September Flashcards
What drugs are renal transplant patients likely to be on?
A corticosteroid plus a steroid sparing drug e.g. cyclosporin
What is the main side effect of cyclosporin?
Gingival overgrowth
Is antibiotic cover needed for MOS renal transplant patient?
No
What infections are renal transplant patients predisposed to?
Candidosis, herpes simplex or zoster virus (give low dose acyclovir in some cases)
What does renal osteodystrophy result in?
Secondary hyperparathyroidism
What does secondary hyperparathyroidism mean happens in the body?
Ca moves out of the bones
What chemical is not produced which means anaemia occurs?
EPO is not produced by the kidney
How would you describe anaemia of chronic disease?
Normocytic and normochromic
What drug do dialysis patients take?
Heparin
When is the optimum time for dental treatment in dialysis patients?
The day after dialysis - optimal renal function and heparin has worn off
What other oral symptoms could renal transplant/ dialysis patients present with?
Increased oral ulceration, increased oral infection, swelling of salivary glands in particular parotid palatal and buccal keratosis, in kids, delayed eruption etc
What do you have to be aware of when prescribing to a renal patient?
Impaired drug excretion
What drug is nephrotoxic?
Gentamycin
Give 3 examples of drugs that should be given in a reduced dose in renal patients?
Acyclovir, erythromycin, amoxicillin, ampicillin
What drugs should be avoided in renal patients?
Gentamycin, NSAIDs, tetracyclines
What are AKI patients at risk of?
Because of increased K, arrhythmias . Med emergency - calcium resonium and glucose and insulin infusions IV?
What is the effect of PTH?
Increased serum Ca therefore Ca moves out of bones
What is an example of a bone turnover marker?
Beta crosslaps - if increased, bone breaking down more rapidly
What is used to assess osteoporosis?
DEXA - assesses bone mineral density
What is the difference between prim and sec parathyroidism?
Primary - abnormal glands causing hypercalcaemia
Secondary - Ca low for another reason so PTH is appropriately high
What can vit D defincency cause?
Tetany as low Ca
What does a pagets disease x ray look like?
Moth eaten
What is the treatment for pagets?
High dose bisphosphonates
What 3 things are treated with high dose bisphos?
Metastases, pagets, hypercalcaemia
Low dose bisphos?
Osteoporosis
What can cause osteoporosis?
Cushings, steroid treatment, menopause, something effecting Ca and vit D e.g. liver, kidney, nutritional
What DEXA score means osteoporosis?
-2.5 or below
Osteoporosis tx options?
HRT, low dose bisphos, denosumab, PTH injections, Ca and D3 in elderly
Bone metastases tx?
IV bisphos (high dose), radiotherapy, surgery
common primary metastatic cancer sites?
breast, prostate, lung
What is filtered through the glomerulus?
Water, electrolytes, urea, uric acid, glucose, creatinine
What is the macula dense?
Closely packed cells lining the distal tubule wall, where is touches glomerulus (specialised cells)
GFR?
Sum of filtration rate in all functioning nephrons
What is creatinine clearance?
Amount of blood kidneys clear of creatinine (USUALLY PER MIN)
When GFR decreases…
Creatinine increases (a small increase in creatinine indicates big drop in GFR so is significant)
what is creatinine clearance?
Urinary creatinine concxvolume/plasma creatinine conc
What occurs with platelets in CKD?
Don’t work properly but normal count
What is caused by CRF?
Hyperkalaemia and hypocalcaemia, restless legs, hormones crazy and twitches
What is academia treated?
Sodium bicarbonate
What does fluid overload cause - dialysis?
Cardiac tamponade, pericardial effusion, pul oedema, becks triad
What would you give prophy if someone had metal heart valve and dialysis?
Amoxicillin 3g 1hour pre procedure - clindamycin If allergic. Or IV vancomycin or gentamycin?
Name some drugs used immunosuppression dialysis etc?
Prednisolone, Cyclosporin, Tacrolimus, Sirolimus
What are symptoms of orofacial digital syndrome?
Liver cysts, bifid tongue, dental abnormalities, facial milia, cleft palate, limb abnormalities, digit abnormalities X linked dominat
What is korsakoffs psychosis>
B and thiamine deficiency
What is osteoarthritis treated with?
Analgesics, NSAIDs, Steroid injections, Hyaluronan injections, Glucosamine sulphate, weight loss
RA symptoms?
Symmetrical, more deforming and inflammatory than OA, longer morning stiffness, serum RF,
Radiographs - OA vs RA?
OA - whiter X ray, RA = darker x ray, periarticular bone lesions
`further symptoms RA?
Pleurisy, Sjrogens, Anaemia of chronic disease, muscle atrophy, pericarditis, ulna deviation
Give two examples of DMARDs?
Methotraxate, cyclosporin
Patients on anti TNF drugs? Dentally relevant…
FBC before dental tx. Patient should be dentally fit before starting these drugs.
Treatment for psoriasis with psoriatic arthritis?
Methotrexate? anti TNF
What is reiters syndrome?
Reactive arthritis and conjunctivitis and urethritis
Tx Reiters?
DMARds, sometimes NSAIDs, steroid injection or self limiting
What is sjorgens?
The lymphocytic infill of lac/sal glands (interstitial lung disease, renal tubular acidosis, raynauds)
Treatment sjrogens?
things to relieve dryness and steroids
What to do if teeth are involved in a jaw fracture?
It is an open fracture, aim to treat within 24 hours
Classifying fractures?
Site, joint involvement, traumatic/pathological, extent
What does angulation mean in terms of fractures?
Spiral fracture
What does avulsion mean in terms of fractures?
Bone pulled by tendon attached to it
What are the 3 stages of fracture healing?
Inflammation, reparative, remodelling
Rehabilitation for a fracture?
minimise immobilisation, early mobilisation, soft diet, physio
Dental treatment and joint replacement?
oral strep rarely causes infection so not prophylactic advised, if patient is immunocompromised ask!
what happens in osteoporosis?
the bone marrow fills in with bone
What are osteoporosis patients at risk of ?
Post extraction osteomyelitis
Fibrous dysplasia?
Hyperthyroidism, Chinese letter bone
What dental problems pagets?
Ill fitting dentures! Mosaic bone under microscope, Hugh out put cardiac failure, enlarging head
Osteoradionecrosis definition?
Dead bone caused by secondary reaction to radiotherapy - set off by Xla/trauma. Avoid XLA 6 months -1year after radiotherapy
Post DXT xls?
Dont do - refer! but prophy antibiotics for 1 month / till socket heals. when XLA really minimise periosteal lifting and trauma Close St accurately. Trim sharp bone edges. No vasoconstrictor.
What is an oral feature of ankylosing spondylitis?
Minimal mouth opening
Treatment of gout?
NSAIDs then allopurinol
Cleidocranial dystosis oral indications?
Delayed eruption, supernumerary or non eruption of teeth
When is cyclosporin used?
Transplant patient or RA
When is methotrexate used?
Transplant patient or RA
Methotrexate oral effects?
Increased oral ulceration
Baclofen effects?
Xerostomia
Pencillamine oral effects?
Ulceration, lichenoid reactions
BZDs agonist?
Flumazenil
What do antihistamines do?
CNS depress
Uses of anxiolytics?
Sedation, muscle relaxants, premed - oral, amnesic, epilepsy emergency
What is midazolam used for?
IV sedation
