1. reference : Daniel E. Becker,2007
2. summarized by : Ala'a Al-Otaibi
3. 5th year dental student
4. – Diuretics – initial drugs of choice
   1. The use of NSAIDs for more than 5 days may diminish the efficacy of diuretics used to manage hypertension. Although the dosages of most medications should not be altered prior to dental care, diuretics present an exception, especially loop diuretics such as furosemide. When lengthy appointments under intravenous sedation are planned, it is permissible to withhold the morning dose of diuretic until the appointment is completed. This will not diminish control of the medical condition and will obviate the need to interrupt treatment for micturition
   2. Intraoral Hemorrhage
5. – Beta blockers (-olol)
   1. xerostomia
   2. .Patients medicated with nonselective beta-blockers have a significant risk for acute hypertensive episodes if they receive vasopressors contained in local anesthetics, ie, epinephrine or levonordefrin. While treating patients medicated with nonselective beta-blockers, it is wise to record blood pressure and heart rate before administering local anesthetic-vasopressor formulations, then reassess those parameters 3–5 minutes after each cartridge is administered before giving another
   3. .The use of nonsteroidal anti-inflammatory drugs (NSAIDs) for more than 5 days may diminish the antihypertensive efficacy
6. – ACE inhibitors (the -prils)
   1. .The ACE inhibitors and angiotensin-receptor blockers (ARBs) have been implicated in producing severe episodes of hypotension during general anesthesia
   2. .The most common and troubling side effect of ACE inhibitors is a nagging cough. This is most likely related to elevated levels of bradykinin or other inflammatory mediators that are normally metabolized by ACE. The same mechanism presumably explains reported cases of angioedema and perioral swelling that may be confused with similar signs attributed to odontogenic infections
   3. •abnormal taste (metallic or salty taste
7. – Calcium-channel blockers (the -pines)
   1. xerostomia, and dysgeusia
   2. gingival hyperplasia :These drugs have the potential for stimulating the growth of granulation tissue in the gums, which can cause tooth movement.
   3. .The use of NSAIDs for more than 5 days may diminish the efficacy of ACE inhibitors and ARBs when used to manage hypertension
   4. .Unlike other drug classes used to manage hypertension, the efficacy of calcium channel blockers is not reduced by concurrent use of NSAIDs
8. – Alpha blockers
   1. taste disturbance, and xerostomia
   2. Any vasodilator has the potential for producing postural hypotension. Following dental treatment, always proceed cautiously when preparing the patient for discharge.