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oral surgery practical > Practical > Flashcards

Practical Flashcards

1
Q

Max dose for lidocaine?

A

W. epinephrine: 500mg
wo epinephrine: 200mg

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2
Q

Strongest vasodilative LA?

A

Lidocaine

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3
Q

Weakest vasodilative (except cocaine)?

A

Mepivacaine

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4
Q

LA of choice for pts who cannot receive vasoconstrictors (aka cardiac patients, poor controlled diabetes etc)?

A

Mepivacaine

Also: lido & articaine

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5
Q

Max dose for mepivacaine?

A

400 mg

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6
Q

LA contraindicated in pregnancy?

A

Mepivacaine, bupivacaine, prilocaine
Ropivacaine also

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7
Q

Max dose prilocaine?

A

400 mg

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8
Q

Contraindications for use of vasoconstrictors?

A

Hyperthyroidism
Resting BP +200/115
Unstable angina pectoris
MI withinn 6 mo
Cerebro- or cardiovascular accident witing 6 mo
Coronary artery bypass graft within 6 mo
Uncontrolled cardiac arrythmias
Decompensated congestive heart failure
Sulfite-sensitive asthma (vasoconstrictors contain sulfites)

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9
Q

How many ampules max in pregnancy?

A

2 ampules 1:200000 (1 ampule = 2ml)
1 ampule 1:100

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10
Q

LA that cannot be given to children?

A

Mepivacaine

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11
Q

LA for hepatic deficiency?

A

Articaine
Procaine

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12
Q

Procaine max single dose?

A

500 mg

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13
Q

Treatment of vasovagal collapse?
Paleness
Perspiration
Loss of consciousness
Clonic cramps (epilepsy-like)

A

Trendelenburg’s position (head low legs up)
Oxygen therapy

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14
Q

Treatment of CNS toxication
Dizziness, ear ringing
Decreased consciousness, breathing

A

Oxygen therapy

If seizures: diazepam 5-10 mg i.v.

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15
Q

Remedies for immediate hypersensitivity reaction (asthma)?

A

Volume expanders: crystalloids
B2-agonists: phenoterol, salbutamol, albuterol
More severe cases:
Epinephrine im/iv 10-20 μg
Corticosteroids (too slow action for anaphylaxis)

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16
Q

Remedies for delayed hypersensitivity rxn?

A

Oral antihistamines

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17
Q

Ester action (pseudocholinesterase) can be disturbed by?

A

Hepatic or kidney insufficiency
Malnutrition or other eating disorders
3rd trimester
Birth-control pills

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18
Q

Should you cease aspirin therapy in cardiovascular patients?

A

Never in case of low-dose therapy 75-150 mg/day

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19
Q

What medications should not be used in immunocompromised patients?

A

Steroids

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20
Q

Rules for surgery in pregnancy?

A

Elective: 6 weeks post-delivery
Urgent: 2nd trimester
Emergency: any time

Upright position due to risk of hypoxia

21
Q

High risk patients?

A

Cardiac
Hemodialysis
Endocrine disorders
Pregnancy
Asthma
Previous surgeries or hospitalizations
Immunocompromised
Biphosphonate therapy
Liver disorders

22
Q

Antibiotics in pregnancy?

A

Penicillin G, amoxicillin
Penicillin allergy: clindamycin
Cephalosporins

23
Q

Drugs/antibiotics to avoid in pregnancy?

A

Tetracyclines
Aminoglycosides
Clarithromycin
Metronidazole
Sulfonamides

24
Q

Antibiotic dosages for adults and kids?

A

Amoxicillin or ampicillin iv/im/oral
Adults 2000mg
Children: 50mg/kg

Oral 60 min pre-op
Iv/im 30 min pre-op

25
Q

Uncontrolled diabetes?

A

Avoid elective surgery
Emergency: one-shot antibiotic prophylaxis
Another pp says at least 5 day regimen
amoxicillin 500mg 3xday
clindamycin 300mg 3xday

Which is correct?

26
Q

How to prevent thyrotoxic crisis in hyperthyroidism?

A

Propylthiouracil

27
Q

LA in alcoholism?

A

Articaine, procaine

28
Q

Pain medication in pregnancy (analgesics) considerations?

A

Only when necessary and as short as possible!

Paracetamol may lead to ADHD & asthma in children (esp 1st tri)
Ibuprofen and other NSAIDS in 1st or 3rd may lead to serious defects

29
Q

Patients at risk of IE?

A

Any prosthetic valve
Congenital heart disease:
- Any cyanotic CHD
- Any CHD repaired with prosthetic material <6 mo after procedure; lifelong if residual shunt or regurgitation still remains

Previous episode of IE

30
Q

Medication in case of urgent surgery of uncontrolled hypertension aka >200/115?

A

No vasoconstrictor!
Rapid-onset hypotensive drugs: sublingual captopril

31
Q

Can you use norepinephrine in controlled hypertension?

A

No
It increases both systolic and diastolic BP, epinephrine doesn’t

32
Q

Where is the action of anticoagulants?

A

Veins

33
Q

Where is the action of antiplatelets?

A

Arteries

34
Q

When should warfarin/acenocoumarol dose be reduced?

A

Not during small surgeries with INR <4 (5% tranexamic mouth was can stabilize clot)

If INR >4 –> anticoagulant can be diminished to bring INR to 2-3

35
Q

What antibiotic is preferred in case of penicillin allergy and what is the dosage?

A

Clindamycin
600mg adult or 20 mg/kg children

Azitromycin
500mg adult or 15 mg/kg in children

36
Q

Bridging therapy?

A

Major surgical procedure
Warfarin or acenocoumarol discontinuation 5/3 days pre-operatively
Start LMWH until 24h pre-operatively

Restart anticoagulant 12h post-operatively
Restart LMWH 24h post-operatively and discontinue 3/5 days post-operatively

37
Q

Anticoagulants?

A

VKA - Warfarin, acenocoumarol
Heparin
Direct Xa factor inhibitor - Rivaroxaban
Direct thrombin inhibitor - Dabigatran

38
Q

Antiplatelets?

A

Aspirin
Clopidogrel
Ticlopidine

39
Q

Should you discontinue rivaroxaban/dabigatran before surgery?

A

Minor surgery:
Discontinue 48h preop
Continue 24h postop

Major (bridging might be needed, consult GP)
Discontinue 72h preop
Continue 48h postop

40
Q

Dual antiplatelet therapy aspirin+clopidogrel?

A

Typical in pts w. stent implants - aspirin must never cease in whole lifetime

Clopidogrel can be ceased:
12 months after acute cardiovascular event or implantation of drug-eluting stent
3 months after implantation of bare-metal stent
During that timeframe - no elective surgery

Clopidogrel discontinuation 5 days preop
Continuation 24h postop

41
Q

How to proceed with patients about to receive radiotherapy?

A

Extract teeth prior to radiation
Surgery after radio - avoid if possible; however always w. antibiotic therapy before & after

Advice to pt during radiotherapy: soft diet and avoid dental prosthesis to prevent trauma to fragile oral mucosa

42
Q

What diseases is bisphosphonate therapy associated with?

A

Osteoporosis
Bone metastasis
Paget’s disease (bone can become fragile, misshaped)
Multiple myeloma

43
Q

Considerations in case patient takes BPs?

A

Consult pt’s GP for discontinuation
Surgery can precipitate or exacerbate osteonecrosis

Antibiotic therapy always before & after
Chlorhexidine mouthwash

44
Q

Considerations for HIV patients?

A

CBC w. platelets
Liver function test for coagulation
CD4 count (antibiotics prophylaxis if <350)

45
Q

What conditions require antibiotics?

A

Risk of IE
Radiotherapy
BP therapy
HIV <350
Poor metabolic diabetes
Hemodialysis
Pregnancy only if necessary

46
Q

Antibiotics in hemodialysis?

A

2g amoxicillin or 600mg clindamycin
60 min preop orally

47
Q

Considerations for pts with hemodialysis?

A

High risk of postoperative bleeding, pts on heparin
Desmopressin 0.3mg/kg - stimulates von
Willebrand factor

Urgent surgery: protamin sulfate (100 i.u.), to neutralize heparin, if necessary (unfractionated heparin action lasts 4h, so if surgery is to be within that time frame)

48
Q

Conditions not requiring antibiotics?

A

Good metabolic diabetes
Other CHD or acquired heart disease
History of myocardial or cerebral infarction
Implanted pacemaker
By-pass surgery
HBV & HCV

49
Q

Antibiotics in IE?

A

Amoxicillin wo clavulanic acid or
ampicillin wo sulbactam
2000mg adult and 50 mg/kg children

oral surgery practical (3 decks)

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