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LO 8 Flashcards

1
Q

Define cardiovascular

A

Heart & blood vessels path.

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2
Q

How long are patients usually on CV medication?

A

For life

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3
Q

_________% of the top 200 drugs are CV drugs

A

25

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4
Q

CV disease cause high __________ and high _________

A
  1. morbidity
  2. mortality
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5
Q

What are the contraindications for working on a CV patient?

A
  1. Recent 4-6 weeks post heart attack (MI>6 weeks - 6 months: must get med clearance)
  2. unstable angina
  3. uncontrolled CHF (congestive heart failure)
  4. uncontrolled hypertension
  5. Recent stroke <6 months
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6
Q

What treatment plan modifications should you put in place for a CV patient

A
  1. High infective endocarditis risk=> Antibiotic prophylaxis indicated.
  2. Limit epinephrine to max epin cardiac dose 0.04mg (= 2 LA carps w 1:100,000 epin)
  3. pace makers are now shielded - can use instruments with magnetics
  4. decrease stress
  5. Heart issues may present in conjunction with perio
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7
Q

What aspects of heart function can drugs impact?

A
  1. Contraction strength (Inotropic effect)
  2. Contraction rate (Chronotropic effect)
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8
Q

Research has found a relationship between periodontal disease and both cardiovascular disease and ___________

A

stroke

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9
Q

Describe congestive heart failure

A
  1. Insufficient cardiac output decreasing oxygen, leading to hypoxia
  2. Ventricular hypertrophy (enlarged ventricles)
  3. Different symptoms depending on which ventricle is impacted.
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10
Q

What symptom accompanies left ventricular hypertrophy?

A

Lung edema (water in the lungs)

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11
Q

What symptom accompanies right ventricular hypertrophy?

A

Peripheral pitting edema

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12
Q

What is Congestive Heart Failure (CHF) precipitated by?

A
  1. hyperthyroidism
  2. hypertension
  3. pregnancy
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13
Q

What treatment plan modifications should be put in place for Congestive Heart Failure (CHF) patients?

A

Chair position: semi reclined

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14
Q

What is the gold standard medication for treating Congestive Heart Failure (CHF) patients?

A

lorsartan = Cozaar First line therapy (angiotensin II receptor antagonist)

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15
Q

What drug used to be the most common to treat Congestive Heart Failure (CHF) patients?

A

Digoxin

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16
Q

Other than lorsartan/Cozaar and Digoxin, what types of drugs are used for Congestive Heart Failure (CHF) patients?

A
  1. Diuretics
  2. Nitrates (vasodilation)
  3. β-blockers (Negative chronotropic)
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17
Q

Define Arrhythmias

A
  1. Abnormal rhythm due to abnormal impulse generation or abnormal impulse conduction
  2. Usually w/ AV nodes and purkinje fibers
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18
Q

What are the 2 types of Arrhythmias?

A
  1. supraventricular (atrial)
  2. ventricular
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19
Q

Describe dental management for Arrhythmias

A
  1. Narrow therapeutic index
  2. take pulse at each appointment, check for abnormal heart beat
  3. oral side effects (xerostomia, gingival enlargement)
  4. systemic side effects (vomit, diarrhea)
  5. always check for digoxin toxicity
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20
Q

List the classes of drug used for Arrhythmias

A
  1. Class I: Na+ channel blockers
  2. Class II: Beta-blockers
  3. Class III: Potasium channel blockers
  4. Class IV: Calcium Channel Blockers CCB
  5. Class V: digoxin
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21
Q

What are the adverse reactions for Class I: Na+ channel blockers (e.g. lidocaine)?

A

anticholinergic like - xerostomia

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22
Q

What are the adverse reactions for Class II: Beta-blockers (e.g. Propranolol)?

A

Xerostomia and Bradycardia

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23
Q

What are the adverse reactions for Class III: Potassium channel blockers?

A
  1. liver toxicity
  2. blue skin
  3. photosensitivity
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24
Q

What are the adverse reactions for Class IV: Calcium Channel Blockers CCB (e.g. Verapamil)

A

gingival hyperplasia

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25
Q

What are the actions for Class V: digoxin (Drug class: Digitalis Glycoside)

A

Has a positive inotropic and negative chronotropic effect on the heart

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26
Q

Describe the adverse reactions of Digoxin

A
  1. Narrow therapeutic index
  2. G.I signs of toxicity - anorexia, nausea, vomiting, copious salivation
  3. CV signs of toxicity - Arrhythmias
  4. Neurologic signs of toxicity - headache, drowsiness, and visual disturbances; green/yellow halos; pain in mand - check that it’s not angina; trigeminal neuralgia
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27
Q

What drugs interact with Digoxin?

A
  1. Adrenergic agonists: α + β agonists will cause arrhythmia
  2. certain antibiotics (tetracycline and erythromycin) can cause digoxin toxicity
28
Q

What should be done for clients on Digoxin?

A
  1. Watch for signs of toxicity
  2. Limit epinephrine
  3. Monitor pulse and rhythm at every appointment
  4. Avoid AB that can cause toxicity
29
Q

Define Angina Pectoris

A
  1. PARTIAL obstruction in one or more of the coronary arteries (4 arteries)
  2. Signs & symptoms - Intense chest pain/pressure radiating to L arm, L shoulder, L mand, neck, back
  3. pain increases with exercise/stress
  4. pain decreases with rest & Nitrate treatment
30
Q

What are the 3 types of drug treatments for anginas?

A
  1. Nitrates
  2. Calcium channel blockers (e.g. verapamil or nifedipine (dipines) e.g. amlodipine)
  3. B-blockers - “olol ” (e.g. propranolol and atenolol) - negative inotropic and chronotropic effect on the heart
31
Q

What drugs are known to cause gingival hyperplasia?

A

Calcium channel blockers (e.g. verapamil and nifedipine)

DDS/RDH management of Gingival Hyperplasia
1. OHI
2. Frequent visits to control gingival hyperplasia (2-3 months)
3. Refer to own MD to decrease the dose or another drug?
4. Gingivectomy

32
Q

What are the 3 routes of administration for Nitroglycerine?

A
  1. Sublingual tablets (Nitrostat)
  2. Sublingual spray (Nitrolingual)
  3. Transdermal and I.V.
33
Q

_________ can develop with nitroglycerine with long-term regular use

34
Q

List the adverse reactions of nitroglycerine

A
  1. Burning/ tingling
  2. Headaches
  3. Flushed (very red)
  4. Hypotension
  5. Syncope (fainting)
35
Q

Once open, how long are nitroglycerine pills (Nitrostat) good for?

A

3-6 months

36
Q

Once open, how long is nitroglycerine spray good for?

A

Until the expiry date on the bottle

37
Q

What can nitroglycerine react with?

A
  1. Sildenafil (Viagra)
  2. The combination can cause dangerously low blood pressure
38
Q

Describe the treatment of an acute angina attack in clinic

A
  1. NTG always available in the drug kit
  2. make sure the patient has not used a PDE5 inhibitor (e.g. Viagra) within the past 24 hours; if such is the case, call 911
  3. Seat client before NTG administration
  4. Instruct client tonot inhale spray*
  5. 1 tab q 5 min X3 times
  6. If Pt does not feel better must call 911 (M.I. in progress)
39
Q

Describe a heart attack (myocardial infarction)

A
  1. COMPLETE obstruction of one or more of the coronary arteries
  2. An anginal attack not relieved by three doses of sublingual nitroglycerine may be experiencing an MI
  3. Call 911, provide chewable aspirin + O2 and CPR if needed
40
Q

Describe Hyperlipidemia

A

High LDL cholesterol & tri-glycerides and therefore increase the risk for CV Disease

41
Q

How is Hyperlipidemia treated?

A
  1. The “statins”
  2. atorvastatin (Lipitor)
  3. rosuvastatin (Crestor)
42
Q

What are the adverse reactions of statins?

A

Muscle pain

43
Q

What hyper coagulant is used to treat Blood Coagulation and what is its adverse reaction?

A
  1. Tranex (tranexamic acid)
  2. intravascular thrombosis
44
Q

What are the 3 types of anticoagulants “blood thinners”?

A
  1. Vitamin K antagonist e.g. heparin: IV, warfarin (Coumadin) (require regular INR blood tests
  2. New anticoagulants: Elaquis, Xarelto and Pradaxa no INR is necessary
  3. mild anticoagulants: e.g Aspirin & Plavix
45
Q

What level INR must a patient on heparin or warfarin have in order to qualify for elective dental treatment?

A

Between 1-3

46
Q

What are the adverse reactions of heparin/warfarin

A
  1. Prolonged bleeding
  2. Petechial and ecchymosis esp on the hard palate and without trauma
47
Q

Should we stop anticoagulant before dental surgery?

A
  1. If excessive bleeding occurs: Anticoagulants should only be temporarily stopped before an appointment after the patient’s physician has been consulted and agrees with the decision.
  2. Usually we do not.
48
Q

Describe hypertension

A
  1. Defined as equal to or more than140/90
  2. The higher the BP the worse the hypertension
  3. Normal BP: below 120/80
  4. Most common CV disease : ~30% population
  5. “Silent killer”
  6. Associated with high morbidity and high mortality
49
Q

What is the evil triad?

A

Diabetes, HT, high cholesterol

50
Q

What are the 2 major types of hypertension?

A
  1. Essential (90%) - multifactorial/genetic
  2. Secondary (10%) - caused by renal and/or endocrine malfunction or meds
51
Q

What medications can cause hypertension?

A
  1. NSAIDS (Advil, ibuprofen.)
  2. Tricyclic antidepressants
  3. Certain decongestants
52
Q

What are the 3 stages of hypertension?

A
  1. 140-159/90-99
  2. 160-179/100-109
  3. > 180/>110
53
Q

What are the treatments for primary and secondary hypertension?

A
  1. Primary - antihypertensives
  2. Secondary - remove the cause
54
Q

What are the RDH treatment modifications for high blood pressure?

A
  1. Take blood pressure reading at every appointment
  2. Postpone Tx if BP > 160/100
  3. Obtain medical clearance
  4. Short appointments
  5. Stress-free appointments
55
Q

Describe the recommended lifestyle modifications to treat hypertension

A
  1. Limit salt
  2. Exercise
  3. Dietary changes
  4. Lose weight
  5. Stop smoking
56
Q

List the hypertensive drugs

A
  1. Diuretics: Thiazides
  2. C.C.B. (calcium channel blockers)
  3. β-blockers ‘olol ‘
  4. α-blockers
  5. α- and β-blockers ‘alol ‘
  6. Angiotensin Drugs: either ACE inhibitors “-pril” or Angiotensin II receptor blocker (ARB) “-sartan”
57
Q

Describe Diuretics (Thiazides)

A
  1. Hydrochlorothiazide
  2. Adverse reactions - hypoKalemia - Must take potassium (K) supplements; xerostomia; Lichenoid rxn (red lesions in mouth
58
Q

Describe calcium channel blockers for hypertension

A
  1. verapamil/nifidipine
  2. Adverse reactions - gingival hyperplasia
59
Q

Describe β-blockers used for hypertension

A
  1. atenolol/atenolol
  2. Adverse reactions - xerostomia; Bradycardia
  3. Drug-drug interaction with epinephrine
60
Q

Describe α-blockers for hypertension

A
  1. Adverse reactions - orthostatic hypotension
  2. Drug interaction with epinephrine - epinephrine reversal effect
61
Q

What α+β-blocker is used for hypertension?

62
Q

Describe angiotensin drugs for hypertension

A
  1. ACE inhibitors ‘pril’ - captopril
  2. Adverse Reactions - taste changes
  3. Angiotensin II receptor blockers “sartan” - e.g. losartan
63
Q

List the combination antiypertensives

A
  1. losartan/hydrochlorothiazide =Hyzaar
  2. telmisartan+ hydrochlorothiazide (HCT)= MicardisPlus
  3. amlodipine/valsartan = Exforge
64
Q

Most antihypertensives have adverse drug interaction with ____________ and ____________, resulting in decrease efficacy of the antihypertensive drugs, elevating otherwise controlled blood pressure.

A
  1. NSAIDs
  2. ASA/Aspirin
65
Q

What food should you never eat when on antihypertensives?

A

grapefruit

Pharmacology (15 decks)

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