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Clinical Applications II > Medical Management: Summary Pages through Hematologic > Flashcards

Medical Management: Summary Pages through Hematologic Flashcards

1
Q

dental modifications for epilepsy patients

A

-Short appointment times
-Reduce anxiety and stress.
-Emphasize plaque control to prevent Dilantin hyperplasia.
-Choose fixed, all-metal prostheses to prevent dislodging/minimize fracture.
-Alcohol may precipitate a seizure. If alcohol consumption is suspected,
the patient should not be treated.

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2
Q

potential emergency situations for epilepsy patients

A

seizure, syncope, cardiac depression, cardiac arrest

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3
Q

dental modifications for MS/CP/Parkinson’s disease patients

A
  1. Schedule shorter appointments.
  2. Use mouth props.
  3. Transfer by wheelchair.
  4. Emphasize oral hygiene and disease prevention to control and
    eliminate oral infection.
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4
Q

drugs to avoid for MS/CP/Parkinson’s disease patients

A

Nitrous Oxide

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5
Q

potential emergency situations for MS/CP/Parkinson’s disease patients

A

airway obstruction

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6
Q

dental modifications for patients with arthritis, rheumatism, swollen joints

A
  1. Schedule afternoon appointments, since joints may be stiff in the morning
  2. Schedule shorter appointments.
  3. Change chair position/use additional physical supports to ensure comfort.
  4. Mouth props may be necessary if the TMJ is affected
  5. A patient may have a limited range of opening the mouth.
  6. Home care modifications
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7
Q

dental modifications for patients with heartburn/stomach ulcers

A
  1. Reduce anxiety.
  2. Salivary substitutes or products designed to replenish salivary
    enzymes may be necessary.
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8
Q

drugs to avoid for stomach ulcers/hearburn patients

A
  1. aspirin or nonsteroidal anti-inflammatory drugs
    (NSAIDs)
  2. If severe xerostomia (dry mouth) exists, do not recommend OTC or Rx mouth rinses with high alcohol content.
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9
Q

dental modifications for hepatitis/jaundice/liver disease

A
  1. Do not perform routine elective care on a patient with active hepatitis.
  2. Because most hepatitis carriers are undetectable by medical Hx,
    use standard precautions when treating every patient.
  3. If liver damage is suspected, minimize administration of drugs metabolized by
    the liver and reduce the dosage if these drugs must be used.
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10
Q

drugs to avoid in patient’s with liver damage

A

acetaminophen, narcotics, barbiturates,

and any other drugs or those specified by the patient’s physician. Minimize amount of local anesthetic

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11
Q

potential emergency situations for those with liver damage

A

Non-cardiac: Hemorrhaging

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12
Q

modifications for liver transplant patients

A

Premed is required

Provide emergency Tx only for 3 months following transplantation.
After 3 months most patients will have a stable transplant. Reinforce oral
hygiene procedures for disease prevention.

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13
Q

drugs to avoid in liver transplant patient

A

Drugs and medications specified by the patient’s physician

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14
Q

dental modifications for diabetes patients

A
  1. Avoid tissue trauma.
  2. Minimize stress (it could have an anti-insulin effect)
  3. Schedule frequent recall appointments with emphasis on disease prevention.
  4. Schedule appointments soon after meal time to avoid the
    possibility of hypoglycemia (insulin shock).
  5. Complications of diabetes such as hypertension, angina, kidney failure, and
    congestive heart failure may require treatment modification
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15
Q

drugs to avoid in diabetes patients

A
  1. Use of a general anesthetic necessitates the omission of food prior
    to administration which may interfere with the scheduled use of
    insulin.
  2. Epinephrine in larger doses may produce anti-insulin action.
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16
Q

potential emergency situations for diabetic patients

A 
Non-cardiac: Diabetic Coma (hyperglycemia)
Insulin Shock (hypoglycemia)
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17
Q

dental modifications for thyroid disease

A

If a large goiter is present, position the patient upright to avoid breathing difficulties.

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18
Q

drugs to avoid in poorly controlled hyperthyroidism

A
  1. Atropine increases the HR and could precipitate a thyroid storm.
  2. Epinephrine acts as a cardiovascular stimulant. Hyperthyroidism already
    stimulates the cardiovascular system. Therefore, epinephrine could precipitate
    arrhythmia or thyroid storm.
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19
Q

drugs to avoid in poorly controlled hypothyroidism

A 
CNS depressants (barbiturates, tranquilizers)
given in normal doses to a patient with hypothyroidism may be overdoses
because of his/her extreme sensitivity to the depressant actions of these drugs
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20
Q

potential emergencies for hypothyroid/hyperthyroid patients

A

Non-cardiac: Hyperthyroidism—thyroid storm or crisis

Cardiac: Hypothyroidism—congestive heart failure

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21
Q

dental modifications for TB patients

A
  1. Because most patients with infectious diseases are undetectable
    through information on Med Hx, use standard precautions.
  2. Treat patients with active TB in a hospital setting if possible and
    limit treatment to emergency care.
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22
Q

drugs to avoid in TB patients

A

none

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23
Q

potential emergency situations for TB patients

A

none

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24
Q

dental modifications for emphysema/COPD patients

A
  1. Schedule late morning or afternoon appointments.

2. Place the patient in an upright position in the dental chair.

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25
Q

drugs to avoid for emphysema/COPD patients

A

In severe cases, nitrous oxide and respiratory depressants such as darvon,
codeine or tranquilizers

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26
Q

potential emergency situations for COPD/emphysema patients

A

Chest pain may indicate angina pectoris, myocardial infarction, or
pulmonary embolism.

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27
Q

dental modifications for asthmatic patients

A
  1. Schedule late morning or afternoon appointments.
  2. Provide immediate access to a patient’s inhaler.
  3. Minimize stress if identified as a precipitating factor.
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28
Q

drugs to avoid for asthmatic patients

A

Minimize vasoconstrictors such as epinephrine, aspirin, NSAIDs

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29
Q

potential emergency situations for asthmatic patients

A

Asthmatic attack

30
Q

dental modifications for rheumatic heart disease

A

Stress the importance of obtaining/maintaining excellent oral hygiene and
good dental repair to minimize physiologic bacteremia.

31
Q

drugs to avoid for rheumatic heart disease

A

none

32
Q

potential emergency situations for rheumatic heart disase

A

none

33
Q

drugs to avoid for those with a history of stroke, heart attack, angina pectoris

A

vasoconstrictors, other drugs/meds indicated by physician

34
Q

patients with an ____(____) heart murmur should be seen by a physician

A

organic (pathologic)

35
Q

dental modifications for heart murmurs

A

none

36
Q

drugs to avoid for heart murmurs

A

none

37
Q

potential emergency situations for heart murmurs

A

none

38
Q

dental modifications for mitral valve replacement

A
  1. If a patient is taking anticoagulants, avoid unnecessary gingival trauma.
  2. Evaluate INR prior to extractions, periodontal therapy, or other
    surgical dental procedures.
39
Q

drugs to avoid in mitral valve replacement

A

none unless specified by physician

40
Q

potential emergency situations for mitral valve replacement

A

cardiac arrest, difficulties breathing

41
Q

dental modifications for infective endocarditis

A

none besides a premedication

42
Q

drugs to avoid in infective endocarditis

A

none unless specified by physician

43
Q

potential emergency situations for infective endocarditis

A

cardiac arrest, breathing difficulties

44
Q

dental modifications in patients with pacemaker

A

avoid use of ultrasonic/sonic equipment if pacemaker is older, less insulated

45
Q

drugs to avoid with pacemaker

A

none

46
Q

potential emergency situations

A

cardiac arrest, arrhythmias

47
Q

INR levels for Tx/no Tx

A
  • 3.5 or less, Tx can be done

- greater than 3.5, anticoagulant dosage will have to be reduced

48
Q

dental modifications for prosthetic heart valves

A

obtain INR before surgical or periodontal therapy procedures

49
Q

drugs to avoid for prosthetic heart valves

A

none

50
Q

potential emergency situations for prosthetic heart valves

A

cardiac arrest

51
Q

dental modifications for patients who have had open heart surgery

A
  1. INR levels
  2. Provide emergency Tx only for 3 months following surgery.
    After 3 months most patients will be stable. Reinforce oral
    hygiene procedures for disease prevention.
52
Q

drugs to avoid in open heart surgery patients

A

none unless specified by physician

53
Q

potential emergency situations open heart surgery patients

A

cardiac arrest

54
Q

modifications for hypertension patients (2/2)

A
  1. Avoid the use of general anesthesia.
  2. If necessary, consider using nitrous oxide-oxygen inhalation sedation
    for stress reduction.
  3. If patient becomes stressed, stop procedure.
55
Q

modifications for hypertension patients (1/2)

A
  1. reduce stress/anxiety
  2. shorter appointments
  3. minimize local anesthetics with vasoconstrictors.
  4. Do not use topical vasopressors to control local bleeding.
  5. Do not use gingival packing material that contains epinephrine.
56
Q

drugs to avoid in hypertension patients

A
  1. Vasoconstrictors in larger doses (Most patients can tolerate 2 cartridges of
    2% lidocaine with 1;100,000 epinephrine).
  2. Any other drugs specified by physician
57
Q

potential emergency situations for hypertension patients

A

cardiac arrest, heart failure, stroke

58
Q

dental modifications for anemic patients (1/2)

A
  1. Schedule shorter appointments for patients with weakness or fatigue.
  2. Prevent trauma during instrumentation procedures.
  3. Lubricate lips if dry or if angular cheilosis is present.
  4. Emphasize oral hygiene to promote healthy tissues.
59
Q

dental modifications for anemic patients (2/2)

A
  1. Emphasize the importance of a balanced diet; provide dental
    dietary counseling as needed.
  2. Avoid infection.
60
Q

drugs to avoid in sickle-cell anemia patients

A
  1. Avoid barbiturates, strong narcotics, and salicylates.
  2. Avoid use of general anesthesia.
  3. If nitrous oxide is used, provide 50% O2 at all times.
  4. Avoid use of vasoconstrictor in local anesthetics except for
    surgical procedures.
61
Q

drugs to avoid in G6PD patients

A

phenacetin, sulfa, aspirin, and chloraphenicol.

62
Q

dental modifications for leukemia patients (1/2)

A
  1. Avoid all dental care if possible during acute stages of disease.
  2. During states of remission, perform all dental treatment and establish
    prevention
63
Q

dental modifications for leukemia patients (2/2)

A
  1. Determine platelet count prior to providing dental care that may involve
    bleeding. If platelet count is less than 50,000/mm3, postpone dental treatment
    until replacement restores count to over 50,000/mm3
  2. Shorten appointments.
64
Q

drugs to avoid in leukemia patients

A

none unless specified by physician

65
Q

potential emergency situations in leukemia patients

A

hemorrhage

66
Q

did you look at the dental modifications for hemophilia patients?

A

I hope so! there’s around a page of information to know!

67
Q

drugs to avoid in hemophilia patients

A
  1. aspirin and aspirin-containing compounds

2. NSAIDS

68
Q

potential emergency situations in hemophilia patients

A

hemorrhage, shock

69
Q

dental modifications for patients who received blood transfusions

A

none

70
Q

drugs to avoid for patients who received blood transfusions

A

none

71
Q

potential emergency situations for patients who received blood transfusions

A

none

Clinical Applications II (12 decks)

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