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Hospital Dentistry - ABGD Oral Boards > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are Libman-Saks Lesions associated with?

A

Endocarditis

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2
Q

What is the causitive agent in Infective Endocarditis?

A

Bacterial or Fungal

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3
Q

What do the AHA Guidelines state regarding conditions requiring prophylaxis?

A
  • Prostehtic Heart Valve
  • Past History of Infective Endocarditis
  • Unrepaired Cyanotic Congential Heart Defects - 6 months following repair
  • Cardiac Transplants with Valvulopathy
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4
Q

What types of dental procedures require antibiotic prophylaxis?

A
  • Procedures that require manipulation of gingival tissue
  • Apical region of teeth
  • Perforation of mucosa
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5
Q

What are some exceptions to antibiotic prophylaxis?

A
  • Dental radiographs
  • Injections through non-infected tissue
  • Removable appliances
  • Ortho-bracket or adjustment
  • Shedding of deciduous teeth
  • Trauma to lips
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6
Q

What is the Sig for Amoxicilline regarding BE Chemoprophylaxis?

A

Amoxicillin: Adults, 2 g (children, 50 mg/kg)

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7
Q

Waht is the Sig for Adults/Children for Clindamycin for BE Chemoprophylaxis?

A

600 mg (children 20 mg/kg)

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8
Q

What is the Sig for Cephalexin for BE Chemoprophylaxis?

A

2 g (children 50 mg/kg)

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9
Q

What is the Sig for Azithromycin or Clarithromycin regarding BE Chemoprophylaxis?

A

500 mg (children 15 mg/kg)

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10
Q

When do you tell patients to take drugs in regards to BE?

A

30-60 minutes prior to dental treatment

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11
Q

If a patient is unable to take oral meds, what is a SIG for Ampicillin?

A

2 g (children 50 mg/kg)

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12
Q

If someone cannot take oral meds for BE, what is a SIG for Cefazolin or Ceftriaxone?

A

1 g (children 50 mg/kg)

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13
Q

If a patient cannot take oral meds, what is the Sig for Clindamycin regarding BE?

A

600 mg (children 20 mg/kg)

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14
Q

Can BE Chemoprophylaxis be taken after a dental procedure?

A

Yes!

Up to 2 hours post-op

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15
Q

What do you do if a patient is already taking antimicrobial treatment and you need to prescribe them BE Chemoprophylaxis?

A

Switch class of drug OR wait 7-10 days between doses

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16
Q

If a patient is being treated for BE with IV antibitoics, when should the drug be dosed?

A

30-60 minutes prior to dental treatment

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17
Q

What is Angina?

A

Chest Pain

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18
Q

What is angina typically a symptom of?

A

Myocardial Ischemia

19
Q

What are 3 types of Angina?

A
  1. Stable
  2. Unstable
  3. Prinzmetal
20
Q

Describe Stable Angina…

A
  • Chronic Unchanged
  • Relieved with rest
  • RElieved with NTG in 5 minutes
  • > 5 minutes may be myocardial infarction
21
Q

Describe Unstable Angina…

A
  • New onset
  • Pain at rest
  • Angina after MI
  • Increased frequency, intensity, and duration
  • Awakens patient up at night
22
Q

What is Prinzmetal Angina?

A
  • Typically unpredictable
  • Coronary artery spasm
23
Q

What can you do to treat angina?

A
  • Nitroglycerin/Beta Blockers
  • PRN
  • Sublingual Tablets
  • Spray
  • Transdermal Patch
  • Isosorbide Mononitrate
24
Q

How do you dentally manage an angina patient?

A
  • Schedule AM or early PM appointments
  • Increase oxygen availability
  • Reduce stress and anxiety
  • Keep NTG availability
  • Limit Vasoconstrictor
  • Terminate procedure if patient develops symp;toms
25
Q

How do you manage a patient who has angina in the dental chair mid procedure?

A
  • Terminate procedure
  • Semi-sitting position
  • NTG 0.3 - .5 mg SL Q5 X 3
  • O2 per NC 4 - 6 L/min
  • Monitor vital signs
  • Call EMS
26
Q

What is the max dose of epinephrine in a normal patient?

A

0.2 mg

27
Q

What is the max dose of epinephrine in a cardiac patient?

A

.04 mg

28
Q

What are some tips when using vasoconstrictors in dentistry?

A
  • Use that which is necessary for thorough pain control, both depth and duration
  • Endogenous release in response to pain 300 times higher than in 1 carpule 1:100,000
  • Space anestehtic injections
  • Monitor the patient for physiologic reseponse to epinephrine
  • Aspirate, aspirate, aspirate
29
Q

How long should you wait before conducting dental treatment on a patient who has had an MI?

A
  • Safe to wait 4-6 weeks after MI
  • Adequate revscularization
  • Low risk treadmill test
  • Patient likely on Plavix/ASA
  • Local measures
  • Likelihood of reinfarcation after non-cardiac surgery is low
30
Q

What is the mechanism of action for the Anti-platelet agent Asprin?

A

Cox Inhibitor

31
Q

What is the mechanism of action for the Anti-Platelet drug Clopidogrel (Plaxix)?

A

Inhibits binding of ADP to platelet receptor

32
Q

What is the mechanism of action for the Anti-Platelet Agent Ticagrelor (Brilinta)

A

ADP Receptor Blocker (reversible)

33
Q

What is the mechanism of action for the Anti-Platelet Agent Aggrenox (ASA/Dipyridamole)?

A
  • Cox inhibitor + ADP blocker
34
Q

How would you describe Congestive Heart Failure in 2 words…

A

“Pump Failure”

35
Q

Where will you have edema if you have left side CHF?

A

Pulmonary Edema

36
Q

Where will you have edema for right side CHF?

A

Peripheral Edema

37
Q

During an evaluation, what are considered some minor cardiovascular clinical predictors?

A
  • Advanced age
  • Abnormal ECG
  • Rhythm other than sinus
  • Low functional capacity
  • History of stroke
  • Uncontrolled HTN
38
Q

What are some Intermediate cardiovascular clinical predictors for denitstry?

A
  • Mild angina pectoris
  • Prior MI
  • Compensated or prior CHF
  • Diabetes Mellitus
39
Q

What are some major cardiovascular clinical predictors?

A
  • Unstable coronary sundromes
  • Decompensated CHF
  • Significant arrhythmias
  • Severe VHD
40
Q

What types of operations are considered low risk (<1% event risk)?

A
  • Endoscopic
  • Opthalmologic
  • Breast
  • Other superficial procedures
41
Q

What types of procedures are considred Intermediate Risk (< 5% event rate)?

A
  • Carotid
  • Head & Neck
  • Intraperitoneal
  • Intrathoracic
  • Orthopedic
42
Q

What are considered some High Risk procedures (> 5% event rate)?

A
  • Emergent procedures
  • Aortic and Peripheral Vascular
  • Prolonged Intraperitoneal & Intrathoracic
43
Q

What types of heart conditions are considered “low risk” and would not need formal cardiac evaluation?

A
  • In absence of active ischemia
  • Unstable rhythms
  • Decompensated CHF or
  • Unstable valvular heart disase

Hospital Dentistry - ABGD Oral Boards (10 decks)

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