Chapter 1: The Medically Compromised Patient In The Dental Clinic Flashcards
The factors that define a medically compromised patient?
- High medical risk.
- Difficulty of management (in technique or behaviour).
- Oral lesions that are characterstic to the systemic disease.
- Interactions between the systemic disease and the dental treatment.
ASA I?
- healthy patient, good at tolerating stress.
- no modifications necessary.
- null or minimum anxiety.
- NON-SMOKER.
ASA II?
- mild systemic disease.
- healthy with maximum anxiety.
- adjust the treatment to their necessity.
- type I diabetes, epilepsy, asthma, advanced age, pregnancy, allergies, smoker.
ASA III?
- severe systemic disease, not disabling.
- minimise risk during treatment.
- angina pectoris of long evolution, stroke longer than 6 months ago, COPD, epilepsy or asthma badly controlled.
ASA IV?
- disabling disease.
- necessary modifications and treat in hospital.
- angina pectoris or recent stroke less than 6 month ago, severe arrhythmia, severe COPD, severe hypertension, uncontrolled diabetes, uncontrolled epilepsy.
ASA V?
- dying patient.
- palliative dental treatment.
- advanced cancer patients, terminal liver or kidney pathologies, infectious patients.
Side effects of NSAIDs?
GI damage.
Lower analgesic dose, higher anti-inflammatory dose, absorption with arginine speeds up its absorption? Which NSAID?
Ibuprofen
Dose of ibuprofen?
Adults: 400-600mg/ 8-12 hours.
Children: 5-10mg/kg/dose 6-8 hours.
Gold standard analgesic and antipyretic, doesn’t cause gastric irritation, but high doses cause hepatoxcity, not an inflammatory analgesic. Which NSAID?
Paracetamol
Doses of paracetamol?
Adults: 500mg-1gr/ 4-6 hours.
Children: 10-15mg/kg 4-6 hours.
Analgesic and antipyretic, but withdrawn due to onset of agranulocytosis?
Metamizole (dipyrone).
Doses of Metamizole?
500mg/ 6-8 hours
Which NSAID doesn’t interfere with anticoagulant levels, and is very gastro tasting?
Diclofenac
Doses of diclofenac?
50mg/ 8 hours (With food)
Risk factors in gastropathy for NSAIDs?
- over 60 years old.
- previous ulcerous history.
- high doses of NSAIDs.
- severe illnesses.
- treatment associated with anticoagulants.
- treatment associated with corticosteroids (at doses > 10md/day).
Side effects of NSAIDs?
- Alteration of renal function.
- Hepatotoxicity.
- Anti-platelet hemorrhagic complications.
- Forbidden in pregnancy.
- Emergence of allergic reaction.
- Reye syndrome in children with viral disease after intake of aspirin.
Associated with non-opioid analgesic, potentiates its effect, produces constipation. Which narcotic analgesic?
Codeine
Association of codeine?
500mg paracetamol, or 400-600mg ibuprofen.
Doses of codeine?
30mg/ 4-6 hours.
Dizziness and nausea. Which narcotic analgesic?
Tramadol adolonta-zaldiar
Association of tramadol?
37.5mg tramadol with 375mg paracetamol.
Doses of tramadol?
50-100mg/ 6-8 hours.
Which anti-inflammatory is NOT used with diabetics?
Glucocorticoids, because they increase glucose levels in the blood.
Glucocorticoids should be used:
- minimum dosage required for process control.
- during the shortest possible time.
- with the largest possible dose interval.
- with the fastest possible reduction.
Side effects of glucocorticoids?
- gastro toxicity.
- alteration of glucose metabolism.
- suppression of the hypothalamic-hypophyseal axis- adrenal.
What are glucocorticoids associated and prescribed with?
Antibiotics. To speed up healing and reduce the swelling and inflammation from an infection.
What are glucocorticoids used to treat?
Asthma, COPD, allergies.
The glucocorticoids with the highest anti-inflammatory potential are?
Dexamethasone (25).
Betamethasone (25-30).
Do ATB eradicate the infection or the pain?
No, they help by making it not spread. The immune system removes the infection.
ATB prophylaxis is given for?
2-3 days before, 5-7 days after the treatment.
Antibiotic prophylaxis is given to which patients?
- healthy patient.
- patient at risk.
- prophylaxis of bacterial endocarditis.
- prophylaxis ATB in patients with total joint prosthesis.
+ in hereditary hemorragial telangiectasia or Enf. From rendu osler weber.
Infection prevention of articular prosthesis?
- prosthesis < 2 years.
- history of infections.
- type I diabetes.
- malnutrition.
- haemophilia.
- systemic arthropathies (rheumatoid arthritis, lupus).
The penicillins ATB include?
- amoxicillin
- amoxicillin with clavulanic acid.
- ampicillin.
(-Cillin).
Same as beta lactam ATBs.
Penicillins are:
Wide spectrum and bactericidal.
The imidazole ATBs are?
- metronidazole (flagyl).
- metronidazole + spiramycin (rhodogil).
- (Azoles).