Exam 3: PreMedication Flashcards Preview

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Flashcards in Exam 3: PreMedication Deck (56):
1

Amoxicillin- __ gm orally ___ hour(s) before procedure.

2 gm....1 hour

2

Ampicillin- ___ gm IM or IV within ___ min before procedure.

2 gm IM or IV....30 min

3

Clindamycin- ____ mg orally __ hour(s) before procedure.

600 mg...1 hour

4

Cephalexin- ___ gm orally __ hour(s) before procedure.

2 gm...1 hour

5

Azithromycin/Clarithromycin- ___ mg orally __ hour(s) before procedure.

500mg...1 hour

6

Clindamycin ___ mg IV within ___ min before procedure.

600 mg... 30 min

7

Cefazolin ____ gm IM or IV within ___ min before procedure.

1 gm...30 min

8

Ceftriaxone ___ gm IM or IV within ___ min before procedure.

1 gm...30 min

9

No _________ supports that antibiotic prophylaxis defends against IE or prosthetic joint infection.

scientific evidence

10

Antibiotic Prophylaxis for patients at risk for
_______ endocarditis when undergoing invasive dental procedures

INFECTIVE

11

Infectious Endocarditis: 400 fold increase in patients with ________ and ________

prosthetic valves and previous history of endocarditis

12

________ from periodontal pathogens initiate the clotting
cascade...*why IE is also treated with ________

Endotoxins....anticoagulants

13

What are the BIG FOUR? The FINAL FOUR? The guidelines for prophylactic antibiotic prescriptions..

1.Prosthetic Cardiac Valve 2. Previous history of infective endocarditis 3. Congentical Heart Disease (up to 6 mo post procedure) (with residual defects) 4. Cardiac Transplantation

14

Warning a ______ shunt which is a CHD is NOT THE SAME as a ArterioVenous Shunt for dialysis.

Cardiac Shunt (atrio-ventricular)

15

Bateremia occurs with in ______ of a dental procedure!

5 minutes

16

Bacteremia study: did prophylactic antibiotics help bacteremia?

Yes 56% bacteremia vs 79% bacteremia w/o...however by 20 min they are mostly gone and 0% gone with pre procedure drugs

17

Premedication with amoxicillin before EXT significantly ______ positive cultures at 1.5, 5 and 20 minutes

reduced!

18

After a big study: there should be a greater focus on avoidance of _______ in patients at risk for distant site infection in general and infective endocarditis in particular..

dental disease

19

Infection is _______ most common cause of prosthetic joint failure

second (obesity is #1)

20

Infection of a prosthetic joint can be from failure to give antimicrobial prophylaxis during ______.

the actual surgery (S. Aureus)

21

_______ is risk factor for hematogenous prosthetic joint infection....Especially with _______

Bacteremia....Staphylococcus aureus

22

______ are rarely implicated in bacteremia following dental procedures

Staph Aureus

23

_________ constitute most of facultative oral flora

Viridans-group Streptococci

24

Strep Virdans only account for ___% of all hematogenous prosthetic joint infections!

2%

25

After dental procedures, bacteria levels are at much _______ than that needed for hematogenous seeding on prostheses (from animal studies)

lower levels

26

Cumulative exposure to transient bacteremia through daily activities is ________ than following a single exposure during a dental procedure.

several times higher

27

Dental Procedures caused ____% of primary knee arthroplasties.... ___% of primary hip arthroplasties

0.2%....6%

28

The Mayo Clinic study: Neither ______ nor ______ dental procedures were associated with an increased risk of prosthetic knee or hip infection.

low-risk nor high-risk

29

BOOM: Good oral hygiene and prevention of dental disease may potentially decrease frequency of _______ from daily activities

bacteremia

30

Antibiotic premedication before dental treatment was not associated with _______.

Lower Risk

31

__________ were most commonly encountered organisms isolated from the infection sites

Stapholococci

32

In the Mayo Study 35 (_____%) of joint infection cases were associated with bacterial flora of potential oral or dental origin

13.5%

33

Bacterial species from dental procedures include WHAT 3 TYPES of bacteria??? = species not ordinarily associated with prosthetic hip or knee infections

viridans group streptococci, beta- hemolytic streptococci, and gram-positive anaerobes

34

When the ADA and AAOS came together they decided that Important to assess risk:
1. History of previous:
2. History of :
3. Existing :

joint infection/complications/post-surgical complications...joint replacement failure... pain or swelling around the implant or device

35

When the ADA and AAOS came together...stop prophy meds ___ years after a joint replacement surgery.

2 years

36

When the ADA and AAOS came together..._________ patients and ________ patients are two examples of when to prescribe.

immunocomp..malnourished

37

Orthopedic surgeons prefer _________ versus amoxicillin because they enter ________.

cephalosporins...synovial fluid

38

Dosing regiments are ______ as those found in the AHA guidelines.

the same

39

AAOS/ADA recommendations in 2012: The practitioner might ______ discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic implants undergoing dental procedures.
Strength of evidence: _______

consider

40

AAOS/ADA recommendations in 2012: The work group was ______ to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopedic implants undergoing dental procedures.
Strength of evidence: _______

unable...inconclusive

41

IAAOS/ADA recommendations in 2012: n the absence of reliable evidence linking poor oral health to prosthetic joint infection, it is the opinion of the work group that patients with prosthetic joint implants or other orthopedic implants maintain __________.
Strength of evidence: _______

appropriate oral hygiene..consensus

42

MOST RECENT ADA: When there is _______ certainty of no association = strength of recommendation is _______!!!

moderate....against! (not implementing intervention or discontinuing ineffective procedures)

43

KNOW THE RISK FACTORS! *Wound drainage or wound _______ after arthroplasty...*Postoperative _____...Prior operation/arthroplasty on index joint..._________!!!!!.....____________ (RA, steroids, immunosuppressants, diabetes mellitus, malignancy, CKD disease)

hematoma....UTI...Diabetes Mellitus!!!!!! Immunocompromised

44

No premed needed for ______ placed in coronary arteries

stents

45

pins, plates, screws?

no

46

breast*, dental or corneal implants?

no

47

penile implants?

maybe

48

hx of IV drug abuse if valve damage?

yes

49

coronary stents (never been a reported case of IE)?

no

50

acemakers, defibrillators?

no

51

arteriovenous shunts? tunneled catheter? peritoneal port?

yes

52

fistula access (dialysis)?

no

53

Picc line, Hickman catheter, Portacath, CSF shunts?

yes

54

History of taking Fen-Phen for weight loss?

yes

55

Decreased WBC from chemotherapy or
other immunosuppressive drug therapy?

yes

56

Organ transplant recipients?

yes