

A

Antiplatelet: irreversibly inhibits COX-1, prevents formation of thromoxane 2 (induce plt aggregation)

93
Q

Clopidogrel works by

A

Irreversible binding to ADP P2Y receptor in the plt surface

94
Q

Ticagrelor works by

A

REVERSIBLY bind to ADP P2Y receptor on plt surface

95
Q

Prasugrel works by

A

Irreversibly binding to ADP P2Y receptor in plt surface (same as Clopidogrel

96
Q

Prasugrel is used

A

Post MI, PTCA (percutaneous transluminal coronary angioplasty) CABG (coronary artery bypass graft)

97
Q

Anticoagulants are

A

Vitamin K agonists - which interferes with synthesis of Vit K dependent clotting factors (II, VII, IX, X)

98
Q

Warfarin (coumadin) is

A

An anticoagulant

99
Q

Management of those on anticoagulants

A

Bleeding time is prolonged, numerous drug interactions(abs), analgesics: aspirin is contraindicated unless taking 1 daily for anticoagulant effect

100
Q

INR before dental work should be for a normal person
Those on warfarin:
Mechanical valve

A

<3.5
2-3
2.5-3.5

101
Q

Dental implications of CVD

A

Contraindications, vasoconstrictor limits, cardiac pacemakers, perio and CVD, adverse effects of CV drugs

102
Q

These CV drugs cause xerostomia

A

Beta blockers, Ca channel blockers and diuretics

103
Q

These drugs cause gingival hyperplasia

A

Ca channel blockers

104
Q

These drugs cause taste disturbance s

A

Ca channel blockers and ACE inhibitors

105
Q

Angioedema is caused by these drugs

A

ACE inhibitors and ARBs (less likely)

106
Q

Contraindications for dental tx

A 
Uncontrolled bp (>180/110) 
MI within the past 6 months 
Unstable or progressive angina 
Uncontrolled/symptomatic HF
Uncontrolled arrythmias
107
Q

The cardiac limit dose of epi for severely affected patients (non-cardioselective beta blockers)

A

0.04mg

Pharm Final (12 decks)

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