ban quiz 3

neoplasia/neoplasm

clonal overgrowth of genetically abnormal cells with loss of normal growth control, can be benign OR malignant in nature.

stop 6 hours before, continue after clot forms

POA prior to surgery for patient on heparin

stop 1-5 days before

POA prior to surgery for patient on dabigitran

call MD, ½ dose 24 hrs before, none day of

POA prior to high risk procedure for patient taking LMWH

stop 24 hours before

POA prior to high risk procedure for patient taking rivaroxaban

stop 48 hours before

POA prior to high risk procedure for patient taking apixaban

delay (7-10 days)

POA prior to high risk procedure for patient taking large doses of ASA (asprin)

re-bleed after 5-7 days (clot lysis begins)

what to watch out for after treating patient on anticoagulants

liver disease, alcohol abuse, malnourishment, kidney disease (CKD), antibiotics

causes of vitamin K deficiency

cancer

collection of disease caused by unregulated proliferation of cells

malignant

invasion PAST BASEMENT MEMBRANE, can spread to other areas of body

benign neoplasm

a non-cancerous tumor that does not invade surrounding tissues or spread to other parts of the body

normal, metaplasia, hyperplasia

benign tissue growths

in situ neoplasia

cells have mutation and loss of normal growth, NOT PAST BASEMENT MEMBRANE (localized)

dysplasia, carcinoma in-situ , adenoma, squamous intraepithelial lesion

terms for in-situ neoplasia

NOT CANCER (yet)

important thing to remember about in-situ neoplasia

early detection/screening

best method of decreasing cancer deaths

carcinoma

epithelial neoplasia/cancer

adeno, squamous, transitional

types of carcinomas

sarcoma

mesenchymal neoplasia/cancer

fibro,lipo,osteo,chondro, leiomyo

types of sarcomas

adenocarcinoma

cancer that originates from glandular epithelium

squamous cell carcinoma

cancer that originates from squamous epithelium

urothelial carcinoma

cancer that originates from urothelium/transitional epithelium

metastasis

neoplastic cell invade lymphatics or blood vessels and spread to other regions of body

angiolymphatic invasion

the spread of cancer through lymphatic vessels and blood vessels which allows for metastasis

sarcomas, melanomas, germ cell tumors

cancers that are not normally contained by basement membrane

overgrowth, disorganization, destruction, nuclear abnormalities, mitotic rate, loss of cell relationships

how are non-epithelial malignancies defined

grade

differentiation measure based on cells appearance/histologic features. may determine AGRRESSIVENESS

low grade

grade of well differentiated cells

intermediate grade

grade of moderately differentiated cells

high grade

grade of poorly differentiated cells

stage

defined where cancer has grown/spread

stage I

stage of cells CONFINED to organ

stage 2

stage of cells LOCALLY invasive

stage 3

stage of cell spread to ADJACENT organs

stage 4

stage of cells that have METASTASIZED to DISTANT sites in the body.

tis

pathologic staging for carcinoma in-situ (stage 0)

T 1-4

pathologic staging detonating increasing size and or local extent of the
primary tumor

N0-3

pathologic staging indicating the extent of regional lymph node involvement in cancer.

clinical stage

stage based on clinical data such as exam and radiographs

breast

most common cancer

lung

most deadly cancer

50-80 AND 20 pack year smoker

who requires yearly CT scans for lung cancer screening

TF, VII

extrinsic clotting factors

VIII,IX,XI,XII

intrinsic clotting factors

TF, VII

coagulation factors measured by PT/INR

XII,XI,IX,VIII

coagulation factors measured by PTT

X,V,II,I

coagulation factors in the common pathway

II,VII,IX,X

clotting factors warfin affects

PTT

which test would be valuable in evaluating patients treated with heparin

≤3.5

INR level needed to safely proceed with dental extraction

warfarin/coumadin

inhibits vitamin K dependent clotting factors (IIa, VIIa,IXa,Xa)

rivaroxaban (xarelto) and apixaban

inhibitors of factor Xa only

NSAIDs (aspirin)

inhibit COX pathway (production of thromboxanee) and IMPAIRS platelet aggregation.

NSAIDs (asiprin, ibuprofen ect.) and P2RY12 inhibitors (plavix/clopigogrel)

major antiplatelet agents seen in dental practice

decrease vitamin K producing bacteria

how do antibiotics increase bleeding risk

2.0-3.0

target range of anticoagulation with warfarin

warfarin/coumadin

PT/INR is most useful when assesing bleeding risk in a patient treated with which medication

low molecular weight heparin (enoxaparin/lovenox)

A type of anticoagulant that inhibits factor Xa and is used for the prevention and treatment of thromboembolic disorders.

deep vein thrombosis, atrial fibrilation

reasons a patient might be on anticoagulation medication

liver disease, vitamin K deficiency

what might cause elevated PT/INR and PTT

within 24 hours

within what time frame should an INR test be performed prior to surgery

vitamin K

emergency antidote to warfarin

direct oral anticoagulant (DOAC)

a class of anticoagulant medications that directly inhibit specific coagulation factors, used for preventing and treating thromboembolic disorders. ex: apixaban, rivaroxaban, dabigatran

holding off on medication

preoperative strategy with pts taking DOACs (ex: apixaban) but not warfarin due to DOACs shorter half-life

supragingival scaling, simple restor, local anesthetic

low bleeding risk procedures

subgingival scaling, subgingival restore, RCT, simple EXT, regional anesthetic

moderate bleeding risk procedures

extensive surgery, apicoectomy (root removal), alveolar surgery (bone removal), multiple EXT

high bleeding risk procedures

immune thrombocytopenia (ITP)

immune system targets platelets

50 (50,000/µL)

Under what platelet count would you defer an invasive surgical
procedure or perform with additional precautions in place?

collaplug (collagen), gelfoam (gelatin), surgicel (oxidized cellulose), avitene (microfibrillar collagen), hemcon

What material(s) can be placed in the extraction socket to decrease post-operative bleeding risk (hemostatics)?

apply gauze pressure (30-60min), no straws, no smoking, no spitting, avoid trauma

What instructions will you give the patient after
extraction to decrease bleeding risk?

aspirin (ASA) and other NSAIDs

Which common pain medication(s) should be avoided post-extraction?

factor VIII replacement

intervention for Patient withHemophilia A prior to extraction?

platelet transfusion

intervention for patient with chemotherapy induced thrombocytopenia

protamine

a medication used to reverse the effects of LMWH (enoxaparin) in patients undergoing surgery or invasive procedures.

idaricizumab

monoclonal antibody used as reversal agent for DABIGATRAN in cases of major bleeding or urgent surgery.

andexanet alfa

recombinant protein used to reverse anticoagulant effects of Xa inhibitors in cases of major bleeding.

diagnosing

DEFINITIVE process to CONFIRM or RULE OUT the presence of a DISEASE, results will inform whether an individual will receive therapy or management.

biopsy, lab test, radiologic test (ie. xray, ultrasound ect.)

diagnostic test examples

screening

PRELIMINARY process to IDENTIFY people who are at a greater RISK of
having a disease, results will inform whether an individual should be tested further.

diagnosis

the identification of a disease or condition based on evaluation of symptoms and test results.

differential diagnosis

list of possible diagnoses that could cause a given finding

working diagnosis

best guess as you do more studies/tests to determine the true diagnosis.

sensitivity

ability of screening test to detect disease when present (TRUE POSITIVES)

specificity

ability of a screening test to detect health when healthy (TRUE NEGATIVES)

positive predictive value

odds of having a disease if screening test is positive

negative predictive value

odds of health if screening test is negative

High sensitivity

screening test doesn’t miss those with the disease (true positives)

high specificity

screeening test doesn’t include those without the disease (true negatives)

mammogram, chest CT, colonoscopy, pap smear

examples of screening test

pap smear/test

most successful screening test for cancer

pathognomonic signs

specific clinical signs indicative of a particular disease

consult patients physician

what should be done before making changes to patients anticoagulant therapy

platelet count (PLT)

lab test order prior to treating pt with immune thrombocytopenia (ITP)

inhibit fibrinolysis

how so tranexamic acid (TXA) and E-Amino Aminocaproic acid decrease bleeding risk

clonal

cancers that originate from one cell “gone wild”, what majority of cancers start out as

apoptosis

the process of programmed cell death that occurs in multicellular organisms, crucial for maintaining cellular homeostasis.

philadelphia chromosome

a genetic abnormality associated with chronic myeloid leukemia (CML)