medically complex Flashcards
what post op drugs to avoid in HTN patients
NSAIDs as prolonged use decreases the efficacy of antihypertensives and increases risk for MI/ stroke
whats the difference between STEMI and NSTEMI
STEMI is ST segment elevation MI that is caused by complete blockage of coronary blood flow and more profound ischemia
NSTEMI is MI without ST segment and is caused by a partial blockage of coronary flow
drugs contraindicated in patients who recently undergone CABG surgery or patients with recent MI
all NSAIDs contraindicated
what is normal INR, INR for mechanical heart valves and INR that we can do exo
normal INR is 1, above 1 means clotting time is prolonged
INR maintained at 2.5-3.5 for mechanical heart valves bc they are thrombogenic
only do exo when INR is <3 for NUH guidelines
what painkiller portentiates warfarin
paracetamol!!!! if you take 2g a day for more than several days its unsafe bc it potentiates the anticoag response
NSAID is also a potentiator, we will still advise patient to take paracet for pain relief rather than NSAIDs but just beware not to take a higher dose of paracet
what is the INR required to hit after LMWH BRIDGING
<1.5
what are local measures to prevent excessive bleeding
- remove granulation tissue as granulation tissue tends to bleed more
- wound compression with pressure gaze
- local hemostatic agents - surgicel or gelfoam
- suture
- 5% tranexamic acid m/w 4x a daily for 2 days (Carter, Gross et al 2003)
- if necessary can consider electrocautery and bone wax
what platelet count is normal, and what count is necessary for the following
- major os procedure
- minor os procedure
- routine dental procedure
- defer all elective dental tx
normal is 150k to 400k per microliter or 150-400 x 10^9/L
> 80k major oral surgery can
> 50k minor oral surgery can
30-50k routine dental procedure
<30k defer all elective dental tx
