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Internal Med- Dental Management > Dental Management > Flashcards

Dental Management Flashcards

1
Q

When is the best time to treat pt receiving hemodialysis

A

Day after they receive dialysis or anytime inbetween their treatment, need platelet count

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2
Q

What’s the difference between pts on peritoneal dialysis and hemodialysis

A

Peritoneal dialysis has NO ANTICOAGULATION

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3
Q

Pt with moderate renal failure (

A

No contraindication to routine tx

  • consult physician to optimize if stage is 4
  • use acetaminophen
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4
Q

Hyperventilation typical cause

A

ANXIETY

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5
Q

Hyperventilation prevention protocol

A

STRESS REDUCTION PROTOCOL (SRP)

- nitrous, increased lidocaine, morning apt, decrease duration

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6
Q

How to handle a hyperventilation attack

A

STOP PROCEDURE

  • sit patient upright
  • comfort
  • have pt breathe into something to restore CO2
  • reschedule
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7
Q

What does an increasing amount of drugs in a hypertensive patient usually indicate

A

The disease is not easily controlled

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8
Q

Can you give nitro to hypotension patients

A

NO

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9
Q

Dentists role in hypertensive patients

A

Monitor and detect

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10
Q

Patient with BP > 180/110

A

Defer elective tx

Only do emergency

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11
Q

Does epinephrine need to be modified for hypertensive patients?

A

Yes, modify epi, but still get extremely numb (SRP)

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12
Q

If your hypertensive patient is on non-selective b-blockers how do you modify tx

A

Decrease epi, can lead to tachycardia

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13
Q

If hypertensive patient is on anti hypertensives?

A

Decrease NSAIDS (use Tylenol?)

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14
Q

1 cause of death in Type 2 diabetes

A

MI

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15
Q

1 cause of death in type 1 diabetes

A

ESRD

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16
Q

What # does HBA1c need to be below

A

7

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17
Q

Tx for well-controlled diabetes

A

Any elective care ok- just take glucose levels prior to tx

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18
Q

If glucose levels

A

GIVE CARBS- or defer tx

Pt is hypoglycemic

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19
Q

If glucose levels are >200 mg/dl

A

DEFER TX

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20
Q

What are some things a dentist can do to prevent insulin reaction?

A
  1. Make sure pt eats and takes insulin prior to apt
  2. Morning apt
  3. Have sugar source in office
  4. Have patient tell you if feeling symptoms
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21
Q

Insulin reaction stages

A
  1. Mild- hunger, weakness, sweating
  2. Moderate- “snickers commercial” uncooperative, disoriented, belligerent
  3. Severe- unconscious, tachycardia, hyotensive
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22
Q

How do you treat the first two stages of insulin reaction

A

Give oral sugar (cake icing)

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23
Q

How do you treat a severe insulin reaction?

A

Call EMS and give glucagon injection

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24
Q

What are 3 concerns a dentist would have with an uncontrolled diabetic patient

A
  1. Infection
  2. Poor wound healing
  3. Systemic risk
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25
Q

How can a dentist prevent infection in uncontrolled diabetic

A

Strict glycemic control

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26
Q

How can a dentist prevent poor wound healing in uncontrolled diabetic

A

Avoid elective surgery if HBA1c is >7

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27
Q

What can acute odontogenic infection lead to in diabetic patient

A

LOSS OF DIABETIC CONTROL (or visa versa)

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28
Q

What do you do if an uncontrolled diabetic patient comes in with a painful (infected) tooth

A

EXTRACT IMMEDIATELY

  • treat infection aggressively
  • don’t even need AIc,
  • can do I&D and antibiotics also
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29
Q

Main objective with heart failure patient

A

KEEP STABLE- want to leave the same way they came

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30
Q

What drug will severe heart failure patients be taking and why is that important for dentists to know?

A

Digoxin- toxic with epinephrine

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31
Q

Signs and symptoms of heart failure

A
  • SOB
  • Pitting edema (swollen ankles)
  • coughing
  • muscle fatigue
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32
Q

Tx for compensated heart failure (no SOB even with activity) and decompensated class 2 (SOB only with activity)

A

elective care ok

  • SRP
  • chair positioning more upright
  • avoid NSAIDS
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33
Q

What drugs should you avoid in heart failure patients because it increases fluid retention –> increase BP

A

NSAIDS

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34
Q

What tx can you do for class 3 & 4 heart failure patient (SOB at rest and with light activity)

A

NO ELECTIVE CARE- SYMPTOMATIC

- emergency, non invasive ok

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35
Q

Stable angina tx (MI >1 mo ago)

A

Elective care ok

- SRP

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36
Q

What are characteristics of stable angina

A
  • Relieved by rest and nitroglycerin
  • precipitated by activity
  • unchanged and consistent
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37
Q

What are characteristics of unstable angina

A
  • occurs at rest
  • inconsistent
  • rest and nitro don’t relieve
  • can lead to MI
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38
Q

What tx for unstable angina

A

Emergency only w/ periodic vitals

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39
Q

What can be done prior to emergency tx for unstable angina

A

Propy of nitroglycerin

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40
Q

Emergency protocol for Angina

A
  1. STOP
  2. Nitro- 1 spray/tablet every 5 min (up to 3 doses)
  3. O2 (2-4L/min)
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41
Q

What if patient isn’t responding to emergency angina tx

A
  1. Call EMS
  2. Chew on aspirin
  3. BLS
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42
Q

2 types of stents for CV disease

A

Bare metal- possible restenosis within 6 mo

Drug-eluding- increased risk for thrombosis for 1 year

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43
Q

What drugs are patients on with drug-eluding stents?

A

Anti platelet therapy for 1 year (Clavix or aspirin)

—> BLOODY EXTRACTIONS

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44
Q

Can we as dentists stop antiplatelet therapy for patients with stents prior to surgery?

A

NO

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45
Q

What if patient has a pacemaker?

A

Avoid Using ultrasonic or doing electrosurgery

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46
Q

Renal Disease Pt on Hemodialysis

A
  • NO PROPHYLAXIS
  • NO BP cuff on AV fistula
  • increase bleeding due to platelet destruction so need platelet count (>50,000)
  • avoid/adjust nephrotoxic drugs–> use acetaminophen instead
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47
Q

Dental tx for well-controlled thyroid disease

A

Any routine care

– if increase in Metabolic demand anticipated (extensive surgery) may need more Thyroid hormone, consult PCP

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48
Q

Tx for un-controlled thyroid disease

A

No elective care

  • tx infections with PCP
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49
Q

Concerns w// uncontrolled hyperthyroidism

A

Adverse rxn to. Epi

Infection//wound healing problems

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50
Q

Concerns with uncontrolled hypothyroidism

A

Exaggerated response to CNS depressants
- narcotics and sedatives

  • use Tylenol and. Ibuprofen
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51
Q

What medication are patients with cardiac arythmias usually on

A

Warfarin- high risk (ALWAYS NEED. INR)

Aspirin- low risk

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52
Q

What are the most serious risks for arythmias

A

1- stroke

2- heart failure

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53
Q

Which arythmia has no. Pulse

A

Ventricular fibrillation- SERIOUS

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54
Q

When should you avoid elective care for arythmia patients

A
  1. High grade AV block

2. Sympathetic ventricular rhythms

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55
Q

What type of valve. Replacements. Can patients have

A

Mechanical= lifelong
- on antiplatelet. For life

Bioprosthetic= temporary
– on antiplatelet for 3 months

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56
Q

Do you Prophy for valve. Patients?

A

YES. BOTH TYPES

- and previous IE

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57
Q

Do. You need INR for. Valve. Replacements?

A

YES, don’t forget to prophy

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58
Q

Modifications for well-controlled adrenal insufficiency patient

A

NONE- all routine care is ok

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59
Q

Problems with uncontrolled adrenal insufficiency

A

May not be able to keep up with metabolic demand

  1. Delayed healing
  2. Susceptible to infection
  3. Intolerant to stress
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60
Q

What is the most potent stress activator

A

Surgery

- post-op = highest cortisol demand

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61
Q

What is given exogenously to adrenal insufficient patients

A

Glucocorticoids

- needed for surgery or management of dental infection (contact PCP)

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62
Q

What can be done to prevent acute adrenal crisis

A

SRP
Pre-emptive analgesia (ibuprofen)
Monitor BP (

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63
Q

What do you do in an acute adrenal crisis

A
  1. EMS!
  2. Position patient in supine position to get O2 to face
  3. BLS
64
Q

Patient with active sputum and + TB

A

NO outpatient to

65
Q

Patient with history of TB

A

Careful workout to decide what his status of infectivity is currently

66
Q

+ TB test

A

Chest X-ray to make sure no active TB

Then routine care

67
Q

What is one condition when you DO NOT give nitrous

A

Severe COPD

68
Q

What can Rifampin (TB drug) cause

A

Decrease in WBC

  • Increase in bleeding
  • Infection
  • Decrease in healing
69
Q

Because the cocktail drugs for TB are hepatotoxic what do you need to be worried about?

A

Drugs that get cleared/metabolized in the liver

- lower doses of Tylenol (2g/day)

70
Q

2 important roles that are impaired with liver disease

A
  1. Vit K synthesis–> decrease in coagulation factors

2. Drug metabolism

71
Q

2 things that can cause cirrhosis

A
  1. Viral

2. Alcoholism

72
Q

When do symptoms show up for liver disease?

A

After the damage has already been done (cirrhosis)

73
Q

Because patients with liver disease are predisposed to bleeding what do you need to know before treatment

A

PT (if too low no surgery)

74
Q

What are some local Hemostatic measures that can be taken for excessive bleeding with liver disease patients

A
  1. Fresh frozen plasma

2. Tx in hospital setting

75
Q

If patient has active Hep C

A

NO routine to

76
Q

Chronic hep c patient

A

Routine care ok, consult PCP

77
Q

Bone marrow suppression in liver disease requires what knowledge prior to surgery

A 
Platelet count (>50,000)
- maybe use antibiotics for elective surgery because prone to infection (ask PCP)
78
Q

Altered drug metabolism in mild/moderate liver disease causes what?

A

Increased tolerance —> need larger doses of meds

79
Q

Altered drug metabolism in severe liver disease patients causes what

A

Increase in unexpected drug effects –> limit Tylenol (2g/day)

80
Q

Dental tx adjustments for stable COPD

A
  • chair positioning (upright)
  • local anesthesia (no bilateral blocks)
  • avoid nitrous in severe
  • avoid anticholinergics and antihistamines (dry out secretions)
81
Q 
If patient comes in with these S/S
- SOB
- cough
- upper respiratory tract infection
 What should you do?
A

This is symptomatic COPD—> reschedule elective tx

82
Q

COPD patients may be taking Theophylline, why is this drug important to know?

A

Toxic with macrolide and ciprofloxacin antibiotics

83
Q

What can you supplement COPD patients with

A

O2

84
Q

What else do you need to avoid with COPD because it decreases respiratory drive?

A

Barbiturates and narcotics (use ibuprofen and Tylenol)

85
Q

Are NSAIDS ok for asthmatic patients?

A

Ask if they can tolerate them first, may be a trigger

86
Q

Instructions for asthma patients prior to apt

A
  1. Take meds like normal

2. Bring inhaler

87
Q

Is nitrous ok for asthma pt?

A

YES! Use for SRP

88
Q

What do you do if you patient starts to have an asthma attack?

A
  1. Give puff of inhaler every 20 min
89
Q

What if asthma attack is not resolving with inhaler?

A

Epi pen

  • support with O2
  • check vitals
  • call EMS
90
Q

What are the S/S of asthma attack

A
  • tight chest, coughing, tachypnea, SOB, wheezing
91
Q

What needs to be avoided for Peptic ulcer disease

A
  • NSAIDS or Aspirin (use Tylenol)

- Corticosteroids

92
Q

S/S of peptic ulcer disease

A

Epigastric pain
Relief w/ food, milk, antacids
** change in symptom –> worsening ulcer

93
Q

Two types of inflammatory bowel syndrome

A
  1. Crohns

2. Ulcerative colitis

94
Q

When should you schedule a patient with inflammatory bowel syndrome?

A

During remission

95
Q

What drugs should you not give inflammatory bowel syndrome patients?

A
  1. Antibiotics (caution) –> monitor for colitis if have to give
  2. Anti-inflammatory
96
Q

Do you need a test prior to surgery for inflammatory bowel syndrome patients?

A

CBC to evaluative WBC and platelets

97
Q

When do S/S show up for pseudomembranous colitis?

A

4-10 days after antibiotic given

98
Q

What are S/S of p. Colitis

A

Diarrhea (watery= mild, bloody= severe)
Severe dehydration
Hypotension
Peritonitis

99
Q

Dental tx of patient with p colitis

A

Wait until symptom free

- must have sound reason to prescribe antibiotics (1 Prophy dose is ok)

100
Q

What trimester do you avoid if at all possible

A

1st (and end of 3rd)

101
Q

What drugs do you avoid in pregnant patients

A

NSAIDS
Sedatives
Tetracycline

102
Q

What about radiographs for pregnant patients?

A

FINE! Avoids 1st if possible

103
Q

If pregnant patient suddenly has drop in BP and bradycardia

A

Baby is probably compressing IVC, have mom lay on her side

104
Q

Transplant patients are _____ for life

A

Immunosuppressed!

105
Q

What risks do transplant pt’s possess

A

Increased bleeding
Increased risk for infection
Decreased healing (pancytopenia)

106
Q

How long are transplant patients immune system completely destroyed after receiving the transplant?

A

6 mo post surgery

- only emergency tx during this time

107
Q

What happens during a dental “clearance” for transplant patients

A

Diagnosis and treatment of present and potential diseases

- extremely quick and aggressive

108
Q

During a transplant patients “stable” period what dental tx can be done

A

“Stable” period= 6+ mo after surgery

  • consider which organ was replaced and modify treatment accordingly
  • routine treatment is ok just consult transplant team to verify antibiotic prophylaxis etc.
109
Q

What tests are important for dental tx of AIDS patient ?

A

Platelet and WBC count
Viral load
CD4+ count

110
Q

What level does CD4+ have to drop below to be considered AIDS

A

200

111
Q

What tx does a symptomatic AIDS pt receive

A

Emergency only

112
Q

What happens if WBC is

A

Prophylaxis prior to to

113
Q

Asymptomatic AIDS patient tx

A

Routine care ok!

114
Q

Asymptomatic AIDS patient with low CD4+

A

Routine and complex ok!

- invasive surgery must obtain WBC (>2,000) and Platelet count (>50,000)

115
Q

Concerns for leukemia/lymphoma patients

A

Increased bleeding
Increased infection risk
Delayed wound healing

…. Same as everything else basically

116
Q

What dental work needs to be accomplished prior to chemo/radiation

A

All disease/infection eliminated

  • must get lab values from oncologist before
  • platelet >50,000; WBC >2,000 or PMN >500
117
Q

What if platelets and WBC are below their required values? (>50,000 and >2,000)

A

Antibiotic Prophy

118
Q

Guidelines for extractions for WBC disorder patients

A
  1. Be prepared to treat bleeding!
  2. Extraction done at least 10-14 days before chemo/radiation
  3. Primary closure if at all possible
119
Q

dental tx during radiation/chemo

A

Only emergency and preventive

120
Q

How must you treat a patient with sickle cell TRAIT differently

A

You don’t treat them differently

121
Q

What could cause a sickling crisis

A

Infection

122
Q

How important is O2 for sickle cell disease patient

A

VERY- make sure well oxygenated prior to and during surgery

123
Q

What is one key difference in stress reduction protocol for sickle cell disease

A

Nitrous must have at LEAST 50% O2

124
Q

When should you schedule dental treatment for sickle cell disease patient

A

During non crisis period

125
Q

What can you give sickle cell patient post op for pain

A

Tylenol or codeine

126
Q

Sickle cell disease patient comes to your with cellulitis (severe infection)

A

TREAT INFECTION AGGRESSIVELY

- could cause a crisis

127
Q

First stage in seizures

A

Aura- sensory alteration with smell or visual disturbances

* make sure you know your patients aura

128
Q

Epileptic patient

A

Routine care

  • stress importance of taking meds regularly
  • SRP
129
Q

How do you manage a seizure?

A
  1. Stop and take everything out of mouth
  2. Passively support pt to prevent injury
  3. Returns to consciousness in a few minutes
  4. Escort home
130
Q

What time period after a stroke must you be on high alert for S/S of another stroke

A

Within 6 mo

131
Q

What patients should you not treat regarding stroke?

A

Unstable patients and recent TIA (mini stroke)

132
Q

Dental alterations for stroke patients

A
  • Just expect to bleed more (no need for platelet count)
  • INR for patients on Coumadin
  • SRP
  • tylenol
133
Q

S/S of a stroke

A 
FAST
F- face drooping
A- arm weakness 
S- speech difficulty 
T- time to call 911
134
Q

If there is a platelet problem when will you notice?

A

Immediately, it will start bleeding and won’t stop

135
Q

If there’s a coagulation problem when will you notice?

A

Several hours-days later

- achieve clot but it’s not stable

136
Q

Platelet number that = spontaneous bleeding

A
137
Q

Coagulation tests

A

PT and PTT

- replaced by INR

138
Q

How to treat patient on anti-platelet therapy (aspirin)

A

NOT TO WORRY!

  • just expect some extra bleeding
  • DO NOT stop their anti-platelet medication
  • local measures to control Hemostasis
139
Q

Patients on anti-coagulant therapy regimen are taking what?

A

Coumadin (warfarin)- NEED INR

- pradaxa and xarelto –> don’t need INR, more stable drugs

140
Q

What patients can you expect to see on Coumadin/warfarin

A
  • history of MI
  • arrhythmia
  • valve replacement
  • recent drug eluding cardiac stent
  • CVA and DVT?
141
Q

For which diseases do you want INR to be 2.5-2.5

A
  1. Mechanical heart valve

2. Prevention of recurrent MI

142
Q

for which diseases do you want INR to be between 2.0-3.0

A
  1. Treatment of DVT and PE

2. Prevent systemic embolism

143
Q

How long ago can INR be accepted for pre-op evaluation

A

No longer than 48 hours

144
Q

What should INR be under for surgery/invasive procedures

A

3.0

145
Q

What happens if INR is too high for dental procedure

A

PCP must adjust warfarin dosage and patient can come back in about 5 days

146
Q

What are some local measures for hemostasis

A
  • gel foam
  • thrombin
  • primary closure
147
Q

NSAIDS or Tylenol for bleeding disorders?

A

Tylenol

NSAIDs can potentiate bleeding

148
Q

What are some instructions for post-op care

A

No swishing, sucking out of straw, spitting

149
Q

When do you NOT want to do surgery on bleeding disorder patient

A

Friday’s- don’t want to bleed over the weekend

150
Q

What do you give pre-op and post-op for type 1 and 2 Von willbrand disease

A

Pre- desmopressin therapy
Post- aminocaproic acid
- hematologist walks you through all of the genetic bleeding disorders

151
Q

What do you give severe Von willbrand diseaes patients

A

fresh frozen plasma
Vit k
Factor VIII concentrate

152
Q

Drugs NOT to give patient with bleeding disorder

A

NSAIDS AND ASPIRIN

153
Q

Hemophilia A patient management

A

Elective outpatient care normally ok

154
Q

What not to give hemophilia patient

A

Anesthetic blocks (without management)

155
Q

When do you want to get platelet numbers

A
  1. Bone marrow cancers
  2. Dialysis
  3. HIV (causes bone marrow suppression)
  4. Transplant (“)
  5. Alcoholism (“)
156
Q

Do you need to get platelet #’s for bleeding disorders?

A

NO- just expect they will bleed

Internal Med- Dental Management (1 decks)

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