Pharmacology

The client with cardiovascular disease (CVD) poses a risk for cardiovascular complicatsion such as ___________ and ____________, during oral health care procedures

Clinical implications when providing dental hygiene care to a CV pt include the fact that stress can lead to what 3 cardiovascular complications?

What are 4 topics that we emphasize in regards to the importance of understanding CV in relation to dental hygiene care?

of the top 200 drugs, _______ of the top 20 are CVD drugs

What does CVD refer to?

Name 4 diseases of the heart and blood vessels (CV diseases)

fill in the blanks of the following: chronic diabetes can lead to _________, which can lead to atherosclerosis, which can lead to __________, which can lead to ________, __________, or ____________

What is the leading cause of disease and morbidity in the US and developed countries?

What is the goal of dental treatment for cardiovascular pts?

What are 3 special consideration that may be required during pt assessment of CVD pts?

Cardiac risks are increased in pts who are unable to meet a _____-MET demand

The following are what rank of clinical predictors of CVD?
advanced age
atrial fibrilation
low functional capacity
stroke
uncontrolled hypertension
anxiety levels

The following are what rank of clinical predictors of CVD?
stable angina
previous MI
compensated heart failure
diabetes mellitus
renal insufficiency

The following are what rank of clinical predictors of CVD?
unstable angina
decompensated heart failure
severe valvular disease
significant arrhythmias

What are 7 factors used to assess cardiovascular status?

What has the American Heart Association stated/recommended in task force on practice conditions guidelines in regards to waiting 6 months after a pt has had an MI to treat them in the dental office?

What test is used to evaluate pt's overall cardiac risk for oral healthcare procedures; and provides a reasonable approach to assess pts physical and emotional ability to undergo comprehensive dental hygiene care?

What should we do if we have a pt who cannot complete one or more of the activities of 4 METs?

The following activities are what MET level?
dress, eat, use the toilet
walk indoors around house
complete light housework (dusting, washing dishes)
walk a block on level ground at 2-3 mph

The following activities are what MET level?
climb a flight of stairs, walk up a hill
walk on level ground at 4 mph
run a short distance
complete heavy housework (scrubbing floors, moving heavy furniture)
participate in moderate recreational activities (golf, bowling, dancing)

The following activities are what MET level?
strenuous sports (swimming, skiing, singles tennis, basketball)

What measurements that are taken at dental appointments provide clues to confirm or rule out significant CV disease?

true or false. blood pressure and pulse need to be recorded on all new pts at the initial apointment. BP and pulse need to be measured at every appointment on pts with a history of CV.
True False

Blood pressure of what level is contraindicated for elective dental procedures, and indicates referral for medical evaluation?

Pulse pressure closely correlates with systolic or diastolic pressure?

What is needed preoperatively in pts with the presence of arrhythmias?

What are 3 significant findings in regards to pulse rate and rhythm in pts?

Research suggests that periodontal disease may play a role in the _______________ aspect of coronary heart disease.

Oral bacteria may increase the risk of Cardiovascular disease via what?

Atheroslcerosis may represent a response to injury to the blood vessel walls by what 3 types of insult? And what do these include?

true or false. Most individuals with CV can be treated in the dental office and recieve local anesthesia
True False

If a pt comes to the dental office with a recent diagnosis of CV or evidence of uncontrolled disease, what does it require?

List 4 contraindications for elective procedures including dental hygiene care.

What is the most common form of hypertension?

Who recommends that all pts whould have an annual BP measurements at recall appointments as a screening measure to identify hypertensive individuals?

The goals of prevention and management of hypertension are to reduce morbidity and mortality by maintaining systolic BP below _____ and diastolic BP below ________

treatment and medical management of hypertension may prevent what 3 things?

true or false. The major treatment for hypertension is PHARMACOLOGIC
True False

Adoption of a ________ __________ is critical for prevention of hypertension; and also for management of those with hypertension.

Major lifestyle modifications that aid in the prevention and management of hypertension include what 3 things?

What are 4 therapeutic goals and pharmacologic srategies for hypertension?

Name 6 classes of drugs that are selected common antihypertensive drug.

Which class of selected common hypertensive drugs cause the body to eliminate excess fluids and sodium through urination?

Which class of selected common hypertensive drugs decrease the heart rate and output of blood from the heart by blocking beta-sympathetic stimulation in the heart?

Which class of selected common hypertensive drugs expand blood vessels (vasodilation) and decrease resistance to blood flow?

Which class of selected common hypertensive drugs interrupt the movement of calcium into the cells of the heart and blood vessels to produce vasodilation?

Which class of selected common hypertensive drugs inhibit vasoconstriction by blocking angiotensin binding, resulting in vasodilation?

Which class of selected common hypertensive drugs prevent sympathetic innervation to alpha-receptors, thereby blocking vasoconstricion and tachycardia?

All of the following are CV conditions contraindicated for elective dental procedures, such as dental hygiene care, except for one, which is it?
severe hypertension
recent history of myocardial infarction
thromboembolic disorders
uncontrolled congestive heart failure resulting in low functional capacity
unstable angina pectoris

Name the 3 main types of diurtetics.

What is the prototype thiazide diuretic?

Which type of drug is among the most common agents used for hypertension?

The mechanism of action of which type of drug is to interfere with sodium reabsorption in the distal tubule of the kidney and promote diuresis?

What is the most common adverse reaction of the use of thiazide diuretics? What is done to help this?

What is another common adverse reaction of the use of thiazide diuretics besides the most common hypokalemia?

What is a dental drug interaction with the use of thiazide diuretics?

What is the most commonly used LOOP diuretic?

Which drugs mechanism of action is to inhibit reabsorption of sodium and promote diuresis? they act on the ascending limb of the loop of Henle.

What is an adverse effect of loop diuretics? What is done to help with this?

Furosemide (the most commonly used loop diuretic) is often used to reduce fluids associated with what?

What is a dental drug interaction with the use of furosemide (loop diuretics)?

What are the 2 main drugs in the potassium-sparing diuretics class?

Which drugs mechanism of action is to interfere with the potassium/sodium exchange in the collecting tubules and collecting duct to conserve potassium that is reabsorbed at the expense of sodium in the exchange system?

potassium-sparing diuretic/thiazide combination therapy is common, with the most frequently used agent including what?

What are the three different types of beta blocking agents?

Most beta blockers end with what suffix?

which type of beta blocker agents can cause an increased risk of hypertension when vasoconstrictors are used in LA? Which type of beta blockers have less risk with vasoconstrictors?

What are 5 possible side effects that may occur with the use of beta blocking agents?

What is a dental drug interaction with the use of beta blocking agents?

What is the prototype non-selective beta blocking agent?

true or false. When nonselective beta-blockers are reported on the medical history, vasoconstrictors should be used in low concentrations with an aspirating technique, taking care to avoid intravascular injection
True False

Which beta receptor do selective beta blockers inhibit more? Which makes this the agent of choice with what condition?

Are vasoconstrictors in LA safe to use if the pt is taking a selective beta blocker?

What type of drug has the same effects as propranolol with less peripheral resistance, may be prescribed in combination with a diuretic and has side effects similar to beta blocking agents? Labetalol (Normodyne) is an example of this type.

Calcium-channel blockers (antihypertensive drugs) are effective for what 3 CV conditions?

The choice of the specific CCB used depends on what?

One type calcium channel blocker is derived from a dihydropyridine structure; what do the names of these agents end in?

Several Calcium channel blockers (especially nifedipine) cause what 3 adverse effects?

What are 2 calcium channel blockers that are less likely to cause gingival hyperplasia?

Oral health education plan for pts taking calcium channel blockers and are experiencing gingival hyperplasia include what 4 things?

What is an antihypertensive drug that has no interaction with COX inhibitors so they can be used for analgesics?

What are the 2 classes of drugs that affect angiotensin receptors to reduce blood pressure?

Which type of angiotensin inhibitors prevent the formation of angiotensin II by blocking the release of the enzyme responsible for converting angiotensin I to angiotensin II?

Lisinopril blocks vasoconstriction of what?

Which angiotensin inhibitor does not disturb the enzyme levels, but blocks angiotensin-II receptor, preventing vasoconstriction.

Which angiotensin inhibitor is more selective with fewer side effects, is usually prescribed with diuretic or agent from another antihypertensive class, and COX inhibitors can antagonize antihypertensive effects of it?

Which antihypertensive drugs end in -pril?

Which type of angiotensin inhibitor blocks vasoconstriction, reducing peripheral resistance and fluid retention; and also retards the progression of nephropathy in diabetes; which makes it the agent of choice for management of hypertension in diabetes?

What are 2 common side effects of angiotensin-converting enzyme inhibitors?

What is the prototype drug for Angiotensin-II receptor inhibitors?

Which angiotensin inhibitor has the mechanism of action of vasoconstriction by blocking aldosterone secretion and lowers BP?

true or false. Side effects are minimal with the use of angiotensin-II inhibitors, but they should NOT be used during pregnancy (category D, 2nd and 3rd trimestor).
True False

List 2 other antihypertensive drugs that are used when the other agents are not successful (often used in combination therapy).

what are 3 common side effects of 'other' antihypertensive drugs? (alpha 1-adrenergic blockers, and CNS-mediated action drugs)

which type of drug used for antihypertension has a potential drug interaction with epi; it reduces the duration of the LA, it can cause severe postural hypotension; but is less frequently in reflex tachycardia, and COX inhibitors reduce the antihypertensive effect?

Which antihypertensive drug is the drug of choice for hypertension associated with pregnancy?

what are 2 side effects of hydralazine that affect dental hygiene?

The following are all common adverse drug effects with the use of antihypertensive agents; list the drug that causes the effect.
urination
fatigue
chronic dry cough
gingival hyperplasia
postural hypotension and xerostomia

When is gingival enlargement (from gingival hyperplasia caused most commonly by nifedipine) noted after initiation of therapy?

gingival hyperplasia primarily effects what areas of the gingiva?

What condition is most likely occuring; it is associated with erythematous and edematous chronic inflammation; pt may report pain, gingival bleeding, and difficulty with mastication; frequent maintenance schedule and plaque removal via oral hygiene procedures are indicated to prevent overgrowth.

will plaque control prevent gingival hyperplasia?

What drug used in dentistry reduces the efficacy of most antihypertensive agents?

Which drug used in dentistry decreases the effect of beta-adrenergic blockers (pharmacologic antagonism)?

because nonselective beta blockers and epinepherine can result in a hypertensive reaction by unopposed alpha-adrenergic stimulation what should be done?

What can happen if alph-blockers are being used and epinepherine is introduced into the vascular system?

What is the name of the drug used in dentistry to stimulate salivation that may have an additive effect with antihypertensive agents and lead to hypotension?

Atherosclerosis causes what CVD?

What disease impedes the supply of oxygenated blood when there is an increased demand for oxygen in cardiac muscle?

What are 3 factors that increase the hearts demand for oxygen?

What is a temporary deficiency of oxygen to a portion of the myocardium?

What is permanent deficiency of oxygen to a portion of the myocardium resulting in necrosis?

The following are therapeutic goals in the management of CAD. List the pharmacologic strategy for each goal.
inhibit progression of atherosclerosis
improve circulation in coronary arteries
reduce workload
prevent thrombus formation
prevent coagulation

What are 3 important implications for dental hygiene treatment in the medical management of coronary artery disease?

COX inhibitors may only be used for pain management with which agent?

There is a high risk factor for CAD if a pt has high levels of what 3 things?

The effects of high cholesterol levels can lead to what 3 conditions?

The recommendations for healthy total cholesterols are:
total cholesterol < _________ mg/dl
LDL < ___________ mg/dl

Which type of drug is the most widely used class of anticholesterol drugs?

Which class of drug is commonly referred to as statins? And list 4 examples of this class of agent.

What is the mechanism of action of HMG-coA reductase inhibitors?

true or false. HMG-CoA reductase inhibitor drugs are well tolerated, and ADEs are usually mild and o not affect the dental hygiene treatment plan

The following drugs are examples of agents in which anticholesterol class?
cholestyramine
colesevelam
colestipol

Which class of anticholesterol drugs mechanism of action is that the agents bind with bile in the intestine and form insoluble complex; they may be used in combination with HMG-coA reductase inhibitors, and may delay or reduce absorption of other oral medications?

why is it important to take other drugs 4-6 hours after or one hour before taking bile acid sequestrants?

Which type of anticholesterol drug is used to lower cholesterol and triglycerides and increase HDL levels?

Lopid and TriCor are examples of what class of anticholesterol drugs?

Which type of anticholesterol drug's mechanism of action is to inhibit synthesis and increase clearance of LDLs and reduce triglycerides by decreaseing hepatic extractino of free fatty acids?

true or false. There are no drug-drug interactions with the use of fibric acid derivatives in dentistry.
True False

What are 3 ADEs of the use of fibric acid derivatives?

Niacin (nicotinic acid-or niacor) is an anticholesterol agent and has the following results:
reduces _________% reduction in total and LDL cholesterol
Reduces ________% reduction intriglycerides
Increase_________% in HDL

What is the mechanism of action for Niacin (anticholesterol agent)? And give an example of a drug.

Which anticholesterol agent has an unclear mechanism of action, is taken with meals to avoid GI upset, can cause orthostatic hypotension so we must follow protocol to prevent it; and has no drug interactions with dental drugs?

The drugs Ezetimibe (Zetia), and ezetimibe and simvastatin (Vytorin) are found in plant stanol ester food products, and are drugs that are in what class?

amyl nitrite, and nitroglycerin are drugs used as vasodilation agents to relieve angina pectoris, are they fast acting or long acting agents?

Isosorbide dinitrate, isosorbide mononitrate, and calcium channel blockers are used as vasodilation agents to relieve angina pectoris, are they fast acting or long acting agents?

What is a common vasocilator used to manage anginal pain- and a sublingual agent is carried by the pt at all times?

two dose forms of nitroglycerin include:
ointment
IV formulation
What are each used for?

true or false. If a pt presents for an apointment and has nitroglycerin it is necessary to investigate side effects based on the agent used.
True False

Which vasodilation drugs are used to prevent and treat angina caused by CAD - but are not the first-choice drugs in an angina emergency?

Why is it necessary to monitor blood pressure if pts are taking isosorbid mononitrate or dinitrate and general anesthetics are used?

Pts with coronary artery disease can recieve dental hygiene care if they can meet a ____ MET.

for pts with CAD; appointments should be kept short and minimal stressful and at what time of the day is recommended?

true or false. It is important to used profound anesthesia in pts with CAD to minimize stress caused by pain.
True False

What are 4 procedures to carry out if a pt has an angina attack?

What is the primary pace maker of the heart?

Interruption of cardiac rhythm by arrhythmia compromises tissue oxygenation and may lead to death; What are 6 cardiovascular causes of cardiac arrhythmia?

What is the goal for medical treatment and management of cardiac arrhythmia?

true or false. Many antiarrhythmic drugs are used to treat other CVD conditions, so it is important to question the pt about why the drug is taken.
True False

Agents used to prevent clot formation are also effective in preventing what?

What are 3 possible ADEs with the use of antiarrhythmatic agents?

Which type of antiarrhythmic agent has increased CNS effects that are possible when LA's are used, so we should use the lowest dose?

Vasoconstrictors may interact adversely with Which Miscallaneous antiarrhythmic agent?

Vasoconstrictors are _______ in intractable arrhythmias, and used with ____________ with pacemakers and implanted defibrillators

Pts with normal pulse pressure and rhythm can receive _________ _________ procedures, and ___________________

What aspects of the pulse are evaluated for disease control during assessments?

true or false . Vasoconstrictors should be used in low concentrations in pts with antiarrhythmic agents
True False

does the ANA recommend antibiotic prophylaxis when pacemakers or defibrillator devices are worn?

What is the normal process when an event disrupts the integrity of a blood vessel that is designed to prevent blood loss due to breakage of blood vessel integrity?

What occurs when the clooting mechanism of blood overacts forming a clot within the vessel, imparing the blood flow to tissues; it can be arterial or venous in origin.

Which type of thrombus begins when platelets aggregate and become surrounded by fibrin and erythrocyteds; eventually it can occlude blood vessels and cause tissue eschemia?

Which type of thrombus develop in areas of slow blood flow; the clot forms rapidly and lacks organization; it is a great concern that a small emboli will detach from the thrombi move through large vessels and wedge into small pulmonary arteries preventing deosygenated blood from entering that portion of the lung

Which type of thrombus contributes to each of the following conditions:
rasient ischemic attacks and stroke
occlusion of coronary artery grafts
coronary artery rethrombosis after tx to remove clots
MI and death in unstable angina
increased incidence of periprocedural MI in pts who are undergoing coronary angioplasty
mural thrombosis after MI
recurrent MI

What type of drug therapy is frequently administered for pts with prosthetic cardiac valves as well as thromboembolic disease?

What is the goal of treatment of pts with thromboembolic complications of CV disease?

Name an oral anticoagulant that is effective in the prevention of a thromboembolic event? Name a parenteral anticoagulant that is effective in prevention AND treatment of thromboembolism?

What are the two main classes of antithrombotic agents?

Aspirin is available in what 2 tablet doses?

How is clopidogrel available?

What drug is prescribed for pts who cannot take aspirin, and may be used in combination with aspirin for an additive effect?

What is the mechanism of actino of clopidogrel?

are there any contraindications for dental hygiene tx if pt is taking aspirin or clopidogrel?

What are the two main groups of anticoagulant agents?

Which type of anticoagulant drug is a new group for use at home after joint replacement surgery or abdominal surgery; it reduces deep vein thrombosis leading to pulmonary embolism?

Which anticoagulant is commonly prescribed alone or in combination with clopidogrel?

What are 2 low molecular weight heparin agents that are available for home use?

What is an adverse effect of low molecular weight heparin agents?

What drugs should not be taken with low molecular weight heparin agents?

What type of anticoagulant drugs mechanism of action is that it interferes with the synthesis of several vitamin K clotting factors including thrombin in the liver? And an adverse effect is excessive bleeding?

blood clotting factors are measured through what test?

with therapeutic doses, the INR for pts taking warfarin are between what range? also, subgingival/debridement can be safely performed with INR at what level?

How long does it take for the development of clotting factors after the dose of warfarin has been reduced?

What are 2 types of drugs used in dentistry that can increase the INR level when warfarin is taken?

What drug used in dentistry increases metabollism and reduces the anticoagulant effect of warfarin?

What are some good drugs that can be used with warfarin if analgesic is needed?

What is an anticoagulant that is used for pts after the replacement of prosthetic heart valves; the mechanism of action is that it inhibits platelet adhesion and prolongs the life of platelets, and it can be combined with aspirin (Aggrenox) which reduces stroke in pts with transient ischemia of brain or ischemic stroke caused by thrombus?

If pts are taking agents that affect platelet adhesion do they require excessibe bleeding blood test before DH care?

if a pt is taking warfarin, what are 3 dental hygiene implications?

are pts taking 81-325 mg of aspirin a day likely to have prolonged bleeding? If the dose is higher should they be monitored?

How long before periodontal procedures does the use of aspirin need to be discontinued?

If pts have congestive heart failure do most pts develop right or left sided heart failure?

edema in lower legs is a sign of what heart failure?

orthopnea; edema in the lungs is a sign of what heart failure?

What are 4 lifestyle modifications in the medical management of congestive heart failure?

What are 5 effects of pharmacologic management of pts with congestive heart failure?

cardiac glycosides increase the force of contraction (inotropic effect) to improve cardiac output and amount of blood leaving the left ventricle. these drugs are used for pts with what condition?

What are 3 examples of cardiac glycosides used for pts with congestive heart failure? Which of the 3 is most common?

What combination drug is used for african american individuals with heart failure?

The following adverse effects may occur with the use of what agent used in heart failure?
narrow margin of safety
blood levels monitor frequently
toxicity can develop owing to changes in dose, metabolism, or absorption of it
anorexia
cardiac arrhythmia
gagging
increased salivation

What is the first sign of digoxin toxicity (which is common)? And what are 3 signs after that?

List 5 drugs used in dentistry that can increase digoxin serum levels.

What dose of vasoconstriction is recommended if pts are taking digoxin?

the __________ decrease heart rate and the output of blood from the heart

the __________ interrupt the movment of calcium into the cells of the heart and blood vessels to produce vasodilation

_____ is a common diuretic used to eliminate excess fluids and sodium through urination and decrease hydrostatic pressure

The antihypertensive drugs that prevent conversion of a body enzyme to one that causes vasoconstriction are what?