chapter 12

Question 1

What disorders are considered cardiovascular diseases? What are the risks of cardiovascular diseases?

Answer 1

Hypertension
Angina pectoris
Cognestive Heart Failure
Cardiac arrhythmias
Hyperlipidemia
Clotting problems

Increased risks of heart disease heart attack stroek etc.

Question 2

Why is there a relationship between periodontal health and cardiovascular health? What is the relationship?

Answer 2

They are related to one another
periodontal disease leads to increased prostaglandin secretion and other factors.
- associated w/ inflam and stress response

The worse the periodontal disease the higher the risk of cardiovascular disease.

Question 3

What is hypertension? What blood pressures indicate stage 1 vs. stage 2 hypertension?

Answer 3

High blood pressure

Stage 1: BP 130/80-139/89
Stage 2: Greater than or euqal to 140/90

Question 4

How do primary and secondary hypertension differ from one another?

Answer 4

Primary has no identifiable cause 95% while secondary is caused by underlying medical conditions 5%.

Question 5

What are the first-line treatments for hypertension?

Answer 5

lifestyechanges

Question 6

There are several types of diuretics. In which part of the nephron does each one work? What does it do?

Answer 6

• Thiazide diuretics works in the distal nephron- prevents na+ reabsorption, water stays in filtrate
• Loop diuretics works in the nephron- prevent na+ active transport.
• Aldosterone antagonoist work in the distal nephron.- weak, has reduced k+ loss.
  -decreased absoprtion of Na+

Question 7

How are ACE inhibitors used to treat hypertension? What is their mechanism of action? What are the adverse reactions associated with their use?

Answer 7

To block angiotensin I to angiotensin II conversion

Enalapril (vasotec)
Lisinopril (prinivil)

Adverse reactions: CNS, Cardiovascular, nephrotocity, gi distress, preg D, NSAIDS.

Question 8

How are angiotensin receptor blockers used to treat hypertension?

Answer 8

It blocks the action of angiotensin II which constricts blood vessels and increases blood pressure.

Question 9

How can calcium-channel blockers be used to treat hypertension? What are the adverse reactions associated with their use?

Answer 9

prevent movement of Ca2+ into muscle cells.
- relaxes vascular smooth muscles
- decreases contraction rate of heart

Adverse reaction: Hypotension
Headache
GI DIstress
Cardio
Dysgeusia
Gingival enlargment

Question 10

What are the drug that are used to treat hypertension which are calcium channel blocker?

Answer 10

Verapmil
Amlodipine (Norvasc)
Nifedipine

Question 11

How are a- and b-blockers used to treat hypertension? Which ones are cardioselective?

Answer 11

Beta-blockers are primarily used to treat hypertension by blocking the effects of adrenaline on the heart, causing it to beat slower and with less force, thereby lowering blood pressure; while cardioselective beta-blockers, like atenolol, metoprolol, and bisoprolol, are preferred as they primarily target the heart’s beta-1 receptors, minimizing side effects in other areas of the body like the lungs compared to non-selective beta-blockers.

Alpha-blockers relaxing blood vessels by blocking alpha-1 receptors which prevents norepinephrin from constricting blood vessels, leading to lowered blood pressure.

Question 12

What other treatments exist for hypertension?

Answer 12

Clonidine: causes peripheral vasodilation through action on a-receptors via CNS mediated pathway

Hydralazine: direct vasodilator of Arterioles
- first line therpay for hypertensive pregnant women.

Question 13

What is congestive heart failure? What happens when the right side of the heart fails? The left side?

Answer 13

Ventricles stretched due to structural abnormalities, injury or infection. Heart cannot pump blood effectively.

Leftside: Pulmonary Edema
Right side: Peripheral Edema

Question 14

What are the goals of drugs for congestive heart failure?

Answer 14

• To increase strength of heart contractility
• it does not increase oxygen but cardiac output.

Question 15

What is angina pectoris and why does it occur? How might someone describe the pain of angina?

Answer 15

A decreased blood flow to myocardium.

Chest pain

Chest, left arm, left shoulder, back, neck and mandible

Question 16

What conditions can bring on an acute attack of angina pectoris, and how is this relevant to dental practice?

Answer 16

Stress, anxiety or exercise

Question 17

How is an acute attack of angina pectoris treated, and how does the treatment work?

Answer 17

Treatments are either for acute pain, prophylactic care.

Acute angina pectoris: Nitrogylcerin and related drugs.

Prophylactic treatments: Ca2+ channel blockers, ranolazine (works as a vasodilator).

Needs daily aspirin regimen to help prevent clotting that can lead to angina.

Question 18

What are the prophylactic treatments for angina pectoris?

Answer 18

Daily aspirn regimen to help prevent clotting.
- ranolazine

Question 19

What are the common PDE5 inhibitors, and why is it dangerous to use an acute angina treatment on a patient who has recently taken a PDE5 inhibitor?

Answer 19

• Common PDE5 Inhibitors
  Sildenafil, Tadalafil,
  Treat erectile dysfunction and pulmonary hypertension.
• Danger of Combining with Nitrates
  Both cause vasodilation, leading to severe hypotension.
• Results: dizziness, fainting, heart attack, or death.
  Avoid Nitrates For:
  24 hrs after Sildenafil/Vardenafil.
  48 hrs after Tadalafil.
  Alternative: Use non-nitrate treatments for angina.

Question 20

How should an acute angina attack be treated in the dental office?

Answer 20

• Have the patient bring medication for acute attacks to appointment.
• can pretrear with ani-axiety meds to reduce risk of acute atttack

Question 21

What are cardiac arrhythmias?

Answer 21

Abnormal rhythm of the heart. can be atrial or ventricular

Question 22

What are the classes of drugs that treat cardiac arrhythmias? How does each one work to regulate the heart rate?

Answer 22

Class I: Na+ Channel Blockers

Class II: Beta Blockers
Block beta receptors → ↓ heart rate,

Class III: K+ Channel Blockers
Delay repolarization → prolong action potential

Class IV: Ca2+ Channel Blockers

Question 23

What diseases are associated with hyperlipidemia? What are the first-line treatments for these conditions?

Answer 23

High cholesterol

Treatment: lifestyle changes

Question 24

How do the HMG-CoA reductase inhibitors (statins) reduce cholesterol?

Answer 24

• Stimulates LDL receptors
• increases clearance of bad cholesterol

Question 25

Why are they sometimes combined with a cholesterol uptake inhibitor?

Answer 25

like Vytorin.

Works well for patients where a STATIN drug is not enough

Question 26

What are the other treatments for hyperlipidemias, and how do they work?

Answer 26

• Cholestyramine
• Colesevalam
• binds to preformed bile acids in the small intestin so they cannot be reabsorbed.
• paitne compliance is low.

*Nicotinic acid
- niacin
- vit b
- blocks fat breakdown in adipose tissue
- Decreases LDL and VLDL levels
- can associate increase in HDL levels

*Fibrates
- Fenofibrate
- works by varitey of mechanisms
- cna cause gallstone
- contraindicated for patients with hepato or nephrotoxity.

Question 27

Why do people use treatments for blood clotting disorders? Which treatments are available, and for which conditions do they work?

Answer 27

• excessive clotting or clotting deficiency.
  -excessive clotthing occures when blood vessel wall is rough and leads to a stroke or embolism
• clotthing deficiency occurs due to genetic disorders or certain medications

Meds: Warfarin/ Coumadin
asprin/dipyridmole
rivaroxaban
apixaban
dabigatran
heparin

Question 28

Which drug is used to increase clotting?

Answer 28

Aminocaproic acid
prevent fibrin breakdown to increase clotting
can be used to treat postoperative bleeding.