Download CARDIO – Conditions and Medications

Drugs
Patients
CARDIO – Conditions and
Medications
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Ima Bigheart
I. P. Freely
Chester Payne
Seymore Butts
Fun K. Rythm
Etiology, Treatment and
Dental Hygiene Considerations
Ima Bigheart
Congestive heart failure (CHF) - Overview
• Failing heart muscle is
enlarged and weak,
resulting in reduced
cardiac output
• Cardiac glycosides are
often used to increase
heart contractions
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Cardiac glycosides
ACE inhibitors
Diuretics
Sodium channel blockers
Calcium channel blockers
Beta blockers
Alpha blockers
Nitrates
Anticoagulants
Anti lipids
• If right side fails,
blood pools in lower
extremities, swelling,
thrombi may form,
throw emboli.
Anticoagulants or antiplatelet aggregation
medications are used for prevention
http://heart.healthcentersonline.com/bloodclot/embolism5.cfm
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DH Considerations with C H F
• If left side fails, blood
pools in lungs, causing
dyspnea, orthopnea
• Often both sides fail
with combination of
symptoms
RIGHT
LEFT
Cardiac Glycosides
• Drug treatment: cardiac
glycosides ie digoxin (Lanoxin),
to increase contraction force
• Glycosides have narrow
therapeutic index, overdose
possible (arrhythmias, nausea,
l off saliva)
lots
li ) beware
b
off
epinephrine, OTC cough, cold
medicines
• Tetracycline, erythromycin can
potentiate digoxin by destroying
gut flora necessary to deactivate
digoxin, cause overdose
antiplatelet aggregation drugs
• Used to prevent
“atherothrombotic events”
• Keeps platelets from sticking
together
• has a higher therapeutic
index than Coumadin
• Plavix is an example
• Consult physician, patient
can be safely off
• If on anticoagulant or antiplatelet aggregation
medication, get medical OK, may have to be
off drug
• Avoid epinephrine if patient taking cardiac
glycosides may trigger arrhythmias
glycosides,
• May have to sit up patient up while treating
because of breathing difficulty
• Raise chair back slowly to prevent orthostatic
hypotension
Anticoagulants
• Anticoagulants (Coumadin)
used to prevent thrombi and
emboli
• Heparin used only in hospitals
• Coumadin
C
di increases
i
prothrombin time from 1.5 to
2.5 times normal
• 1.5 times OK, higher is
contraindicated
• Physician consult necessary
before treatment
I. P. Freely
Hypertension - Overview
• For an adult, over 140/90 is
high
• Over 120/80 is
p yp
prehypertensive
• 90% of HBP patients have
essential HBP, exact cause
unknown – but diet, stress,
heredity big factor
• 10% have secondary HBP,
other factors cause it
(kidneys, CHF)
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Hypertension
• 5% have malignant HBP (diastolic >120)
• HBP is often asymptomatic, but can have
headache, tinnitus, lightheadedness
• Changing lifestyle (diet, exercise, stress,
smoking etc.)
smoking,
etc ) can control it
it, if not
not, drug
therapy recommended.
Why is a low salt diet recommended for HBP patients?
Drug Treatment for
Hypertension
Drugs Therapy includes,
• Beta blockers
• Calcium channel blockers
• Diuretics
• Alpha blockers
• ACE inhibitors
Beta Blockers
Beta Blockers
Parasympathetic nerve (Vagus)
Slows heart (rest, digest)
Sympathetic nerve speeds
p heart ((fight,
g flight),
g )
up
constricts blood vessels to
increase BP
Sympathetic nerve connects
to heart via beta 1 receptor
Beta1 blocker drug [Inderal,
(propranolol) other –olol’s)
slow heart rate(ie decrease cardiac
output) by blocking sympathetic
beta receptor
p
beta blocker,, beta 2
If nonspecific
in lungs blocked, broncospasm
(cough) can occur
Other beta blocker side effects are
insomnia, depression, fatigue,
sexual inactivity
Block the beta receptor and blood
pressure doesn’t increase
Alpha Blockers
Sympathetic nerves connect to peripheral blood vessels
via an alpha receptor
A sympathetic response causes blood vessel to
Constrict causing increase in BP
Block the alpha receptor and vessel
doesn’t respond
Alpha Blockers
• Alpha blockers
include
– Minipress (prazosin),
C d
Cardura
(d
(doxazosin),
i )
Hydrin (terazosin)
• Side effects include
xerostomia, cough
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CALCIUM CHANNEL BLOCKERS
For SA node and cardiac muscle
fibers to work, calcium
channels in special cells must open
to allow exchange of sodium
and calcium.
Calcium Channel Blockers
Calcium channel blocking drugs
Calan (verapamil),
Procardia (nifedipine),
Cardizem (diltiasem )
slow heart by blocking
i calcium
i
movement
Block the calcium channels, and
the heart won’t beat as often
CCB’s can cause
gingival hyperplasia
Name two other drugs that
Cause hyperplasia.
Diuretics
ACE Inhibitors
• Diuretics inhibit reabsorption of sodium by
kidneys causing diuresis (increased urination)
• Plasma volume decreases reducing demands on
heart, lowering BP
• Three kinds,
– thiazide (HCTZ, Lozol),
– loop (Lasix),
– Potassium sparing (Aldactone)
• Thiazides used most
• Can cause xerostomia
ACE Inhibitors
ACE INHIBITOR
ANGIOTENSION - I
• Angiotension II is a naturally occurring
polypeptide that raises blood pressure and
causes the release of aldosterone (adrenal
cortex hormone that controls kidney mineral
reabsorption)
• Angiotension II is formed when angiotension I
combines with the angiotension converting
enzyme (ACE)
• Inhibit ACE and elevated blood pressure is
prevented
ANGIOTENSION CONVERTING
FACTOR
• Common ACE inhibitors include
– Zestril (lisinopril),
– Vasotec (enalopril),
– Lotensin
L
i (benazopril)
(b
il)
• Side effects include
ANGIOTENSION - II
=
INCREASED BP
– Cough
– headache
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Chester Payne
Angina Pectoris - Overview
• Coronary artery becomes
blocked or constricted due to
atherosclerosis, heart does
not get enough oxygen
• Angina pain severe, patient
usually
ll sits
i motionless
i l
• Treatment – remove or go
around block, angioplasty,
bypass, stent
• Treat with drugs to reduce
stress on heart, ie beta
blockers, calcium channel
blockers
Seymore Butts
Myocardial Infarction - overview
• Myocardial
infarction (heart
attack) occurs when
lack of O2 causes
heart muscle to die
• Patient squirms to
get comfortable,
different from
angina, pain into left
arm, sweat
Angioplasty
Nitroglycerin
• Available in a spray, a patch or a
pill
• Immediate relief of pain by dilating
peripheral blood vessels, relieving
demand on the heart
• Make sure angina patients have
medication handy, they medicate
themselves, not you
• If multiple doses don’t help, it’s
probably a myocardial infarction
Myocardial Infarction
• Many patients take daily
aspirin to prevent
platelet aggregation
• should not affect
bleeding, more will
• Patients taking Plavix
must discontinue for
several days before
dental treatment
STENT
After angioplasty, a metal mesh tube called a stent
is sometimes inserted to keep new passage open.
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Anti lipids
• Body needs cholesterol to
maintain cell walls
• Lipoprotein needed to
transport cholesterol
• LDL (low density
lipoprotein) can build up in
blood vessels
• (High density lipoprotein)
HDL, helps eliminate LDL,
therefore “good”
Fun K. Rythm
Arrhythmia - overview
Abnormal action potentials
can cause arrhythmias
requiring pacemaker,
defibrillators,, ablation,, or
medication
Ablation – a surgical procedure
Where the part of the heart
sending abnormal action potential
is inactivated
Defibrillator
Patient automatically given a shock if heart
WHERE in OMNI?
goes into ventricular fibrillation
Anti lipids
• Antilipids help lower
LDL, increase HDL
• Drugs include Zocor,
Vytorin, Mevacor
• NSAIDS can
aggravate side effects
Ablation
• Catheter is guided into
heart
• Energy source
destroys that part of
heart sending
electrical signals
causing arrthythmia
Patients with Pacemakers,
Defibrillators
• Office equipment
could interfere but not
a big
g problem
p
• Newly placed device
may require premed –
ask physician
• Have a healthy mouth
before surgery
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Sodium Channel Blockers
• Used for life threatening
arrhythmias
• Xylocaine injected directly
into heart for critical
arrhythmias
• Norpace taken daily but
causes xerostomia
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