1. Monitor vital signs at every appointment because of cardiovascular and respiratory side effects.

2. Report any evidence of angioede-ma (swelling of face, lips, extremities, tongue, mucous membranes, glottis, or larynx) esp. after first dose (but may also be delayed response).

3. Have the patient sit up slowly and remain seated for at least two minutes after being supine in order to minimize the risk of orthostatic hypotension.

4. Decreased saliva flow can put the patient at risk for dental caries, perio-dontal disease, and candidiasis.

5. Dental procedures may cause the patient anxiety or place stress on the heart. Assess cardiovascular patient for this risk.

6. Early-morning and shorter appointments as well as methods for addressing anxiety levels in the patient can help to reduce the amount of stress that the patient is experiencing.

7. Patients on chronic drug therapy may develop blood dyscrasias. Symptoms include fever, sore throat, and bleeding, and poor wound healing.

8. Patients on sodium-restricted diets should receive sodium-containing fluids (i.e., saline solution) with caution.

9. Vasoconstrictors should be used with caution, in low doses, and with careful aspiration.

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