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Tim's Cards > Oral Medicine IV - the Brennan Mystery > Flashcards

Oral Medicine IV - the Brennan Mystery Flashcards

1
Q

Normal BP/Dental Tx/Referral

PreHTN/Tx/Referral

HTN Stage1/Tx/Referral

HTN Stage2/Tx/Referral

EmergentHTN/Tx/Referral

A

< 120/80 Any No

< 140/90 Any Encourage pt see PCP

< 160/100 Any Encourage see PCP

< 180/110 Intraoperative monitoring Prompt Referral

> 180/110 Defer refer ASAP (symptomatic=immediate)

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2
Q

When would you consider Intraoperative monitoring for HTN?

Referral?

A

between 160/100 and 180/110

Prompt

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3
Q

Urgent HTN:

Referral when?

If symptomatic, refer when?

A

over 180/110

ASAP

Immediate

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4
Q

2 Follow-up questions for HTN:

A

Did you take meds today?

Do you know your normal baseline limit?

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5
Q

Example of non-selective Beta Blocker:

Max limit of epi if on this:

Max limit levonordefrin:

A

Propanolol

.036 mg

.20 mg

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6
Q

If a pt is taking a Thiazide Diuretic, what is the Vasoconstrictor (epi) limit?

A

None

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7
Q

Non-selective Beta blockers block…

Selective blocks…

If on non-selective…

A

Beta 1 and Beta 2

Beta 1 only

use caution

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8
Q

If pt forgot to take meds and no Emergency…

A

Postpone/re-appoint

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9
Q

If pt has altered/high BP, ask what?

A

Did you take meds today?

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10
Q

If a pt forgot to take their HTN meds, you can assume if they take them it will….

A

Put them back in normal range

*postpone Tx

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11
Q

JNC8, if older than _____, SBP should be _____

If younger than _____, SBP should be _____

CKD or Diabetes, SBP should be _______

Diastolic Goal:

A

60 < 150

60 <140

140

< 90

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12
Q

If pt has had an MI, know what?

We won’t Tx if less than ______ unless absolutely necessary

probably want what?

A

The date

30 days

med consult

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13
Q

Coronary Artery Disease and MI, what is important?

2 ways to accomplish:

A

Stress reduction - Anxiolysis

Premedicate and pain control

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14
Q

CAD/MI, use what 2 methods to premedicate?

A

Benzos, Nitrous

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15
Q

When is it inappropriate to do a medical consult?

A

Confirmation med Rx nothing to do w/ scenario

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16
Q

What is the best regimen to Mitral Valve Prolapse Prophylaxis?

A

None

*red herring

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17
Q

AHA guidelines, premedicate for what 4 conditions?

A

Artificial Heart Valves

Hx Infective Endocarditis

Cardiac Transplant w/ Valvulopathy

Congenital (3)

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18
Q

What are the 3 Congenital Conditions requiring premedication via AHA guidelines?

A

Unrepaired/incompletely repaired Cyanotic HD (including palliative shunts/conduitis)

Completely repaired defect w/ Prosthetic matl/device first 6 months after procedure

Repaired w/ residual defect at site/adjacent to site of Prosthetic patch/device

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19
Q

5 Examples of when Not to Premedicate:

needed in the past, not now

A

Mitral valve prolapse

Rheumatic HD

Bicuspid valve disease

Calcified aortic stenosis

Congenital - ventricular/atrial septal defect, hypertrophic cardiomyopathy

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20
Q

5 Dental procedures that do not require Abx prophylaxis (if Infective Endocarditis, etc)

A

Anesthetic through non-infected tissue

Radiographs

RPD/Ortho placement

Ortho adjustment

Shedding deciduous teeth/bleeding trauma oral mucosa/lips

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21
Q

PRJ (prosthetic Joint replacements), follow what guide?

A

AUC (appropriate use criteria)

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22
Q

The AUC was created to Tx what two groups?

A

High risk

Immunocompromised

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23
Q

6 types Immunocompromised pts:

*AUC criteria

A

AIDS (CD4 < 200)

Immunosuppressive chemo w/ neutropenia

RA using TNF alpha or Prednisone > 10 mg/day

Organ transplant immunosuppressants

Inherited immunodeficiency

Marrow transplant (pre/post graft or posttranslplantation)

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24
Q

AUC criteria can be immunocompromised or preiprosthetic/deep ______

A

Prosthetic Joint Replacement

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25
Q

3 types of AUC recommendations:

A

Limited: evidence quality unconvincing

Inconclusive: lack of evidence

Consensus: Expert opinion supports recommendation even though there is no empirical evidence that meets inclusion criteria

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26
Q

When would we prophylax for Pins/Plates/Screws?

A

Never

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27
Q

Does pt preference matter for BisPhosphonate premed?

A

“pt preference should have a substantial influencing role”

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28
Q

Tx guidelines for Oral Antiresorptive Meds: Elective Tx:

Inform there is a small risk of developing what?

If pt is on the drug for less than 4 years…

If pt is on the drug for less than 4 yrs w/ Prednisone…

If pt is on the drug for more than 4 years…

A

Not contraindicated

MRONJ (less than 1%)

no alteration/delay for Tx

consider: 2 mo prior/3 mo post Drug holiday

2 prior/3 post Drug holiday

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29
Q

MRONJ is Worse: Cancer vs Osteoporosis:

IV meds vs Oral meds

_____ surgery

> 4 yrs vs < 4 yrs (duration)

mandible vs maxilla

A

Cancer

IV meds

Dentoalveolar surgery

greater than 4 years

Mandible

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30
Q

Even though MRONJ is worse w/ Cancer, IV meds, Dentoalveolar surgery, greater than 4 yrs duration BisPh’s, and in the Mandible… risk is still very low

A

True

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31
Q

Risk of MRONJ is worse w/:

Cancer

IV meds

Dentoalveolar surgery

greater time/Prednisone

Maxilla

A

False

*Mandible is worse

32
Q

If pt has a cirrhotic liver, ask about…

2 concerns:

A

Bleeding

hemostasis and susceptibility to infection

33
Q

Liver function tests for Hemostasis (2 of them)

A

Platelet count

INR

34
Q

Hemostasis tests for Liver function, Platelet count should be:

INR should be:

A

greater than 50,000

less than 3.5

*for most surgical procedures

35
Q

Liver function, infection susceptibility, Neutrophil less than what requires Abx prophylaxis?

A

< 0.5 or 500 mm3

  • (depending on units)
36
Q

If liver disease, avoid what analgesics?

Use what/limit to what dose?

Opioids should be used short term at _____ intervals (liver conjugates)

LA below ___ mg/kg w/ epi

Benzos:

Avoid ___ w/ EtOH

A

NSAIDS/Aspirin

Acetaminophen, less than 4g/day

increased

7 mg/kg

decreased dose

CNS depressants

37
Q

Medical Consult w/ Liver Disease, you need to confirm what 2 things?

Need to Evaluate Liver function tests (ALT/AST, bilirubin, alkaline phosphatase) if ______ is 4x normal

and/or ______

A

Platelets greater than 50,000

INR less than 3.5

ALT/AST

Cirrhosis

38
Q

GERD, avoid what 2 drugs?

Tx enamel erosion, use what Fluoride Tx?

Use what rinses?

A

Aspirin/NSAIDS

topical, varnish, custom trays

Mild baking soda (1 teaspoon in 8 oz water)

39
Q

DDI to know for GERD:

A

Cimetidine (antacid) inhibits absorption of Ketoconazole (antifungal)

40
Q

Chronic Kidney Disease: Stage 1/GFR

Stage 2/GFR

Stage 3/GFR

Stage 4/GFR

Stage 5/GFR

A

greater than 90

60-89

30-59

15-29

less than 15

41
Q

Chronic Kidney Disease, when to monitor pt, ensure stability and Tx, no other mods

Medical consultation necessary

A

Stage 3 and below (30 or better GRF)

Stage 4 or higher (29 and below)

42
Q

When we get a medical consult one of the key things we need to know is Kidney Function

43
Q

Pt on Dialysis, 5 things to know if in Dental Chair:

A

Increased tooth loss

Perio associated w/ C-reactive protein - major risk factor for CKD

Excess bleeding - get platelet count

Anemia - need Hb/Hematocrit prior to Nitrous

Tx on non-dialysis days

44
Q

There are no contraindications to Tx if pt on _____ dialysis

A

Peritoneal

45
Q

AV site w/ pt on Dialysis:

No IV/IM meds on that arm

A

Take BP on other arm

True

46
Q

Dialysis pts have increased susceptibility to infections

Infective Endocarditis of ____ % incidence

*follow AHA guidelines

47
Q

pt has BP 173/103, what guidelines?

A

Any Tx, consider monitoring BP intraoperatively

*b/c Stage II HTN

48
Q

Dyspnea:

Hemoptysis:

A

Trouble Breathing

Coughing up blood

49
Q

Orthopnea:

Claudication:

A

Shortness of breath while lying flat

Exercise induced cramping

50
Q

Pruritis

Dysphagia:

Hematemesis:

Melena:

Hematochezia:

A

Itchy skin

difficulty swallowing

Vomiting blood

dark blood in stool

Fresh blood through anus

51
Q

Dysuria

Hematuria

Nocturia

A

painful urination

blood in urine

excessive urination at night

52
Q

Dysmenorrhea

A

painful periods

53
Q

Polyuria

Polydipsia

Polyphagia

A

lots of urine (dilute)

excessive thirst

excessive hunger

54
Q

Epistaxis

Syncope

A

nosebleed

fainting

55
Q

Symptom:

Sign:

A

subjective

objective

56
Q

Ideally BisPh’s should be Rx after dental consult b/c much better to have extractions done before

57
Q

What is the most common primary diagnosis in the US?

15-20% of pts have?

A

HTN

white coat HTN

58
Q

Amoxicillin is Oral and ___g prior to Dental procedure

If unable to take oral, ____ or ______

Allergic to Penicillin - ORAL (3 drugs)

Allergic to Penicillin/Unable to take oral

A

2 g

Ampicillin (2g), Cefazolin/Ceftriaxone (1g)

Cephalexin (2g), Clindamycin (600mg), Azithromycin/Clarithromycin (500mg)

Cefazolin/Ceftriaxone (1g), Clindamycin (600mg)

59
Q

2 Oral Bisphosphonates and 1 Oral/IV

A

Alendronate (Fosamax)

Risendronate (Actonel)

Ibandorate (Bonive) can be both

60
Q

What Heps tend to self resolve?

Which are more serious?

A

A and E

B, C, D

61
Q

Pts w/ liver disease can present as a Sjogren’s like syndrome

62
Q

The coagulating factors are associated with what Vitamik?

63
Q

If there are any liver problems, what to use besides Lidocaine?

A

Articaine/Prilocaine

64
Q

If liver disease, Beta-lactam drugs can be used safely

Use ____ w/ caution

Avoid clindamysin, aminoglycosides, vancomycin, and macrolides,

Tetracycling, minocycline, doxy used at reduced dose

A

True

Metronidazole

True

True

65
Q

2 types of Hepatitis that need med consult even if not active:

A

B, C

*need to know bleeding concerns

66
Q

In acute liver disease, only emergency care can be provided

67
Q

GFR, may have hematuria/proteinuria:

anemia, secondary hyperparathyroidism

dialysis/transplant prep:

initiate dialysis

A

greater than 60

30-60

15-30

less than 15

68
Q

Blood Urea Nitrogen (BUN) very important lab test for kidneys

*also Creatinine level/clearance

69
Q

To achieve hemostasis Hematocrit levels should be greater than…

70
Q

Wary of Nitrous and CKD pts

71
Q

Hydrochlorothiazide

A

HTN - angiotensin receptor blocker

72
Q

You can give Abx 2 hrs after procedure if Infective Endocarditis is missed

73
Q

Ca channel blocker causes puffy gums

A

Nifedipine

74
Q

AUC guidelines are for ____ only

A

joint replacement

75
Q

If Hep C, need…

for bleeding concerns, CBC, if neutropenia…

Consider ______ instead of Lido

A

med consult

premedicate

articaine/prilocaine

Tim's Cards (140 decks)

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