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Internal Med > Adrenal Insufficiency - Bleeding disorders > Flashcards

Adrenal Insufficiency - Bleeding disorders Flashcards

1
Q

when is aldosterone secreted?

A

when there is a fall in renal BP

*causes reuptake of sodium and H2O

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2
Q

maintains homeostasis during physical/emotional stress

A

cortisol

*most important in dentistry

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3
Q

what are examples of primary and secondary adrenal insufficiency?

A

primary - injury

secondary - tumor of the gland or pituitary

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4
Q

what innactivates cortisol?

A

negative feedback loop

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5
Q

what are the dental modifications to well - controlled adrenal disorders

A

no modifications to tx

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6
Q

what are some problems with uncontrolled adrenal pts?

A

may not meet metabolic demand

  • delayed healing
  • suseptability to infection
  • intolerant to stress
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7
Q

what is the most potent activator of the HPA axis

A

surgery

*post-op is highest cortisol demand

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8
Q

how do you treat acute adrenal insufficiency?

A

give exogenous cortisol for primary only

*cant do anything for secondary

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9
Q

how would a dentist prevent any problems with adrenal pts?

A
  • stress reduction
  • AM appts
  • pain control
  • monitor BP
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10
Q

what do you do if a pt has an acute adrenal crisis in your office?

A

EMS!!!!!

  • there is nothing you can do bc it is medical emergency
  • get feet raised above the heart
  • BLS
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11
Q

when should you avoid tx with a pregnant pt?

A

1rst trimester

*emergency care ok anytime though

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12
Q

what is a way to keep pregnant pts comfortable?

A

semi-reclined chair
short appts
allow pt to change positions

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13
Q

can you do radiographs with pregnant pts?

A

yes just NOT in the first trimester

-dont do full mouth series

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14
Q

can you give drugs to a pregnant pt

A

ideally no drugs at all during pregnancy but especially not in the first trimester

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15
Q

pregnancy drug that has controlled human studies, no demonstrated risk, and has remote posiibility to fetal harm

A

A

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16
Q

pregnancy drug that has animal studies, no demonstrated risk to humans but have shown risk to animals

A

B

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17
Q

pregnancy drug that has animal studies that have demonstrated risk, or animal studies are not available

A

C

*most dental drugs

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18
Q

pregnancy drug that has positive evidence of human risk

A

D

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19
Q

pregnancy drug that has evidence of fetal abnormalities, the risks outweigh the benefits

A

X

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20
Q

what antibiotics can you NOT GIVE to pregnant pts?

A

tetracycline

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21
Q

what type of anagesic drug can you NOT GIVE to pregnant pts?

A

NSAIDS

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22
Q

can you give sedatives to pregnant pts?

A

no

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23
Q

after the baby is born, when should the mother start taking drugs?

A

immediately after breast feeding

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24
Q

when do you want to do surgery on a transplant pt?

A

before the transplant occurs

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25
Q

what risks are there with transplant pts?

A 
IMMUNOSUPPRESSION (dont on purpose)
leads to:
-pancytopenia (low WBCs)
-inc risk for infection
-bleeding disorders

*may need to do bone marrow transplant and will require a dental clearance exam

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26
Q

how are you supposed to treat a pre transplant pt?

A

aggressively and quickly

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27
Q

how long after a transplant is a pt not able to have elective dental care (only emergency)

A

6 months

28
Q

when does HIV become AIDS?

A

when CD4 drops below 200

29
Q

what test is performed to see if a pt has AIDS

A

ELISA test

30
Q

what must you ask a pt with HIV/AIDS?

A
  • CD4 and lymphocyte count
  • viral load
  • WBC count
  • platelet count
31
Q

what type of dental tx can you do for a pt that is asymptomatic HIV seropositive

A

all dental care is indicated

*you wouldnt know they had the disease if they didnt tell you

32
Q

what type of dental tx can you do for a pt that is asymptomatic, HIV infected with decreasing CD4+ count

A

can still do routine and complex restorative tx

-must get platelet count and WBC count for invasive surgical procedures

33
Q

what type of dental tx can you do for a pt that has AIDS (CD4+ count less than 200)

A

emergency care only

34
Q

rapid accumulation of immature, non-functioning WBCs in marrow

A

Acute leukemia

35
Q

leukemia that is more common in adults over 65

A

chronic leukemia

36
Q

can acute leukemia be cured?

A

yes, after doing three phases of chemo

-induction, consolidation, maintenance

37
Q

can CML be cured?

A

yes, possible to obtain complete remission

38
Q

can CLL be cured?

A

no, tx has little change on quality of life

39
Q

which type of lymphoma is more likely to be cured?

A

hodgkins

40
Q

lymphoprolifeative disorder taht is an overproduction of malignant PLASMA cells. has multiple tumor masses through the skeletal system

A

multiple myeloma

41
Q

what are the concerns in dentistry of a pt has leukemia-lymphoma?

A
  • infection
  • delayed healing
  • bleeding
42
Q

what do you need to have in order to do dental surgery on a pt with leukemia/lymphoma?

A

medical consultation

  • platelets must be over 50,000
  • WBCs must be higher than 2000
43
Q

how long should you wait between dental extractions and chemo tx for lymphoma/leukemia pts?

A

10-14 days

44
Q

what type of dental care can you do DURING cancer tx for leukemia/lymphoma?

A
  • preventative only

- no elective

45
Q

platelet count that makes pt bleed excessively with minor trauma?

A

less than 50,000

46
Q

platelet count that makes a pt bleed spontaneously

A

less than 20,000

47
Q

what is the best single screening test for coagulation disorders?

A

PTT

48
Q

what replaced the PT test?

A

INR (warfarin)

49
Q

what type of disease is both an acquired platelet and an aquired coagulation disorder?

A

liver disease

50
Q

how does a dentist manage a pt on antiplatelet therapy?

A

DO NOT discontinue the antiplatelet drugs

-use local measures to control homeostasis

51
Q

what type of drug is coumadin?

A

anti - COAGULATION

  • inhibits synthesis of vitamin K dependent coagulation factors
  • INR used to monitor
52
Q

what should an INR be in order to have dental surgery?

A

below 3

53
Q

how does a dentist control local measures when dealing with a warfarin pt?

A

keep gelfoam around (used with thrombin and primary closure)

if bleeding does not stop after using gelfoam then contact hematologist

54
Q

what type of anagesic should be used with warfarin pts?

A

tylenol (NO NSAIDS)

55
Q

most common congenital bleeding disorder?

A

von Willebrand disease

56
Q

is hemophilia A or B more common?

A

A

57
Q

what are the two jobs of von Willebrand factor?

A
  • bind and carry factor VIII in the blood (is destroyed if it is unbound)
  • all platelets to adhere to surfaces
58
Q

type 1 vWF

A
  • LOW levels of vWF
  • 75% of pts (most common)
  • symptoms usually mild
59
Q

type 2 vWF

A
  • NORMAL levels of vWF but it does NOT WORK RIGHT
  • 15-25% of pts
  • moderate/severe symptoms
60
Q

type 3 vWF

A
  • LITTLE OR NO vWF
  • 5% (rare)
  • most severe symptoms
61
Q

what are common occurences with type 1 vWF?

A
  • epistaxis (nose bleeds)

- menorrhagia (long menstral cycles)

62
Q

what treatment should be used with type 1 vWF?

A

DESMOPRESSIN!

-causes release of vWF from endothelial cells

63
Q

what should you use to treat types 2 or 3 vWF?

A

FACTOR VIII REPLACEMENT!

-NO desmopressin bc it they dont have vWF so it wouldnt work!

64
Q

can you treat vWF pts at outpatient therapy?

A

yes but only type 1 and 2

use desmopression as peri-op

65
Q

what type of vWF pts must be seen in a hospital?

A

severe type 2 and type 3

66
Q

disorder in which a pt does not have enough factor VIII in the blood

A

hemophelia A

67
Q

what is the dental management of a pt with hemophilia A?

A
  • consult with physician
  • outpatient care is ok
  • no local anesthetic blocks without managment
  • use tylenol not NSAIDS

Internal Med (3 decks)

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