Juvenile onset insulin dependent (Autoimmune- Kills b cells that make insulin) Insulin Deficiency Ketone Breath No way to prevent All cases require insulin injections

Adult onset non-insulin dependent Insulin Resistance Most cases can be prevented Late stage cases require insulin injections

Oral Medicine Flashcards by Connor Schmidt

When is antibiotic prophylaxis recommended?

Previous hx of infective endocarditis
Prosthetic heart valve or heart valve repair w/prosthetic material
Heart transplant w/valvular regurgitation
Reapired congenital heart defect w/residual shunts or valvular regurgitation
Unrepaired cyanotic heart diseases

Peds:
* completely repaired congenital heart defect w/prosthetic material–>Antibiotics for 1st 6 months after sx.

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When scenarios should antibiotic prophylaxis be used?

Dental Procedures:
* Manipulation of gingival tissue or periapical region or perforation of oral mucosa
* ext, cleaning, SRP, biopsy, sutures, probing

Severely immunocompromised states:
* HIV w/CDR < 200
* AIDs related opportunistic infection
* Bone marrow or organ transplant
* Neutropenia
* Cancer chemotherapy
* Hx of H&N radiation
* RA w/prednisone>10mg/day
* SCID
* Autoimmune disease (SLE, juvenile arthritis)

Hyperglycemic states (Uncontrolled diabetes)
* Hba1c> 8%
* Random blood glucose > 200 mg/dL

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HTN Categories

Stage 1: 1 medication
Stage 2: 2 meds from different drug classes
Hypertensive crisis: Hospitalization if signs of organ damage

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Oral Manifestations of HTN

Dry mouth, taste changes and ulcerations related to HTN meds

Gingival Hyperplasia

ANgioedema

Gingival Bleeding

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Diabetes Mellitus

Leads to High blood glucose
* body cannot produce or react to insulin
* Polydipsia (thirsty), Polyphagia (hungry), and polyuria (urinate a lot)

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Diabetes Insipidus

Kidneys can’t retain water
* can’t produce or react to ADH
* Polydipsia, polyuria

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Type 1 Diabetes

Juvenile onset
insulin dependent (Autoimmune- Kills b cells that make insulin)
Insulin Deficiency
Ketone Breath
No way to prevent
All cases require insulin injections

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Type 2 Diabetes

Adult onset
non-insulin dependent
Insulin Resistance
Most cases can be prevented
Late stage cases require insulin injections

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Blood Glucose Measurement

Measures glucose conc. in a blood sample

Varies throughout the day

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HbA1c measurement

Measures glycosylated hemoglobin

Stable for 3 months
* life cycle of blood cell

want under 7%

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Diabetic vs Prediabetic vs Normal:
* A1c Test
* Fasting Blood sugar test
* Glucose Tolerance Test

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Medications used for Type 1 diabetes

Insulin
* rapid Acting: Lispro, Aspart, Glulisine
* Short acting: Human insulin
* Intermediate acting: NPH
* Long-acting: Determir, glargine

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Medications used for Type 2 Diabetes

Sulfonylurea: 30 mins b4 meals
Biguanide: Taken w/ meals

DP4 inhibitor: -liptan
Thiazolidinedione: -litazone
SGLT3 inhibitor: Liflozin

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Hypoglycemia

COLD AND CLAMMY NEED SOME CANDY
TIRED:
* Tachycardia
* Irritability
* Restlessness
* Excessive Hunger
* Diaphoresis (Sweating)

Blood sugar < 70 mg/dL

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Hyperglycemia

HOT AND DRY SUGAR HIGH
SINFUL:
* Sweet breath (ketone breath)
* Increased Thirst
* Nausea & Vomitting
* Frequent
* Urination (Polyuria)
* Loss of clear vision

Fasting Blood sugar >/= 126 or
Post-prandial >/= 200

Can lead to life threatening complications:
* Diabetic ketoacidosis
* Hyperosmolar hyperglycemic state

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Patient with diabetes is undergoing general anesthesia. what do you do?

Severe diabetes should not if possible

Well controlled can but recommend:
* Fasting at midnight
* use only 1/2 insulin dose

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ASA Classification

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CPR Checklist

5 A’s
1. Appraise scene safety
2. Assess responsiveness
3. Alert for Help
4. Assess Breathing & Pulse
5. Activate EMS

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CPR Compressions

30
* lower half of sternum b/w nipples
* 2 inches
* 100-120 compression per min

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CPR Airway

Head tilt-chin lift
* if trauma=jaw thrust

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CPR: Breathing

Study These Flashcards

2 breaths

AED

Study These Flashcards

Automated External Defibrillator
* Stop an abnorally beating heart
* attach pads to UR & LL of chest
* over 8 y.o=adult pads

Witnessed Cardiac arrest: Use AED ON ARRIVAL
Unwitnessed Cardiac arrest: Use AED after 5 cycles/2 mins of CPR
* Cardiac arrest=no pulse + Abnormal breathing

Cardiac Arrest + Respiratory Arrest

Study These Flashcards

Respiratory arrest:
* pulse
* Abnormal breathing

Cardiac Arrest:
* no pulse
* Abnormal breathing

Child/Infant CPR:

Study These Flashcards

Pulse:
* Child/Adult=Carotid
* Baby=Brachial

Start CPR immediately if unwitnessed collapse

Small children: 1 hand
Infant: 2 fingers
compress: 1/3 depth of chest

15 compressions for every 2 breaths if 2 rescuers

Rescue Breating

Do if-->Pulse + Abnormal breathing (Respiratory arrest) K I D: 1 breath every **3 seconds** A D U L T: 1 breath every **5 seconds**

Choking/Foreign Body Obstruction

IF CONSCIOUS: **Encourage coughing** * Can't cough, but conscious=abdominal thrusts- **b/w xiphoid process & navel** * Infants: 5 back slaps then 5 chest thrusts IF UNCONSCOUS: * Check mouth before breaths * CPR

How long can the brain survive w/o oxygen?

6 mins

Nitrous Oxide: Indications vs Contraindications

Indications: * Dental ANxiety * Gag Reflex * Asthma Contraindications: * COPD * Nasal Obstruction * Multiple Sclerosis * Pregnant (1st trimester especially) * Otitis Media * Sickle Cell Disease

Supplemental Oxygen: Indications vs Contraindications

Indications: * COPD * Asthma Contraindications: * Bleomycin * Paraquat poisoning (toxic herbicide)

Steroids:

* Derived from Cholesterol * Glucocorticoids=cortisol

Cushing Syndrome

HIGH CORTISOL levels Endogenous: Due to benign tumor * Primary: Increased cortisol at adrenal cortex * Secondary: Increased ACTH at anterior pituitary * Tertiary: Increased CRH at hypothalamus Exogenous: Due to taking too many glucocorticoids * Rule of 2s: 20 mgs of exogenous cortisol + for 2 weeks + within last 2 years==>Suspect: suprresion of adrenal cortex & Possible Crisis * 20 mg hyrocoritsone=5 mg prednisone=0.75 dexamethasone Symptoms: * Moon facies: round, red, and fulll f ace * Bufallo hump: fat b/w shoulders

Addison's Disease

Low CORTISOL Levels Endogenous: due to immune-mediated tissue destruction * Primary: Decrease cortisol at adrenal cortex * Secondary: Decreased ACTH at anterior pituitary * Tertiary: Decreased CRG at hypothalamus SYmptoms: * Hyperpigmentation: Bronzing, brown macules on lips/mucosa

Addisonian Crisis

Aka Acute Adrenal Insufficiency/Adreanl Crisis **Corticosteroids are critcally Low** stress leads to **Hypovolemic shock** (Severe fluid loss=heart unable to pump blood) Activate EMS * Apply ice packs * monitor vital signs * * Start IV Saline (to help w/hypovoemia) * **GIVE IV HYDROCORTISONE**

Bisphosphonates

Prevent bone resorption by **Osteoclasts apoptosis** * increase bone density * slows tooth movement * impairs bone healing * may lead to osteonecrosis

Bisphosphonates are used in what conditions?

* Osteoporosis * Pagets disease * Multiple myeloma * Metastatic bone lesions of various cancers

Bisphosphonate Medications

-Dronate