Loading...
Question 1
What are anticoagulants?
Anticoagulants are medications that prevent blood from clotting.
Question 2
What are thrombolytics?
Thrombolytics are medications that dissolve blood clots.
Question 3
What are antiplatelet drugs?
Antiplatelet drugs inhibit platelet aggregation and prevent blood clot formation.
Question 4
What are the general symptoms of anemia?
Fatigue, shortness of breath, pallor, and dizziness
Question 5
What are the treatment strategies for severe anemia or hemolytic anemia?
Blood transfusion to rapidly restore blood parameters.
Question 6
What are the treatment strategies for anemias due to chronic kidney disease or chemotherapy?
Erythropoiesis-stimulating agents (Erythropoietin and darbepoetin) to stimulate erythroid precursor cell proliferation in the bone marrow.
Question 7
What is the definition of sickle cell disease?
An inherited genetic mutation in the β-globin gene.
Question 8
What is the adverse effect of hydroxyurea in sickle cell disease?
Bone marrow suppression (neutropenia) and thrombocytopenia (bleeding/anemia).
Question 9
What is Casgevy and how does it work?
Casgevy is a genome editing technology approved in 2023 that uses CRISPR/Cas9 technology to genetically modify HSCs DNA to produce HbAT87Q.
Question 10
What is megaloblastic anemia?
Megaloblastic anemia is a type of anemia caused by a deficiency in vitamin B12 or folate (vitamin B9).
Question 11
How is megaloblastic anemia corrected?
It is corrected by sublingual/parenteral vitamin B12 for pernicious anemia or oral/parenteral folic acid administration for folate deficiency.
Question 12
What is the outcome of excess vitamin B12 or folic acid administration?
There are no major adverse effects associated with excess vitamin B12 or folic acid administration.
Question 13
What is the most common type of nutritional anemia?
Iron deficiency anemia
Question 14
What are the lab results for iron deficiency anemia?
Low RBCs, low hemoglobin, and low serum ferritin
Question 15
What are the examples of iron supplements mentioned?
Ferrous sulfate, ferrous gluconate
Question 16
What are the adverse effects of iron supplements?
GI symptoms including nausea, flatulence, and constipation.
Question 17
What dental implications can arise from taking iron supplements?
Iron supplements may cause teeth staining and a metallic taste.
Question 18
What happens when iron and tetracycline are administered simultaneously?
It hinders the GI tract absorption of both drugs.
Question 19
What are clotting disorders?
Abnormalities in the blood's ability to clot, leading to excessive bleeding or clotting.
Question 20
What are some common drugs used to treat clotting disorders?
Anticoagulants like warfarin and heparin, and thrombolytics like alteplase.
Question 21
What is the process called when platelets aggregate and form a platelet plug?
Primary Hemostasis
Question 22
What initiates the coagulation cascade in secondary hemostasis?
Tissue factor (TF) released by vascular damage
Question 23
What is the difference between an artery and a vein in terms of thrombosis?
Arteries form white clots due to platelet-rich thrombi, while veins form red clots due to RBCs and fibrin-rich thrombi.
Question 24
What are the two main types of antiplatelet medications and why are they used?
Antiplatelet medications include antiplatelet medication because they are platelet-rich, and anticoagulants because they are RBCs and fibrin-rich.
Question 25
What are the four categories of anticoagulant drugs mentioned in the slide?
Heparins, Direct thrombin inhibitors, Direct factor Xa inhibitors, Warfarin
Question 26
Which anticoagulant drug is a vitamin K antagonist?
Warfarin
Question 27
What is the general recommendation regarding anticoagulation or antiplatelet therapy before dental intervention?
It is not necessary to alter anticoagulation or antiplatelet therapy prior to dental intervention.
Question 28
What should be done for patients with higher risk of bleeding before dental surgery?
Any suggested modification to the medication regimen prior to dental surgery should be done in consultation with and on advice of the patient’s physician.
Question 29
What are anticoagulants?
Substances that prevent blood from clotting
Question 30
What is the primary function of anticoagulants?
To inhibit the formation of blood clots
Question 31
What are the examples of parenteral anticoagulants mentioned in the slide?
Heparin (Heparin®) and low molecular weight fractions of heparin (LMWHs) like dalteparin (Fragmin®)
Question 32
What is the mechanism of action (MOA) of heparin?
Heparin binds to endogenous antithrombin, leading to the inactivation of thrombin (factor IIa) and factor Xa.
Question 33
What are the indications for using heparin?
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.
Question 34
What are the routes of administration for Heparin?
Heparin is injected via the intravenous route or the subcutaneous route.
Question 35
What are the adverse effects of Heparin?
The adverse effects include bleeding, heparin-induced thrombocytopenia, and hypersensitivity.
Question 36
What is the major dental complication for patients treated with heparin or LMWHs?
Risk of bleeding during invasive procedures
Question 37
What is the half-life of heparin?
1-4 hours
Question 38
What is the half-life of other LMWHs?
3-12 hours
Question 39
What is Heparin-associated thrombocytopenia?
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.
Question 40
What is the full name of Heparin-associated thrombocytopenia?
Type I heparin-induced thrombocytopenia.
Question 41
What is Heparin Induced Thrombocytopenia (HIT)?
An immune-mediated reaction that develops between 5-14 days after heparin exposure.
Question 42
How does heparin induce thrombocytopenia?
Heparin binds to PF4 forming an immunogenic complex, leading to platelet aggregation and hypercoagulation.
Question 43
What is Warfarin?
Warfarin is an oral anticoagulant.
Question 44
When was Warfarin approved for human use?
1955
Question 45
What is Warfarin's trade name?
Coumadin, Jantoven
Question 46
What is Warfarin's mechanism of action (MOA)?
Warfarin acts as an antagonist for vitamin K through inhibiting vitamin K epoxide reductase, leading to reduced vitamin K availability.
Question 47
Which vitamin K-dependent clotting factors are affected by Warfarin?
Clotting factors II, VII, IX, and X
Question 48
What is the pharmacokinetics of warfarin?
Warfarin is absorbed after oral administration, metabolized by the cytochrome P450 enzyme system, conjugated with glucuronic acid, and excreted in urine.
Question 49
What are the indications for warfarin?
Prevention and treatment of venous and pulmonary thromboembolism, and stroke prevention in Afib.
Question 50
What is the half-life of clotting factors and how does it affect the anti-coagulant effect of warfarin?
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.
Question 51
What are the CYP2C9 and CYP3A4 enzymes and how do they affect warfarin metabolism?
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.
Question 52
What are the effects of vitamin K on warfarin treatment?
Vitamin K decreases the efficacy of warfarin treatment.
Question 53
What are the adverse effects of warfarin?
Bleeding, which can occur even at therapeutic levels, and toxicity associated with uncontrolled bleeding.
Question 54
How long does it take for vitamin K to reverse the action of warfarin?
Around 24 hours.
Question 55
What is the International Normalized Ratio (INR)?
INR is a standardized method to measure the effect of anticoagulant drugs like Warfarin.
Question 56
What is the formula for calculating INR?
INR = Patient's PT / Control PT
Question 57
What is the normal range for INR?
Normal INR ≤ 1.1
Question 58
What are direct thrombin inhibitors and what are some examples?
Direct thrombin inhibitors are a class of anticoagulants that directly inhibit thrombin (factor IIa). Examples include Desirudin (Iprivask), Bivalirudin (Angiomax), and Dabigatran (Pradaxa).
Question 59
What are the limitations of direct thrombin inhibitors?
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.
Question 60
What are the examples of direct acting anticoagulants?
Rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa)
Question 61
How do direct acting anticoagulants work?
They inhibit the activated factor Xa, preventing fibrinogen activation.
Question 62
What are the pharmacokinetic characteristics of direct acting anticoagulants?
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.
Question 63
What is a strong inhibitor of the cytochrome P450 enzyme family?
Azole anti-fungal agents
Question 64
What is Andexanet alfa (Andexxa) approved to do?
Reverse the anticoagulant effects of factor Xa inhibitors
Question 65
What are the two main categories of drugs used in clotting disorders?
Anticoagulants and Anticlotting drugs
Question 66
What are the two main subcategories of Anticlotting drugs?
Thrombolytics and Antiplatelet drugs
Question 67
What are Thrombolytics also known as?
Fibrinolytic drugs
Question 68
What is the mechanism of action (MOA) of Thrombolytics?
Activates plasmin, a proteolytic enzyme that causes fibrinolysis
Question 69
What are Thrombolytics used for in a hospital setting?
To dissolve recent blood clots seen in pulmonary embolism or deep vein thrombosis
Question 70
What are the three main categories of drugs used in clotting disorders?
Anticoagulants, Thrombolytics, and Antiplatelet drugs
Question 71
List the types of antiplatelet drugs mentioned in the slide.
Glycoprotein IIb/IIIa inhibitors, ADP inhibitors (clopidogrel), PDE/adenosine uptake inhibitors
Question 72
What are the main targets of antiplatelet drugs?
The main targets are TXA2, ADP, and αβ-integrin.
Question 73
What are the three main categories of antiplatelet drugs mentioned in the slide?
The categories are TXA2 inhibitors, ADP-receptor antagonists, and αβ-integrin inhibitors.
Question 74
What is the mechanism of action (MOA) of aspirin?
Aspirin irreversibly inactivates cyclooxygenase (COX)-1, inhibiting the formation of thromboxane A2 (TXA2).
Question 75
How long does aspirin-induced platelet suppression last?
Aspirin-induced platelet suppression lasts for the life of the platelet (7 to 10 days).
Question 76
What are the adverse events associated with aspirin?
Adverse events include GI irritation, increased risk of bleeding, allergy, and aspirin-induced asthma.
Question 77
What is the indication for aspirin use?
Aspirin is used in a low dose form of 75-325 mg (commonly 81 mg/day) for prophylaxis or prevention of clot formation and future CVS adverse events.
Question 78
What is the drug-drug interaction of aspirin with NSAIDs?
NSAIDs may enhance the antiplatelet effect of aspirin.
Question 79
What are the contraindications for aspirin use?
Patients with bleeding disorders like hemophilia patients or patients with active GI bleeding.
Question 80
What is the mechanism of action (MOA) of ADP-inhibitors?
Oral Prodrugs. Active metabolite inhibits binding of ADP to platelets and consequently inhibits platelet aggregation and activation.
Question 81
What are the indications for ADP-inhibitors?
Preventive for thrombotic events (MI...)
Question 82
What are Glycoprotein IIb/IIIa inhibitors?
They are drugs that block the GP IIb/IIIa receptor, preventing platelet aggregation.
Question 83
What are the examples of Glycoprotein IIb/IIIa inhibitors?
Abciximab and tirofiban.
Question 84
How are Glycoprotein IIb/IIIa inhibitors administered?
They are administered intravenously.
Question 85
What are Phosphodiesterase inhibitors?
Enzymes that inhibit the activity of phosphodiesterase, leading to increased cAMP levels and promoting vasodilation.
Question 86
What is the main mechanism of action (MOA) of Phosphodiesterase inhibitors?
Inhibiting phosphodiesterase increases cAMP levels, promoting vasodilation and decreasing platelet activation.
Question 87
What is petechiae?
Small, pinpoint hemorrhages under the skin
Question 88
What is ecchymosis?
A bruise or area of skin discoloration caused by bleeding under the skin
Question 89
What is epistaxis?
Nosebleed
Question 90
What does the American Academy of Neurology recommend for patients taking aspirin or warfarin undergoing dental procedures?
Continue taking their medications.
Question 91
What is the monitoring test for warfarin therapy before a scheduled dental procedure?
INR test.
Question 92
What are the two categories of drugs used in clotting disorders?
Anticoagulants and Anticlotting drugs
Question 93
What is the main function of Vitamin K?
Facilitates clotting
Question 94
What is the role of Vitamin K in the context of clotting?
Vitamin K helps correct vitamin K deficiency and is often observed in patients with abnormalities in fat absorption.
Question 95
What are Clotting factors and how are they used in medical treatment?
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.
Question 96
What is the mechanism of action of Antiplasmin agents like tranexamic acid?
Antiplasmin agents like tranexamic acid inhibit fibrinolysis by inhibiting plasminogen activation.
Question 97
What is the trade name of Tranexamic acid?
Cyklokapron®
Question 98
What are the pharmacokinetic forms of Tranexamic acid?
Oral tablet, oral rinse (4.8 %), and IV drug forms.
Question 99
What percentage of Tranexamic acid is excreted unchanged in urine?
95 %
Question 100
What is the Mechanism of Action (MOA) of the drug mentioned?
Inhibits conversion of plasminogen to plasmin, increases collagen synthesis which increases the strength of fibrin clot.
Question 101
What are the indications for the drug in dental practice?
Reduce blood loss and post-operative bleeding in patients with hemostatic defects like hemophilia patients.
Question 102
What is the off-label use of the drug in dentistry?
Control bleeding in patients receiving anticoagulant therapy.
Question 103
What is the purpose of applying direct pressure in managing bleeding?
To stop bleeding by applying pressure to the wound
Question 104
What is the mechanism of action of microfibrillar collagen in managing bleeding?
Collagen activates platelet aggregation
Question 105
What is chemical cauterization and how does it achieve hemostasis?
Chemical cauterization uses silver nitrate and 20% aluminum chloride to promote protein denaturation and coagulation
Question 106
Describe the two-component system of fibrin sealant.
The system consists of one syringe containing thrombin and calcium, and another syringe containing fibrinogen, factors XIII, and other plasma proteins.
Question 107
What happens when the fibrin sealant is mixed?
Upon mixing, the soluble fibrinogen is converted to fibrin by thrombin, forming a soft mass that adheres to the wound surface and causes hemostasis.