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Flashcards in Cardiovascular Deck (43)
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1

What are Libman-Saks Lesions associated with?

Endocarditis

2

What is the causitive agent in Infective Endocarditis?

Bacterial or Fungal

3

What do the AHA Guidelines state regarding conditions requiring prophylaxis?

  • Prostehtic Heart Valve
  • Past History of Infective Endocarditis
  • Unrepaired Cyanotic Congential Heart Defects - 6 months following repair
  • Cardiac Transplants with Valvulopathy

4

What types of dental procedures require antibiotic prophylaxis?

  • Procedures that require manipulation of gingival tissue
  • Apical region of teeth 
  • Perforation of mucosa

5

What are some exceptions to antibiotic prophylaxis?

  • Dental radiographs
  • Injections through non-infected tissue
  • Removable appliances
  • Ortho-bracket or adjustment
  • Shedding of deciduous teeth
  • Trauma to lips

6

What is the Sig for Amoxicilline regarding BE Chemoprophylaxis? 

Amoxicillin: Adults, 2 g (children, 50 mg/kg)

7

Waht is the Sig for Adults/Children for Clindamycin for BE Chemoprophylaxis?

600 mg (children 20 mg/kg)

8

What is the Sig for Cephalexin for BE Chemoprophylaxis?

2 g (children 50 mg/kg)

9

What is the Sig for Azithromycin or Clarithromycin regarding BE Chemoprophylaxis?

500 mg (children 15 mg/kg)

10

When do you tell patients to take drugs in regards to BE?

30-60 minutes prior to dental treatment

11

If a patient  is unable to take oral meds, what is a SIG for Ampicillin?

2 g (children 50 mg/kg)

12

If someone cannot take oral meds for BE, what is a SIG for Cefazolin or Ceftriaxone?

1 g (children 50 mg/kg)

13

If a patient cannot take oral meds, what is the Sig for Clindamycin regarding BE?

600 mg (children 20 mg/kg)

14

Can BE Chemoprophylaxis be taken after a dental procedure?

Yes!

Up to 2 hours post-op

15

What do you do if a patient is already taking antimicrobial treatment and you need to prescribe them BE Chemoprophylaxis?

Switch class of drug OR wait 7-10 days between doses

16

If a patient is being treated for BE with IV antibitoics, when should the drug be dosed?

30-60 minutes prior to dental treatment

17

What is Angina?

Chest Pain

18

What is angina typically a symptom of?

Myocardial Ischemia

19

What are 3 types of Angina?

  1. Stable
  2. Unstable
  3. Prinzmetal

20

Describe Stable Angina...

  • Chronic Unchanged
  • Relieved with rest
  • RElieved with NTG in 5 minutes
  • > 5 minutes may be myocardial infarction

21

Describe Unstable Angina...

  • New onset
  • Pain at rest
  • Angina after MI
  • Increased frequency, intensity, and duration
  • Awakens patient up at night

22

What is Prinzmetal Angina?

  • Typically unpredictable
  • Coronary artery spasm

23

What can you do to treat angina?

  • Nitroglycerin/Beta Blockers
  • PRN
  • Sublingual Tablets
  • Spray
  • Transdermal Patch
  • Isosorbide Mononitrate

24

How do you dentally manage an angina patient?

  • Schedule AM or early PM appointments
  • Increase oxygen availability
  • Reduce stress and anxiety
  • Keep NTG availability
  • Limit Vasoconstrictor 
  • Terminate procedure if patient develops symp;toms

25

How do you manage a patient who has angina in the dental chair mid procedure?

  • Terminate procedure
  • Semi-sitting position
  • NTG 0.3 - .5 mg SL Q5 X 3
  • O2 per NC 4 - 6 L/min
  • Monitor vital signs
  • Call EMS

26

What is the max dose of epinephrine in a normal patient?

0.2 mg

27

What is the max dose of epinephrine in a cardiac patient?

.04 mg 

28

What are some tips when using vasoconstrictors in dentistry?

  • Use that which is necessary for thorough pain control, both depth and duration
  • Endogenous release in response to pain 300 times higher than in 1 carpule 1:100,000
  • Space anestehtic injections
  • Monitor the patient for physiologic reseponse to epinephrine
  • Aspirate, aspirate, aspirate

29

How long should you wait before conducting dental treatment on a patient who has had an MI?

  • Safe to wait 4-6 weeks after MI
  • Adequate revscularization
  • Low risk treadmill test
  • Patient likely on Plavix/ASA
  • Local measures
  • Likelihood of reinfarcation after non-cardiac surgery is low

30

What is the mechanism of action for the Anti-platelet agent Asprin?

Cox Inhibitor

31

What is the mechanism of action for the Anti-Platelet drug Clopidogrel (Plaxix)?

Inhibits binding of ADP to platelet receptor

32

What is the mechanism of action for the Anti-Platelet Agent Ticagrelor (Brilinta)

ADP Receptor Blocker (reversible)

33

What is the mechanism of action for the Anti-Platelet Agent Aggrenox (ASA/Dipyridamole)?

  • Cox inhibitor + ADP blocker

34

How would you describe Congestive Heart Failure in 2 words...

"Pump Failure"

35

Where will you have edema if you have left side CHF?

Pulmonary Edema

36

Where will you have edema for right side CHF?

Peripheral Edema

37

During an evaluation, what are considered some minor cardiovascular clinical predictors?

  • Advanced age
  • Abnormal ECG
  • Rhythm other than sinus
  • Low functional capacity
  • History of stroke
  • Uncontrolled HTN

38

What are some Intermediate cardiovascular clinical predictors for denitstry?

  • Mild angina pectoris
  • Prior MI
  • Compensated or prior CHF
  • Diabetes Mellitus

39

What are some major cardiovascular clinical predictors?

  • Unstable coronary sundromes
  • Decompensated CHF
  • Significant arrhythmias
  • Severe VHD

40

What types of operations are considered low risk (<1% event risk)?

  • Endoscopic
  • Opthalmologic
  • Breast
  • Other superficial procedures

41

What types of procedures are considred Intermediate Risk (< 5% event rate)?

  • Carotid
  • Head & Neck
  • Intraperitoneal
  • Intrathoracic
  • Orthopedic

42

What are considered some High Risk procedures (> 5% event rate)?

  • Emergent procedures
  • Aortic and Peripheral Vascular
  • Prolonged Intraperitoneal & Intrathoracic

43

What types of heart conditions are considered "low risk" and would not need formal cardiac evaluation?

  • In absence of active ischemia
  • Unstable rhythms
  • Decompensated CHF or 
  • Unstable valvular heart disase