Medically compromised Flashcards
percentage of US population with HTN in 2000? (According to National Health and Nutrition examination survey)
25%
Definition of htn (according to JNC 7)?
140/90
Percentage of Americans over 65 with HTN
50%
which blood pressure continues to rise throughout life?
When does the other one level or fall off?
systolic: continues to rise throughout life
diastolic: levels off or falls around age 50
two types of hypertension? Percentage of patients with each?
90% of patients have primary (essential) hypertension- no identifiable cause
10% of patients have secondary hypertension- identifiable cause (sleep apnea, drug induced, kidney disease, primary aldosteronism, renovascular disease, thyroid…etc.
Hypertension that older adults often get? What causes it?
Isolated systolic HTN. central arterial stiffness, loss of elasticity.
constitutes an important risk factor for cardiovascular disease.
Blood pressures above _____ are associated with increased risk of cardiovascular disease.
115/75
Definition of systolic and diastolic pressure?
systolic pressure: pressure at the peak of ventricular contraction
diastolic pressure: total resting resistance in the arterial system after passage of the pulsating force produced by contraction of the left ventricle.
pulse pressure:
mean arterial pressure:
systolic minus diastolic pressure
sum of the diastolic pressure plus one-third the pulse pressure
According to JNC 8, at what level should BP medication be administered?
for >60 with no diabetes or CKD, >150/90. For 140/90
One of which four HTN medications should be used initially on non-blacks?
thiazide, ACE inhib, angiotensin receptor blocker, Ca channel blocker
One of which two HTN medications should be used initially on black patients?
thiazide or Ca Channel blocker
One of which two HTN medications should be used initially on CKD patients (all races)?
ACE inhib or angiotensin receptor blocker
Which two HTN medications should not be used in combination?
ACE inhib and angiotensin receptor blocker
Three most commonly prescribed HTN meds in 2013?
- Lisinopril (Prinivil or Zestril) ACE inhib
- Norvasc (Amlodipine besylate (Ca Channel blocker)
- Hydrochlorothiazide
How do ACE inihibs work?
inhibit angiotensin-converting enzyme (a component of the blood pressure-regulating renin-angiotensin system),that turns angiotensin 1 into angiotensin 2, thereby decreasing the tension of blood vessels and blood volume, thus lowering blood pressure.
Three common ACE inhibitors?
Captapril
Enalapril
Lisinopril
How does the renin-angiotensin-aldosterone system work?
Renin is released by the kidney, which produces antiogensin, which signals the adrenal gland to produce aldosterone, which increases blood pressure.
How do ARB’s work?
They block Angiotensin II receptors, which causes vasodilation, and slows the production of aldosterone.
5 common ARB’s?
Eprosartan (tevoten), candesartan (atacand), losartan (cozaar), valsartan(diovan), irbesartan (avapro)
What is an ARB?
An angiotensin II Receptor Antagonist (or Angiotensin receptor blocker).
What is Norvasc?
The most popular calcium channel blocker (amlodipine besylate)
How do calcium channel blockers work (3)?
The prevent the opening of calcium channels, which in smooth muscle causes vasodilation, in cardiac muscle reduces force of contraction, and they slow down electrical activity of the heart, slowing the heartbeat.
How does hydrochlorothiazide work?
Acts on the kidneys to reduce sodium reabsorption in the distal tubule, thus inhibiting the kidney’s abilities to retain water and reducing the volume of blood.
Three common uses for beta blockers?
Preventing cardiac arrhythmias, preventing a second MI after a first one has occured, and treating HTN.
How do Beta blockers work on HTN?
beta blockers block the action of catecholamines on beta adrenergic receptors, thus decreasing the heart rate.
Also Blockade of the sympathetic nervous system on renin release leads to reduced aldosterone via the renin-angiotensin-aldosterone system, with a resultant decrease in blood pressure due to decreased sodium and water retention.
Difference between nonselective and cardioselective beta blockers?
Nonselective (blockades beta one and beta two receptors) increase in BP possible don’t use more than .036 epi
Cardioselective (blockades only beta 1 receptors) can use epi normally
Two big beta blockers?
Atenolol
Metoprolol
What is INR? What is the range for healthy? for those with A fib?
Derivative of prothrombin time (measures how fast someone clots) .8-1.2 for healthy, 2-3 target for A Fib
How does warfarin work?
Blocks the formation of vitamin K dependent clotting factors.
How to reverse warfarin?
Vitamin K
What is amicar?
A topical agent to keep your body from breaking down clots
If you use NSAIDS after previous MI, which is best one to use? Other precaution?
Use NSAIDS for less than seven days. Naproxen is best (220 mg x 2, q. 8 h.) 1600 mg/day max dose.
What is a healthy glomular filtration rate?
Greater than 90 mL/min
What defines end stage renal disease?
Glomular filtration rate less than 15 mL/min or dialysis
Minimum platelet count to perform minor dental procedures?
30,000/ microliter
Four most common causes of end stage renal disease?
diabetes, HTN, chronic glomerulonephritis, polycystic kidney disease
What happens in type one diabetes?
Pancreatic beta cell destruction leads to insulin deficiency
what happens in type two diabetes
The cells of the body develop insulin resistance
Fasting glucose normal range? Refer if fasting blood glucose is: or postprandial is:
70-120 mg/mL. Refer if >126 mg/mL, or > 200 mg/mL
How does metformin work?
It decreases hyperglycemia by suppressing glucose production by the liver.
Changes to dental treatment for adrenal insufficiency?
For primary adrenal insufficiency, supplement with 25 mg hydrocortisone for minor oral sx, 50-75 mg for mod oral sx, 100-150 mg for major oral sx.
Two parts of the adrenal gland
The medulla and the cortex
What do the two parts of the adrenal gland produce?
The medulla produces epinephrine. The cortex produces several steroid hormones: glucocorticoids (cortisol), mineralocorticoids (aldosterone) and androgens.
C4+ lymphocyte count for someone with HIV? With AIDS?
CD4+ less than 500/microliter is HIV. If it drops below 200/microliter– AIDS.
Three precautions for sickle cell?
Monitor with pulse ox, use a maximum of two carpules of L/A with epi, avoid aspirin–could cause acidosis that could lead to an acute crisis.
Use prophylaxis for antibiotics if white blood cell is less than? or neutrophil is less than?
white blood cell 2000/microliter or neutrophil 500/microliter
For major surgery, platelet replacement may be necessary if it is below ? For minor dental procedures, platelet count should be above?
50,000/microliter, 30,000/microliter
What is used to measure kidney function?
What is a normal value?
BUN (blood urea nitrogen)
5-22 mg/dl
Serious impairment of the kidney has occurred when the BUN reaches:
50 mg/dl
End stage renal disease is when the BUN is over
250 mg/dl
What is creatine? What is normal serum creatine?
Normal byproduct of muscle metabolism
1 mg/dl
At what serum level of creatine does the kidney patient need close management? dialysis?
close management: 5 mg/dl
dialysis: 8-12 mg/dl
Creatine clearance of what requires close attention?
of what requires dialysis to sustain life?
less than 30 cc / min
less than 10 cc/min
Common problems of patient with kidney disease: (5)
anemia, calcium phosphorous imbalances, oral ulcerations, ammonia-like breath, bleeding problems
What is the glomular filtration rate?
measures how much blood passes through the glomeruli each minute
Normal GFR?
90 - 120 mL/min/1.73 m2
GFR indicative of kidney disease?
kidney failure?
Lower than 60 mL/min/1.73 m2
Lower than 15 mL/min/1.73 m2
Two things that will be elevated in the blood in liver disease?
The two aminotransferases: alanine aminotransferase (ALT or SGPT) and aspartate aminotransferase (AST or SGOT). These liver enzymes form a major constituent of the liver cells, and leak into the blood in liver disease.
Two problems to consider for patients with livers disease:
blood clotting and drug metabolism
What are PT and PTT
PT=prothrombin time
PTT= partial thromboplastin time
What is prothrombin time?
used to determine the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status. (extrinsic pathway)
What is partial thromboplastin time?
characterizes blood coagulation. used when patient is taking heparin (intrinsic pathway)
What does INR stand for?
International Normalized Ratio
What does INR measure?
like PT, used to determine the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status.
What is Christmas disease?
blood clotting disorder caused by a mutation of the factor IX gene, leading to a deficiency of factor IX (second most common type of hemophilia)
How is Christmas disease treated?
With IV injections of factor IX
how is a platelet plug formed
when platelets interact with collagen outside the blood vessel, they stick together, strengthened to fibrin
why doesn’t fibrin stick to platelets as it’s circulating in the blood?
because when it circulates in the blood, it is fibrinogen. tissue factor outside the blood vessel activates thrombin turns fibrinogen to fibrin
chronic obstructive pulmonary disease (COPD) are
pulmonary disorders characterized by chronic airflow limitation of the lungs that is not fully reversible
What happens in emphysema?
destruction of alveolar walls distal to terminal bronchioles (at the acinar level)
what type of copd causes pursed lips, and barrel chested
emphysema
what type of copd causes excessive tracheobronchial mucous production occurs in?
chronic bronchitis
What is asthma? what is it mediated by
A chronic inflammatory disease, mediated by IgE, that causes bronchoconstriction and mucous production
What does HbA1C measure?
the glucose attached to hemoglobin
Why can’t you take ibuprofen when pregnant?
The ductus arterioles needs to be patent in utero (and is kept patent by prostaglandins). NSAIDS could decrease prostaglandins and cause it to open up
ok to use nitrous with sickle cell anemia?
Yes
ok to use nitrous with COPD patients?
NO!
when should supplemental oxygen be used in sickle cell patients?
If hemoglobin levels are less than 11 g/dL
