Management of Bleeding

Question 1

How do barbituates interact with warfarin?

Answer 1

Decreases bleeding

Question 2

How does liver disease affect bleeding?

Answer 2

All clotting factors are made in the liver

So if there is liver impairment the amount of clotting factors will reduce so decrease in clot formation

Question 3

What systemic agents can be given to aid abnormal bleeding (5)

Answer 3

1. Clotting factors
2. Platelets
3. Vitamin K
4. Desmopressin
5. Tranexamic acid

Question 4

Give 4 examples of NOACs

Answer 4

1. Dabigatran (Pradaxa)
2. Rivaroxaban (Xarelto)
3. Apixaban (Eliquis)
4. Edoxaban (Lixiana)

Question 5

How does fluconazole interact with warfarin?

Answer 5

Increases bleeding

Question 6

What is Thrombocytopenia

Answer 6

Reduced platelet numbers

Question 7

During a clotting cascade when is the intrinsic pathway activated?

Answer 7

When there is damage to tissue in the blood vessel

Question 8

How do NSAIDs interact with warfarin?

Answer 8

Increases bleeding

Question 9

What defiences are detected by APTT (Activated partial thromboplastin time)?

Answer 9

Factors 8,9,11 and 12

Question 10

What is the initial response from the body when you have a wound?

Answer 10

Vasoconstriction of blood vessel

Question 11

What does APTT (Activated partial thromboplastin time) assess?

(not specifically what it detects)

Answer 11

The integrity of intrinsic and common pathways in the clotting cascade

Question 12

During a clotting cascade when is the extrinsic pathway activated?

Answer 12

Damage to tissue outside the blood vessel

Question 13

Comment on the type of dental treatment that can be given to leukemia patients

Answer 13

Dental treatment other than preventive should be postponed until a remission period

Question 14

What does PT (Prothombin time) assess?

Not specfically what it detects

Answer 14

Assesses the integrity of the extrinsic and common pathways

Question 15

How does alcohol interact with warfarin?

Answer 15

Increases bleeding

Question 16

How does metronidazole interact with warfarin?

Answer 16

Increases bleeding

Question 17

What is pancytopenia and why is it relevant when taking a patient history?

Answer 17

Reduced numbers of RBCs WBCs and platelets

Patients undergoing chemotherapy may have pancytopenia, therefore increases bleeding post XLA

Question 18

What defiences are detected by PT (Prothombin time)

Answer 18

Factors 2, 5, 7 and 10

Question 19

Where are platelets formed in the body?

Answer 19

Bone marrow

Question 20

Haemophilia B is the deficiency of what factor?

Answer 20

Factor IX (9)

Question 21

Why should NSAIDs be avoided in leukaemia patients?

Answer 21

As it increases the risk of gastrointestinal bleeding

Question 22

Describe the steps in platelet plug formation

Answer 22

1. Platelets bind to the exposed collagen
2. Release of platelet factors from granules
3. More platelets are attracted
4. Platelet plug is formed

Question 23

Haemophilia A is the deficiency of what factor?

Answer 23

Factor VIII (8)

Question 24

What could be given to a thrombocytopenia patient prior to an extraction?

Answer 24

Transfusion pre extraxtion

Liase with haemotologist

Question 25

What oral problems could arise from a leukaemia patient?

Answer 25

Oral infections
Gingival swelling
Anaemia
Bleeding

Question 26

How does warfarin work?

Answer 26

Inhibits vitamin K-dependant parts of clotting cascade