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Oral Surgery final
Medically complex patients
| Question | Answer |
|---|---|
| Lovonordefrin should be avoided in what type of patients? Why? | Hypertensive. excessive alpha 1 effect and minimal beta 2 effect. |
| What is the concern with epi and beta blockers? | Epi with non selective beta blockers can cause an excessive rise in BP |
| What is the average metabolic equivalent level? Give examples. | 8 For example level walking at 4mph or climbing a flight of stairs each equal 4 METS |
| If a pt needs prophylactic AB tx /p surgery, what is the max duration of tx? | <6wks |
| Can epi be used in patients with unstable anginia? | Epi should be avoided. Limit use to 2 carpules of 1:100,000 epi or 1:20,000 levo ok. Avoid epi in retraction cord. |
| Describe each class of NYHA | 1 no problem 2 moderate sx with normal activity 3 activity limited 4 sx at rest |
| Do I need an MD consult if a patient has an arrhythmia? | Yes |
| What type of local should I use with arrhythmia patients? | Long lasting local without epi in high risk arrhythmias |
| What classes of NYHA should avoid epi? | Avoid in class 3 or 4. |
| What is the concern with digoxin with vasoconstrictor use | May cause arrhythmias |
| How high is the bilirubin when a patient is jaundiced? | 3x's normal |
| What treatment can be done on patients with active hepatitis? Why? What meds can be used? | Urgent care only because they have marked liver disfunction. Avoid any drugs metabolized in liver (lido, carbo). Get doc consult. |
| What % of patients don't know they are positive for hepatitis? What % of patients are wrong about the type of hepatitis they have? | 80% don't know and 50% wrong |
| Name two typical features of alcoholic cirrhosis? | cirrhosis and portal HTN |
| Name three distinct clinical features of alcoholic hepatitis | fever, RUQ pain and jaundice |
| Name two key features of cirrhosis | hypoproteinemia and encephalopathy (due to portal shunting) |
| Petechiae, hematoma and gingival bleeding are all signs of what? | coagulopathy |
| How do nutritional deficiencies present in the mouth? | glossitis |
| What oral problems can a patient with liver disease expect after treatment? | Bruising and slower healing |
| How does acquired coagulopathy affect liver function? | abnormal clotting and fibrin. low platelets |
| Cirrhosis inhibits all clotting factors except? | VIII:vWF |
| Vitamin K is essential for what clotting factors? | 3,7,9,10 |
| Name the local that isn't metabolized in the liver? | septocaine (articaine) |
| Which analgesics are not metabolized in the liver; tylenol, codeine, motrin, hydrocodone, oxycodone? | All are metabolized in the liver |
| Where is diazepam metabolized | liver |
| What antibiotics are metabolized in the liver? | tetracycline, metronidazole (disulfuram rxn causes nausea in alcoholics, erythromycin |
| dental treatment should be avoided or diminished doses of analgesics should be given if aminotransferase levels are? Serum bilirubin levels are? serum albumin levels are? or if the patient has clinical signs of? | aminotransferase >4x's normal, bilirubin >2mg/dL, albumin <35mg/L. signs of acites, encephalopathy or prolonged bleeding time. |
| What bug is the most common cause of peptic ulcer disease? | H. pylori |
| What are cimetidine, ranitidine and famotidine used for? What are their generic names? | Tx ulcer disease not associated with H. pylori. Tagamet, Zantac and Pepcid. |
| What are side effects of proton pump inhibitors and H2 blockers in the treatment of peptic ulcer disease? | PPI - alter taste, cimetidine and ranitidine - suppress bone marrow (i.e. low rbc, wbc and platelets) and erythema multiforme, pepcid - xerostomia |
| What meds should be avoided in peptic ulcer disease? | NSAIDS. If need to use NSAID choose celebrex due to selective inhibitor of Cox-2 |
| What meds should be used to decrease the risk of GI bleed if NSAIDS are used with peptic ulcer disease? | Proton pump inhibitors - prilosec, prevacid, nexium, aciphex |
| What effects do antiacids (H2 blockers) have on lidocaine, valium, codeine, hydrocodone, oxycodone, tetracycline and erythromycine? | lido and valium - decrease metabolism=increased effect. Opioids and antibiotics - decrease effect |
| What antibiotics are commonly used with peptic ulcer disease? | amoxicillin 1g bid, clarithromycin (biaxin) 500mg bid, metronidazole 500mg bid. |
| What's the primary difference between Crohn's and Ulcerative colitis? | Location - Crohn's any part of GI esp smokers; Colitis colon only /c bloody diarreha. |
| name three ways ulcerative colitis and Crohn's differ. | colitis is a inflammatory, mucosal disease. Crohn's is a idiopathic disease with transmural ulcerations. Each has a different location |
| 5 aminosalicylates (5-ASA) steroids, antibiotics,immunosuppressants and biological therapy are all used to treat? | Irritible bowel disease (Crohn's and Ulcerative colitis) |
| Sulfasalazine/azulfidine, mesalazine, asacol, pentasa are all used to treat? | Irritable bowel disease. S/E include low wbc,rbc and platelets |
| What medication is used for moderate to severe relapses IBD? | glucocorticoids |
| Suspect suppression of hypothalamus, pituitary adrenal axis if? | >20mg cortisol daily (5mg prednisone) for more than two weeks in the last two years |
| What A/B's are used in IBD? | flagyl and cipro |
| diarrhea, nausea, thrombophlebitis, hypersensitivity reaction, metallic taste and candidiasis are all S/E's of what two A/B's? | flagyl and cipro |
| Sulfasalazine/azulfidine, mesalazine, asacol, pentasa are all used to treat? | Irritable bowel disease. S/E include low wbc,rbc and platelets |
| What medication is used for moderate to severe relapses IBD? | glucocorticoids |
| Suspect suppression of hypothalamus, pituitary adrenal axis if? | >20mg cortisol daily (5mg prednisone) for more than two weeks in the last two years |
| What A/B's are used in IBD? | flagyl and cipro |
| diarrhea, nausea, thrombophlebitis, hypersensitivity reaction, metallic taste and candidiasis are all S/E's of what two A/B's? | flagyl and cipro |
| thiopurines (azathioprine and 6-mercaptopurine), cyclosporin and methotrexate are what class of meds? and are used to treat? | immunosuppressants, IUD |
| Name a oral complication of cyclosporin use? | gingival hyperplasia. Can also cause renal impairment, tremor, paresthesia, malaise and H/A. |
| Name a complication of methotrexate? | hepatic fibrosis |
| What meds should be avoided in IBD patients? | NSAIDS. In currently taking opioids; adjust dose. |
| What lab test should be checked with IBD patints? | CBC |
| What treatment can be done with at patient who has a IBD exacerbation? | urgent care only. |
| Pyostomatitis vegetans can be found in what type of patient and has what clinical appearance? | IBD. raised yellow on red base with snail track lesions |
| are benzo's safe in asthma patients? What about narcotics and barbiturates? | Yes. No because they may release histamine |
| What antibiotics should be avoided in asthmatics? | macrolides - clarithromycin-(biaxin), erythromycin |
| What type medications are albuteral and terbutaline? | beta 2 adrenergic agents |
| how do beta agonists affect mouth? Why | Increase caries - reduce saliva, increase lactobacillus and strep mutans. some meds have sugar. |
| What are the cell types affected in COPD? Asthma? | COPD epi Macrophage CD8 neutophil, Asthma epi and mast CD4 eosinophil |
| What parts of the airway are affected in COPD and asthma? | COPD small airway narrowing and alveoli destroyed. Asthma bronchoconstriction |
| What time frame indicated chronic bronchitis? | cough for 3 months in each of 2 conseutive years |
| Emphysema definition? | destruction of alveoli |
| A blue bloater and pink puffer describe? | bloater = chronic bronchitis, puffer = COPD |
| How is pCO2 and pO2 affected in bronchitis? emphysema? | elevated pCO2 and decreased pO2, normal pCO2 and decreased pO2 |
| name the sites of obstruction during sleep apnea? | tongue and laryngopharynx |
| Normal BUN | 5-20mg/dl, 30-50 in moderate renal failure, >50 in severe renal failure. |
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