[2015] AmandaB ErikaB: Lisinopril

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[2015] AmandaB ErikaB: Lisinopril

lisinopril(Zestril,Prinival)

Chemical Structure

Glog by: Amanda Beradino & Erika Barras

Mechanism Of ActionACE inhibitor suppresses the renin - angiotensin-aldosterone system and prevents conversion of angiotensis I to angiotensin II, a potent vasoconstrictor , may also inhibit angiotenion II at local vacsular and renal sites. Decreases plasma angiotensin II , increases plasma renin activity , and decreases aldosterone secretion.

Category & SchedulePregnancy risk catagory: C(D if used in second or third trimester.Drug Class: Angiotensin- converting enzyme ( ACE) Side Effects/ Adverse reactionsFrequent : Headache ,dizzinesss,postural hypotensionOccasional:Chest discomfort, fatique,rash,abdominal pain,nausea,diarrhea,upper respitory infectionRare: Palpations,tachycardia, peripheral edma, insomina,paresthesia, confusion,constipation,dry mouth,muscle cramps tachycardia

Therapeutic Effects:Reduces peripheril arterial resistance , BP, afterload, pulmonary capillary wedge pressure ( preload) and pulmonary vascular resistance. In those with heart failure, also decreases heart size, increases cardiac output , and ecercise tolerance timeUses:Treatment of mild -to- moderate hypertension, post MI if hemodynamically stable, heart failueDental Considerations:-Monitor vital signs at every appointment because of cardiovasular and respiratory side effects.-After supine positioning, have patient sit up for atleast 2 minutes to avoid orthostatic hypertension.- Patients on chronic thearpy may rarely have symptoms of blood dycrasias, which can include infection, bleeding, and poor healing.- Assess salivary flow as a factor in caies, periodontal disease , and candidasis - Limit use of sodium-containing products,such as saline IV fluids, for patients with a dietary salt restriction. - Use vasoconstrictors with caution , in low doses, and wit careful aspiration. - Short appointments ,and stress - reduction protocal may be required for anxious patints.Consultationns: Medical consultation may be required to assess disease control and patients ability to tolerate stress.In a patient with symptoms of blood dycrasis , request a medical consult for blood and postpone dental treatment until normal values are reestablished .Take precausions if dental surgery is anticipated and sedation or general anesthesia is required : risk of hypotensive episode.

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Precautions :This drug may make yu dizzy , limit the amound of alcoholic beverages, reduce risk of dizziness and lightheadedness by getting up slowly when rising from a sitting or lying postion. Interactions : Somg products may interact with this drug, check the labels on all of your medicines ( cough and cold products, diet aids, or NSAIDS such as ibuprofen , naproxen because they may contain ingrediants taht could increase your blood pressure or worsen heart failure.

2% Lidocaine2% Lidocaine ( 2% concentration)MRD: 300mg)2g/100ml= 200mg/ml X 1.8 ml/cartridge= 36mg/cartridgeIn a 1.7ml cartridge 20mg/ml X1.7ml/cartridge = 34mg/ cartridegeMaximum Cartridge for a 1.8ml is 200mg/36=8.33 CartMaximum cartridge for a 1.7ml cartidge is 300mg/34=8.82 cartridge

1:100,000 Epinephrine Maximum safe dose for a cardiovascular patient is 0.04mg 1g epi/100,000ml=1mg epi/100ml=0.01mg epi 0.01epi /1.8 cartridge = 0.018mg/cartridge 0.01mg epinephrine/1.7mlcartidge=0.017mg/cartridge 0.004mg/0.018mg=2.22 cartridges

Whats safe for this patient?2% Liocaine with 1:100,000 would be safe to be adminstered at the lowered reccomened dose of 0.04mg . The reason we would use a lowered amount is because epinephrine can speed up the heart rate and because this patient already has hypertension he is at risk of a cario problem. Lidoccaine unlike many other local anestheics depresses the heart rate before stiumlating it.

Work Cited* Jeske,Arthur H. Mosby's Dental Drug Reference 11th edition.Louis, MO : Elsevier Mosby,2010*http:www.dentalgentlecare.com/medications_effects.htm*www.script.com/health/centers/heart_health/drugs/lisinopril.aspx


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