Cardiovascular drugs Flashcards
what are the 5 cardiovascular contraindications to dental treatment
1- acute/recent myocardial infarction (within preceding 3-6 months)
2- unstable or recent onset of angina pectoris
3- uncontrolled congestive heart failure
4- uncontrolled arrhythmias
5- significant, uncontrolled hypertension
Give 3 examples of cardiovascular disease
1- hypertension
2-angina pectoris
3- congestive heart failure
What is Congestive Heart Failure (CHF)?
The heart’s pumping mechanism is inefficient and is unable to keep up with the body’s needs for oxygen. This results in:
- inadequate cardiac output
- unsatisfactory circulation
in congestive heart failure, where can the blood end up if there is inefficient pumping?
The blood backs up behind the part of the heart that is failing.
- if heart is failing on the RIGHT side: causes systemic congestion oedema in the extremities (pedal oedema)
- if heart is failing on the LEFT side: causes congestion in the pulmonary circulation- lungs Can cause shortness of breath (orthopnea/dyspnea)
What drug is used to treat congestive heart failure?
What else can it be used to treat?
- Cardiac glycoside: Digoxin (Lanoxin)
- can also be used to treat arrhythmias
What is Digoxin (Lanoxin)?
How does it work?
- it is a cardiac glycoside
- increases sympathetic action, so increases heart rate.
- also reduces oedema by increasing glomerular filtration rate.
- slows AV conduction, prolongs refractory period of AV node and decreases rate of SA node: treats arrhythmias
What are the 5 adverse reactions to cardiac glycosides?
1- Gastrointestinal effects (nausea, vomiting)
2- Arrhythmia (if overdose, but it is often used to treat arrhythmias too)
3-neurological effects (headache, drowsiness, visual disturbances)
4-Drug interactions (diuretics)
5-Adrenalin administration (adrenalin should be used with caution, glycoside can sensitise myocardium to arrhythmias)
What drugs are used to treat angina pectoris?
Vasodilators
- nitrates: nitroglycerin (NTG)
- calcium channel blockers
Cardio-inhibitory drugs
- Beta blockers
- calcium channel blocker
What is NTG?
how does it work?
what are the forms of this drugs?
- nitroglycerin, it is a vasodilator
- It relaxes vascular smooth muscle throughout the body , and reduces resistance against which the heart must pump. This decreases the oxygen demand which relieves angina pain.
- Nitrostat (sublingual tablet), Nitrolingual (spray)
What type of drug is a calcium channel blocker?
What oral implications does it have?
- vasodilator AND cardio-inhibitory drug
- inhibits the calcium movement during contraction of the cardiac and vascular smooth muscle.
- reduces contraction of heart
- reduces conduction of heart
- reduces oxygen demand
-Nifedipine has been associated with gingival hyperplasia (overgrowth) and dysgeusia (change in sense of taste)
What type of drug is a propanolol, atenolol?
How does it work?
Use?
- it is a cardioinhibitory drug: beta-adrenergic blocker
- It reduces myocardial oxygen demand.
- It is effective in stress-/exercise-induced anginal episodes and hypertension
What type of drug is atorvastatin, fluvastatin?
How does it work?
Use?
Contraindicated?
- statin
- inhibits the enzyme involved in cholesterol synthesis (particulalry LDLs)
- used to lower cholesterol, reduce the risk of stroke
- contraindicated with active liver disease, pregnancy and breast feeding.
What drugs are used to reduce high cholesterol?
give examples
- statins
- examples: atorvastatin, fluvastatin
What is the most common cardiovascular disease?
hypertension
What is the defined as hypertension?
blood pressure greater than 140/90 mm Hg
What are the 3 categories of hypertension?
What is the % of each?
What is the treatment for each category?
1- Essential hypertension: 90% of hypertensive patients. This is also known as; essential, idiopathic or primary hypertension. The cause is UNKOWN.
Treatment: antihypertensive agents to control blood pressure
2- Secondary hypertension: 10% of hypertensive patients.
This is associated (secondary to) a specific disease involving endocrine or renal system. (narrowed artery to kidney)
Treatment: remove the cause of the hypertension
3-Malignant hypertension: can develop in 5% of patients with primary/secondary hypertension.
Blood pressure rises very rapidly and there is evidence of retinal and renal damage.
Treatment: intensive treatment with antihypertensive agents
What is the 4 stepped-care for the treatment of hypertension?
- Step 1: lifestyle changes (smoking cessation, stress reduction, increase exercise, salt restriction)
- Step 2: Therapy is initiated, drugs introduced (over 50s get diuretics. Under 50s get B-blockers) ACE inhibitor, calcium channel blocker.
- Step 3: Dose of drugs is increased, mixed together or other agents (vasodilators) added
- Step 4: Mix 2 or 3 of the drugs to achieve the right combination, maybe add neuronal blocker (guanethidine)
What drugs are used to treat hypertension?
Give examples
-Diuretic agents
thiazide diuretics
loop diuretics
potassium-sparing diuretics
- vasodilator: Angiotensin Converting Enzyme (ACE) inhibitors, calcium channel blocker
- cardioinhibitory: beta blocker
How do thiazide and loop diuretics work?
- inhibit sodium reabsorption in the distal convoluted tubule of the kidney.
- chloride ions and water accompany sodium and diuresis results.
- Increase in potassium excretion
How do ACE inhibitors work?
-Prevent the formation of angiotensin II and reduces vasoconstriction and water retention. Causes blood pressure to be reduced.
What value is considered as high blood pressure?
high blood pressure is considered to be 140/90mmHg or higher
140: systolic
90: diastolic
What value is considered as normal blood pressure?
Normal blood pressure is below 120/80 mm Hg.
120: systolic
80: diastolic
What is the difference between angina and myocardial infarction?
angina: narrowing of blood vessel, causes acute pain across chest.
myocardial infarction: when a clot fully blocks the blood vessel. This is a heart attack
What are the side effects of ACE inhibitors?
- Loss of taste
- Lichenoid reactions
- Erythema multiforme (hypersensitivity reaction which tends to develop abruptly)
- Burning mouth syndrome
What are the side effects of anti-hypertensives?
- xerostomia
- dysgeusia
- gingival overgrowth
- postural hypotension (Guanethidine)
- constipation
- CNA sedation
