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BDS2 BAMS > Cv medicine > Flashcards

Cv medicine Flashcards

1
Q

What are 3 irreversible risk factors for CV diseas e?

A
  • Age
  • Sex
  • Family History
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2
Q

What are 4 reversible risk factors for CV disease?

A
  • Smoking
  • Obesity
  • Diet
  • Exercise
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3
Q

What are 3 primary preventions for CV disease?

A
  • Exercise
  • Diet
  • Not smoking
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4
Q

What is hypertension?

A

High blood pressure

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5
Q

What is hyperlipidaemia?

A
  • High Cholesterol
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6
Q

What are the 4 things a patient needs to have for a patient centred and controlled was of reducing their risk of getting CV disease?

A
  • Information
  • Belief
  • Motivation
  • Behavioural change
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7
Q

What does primary prevention do?

A
  • Stops the risk that is going to give you the disease before you actually get the problem
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8
Q

What is meant by secondary prevention?

A
  • Once you have the disease, how can you stop it from getting worse
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9
Q

What is an example of secondary prevention?

A
  • Medical treatment to reduce the risk
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10
Q

Primary prevention is an opportunistic approach. What do you need to look at for primary prevention of CV disease? (6 points)

A
  • Family history
  • Diet
  • Smoking
  • Test cholesterol
  • Test blood pressure
  • Test for diabetes (type 2)
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11
Q

What is claudication?

A
  • A condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries
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12
Q

What 4 conditions are you trying to prevent when providing secondary intervention for CV disease?

A
  • Angina
  • Heart Attack
  • Stroke
  • Claudication
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13
Q

One approach to prevention is to control total cholesterol levels. How can we do this and what level do we want it to be?

A
  • Statin treatment

- Reduce cholesterol <5.0mmol/L or 25%

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14
Q

In order to control hypertension what do you want to reduce the blood pressure to?

A

A target of <140/85

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15
Q

When would you give anti-platelet drugs like aspirin in the prevention of CV disease? ( 2 points)

A
  • When identified CV disease

- When HIGH RISK with no identified disease

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16
Q

What 2 things are drugs used in the CV system used to do?

A
  • Prevent further disease

- Reduce symptoms of current disease

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17
Q

What are 4 examples of drugs used in the CV system that are used to prevent further disease?

A
  • Anti platelet drugs
  • Lipid lowering drugs
  • Anti-arrhythmics
  • Anticoagulants
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18
Q

What are 5 examples of drugs used in the CV system that are used to reduce the symptoms of the current disease?

A
  • Diuretics
  • Anti-arrhythmics
  • Nitrates
  • Calcium channel blockers
  • Ace inhibitors
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19
Q

What are 3 examples of anti-platelet drugs?

A
  • Aspirin
  • Clopidogrel
  • Dipyridamole
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20
Q

What does aspirin do as an anti-platelet drug? (3 points)

A
  • Inhibits platelet aggregation
  • Alters the balance between thromboxane A2 and prostacyclin
  • Irreversible for the life of the platelet
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21
Q

What does Clopidogrel do as an anti-platelet drug?

A
  • Inhibits ADP induced platelet aggregation
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22
Q

Does giving Aspirin and Clopidogrel together change their effect?

A
  • Yes, it gives an added effect
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23
Q

What does Dipyridamole do as an anti-platelet drug?

A
  • Inhibits platelet phosphodiesterase
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24
Q

What happens when anti-platelet drugs are used in combination?

A
  • Increases the effect
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25
Q

What do anti-platelet drugs significantly reduce the chances of? (2 points)

A
  • Heart attack

- Stroke

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26
Q

What is a negative aspect of using anti-platelet drugs?

A
  • Prolong the bleeding time following dental extraction

- Not significant problem individually but drug combinations increase the risk

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27
Q

What are the names of 2 new antiplatelet drugs?

A
  • Prasugrel

- Ticagrelor

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28
Q

What can prasugrel and ticagrelor only be prescribed in conjunction with?

A
  • Aspirin
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29
Q

What are Prasugrel and Ticagrelor only licenced for?

A
  • Acute coronary syndromes
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30
Q

What is there poor evidence of for Prasugrel and Ticagrelor in dentistry?

A
  • Bleeding risk
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31
Q

What are 4 examples of oral anticoagulants?

A
  • Warfarin
  • Rivaroxiban
  • Apixaban
  • Dabigatran
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32
Q

Warfarin is the most common oral anticoagulant. What varies between each patient for warfarin?

A
  • The dose as each patient needs a very specialised dose
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33
Q

What are antiplatelet drugs?

A
  • Drugs that stops platelets from sticking to blood vessel walls and platelets together (have an effect on platelets)
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34
Q

What are anticoagulants?

A
  • Drugs which reduce clot formation but have no effect on platelets
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35
Q

What is another name for Warfarin?

A
  • Coumarin based anticoagulant
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36
Q

What does Warfarin do?

A
  • Inhibits synthesis of Vitamin K dependent clotting factors:
  • 2, 7, 9, 10
  • Protein S and Protein C
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37
Q

How long does it take for Warfarin to act on The vitamin K dependent clotting factors 2, 7, 9 and 10?

A
  • Slow - 2 days
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38
Q

How long does it take for Warfarin to act on Protein C and Protein S?

A
  • Quick
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39
Q

How long does anticoagulation take to work?

A
  • 2-3 days
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40
Q

What is Herparin?

A
  • A compound occurring in the liver and other tissues which inhibits blood coagulation
  • It is often used concurrently initially with Warfarin to produce initial hypercoagulation
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41
Q

Once stabilised, how long will it take for the effect of Warfarin to stop if the drug is stopped?

A

2-3 days

42
Q

Why must Warfarin be monitored regularly?

A

Drug and food interaction with:

  • Plasma protein binding
  • Liver metabolism
43
Q

What test is Warfarin monitored with and what is the therapeutic range for Warfarin?

A
  • International normalised ratio test: standardised prothrombin time (PT)
  • Usually the therapeutic rnge is 2-4 (if less than 2 then patient is not receiving a high enough dose and they are at risk of a clot)
44
Q

If the therapeutic INR range for Warfarin for a patient is within the wanted range what should a dentist do?

A
  • No alteration needed for dental care
45
Q

If the therapeutic INR range for Warfarin for a patient is out with the wanted range what should a dentist do?

A
  • Refer for medical advice before treating
46
Q

Should local haemostatic measure be used for a patient on Warfarin?

A
  • Yes, always
47
Q

What drugs interact with Warfarin?

A
  • Assume all drugs interact with warfarin
48
Q

Which drugs are safe to use with Warfarin?

A
  • Local anaesthetics
49
Q

What are 4 examples of drugs that interact with Warfarin?

A
  • Amoxycillin
  • Metronidazole
  • Erthromycin
  • NSAID’s
50
Q

What are 3 examples of new oral anticoagulants and hoe often can you have these ?

A
  • Rivaroxiban (1x daily)
  • Apixaban (2x daily)
  • Dabigatran (2x daily)
51
Q

What is the half life of new oral anticoagulants?

A
  • Short half life - effect rapidly lost
52
Q

What anticoagulant test is used for new oral anticoagulants?

A
  • No test used

- Bioavailability predictable

53
Q

Are NOAC’s safe with dental antibiotics?

A
  • Yes, except Macrolides (Erythromycin and Clarithromycin)
54
Q

Are NOAC’s safe with Antifungals?

A
  • Yes, topical and fluconazole
55
Q

Are NOAC’s safe with LA?

A
  • Yes
56
Q

Are NOAC’s safe with Antivirals?

A
  • Yes
57
Q

What is the problem with the interaction between NOAC and NSAID’s?

A
  • They will prolong the action and inhibit platelets - AVOID
58
Q

What other drugs, apart from warfarin, are used to prevent CV disease? (5 points)

A
  • Statins
  • Beta-adrenergic blockers
  • Diuretics
  • Calcium channel blockers
  • ACE inhibitors
59
Q

Statins are lipid lowering drugs. What is another name for these?

A
  • HMG coA Reductase inhibitors
60
Q

What are 3 types of statins?

A
  • Simvastatin
  • Atorvastatin
  • Rosuvastatin
61
Q

Sim vastatin is a ‘prodrug’. What does this mean?

A
  • It is metabolised in the liver to give an active drug
62
Q

What do statins do?

A
  • They inhibit cholesterol synthesis in the liver

- Reduce total cholesterol and LDL-cholesterol

63
Q

What are the side effects of taking statins?

A
  • Possible myositis with some drug interactions - includes antifungals
  • Myositis = inflammation of the muscles that are used to move the body
64
Q

What is Myositis?

A
  • Inflammation of the muscles that are used to move the body
65
Q

Which antifungal interacts with statins and what should you do when a patient is on statins but needs antifungals?

A
  • FLUCONAZOLE - causes plasma levels of the statins to go up a lot and trigger muscle pain
  • Omit statin during antifungal treatment
  • This will not make a difference as taking statins is a lonf time benefit
66
Q

Atenolol is a selective beta-adrenergic blocker. What does this mean?

A
  • B1 only
  • Block the affects of adrenaline on the heart and therefore better for CVD patient (makes the heart slower and function less well to prevent stress on the heart)
67
Q

Propranolol is a non-selective beta-adrenergic blocker. What does this mean and what is it good for?

A
  • B1 and B2

- Good for anxious patients - Not so much CV patients

68
Q

What do beta-adrenergic blockers do in relation to the heart? (2 points)

A
  • Stop arrhythmias leading to cardiac arrest (ventricular fibrillation - VF)
  • Reduced heart muscle excitement
69
Q

Beta-adrenergic blockers prevent an increase in heart rate. What are the consequences of this (good and bad)? (2 points)

A
  • Cause postural hypotension

- Prevent unusual heart rhythms which can lead to heart attacks

70
Q

What is postural hypotension?

A
  • A drop in blood pressure due to a change in the body position when a person moves to a more vertical position e.g. from sitting to standing
71
Q

beta blockers reduce heart efficiency. What des this make worse?

A

Heart failure

72
Q

There are beta blocker receptors in the lungs. What does this make worse?

A
  • Makes asthma worse or more difficult to treat
73
Q

What is the function of diuretics? (3 points)

A
  • increase salt and water LOSS
  • Reduce plasma volume
  • Reduce cardiac workload
74
Q

What conditions are diuretics used for? (2 points)

A
  • Antihypertensive

- Heart failure

75
Q

What are the 2 types of diuretics and what is an example of these?

A
  • Thiazide diuretics (bendroflumethazide)

- Loop Diuretics (frusemide)

76
Q

What is the common side effect of diuretics?

A
  • Can lead to a sodium/potassium imbalance if not carefully monitored
77
Q

What is a common side effect for the elderly when taking diuretics?

A
  • Dry mouth
78
Q

What is an example of a short acting nitrate and what is it used for?

A
  • Glyceryl Trinitrate (GTN)

- Emergency management of angina pectoris

79
Q

What is an example of a long-acting nitrate and what is this used for?

A
  • Isosorbide Mononitrate

- Prevention of angina pectoris

80
Q

What is angina pectoris?

A
  • A condition marked by severe pain in the chest, often also spreading to the shoulders, arms and neck, owing to an inadequate blood supply to the heart
81
Q

Nitrates dilate veins. What does this reduce?

A
  • The preload to the heart
82
Q

Nitrates dilate resistance arteries. What does this reduce? (2 points)

A
  • Reduces cardiac workload (afterload)

- Reduces cardiac oxygen consumption

83
Q

Nitrates dilate collateral coronary artery supply. What does this reduce?

A
  • Anginal pain
84
Q

Nitrates are inactivated by first pass metabolism. What are the ways in which nitrates can be put into the body? (3 points)

A
  • Sublingual
  • Transdermal
  • Intravenous
85
Q

What is meant by transdermal?

A
  • Relating to the application of a medicine or drug through the skin, typically by using an adhesive patch, so that it is absorbed slowly into the body
86
Q

How quickly do nitrates work if they are given as a spray (sublingually)?

A
  • Short acting - works in minutes
87
Q

How quickly do nitrates work if they are given as a transdermal patch?

A
  • Works for many hours
88
Q

How long a shelf life do nitrates have?

A
  • Short shelf life
89
Q

What is a common side effect of nitrates?

A
  • Headaches
90
Q

What condition are calcium channel blockers used for?

A
  • Hypertension
91
Q

What do calcium channel blockers do?

A
  • Block calcium channels in smooth muscles
  • Some more active on peripheral blood vessels (relaxation and vasodilation)
  • Some more active on heart muscle (slow conduction of pacing impulses)
92
Q

Some Calcium channel blockers are more active on peripheral blood vessels. Give 2 examples of these?

A
  • Nifedipine

- Amlodipine

93
Q

Some calcium channel blockers are more active on the heart muscle. Give an example of one of these?

A
  • Verapamil
94
Q

What is a side effect of taking calcium channel blockers?

A
  • Lumpy, fibrous gums

also seen with cyclo sporin and phenytoin

95
Q

What does ‘ACE’ inhibitors stand for?

A
  • Angiotensin Converting Enzyme
96
Q

What are 3 examples of ACE inhibitors?

A
  • Enalapril
  • Ramapril
  • Lisinopril

(-pril)

97
Q

What do ACE inhibitors do?

A
  • Inhibit conversion of angiotensin I to angiotensin II

- This prevents aldosterone dependent reabsorption of salt and water

98
Q

What effects do ACE inhibitors have on blood pressure and fluid retention?

A
  • Reduce blood pressure

- Reduce excess salt and water retention

99
Q

What are 2 side effects of ACE inhibitors?

A
  • Cough

- Hypotension (low blood pressure)

100
Q

Angiotensin II blockers inhibit the same system as ACE inhibitors but by a different system as they block the receptor but don’t stop you making it. What is an example of an angiotensin II blocker?

A
  • Losartan
101
Q

One side effect on taking ACE inhibitor is the development of angio-oedema. What is this?

A
  • A condition characterised as a severe swelling under the skin surface

BDS2 BAMS (57 decks)

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