CMS Flashcards
what types of disease can arthersclerosis cause?
ischaemic heart disease
peripheral vascular disease
cerebrovascular disease
renovascular disease
what are the biggest risks of heart disease?
smoking high cholesterol high bp diabetes genes
what is primary hypertension?
caused by obesity, alcohol, high salt diet, genetics
what is secondary hypertension?
endocrine - excess hormones
renal - kidneys not working
what drugs are used in the tx of hypertension?
B blockers duiretics ACE inhibitors angiotensin 2 inhibitors Ca channel blockers
what are the types of ischaemic heart disease?
angina
acute coronary syndromes
heart failure
arrhytmias
what are the types of peripheral vascular disease?
chronic - intermittent claudication
acute - ischaemic limb
what medications manage angina?
antiplatelets
statins
symptom relief - nitrates, calcium antagonists, B blockers
why can heart failure happen?
IHD
hypertension
valvular heart disease
alcohol excess
why should NSAIDs be avoided in heart failure?
fluid retention
what is regurgitation?
stenosis?
- leaky valve
- narrow valve
what do patients with valvular disease at risk of?
what is it caused by?
infective endocarditis
strep viridans
staph aureus
what is AF associated with? what does it cause an increased chance of?
cerebrovascular disease
Stroke
what is SVT?
tachyarrhytmia - too fast and irregular
adenosine
what is bradyarrhytmia?>
too slow
what is Ventricular arrythmia?
tachycardia
med emergency
what oral side effects can statins cause?
Taste disturbance
lichenoid reaction
what oral side effects can beta blockers cause?
lichenoid reactions
what oral side effects can nifedipine cause?
hyperplasia
what oral side effects can ACE inhibitors cause?
taste disturbance
lichen planus
what oral side effects can nicorandil cause?
painful oral ulcers
what oral side effects can antihypertensives cause?
dry mouth
in what situations would you not treat a cardiac patient?
1 month post MI
unstable angina
why should you be cautious with adrenaline?
interacts with vasoconstrictors
what are the links of IE and dentistry?
no association with dental procedures
reg TB as much of a risk
prophylaxis not cost effective
what patients are at risk of IE?
valvular heart disease
valve replacement
structural congenital heart disease
prev IE
what oral side effects can anaemia cause?
recurrent apthous stomatitis - minor, major, herpetiform
what oral side effects can type 2 diabetes cause?
acute pseudomembranous candidosis
what is burning mouth syndrome and what can it be associated with?
idiopathic burning and oral discomfort
amitryptiline, gabapentin
if a lichen planus pt has an oral lesion what percent chance do they have a skin lesion?
if they have a skin lesion percent chance of an oral lesion?
25-30%
70-75%
opthalmic disease can be associated with what orally?
mucous membrane pemphigoid
what can GI disease be associated with orally?
recurrent oral ulceration
what can HIV/AIDS present with orally?
hairy leukoplakia
kaposi’s sarcoma
candidosis
what is the definition of MRONJ?
current or prev tx with bisphosphonates or anti angiogenic agents
exposed bone or bone that can be probed through an intra oral or extra oral fistula in the maxillofacial region that has persisted for 8 or more weeks
no history of radiation to the jaws or obvious metastatic jaw disease
what meds can cause MRONJ?
bisphosphonates
Rank ligand inhibitor - denosumab
antiangiogenics
what is the action of bisphosphonates?
used orally to tx? IV to tx?
deposit in bone and persist inhibit formation, recruitment and function of osteoclasts increase apoptosis orally - osteoporosis iv - cancer
what is the action of denosumab?
ab against RANK ligand
inhibits osteoclast function
inhibits bone resorption
what happens during MRONJ?
reduced bone turnover reduced vascularity inflammation and infection adverse effects on soft tissues immune dysfunction
what risks increase the chance of MRONj?
potency of drug
route of administration
antiangiogenic and bisphosphonate
systemic corticosteroids, immunosuppressants, chemo and radio
what is stage 0 MRONJ?
no clinical evidence
non specific symptoms or clinical radiographic findings
what is stage 1 MRONJ?
exposed necrotic bone or fistulas that probe to bone
asymptomatic
what is stage 2 MRONJ?
exposed bone that is nectrotic or fistulas that probe to bone
associated with infections
pain/erythema
what is stage 3 MRONJ?
same as stage 2 with necrosis extending past alveolar bone pathological fracture extra oral fistula oral antral or nasal communication
what is the tx of the stages of MRONJ?
0 - nil
1- antimicrobial rinses
2- antimicrobial rinses with systemic antibiotics and analgesics and debridement
in pregnancy avoid high doses of what antibiotic?
metronidazole
caution with what local anaesthetic in early pregnancy?
mepivicaine
oral manifestations during pregnancy are secondary to?
increased vascular permeability
reduced immunocompetence
increased infection susceptibility
why is gingivitis likely to happen during pregnancy?
progesterone
when is a pregnancy epulis likely to happen?
1st trimester
what is pytalism?
linked to nausea
settles in 12-14 weeks
why is there an increased erosion risk during pregnancy?
secondary to vomitting
what is the link with gestational diabetes and perio?
9x more likely to suffer from perio disease
perio is associated with what in terms of pregnancy?
pre term birth weight
pre eclampsia
low birth weight
what is asthma?
reversible small airway obstruction
what drugs are used to tx asthma?
inhaled beta agonists - sabutamol
inhaled corticosteroids
combo inhalers
anti leukotrienes
avoid prescribing what drug with asthma?
NSAIDs
what side effects can asthmatic drugs cause?
oral candidiosis
altered taste
dry mouth
what is COPD?
airway obstruction that is not fully reversible
what is pneumonia?
lung infection
what is a pneumothorax?
leak of air into the pleural space
what is sleep apnoea?
failure of upper airways during sleep
what is intersitial lung disease?
inflammation of lung tissue
restrictive lung defect
avoid sedation
what is CF?
gene defect = abnormal cl channels
highly viscous mucous - lungs, pancreas, gonads
avoid what in dentistry with CF patients?
immunosuppressants
sedation
what are too big cells? too small? increased white blood cells? reduced white blood cells? increased platelets? reduced platelets?
macrocytic microcytic leukocytosis leukopenia thrombocythaemia thrombocytopenia
what are the causes of anaemia?
lack of raw materials - vit b12, iron, folate
production problems - erythropoietin lack, bone marrow failure
longevity problem - haemolysis
what is neutropenia?
white cell deficiency
BM failure, autoimmune
candida, herpes simplex
what is leukeamia?
proliferation of immature cells in blood and bone marrow
what is lymphoma?
proliferation of cells in nodes/spleen, liver, bone marrow
what can haematological conditions cause orally?
atypical infections
bleeding
lymphadenopathy
gum infiltraion
what is the coagulation cascade?
vessel injury - vasoconstriction, platelet aggregation, coagulation cascade = clot formation
what can interfere with coagulation cascade?
protein deficiency - liver disease/malnutrition
congenital - haemophilia, von wilebrands
what is haemophilia?
absent or low factor VIII, IX
what is von willebrands?
function problem of factor VIII
what are types of coagulopathy?
acquired - alcoholics, thrombocytopenia, drugs
congenital - haemophilia A/B, von willebrands, antiphsopholipid
what drugs should be avoided with idiopathic thrombocytopenic purpura?
NSAIDS
aspirin
what can anaemia cause orally?
angular chelitis
candidiasis
minor apthous ulcers
how does warfarin work?
antagonises Vit K
48-72 hours to develop
reversed by vit K
what happens if INR is over 1?
longer clotting time
what should be established about the INR prior to tx?
assessed within 72 hours
stable
<4
what is INR controlled by warfarin influenced by?
irregular tablet taking
high vit K
alcohol indigestion
cranberry juice
what are types of antiplatelets?
aspirin
clopidogrel
what are NOAC’s and what are they used for?
rivaroxaban
prophylaxis of venous thromboembolism`
dentally, what should we be aware of with upper GI problems?
NCTSL - acid reflux
osoephagus/stomach - caution with NSAIDs
oral ulceration/chronic blood loss anaemia
what is coeliac?
multi system autoimmune problem not an allergy
Small intenstinal venous atrophy
what are oral feautres of malabsorption?
iron, folate deficiency
oral ulceration
caution with what drug an coeliac pts?
bisphosphonates
what is IBD?
crohns - entire GI tract, non continuous lesions
UC - large intestine - continuous
oral features of crohns disease?
ulcers facial labial swelling mucosal tags cobblestone mucosa angular chelitis
what are the stages of swallowing?
pre swallow oral prep oral stage pharyngeal stage oseophageal stage
with aging how is swallowing affected?
delayed pharyngeal elicitation
loss of muscle reserve
increased laryngeal penetration
what are causes of dysphagia?
dementia CVA poor oh thrush parkinsons head injruy degenerative neurological disorders burns facial trauma