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Flashcards in Pharmacology 3 Deck (68):
1

The premise of antibiotics prior to a dental procedure is to prevent what 2 things?

Infective endocarditis

Prosthetic joint infections

2

T/F
There is NO scientific evidence that supports antibiotic prophylaxis defends against IE (infective endocarditis) and Prosthetic Joint Infections.

True

3

The introduction of bacteria in the bloodstream is called?

Bacteremia

4

T/F
Bacteremia is linked to IE (infective endocarditis) and PJI (prosthetic joint infections).

False

5

What are the 2 pathogen species responsible for IE and PJI?

viridans Streptococci

Staph aureus

6

There is a _____ fold increase in pts with prosthetic valves and previous history of Endocarditis for IE.

400

7

T/F
Rheumatic valvular disease, cyanotic congenital heart disease, and degenerative valve lesions are also at risk for Infective Endocarditis

True

8

What are the 4 conditions that require prosthetic antibiotics in a dental setting?

Prosthetic cardiac valve

Previous history of Infective Endocarditis

Congenital heart disease

Cardiac Transplantation

9

How long after a Congenital Heart Defect is repaired must prosthetic antibiotics be administered?

First 6 months

10

Congenital heart disease will be given if there is _____ cyanotic CHD, including _____ shunts and conduits.

Unrepaired

Palliative

*means vessels swapped, defective valves, vessels

11

T/F
Severe cases of Great Artery transposition can be fatal, and are associated with many conditions later in life, including leaky heart valves, arrhythmias, declining function, etc.

True

12

T/F
Blue babies (transposition of great arteries) require lifelong follow-ups with a cardiologist

True

13

The AHA recommends that any repaired CHD with _________ at the site / adjacent to the site should be given prosthetic antibiotics

Residual Defects

14

Cardiac transplantation may develop cardiac ________, which is why antibiotic prophylaxis is recommended.

vavulopathy

15

T/F
A Cardiac shunt (congenital) is the same as an Arteriovenous Shunt

False

*bypass with tubing, limited life-span

16

T/F
Within the 1st 5 minutes of a dental procedure, you get bacteremia

True

*79% placebo
*56% amoxicillin
*28% toothbrushing

17

Bacteremia after dental procedures is usually less than 20 minutes, what % of the extraction/placebo group had an IE related species after 60 minutes?

% toothbrushing group?

% extraction/amoxicillin?

5%

2%

0%

18

Viridans strept were found in ____% in brushing group

____% extraction/amoxicillin

____% extraction/placebo

48%

49%

70%

19

T/F
Amoxicillin significantly reduces viridans Strept.

True

20

Why is antibiotic prophylaxis so contentious with joint replacements?

Infection 2nd common cause failure

*aseptic loosening primary

21

T/F
Prior joint surgery, failure antimicrobial prophylaxis during surgery, immunosuppression, history, high ASA score are factors with higher risk of Prosthetic Joint Infection

True

22

________ is a risk factor for hematogenous prosthetic joint infection, especially with _________ (bacteria).

Bacteremia

Staph aureus

23

T/F
Chewing causes transient bacteremia in 40% of episodes

True

24

____ are rarely implicated in bacteremia

_____-group Streptococci constitute most facultative oral flora and are the ________ cause of transient bacteremia.

Staph

Viridans

Most common

25

Viridans Streptococci acount for ____% of all hematogenous prosthetic joint infections.

2%

26

Prolonged, high-grade bacteremia is associated with PJI, and after dental procedures bacteria are at _____ levels needed to seed prosthesis (animal studies)

much lower levels

(basically, dental procedures couldn't cause)

27

The cumulative exposure to transient bacteria due to chewing, brushing, etc, is Higher/Lower than following single exposure during dental procedure.

Several times Higher

28

T/F
According to 1 study, PJI from a dental source occured after 0.2% knees and 6% hip replacements

True

*other studies counter claim

29

T/F
According to Mayo study, neither low-risk nor high-risk dental procedures were associated with an increased risk of prosthetic knee or hip infection

T/F
Antibiotic premedication was not associated with lower risk.

True

True

30

According to the Mayo study, what may decrease bacteremia from daily activities?

Good oral hygiene

31

Cultures from infected joints are most often ______, according to Mayo study

What species are associated with dental procedures?

Staph

viridans Strept, beta hemolytic strept, G+ anaerobes

32

The 2003 study recommended prophylaxis for 2 years, and asked to consider premed all the time in immunocompromised pts and pts with previous prosthetic joint infections, malnourishment, hemophilia, HIV, Type I diabetes, and malignancy.

True

33

Why do orthopedic surgeons prefer cephalosporins to amoxicillin?

Cephalosporins enter synovial fluid

*Amoxicillin still ok though

34

High risk and low risk dental procedures _____ factors for joint infections for at-risk subgroups

Not Risk

35

Bottom line: in 3 of 4 case studies no association was demonstrated between dental procedures and PJI, therefore...

No need to treat prophylactically

*moderate certainty of no association

36

Antibiotic Stewardship (overprescribing) is a major factor in NOT prophylactically prescribing.

True

37

Postoperative UTI and Wound drainage/hematoma after arthroplasty (and a host of other conditions) ARE risk factors for PJI independent of Dental Procedures

True

38

T/F
In general, pts with prosthetic joint implants are NOT recommended to have prophylactic antibiotics

True

39

What are 2 other conditions that may require prophylactic antibiotics?

Penile implants

hx drug abuse and valve damage

40

Is there premed recommended for stents?

No

41

What 3 methods of dialysis would require premed?

What 1 method doesn't?

A/V shunts, tunneled catheter, periotoneal port

fistula access

42

T/F
Picc line, Hickman catheter, Portacath, and CSF shunts don't require premed

False

43

What are 4 conditions that don't have premed guidelines?

Fen-Phen hx

Decreased WBC from chemo/immunosuppressive therapy

Organ Transplant

IV drub abus hx

44

Prophylaxis is indicated when _____ is likely.

Bleeding

45

If there is ______ bleeding, antibiotics are given immediately.

Unanticipated

46

If a sequence of procedures is needed, a ________ day interval is recommended to minimize resistance.

9-14

47

Premed is recommended in which dental procedures?

All involving manipulation of gingival tissue, perforation, or periapical region of teeth.

48

T/F
Acute infections at distant sites (like oral cavity) increase risk of infection in PJI.

True

*includes perio infection

49

How do most devices cause infection?

Contamination time of insertion

50

T/F
If no complications after 2 years, premed is not indicated

True

*as well as pins, plates, screws, breast, dental, and corneal implants

51

T/F
Complications following initial placement, recurrent pain, and history of previous joint replacement failures put one at high risk for joint infections.

True

52

2014 task force High Risk pts identified with Prior Operation on Joint, Diabetes, Immunocompromised, and what 2 other major factors?

Wound draingage/hematoma after arthroplasy/or post op infection

Post-op UTI

53

If not allergic to Penicillin, what is the premed regimen for pts with prosthetic implants?

(3 possibles)

Cephalexin (Keflex) 2 gm orally 1 hr prior

Cephradine (Velosef)

Amoxicillin (Amoxis, Trimox)

54

If not allergic to Penicillin, but unable to take oral meds, what is the premed regimen for pts with prosthetic implants?

(2 possibles)

Cefazolin (Ancef) 1 gm IM or IV 1 hr prior

Ampicillin 2 gm IM or IV 1 hr prior

55

If allergic to Penicillin, what is the premed regimen for pts with prosthetic implants?

Clindamycin (Cleosin) 600 mg oral 1 hr prior

56

If allergic to Penicillin and unable to take oral meds, what is the premed regimen for pts with prosthetic implants?

Clindamycin (Cleosin) 600 mg IV 1 hr prior

57

What is standard general prophylaxis for Adults?

Children?

Amoxicillin

Adults: 2 gm oral 1 hr prior

Children: 50 mg/kg oral 1 hr prior

58

What is standard general prophylaxis for Adults/children if unable to take oral meds?

Ampicillin

Adults: 2 gm IM or IV 30 min prior

Children: 50 mg/kg IM or IV within 30 min

59

If allergic to Penicillin, what are 4 options for general prophylaxis?

Clindamycin (Cleocin) A: 600mg 1hr prior C: 20 mg/kg 1 hr prior

Cephalexin (Keflex) A: 2 gm oral 1 hr prior C: 50 mg/kg 1 hr prior

Azithromycin (Zithromax) A: 500 mg oral 1 hr prior C: 15 mg/kg oral 1 hr prior

Clarithromycin (Biaxin) (same as azithromycin)

60

Pediatric dose =

(weight of child/150) x adult dose

61

If allergy to Penicillin is mild or in the distant past, what should replace?

If allergy was full blown Type 1 hypersensitivity?

Cephalosporin (6-8% chance allergic)

Clindamycin (azithromycin/clarithromycin secondarily)

*20% chance cephalosporin allergy w/ type 1

62

If already taking tetracycline, what would be a good premed?

Macrolides: azithromycin and clarithromycin

*must be static

***wouldn't use clindamycin b/c premed dose cidal

63

T/F
If pt already on an antibiotic, a premed should come from a different class.

True

64

If allergic to Penicillin and unable to take oral meds, name 3 options for General Prophylaxis:

clindamycin: A: 600 mg IV w/in 30 min C: 20 mg/kg IV w/in 30 min

cefazolin (Ancef/Kefzol/Zolicef) A: 1 gm IM/IV w/in 30 min C: 50 mg/kn IM/IV w/in 30 min

ceftriaxone (Rocephin) A: 1 gm IM/IV w/in 30 min C: 50 mg/kg IM/IV w/in 30 min

65

Premed regimen for pts with Total Joint Replacement if not allergic to Penicilin:

Cephalexin (Keflex) or Cephradine (Velosef)

2 gm orally 1 hr prior

(Amoxicillin, general, is acceptable)

66

Premed regimen for pts with Total Joint Replacement if not allergic to penicillin but unable to take oral meds:

Cefazolin (Ancef) 1 gm IM/IV 1 hr prior

(Ampicillin 2 gm IM/IV 1 hr prior acceptable) `

67

Premed regimen for pts with Total Joint Replacement if allergic to penicillin

Clindamycin (Cleosin) 600 mg oral 1 hr prior

68

Premed regimen for pts with Total Joint Replacement if allergic to penicillin and unable to take oral meds:

Clindamycin (Cleosin) 600 mg IV 1 hr prior

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