Dr.BrenDr.PatExam1-Neuro/Blood Flashcards
Parkinson’s Disease: Medications cause _______….increased caries/fungal infections
xerostomia
Parkinson’s Disease: Difficulty with __________ (breaking, swallowing or falling out)
removable appliances
Parkinson’s Disease: ______ changes impact oral hygiene, dental treatment ease, swallowing (increased risk of aspiration)
Motor
Parkinson’s Disease: _________ (levodopa) – affects jaw as well
Dyskinesias
Parkinson’s Disease: Cognitive impairment…Take meds _________ prior to appt (peak response period), brief visits
60-90 minutes
What condition is responsible for 15-20% of ALL STROKES??
Atrial Fibrillation
What is the biggest risk associated with Atrial Fibrillation?
ischemic stroke
What are the two main antithrombotic treatments for A-Fib?
1.ASA and 2.Warfarin
How long do we wait after a STROKE, TIA, or reversible near defect? HOWEVER: A NEW STUDY showed Tx can be safely administered within _______ of CVA “as long as pts are kept under optimal medical surveillance.”
6 months….a few weeks
What is the most common inherited clotting disorder?
hemophilia A
What is another name for hemophilia B? Which clotting factor is involved?
Christmas disease…factor IX
Interesting: inherited blood disorders lack ____ coagulation factors where as acquired disorders lack ____ coagulation factors…
inherited - just 1…aquired - multiple
KNOW THIS KOLD: What are the 4 vitamin K dependent clotting factors made in the liver?
1972….lol II, VII, IX, and X
So Vit K affects clotting factor VII, which system is this found in? (extrinsic, intrinsic, common)
VII is EXTRINSIC
So Vit K affects clotting factor IX, which system is this found in? (extrinsic, intrinsic, common)
IX is INTRINSIC
So Vit K affects clotting factor X, which system is this found in? (extrinsic, intrinsic, common)
common
So Vit K affects clotting factor II, which system is this found in? (extrinsic, intrinsic, common)
common
What is another name for clotting factor II?
thrombin
What is another name for clotting factor I?
fibrin
Which blood test assesses the intrinsic clotting system?
aPPT
Which blood test assesses the extrinsic clotting system?
PT (INR)
Here we go: what does aPPT stand for?
activated Partial ThromboPlastin Time
Which condition is an aPPT typically used for?
Hemophilias
Which clotting factors are tested in an aPPT?
(intrinsic)…VIII, IX, XI, XII
Which test is a great indicator for those Vit K dependent clotting factors?
PT
What does PT stand for?
Prothrombin Time
Which clotting system does the PT gauge?
Extrinsic
Which factors are assessed with a PT?
VII, V, X, Prothrombin II, Fibrinogen I (notice no IX!!)
Which test do you use to check the effectiveness of warfarin?
PT (INR)
Which test do you use to assess the effectiveness of aspirin?
Platelet count
What does a platelet count assess?
hemostasis
What is a great question to assess if a patient has a bleeding disorder?
Do you bleed or bruise easily?
Which two conditions warrant a risky level of warfarin?
prosthetic heart valves and DVT
What are the MAGIC numbers for INR and PT?
INR LESS THAN 3.5 and PT LESS THAN 20 seconds
What is the best medication for post op pain control with coumadin?
minimal does of acetominophen w. codeine
What is the SELF LIFE for an INR for you to consider it valid?
24 hours!
What are two substances that ENHANCE the anti-coagulation effects of warfarin?
EtOH and Cranberry juice
What type of food can COMBAT the effects of warfarin?
Vit K rich foods-GREENS
What is the effect of ACETAMINOPHEN on INR?
INCREASES INR MARKEDLY (causes thinner blood) (higher INR = thinner blood)
WHY is ASA/NSAIDS contraindicated with Warfarin use?
GI Bleed…NO increase in INR!! VERY INTERESTING!!
Which antibiotics are best for patients on Warfarin? (no effects on INR)
Pen V or Clindamycin
INR values: at ASDOH we stay under _____. DUMB EXAM QUESTION: What is the range a patient with a Hx of DVT might be in?
3.5…..2.5-3.5
FRAME THIS AND PUT IT ON YOUR WALL! “Clinician’s judgment, experience, _______, and accessibility to appropriate bleeding management strategies are all important components in any treatment decision.”
training
ASA, TicLid, and Plavix…Primary prophylaxis of coronary _______….Secondary prevention of adverse thromboembolic events in patients with a history of coronary thrombosis, stroke and unstable _____
thrombosis… angina (an GIN Ah)
With anti platelet therapy: Increased clinical risk of bleeding with ASA or NSAIDS, alcohol use, advanced ____,
liver disease and existing coagulopathies.
age
With Anti-platelet therapy: Little or no indication to ______ antiplatelet drugs for dental procedures
interrupt
Not necessary to interrupt low-dose ______ therapy (____mg/day or less) for SIMPLE dental extractions
ASPIRIN…100mg
For patients with a DES (Drug Eluding Stint), Premature discontinuation of antiplatelet therapy greatly _______ the risk of stent thrombosis, MI & death
INCREASES
HOW long is the COMBINATION of ASA and PLAVIX post stint placement?
12 months
How long do we postpone Elective dental surgery after a Drug Eluding Stent placement? How about a Bare Metal Stint?
DES-1 year…Bare metal-1 month
What are three of the NOA (New Oral Anticoagulants) brand names?
Pradaxa, Xeralto, Eliquis
Which system and clotting factor does Pradaxa effect?
Direct thrombin inhibitor (common, factor II)
Which system and clotting factor do Xeralto, Eliquis, and Savaysa act on?
Factor Xa..beginnnign of common pathway
What is the biggest unknown with the NOA’s?
there is no REVERSAL AGENT!!
It does not appear that it is necessary to discontinue the use of dabigatran (_______) in patients with normal renal function and without other risks for impaired hemostasis, especially if adjunctive local hemostatic measures† are used when indicated.”
PraDaxa
