Anticoagulants are medications that prevent blood from clotting.
2
What are thrombolytics?
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Thrombolytics are medications that dissolve blood clots.
3
What are antiplatelet drugs?
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Antiplatelet drugs inhibit platelet aggregation and prevent blood clot formation.
4
What is anemia?
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A condition characterized by a deficiency in the number of healthy red blood cells or in the amount of hemoglobin in the blood, leading to reduced oxygen-carrying capacity.
5
What are the main types of anemia?
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Anemia can be categorized into several types including iron deficiency anemia, vitamin B12 deficiency anemia, folate deficiency anemia, and anemia of chronic disease.
6
What is the prevalence of anemia globally?
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One third of the global population
7
What are the general symptoms of anemia?
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Fatigue, shortness of breath, pallor, and dizziness
8
List the causes of anemia.
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Blood loss (acute or chronic), bone marrow abnormalities, hemolysis, renal failure, nutritional, malignancy, genetic
9
What are the treatment strategies for severe anemia or hemolytic anemia?
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Blood transfusion to rapidly restore blood parameters.
10
What are the treatment strategies for anemias due to chronic kidney disease or chemotherapy?
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Erythropoiesis-stimulating agents (Erythropoietin and darbepoetin) to stimulate erythroid precursor cell proliferation in the bone marrow.
11
What is the definition of sickle cell disease?
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An inherited genetic mutation in the Ī²-globin gene.
12
What is the adverse effect of hydroxyurea in sickle cell disease?
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Bone marrow suppression (neutropenia) and thrombocytopenia (bleeding/anemia).
13
What is Casgevy and how does it work?
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Casgevy is a genome editing technology approved in 2023 that uses CRISPR/Cas9 technology to genetically modify HSCs DNA to produce HbAT87Q.
14
What is the process shown in the slide called?
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CRISPR/Cas9 editing of Ī²-globin Gene
15
What is the purpose of the CRISPR/Cas9 editing process in the slide?
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To correct the Ī²-globin gene mutation in sickle cell disease patients
16
What is megaloblastic anemia?
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Megaloblastic anemia is a type of anemia caused by a deficiency in vitamin B12 or folate (vitamin B9).
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How is megaloblastic anemia corrected?
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It is corrected by sublingual/parenteral vitamin B12 for pernicious anemia or oral/parenteral folic acid administration for folate deficiency.
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What is the outcome of excess vitamin B12 or folic acid administration?
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There are no major adverse effects associated with excess vitamin B12 or folic acid administration.
19
What is the most common type of nutritional anemia?
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Iron deficiency anemia
20
What are the lab results for iron deficiency anemia?
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Low RBCs, low hemoglobin, and low serum ferritin
21
What are the examples of iron supplements mentioned?
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Ferrous sulfate, ferrous gluconate
22
What are the adverse effects of iron supplements?
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GI symptoms including nausea, flatulence, and constipation.
23
What dental implications can arise from taking iron supplements?
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Iron supplements may cause teeth staining and a metallic taste.
24
What happens when iron and tetracycline are administered simultaneously?
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It hinders the GI tract absorption of both drugs.
25
What are clotting disorders?
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Abnormalities in the blood's ability to clot, leading to excessive bleeding or clotting.
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What are some common drugs used to treat clotting disorders?
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Anticoagulants like warfarin and heparin, and thrombolytics like alteplase.
27
What is the process called when platelets aggregate and form a platelet plug?
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Primary Hemostasis
28
What initiates the coagulation cascade in secondary hemostasis?
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Tissue factor (TF) released by vascular damage
29
What is the difference between an artery and a vein in terms of thrombosis?
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Arteries form white clots due to platelet-rich thrombi, while veins form red clots due to RBCs and fibrin-rich thrombi.
30
What are the two main types of antiplatelet medications and why are they used?
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Antiplatelet medications include antiplatelet medication because they are platelet-rich, and anticoagulants because they are RBCs and fibrin-rich.
31
What are the four categories of anticoagulant drugs mentioned in the slide?
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Heparins, Direct thrombin inhibitors, Direct factor Xa inhibitors, Warfarin
32
Which anticoagulant drug is a vitamin K antagonist?
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Warfarin
33
What is the general recommendation regarding anticoagulation or antiplatelet therapy before dental intervention?
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It is not necessary to alter anticoagulation or antiplatelet therapy prior to dental intervention.
34
What should be done for patients with higher risk of bleeding before dental surgery?
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Any suggested modification to the medication regimen prior to dental surgery should be done in consultation with and on advice of the patientās physician.
35
What are anticoagulants?
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Substances that prevent blood from clotting
36
What is the primary function of anticoagulants?
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To inhibit the formation of blood clots
37
What are the examples of parenteral anticoagulants mentioned in the slide?
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Heparin (HeparinĀ®) and low molecular weight fractions of heparin (LMWHs) like dalteparin (FragminĀ®)
38
What is the mechanism of action (MOA) of heparin?
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Heparin binds to endogenous antithrombin, leading to the inactivation of thrombin (factor IIa) and factor Xa.
39
What are the indications for using heparin?
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Heparin is used for immediate anticoagulation in acute coronary syndrome and deep vein thrombosis (DVT). It is also used adjunctively in surgical interventions to prevent clotting in extracorporeal circulation devices.
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What are the routes of administration for Heparin?
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Heparin is injected via the intravenous route or the subcutaneous route.
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What are the adverse effects of Heparin?
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The adverse effects include bleeding, heparin-induced thrombocytopenia, and hypersensitivity.
42
What is the major dental complication for patients treated with heparin or LMWHs?
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Risk of bleeding during invasive procedures
43
What is the half-life of heparin?
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1-4 hours
44
What is the half-life of other LMWHs?
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3-12 hours
45
What is Heparin-associated thrombocytopenia?
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A non-immune acute reaction to heparin, more common, with an unknown mechanism, can develop as early as day 1, and is a mild condition that normalizes spontaneously.
46
What is the full name of Heparin-associated thrombocytopenia?
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Type I heparin-induced thrombocytopenia.
47
What is Heparin Induced Thrombocytopenia (HIT)?
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An immune-mediated reaction that develops between 5-14 days after heparin exposure.
48
How does heparin induce thrombocytopenia?
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Heparin binds to PF4 forming an immunogenic complex, leading to platelet aggregation and hypercoagulation.
49
What is Warfarin?
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Warfarin is an oral anticoagulant.
50
When was Warfarin approved for human use?
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1955
51
What is Warfarin's trade name?
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Coumadin, Jantoven
52
What is Warfarin's mechanism of action (MOA)?
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Warfarin acts as an antagonist for vitamin K through inhibiting vitamin K epoxide reductase, leading to reduced vitamin K availability.
53
Which vitamin K-dependent clotting factors are affected by Warfarin?
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Clotting factors II, VII, IX, and X
54
What is the pharmacokinetics of warfarin?
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Warfarin is absorbed after oral administration, metabolized by the cytochrome P450 enzyme system, conjugated with glucuronic acid, and excreted in urine.
55
What are the indications for warfarin?
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Prevention and treatment of venous and pulmonary thromboembolism, and stroke prevention in Afib.
56
What is the half-life of clotting factors and how does it affect the anti-coagulant effect of warfarin?
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Factor VII has the shortest half-life and Factor II has the longest half-life. The anti-coagulant effect of warfarin is usually observed after 72 hours due to the depletion of existing clotting factors.
57
What are the CYP2C9 and CYP3A4 enzymes and how do they affect warfarin metabolism?
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CYP2C9 and CYP3A4 are enzymes that metabolize warfarin. Inhibitors of these enzymes, such as fluconazole and trimethoprim-sulfamethoxazole, can increase warfarin's metabolism, while inducers like barbiturates can decrease it.
58
What are the effects of vitamin K on warfarin treatment?
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Vitamin K decreases the efficacy of warfarin treatment.
59
What are the adverse effects of warfarin?
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Bleeding, which can occur even at therapeutic levels, and toxicity associated with uncontrolled bleeding.
60
How long does it take for vitamin K to reverse the action of warfarin?
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Around 24 hours.
61
What is the International Normalized Ratio (INR)?
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INR is a standardized method to measure the effect of anticoagulant drugs like Warfarin.
62
What is the formula for calculating INR?
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INR = Patient's PT / Control PT
63
What is the normal range for INR?
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Normal INR ā¤ 1.1
64
What are direct thrombin inhibitors and what are some examples?
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Direct thrombin inhibitors are a class of anticoagulants that directly inhibit thrombin (factor IIa). Examples include Desirudin (Iprivask), Bivalirudin (Angiomax), and Dabigatran (Pradaxa).
65
What are the limitations of direct thrombin inhibitors?
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The limitations include the lack of a reversal agent to stop uncontrolled bleeding (except for idarucizumab which inactivates dabigatran) and the absence of an easy lab monitoring tool.
66
What are the examples of direct acting anticoagulants?
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Rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa)
67
How do direct acting anticoagulants work?
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They inhibit the activated factor Xa, preventing fibrinogen activation.
68
What are the pharmacokinetic characteristics of direct acting anticoagulants?
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They have a fast onset of action and shorter half-life than warfarin, undergo cytochrome P 450 dependent and independent metabolism, and are administered as a fixed oral dose.
69
What is a strong inhibitor of the cytochrome P450 enzyme family?
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Azole anti-fungal agents
70
What is Andexanet alfa (Andexxa) approved to do?
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Reverse the anticoagulant effects of factor Xa inhibitors
71
What are the two main categories of drugs used in clotting disorders?
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Anticoagulants and Anticlotting drugs
72
What are the two main subcategories of Anticlotting drugs?
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Thrombolytics and Antiplatelet drugs
73
What are Thrombolytics also known as?
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Fibrinolytic drugs
74
What is the mechanism of action (MOA) of Thrombolytics?
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Activates plasmin, a proteolytic enzyme that causes fibrinolysis
75
What are Thrombolytics used for in a hospital setting?
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To dissolve recent blood clots seen in pulmonary embolism or deep vein thrombosis
76
What are the three main categories of drugs used in clotting disorders?
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Anticoagulants, Thrombolytics, and Antiplatelet drugs
77
List the types of antiplatelet drugs mentioned in the slide.
A bruise or area of skin discoloration caused by bleeding under the skin
95
What is epistaxis?
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Nosebleed
96
What does the American Academy of Neurology recommend for patients taking aspirin or warfarin undergoing dental procedures?
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Continue taking their medications.
97
What is the monitoring test for warfarin therapy before a scheduled dental procedure?
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INR test.
98
What are the two categories of drugs used in clotting disorders?
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Anticoagulants and Anticlotting drugs
99
What is the main function of Vitamin K?
Show answer
Facilitates clotting
100
What is the role of Vitamin K in the context of clotting?
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Vitamin K helps correct vitamin K deficiency and is often observed in patients with abnormalities in fat absorption.
101
What are Clotting factors and how are they used in medical treatment?
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Clotting factors are used to correct genetic clotting factor deficiencies. For example, factor VIII is used for hemophilia A patients and factor IX is used for hemophilia B patients.
102
What is the mechanism of action of Antiplasmin agents like tranexamic acid?
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Antiplasmin agents like tranexamic acid inhibit fibrinolysis by inhibiting plasminogen activation.
103
What is the trade name of Tranexamic acid?
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CyklokapronĀ®
104
What are the pharmacokinetic forms of Tranexamic acid?
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Oral tablet, oral rinse (4.8 %), and IV drug forms.
105
What percentage of Tranexamic acid is excreted unchanged in urine?
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95 %
106
What is the Mechanism of Action (MOA) of the drug mentioned?
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Inhibits conversion of plasminogen to plasmin, increases collagen synthesis which increases the strength of fibrin clot.
107
What are the indications for the drug in dental practice?
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Reduce blood loss and post-operative bleeding in patients with hemostatic defects like hemophilia patients.
108
What is the off-label use of the drug in dentistry?
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Control bleeding in patients receiving anticoagulant therapy.
109
What is the purpose of applying direct pressure in managing bleeding?
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To stop bleeding by applying pressure to the wound
110
What is the mechanism of action of microfibrillar collagen in managing bleeding?
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Collagen activates platelet aggregation
111
What is chemical cauterization and how does it achieve hemostasis?
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Chemical cauterization uses silver nitrate and 20% aluminum chloride to promote protein denaturation and coagulation
112
What is the difference between topical thrombin and intravenous thrombin?
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Topical thrombin must be applied to the wound surface, while intravenous thrombin can cause extensive blood clotting and lead to death.
113
Describe the two-component system of fibrin sealant.
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The system consists of one syringe containing thrombin and calcium, and another syringe containing fibrinogen, factors XIII, and other plasma proteins.
114
What happens when the fibrin sealant is mixed?
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Upon mixing, the soluble fibrinogen is converted to fibrin by thrombin, forming a soft mass that adheres to the wound surface and causes hemostasis.
115
What is pharmacology?
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The study of drugs and their effects on living organisms.
116
What are the two books shown in the slide?
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Pharmacology and Therapeutics for Dentistry and Lippincott Illustrated Reviews Pharmacology.