chapter 12 Flashcards
What disorders are considered cardiovascular diseases? What are the risks of cardiovascular diseases?
Hypertension
Angina pectoris
Cognestive Heart Failure
Cardiac arrhythmias
Hyperlipidemia
Clotting problems
Increased risks of heart disease heart attack stroek etc.
Why is there a relationship between periodontal health and cardiovascular health? What is the relationship?
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.
What is hypertension? What blood pressures indicate stage 1 vs. stage 2 hypertension?
High blood pressure
Stage 1: BP 130/80-139/89
Stage 2: Greater than or euqal to 140/90
How do primary and secondary hypertension differ from one another?
Primary has no identifiable cause 95% while secondary is caused by underlying medical conditions 5%.
What are the first-line treatments for hypertension?
lifestyechanges
There are several types of diuretics. In which part of the nephron does each one work? What does it do?
- 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+
How are ACE inhibitors used to treat hypertension? What is their mechanism of action? What are the adverse reactions associated with their use?
To block angiotensin I to angiotensin II conversion
Enalapril (vasotec)
Lisinopril (prinivil)
Adverse reactions: CNS, Cardiovascular, nephrotocity, gi distress, preg D, NSAIDS.
How are angiotensin receptor blockers used to treat hypertension?
It blocks the action of angiotensin II which constricts blood vessels and increases blood pressure.
How can calcium-channel blockers be used to treat hypertension? What are the adverse reactions associated with their use?
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
What are the drug that are used to treat hypertension which are calcium channel blocker?
Verapmil
Amlodipine (Norvasc)
Nifedipine
How are a- and b-blockers used to treat hypertension? Which ones are cardioselective?
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.
What other treatments exist for hypertension?
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.
What is congestive heart failure? What happens when the right side of the heart fails? The left side?
Ventricles stretched due to structural abnormalities, injury or infection. Heart cannot pump blood effectively.
Leftside: Pulmonary Edema
Right side: Peripheral Edema
What are the goals of drugs for congestive heart failure?
- To increase strength of heart contractility
- it does not increase oxygen but cardiac output.
What is angina pectoris and why does it occur? How might someone describe the pain of angina?
A decreased blood flow to myocardium.
Chest pain
Chest, left arm, left shoulder, back, neck and mandible
What conditions can bring on an acute attack of angina pectoris, and how is this relevant to dental practice?
Stress, anxiety or exercise
How is an acute attack of angina pectoris treated, and how does the treatment work?
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.
What are the prophylactic treatments for angina pectoris?
Daily aspirn regimen to help prevent clotting.
- ranolazine
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?
- 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.
How should an acute angina attack be treated in the dental office?
- Have the patient bring medication for acute attacks to appointment.
- can pretrear with ani-axiety meds to reduce risk of acute atttack
What are cardiac arrhythmias?
Abnormal rhythm of the heart. can be atrial or ventricular
What are the classes of drugs that treat cardiac arrhythmias? How does each one work to regulate the heart rate?
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
What diseases are associated with hyperlipidemia? What are the first-line treatments for these conditions?
High cholesterol
Treatment: lifestyle changes
How do the HMG-CoA reductase inhibitors (statins) reduce cholesterol?
- Stimulates LDL receptors
- increases clearance of bad cholesterol
Why are they sometimes combined with a cholesterol uptake inhibitor?
like Vytorin.
Works well for patients where a STATIN drug is not enough
What are the other treatments for hyperlipidemias, and how do they work?
- 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.
Why do people use treatments for blood clotting disorders? Which treatments are available, and for which conditions do they work?
- 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
Which drug is used to increase clotting?
Aminocaproic acid
prevent fibrin breakdown to increase clotting
can be used to treat postoperative bleeding.
