ALL PHARM

What are contraindications to dental treatment for cardiovascular patients?

Acute/recent MI within 3-6 months, unstable angina, uncontrolled CHF, uncontrolled arrhythmias, significant uncontrolled hypertension.

What is the recommended cardiac dose of epinephrine for cardiovascular patients?

0.04 mg may be warranted in severe cases.

How does periodontal disease relate to cardiovascular disease?

Periodontal disease can increase morbidity and mortality from cardiovascular disease, although some studies reject this relationship.

What is congestive heart failure (CHF)?

A condition where the heart does not provide adequate cardiac output, leading to blood accumulation in the ventricles and ineffective pumping.

What are common symptoms of left-sided heart failure?

Pulmonary edema, dyspnea, and orthopnea.

What is the primary treatment for heart failure related to fluid retention?

Diuretics, with loop diuretics being more effective than thiazide diuretics.

What are Angiotensin-Converting Enzyme Inhibitors (ACEIs) used for?

They are prescribed for all symptomatic heart failure patients and asymptomatic patients with decreased left ventricular ejection fraction or history of MI.

What is the role of Angiotensin Receptor Blockers (ARBs) in heart failure treatment?

ARBs reduce mortality and symptoms and are used for patients who cannot tolerate ACEIs.

Which beta-adrenergic blockers are recommended for heart failure?

Bisoprolol, carvedilol, and sustained-release metoprolol.

When should aldosterone antagonists be used in heart failure?

For patients with symptoms of heart failure and LVEF of < 35% to reduce morbidity and mortality.

What is the function of vasodilators in heart failure treatment?

They lower peripheral resistance and reduce the workload of the heart.

What is the combination drug Entresto used for?

It combines sacubitril (neprilysin inhibitor) and valsartan (ARB) to reduce the risk of CV death and hospitalization for chronic heart failure.

What is the mechanism of action of Ivabradine?

It inhibits the If ion channel in the SA node, reducing cardiac pacemaker activity and slowing heart rate.

What are the pharmacologic effects of Digoxin?

Increases force of heart contraction, reduces edema in CHF, and slows AV conduction.

What are common adverse reactions of Digoxin?

GI issues (anorexia, nausea, vomiting), arrhythmias, neurologic symptoms (headache, visual disturbances).

What dental drug interactions should be monitored with Digoxin?

Digoxin can interact with sympathomimetics, erythromycin, and tetracycline, increasing the risk of arrhythmias and toxicity.

What are the causes of arrhythmias?

Abnormal impulse generation and conduction, often due to myocardial anoxia, arteriosclerosis, or heart block.

What are the types of arrhythmias?

Supraventricular (atrial) and ventricular types, which may result in bradycardia or tachycardia.

What is angina pectoris characterized by?

Pain or discomfort in the chest radiating to the left arm and shoulder.

What is the primary pharmacological action of antianginal drugs?

Reduction of the workload of the heart by decreasing cardiac output and/or peripheral vascular resistance.

What is the action of Nitroglycerin?

It is a vasodilator that decreases oxygen demand and relieves angina symptoms.

What is amyl nitrite used for?

It is a volatile agent used in emergencies by crushing the container and inhaling the fumes.

What is the primary use of sublingual nitroglycerin?

It is used to treat acute anginal attacks.

How long does sublingual nitroglycerin take to act?

It has a rapid onset and can last up to 30 minutes.

What are common adverse reactions to nitroglycerin?

Severe headaches, flushing, hypotension, lightheadedness, and syncope.

How should nitroglycerin be stored?

In its original brown glass container, away from heat and moisture, and not refrigerated.

What is a significant drug interaction with nitroglycerin?

Combination with phosphodiesterase (PDE5) inhibitors like sildenafil can cause dangerously low blood pressure.

What are beta-adrenergic blocking agents used for?

They are used in the treatment of angina pectoris and hypertension.

What are common adverse effects of beta-blockers?

Bradycardia, congestive heart failure (CHF), headache, xerostomia, blurred vision, and unpleasant dreams.

What is the mechanism of action for calcium-channel blocking agents?

They inhibit the movement of calcium during contraction of cardiac and vascular smooth muscle, leading to vasodilation.

What are common adverse effects of calcium-channel blockers?

Dizziness, weakness, constipation, hypotension, and dysgeusia (specifically with nifedipine).

What is ranolazine used for?

It is used for the treatment of chronic angina, either alone or in combination with other antihypertensives.

What are the recommendations for angiotensin-converting enzyme (ACE) inhibitors?

They are recommended for all patients with chronic stable angina who also have high blood pressure, diabetes, or chronic kidney disease.

What is the difference between essential and secondary hypertension?

Essential hypertension has no identifiable cause, while secondary hypertension is linked to a specific disease process.

What is malignant hypertension?

It is characterized by extremely high blood pressure with evidence of retinal and renal damage.

What lifestyle modifications are recommended for hypertension management?

Cessation of smoking, stress reduction, increased exercise, weight reduction, and salt restriction.

What are thiazide diuretics commonly used for?

They are among the most used agents for the treatment of high blood pressure.

What are common side effects of thiazide diuretics?

Hypokalemia, hyperuricemia, hyperglycemia, hyperlipidemia, and xerostomia.

What is the role of potassium-sparing diuretics?

They help conserve potassium while promoting sodium excretion through diuresis.

What is the mechanism of action of spironolactone?

It acts as an aldosterone antagonist, promoting sodium excretion and conserving potassium.

What should be done in case of an acute anginal attack during dental treatment?

Administer sublingual nitroglycerin and ensure the patient has not taken a PDE5 inhibitor in the past 24 hours.

What is the protocol if a patient does not experience relief after three doses of sublingual nitroglycerin?

The patient may be having a myocardial infarction (MI) and should be taken to the emergency room.

What is the importance of checking the expiration date of nitroglycerin in a dental office?

To ensure the medication is effective and safe for use in emergencies.

What is the effect of NSAIDs on thiazide diuretics?

NSAIDs can reduce the antihypertensive effect of thiazide diuretics.

What is the combination of triamterene and hydrochlorothiazide used for?

It is one of the most frequently used preparations for managing hypertension.

What is hypokalemia?

A condition characterized by low potassium levels in the blood.

In which patients are potassium-sparing diuretics relatively contraindicated?

Patients with severe renal impairment or those receiving potassium-sparing diuretics.

What is the most common adverse reaction to potassium salts?

Nausea and gastrointestinal irritation.

What should be questioned when patients are taking potassium supplements?

Their diuretic use.

What do ACE inhibitors do?

Prevent the formation of angiotensin II.

List some adverse reactions of ACE inhibitors.

Hypotension, dizziness, chest pain, insomnia, fatigue, headache, nausea, vomiting, diarrhea, dry cough, allergic reactions.

What is the prototype angiotensin II receptor antagonist?

Losartan.

What are common adverse reactions of losartan?

Dizziness, fatigue, dry cough, nasal congestion, diarrhea, muscle cramps, leg/back pain, angioedema.

What is Tekturna indicated for?

Oral use as monotherapy or in combination with other antihypertensives.

What is the mechanism of calcium channel blockers?

Inhibit the movement of extracellular calcium ions into cells.

What are the pharmacologic effects of calcium channel blockers on smooth muscle?

Relaxation of vascular smooth muscle and dilation of coronary and peripheral arteries.

What are some adverse reactions of calcium channel blockers?

Hypotension, nausea, vomiting, constipation, bradycardia, peripheral edema, shortness of breath.

What dental drug interactions are associated with calcium channel blockers?

Diltiazem and verapamil may increase levels of carbamazepine.

What is the prototype nonselective beta-adrenergic blocker?

Propranolol.

How do beta-adrenergic blockers lower blood pressure?

By decreasing cardiac output, plasma volume, and peripheral resistance.

What are common side effects of beta-adrenergic blocking agents?

Bradycardia, mental depression, confusion, dizziness, nausea, vomiting.

What is labetalol?

A nonselective beta-adrenergic receptor with alpha-receptor blocking activity.

What do alpha-1 adrenergic blocking agents like doxazosin and terazosin do?

Produce vasodilation and decrease peripheral vascular resistance.

What are some adverse reactions of alpha-1 adrenergic blocking agents?

Orthostatic hypotension, CNS depression, tachycardia, peripheral edema.

What is clonidine used for?

Management of essential hypertension as a CNS mediated antihypertensive.

What are common oral effects of clonidine?

High incidence of xerostomia, parotid gland swelling, pain, dysgeusia.

What is hydralazine's mechanism of action?

Acts directly on arterioles to reduce peripheral resistance.

What are some side effects of hydralazine?

Cardiac arrhythmias, angina, headache, dizziness.

What is Reserpine used for?

It is used in low doses as an antihypertensive agent.

What are some adverse reactions of Reserpine?

Bad dreams, sedation, diarrhea, aggravation of peptic ulcers, gynecomastia, galactorrhea, and breast engorgement.

What should be checked for in dental patients taking antihypertensive agents?

Xerostomia, gingival enlargement (if on CCB), blood pressure, altered sense of taste, hypokalemia (if on diuretics), neutropenia (if on ACE inhibitors), constipation, and CNS depression.

What is hyperlipidemia?

Elevations of plasma lipid concentrations above accepted normal values.

What is HDL and why is it considered 'good cholesterol'?

High-density lipoproteins (HDL) have the lowest cholesterol content and carry cholesterol away from blood vessels.

What is the first line treatment for hyperlipoproteinemia?

Increased exercise and decreased saturated fat and cholesterol in the diet.

What are HMG Co-A reductase inhibitors commonly known as?

Statins.

Name two examples of HMG Co-A reductase inhibitors.

Lovastatin and atorvastatin.

How do statins lower cholesterol?

By inhibiting HMG Co-A reductase, the rate-limiting enzyme in cholesterol synthesis.

What are some adverse effects of statins?

GI pain, constipation, gas, myositis, blurred vision, lens opacities; they are also FDA Category X.

What is Ezetimibe used for?

To treat elevated cholesterol and low HDL levels by inhibiting intestinal absorption of cholesterol.

What are the adverse effects of Ezetimibe?

Fatigue, abdominal pain, and diarrhea.

How does Niacin lower cholesterol levels?

By inhibiting secretion of VLDLs without accumulating triglycerides in the liver, which decreases LDL synthesis.

What are some adverse reactions associated with Niacin?

Cutaneous flushing, allergic reactions, cholestasis, hepatotoxicity, and orthostatic hypotension.

What type of drug is Cholestryamine?

A bile acid-binding resin that lowers cholesterol concentrations.

What are the adverse reactions of Cholestryamine?

Constipation, bloating, and poor taste.

What is Gemfibrozil used for?

Treatment of hyperlipidemias, especially when triglycerides are elevated.

What are the risks associated with Gemfibrozil?

Gallstone formation, muscle cramping, myopathy, and rhabdomyolysis when given with statins.

What is the role of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors (PCSK9)?

They bind to LDL cholesterol receptors in the liver and can lower LDL cholesterol by up to 60%.

What are some dental implications for patients taking antihyperlipidemic agents?

Higher risk for hypertension, coronary artery disease, myocardial infarction, and cardiac arrest; BP and HR should be monitored at each appointment.

What is the primary indication for anticoagulants?

To prevent clotting after an MI, thrombophlebitis, or stroke.

What is the most important oral anticoagulant?

Warfarin.

How is hemostasis defined?

A normal mechanism in the body designed to prevent loss of blood after injury to a blood vessel.

What is the function of Heparin?

It is an anticoagulant given by injection to hospitalized patients with excessive clotting.

What is the purpose of monitoring INR in patients on Warfarin?

To assess the effectiveness of anticoagulation therapy.

What are some adverse effects of oral anticoagulants?

Bleeding/hemorrhage, petechial hemorrhages, and ecchymoses.

What serious interaction can occur with warfarin?

Bleeding episodes and fatal hemorrhages.

How does aspirin affect warfarin?

Aspirin alters platelet adhesiveness, irritates the GI tract, and competes for the same binding site as warfarin, potentially increasing warfarin's activity.

What is the effect of high doses of acetaminophen on INR?

Doses greater than 9 grams/week can increase the likelihood of presenting with an abnormal INR by 10-fold.

Which antibiotics have the greatest effect on warfarin's anticoagulant action?

Erythromycin and metronidazole.

Is it necessary to stop warfarin before dental therapy?

No, it is not necessary to stop warfarin prior to dental therapy.

What are common side effects of Factor Xa inhibitors like Xarelto and Eliquis?

Increased risk for bleeding.