Management of the Medically Compromised Patient Flashcards
What drugs might you need for syncope/vaso-vagal attack/fainting
Oxygen lol
What drugs might you need for anaphylaxis
- Oxygen
- Adrenaline
What drugs might you need for Asthma
- Oxygen
- Salbutamol
- Adrenaline
What drugs might you need for ACS (includes heart attacks etc.)
- Oxygen
- Aspirin
- GTN
What drugs might you need for Epilepsy
- Oxygen
- Buccolam (contains midazolam)
What drugs might you need for Hypoglycaemia
- Oxygen
- Glucagon
What is the normal range in g/dL for haemoglobin
13-17.0g/dL
What is the normal range for mean cell volume in fL
83-101 fL
What is the normal range for red cell folate in umol/L
0.36 - 1.44 umol/L
What is the normal range for Vitamin B12 nmol/L
0.13 - 0.68 nmol/L
What is the normal range for WBCs per litre
4 - 7 x 10^9/L
What is the normal range for neutrophils per litre
2 - 7 x 10^9/L
What is the normal range for platelets per litre
150.0 - 400.0 x 10^9/L
What is the normal range for INR
0.9 - 1.1
What is the normal range for APPT
21 - 31 seconds
What is the normal range for TT
14 - 19 seconds
What platelet count requires a patient to have extra added platelets for major surgery
< 75 x 10^9/litre
If a patient has less than 0.5 x 10^9/litre of neutrophils, what precaution should be taken for surgeries
Antibiotics should be administered
What BMI is overweight, obese and underweight
Overweight = >25 Obese = > 30 Underweight = < 18
What problems can arise from overweight patients
- Airway management and patient handling problems
- Comorbidities like CVD, Diabetes and Fatty Liver Disease
What problems can arise from underweight patients
- Anaemia
- Bradycardia, hypotension
- Psychiatric disease
- Osteoporosis
- Reflux
- Dental implications
When should you review the control of asthma in an asthma patient
Review it on the day of the treatment - essential
What drugs are there up the ladder of Respiratory treatments (mainly asthma)
- Salbutamol
- Budenoside / beclometasone
- Formoterol
- Theophylline
AY BAWS CAN I HABE DE NOTE PLEASE
COPD is often undiagnosed in patients
What HbA1c % indicates poorly controlled blood sugar
< 6.5% (< 48mmol/mol)
OR
>10% (>86mmol/mol)
In what cardiac patients might you need to consider AB cover?
- Previous Infective Endocarditis (IE) patients
- Prosthetic heart valves
- Some congenital heart defects
What type of cover should be given if a patient is indicated to need AB cover due to cardiac conditions
- Amoxil 3g PO/IV (50mg/kg in children)
OR - Clindamycin 600mg PO (20mg/kg in children)
Name some types of NOAC (Novel Oral Anti Coagulant)
- Apixaban
- Dabigatran
- Rivaroxaban
If a patient is taking Apixaban or Dabigatran how should they alter their drug schedules if undergoing dental treatment that involves bleeding
- Miss their morning dose (pre treatment)
- Post treatment dose should be at the usual time in the evening
If a patient is taking Rivaroxaban how should they alter their drug schedules if undergoing dental treatment that involves bleeding
- If they normally take their dose in the evening then they don’t need to change anything
- If they normally take their dose in the morning then they should delay it until 4 hours after haemostats has been achieved
What types of bleeding and symptoms can indicate a defect in the primary haemostasis of a patient
- Immediate bleeding
- Oozing 24 hours post op unto 3 days
- Petechiae in multiple sites
What types of bleeding and symptoms can indicate a defect in the secondary haemostasis of a patient
Deep tissue bleeding
What is especially important to go through in the MH of a haematology patient
- Type of bleeding disorder e.g. haemophilia/vW disease
- Severity of disease - % of Factor XIII
- How dental tx managed in the past
What is the diagnosis test for a patient with renal disease
- Blood test for Creatinine, which is a breakdown of muscle metabolism
- Higher levels of creatinine indicates a lower GFR
- Urinalysis - Proteinurea + renal biopsy
What are some of the signs and symptoms of a patient with renal disease
- Lemon tinge to skin
- Halitosis
- Itchy skin
- Hypertension
- Anaemia
- Peritonitis
- Proteinurea
- Bone pain
What are the medical management options of Renal disease
- No treatment
- Haemodialysis
- Peritoneal dialysis
- Transplant
What patient factors present risk in renal disease patients for dental treatment
- Anaemia
- Increased bleeding
- Increased risk infection
What GFR indicates Stage 1 of loss in renal function
≥90ml/min/1.73 m^2
What GFR indicates end stage renal failure
<15 ml/min/1.73 m^2
What are some of the signs and symptoms of a patient with Liver disease
- Encephalopathy
- Bleeding
- Jaundice
- Dry mouth/excessive thirst
- Telangiectasia
- Ascites
- Gynecomastia
- Resting tremor
- Dupytren’s contracture
- Hepatocellular carcinoma
Name some immunosuppressant drugs that a transplant patient might be taking
- Tacrolimus
- Cyclosporin gingival swelling
- Mycophenolate mofetil
- Prednisolone
- Monoclonal antibodies
What are some common drugs used in the treatment of HIV
- Atripla
- Combivir
- Kaletra
When a patient comes in with HIV what questions are particularly important to ask
- How long?
- Medications?
- CD4 count? Viral load?
What CD4 levels qualify a patient to have AIDS
under 200
At what viral load is HIV typically undetectable
under 40
Name some typical antipsychotics used to treat some forms of psychiatric disease
- Clozapine
- Haloperidol
Name some atypical antipsychotics used to treat psychiatric disease
- Olanzapine
- Risperidone
- Amisulpride
- Aripiprazole
- Quetiapine
What complications can arise as a result of thalassaemias
Anaemia
Cardiomyopathy
Patients often require splenectomy
What drugs are common in thalassaemia patients
Bisphosphonates
Name some things that can precipitate sickling of cells in a patient with Sickle Cell Anaemia
- Cold
- Infection
- Dehydration
- Acidosis
- Hypoxia
Why should you avoid high doses of aspirin in SCA patients
Risk of inducing acidosis
What size of tumour does T1 - T4 indicate
T1 = < 2cm T2 = 2 < x < 4cm T3 = > 4cm T4 = Deep invasion into bone, muscle, skin, adjacent structures; massive tumour
What does the notation of N0-N2 indicate about the nodes of an oncology patient
N0 = No nodes N1 = Single, unilateral node < 3cm N2 = Single, unilateral node 3-6cm/ multiple unilateral nodes not > 6cm
What does M0 and M1 indicate about the state of metastases in oncology patients
M0 - no distant metastases
M1 - Distant metastases
What are the general signs and symptoms of a cancer patient
- Lymphadenopathy
- Bleeding gums
- Infections
- Haematurea
- Weight loss
- Fever
- Malaise
What is the acronym used for the symptoms/signs of multiple myeloma what does it stand for
C = Calcium elevation in the blood (serum calcium > 10.5 mg/L) R = Renal insufficiency (serum creatinine > 2mg/dL) A = Anemia (haemoglobin < 10g/dL) B = Lytic bone lesions or osteoporosis
What methods of diagnosis are there for cancer
- Clinical
- MRI/CT
- PET scans
- Biopsies
What methods of treatment are there for cancer patients
- Chemotherapy
- Radiotherapy
- Surgery
- Combination
What drugs can lead to MRONJ
Zometa and Denosumab etc
Bisphosphonates carry the highest risk of this
What are some of the treatments that are provided to patients with Stage 1 and above MRONJ
- Antibacterial mouth rinse
- Pain control
- Antibiotic therapy
- Debridement to relive soft tissue irritation and infection control
