Exam 3 - antibiotic premed Flashcards
What 4 groups of people are MOST at risk for infective endocarditis?
- Replacement prosthetic cardiac valve
- Previous history of infective endocarditis
- Cardiac transplantation patients who develop cardiac valvulopathy
- Congenital heart disease CHD
4 types of CHD
- Unrepaired cyanotic CHD
- Transposition of great arteries TGA
- Completely repaired CHD within in first 6 months of procedure
- Repaired CHD with residual defects
Even with corrective surgery, previous TGA patients may develop what 6 things?
- leaky heart valves
- coronary artery problems
- arrhythmias
- decline in function of the heart muscle or heart valves
- heart failures
- damage to lungs & difficulty breathing
What are 7 indicators in patients with prosthetic devices that would require antibiotic premed prior to dental treatment?
- Immunocompromised/suppressed
- Previous prosthetic joint infections
- Malnourishment
- Hemophilia
- HIV infection
- Type 1 diabetes
- Malignancy
What 3 indicators for possible prosthetic joint infection puts patients most at risk:
- _____ of previous joint infection / _________
- History of joint replacement _______
- Existing _____ or ____ around the implant device
History Complications Failure Pain Swelling
7 Risk factors for developing prosthetic joint infection caused by microorganisms found in the mouth.
- Prior joint surgery
- Failure to give antimicrobial prophylaxis during surgery
- Immunosuppression
- Perioperative wound complications
- High ASA score
- Prolonged operative time
- History of prosthetic joint infection
_______ is a risk factor for hematogenous prosthetic joint infection.
Bacteremia
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
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
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
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
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
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
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
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
