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Medically Complex Tx Planning > 1. Hypertension & MI > Flashcards

1. Hypertension & MI Flashcards

1
Q

What blood pressure is considered hypertensive and prehypertensive?

A
  • Hypertensive - 140/90
  • Pre - 120-139/80-90
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2
Q

What are the risk factors for having an increased blood pressure?

A
  • Heart Attack (MI)
  • Heart failure
  • Stroke
  • Kidney disease
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3
Q

What are the target organs for late hypertension?

A
  • Kidney
  • Brain
  • Heart
  • Eye
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4
Q

What is the goal for tx in patients with hypertesion?

A
  • Reduce BP <140/90
  • <130/80 for patients with diabetes and renal disease
    • Reduces stroke (35-40%), MI (20-25%), and heart failure (>50%)
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5
Q

What are the common drugs patients with hypertension will be on?

A
  • Thiazide diuretics in combination with ACE inhibitors
  • Angiotensive receptor blockers
  • Beta blockers
  • Calcium channel blockers
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6
Q

When would you want to defer elective dental tx in a hypertensive patient?

A
  • BP is at or above 180/110
  • Refer to physician asap, if symptomatic - refer immediately
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7
Q

What effects do NSAIDS have on blood pressure?

A

Increase blood pressure - most significantly in those with diagnosed HTN

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8
Q

What are the target blood pressure recommendations for the following:

  1. ≥ 60 years
  2. < 60 years
  3. > 18 years with CKD
  4. > 18 years with diabetes
A
  1. <150/<90
  2. <140/<90
  3. <140/<90
  4. <140/<90
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9
Q

What are some dental concerns in patients with hypertension?

A
  • Use of epinephrine in local anesthetics is not contraindicated, results only a minimal adverse response
  • When general anesthesia is used in patients taking HTN medications - potential wide fluctuations in BP and risk hypotension
  • Do not use topical vasoconstrictors
  • Do not use vasoconstrictors in patients on cocaine
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10
Q

What vasoconstrictors would you want to avoid in patients with HTN?

A
  • Norepinephrine
  • Leveonordefrin
    • Especially in those taking non-selective beta blockers - increase pressure in BP with bradycardia
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11
Q

What is said about giving hypertensive patients local anesthetics with epinephrine?

A

Recommendations against the use of epi-containing solutions, even in high-risk populations CANNOT be made.

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12
Q

What would you want to do after giving anethetics with epi to a HTN patient?

A

Check blood pressure - and exercise caution on pts taking non-selective beta blockers

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13
Q

How many metabolic equivalents should be met in a patient before deciding to perform dental tx?

A

4 METs

If unable to meet 4 METs - delay Tx until further medical testing - referral to cardiologist

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14
Q

Why would you want to reduce stress for HTN patients?

A
  • Anxiety, fear & pain provoke release of endogenous catecholamines from the adrenal gland, increase HR, causes vasoconstriction and increased BP
  • Need for adequate pain control
  • Anxious patients - anti-anxiety meds (benzo’s) or nitrous oxide
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15
Q

What pain meds are safe for HTN patients?

A
  • Post-procedure analgesia - acetaminophen
  • APAP is a safe drug in this situation
  • Analgesics contribute to CV stability. use short term at the lowest effective dose
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16
Q

What is the dental complications in providing care in patients with post MI?

A
  • No Tx the first 30 days after MI!
    • Risk highest in the first 30 days following MI
    • 19% of all sudden deaths or episodes of cardiac arrest occured
17
Q

What are the complications of malignant HTN and severe HTN?

A
  • Malignant - possible facial palsy
  • Severe - increased bleeding with surgery
18
Q

What are some of the symptoms of anti-hypertensive drugs?

A
  • Dry mouth
  • Oral lesions
  • Lichenoid reactions
  • Neutropenia
  • Delayed healing
  • Gingival bleeding
  • Nonallergic angiodema
  • Burning mouth
  • Gingival hyperplasia
19
Q

What can you do to manage the care of patients with HTN or MI?

A
  • Thorough physical exam
  • Stress reduction
  • Conservative use of vasoconstrictor

Medically Complex Tx Planning (7 decks)

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