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pom- ie prophy Flashcards

1
Q

definition of ie

A

microbial infection of heart valves or endocardium

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2
Q

lesion of ie

A

vegetation on a heart valvue, or eslsewhere on endocardium

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3
Q

ie is higher among…?

A

ie drug users- usually leion on mitral but in drug users , tricuspid

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4
Q

2-6% risk for ie for pt with ?

A

hemodialysis

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5
Q

2-31% risk for pt with?

A

previous ie

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6
Q

amphotocerin b can cause

A

renal toxicity

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7
Q

renal toxicity can lead to

A

anemia

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8
Q

put pt on ? for fungal ie

A

amphotocerin b

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9
Q

if put pt on amphotocerin b for ie what might happen?

A

renal toxicity and anemia

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10
Q

ie is more common in men or women?

A

men

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11
Q

median age of onset of ie?

A

50

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12
Q

ie is more common in??

A

elderly- 25% cases

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13
Q

endocarditis etiology

A

bac infect damed endocardium or endothelial tissue located near high flow shunts between arterial/ venous channels

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14
Q

80% of ie cases caused by

A

staph

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15
Q

% caused by what is decreasing?

A

strep

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16
Q

what is a major risk of ie in hiv infected pt?

A

continued iv drug use

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17
Q

3 groups of ie lesions

A

cardiac, embolic, general

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18
Q

cardiac lesion describe

A

usually on valvue it self- mitral valve- but no longer required to prophy
can occur at contact area of jet flow, non bacterial thrombotic endocarditis (NBTE)

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19
Q

NBTE

A

nonbac thrombotic endocarditis

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20
Q

jet flow

A

area where blood keeps pulstaing and bringing bacteria back in

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21
Q

embolic lesion

A

vegetasions become friable and dtach

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22
Q

petichial hemorrhages on skin and mucous membranes in embolic lesions?

A

osler’s nodes, splinter hemorrhages

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23
Q

splinter hemmorage

A

look like got spliner onder fingernail

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24
Q

oslers nodes

A

on lower extremeity

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25
general lesion
enlarged spleen, club fingers, arthritis, systemic dz, organ failure, morbidity mortality is 10-80%
26
classic findings of ie? 4
fever, anemia, + blood cultures, heart murmur
27
diagnostic triad of ie?
fever, cardiac murmur, + blood cultures- not always present!
28
2 types of ie we need to know
sbe, abe
29
abe
acute bacterial endocarditis- usually by staph
30
clinical appearance of abe
``` dev over days or 1-2 week complications dev death in 6 wk w/o tx staph aureas preceded by suppurative infection NOT oral bc staph doesnt live in oral cavity ```
31
sbe clincial appearance
MORE IMPORTNAT TO DENTIST, MAY OCCUR AFTER ORAL PROCEDURE BC SCAUSE BY ALPHA HEMOLYTIC STREPH symptoms in 2 weeks progress over weeks to months
32
more immature neutraphils means
acute infection
33
lab findings in ie
cbc - elevated wbc, neutraphil esr- elevated in 90% c- reactive protein is positive serum ig is increased
34
s aureus causes
abe
35
s viridans causes
sbe
36
electrocardiogram
if infection goes into myocardium-disturbance of conduction
37
tte
test for diag of ie- transthoracic echocardiogram- put over sternum
38
tee
more accurate echocardiogram for diag ie- but more invasive (transesophogeal echocardiogram)
39
other imaging studies for ie
chest x ray, ct, mri, angiography
40
how to tx ie?
early, antibiotics via iv for awhile
41
tx of s viridans endo? (remember sbe)
penni G- 4 million units iv for 4 week
42
tx pcn resistant strep?
penni g IV and Gentimicin IV for 6 wk
43
s aureus endo- tx if infection doesnt involve prosthetic material and is methicillin susceptible
naficillin iv
44
s aureus assoc with prosthetic materials and methicillin susceptible
naficillin iv and gentamicin iv, 6 wk
45
methi resistant s aureus ie?
vancomycin iv + gentimicin iv + rifampin 300 mg po for 6 wk or longer
46
when to operate?
debride if fungus, valve replacement, , heart failure
47
aha designations made in 1997?
high, mod, neg | NEED TO PREMED MOD AND HIGH
48
who to premed? 4 categories
prosthetic cardiac valve or prosthetic material used for cardiac valve repair, previous infective endocarditis, congentital heard disease, cardiac transplantation recipients who develop cardiac valvulopathy
49
which types of CHD do we premed?
unrepaired cyanoic CHD (pallitave shunts and conduits), completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention during the first six months after the procedure, and repaired chd with residual defects at the site or adj to site of prosthetic pattch or prosthetic deice
50
cyanotic congenital heart dz- cyanosis?
results from mixing of unoxygenated blood in the systemic circ caued by intracardiac shunting of blood from rigt to left side of heart
51
is prophy rec for cabg or coronary artery stent?
NO
52
bleeding during dental work can result in
transient bacteremia
53
when else can transient bacteremia occur?
brushing, flossing
54
how likely for TB to occur during perio, ext?
perio-88, ext- 85
55
do dental procedure cause ie?
it's not really that likely- 3-20% likely
56
how effective is prophy?
49-91%
57
what are we prophying against in dental prophy
alpha hemo strep
58
what do we use to prophy?
amox
59
is prophy helpful?
- sometimes, but condition would occur 47 times in 10 million if not prophy- v small, but v bad dz so worth it? but no prophy leads to 5 cases ie and no death, prophy leads to 2 cases of death, 175 allergy
60
why do we prophy?
CYA
61
what procedure should you prophy for?
if you're gonna manip the gum, prophy
62
what are we giving
amox 2 g 1 hour before procedure
63
children prophy? what do we give?
50 mg 1 hour before
64
what if allergic to amox?
clinda 600mg for adult, 20 mg/kg for kid or cephalexin 2 g adult, 50 m/kg kid or azithromycin or clarithromycin 500mg adult, 15 mg/kg kid
65
what if allergic to penni or ampi and can't take oral?
cefazolin or ceftraxone , 1 gm IM or IV adult, 50 mg/kg IM or IV for kid OR clinda 600 mg IM or IV , kid- 20 mg/kg IM < IV
66
if pt bleeds during procedure and you didnt have them prophy?
do prophy within 2 hrs
67
if pt is taking oral penni already, what should you do?
give clinda
68
what else can we do to dec chance of bacteremia?
chlorohexidine, OH, peiro maint, max dental tx at each appt
69
how long should you wait between prophy visits?
10 day
70
how long before appt to prophy-?
30-60 min
71
1st of 3 new prosthetic prophy recs?
you can maybe discontinue prophy prostethic pt, just be mindful and involve pt in decisin (silly)
72
2nd of 3 recs for prosthetic prophy
chlorohexidine rinse, inconclusive, use your judgement
73
3rd of 3 recs for prosthetic prophy
about oral hygiene- what is appropriate is different for everyone- you decide

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