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Cardio Drugs, DH
| Question | Answer |
|---|---|
| Cardiac dose of epi | .04mg |
| Allows heart to do more work w/o increasing O2 usage. Reduces edema that occurs w/CHF. Used for atrial flutter and atrial fibrillation. | Digoxin (Lanoxin); digitalis glycoside |
| Drug interacgtions of digoxin(Lanoxin) | sympathomimetics, vasoconstrictors can increase chance of arrythmia. Erythromycin and tetracycline can increase toxicity of digoxin. |
| Dental mngmt of pt taking digoxin | Can cause bradycardia or arrythmias. Pts pulse should be checked before each dental appt. |
| Adverse reactions of digitalis glycosides | arrythmias, toxicity, increased salivation, increase in gagging |
| Hydralazine | digitalis glycoside; arterial vasodilator; reduces peripheral resistance. |
| Nitroglycerin | digitalis glycoside; venous dilator; reduces the work of the heart |
| angiotensin II receptor antagonists | losartan - first line of therapy for CHF; carvedilol - an alpha and beta blocker |
| Sodium Channel Blockers | Class I antiarrhythmics; interferes w/ influx of sodium into nerve cell; prevents depolarization transmission of nerve impulse, |
| Beta blockers | Class II;decreases sympathetic activity; sympatholytic; decreases epinephrine and norepinephrine; propranolol |
| Adrenergic neuronal blockers | Class III; decrease release of norepinephrine from adrenergic nerve endings; increases refractory period of ventricles; ex. cordarone, bretylol |
| Calcium channel blockers | Class IV; blocks influx of calcium into cardiac muscle; decreases rate of firing of SA and AV nodes; causes vasodilation; verapamil, diltiazem, nifedipine |
| Nitroglycerin | most frequently used nitrate for management of acute anginal episodes; is a vasodilator |
| Nitrostat, NitroQuick | Sublingual tablet |
| Nitrolingual | sublingual spray |
| Antianginal Drugs | Nitroglycerin-like compounds, calcium channel blockers, Beta blockers; reduce the workload of the heart by decreasing cardiac output, peripheral resistance or both |
| Isosorbide dinitrate | Sublingual form is effective for acute anginal attacks; tablets and topical are used for prophylaxis of anginal attacks |
| Amyl nitrite | the only nitroglycerin-like compound that is not a nitrate; not frequently used |
| Examples of B-adrenergic blocking agents | propranolol, metaprolol, atenolol |
| Stepped-care approach to management of hypertension | 1)Lifestyle changes, 2)drug therapy;diuretics or beta blockers, 3)drugs are increased in dose, mixed, or combined, 4)mixing 2 or 3 drugs or addition of a neuronal blocker(guanethidine) |
| Abrupt discontinuation of some BP meds may result in | rebound hypertension |
| 3 major types of diuretics | Thiazides, Loop, Potassium (K) Sparing |
| Thiazides | Most common for tx of hypertension. HCTZ is most commonly used thiazide. Decreases peripheral vascular resistance. NSAIDS can reduce the antihypertensive effect. |
| Adverse reactions of thiazides | can cause hypokalemia and sensitize myocardium to developing arrhythmias. Potential for arrhythmias exacerbated by digoxin. Epi in LA has arrhythmogenic potential (use cardiac dose). Potentiate the action of other hypertensives,increases hypo potential |
| Loop Diuretics | fusosemide(lasix) - most commonly used loop. Used in pts w/CHF. NSAIDs interfere w/antihypertensive action. |
| Potassium sparin diuretics | have a weak diuretic action. A combo product is designed to reduce the amount of potassium loss and prevent hypokalemia. (combo of triamterene and HCTZ, dyazide or maxzide, is most common). |
| Potassium Salts | indicated in tx of hypokalemia. Contraindicated in pts w/severe renal impairment or those taking K-sparing diuretics |
| B-adrenergic blocking agents, nonselective | nonselective drugs block B1 and B2 receptors (propranolol), can react with epi, resulting in hypertension. Give cardiac dose of epi |
| B-adrenergice blockers, selective | or specific; block B1 receptors more than B2; metoprolol. Good for asthmatics. Less likely to produce drug interaction w/epi |
| Calcium channel blockers | end in "dipine"; tx of hypertension, arrythmias and angina; verapamil, nifedipine, diltiazem; vasodilator; decrease total peripheral resistance; effects not reduced by NSAIDs |
| Angiotensin-related agents | end in "pril"; 2 types: Angiotensin-converting enzyme(ACE) inhibitors (captopril, enalapril,lisinopril). Angiotensin II receptor antagonist: blocks effect of angiotensin II(Losartan). |
| Adverse effects of ACE inhibitors (antagonists have fewer rxns) | dry, nonproductive, persistant cough that may be worse at night or in supine position; dysgeusia(altered taste). Effectiveness is reduced by NSAIDs. |
| Drug interactions with angiotensin II rec. antagonists | NSAIDs may antagonize the antihypertensive effect of losartan. |
| A1-adrenergic blocking agents | antihypertensive; selective A1 blockers:doxazosin, terazosin. More effective when combined w/diuretics or B blockers; Peripheral vasodilation. NSAIDs can reduce antihyper effect; epi can increase the antihyper effects of doxazosin, can result in hypoten |
| Clonidine(catapres) | antihypertensive; used when other meds are ineffective; oral or transdermal patch; xerostomia, parotid gland swelling, dysgeusia |
| adverse effects of antihypertensives | xerostomia,dysgeusia,gingival enlargement(calcium channel blockers), orthostatic hypotension (guanethidine) |
| Dental meds that should be used with caution | CNS depressants, no gingival retraction cord w/epi; no more than 2 1.8 ml carpules of 2% lidocaine w/ 1:100,000 epi |
| antihyperlipidemics | HMG Co-A reductase inhibitors end in "statin"; most common antihyperlipidemic; liver fx test bc of small potential for hepatoxicity. Increases the anticoagulant effect of warfarin |
| Niacin | B-vitamin produces a therapeutic effect in larger doses; cutaneous flushing common and warm sensation(blocked by aspirin or ibuprofen); hyperuricemia can occur(treated w/allupurinol) |
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