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What are the 11 supplements that require tx modifications in clinical dentistry?
- 1. Diet or Energy Supplements
- 2. Echinacea
- 3. Fish Oil (>3g/day)
- 4. Garlic
- 5. Ginger
- 6. Ginkgo
- 7. Ginseng
- 8. Kava
- 9. St. John's Wort
- 10. Valerian
- 11. Vit E (>4001.U.)
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What are the peri-surgical considerations w/:
Diet/energy supplements (Ephedra-ma huang)
Chronic Echinacea
Kava
St. John's Wort
Valerian
- Diet/energy supplements - Hypertension
- Chronic echinacea - Chronic immune suppression; allergic rxn-dec. effectiveness to immunosuppressants
- Kava - Potential to increase sedative effect of anesthetics; potential for addiction, tolerance, and withdrawal
- St. John's Wort - Induction of cytochrome P450 enzymes -->drug intx (cyclosporine, warfarin, steroids, protease -, BZ, Ca channel blockers, etc)
- Valerian - Potential to increase sedative efects of anesthetics, BZ-like acute withdrawal
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Surgical Considerations for the supplements that affect hemostasis: GARLIC
Garlic: CS anticoag. esp @ high dose, PAI, FFI, discontinue atleast 7 day before surgery
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Surgical considerations for Vitamin E
May be CS esp. @ high doses, can potentiate effect of warfarin or aspirin; 400UI/day inc. bleeding, discontinue use 3 day prior to surgery
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Surgical considerations for Fish oil
May increase risk of bleeding
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Surgical Considerations for the supplements that affect hemostasis: GINGER
Ginger: possible CS but >1g/day, PAI
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Surgical Considerations for the supplements that affect hemostasis: GINKGO
Ginko: CS anticoag., PAI, discontinue atleast 36hrs before surgery
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Surgical Considerations for the supplements that affect hemostasis: GINSENG
Ginseng: PAI, FFI, inc. bleeding, dec. anticoag effect of warfarin, discontinue atleast 7 days before surgery
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What are the peri-surgical considerations w/:
Diet/energy supplements (Ephedra-ma huang)
HYPERTENSION
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What are the peri-surgical considerations w/:
Echinacea
CHRONIC IMMUNE SUPPRESSION
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What are the peri-surgical considerations w/:
4 G's
BLEEDING
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What are the peri-surgical considerations w/:
Kava
SEDATION
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What are the peri-surgical considerations w/:
St. John's Wort
DRUG INTX
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What are the peri-surgical considerations w/:
VALERIAN
SEDATION
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Which herbal supplements cause - REVERSIBLE platelet effects & should be discontinued 3 days prior to surgery?
GINKGO & VIT E
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Which herbal supplements cause - IRREVERSIBLE platelet effects and should be discontinued 7-10 days prior to surgery?
GARLIC, GINSENG
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