Lecture 6 Flashcards
Dx Hypertension
TWO readings of at least 140/90 at TWO appointments
Primary Hypertension
Most Common
Unknown Etiology
Older People
Secondary Hypertension
Less Common
Has some cause
Younger People
Hypertension Results in
End organ damage- heart, kidneys, brain, eyes
Stage 1 Hypertension Numbers
140-159/90-99
Normal Tension Numbers
Stage 2 Hypertension Numbers
160-179/100-109
Pre-Hypertension
120-139/80-89
Hypertensive Emergency
>180/>110 AND have symptoms: Confusion Chest Pain Renal Failure Visual Changes
Five Types of hypertension drugs
Diuretics (Thiazides, Loop) Adrenergic Agents CCB ARB ACEI
Thiazides: Mechanism
Act on distal Convuluted Tubule
Inhibit Na reabsorption
SE of Thiazides
Hypokalemia
Hyperuricemia
Xerostomia
Anorexia
Loop Diuretics: Mechanism
Act on Ascending Loop of Henle
Inhibit Na reabsorption
SE of Loop Diuretics
Hypokalemia
Hyperuricemia
What type of pts use Loop Diuretics
Hypertensive pts with CHF
Can cause rapid diuresis
Potassium Sparing Diuretics: Mech
Spirinolactone and Eplereone - Block Aldosterone Receptor
Amiloride and Triamterene - Block Na channels
Potassium Sparing D’s
Not as strong as other D’s- used as adjunct
SE of K Sparing D’s
Hyperkalemia
Arrythmia
Adrenergic Meds for Hypertensions: Types
A2 agonist
A1 antagonist
B blocker
B1 selective blocker
Adrenergic System Responses
A1 - Inc BP
A2 - Inhibits NE
B1 - Inc HR and Contraction
B2 - Inc vasoDILATION
A2 Agonist: Action
Inhibit Epi and NE –>
Vessel Dilation
SE of A2 Agonist
Drowsiness
Sedation
A1 Antagonist: Action
Block receptors in arteries and veins–> relax smooth muscle–> Reduce HTN
SE of A1 Antagonist
Postural Hypotension
Disadvantages of Non-selective B blockers and of Selective B1 Blockers
Non selective - reactive airway disease
Selective - hypotension and bradycardia
CCB’s: action
Inhibit movement of Ca into cardiac cells –> vasodilation and reduces afterload
Uses for CCB’s
Hypertension
Arryhthmias
Angina
SE’s of CCBs
Gingival growth
Excessive hypotension
Nausea/vomiting
Bradycardia
ACEI’s: Mech
Blocks ACE and thus blocks conversion of Angiotensin I to II
Angiotensin II produces vasoconstriction and stimulates aldosterone release and water retention
ACEI’s SE’s
Hypotension URI Nausea and vomiting LICHENOID ORAL LESIONS Drug interaction w/ NSAID's
ARB’s: Mech
Bind to Angiotensin II receptor and block action
–> blocks release of aldosterone
When is BP an EMERGENCY
> 180/110
ARB’s SE’s
Fewer than w/ ACEI's Dizziness, fatigue, insomnia URI's Diarrhea muscle cramping angioedema
Meds to take after MI and Stent Placement
Clopidogrel - anti platelet
Felodipine - CCB
Nitroglycerine - vasodilator
Stents, when need SBE Prophylaxis?
Only immediately after: 4-12 weeks post placement
Types of PCI
Bare Metal Stent
Drug Eluting Stent
Drugs to take with PCI’s
Aspirin and Clopidogrel (Plavix)
Duration of Platelet Therapy drugs with each stent type
Bare Metal - 1 month, ideally a year
Drug-Eluting - 6 months, ideally a year
With Bare Metal, at 6 weeks, what should you do
Bleeding risk low- continue dual-platelet therapy
High-risk surgery - just continue ASA
If Drug-eluting, defer all high risk procedures for 12 mo.
LA recommendation for pts with MI/stent hx
Restrict Epi to 0.04 mg - 2.2 carps
Angina
Mismatch of O2 needs of heart and delivery of it to heart
Angina: Tx
100% O2
Sublingual Nitroglycerin 0.4mg
Should relieve in 3-5 min - if doesn’t, suspect MI!
Anti-Angina Drugs
Nitroglycerin
CCB’s
B-Blockers
NTG Mech
Activate guanylyl cyclase and increase cGMP to cause Vasodilation!
NTG SE’s
Severe headaches
Flushing, hypotension, light-headedness
Syncope
Localized burning or tingling where places sublingually
MI
ischemia leading to myocardial muscle tissue death
Disrhythmias associated with MI
Premature ventricular contractions
Ventricular tachycardia
Ventricular fibrillation
Asystole
CHF: Mech
Heart is unable to fill/eject blood to meet bodily demands
Right Side CHF vs Left Side CHF
Right Side - Systemic Edema
Left Side- Pulmonary Congestion
CHF Classes
1 - symptomatic w/ greater thn normal activity
2 - symptomatic w/ normal activty
3 - symptomatic w/ minimal activity
4 - symptomatic w/out any activity
CHF Tx
Digoxin
Diuretics
ACEI’s
Digoxin
Most common CHF drug
Digoxin: Mech
Inc force and strength of contraction of myocardium- allows heart to do more work w/out inc use of O2–> more efficient
Digoxin SE’s
Narrow therapeutic index
Arryhthmias
Visual changes
Nausea vomiting
Digoxin Pts
Check for SE’s, minimize Epi, monitor for bradycardia
Tetracycline and Erythromycin can Inc digoxin levels!!!
First line against CHF
ACEI’s and ARB’s
Signs of poor control of CHF
Shortness of breath
Peripheral Edema
Fluctuations in body weight
CHF pts
Continue all meds on day of procedure
Obtain cardiology clearance
Minimize BP and HR fluctuation
Atrial Fibrillation
Multiple areas in atria depolarize - can lead to rate in the 180s
7x increase risk of CVA
Higher possibility of thrombus formation
Acute A Fib Tx
48 hrs- Anticoagulant for 3 weeks, then Cardiovert
Stable/Chronic A Fib Tx
CCB and B-Blockers to control rate
Anticoagulant
AntiArrhythmic Agents
Work by depressing parts of the heart that are causing abnormal beating
Dec depolarization velocity, propogation
Classes of AntiArrhythmic Agents
I - Na blockers
II - B Blockers
III - K Blockers
IV - Ca Blockers
Antiarrythmic agents Caution
Have narrow TI - so only use if arrhythmi is preventing proper heart function
Hyperlipidemia
Can cause inc in Chylomicrons
VLDL’s
LDL’s
Hyperlipidemia: Tx
Lifestyle changes
HMG CoA Reductase Inhibitors (statins)
Intestinal absorption inhibitors
Gemfibrozil
Statins: Mech and SE’s
Inhibit HMG CoA Reductase, the rate limiting enzyme in cholesterol synthesis SE's: GI issues Muscle pain Skin rash Can inc effect of warfarin
Ezetimibe
Inhibits intestinal absorption of Cholesterol
Gemfibrozil
Increases lipolysis of triglycerides and inhibits secretion of VLDL’s from liver
SE’s of Gemfibrozil
Gall stones (cholelithiasis) Taste perversion, hyperglycemia
Valve disease: Pressure overload problem
Mitral or Aortic Stenosis
Valve disease: Volume Overload problem
Mitral or Aortic Regurgitation
Heart Murmur: Systole
Aortic and pulmonary stenosis or
Mitral or tricuspid regurgitatoin
Heart Murmur: Diastole
Aortic or pulmonary regurgitation or
Mitral or tricuspid stenosis
Aortic Stenosis
Leads to ventricular hypertrophy Increased risk for MI Symptoms: Angina Syncope Dyspnea
Aortic Stenosis Prognosis
75% die in 3 years if don’t replace valve
Aortic Stenosis Mgmt
Heart rate control w/ B Blockers, CCB, Digoxin
BP Control w/ ACEI and ARB
Surgical Tx of Aortic Stenosis
Mechanical valve - last 20-30 years, long-term anticoagulant
Biologic Valve - last 10-15 years, long-term anticoagulation NOT needed
Pacemakers
Used for Sick Sinus Syndrome
Tx for Long-term bradycardia
Can pace atria, ventricles, or both
ICD
Provide shocks w/in 15 seconds if sense disrhythmia
For patients with V fib, increase risk of cardiac death, or advanced CHF
Dental treatment for people with Aortic Stenosis
DON’T TREAT - refer to OMS, continue all meds
Monopolar Cautery
DON’T EVER USE- can reset ICD
