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Year 3 Human Disease > Bleeding, leukaemia and dentistry > Flashcards

Bleeding, leukaemia and dentistry Flashcards

1
Q

process of haemostasis

A

injury/ tissue damage –> vascular response –> platelet adhesion, aggregation –> unstable platelet clot –> coagulation factor cascade –> fibrin –> stable clot

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2
Q

draw clotting cascade

A

see lecture

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3
Q

what is the vascular response of haemostasis

A

vasoconstriction

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4
Q

what is the platelet response of haemostasis

A

von willebrand factor + platelet + fibrinogen –> unstable platelet clot
–> clotting cascade –> fibrin –> stable clot

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5
Q

why should dentists be aware of haemophilia

A

more bleeding, esp with extractions

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6
Q

2 considerations of injections with haemophiliac pts

A
  • blocks/ FOM injections may cause haemorrhage to track through tissue planes –> airway obstruction
  • avoid intramuscular injections
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7
Q

when is heparin used

A

acute thromboembolism

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8
Q

when is enoxaparin used and how does it work

A

prophylaxis for DVT/ PE

LMW heparin, inhibits factor Xa

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9
Q

how does warfarin work

A

impairs vit K synthesis dependent coagulation factors (2,7,9,10) in the LIVER

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10
Q

how long does warfarin take to become effective

A

2-4 days

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11
Q

7 indications of oral anticoagulation SHORT TERM

A
  • prophylaxis to prevent DVT
  • myocardial infarction (3 months)
  • established DVT (3 months)
  • xenograft heart valves (3 months)
  • pulmonary embolism (6 months)
  • coronary artery bypass grafts (CABG, 2 months)
  • atrial fibrillation
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12
Q

3 indications of oral anticoagulants LONG TERM

A
  • recurrent venous thromboembolism
  • rheumatic heart diease and atrial fibrillation
  • cardiac prosthetic valve replacement and arterial grafts
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13
Q

what is used to measure anticoagulant effect, how to caculate

A

INR = prothrombin time (test)/ prothrombin time (control)

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14
Q

INR values

A

1= normal
2.5= DVT, PE, AF
3.5= recurrent DVT/ PE, mechanical heart valves
>4=dop not extract

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15
Q

when must INR be checked

A

on the day/ no more than 24-36 hours before procedure

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16
Q

3 warfarin potentiating factors

A
  • antibiotics
  • miconazole oral gel (antifungal)
  • aspirin/ NSAIDS
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17
Q

5 relevant drug interactions/ considerations with warfarin

A
  • amoxicillin (single 3g dose ok)
  • metronidazole (halves effect of warfarin)
  • erythromycin (unpredictable, only affects some pts
  • NSAIDs (inc bleeding, GI bleeds)
  • daktarin oral gel
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18
Q

when and why alter INR 2

A

before surgery to decrease bleeding (NOT by dentists)

  • stop meds 48hrs before surgery
  • reduce warfarin by 50% for 48hrs
19
Q

2 new anti-coagulants and how they work/ when used

A

rivaroxaban: Xa inhibitor, prophylaxis for hip/ knee repacement
dabigatran: direct thrombin inhibitor, prophylaxis for hip/knee replacement, stroke, AF, valve replacement

20
Q

what is normal bleeding time

compare genders

A

2-10 mins

longer in women than men

21
Q

effect of antiplatelet agents on

a. bleeding time
b. haemostasis

A

a. bleeding time: prolongs

b. haemostasis: minimal effect

22
Q

5 coagulation defects causes

A
  • liver disease
  • hepatocellular failure
  • vit k deficiency
  • increased fibrinolysis
  • thrombocytopenia
23
Q

healthy platelet count

A

150-450000 per microlitre

24
Q

symptoms of thrombocytopenia

A

100-150m bleeding time
x20-100 increase in bleeding time
x20 risk of spontaneous bleeding

25
Q

tx for thrombocytopenia

A

autoimmune: steroids or splenectomy

leukaemia/ aplastic anaemia: platelet transfusion

26
Q

define leukaemia

A

neoplastic proliferation of white blood cells in bone marrow

27
Q

4 causes of leukaemias

A
  • genetic (eg downs syndrome)
  • ionizing radiation (chernobyl)
  • chemicals (benzene)
  • viruses
28
Q

2 types of leukaemia

A

lymphoblastic

non-lymphoblastic

29
Q

4 effects of chemotherapy on bone marrow

A
  • leukopenia
  • neutropenia
  • thrombocytopenia
  • anaemia
30
Q

1 reason oral screening is required alongside chemo

A

-identify and stop causes of sepsis (eg after tooth extraction)

31
Q

oral side effects of chemo

A
  • mucositis (oral mucosa breaks down bc its rapidly dividing)
  • oral ulceration
  • opportunistic infections (pseudomonas, candida, herpes simplex)
32
Q

3 things chemo patients take as prophylaxis

A

antivirals eg acyclovir
antifungals eg fluconazole/ itraconazole
antibiotics

33
Q

6 useful aids to symptomatic tx of chemo

A
  • corsodyl rinse/ gel
  • gelclair mucosal bandage
  • difflam rinse/ spray
  • betnesol mouth rinse
  • becotide spray
  • bite guards (suck down splints 1-2mm)
34
Q

difference between oral and neutropenic ulcers

A

oral ulcers: erythematous halo around ulcer

neutropenic ulcers: no halo

35
Q

opportunistic infections with chemo

A
  • candida
  • systemic aspergillosis
  • herpes simplex
  • herpes zoster/ varicella (chicken pox: vesicles –> oral ulcers)
36
Q

5 recommendations about oral health prior to cancer therapy

A
  • oral assessment
  • OHI, supplement with chlorhexidine mouthwash/ gel
  • carious teeth stabilised w restorations
  • smooth sharp teeth/ restorations
  • remove teeth with doubtful prognosis
37
Q

7 dental recommendations during cancer therapy

A
  • support from hygienist
  • high standard of OH
  • chlorhexidine mw/ gel
  • fluoride mw in those undergoing radiotherapy of head/neck
  • decrease mucositis
  • treat xerostomia
  • avoid dental tx where possible
38
Q

what counts as immunocomp for

a. neutrophils
b. platelets

A

a. neutrophils:

39
Q

2 reasons prophylactic antibiotics are recommended

A
  • pt neutropenic at time of tx

- tx likely to induce significant bacteraemia

40
Q

what to check if cancer pt needs dental surgery

A

platelet count, white cell count

41
Q

when is platelet cover required

A

when platelet count is less than 50x10^9

42
Q

best time for dental treatment of chemo pts and why

A

just before/ just after chemo (highest neutrophil count)

43
Q

what teeth to remove for chemo pts 3 and why

A

-advanced perio disease
-pulp infection
-chronic apical pathology
reduce chance of infection, as can be deadly for chemo pts

Year 3 Human Disease (28 decks)

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