Oral Med- ABGD Flashcards
What are the parameters for HTN?
2017 classification
<120 and 80 = normal
120-129/ and <80 = elevated
Stage 1: 130-139 or 80-89
Stage 2: ≥ 140 or ≥90
Stage 2 Crisis: >180 or >120 (my limit is 110 palliative/urgent care only)
if symptomatic- no care
What are the treatment considerations for each category of HTN?
Normal: None
Elevated: let pt know, recommend lifestyle changes, follow up with PCP
Stage 1: routine, referral to PCM
Stage 2: routine, if asymptomatic
dont treat above 180/110
What are the conditions requiring SBE prophy
hx of endocarditis
prosthetic heart valve or repair
unrepaired cyanotic defect
repaired cyanotic defect if less than 6 mos
reparied cyanotic defec with prosthetic materials
heart transplant with valvulopathy
Which heart conditions are cyanotic defects?
Tetralogy of Fallot.
Transposition of the great vessels.
Pulmonary atresia.
Total anomalous pulmonary venous return.
Truncus arteriosus.
Hypoplastic left heart syndrome.
Tricuspid valve abnormalitie- congenital
What procedures require ABO prophy?
anything that disrupts the gingival tissue,apical region, or perforation the mucosa
except: xrays, injections if not infected, removable appliances, ortho brackets/adjustments, shedding of baby teeth or trauma to lips
What oral meds are given for ABO prophy?
AMOX 2 gram
Cephalexin (cephalosporin)- 2 gram (do NOT give if there is a IgE rxn to PCN aka anaphylaxis)
Clinda- 600mg
Azith or Clarithromycin- 500mg
What are the IV meds given for ABO prophylaxis?
Ampicillin: 2g
Cefazolin, 1g
Clindamycin: 600g
If the ABO Prophy dose can’t be given prior to tx, when should it be given? What about if they are already on ABX?
2 hrs after
switch class of drug, or wait 7-10 days between
What is angina and what are the types?
Angina- chest pain & a symptom of MI
STABLE: chronic, relieved with rest, relieved in 5 min with NG (if longer than 5 min= MI)
UNSTABLE: new onset, pain at rest, angina after MI, increased frequency, intensity and duration
PRINZMETAL: typically unpredictable, pain at rest, possible coronary artery spasm, vasodilators
What is the dental management with patient with a hx of angina?
Early AM appt
increase O2 if needed
decrease stress/anxiety
Have NTG ready
no epi > 0.04mg
What shoudl you do if your pt develops angina if they have a hx of it?
STOP procedure
semi sit up
NTG: 0.3-0.5mg sublingual Q3-5min
O2: NC 4-6L/min
monitor VS
call EMS
What is the max dose of epi? Healthy vs cardiac pt
Healthy: 0.2mg
Cardiac: 0.04mg
What precautions should be taken for dental treatment on a post-MI pt?
Wait 4-6 weeks post MI to allow for adequate re-vascularization
low risk treadmill test
pt likely on plaxix or asa- so have local measure ready for bleeding
likelihood of reinfarcation after non-cardiac sx is low
What are anti-platelet agents and what is the MOA?
ASA- COX inhibitor
Clopidogrel (Plavix): inhibits binding of ADP to PLT receptor
Ticagrelor (Brilinta):ADP receptor blocker (reversible)
Aggrenox (ASA/Dipyrimadole) Cox inhibitor and ADP blocker
PLT Glycoprotient IIb/IIIa inhibitors
What are the signs of CHF?
pulmonary edema (left side)
peripheral edema (R side)
Dental management for after stroke?
Risk of 2nd decreases over time
pallitive only during 1st 6 months
normal care after 6 months
meds may increase bleeding and risk should be considered with future sx
What the phases of hemostasis?
Primary-
vascular (immediate)
PLT phase: 1-2 secs
Secondary:
coagulation phase (10-20secs)
fibrin formation (1-3 min)
Do medication induced PLT disorders affect the quality or quantity of PLTs?
Quality
What lab tests would be prolonged in a patient with von Willebrand’s disease?
BT
PTT- partial prothromibin time = intristic pathway
Normal PT- prothrombin time = extrinsic and common pathways
PTT normal time ranges by lab ~25-30 secs
PT of 11 to 13.5 seconds.
INR of 0.8 to 1.1
Why might a patient be on anticoagulation meds?
mechanical valves,
hx of atrial fib
h of thromboembolic stroke, TIA,
Anti platelet: hx of DVT or pulm embolism
What are some examples of anticoagulation drugs- whats the MOA?
Coumadin- inhibits Vit K, factors II, VII, IX, and X
Heparin: IV, inhibits intrinsic pathway
Lovenox: Sq, inhibits intrinsic pathway
Lepirudin: IV direct thrombin inhibitor
Arixtr: SQ direct thrombin inhibitor
Pradaxa: PO direct thrombin inhibitor
Xarelto/eliquid: PO, activated Factor X inhibitor
What is DM? and what the are classifications?
most common endocrine disorder, #1 cause of ESRD
Type 1: immune mediated or idiopathic
Type 2: hindered
Gestational: 2-10% of pregnancies, which increase 35-60% risk of developing DM2 in 10-20 years
eat= sugar. sugar=glucose. glucose in blood asks the pancreas to release insulin which helps glucose get into cells for energy.
How do you dx DM?
Measure glycated hemoglobin (HbA1C) - 3 month average (RBC lifespan is 4 mo)
Normal: <5.7%
Pre-diabetic: 5.7-6.4%
Diabetic: ≥6.5%
What meds are used for DM1?
insulin
RAPID: aspart, lispro (Onset: 15min, Peak 30min, Dur 4-5hr)
SHORT: Regular (O: 30-60min, P: 50-120min, D: 58Hr)
INTERMEDIATE: NPH ( O:1-3hr, P:8hr, D:30 hr)
LONG: Glargine: (O: 1hr, P: n/a, D: 24hr)
What meds are used for DM2?
Biguanides( Metformin)-
decreased hepatic glucose production. decreased insulin resistance and decreased glucose adsorption
alpha glucosidase inhibitors (arcarbose)-
delays digestion of carbs and adsorption glucose
Thiazolidinediones (Rosiglitazone) -
decreased IR, decrease HGP, increased glucose disposal
DPP-4 Inhibitors (Januvia)
inhibits enzymatic breakdown of GLP1 and GIP, these are incretin hormones that stmulate the release of insulin
SGTL2 inhibitor(Jardiance)
Oraly Hypoglycemia agents
- Sulfonylureas (Glyburide, Glipizide)
increased pancreatic insulin secretion, chronicly
Meglitinides (repaglinide)
increased pancreatic insulin secretion, acutely
What is ozempic and what is it used for
semulglide incretin mimetics, also for weight loss
How would you manage
diabetic patients in a dental
setting?
-minimize stress: short, mid-morning appts
*higher insulin activity in afternoon
*increased risk of hypoglycemia
-patients should take all usual meds
-continue usual diet: post procedure dietary intake
-may need to alter insulin regimen:
*increased release of EPI and corticosteroids induces hyperglycemia
-consider antibiotics if poorly controlled (>8% HbA1c)
-pre-op/post-op finger stick
-F/U
-consult with PCM
What are the medical comorbidities of DM?
Cardiovascular
-CAD (coronary artery disease)
-CHF
-functional mets = 4
HTN
Decreased renal function
-NSAIDs
-Dialysis
What are the signs and symptoms of hypoglycemia?
Initial State
-weakness, trembling, hunger, sweating, tachycardia, anxiety, confusion
Moderate State
-combative, incoherent
Severe State
-unconsciousness, hypotension, hypothermia
How would you manage a patient who is experiencing hypoglycemia in your chair?
-GLUCOSE
-soda (not diet), fruit juice
*beware of aspiration risk if forced
-IV glucose
-glucagon auto injector
-cake frosting under tongue
In a radiated mandible, why can ORN occur after tooth ext?
Radiation makes the mandible:
Hypoxic
Hypocellular
Hypovascular
What are the dental side effects of radiation therapy?
xerostomia
mucositis
muscle fibrosis
What is the rule of 2s for corticosteriods?
20mg of cortisol equivalent daily for 2 weeks or longer within last two years.
Not widely used anymore
What is current corticosteroid recommendations?
Routine dentistry- no supplementation
If primary adrenal insufficiency
Minor sx: : 25mg hydrocortisone equivalent, preop on DOS
Moderate sx: 50-75mg on DOS, and 1 day after
Major sx stress: 100-150mg/ day for 2-3 days
THEN IV 50mg Q8H after initail dose for 48-72 hrs after sx
IF there is 2ndary adrenal insufficiency, then no change to daily therapeutic dose
what dz is a primary adrenal insufficiency
addisons’ disease
what are hte corisol equivalent doses?
20mg = endogenous cortisol release
Hydrocortisone: 20mg
Prednisone: 5mg
Dexamethasone: 0.75mg
Cortisol: 25mg
Patient indicates a history of asthma…what questions do you ask?
When diagnosed. What cuases
What emds, how often?
Ever hospitalized?
What type?
What are the three types of asthma?
Extrinsic (most common) form of allergen
Intrinsic: later onset, often ASA induced
Exercise induced: hyperventilation triggers mast cell medication release, more common on cold, dry climates
How do you dentally manage asthmatics
determine severity
bring inhaler to all appts
consider use of B2 agonist inhaler pre-op
AVOID: ASA meds, demerol
Asthma attack: wheezing, coughing, dyspnea- prevention with known triggers
What does a RANKL inhibitor do? What is an example?
Denosumab (Xgeva)
human monoclonal antibody to RANKL and during pre-clincial trials was first used to treat post menopausal pt with osteoporosis
decreased bone turnover
reduces fractures
increase one mineral density
good for breast nd prostate cancer bone loss too
If there was a total hip replacement 1 year ago- do you premed?
no, unless PCM wants it…and it depends if they are severely immunocompromised and or uncontrolled diabetes.
What is your comfort zone for INR range for EXT with anticoag pts.
most dentistry up to 3.5 with local measures.
FMX: prefer to stop at 2,
Really extensive sx: 1.5-2
Why do you have ot give a lower concentration of O2 to COPD pts?
CO2 related respiratory drive. They have become adapted to a high CO2 level (higher bicarb level)
this adjusts the central chemoreceptors sensitivity to O. high O2 can decrease respiratory drive
For a patient with a reduced glomerular filtration rate, what dental consideration would you take?
Consult PCM/Nephrology to determine meds, severity of disease, dialysis and progression
suspect HTN, DM, bleeding issures
AVOID: NSAIDS and cephalosporin
do not do sx on dialysis days, dont use arm that the fistula is placed in for BP
What is the TMN tumor classification?
T= tumor size— Tx-T4
M= metastases— Mx-M1
N: node involvement —-N0-N3
Stages of Cancer?
Stage 1: T1, N0, M0
Stage 2: T2, N0, M0
Stage 3: T3, N0,M0,
Any T, N1, M0
Stage 4A: T4, N0, M0
T4, N1, M0
Any T, N2, M0
Stage 4B: Any T, N3, M0
Stage 4C: Any T, Any N, M1
Which lymph nodes shoudl be inspected during a head and neck screening
anterior and post cervical
submand
subment
Preauricular
tonsilar
Supraclavicular
What are dental considerations for a pregnant patient?
no NSAIDS
no Nitrous in 1st trimester
routine exam/prophy good
2nd trimester is safest
emergency tx always good
consult OB if needed
Class B = good in animals only unk in humans
Lido, Amox, APAP
OSA risk factors/screening tool
STOP BANG
Snoring
Tired
Observed stop breathing
High BP
BMI >35
Age >50
Neck (>16 men, 17 for women)
Gender male
Epworth sleepiness scale- 0-3 sleepiness in normal activities
how is OSA dx
sleep study - resulting in AHI (hypopnea Apnea Index)
Mild: 5-15
Moderate: 15-30
Severe: 30+
apnea= 10 secs without breathing
how does dental help with OSA?
eval and screen
make oral appliances. open the pharyngeal airway space for pts who cannot tolerate CPAP or need a device for travel
What would you prescribe for apthous stomatitis, and licehen planus- or concerns for pemphigoid/gus?
Topical steriod. Fluocinonide 0.05% gel, 30-60gm tube, apply to affected area 2-3x/day,
for lichen ABX: doxy 20mg, BID, disp 50
What would you prescribe for herpetic gingivostomatitis?
acyclovir 500mg, 5x/day, for 5-7 days.
Valacyclovis, 2gram STAT, then 2gm 12 hrs later. , repeat 5-7 days for severe cases
How might you treat burning mouth?
elimination of nutritional deficiency, neuro disorders, masses
send to neurology, pain management, mental health.
What kind of med is Amlodipine?
CCB - decreased cardiac load
for HTN
Hydrochlorthiazide
HTN,CHF thiazide diuretic
lisinopril
ace inhibitor
metoprolol
beta blocker (reduce HR and cardiac force)
