D3 rotation

Question 1

1.) What patients, in general, are recommended for antibiotic prophylaxis for prevention of bacterial endocarditis

Answer 1

1.) patients with highest risk of adverse outcomes

resulting from infective endocarditis

Question 2

2.)7 dental procedures requiring antibiotic prophylaxis for bacterial endocarditis

Answer 2

2.) extraction
Routine cleaning
Scaling and root planning 
Periapical root canal treatment 
Fitting ortho bands
Placing subgingival medications 
Biopsy

Question 3

3.) If local anesthesia is going to be injected through non-infected tissue, is antibiotic prophylaxis required

Answer 3

no

Question 4

4.) If ortho band placement requires antibiotic prophylaxis does the placement of ortho brackets require antibiotic prophylaxis

Answer 4

no

Question 5

5.) Does patient require antibiotic prophylaxis for normal shedding of deciduous teeth

Answer 5

no

Question 6

6.) Does a patient require antibiotic prophylaxis if they have trauma to the lips or oral mucosa

Answer 6

no

Question 7

7.) 5 general Cardiac conditions associated with High Risk of Infective Endocarditis, i.e. requiring antibiotic prophylaxis

Answer 7

7.) prosthetic cardiac valve
Prosthetic material used for cardiac-valve repair
Previous history of Infective endocarditis
Congenital heart disease
Cardiac transplant recipient who develop valvulopathy

Question 8

8.) What are the 2 indications for still prescribing antibiotic prophylaxis when the Congenital Heart Disease is repaired

Answer 8

8.) completely repaired CHD with prosthetic material or device during first six months after procedure
Repaired CHD with residual defects at site or adjacent to site of prosthetic patch or prosthetic device

Question 9

9.) Can a person have a congenital heart condition that does not require antibiotic prophylaxis

Answer 9

9.) Yes, it seems if it is a non-cyanotic CHD (e.g. ventricular septal defect, atrial septal defect) or hypertropic cardiomyopathy, they no longer require antibiotic coverage

Question 10

10.) If a patient has a joint replacement, do they require antibiotic prophylaxis for dental procedures where there will be significant bleeding (EXT, routine cleaning, SRP, periapical RCT, fitting ortho bands, placing Subgingival meds, biopsy)

Answer 10

yes

Question 11

11.) What is the most common joint infection

Answer 11

staph

Question 12

12.) Of the antibiotics we prescribe, which 2 cover a

staph infection

Answer 12

12.) Cephalexin and Augmentin (Cluvanic acid in the

augmentin is what kills the Staph)

Question 13

13.) Of Augmentin and Cephalexin, which does Dr. Smagalski prescribe for antibiotic coverage for joint replacement patient

Answer 13

13.) Cephalexin

Question 14

14.) Rx for pre-op Cephalexin for joint replacement pt.

Answer 14

14.) Cephalexin (500mg/tab) Disp: 4 (Four)

Sig: Four tabs orally two hours prior to treatment

Question 15

15.) What is the adult dosage for Cephalexin

Answer 15

15.) 2 g

Question 16

16.) Is Amoxicillin indicated for antibiotic coverage in joint replacement

Answer 16

16.) No. Amoxicillin alone does not cover staph infections

Question 17

17.) Why would another antibiotic be prescribed for antibiotic prophylaxis of a joint replacement patient if the patient is allergic (anaphylaxis, angioedema, urticaria[hives]) to Penicillin

Answer 17

17.) Because cephalexin (cephalosporins) are not to be used in the those pts as 5% are cross-allergic to both

Question 18

18.) What is the alternative antibiotic prophylaxis for joint replacement patient who is allergic to Penicillins

Answer 18

18.) Clindamycin

Question 19

19.) When is Clindamycin also indicated dentally

Answer 19

19.) infection is anaerobic, e.g. suspect deep space infection

Question 20

20.) Rx for pre-op Clindamycin for joint replacement pt.

Answer 20

20.) Clindamycin (300mg/tab) Disp: 2 (two)

Sig: Two tabs orally one hour prior to treatment

Question 21

21.) What is the adult dose for Clindamycin

Answer 21

21.) 600 mg

Question 22

22.) Drug of Choice for Oral Prophylaxis

Answer 22

22.) Amoxicillin

Question 23

23.) Format for writing a prescription

Answer 23

23.) Line 1: Drug Name (Dose/form)
Line 2: Disp: total number or volume (written out)
to get person to their max dose/24 hr period for as long as you want them to take it
Line 3: Sig: # of med to take, route of admin, freq, special instruction

Question 24

24.) Does a prescription for an antibiotic require a DEA number

Answer 24

24.) No, only controlled substance prescriptions require a DEA number

Question 25

25.) Basic antibiotic for oral aerobic infections

Answer 25

25.) Pen VK

Question 26

26.) When deciding how many to Disp on the | prescription, what must you figure

Answer 26

26.) Length of course (e.g. 7 days) Max dose/24 hrs Mg of drug/tab e.g. Pen VK for 7 days Page 3 of 6 Max dose/ 24 hrs =2g = 2000mg Mg of drug/tab=500mg/tab Max dose/mg drug per tab = 2000mg/500mg = 4 x day 4 x 7 = 28 tabs disp

Question 27

27.) Are antibiotics indicated for pain

Answer 27

27.) No

Question 28

28.) When is antibiotic coverage indicated (list we made during lecture)

Answer 28

28.) signs of sinus communication after EXT Signs of infection Immunocompromised pt (HIV, long term steroid user [RA, SLE, severe asthmatic], transplant recipient0 Systemic signs of infection (fever) Impaired healing (diabetes) Extensive surgery (e.g. 5 EXTs in one appt) Location of infection (e.g. canine space) Laying a flap(e.g. older denture patient)

Question 29

29.) Is age ever an indication for prescribing an antibiotic

Answer 29

29.) No, but it is a consideration

Question 30

30.) If have a maxillary tooth EXT and desire antibiotic cover, choose which and why: Pen VK or Amoxicillin

Answer 30

30.) Amoxicillin. Broader spectrum than Pen VK and will kill sinus infection (e.g. H. influenza)

Question 31

31.) If pt is allergic to Penicillin will they be allergic to Amoxicillin

Answer 31

31.) Yes, they both have β-lactam ring

Question 32

32.) Antibiotic that kills the same thing as Amoxicillin (aerobes + sinus infection) as well as targeting Staph infections

Answer 32

32.) Cephalexin

Question 33

33.) 2 examples of Cephalexin indications

Answer 33

33.) Joint replacement pre-dental treatment prophylaxis Pt with busted teeth and skin scrapes from bike wreck

Question 34

34.) If patient has a true allergy to Penicillin/Amoxicillin (anaphylaxis, angioedema, urticaria), should they be prescribed Cephalexin

Answer 34

34.) No. Could be cross-allergic

Question 35

35.) Clindamycin covers what bacteria

Answer 35

35.) both aerobic and anaerobic

Question 36

36.) What infections would indicate Clindamycin

Answer 36

36.) Deep space infection | Long standing dental infection (note anaerobes will have fetid odor)

Question 37

37.)Side effect of Clindamycin

Answer 37

37.) pseudomembranous colitis from C. Diff

Question 38

38.) What should be our instructions if patient calls complaining of diarrhea and nausea after taking Clindamycin for a while

Answer 38

38.) Stop taking the Clindamycin, refer pt to PCP or Oral | Surgeon

Question 39

39.) What is the only way to i.d. a C. diff infection

Answer 39

39.) stool culture

Question 40

40.) What will the PCP or Oral Surgeon use to treat the C.diff pseudomembranous colitis caused by the Clindamycin

Answer 40

40.) Metranidazole/Flagill

Question 41

41.) What is a side effect of Metranidazole/Flagill used to treat the C. diff pseudomembranous colitis caused by Clindamycin

Answer 41

41.) Neurotoxicity (tingling in extremities)

Question 42

42.) What is the Disp for Clindamycin to solely reduce cost

Answer 42

42.) 150 mg/tab vs 300 mg/tab. Disp 42 of the 150mg/tab Sig: Two tabs orally three times a day

Question 43

43.) What is Augmentin

Answer 43

43.) Amoxicillin + 125 mg Cluvanic Acid

Question 44

44.) If augmentin at a low dose is not helping the patient, should you instruct the patient to just double up on the current prescription or should a new prescription be written for a higher dose of the amoxicillin in the Augmentin

Answer 44

44.) Write new script for higher does. Doubling current prescription could overdose pt on the Cluvanic acid

Question 45

45.) When prescribing pain meds, what is the dosage and number of tabs dispensed dependent on

Answer 45

45.) individual patient pain control requirement

Question 46

46.) NSAID preferred over Acetaminophen

Answer 46

46.) Ibuprofen (400 mg every 4-6 hrs as needed for pain)

Question 47

47.) for pain control prescription, what special instructions should be included on the Sig line

Answer 47

47.) “as needed for pain” or “prn pain”

Question 48

48.) Tylenol #1,#2,#3,#4 all have how much Acetaminophen and how much codeine

Answer 48

``` 48.) all have 300 mg Acetaminophen Each number doubles the Codeine starting at 7.5mg Tylenol #1 = 7.5 mg Codein Tyl #2=15 mg Codeine Tyl #3=30mg Codeine Tyl #4=60mg Codeine ```

Question 49

49.) What is a side effect of Tylenol #3

Answer 49

49.) vomiting (1 in 3)

Question 50

50.) Is there an allergic risk with Tylenol #3

Answer 50

50.) Yes, due to sulfite preservative. Do not prescribe if Sulfa drug allergy

Question 51

51.) What patients are Tylenol contraindicated in (list we made in lecture)

Answer 51

51.) alcoholics Any liver issues (e.g. Hepatitis) If taking other acetaminophen drugs Allergic acetaminophen

Question 52

52.) What patients are Aspirin contraindicated in(list we | made in lecture)

Answer 52

``` 52.) kids Bleeding problems (Hemophilia, thrombocytopenia) Pt on anticoagulants (Coumadin/Warfarin, Heparin, Prodoxil, Plavix) Pt already on aspirin Von Willibrand’s Disease Asthmatic (will trigger bronchiospasm) Aspirin allergy Pregnant Liver problems Chrone’s disease ```

Question 53

53.) Is Tyl #3 safe in pregnancy

Answer 53

yes

Question 54

54.) Should you ever write for Tyl #4

Answer 54

no

Question 55

55.) Lortab and Vicadyn have what narcotic paired with Tylenol

Answer 55

55.) Hydrocodone

Question 56

56.) What is the preferred amount acetaminophen in Lortab and Vicadyn

Answer 56

56.) 325 mg acetaminophen

Question 57

57.) Normal hyrdrocodone/acetaminophen dosage for Lortab

Answer 57

57.) 7.5mg/325 mg

Question 58

58.) Percocet is what narcotic paired with acetaminophen

Answer 58

58.) Oxycodone

Question 59

59.) Med to counteract nausea

Answer 59

59.) Zofran

Question 60

60.) Rx for Zofran

Answer 60

60.) Zofran (8mg/tab) Disp: 6(six) | Sig: One tab orally every 6 hrs as needed for nausea

Question 61

61.) If pt is hypoglycemic and dehydrated days after an EXT and unable to take the antibiotic, what should be the protocol for treatment

Answer 61

61.) Take Zofran, keep down for 20 min, give sugar(e.g. juice [ no diet]) keep hydrating, get foods in (eggs, mac and cheese), then advil to aide pain control, call in hydrocodone 5 mg(lortab 5mg/325mg)

Question 62

62.) What is the maximum/desired max daily dose Acetaminophen

Answer 62

62.) 3200mg, desire to keep below 3g/ day

Question 63

63.) All prescriptions on the page are assumed for what weight adult

Answer 63

150 lb adult

Question 64

64.) Drug, dosage, and quantity should be adjusted for each patient based on what

Answer 64

64.) wt Age | Procedure

Question 65

65.) Antibiotic and pain med safe in pregnancy

Answer 65

65.) Penicillin | Tyl #3

Question 66

66.) When working on a diabetic, would you prefer them to be hyperglycemic or hypoglycemic

Answer 66

66.) a little hyperglycemic so they have a glucose reserve for stress