-
Heart Failure Drugs can improve the heart by indirectly reducing the cardiac workload (decrease preload) and reduce edematous fluid (preload) with
diuretics
-
Heart Failure Drugs can improve the heart by directly increasing heart contractions with
cardiac glycosides
-
Heart Failure Drugs can improve the heart by reducing sympathetic stimulation to the heart with
β1-blockers
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________ are the most commonly used for initial treatment of heart failure. What is it's mechanism of action and what are the adverse side effects?
Diuretics
Reduce systemic or peripheral (body) or pulmonary (lung) edema
–Loss of electrolytes (potassium) and xerostomia
-
What is the prototype for Cardiac Glycosides and what is the mechanism of action on CHF
- digoxin (Lanoxin)
- Used for CHF and heart arrhythmias
- Increased constriction of smooth muscle
- Increase cardiac output
- Improve circulation
-
Positive ionotropic effect is the ability to
increase heart contraction
-
What are the adverse side effects of digoxin
- Carefully monitor serum levels
- Hypokalemia (low potassium)—heart arrhythmias
- Visual disturbances
-
Vasodilators are useful in the treatment of HF because they reduce __, which decreases ______, and dilate arteries, which increases _______. Name one
-
What is the prototype ACE inhibitor used for CHF and what is its primary function
- captopril (Capoten)
- lower peripheral resistance (reduces load on the heart/afterload) and reduce blood volume by increasing Na+ and H2O excretion
–Slows or prevent the progression of heart failure
-
What medication is used in the treatment of CHF after standard treatments have been tried and what is the prototype drug used
Beta 1 blockers
Carvedilol (Coreg)
-
What is the prototype Sympathomimetic drug used in the treatment of CHF
Dobutamine (Dobutrex)
-
The sinoatrial (SA) node is a
a small mass of tissue in the right atrium paces the heart by stimulating the nerves with an electrical impulse that originates here
-
Arrhythmia occurs when there is a change in _______ either the _______, or the rate of _________
- the rhythm of the heart
- impulse rhythm does not start in the SA node
- heartbeats is abnormal (normally 70-80), or it is not under automatic control
-
Most common arrhythmia is _________ where the ________
- atrial fibrillation
- heart is beating without regard for impulses originating in the SA node
-
Antiarrhythmic Drugs suppress the arrhythmia by ________ or __________
blocking either autonomic function or Blocking calcium, potassium, or sodium channels
-
What are the four classes of Antiarrhythmic Drugs
- –Class I: sodium (Na) channel blockers
- Class IA, IB, IC
- –Class II: beta-adrenergic blockers
- –Class III: potassium (K) channel blockers
- –Class IV: calcium (Ca) channel blockers (CCBS)
-
Class I antiarrhythmic drugs are the ________. What are the prototype drugs?
- largest group
- Quinidine (Quinaglute)- class 1-A
- Lidocaine (Xylocaine) - class 1-B, used in ventricular arrhythmias
-
What are the Class II Antiarrhythmic Drugs
- metaprolol (Lopressor)
- propanolol (Inderal)
-
What is the mechanism of action of Class III Antiarrhythmic Drugs, what cases are they used in and what is the prototype drug
potassium channel blockers; prolong the action potential duration and refractory period
- For supraventricular and ventricular arrhythmias
- amiodarone (Cordarone)
-
What are the Class IV Antiarrhythmic Drugs prototype drugs and what cases is it used in
diltiazem (Cardizem) and verapamil (Calan)
Treats supraventricular arrhythmias
-
Are there special precautions with patients with controlled arrhythmias?
There are no special precautions when treating a patient with controlled arrhythmias. The patient’s pulse should be taken to determine normal rate and rhythm
-
The low dose of epinephrine injected in dental anesthesia stimulates ___ receptors and causes ________
- β2
- dilation of the blood vessels supplying the heart (coronary arteries).
-
In normal healthy patients the maximum amount of EPI is ____ mg ____ cartridges per appointment and in patients with clinically significant cardiovascular impairment ___ mg __ cartridges per appointment
-
Both Triglycerides and Cholesterol are insoluble in blood, so they are transported in blood in the form of
lipoproteins
-
________ are the most common lipid
Triglycerides
-
Highest amount of cholesterol is carried to various sites of the body by ___ which is considered the _____ cholesterol
- LDL low-density lipoprotein
- Bad
-
____ transports cholesterol to the liver, where it is eventually removed from the body and is considered the ____ cholesterol
-
A high cholesterol level (hypercholesterolemia) contributes to the development of
atherosclerosis
-
Lipid-lowering drugs are indicated in patients with _________ because of multiple risk factors
high risk or coronary artery disease
-
What is the mechanism of action of HMG-CoA Reductase Inhibitors (or “Statin” Drugs), prototype drug and adverse side effects
- Primarily reduces LDL-C
- Inhibit HMG-CoA reductase, which results in less cholesterol formation
- –Hepatotoxicity
- –Myopathy (muscle weakness)
-
What are the drug interactions with Statin drugs
- –Erythromycin + clarithromycin/increase statin levels
- –Grapefruit juice
-
What drugs were used prior to the discovery of the statin drugs and what is the mechanism of action
- Bile Acid Sequestrants
- These drugs bind bile acids, which contain high amounts of cholesterol
-
Fibric Acid Drugs reduce ________ but can displace _______ and the prototype drug is
triglyceride levels
- other highly protein-bound drugs (e.g., warfarin) from their receptors, causing elevated plasma levels
- gemfibrozil (Lopid)
-
Nicotinic Acid (Niacin):
- Lowers triglycerides and LDL-C and increases HDL-C
- Contraindicated in diabetics and people with peptic ulcer disease
- Gastric irritation, glucose intolerance, flushing, skin problems, myalgia
-
What combination drugs are the latest approach to drug management for LDL-C reduction? These drugs ______
- amlodipine/atorvastatin (Caduet)
- ezetimibe/simvastatin (Vytorin)
block the absorption of cholesterol (cholesterol absorption inhibitors) from food and also reduce the cholesterol that the body makes in the liver
-
Anticoagulant Drugs _______ and prevent the occurrence of a ________. The prototype drugs are ________ and the indication are for
- retard coagulation
- thrombus
- –Heparin: injectable
- –Warfarin (Coumadin): oral and injectable
- –Thromboembolic disorder
- –Artificial heart valves
-
Warfarin is metabolized by ______ in liver. _______ inhibit these enzymes
- CYP3A4 enzymes
- Erythromycin, clarithromycin (Biaxin)
-
With Warfarin INR (International Normalized Ratio) of _____ is recommended for periodontal debridement procedures
< 3 to 4
-
What are some antiplatelet drugs
- Aspirin
- Clopidogrel (Plavix)
- Dipyridamole (Persantine)
- –Prevent thrombosis associated with artificial heart valves
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