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Cvs pharmacology for dental students

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Cvs pharmacology for dental students

  1. 1. Drugs Affecting Cardiovascular Diseases Dental Pharmacology By Taha Hussein Kadi , MSc Lecturer of Pharmacology & Toxicology UST
  2. 2. What’s a Hypertension ?
  3. 3. Hypertension • Hypertension is a common cardiovascular disease affecting worldwide population. • A persistent and sustained high blood pressure has damaging effects on the heart, brain, kidneys and eyes. Could be: 1. Primary or essential hypertension: It is the most common type. There is no specific underlying cause. 2. Secondary hypertension: It can be due to renal, vascular, endocrine disorders, etc.
  4. 4. Blood Pressure • Systolic blood pressure (SBP): It is the maximum pressure recorded during ventricular systole. • Diastolic blood pressure (DBP): It is the minimum pressure recorded during ventricular diastole. • Pulse pressure (PP): It is the difference between systolic and diastolic blood pressure (PP = SBP –DBP) Hypertension
  5. 5. Hypertension
  6. 6. • Diuretics – Thiazides and related agents: hydrochlorothiazide, indapamide. – Loop diuretics: Furosemide, bumetanide, torsemide. – Potassium-sparing diuretics: spironolactone, Amiloride, triamterene. • ACE inhibitors: Captopril, enalapril, lisinopril, ramipril. • Angiotensin II receptor antagonists: Losartan, candesartan, valsartan. • Calcium channel blockers: – Non- Dihydropyridine : Diltiazem, verapamil. – Dihydropyridine : nifedipine, amlodipine …etc. Classification of Antihypertensive Drugs
  7. 7. • Sympatholytic agents – Centrally acting adrenergic drugs: Clonidine, methyldopa. – Adrenergic blockers: Atenolol, metoprolol, propranolol etc – Adrenergic blockers with additional a-blocking activity: Labetalol, carvedilol. – α-Adrenergic blockers: • Selective: Prazosin, terazosin, doxazosin. • Nonselective: Phenoxybenzamine, phentolamine. • Vasodilators – Arteriolar: Hydralazine, minoxidil, Diazoxide – Arteriolar and venodilator: Sodium nitroprusside Classification of Antihypertensive Drugs
  8. 8. Diuretics
  9. 9. ACE inhibitors
  10. 10. Angiotensin II receptor antagonists
  11. 11. Calcium channel blockers
  12. 12. Vasodilators
  13. 13. Hydralazine
  14. 14. • It is characterized by a very high blood pressure (systolic >220 and/or diastolic >120 mmHg) with progressive end-organ damage such as renal dysfunction and/or hypertensive encephalopathy. • The BP should be reduced by not more than 25% within minutes to 2 h, and then to 160/100 mm of Hg within 2–6 h. Hypertensive Crisis (Hypertensive Emergencies)
  15. 15. • The preferred drug to treat the condition is sodium nitroprusside (i.v. infusion). • The other drugs : – nitroglycerin (i.v. infusion) – hydralazine (i.v.) – labetalol (i.v.) Hypertensive Crisis (Hypertensive Emergencies)
  16. 16. Angina pectoris afYCN3Upy_w
  17. 17. Angina pectoris • Angina pectoris is a symptom of ischaemic heart disease. It is due to an imbalance between oxygen supply and oxygen demand of the myocardium. Types of angina pectoris • Stable angina (classical angina): It is characterized by episodes of chest pain commonly associated with exertion. • Unstable angina: It is characterized by angina at rest or increased frequency and duration of anginal attacks. – due to rupture of an atheromatous plaque and platelet deposition in the coronary artery, leading to progressive thrombosis. • Prinzmetal’s angina (variant angina): Angina that occurs at rest and is due to spasm of coronary arteries.
  18. 18. Pathophysiology Angina occurs due to imbalance in oxygen supply and demand by the myocardium.
  19. 19. Treatment Strategies
  20. 20. 1. Nitrates: Nitroglycerin , isosorbide dinitrate, isosorbide mononitrate, Amyl nitrite (Inhalation) 2. β-Adrenergic blockers: Propranolol, metoprolol, atenolol. 3. Calcium channel blockers (CCBs): Verapamil, diltiazem, nifedipine, amlodipine. 4. Others: – Antiplatelet agents(low-dose aspirin,clopidogrel) – Statins “Atorvastatin” ( antihyperlipidemia) Classification
  21. 21. Nitrates • For an acute attack, nitroglycerin is commonly administered sublingually with an initial dose of 0.5 mg, which usually relieves pain in 2–3 min. • Patient is advised to spit out the tablet as soon as the pain is relieved to avoid side effects (hypotension and headache). • If the pain is not relieved, the tablet can be repeated after 5 min; but not more than three tablets in 15 min. • If pain is not relieved, it could be MI. Give tablet aspirin 325 mg orally, oxygen by face mask, then refer the patient to cardiologist.
  23. 23. CONGESTIVE CARDIAC FAILURE • The function of the heart is to pump an adequate amount of blood to various tissues. • In CCF, there is an inadequate contraction of the heart leading to reduced cardiac output (CO). • The compensatory mechanisms that try to maintain the cardiac output are: • Increased sympathetic activity. • Increased renin–angiotensin–aldosterone activity. • Myocardial hypertrophy.
  24. 24. • As time progresses, the compensatory mechanisms fail and gradually clinical symptoms of failure appear. • The basic haemodynamic disturbances seen in congestive cardiac failure are: – Pulmonary edema which is characterized by dyspnea. – Decreased cardiac output leading to peripheral edema, tissue hypoxia. CONGESTIVE CARDIAC FAILURE
  25. 25. Increase contractility
  26. 26. Case • Nina is 56 years old and has been coming to your practice for close to 15 years. Until recently, she would take only acetaminophen for an occasional headache. Mrs. Nina went to the doctor last week for her annual check-up. She had not been “feeling herself ” for the last several months. Upon examination, Mrs. Nina learned that she has hypertension and elevated cholesterol values. Life has not been the same since. Mrs. Nina started having some chest pain, which was attributed to anxiety regarding her diagnosis. Now, in addition to acetaminophen, Mrs. Nina is taking lisinopril and hydrochlorothiazide to treat hypertension and atorvastatin to treat cholesterol levels. • What is lisinopril and what is its role in the treatment of hypertension? • Are there any dental concerns associated with lisinopril? • What are the dental concerns associated with antihypertensive therapy? Counsel the patient about them.

Notas del editor

  • Common
    Hypokalemia (hydrochlorothiazide, furosemide)
    Hyperglycemia (hydrochlorothiazide, furosemide)
    Dry mouth

    Hypotension (furosemide)
    Cardiac arrhythmias (hydrochlorothiazide, furosemide)
    Nephrotoxicity (triamterene)
  • Xerostomia. Dry mouth is an adverse reaction associated with
    several of the antihypertensives. If the dental health care worker
    notices this effect, it is imperative to discuss with the patient
    methods used to alleviate this discomfort.
    Dysgeusia. With some antihypertensives, an altered sense of
    taste may occur, which may be related to xerostomia.
    Gingival enlargement. CCBs have the ability to produce gingival
    enlargement. Meticulous oral hygiene and frequent recall
    appointments may minimize this effect.
    Orthostatic hypotension. When a patient has been in a supine
    position and suddenly rises to an upright position, a sudden
    drop in blood pressure may occur. This side effect is called orthostatic
    hypotension. Patients taking antihypertensive agents who
    have been supine for some time should be slowly raised from
    that position. They should dangle their legs over the side of the
    chair or bed and wiggle them before rising to the standing position.
    The patient should be supported for a few steps to prevent
    syncope. Guanethidine causes this problem often; other agents
    produce variable amounts of orthostatic hypotension.
    Constipation. Some antihypertensive agents (e.g., verapamil)
    can cause constipation, which could be additive with the constipation
    produced by the opioids. An increase in dietary fiber, a
    bulk laxative, or a stool softener may be considered if an opioid is
    prescribed for a patient receiving a constipation-producing antihypertensive
    Central nervous system sedation. Several antihypertensives
    (β-blockers, methyldopa) can produce sedation, which is additive to effects of other CNS depressants such as opioids or
  • Dental Drug Interactions
    Nonsteroidal antiinflammatory drugs. NSAIDs, especially indomethacin, can reduce the antihypertensive effect of the α1-blockers (Box 14-7). They produce this effect by inhibiting renal prostaglandin synthesis or causing sodium and fluid retention.
    Epinephrine. The sympathomimetics can increase the antihypertensive effects of doxazosin. The α1-blockers prevent the α1-agonist effects (vasoconstriction) of epinephrine, leaving the β1- and β2-agonist effects (vasodilation) to predominate. The combined vasodilation can result in severe hypotension and reflex tachycardia.
  • Answer in slide 17