What classifies mild-moderate hypertension?
systolic
What classifies mild-moderate hypertension?
systolic
What classifies severe hypertension?
systolic >200, diastolic >110
If the Pt has bp of 205/115 but no symptoms, what would that be classified as?
Severe HTN
If the Pt has bp of 205/115 and is symptomatic (sob, fatigue, etc) what would that be classified as?
Hypertensive emergency
Cardiac patients and even ones with HTN cannot exceed what dose of epinephrine?
0.04 mg in a single visit
What two demographics have the highest prevalence of angina?
Men over 40, and post-menopausal women
What is angina?
A mismatch in myocardial oxygen demand and oxygen supply (symptom of ischemic heart disease)
If your patient experiences angina, what five general things should you ask questions about?
frequency, duration, severity, response to medications, and if it’s stable
Can you treat someone with stable angina?
Yes, but have precautions set in place in case they have an episode in the chair
How do we measure cardiac functional status?
Metabolic Equivalents (MET)
They have poor cardiac functional capacity
How long do you have to defer surgeries after a Pt has an MI?
at least 6 months
If the Pt has bp of 205/115 but no symptoms, what would that be classified as?
Severe HTN
If the Pt has bp of 205/115 and is symptomatic (sob, fatigue, etc) what would that be classified as?
Hypertensive emergency
Cardiac patients and even ones with HTN cannot exceed what dose of epinephrine?
0.04 mg in a single visit
What two demographics have the highest prevalence of angina?
Men over 40, and post-menopausal women
Do you need to provide antibiotic prophylaxis to Pts with cardiac dysrhythmias?
Nope
If your patient experiences angina, what five general things should you ask questions about?
frequency, duration, severity, response to medications, and if it’s stable
Can you treat someone with stable angina?
Yes, but have precautions set in place in case they have an episode in the chair
How do we measure cardiac functional status?
Metabolic Equivalents (MET)
They have poor cardiac functional capacity
What are two things on the EKG that signal the Pt is having an MI?
Inversion of QRS interval, and ST segment elevates
How long do you have to defer surgeries after a Pt has an MI?
at least 6 months
What steps do you take with a Pt with a history of MI?
Consult Pt’s PCP; Determine if dental tx is needed before 6 month mark; Is Pt on anticoagulants; Use anxiety reduction protocol;
What steps should you follow if the Pt has chest pain or an MI in the chair?
M - morphine
O - oxygen (10 L)
N - nitroglycerine (sublingual)
A - aspirin (325 mg)
How long do Pts have to be on dual anti platelet therapy following PCI or stent placement?
12 months
risk for re-thrombosis in this 12 months is very high
What four drugs are given for DAPT (dual anti platelet therapy)?
aspirin, plavix, coumadin, and xabans
Do you need to provide antibiotic prophylaxis to Pts with cardiac dysrhythmias?
Nope
What are some common symptoms of congestive heart failure (CHF)?
coughing, tiredness, SOB, weak heart beat, abdominal swelling, ankle/leg edema
What is the most common cause of IE?
Streptococcus viridans
You should provide antibiotic prophylaxis in what four situations?
If pt has prosthetic cardiac valve, Had previous IE, Has congenital heart disease, or is a transplant recipient with cardiac valvulopathy
What are some orally administered prescription options for antibiotic prophylaxis?
All 30-60 min prior to procedure: Amoxicillin (2g), Clindamycin (600mg), Cephalexin (2g), AZT (500mg)
What should you prescribe kids if they need antibiotic prophylaxis?
Amoxicillin (50mg/kg), Clindamycin (20mg/kg)
How should you treat a Pt with a BP of 205/120?
Defer dental treatment and send them to their PCP immediately
What two ways can you measure if the Pt’s MET is under 4?
If they cannot walk a city block or up a flight of stairs without SOB
What is INR?
international normalized ratio used to measure coagulability of the blood
What is a normal INR?
- 0
* higher than that means they have thinner blood*
What is bridged therapy?
Where you ween the patient off of one drug while simultaneously giving them another for the same effect. i.e. heparin bridge for coumadin Pts
What INR should the patient be under before extracting a tooth?
2.0
When does the INR of a Pt need to be measured to go through with treatment?
within 24-hours prior to appointment
How long does coumadin have an effect in the body?
3-5 days