Module 9 Exam 4 Flashcards
(113 cards)
1
Q
What kinds of bleeding disorders are there
A
- alteration of blood vessels, platelets, coagulation factors
- erythrocyte damage or decrease
2
Q
What medical conditions require patients to take anti coagulants
A
-MI CVA thrombophlebitis atrial fib open heart surgery replacement of diseased arteries damaged heart valves recent hip or knee replacement
3
Q
what patients use long term asprin
A
rhumatiod arthritis
4
Q
what does aspirin block
A
prostaglandins (locally acting hormones)
5
Q
what do prostaglandins influence
A
-vascular constriction
aggregation of platelets
induce inflammation
increase pain response
6
Q
what blocks production of prostaglandins
A
cyclooygenase 1 and 2
7
Q
what is the most common inherited bleeding disorder*
A
Von Willebrands Disease
8
Q
what does a deiciency of VWF cause
A
poor platelet adhesion
9
Q
what is treatment of von willebrands
A
- F VIII that retains VWF
10
Q
what is a defect of F- VIII*
A
Hemophilia A
11
Q
Can you tx a pt with hemophilia A
A
do a consult
12
Q
What is a deficiency of Factor IX*
A
Hemophilia B
13
Q
What is the treatment of Hemophilia B
A
-prednisone, platelet transfusion
14
Q
What is the treatment of Hemophilia A
A
F-VIII
15
Q
What is the dental management of a patient with a bleeding disorder
A
- do an MD consult to determine the severity of the disorder and pre op considerations
16
Q
What enhances the effect of coumadin
A
acetaminophen
17
Q
What should you do in treatment of a patient with a bleeding disorder
A
-treat infection
-good OH
-pressure packs
-avoid asprin and NSAID
-
18
Q
What encourages bleeding
A
aspirin therapy
19
Q
what does aspirin therapy do
A
inhibits platelet aggregation and can last up to 9 days after therapy is stopped
20
Q
What is anemia
A
a reduction in the oxygen carrying capacity of the blood
21
Q
what does anemia result from
A
- number of RBC
- Damaged RBC (sickle cell)
- Loss of RBC (hemorrhage)
22
Q
what is the percentage of Hg of a normal RBC
A
33%
23
Q
What is the “sensor” that determines the level of oxygenation
A
Kidney
24
Q
What does the kidney do if the level of oxygen is low
A
releases erythropoietin, which stimulates bone marrow to release RBC
25
What is the most common anemia?*
Iron Deficiency Anemia
26
What is anemia a result of?*
- poor iron intake
- poor iron adsorbtion
- increase demand
27
What is the most common cause of cause of iron deficiency anemia in adults
blood loss (women menstruation, men- serious underlying factors)
28
What does a Vitamin B12 and folic acid deficiency effect
RBC formation
Growth within bone marrow
RBC Maturation
29
What compromises adsorbtion of B12
alcohol, celiac, dilantin
30
What is the treatment of B12 and folic acid anemia
- supplements
| - green leafy veggies
31
What is pernicious anemia
caused by a deficiency of intrinsic factor that is necessary for B12 adsorbtion
32
When is the onset of pernicious anemia
40's
33
What is sickle cell anemia
-RBC are sickle shaped due to Hg damage which leads to decreased 02
34
What do sickle shaped RBC result in
-increased blood viscosity
reduced blood flow
hypoxia
vascular occlusion
35
What may the trabecular pattern of the bone in sickle cell be due to?*
hyperplasia of marrow elements
36
What do you see on x-rays of people who have sickle cell?*
- widening and decreased trabeculae
- more radiolucent
- stepladder
37
What should you use on a patient who has sickle cell?
pulse oximeter
38
What meds should you avoid in a pt. with sickle cell
barbituates, strong narcotics, valium
39
If you use nitrous on a pt with sickle cell what should you have it set at
02 greater than 50%
40
What is peptic ulcer disease
occurs when there is an imbalance between gastric acid, pepsin, and mucosal defense
41
what is pepsin
-stomach enzyme/breaks down proteins
42
What is a gastric ulcer
ulcer of stomach
43
what is a duodenal ulcer
duodenum
44
what is a esophageal ulcer
ulcer of esophagus
45
What characterizes peptic ulers
- break in GI mucosa
| - excessive prod of gastric juices
46
how much hydrychloric acid is produced a day
2 liters
47
Where are most GI ulcers located
in the duodenum or stomach
48
Do most peptic ulcers stop bleeding on their own
yes, 80%
49
What drugs are associated with ulcers
NSAIDS, Aspirin, corticosteriods
50
What are the causative factors of GI disease
- H. Pylori
| - HYpersecretion of acid
51
What are the signs and symptoms of GI disease
- asymptomatic, epigastric pain,discomfort 90 min-3 hrs after eating
- wake individuals at night, eating or antacids releive pain
52
What meds are used in the tx of GI disease?*
Zantac, Biaxin, amoxicillin
53
What medications increase the pH of gastric secretions in medical management of GI Disease
-Tagamet, Zantac, Pepto-bismol, Tums
54
What medication in GI diseases decreases metabolism of lidocaine and diazepam*
Tagamet
55
What medications should be avoided in GI diseases
asprin, NSAIDS
56
What may impair absorbtion of tetracycline and erythromycin in GI disease*
-antacids
57
What are oral complications of GI Disease?*
Candidiasis- due to antibiotic tx*
| Enamel erosion_ due to regurgitation*
58
What can pseudomembranous colitis result from?*
long term use of broad spectrum antiboitics, severe and sometimes fatal
59
What are broad-spectrum antiboitics?*
clindamycin, ampicillin, amoxicillin
60
what is teh most common symptom of broad spectrum antibiotics
diarrhea
61
What is dental management of pseudomembranous colitis
postpone elective care
62
WHat is the metical treatment of pseudomembranous colitis
- discontinue current antibiotic
| - use flagyl or vancomycin*
63
What is the largest organ of the body
liver, 3 lbs
64
People with liver problems are also likely to have what
bleeding problems
65
What are the metabolic functions of the liver
- secrection of bile-fat digestion
- conversion of glucose to glycogen
- excretion of bilirubin-waste of Hg
66
what are dental concerns of a compromised liver
- decreased synthesis of coagulation
| - compromised drug metabolsim
67
What is hepatitis
inflammation of the liver
68
What is hepatitis caused by
- infection(viral)
| - noninfectious (prolonged use of drugs)
69
What is Hepatitis A caused by
fecal contamination of food or water
| - enhanced by poor hygiene, Travelers
70
What are symptoms of hepatits A
Abrupt onset (flu like)
-fever, vomiting, headaches, nausea, abdominal pain, tender liver
71
What is immunity in Hep A
-anti-HAV detectable in blood within weeks of onset
72
is there a carrier state for Hep A
no
73
What is the vaccine for Hep A
- harivax, twinrix
| - early immunization recommended, adults need booster
74
Who is the Hep A vaccine recommended for
```
-children
foreign traveler
military
food handlers
day care workers
```
75
What is the transmission of the Hep B virus
blood transmission (transfer of infective serum or plasma via inanimate surfaces/vectors)
76
What are the 2 ways Hep B transmission has occured
- infected blood transfusions
| - exposure to infected
77
Does fecal transmission occur in Hep B*
no
78
Is airborne transmission epidemiologically important in Hep B*
no
79
WHat is the risk of infection directly related to in Hep B*
blood
80
What people are at risk for at Hep B infection
- occupational risk
- healthcare workers
- pub safety worker
- staff and clients of institutions for developmentally disabled
- hemodialysis pt.
- household contacts and sex partners of hep B virus carriers
- Adoptees from countries where HBV
- *drug users
- international travelers
- multiple partners
- inmates
81
What are clinical findings of Hep B
- similar to HAV
| - slower onset- longer duration
82
What are the symptoms of Hep B
- most are asymptomatic
- jaundice
- skin rashes, itching, joint pain
83
When do Hep B patients get immunity
post exposure
84
How else can you get Hep B immunity
Hepatitis B immunoglobulin, acquired immunity, given in 24-48 htd
85
How is Hep C transmitted
primarily through blood
86
Is there a Hep C vaccine*
no
87
What is the most common chronic blood borne infection in the US
Hep C
88
Can a hep D infection occur alone
NO
89
WHat does Hep D occur in the presence of
HBV*
| mult exposures to HBV*
90
How do pts get mult exposures to HBV
- iv drug users
| - hemophilia
91
What does Hep E resemble*
Hep A, No Vaccine
92
What is Hep G a co-infection with *
HCV
93
What are liver diseases characterized by
degeneration and necrosis of liver cells
94
What is iteric(jaundice) caused by
accumulation of bilirubin
95
what is bilirubin
by product of breakdown of RBC
96
What are the 3 phases of liver disease
preicteric, iteric, posticteric
97
WHat is the first phase of liver disease*
- preicteric (prodromal)
| - precedes the onset of jaundice
98
What is the second phase of liver disease*
Icteric phase, onset of clinical jaundice
99
What is the third phase of liver disease *
Posticteric phase, convalescent (abnormal liver ufnction, symptoms disappear, can last 6 month)
100
What should we do in dental management with active hepatitis
delay elective care
101
what should you do in dental management in patients that are hepatitis carriers
-evaluate clotting ability
102
DO pts who have recovered from hepatitis require tx planning modifications
no
103
What is an interferon
a protein formed when cells are exposed to viral nucleic acid
104
What is needed in medical management of chronic hepatitis
-interferon tx, 3-10 million units 3 times a week for 6 mo to a year
105
what are the 3 entites of alcoholic liver disease
- fatty infiltrate
- alcoholic hepatitis
- cirrosis
106
what is fatty infiltrate*
-hepatocytes become engorged with fatty lobules and distend causing enlargment of the liver- REVERSIBLE
107
what is alcoholic hepatitis*
- inflammation of the liver
- leads to destructive cellular changes
- SOME CHANGES ARE IRREVERSIBLE
108
What is cirrhosis*
- IRREVERSIBLE condition
| - fibrosis of liver leads to hepatic failure
109
What do we do in medical management of patients who have alcohol heptatitis
- minimize drugs metabolized in the liver*
| - have clotting ability evaluated if surgery*
110
WHat are the oral complication of alcohol hepatitis
- poor OH
- oral neglect
- glossitis
- angular cheilosis
- candidiasis
- ging bleeding
111
what drugs are associated with alcohol treatment
* antabuse
| * temposil
112
What does antabuse (disulfram) do?*
prevents elimination of acetaldehyde (cause of hangover, intensifys hangover)
113
What does temposil (calcium-carbonate) do?*
works the same as antabuse, safer
