Oral Surgery Rotation Flashcards
What patients, in general, are recommended for antibiotic prophylaxis for prevention of bacterial endocarditis?
Patients with highest risk of adverse outcomes resulting from infective endocarditis
What are 7 dental procedures requiring antibiotic prophylaxis for bacterial endocarditis?
- Extraction
- Routine cleaning
- Scaling and root planning
- Periapical root canal treatment
- Fitting ortho bands
- Placing subgingival medications
- Biopsy
If local anesthesia is going to be injected through non-infected tissue, is antibiotic prophylaxis required?
No
If ortho band placement requires antibiotic prophylaxis does the placement of ortho brackets require antibiotic prophylaxis?
No
Does patient require antibiotic prophylaxis for normal shedding of deciduous teeth?
NO
Does a patient require antibiotic prophylaxis if they have trauma to the lips or oral mucosa?
No
What are 5 general cardiac conditions associated with High Risk of Infective Endocarditis, i.e. requiring antibiotic prophylaxis?
- Prosthetic cardiac valve
- Prosthetic material used for cardiac-valve repair
- Previous history of Infective endocarditis
- Congenital heart disease
- Cardiac transplant recipient who develop valvulopathy
What are the 2 indications for still prescribing antibiotic prophylaxis when the Congenital Heart Disease is repaired?
- Completely repaired CHD with prosthetic material or device during first six months after procedure
- Repaired CHD with residual defects at site or adjacent to site of prosthetic patch or prosthetic device
Can a person have a congenital heart condition that does not require antibiotic prophylaxis?
Yes, it seems if it is a non-cyanotic CHD (e.g. ventricular septal defect, atrial septal defect) or hypertropic cardiomyopathy, they no longer require antibiotic coverage
If a patient has a joint replacement, do they require antibiotic prophylaxis for dental procedures where there will be significant bleeding (EXT, routine cleaning, SRP, periapical RCT, fitting ortho bands, placing Subgingival meds, biopsy)?
Yes
What is the most common (artificial) joint infection?
Staph
Of the antibiotics we prescribe, which 2 cover a staph infection?
- Cephalexin
2. Augmentin (Cluvanic acid in the augmentin is what kills the Staph)
Of Augmentin and Cephalexin, which does Dr. Smagalski prescribe for antibiotic coverage for joint replacement patient?
Cephalexin
How would you write a prescription for pre-op Cephalexin for a joint replacement patient?
Cephalexin (500mg/tab) Disp: 4 (Four)
Sig: Four tabs orally two hours prior to treatment
What is the adult dosage for Cephalexin?
2 g
Is Amoxicillin indicated for antibiotic coverage in joint replacement?
No. Amoxicillin alone does not cover staph infections
Why would another antibiotic be prescribed for antibiotic prophylaxis of a joint replacement patient if the patient is allergic (anaphylaxis, angioedema, urticaria[hives]) to Penicillin?
Because cephalexin (a cephalosporin) is not to be used in the those pts as 5% are cross-allergic to both
What is the alternative antibiotic prophylaxis for joint replacement patient who is allergic to Penicillins?
Clindamycin
When is Clindamycin also indicated dentally?
Infection is anaerobic, e.g. suspect deep space infection
How would you write a prescription for pre-op Clindamycin for a joint replacement patient?
Clindamycin (300mg/tab)
Disp: 2 (two)
Sig: Two tabs orally one hour prior to treatment
What is the adult dose for Clindamycin?
600 mg
What is the drug of Choice for Oral Prophylaxis?
Amoxicillin
What is the format for writing a prescription?
Line 1: Drug Name (Dose/form)
Line 2: Disp: total number or volume (written out) to get person to their max dose/24 hr period for as long as you want them to take it
Line 3: Sig: # of med to take, route of admin, freq, special instruction
Does a prescription for an antibiotic require a DEA number?
No, only controlled substance prescriptions require a DEA number
What is the basic antibiotic for oral aerobic infections?
Pen VK
When deciding how many to “Disp” on the
prescription, what must you figure?
Length of course (e.g. 7 days)
Max dose/24 hrs
Mg of drug/tab
e.g. Pen VK for 7 days Max dose/ 24 hrs =2g = 2000mg Mg of drug/tab=500mg/tab Max dose/mg drug per tab = 2000mg/500mg = 4 x day 4 x 7 = 28 tabs disp
Are antibiotics indicated for pain?
No
When is antibiotic coverage indicated (list we made during lecture)?
Signs of sinus communication after EXT
Signs of infection
Immunocompromised pt (HIV, long term steroid user [RA, SLE, severe asthmatic], transplant recipient0
Systemic signs of infection (fever)
Impaired healing (diabetes)
Extensive surgery (e.g. 5 EXTs in one appt)
Location of infection (e.g. canine space)
Laying a flap(e.g. older denture patient)
Is age ever an indication for prescribing an antibiotic?
No, but it is a consideration
If have a maxillary tooth EXT and desire antibiotic cover, choose which and why: Pen VK or Amoxicillin?
Amoxicillin. Broader spectrum than Pen VK and will kill sinus infection (e.g. H. influenza)
If pt is allergic to Penicillin will they be allergic to Amoxicillin?
Yes, they both have a beta lactam ring
Which antibiotic kills the same thing as Amoxicillin (aerobes + sinus infection) as well as targeting Staph infections?
Cephalexin
What are 2 examples of Cephalexin indications?
- Joint replacement pre-dental treatment prophylaxis
2. Pt with busted teeth and skin scrapes from bike wreck
If patient has a true allergy to Penicillin/Amoxicillin (anaphylaxis, angioedema, urticaria), should they be prescribed Cephalexin?
No. Could be cross-allergic
Clindamycin covers what bacteria?
Both aerobes and anaerobes
What infections would indicate Clindamycin?
- Deep space infection
2. Long standing dental infection (note anaerobes will have fetid odor)
What is the major side effect of Clindamycin?
Pseudomembranous colitis from C. Diff
What should be our instructions if patient calls complaining of diarrhea and nausea after taking Clindamycin for a while?
Stop taking the Clindamycin, refer pt to PCP or Oral Surgeon
What is the only way to i.d. a C. diff infection?
Stool culture
What will the PCP or Oral Surgeon use to treat the C.diff pseudomembranous colitis caused by the Clindamycin?
Metranidazole/Flagill
What is a side effect of Metranidazole/Flagill used to treat the C. diff pseudomembranous colitis caused by Clindamycin?
Trembling in extremities
What is the Disp for Clindamycin to solely reduce cost?
150 mg/tab vs 300 mg/tab. Disp 42 of the 150mg/tab Sig: Two tabs orally three times a day
What is Augmentin?
Amoxicillin + 125 mg Cluvanic Acid
If augmentin at a low dose is not helping the patient, should you instruct the patient to just double up on the current prescription or should a new prescription be written for a higher dose of the amoxicillin in the Augmentin?
Write a new script for a higher dose. Doubling current prescription could overdose pt on the Cluvanic acid
When prescribing pain meds, what is the dosage and number of tabs dispensed dependent on?
Individual patient pain control requirement
What NSAID is preferred over Acetaminophen?
Ibuprofen (400 mg every 4-6 hrs as needed for pain)
For pain control prescription, what special instructions should be included on the Sig line?
“as needed for pain” or “prn pain”
Tylenol #1,#2,#3,#4 all have how much Acetaminophen and how much codeine?
All have 300 mg Acetaminophen Each number doubles the Codeine starting at 7.5mg Tylenol #1 = 7.5 mg Codeine Tylenol #2 = 15 mg Codeine Tylenol #3 = 30mg Codeine Tylenol #4 = 60mg Codeine
What is a side effect of Tylenol #3?
Vomiting (1 in 3)
Is there an allergic risk with Tylenol #3?
Yes, due to sulfite preservative. Do not prescribe if Sulfa drug allergy
What patients are Tylenol contraindicated in (list we made in lecture)?
Alcoholics
Any liver issues (e.g. Hepatitis)
If taking other acetaminophen drugs
Allergic to acetaminophen
What patients are Aspirin contraindicated in?
- Kids
- Bleeding problems (Hemophilia, thrombocytopenia)
- Pt on anticoagulants (Coumadin/Warfarin, Heparin, Prodoxil, Plavix)
- Pt already on aspirin
- Von Willibrand’s Disease
- Asthmatic (will trigger bronchiospasm)
- Aspirin allergy
- Pregnant
- Liver problems
- Crohn’s disease
Is Tyl #3 safe in pregnancy?
Yes
Should you ever write for Tyl #4?
No
Lortab and Vicodin have what narcotic paired with Tylenol?
Hydrocodone
What is the preferred amount of acetaminophen in Lortab and Vicodin?
325 mg acetaminophen
What is the normal hyrdrocodone/acetaminophen dosage for Lortab?
7.5mg/325 mg
Percocet is what narcotic paired with acetaminophen?
Oxycodone
What is a medication to counter nausea?
Zofran
How would you write a prescription for Zofran?
Zofran (8mg/tab)
Disp: 6(six)
Sig: One tab orally every 6 hrs as needed for nausea
If pt is hypoglycemic and dehydrated days after an EXT and unable to take the antibiotic, what should be the protocol for treatment?
Take Zofran, keep down for 20 min, give sugar(e.g. juice [ no diet]) keep hydrating, get foods in (eggs, mac and cheese), then advil to aide pain control, call in hydrocodone 5 mg(lortab 5mg/325mg)
What is the maximum/desired max daily dose Acetaminophen?
3200mg, desire to keep below 3g/ day
All prescriptions on the page are assumed for what weight adult?
150 lb adult
Drug, dosage, and quantity should be adjusted for each patient based on what?
Weight
Age
Procedure
Which antibiotic and which pain med are safe in pregnancy?
Antibiotic: Penicillin
Pain medication: Tylenol #3
When working on a diabetic, would you prefer them to be hyperglycemic or hypoglycemic?
A little hyperglycemic so they have a glucose reserve for stress
If you extract a maxillary posterior tooth, what antibiotic would be good to prescribe and why?
Amoxicillin, good at killing things like H influenza which may be in sinus
Which antibiotic would be good for a salivary gland infection (but should not be prescribed by a dentist as it would be outside of his or her scope of practice)?
Cephalexin
Which antibiotic kills anaerobes?
Clindamycin
Which antibiotic is good for deep space infections?
Clindamycin
What amount of clavulanic acid is in each tab of augmentin?
125 mg
What does clavulanic acid do?
Kills staph
Which drug may have adverse affects on the kidneys?
Ibuprofen
Ibuprofen tablets should not have more than what amount in them?
No more than 400mg (so 600mg and 900mg are not allowed).
People under what age should not use Zofran?
12 years old
Generally speaking, how many tablets of each pain killer should be prescribed?
20 (at least for our purposes on this test)
How would you write a prescription for percocet?
Oxycodone-APAP (5mg/325mg)
Disp: 20 (Twenty)
Sig: One tab orally every 4-6 hours as needed for pain
How would you write a prescription for Lortab?
Hydrocodone-APAP (5mg/325mg)
Disp: 20 (Twenty)
Sig: One tab orally every 4-6 hours as needed for pain
How would you write a prescription for Tylenol #3?
Tylenol #3, which is about 300mg Tylenol and 30mg codeine
Disp: 20 (Twenty)
Sig: One tab orally every 4-6 hours as needed for pain
How would you write a prescription for Ibuprofen?
Ibuprofen (200mg)
Disp: 20 (Twenty)
Sig: One tab orally every 4-6 hours as needed for pain
How would you write a prescription for augmentin?
Augmentin (500mg tab)
Disp: 21 (twenty-one)
Sig: One tab orally 3 times a day
How would you write a prescription for Clindamycin?
Clindamycin (300mg tab) or (150mg 42 count, two at a time three times a day)
Disp: 21 (twenty-one)
Sig: One tab orally three times a day
How would you write a prescription for cephalexin?
Cephalexin (500mg/tab)
Disp: 28 (Twenty-eight)
Sig: One orally 4 times per day
How would you write a prescription for amoxicillin?
Amoxicillin (500mg/tab)
Disp: 21 (Twenty-one)
Sig: One orally three times per day
