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Oral Medicine > Lecture 3a: GI disease > Flashcards

Lecture 3a: GI disease Flashcards

1
Q

4 H2 receptor antagonists

A

Cimetedine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepsid)
Nizatidine (Axid)

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2
Q

2 dental management considerations with the use of cimetidine (tagamet)

A

Delayed liver metabolism of benzodiazepines

Reversible joint symptoms with pre-existing arthritis

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3
Q

2 dental management considerations with the use of famotidine (pepsid)

A

Dry mouth

Anorexia

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4
Q

Dental consideration with the use of nizatidine

A

Potentially increase serum salicylate levels with concurrent aspirin use

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5
Q

5 proton pump inhibitors

A 
Omeprazole (rapid release form; Prilosec, zegarid)
Lansoprazole (Prevacid)
Pantoprazole (Protoniz, protium)
Rabeprazole (Aciphex)
Esomeprazole (Nexium)
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6
Q

3 drugs whose absorptions may be reduced by proton pump inhibitors

A

Ampicillin
Ketoconazole
Itraconazole

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7
Q

2 PPIs that may increase the concentration of benzodiazepines, warfarin, and phenytoin

A

Omeprazole

Esomeprazole

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8
Q

2 PPIs that may increase the concentration of warfarin

A

Lansoprazole

Pantoprazole

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9
Q

PPI that may increase the concentration of clarithromycin and warfarin

A

Rabeprazole

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10
Q

Prostaglandin drug used for the treatment of peptic ulcer

A

Misoprostol (Cytotec)

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11
Q

2 dental management considerations with the use of prostaglandins for the treatment of peptic ulcer disease

A

DIarrhea

Cramps

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12
Q

3 drugs to avoid prescribing with a history of peptic ulcer

A

Aspirin
Aspirin-containing compounds
NSAIDs

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13
Q

Alternative to aspirin or NSAIDs for analgesic prescription

A

Acetaminophen and compounded acetaminophen products

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14
Q

Analgesic prescription if NSAIDs necessary

A

COX-2 selective inhibitors in combination with PPI or misoprostol (Cytotec)

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15
Q

3 dentally prescribed drugs who have decreased metabolism and enhanced duration of action due to antacids

A

Diazepam
Lidocaine
TCAs (tricyclic anti-depressants)

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16
Q

4 drugs that impair absorption of antacids

A

Tetracycline
Erythromycin
Oral iron
Fluoride

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17
Q

When to give anti-anxiety drugs, antibiotics and dietary supplements with respect to antacid administration

A

2 hours before or after

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18
Q

Risk of H pylori in dental plaque

A

Reservoir of infection and re-infection along GIT

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19
Q

3 points of dental management for a patient with peptic ulcer with risk of H pylori infection

A

Good oral hygiene
Periodic scaling and prophylaxis
Rigorous hygiene measure should be explained if history of peptic ulcer disease/symptomatic/recurrent

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20
Q

Oral complications of using systemic antibiotics

A

Fungal overgrowth (prescribe antifungal agents)

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21
Q

Oral complications for elderly people with peptic ulcer disease

A

Vascular malformation of the lips

22
Q

When can enamel erosion occur for a patient with peptic ulcer?

A

Pyloric stenosis –> regurgitation (refer to MD if erosion + hx of reflux)

23
Q

Oral complication of PPIs

A

Dysgeusia

24
Q

Oral complications of H2 receptor antagonists

A

Toxic effect of bone marrow

Infrequent anemia, agranulocytosis, thrombocytopenia

25
Q

Oral manifestations of agranulocytosis

A

Mucosal ulcerations

26
Q

Oral manifestations of anemia

A

Mucosal pallor

Glossitis (depapillation)

27
Q

Oral manifestations of thrombocytopenia (secondary to hemolytic anemia)

A

Gingival bleeding or petechiae

28
Q

4 extraintestinal manifestations of ulcerative colitis

A
  • Arhtritis
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Eye –> iritis and uveitis
29
Q

3 extraintestinal manifestations of crohn’s disease

A

Peripheral arthritis
Erythema nodosum
Aphthous (non-specific ulcer in mouth)

30
Q

IBD profile that suits in-office dental work (4 points)

A

Mild dz:

  • No symptoms
  • No fever
  • < 4 bowel movements/d w/ little or no blood
  • ESR < 20 mm/hr
31
Q

IBD profile that requires MD consult (4 points)

A

Moderate dz or severe

  • 6+/d w/ blood
  • Fever
  • Anemia
  • ESR >30
32
Q

Anti-inflammatory drugs to be avoided in IBD

A

Aspirin and NSAIDs

33
Q

2 alternatives to aspirin and NSAIDs for anti-inflammation

A

Acetaminophen (alone or with opioids)

COX-2 inhibitor + PPI

34
Q

Antibiotic to be cautious with in IBD and why

A

Clindamycin (can lead to C. diff infection –> diarrhea; very strong and can trigger pseudomembranous colitis)

35
Q

Risk of immunosuppressants in IBD

A

5% pancytopenia

Increased risk of lymphoma and infection (i.e. mono, recurrent fever)

36
Q

4 points of modification for treatment plan in IBD patient if acute exacerbations

A
  • 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)
37
Q

2 points of management for a IBD patient on sulfasalazine

A
  • Review patient’s systemic health

* Blood test (CBC & diff)

38
Q

2 reasons for taking blood tests for IBD patient on sulfasalazine

A
  • Nephrotoxic –> renal function

* Associated with hematologic abnormalities (leukopenia, thrombocytopenia, anemia..)

39
Q

Profile of patients who are at a higher risk of peptic ulcer disease (4 points)

A
  • > 65 years of age
  • Previous hx of ulcer complications
  • Prolonged use of NSAIDs
  • Concomitant use of anticoagulants, corticosteroids and bisphosphonates
40
Q

Profile of patients who are at a higher risk of pseudomembranous colitis (4 points)

A
  • > 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
41
Q

2 risk factors for IBD flare up

A
  • Symptomatic

* Fever

42
Q

Consequential risk of having ulcerative colitis

A

Colon cancer

43
Q

2 oral complications of ulcerative colitis

A

Aphthous-like lesions (20%)

Pyostomatitis vegetans

44
Q

6 areas where aphthous-like lesions can occur in UC patients

A 
Alveolor
Labial
Buccal mucosa
Soft palate
Uvula
Retromolar trigone
45
Q

4 areas where pyostomatitis can occur in UC

A

Labial mucosa
Gingiva
Palate
Tongue (rare)

46
Q

2 oral complications of Crohn’s disease

A
  • 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)
47
Q

3 medications that are the usual cause of pseudomembranous colitis

A
  • Clindamycin (2 % to 20 %)
  • Amipicillin or amoxicillin(5 % to 9 % )
  • Cephalosporin 3rd generation (<2%)
48
Q

4 medications that are less frequently involved in the development of pseudomembranous colitis

A

Maclide
Penicillins
Trimethoprim-sulfamethoxazole (Bactrim, Septra)
Tetracycline

49
Q

4 medications that are rare causes of pseudomembranous colitis

A

Aminoglycosides
Antifungal agents
Metronidazole
Vancomycin

50
Q

Treatment planning modification for patient with pseudomembraous colitis

A

Delay until resolved

51
Q

Oral complications and maifestations of pseudomembranous colitis

A

Possible fungal growth in oral cavity

Oral Medicine (5 decks)

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