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Oral Med > Dental Implications For Managing Pateints With Systemic Disease > Flashcards

Dental Implications For Managing Pateints With Systemic Disease Flashcards

0
Q

What follows vascular response in haemostasis?

A

Platelet becomes activated once bound to the VWF at the damaged tissue site and adhesion and aggregation which produced an unstable clot

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1
Q

What is the first stage in haemostasis ?

A

Vascular response where there’s is vasoconstriction

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2
Q

What happens once the platelets become activated?

A

The coagulation cascade begins

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3
Q

What is fibrin?

A

It is a natrual anticoagulant controlled by fibrinolysis which give the clot stability

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4
Q

What are the types of coagulation defects?

A 
Genetic: haemophilia A, B, C and Von Willebrands
Aquired: 
drugs: warfarin , heparin, NOAC
Liver disease
Vit K def
DIC
Blood transfusion
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5
Q

What is haemophilia A?

A

Factor 8 def

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6
Q

How can haemophilia A be classified?

A

Mild moderate and severe

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7
Q

What is mild haemophilia A?

A

5-40%

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8
Q

What is moderate haemophilia a?

A

2-5%

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9
Q

What is severe haemophilia A?

A

0-1%

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10
Q

What is haemophilia B?

A

Factor 9 missing

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11
Q

How long is the glad life for factor 9 compared to factor 8?

A

Factor 9 is longer which means can be given daily

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12
Q

What is haemophilia C?

A

Factor 11 def

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13
Q

What is the consequence of factor 11 missing?

A

Rapid fibrinolysis

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14
Q

How do you manage haemophlili c?

A

FFP

Factor 11 and transexamic acid

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15
Q

How many types of VWD are there?

A

1 (mild)
2 and 3 (most symptomatic )
Pseudo VWD

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16
Q

What type of haematological disease is VWD similar to?

A

Haemophilia A

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17
Q

How do you manage VWD in major procured?

A

Factor 8 infsuin

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18
Q

How do you manage VWD in minor procedures?

A

Desmopressin acetate and transexamic acid

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19
Q

What types of injections must you avoid in people with genetic haematological diseases?

A

Regional blocks and IM

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20
Q

When is heparin given?

A

Immediate effect in acute thromboembolism

21
Q

What does warfarin do?

A

Impairs synthesis of VIt K dependant. 2, 7, 9, 10

22
Q

When would warfarin be administered?

A 
Short term:
CABG 2 months 
Prophylaxis to prevent DVT 3 months
MI 3 months
Established DVT 3 mths
Xenograft cardiac valves 3 months
PE 3-6 months

Long term
Recurrent DVT
RHD and AF
Cardiac prosthetic valves and arterial grafts

23
Q

How do you manage the level of anticoagulant with warfarin?

A

INR which measures PT time

24
Q

What is the normal PT ?

A

1

25
Q

What is the PT time in DVT, PE and AF?

A

2.5

26
Q

What is the PT in in recurrent DVT and PE and pros heart valves ?

A

3.5

27
Q

What is the effect of amoxicillin on warfarin?

A

Be vigilan

3xg does usually okay

28
Q

What is the effect of metronidazole on warfarin?

A

Avoided since warfarin rescued by half

29
Q

What is the effect of erythromycin on warfarin?

A

Unpredictable

30
Q

What is the effect of NSAIDS on warfarin?

A

Increaed bleeding and GI bleeds

31
Q

What is the effect of daktarkn gell on warfarin?

A

INR 20

32
Q

T/F the effects of the NOAC are reversible?

A

F

33
Q

What are the pitons for anti platelet medication?

A

Ticlopidine
Clopidegerel
Low doses aspirin
Dypyramidole

34
Q

What is the effect of aspirin , ticlopidind and clopodefrel? How long do they last for?

A

Inhibit platelet aggregation to blood vessel wall

Last for 7-10 days which is life time of platelet d

35
Q

T/F dypyrimidole effect is reversible?

A

T

Since only acts directly on enzyme In platelets and vessel cell walls

36
Q

What are the examples of NDAIDS?

A

Ibuprofen
Disclofensc
NSAIDS

37
Q

T/F ibruprofen and Disclofensc have a reversible effect?

A

T once with drug is cleared platelet function restored

38
Q

How commonly are NSAIDS used for anti platelet effect?

A

Not common

39
Q

How long is the normal bleeding time?

A

2-10 mins longer in women

40
Q

What is the normal platelet count?

A

150-400 x 10^9

41
Q

What is the effect of having only 100-150 x 10^9 platelets?

A

None

Normal bleeding time

42
Q

What is the effect of having 20-100x 10^9 platelets on bleeding time?

A

Increaed and transfusion may be needed

43
Q

What is the effect of having less than 20 x 10^9 platelets on bleeding time?

A

Risk of spontaneous bleeding

44
Q

When is thrombocytopenia significant? And what are the signs of this?

A

When platelets less than 100 x 10^9 /l

Petechia
Ecchymoses
Purpura
Gingival bleeding

Post op bleeding

45
Q

How do you manage AI thrombocytopenia ?

A

Steroid or splenectomy

46
Q

What can be given prophylictcally for people with high risk for IE?

A

Corsodyl mouthwash o.2% held 10ml held in mouth for 1min

47
Q

In which type of patients should AB prophylaxis be provided other than those at risk form IE?

A

Hip replacement

48
Q

Which type of hip replacement patients should have AB prophylaxis?

A 
Those that are susceptible. 
Including 
Previous infection
RA
Immunosuppression 
Insulin dependant diabetic
49
Q

Which AB is the drug of choice for hip replacement?

A

cephalosporins with clindamycine for penicillin allergy

1g cephadrine orally 1-1.5 hours pre op
600 mg clinidamycin 1 hour pre op

Oral Med (31 decks)

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