CVS Flashcards
What are the drugs that end in -pril? (i.e. Enalapril)
ACE inhibitors
How do ACE inhibitors work?
- Inhibit the conversion of angiotensin I to angiotensin II and prevent aldosterone dependent reabsorption of salt and water.
- Basically they reduce blood pressure by reducing excess salt and water retention
What are some side effects of taking ACE inhibitors?
- Chronic cough primarily but others too…
- Oral lichenoid reactions
- Postural hypotension (may effect when sitting patients up in the chair)
WHat should you be mindful of when prescribing NSAIDs (i.e ibuprofen, aspirin..) to someone on ACE inhibitors?
The interaction could reduce the anti-hypertensive effect as well as increase the risk of acute renal injury.
What are the drugs that end in -artan? (i.e Losartan, candesartan…)
Angiotensin II blockers
What is the mode of action of angiotensin II blockers?
Similar to how ACE inhibitors work EXCEPT; ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II, while the ARBs antagonize receptor binding of angiotensin II to AT1 receptors.
What are some side effects of ARBs?
Renal impairment, cough, postural hypotension
What should you be mindful of prescribing for someone taking ARBs?
NSAIDs
What drugs (most often but not always) end in -ipine? (i.e Amlodipine, Nifedipine, verapamil, diltiazem..)
Calcium channel blockers
What is the mode of action of calcium channel blockers?
Calcium channel blockade affects smooth muscle and results in vasodilation and a reduction in heart rate (useful in treating some arrhythmias).
Which of the CCBs are more are more active on peripheral blood vessels compared with ones that are more active on the heart muscle?
Some drugs are more active on peripheral blood vessels (-ipines) and others are more active on the heart muscle (verapamil, diltiazem)
What are some dental implications of a patient taking calcium channel blockers?
gingival hyperplasia, postural hypotension
What antibiotic should you be cautious of prescribing for a patient on calcium channel blockers?
Macrolides
What bendroflumethiazide and furosemides?
Diuretics
Bendroflumethiazide
Thiazide diuretic
Furosemide
Loop diuretic
Thiazide compared with loop diuretics and indications for both
Thiazides are used to relieve oedema due to chronic heart failure and, in lower doses, to reduce blood pressure. Loop diuretics are used in pulmonary oedema due to left ventricular failure and in patients with chronic heart failure.
Mode of action of diuretics
- Used in Hypertension and for heart failure.
- Increase salt and water LOSS leading to reduced plasma volume and therefore reduced cardiac workload
What are some side effects of diuretics use?
SE: can lead to Na+/K+
imbalance if not monitored carefully
Dental: Dry Mouth
What are the drugs ending in -olol? (i.e. bisoprolol, propranolol, atenolol…)
Beta-blockers
Mode of action for beta-blockers
Beta-blockers work by blocking beta receptors, hindering the effects of adrenaline. This reduces heart rate and blood pressure, making them effective for conditions like hypertension and anxiety. Picture beta-blockers as “stress shields” that calm the heart’s response to adrenaline, like a protective barrier against excessive excitement and high blood pressure.
Uses of beta blockers
Used in management of IHD, Hypertension AND Arrhythmias.
Stop arrhythmias leading to cardiac arrest (Ventricular fibrillation – VF). They prevent increase in heart rate by reducing heart muscle excitability.
Side effects of beta blockers
worsen asthma, postural hypotension
Drugs that end in -statin (atorvastatin, rosuvastatin, simvastatin etc)
HMG coA Reductase inhibitors
Statins mode of action
HMG-CoA reductase inhibitors, commonly known as statins, act on a key enzyme called 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase in the liver. By inhibiting this enzyme, statins reduce the synthesis of cholesterol, lowering overall cholesterol levels in the blood. Including, LDL cholesterol.
LDL cholestrol
Low-density lipoprotein (“bad cholestrol”)
Side effects of statins
Myositis (“muscle” + “inflammation”) with some drug interactions - such as dental antifungals.
Fluconazole - stop taking the statin whilst on this anti fungal and then restart when course is over.
Examples of anti-anginal drugs
Nitrates:
1. Isosorbide mononitrate - prevents angina
2. Glyceryl trinitrate (GTN spray) - short acting, useful in emergency management of angina symptoms
Mode of action of nitrates
Dilate VEINS and reduce preload to the heart
Dilate resistance arteries and reduce cardiac workload (afterload) and cardiac oxygen consumption
Dilate collateral coronary artery supply and reduce anginal pain
Side effects of nitrates
Headache, hypotension. No specific dental implications.
What are some examples of anti-platelet drugs?
Aspirin, clopidogrel, dipyridamole, new antiplatelet drugs (Prasugrel, Ticagrelor etc.)
Mode of action of aspirin
By inhibiting COX-1 in platelets, aspirin reduces the formation of thromboxane A2, a prostaglandin that promotes platelet aggregation.
Favouring; thromboxane A2 over prostaglandin may result in excessive platelet aggregation and vasoconstriction - aspirin corrects this ratio.
Mode of action of clopidogrel
Requires metabolic activation in the liver to become effective. Once activated, clopidogrel inhibits a specific receptor called the P2Y12 receptor (ADP usually acts on this to form clots) on the surface of platelets.
Mode of action of Dipyridamole
Inhibits platelet phosphodiesterase
When would new antiplatelet drugs be prescribed?
They are only licensed in the management of ACS.
Side effects of anti-platelet drugs
Increased bleeding risk. Bleeding implications - local haemostatic measures.
Anti-coagulants examples
Warfarin
Mode of action of warfarin
Inhibits synthesis of Vitamin K dependent clotting factors.
Side effects of warfarin
SE: Multiple drug interactions – Assume ALL drugs interact with Warfarin!
Dental: Bleeding Risk – local haemostatic measures
New oral anti-coagulants (NOACs) examples
• Rivaroxiban
• Apixaban
• Edoxaban
• Dabigatran
NOACs - Factor Xa Inhibitors examples
• Rivaroxiban
• Apixaban
• Edoxaban
NOACs - Direct Thrombin Inhibitor examples?
Dabigatran
Factor Xa inhibitors mode of action
Directly inhibit prothrombinase complex and Factor Xa resulting in a reduction in thrombin.
Direct Thrombin inhibitor mode of action
Targets Thrombin (Factor IIa) preventing thrombin-mediated activation of coagulation factors
Side effects of NOACs
No significant drug interactions relevant to dentistry
Dental: Bleeding risk
