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BDS 2 Diseases of Human Systems > Blood Disorders > Flashcards

Blood Disorders Flashcards

1
Q

coagulation cascade

A

series of reactions catalysed by protein enzy,es known as coagulation factors
steps in response to bleeding, to clot the blood and stop bleeding

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2
Q

extrinsic coagulation cascade

A

response to tissue damage/factors
factor 7 - 7a

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3
Q

intrinsic coagulation cascade

A

response to triggers from the blood
collagen triggers this
1 - 1a, 8-8a for stable clot

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4
Q

antithrombotic medicine

A

injectable - herapin
oral anticoaugalnt - courmarin
antiplatelet - asprin

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5
Q

injectable drugs

A

usually temporary
unfractioned heparin, low molecular weight heparin

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6
Q

unfractioned heparin

A

injected, infusion, active for few mins
rapid control, rapid onset
inhibits antithrombin3
hospital based tx

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7
Q

low molecular weight heparin

A

given subcutaneous injection
stops clotting without increase bleeding risk
uncomfortable to administer
no dental issue

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8
Q

oral anticoagulants

A

interfere with coagulation cascade
warfarin, apixaban, edoxoban, rivaroxaban, dabigatran

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9
Q

oral antiplatelets

A

interfere with platelet numbers/function
low dose apsirinm clopidogrel, dipyramidole,abciximab

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10
Q

safe dental care with no drugs being a risk

A

hygiene therapy, RPD, restorative, endo, ortjo

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11
Q

caution dental care - big risks

A

extractions, minor oral surgery, implants, periodontal surgery

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12
Q

indications for anticoagulation

A

conditions wjere blood clots form
atrial fibrillation, deep vein thrombosis, heart valve disease, mechanical heart valves, thrombophilia

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13
Q

types of anticoagulants

A

coumarins - warfarin
indanediones - phenindione
direct thrombin inhibitor - dabigatran
factor 6a inhibitor - apixaban, rivaroxaban

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14
Q

warfarin is a

A

anticoagulant, vitamin K agonist, interferes with action of VitK and changes syntehsis of clotting factors
2, 7, 9 , 10

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15
Q

warfarin onset

A

slow, 2-3 days
initial hypercoagulability due to protein C + S inhibition [immediately]
increased coagulation risk initially, may be on heparin in hospital
if stopping, when starting again, pulmonary embolism risk

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16
Q

warfarin + INR

A

normal 2-3 if on anticoagulant
3-4 in prosthetic valve, higher risk of DVT
checked every 4-8 weeks,

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17
Q

INR

A

measurement of how long it takes for blood to clot
not always well controlled, foods and medicines can interact with warfarin and upset INR

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18
Q

warfarin + dental px

A

cause prolonged bleeding, haemorrhage
INR and bloof test 72hrs of tx
early in day, early in week
local haemostatic measures - sutures, cellular sponge, LA infiltration
post op instructions, contact number

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19
Q

drug interactions w warfarin

A

potentiating drugs = increase INR
- amiodarone, antibiotics, alcohol, NSAIDs [no ibu]
inhibiting drugs = decrease INR
- carbamazepine

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20
Q

avoid prescribing for px on warfarin

A

aspirin, NSAIDs, azole antifungals [fluconazole]
need to monitor INR, GP

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21
Q

hazards taking warfarin

A

haemorrhage, 1% risk of bleed, 25% fatal
due to trauma like fall, serious if older
soft tissue injury - bleeding into muscles
rapid reversal of vitK agonist possible in hospital

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22
Q

new oral anticogulants

A

to resolve issues of warfarin
- dont need to monitor aciton, predicatable bioavailability
- rapid onset of action, 1hr
- short duration of action, 1 day
- short tx
- reversable agents for severe bleeding/trauma
good for those rurally

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23
Q

how do new oral anticoagulants work and examples

A

prevent factor Xa
- rivaroxaban [1x daily]
- apixaban [2]
- edoxaban [1]
- diabigatran [1]

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24
Q

dental tx and NOACs

A

assess bleeding risk, early in day, limit initial tx
if high risk - miss/delay morning dose
restart immediately
haemostatic measures
keep 20 mins after to assess bleeding

25
Q

NOAC drug interactions

A

safe with antibiotics except erythromycin
safe with antifungals, LA, antivirals
AVOID NSAIDS, CARBAMEZEPINE

26
Q

antiplatelets

A

stop platelet aggregation

27
Q

antiplatelet standard therapy

A

low dose aspirin 75mg
clopidogrel
dipyridamole

28
Q

antiplatelets in clinical practice

A

inhibits platelet aggregattiom, inhibits thrombus formation in arterial medication
local haemostatic measures

29
Q

dual therapy

A

non-aspirin single therapy, dual therapy with aspirin
do nto interrupt tx, expect prolonged bleeding, haemostasis
if 2 antip without aspirin
discuss w doctor
post op and contact no

30
Q

antiplatelets + dental drug interactions

A

avoud NSAIDs if poss
clopidogrel = erythromycin/fluconazole reduce efficacy
ticagrelor = claeithromycin
carbamazepine / omperazole reduce efficacy

31
Q

inherited bleeding disorders

A

an acquired defect which affects the coagulation of bloof
affects - coagulation cascade, platelets

32
Q

haemophilia

A

too little clot formed

33
Q

thrombophilia

A

too much clot formed

34
Q

disorders reducing coagulation factors

A

factor VIII defiency
haemphilia A
factor IX deficiencu
haermphiia B
von willebrands
reduced factor VIII, redued platelet aggregation

35
Q

haemophilia A + B

A

inheritance, sex linked recessive gene
defective X chrmosome, males affected, females carrier
severity depnds of amount of factor produced

36
Q

haemophilia iu

A

international unit
1iu is normal
carrier 0.5iu
severe = <0.02
mod = 0.02-0.09
mild - 0.1-0.4

37
Q

haemophilia A

A

deficiency in factor 8

38
Q

haemophilia A management

A

severe/mod
- recombinant factor 8
mild/carriers
- DDAVP, oral tranexamic acid

39
Q

DDAVP

A

desmopressin, releases factor 8 which has been bound to endothelial cells, temporary boost to f8 levels and clotting abiluty
doesnt itself have effects of coagulation cascade, cannot be used reguarly as only displaces those on wall, wont work

40
Q

tranexamic acid

A

inhibitor of fibrinolysis, keeps any clot that is formed
same effect as increasing f8 in blood

41
Q

haemophilia B

A

chrtistmas disease
deficiency of factor 9 IX

42
Q

management of haemophilia B

A

severe/mod
mild/carriers
- recomvinant factor 9
- no alternative

43
Q

coagulation factor inhibitors

A

antibodies which develop to f8 and 9
antibody response produced
give new drugs infrequently
each dose has to be higher to overcome inhibitors from previous dose

44
Q

von willebrand disease

A

factor 8 problem associated w platelet issues
high incidence
poor clot activty
autosomal dominant, bothh sexes equally effected
type1/2 mild, tpye 3 severe

45
Q

management of von willebrands

A

severe/mod
- DDAVP
mild/carriers
- oral tranexamic acid
haematologist advice, tailored tx

46
Q

rare bleeding disorders

A

hard to characterise, defects of other factors in coagulation cascade

47
Q

management of px w bleeding disorders

A

high degree factor activty, low rik
assess risks, location of tx may need to be done in hospital or sepcialist

48
Q

haemophilia dental care managing

A

sev/mod - haemophilia centre
mild/carrier - dpenedent on procedure, review at haem centre every 2 years

49
Q

which procedures require special care for haemphilia px

A

administration of LA, extractions, minor oral surgery, periodontal surgery, biopsies

50
Q

LA safe or danger in haem px

A

safe - buccal infiltration, intraligamentary, intrapapillary
danger - inferior alveolar nerve block, lingual infiltration , posterior superior nerve block

51
Q

most important aspect of care w those w bleeding disorders

A

PREVENTION
OHI, regular dental visits, fluoride, sealants, dietary advice, smoking cessation

52
Q

thrombophilia

A

increased risk of clot development, greater than clot breakdown
acquired imposed on genetic tendency
can lead to blockage of major blood vessels in heart/lungs

53
Q

thrombophilia inherited syndromes

A

inherited - protein C/S deificency, factor V leiden, antithrombin III deficiency
acquired - antiphospholipid syndrome lupus, oral contraceptive, trauma, cancer, pregnancy

54
Q

thrombocytopenia

A

low number of normal platelets
drug related - alcohol, penicillin

55
Q

thrombocythemia

A

high number of poor functioning platelets

56
Q

qualitative platelet disorders

A

normal platelet number but abnormal function
inherited - hermanksy, bernaer soulier syndrome
acquired - cirrhpsis, drigs, alcohol

57
Q

dental care + platelet disorders

A

no additonal precaution
greater than 100x109/L

58
Q

platelet count and place of dental care

A

below 100x109/L = primary care
below 50x109/L = hospital
above 500x109/L = either

special care for - extractions, periodontla surgeyr, oral surgeyr

BDS 2 Diseases of Human Systems (9 decks)

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