What is the difference between primary and secondary hypertension?
Primary: has an unknown cause (90%)
Secondary: has a known cause (10%)
T/F: Hypertension is associated with diagnostic clinical symptoms.
False
What are the arterial changes in hypertension that lead to complications?
- Fat and calcium build up
2. Plaque stiffens and narrows artery
What are the three major target organs of hypertension?
Kidneys, brain, heart
At which stage of hypertension is pharmacological therapy involved?
Stage 1: 130-139 or 80-89
Stage 2: 140 and above or 90 and above
T/F: A BP of 125/76 is considered elevated.
True
T/F: A BP of 118/84 is considered elevated.
False
Stage 1 HTN due to diastolic over 80
What is the typical BP goal of a patient with HTN?
130/80
List four classes of HTN drugs.
- ACE inhibitors
- Angiotensin receptor blockers
- Thiazide diuretics
- Calcium channel blockers
What could indicate uncontrolled HTN?
- Non-compliance
- Changing/addition to medication
- Complications
The ability for a patient to climb a flight of stairs without problems tells us what about the patient?
They have a METs score of over four
At what BP would you consider sending the patient to the ER?
Diastolic >120 or if they are symptomatic
If BP is over 180/110 but patient is asymptomatic should be referred to primary care within 1 week and elective treatment should be deferred
T/F: NO should be avoided with HTN patients.
False
Can help with anxiety
T/F: Retraction cord with epinephrine should be avoided in HTN patients.
True
Which type of angina will come on during physical effort and will go away with rest and nitroglycerin?
Stable angina
What characterizes an unstable angina?
Comes on during rest, changing character, and hard to get relief from rest and nitroglycerin
What are the three types of pharmacological treatments for angina?
- Nitrates
- Beta blockers
- Antiplatelets
T/F: Many patients will have re-stenosis and return of symptoms 6 months after a balloon angioplasty.
True
10-50%
T/F: A history of angina/MI is considered a major risk factor for treatment.
False
Intermediate. Unstable angina is major risk factor
T/F: Patients with heart attacks in the last month are okay for elective care.
False
Should defer elective care for unstable angina and MI in last month
T/F: Anti-platelets should be discontinued prior to dental treatment.
False
What is a major contraindication for giving nitroglycerin?
Low blood pressure
How many doses of nitroglycerin can be given to a patient experiencing an acute episode of angina?
Up to 3 doses, 5 minutes apart
T/F: If chest pain does not resolve with nitroglycerin, you should have the patient swallow an aspirin.
False
CHEW and swallow 325mg aspirin
What are some examples of supraventricular arrhythmias?
- Sinus nodal disturbances
- Disturbances of atrial rhythm
- Heart block
What are some examples of ventricular arrhythmias?
- Premature ventricular complexes
- Ventricular tachycardia
- Ventricular fibrillation
__________ is characterized by rapid, disorganized, weak atrial contractions bombarding the AV node.
Atrial fibrillation (a-fib)
A ___________ involved the impulse being slowed or blocked in the AV node. Ventricles may contract slower.
Heart block
A patient with ___________ will experience rapid, but regular, ventricular contractions and will have inadequate ventricular filling/pumping.
Ventricular tachycardia
____________ results in rapid, chaotic impulses to the ventricles and can be fatal.
Ventricular fibrillation
T/F: Implantable pacemakers can be used for patients with tachycardia.
False
Will be used with bradycardia (slow) to speed the heart up
T/F: Patients with a-fib would be on anticoagulants.
True
What should the INR of a patient on Coumadin be for dental treatment?
2-3
Patients with which arrhythmias should be deferred for elective care?
High-grade AV blocks and symptomatic ventricular rhythms
When should the INR of a patient on Coumadin be drawn prior to treatment?
Within 48 hours
What are the cardinal symptoms of heart failure?
Dyspnea (SOB) and fatigue
T/F: A patient with no symptoms is considered to have compensated heart failure.
True
What is the difference between class II, III, and IV heart failure?
II and III - symptoms with activity
IV - symptoms at rest
Which class of heart failure should be deferred for elective treatment?
IV - symptoms at rest
T/F: Decompensated heart failure is a major risk factor.
True
What is the key with patients who have had a stent placed?
If it has been over 6 months since the stent placement be sure to inquire about the patients current symptoms
T/F: A pacemaker will detect when the heart is off of rhythm and will shock the heart back into its normal rhythm.
False
Implantable cardioverter-defibrillator
What are the most commonly diseased valves?
Aortic and mitral
T/F: Patients with a mechanical valve replacement need lifelong anticoagulation and antibiotic prophylaxis.
True
T/F: Patients with a bioprosthetic valve need lifelong anticoagulation and antibiotic prophylaxis.
False
Temporary anticoagulation, lifelong antibiotic prophylaxis
What level of risk factor is a severe valvular disease?
Major risk factor
T/F: Aspirin and NSAIDs can make symptoms of asthma worse.
True
Which drugs would be inhaled to relieve an acute asthma attack?
Inhaled quick-acting beta-2 agonists
What makes an asthma patient not a candidate for elective care?
- Symptomatic on day of visit
- Poor compliance with drugs
- ED visit in last three months
What should be done if a patient experiences an asthma attack?
2-4 puffs of SABA every 20 minutes
Support with O2 and vital monitoring
EMS if more than 20-30 minutes
What is the number one cause of COPD?
Smoking
What symptoms should be looked for in a COPD patient?
SOB at rest, productive cough, upper respiratory infection
T/F: NO should be avoided in severe COPD patients.
True
T/F: Narcotics are safe to give to COPD patients.
False
Could decrease respiratory drive
T/F: Patients with an active TB infection should be given elective care.
False
T/F: Patients with a history of TB/positive TB skin test should be given elective care.
True
Patient should report a negative exam and chest x-rays
Which Hepatitis viruses will are transmitted through serum/body fluids?
B, C, and D
Most of the chronic viral carriers of hepatitis have which virus?
hep C
Which hepatitis virus is most likely to cause liver failure?
Hep B
What is the earliest stage of liver damage from alcohol?
Fatty liver - reversible
T/F: Local anesthetics, analgesics, and antibiotics may need dosage adjustments in patients with liver disease.
True
What are three key problems for treating patients with liver dysfunction?
- Bleeding - vitamin K
- Altered drug metabolism
- Infection
T/F: Patients with chronic hepatitis should not be given elective dental care.
False
Active hepatitis