Medical Considerations

Question 1

Risks of high BP

Answer 1

Bleeding + MI risk

Question 2

Management of high BP

Answer 2

Check control
Recent readings
Postpone if >160/100
Avoid adrenaline in LA

Question 3

Risks of angina

Answer 3

Angina attack + MI

Question 4

Risk of recent MI

Answer 4

MI

Question 5

Management of recent MI

Answer 5

No XLa’s within 6mths
No GA within 6mths (inc risk of repeated by 50%)

Question 6

Risks of cardiac defects (valve replacement, prev endocarditis, hypertrophic cardiomyopathy)

Answer 6

Infective Endocarditis

Question 7

Management of cardiac defect pts

Answer 7

Ensure they are aware of risks + explain symptoms to look out for

Liaise with cardiologist

Consider antibiotic prophylaxis

Question 8

Risk of liver disease

Answer 8

Bleeding risk (reduced production of coagulation factors)
Immunocompromised
Cross infection risk: Hep B,C,D,E
Reduced drug metabolism

Question 9

Management of liver disease

Answer 9

Liaise with doctor
Consider coagulation screening + FBC

Question 10

Risk of kidney disease

Answer 10

Bleeding risk (platelet dysfunction)
Immunocompromised

Question 11

Management of kidney disease

Answer 11

Liaise + FBC
Tx dialysis patients day after for optimal renal function

Question 12

Risks of diabetics

Answer 12

Hypoglycaemic attack
Impaired wound healing

Question 13

Management of diabetics

Answer 13

Morning appts when glucose is stable
Safe to tx if glucose between 5-15mmol/L

Question 14

Risks of epileptic patients

Answer 14

Seizure due to stress

Question 15

Management of epileptics

Answer 15

Eat beforehand
Enquire about frequency/type
Consider IV

Question 16

Risks of Haemophilia A,B, + VWD

Answer 16

Bleeding due to deficiency of:
Clotting factor 8 (A)
Clotting factor 7 (B)
VW factor (VWD)

Question 17

Management of Haemophilia / VWD

Answer 17

Consider factor assay
50-75% Factor 8 levels required
DDAVP + tranexamic acid may be required
Consider referral

Question 18

Risks of anticoagulants

Answer 18

Bleeding risk

Question 19

Action of warfarin

Answer 19

Vit K antagonist
Inhibits clotting factors 2,7,9,10

Question 20

Indications for warfarin

Answer 20

Prevent blood clots –> MI –> stroke –> death
AF
Thrombosis
Pulmonary embolism

Question 21

Action of apixaban

Answer 21

Factor Xa inhibitor

Question 22

Uses of Apixaban

Answer 22

Prevents blood clots –> MI –> stroke –> death
Non valvular AF
DVT
Pulmonary embolis

Question 23

Action of Dabigtran

Answer 23

Direct thrombin inhibitor

Question 24

Management of anticoagulants

Answer 24

Low risk = do not interrupt medication
High risk
Warfarin INR <4
Apixaban/dabigatran - skip morning dose
Rivaroxaban - delay morning dose
Edoxaban - 1 dose in evening NA

Question 25

What patients should you not interrupt medication for?

Answer 25

Prosthetic heart valves/coronary stents DVT /pulmonary embolism in last 3mths

Question 26

Risks of anti platelets

Answer 26

Bleeding (inhibition of stages required for platelet aggregation)

Question 27

Management of anti platelets

Answer 27

No interruption Staging + suturing + appts early

Question 28

Risks of chemo/radiotherapy

Answer 28

Thrombocytopenia (dec platelets) Neutropenia (dec neutrophils) MRONJ if taking antiresorptive drugs - bisphosphonates ORN from radiotherapy Infection - immunosuppressed

Question 29

Management of chemo/radiotherapy

Answer 29

Liaise with doctor Thrombocytopenia levels >50x109/L Avoid XLas/ensure dentally fit 2wks prior to tx

Question 30

Risks of bisphosphonates

Answer 30

MRONJ - anti resorptive drugs inhibit osteoclasts

Question 31

Management of pts on bisphosphonates

Answer 31

>5yrs on oral/IV Denosumab + systemic glucocorticosteroid Tx for cancer irrespective of length of tx Previously diagnosed with MRONJ Avoid XLas 8 week review