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Pharmacology > Exam 3: PreMedication > Flashcards

Exam 3: PreMedication Flashcards

1
Q

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

A

2 gm….1 hour

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2
Q

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

A

2 gm IM or IV….30 min

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3
Q

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

A

600 mg…1 hour

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4
Q

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

A

2 gm…1 hour

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5
Q

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

A

500mg…1 hour

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6
Q

Clindamycin ___ mg IV within ___ min before procedure.

A

600 mg… 30 min

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7
Q

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

A

1 gm…30 min

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8
Q

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

A

1 gm…30 min

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9
Q

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

A

scientific evidence

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10
Q

Antibiotic Prophylaxis for patients at risk for

_______ endocarditis when undergoing invasive dental procedures

A

INFECTIVE

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11
Q

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

A

prosthetic valves and previous history of endocarditis

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12
Q

________ from periodontal pathogens initiate the clotting

cascade…*why IE is also treated with ________

A

Endotoxins….anticoagulants

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13
Q

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

A

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

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14
Q

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

A

Cardiac Shunt (atrio-ventricular)

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15
Q

Bateremia occurs with in ______ of a dental procedure!

A

5 minutes

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16
Q

Bacteremia study: did prophylactic antibiotics help bacteremia?

A

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

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17
Q

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

A

reduced!

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18
Q

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..

A

dental disease

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19
Q

Infection is _______ most common cause of prosthetic joint failure

A

second (obesity is #1)

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20
Q

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

A

the actual surgery (S. Aureus)

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21
Q

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

A

Bacteremia….Staphylococcus aureus

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22
Q

______ are rarely implicated in bacteremia following dental procedures

A

Staph Aureus

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23
Q

_________ constitute most of facultative oral flora

A

Viridans-group Streptococci

24
Q

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

A

2%

25
Q

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

A

lower levels

26
Q

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

A

several times higher

27
Q

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

A

0.2%….6%

28
Q

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

A

low-risk nor high-risk

29
Q

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

A

bacteremia

30
Q

Antibiotic premedication before dental treatment was not associated with _______.

A

Lower Risk

31
Q

__________ were most commonly encountered organisms isolated from the infection sites

A

Stapholococci

32
Q

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

A

13.5%

33
Q

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

A

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

34
Q

When the ADA and AAOS came together they decided that Important to assess risk:

  1. History of previous:
  2. History of :
  3. Existing :
A

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

35
Q

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

A

2 years

36
Q

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

A

immunocomp..malnourished

37
Q

Orthopedic surgeons prefer _________ versus amoxicillin because they enter ________.

A

cephalosporins…synovial fluid

38
Q

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

A

the same

39
Q

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: _______

A

consider

40
Q

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: _______

A

unable…inconclusive

41
Q

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: _______

A

appropriate oral hygiene..consensus

42
Q

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

A

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

43
Q

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)

A

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

44
Q

No premed needed for ______ placed in coronary arteries

A

stents

45
Q

pins, plates, screws?

A

no

46
Q

breast*, dental or corneal implants?

A

no

47
Q

penile implants?

A

maybe

48
Q

hx of IV drug abuse if valve damage?

A

yes

49
Q

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

A

no

50
Q

acemakers, defibrillators?

A

no

51
Q

arteriovenous shunts? tunneled catheter? peritoneal port?

A

yes

52
Q

fistula access (dialysis)?

A

no

53
Q

Picc line, Hickman catheter, Portacath, CSF shunts?

A

yes

54
Q

History of taking Fen-Phen for weight loss?

A

yes

55
Q

Decreased WBC from chemotherapy or

other immunosuppressive drug therapy?

A

yes

56
Q

Organ transplant recipients?

A

yes

Pharmacology (23 decks)

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