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APPAC > Cardiovascular drugs > Flashcards

Cardiovascular drugs Flashcards

1
Q

what are the 5 cardiovascular contraindications to dental treatment

A

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

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2
Q

Give 3 examples of cardiovascular disease

A

1- hypertension
2-angina pectoris
3- congestive heart failure

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3
Q

What is Congestive Heart Failure (CHF)?

A

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
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4
Q

in congestive heart failure, where can the blood end up if there is inefficient pumping?

A

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)
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5
Q

What drug is used to treat congestive heart failure?

What else can it be used to treat?

A
  • Cardiac glycoside: Digoxin (Lanoxin)

- can also be used to treat arrhythmias

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6
Q

What is Digoxin (Lanoxin)?

How does it work?

A
  • 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
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7
Q

What are the 5 adverse reactions to cardiac glycosides?

A

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)

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8
Q

What drugs are used to treat angina pectoris?

A

Vasodilators

  • nitrates: nitroglycerin (NTG)
  • calcium channel blockers

Cardio-inhibitory drugs

  • Beta blockers
  • calcium channel blocker
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9
Q

What is NTG?
how does it work?
what are the forms of this drugs?

A
  • 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)
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10
Q

What type of drug is a calcium channel blocker?

What oral implications does it have?

A
  • 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)

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11
Q

What type of drug is a propanolol, atenolol?
How does it work?
Use?

A
  • it is a cardioinhibitory drug: beta-adrenergic blocker
  • It reduces myocardial oxygen demand.
  • It is effective in stress-/exercise-induced anginal episodes and hypertension
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12
Q

What type of drug is atorvastatin, fluvastatin?
How does it work?
Use?
Contraindicated?

A
  • 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.
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13
Q

What drugs are used to reduce high cholesterol?

give examples

A
  • statins

- examples: atorvastatin, fluvastatin

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14
Q

What is the most common cardiovascular disease?

A

hypertension

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15
Q

What is the defined as hypertension?

A

blood pressure greater than 140/90 mm Hg

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16
Q

What are the 3 categories of hypertension?
What is the % of each?
What is the treatment for each category?

A

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

17
Q

What is the 4 stepped-care for the treatment of hypertension?

A
  • 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)
18
Q

What drugs are used to treat hypertension?

Give examples

A

-Diuretic agents
thiazide diuretics
loop diuretics
potassium-sparing diuretics

  • vasodilator: Angiotensin Converting Enzyme (ACE) inhibitors, calcium channel blocker
  • cardioinhibitory: beta blocker
19
Q

How do thiazide and loop diuretics work?

A
  • inhibit sodium reabsorption in the distal convoluted tubule of the kidney.
  • chloride ions and water accompany sodium and diuresis results.
  • Increase in potassium excretion
20
Q

How do ACE inhibitors work?

A

-Prevent the formation of angiotensin II and reduces vasoconstriction and water retention. Causes blood pressure to be reduced.

21
Q

What value is considered as high blood pressure?

A

high blood pressure is considered to be 140/90mmHg or higher

140: systolic
90: diastolic

22
Q

What value is considered as normal blood pressure?

A

Normal blood pressure is below 120/80 mm Hg.

120: systolic
80: diastolic

23
Q

What is the difference between angina and myocardial infarction?

A

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

24
Q

What are the side effects of ACE inhibitors?

A
  • Loss of taste
  • Lichenoid reactions
  • Erythema multiforme (hypersensitivity reaction which tends to develop abruptly)
  • Burning mouth syndrome
25
Q

What are the side effects of anti-hypertensives?

A
  • xerostomia
  • dysgeusia
  • gingival overgrowth
  • postural hypotension (Guanethidine)
  • constipation
  • CNA sedation

APPAC (10 decks)

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