Management of SHCN Flashcards
When would you need ABX prophylaxis?
- cardiac conditions
- immunocompromised conditions
- some shunts
which cardiac conditions require SBE prophylaxis?
- prosthetic cardiac valve
- previous IE
- unrepaired cyanotic CHD
- repaired cyanotic CHD w/i 6mos
- repaired cyanotic CHD with residual defects
- cardiac transplant with valvulopathy
which immunocompromised conditions require ABX prophylaxis?
- uncontrolled DM
- hemodialysis
- Sickle Cell Anemia
- chronic high steroid usage
- HIV, neutropenia, severe combined immunodeficiency syndrome, chemotherapy, HPSCT (hematopoietic stem cell transplant), solid organ transplant
- hx of H&N radiotherapy
- autoimmune dz such as SLE, juvenile arthritis
- asplenism or post splenectomy
- bisphosphonate therapy
which shunts require ABX prophylaxis?
VA,VV,VC shunts require it. VP shunts do not.
VA-ventriculoatrial
VV-ventriculovenus
VC-ventriculocardiac
VP-ventriculoperitoneal
do pts with prosthetic joints require ABX prophylaxis?
no because there is evidence that the ABX provided before oral care did not prevent prosthetic joint implant infection and therefore we only increase the potential risks of anaphylaxis, ABX resistance, and opportunistic infections such as Clostridium difficile.
what are some oral and associated systemic complications of immunosuppresive therapy?
pain, mucositis, ulcers, bleeding, taste dysfunction, secondary infections (candidiasis, HSV), caries, salivary gland dysfunction, neurotoxicity, mucosal fibrosis, gingival hypertrophy;
post-radiation osteonecrosis, BRONJ, soft tissue necrosis, TMD, CF and dental developmental anomalies, GVHD
What does cGVHD most commonly affect?
skin, liver, mouth, eyes
What does oral cGVHD most commonly affect?
mouth pain, sensitivity for food, xerostomia due to effects on salivary glands
What is palifermin and what is it used for?
Palifermin is a keratinocyte growth factor-1 that is used for the prevention and treatment of oral mucositis. It is recommended for mucositis prophylaxis for patients undergoing conditioning with hig-dose chemotherapy and total body irradiation followed by HCT.
It works by stimulating epithelial cell reproduction, growth, and development so that mucosal cells damaged by chemotherapy and radiation are replaced quickly, accelerating the healing process.
It’s also produced from E. coli to stimulate growth of new oral/gastro epi cell.
T or F. Chlorhexidine is not recommended for preventing oral mucositis in patients undergoing radiotherapy.
True.
It is because most studies have not demonstrated a prophylactic impact or a reduction in the severity of mucositis, although reduced colonization of candida species has been shown.
T or F. The signs of inflammation and infection may be greatly diminished during neutropenic periods.
True.
Can you give prophylactic nystatin for prevention and/or treatment of fungal infection?
No. It is not effective for the prevention and/or treatment of fungal infections.
(guidelines pg 426)
Why does oral bleeding occur in immunosuppressive therapy?
Due to:
- thrombocytopenia
- disturbance of coagulation factors
- damaged vascular integrity
How do you control bleeding in immunosupressive pts?
Local measures such as pressure packs, antifibrinolytic rinses, or topical agnes, gelatin sponges.
Systemic measures such as platelet transfusions and/or aminocaproic acid.
What type of chemotherapeutic agents can cause deep, constant pain?
Pts who use plant alkaloid chemo agents (ex. vincristine vinblastine) may present as deep, constant pain (affecting the mandibular molars with greater frequency). in the absence of odontogenic pathology.
The pain is transients and generally shortly after dose reduction and/or cessation of chemotherapy.
