Exam 3 - antibiotic premed Flashcards Preview

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Flashcards in Exam 3 - antibiotic premed Deck (18):
1

What 4 groups of people are MOST at risk for infective endocarditis?

1. Replacement prosthetic cardiac valve
2. Previous history of infective endocarditis
3. Cardiac transplantation patients who develop cardiac valvulopathy
4. Congenital heart disease CHD

2

4 types of CHD

1. Unrepaired cyanotic CHD
2. Transposition of great arteries TGA
3. Completely repaired CHD within in first 6 months of procedure
4. Repaired CHD with residual defects

3

Even with corrective surgery, previous TGA patients may develop what 6 things?

1. leaky heart valves
2. coronary artery problems
3. arrhythmias
4. decline in function of the heart muscle or heart valves
5. heart failures
6. damage to lungs & difficulty breathing

4

What are 7 indicators in patients with prosthetic devices that would require antibiotic premed prior to dental treatment?

1. Immunocompromised/suppressed
2. Previous prosthetic joint infections
3. Malnourishment
4. Hemophilia
5. HIV infection
6. Type 1 diabetes
7. Malignancy

5

What 3 indicators for possible prosthetic joint infection puts patients most at risk:
1. _____ of previous joint infection / _________
2. History of joint replacement _______
3. Existing _____ or ____ around the implant device

History
Complications
Failure
Pain
Swelling

6

7 Risk factors for developing prosthetic joint infection caused by microorganisms found in the mouth.

1. Prior joint surgery
2. Failure to give antimicrobial prophylaxis during surgery
3. Immunosuppression
4. Perioperative wound complications
5. High ASA score
6. Prolonged operative time
7. History of prosthetic joint infection

7

_______ is a risk factor for hematogenous prosthetic joint infection.

Bacteremia

8

If patient requires a premed and is allergic to penicillin, what antibiotic should you give?

If allergy to PCN is mild or distant past use CEPHALOSPORIN
If patient had anaphylaxis use CLINDAMYCIN

9

What antibiotic should you give if patient is already taking tetracycline?

clarithromycin or azithromycin (both bacteriostatic)
(Would not use clindamycin because premed dose of clindamycin is bactericidal)

10

What is the recommended standard general prophylaxis premed dose for adults and children?

Amoxicillin:
Adults 2g orally 1 hour before procedure
Children: 50 mg/kg orally 1 hour before procedure

11

What is the recommended standard general prophylaxis premed dose for adults and children if unable to take oral medication?

Ampicillin:
Adults - 2g IM or IV w/in 30 min before procedure
Children - 50 mg/kg IM or IV w/in 30 min before procedure

12

What is the recommended prophylaxis premed dose when allergic to penicillin for adults and children?
Option 1
clindamycin (Cleocin)

Adults: 600 mg orally 1 hours before procedure
Children: 20 mg/kg orally 1 hour before procedure

13

What is the recommended prophylaxis premed dose when allergic to penicillin for adults and children?
Option 2
cephalexin (Keflex)

Adults: 2 g orally 1 hour before procedure
Children 50 mg/kg orally 1 hour before procedure

14

What is the recommended prophylaxis premed dose when allergic to penicillin for adults and children?
Option 3
azithromycin or clarithromycin

Adults: 500 mg orally 1 hour before
Children 15 mg/kg orally 1 hour before procedure

15

ALLERGIC TO PENICILLIN AND UNABLE TO TAKE ORAL MEDICATIONS:
1. clindamycin Adults: ___ mg IV within __ min before procedure Children: __ mg/kg IV within __ min before procedure

cefazolin Adults: __ gm IM or IV within 30 min before procedure
(Ancef, Kefzol, Zolicef) Children: __ mg/kg IM or IV within 30 min before procedure

ceftriaxone (Rocephin) Adults: __ gm IM or IV within 30 min before procedure
Children: __ mg/kg IM or IV within 30 min before procedure

600
30
20
30

1
50

1
50

16

Whats the calculation for finding the correct antibiotic dosage for premeds in children

(Weight of child lbs/150) X (adult dose mg) = pediatric dose
( 1g = 1000mg / 1lb = 2.2 kg)

17

Premeds are not needed for what types of prosthetic replacements?

pins, plates, screws, breast/dental/corneal implants, coronary stents, pacemakers, defibrillators, FISTULA ACCESS FOR DIALYSIS

18

Will you need a premed if the patient has a history of IV drug use, dialysis, PICC line, hickman catheter, Portacath, CSF shunt, history of Fen-Phen, decreased WBC, organ transplant?

YES - maybe needed for penile implant