Adrenal Insufficiency - Bleeding disorders

Question 1

when is aldosterone secreted?

Answer 1

when there is a fall in renal BP

*causes reuptake of sodium and H2O

Question 2

maintains homeostasis during physical/emotional stress

Answer 2

cortisol

*most important in dentistry

Question 3

what are examples of primary and secondary adrenal insufficiency?

Answer 3

primary - injury

secondary - tumor of the gland or pituitary

Question 4

what innactivates cortisol?

Answer 4

negative feedback loop

Question 5

what are the dental modifications to well - controlled adrenal disorders

Answer 5

no modifications to tx

Question 6

what are some problems with uncontrolled adrenal pts?

Answer 6

may not meet metabolic demand

• delayed healing
• suseptability to infection
• intolerant to stress

Question 7

what is the most potent activator of the HPA axis

Answer 7

surgery

*post-op is highest cortisol demand

Question 8

how do you treat acute adrenal insufficiency?

Answer 8

give exogenous cortisol for primary only

*cant do anything for secondary

Question 9

how would a dentist prevent any problems with adrenal pts?

Answer 9

• stress reduction
• AM appts
• pain control
• monitor BP

Question 10

what do you do if a pt has an acute adrenal crisis in your office?

Answer 10

EMS!!!!!

• there is nothing you can do bc it is medical emergency
• get feet raised above the heart
• BLS

Question 11

when should you avoid tx with a pregnant pt?

Answer 11

1rst trimester

*emergency care ok anytime though

Question 12

what is a way to keep pregnant pts comfortable?

Answer 12

semi-reclined chair
short appts
allow pt to change positions

Question 13

can you do radiographs with pregnant pts?

Answer 13

yes just NOT in the first trimester

-dont do full mouth series

Question 14

can you give drugs to a pregnant pt

Answer 14

ideally no drugs at all during pregnancy but especially not in the first trimester

Question 15

pregnancy drug that has controlled human studies, no demonstrated risk, and has remote posiibility to fetal harm

Answer 15

A

Question 16

pregnancy drug that has animal studies, no demonstrated risk to humans but have shown risk to animals

Answer 16

B

Question 17

pregnancy drug that has animal studies that have demonstrated risk, or animal studies are not available

Answer 17

C

*most dental drugs

Question 18

pregnancy drug that has positive evidence of human risk

Answer 18

D

Question 19

pregnancy drug that has evidence of fetal abnormalities, the risks outweigh the benefits

Answer 19

X

Question 20

what antibiotics can you NOT GIVE to pregnant pts?

Answer 20

tetracycline

Question 21

what type of anagesic drug can you NOT GIVE to pregnant pts?

Answer 21

NSAIDS

Question 22

can you give sedatives to pregnant pts?

Answer 22

no

Question 23

after the baby is born, when should the mother start taking drugs?

Answer 23

immediately after breast feeding

Question 24

when do you want to do surgery on a transplant pt?

Answer 24

before the transplant occurs

Question 25

what risks are there with transplant pts?

Answer 25

``` IMMUNOSUPPRESSION (dont on purpose) leads to: -pancytopenia (low WBCs) -inc risk for infection -bleeding disorders ``` *may need to do bone marrow transplant and will require a dental clearance exam

Question 26

how are you supposed to treat a pre transplant pt?

Answer 26

aggressively and quickly

Question 27

how long after a transplant is a pt not able to have elective dental care (only emergency)

Answer 27

6 months

Question 28

when does HIV become AIDS?

Answer 28

when CD4 drops below 200

Question 29

what test is performed to see if a pt has AIDS

Answer 29

ELISA test

Question 30

what must you ask a pt with HIV/AIDS?

Answer 30

- CD4 and lymphocyte count - viral load - WBC count - platelet count

Question 31

what type of dental tx can you do for a pt that is asymptomatic HIV seropositive

Answer 31

all dental care is indicated *you wouldnt know they had the disease if they didnt tell you

Question 32

what type of dental tx can you do for a pt that is asymptomatic, HIV infected with decreasing CD4+ count

Answer 32

can still do routine and complex restorative tx | -must get platelet count and WBC count for invasive surgical procedures

Question 33

what type of dental tx can you do for a pt that has AIDS (CD4+ count less than 200)

Answer 33

emergency care only

Question 34

rapid accumulation of immature, non-functioning WBCs in marrow

Answer 34

Acute leukemia

Question 35

leukemia that is more common in adults over 65

Answer 35

chronic leukemia

Question 36

can acute leukemia be cured?

Answer 36

yes, after doing three phases of chemo -induction, consolidation, maintenance

Question 37

can CML be cured?

Answer 37

yes, possible to obtain complete remission

Question 38

can CLL be cured?

Answer 38

no, tx has little change on quality of life

Question 39

which type of lymphoma is more likely to be cured?

Answer 39

hodgkins

Question 40

lymphoprolifeative disorder taht is an overproduction of malignant PLASMA cells. has multiple tumor masses through the skeletal system

Answer 40

multiple myeloma

Question 41

what are the concerns in dentistry of a pt has leukemia-lymphoma?

Answer 41

- infection - delayed healing - bleeding

Question 42

what do you need to have in order to do dental surgery on a pt with leukemia/lymphoma?

Answer 42

medical consultation * platelets must be over 50,000 * WBCs must be higher than 2000

Question 43

how long should you wait between dental extractions and chemo tx for lymphoma/leukemia pts?

Answer 43

10-14 days

Question 44

what type of dental care can you do DURING cancer tx for leukemia/lymphoma?

Answer 44

- preventative only | - no elective

Question 45

platelet count that makes pt bleed excessively with minor trauma?

Answer 45

less than 50,000

Question 46

platelet count that makes a pt bleed spontaneously

Answer 46

less than 20,000

Question 47

what is the best single screening test for coagulation disorders?

Answer 47

PTT

Question 48

what replaced the PT test?

Answer 48

INR (warfarin)

Question 49

what type of disease is both an acquired platelet and an aquired coagulation disorder?

Answer 49

liver disease

Question 50

how does a dentist manage a pt on antiplatelet therapy?

Answer 50

DO NOT discontinue the antiplatelet drugs | -use local measures to control homeostasis

Question 51

what type of drug is coumadin?

Answer 51

anti - COAGULATION * inhibits synthesis of vitamin K dependent coagulation factors * INR used to monitor

Question 52

what should an INR be in order to have dental surgery?

Answer 52

below 3

Question 53

how does a dentist control local measures when dealing with a warfarin pt?

Answer 53

keep gelfoam around (used with thrombin and primary closure) if bleeding does not stop after using gelfoam then contact hematologist

Question 54

what type of anagesic should be used with warfarin pts?

Answer 54

tylenol (NO NSAIDS)

Question 55

most common congenital bleeding disorder?

Answer 55

von Willebrand disease

Question 56

is hemophilia A or B more common?

Answer 56

A

Question 57

what are the two jobs of von Willebrand factor?

Answer 57

- bind and carry factor VIII in the blood (is destroyed if it is unbound) - all platelets to adhere to surfaces

Question 58

type 1 vWF

Answer 58

- LOW levels of vWF - 75% of pts (most common) - symptoms usually mild

Question 59

type 2 vWF

Answer 59

- NORMAL levels of vWF but it does NOT WORK RIGHT - 15-25% of pts - moderate/severe symptoms

Question 60

type 3 vWF

Answer 60

- LITTLE OR NO vWF - 5% (rare) - most severe symptoms

Question 61

what are common occurences with type 1 vWF?

Answer 61

- epistaxis (nose bleeds) | - menorrhagia (long menstral cycles)

Question 62

what treatment should be used with type 1 vWF?

Answer 62

DESMOPRESSIN! | -causes release of vWF from endothelial cells

Question 63

what should you use to treat types 2 or 3 vWF?

Answer 63

FACTOR VIII REPLACEMENT! | -NO desmopressin bc it they dont have vWF so it wouldnt work!

Question 64

can you treat vWF pts at outpatient therapy?

Answer 64

yes but only type 1 and 2 use desmopression as peri-op

Question 65

what type of vWF pts must be seen in a hospital?

Answer 65

severe type 2 and type 3

Question 66

disorder in which a pt does not have enough factor VIII in the blood

Answer 66

hemophelia A

Question 67

what is the dental management of a pt with hemophilia A?

Answer 67

- consult with physician - outpatient care is ok - no local anesthetic blocks without managment - use tylenol not NSAIDS