Final Sweep 1 Flashcards
Aspirin—irreversible —— inhibitor
cyclooxygenase - can lead to excessive bleeding - antiplatelet drug
ADP receptor inhibitors
(clopidogrel
<20,000
spontaneous bleeding
<50,000
bleed excessively with minor trauma
Vitamin K antagonist -
coumadin/warfarin. Will work on liver to prevent synth of vitamin K clotting factors (yellow circles here)
Von w. diseazse
Missing or defective von Willebrand factor, a clotting protein
Most common bleeding disorder, 1% of US population
VW disease
von Willebrand Factor—
Platelet Adhesion
Binds platelets to exposed collagen (adhesion) Binds platelets to platelets (aggregation)
von Willebrand Factor—
Factor VIII Chaperone
Binds circulating factor VIII
Unbound factor VIII is destroyed
Management of vWD
Desmopressin (DDAVP), replacement therapy with vWF- containing concentrates, and antifibrinolytic therapy
Desmopression (DDAVP)
Stimulates the release of vWF from endothelial cells Increases plasma factor VIII and vWF levels
Antifibrinolytic Therapy
Aminocaproic acid and tranexamic acid Prevent the dissolution of the hemostatic plug Oral and IV formulations
vWD Type 1 and most type 2 can be treated as
outpatient Pre-op: desmopressin
Post-op: antifibrinolytic therapy
Local measures—primary closure if possible
Acetaminophen or acetaminophen-opioid combos for analgesia
Hemophilia A
Inherited —— deficiency
factor VIII
Normal homeostasis requires at least —- factor VIII activity
30%
Anemia Causes:
- decreased RBC production
- blood loss
- destruction of circulating RBCs
Anemia tx Goal = hemoglobin
> 11 g/dL
Sickle cell - ask
Have you had any surgery for sickle? Splenectomy should be a normal thing.
Leukemia
Malignant proliferation of myeloid or lymphoid cells
Acute leukemia -
rapid onset and prog
Leukemia - 3 phases of chemotherapy
Induction & consolidation: ——
Maintenance: —-
hit hard, kill tumor cells
prevent expansion of remaining leukemic cells (patient is in remission at this point)
Chronic Myelogenous:
possible to obtain complete remission
Chronic Lymphocytic:
not curable, treatment has little effect on improving quality of life
Lymphoma
Cancer of
lymphoid organs and tissues Higher grades are more aggressive Hodgkin, non-Hodgkin
Medical Management of Lymphoma
—— to shrink volume —— to remaining mass
Induction chemo
Radiation
Multiple Myeloma
Lymphoproliferative disorder
disorder Overproduction of • malignant plasma cells • Multiple tumorous masses through the skeletal system
WBC concerns
Concerns in Dentistry
Infection Delayed healing Bleeding
• • •
Guidelines for Extraction Patients w/ WBC disorders
Be prepared to treat bleeding Obtain primary closure if possible
Minimum 10-14 days between surgery and start of chemo/radiation
Status Asthmaticus associated with
respiratory infection
Supraventricular Arrhythmias
Sinus nodal disturbances
Disturbances of atrial rhythm
Heart block
Ventricular Arrhythmias
Premature ventricular complexes Ventricular tachycardia Ventricular fibrillation
Ventricular Tachycardia
Rapid, regular ventricular contractions Inadequate ventricular filling/pumping to body
Ejection fraction
35
No nitro if SBC is less than
90
Hypotension is the first sign of
acute adrenal crisis
Anaphylaxis/angioedema - Depressed/absentee vital sign—
0.3-0.5ml 1:1000 epinephrine IM Q5min and CPR prn
NSAIDS can prematurely
close patent ductus arteroisus
Amount of drug excreted in milk ~—-% of maternal dose
1-2
