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Oral surgery > 14. Preparation of patients with concomitant diseases / diabetes, hypertension, patients on anticoagulant therapy, etc > Flashcards

14. Preparation of patients with concomitant diseases / diabetes, hypertension, patients on anticoagulant therapy, etc Flashcards

1
Q

🔸Inability of myocardium to pump enough blood
🔸Lungs/and or circulatory system become congested

A

Congestive heart failure

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2
Q

Stress in congestive heart failure should be avoided due to

A

🔸Increase workload of heart surpassing functional ability
🔸Pulmonary Oedema

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3
Q

Congestive heart failure symptoms

A

🔸Extreme dyspnoea
🔸Hyperventilation
🔸Cough
🔸Hemoptysis(pinkish foam expectoration)
🔸Difficulty breathing

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4
Q

Preferred patient position in congestive heart failure

A

Sitting position

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5
Q

Management of congestive heart failure

A

🔸Consultation with cardiologist
🔸 Oral premedication, e.g., 5–10 mg diazepam (Valium) or 1.5–3 mg bromazepam (Lexotanil), 1 h be-
fore procedure
🔸Small amount of vasoconstrictor
🔸Short appointments as painless as possible

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6
Q

Temporary ischemia in Myocardium, resulting in diminished oxygen

A

Angina Pectoris

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7
Q

Symptoms of angina

A

🔸 Brief paroxysmal pain posterior to the sternum
🔸 Burning sensation, pressure, or tightness
🔸 Pain radiating to the left shoulder, neck, left arm (with a numb sensation as well as tingling), sometimes down the chin and teeth of the mandible (usually the left side)
🔸Pain sometimes felt in epigastrium, causing confusion in diagnosis
🔸Perspiration
🔸Extreme anxiety

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8
Q

These patients have an increased risk of angina pectoris symptoms in dental surgery

A

Coronary heart disease history

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9
Q

Episode of angina pectoris precipitated by

A

🔸Fatugue
🔸Stress
🔸Rich meal

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10
Q

Symptoms of Angina Pectoris subside after

A

🔸2-5 minutes of rest
🔸Administering of vasodilator

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11
Q

Treatment of Angina pectoris

A

🔸Consultation with cardiologist
🔸 5–10 mg diazepam (Valium) or 1.5–3 mg bromazepam (Lexotanil) orally, 1 h before the surgical procedure
🔸Carrying out procedure in hospital
🔸Small amounts of vasoconstrictor in LA
🔸Short appointments

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12
Q

Ischemic necrosis of an area of the heart due to complete blocking of branches of the coronary arteries

A

Myocardial infarction

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13
Q

Myocardial infarction symptoms

A

🔸 Sudden onset with severe pain posterior to the sternum, which increases in severity rapidly
🔸 w/ burning sensation, pressure, and extreme tightness
🔸 More severe compared to angina pectoris, lasts longer than 15 min and does not subside with rest or use of nitrates sublingually
🔸 Radiates to the left shoulder, neck region, mandible, teeth, midback region, epigastrium, and right arm
🔸 Nausea, vomiting, perspiration, and dyspnea

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14
Q

Management of myocardial infarction

A

🔸 Avoid routine dental surgery on patients with recent infarctions (within the last 6 months)
🔸 if treatment necessary (acute infection, pain, etc.), management should take place in a hospital
🔸Six months following the myocardial infarction, patients may also be treated in the dental office- follow same precautions as Angina pectoris

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15
Q

Damage of the mitral and aortic valves, which may be described as stenosis, or insufficiency

A

Rheumatic heart disease

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16
Q

May develop after invasive surgical procedures and is dangerous for patients with rheumatic fever

A

Transient bacteraemia

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17
Q

Management of Rheumatic heart disease

A

🔸Antibiotic treatment prior to surgery
🔸Avoidance of vasoconstrictors/ maximum concentration of 1:100,000

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18
Q

Importance of antibiotics in Rheumatic heart disease

A

Transient bacteraemia after surgical procedures can affect endocardium resulting in endocarditis

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19
Q

Pathologic sounds due to vibrations caused by turbulence in the circulation through the vessels or chambers of the heart

A

Murmurs

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20
Q

Heart murmurs are caused by

A

🔸Valve defects, resulting from rheumatic disease
🔸Septic endocarditis
🔸Syphilis
🔸Congenital heart conditions

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21
Q

Types of murmurs

A

🔸Systolic
🔸Diastolic
🔸Continuous
🔸Innocent/functional- good prognosis

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22
Q

Management of Murmurs

A

🔸Establish whether murmur is functional or pathologic
🔸Antibiotic prophylaxis

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23
Q

Types of congenital heart disease

A

🔸Patent ductus arteriosus
🔸Atrial septal defects
🔸Ventricular septal defects
🔸Idiopathic pulmonary stenosis
🔸Stenosis of pulmonary or aortic valve

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24
Q

Management of main congenital heart diseases

A

🔸Consultation with physician
🔸Premedication before treatment
🔸Antibiotic prophylaxis especially in Rheumatic heart Disease
🔸Limited vasoconstrictor use
🔸Short appointments

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25
Q

Periodic variation in rhythm of heart caused by disturbances in the excitability of the ventricles by sinoatrial node

A

Arrhythmia

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26
Q

Management of Arrhythmia

A

🔸Consultation with doctor
🔸In severe cases avoidance of LA containing vasoconstrictors/ postponing treatment
🔸Premedication before surgical procedure
🔸short appointments and pain control

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27
Q

Management of prosthetic heart values

A

🔸Antibiotic prophylaxis before surgical procedure
🔸Same as valve disease of rheumatic origin

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28
Q

Why antibiotic prophylaxis needed in patients with prosthetic heart valves

A

Endocardium associated with the artificial valve is particularly susceptible to microbial infection

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29
Q

Used for the control of symptoms due to disturbances of the cardiac rhythm

A

Cardiac pacemakers

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30
Q

Management of patients with pacemakers

A

🔸 The use of certain dental instruments increases the risk of abnormal activity of the pacemaker (mono-polar electrosurgery, ultrasonic scalers, electronic dental anesthesia, etc.)
🔸 Local anesthetics with vasoconstrictors may be used safely
🔸 Antibiotic prophylaxis not required

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31
Q

Normal arterial pressure in an adult

A

-Under 140/90
-Hypertension is abnormal elevation of systolic and diastolic pressure over those values

32
Q

Arterial hypertension of unknown etiology that exists in 95% of cases is named

A

Essential hypertension

33
Q

Arterial hypertension where in 5% of cases, the cause is known is called

A

Secondary hypertension

34
Q

High blood pressure values where treatment can be carried out

A

140–160/90–95 mmHg

35
Q

High blood pressure values where premedication is required

A

🔸160–190/95–110 mmHg
🔸30mins to 1 hour before treatment

36
Q

If the blood pressure values remain high even after premedication (e.g., over 180/110 mmHg)

A

the dental session is postponed and the patient is referred to his/her physician for further treatment

37
Q

Blood pressure values where patients not allowed regular dental treatment

A

🔸190/110 mmHg
🔸Treated in hospital

38
Q

Severe hypertension (diastolic blood pressure >140 mmHg can cause

A

🔸 Hypertensive encephalopathy
🔸 Papilloedema and/or retinal hemorrhage

39
Q

Hypertensive encephalopathy symptoms

A

🔸Severe headache
🔸nausea
🔸Vomiting
🔸Confusion
🔸Convulsions and coma

40
Q

In actual practice, a dentist is not meant to administer emergency antihypertensive agents, except in cases of

A

🔸 Repeated cases of Acute pulmonary edema
🔸Intravenous Furosemide(Lasix) administered

41
Q

Management of patients with hypertension

A

🔸 Premedication before surgery
🔸 Blood pressure should be monitored
🔸 Aspiration during LA
🔸 Avoiding noradrenaline in patients receiving anti- hypertensive agents
🔸Short painless appointments

42
Q

sudden drop in blood pressure, when patient quickly placed back to an upright position

A

Orthostatic hypotension

43
Q

Orthostatic hypotension is caused by

A

disturbances of the autonomic nervous system

44
Q

Second most frequently observed cause of transient loss of consciousness in the dental patient, after fainting

A

Orthostatic hypotension

45
Q

Causes of orthostatic hypotension

A

🔸Not entirely known
🔸 Diabetic neuropathy
🔸Antihypertensive agents 🔸Phenothiazines
🔸Sedatives
🔸Prolonged supine position 🔸Pregnancy
🔸Extreme fatigue

46
Q

Symptoms of orthostatic hypotension

A

🔸Drop in Bp as patient gets out of chair
🔸 Dizziness
🔸Weakness
🔸Headache
🔸Loss of balance
🔸sense of fainting
🔸 Loss of consciousness

47
Q

Management of orthostatic hypotension

A

🔸Supporting patient as the get out of chair
🔸Monitoring of Bp
🔸Avoiding sudden changes in chair position
🔸 Evaluate medical history, especially
concerning antihypertensive agents; also, fainting episodes

48
Q

Acute condition causing necrosis of brain tissue, because of intracranial hemorrhage, cerebral embolism, or thrombosis

A

Cerebrovascular accident (Stroke)

49
Q

Symptoms of Cerebrovascular accident (Stroke)

A

🔸 Paralysis of one or both limbs of one side of the body
🔸Difficulty swallowing
🔸Loss of expression or inability to move facial muscles
🔸Dizziness
🔸Severe headache
🔸Perspiration
🔸Pallor

50
Q

Management of Cerebrovascular accident (Stroke)

A

🔸Avoid treatment for 6 months following stroke/ Carry out in hospital
🔸Monitoring Bp
🔸Premedication
🔸Short painless appointments
🔸Low dose of vasoconstrictor

51
Q

Important Anemias in dentistry

A

🔸 Aplastic anemia
🔸Biermer’s megaloblastic anemia (a type of pernicious anemia)
🔸Hypochromic anemias (iron deficiency anemia, thalassemia) 🔸Sickle cell anemia
🔸 Methemoglobinemia.

52
Q

Management of patients with anaemia

A

🔸Thorough medical history
🔸Consultation with hematologist- hematocrit and haemoglobin levels should be as close as possible
🔸Control stress and pain
🔸Avoid abrupt manipulations especially in sickle cell anaemia
🔸Use of LA permitted except in methemoglobinemia

53
Q

In patients with sickle cell disease, pain and stress may cause

A

Sickle cell crisis

54
Q

In patients with sickle cell anaemia, abrupt manipulations during extractions can cause

A

Fractures in mandible due to osteoporosis caused by the disease

55
Q

In methemoglobinemia the anaesthetics that are contraindicated are

A

Articaine and Prilocaine

56
Q

Leukaemia is a pathological condition characterised by

A

🔸Quantitative and qualitative defects in circulating white blood cells
🔸Acute and chronic

57
Q

Patients with leukaemia are susceptible to

A

🔸Severe infection
🔸Post operative haemorrhage

58
Q

Management of patients with leukaemia

A

🔸Consultation with haematologist
🔸Avoid Nerve blocks if infiltrations viable
🔸Surgical procedures (extractions ect) performed in hospital
🔸In chronic leukaemia in state of remission, treatment may be carried out in dental surgery with antibiotic prophylaxis
🔸Avoid abrupt movements

59
Q

Why nerve blocks should be avoided in leukaemia

A

Risk of hematoma

60
Q

Three groups of bleeding disorders

A

🔸Vascular disorders
🔸Thrombocytic disorders
🔸Hemorrhagic diatheses

61
Q

Disorders due to alterations of
the vascular wall, especially of the capillaries

A

Vascular disorders

62
Q

Hereditary hemorrhagic telangiectasia or Rendu–Osler disease, Ehlers–Danlos disease, von Willebrand disease (vascular hemophilia), and congenital bleeding diseases, scurvy, and purpura due to allergy are examples of

A

Vascular diseases

63
Q

Disorders that are due to either decreased numbers of platelets or to congenital functional abnormality of the platelets

A

Thrombocytic disorders

64
Q

Thrombocytopenia, Glanzmann’s disease, and thrombocytosis or thrombocythemia are examples of

A

Thrombotic disorders

65
Q

Disorders of coagulation

A

Hemorrhagic diatheses

66
Q

hemophilias, acquired disorders of the prothrombin complex (vitamin K deficiency), severe liver disease are examples of

A

Hemorrhagic diatheses

67
Q

Management of patients with Hemorrhagic diatheses

A

🔸Consultation with doctor
🔸Treatment in hospital
🔸Premedication
🔸Morning appointments(control bleeding complications)
🔸 Vasoconstrictor La for bleeding control

68
Q

Conditions where anticoagulants are used

A

🔸 Acute myocardial infarction 🔸Vascular grafts
🔸Cerebrovascular accidents 🔸Pulmonary embolism
🔸Venous thrombosis

69
Q

Most common anticoagulant drugs

A

🔸Coumarin
🔸Heparin
🔸Acetylsalicylic acid

70
Q

Effect of Coumarin drugs

A

🔸 Increase the prothrombin time to 2–2.5 times above the normal level (normal range: 11– 12 s)
🔸Delay or prevent the intravascular coagulation of blood

71
Q

Management of patients taking Coumarin drugs

A

🔸Consultation with physician to reduce or stop dose
🔸Prothrombin time reduced to 1.5 times normal value/17-19s (max)
🔸Gradual reduction of therapeutic dose 2 days beforehand
🔸Therapeutic dose increased over next 2 days after treatment

72
Q

Uncomplicated dental extractions can be carried out at INR

A

2-3.5

73
Q

INR for extensive surgical procedures should be

A

1.6-1.9 to reduce risk of bleeding

74
Q

Management of patients taking heparin

A

🔸Discontinued 4h before treatment
🔸Post operative administration same day if no bleeding issues
🔸Patients on low molecular weight heparin (Clexane, Fraxiparine) don’t need to adjust dosage

75
Q

Management of patients taking Aspirin

A

🔸Discontinued use 2-5 days prior to treatment
🔸Continue use 1 day following treatment

76
Q

Alteration of the metabolism of carbohydrates, proteins, and lipids and is caused by abnormalities of the secretion mechanism and effect of insulin

A

Diabetes Mellitus

Oral surgery (106 decks)

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