Bleeding, leukaemia and dentistry Flashcards Preview

Year 3 Human Disease > Bleeding, leukaemia and dentistry > Flashcards

Flashcards in Bleeding, leukaemia and dentistry Deck (43):
1

process of haemostasis

injury/ tissue damage --> vascular response --> platelet adhesion, aggregation --> unstable platelet clot --> coagulation factor cascade --> fibrin --> stable clot

2

draw clotting cascade

see lecture

3

what is the vascular response of haemostasis

vasoconstriction

4

what is the platelet response of haemostasis

von willebrand factor + platelet + fibrinogen --> unstable platelet clot
--> clotting cascade --> fibrin --> stable clot

5

why should dentists be aware of haemophilia

more bleeding, esp with extractions

6

2 considerations of injections with haemophiliac pts

-blocks/ FOM injections may cause haemorrhage to track through tissue planes --> airway obstruction
-avoid intramuscular injections

7

when is heparin used

acute thromboembolism

8

when is enoxaparin used and how does it work

prophylaxis for DVT/ PE
LMW heparin, inhibits factor Xa

9

how does warfarin work

impairs vit K synthesis dependent coagulation factors (2,7,9,10) in the LIVER

10

how long does warfarin take to become effective

2-4 days

11

7 indications of oral anticoagulation SHORT TERM

-prophylaxis to prevent DVT
-myocardial infarction (3 months)
-established DVT (3 months)
-xenograft heart valves (3 months)
-pulmonary embolism (6 months)
-coronary artery bypass grafts (CABG, 2 months)
-atrial fibrillation

12

3 indications of oral anticoagulants LONG TERM

-recurrent venous thromboembolism
-rheumatic heart diease and atrial fibrillation
-cardiac prosthetic valve replacement and arterial grafts

13

what is used to measure anticoagulant effect, how to caculate

INR = prothrombin time (test)/ prothrombin time (control)

14

INR values

1= normal
2.5= DVT, PE, AF
3.5= recurrent DVT/ PE, mechanical heart valves
>4=dop not extract

15

when must INR be checked

on the day/ no more than 24-36 hours before procedure

16

3 warfarin potentiating factors

-antibiotics
-miconazole oral gel (antifungal)
-aspirin/ NSAIDS

17

5 relevant drug interactions/ considerations with warfarin

-amoxicillin (single 3g dose ok)
-metronidazole (halves effect of warfarin)
-erythromycin (unpredictable, only affects some pts
-NSAIDs (inc bleeding, GI bleeds)
-daktarin oral gel

18

when and why alter INR 2

before surgery to decrease bleeding (NOT by dentists)
-stop meds 48hrs before surgery
-reduce warfarin by 50% for 48hrs

19

2 new anti-coagulants and how they work/ when used

rivaroxaban: Xa inhibitor, prophylaxis for hip/ knee repacement
dabigatran: direct thrombin inhibitor, prophylaxis for hip/knee replacement, stroke, AF, valve replacement

20

what is normal bleeding time
compare genders

2-10 mins
longer in women than men

21

effect of antiplatelet agents on
a. bleeding time
b. haemostasis

a. bleeding time: prolongs
b. haemostasis: minimal effect

22

5 coagulation defects causes

-liver disease
-hepatocellular failure
-vit k deficiency
-increased fibrinolysis
-thrombocytopenia

23

healthy platelet count

150-450000 per microlitre

24

symptoms of thrombocytopenia

100-150m bleeding time
x20-100 increase in bleeding time
x20 risk of spontaneous bleeding

25

tx for thrombocytopenia

autoimmune: steroids or splenectomy
leukaemia/ aplastic anaemia: platelet transfusion

26

define leukaemia

neoplastic proliferation of white blood cells in bone marrow

27

4 causes of leukaemias

-genetic (eg downs syndrome)
-ionizing radiation (chernobyl)
-chemicals (benzene)
-viruses

28

2 types of leukaemia

lymphoblastic
non-lymphoblastic

29

4 effects of chemotherapy on bone marrow

-leukopenia
-neutropenia
-thrombocytopenia
-anaemia

30

1 reason oral screening is required alongside chemo

-identify and stop causes of sepsis (eg after tooth extraction)

31

oral side effects of chemo

-mucositis (oral mucosa breaks down bc its rapidly dividing)
-oral ulceration
-opportunistic infections (pseudomonas, candida, herpes simplex)

32

3 things chemo patients take as prophylaxis

antivirals eg acyclovir
antifungals eg fluconazole/ itraconazole
antibiotics

33

6 useful aids to symptomatic tx of chemo

-corsodyl rinse/ gel
-gelclair mucosal bandage
-difflam rinse/ spray
-betnesol mouth rinse
-becotide spray
-bite guards (suck down splints 1-2mm)

34

difference between oral and neutropenic ulcers

oral ulcers: erythematous halo around ulcer
neutropenic ulcers: no halo

35

opportunistic infections with chemo

-candida
-systemic aspergillosis
-herpes simplex
-herpes zoster/ varicella (chicken pox: vesicles --> oral ulcers)

36

5 recommendations about oral health prior to cancer therapy

-oral assessment
-OHI, supplement with chlorhexidine mouthwash/ gel
-carious teeth stabilised w restorations
-smooth sharp teeth/ restorations
-remove teeth with doubtful prognosis

37

7 dental recommendations during cancer therapy

-support from hygienist
-high standard of OH
-chlorhexidine mw/ gel
-fluoride mw in those undergoing radiotherapy of head/neck
-decrease mucositis
-treat xerostomia
-avoid dental tx where possible

38

what counts as immunocomp for
a. neutrophils
b. platelets

a. neutrophils:

39

2 reasons prophylactic antibiotics are recommended

-pt neutropenic at time of tx
-tx likely to induce significant bacteraemia

40

what to check if cancer pt needs dental surgery

platelet count, white cell count

41

when is platelet cover required

when platelet count is less than 50x10^9

42

best time for dental treatment of chemo pts and why

just before/ just after chemo (highest neutrophil count)

43

what teeth to remove for chemo pts 3 and why

-advanced perio disease
-pulp infection
-chronic apical pathology
reduce chance of infection, as can be deadly for chemo pts