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MED COMP PTS > CVD > Flashcards

CVD Flashcards

1
Q

Cardiovascular Disease (CVD)
* Most common cause of?
* Patients frequently have?
* Many different types?

A
  • Most common cause of premature death in the world
  • Patients frequently have more than one CVD
  • Many different types of CVD disease
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2
Q

types of CVD

A
  • Hypertension (HTN)
  • Atherosclerosis
  • Angina Pectoris
  • Congestive Heart Failure
  • Arrhythmias
  • Bacterial Endocarditis
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3
Q

Bacterial Endocarditis results

A
  • infection, inflammation and scarring
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4
Q

Congestive Heart Failure (CHF) results

A
  • dilated ventricles with weak muscles
  • thickened myocardium
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5
Q

Valvular disease results

A

stenotic and not capable of full closure for blood circulation, leads to CHF

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6
Q

Arrhythmia results from

A

–uncoordinated electrical signals

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7
Q

CVD Risk factors: conditions

A
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8
Q

CVD risk factors: behavioral

A
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9
Q

CVD risk factors: family history

A

genetics
age
ethnicity

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10
Q

CVD predisposing etiologies

A
  • Congenital
  • Hypertension (positive CVD feedback cycle)
  • Ischemia (positive CVD feedback cycle)
  • Inflammation
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11
Q

CVD Contributary anatomic abnormalities

A
  • Hypertrophy
  • Dilation
  • Valves
  • Regurgitation
  • Stenosis
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12
Q

CVD physiological changes

A
  • Arrhythmias
  • Heart failure
  • Ischemia
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13
Q

NY heart association HF classes

A

would see mainly classess I and II

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14
Q

Signs and Symptoms of Cardiovascular Disease

A

Signs- objective
* Elevated BP
* Irregular or abnormal heart rate
* Abnormal respiratory rate
* Shortness of breath upon exertion
* Prolonged bleeding/easy bruising
* Surgical scars
​
Symptoms-subjective
* Patient is uncomfortable in supine position

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15
Q

Dental Care for patients with CVD

A
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16
Q

Medical Risk Categories of Dental Treatment

A

low, moderate, and high intervention

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17
Q

low level interventions

A
  • Health/medical evaluation
  • Exams
  • Prophy
  • Radiographs
  • Optical oral scans
  • Alginate impressions
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18
Q

moderate level interventions

A
  • SRP (scaling and root planning)
  • Simple restorative procedures; 1-2 teeth
  • Simple extractions; 1-2 teeth
  • Restorative impressions needing retractions
    and longer setting times
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19
Q

High risk inteventions

A
  • Complex restorative procedures on >2 teeth
  • Multiple extractions
  • Surgical extractions
  • Implant placement
  • Full arch impressions
  • Dental care under general anesthesia
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20
Q

factors of HTN

A
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21
Q

Renin-Angiotensin-Aldosterone

A

Maintains physiologic BP
when BP is low

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22
Q

Primary Hypertension

A
  • Multifactorial, gene-environment
  • 90-95% of cases
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23
Q

Secondary hypertension

A
  • Renal disease and renin-producing tumors
  • Endocrine
    ➢Adrenal
    ➢Exogenous hormones
    ➢Pregnancy
    ➢Pheochromocytoma
    ➢Thyroid
  • Cardiovascular
  • Neurologic
    ➢Psychogenic
    ➢Sleep apnea
    ➢Intracranial vascular pressure
    ➢Exogenous
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24
Q

Hypertension Complications

A
  • Myocardial infarction
  • Stroke
  • Coronary artery disease
  • Peripheral artery disease
  • Heart failure
  • Retinopathy
  • End-stage renal disease
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25
Q

BP categories

A
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26
Q

Goals with HTN tx

A

Goals depend on patient age and comorbidities
Generally, goals are between <130 - 149/80-90 mm Hg

professional intervention with stages 1 and 2

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27
Q

Hypertension Medical Management
* Lifestyle modifications

A

➢ Diet (increase fruit intake, decrease sodium, increased potassium)
➢ Physical exercise/weight loss
➢ Tobacco cessation and alcohol intake reduction

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28
Q

ACEi to know

A

lisinopril and captopril

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29
Q

adverse effects of ACEi

A

neutropenia/ agranulocytosis
angioedema
taste disturbances

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30
Q

Anti-arrhytmatics, Na blockers side effects

A

dry mouth and gingival overgrowth
hypersensitivity rxn syndrome

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31
Q

Ca channel blockers to know

A

Nifedipine and diltiazem

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32
Q

ca channel blocker side effects

A

gingival overgrowth, taste disturbances, dry mouth

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33
Q

diruetics to know

A

hydrochlorothiazide
spironolactone
furosmide

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34
Q

diruetics side effect

A

dry mouth

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35
Q

A andregenic blockers to know

A

methyldopa

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36
Q

A andregenic blockers side effect

A

dry mouth

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37
Q

B andregenic blockers to know

A

atenolol
propranolol
oxprenolol
practolol

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38
Q

B andregenic side effects

A

dry mouth and angioedema

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39
Q

HTN oral manofestations, causes?

A

None due to hypertension itself
* Side-effects of pharmacotherapy:
➢ Dry mouth (anti-adrenergics and diuretics)
➢ Burning mouth (ACEi)
➢ Taste changes (antiadrenergics, ACEi)
➢ Angioedema (ACEi, ARB)
➢ Gingival hyperplasia (calcium-channel blockers, what are the other 2?)
➢ Lichenoid reactions (thiazides, methyldopa, propranolol, and labetalol)
➢ Lupus-like lesions (hydralazine)

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40
Q

what drug can cause lupus like lesions

A

hydralazine

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41
Q

what drugs can cause dry mouth

A

antoandregencis and diruteics

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42
Q

what drugs can cause dry mouth

A

ACEi, antiadren, diuretics, Na blockers, ca blockers

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43
Q

what drugs can cause taste changes

A

Ca channel blockers, antiandrenegenic, and ACEi

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44
Q

what drugs can cause angioedema

A

ACEi and ARB

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45
Q

what drugs cause ginigval hyper

A

Ca channel blockers

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46
Q

what drugs cause lichenoid rxns

A

thiazides, methyldopa, propranolol, and labetalol

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47
Q

antiarrythmatics can cause what oral effects?

Na channel blockers

A

dry mouth, gingival overgrowth, hypersensitivty rxns

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48
Q

Questions to Ask Your Patient with Hypertension
about Physical Activity

A
  • Do you feel shortness of breath at rest?
  • Are you physically active?
    ➢ What kind of physical activities do you engage in?
    ➢ Do you feel shortness of breath after exercise?
    ➢ Does it limit the intensity of your physical activity
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49
Q

Hypertension History questions

A
  • How long have you had high blood pressure?
  • Who manages your blood pressure, primary care or a cardiologist?
  • How long have you been on this current antihypertensive regimen?
  • Have there been any recent changes to your blood pressure medication? Why?
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50
Q

Hypertension Monitoring questions

A
  • What is your usual BP level at the doctor’s office?
  • Do you check your BP at home?
  • What are your usual readings, how high does it get?
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51
Q

Serious potential complications of severe uncontrolled HTN:

A

Serious potential complications of severe uncontrolled HTN:
* Stroke
* Angina
* Arrhythmia
* Myocardial infarction
* Stress, anxiety, fear may increase the patient’s BP and lead to complications

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52
Q

Patients taking nonselective beta-blockers with use vasoconstritors

A

➢Use of vasoconstrictor can cause an acute rise in BP

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53
Q

HTN pts and chair postions

A

Patients may be sensitive to sudden position changes causing orthostatic hypotension

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54
Q

Pre-operative considerations for HTN

A

Pre-operative considerations
* Reduce Stress and Anxiety
➢ May need oral and/or inhalation sedation

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55
Q

Intra-operative considerations of HTN

A
  • Profound anesthesia!!!! (MOST IMPORTANT)
  • Limit epi to 2 carpules if taking a selective beta-blocker, (2 carp rule)*
  • Don’t use epinephrine-gingival retraction cord
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56
Q

Post-operative considerations of HTN
* Avoid what Abx?
* NSAIDS?
* Stage 2 during tx?
* Raising pt?

A
  • Avoid macrolide antibiotics with calcium channel blocker (↑ CCB levels)
  • Avoid long-term use of NSAIDs (>2 weeks)
  • Stage 2, monitor BP during treatment, if 180/110 stop tx!
  • Raise patient slowly after treatment b/c of hypotension
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57
Q

med consult letter for HTN general guidelines

A
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58
Q

low level intervention txs

A
  • Health/medical evaluation
  • Exams
  • Prophy
  • Radiographs
  • Optical oral scans
  • Alginate impressions
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59
Q

Moderate Interventions

A

*SRP (scaling and root planning)
*Simple restorative procedures; 1-2 teeth
*Simple extractions; 1-2 teeth
*Restorative impressions needing retractions
and longer setting times

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60
Q

High Risk Interventions

A

*Complex restorative procedures on >2 teeth
*Multiple extractions
*Surgical extractions
*Implant placement
*Full arch impressions
*Dental care under general anesthesia

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61
Q

MANAGEMENT STRATEGIES FOR PATIENTS WITH HYPERTENSION
(FOR ELECTIVE DENTAL TREATMENT) flow chart

A
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62
Q

Hypertension Medical Consult Questions*

A
  • What is the patient’sBP goal (range)
  • What have been patient’sin-office BP readings?
  • Does the patient have any end-organ damage?
  • Current medications prescribed to manage
    Hypertension
63
Q

cardiac measures for htn

A
  • Stress reduction protocol
  • Nitrous oxide
  • Profound anesthesia
  • Cardiac epi dose = max 0.04mg
    ✓Articaine for maxillary blocks and maxillary or mandibular infiltrations (short acting)
    ✓2% lidocaine 1:100,00 epi for IANB
    ✓3% mepivacaine without epi for anesthesia (long-acting)
64
Q

Atherosclerosis

A
  • Inflammatory disorder with accumulation of
    lipid plaque within the arterial walls
    ➢ Thickened intima (decreased arterial lumen)
    ➢ Decreased oxygen
    ➢ Decreased blood flow to the myocardium
65
Q
  • athersclerosis Leads to
A

➢ Stenosis
➢ Angina (stable ischemic disease)
➢ MI
➢ Ischemic stroke (acute ischemic disease)
➢ Peripheral arterial disease

66
Q

Atherosclerosis –Risk Factors

A

➢Male sex
➢Age
➢Smoking
➢Lack of exercise
➢Obesity
➢Stress
➢Depression
➢Family history of CVD
➢Hyperlipidemia
(↑LDL)
➢Hypertension
➢Insulin resistance
➢Diabetes mellitus

67
Q

Atherosclerotic plaques can lead to:

A

Atherosclerotic plaques can lead to:
- ischemia
- thrombosis, (vascular blockage) if they
rupture/ emboli

68
Q

what occurs for atheroscelrosis to begin development?

A

chronic endo injury

69
Q

what occurs due to endo injury with atherosclerosis

A

endo dysfunction

70
Q

with endothelial dysfunction what occurs next

A

smooth mm from media and macrophages migrate=lumen begins to constrict

71
Q

smooth mm and macrophages of atherscelrosis

A

will engulf lipids and increase plaque size=more lumen constriction

72
Q

end result of atherscelrosis formation

A

ppaque forms with smooth mm prolif, collagen/ECM depostion and lipid uptake

73
Q

what can be used to reduce plaque formation

A

blood thinners

74
Q

Atherosclerosis of the Circulatory System symptoms at the heart

A

➢ Chest pain
➢ Angina

75
Q
  • Complications of Atherosclerosis of the Circulatory System (Heart)
A

➢ Unstable angina
➢ Myocardial infarction (necrosis)
➢ Thrombosis
➢ Embolism
➢ Aneurysm

76
Q

Ischemic Heart Disease

A
77
Q

ischemic heart dx and bp

A

can be increased to attempt to get blood past occluded aa to area of ischemia

78
Q

Angina Pectoris

A
  • Chest pain resultant from ischemic changes
    ➢Mid-chest pain described as
    o“aching, heavy squeezing pressure or tightness”
  • Pain may radiate
    ➢Shoulder, arms, jaw
  • Pain lasts 5-15 minutes
    ➢ If unstable angina, may be longer
  • Vasodilation used to resolve angina
79
Q

stable angina

A

➢Imbalanced cardiac perfusion
➢Stable symptoms, reproducible, predictable, consistent
➢Chest pain precipitated by physical activity/exertion
➢Resolves with cessation of activity

80
Q

unstable angina

A

➢Disruption of atherosclerotic plaque
➢Possible partial thrombosis, embolism or vasospasm
➢Symptoms increasing
➢Chest pain at rest or with less intense physical activity/exertion

81
Q

Ischemic Heart Disease –Myocardial Infarction

A
  • Irreversible coagulative necrosis of the myocardium
    ➢Lose normal conduction and contraction
    ➢Left ventricle MI more common
82
Q

MI symptoms

A
  • Symptoms similar to angina, plus
    ➢Radiating features
    ➢Severe substernal pain with shortness of breath, profuse sweating,
    and loss of consciousness
83
Q

MI symptoms with dialators

A

Pain does not resolve with vasodilators and is more prolonged

84
Q

HTN common pharm tx

A

➢Beta-blockers
➢Calcium channel blockers

85
Q

angina common pharm

A

NG

86
Q

stroke prevention pharm

A

antiplatlet agents

87
Q

Revascularization (interventional) with IHD

A

➢ Percutaneous transluminal coronary angioplasty with stenting (PCI; stent)
➢ Coronary artery bypass grafting (CABG)

88
Q

durgs for hyper lipid

A

➢HMG-CoA reductase inhibitor
oStatins

89
Q

chol absorb inhibitors

A

oEzetimibe

90
Q

➢Bile acid sequestrants

A

work to decrease serum lipid
oCholestyramine
oColestipol

91
Q

fibrates

A

reduce serum lipids

oGemfibrozil

92
Q

niacin

A

reduce serum lipids
oNiaspan

93
Q

➢Omega-3 fatty acids

A

reduce serum lipids
oLovaza

94
Q

do stents and grafts req ABx prophyalxis

A

NO

95
Q

for all ischemic dx you must determine?

A
  1. Severity of the disease
  2. Stability and cardiopulmonary reserve of the patient
    (i.e., the ability to tolerate dental care)
  3. Type and magnitude of the dental procedure
96
Q

Ischemic Heart Disease questions to ask

A

Same questions as HTN + :
* Do you have chest pain?
* Have you ever had cardiac surgery?
* Have you ever had a MI?
* * Do you bruise easily?

97
Q

what to ask regarding IHD chest pain

A
  • Do you get chest pain after exercise or at rest?
  • How often? When was the last time?
  • Has there been any change in frequency or intensity of your chest
    pain?
  • Do you take anything to make it stop?
98
Q

what to know regarding cardiac procedures

A

what kind? how long ago?

99
Q

what to know about MI

A

how long ago?

100
Q

what to do day of tx for IHD pts

A
  • Make sure you and/or patient have nitroglycerin on day of visit to use where applicable.
  • Be aware of signs and symptoms of MI and be prepared for an emergency
101
Q

elective treatment in patient with unstable angina or recent history of MI?

A
  • No elective treatment in patient with unstable angina or recent
    history of MI (major risk)
102
Q

questions for pts with easy bruising

A
  • Are you taking aspirin or clopidogrel (antiplatelet meds)?
  • When you cut yourself how long does it take to stop bleeding?
  • Have you ever been hospitalized for bleeding?
103
Q

operations with increased bleeders

A
  • Increased bleeding expected, have local measures ready
  • In general, no need to stop antiplatelet therapy
  • If extensive surgery, may consider drug holiday with physician consultation
104
Q

Recent Myocardial Infarction <1
month dental care

A
  • Urgent dental care only
    ➢ACUTE dental pain or infection
  • Consultation with physician
  • Consider referral to specialized center
105
Q

Past Myocardial Infarction
>1 month dental care

A
  • Consider severity of cardiac status and comorbidities
  • Ejection Fraction can measure the degree of heart failure
    ➢Measures amount (%) of blood that leaves the left ventricle after contraction.
  • Consider appropriate management protocols
106
Q

what ejection fraction is WNL

A

55-70%

107
Q

Stress Reduction in Stable Angina or Past Myocardial Infarction
* Ideal scenario

A

➢No ischemic symptoms
➢Intermediate risk
➢No other risk factors

108
Q

Stress Reduction in Stable Angina or Past Myocardial Infarction
* Procedural Precautions

A

➢Short appointments in the morning
➢Pre-treatment vital signs
➢Availability of nitroglycerin
➢Oral sedation
➢Nitrous oxide–oxygen sedation
➢Profound local anesthesia
➢Limit amount of vasoconstrictor
➢Avoid epinephrine-impregnated retraction cord
➢Effective post-operative pain control

109
Q

anti anx preop sedation

A

short acting benzodiapene is popular 0.125-.25mg 1hr before or night before
other options: -zepams, triazolem is shortest acting option

110
Q

what drugs can increase statin levels

A
  • Statins –avoid CYP inhibitors (fluconazole, clarithromycin
  • ↑ statin levels
111
Q

caroitd atheromas

A

can be seen on pano due to HTN or hyperlipid, know pt conditon=possible med consult

112
Q

normal cardiac conduction

A

SA node
* Primary pacemaker
* Regulates atrial function
* Produces P wave (atrial depolarization)
AV node
* Regulates atrial impulses entering ventricles
* Slows conduction rate of SA generated impulses

113
Q

QRS complex

A

QRS complex
* Simultaneous depolarization of the
ventricles

114
Q

T wave

A

T wave
* Repolarization of the ventricles

115
Q

Arrhythmia

A

Disruption of the electrical impulse generation or conduction in the heart that leads to abnormal cardiac function
* Formation of abnormal impulse
* Increased impulse formation
* Enhanced or abnormal impulse formation
* Delayed depolarization
* Re-excitation of the heart after refractory period

116
Q

The disruption of arhytmias may be due to:

A
  • Infarction
  • Ischemia
  • Electrolyte imbalance
  • Medication
117
Q

The most common cause of sudden cardiac death is

A

The most common cause of sudden cardiac death is ventricular fibrillation*

118
Q

Causes of arrhythmias

A
  • Cardiovascular disorders
  • Pulmonary disorder
  • Autonomic disorder
  • Hyperthyroidism
  • Drugs
  • Electrolyte imbalance
  • Anxiety and anger
119
Q

cardio dx’s causing arthymia

A
  • Myocardial infarction
  • Mitral stenosis
  • Valvular disease
  • Ischemic heart disease
  • Congestive heart failure
120
Q

Pulmonary disorders causing arthymia

A

➢Pneumonia
➢Obstructive lung disease

121
Q

Drugs causing arrhytmia

A

➢ Epinephrine
➢ Alcohol
➢ Digitalis
➢ Morphine
➢ Beta-blockers
➢ Tricyclic antidepressants, and others

122
Q

symptoms of arryhtmia

A
  • Palpitations, fatigue
  • Dizziness, syncope, angina
  • Congestive heart failure
  • Shortness of breath
  • Orthopnea
  • Peripheral edema
123
Q

Atrial Fibrillation
* commonality?
* atrial activity?
* rhythm?
* Risk of?

A
  • Most common arrhythmia
  • Rapid uncontrolled atrial activity
  • Irregularly irregular rhythm
  • Risk of arterial clot formation
    ➢ Embolism and stroke
124
Q

Heart Block

A

Heart Block
* Impulse is partially or completely blocked
➢Prolonged or no conduction

125
Q

First-degree heart block

A

➢ Longer conduction time

126
Q

second degree heart blocks

A

➢ Mobitz I
oMore prolonged and no P wave
➢ Mobitz II*
oRepetitive or occasional sudden blocks w/o previous prolonged conduction time

127
Q

third degree heart blocks

A

➢ No impulses –COMPLETE BLOCK *
➢ Indication for pacemaker

128
Q

Ventricular Arrhythmias

A
  • Premature ventricular complexes (PVCs)
  • Common
  • Abnormal QRS complex + pause
  • Increased risk of death if patients have underlying CVD (heart failure, MI, valvular heart disease
129
Q

Ventricular tachycardia

A

Ventricular tachycardia
* If more than 3 consecutive PVC at 100 beats/min
* If lasts for more that 30 seconds, requires termination
* Torsades de pointes –potentially life-threatening

130
Q

Ventricular flutter and fibrillation

A
  • Lethal
  • Consequence of ischemic heart disease
  • Cardiac contraction is not sequential, chaotic
131
Q

Pharmacotherapy of arhytmias

A
  • Antiarrhythmics
  • Oral anticoagulants
  • Direct Oral Anticoagulants (DOACs)
132
Q
  • Oral anticoagulants for arrhthmias
A

➢ Clopidogrel (Plavix)
oInhibits platelet agglutination
oplatelet count not affected
➢ ASA (Aspirin 81mg - low dose)
oInhibits platelet agglutination
oplatelet count not affected
➢ Warfarin (Coumadin)
oVitamin K antagonist
oINR monitoring
oHighly variable

133
Q

Direct Oral Anticoagulants (DOACs) for arthymias

A

➢ Direct thrombin inhibitor
oDabigatran (Pradaxa)
oReversal agent available
➢ Direct Factor Xa inhibitors
oRivaroxaban (Xarelto)
oApixaban (Eliquis)
oEdoxaban (Savaysa)
oReversal agents not available
No reliable monitoring test, but drugs are more predictable

134
Q

stop anticoag for tx?

A

NEVER STOP ANTICOAGULATION FOR DENTAL TREATMENT UNLESS EXTENSIVE SURGERY
RISK OF THROMBOSIS > RISK OF MASSIVE BLEED
CONSULT PHYSICIAN IF EXTENSIVE SURGERY NECESSARY
CONSIDER REFERRAL TO SPECIALIZED CENTER

135
Q

Arrhythmia Non-pharmacologic tx

A
  • Pacemakers
  • Implanted Cardioverter-Defibrillator (ICD)
    ➢ Sets pace and shocks
  • Surgery
    ➢ Tissue resection
    ➢ Cardiac ablation
    ➢ Surgery to address underlying cause such as stenosis
  • Electrocardioversion and defibrillation
    ➢ Emergency situations
    ➢ Terminate persistent, refractory or lethal arrhythmias
136
Q

Arrhythmia Dental Treatment Considerations

A
  • What type of arrhythmia?
    ➢ When diagnosed? How frequent?
    ➢ How treated?
    ➢ Do you have a pacemaker or
    defibrillator?
    ➢ Have you ever required emergency
    intervention for arrhythmia?
    ➢ Is your arrhythmia stable now?
  • Assess comorbidities (CVD, pulmonary)
  • ROS: palpitations, chest pain, dizziness,
    shortness of breath, syncope
137
Q

major risk arthymias, dental management of these

A

k

138
Q

intermediate risk arrhytmias, elective care?

A

abnormal Q waves

139
Q

minor risk arrythmias

A
140
Q

High Risk Arrhythmia dental care

A
  • Defer elective dental care
  • Dental treatment should be limited to urgent care only
  • Treatment of ACUTE pain, bleeding, or infection, only
  • If necessary treatment, obtain a medical consult
  • Management may include an IV line, pulse oximeter, BP and oxygen, electrocardiogram monitoring
  • Cautious use of epinephrine (contraindicated if taking digoxin)
  • Prophylactic nitroglycerin
    **Limit Local Anesthetics.
    2 Carp or < Rule (Lido 1:100 epinephrine)
141
Q

Intermediate and Low Risk Arrhythmia dental tx

A

elective care can be provided with following management protocols:
*Stress/Anxiety reduction:
➢Oral sedative &/or inhalation sedative
*Assess pretreatment vital signs, have nitroglycerin available, limit
epinephrine (LA and gingival cord)
*Profound local anesthesia and pain control
*Devices
➢Electrosurgery units contraindicated in patient with pacemakers and ICDs
➢Ultrasonic scalers –low risk interference
➢Battery operated curing lights –low risk interferenc

142
Q

arrhytmias and blood thinners questions to ask

A

Do you take a blood thinner?
➢ How often do you have your INR measured?
➢ What was your last reading? What has been your range? (Ideal: < 3)
➢ When is your next reading?
➢ Does it take a long for you to stop bleeding after a cut?
➢ Have you ever been hospitalized due to bleeding?

143
Q

Local measures for hemostasis with blood thinner pts

A

*Gelatin sponges (Gelfoam)
*Oxidized cellulose
*Chitosan hemostatic products
*Sutures
*Gauze with applied pressure
*Topical tranexamic acid
*Topical aminocaproic acid (Amicar)
*Topical thrombin
Electrocautery - not with pacemakers

144
Q

drug classes causing gingival hyperplasia

A

ca blockers, immunsup, anticonvul

145
Q

lisinopril and captopril are what drug class

A

ACEi

146
Q

ACEi oral effects

A

taste effects, ulcers, dry mouth, lichenoid

147
Q

ACEi systemic effects

A

angioedema
neutropenia
agranulocytosis

148
Q

nifedipine, diltiazem are what class of drugs

A

Ca channel blockers

149
Q

nifedipine, diltiazem could have what oral effects

A

gingival growth
hypersensitivity
taste disturbance

150
Q

which pharm agents dont have a possibility for lichenoid rxn

A

na and k channel blockers

151
Q

hydrochlorothiazide, spironolactone, and furosemide are all:

A

diuretics

152
Q

methyldopa drug class

A

A andregenic blocker

153
Q

drug class of atenolol, propranolol, etc.

A

B blockers

MED COMP PTS (9 decks)

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