Practical Flashcards
Max dose for lidocaine?
W. epinephrine: 500mg
wo epinephrine: 200mg
Strongest vasodilative LA?
Lidocaine
Weakest vasodilative (except cocaine)?
Mepivacaine
LA of choice for pts who cannot receive vasoconstrictors (aka cardiac patients, poor controlled diabetes etc)?
Mepivacaine
Also: lido & articaine
Max dose for mepivacaine?
400 mg
LA contraindicated in pregnancy?
Mepivacaine, bupivacaine, prilocaine
Ropivacaine also
Max dose prilocaine?
400 mg
Contraindications for use of vasoconstrictors?
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)
How many ampules max in pregnancy?
2 ampules 1:200000 (1 ampule = 2ml)
1 ampule 1:100
LA that cannot be given to children?
Mepivacaine
LA for hepatic deficiency?
Articaine
Procaine
Procaine max single dose?
500 mg
Treatment of vasovagal collapse?
Paleness
Perspiration
Loss of consciousness
Clonic cramps (epilepsy-like)
Trendelenburg’s position (head low legs up)
Oxygen therapy
Treatment of CNS toxication
Dizziness, ear ringing
Decreased consciousness, breathing
Oxygen therapy
If seizures: diazepam 5-10 mg i.v.
Remedies for immediate hypersensitivity reaction (asthma)?
Volume expanders: crystalloids
B2-agonists: phenoterol, salbutamol, albuterol
More severe cases:
Epinephrine im/iv 10-20 μg
Corticosteroids (too slow action for anaphylaxis)
Remedies for delayed hypersensitivity rxn?
Oral antihistamines
Ester action (pseudocholinesterase) can be disturbed by?
Hepatic or kidney insufficiency
Malnutrition or other eating disorders
3rd trimester
Birth-control pills
Should you cease aspirin therapy in cardiovascular patients?
Never in case of low-dose therapy 75-150 mg/day
What medications should not be used in immunocompromised patients?
Steroids
Rules for surgery in pregnancy?
Elective: 6 weeks post-delivery
Urgent: 2nd trimester
Emergency: any time
Upright position due to risk of hypoxia
High risk patients?
Cardiac
Hemodialysis
Endocrine disorders
Pregnancy
Asthma
Previous surgeries or hospitalizations
Immunocompromised
Biphosphonate therapy
Liver disorders
Antibiotics in pregnancy?
Penicillin G, amoxicillin
Penicillin allergy: clindamycin
Cephalosporins
Drugs/antibiotics to avoid in pregnancy?
Tetracyclines
Aminoglycosides
Clarithromycin
Metronidazole
Sulfonamides
Antibiotic dosages for adults and kids?
Amoxicillin or ampicillin iv/im/oral
Adults 2000mg
Children: 50mg/kg
Oral 60 min pre-op
Iv/im 30 min pre-op
Uncontrolled diabetes?
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?
How to prevent thyrotoxic crisis in hyperthyroidism?
Propylthiouracil
LA in alcoholism?
Articaine, procaine
Pain medication in pregnancy (analgesics) considerations?
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
Patients at risk of IE?
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
Medication in case of urgent surgery of uncontrolled hypertension aka >200/115?
No vasoconstrictor!
Rapid-onset hypotensive drugs: sublingual captopril
Can you use norepinephrine in controlled hypertension?
No
It increases both systolic and diastolic BP, epinephrine doesn’t
Where is the action of anticoagulants?
Veins
Where is the action of antiplatelets?
Arteries
When should warfarin/acenocoumarol dose be reduced?
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
What antibiotic is preferred in case of penicillin allergy and what is the dosage?
Clindamycin
600mg adult or 20 mg/kg children
Azitromycin
500mg adult or 15 mg/kg in children
Bridging therapy?
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
Anticoagulants?
VKA - Warfarin, acenocoumarol
Heparin
Direct Xa factor inhibitor - Rivaroxaban
Direct thrombin inhibitor - Dabigatran
Antiplatelets?
Aspirin
Clopidogrel
Ticlopidine
Should you discontinue rivaroxaban/dabigatran before surgery?
Minor surgery:
Discontinue 48h preop
Continue 24h postop
Major (bridging might be needed, consult GP)
Discontinue 72h preop
Continue 48h postop
Dual antiplatelet therapy aspirin+clopidogrel?
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
How to proceed with patients about to receive radiotherapy?
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
What diseases is bisphosphonate therapy associated with?
Osteoporosis
Bone metastasis
Paget’s disease (bone can become fragile, misshaped)
Multiple myeloma
Considerations in case patient takes BPs?
Consult pt’s GP for discontinuation
Surgery can precipitate or exacerbate osteonecrosis
Antibiotic therapy always before & after
Chlorhexidine mouthwash
Considerations for HIV patients?
CBC w. platelets
Liver function test for coagulation
CD4 count (antibiotics prophylaxis if <350)
What conditions require antibiotics?
Risk of IE
Radiotherapy
BP therapy
HIV <350
Poor metabolic diabetes
Hemodialysis
Pregnancy only if necessary
Antibiotics in hemodialysis?
2g amoxicillin or 600mg clindamycin
60 min preop orally
Considerations for pts with hemodialysis?
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)
Conditions not requiring antibiotics?
Good metabolic diabetes
Other CHD or acquired heart disease
History of myocardial or cerebral infarction
Implanted pacemaker
By-pass surgery
HBV & HCV
Antibiotics in IE?
Amoxicillin wo clavulanic acid or
ampicillin wo sulbactam
2000mg adult and 50 mg/kg children
