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Dental Drug Interactions: NSAIDs decrease hypotensive effect of ACE inhibitors. Lisinopril (Prinival, Zestril) Enalapril (Vasotec) Benazepril (Lotensin) Quinapril (Accupril) Fosinopril (Monopril) Captopril (Capoten) Ramipril (Altace) Moexipril (Univasc)
Vasodilators + Action: Thiazides cause diuresis due to inhibition Na reabsorption in distal tubule. ACE less formation of vasoconstrictor angiotensin II, less aldosterone secretion. Use: Treatment of hypertension. Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, angioedema, paresthesias, headache, orthostatic hypotension and blood dyscrasias. Dental Drug Interactions: NSAIDs decrease effect of medication. *Lisinopril and **Hydrochlorothiazide (Prinizide, Zestoretic) *Moexipril and **Hydrochlorothiazide (Uniretic)
*Captopril and **Hydrochlorothiazide (Capozide)
Calcium Channel Blockers Action: Inhibits calcium ion influx across cell membrane during cardiac depolarization. Relaxes vascular smooth muscle thus dilating coronary and peripheral arteries. Also decreases SA/AV node conduction. Use: Treat hypertension and angina pectoris. Dental Considerations: Local anesthesia with vasoconstrictor ok. Gingival hyperplasia, dry mouth, altered taste, headache, myalgia, sinusitis, paresthesia, joint stiffness. Dental Drug Interactions: Effect of calcium channel blockers is decreased by indomethacin, other NSAIDs, barbiturates. Amlodipine (Norvasc) Nifedipine (Adalat, Procardia) Diltiazem (Cardizem, Tiazac, Dilacor, Cartia) Verapamil (Calan, Isoptin, Verelan) Isradipine (DynaCirc) Felodipine (Plendil)
Angiotensin II Receptor Blockers (ARBs) Action: Inhibits angiotensin - renin system like ACE inhibitors. Blocks vasoconstrictor and aldosterone releasing effects of angiotensin II. Thus increases urinary flow, excretion chloride, magnesium, uric acid, calcium and phosphate. Use: Treat hypertension. Dental Considerations: Local anesthesia with vasoconstrictor ok. Myalgia, orthostatic hypotension, migraine headache, taste alteration, paresthesia, tinnitus. Dental Drug Interactions : Ketoconazole and sedatives increases hypotensive effects of ARBs. Losartan (Cozaar)
Angiotensin II Receptor Blockers (ARBs) (continued)
Angiotensin Receptor Blockers + Action: ARBs inhibits angiotensin - renin system. Blocks vasoconstrictor and aldosterone releasing effects of angiotensin II. Diuretic inhibits Na reabsorption in distal renal tubule. The net effect is to increase urinary flow; excretion of water, chloride, magnesium, uric acid, calcium, phosphate, sodium, potassium and hydrogen ions. Use: Treatment of hypertension Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, orthostatic hypotension, migraine headache, facial edema, taste alteration, paresthesia, tinnitus, myalgia, blood dyscrasias. Dental Drug Interactions: Tetracycline increases photosensitization. Nonsteroidal anti-inflammatory drugs (NSAIDs), especially indomethacin, decrease hypotensive response. Ketoconazole and sedatives increase hypotensive effects. Losartan and Hydrochlorothiazide (Hyzaar) Telmisartan and Hydrochlorothiazide (Micardis HCT)
Irbesartan and Hydrochlorothiazide (Avalide)
Vasodilators + ACE Inhibitors* Combined with Calcium Channel Blocker** Action: ACE inhibits angiotensin - renin system, decreases aldosterone release and increases diuresis. Calcium Channel blockers relax vascular smooth muscle and myocardium. Use: Treat hypertension. Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache. Dental Considerations: Ca Channel: Gingival hyperplasia. Dental Drug Interactions: Hypotensive effect decreased by NSAIDs, barbiturates. Amlodipine** and Benazepril* (Lotrel)
Enalapril* and Felodipine** (Lexxel)
Trandolapril* and Verapamil** (Tarka)
Action: The major intracellular fluid cation, essential for conduction of nerve impulses in heart, brain and skeletal muscle; necessary for contraction of cardiac, skeletal and smooth muscle. Action: Also maintains normal renal function, acid-base balance, carbohydrate metabolism and gastric secretion. Use: Prevention and treatment of hypokalemia including that secondary to drugs. Dental Considerations: Local anesthesia with vasoconstrictor ok. Paresthesia and throat pain. Dental Drug Interactions: Corticosteroids decrease potassium requirements; NSAIDs increase GI side effects of potassium salts.
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