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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
NOAC drug interactions
safe with antibiotics except erythromycin safe with antifungals, LA, antivirals AVOID NSAIDS, CARBAMEZEPINE
26
antiplatelets
stop platelet aggregation
27
antiplatelet standard therapy
low dose aspirin 75mg clopidogrel dipyridamole
28
antiplatelets in clinical practice
inhibits platelet aggregattiom, inhibits thrombus formation in arterial medication local haemostatic measures
29
dual therapy
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
antiplatelets + dental drug interactions
avoud NSAIDs if poss clopidogrel = erythromycin/fluconazole reduce efficacy ticagrelor = claeithromycin carbamazepine / omperazole reduce efficacy
31
inherited bleeding disorders
an acquired defect which affects the coagulation of bloof affects - coagulation cascade, platelets
32
haemophilia
too little clot formed
33
thrombophilia
too much clot formed
34
disorders reducing coagulation factors
factor VIII defiency haemphilia A factor IX deficiencu haermphiia B von willebrands reduced factor VIII, redued platelet aggregation
35
haemophilia A + B
inheritance, sex linked recessive gene defective X chrmosome, males affected, females carrier severity depnds of amount of factor produced
36
haemophilia iu
international unit 1iu is normal carrier 0.5iu severe = <0.02 mod = 0.02-0.09 mild - 0.1-0.4
37
haemophilia A
deficiency in factor 8
38
haemophilia A management
severe/mod - recombinant factor 8 mild/carriers - DDAVP, oral tranexamic acid
39
DDAVP
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
tranexamic acid
inhibitor of fibrinolysis, keeps any clot that is formed same effect as increasing f8 in blood
41
haemophilia B
chrtistmas disease deficiency of factor 9 IX
42
management of haemophilia B
severe/mod mild/carriers - recomvinant factor 9 - no alternative
43
coagulation factor inhibitors
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
von willebrand disease
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
management of von willebrands
severe/mod - DDAVP mild/carriers - oral tranexamic acid haematologist advice, tailored tx
46
rare bleeding disorders
hard to characterise, defects of other factors in coagulation cascade
47
management of px w bleeding disorders
high degree factor activty, low rik assess risks, location of tx may need to be done in hospital or sepcialist
48
haemophilia dental care managing
sev/mod - haemophilia centre mild/carrier - dpenedent on procedure, review at haem centre every 2 years
49
which procedures require special care for haemphilia px
administration of LA, extractions, minor oral surgery, periodontal surgery, biopsies
50
LA safe or danger in haem px
safe - buccal infiltration, intraligamentary, intrapapillary danger - inferior alveolar nerve block, lingual infiltration , posterior superior nerve block
51
most important aspect of care w those w bleeding disorders
PREVENTION OHI, regular dental visits, fluoride, sealants, dietary advice, smoking cessation
52
thrombophilia
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
thrombophilia inherited syndromes
inherited - protein C/S deificency, factor V leiden, antithrombin III deficiency acquired - antiphospholipid syndrome lupus, oral contraceptive, trauma, cancer, pregnancy
54
thrombocytopenia
low number of normal platelets drug related - alcohol, penicillin
55
thrombocythemia
high number of poor functioning platelets
56
qualitative platelet disorders
normal platelet number but abnormal function inherited - hermanksy, bernaer soulier syndrome acquired - cirrhpsis, drigs, alcohol
57
dental care + platelet disorders
no additonal precaution greater than 100x109/L
58
platelet count and place of dental care
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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