Exam 3: PreMedication

Question 1

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

Answer 1

2 gm….1 hour

Question 2

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

Answer 2

2 gm IM or IV….30 min

Question 3

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

Answer 3

600 mg…1 hour

Question 4

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

Answer 4

2 gm…1 hour

Question 5

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

Answer 5

500mg…1 hour

Question 6

Clindamycin ___ mg IV within ___ min before procedure.

Answer 6

600 mg… 30 min

Question 7

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

Answer 7

1 gm…30 min

Question 8

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

Answer 8

1 gm…30 min

Question 9

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

Answer 9

scientific evidence

Question 10

Antibiotic Prophylaxis for patients at risk for

_______ endocarditis when undergoing invasive dental procedures

Answer 10

INFECTIVE

Question 11

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

Answer 11

prosthetic valves and previous history of endocarditis

Question 12

________ from periodontal pathogens initiate the clotting

cascade…*why IE is also treated with ________

Answer 12

Endotoxins….anticoagulants

Question 13

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

Answer 13

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

Question 14

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

Answer 14

Cardiac Shunt (atrio-ventricular)

Question 15

Bateremia occurs with in ______ of a dental procedure!

Answer 15

5 minutes

Question 16

Bacteremia study: did prophylactic antibiotics help bacteremia?

Answer 16

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

Question 17

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

Answer 17

reduced!

Question 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..

Answer 18

dental disease

Question 19

Infection is _______ most common cause of prosthetic joint failure

Answer 19

second (obesity is #1)

Question 20

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

Answer 20

the actual surgery (S. Aureus)

Question 21

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

Answer 21

Bacteremia….Staphylococcus aureus

Question 22

______ are rarely implicated in bacteremia following dental procedures

Answer 22

Staph Aureus

Question 23

_________ constitute most of facultative oral flora

Answer 23

Viridans-group Streptococci

Question 24

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

Answer 24

2%

Question 25

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

Answer 25

lower levels

Question 26

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

Answer 26

several times higher

Question 27

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

Answer 27

0.2%....6%

Question 28

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

Answer 28

low-risk nor high-risk

Question 29

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

Answer 29

bacteremia

Question 30

Antibiotic premedication before dental treatment was not associated with _______.

Answer 30

Lower Risk

Question 31

__________ were most commonly encountered organisms isolated from the infection sites

Answer 31

Stapholococci

Question 32

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

Answer 32

13.5%

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

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

Answer 35

2 years

Question 36

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

Answer 36

immunocomp..malnourished

Question 37

Orthopedic surgeons prefer _________ versus amoxicillin because they enter ________.

Answer 37

cephalosporins...synovial fluid

Question 38

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

Answer 38

the same

Question 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: _______

Answer 39

consider

Question 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: _______

Answer 40

unable...inconclusive

Question 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: _______

Answer 41

appropriate oral hygiene..consensus

Question 42

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

Answer 42

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

Question 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)

Answer 43

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

Question 44

No premed needed for ______ placed in coronary arteries

Answer 44

stents

Question 45

pins, plates, screws?

Answer 45

no

Question 46

breast*, dental or corneal implants?

Answer 46

no

Question 47

penile implants?

Answer 47

maybe

Question 48

hx of IV drug abuse if valve damage?

Answer 48

yes

Question 49

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

Answer 49

no

Question 50

acemakers, defibrillators?

Answer 50

no

Question 51

arteriovenous shunts? tunneled catheter? peritoneal port?

Answer 51

yes

Question 52

fistula access (dialysis)?

Answer 52

no

Question 53

Picc line, Hickman catheter, Portacath, CSF shunts?

Answer 53

yes

Question 54

History of taking Fen-Phen for weight loss?

Answer 54

yes

Question 55

Decreased WBC from chemotherapy or | other immunosuppressive drug therapy?

Answer 55

yes

Question 56

Organ transplant recipients?

Answer 56

yes