Dental Implications For Managing Pateints With Systemic Disease

Question 0

What follows vascular response in haemostasis?

Answer 0

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

Question 1

What is the first stage in haemostasis ?

Answer 1

Vascular response where there’s is vasoconstriction

Question 2

What happens once the platelets become activated?

Answer 2

The coagulation cascade begins

Question 3

What is fibrin?

Answer 3

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

Question 4

What are the types of coagulation defects?

Answer 4

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

Question 5

What is haemophilia A?

Answer 5

Factor 8 def

Question 6

How can haemophilia A be classified?

Answer 6

Mild moderate and severe

Question 7

What is mild haemophilia A?

Answer 7

5-40%

Question 8

What is moderate haemophilia a?

Answer 8

2-5%

Question 9

What is severe haemophilia A?

Answer 9

0-1%

Question 10

What is haemophilia B?

Answer 10

Factor 9 missing

Question 11

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

Answer 11

Factor 9 is longer which means can be given daily

Question 12

What is haemophilia C?

Answer 12

Factor 11 def

Question 13

What is the consequence of factor 11 missing?

Answer 13

Rapid fibrinolysis

Question 14

How do you manage haemophlili c?

Answer 14

FFP

Factor 11 and transexamic acid

Question 15

How many types of VWD are there?

Answer 15

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

Question 16

What type of haematological disease is VWD similar to?

Answer 16

Haemophilia A

Question 17

How do you manage VWD in major procured?

Answer 17

Factor 8 infsuin

Question 18

How do you manage VWD in minor procedures?

Answer 18

Desmopressin acetate and transexamic acid

Question 19

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

Answer 19

Regional blocks and IM

Question 20

When is heparin given?

Answer 20

Immediate effect in acute thromboembolism

Question 21

What does warfarin do?

Answer 21

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

Question 22

When would warfarin be administered?

Answer 22

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

Question 23

How do you manage the level of anticoagulant with warfarin?

Answer 23

INR which measures PT time

Question 24

What is the normal PT ?

Answer 24

1

Question 25

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

Answer 25

2.5

Question 26

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

Answer 26

3.5

Question 27

What is the effect of amoxicillin on warfarin?

Answer 27

Be vigilan | 3xg does usually okay

Question 28

What is the effect of metronidazole on warfarin?

Answer 28

Avoided since warfarin rescued by half

Question 29

What is the effect of erythromycin on warfarin?

Answer 29

Unpredictable

Question 30

What is the effect of NSAIDS on warfarin?

Answer 30

Increaed bleeding and GI bleeds

Question 31

What is the effect of daktarkn gell on warfarin?

Answer 31

INR 20

Question 32

T/F the effects of the NOAC are reversible?

Answer 32

F

Question 33

What are the pitons for anti platelet medication?

Answer 33

Ticlopidine Clopidegerel Low doses aspirin Dypyramidole

Question 34

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

Answer 34

Inhibit platelet aggregation to blood vessel wall Last for 7-10 days which is life time of platelet d

Question 35

T/F dypyrimidole effect is reversible?

Answer 35

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

Question 36

What are the examples of NDAIDS?

Answer 36

Ibuprofen Disclofensc NSAIDS

Question 37

T/F ibruprofen and Disclofensc have a reversible effect?

Answer 37

T once with drug is cleared platelet function restored

Question 38

How commonly are NSAIDS used for anti platelet effect?

Answer 38

Not common

Question 39

How long is the normal bleeding time?

Answer 39

2-10 mins longer in women

Question 40

What is the normal platelet count?

Answer 40

150-400 x 10^9

Question 41

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

Answer 41

None | Normal bleeding time

Question 42

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

Answer 42

Increaed and transfusion may be needed

Question 43

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

Answer 43

Risk of spontaneous bleeding

Question 44

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

Answer 44

When platelets less than 100 x 10^9 /l Petechia Ecchymoses Purpura Gingival bleeding Post op bleeding

Question 45

How do you manage AI thrombocytopenia ?

Answer 45

Steroid or splenectomy

Question 46

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

Answer 46

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

Question 47

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

Answer 47

Hip replacement

Question 48

Which type of hip replacement patients should have AB prophylaxis?

Answer 48

``` Those that are susceptible. Including Previous infection RA Immunosuppression Insulin dependant diabetic ```

Question 49

Which AB is the drug of choice for hip replacement?

Answer 49

cephalosporins with clindamycine for penicillin allergy 1g cephadrine orally 1-1.5 hours pre op 600 mg clinidamycin 1 hour pre op