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xD3 Oral Surgery Rotation > Oral Surgery Rotation > Flashcards

Oral Surgery Rotation Flashcards

1
Q

What patients, in general, are recommended for antibiotic prophylaxis for prevention of bacterial endocarditis?

A

Patients with highest risk of adverse outcomes resulting from infective endocarditis

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2
Q

What are 7 dental procedures requiring antibiotic prophylaxis for bacterial endocarditis?

A
  1. Extraction
  2. Routine cleaning
  3. Scaling and root planning
  4. Periapical root canal treatment
  5. Fitting ortho bands
  6. Placing subgingival medications
  7. Biopsy
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3
Q

If local anesthesia is going to be injected through non-infected tissue, is antibiotic prophylaxis required?

A

No

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4
Q

If ortho band placement requires antibiotic prophylaxis does the placement of ortho brackets require antibiotic prophylaxis?

A

No

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5
Q

Does patient require antibiotic prophylaxis for normal shedding of deciduous teeth?

A

NO

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6
Q

Does a patient require antibiotic prophylaxis if they have trauma to the lips or oral mucosa?

A

No

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7
Q

What are 5 general cardiac conditions associated with High Risk of Infective Endocarditis, i.e. requiring antibiotic prophylaxis?

A
  1. Prosthetic cardiac valve
  2. Prosthetic material used for cardiac-valve repair
  3. Previous history of Infective endocarditis
  4. Congenital heart disease
  5. Cardiac transplant recipient who develop valvulopathy
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8
Q

What are the 2 indications for still prescribing antibiotic prophylaxis when the Congenital Heart Disease is repaired?

A
  1. Completely repaired CHD with prosthetic material or device during first six months after procedure
  2. Repaired CHD with residual defects at site or adjacent to site of prosthetic patch or prosthetic device
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9
Q

Can a person have a congenital heart condition that does not require antibiotic prophylaxis?

A

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

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10
Q

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)?

A

Yes

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11
Q

What is the most common (artificial) joint infection?

A

Staph

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12
Q

Of the antibiotics we prescribe, which 2 cover a staph infection?

A
  1. Cephalexin

2. Augmentin (Cluvanic acid in the augmentin is what kills the Staph)

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13
Q

Of Augmentin and Cephalexin, which does Dr. Smagalski prescribe for antibiotic coverage for joint replacement patient?

A

Cephalexin

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14
Q

How would you write a prescription for pre-op Cephalexin for a joint replacement patient?

A

Cephalexin (500mg/tab) Disp: 4 (Four)

Sig: Four tabs orally two hours prior to treatment

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15
Q

What is the adult dosage for Cephalexin?

A

2 g

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16
Q

Is Amoxicillin indicated for antibiotic coverage in joint replacement?

A

No. Amoxicillin alone does not cover staph infections

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17
Q

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?

A

Because cephalexin (a cephalosporin) is not to be used in the those pts as 5% are cross-allergic to both

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18
Q

What is the alternative antibiotic prophylaxis for joint replacement patient who is allergic to Penicillins?

A

Clindamycin

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19
Q

When is Clindamycin also indicated dentally?

A

Infection is anaerobic, e.g. suspect deep space infection

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20
Q

How would you write a prescription for pre-op Clindamycin for a joint replacement patient?

A

Clindamycin (300mg/tab)
Disp: 2 (two)
Sig: Two tabs orally one hour prior to treatment

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21
Q

What is the adult dose for Clindamycin?

A

600 mg

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22
Q

What is the drug of Choice for Oral Prophylaxis?

A

Amoxicillin

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23
Q

What is the format for writing a prescription?

A

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

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24
Q

Does a prescription for an antibiotic require a DEA number?

A

No, only controlled substance prescriptions require a DEA number

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25
Q

What is the basic antibiotic for oral aerobic infections?

A

Pen VK

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26
Q

When deciding how many to “Disp” on the

prescription, what must you figure?

A

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

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27
Q

Are antibiotics indicated for pain?

A

No

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28
Q

When is antibiotic coverage indicated (list we made during lecture)?

A

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)

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29
Q

Is age ever an indication for prescribing an antibiotic?

A

No, but it is a consideration

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30
Q

If have a maxillary tooth EXT and desire antibiotic cover, choose which and why: Pen VK or Amoxicillin?

A

Amoxicillin. Broader spectrum than Pen VK and will kill sinus infection (e.g. H. influenza)

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31
Q

If pt is allergic to Penicillin will they be allergic to Amoxicillin?

A

Yes, they both have a beta lactam ring

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32
Q

Which antibiotic kills the same thing as Amoxicillin (aerobes + sinus infection) as well as targeting Staph infections?

A

Cephalexin

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33
Q

What are 2 examples of Cephalexin indications?

A
  1. Joint replacement pre-dental treatment prophylaxis

2. Pt with busted teeth and skin scrapes from bike wreck

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34
Q

If patient has a true allergy to Penicillin/Amoxicillin (anaphylaxis, angioedema, urticaria), should they be prescribed Cephalexin?

A

No. Could be cross-allergic

35
Q

Clindamycin covers what bacteria?

A

Both aerobes and anaerobes

36
Q

What infections would indicate Clindamycin?

A
  1. Deep space infection

2. Long standing dental infection (note anaerobes will have fetid odor)

37
Q

What is the major side effect of Clindamycin?

A

Pseudomembranous colitis from C. Diff

38
Q

What should be our instructions if patient calls complaining of diarrhea and nausea after taking Clindamycin for a while?

A

Stop taking the Clindamycin, refer pt to PCP or Oral Surgeon

39
Q

What is the only way to i.d. a C. diff infection?

A

Stool culture

40
Q

What will the PCP or Oral Surgeon use to treat the C.diff pseudomembranous colitis caused by the Clindamycin?

A

Metranidazole/Flagill

41
Q

What is a side effect of Metranidazole/Flagill used to treat the C. diff pseudomembranous colitis caused by Clindamycin?

A

Trembling in extremities

42
Q

What is the Disp for Clindamycin to solely reduce cost?

A

150 mg/tab vs 300 mg/tab. Disp 42 of the 150mg/tab Sig: Two tabs orally three times a day

43
Q

What is Augmentin?

A

Amoxicillin + 125 mg Cluvanic Acid

44
Q

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?

A

Write a new script for a higher dose. Doubling current prescription could overdose pt on the Cluvanic acid

45
Q

When prescribing pain meds, what is the dosage and number of tabs dispensed dependent on?

A

Individual patient pain control requirement

46
Q

What NSAID is preferred over Acetaminophen?

A

Ibuprofen (400 mg every 4-6 hrs as needed for pain)

47
Q

For pain control prescription, what special instructions should be included on the Sig line?

A

“as needed for pain” or “prn pain”

48
Q

Tylenol #1,#2,#3,#4 all have how much Acetaminophen and how much codeine?

A 
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
49
Q

What is a side effect of Tylenol #3?

A

Vomiting (1 in 3)

50
Q

Is there an allergic risk with Tylenol #3?

A

Yes, due to sulfite preservative. Do not prescribe if Sulfa drug allergy

51
Q

What patients are Tylenol contraindicated in (list we made in lecture)?

A

Alcoholics
Any liver issues (e.g. Hepatitis)
If taking other acetaminophen drugs
Allergic to acetaminophen

52
Q

What patients are Aspirin contraindicated in?

A
  1. Kids
  2. Bleeding problems (Hemophilia, thrombocytopenia)
  3. Pt on anticoagulants (Coumadin/Warfarin, Heparin, Prodoxil, Plavix)
  4. Pt already on aspirin
  5. Von Willibrand’s Disease
  6. Asthmatic (will trigger bronchiospasm)
  7. Aspirin allergy
  8. Pregnant
  9. Liver problems
  10. Crohn’s disease
53
Q

Is Tyl #3 safe in pregnancy?

A

Yes

54
Q

Should you ever write for Tyl #4?

A

No

55
Q

Lortab and Vicodin have what narcotic paired with Tylenol?

A

Hydrocodone

56
Q

What is the preferred amount of acetaminophen in Lortab and Vicodin?

A

325 mg acetaminophen

57
Q

What is the normal hyrdrocodone/acetaminophen dosage for Lortab?

A

7.5mg/325 mg

58
Q

Percocet is what narcotic paired with acetaminophen?

A

Oxycodone

59
Q

What is a medication to counter nausea?

A

Zofran

60
Q

How would you write a prescription for Zofran?

A

Zofran (8mg/tab)
Disp: 6(six)
Sig: One tab orally every 6 hrs as needed for nausea

61
Q

If pt is hypoglycemic and dehydrated days after an EXT and unable to take the antibiotic, what should be the protocol for treatment?

A

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)

62
Q

What is the maximum/desired max daily dose Acetaminophen?

A

3200mg, desire to keep below 3g/ day

63
Q

All prescriptions on the page are assumed for what weight adult?

A

150 lb adult

64
Q

Drug, dosage, and quantity should be adjusted for each patient based on what?

A

Weight
Age
Procedure

65
Q

Which antibiotic and which pain med are safe in pregnancy?

A

Antibiotic: Penicillin

Pain medication: Tylenol #3

66
Q

When working on a diabetic, would you prefer them to be hyperglycemic or hypoglycemic?

A

A little hyperglycemic so they have a glucose reserve for stress

67
Q

If you extract a maxillary posterior tooth, what antibiotic would be good to prescribe and why?

A

Amoxicillin, good at killing things like H influenza which may be in sinus

68
Q

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)?

A

Cephalexin

69
Q

Which antibiotic kills anaerobes?

A

Clindamycin

70
Q

Which antibiotic is good for deep space infections?

A

Clindamycin

71
Q

What amount of clavulanic acid is in each tab of augmentin?

A

125 mg

72
Q

What does clavulanic acid do?

A

Kills staph

73
Q

Which drug may have adverse affects on the kidneys?

A

Ibuprofen

74
Q

Ibuprofen tablets should not have more than what amount in them?

A

No more than 400mg (so 600mg and 900mg are not allowed).

75
Q

People under what age should not use Zofran?

A

12 years old

76
Q

Generally speaking, how many tablets of each pain killer should be prescribed?

A

20 (at least for our purposes on this test)

77
Q

How would you write a prescription for percocet?

A

Oxycodone-APAP (5mg/325mg)
Disp: 20 (Twenty)
Sig: One tab orally every 4-6 hours as needed for pain

78
Q

How would you write a prescription for Lortab?

A

Hydrocodone-APAP (5mg/325mg)
Disp: 20 (Twenty)
Sig: One tab orally every 4-6 hours as needed for pain

79
Q

How would you write a prescription for Tylenol #3?

A

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

80
Q

How would you write a prescription for Ibuprofen?

A

Ibuprofen (200mg)
Disp: 20 (Twenty)
Sig: One tab orally every 4-6 hours as needed for pain

81
Q

How would you write a prescription for augmentin?

A

Augmentin (500mg tab)
Disp: 21 (twenty-one)
Sig: One tab orally 3 times a day

82
Q

How would you write a prescription for Clindamycin?

A

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

83
Q

How would you write a prescription for cephalexin?

A

Cephalexin (500mg/tab)
Disp: 28 (Twenty-eight)
Sig: One orally 4 times per day

84
Q

How would you write a prescription for amoxicillin?

A

Amoxicillin (500mg/tab)
Disp: 21 (Twenty-one)
Sig: One orally three times per day

xD3 Oral Surgery Rotation (1 decks)

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