7. Medical History and Physical Evaluation

Blood pressure categories

Pts on renal dialysis

• Antibiotic prophylaxis is not prescribed

• Never instruct pt to stop taking coumadin/warfarin (anticoagulant) unless instructed by MD → 1% rebound risk of thromboembolic phenomenon

Antibiotic prophylaxis

Prosthetic implants: Not recommended unless orthopedic surgeon indicates them

Used for: Prosthetic cardiac valves, prosthetic material used for cardiac valve repair, previous IE, unrepaired or partially repaired cyanotic congenital heart disease or repaired congenital heart disease, cardiac transplant with valve regurgitation due to a structurally abnormal valve

Dental Drug Interactions

• Total dose cannot exceed the lowest maximum recommended dose of anesthetic

• Vasoconstrictor + Cocaine can cause lethal dysrhythmia

• Local anesthetics and opioid sedation should decrease the dose of anesthetic in young children

• Epinephrine and non-selective beta blockers can cause elevation of BP

• Epinephrine and Hydrocarbon inhalation anesthetics can cause cardiac dysrhythmias

• If on antidepressants, avoid or decrease epinephrine use

What drugs can be used with pregnancy? What is to be avoided in pregnancy?

Lidocaine and Prilocaine are class B, no risk

• Avoid all other anesthetics, avoid nitrous oxide

What anesthetic may be preferred in cases of hepatic dysfunction?

Articaine because it is metabolized by blood cholinesterase in 27 min

Antibiotic flow chart

1. Oral amoxicillin (2g adults 50m/kg children) or 2g IM/IV

2. Mild rash to penicillin→ cephalexin (2g adult, 50mg/kg children) (or 1g IV/IM)

3. Anaphylactic shock to penicillin → Clindamycin (600mg adult or 20mg/kg children) or Azithromycin (500mg adults or 15mg/kg children)

"Epinephrine allergies”

Most times pt refers to a sodium bisulfite allergy, oxidant added when there is epinephrine in the cartridge to increase shelf life

• Usually 5% of asthmatic pts have this allergy

Anaphylaxis requires at least 2 of what symptoms

• Skin

• Respiratory

• Cardiovascular

• GI

#1 Risk Factor for stroke and CV disease

• Signs of CV disease

Hypertension

• Signs: clubbed fingers → cardiac or pulmonary; angioedema of the tongue → ACE-inhibitor induced due to accumulation of bradykinin

Rheumatoid arthritis tx

• Disease-modifying-Antirheumatic drugs (DMARDS)

• Biologics

• JAK Inhibitors

Malignant Hyperthermia

Usually occurs with succinylcholine and Halothane but does NOT occur with lidocaine

SAMPTER’s TRIAD

Aspirin-exacerbated Respiratory Disease that is not IgE mediated but is instead Leukotriene inflammatory

What may increase the risk of morphine overdose  in nursing infants

Nursing infants whose mothers are taking codeine and are ultra-metabolizers of codeine

What drug increases the risk of premature closure of the ductus arteriosus in fetuses?

NSAID’s in the 3rd trimester (20>_ weeks)

HbA1C vs Time in range

HbA1c is a 3 month average and time in range is daily

Other random things

Down Syndrome: Most, if not all, will develop Alzheimer’s Disease

Hepatitis: Hepatitis B is vaccine preventable. Hepatitis C has a cure

Cystic Fibrosis: A life-limiting chronic disease affecting 30,000 people in USA. Trikafta(2019) “Game changing” triple therapy drug which will improve quality & extend life for 9 of 10 CF patients

Post-ICU Syndrome: A new or worsening persistent, cognitive, physical or mental health impairment. Not well understood. 50% employed at illness, 36% of them had not returned to work 2 years post-discharge.

Ozempic, Wegovy: With delayed gastric emptying and delayed GI motility. increased risk of vomiting & aspiration with general anesthesia