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Oral Med- ABGD Flashcards

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1
Q

What are the parameters for HTN?

A

2017 classification
<120 and 80 = normal
120-129/ and <80 = elevated
Stage 1: 130-139 or 80-89
Stage 2: ≥ 140 or ≥90
Stage 2 Crisis: >180 or >120 (my limit is 110 palliative/urgent care only)
if symptomatic- no care

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2
Q

What are the treatment considerations for each category of HTN?

A

Normal: None
Elevated: let pt know, recommend lifestyle changes, follow up with PCP
Stage 1: routine, referral to PCM
Stage 2: routine, if asymptomatic
dont treat above 180/110

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3
Q

What are the conditions requiring SBE prophy

A

hx of endocarditis
prosthetic heart valve or repair
unrepaired cyanotic defect
repaired cyanotic defect if less than 6 mos
reparied cyanotic defec with prosthetic materials
heart transplant with valvulopathy

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4
Q

Which heart conditions are cyanotic defects?

A

Tetralogy of Fallot.
Transposition of the great vessels.
Pulmonary atresia.
Total anomalous pulmonary venous return.
Truncus arteriosus.
Hypoplastic left heart syndrome.
Tricuspid valve abnormalitie- congenital

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5
Q

What procedures require ABO prophy?

A

anything that disrupts the gingival tissue,apical region, or perforation the mucosa

except: xrays, injections if not infected, removable appliances, ortho brackets/adjustments, shedding of baby teeth or trauma to lips

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6
Q

What oral meds are given for ABO prophy?

A

AMOX 2 gram
Cephalexin (cephalosporin)- 2 gram (do NOT give if there is a IgE rxn to PCN aka anaphylaxis)
Clinda- 600mg
Azith or Clarithromycin- 500mg

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7
Q

What are the IV meds given for ABO prophylaxis?

A

Ampicillin: 2g
Cefazolin, 1g
Clindamycin: 600g

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8
Q

If the ABO Prophy dose can’t be given prior to tx, when should it be given? What about if they are already on ABX?

A

2 hrs after

switch class of drug, or wait 7-10 days between

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9
Q

What is angina and what are the types?

A

Angina- chest pain & a symptom of MI

STABLE: chronic, relieved with rest, relieved in 5 min with NG (if longer than 5 min= MI)

UNSTABLE: new onset, pain at rest, angina after MI, increased frequency, intensity and duration

PRINZMETAL: typically unpredictable, pain at rest, possible coronary artery spasm, vasodilators

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10
Q

What is the dental management with patient with a hx of angina?

A

Early AM appt
increase O2 if needed
decrease stress/anxiety
Have NTG ready
no epi > 0.04mg

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11
Q

What shoudl you do if your pt develops angina if they have a hx of it?

A

STOP procedure
semi sit up
NTG: 0.3-0.5mg sublingual Q3-5min
O2: NC 4-6L/min
monitor VS
call EMS

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12
Q

What is the max dose of epi? Healthy vs cardiac pt

A

Healthy: 0.2mg
Cardiac: 0.04mg

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13
Q

What precautions should be taken for dental treatment on a post-MI pt?

A

Wait 4-6 weeks post MI to allow for adequate re-vascularization
low risk treadmill test
pt likely on plaxix or asa- so have local measure ready for bleeding
likelihood of reinfarcation after non-cardiac sx is low

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14
Q

What are anti-platelet agents and what is the MOA?

A

ASA- COX inhibitor
Clopidogrel (Plavix): inhibits binding of ADP to PLT receptor
Ticagrelor (Brilinta):ADP receptor blocker (reversible)
Aggrenox (ASA/Dipyrimadole) Cox inhibitor and ADP blocker
PLT Glycoprotient IIb/IIIa inhibitors

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15
Q

What are the signs of CHF?

A

pulmonary edema (left side)
peripheral edema (R side)

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16
Q

Dental management for after stroke?

A

Risk of 2nd decreases over time
pallitive only during 1st 6 months
normal care after 6 months
meds may increase bleeding and risk should be considered with future sx

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17
Q

What the phases of hemostasis?

A

Primary-
vascular (immediate)
PLT phase: 1-2 secs
Secondary:
coagulation phase (10-20secs)
fibrin formation (1-3 min)

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18
Q

Do medication induced PLT disorders affect the quality or quantity of PLTs?

A

Quality

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19
Q

What lab tests would be prolonged in a patient with von Willebrand’s disease?

A

BT
PTT- partial prothromibin time = intristic pathway
Normal PT- prothrombin time = extrinsic and common pathways

PTT normal time ranges by lab ~25-30 secs
PT of 11 to 13.5 seconds.
INR of 0.8 to 1.1

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20
Q

Why might a patient be on anticoagulation meds?

A

mechanical valves,
hx of atrial fib
h of thromboembolic stroke, TIA,

Anti platelet: hx of DVT or pulm embolism

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21
Q

What are some examples of anticoagulation drugs- whats the MOA?

A

Coumadin- inhibits Vit K, factors II, VII, IX, and X
Heparin: IV, inhibits intrinsic pathway
Lovenox: Sq, inhibits intrinsic pathway
Lepirudin: IV direct thrombin inhibitor
Arixtr: SQ direct thrombin inhibitor
Pradaxa: PO direct thrombin inhibitor
Xarelto/eliquid: PO, activated Factor X inhibitor

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22
Q

What is DM? and what the are classifications?

A

most common endocrine disorder, #1 cause of ESRD
Type 1: immune mediated or idiopathic
Type 2: hindered
Gestational: 2-10% of pregnancies, which increase 35-60% risk of developing DM2 in 10-20 years

eat= sugar. sugar=glucose. glucose in blood asks the pancreas to release insulin which helps glucose get into cells for energy.

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23
Q

How do you dx DM?

A

Measure glycated hemoglobin (HbA1C) - 3 month average (RBC lifespan is 4 mo)
Normal: <5.7%
Pre-diabetic: 5.7-6.4%
Diabetic: ≥6.5%

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24
Q

What meds are used for DM1?

A

insulin
RAPID: aspart, lispro (Onset: 15min, Peak 30min, Dur 4-5hr)
SHORT: Regular (O: 30-60min, P: 50-120min, D: 58Hr)
INTERMEDIATE: NPH ( O:1-3hr, P:8hr, D:30 hr)
LONG: Glargine: (O: 1hr, P: n/a, D: 24hr)

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25
What meds are used for DM2?
Biguanides( Metformin)- decreased hepatic glucose production. decreased insulin resistance and decreased glucose adsorption alpha glucosidase inhibitors (arcarbose)- delays digestion of carbs and adsorption glucose Thiazolidinediones (Rosiglitazone) - decreased IR, decrease HGP, increased glucose disposal DPP-4 Inhibitors (Januvia) inhibits enzymatic breakdown of GLP1 and GIP, these are incretin hormones that stmulate the release of insulin SGTL2 inhibitor(Jardiance) Oraly Hypoglycemia agents - Sulfonylureas (Glyburide, Glipizide) increased pancreatic insulin secretion, chronicly Meglitinides (repaglinide) increased pancreatic insulin secretion, acutely
26
What is ozempic and what is it used for
semulglide incretin mimetics, also for weight loss
27
How would you manage diabetic patients in a dental setting?
-minimize stress: short, mid-morning appts *higher insulin activity in afternoon *increased risk of hypoglycemia -patients should take all usual meds -continue usual diet: post procedure dietary intake -may need to alter insulin regimen: *increased release of EPI and corticosteroids induces hyperglycemia -consider antibiotics if poorly controlled (>8% HbA1c) -pre-op/post-op finger stick -F/U -consult with PCM
28
What are the medical comorbidities of DM?
Cardiovascular -CAD (coronary artery disease) -CHF -functional mets = 4 HTN Decreased renal function -NSAIDs -Dialysis
29
What are the signs and symptoms of hypoglycemia?
Initial State -weakness, trembling, hunger, sweating, tachycardia, anxiety, confusion Moderate State -combative, incoherent Severe State -unconsciousness, hypotension, hypothermia
30
How would you manage a patient who is experiencing hypoglycemia in your chair?
-GLUCOSE -soda (not diet), fruit juice *beware of aspiration risk if forced -IV glucose -glucagon auto injector -cake frosting under tongue
31
In a radiated mandible, why can ORN occur after tooth ext?
Radiation makes the mandible: Hypoxic Hypocellular Hypovascular
31
What are the dental side effects of radiation therapy?
xerostomia mucositis muscle fibrosis
32
What is the rule of 2s for corticosteriods?
20mg of cortisol equivalent daily for 2 weeks or longer within last two years. Not widely used anymore
33
What is current corticosteroid recommendations?
Routine dentistry- no supplementation If primary adrenal insufficiency Minor sx: : 25mg hydrocortisone equivalent, preop on DOS Moderate sx: 50-75mg on DOS, and 1 day after Major sx stress: 100-150mg/ day for 2-3 days THEN IV 50mg Q8H after initail dose for 48-72 hrs after sx IF there is 2ndary adrenal insufficiency, then no change to daily therapeutic dose
34
what dz is a primary adrenal insufficiency
addisons' disease
35
what are hte corisol equivalent doses? 20mg = endogenous cortisol release
Hydrocortisone: 20mg Prednisone: 5mg Dexamethasone: 0.75mg Cortisol: 25mg
36
Patient indicates a history of asthma…what questions do you ask?
When diagnosed. What cuases What emds, how often? Ever hospitalized? What type?
37
What are the three types of asthma?
Extrinsic (most common) form of allergen Intrinsic: later onset, often ASA induced Exercise induced: hyperventilation triggers mast cell medication release, more common on cold, dry climates
38
How do you dentally manage asthmatics
determine severity bring inhaler to all appts consider use of B2 agonist inhaler pre-op AVOID: ASA meds, demerol Asthma attack: wheezing, coughing, dyspnea- prevention with known triggers
39
What does a RANKL inhibitor do? What is an example?
Denosumab (Xgeva) human monoclonal antibody to RANKL and during pre-clincial trials was first used to treat post menopausal pt with osteoporosis decreased bone turnover reduces fractures increase one mineral density good for breast nd prostate cancer bone loss too
40
If there was a total hip replacement 1 year ago- do you premed?
no, unless PCM wants it...and it depends if they are severely immunocompromised and or uncontrolled diabetes.
41
What is your comfort zone for INR range for EXT with anticoag pts.
most dentistry up to 3.5 with local measures. FMX: prefer to stop at 2, Really extensive sx: 1.5-2
42
Why do you have ot give a lower concentration of O2 to COPD pts?
CO2 related respiratory drive. They have become adapted to a high CO2 level (higher bicarb level) this adjusts the central chemoreceptors sensitivity to O. high O2 can decrease respiratory drive
43
For a patient with a reduced glomerular filtration rate, what dental consideration would you take?
Consult PCM/Nephrology to determine meds, severity of disease, dialysis and progression suspect HTN, DM, bleeding issures AVOID: NSAIDS and cephalosporin do not do sx on dialysis days, dont use arm that the fistula is placed in for BP
44
What is the TMN tumor classification?
T= tumor size--- Tx-T4 M= metastases--- Mx-M1 N: node involvement ----N0-N3
45
Stages of Cancer?
Stage 1: T1, N0, M0 Stage 2: T2, N0, M0 Stage 3: T3, N0,M0, Any T, N1, M0 Stage 4A: T4, N0, M0 T4, N1, M0 Any T, N2, M0 Stage 4B: Any T, N3, M0 Stage 4C: Any T, Any N, M1
46
Which lymph nodes shoudl be inspected during a head and neck screening
anterior and post cervical submand subment Preauricular tonsilar Supraclavicular
47
What are dental considerations for a pregnant patient?
no NSAIDS no Nitrous in 1st trimester routine exam/prophy good 2nd trimester is safest emergency tx always good consult OB if needed Class B = good in animals only unk in humans Lido, Amox, APAP
48
OSA risk factors/screening tool
STOP BANG Snoring Tired Observed stop breathing High BP BMI >35 Age >50 Neck (>16 men, 17 for women) Gender male Epworth sleepiness scale- 0-3 sleepiness in normal activities
49
how is OSA dx
sleep study - resulting in AHI (hypopnea Apnea Index) Mild: 5-15 Moderate: 15-30 Severe: 30+ apnea= 10 secs without breathing
50
how does dental help with OSA?
eval and screen make oral appliances. open the pharyngeal airway space for pts who cannot tolerate CPAP or need a device for travel
51
What would you prescribe for apthous stomatitis, and licehen planus- or concerns for pemphigoid/gus?
Topical steriod. Fluocinonide 0.05% gel, 30-60gm tube, apply to affected area 2-3x/day, for lichen ABX: doxy 20mg, BID, disp 50
52
What would you prescribe for herpetic gingivostomatitis?
acyclovir 500mg, 5x/day, for 5-7 days. Valacyclovis, 2gram STAT, then 2gm 12 hrs later. , repeat 5-7 days for severe cases
53
How might you treat burning mouth?
elimination of nutritional deficiency, neuro disorders, masses send to neurology, pain management, mental health.
54
What kind of med is Amlodipine?
CCB - decreased cardiac load for HTN
55
Hydrochlorthiazide
HTN,CHF thiazide diuretic
56
lisinopril
ace inhibitor
57
metoprolol
beta blocker (reduce HR and cardiac force)
58
-startan
angiotension II receptor blocker
59
What are the implications of CCBs in dental?
gingival hyperplasia dizziness, hypotension tachycardia
60
-statin (atorvastatin, lovastatin, simvastatin)
HMG-CoA reductase inhibitor lipid management
61
Apixiban, aka? MoA? for?
eliquis Direct inhibitor of factor Xa (common pathway) A fib, DVT management
62
rivaroxiban aka? MoA? for?
xarelto Direct inhibitor of factor Xa (common pathway) A fib, DVT management
63
dabigatran aka? MoA? for?
pradaxa direct thrombin inhibitor (common pathway) A fib, DVT management
64
aspirin?
TxA2 inhibitor- antiplatlet
65
Clopidogrel aka? MoA? for?
ADP receptor blocker (antiplatelet)
66
Ticafrelor aka? MoA? for?
ADP receptor blocker (antiplatelet)
67
What are people often prescribed after an MI?
Statin, Angiotension II receptor blocker, beta blocker Aspirin and ADP blockers in first 12 month after MI
68
Furosemide
Lasix- Loop diuretic for CHF
69
bumetanide
bumex- Loop diuretic for CHF
70
torsemide
Demadex- Loop diuretic for CHF
71
chlorothiazide
Thiazide diuretic Diuril
72
When working on someone who has angina or suspected MI what do you need to do?
nitroglycerin avail O2 avail stop procedure call EMS- is suspect MI or stroke BLS/ACLS consider sedation or anxiolysis Consider reduction in vasoconstrictor (limit to 0.04mg) (but keep stress low, because they procedures 300x if stressed)
73
When do you do dental care on someone with an MI?
elective tx- defer by 6 wks. EF >50-55%, treadmill (6-8METS+)
74
When do you tx someone who had a stroke?
defer for 6 mo
75
what are two categories kind of bronchodilators?
beta 2 agonists anticholinergics they relax smooth muscle
76
What kind of meds are people who have COPD on?
steroids and brochodilators
77
What is albuterol?
beta 2 agonist bronchodilator
78
What is singular?
monelukast leukotriene modifer
79
Things to consider in dental with a pt with COPD
avoid high flow o2, avoid postions that will stress the airway steriods- pt may be immunosuppresed asthma- have things availible like inhaler. determine is stable or unstable.
80
What ios cetirizine?
zyrtex- antihistamine
81
What is fexofenadine
allegrea, antihistamine
82
what is loratadine
claritin antihistamine
83
What rescue meds shoudl you have for allergies
Epi pseudoephedine - be careuful with meth use
84
What is carbamazepine(tegretol) used for?
antiseizure
85
phenytoin (dilantin)
antiseizure
86
valproic acid (Depakote)
antiseizure
87
What is pregabalin and what is the brand name?
lyrica, reduces synaptic NT release
88
What are three SNRI?
Cymbalta (Duloxetine_ Effexor (venlaxafine Desvenlaxafine (Pristiq)
89
How do NSAIDS work?
Cyclooxygenase inhibition, reduces pain mediators
90
What is sumatriptan?
For migraines Imitrex SSR agonist- narrows intracranial vessels, reduce pain signaling
91
What is Rizatriptan?
For migraines maxalt SSR agonist- narrows intracranial vessels, reduce pain signaling
92
What is Lasmitidan
For migraines SSR agonist- narrows intracranial vessels, reduce pain signaling
93
What is Ubrelvy (ubrogepant)
calcitonin gene related peptide receptor agonist
94
What are dental implications in patients with seizures?
may be hypersensitive to local rescue meds- benzo may need O2 consider IV access, anxiolysis, concious sedation
95
What are dental implications for patients with diabetic neuropathy
consider these poorly controlled DM- immunosuppressed, prone to glycemic (hyper/hypo) medication may sedate, make xerostomia, oral pigmentation
96
what blood thinner are iHD on?
heprin during dialysis
97
What is isoniazid used for?
TB prevention in a transplant patient
98
What is azathioprine?
immunosuppressant
99
What is prednisolone
immunosuppressant, steroid
100
What is cyclophosphamide
immunosuppressant
101
What is cyclosporine
immunosuppressant, T cell inhibitor
102
What meds should you avoid in someone with CKD?
antifungals antibiotics antibirals NSAIDS antacids statins DM meds
103
What does the kidney also procedure and why may it be an issue?
erythropoietin (anemic) vit D ( lead to parathyroid hyperfunction) renin-angiotensin-aldosterone regulation (poor BP control)
104
What is cimetidine?
Tagemet - antihistamine H2 blocker
105
What is Famotifdine
pepcid antihistamine H2 blocker
106
What is nexium/ esomeprazole and Prevacid lansopazole and omepazole (prilosec) and pantoprazole (protoniz)
PPI- proton pump inhibitor
107
What does the ending of "-mab" mean?
monoclonal antibody (immunosuppresant)
108
What does insulin do?
improves cellular GIc absorption
109
What does metformin do
inhibits hepatic gluconeogenesis (hypoglycemic agent)
110
Saxagliptin and sitagliptin? what side effects may you look for?
DM meds, DPP4 inhibtor- insulin release, and glucagon decrease....skin rashes or oral ulcerative dx
111
-flozin (jardiance)
SGLT2 inhibitor, reduce renal glucose absorption
112
aldendronate (foasamax), how often
weekly, osteoclas inhibitor
113
risendronate (actonel) how often
weekly or monthly, osteoclast inhibitor
114
ibandronate (boniva) how often
PO monthly, IV quarterly, osteoclast inhibitor
115
zoledronic acid (reclast) how often
IV yearly, osteoclast inhibitor
116
denosumabo (xgevia, prolia) how often
SQ every 6 months. monoclonal antibiody, RANK ligand, osteoclast inhibitor
117
-dronate
osteoclast inhibitor
118
How long do bisphosphonates last in bone?
>10 years
119
What is the risk level for denosumab regarding MRONJ?
intermediate-shorter half life.
120
What things might cause tumor hypercalcemias?
breast or prostate cancer- present as mixed radiodensities in jaw metastatic adenocarcinomas- often low density myeloma osteosarcoma and chondrosarcoma
121
Hydroxychloroquine and chloroquine- waht are they used for, what do they do?
antiinflammatory/immunosuppersant for antoimmue and rheumatologic dz.
122
What is systemic lupus a disease of?
collagen- may need anticoag or SBE prophy due to valvulopathy skin rash
123
what is celexa - citaprolam
ssri
124
what is escitalopram- lexapro
ssri
125
what is fluoxetine prozac
ssri
126
what is paroxetine-paxil
ssri
127
what is sertraline- zoloft
ssri
128
dental side effects of ssri?
xerostomia, bruxism
129
what is alprazolam?
xanax- benzo
130
clonazepam?
klonipin, benzo
131
diazepam
valium, benzo
132
lorazepam
atavan, benzo
133
What is the rescue drug for benzos?
Flumazenil injection
134
What are tobacco cessation drugs?
varenicline (chantix) wellbutrin - buproprion HCL nicotine replacement
135
What can antipsycotics cause?
gingival pigmentation
136
Is it cidal or static? how does it work? class amox
cidal, inhibits wall synthesis, PCN
137
Is it cidal or static? how does it work? class azith
both, inhibits protein synthesis vis ribosome, macrolide
138
Is it cidal or static? how does it work? class clinda
both, protein synthesis via ribosome, macrolide
139
how does it work?, class metronidazole
inhibits protien synthesis vis DNA breakage
140
Is it cidal or static? how does it work? class doxy
static, protiene synthesis, tetracycline
141
Is it cidal or static? how does it work? class? minocycline
static, protien synthesis, tetracycline
142
Is it cidal or static? how does it work? class? ciprofoxacin
cidal, inhibit cell division, fluoroguinolone
143
Is it cidal or static? how does it work? class? cephalexin
cidal, inhibits wall synthesis cephalosporin
144

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