Cardiovascular Pharmacology Flashcards
What part of the cardiovascular system is most likely to fail?
Blood vessels
What is the main action of cardiovascular disease?
- As the demand for O2 increases, the heart and BV compensate
- Cardiac force/rate increase to pump larger V under high pressure
- BV contract or dilate to direct blood flow to the areas requiring more O2
- CV syst. fails when heart/lungs fail to provide sufficient O2
What cardiac deficit leads to organ failure?
The demand for O2 goes up with age but supply goes down
What are different types of cardiovascular disease?
Hypertension
Coronary artery disease
Cardiac Arrhythmia
Congestive heart failure
What is conundrum #1 for patients with CV diseases?
- Patients w/ CV disease are at higher risk for medical complications due to the nature of the disease and meds
- Pt.s w/ perio may be at higher risk for thromboembolic events
- BUT If we don’t treat, their disease gets worse
What is conundrum #2?
Pts with CV have reduced functional reserve or ability to withstand stressful situations, including dental treatment
What is conundrum #3?
Benefits of using epi must outweigh the associated CV risk
Risk–> tachycardia w/ epi
What is conundrum #4?
The benefits of continued anti-thromboembolic therapy must be weighed against the associated risk of bleeding during treatment
If you tell a pt. to stop taking their blood thinners leading up to an appointment and they get sick or throw a clot, it is your fault. Consulting a physician is not a legal defense
What is hypertension?
Where the V of blood in the CV system exceeds the capacity of the system
Can be due to a failure in fluid V homeostasis in the renin-angitensinaldosterone system– or increased fluid (diuretics) or stress (beta blockers)
What types of drugs may be used to treat hypertension?
- Diuretics
- Calcium Channel Blockers
- Alpha-1 Blockers
- ACE Inhibitors
- Angiotensen II Blockers
- Beta-1 Blockers
- Clonidine
What are the goals of treatment for hypertension?
- Reduce plasma volume
- Dilate blood vessels
- Restore RAAS fluid homeostasis
- Reduce SANS-induced cardiac output
What are some non-pharmacologic treatments of hypertension?
- Reduce weight
- Limit alcohol
- Increase aerobic activity
- Reduce sodium intake
- Stop smoking
What are the adverse effects of diuretics?
Xerostomia
Orthostatic hypotension (low pressure can cause dizziness)
Hypokalemia (too little potassium)
What drugs may decrease the effectiveness of diuretics?
NSAIDs
Can cause retention of fluids
What is the main mechanism of calcium channel blockers?
Vasodilation
What are calcium channel blockers used to treat?
Hypertension
Angina
Cardiac arrhythmia
What are the adverse effects of calcium channel blockers?
Orthostatic hypotention
Constipation
What are patient care considerations with CCB’s?
Not affected by NSAIDs
Possible gingival enlargement
Dysgeusia (altered taste)
Which CCB will cause gingival enlargement?
Lodipine
What are some examples of CCBs?
Amlodipine- Norvasc
Diltiazem- Cardizem
Nifedipine- Procardia
Lodipine
What are the two types of drugs used to treat cardiac arrhythmia?
Calcium channel blockers
Beta-1 Blockers
What is the suffix used for alpha-1 blockers?
“-zosin”
What are some examples of alpha-1 blockers?
Doxazosin- Cardura
Terazosin- Hytrin
What are alpha-1 blockers used to treat?
Hypertension
What are some adverse effects of alpha-1 blockers?
- Orthostatic hypotension (can be more severe with epi)
- Xerostomia
What is a patient care consideration for alpha-1 blockers?
May interfere with action of epinephrine in LA
What are the only type pf drugs not affected by NSAIDs?
Calcium Channel Blockers
What are the two catergories of RAAS antihypertensive agents?
- ACE inhibitors
- Angiotensin II Receptor Blockers
What is the suffix used for ACE inhibitors?
“-pril”
What is the suffix used for angiotensin II receptor blockers?
“-sartan”
What are some examples of ACE inhibitors?
- lisinopril- Prinivil
- ramipril- Altace
What are some examples of angiotenin II receptor blockers?
- irbesartan- Avapro
- valsartan- Diovan
What are the dseases treated by ACE ihibitors and angiotensin II receptors?
- Hypertension
- Congestive heart failure
Adverse effects of ACEI’s and ARB’s?
Orthostatis hypotension
Adverse effects of ACEI’s and ARB’s?
Orthostatis hypotension
What adverse effect is caused by ACEI’s but not ARB’s?
Dry, unproductive cough
Which drug causes the most side effects?
Beta-1 Blockers
What are beta-1 blockers used to treat?
- Cardiac arrhythmia
- Hypertension
- Angina
- Migraines
What is the suffix used for beta-1 blockers?
“-olol”
What is the action of beta-1 blockers?
Reduces heart rate and force of contraction by cardiac activity
What are some examples of beta-1 blockers?
Cardioselective:
atenolol- Tenormin
metoprolol ER- Toprol KL
Non-Cardioselective:
nadolol- Corgard
propranolol- Inderal
What are the adverse effects of beta-1 blockers?
- Depression
- Fatigue
- Increased sensitivity to cold
What are some patient considerations with beta-1 blockers?
Beta-blockers may mask symptoms of hypoglycemia in diabetic patients
What do alpha-2 agonists treat?
- Hypertension
- Managing withdrawl effects
- ADHD
- Migraines
What are the adverse effects of alpha-2 agonists?
- Xerostomia
- Orthostatic hypotension
- Broncho-constriction
Patient care considerations for alpha-2 agonists
- CNS depression
- Fatigue
- Xerostomia
- Respiratory depression
- Rebound hypertension
