Medical Considerations

Question 1

Risks of high BP

Answer 1

Bleeding + MI risk

Question 2

Management of high BP

Answer 2

Check control
Recent readings
Postpone if >160/100
Avoid adrenaline in LA

Question 3

Risks of angina

Answer 3

Angina attack + MI

Question 4

Management of angina

Answer 4

GTN spray 400ug
Enquire about frequency of angina attacks

Question 5

Risk of recent MI

Answer 5

MI

Question 6

Management of recent MI

Answer 6

No XLa’s within 3mths
No GA within 6mths (inc risk of repeated by 50%)

Question 7

Risks of cardiac defects (valve replacement, prev endocarditis, hypertrophic cardiomyopathy)

Answer 7

Infective Endocarditis

Question 8

Management of cardiac defect pts

Answer 8

Ensure they are aware of risks + explain symptoms to look out for

Liaise with cardiologist

Consider antibiotic prophylaxis

Question 9

Risk of liver disease

Answer 9

Bleeding risk (reduced production of coagulation factors)
Immunocompromised
Cross infection risk: Hep B,C,D,E
Reduced drug metabolism

Question 10

Management of liver disease

Answer 10

Liaise with doctor
Consider coagulation screening + FBC

Question 11

Risk of kidney disease

Answer 11

Bleeding risk (platelet dysfunction)
Immunocompromised

Question 12

Management of kidney disease

Answer 12

Liaise + FBC
Tx dialysis patients day after for optimal renal function

Question 13

Risks of diabetics

Answer 13

Hypoglycaemic attack
Impaired wound healing

Question 14

Management of diabetics

Answer 14

Morning appts when glucose is stable
Safe to tx if glucose between 5-15mmol/L

Question 15

Risks of epileptic patients

Answer 15

Seizure due to stress

Question 16

Management of epileptics

Answer 16

Eat beforehand
Enquire about frequency/type
Consider IV

Question 17

Risks of Haemophilia A,B, + VWD

Answer 17

Bleeding due to deficiency of:
Clotting factor 8 (A)
Clotting factor 7 (B)
VW factor (VWD)

Question 18

Management of Haemophilia / VWD

Answer 18

Consider factor assay
50-75% Factor 8 levels required
DDAVP + tranexamic acid may be required
Consider referral

Question 19

Risks of anticoagulants

Answer 19

Bleeding risk

Question 20

Action of warfarin

Answer 20

Vit K antagonist
Inhibits clotting factors 2,7,9,10

Question 21

Indications for warfarin

Answer 21

Prevent blood clots –> MI –> stroke –> death
AF
Thrombosis
Pulmonary embolism

Question 22

Action of apixaban

Answer 22

Factor Xa inhibitor

Question 23

Uses of Apixaban

Answer 23

Prevents blood clots –> MI –> stroke –> death
Non valvular AF
DVT
Pulmonary embolis

Question 24

Action of Dabigtran

Answer 24

Direct thrombin inhibitor

Question 25

Management of anticoagulants

Answer 25

Low risk = do not interrupt medication
High risk
Warfarin INR <4
Apixaban/dabigatran - skip morning dose
Rivaroxaban - delay morning dose
Edoxaban - 1 dose in evening NA

Question 26

What patients should you not interrupt medication for?

Answer 26

Prosthetic heart valves/coronary stents
DVT /pulmonary embolism in last 3mths

Question 27

Risks of anti platelets

Answer 27

Bleeding (inhibition of stages required for platelet aggregation)

Question 28

Management of anti platelets

Answer 28

No interruption
Staging + suturing + appts early

Question 29

Risks of chemo/radiotherapy

Answer 29

Thrombocytopenia (dec platelets)
Neutropenia (dec neutrophils)
MRONJ if taking antiresorptive drugs - bisphosphonates
ORN from radiotherapy
Infection - immunosuppressed

Question 30

Management of chemo/radiotherapy

Answer 30

Liaise with doctor
Thrombocytopenia levels >50x109/L
Avoid XLas/ensure dentally fit 2wks prior to tx

Question 31

Risks of bisphosphonates

Answer 31

MRONJ - anti resorptive drugs inhibit osteoclasts

Question 32

Management of pts on bisphosphonates

Answer 32

> 5yrs on oral/IV
Denosumab + systemic glucocorticosteroid
Tx for cancer irrespective of length of tx
Previously diagnosed with MRONJ
Avoid XLas
8 week review