Haematology Flashcards
What local factors can increase a patients risk of developing pseudomembranous candidosis?
- antibiotic use
- dentures
- local corticosteroid use
- xerostomia
What general factors can increase a patients risk of developing pseudomembranous candidosis?
- drugs
- extremes of age
- endocrine: diabetes mellitus or cushing’s syndrome
- immunodeficiency
- nutritional deficiencies
- smoking
What is Atrial Fibrillation?
The electrical impulses in the atria of the heart fire irregularly and chaotically, causing them to quiver or twitch.
What can increase your risk of developing hypertension?
- smoking
- alcohol excess
- being overweight
- lack of exercise
- eating too much salt
How does warfarin work?
antagonistic effect on vitamin K
How does Apixaban work?
inhibitors of activated factor Xa which prevents thrombin generation and thrombus development
What is simvastatin? What is it used for?
- HMG CoA reductase inhibitor
- treats hyperchlosterolaemia
What is Furosemide? why is it used?
- loop diuretic
- used to control resistant hypertension
What is Carvedilol? What is it used for?
- beta blocker
- used for management of hypertension
What would triple therapy management of diabetes suggest? (using 3 drugs)
Difficulty in controlling condition
- condition is severe
How is the soft tissue infection ‘pseudomembranous candidosis’ managed without medication use? Patient has:
- removable denture
- poor OH
- on warfarin
- diabetes
- assess potential reasoning for presence of disease
- use a toothbrush to clean the palate
- short term use of Corsodyl mouthwash
- remove denture at night
- appropriate cleaning of denture
How is the soft tissue infection ‘pseudomembranous candidosis’ managed WITH medication use? Patient has:
- removable denture
- poor OH
- on warfarin
- diabetes
Nystatin should be used
(miconazole is contraindicated as the patient is taking warfarin)
What is INR?
Ratio calculated by:
- taking the prothrombin time of the patient and dividing it by a reference PT plasm value
Your patient is taking warfarin, he is requiring extensive dental treatment. What test must be done & how close to his dental appointment must this be?
Obtain INR at least 24 hours prior to providing care (can be up to 72 hours but not as good)
A patient requiring an extraction has an INR of 4, what treatment are you willing to provide today?
It is not safe to provide extraction today (SDCEP states INR should be less than 4)
You are treating a patient who takes warfarin and is requiring extractions. His INR has stabilised at 3 and he is having his INR checked every 2 weeks. How would you stage the treatment of this patient?
- Consider if the drug regime is short or long term, can the extractions be delayed?
- Plan the treatment for early in the day & week in order to allow time for any management of complications
- Undertake atraumatic technique to dental extractions
- Use appropriate haemostasis measures
- Limit the initial area of surgery & evaluate haemostasis before proceeding
- Advise on use of paracetamol as post-op analgesia (NO NSAIDs)
- Provide full written instructions and give contact number
What local measures can be used to achieve haemostasis in a patient taking warfarin?
- local anaesthetic with vasoconstrictor administered by infiltration or intraligamentary
- sockets packed with oxidised cellulose (Surgicel)
- sutures
- pressure applied to socket using gauze pad
- tranexamic acid mouthwash
- diathermy
How would blood results suggest that a patient has severe haemophilia?
<1% factor present
How would blood results suggest that a patient has moderate haemophilia?
2-5% factor present
How would blood results suggest that a patient has mild haemophilia?
6-40% factor present
A patient attends your practise and lets you know that they have Haemophilia A, what dental procedures must be carried out at a dental clinic associated with a haemophilia centre?
- extractions
- surgical procedures
- subgingival scaling
- anaesthesia requiring IDB or lingual nerve blocks
What medications are commonly used in the treatment of Haemophilia A?
- DDAVP (stimulate release of factor VIII from body stores)
- tranexamic acid (help slow the breakdown of clots)
- factor VIII replacement therapy
Why should the number of times a patient receives factor replacement therapy be reduced when it can be?
- risk of blood borne infections
- risk of local site infection
- risk of inhibitors/antibodies developing
- cost
A haemophilia A patient attends your surgery with facial swelling and pain, you determine that he needs an extraction but he has not visited the haemophilia unit in years. What is your course of treatment?
Prescribe a course of antibiotics until the proper assessments and planning can be made in conjunction with the haemophilia unit
