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Oral Board - medical history > HTN, IE > Flashcards

HTN, IE Flashcards

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1
Q

Cardiac conditions associated with the higher risk of Infectious Endocarditis for which prophylactic antibiotic with dental procedures is recommended

A

According to the current AHA guideline in 2021,
prophylactic antibiotics are recommended
1. prosthetic cardiac valve or material
2. previous or recurrent infectious endocarditis
3. congenital heart disease
4. cardiac transplantation recipient who develop cardiac valvulopathy

  • Prophylactic abx is no suggested for pacemaker, hemodialysis, coronary artery stent.
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2
Q

Dental procedures in pts with cardiac condition for which IE prophylaxis is recommended

A

All dental procedures that involve manipulation of 1. gingival tissue or 2. periapical tissue or 3. perforation of the oral mucosa

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3
Q

Classification of Blood Pressure in adults

A

normal 120/80
elevated 120-129 or <80
stage 1 HTN 130-139 or 80-89
stage 2 HTN 140/90 - 180/110
(>=140 or >=90)
uncontrolled HTN >180/110
HTN emergency >180/120

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4
Q

Dental management based on blood pressure

A

Pts with a BP 180/110 may receive any necessary dental tx; consider BP monitoring during tx for stage 2 HTN (140/90-180/110).
Pts with a BP >180/100 (severely uncontrolled HTN) should defer elective tx.

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5
Q

Chlorothiazide (Diuril), Hydrochlorothiazide (HCTX)
Furisemide (Lasix), Bumetanide (Bumex)
Amiloride (Midamor)

A

diuretics

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6
Q

Propranolol (Inderal)

A

nonselective beta blocker
1. avoid prolonged use of NSAIDs - may reduce antihypertensive effects
2. drug interaction with epinephrine - potential increase in BP (use maximum of 0.036mg of epi)

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7
Q

Lisinopril

A

Angiotensin-Converting Enzyme (ACE) inhibitors

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8
Q

Losartan

A

Angiotensin Receptor Blockers

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9
Q

Amlodipine (Norvasc), Nifedipin

A

Calcium Channel Blockers
1. gingival overgrowth
2. avoid macrolide abx (erythromycin, clarithromycin, not azithromycin) - can raise plasma levels of CCBs resulting in hypotension

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10
Q

Doxazosin (Catapres), Terazosin (Hytrin)

A

alpha1-adrenergic blockers

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11
Q

Clonidine (Catapres), Methyldopa (Aldomet), Reserpine

A

alpha2-adrenergic agonists

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12
Q

Hydralazine, Minoxidil (Loniten)

A

direct vasodilators

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13
Q

HTN - antibiotics

A

Avoid erythromycin, clarithromycin (not azithromycin) with CCBs because the combination can enhance hypotension

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14
Q

HTN-anxiety

A
  1. Use stress reduction protocol
  2. Consider the use of pre-op oral sedation (short-acting benzodiazepine 1hr before procedure
  3. Consider the use of N2O inhalation sedation intraoperatively (Stanly?)
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15
Q

HTN-anesthesia

A
  1. Ensure profound LA
  2. Avoid excessive amounts of epi in pts who take nonselective beta blockers, which can cause a spike in BP and appears to be dose dependent
  3. limit to 2 carpules of 1:100K epi
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16
Q

HTN-BP

A

For pts with starge 2 HTN (BP>140/90), periodic BP monitoring during tx may be advisable.

17
Q

HTN-capacity to tolerate care

A

Pts with HTN <180/110 may receive routine dental care.
BP>180/120 is HTN emergency.

18
Q

HTN-chair position

A
  1. Avoid rapid position changes d/t possibility of antihypertensive drug-associated orthostatic hypotension.
  2. After the procedure, allow pt to sit in upright for several mins before dismissing to avoid dizziness.
19
Q

HTN-drug

A

Avoid long-term (>2wks) use of NSAIDs because these agents may interfere with effectiveness of antihypertensive drugs.

20
Q

HTN-emergencies

A

activate EMS, provide CPR, use AED, if needed

21
Q

AHA antibiotics regimes for dental procedures
1. oral
2. unable to take oral meds
3. allergic to PCNs
4. allergic and unable to take oral meds

A
  1. AMX 2g
  2. Ampicilline 2g IM/IV
    Cefazolin or Ceftriaxone 1g IM/IV
  3. Azithromycine or Clarithromycin 500mg
    Doxycycline 100mg
  4. Cefazolin or Ceftriaxone 1g IM/IV
  • Caphalosporins should not be used in an individuals with a history of anaphylaxis, angioedema, or urtecaria with penicillne or ampicillin

Oral Board - medical history (5 decks)

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