Oral Medicine IV - the Brennan Mystery Flashcards Preview

Tim's Cards > Oral Medicine IV - the Brennan Mystery > Flashcards

Flashcards in Oral Medicine IV - the Brennan Mystery Deck (75):
1

Normal BP/Dental Tx/Referral

PreHTN/Tx/Referral

HTN Stage1/Tx/Referral

HTN Stage2/Tx/Referral

EmergentHTN/Tx/Referral

< 120/80 Any No

< 140/90 Any Encourage pt see PCP

< 160/100 Any Encourage see PCP

< 180/110 Intraoperative monitoring Prompt Referral

> 180/110 Defer refer ASAP (symptomatic=immediate)

2

When would you consider Intraoperative monitoring for HTN?

Referral?

between 160/100 and 180/110

Prompt

3

Urgent HTN:

Referral when?

If symptomatic, refer when?

over 180/110

ASAP

Immediate

4

2 Follow-up questions for HTN:

Did you take meds today?

Do you know your normal baseline limit?

5

Example of non-selective Beta Blocker:

Max limit of epi if on this:

Max limit levonordefrin:

Propanolol

.036 mg

.20 mg

6

If a pt is taking a Thiazide Diuretic, what is the Vasoconstrictor (epi) limit?

None

7

Non-selective Beta blockers block...

Selective blocks...

If on non-selective...

Beta 1 and Beta 2

Beta 1 only

use caution

8

If pt forgot to take meds and no Emergency...

Postpone/re-appoint

9

If pt has altered/high BP, ask what?

Did you take meds today?

10

If a pt forgot to take their HTN meds, you can assume if they take them it will....

Put them back in normal range

*postpone Tx

11

JNC8, if older than _____, SBP should be _____

If younger than _____, SBP should be _____

CKD or Diabetes, SBP should be _______

Diastolic Goal:

60 < 150

60 <140

140

< 90

12

If pt has had an MI, know what?

We won't Tx if less than ______ unless absolutely necessary

probably want what?

The date

30 days

med consult

13

Coronary Artery Disease and MI, what is important?

2 ways to accomplish:

Stress reduction - Anxiolysis

Premedicate and pain control

14

CAD/MI, use what 2 methods to premedicate?

Benzos, Nitrous

15

When is it inappropriate to do a medical consult?

Confirmation med Rx nothing to do w/ scenario

16

What is the best regimen to Mitral Valve Prolapse Prophylaxis?

None

*red herring

17

AHA guidelines, premedicate for what 4 conditions?

Artificial Heart Valves

Hx Infective Endocarditis

Cardiac Transplant w/ Valvulopathy

Congenital (3)

18

What are the 3 Congenital Conditions requiring premedication via AHA guidelines?

Unrepaired/incompletely repaired Cyanotic HD (including palliative shunts/conduitis)

Completely repaired defect w/ Prosthetic matl/device first 6 months after procedure

Repaired w/ residual defect at site/adjacent to site of Prosthetic patch/device

19

5 Examples of when Not to Premedicate:
(needed in the past, not now)

Mitral valve prolapse

Rheumatic HD

Bicuspid valve disease

Calcified aortic stenosis

Congenital - ventricular/atrial septal defect, hypertrophic cardiomyopathy

20

5 Dental procedures that do not require Abx prophylaxis (if Infective Endocarditis, etc)

Anesthetic through non-infected tissue

Radiographs

RPD/Ortho placement

Ortho adjustment

Shedding deciduous teeth/bleeding trauma oral mucosa/lips

21

PRJ (prosthetic Joint replacements), follow what guide?

AUC (appropriate use criteria)

22

The AUC was created to Tx what two groups?

High risk

Immunocompromised

23

6 types Immunocompromised pts:
*AUC criteria

AIDS (CD4 < 200)

Immunosuppressive chemo w/ neutropenia

RA using TNF alpha or Prednisone > 10 mg/day

Organ transplant immunosuppressants

Inherited immunodeficiency

Marrow transplant (pre/post graft or posttranslplantation)

24

AUC criteria can be immunocompromised or preiprosthetic/deep ______

Prosthetic Joint Replacement

25

3 types of AUC recommendations:

Limited: evidence quality unconvincing

Inconclusive: lack of evidence

Consensus: Expert opinion supports recommendation even though there is no empirical evidence that meets inclusion criteria

26

When would we prophylax for Pins/Plates/Screws?

Never

27

Does pt preference matter for BisPhosphonate premed?

"pt preference should have a substantial influencing role"

28

Tx guidelines for Oral Antiresorptive Meds: Elective Tx:

Inform there is a small risk of developing what?

If pt is on the drug for less than 4 years...

If pt is on the drug for less than 4 yrs w/ Prednisone...

If pt is on the drug for more than 4 years...

Not contraindicated

MRONJ (less than 1%)

no alteration/delay for Tx

consider: 2 mo prior/3 mo post Drug holiday

2 prior/3 post Drug holiday

29

MRONJ is Worse: Cancer vs Osteoporosis:

IV meds vs Oral meds

_____ surgery

> 4 yrs vs < 4 yrs (duration)

mandible vs maxilla

Cancer

IV meds

Dentoalveolar surgery

greater than 4 years

Mandible

30

Even though MRONJ is worse w/ Cancer, IV meds, Dentoalveolar surgery, greater than 4 yrs duration BisPh's, and in the Mandible... risk is still very low

True

31

Risk of MRONJ is worse w/:

Cancer

IV meds

Dentoalveolar surgery

greater time/Prednisone

Maxilla

False

*Mandible is worse

32

If pt has a cirrhotic liver, ask about...

2 concerns:

Bleeding

hemostasis and susceptibility to infection

33

Liver function tests for Hemostasis (2 of them)

Platelet count

INR

34

Hemostasis tests for Liver function, Platelet count should be:

INR should be:

greater than 50,000

less than 3.5

*for most surgical procedures

35

Liver function, infection susceptibility, Neutrophil less than what requires Abx prophylaxis?

< 0.5 or 500 mm3

* (depending on units)

36

If liver disease, avoid what analgesics?

Use what/limit to what dose?

Opioids should be used short term at _____ intervals (liver conjugates)

LA below ___ mg/kg w/ epi

Benzos:

Avoid ___ w/ EtOH

NSAIDS/Aspirin

Acetaminophen, less than 4g/day

increased

7 mg/kg

decreased dose

CNS depressants

37

Medical Consult w/ Liver Disease, you need to confirm what 2 things?

Need to Evaluate Liver function tests (ALT/AST, bilirubin, alkaline phosphatase) if ______ is 4x normal

and/or ______

Platelets greater than 50,000

INR less than 3.5

ALT/AST

Cirrhosis

38

GERD, avoid what 2 drugs?

Tx enamel erosion, use what Fluoride Tx?

Use what rinses?

Aspirin/NSAIDS

topical, varnish, custom trays

Mild baking soda (1 teaspoon in 8 oz water)

39

DDI to know for GERD:

Cimetidine (antacid) inhibits absorption of Ketoconazole (antifungal)

40

Chronic Kidney Disease: Stage 1/GFR

Stage 2/GFR

Stage 3/GFR

Stage 4/GFR

Stage 5/GFR

greater than 90

60-89

30-59

15-29

less than 15

41

Chronic Kidney Disease, when to monitor pt, ensure stability and Tx, no other mods

Medical consultation necessary

Stage 3 and below (30 or better GRF)

Stage 4 or higher (29 and below)

42

When we get a medical consult one of the key things we need to know is Kidney Function

True

43

Pt on Dialysis, 5 things to know if in Dental Chair:

Increased tooth loss

Perio associated w/ C-reactive protein - major risk factor for CKD

Excess bleeding - get platelet count

Anemia - need Hb/Hematocrit prior to Nitrous

Tx on non-dialysis days

44

There are no contraindications to Tx if pt on _____ dialysis

Peritoneal

45

AV site w/ pt on Dialysis:

No IV/IM meds on that arm

Take BP on other arm

True

46

Dialysis pts have increased susceptibility to infections

Infective Endocarditis of ____ % incidence

*follow AHA guidelines

True

2.7%

47

pt has BP 173/103, what guidelines?

Any Tx, consider monitoring BP intraoperatively

*b/c Stage II HTN

48

Dyspnea:

Hemoptysis:

Trouble Breathing

Coughing up blood

49

Orthopnea:

Claudication:

Shortness of breath while lying flat

Exercise induced cramping

50

Pruritis

Dysphagia:

Hematemesis:

Melena:

Hematochezia:

Itchy skin

difficulty swallowing

Vomiting blood

dark blood in stool

Fresh blood through anus

51

Dysuria

Hematuria

Nocturia

painful urination

blood in urine

excessive urination at night

52

Dysmenorrhea

painful periods

53

Polyuria

Polydipsia

Polyphagia

lots of urine (dilute)

excessive thirst

excessive hunger

54

Epistaxis

Syncope

nosebleed

fainting

55

Symptom:

Sign:

subjective

objective

56

Ideally BisPh's should be Rx after dental consult b/c much better to have extractions done before

True

57

What is the most common primary diagnosis in the US?

15-20% of pts have?

HTN

white coat HTN

58

Amoxicillin is Oral and ___g prior to Dental procedure

If unable to take oral, ____ or ______

Allergic to Penicillin - ORAL (3 drugs)

Allergic to Penicillin/Unable to take oral

2 g

Ampicillin (2g), Cefazolin/Ceftriaxone (1g)

Cephalexin (2g), Clindamycin (600mg), Azithromycin/Clarithromycin (500mg)

Cefazolin/Ceftriaxone (1g), Clindamycin (600mg)

59

2 Oral Bisphosphonates and 1 Oral/IV

Alendronate (Fosamax)

Risendronate (Actonel)

Ibandorate (Bonive) can be both

60

What Heps tend to self resolve?

Which are more serious?

A and E

B, C, D

61

Pts w/ liver disease can present as a Sjogren's like syndrome

True

62

The coagulating factors are associated with what Vitamik?

K

63

If there are any liver problems, what to use besides Lidocaine?

Articaine/Prilocaine

64

If liver disease, Beta-lactam drugs can be used safely

Use ____ w/ caution

Avoid clindamysin, aminoglycosides, vancomycin, and macrolides,

Tetracycling, minocycline, doxy used at reduced dose

True

Metronidazole

True

True

65

2 types of Hepatitis that need med consult even if not active:

B, C

*need to know bleeding concerns

66

In acute liver disease, only emergency care can be provided

True

67

GFR, may have hematuria/proteinuria:

anemia, secondary hyperparathyroidism

dialysis/transplant prep:

initiate dialysis

greater than 60

30-60

15-30

less than 15

68

Blood Urea Nitrogen (BUN) very important lab test for kidneys

*also Creatinine level/clearance

True

69

To achieve hemostasis Hematocrit levels should be greater than...

25%

70

Wary of Nitrous and CKD pts

True

71

Hydrochlorothiazide

HTN - angiotensin receptor blocker

72

You can give Abx 2 hrs after procedure if Infective Endocarditis is missed

True

73

Ca channel blocker causes puffy gums

Nifedipine

74

AUC guidelines are for ____ only

joint replacement

75

If Hep C, need...

for bleeding concerns, CBC, if neutropenia...

Consider ______ instead of Lido

med consult

premedicate

articaine/prilocaine

Decks in Tim's Cards Class (140):