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1. Monitor vital signs at every appointment because of cardiovascular and respiratory side effects.

2. Have the patient sit up slowly and remain seated for at least two minutes after being supine in order to minimize the risk of orthostatic hypotension.

3. Decreased saliva flow can put the patient at risk for dental caries, perio-dontal disease, and candidiasis.

4. Dental procedures may cause the patient anxiety or place stress on the heart. Assess cardiovascular patient for this risk.

5. Early-morning and shorter appointments as well as methods for addressing anxiety levels in the patient can help to reduce the amount of stress that the patient is experiencing.

6. Vasoconstrictors should be used with caution and in low doses. Avoid epinephrine-containing gingival retraction cords.

7. Patients on chronic drug therapy may develop blood dyscrasias. Symptoms include fever, sore throat, and bleeding, and poor wound healing.

OPHTHALMIC DROPS

1. Assess patient for compliance with drug regimen for glaucoma.

2. Avoid direct dental light in the patient's eyes. Keep dark glasses available for patient comfort. Consultation with Primary Care Provider

1. Patients with symptoms of blood dyscrasias should be referred to their primary care provider for complete blood counts. Treatment should be postponed until the results are known.

2. Consultation with appropriate health care provider may be necessary to evaluate level of disease control.

3. General anesthesia should be used with caution in patients requiring dental surgery.

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