Pharmacology Chapter 14 - Cardiovascular Drugs

(True/False) Most patients with cardio vascular disease can safely be seen in the dental clinic, but sometimes treatment may need to be postponed.

True

What are the absolute cardiac contraindications for dental treatment?

MI within the last 6 months, unstable or recent onset of angina pectoris, uncontrolled heart failure, uncontrolled arrhythmias, and significant uncontrolled hypertension.

What vasoconstrictor should the cardiac patient receive?

Epinepherine

What is the cardiac limit for epinephrine?

0.04mg

Is there a direct relationship between periodontal disease and cardiovascular disease?

Research both agrees and disagrees

What is it called when the heart cannot pump enough blood to meet the demands of the body?

Congestive Heart Failure (CHF)

What is it called when the blood volume is great compared to the space available inside the vessels?

Hypertension

What is another name for hypertension?

High blood pressure

What is angina more commonly called?

Chest pain

What is angina?

The hearts way of signaling that it is not getting enough oxygen

What is called when the electrical conduction pathways are malfunctioning?

Arrhythmia

What is it called when the blood supply to the brain is impaired?

Cerebrovascular accident (CVA)

What is a cerebrovascular accident more commonly called?

Stroke

What is the muscle that pumps blood through a system of blood vessels that have a limited volume capacity and the electrical conduction system maintain its regular rate and rhythm?

Heart

What are some characteristics of CHF?

The heart pumps oxygenated blood to all the body tissues, the heart pumps more oxygen when exercising, if the heart is unable to meet additional needs, the hear will enlarge to meet additional needs, and eventually the heart will stretch beyond its maximum and will no longer pump effectively.

What are characteristics of heart failure?

Over time, the blood accumulates in the failing ventricle and the ventricles enlarge and as a response finally no longer pump effectively

Is it left or right heart failure if the pulmonary circulation is backed up and pulmonary edema occurs, which causes dyspnea and orthopnea?

Left failure

Is it left or right heart failure when blood is unable to be removed on the right side and causes systemic congestion and peripheral or pedal edema?

Right failure

(True/False) Heart failure is treated based on the staging of the heart failure suggested by the AHA.

True

What medications are taken for the treatment of heart failure?

Diuretics, angiotensin-converting enzyms inhibitors, angiotensin receptor blockers, beta-adrenergic blockers, aldosterone antagonistis, vasodilators, and cardiac glycosides

What is used to treat patients with heart failure and fluid retention (edema)?

Diuretic

What is the major group of drugs used to treat CHF, digoxin (lanoxin) is the most common?

Cardiac glycosides

What are the names of cardiac glycosides?

Digoxin (Lanoxin), digitalis, digitoxin, and deslanoside

What cardiac drug has a positive inotropic effect and increases the force and strength of the contraction?

Cardiac glycosides

What are the conditions that cardiac glycosides treat?

Heart failure, atrial arrhythmias and paroxysmal atrial tachycardia

(True/False) Even slight dose changes with cardiac glycosides affect toxicity, which is not uncommon.

True

What are some other adverse reactions of cardiac glycosides?

Headache, drowsiness, visual disturbances, pain in lower face, weakness, and confusion

What happens when cardiac glycosides and diuretics interact?

Arrhythmia

"Abnormal rhythm"

Arrhythmia

What is it called when the heart has an intrinsic rhythm, these can result from abnormal impulse conduction, and can be caused by anoxia, ateriosclerosis, or a heart blockage?

Arrhythmia

(True/False) Different types of arrhythmia's can cause abnormalities of the heartbeat, they can either be supraventricular (atrial) or ventricular, depending on where the arrhythmia begins.

True

What is the "pacemaker" of the heart?

SA node

The ____ node is innervated by both the parasympathetic and the sympathetic nervous system.

SA

The action potential begins in the ___ node and travels to the ___ node via the atrial muscles.

SA; AV

The ___ node sends the message via the bundle of his to the Purkinje fibers to the apex of the ventricles, signaling them all to contract.

AV

What interferes with the depolarization and transmission of the nerve impulse?

Class I - Sodium channel blockers

What decreases the effects of the sympathetic stimulation?

Class II - B-adrenergic blockers

What is used to prolong the action potential?

Class III - Potassium channel blockers

What is used to decrease the rate of firing at the SA node and AV nodes?

Class IV - Calcium channel blockers

What is a device implanted in the chest to regulate the rate of the heart?

Cardiac pacemaker

What is insufficient oxygen for the body's demand characterized by pain or discomfort in the chest radiating to the left arm and shoulder, to the neck, back and lower jaw? There is not enough oxygen to the heart muscle to work.

Angina pectoris

_____ _____ is managed by decreasing the oxygen requirements by reducing the workload of the heart, by decreasing cardiac output, and/or decreasing peripheral resistance.

Angina pectoris

What is the most frequently used nitrate to treat angina, is administered sublingually for acute attacks, rapid onset, and lasts up to 30 minutes?

Nitroglycerin

What are some adverse reactions that can happen with nitroglycerin?

Severe headache, facial flushing, hypotension, GI upset, and fainting

What are used in initial therapy of angina and in exercise or stress induced angina?

B-adrenergic blocking agents

What is the most common of all cardiovascular disease?

Hypertension

What is the "silent killer"?

Hypertension

Blood pressure greater that 140/90.

Hypertension

What organs does hypertension effect?

Heart, kidney, brain, and retina

What type of hypertension can be familial or because of environmental or genetic factors?

Essential hypertension

What type of hypertension can be identified and associated with a specific cause, such as renal or endocrine disease?

Secondary hypertension

What type of hypertension is the most severe form of hypertension where blood pressures are very high or rapidly rising, and there is usually evidence of renal damage?

Malignant hypertension

What is the first treatment for hypertension?

Lifestyle changes, such as quitting smoking, exercise, reduce stress, lose weight, improve dies, limit alcohol consumption, and reduce salt intake

Secondary treatment for hypertension would be?

B-blockers, calcium channel blockers, angiotensin receptor blockers, diuretics, and ACE inhibitors

What is the third treatment for hypertension?

Increase dosage of medication

What is the fourth treatment for hypertension?

Mix 2-3 drugs, depending on the degree of hypertension and side effects

What is the most commonly used agent for hypertension?

Diuretics

What are the three types of diuretics?

Thiazide, loop diuretics, and potassium-sparing

Which type of diuretic is the most common and it decreases sodium absorption?

Thiazide

What type of diuretic is a stronger diuretic, but is less effective and is used for patients with CHF and hypertension or where rapid diuresis is needed?

Loop diuretics

What type of diuretic is used with thiazide and has a weak diuretic action on its own?

Potassium-sparing diuretics

What are the common ACE inhibitors?

Capto'pril' (Capoten), Lisino'pril' (Prinvil, Zestril), and Enala'pril' (Vasotec)

(True/False) ACE enzymes convert Angiotensin 1 to Angiotensin 2, which causes vasoconstriction and causes aldosterone release, which causes water retention, including blood pressure.

True

By blocking ACE enzymes, _____ _____ is lowered.

Blood pressure

What is the most common angiotensin receptor blocker?

Losartan (Cozaar)

What blocks the effect of angiotensin 2 (the enzyme that causes vasoconstriction and increases PR(?)) which stimulates the release of aldosterone and water retention?

Angiotensin receptor blockers

What is a calcium channel blocker?

Nifedipine

What inhibits calcium ions through slow channels across the cell membranes?

Calcium channel blockers

What prevents or reduces the action of the SNS and with the alpha or beta receptors?

Adrenergic blocking agents

What lowers the blood pressure by decreasing the cardiac output?

B-adrenergic blocking agents

Do B1 or B2 receptors increase the heart rate, contractility, and AV conduction?

B1

Do B1 or B2 receptors cause vasodilation in skeletal muscles and bronchodilation in lung tissues?

B2

The _____ (selective/nonselective) B-blockers are preferred in patients who may have bronchospastic disease (asthma)?

Selective

The _____ (selective/nonselective) B-blockers are less likely to have a drug interaction with epinephrine?

Nonselective

What are central a-adrenergic agonists?

Clonidine (Catapres), Methyldopa (Aldomet), and direct vasodilators

What is a side effect of many antihypertensives?

Xerostomia

What are some other adverse reactions of antihypertensives?

Altered taste (dysgeusia), gingival enlargement, orthostatic hypertension, constipation, and CNS sedation

What does an antihyperlipidemic agent do?

Lowers cholesterol

"Bad cholesterol".

Low density lipoproteins (LDL)

"Good cholesterol".

High density lipoproteins (HDL)

What would be the first choice for patients with atherosclerotic heart disease and high cholesterol?

3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors ("Statins")

What vitamin in higher doses lowers cholesterol?

Niacin (B3)

What are some antihyperlipidemic agents?

Cholestyramine, fibric acid derivatives, and fish oils

What are drugs that prevent blood from clotting?

Anticoagulants

What is an oral anticoagulant that is most common?

Warfarin (Caumadin)

What drug is used in low doses in patients with previous MI?

Aspirin

What is an injectable anticoagulant?

Heparin