Lecture 4: Kidney Disease Flashcards by Jodeci Malixi

Uremic syndrome: cardiovascular symptoms (4)

HTN
Arrhythmia
CHF
Pericarditis

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Uremic syndrome: neurological symptoms (8)

Fatigue
Impaired cognition
Irritability/behavioral changes
Drowsiness
Vision changes
Peripheral neuropathy
Encephalopathy
Coma

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Uremic syndrome: GI symptoms (5)

Stomatitis
Anorexia
Nausea
Vomiting
GI bleeding

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Uremic syndrome: pulmonary symptoms (2)

Cough

Hemoptysis

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Uremic syndrome: hematologic/ immunologic/ dermatologic symptoms (6)

Anemia
Immunodeficiency
Bruising
Pallor
Hyperpigmentation
Uremic frost

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Uremic syndrome: musculoskeletal symptoms (2)

Arthralgia

Muscle wasting

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3 risks to consider when initiating dental management

Anemia/excessive bleeding
RIsk of infection
Medication intolerance

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6 lab tests to order prior to dental treatment if it will be carried out on an outpatient basis

CBC (Hb,Hct)
BUN
Cr
platelet count 
Routine hep B surf Ag
LFT (PT; PTT)

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4 points of treatment during dental procedure if it will be carried out on an outpatient basis

Continuous blood pressure monitoring

Ascertain anesthesia (decrease stress)

Meticulous attention to good surgical technique to decrease risk of excessive bleeding or infection

Let patient to stand and walk if long procedure

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5 medical considerations for a patient on dialysis

Blood tests

Treat on nondialysis day

Endarteritis – source of bacteremia; nephrologist consult to be considered for Ab prophy (for hemoaccess site)

Avoid blood pressure cuff on the side of arteriovenous fistula (infection and clotting)

Hemolysis secondary to hemodialysis and lack of erythropoetin production

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6 drugs that are mainly excreted by the kidney

Tetracycline
Aminoglycosides
Peniclline
Cephalosporins
Acyclovir
Ketoconazole

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Pharmacological considerations for pain control

Acetaminophen may be safer than ASA, NSAIDs

NSAIDs –> Nephrotoxicity (avoid in renal insufficiency NOT in ESRD; May cause bleeding or fluid retention)

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Pharmacological considerations for anaesthesia

Vasoconstriction should be used with caution ~ underlying HTN

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Pharmacological considerations for narcotics

Primarily metabolized in liver
With caution due to prolong effect – avoided with uremia
Avoid meperidine – active metabolites can accumulate leading to seizure

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When is clindamycin used?

Abscesses

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When is metronidazole used?

Periodontal disease

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Antibiotics to avoid (2)

Aminoglycoside (streptomycin) and polymyxin B

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Antibiotics to be careful with (3)

Tetracyclin
Cephalosporine
Penicillin (in case of potassium content in setting of hyperkalemia – need dialysis)

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Analgesics considerations (2 points)

Avoid long term NSAIDs in CKD
Avoid narcotics (can cause prolonged sedation and resp. depression)

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At what GFR is drug dosage adjustment likely?

<60

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Antibiotics considerations (30

Aggressively manage orofacial infections with culture and sensitivity testing and antibiotics

Consider hospitalization for severe infections and major procedures

Loading dose may be required for concurrent infection and CKD

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Drugs not requiring dosage adjustment

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Local anaesthesia

Single-dose benzodiazepine (anti-anxiety)

How to reduce risk of emergencies

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Avoid invasive procedures and long appointments if CKD stage 3 or higher or not well-controlled

6 oral manifestations

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Increased attention for orofacial infections
Dry mouth; parotitis; pallor
Bad odor; metallic taste
Uremic stomatitis
Uremic frost
Renal osteodystrophy (Compensatory hyperparathyroidism)

Define petechiae

Disrupted blood vessels in the setting of anemia (looks like red dots)

4 early signs and symptoms of hypertension

Elevated BP readings Headache Dizziness Tinnitus

6 avanced signs and symptoms of HTN

``` Angina pectoris CHF Rupture and hemorrhage of retinal arterioles Dementia Renal failure Encephalopathy ```

4 organs involved in the late signs and symptoms of HTN

Eyes Heart Kidneys Brain

5 classes of drugs for treatment of HTN

``` Thiazide diuretics ACE inhibitors ARBs Beta blockers Calcium channel blockers ```

2 oral manifestations that can arise with the use of thiazide diuretics

Dry mouth | Lichenoid reactions

2 medical considerations with the use of thiazide diuretics

Orthostatic hypotension | Avoid prolonged NSAIDs (may reduce anti-HTN effects)

Vasoconstrictor interactions with the use of non-selective beta blockers

Potential BP increase (max 0.036 mg epinephrine) | Avoid levonordefrine

2 oral manifestations of non-selective beta blockers

Taste changes | Lichenoid reactions

Medical consideration with the use of non-selective beta blockers

Avoid prolonged NSAIDs (may reduce anti-HTN effects)

Vasoconstrictor interactions with the use of combined alpha and beta blockers

Both B1 and B2 adrenergic receptor site blocked = potential adverse effects, but alpha receptor blockade compensates --> unlikely

Oral manifestations of combined alpha and beta blockers

Taste changes

2 medical considerations with the use of combined alpha and beta blockers

Orthostatic hypotension | Avoid prolonged NSAIDs (may reduce anti-HTN effects)

3 oral manifestations of ACE inhibitors

Angioedema of face, lips, tongue Taste changes Oral burning

2 medical considerations with the use of ACE inhibitors

Orthostatic hypotension | Avoid prolonged NSAIDs (may reduce anti-HTN effects)

Oral manifestations of ARBs

Angioedema of face, lips, tongue

Medical considerations with the use of ARBs

Orthostatic hypotension

Oral manifestations of calcium channel blockers

Gingival hyperplasia

2 oral manifestations of alpha1-adrenergic blockers

Dry mouth | Taste changes

Other medical considerations with the use of alpha1-adrenergic blockers

Orthostatic hypotension | Avoid prolonged NSAIDs (may reduce anti-HTN effects)

2 oral manifestations of central a2-adrenergic blockers and other centrally acting drugs

Dry mouth | Taste changes

Other medical considerations with the use of central a2-adrenergic blockers and other centrally acting drugs

Orthostatic hypotension

2 oral manifestations of direct vasodilators

Lupus-like oral skin lesions | Lymphadenopathy

2 other medical considerations with the use of direct vasodilators

Orthostatic hypotension | Avoid prolonged NSAIDs (may reduce anti-HTN effects)

At what BP do we defer elective treatment and refer to a physician ASAP? Give one reason?

> or = to 180/100 | Vasoconstrictors, i.e. epinephrine, not advised in patients with uncontrolled HTN

4 points of epinephrine usage in the event of necessary urgent treatment and uncontrolled HTN

Will be dictated by the situation Modest doses (e.g., one or two carpules) Care is taken to avoid inadvertent intravascular injection Consultation with the patient’s physician is advisable

2 methods of vasoconstrictor application that should not e used in a patient with HTN

Topical vasoconstrictors generally should not be used for local hemostasis Avoid using gingival retraction cord containing epinephrine

3 alternatives to epinephrine for anesthesia in a patient with HTN

Tetrahydrozoline Oxymetazoline Phenylephrine

3 types of drugs that lead to the development of orthostatic hypotension and potentiate the actions of anxiolytic and sedative drugs

Alpha blockers, alpha-beta blockers, and diuretics

2 drugs that exacerbate the hypotensive effect of calcium channel blockers

Erythromycin and clarithromycin

Lecture 4: Kidney Disease Flashcards

(54 cards)