Adrenal Insufficiency - Bleeding disorders Flashcards
when is aldosterone secreted?
when there is a fall in renal BP
*causes reuptake of sodium and H2O
maintains homeostasis during physical/emotional stress
cortisol
*most important in dentistry
what are examples of primary and secondary adrenal insufficiency?
primary - injury
secondary - tumor of the gland or pituitary
what innactivates cortisol?
negative feedback loop
what are the dental modifications to well - controlled adrenal disorders
no modifications to tx
what are some problems with uncontrolled adrenal pts?
may not meet metabolic demand
- delayed healing
- suseptability to infection
- intolerant to stress
what is the most potent activator of the HPA axis
surgery
*post-op is highest cortisol demand
how do you treat acute adrenal insufficiency?
give exogenous cortisol for primary only
*cant do anything for secondary
how would a dentist prevent any problems with adrenal pts?
- stress reduction
- AM appts
- pain control
- monitor BP
what do you do if a pt has an acute adrenal crisis in your office?
EMS!!!!!
- there is nothing you can do bc it is medical emergency
- get feet raised above the heart
- BLS
when should you avoid tx with a pregnant pt?
1rst trimester
*emergency care ok anytime though
what is a way to keep pregnant pts comfortable?
semi-reclined chair
short appts
allow pt to change positions
can you do radiographs with pregnant pts?
yes just NOT in the first trimester
-dont do full mouth series
can you give drugs to a pregnant pt
ideally no drugs at all during pregnancy but especially not in the first trimester
pregnancy drug that has controlled human studies, no demonstrated risk, and has remote posiibility to fetal harm
A
pregnancy drug that has animal studies, no demonstrated risk to humans but have shown risk to animals
B
pregnancy drug that has animal studies that have demonstrated risk, or animal studies are not available
C
*most dental drugs
pregnancy drug that has positive evidence of human risk
D
pregnancy drug that has evidence of fetal abnormalities, the risks outweigh the benefits
X
what antibiotics can you NOT GIVE to pregnant pts?
tetracycline
what type of anagesic drug can you NOT GIVE to pregnant pts?
NSAIDS
can you give sedatives to pregnant pts?
no
after the baby is born, when should the mother start taking drugs?
immediately after breast feeding
when do you want to do surgery on a transplant pt?
before the transplant occurs
what risks are there with transplant pts?
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
how are you supposed to treat a pre transplant pt?
aggressively and quickly
how long after a transplant is a pt not able to have elective dental care (only emergency)
6 months
when does HIV become AIDS?
when CD4 drops below 200
what test is performed to see if a pt has AIDS
ELISA test
what must you ask a pt with HIV/AIDS?
- CD4 and lymphocyte count
- viral load
- WBC count
- platelet count
what type of dental tx can you do for a pt that is asymptomatic HIV seropositive
all dental care is indicated
*you wouldnt know they had the disease if they didnt tell you
what type of dental tx can you do for a pt that is asymptomatic, HIV infected with decreasing CD4+ count
can still do routine and complex restorative tx
-must get platelet count and WBC count for invasive surgical procedures
what type of dental tx can you do for a pt that has AIDS (CD4+ count less than 200)
emergency care only
rapid accumulation of immature, non-functioning WBCs in marrow
Acute leukemia
leukemia that is more common in adults over 65
chronic leukemia
can acute leukemia be cured?
yes, after doing three phases of chemo
-induction, consolidation, maintenance
can CML be cured?
yes, possible to obtain complete remission
can CLL be cured?
no, tx has little change on quality of life
which type of lymphoma is more likely to be cured?
hodgkins
lymphoprolifeative disorder taht is an overproduction of malignant PLASMA cells. has multiple tumor masses through the skeletal system
multiple myeloma
what are the concerns in dentistry of a pt has leukemia-lymphoma?
- infection
- delayed healing
- bleeding
what do you need to have in order to do dental surgery on a pt with leukemia/lymphoma?
medical consultation
- platelets must be over 50,000
- WBCs must be higher than 2000
how long should you wait between dental extractions and chemo tx for lymphoma/leukemia pts?
10-14 days
what type of dental care can you do DURING cancer tx for leukemia/lymphoma?
- preventative only
- no elective
platelet count that makes pt bleed excessively with minor trauma?
less than 50,000
platelet count that makes a pt bleed spontaneously
less than 20,000
what is the best single screening test for coagulation disorders?
PTT
what replaced the PT test?
INR (warfarin)
what type of disease is both an acquired platelet and an aquired coagulation disorder?
liver disease
how does a dentist manage a pt on antiplatelet therapy?
DO NOT discontinue the antiplatelet drugs
-use local measures to control homeostasis
what type of drug is coumadin?
anti - COAGULATION
- inhibits synthesis of vitamin K dependent coagulation factors
- INR used to monitor
what should an INR be in order to have dental surgery?
below 3
how does a dentist control local measures when dealing with a warfarin pt?
keep gelfoam around (used with thrombin and primary closure)
if bleeding does not stop after using gelfoam then contact hematologist
what type of anagesic should be used with warfarin pts?
tylenol (NO NSAIDS)
most common congenital bleeding disorder?
von Willebrand disease
is hemophilia A or B more common?
A
what are the two jobs of von Willebrand factor?
- bind and carry factor VIII in the blood (is destroyed if it is unbound)
- all platelets to adhere to surfaces
type 1 vWF
- LOW levels of vWF
- 75% of pts (most common)
- symptoms usually mild
type 2 vWF
- NORMAL levels of vWF but it does NOT WORK RIGHT
- 15-25% of pts
- moderate/severe symptoms
type 3 vWF
- LITTLE OR NO vWF
- 5% (rare)
- most severe symptoms
what are common occurences with type 1 vWF?
- epistaxis (nose bleeds)
- menorrhagia (long menstral cycles)
what treatment should be used with type 1 vWF?
DESMOPRESSIN!
-causes release of vWF from endothelial cells
what should you use to treat types 2 or 3 vWF?
FACTOR VIII REPLACEMENT!
-NO desmopressin bc it they dont have vWF so it wouldnt work!
can you treat vWF pts at outpatient therapy?
yes but only type 1 and 2
use desmopression as peri-op
what type of vWF pts must be seen in a hospital?
severe type 2 and type 3
disorder in which a pt does not have enough factor VIII in the blood
hemophelia A
what is the dental management of a pt with hemophilia A?
- consult with physician
- outpatient care is ok
- no local anesthetic blocks without managment
- use tylenol not NSAIDS
