htn

Question 0

loop diuretics- effects the __ __ __ of ___, is more ___ than thiazide diuretics

• also used to treat? (4)
• examples? (3)
• adverse effects? (5)
• dental drug interaction: concomitent use of ___ and ___ ___ and ____ should be avoided

Answer 0

• thick ascedning loop of henle, potent
• pulmonary, cardiac, renal, and hepatic edema
• 1. Furosemide (lasix)
     
     2. bumetamide (bumex)
     3. ethacrynic acid- ethacrynate
• 1. hyperglycemia, hypercholestemia
     
     2. hypokalemia, postural hypotention
     3. dehydration
     4. circulatory collapse
     5. metabolic acidosis
• lasix + aminoglycoside antibiotics + indomethacin

Question 1

Thiazide diuretics-interfere with ___ ___ at the __ __ __ -> cause net ___ of __ and ___ initially –> prevent longtern __ ___

• Examples? (4)
• adverse effects? (4)
• dental drug interactions?

Answer 1

• sodium absorption, distal renal tubule -> excretion, sodium, water -> fluid retention
• 1.hydrochlorothiazide (HCTZ)- esidrix
  2. chlorothiazide- diuril
  3. chlorthalidone- hygroton
  4. indapamide - lozol
• 1.hyperglycemia, hyperuricemia, hypercholesteremia
  2. hypokalemia
  2. sexual dysfunc
  4. photosensitivity
• none

Question 2

Potassium sparing diuretics-interferes with __/__ exchage at the ___ ___, counteracts ___ __ by other diuretics

• also used for: ___ conditions like __ __ __ or __ __
• examples? (3)
• adverse effects? (4)
• dental drug interaction: causes ____ especially when used with other __ __ __, or ___ supplements, __ __ and _____

Answer 2

• potassium/sodium, distal tubule, potassium loss
• edematous conditions, congestive heart failure, liver cirrhosis
• 1.spironolactone- aldactone
  2. amiloride- midamor
  3. triamterene- direnium
• 1. hyperkalemia
     
     2. dehyrdratio
     3. metabolic acidosis
     4. nausea
• hyperkalemia; potassium sparing diuretics, potassium supplements, ACE inhibitors, Indomethacine

Question 3

• beta adrenergic blockers-are potent cardiac __ aftecting ___, __ __, and __ __
• indicated for htn ptns w/ ___, ___, and hx of ___
  1) non-cardioselective blockers- block ___ receptors in the heart and __ receptors in the ___
• examples? (2)
• adverse effects? (3)
• dental drug interaction: ____ reduce ___ effect of beta blockers, short term use of ___ (less than __ days) requires no special precautions: use of ___ with this can signifi increase ____
  2) cardioselective- block ___ receptors in heart a concertations ___ those required to block __ receptors in the __ and ____ ___ ___
• have less tendancy to __ ___ associated with ____ in ____ (which is an important clinical sign)
• examples? (2)
• adverse effect/ddi: ____

Answer 3

• depressants; contractibility, cardiac output and heart rate
• angina, migraines, hx of MI
  1) B1 receptors, B2, bronchi
• 1. propranolol (inderal)
     
     2. nadolol (corgard)
• 1. may precipitate severe bronchospasm
     
     2. enhances pressor response to epinephrine -> results in HTN and bradycardia (bradycarid reflex)
     3. masks tachycardia associated with hypoglycemia
• NSAIDS, hypotensive; NSAIDS, 3; vasoconstrictors, BP
  2) b1 receptors, below, b2, bronchi and peripheral blood vessels
• mask tachycardia, hypoglycemia, diabetics
• atenolol (tenorim); metaprolol (lopressor)
• NSAIDS

Question 4

Alpha adrenergic blockers (____ acting)- act at vascular ___ ___ receptors to produce __ and ___ ____

• examples? (3)
• adverse effects? (5)
• ddI: _____-short term use for post op pain is not ____

Answer 4

peripheral, postsynaptic alpha, arteriol and venous dialation

• 1. prazosin (minipress)
     
     2. terazosin (hytrin)
     3. daxazosin (cardora)
• 1. orthostatic hypotention
     
     2. drymouth in 10%
     3. fluid retention
     4. vertigo
     5. syncope
• NSAIDS, contraindicated

Question 5

Calcium channel blockers- inhibit ca ions from entering __ channels of __ __ __ and ___ -> results in ___ of ___ __ smooth muscle and __ ___

• these and diuretics are more effective than ___ or __ __ in black ptns
• examples? (3)
• adverse effects? (5)
• dental drug interaction: increased ____ effect with ____

Answer 5

• slow, vascular smooth muscle and myocardium -> relaxation, coronary artery, coronary vasodialation
• ace inhibitors or beta blockers
• 1. verapamil (calan)
     
     2. nifedipine (procardia)
     3. diltiazem (cardizem)
• 1. gingival enlargement
     
     2. vertigo
     3. peripheral edema
     4. heart failure
     5. headaches
• hypotensive, fentanyl

Question 6

Ace inhibitors- inhibit conversion of ___ to ____ -> reduces the syn of this potent ___ and inhibits metaboloism of ____ (a potent ____); these are ___ and well ___

• ptns that betefit most from ace inhibitors are ___, esp ____
• for ptns with ____ -> ace inhibitors, __ ___ or __ __ ___ are better choice
• examples? (3)
• adverse effects? (4)
• ddi: ____

Answer 6

• angiontensin I to angiotensin II -> vasoconstrictor, bradykinin (vasodialator); effective, tolerated
• diabetics, neuropathy
• hyperlipidemia -> alpha blockers, ca channel blockers
• 1. captopril (capoten)
     
     2. benezapril (lotensin)
     3. llisinopril (zestril/prinivi)
• 1. hypotention
     
     2. altered taste
     3. angioedema
     4. cough
• NSAIDS

Question 7

Angiotensin II receptor antagonist- block ____ and ___ secreting effects of angiotensin II

• examples? (2)
• adverse effects? (1)
• ddi: decreased effect with _____

Answer 7

vasoconstrictor and aldosterone

• 1.losartan (cozaar)
  2. valsartan (diovan)
• hypotention w/o reflex tachycardia
• ketoconazol

Question 8

Direct vasodialators- cause direct vasodia of ___ (w/ little effect on ___) and decreases ___ ___ -> fall in total __ ___ -> reflex elevation of ___ and increased __ ___ -> so must be given in ____ with __ ___ and a ____

• examples (2)
• adverse effects? (5)
• ddi:______

Answer 8

• arterioles (veins), systemic resistence -> peripheral resistence -> HR, cardiac output -> conjugation, beta blockers, diuretic
• 1.hydrolazine (apresoline)
  2. minoxidil (rogaine, loniten)))
• 1. tachycardia
     
     2. fluid retention
     3. Hirsatism
     4. lupus-like rash
     5. stevens-johnson’s syndrome
• NSAIDS

Question 9

Dental management of ptns w/ HTN:

1) ___ ___ obtained for __ patients ___; ptns with pre-htn, stage 1&2 bp taken at ___ ___ ___
* normal -> recheck in __ yr
* stage 1 -> ___ to ___ w/i ___ month
* stage 2, asymptomatic -> __ to __ w/i ___ month
* stage 2, symptomatic –> refer to MD ___
* for stage 2 ptns, ___ ___ must be used when considering tx, individuals assessed for ___/___ of ___ ___ dx and ___ of ___ ___; if symptomatic -> ____ ____ dental tx
2) obtain complete med hx: review ___ ___ and additional __ ___; document __ and ___ of htn, ___ (recent ___ and ___), ___ of physician follow up, ___ of __ ___ disease
3) keep appt __ and minimize ___ -> ___ if ptn becomes overly ___
4) avoid ___ ____ by chaning chair position ___ and ___ ptn when __ ___
5) achieve ____ anesthesia: the benefit of ___ (associated with judicious use of ___ ___ with ___ ) outwieghts the risk of increased __ and __ secondary to high levels of ___ ____
* for stage 1&2 ptns or ptns take ___ ___ -> limit use of ___ to ____mg per visit (=__ carpules of __% ___ with ___ 1:____)
* fore stage 1&2 -> avoid use of __ __ retraction cord

6) if using nitrous oxide avoid ___ to prevent relex ____. avoid stimulating __ ___
7) following consultation of stage 2 ptn, provide __ ___ only and minimize use of ____
8) check bp __ and ___ admin of __ ___
9) check bp before ____
10) careful selection of post op meds: __ __ can decrease ___ activity of most ____ drugs

Answer 9

1) baseline bp, all, annually; at each visit
* 1 yr
* refer to md, 2 months
* refer to md, 1 month
* stat
* clinical judgement; signs/symp of target organ, type, procedure planned; defer elective
2) family hx, risk factors; duration level, meds (changes and dose), frequency,history of target oragan dx
4) orthostatic hypotention, slowly, assiting, standing
5) profound; profound (local anesthesia, epinephrine), hr and bp, exogenous epinephrine
* noncardioselective beta blockers -> epinephrine, 0.036mg per visit (=2, 2%, epinephrine, 1:100,000)
* for stage 1&2: epi impregnated
6) hypoxia, hypertension; gag reflex
7) urgent care, vasoconstrictors
8) b/f and af, local anesthesia
9) dismissal
10) long-term NSAIDS, hypotensive, anti-hypertensive