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Medicine 2 > MED 2 HEMAT ASA > Flashcards

MED 2 HEMAT ASA Flashcards

Anemias, Stress Management

1
Q

Mild Nuetropenia vs MOD?

A

Mild = pre-med with major tx
MOD- pre-med with all
Seve = no tx

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2
Q

23 yo Male, college athlete. Got it with a hockey puck. Trauma sustained only to #9. Drinks on occasion. No family hx of illness. What is his ASA status?

A

ASA 1

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3
Q

The ANC count helps assess _______?

A

the gravity of the leucopenia

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4
Q

Healthy patient with NO organic, physiologic, or psychiatric disturbance and with good exercise tolerance, non-smoking, no or minimal alcohol use

Patients are able to walk up one flight of stairs or two level city blocks without distress.
Patient has little or no anxiety

A

ASA 1

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5
Q

ANC Calculation Formula:

A

ANC = Total WBC count x (% Neutrophils + % Bands*)

Example: WBC 2000 x (45 Neutrophils + 5 Bands ) ÷ 100 = 1000 Neutrophils

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6
Q

T/F. Ok to use local anesthetics containing EPI in ASA 2 pts

A

True

Stress management for ASA 1/2 pt: O2 + N2O ; Benzos
EPI ok

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7
Q

Only use which local anesthetic _____________ (if not hypoxic) in the ASA IV patients

A

Carbocaine (3% mepiv) or Citanest plain (4% Prilocane)

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8
Q

MCP with MOD perio needs gum flap surgery. Labs show ANC of 700. Can you treat this patient now or wait for better health status. Does he needs any medication pre/post- tx?

A

MOD NEUTROPENIA: 500-1000
OK to treat
Gum flap sx = major dent tx –> needs pre-med
Give antibiotics for 3-5 days after major dentistry

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9
Q

Stress management for ASA 1/2 pt:

A

O2 + N2O
Benzos [Versad; Triazolam; Diazepam (Valium); Ativan (Benadryl)]

LA with Epinephrine or epinephrine cords can be used

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10
Q

47 YO M. DM2. Homeless. Right foot ulcer. Chronic bronchitis. ETOH dependence.

A

ASA 3

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11
Q

79 yo granny in SNF d/t TIA last month with wiht defecits to Right side.

A

ASA 4

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12
Q

T/F.

ASA 3/4 patients may be treated for 3 hours in a horizontal or semi-sitting position

A

F.

These patients should not be in the chair for more than 1 ½-2 hours

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13
Q

66 yo fm. Former athlete now gym teacher. Lives alone. No family/spouse.Drinks glass of wine with dinner. HTN for the past 10 years. Takes SSRIs for bouts of depression. ASA status.

A

ASA 2

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14
Q

T/F. Ok to give ativan or NO2 to mod anx ASA 2 pt

A

T

Stress management for ASA 1/2 pt: O2 + N2O ; Benzos
EPI ok

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15
Q

Calc ANC:

WBC: 2000
% Neutrophils: 45
% bands: 5

A

[ 2000 * (45+5) ] / 100 = 1000

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16
Q

Male pt with ANC of 1000-1,500 Neutrophils/mm3

A

MILD NEUTROPENIA:

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17
Q

SEVERE NEUTROPENIA:

A

0-500 Neutrophils/mm3

Severe life threatening infection risk

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18
Q
  1. Male personal trainer. MOD anx to dentist. NOo illness or dz. ASA status
A

ASA 2

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19
Q

Female pt with Hgb 12-16. Anemia status?

A

None. 12- 16 is normal in Females

Male normal is 13.5 - 17.5 g/dL

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20
Q 
Examples include (but not limited to): 
Recent ( < 3 months): MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia, unstable angina or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing dialysis; symptomatic COPD, symptomatic CHF, hepatorenal failure

Patients are unable to walk up one flight of stairs or walk two level city blocks. Distress is also present at rest.

A

ASA 4

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21
Q

MODERATE NEUTROPENIA = ANC value of?

A

500-1,000 Neutrophils/mm3

Moderate risk of infection

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22
Q

Hgb lvls for :
MILD (M/F)
MOD (M/F)
SEV (M/F)

A
  • MILD: 10-13(m) ; 9-12 (F)
  • MOD: 7-9 (m) ; 6- 8 (f)
  • SEV: <7 (m) ; <6 (f)
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23
Q

47 YO M. DM2. Homeless. Right foot ulcer. Chronic bronchitis. ETOH dependence. ESRD scheduled for dialysis MWF but goes when he feels like, sometimes not at all.

A

ASA 4

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24
Q

T/F. Ok to use Epi cord in ASA 3/4 pts

A

NO F.

Avoid LA with 1:100,000 EPI in ASA3/4

LAs with 1:200k epi may be used in the ASA III patient

Use Alum cords instead of epinephrine cords
Alum is a good substitute as a hemostatic agent
Alum is safer and has fewer systemic effects

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25
Q

AIDS pt comes into the office with pain in RUQ. Labs show ANC of 420. What is his immune status? Can you treat him?

A

SEVERE NEUTROPENIA: 0-500 Neutrophils/mm3
Severe life threatening infection risk
NO TX

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26
Q

56 yo dad retired veteran. Hx of agina/MI 6mo ago. No surgical intervention needed.

A

ASA 3

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27
Q

The Normal ANC Count:

A

1,500-7,200 cells/mm3

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28
Q

28 yo female. Walks 5miles a day. 26 wks gestation. No hx of illness/dz.

A

ASA 2

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29
Q

Males pt wiht Hgb <7

A

SEV Anemia

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30
Q

Pink puffer/Blue bloater

A

ASA 4 - COPD with symptoms

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31
Q

No functional limitations; has well-controlled mild disease of ONE body system. & without substantive functional limitations
Examples include (but not limited to):
Well controlled DM/HTN without systemic effects; current cigarette smoking/social drinking,
mild lung disease but without COPD;
pregnancy, obesity (30 < BMI < 40),
healthy ASA I patients who show a more extreme anxiety and fear toward dentistry

Patients are able to walk up one flight of stairs or two level city blocks, but will have to stop after reaching the top

A

ASA 2

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32
Q

28 yo teacher. Frightened, worried or teary eyed when hears high-speed hand drill

A

ASA 3

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33
Q

Stress management for ASA 3/4 :

A

O2 + N2O ( is a must)

Stress management can also be preemptive using NTG/Isordil/inhaler spray

DO NOT use Benzodiazepines

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34
Q

70 yo male with mild lung disease but without COPD. ASA status?

A

ASA 2

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35
Q

Substantive functional limitations; One or more moderate to severe diseases involving more than one system or one major system. No immediate danger of death.
Examples include (but not limited to):
Poorly controlled DM/HTN,
COPD with INTERMITTENT symptoms, morbid obesity (BMI ≥40),
active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction,
ESRD undergoing dialysis, controlled congestive heart failure (CHF), stable angina, old history of (>3 months): MI, CVA, TIA, or CAD/stents.
Frightened, worried or teary eyed patient

Patients are able to walk up one flight of stairs or two level city blocks, but will have to stop frequently because of distress.
Thus have substantive functional limitations.

A

ASA 3

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36
Q

Can you give ASA3/4 Benzos? Lidocane?

A

NO!!
NO!! ( lido/Xylocaine = 1:50k or 1:100k)

Avoid LA with 1:100,000 EPI in ASA3/4

LAs with 1:200k epi may be used in the ASA III patient

Only use Carbocaine or Citanest plain (if not hypoxic) in the ASA IV patients

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37
Q

T/F. YOu can give COPD pt NO2 but not benzos

A

F.

All types of stress management is contraindicated especially with MO-SEV-very severe COPD: Use preemptive inhalers instead

Use low dose Ativan or Valium cautiously in the MILD COPD patient after
confirming with MD: Preemptive inhalers instead can also be used

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38
Q

T/F. Low does Ativan is ok in MOD-SEV COPD pts

A

F.

low dose Ativan or Valium ok when used cautiously in the MILD COPD patient after confirming with MD

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39
Q

T/F. Avoid LA with 1:100,000 EPI in ASA3/4

T/F. LAs with 1:200k epi may be used in the ASA III patient

A

T

T

Use Alum cords instead of epinephrine cords
Alum is a good substitute as a hemostatic agent
Alum is safer and has fewer systemic effects

40
Q

86 yo f. Third degree heart block. Implanted pacer to LUChest. On Digoxin, metoprolol, asprin 81mg.

A

ASA 3

41
Q

LAs ok to give with each degree of anemia (mild, mod, sev)

A

MILD: xylocaine (epi) , max 2 carpules
MOD: Marcaine 1:200k for major procedures; Carbocanie for routine
SEV: NO/Defer Tx

42
Q

Stress Management drugs (3):

A

Benzos, Barbituates, Narcotics

43
Q

MAx dose Valium?

A

Max. dose 10 mg PO

44
Q

AVOID CITANEST or ARTICAINE in

4 pt groups

A

> Patients with moderate to severe anemia

> Patients with severe COPD

> Patients with cyanotic congenital cardiac defects

> Patients with neuro-muscular dysfunction such as:
- MD, MG, MS, ALS, Neuropathies of various kinds

45
Q

Can you tx pt with stress management drugs if they walked to the office/was dropped off?

A

NO.

Use Benzodiazepines only if the patient can be ESCORTED to the office

46
Q

Common causes for Macrocytic cells are:

A

Pernicious anemia/B12 /Folic acid deficiency
HIV/AIDS medications
Some Cytotoxic drugs

47
Q

Draw out Anemia Patterns chart:

A

Micro,Hypo Marco,Normo Normo,normo
hgb dec dec dec
hct dec dec dec
MCV dec INC NORM
MCHC dec NORM NORM

Dx: Hgb Synth: DNA synth: Dec RBC:
Fe Def Pernic Anem SLE
Thalassemia B12 and Folate RA
Cytotox rx CRF
HIV/AIDS
Dilantin

48
Q

Oxygen + IV methylene blue 1% solution (10 mg/ml) 1-2 mg/kg slowly over 5 minutes( Repeat the dose in 1h if needed) is the treatment for?

A

Methemoglobinemia crisis

[Methglob lvls inc by sulfonamides (abx), LA (citanest/articaine/benzocaine) ]

49
Q

Safe abx for anemias?

A
  • Penicillins
  • Macrolides (NOT with iron pills for Fe def anemia)
  • Clindamycin
  • Cephalosporins
50
Q

Polycythemia Vera should be considered when:
Hematocrit is _____ in women and ____ in men
Hemoglobin is _____ in women ____in men

A

Hct: > 48% FM and > 52% M
Hgb: > 16.5 FM and > 18.5

51
Q

Polycythemia is a condition associated with an _____ number of circulating RBCs

A

increased

Neoplastic bone marrow disorder characterized by ↑ production of hematopoietic cells
It mainly causes an increased Red Cell mass; MCV, MCH may be normal or decreased

52
Q

Polycythemia Vera Treatment (PAAS)

A

PAAS

  • Phlebotomy: 1/k keep hct < 45% in men < 42% in women
  • Aspirin: 81 mg daily
  • Antineoplastic therapy: ↑ risk for thrombosis (Hydroxyurea)
  • Splenectomy: if splenomegaly or repeat splenic infarction
53
Q

In the presence of significant thrombocytopenia assess CBC with platelets. The lab test must be_________

A

less than 7 days old

54
Q

Out-patient OMFS/Periodontal surgery: Platelet count must be_______.

Major dental procedures done in OR: Platelet count must be _________.

A

> 75,000/mm3

> 100,000/mm3

55
Q

LA to avoid with anemias

A

AVOID CITANEST & ARTICAINE with all anemias ESPECIALLY if the anemia is moderate-severe

56
Q

LA to use in pt with G6PD anemia

A

Use Carbocaine ONLY with G6PD anemia

57
Q

Anelgesics to avoid wiht anemic pts

A

AVOID Aspirin & NSAIDs

58
Q

___________ is a form of hemoglobin that contains iron in the oxidized or ferric state which does not bind oxygen

A

Methemoglobin

Methemoglobin >30% of total hemoglobin causes hypoxia & cyanosis

59
Q

Iron Deficiency Anemia & Thalassemia: Comparison

A

Iron Deficiency Anemia RDW: INCREASED

Thalassemia: RDW: NORMAL

All else equal (RBC, Hgb,Hcty, MCV, MCHC all dec/microcytic/hypochromic)

60
Q

Congenital / Hemolytic Anemias? (4)

A
  • Sickle cell
  • Thalassemia major / minor
  • Hereditary Spherocytosis
  • G6PD Deficiency Anemia
61
Q

When abundant immature cells enter the circulation, CBC can show:

A

Shift to the Left” or Myeloid Reaction:
assoc w/ an influx of immature bands in the bld–> response to acute bacterial infection, like Pneumonia

Shift to the Right” or Lymphoid Reaction:
Assoc w/ an influx of immature lymphocytes in bld
–> response to viral infections

62
Q

AVOID using Benzodiazepines in:

A
  • MG
  • Pregnant or Lactating
  • Obese
  • Frail elderly
  • severe respiratory insufficiency or sleep apnea
  • severe hepatic insufficiency
  • CNS drugs or H2 blockers

BENZOs ( Versed, Valium, Ativan)
Antidote= Romazicon

63
Q

INC WBC Count + DEC Neutrophils + INC Lymphocyte Pattern

A

viral infections

64
Q

Can LAs like articaine or cinest be give to anemic pt?

A

No.

NO sve anemia
NO COPD
NO Congentical heart defects
NO MS, MD, MG, ALS

65
Q

T/F. All epinephrine containing LAs contain metabisulfite

A

T

66
Q

Initial Narcan dose?

A

0.4 mg to 2 mg is given IV increments of 0.1-0.2 mg q2-3 minutes intervals

UNDILUTED IV Narcan for Acute Respiratory Distress (ARD) needing full Reversal:
Administer 0.4 mg UNDILUTED (entire 1 mL vial) IV, push over 15 seconds
May repeat q2-3 minutes as needed till patient opens his/her eyes & talks in 1-2 minutes

67
Q

Analgesics for G6PD:

A
  • OxyContin without Tylenol
  • Codeine Phosphate
  • Tramadol
68
Q

Safe anagelsics for anemics

A

SAFE Analgesics: Regular strength/RS Tylenol

Oxycodone/Codeine/Hydrocodone with Tylenol

69
Q

The normal Hematocrit:

A

37%-47%

70
Q

_____is the leading cause for MICROCYTIC cells followed by Thalassemia

A

Iron deficiency

71
Q

Polycythemia Vera (PV) Oral Features

NVIP

A 
Pale mucosa
Reactive keratosis
Different forms of candidiasis
Mucosal ulcers
Gingival bleeding and various degrees of gingival enlargement
72
Q

INC WBC Count + INC Neutrophil Count Pattern

A

bacterial infection

73
Q

Abx to avoid in G6PD pt?

A

Avoid sulpha drugs (eg Bactrim) - to prevent hemolysis

Bactrim (Trimethoprim & Sulphamethoxazole) is not effective for oral infections - treats RI/UTIs

74
Q

The normal RBC Count:

A

Male patients: 4.5-5.9 million/microL

Female patients it is 4-5.2 million/microL

75
Q

Bleeding disorders associated with oral manifestations & complications are (5):

A
  • Iron deficiency anemia
  • Hemolytic anemia
  • Vitamin B12 & Folate deficiency anemia
  • Aplastic anemia
  • Polycythemia
76
Q

The Reticulocyte count (not part of CBC) also evaluates the status of:

A

Anemia
Polycythemia
Hemochromatosis

77
Q

Drugs affecting Platelet Function

A
  • Aspirin
  • NSAIDS**
  • ADP inhibitors
  • Clopidogrel (Plavix)
  • Ticlopidine (Ticlid)

*The Platelet COUNT is not affected by any one of these drugs

**All except NSAIDS, irreversibly & permanently affect entire life-span of platelets

NSAIDS affect is temporary lasts till drug clears system (24 hours )

78
Q

Should I stop the thrmobosis regime (asa + plavix) for my dental pt? Minor tx? Major tx?

A

NO. Minor tx ( amalgams/Composites, Cleanings, Deep scaling) No need to stop any one of these drugs

MAJOR:
Consult with the patient’s MD before you plan to stop any of these drugs.
If approved,all stopped 7 days prior to surgery. Then restarted 1-2 days post op.

Stop NSAIDS 24 h prior to surgery; restart evening of/next day once bleeding stops

79
Q

Thrombocytopenia Causes:

A

Drugs ( IV Heparin, Chemo, etoh)
Cancer ( Leukemia, Lymphoma or BM tumors)
Infections (HIV, Mumps, Rubella or Parvovirus)
Spleen (Sequestration of PLTs by enlarged Spleen)
ITP (Autoimmune destruction of PTLS by IgG)

80
Q

ITP occurs from antibody destruction of the___

A

platelets

81
Q

Always consult with MD prior to dentistry if platelet count is______

A

< 50,000/mm3

82
Q

Thrombocytopenia Treatment (except ITP):

A

Platelet Rich Plasma (PRP)
Platelet Rich Concentrate (PRC) transfusion
Desmopressin/Stimate/DDAVP

83
Q

______ Occurs more commonly in men and post menopausal women and is the most common genetic disease in Caucasians

A

Hemochromatosis

Excess iron is stored in the tissues of major organs, esp liver and this –> toxic to the body –> organ failure

84
Q

T/F:

  1. All Type 3 are not able to transport Factor VIIIc
  2. All Type 2 patients are not able to transport Factor VIIIc
A
  1. True.
  2. False

All Type 3 & some Type 2 patients are not able to transport Factor VIIIc

85
Q

Local Hemostats

A
  • Microfibrillar Collagen (Avitene or Helistat)
  • Gel foam
  • Thrombostat
  • Fibrin Glues
  • Surgicel
  • Amicar or Cyklokapron Mouthwashes
  • Calcium Sulfate
  • Moist tea bag ( tannic acid)
86
Q

VWD Dental Guidelines

A

Surgery can begin immediately after Factor transfusion

Cryoprecipitate contains 10 times the amount of Factor VIII compared to
FFP & the highest concentration of VWF

The use of Cryoprecipitate is strongly discouraged by National
Hemophilia Foundation, (except in life-threatening situations) when no
VWF concentrate is available
This is because Cryoprecipitate is NOT virally inactivated

87
Q

ORAL ANTI-FIBRINOLYTIC DRUGS:

A

Tranexamic acid (Cyklokapron)

Epsilon Aminocaproic acid (Amicar)

Before you prescribe anti-fibrinolytic drugs PO, always confirm patient has no prior hx of:
Mod-sev HA, acute vision problems, TIAs, CVAs, blood clots or H/O thrombosis

Confirm that the liver and kidney are optimally functioning

88
Q

t/f. Chronic small bowel disease affects Vitamin K absorption

A

t

89
Q

ITP is treated with

?

A

Corticosteroids, immune-globulins or splenectomy

  • Initial(1mg/kg/day Prednisone, P.O for 2-6 weeks)
  • Subsequent (Prednisone dose is individualized, usually tapered to < 10mg per day x 3 months and then withdrawn)
  • Splenectomy is done if discontinuation of Prednisone causes a relapse
90
Q

In patients who have mild to moderate VWD what can be given for hemostasis?

A

Tranexamic acid is given topically as “swish & spit” every 6 hours

Applied pressure
Other Topical agents
Suturing of surgical sites

91
Q

Platelet transfusion when needed is given______prior to planned procedure

A

20 minutes

1 platelet concentrate transfusion increases the platelet count by 10,000

92
Q

With chronic steroid use, check for ___?

A
  • oral candidiasis,
  • increased susceptibility to infections
  • osteoporosis
93
Q

VWD Dental Guidelines

A

Consult with the patient’s MD for the Type & severity of the condition

Relay to the MD the type of procedures planned, both major and minor dentistry

Confirm if DDAVP/Factor/Platelet transfusion/Topical rinses is/are needed

With IV DDAVP the surgery can begin in 30-60 minutes

With oral/PO or intranasal DDAVP, the surgery can begin 60-90 minutes later

With Platelet transfusion the surgery can begin in 20 minutes

94
Q

Avoid_______ with Coumadin, IV Heparin, LMWH & all NOACs

A

ASPIRIN or NSAIDs

95
Q

______ can occur without interruption of anticoagulation with NOACs

A

Extractions

Novel Oral Anticoagulants (NOACs)

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