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oral surgery practical > Practical > Flashcards

Practical Flashcards

(49 cards)

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1
Q

Max dose for lidocaine?

A

W. epinephrine: 500mg
wo epinephrine: 200mg

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2
Q

Strongest vasodilative LA?

A

Lidocaine

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3
Q

Weakest vasodilative (except cocaine)?

A

Mepivacaine

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4
Q

LA of choice for pts who cannot receive vasoconstrictors (aka cardiac patients, poor controlled diabetes etc)?

A

Mepivacaine

Also: lido & articaine

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5
Q

Max dose for mepivacaine?

A

400 mg

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6
Q

LA contraindicated in pregnancy?

A

Mepivacaine, bupivacaine, prilocaine
Ropivacaine also

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7
Q

Max dose prilocaine?

A

400 mg

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8
Q

Contraindications for use of vasoconstrictors?

A

Hyperthyroidism
Resting BP +200/115
Unstable angina pectoris
MI withinn 6 mo
Cerebro- or cardiovascular accident witing 6 mo
Coronary artery bypass graft within 6 mo
Uncontrolled cardiac arrythmias
Decompensated congestive heart failure
Sulfite-sensitive asthma (vasoconstrictors contain sulfites)

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9
Q

How many ampules max in pregnancy?

A

2 ampules 1:200000 (1 ampule = 2ml)
1 ampule 1:100

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10
Q

LA that cannot be given to children?

A

Mepivacaine

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11
Q

LA for hepatic deficiency?

A

Articaine
Procaine

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12
Q

Procaine max single dose?

A

500 mg

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13
Q

Treatment of vasovagal collapse?
Paleness
Perspiration
Loss of consciousness
Clonic cramps (epilepsy-like)

A

Trendelenburg’s position (head low legs up)
Oxygen therapy

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14
Q

Treatment of CNS toxication
Dizziness, ear ringing
Decreased consciousness, breathing

A

Oxygen therapy

If seizures: diazepam 5-10 mg i.v.

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15
Q

Remedies for immediate hypersensitivity reaction (asthma)?

A

Volume expanders: crystalloids
B2-agonists: phenoterol, salbutamol, albuterol
More severe cases:
Epinephrine im/iv 10-20 μg
Corticosteroids (too slow action for anaphylaxis)

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16
Q

Remedies for delayed hypersensitivity rxn?

A

Oral antihistamines

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17
Q

Ester action (pseudocholinesterase) can be disturbed by?

A

Hepatic or kidney insufficiency
Malnutrition or other eating disorders
3rd trimester
Birth-control pills

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18
Q

Should you cease aspirin therapy in cardiovascular patients?

A

Never in case of low-dose therapy 75-150 mg/day

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19
Q

What medications should not be used in immunocompromised patients?

A

Steroids

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20
Q

Rules for surgery in pregnancy?

Study These Flashcards
A

Elective: 6 weeks post-delivery
Urgent: 2nd trimester
Emergency: any time

Upright position due to risk of hypoxia

21
Q

High risk patients?

Study These Flashcards
A

Cardiac
Hemodialysis
Endocrine disorders
Pregnancy
Asthma
Previous surgeries or hospitalizations
Immunocompromised
Biphosphonate therapy
Liver disorders

22
Q

Antibiotics in pregnancy?

Study These Flashcards
A

Penicillin G, amoxicillin
Penicillin allergy: clindamycin
Cephalosporins

23
Q

Drugs/antibiotics to avoid in pregnancy?

Study These Flashcards
A

Tetracyclines
Aminoglycosides
Clarithromycin
Metronidazole
Sulfonamides

24
Q

Antibiotic dosages for adults and kids?

Study These Flashcards
A

Amoxicillin or ampicillin iv/im/oral
Adults 2000mg
Children: 50mg/kg

Oral 60 min pre-op
Iv/im 30 min pre-op

25
Uncontrolled diabetes?
Avoid elective surgery Emergency: one-shot antibiotic prophylaxis Another pp says at least 5 day regimen amoxicillin 500mg 3xday clindamycin 300mg 3xday Which is correct?
26
How to prevent thyrotoxic crisis in hyperthyroidism?
Propylthiouracil
27
LA in alcoholism?
Articaine, procaine
28
Pain medication in pregnancy (analgesics) considerations?
Only when necessary and as short as possible! Paracetamol may lead to ADHD & asthma in children (esp 1st tri) Ibuprofen and other NSAIDS in 1st or 3rd may lead to serious defects
29
Patients at risk of IE?
Any prosthetic valve Congenital heart disease: - Any cyanotic CHD - Any CHD repaired with prosthetic material <6 mo after procedure; lifelong if residual shunt or regurgitation still remains Previous episode of IE
30
Medication in case of urgent surgery of uncontrolled hypertension aka >200/115?
No vasoconstrictor! Rapid-onset hypotensive drugs: sublingual captopril
31
Can you use norepinephrine in controlled hypertension?
No It increases both systolic and diastolic BP, epinephrine doesn't
32
Where is the action of anticoagulants?
Veins
33
Where is the action of antiplatelets?
Arteries
34
When should warfarin/acenocoumarol dose be reduced?
Not during small surgeries with INR <4 (5% tranexamic mouth was can stabilize clot) If INR >4 --> anticoagulant can be diminished to bring INR to 2-3
35
What antibiotic is preferred in case of penicillin allergy and what is the dosage?
Clindamycin 600mg adult or 20 mg/kg children Azitromycin 500mg adult or 15 mg/kg in children
36
Bridging therapy?
Major surgical procedure Warfarin or acenocoumarol discontinuation 5/3 days pre-operatively Start LMWH until 24h pre-operatively Restart anticoagulant 12h post-operatively Restart LMWH 24h post-operatively and discontinue 3/5 days post-operatively
37
Anticoagulants?
VKA - Warfarin, acenocoumarol Heparin Direct Xa factor inhibitor - Rivaroxaban Direct thrombin inhibitor - Dabigatran
38
Antiplatelets?
Aspirin Clopidogrel Ticlopidine
39
Should you discontinue rivaroxaban/dabigatran before surgery?
Minor surgery: Discontinue 48h preop Continue 24h postop Major (bridging might be needed, consult GP) Discontinue 72h preop Continue 48h postop
40
Dual antiplatelet therapy aspirin+clopidogrel?
Typical in pts w. stent implants - aspirin must never cease in whole lifetime Clopidogrel can be ceased: 12 months after acute cardiovascular event or implantation of drug-eluting stent 3 months after implantation of bare-metal stent During that timeframe - no elective surgery Clopidogrel discontinuation 5 days preop Continuation 24h postop
41
How to proceed with patients about to receive radiotherapy?
Extract teeth prior to radiation Surgery after radio - avoid if possible; however always w. antibiotic therapy before & after Advice to pt during radiotherapy: soft diet and avoid dental prosthesis to prevent trauma to fragile oral mucosa
42
What diseases is bisphosphonate therapy associated with?
Osteoporosis Bone metastasis Paget's disease (bone can become fragile, misshaped) Multiple myeloma
43
Considerations in case patient takes BPs?
Consult pt's GP for discontinuation Surgery can precipitate or exacerbate osteonecrosis Antibiotic therapy always before & after Chlorhexidine mouthwash
44
Considerations for HIV patients?
CBC w. platelets Liver function test for coagulation CD4 count (antibiotics prophylaxis if <350)
45
What conditions require antibiotics?
Risk of IE Radiotherapy BP therapy HIV <350 Poor metabolic diabetes Hemodialysis Pregnancy only if necessary
46
Antibiotics in hemodialysis?
2g amoxicillin or 600mg clindamycin 60 min preop orally
47
Considerations for pts with hemodialysis?
High risk of postoperative bleeding, pts on heparin Desmopressin 0.3mg/kg - stimulates von Willebrand factor Urgent surgery: protamin sulfate (100 i.u.), to neutralize heparin, if necessary (unfractionated heparin action lasts 4h, so if surgery is to be within that time frame)
48
Conditions not requiring antibiotics?
Good metabolic diabetes Other CHD or acquired heart disease History of myocardial or cerebral infarction Implanted pacemaker By-pass surgery HBV & HCV
49
Antibiotics in IE?
Amoxicillin wo clavulanic acid or ampicillin wo sulbactam 2000mg adult and 50 mg/kg children

oral surgery practical (3 decks)

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