Baker's Exam 3: Other Cardiovascular Medications

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Author:
kmaher
ID:
121774
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Baker's Exam 3: Other Cardiovascular Medications
Updated:
2011-12-08 00:43:29
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Dental Therapeutics
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Cardiovascular Medications
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  1. What is the category of Nitroglycerin SL and Isosorbide dinitrate?
    Nitrates
  2. What is the category of Amiodarone, Digoxin, Flecainide, and Sotalol?
    Antiarrhythmics
  3. What is the category of Atorvastatin, Ezetimibe, Gemfibrozil, Lovastatin, Nicotinic acid, Pravastatin, Rosuvastatin, Simvastatin, and Simvastatin/Ezetimibe (Vytorin)?
    Lipid lowering
  4. What is the category of Aspirin, Clopidogrel, and Warfarin?
    Blood Thinners
  5. What are the common dentally significant adverse effects of Antiarrhythmics?
    *amiodarone, digoxin, flecainide, sotalol*
    • amiodarone skin discoloration
    • all agents-bradycardia
  6. What are the common dentally significant adverse effects of Lipid lowering drugs?
    *atorvastatin, ezetimibe, gemfibrozil, lovastatin, Nicotinic acid, pravastatin, rosuvastatin,
    simvastatin,
    Simvastatin/ezetimibe (Vytorin)*
    • Statins-HA
    • GI
    • abnormal taste
    • muscle pain/weakness
    • Increased gag reflex (all lipid drugs can cause this effect)
    • Nicotinic Acid-“hot flashes”
    • Ezetimibe-not used much now due to possible pancreatitis risk
  7. What are the common dentally significant adverse effects of Blood Thinners?
    *aspirin, clopidogrel, warfarin*
    Most worrisome adverse effect is excessive bleeding and this is potentially most significant with warfarin therapy
  8. What are the common dentally significant adverse effects of Nitrates?
    *nitroglycerin SL, isosorbide dinitrate*
    • dizziness
    • orthostatic hypotension
    • flushing
    • HA
  9. What are the major dental tx impacts of Nitrates?
    *Nitroglycerin SL, isosorbide dinitrate*
    • Short midday appts
    • Premed for stress reduction w/BZDP or N2O
    • Limit epi to 0.04mg/2hr visit
    • Keep SL nitro or spray in office
    • Do angina history often
    • Max office dose of nitro is 2 tabs, DO NOT give 3rd tablet if systolic BP is below 90mmHg
    • Call 911 if chest pain not resolving after 10 min and 2 nitro tabs SL
    • Halitosis with Isosorbide Dinitrate
  10. What are the major dental tx impacts of Antiarrythmics?
    *amiodarone, digoxin, flecainide, sotalol*
    • amiodarone: intx with fentanyl - causing hypotension, bradycardia & can increase lidocaine levels
    • digoxin: dental drug intx (inc. by BZDP, erythromycin, tetracycline, ibuprofen) & recognition of dig toxicity
    • all agents: represent “flag” for epi dosage limits, decreased stress tolerance & arrhythmia assessment
  11. What are the major dental tx impacts of Lipid lowering medications?
    *atorvastatin, ezetimibe, gemfibrozil, lovastatin, Nicotinic acid, pravastatin, rosuvastatin,
    simvastatin,
    Simvastatin/ezetimibe (Vytorin)*
    • All agents: increase gag reflex and cause taste disturbances
    • Statins: intx with macrolides and azole antifungals
    • Statins: muscle pain and weakness can be orofacial
  12. What are the major dental tx impacts of Blood thinners?
    *aspirin, clopidogrel, warfarin*
    • Warfarin: drug intx (inc bleeding w/ASA, ABX, Metronidazole, Azole antifungals), guidelines for INR and dental treatment (Pts w/INR 1.5-3.5X normal can be managed w/o dose change but confirm on surgery day), avoid NSAIDs
    • Dabigatran (Pradaxa): MOA, indications - reduce risk of stroke and systemic embolism in pts w/non-valvular atrial fibrillation, management - monitor bleeding
    • Clopidogrel: antiplatelet so don’t discontinue, inc by NSAIDS
    • ASA: antiplatelet so don’t discontinue, discontinue high-dose (2400mg/day) for 7 days before surgery
    • Most patients will be managed with “local measures”
  13. What is the normal INR of person not on Warfarin?
    1.0
  14. What is the therapeutic range for pts on Warfarin? Should you alter there Warfarin therapy?
    • Therapeutic range (INR) = 2.0-4.0
    • Warfarin does not need to be stopped and dose does not need to be adjusted before primary care dental surgical procedures for pts w/an INR <4.0.
    • They may bleed more but this can easily be treated with local measures
    • Risk of thromboembolism after withdrawl outweighs risk of oral bleeding

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