Lecture 3a: GI disease Flashcards
4 H2 receptor antagonists
Cimetedine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepsid)
Nizatidine (Axid)
2 dental management considerations with the use of cimetidine (tagamet)
Delayed liver metabolism of benzodiazepines
Reversible joint symptoms with pre-existing arthritis
2 dental management considerations with the use of famotidine (pepsid)
Dry mouth
Anorexia
Dental consideration with the use of nizatidine
Potentially increase serum salicylate levels with concurrent aspirin use
5 proton pump inhibitors
Omeprazole (rapid release form; Prilosec, zegarid) Lansoprazole (Prevacid) Pantoprazole (Protoniz, protium) Rabeprazole (Aciphex) Esomeprazole (Nexium)
3 drugs whose absorptions may be reduced by proton pump inhibitors
Ampicillin
Ketoconazole
Itraconazole
2 PPIs that may increase the concentration of benzodiazepines, warfarin, and phenytoin
Omeprazole
Esomeprazole
2 PPIs that may increase the concentration of warfarin
Lansoprazole
Pantoprazole
PPI that may increase the concentration of clarithromycin and warfarin
Rabeprazole
Prostaglandin drug used for the treatment of peptic ulcer
Misoprostol (Cytotec)
2 dental management considerations with the use of prostaglandins for the treatment of peptic ulcer disease
DIarrhea
Cramps
3 drugs to avoid prescribing with a history of peptic ulcer
Aspirin
Aspirin-containing compounds
NSAIDs
Alternative to aspirin or NSAIDs for analgesic prescription
Acetaminophen and compounded acetaminophen products
Analgesic prescription if NSAIDs necessary
COX-2 selective inhibitors in combination with PPI or misoprostol (Cytotec)
3 dentally prescribed drugs who have decreased metabolism and enhanced duration of action due to antacids
Diazepam
Lidocaine
TCAs (tricyclic anti-depressants)
4 drugs that impair absorption of antacids
Tetracycline
Erythromycin
Oral iron
Fluoride
When to give anti-anxiety drugs, antibiotics and dietary supplements with respect to antacid administration
2 hours before or after
Risk of H pylori in dental plaque
Reservoir of infection and re-infection along GIT
3 points of dental management for a patient with peptic ulcer with risk of H pylori infection
Good oral hygiene
Periodic scaling and prophylaxis
Rigorous hygiene measure should be explained if history of peptic ulcer disease/symptomatic/recurrent
Oral complications of using systemic antibiotics
Fungal overgrowth (prescribe antifungal agents)
Oral complications for elderly people with peptic ulcer disease
Vascular malformation of the lips
When can enamel erosion occur for a patient with peptic ulcer?
Pyloric stenosis –> regurgitation (refer to MD if erosion + hx of reflux)
Oral complication of PPIs
Dysgeusia
Oral complications of H2 receptor antagonists
Toxic effect of bone marrow
Infrequent anemia, agranulocytosis, thrombocytopenia
Oral manifestations of agranulocytosis
Mucosal ulcerations
Oral manifestations of anemia
Mucosal pallor
Glossitis (depapillation)
Oral manifestations of thrombocytopenia (secondary to hemolytic anemia)
Gingival bleeding or petechiae
4 extraintestinal manifestations of ulcerative colitis
- Arhtritis
- Erythema nodosum
- Pyoderma gangrenosum
- Eye –> iritis and uveitis
3 extraintestinal manifestations of crohn’s disease
Peripheral arthritis
Erythema nodosum
Aphthous (non-specific ulcer in mouth)
IBD profile that suits in-office dental work (4 points)
Mild dz:
- No symptoms
- No fever
- < 4 bowel movements/d w/ little or no blood
- ESR < 20 mm/hr
IBD profile that requires MD consult (4 points)
Moderate dz or severe
- 6+/d w/ blood
- Fever
- Anemia
- ESR >30
Anti-inflammatory drugs to be avoided in IBD
Aspirin and NSAIDs
2 alternatives to aspirin and NSAIDs for anti-inflammation
Acetaminophen (alone or with opioids)
COX-2 inhibitor + PPI
Antibiotic to be cautious with in IBD and why
Clindamycin (can lead to C. diff infection –> diarrhea; very strong and can trigger pseudomembranous colitis)
Risk of immunosuppressants in IBD
5% pancytopenia
Increased risk of lymphoma and infection (i.e. mono, recurrent fever)
4 points of modification for treatment plan in IBD patient if acute exacerbations
- Determine if anxious / stress / depression
- Urgent dental care only
- Elective dental care rescheduled during period of remission
- Assess current dz severity by taking patient’s temperature and brief ROS (diarrheal bowel movement /d w/ or w/o blood)
2 points of management for a IBD patient on sulfasalazine
- Review patient’s systemic health
* Blood test (CBC & diff)
2 reasons for taking blood tests for IBD patient on sulfasalazine
- Nephrotoxic –> renal function
* Associated with hematologic abnormalities (leukopenia, thrombocytopenia, anemia..)
Profile of patients who are at a higher risk of peptic ulcer disease (4 points)
- > 65 years of age
- Previous hx of ulcer complications
- Prolonged use of NSAIDs
- Concomitant use of anticoagulants, corticosteroids and bisphosphonates
Profile of patients who are at a higher risk of pseudomembranous colitis (4 points)
- > 65 years of age
- Hx of recent hospitalization
- Taking broad-spectrum antibiotics (clindamycin, cephalosporin, ampicillin) or multiple antibiotics
- HIV-seropositive status associated with immune suppression
2 risk factors for IBD flare up
- Symptomatic
* Fever
Consequential risk of having ulcerative colitis
Colon cancer
2 oral complications of ulcerative colitis
Aphthous-like lesions (20%)
Pyostomatitis vegetans
6 areas where aphthous-like lesions can occur in UC patients
Alveolor Labial Buccal mucosa Soft palate Uvula Retromolar trigone
4 areas where pyostomatitis can occur in UC
Labial mucosa
Gingiva
Palate
Tongue (rare)
2 oral complications of Crohn’s disease
- Mucosal ulceration and diffuse swelling of the lip and cheeks (orofacial granulomatosis)
- Oral ulcer ~ linear mucosal ulcers w/ hyperplastic margins or papulonodular ‘’cobblestone’’ proliferations of mucosa (buccal vestibule and soft palate)
3 medications that are the usual cause of pseudomembranous colitis
- Clindamycin (2 % to 20 %)
- Amipicillin or amoxicillin(5 % to 9 % )
- Cephalosporin 3rd generation (<2%)
4 medications that are less frequently involved in the development of pseudomembranous colitis
Maclide
Penicillins
Trimethoprim-sulfamethoxazole (Bactrim, Septra)
Tetracycline
4 medications that are rare causes of pseudomembranous colitis
Aminoglycosides
Antifungal agents
Metronidazole
Vancomycin
Treatment planning modification for patient with pseudomembraous colitis
Delay until resolved
Oral complications and maifestations of pseudomembranous colitis
Possible fungal growth in oral cavity
