Cardiovascular Drugs - Simplified

Front 1

What do Digatalis Glycosides (Digoxin) treat? (2)

Back 1

1) Congestive Heart Failure

2) arrhythmia

Front 2

What do ACE Inhibitors treat? (2)

Back 2

1) CHF

2) Hypertension

Front 3

What do ARBs treat? (2)

Back 3

1) CHF

2) Hypertension

Front 4

What do Beta Blockers treat? (3)

Back 4

1) CHF

2) angina

3) hypertension

Front 5

What do Vasodialators treat? (1)

Back 5

1) CHF

Front 6

What do Diuretics treat? (2)

Back 6

1) CHF

2) hypertension

Front 7

What do Aldosterone treat? (1)

Back 7

1) CHF

Front 8

What do Calcium Channel Blockers treat? (2)

Back 8

1) angina

2) hypertension

Front 9

What does Niacin treat? (1)

Back 9

1) Hyperlipidemia

Front 10

What do statins treat? (1)

Back 10

1) Hyperlipidemia

Front 11

List the 2 most important anticoagulant drugs.

Back 11

1) Warafin

2) Hemostasis

Front 12

List the 6 other anticoagulant drugs.

Back 12

1) Heparin
2) Clopidogrel (Plavix)
3) Ticlopidine
4) Streptokinase and Ateplase: clot busters
5) Dipryridamole
6) Pentoxifylline

Front 13

7 Drugs that treat CHF

Back 13

1) Digitalis Glycosides (Digoxin)
2) ACE Inhibitors
3) ARB
4) Beta Blockers
5) Vasodilators
6) Diuretics
7) Aldosterone

Front 14

1 Drug that treats Arrhythmia

Back 14

1) Digitalis Glycosides (Digoxin)

Front 15

3 Drugs that treat Angina

Back 15

1) Beta blockers

2) Nitroglycerin

3) Calcium Channel Blockers

Front 16

5 Drugs that treat Hypertention

Back 16

1) ACE Inhibitor

2) Diuretics

3) ARB

4) Calcium Channel Blockers

5) Beta Blockers

Front 17

2 Drugs that treat Hyperlipidemia

Back 17

1) Statins

2) Niacin

Front 18

Sufix of "-olol"

Back 18

Beta Blockers

Front 19

Sufix of "-dipine"

Back 19

Calcium Channel Blocker

Front 20

Sufix of "-pril"

Back 20

ACE Inhibitor

Front 21

Sufix of "-statin"

Back 21

Statins

Front 22

What drugs are Vasodilators

Back 22

1) Nitroglycerin
2) Calcium channel blockers

Front 23

Contraindications to dental treatment (5)

Back 23

1) Acute / recent myocardio infarction within preceeding 3-6 months

2)Unstable / recent onset of angina

3) Uncontrolled congestive heart failure

4) Uncontrolled arrhythmias

5) Significant, uncontrolled hypertension.

Front 24

2 Ablsolute contraindications for elective treatment

Back 24

1) Acute / recent myocardio infarction within preceeding 3-6 months

2) Significant, uncontrolled hypertension.

Front 25

Cardiac dose of EPI

Back 25

0.04 mg

Front 26

Pre-meds are needed when?

Back 26

- to prevent infective endocarditis in cases where necessary

Front 27

When are pre-meds not required?

- Note

Back 27

Pre-meds are not required with pacemakers.

Note: if not properly shielded, certain electronic devices in the dentistry can interfere w/ pacemakers. (Ex. ultrasonics, etc)

Front 28

Relationship between _________ disease & cardiovascular disease or stroke has been established.

Back 28

Relationship between PERIODONTAL disease & cardiovascular disease or stroke has been established.

Front 29

How do you position the patient for dental treatment, when the patients left side of the heart fails in congestive heart failure?

Back 29

The patient MAY need to have dental treatment performed while in a semi-reclined position

Front 30

Management of Dental Patients on Digoxin (3)

Back 30

1) Beware of nausea/vomitting

2) EPI with caution

3) Check pulse before apts. for normal rate an rythem

Front 31

Beta Adrenergic Blockers
- mechanism of action (1)
- adverse rxns (3)

Back 31

Mechanism of action
1) reduce oxygen demands on heart

Adverse Rxns
1) bradycardia
2) headache
3) drymouth

Front 32

Dental Implications of Angina
- What to do? (6)

Back 32

1) Be prepared to treat an attack
2) If dispensin the nitroglycerin, ask if they've taken a PDE5 inhibitor(Viagra) with in the past 24 hours
3) Patient nitroglycerin should be available
4) Should have SL nitroglycerin on hand in the office
5) Seat patient, administer 1 tablet every 5 minutes up to 3 tablets. (If they don't stop the attack, the patient must go to ER immediately.

Front 33

Poor pain control releases ____ endogenously anyway.

Back 33

Poor pain control releases EPI endogenously anyway.

Front 34

Severity of the patients disease should be considered when using a _________. (such as ____)

Back 34

Severity of the patients disease should be considered when using a VASOCONSTRICTOR. (such as EPI)

Front 35

Contraindications to dental treatment (5)

Back 35

1) Acute / recent myocardio infarction within preceeding 3-6 months

2)Unstable / recent onset of angina

3) Uncontrolled congestive heart failure

4) Uncontrolled arrhythmias

5) Significant, uncontrolled hypertension.

Front 36

2 Ablsolute contraindications for elective treatment

Back 36

1) Acute / recent myocardio infarction within preceeding 3-6 months

2) Significant, uncontrolled hypertension.

Front 37

Poor pain control releases ____ endogenously anyway.

Back 37

Poor pain control releases EPI endogenously anyway.

Front 38

Severity of the patients disease should be considered when using a _________. (such as ____)

Back 38

Severity of the patients disease should be considered when using a VASOCONSTRICTOR. (such as EPI)

Front 39

Cardiac dose of EPI

Back 39

0.04 mg

Front 40

Management of Dental Patients on Digoxin (3)

Back 40

1) Beware of nausea/vomitting

2) EPI with caution

3) Check pulse before apts. for normal rate an rythem

Front 41

Diuretic Thiazides
- Drug interactions (3)

Back 41

1) NSAIDs (most important)

2) Digoxin

3) EPI

Front 42

How do Digoxin & EPI interact with Diuretic Thiazides? (3)

Back 42

They increase the risk of arrhythmia

Front 43

Selective blockers are useful for people with...?
Because?

Back 43

pre-exsisting bronchospastic conditions (asthma)

-->because they don't block B2 bronchodilation & are less likely to produce drug interaction with EPI

Front 44

Beta Blockers for Hypertention
- mechanism of action (1)
- adverse rxns

Back 44

Mechanism of Action
1) decreases cardiac output (primary)

Adverse Rxns
1) bradycardia
2) dizziness
3) xerostomia
4) exacerbate asthma

Front 45

Beta Blockers
- Dental Interactions (3)

Back 45

1) Non-selective interact with EPI causing increase in BP
--> this hypertension triggers a reflex bradycardia (through vagus nerve

2) In patients w/ CV disease or higher blood pressure, EPI should be limited to the cardiac dose (unless you carefully monitor BP)

3) Retraction cord w/ EPI should not be used

4) Usual doses of EPI can be used on patients taking selective B1 blockers

Front 46

Dental hygienist uses what to identify a patient with Cardiovascular disease?

Back 46

Health History

Front 47

Contraindications to dental treatment (5)

Back 47

1) Acute / recent myocardio infarction within preceeding 3-6 months

2)Unstable / recent onset of angina

3) Uncontrolled congestive heart failure

4) Uncontrolled arrhythmias

5) Significant, uncontrolled hypertension.

Front 48

Angina is induced by...

Back 48

- stress (dental visit)
- physical activity
- anxiety

Front 49

Relationship between _________ disease & cardiovascular disease or stroke has been established.

Back 49

Relationship between PERIODONTAL disease & cardiovascular disease or stroke has been established.

Front 50

How do you position the patient for dental treatment, when the patients left side of the heart fails in congestive heart failure?

Back 50

The patient MAY need to have dental treatment performed while in a semi-reclined position

Front 51

Dental Implications of Angina
- What to do? (6)

Back 51

1) Be prepared to treat an attack
2) If dispensin the nitroglycerin, ask if they've taken a PDE5 inhibitor(Viagra) with in the past 24 hours
3) Patient nitroglycerin should be available
4) Should have SL nitroglycerin on hand in the office
5) Seat patient, administer 1 tablet every 5 minutes up to 3 tablets. (If they don't stop the attack, the patient must go to ER immediately.

Front 52

Beta Adrenergic Blockers
- mechanism of action (1)
- adverse rxns (3)

Back 52

Mechanism of action
1) reduce oxygen demands on heart

Adverse Rxns
1) bradycardia
2) headache
3) drymouth

Front 53

Diuretic Thiazides
- Adverse rxns (7)

Back 53

1) Hyperglycemia
2) Hyperlipidemia
3) Hypercalcemia
4) Anorexia
5) Hyperuricemia (inhibits uric acid secretion)
6) Xerostomia
7) Lichenoid eruption (sores in mouth)

Front 54

Pre-meds are needed when?

Back 54

- to prevent infective endocarditis in cases where necessary

Front 55

When are pre-meds not required?

- Note

Back 55

Pre-meds are not required with pacemakers.

Note: if not properly shielded, certain electronic devices in the dentistry can interfere w/ pacemakers. (Ex. ultrasonics, etc)

Front 56

BP indications of Hypertension
- What are the BPs for these levels
1) Normal BP: __?
2) Pre-hypertension: __?
3) Hypertension Stage 1: __?
4) Hypertension Stage 2: __?

Back 56

1) Normal BP: 120 / 80

2) Pre-hypertension: 120-139 / 80-90

3) Hypertension Stage 1: 140-159 / 90-99

4) Hypertension Stage 2: >= 160 / >=100

Front 57

Beta Blockers for Hypertention
- mechanism of action (1)
- adverse rxns

Back 57

Mechanism of Action
1) decreases cardiac output (primary)

Adverse Rxns
1) bradycardia
2) dizziness
3) xerostomia
4) exacerbate asthma

Front 58

Calcium Channel Blockers for Hypertension
- adverse rxns (5)

Back 58

1) usually an extention of pharm effects
2) dizziness / lightheadedness (ask patient to get up slowly)
3) GI upset
4) xerostomia
5) gingival enlargement

Front 59

After 3 tablets of nitroglycerin, if pain persists, the patient may be having a ___________.

Back 59

After 3 tablets of nitroglycerin, if pain persists, the patient may be having a HEART ATTACK / MYOCARDIAL INFARCTION.

Front 60

Hypertension increases in prevalence with...?
And is higher among...?

Back 60

- age

- among women than men

Front 61

True or False?
A person is concidered hypertensive if either or both the systolic/diastolic BP are in the hypertensive catigories.

Back 61

True

Front 62

The BIG 5 Hypertension Drugs

Back 62

1) ACE Inhibitors

2) Diuretics

3) Angiotensin Receptor Blockers

4) Ca Channel Blockers

5) Beta Blockers

Front 63

Ca Channel Blocker Gingival Enlargement
- Begins where?
- What does it look like?

Back 63

Begins at the anterior labial papilla & can proceed to lingual and palatal; even extending to crown.

Begins nodular and firm and BOP easily

Front 64

Is gingival enlargement due to Ca Channel Blockers reversable?

Back 64

Yes, if the drug is discontinued.
--> the patient may need gingivectomy

Front 65

Calcium Channel Blockers
- Adverse rxns

Back 65

1) dizziness
2) weakness
3) constipation
4) hypotension
5) gingival hyperplasia
---> patients should be given additional OHI and have frequent apts.

Front 66

Dental Implacations of Cardiac Glycosides (2)

Back 66

1) Oral: increased salivation

2) Interacts with dental sympathomimetics (EPI) which should be used with caution (increased chance of arrhythmias)

Front 67

Management of Dental Patient on Antihypertensives

Back 67

1) Check for xerostomia
2) CCB’s watch for gingival enlargement
3) Check BP at each appt
4) Raise chair slowly b/c possible orthostatic hypotension
5) Limit EPI
6) Limit NSAIDs (depending on drug)

Front 68

Dental Implications of antihyperlipidemic agents

Back 68

1) Patients are at higher risk of arteriosclerosis and increased risk of CV emergency, MI and cardiac arrest

2) Take BP and pulse b/f each appt (good info in case emergency occurs) record in chart

Front 69

Dental Management of Warfarin

Back 69

1) Thorough HH that explains need/underlying disease
2) Obtain PT or INR
3) For PT or INR 2x normal, request dose reduction and work closely with physician; may require med consult before any procedure causing bleeding
4) Avoid aspirin
5) Acetaminophen and opiods are okay
6) Increased bleeding with scaling

Front 70

Dental management with Carbamazepine (4)

Back 70

1) Check for dry mouth, glossitis, stomatitis
2) Use drugs that can alter coagulation cautiously
3) Drug interactions: doxycycline, erythromycin
4) Emphasize oral hygiene in the people using chewable tabs (children)

Front 71

Dental Treatment of Patient with Epilepsy (3)

Back 71

1) Detailed HH with probing questions about seizure hx and what might bring on a seizure.
2) Do they get an aura or other prodromal warning?
3) Know what to do in case of a tonic-clonic seizure
--> Remove instruments from mouth and clear the area around the patient

Front 72

Dental Adverse Rxn to ACE Inhibitors

Back 72

1) Altered sense of taste

2) Autoimmune oral lesions

Front 73

Dental Implications of Warfarin

Back 73

1) Oral anticoagulant

2) Monitored using the (INR) and the (PT)
--> INR= [PT(patient)/PT control]ISI and target is between 2 and 3

Front 74

Drugs that Increase Blood Clotting

Back 74

Hemostatic agents
--> Aminocaprioc acid/tranexamic acid used IV, orally or topically

Front 75

Dental implications of Carbamazepine (Tegretol)

Back 75

1) Xerostomia, glossitis, stomatitis

2) Chewable tabs for children contain 63% sugar and are taken 4x a day

Front 76

Dental Implications of Phenytoin (Dilantin)

Back 76

Gingival Enlargement
-->Occurs in 50% of chronic users
--> In 30% of cases, surgery is required to correct
--> It is thought that excellent oral hygiene can lower the chance of lesions occurring; or make them less severe when they do occur

Front 77

Managment of Gingival Enlargment

Back 77

1) Med consult
2) Use different drug with same efficacy
--> Discontinuing phenytoin will reverse effect over 1 year’s time
3) Improve oral hygiene/more frequent appts
--> May delay or reduce onset
5) Gingivectomy
-->Not permanent solution
6) No drugs shown effective to treat

Front 78

Alpha adrenergic blockers increases the effect of what?

Back 78

EPI

Front 79

Drugs that cause gingival enlargement

Back 79

1) Ca Channel Blockers

2) Phenytoin (Dilantin)