Pharmacology Week 6 Ppt Review

Front 1

Back 1

Vena Cava

Front 2

Back 2

SA Node

Front 3

Back 3

Right Atrium

Front 4

Back 4

Right Ventricle

Front 5

Back 5

Purkinje Fibers

Front 6

Back 6

Left Atrium

Front 7

Back 7

Left Ventricle

Front 8

Back 8

Bundle of His

Front 9

What refers to diseases of the
heart and blood vessels?

Back 9

Cardiovascular Disease

Front 10

What 6 things do
Cardiovascular Disease Drugs include?

Back 10

Cardiovascular Disease includes:
25% of the top 200 drugs, such as for:
Hypertension
Angina pectoris
Coronary Artery Disease
Cerebrovascular Accident (CVI)
Congestive Heart Failure (CHF)

Front 11

What are 5 Dental Considerations concerning Cardiovascular Drugs?

Back 11

Contraindications to Treatment
Vasoconstrictor Limit
Infective Endocarditis
Cardiac Pacemakers
Relationship Between Periodontal Disease and Both Cardiovascular Disease and Stroke

Hint 11

treatment limit infective cardiac relationship

Front 12

What are 5 Contraindications to Treatment?

Back 12

Acute or Recent Myocardial Infraction (MI)
Unstable or Recent Onset of Angina Pectoris
Uncontrolled CHF
Uncontrolled Arrhythmias
Significant, Uncontrolled Hypertension

Front 13

Vasoconstrictor Limit:
The majority of cardiovascular patients should benefit from what in the local anesthetic agent?

Back 13

The majority of cardiovascular patients should benefit from the use of epinephrine in the local anesthetic agent

Front 14

Vasoconstrictor Limit:

What must the amount and effect of epinephrine administration be weighed against?

Back 14

• The amount and effect of epinephrine administered must be weighed against the fact that discomfort can cause the release of endogenous epinephrine

Front 15

Vasoconstrictor Limit:
Who may warrent limiting the dose of epinepherine to the cardiac dose?
What is the cardiac dose?

Back 15

Limiting the dose (of epinephrine in the local anesthetic agent) to the cardiac dose may be warranted in a few severely affected patients.
The cardiac dose: 0.04mg

Front 16

Vasoconstrictor Limit:

When should prophylactic antibiotics

be prescribed?

Back 16

• When a risk of producing infective endocarditis exists, prophylactic antibiotics should be prescribed, if warranted by the dental procedure being performed

Front 17

Infective Endocarditis -

Prophylactic Antibiotic Indications (2007 AHA):

What are the 5 Key points indicating prophylactic antibiotics.

Back 17

• Indicated - artificial heart valves
• Indicated - history of infective endocarditis
• Indicated - specific, serious congenital heart conditions.
• Indicated - cardiac transplant that develops a problem in a heart valve
• These recommendations apply to many procedures including cleanings and extractions

Front 18

Infective Endocarditis -
Prophylactic Antibiotic Indications (2007 AHA):
What are the 3 Specific, Serious
Congenital Heart Defect?

Back 18

Unrepaired or incompletely repaired cyanotic CHD (palliative shunts and conduits)
Completely repaired congenital heart defect with prosthetic material or device during the first 6 months after the procedure (either by surgical or catheter placement)
Any repaired congenital heart defect with residual defect at site or adjacent to site of a prosthetic patch or prosthetic device

Front 19

What is a cardiac pacemaker?

Back 19

• A cardiac pacemaker is an electrical device implanted in a patient's chest to regulate the rhythem

Front 20

Cardiac Pacemakers:

What is NOT required for pacemakers?

Back 20

• Premedication NOT required for pacemakers

Front 21

Cardiac Pacemakers:

What is IMPORTANT to remember about pacemakers , shielding, and dentistry?

Back 21

• If not appropriately shielded, some electrical devices used in dentistry may interfere with pacemaker activity

Front 22

Cardiac Pacemakers:

What device could be dangerous to use around unshielded cardiac pacemakers?

Back 22

• Ultrasonic devices could possibly create electromagnetic interference leading to pacemaker malfunction

Front 23

Cardiac Pacemakers:

Although there are no reports of unltrasonic devices actually interfering with a cardiac pacemaker performance, what has a study shown? Does this affect them all the same?

Back 23

• A study has shown that use of ultrasonic devices within 4-6 inches of the cardiac implant can interfere with their performance
• Not all pacemakers may be affected by this

Front 24

Cardiac Pacemakers:

Who may have recommendations for use of ultrasonic devices on patients with cardiac pacemakers? Who may need consulted before treatment.

Back 24

• Manufacturers of ultrasonic devices may have recommendations for use
• consult with physician may be appropriate before treatment

Front 25

Heart Failure:

In CHF, what does the heart do or not do?

Back 25

• The heart does not provide adequate cardiac output

Front 26

Heart Failure:

In CHF, why does the heart not provide adequate cardiac output?

Back 26

• Blood accumulates in failing ventricle(s), the ventricle(s) enlarge(s) and finely become(s) ineffective as a pump.

Front 27

Heart Failure:

What does left side failure lead to?

Back 27

• Left side failure backs into pulminary circulation (lungs) leading to edema, dysnpnea (difficulty breathing) and orthopnea (shortness of breath when reclined).

Front 28

Heart Failure:

What does right side failure lead to?

Back 28

• Right side failure causes systemic congestion leading to peripheral edema with fluid accumulation evidence by pitting edema (pedal edema)

Front 29

Heart Failure:

What may be an ATC consideration for

patients with CHF?

Back 29

• CHF patients may need simi-supine dental chair position

Front 30

Heart Failure Treatment:

Once stabilized, what should be used as a first line therapy?

Back 30

• Once stabilized use ACEIs (or ARBs) as a first line therapy or Beta blockers

Front 31

Heart Failure Treatment:

What should be used to treat fluid over load?

What should be used to treat ischemic HF?

Back 31

• Diuretics for fluid overload, nitrates for ischemic HF

Front 32

Heart Failure Treatment:
What should be used to reduce afterload and preload? What are 3 given examples?

Back 32

Vasodilators to reduce afterload and preload
i.e. hydralazine and/or isosorbide dinitrate; Aldostrone antagonist (spironolactone)

Front 33

Heart Failure Treatment:

What treatment should be avoided?

Why?

Back 33

• AVOID NSAID's
• They will worsen HF

Front 34

What is Digitalis Glycosides?

Back 34

• The most common type of drug used in the treatment of CHF

Front 35

Digitalis Glycosides:

What are three considerations?

Back 35

• Not considered first-line therapy
• Reduces symptoms
• No mortality benifit

Front 36

Digitalis Glycosides:
In addituon to HF, what are 3 conditions it is used for?

Back 36

Used for Atrial arrhythmias, including atrial fibrillation, and paroxysmal atrial tachycardia

Front 37

Digitalis Glycosides:

What is used as the prototype?

Back 37

• digoxin (Lanoxin) is used as the prototype

Front 38

Digitalis Glycosides:
What affect does this have on the heart?

Back 38

Increases force and strength of contraction of the myocardium (positive inotropic effect)

Front 39

What are 4 ways that Digitalis Glycosides's affect on the heart act as a treatment of CHF?

Back 39

• Allows the heart to do more work without increasing the use of oxygen
• The heart becomes more efficient and cardiac output is increased
• Decreases heart rate (bradycardia)
• Reduces edema due to increased filtration through the kidneys (diuresis)

Front 40

Adverse Reactions of Digitalis Glycosides:

What can trigger toxic symptoms?

Back 40

• Narrow therapeutic index: slight changes in does, absorption, or metabolism can trigger toxic symptoms

Front 41

Adverse Reactions of Digitalis Glycosides:

What are the GI signs of toxicity?

Back 41

• Gastrointestinal (GI): Signs of toxicity include anorexia, nausea, vomiting, copious salivation

Front 42

Adverse Reactions of Digitalis Glycosides:

Which two Digitalis Glycosides toxicity can cause predisposition to arrhythmias?

Back 42

• Arrhythmias: toxicity of digoxin or hypokalemia (caused by diuretics) can predispose to arrhythmias

Front 43

Adverse Reactions of Digitalis Glycosides:

What are the neurologic signs of toxicity?

Back 43

• Neurologic: signs of toxicity include headache, drowsiness, and visual disturbances

Front 44

Adverse Reactions of Digitalis Glycosides:

Which dental drug interactions can increase the chances of arrhythmia in patients with

severe cardiac disease?

Back 44

• Dental drug interactions: interaction with sympathomimetics can increase chances of arrhythmia in severe cardiac disease

--The epinephrine dose may be limited to the cardiac dose (0.04mg)

Front 45

Adverse Reactions of Digitalis Glycosides:

What antibiotics may increase digoxin levels?

Back 45

• Tetracycline and erythromycine may increase digoxin levels

Front 46

Antiarrythmatic Agents:

What may arrhythmias result from?

Back 46

• Arrhythmias may result from abnormal impulse generation or abnormal impulse conduction

Front 47

Antiarrythmatic Agents:

How do antiarrhythmatic agents work?

Back 47

• Antiarrhythmatic agents work by depressing parts of the heart that are beating abnormally

Front 48

Antiarrythmatic Agents:

What are three ways antiarrhythmatic agents depress parts of the heart

that are beating abnormally?

Back 48

They may:

• decrease the velocity of depolarization
• decrease impulse propagation
• inhibit aberrant impulse propagation

Front 49

Antiarrythmatic Agents:

What are two draw backs of

antiarrhythmatic agents?

Back 49

• Antiarrhythmatic agents have a narrow therapeutic index and are difficult to manage

Front 50

Antiarrythmatic Agents:

Which patients are

antiarrhythmatic agents used for?

Back 50

• Only used for patients with arrhythmias that prevent the proper functioning of the heart

Front 51

Automaticity:
What is automaticity?

Back 51

The intrinsic rhythm that cardiac muscle cells have

Front 52

Automaticity:
Which node has the fastest rate of depolarization and directs
other cells of the heart?

Back 52

The sinoatrial (SA) node in the right atrium has the fastest rate of depolarization and directs other cells of the heart

Front 53

Automaticity:

Which nervous system is the

sinoatrial (SA) node innervated by?

Back 53

• The sinoatrial (SA) node is innervated by both the parasympathetic and sympathetic nervous systems

Front 54

Automaticity:

Which node is signaled by the

sinoatrial (SA) node?

Back 54

• It signals the atrioventricular (AV) node

Front 55

Automaticity:

What does the artioventricular (AV) node

send signals through?

Back 55

• The atrioventricular (AV) node sends signals through the Bundle of His

Front 56

Automaticity:

Where does the artioventricular (AV) node

sends signals to through the bundle of his?

Back 56

• The atrioventricular (AV) node sends signals through the Bundle of His to Purkinjel fibers and ventricles

Front 57

Automaticity - Action Potentioal:

What is an action potential generated by?

Back 57

• An action potential is generated by movement of ions across the membrane produced by electrical excitation from the nerve

Front 58

Automaticity - Action Potential:

What is an action potential visualized as?

Back 58

• An action potential is visualized as an electrocardiogram (ECG)

Front 59

Automaticity - Action Potential:

A relationship exists between

the action potential and what?

Back 59

• A relationship exists between the action potential and the ECG tracing

Front 60

What is digoxin used to treat?

Back 60

• Digoxin is used to treat some arrhythmias

Front 61

Antiarrhythmic Agents:

What is digoxin not included in?

Back 61

• Digoxin is not included in the other groups of aniarrhythmics

Front 62

Antiarrhythmic Agents:
What are 3 reasons digoxin is
used to treat arrhythmia?

Back 62

Digoxin:
decreases rate of the sinoatrial (SA) node
slows atrioventricular (AV) node conduction
prolongs refractory period of the AV node
-- Reduces number of impulses transmitted to the ventricle resulting in a decreased heart rate

Front 63

Antiarrhythmic Agents -

Classification and Mechanism of Action:

What is the MOA of Class IA and

which drugs does this class include?

Back 63

• Sodium (Na+) channel blocker (medium)
• Quinidine, procainamide

Front 64

Antiarrhythmic Agents -

Classification and Mechanism of Action:

What is the MOA of Class IB and

which drugs does this class include?

Back 64

• Sodium (Na+) channel blocker (fast)
• Lidocaine - not used in outpatient settings

Front 65

Antiarrhythmic Agents -

Classification and Mechanism of Action:

What is the MOA of Class IC and

which drugs does this class include?

Back 65

• Sodium (Na+) channel blocker (slow)
• Flecainide, propafenone

Front 66

Antiarrhythmic Agents -

Classification and Mechanism of Action:

What is the MOA of Class II and

which drugs does this class include?

Back 66

• Beta (B)-blockers
• Propranolol, acebutolol, sotalol

Front 67

Antiarrhythmic Agents -

Classification and Mechanism of Action:

What is the MOA of Class III and

which drugs does this class include?

Back 67

• Potasium (K+) channel blockers
• Bretylium and d-sotalol (non-beta-blocking enantiomer)

Front 68

Antiarrhythmic Agents -

Classification and Mechanism of Action:

What is the MOA of Class IV and

which drugs does this class include?

Back 68

• Calcium channel blockers (CCBs)
• Verapamil, diltiazem

Front 69

Aniarrhythmatic Agents -
Management of Dental Patients:
What should you check for on ALL antiarrhythmatic agent-taking patients?

Back 69

All: abnormal or extra beats when taking blood pressure and pulse?

Front 70

Aniarrhythmatic Agents -

Management of Dental Patients:

What should you check for on

AF patients taking warfarin?

Back 70

• AF: pt. on warfarin - check international normalized ratio (INR)

Front 71

Aniarrhythmatic Agents -

Management of Dental Patients:

What should you check for on

patients who are taking

calcium channel blockers (CCBs)?

Back 71

• Calcium channel blockers (CCBs): gingival enlargement

Front 72

Aniarrhythmatic Agents -

Management of Dental Patients:

What should you check for on

patients who are taking Class IA drugs?

Back 72

• Class IA drugs: Xerostomia

Front 73

Aniarrhythmatic Agents -

Management of Dental Patients:

What should you check for on

patients taking Quinidine?

Back 73

• Quinidine: nausea, vomiting, diarrhea; cinchonism with large doses; atropine-like effect, xerostomia

Front 74

Aniarrhythmatic Agents -

Management of Dental Patients:

What should you check for on

patients taking Phenytoin?

Back 74

• Phenytoin: gingival enlargement

Front 75

Aniarrhythmatic Agents -

Management of Dental Patients:

What do beta-blockers interact with?

Back 75

• Beta-blockers will interact with epinephrine, however, not clinically relevant problems when used as LA in dental

Front 76

Angina Pectoris:

What is angina pectoris characterized by?

Back 76

• Characterized by pain or discomfort in the chest radiating to the left arm and shouder

Front 77

Angina Pectoris:

Besides the left arm and shoulder,

where else can the chest pain or discomfort radiate to and what can it be confused with?

Back 77

• Pain can also radiate to the neck, back and lower jaw
• Jaw pain may be confused with a toothache

Front 78

Angina Pectoris:
When does angina pectoris occure?

Back 78

Occurs when coronary arteries do not supply enough oxygen to the myocardium

Front 79

Angina Pectoris:

At one time, what were the only drugs that could relieve the symptoms of angina pectoris?

Back 79

• At one time, NTG-like compounds were the only drugs that could relieve the symptoms

Front 80

Angina Pectoris:

Today, what has added a new dimension to relieving angina pectoris symptoms?

Back 80

• Today, beta-adrenergic blockers and calcium channel blockers (CCBs) have added a new dimension

Front 81

Angina Pectoris:

What is the effect of NTG-like compounds, beta-adregenic blockers and

calcium channel blockers (CCBs)?

Back 81

• The effect of these drugs is to reduce the workload of the heart

Front 82

Angina Pectoris:
How do the NTG-like compounds, beta-adrenergic blockers and
calcium channel blockers (CCBs) reduce painful symptoms and the workload of the heart?

Back 82

Oxygen requirements of myocardium is reduced, relieving painful symptoms
Reduce workload by decreasing cardiac output and/or peripheral vascular resistance

Front 83

Nitroglycerin-Like Compounds:

What is NTG the most often used nitrate for?

Back 83

• Nitroglycerin-liek compounds is by far the most often used nitrate for management of acute anginal episodes
• To prevent anginal attacks induced by stress or exercise.

Front 84

Nitroglycerin-Like Compounds:

Is NTG a vasodilator or vasoconstrictor?

Back 84

• Nitroglycerin-like compounds is a vasodilator

Front 85

Nitroglycerin-Like Compounds:

What does NTG release?

Back 85

• NTG releases free nitrite ion and nitric oxide

Front 86

Nitroglycerin-Like Compounds:

By reducing workload on the heart,

what does NTG do?

Back 86

• By reducing workload on the heart, NTG decreases the oxygen demand

Front 87

Nitroglycerin-Like Compounds:

What is Amyl nitrate?

Back 87

• Amyl nitrate is a volatile agent in a closed container

Front 88

Nitroglycerin-Like Compounds:

How is amyl nitrate administered?

Back 88

• It is administered by crushing the container and inhaling the fumes

Front 89

Nitroglycerin-Like Compounds:
Is amyl nitrate often used? why

Back 89

It is not often used due to abuse potential

Front 90

Nitroglycerin-Like Compounds:

What Sublingual (SL) NTG is available?

Back 90

• Sublingual (SL) NTG is available as an SL tablet (Nitrostat) or spray used sublingually (Nitroingual)

Front 91

Nitroglycerin-Like Compounds:
Besides nitrostat and nitroingual, what other SL is also effective for an acute anginal attack?

Back 91

SL isosorbide dinitrate is also effective for an acute anginal attack

Front 92

Nitroglycerin-Like Compounds:

Where should this be kept in a dental office?

Back 92

• One of the NTG products should be in the dental office emergency kit.

Front 93

Nitroglycerin-Like Compounds:

What should patients who use NTG

do at each appointment?

Back 93

• Patients should bring their NTG to each appointment.

Front 94

Nitroglycerin-Like Compounds:

What do most NTG adverse reactions effect?

Back 94

• Most adverse reactions effect vascular smooth muscles

Front 95

Nitroglycerin-Like Compounds:

What are 5 symptoms that can result

from adverse reactions?

Back 95

• Severe headaches are often reported
• Flushing, hypotension, light-headedness, and syncope can also result.

Front 96

Nitroglycerin-Like Compounds -

Drug Interactions/Contraindications:

What are 3 inhibitors of phosphodiesterase 5 (PDE5)? What are they also used for?

Back 96

• Phosphodiesterase 5 (PDE5) inhibitors include: sildenafil (Viagra), vardenafil (Levitra) Tadalafil (Cialis)
• Also used for pulmonary hypertension

Front 97

Nitroglycerin-Like Compounds -

Drug Interactions/Contraindications:

The administration of administration of PDE5 inhibitors are contraindicated with what? Why?

Back 97

• The administration of any PDE5 with doses of any nitrate is contraindicated
• The combination can cause dangerously low blood pressure

Front 98

Nitroglycerin-Like Compounds:

What are nitroglycerin-like compounds degraded by? What are they not degraded by?

Back 98

• Degraded by heat and moisture
• Not degraded by light

Front 99

Nitroglycerin-Like Compounds:

What should tablets be stored in?

Back 99

• Tablets should be stored in the original dark-brown glass container

Front 100

Nitroglycerin-Like Compounds:

How long is NTG good for?

Back 100

• NTG tablets: if opened, 3-6 months
• NTG spray: effective until its expiration date

Front 101

Nitroglycerin-Like Compounds:

What are long-acting NTG-like

products available for?

Dose forms include what?

Back 101

• Long-acting NTG-like products are available for long-term prophylaxis of anginal attacks
• Dose forms include tablets and topical producs

Front 102

Nitroglycerin-Like Compounds:

What occurs with long-term regular use

of NTG like products?

Back 102

• With long-term regular use, tolerance develops

Front 103

Nitroglycerin-Like Compounds:

What should prophylactic nitrates

be given with?

Back 103

• Prophylactic nitrates should be given with an 8-12 hr "vacation" every day

Front 104

Nitroglycerin-Like Compounds:

What does mononitrate dose form require?

Back 104

• Mononitrate dose form requires a 7-hr "vacation" every day

Front 105

Nitroglycerin-Like Compounds:

What 3 types of long acting nitates

have prophylactic use?

Back 105

• NTG (Nitro-Bid) (Nitro Dur, Minitran)
• isorbide dinitrate (Isordil, Sorbitrate-DIS)
• isorbide mononitrate (Imdur, Ismo, Monoket)

Front 106

Nitroglycerin-Like Compounds:
Besides long-acting nitrates, which NTG-like compounds have prophylactic use?

Back 106

Beta-blockers - Propranolol
Calcium Channel blockers (CCBs)

Front 107

Calcium Channel Blocking Agents:

What does the MOA of CCBs inhibit?

Back 107

• MOA inhibits movement of calcium during contraction of cardiac and vascular smooth muscle

Front 108

Calcium Channel Blocking Agents:
What results from the MOA of CCB's?

Back 108

Vasodilation and a decrease in peripheral resistance results, decreasing the workload of the heart

Front 109

Calcium Channel Blocking Agents:
What are the two broad categories?

Back 109

Non-dihydropyridines and dihydropyridines

Front 110

Calcium Channel Blocking Agents:
What do Non-dihydropyridines include?
What do they cause?

Back 110

Non-dihydropyridines include verapamil and diltiazem
Coronary vascular smooth muscle relaxation and coronary vasodilation
Depresses activity of SA and AV nodes (direct myocardial activity)

Front 111

Calcium Channel Blocking Agents:
What do dihydropyridines include?
What do they cause?

Back 111

Dihydropyridines include nifedipine and other "...pines"
Affect vascular smooth muscle and myocardium (peripheral arterial vasodilation, coronary vascular smooth muscle relaxation and vasodilation)
Reflex tachycardia

Front 112

Calcium Channel Blocking Agents:

What are CCBs also used to treat?

Back 112

• CCBs are also used in treatment of cardiac arrhythmias and hypertension

Front 113

Calcium Channel Blocking Agents:

What do adverse effects include?

What is Nifedipine associated with?

Back 113

• Adverse effects include dizziness, weakness, constipation, and hypotension
• Nifedipine is associated with gingival enlargement and dysgeusia

Front 114

Beta-Adrenergic Blocking Agents:

What are beta-adrenergic

blocking agents used for?

Back 114

• used in treatment of angina (as well as hypertension)

Front 115

Beta-Adrenergic Blocking Agents:

What do they block? What does this reduce?

Back 115

• Block the beta response to catecholamine stimulation
• Reduces both chronotopic (heart rate) and inotropic (force of contraction) effects.

Front 116

Beta-Adrenergic Blocking Agents:

What is the net result of their use?

Back 116

• Net result is a reduced myocardial oxygen demand

Front 117

Beta-Adrenergic Blocking Agents:

What do 6 adverse effects include?

Back 117

• bradycardia
• CHF
• headache
• dry mouth (Xerostomia)
• blurred vision
• unpleasant dreams

Front 118

Beta-Adrenergic Blocking Agents:
What 3 drugs are included in this category?

Back 118

propranolol, metroprolol, atenolol

Front 119

ranolazine (Ranexa):

What is ranolazine (Ranexa)?

Back 119

• A new drug treatment for chronic angina

Front 120

ranolazine (Ranexa):

What is its MOA and

which patients should it be used in?

Back 120

• Exact MOA is unknown
• Should only be used in patients that have not responded to long-acting nitrates, CCBs, and beta-blockers

Front 121

Treatment of an Acute Angina Attack:
What should be done

before administering NTG?

Back 121

• Before administering NTG, the dental team should make sure the patient has not used PDE5 inhibitor within the past 24 hours

Front 122

Treatment of an Acute Angina Attack:

If the patient has used PDE5 inhibitor within the past 24 hours, what should be done?

Back 122

• The dental team should call 911

Front 123

Treatment of an Acute Angina Attack:

What should be available?

Back 123

• The patient's personal NTG tablets or spray should be available (check expiration date)

Front 124

Treatment of an Acute Angina Attack:

What is not useful for treatment of

acute anginal attack?

Back 124

• Long acting nitrates and topical products are not useful for the treatment of acute anginal attack

Front 125

Treatment of an Acute Angina Attack:

What should the dental office

have for acute emergencies?

Back 125

• For acute emergencies, the office should have a supply of SL NTG

Front 126

Treatment of an Acute Angina Attack:

How should NTG be administered?

Back 126

• 3 tables or doses, each 5 min. apart

Front 127

Treatment of an Acute Angina Attack:

What should be done if the anginal attack

is not stopped after 3 tablets or doses?

Back 127

• If the anginal attack is not stopped, the patient should be taken to the emergency room as patient may be having a heart attack

Front 128

Prevention of Anginal Attack:

What are 2 methods of preventing

an acute anginal attack?

Back 128

• 2 Methods to prevent an acute anginal attack include pretreatment with either an anxiolytic agent or SL NTG

Front 129

Treatment of an Acute Angina Attack:

Which anxiolytic may be prescribed and why?

Back 129

• Anxiolytics: Such as benzodiazepine or nitrous oxide may be prescribed to allay anxiety and prevent an acute anginal attack

Front 130

Treatment of an Acute Angina Attack:

What does using SL NTG to

premedicate and anxious patient do?

When should this not be used?

Back 130

• NTG: premedicating an anxious patient with SL NTG can reduce the chance of an attack
• Do not used if PDE5 inhibitor has been used within the last 24 hours