Card Set Information

2011-04-09 18:34:37
Chapter seventeen

week thirteen
Show Answers:

  1. The client with cardiovascular disease (CVD) poses a risk for cardiovascular complicatsion such as ___________ and ____________, during oral health care procedures
    • myocardial infarction
    • stroke
  2. Clinical implications when providing dental hygiene care to a CV pt include the fact that stress can lead to what 3 cardiovascular complications?
    • MI
    • angina pectoris
    • CVA
  3. What are 4 topics that we emphasize in regards to the importance of understanding CV in relation to dental hygiene care?
    • ADEs
    • signs to indicate emergencies
    • local anesthesia
    • drugs pt is taking
  4. of the top 200 drugs, _______ of the top 20 are CVD drugs
  5. What does CVD refer to?
    disease of the heart and blood vessels
  6. Name 4 diseases of the heart and blood vessels (CV diseases)
    • arrhythmias
    • hypertension
    • myocardial infarction
    • heart failure
  7. 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 ____________
    • hyperglycemia
    • hypertension
    • heart attack
    • stroke
    • heart failure
  8. What is the leading cause of disease and morbidity in the US and developed countries?
    cardiovascular disease
  9. What is the goal of dental treatment for cardiovascular pts?
    to provide timely preventive and therapeutic treatment
  10. What are 3 special consideration that may be required during pt assessment of CVD pts?
    • use vasoconstrictors with caution
    • take accurate record of current medications
    • use of tobacco products, alcohol, and OTC and recreational drugs documented
  11. Cardiac risks are increased in pts who are unable to meet a _____-MET demand
  12. The following are what rank of clinical predictors of CVD?
    advanced age
    atrial fibrilation
    low functional capacity
    uncontrolled hypertension
    anxiety levels
    MINOR clinical predictors
  13. The following are what rank of clinical predictors of CVD?
    stable angina
    previous MI
    compensated heart failure
    diabetes mellitus
    renal insufficiency
    INTERMEDIATE clinical predictors
  14. The following are what rank of clinical predictors of CVD?
    unstable angina
    decompensated heart failure
    severe valvular disease
    significant arrhythmias
    MAJOR clinical predictors
  15. What are 7 factors used to assess cardiovascular status?
    • anxiety level
    • diabetes mellitus
    • hyperlipidemia
    • vital signs and qualities
    • advanced age
    • renal insufficiency
    • MET (metabolic equivalents)
  16. 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?
    they recommend that determination of the pt's functional capacity is a reliable indicator of risk in treatment rather than just waiting 6 months
  17. 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?
    Metabolic Equivalents (METs)
  18. What should we do if we have a pt who cannot complete one or more of the activities of 4 METs?
    do not treat and refer for medical evaluation
  19. 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
    less than or equal to 1 MET
  20. 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)
    less than or equal to 4 METs
  21. The following activities are what MET level?
    strenuous sports (swimming, skiing, singles tennis, basketball)
    less than or equal to 10 METs
  22. What measurements that are taken at dental appointments provide clues to confirm or rule out significant CV disease?
    blood pressure and pulse
  23. 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.
  24. Blood pressure of what level is contraindicated for elective dental procedures, and indicates referral for medical evaluation?
    greater than or equal to 180/110
  25. Pulse pressure closely correlates with systolic or diastolic pressure?
  26. What is needed preoperatively in pts with the presence of arrhythmias?
    medical consultation
  27. What are 3 significant findings in regards to pulse rate and rhythm in pts?
    • hypertension
    • coronary heart disease
    • valvular pts with PVCs (premature ventricular contractions)
  28. Research suggests that periodontal disease may play a role in the _______________ aspect of coronary heart disease.
  29. Oral bacteria may increase the risk of Cardiovascular disease via what?
    platelet aggregation
  30. Atheroslcerosis may represent a response to injury to the blood vessel walls by what 3 types of insult? And what do these include?
    • mechanical
    • biochemical
    • bacterial
    • includes: chlamydial infection and severe generalized periodontal disease
  31. true or false. Most individuals with CV can be treated in the dental office and recieve local anesthesia
  32. If a pt comes to the dental office with a recent diagnosis of CV or evidence of uncontrolled disease, what does it require?
    physician consultation with a medical clearance
  33. List 4 contraindications for elective procedures including dental hygiene care.
    • severe hypertension: BP greater than or equal to 180/110
    • recent history of MI: within 1 month
    • uncontrolled congestive heart failure resulting in low functional capacity: less than 4 METS capacity
    • unstable angina pectoris
  34. What is the most common form of hypertension?
    essential hypertension
  35. Who recommends that all pts whould have an annual BP measurements at recall appointments as a screening measure to identify hypertensive individuals?
  36. The goals of prevention and management of hypertension are to reduce morbidity and mortality by maintaining systolic BP below _____ and diastolic BP below ________
    • 140
    • 90
  37. treatment and medical management of hypertension may prevent what 3 things?
    • prevent stroke
    • preserve kidney function
    • prebent or slow progression to heart failure
  38. true or false. The major treatment for hypertension is PHARMACOLOGIC
  39. Adoption of a ________ __________ is critical for prevention of hypertension; and also for management of those with hypertension.
    healthy lifestyle
  40. Major lifestyle modifications that aid in the prevention and management of hypertension include what 3 things?
    • aerobic exercise
    • weight reduction
    • good diet
  41. What are 4 therapeutic goals and pharmacologic srategies for hypertension?
    • reduce volume overload: thiazide-type diuretics
    • blocking adrenergic receptors in the heart
    • dilating blood vessels
    • reducing sympathetic outflow from the CNS
  42. Name 6 classes of drugs that are selected common antihypertensive drug.
    • diuretics
    • beta blockers: olols
    • ACE inhibitors: prils
    • calcium-channel blockers: pines
    • angiotensin-receptor blockers
    • alpha-blockers
  43. Which class of selected common hypertensive drugs cause the body to eliminate excess fluids and sodium through urination?
  44. 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?
    beta-blockers: olols
  45. Which class of selected common hypertensive drugs expand blood vessels (vasodilation) and decrease resistance to blood flow?
    ACE inhibitors: prils
  46. Which class of selected common hypertensive drugs interrupt the movement of calcium into the cells of the heart and blood vessels to produce vasodilation?
    calcium-channel blockers: pines
  47. Which class of selected common hypertensive drugs inhibit vasoconstriction by blocking angiotensin binding, resulting in vasodilation?
    angiotensin-receptor blockers
  48. Which class of selected common hypertensive drugs prevent sympathetic innervation to alpha-receptors, thereby blocking vasoconstricion and tachycardia?
  49. 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
    thromboembolic disorders
  50. Name the 3 main types of diurtetics.
    • thiazide
    • loop
    • potassium sparing
  51. What is the prototype thiazide diuretic?
    hydrochlorothiazide (HCTZ)
  52. Which type of drug is among the most common agents used for hypertension?
    thiazides: diuretic class
  53. 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?
    thiazide diuretics
  54. What is the most common adverse reaction of the use of thiazide diuretics? What is done to help this?
    • hypokalemia: loss of too much potassium
    • Pts often take potassium supplements: K-Dur
  55. What is another common adverse reaction of the use of thiazide diuretics besides the most common hypokalemia?
    postural hypotension
  56. What is a dental drug interaction with the use of thiazide diuretics?
    COX inhibitor analgesics: reduce the antihypertensive effect of the agent
  57. What is the most commonly used LOOP diuretic?
    furosemide (Lasix)
  58. 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.
    Loop diuretics
  59. What is an adverse effect of loop diuretics? What is done to help with this?
    • hyperkalemia
    • potassium replacement therapy
  60. Furosemide (the most commonly used loop diuretic) is often used to reduce fluids associated with what?
    congestive heart failure
  61. What is a dental drug interaction with the use of furosemide (loop diuretics)?
    COX inhibitor: cause it to lose antihypertensive effect
  62. What are the 2 main drugs in the potassium-sparing diuretics class?
    • spironolactone
    • triamterene
  63. 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 diuretics
  64. potassium-sparing diuretic/thiazide combination therapy is common, with the most frequently used agent including what?
    triamterene and HCTZ: Dyazide, Maxzide
  65. What are the three different types of beta blocking agents?
    • nonselective beta blockers
    • selective agents: block B1 more than B2
    • agents that block both alpha and beta
  66. Most beta blockers end with what suffix?
  67. 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?
    • nonselective: risk of hypertension with LA
    • selective and alpha/beta blockers: less risk
  68. What are 5 possible side effects that may occur with the use of beta blocking agents?
    • bradycardia
    • dizziness
    • fatigue
    • nausea
    • mild xerostomia
  69. What is a dental drug interaction with the use of beta blocking agents?
    COX inhibitors: antagonize the antihypertensive effects of them?
  70. What is the prototype non-selective beta blocking agent?
    propranolol (Inderal)
  71. 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
  72. Which beta receptor do selective beta blockers inhibit more? Which makes this the agent of choice with what condition?
    • beta 1
    • conditions of bronchospasms
  73. Are vasoconstrictors in LA safe to use if the pt is taking a selective beta blocker?
    yes, but the safety is reduced with increased dose of the drug
  74. 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.
    Alpha- and Beta- adrenergic blocking agent
  75. Calcium-channel blockers (antihypertensive drugs) are effective for what 3 CV conditions?
    • hypertension
    • arrhythmia
    • angina pectoris
  76. The choice of the specific CCB used depends on what?
    the specific disease being managed
  77. One type calcium channel blocker is derived from a dihydropyridine structure; what do the names of these agents end in?
  78. Several Calcium channel blockers (especially nifedipine) cause what 3 adverse effects?
    • gingival hyperplasia
    • xerostomia
    • dysgeusia
  79. What are 2 calcium channel blockers that are less likely to cause gingival hyperplasia?
    • amlodipine
    • isradipine
  80. Oral health education plan for pts taking calcium channel blockers and are experiencing gingival hyperplasia include what 4 things?
    • effective biofilm removal to reduce rate of enlargement
    • maintenance schedule: at every 3 months
    • monitor teeth for caries
    • include caries preventive agents for home care
  81. What is an antihypertensive drug that has no interaction with COX inhibitors so they can be used for analgesics?
    calcium-channel blockers
  82. What are the 2 classes of drugs that affect angiotensin receptors to reduce blood pressure?
    • Angiotensin-converting enzyme inhibitors (ACEI)
    • angiotensin-II receptor antagonists
  83. 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?
    Angiotensin-converting enzyme inhibitors (ACEIs)
  84. Lisinopril blocks vasoconstriction of what?
    coronary arteries
  85. Which angiotensin inhibitor does not disturb the enzyme levels, but blocks angiotensin-II receptor, preventing vasoconstriction.
    Angiotensin-II receptor antagonists
  86. 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?
    Angiotensin-II receptor antagonists
  87. Which antihypertensive drugs end in -pril?
    angiotensin-converting enzyme inhibitors (ACEI)
  88. 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?
    angiotensin-conerting enzyme inhibitors (ACEI)
  89. What are 2 common side effects of angiotensin-converting enzyme inhibitors?
    • dry, hacking cough: which worsens in supine position
    • other side effects: similar to other antihypertensives
  90. What is the prototype drug for Angiotensin-II receptor inhibitors?
    losartan (Cozaar)
  91. Which angiotensin inhibitor has the mechanism of action of vasoconstriction by blocking aldosterone secretion and lowers BP?
    angiotensin-II receptor inhibitors
  92. 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).
  93. List 2 other antihypertensive drugs that are used when the other agents are not successful (often used in combination therapy).
    • alpha 1 adrenergic blockers: doxazosin, terazosin
    • CNS-mediated action: clonidine, guanethidine, and reserpine
  94. what are 3 common side effects of 'other' antihypertensive drugs? (alpha 1-adrenergic blockers, and CNS-mediated action drugs)
    • postural hypotension
    • taste disturbance
    • xerostomia
  95. 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?
    alpha-adrenergic blockers
  96. Which antihypertensive drug is the drug of choice for hypertension associated with pregnancy?
  97. what are 2 side effects of hydralazine that affect dental hygiene?
    • orthostatic hypotension
    • cardiac palpitation
    • (monitor BP at each appointment)
  98. The following are all common adverse drug effects with the use of antihypertensive agents; list the drug that causes the effect.
    chronic dry cough
    gingival hyperplasia
    postural hypotension and xerostomia
    • urination: diuretics
    • fatigue: beta blockers
    • chronic dry cough: ACE inhibitors
    • gingival hyperplasia: some CCBs
    • postural hypotension and xerostomia: several classes
  99. When is gingival enlargement (from gingival hyperplasia caused most commonly by nifedipine) noted after initiation of therapy?
    1-2 months
  100. gingival hyperplasia primarily effects what areas of the gingiva?
    labial or facial interdental papillae
  101. 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.
    gingival hyperplasia
  102. will plaque control prevent gingival hyperplasia?
  103. What drug used in dentistry reduces the efficacy of most antihypertensive agents?
    COX-1 inhibitors
  104. Which drug used in dentistry decreases the effect of beta-adrenergic blockers (pharmacologic antagonism)?
    sympathomimetic amines
  105. because nonselective beta blockers and epinepherine can result in a hypertensive reaction by unopposed alpha-adrenergic stimulation what should be done?
    • use basoconstrictor in low concentration
    • cardiac dose
  106. What can happen if alph-blockers are being used and epinepherine is introduced into the vascular system?
    excessive hypotension
  107. 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?
    pilocarpine (Salagen)
  108. Atherosclerosis causes what CVD?
    coronary artery disease (CAD)
  109. What disease impedes the supply of oxygenated blood when there is an increased demand for oxygen in cardiac muscle?
    coronary artery disease
  110. What are 3 factors that increase the hearts demand for oxygen?
    • heart rate
    • vascular wall tension
    • contractile state
  111. What is a temporary deficiency of oxygen to a portion of the myocardium?
    angina pectoris
  112. What is permanent deficiency of oxygen to a portion of the myocardium resulting in necrosis?
    myocardial infarction
  113. 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
    • inhibit progression of atherosclerosis: lipid-lowering agents; HMG-co-A reductase inhibitors, bile acid sequestrants, niacin and others
    • improve circulation in coronary arteries: nitrates; calcium channel blocking agents
    • reduced workload: beta 1 adrenergic receptor antagonists
    • prevent thrombus formation: antithrmobotic agent
    • prevent coagulation: anticoagulants (warfarin)
  114. What are 3 important implications for dental hygiene treatment in the medical management of coronary artery disease?
    • CAD pt is at increased risk for CV emergencies
    • follow protocol to reduce stress
    • limited dose of epi may be warranted: 1 cartridge of 1:50,000; 2 cartridges of 1:100,000; or 4 cartridges of 1:200,000
  115. COX inhibitors may only be used for pain management with which agent?
    calcium-channel blocking agents
  116. There is a high risk factor for CAD if a pt has high levels of what 3 things?
    • cholesterol
    • low-lipid lipoproteins (LDLs)
    • triglycerides
  117. The effects of high cholesterol levels can lead to what 3 conditions?
    • stroke
    • MI
    • hypertension
  118. The recommendations for healthy total cholesterols are:
    total cholesterol < _________ mg/dl
    LDL < ___________ mg/dl
    • 200
    • 130
  119. Which type of drug is the most widely used class of anticholesterol drugs?
    HMG coA reductase inhibitors
  120. Which class of drug is commonly referred to as statins? And list 4 examples of this class of agent.
    • HMG coA reductase inhibitors
    • liptor
    • zocar
    • restor
    • lescol
  121. What is the mechanism of action of HMG-coA reductase inhibitors?
    interfere with cholesterol synthesis in the liver
  122. 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
    both are TRUE
  123. The following drugs are examples of agents in which anticholesterol class?
    bile acid sequestrants
  124. 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?
    bile acid sequestrants
  125. why is it important to take other drugs 4-6 hours after or one hour before taking bile acid sequestrants?
    because they can delay or reduce the absorption of other oral meds
  126. Which type of anticholesterol drug is used to lower cholesterol and triglycerides and increase HDL levels?
    Fibric acid derivatives
  127. Lopid and TriCor are examples of what class of anticholesterol drugs?
    fibric acid derivatives
  128. 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?
    fibric acid derivatives
  129. true or false. There are no drug-drug interactions with the use of fibric acid derivatives in dentistry.
  130. What are 3 ADEs of the use of fibric acid derivatives?
    • they are all mild
    • dyspepsia
    • abdominal pain
    • diarrhea
  131. 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
    • 10-20%: reduction total and LDL cholesterol
    • 30-70%: reduction in triglycerides
    • 20-35%: increase in HDL
  132. What is the mechanism of action for Niacin (anticholesterol agent)? And give an example of a drug.
    • mechanism of action: unclear
    • example: Niaspan
  133. 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?
  134. 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?
    lipid-lowering, or anticholesterol drugs
  135. amyl nitrite, and nitroglycerin are drugs used as vasodilation agents to relieve angina pectoris, are they fast acting or long acting agents?
    fast acting
  136. 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?
    long acting
  137. What is a common vasocilator used to manage anginal pain- and a sublingual agent is carried by the pt at all times?
  138. two dose forms of nitroglycerin include:
    IV formulation
    What are each used for?
    • ointment: prevent angina
    • IV: hospital use
  139. 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.
  140. Which vasodilation drugs are used to prevent and treat angina caused by CAD - but are not the first-choice drugs in an angina emergency?
    • isosorbide mononitrate
    • isosorbide dinitrate
  141. Why is it necessary to monitor blood pressure if pts are taking isosorbid mononitrate or dinitrate and general anesthetics are used?
    because of the LAs additivi hypotensive effects
  142. Pts with coronary artery disease can recieve dental hygiene care if they can meet a ____ MET.
  143. for pts with CAD; appointments should be kept short and minimal stressful and at what time of the day is recommended?
    early afternoon appointments
  144. true or false. It is important to used profound anesthesia in pts with CAD to minimize stress caused by pain.
  145. What are 4 procedures to carry out if a pt has an angina attack?
    • terminate procedure provide 100% oxygen and nitroglycerin
    • pain that persists after agent provided and a 10 min time period: indication of MI
    • contact EMS and provide oxygen and 325 mg aspirin
    • automatic external cardiac defiberillator and CPR as needed
  146. What is the primary pace maker of the heart?
    sinoatrial SA node
  147. Interruption of cardiac rhythm by arrhythmia compromises tissue oxygenation and may lead to death; What are 6 cardiovascular causes of cardiac arrhythmia?
    • myocardial ischemia
    • bradycardia
    • hypertensive heart disease
    • increased sympathetic activity
    • congestive heart failure
  148. What is the goal for medical treatment and management of cardiac arrhythmia?
    to restore synchronous myocardial contraction and to prevent thromboembolic episodes
  149. 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.
  150. Agents used to prevent clot formation are also effective in preventing what?
  151. What are 3 possible ADEs with the use of antiarrhythmatic agents?
    • xerostomia
    • gingival enlargement
    • blood dyscrasias is possible
  152. Which type of antiarrhythmic agent has increased CNS effects that are possible when LA's are used, so we should use the lowest dose?
    Propafenone (class I)
  153. Vasoconstrictors may interact adversely with Which Miscallaneous antiarrhythmic agent?
    • digoxin
    • nonselective beta-adrenergic blocking drugs
  154. Vasoconstrictors are _______ in intractable arrhythmias, and used with ____________ with pacemakers and implanted defibrillators
    • contraindicated
    • caution
  155. Pts with normal pulse pressure and rhythm can receive _________ _________ procedures, and ___________________
    • oral healthcare
    • vasoconstrictors
  156. What aspects of the pulse are evaluated for disease control during assessments?
    • regularity
    • rate
  157. true or false . Vasoconstrictors should be used in low concentrations in pts with antiarrhythmic agents
  158. does the ANA recommend antibiotic prophylaxis when pacemakers or defibrillator devices are worn?
  159. 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?
    • coagulation
    • hemostasis
  160. 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.
  161. 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?
  162. 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
  163. 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
    arterial thrombi
  164. What type of drug therapy is frequently administered for pts with prosthetic cardiac valves as well as thromboembolic disease?
    anticoagulant therapy
  165. What is the goal of treatment of pts with thromboembolic complications of CV disease?
    the use of antithrombotic agents to reduce morbidity and mortality from thromboembolic events
  166. 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?
    • warfarin
    • heparin
  167. What are the two main classes of antithrombotic agents?
    • aspirin
    • clopidogrel (Plavix)
  168. Aspirin is available in what 2 tablet doses?
    • 81 mg
    • 325 mg
  169. How is clopidogrel available?
    75 mg once daily
  170. What drug is prescribed for pts who cannot take aspirin, and may be used in combination with aspirin for an additive effect?
    clopidogrel (Plavix)
  171. What is the mechanism of actino of clopidogrel?
    similar to aspirin, it affects the ability of the platelet to clump together
  172. are there any contraindications for dental hygiene tx if pt is taking aspirin or clopidogrel?
  173. What are the two main groups of anticoagulant agents?
    • heparin (IV)
    • warfarin (coumadin): given orally
  174. 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?
    low molecular weight heparins
  175. Which anticoagulant is commonly prescribed alone or in combination with clopidogrel?
  176. What are 2 low molecular weight heparin agents that are available for home use?
    • dalteparin
    • enoxaparin
  177. What is an adverse effect of low molecular weight heparin agents?
    bleeding (risk is minimal)
  178. What drugs should not be taken with low molecular weight heparin agents?
    drugs affecting homeostasis (aspirin, ibu, naproxen, and ketorolac)
  179. 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?
  180. blood clotting factors are measured through what test?
  181. 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?
    • 2-3.5
    • less than or equal to 3.5
  182. How long does it take for the development of clotting factors after the dose of warfarin has been reduced?
    3 days
  183. What are 2 types of drugs used in dentistry that can increase the INR level when warfarin is taken?
    • COX-1 inhibitors
    • some antibiotics
  184. What drug used in dentistry increases metabollism and reduces the anticoagulant effect of warfarin?
  185. What are some good drugs that can be used with warfarin if analgesic is needed?
    • acetaminophen
    • analgesics without aspirin
  186. 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?
    dipyridamole (Persantine)
  187. If pts are taking agents that affect platelet adhesion do they require excessibe bleeding blood test before DH care?
  188. if a pt is taking warfarin, what are 3 dental hygiene implications?
    • monitor INR levels greater than or equal to 3.5
    • apply pressure for uncontrolled bleeding with local hemostatic measures
    • topical clotting agents can be used
  189. are pts taking 81-325 mg of aspirin a day likely to have prolonged bleeding? If the dose is higher should they be monitored?
    • no
    • yes
  190. How long before periodontal procedures does the use of aspirin need to be discontinued?
    1-2 weeks
  191. If pts have congestive heart failure do most pts develop right or left sided heart failure?
  192. edema in lower legs is a sign of what heart failure?
    right side
  193. orthopnea; edema in the lungs is a sign of what heart failure?
    left side
  194. What are 4 lifestyle modifications in the medical management of congestive heart failure?
    • diet restrictions
    • avoid exposure to heavy air pollution
    • air conditioning is essential
    • regular physical activity is encouraged
  195. What are 5 effects of pharmacologic management of pts with congestive heart failure?
    • reduction of cardiac workload and myocardial oxygen consumption
    • imrpovment in cardiac muscle contractility
    • control of sodium and fluid retention
    • increased peripheral tissue perfuaion and oxygenation
    • prevention of thromboembolic episodes
  196. 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?
    congestive heart failure
  197. What are 3 examples of cardiac glycosides used for pts with congestive heart failure? Which of the 3 is most common?
    • digitalis
    • digitoxin
    • digoxin
    • digoxin (Lanoxin): most common
  198. What combination drug is used for african american individuals with heart failure?
    isosorbide dinitrate and hydralazine HCI (BiDil)
  199. 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
    cardiac arrhythmia
    increased salivation
  200. What is the first sign of digoxin toxicity (which is common)? And what are 3 signs after that?
    • gastrointestinal effects: first sign
    • fatigue
    • dizziness
    • altered cardiac rhythm
  201. List 5 drugs used in dentistry that can increase digoxin serum levels.
    • benzodiazepines
    • itraconazole
    • erythromycin
    • clarithromycin
    • tetracyclines
  202. What dose of vasoconstriction is recommended if pts are taking digoxin?
  203. the __________ decrease heart rate and the output of blood from the heart
  204. the __________ interrupt the movment of calcium into the cells of the heart and blood vessels to produce vasodilation
  205. _____ is a common diuretic used to eliminate excess fluids and sodium through urination and decrease hydrostatic pressure
  206. The antihypertensive drugs that prevent conversion of a body enzyme to one that causes vasoconstriction are what?
    the prils