* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Power Point
Survey
Document related concepts
Drug discovery wikipedia , lookup
Discovery and development of ACE inhibitors wikipedia , lookup
Psychedelic therapy wikipedia , lookup
Pharmacokinetics wikipedia , lookup
Prescription drug prices in the United States wikipedia , lookup
Pharmacognosy wikipedia , lookup
Discovery and development of beta-blockers wikipedia , lookup
Neuropsychopharmacology wikipedia , lookup
Neuropharmacology wikipedia , lookup
Prescription costs wikipedia , lookup
Pharmaceutical industry wikipedia , lookup
Pharmacogenomics wikipedia , lookup
Transcript
Pharmacology Drugs That Alter Dental Treatment Cardiovascular Drugs Module #6A Chapter 15 Cardiovascular Drugs Cardiovascular Diseases Hypertension Angina pectoris Congestive heart failure Myocardial infarction (MI) Cerebrovascular accident (stroke) Contraindications to Dental Care Clients with the following conditions are ASA IV and generally are not scheduled for elective dental treatment. Recent acute MI (6 months) Unstable (or recent onset) angina pectoris CHF – uncontrolled Uncontrolled cardiac arrhythmias Significant uncontrolled hypertension Implications for Dental Treatment Vasoconstrictor Limit Use of epinephrine in the local anesthetic agent Cardiac dose 0.04 mg maximum Infective endocarditis Rheumatic heart disease or valvular problems Antibiotic premedication Implications for Dental Treatment Cardiac pacemakers & defibrillators Consult with medical provider No premedication necessary Periodontal disease Increased risk Link between perio and CVD The Oral-Systemic Health Connection Congestive Heart Failure Heart cannot meet the needs of the body Inadequate output Not enough oxygen Symptoms Pulmonary edema- failure of left side of heart Dyspnea- difficulty breathing Orthopnea- difficulty breathing when lying flat Peripheral edema- failure of right side CHF Treatments Drugs First line of therapy ACE inhibitors- (Angiotensin-converting enzyme inhibitors) Second line of therapy Cardiac glycosides Digoxin (Lanoxin) (digitalis) Narrow therapeutic index Angiotensin-converting Enzyme Inhibitors (ACE inhibitors) 1st line therapy for CHF Improve symptoms Decrease hospitalization Prolong survival Digoxin Pharmacological effects: Increases force/ strength of heart contraction Increases volume of output Decrease heart rate & size Reduces edema Uses CHF Arrhythmias Digoxin cont. Adverse effects Narrow TI- possibility of toxicity GI- Nausea and vomiting Arrhythmias- can progress to vent. fibrillation Neurologic- headache, green/ yellow vision Oral- increased salivation, increased gag reflex Digoxin Drug Interactions digitalis & epinephrine > additive, increase risk of arrhythmias digitalis & diuretics > hypokalemia may lead to arrhythmias Dental Implications- Digoxin Narrow TI Watch for overdose side effects such as nausea, vision changes and excess salivation Avoid triggering gag reflex Helps with difficulty breathing Monitor pulse @ each appointment Nausea Semireclined position Check for bradycardia Epinephrine in LA Cardiac dose limit Review Book Question Which of the following is NOT a pharmacologic effect of digitalis (a cardiac glycoside)? a. b. c. d. e. Improves myocardial contractile force Increases ventricular rate Increases cardiac output Decreases venous pressure Decreases blood volume Cardiac Arrhythmias Causes Abnormal impulse generation Abnormal impulse conduction Myocardial anoxia, ateriosclerosis, heart block Symptoms tachycardia bradycardia dysrhythmia Cardiac Arrhythmias Drugs Sodium channel blockers Beta blockers Quinidine and procainamide propanolol Calcium channel blockers verapamil Antiarrhythmic Agents Narrow therapeutic index Possibility of toxicity Difficult to manage Only used when necessary for proper heart functioning Antiarrhythmic Agents- Adverse Effects Gingival enlargement Xerostomia Calcium channel blockers procainamide Nausea & vomiting quinidine Board Review Question Quinidine is used to treat which of the following conditions? a. b. c. d. e. Cardiac arrhythmias Cardiac insufficiency Congestive heart failure Hypertension Hypotension Angina Pectoris Insufficient oxygen for body’s demand May be precipitated by stress (physical or emotional) Symptoms pain in chest Radiates to left arm and shoulder May also radiate neck, back, and lower jaw Angina Pectoris Treatment Drugs: Nitroglycerin Nitrostat, Nitro-dur Calcium channel blockers Verapamil, nifedipine Nitrogylcerin Pharmacological effects Uses Vasodilation Treatment of angina attacks Prevention of angina attacks Adverse effects Hypotension Fainting/ headache Interaction with drugs used for ED Dental implications- Nitroglycerin Prevention of angina attack Acute MI Can be taken before symptoms start If pain does not go away, send patient to ER Storage of nitroglycerin Avoid heat and moisture Keep in original brown glass container After opened, discard after 3-6 months Pilot Board Question Which of the following BEST represents the reason that nitroglycerin is effective in treating anginal pain? a. b. c. d. e. Causes general vascular dilation Possesses central analgesic actions Produces specific coronary vasodilation Increases efficiency of the myocardium Has a negative inotropic effect on the heart Hypertension Most common CVD High blood pressure Essential (primary) Unknown cause (90% of cases) Secondary Cause is identifiable (endocrine, renal disease) Related to drug therapy (steroids, NSAIDs, ect.) Malignant Very high BP, rapidly rising, retinal/ renal damage Classification of Blood Pressure Normal <120/80 mm Hg Pre-hypertension 120-139/ 80-89 Stage 1 hypertension 140-159/ 90-99 Stage 2 hypertension >160/100 Managing Hypertension (fig 15-4) Lifestyle modifications Initial drug choices Not at goal BP- combination drug therapy Lifestyle Modifications Weight reduction, physical activity, healthy diet low in saturated fat, sodium restriction, moderate alcohol intake, smoking cessation Hypertension Treatment Stepped-care 1 – lifestyle changes 2 – use 1 of big 5 3 – mix drugs; dose 4 – use 2-3 drugs Big 5 Diuretics Beta-blockers Ca channel blockers ACE inhibitors ARBs Anti-hypertensive Drugs Diuretics Beta-blockers Calcium channel blockers ACE inhibitors ARBs- angiotensin receptor blockers Diuretics 3 main types Thiazides Loop Potassium (K) sparing Thiazide Diuretics Most commonly used- HCTZ Act on kidney tubule to increase water excretion Adverse reactions Hypokalemia- potassium loss Arrhythmias- avoid epinephrine (cardiac dose of vasoconstrictor in LA) Interactions with NSAIDs- decreased diuretic effect with ongoing use Loop Diuretics Furosemide (Lasix) Acts on loop in kidney tubule More potent than Thiazides Also cause hypokalemia Used for CHF and hypertension Potassium Sparing Diuretics Spironolactone and triamterene Increase sodium excretion but retain K Weak compared to Thiazides and Loops Combined with other diuretics to combat side effects Drug combo example: Dyazide= thiazide and triamterene Beta-Blockers Examples: propanolol, atenolol, labetolol Uses Decrease BP by decreasing cardiac output Consideration Orthostatic hypotension When a person stands after being in the supine position, blood flow to brain is reduced Causes dizziness and potential fainting Calcium Channel Blockers Examples: Verapamil, nifedipine Lowers BP by reducing cardiac output Oral side effects: Xerostomia Dysgeusia Gingival enlargement Gingival Enlargement Calcium channel blocker Nifedipine (Procardia) Nifedipine Gingival Enlargement Gingival Enlargement Nifedipine Gingival overgrowth and ulceration in a patient taking nifedipine for hypertension ACE Inhibitors Examples: captopril, enalapril, lisinopril Lower BP by reducing peripheral vascular resistance Side effects: Cardiovascular hypotension (dizziness, fainting) CNS- dizziness, headache Respiratory- cough Oral-dysgeusia ARBs Examples: losartan (Cozaar) Lowers BP by causing vasodilation Very similar to ACE inhibitors (more specific site of action) and have fewer side effects Patient management: Possibility of leg cramps NSAIDs interference Video- YouTube Review of Cardiac Drugs https://www.youtube.com/watch?v=2Vv1y ed_urs https://www.youtube.com/watch?v=SU7Ef mXZLDc General Adverse Effects of Antihypertensive Drugs Orthostatic hypotension Xerostomia CNS sedation Sit patient up slowly Additive with other CNS depressants Dysgeusia Gingival enlargement CCBs Review Book Question Which drug does NOT cause gingival hyperplasia? a. b. c. d. Phenytoin Cyclosporin Nifedipine Inderal Anti-hyperlipidemics Used for treating high cholesterol Risk factors Untreated hypertension, smoking, obesity, alcohol use Review HDL- good cholesterol LDL- bad cholesterol VLDL- very bad cholesterol Treating High Cholesterol Non-drug therapy Exercise saturated fat dietary cholesterol total fat Drug therapy HMG Co-A reductase inhibitors “statin’s” HMG Co-A Reductase Inhibitors Mechanism of action Inhibit LDL cholesterol synthesis Adverse reactions GI upset Hepatoxicity- liver testing Niacin B Vitamin Large doses inhibit synthesis of VLDL Causes skin flushing in many patients Anti-coagulants Interfere with blood clotting Purpose of anti-coagulant therapy Reduce intravascular clotting and prevent lifethreatening situations Embolism- blockage of a BV by an embolus Mechanism of action of anti-coagulants Vitamin K antagonist – interferes w/ synthesis of clotting factors Warfarin (coumadin) narrow TI many drug interactions Dental considerations Bleeding Consult physician to determine whether the drug needs to be discontinued prior to dental procedure Analgesic choice NO aspirin- increased risk of hemorrhage NSAIDs also contraindicated- inc risk of bleeding Use APAP or opioids for pain relief Warfarin Drug Interactions ASA - effect of warfarin Prone to excessive bleeding, hemorrhage vitamin K - effect of warfarin Prone to clotting, may form embolus INR International Normalized Ratio Should be 2-3 Prosthetic heart valve 2.5- 3.5 Ranges from 1 (no drug effect) to 4 (overdose- too much drug effect) Clopidogrel (Plavix) Inhibits platelet aggregation Increased bleeding risk Has no effect on PT or INR values Penny Purple What are the classifications of drugs Lanoxin – cardiac glycoside ASA – analgesic Advil – NSAID Need to consult? Yes – why taking Lanoxin, ok to treat, epi? Time of day Position Morning Upright Anesthesia No epinephrine – mepivacaine or priliocaine plain Charlie Cherry Clarify heart attack reason for Quinora Needed info. OK to work on him epinephrine OK Classification Quinora – IA antiarrhythmic Vital signs Emergency? pulse BP – possible hypotension syncope Pacemaker ultrasonic, EPT, iontophoresis, electrosurgery Board Review Question Which of the following is the most common of all cardiovascular diseases? a. b. c. d. e. Coronary artery disease Stroke Angina Hypertension Cardiac arrhythmia