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Tim's Cards > Pharmacology 3 > Flashcards

Pharmacology 3 Flashcards

1
Q

The premise of antibiotics prior to a dental procedure is to prevent what 2 things?

A

Infective endocarditis

Prosthetic joint infections

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2
Q

T/F
There is NO scientific evidence that supports antibiotic prophylaxis defends against IE (infective endocarditis) and Prosthetic Joint Infections.

A

True

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3
Q

The introduction of bacteria in the bloodstream is called?

A

Bacteremia

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4
Q

T/F

Bacteremia is linked to IE (infective endocarditis) and PJI (prosthetic joint infections).

A

False

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5
Q

What are the 2 pathogen species responsible for IE and PJI?

A

viridans Streptococci

Staph aureus

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6
Q

There is a _____ fold increase in pts with prosthetic valves and previous history of Endocarditis for IE.

A

400

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7
Q

T/F
Rheumatic valvular disease, cyanotic congenital heart disease, and degenerative valve lesions are also at risk for Infective Endocarditis

A

True

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8
Q

What are the 4 conditions that require prosthetic antibiotics in a dental setting?

A

Prosthetic cardiac valve

Previous history of Infective Endocarditis

Congenital heart disease

Cardiac Transplantation

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9
Q

How long after a Congenital Heart Defect is repaired must prosthetic antibiotics be administered?

A

First 6 months

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10
Q

Congenital heart disease will be given if there is _____ cyanotic CHD, including _____ shunts and conduits.

A

Unrepaired

Palliative

*means vessels swapped, defective valves, vessels

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11
Q

T/F
Severe cases of Great Artery transposition can be fatal, and are associated with many conditions later in life, including leaky heart valves, arrhythmias, declining function, etc.

A

True

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12
Q 
T/F
Blue babies (transposition of great arteries) require lifelong follow-ups with a cardiologist
A

True

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13
Q

The AHA recommends that any repaired CHD with _________ at the site / adjacent to the site should be given prosthetic antibiotics

A

Residual Defects

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14
Q

Cardiac transplantation may develop cardiac ________, which is why antibiotic prophylaxis is recommended.

A

vavulopathy

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15
Q

T/F

A Cardiac shunt (congenital) is the same as an Arteriovenous Shunt

A

False

*bypass with tubing, limited life-span

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16
Q

T/F

Within the 1st 5 minutes of a dental procedure, you get bacteremia

A

True

  • 79% placebo
  • 56% amoxicillin
  • 28% toothbrushing
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17
Q

Bacteremia after dental procedures is usually less than 20 minutes, what % of the extraction/placebo group had an IE related species after 60 minutes?

% toothbrushing group?

% extraction/amoxicillin?

A

5%

2%

0%

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18
Q

Viridans strept were found in ____% in brushing group

____% extraction/amoxicillin

____% extraction/placebo

A

48%

49%

70%

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19
Q

T/F

Amoxicillin significantly reduces viridans Strept.

A

True

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20
Q

Why is antibiotic prophylaxis so contentious with joint replacements?

A

Infection 2nd common cause failure

*aseptic loosening primary

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21
Q

T/F
Prior joint surgery, failure antimicrobial prophylaxis during surgery, immunosuppression, history, high ASA score are factors with higher risk of Prosthetic Joint Infection

A

True

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22
Q

________ is a risk factor for hematogenous prosthetic joint infection, especially with _________ (bacteria).

A

Bacteremia

Staph aureus

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23
Q

T/F

Chewing causes transient bacteremia in 40% of episodes

A

True

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24
Q

____ are rarely implicated in bacteremia

_____-group Streptococci constitute most facultative oral flora and are the ________ cause of transient bacteremia.

A

Staph

Viridans

Most common

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25
Q

Viridans Streptococci acount for ____% of all hematogenous prosthetic joint infections.

A

2%

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26
Q

Prolonged, high-grade bacteremia is associated with PJI, and after dental procedures bacteria are at _____ levels needed to seed prosthesis (animal studies)

A

much lower levels

basically, dental procedures couldn’t cause

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27
Q

The cumulative exposure to transient bacteria due to chewing, brushing, etc, is Higher/Lower than following single exposure during dental procedure.

A

Several times Higher

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28
Q

T/F

According to 1 study, PJI from a dental source occured after 0.2% knees and 6% hip replacements

A

True

*other studies counter claim

29
Q

T/F
According to Mayo study, neither low-risk nor high-risk dental procedures were associated with an increased risk of prosthetic knee or hip infection

T/F
Antibiotic premedication was not associated with lower risk.

A

True

True

30
Q

According to the Mayo study, what may decrease bacteremia from daily activities?

A

Good oral hygiene

31
Q

Cultures from infected joints are most often ______, according to Mayo study

What species are associated with dental procedures?

A

Staph

viridans Strept, beta hemolytic strept, G+ anaerobes

32
Q

The 2003 study recommended prophylaxis for 2 years, and asked to consider premed all the time in immunocompromised pts and pts with previous prosthetic joint infections, malnourishment, hemophilia, HIV, Type I diabetes, and malignancy.

A

True

33
Q

Why do orthopedic surgeons prefer cephalosporins to amoxicillin?

A

Cephalosporins enter synovial fluid

*Amoxicillin still ok though

34
Q

High risk and low risk dental procedures _____ factors for joint infections for at-risk subgroups

A

Not Risk

35
Q

Bottom line: in 3 of 4 case studies no association was demonstrated between dental procedures and PJI, therefore…

A

No need to treat prophylactically

*moderate certainty of no association

36
Q

Antibiotic Stewardship (overprescribing) is a major factor in NOT prophylactically prescribing.

A

True

37
Q

Postoperative UTI and Wound drainage/hematoma after arthroplasty (and a host of other conditions) ARE risk factors for PJI independent of Dental Procedures

A

True

38
Q

T/F

In general, pts with prosthetic joint implants are NOT recommended to have prophylactic antibiotics

A

True

39
Q

What are 2 other conditions that may require prophylactic antibiotics?

A

Penile implants

hx drug abuse and valve damage

40
Q

Is there premed recommended for stents?

A

No

41
Q

What 3 methods of dialysis would require premed?

What 1 method doesn’t?

A

A/V shunts, tunneled catheter, periotoneal port

fistula access

42
Q

T/F

Picc line, Hickman catheter, Portacath, and CSF shunts don’t require premed

A

False

43
Q

What are 4 conditions that don’t have premed guidelines?

A

Fen-Phen hx

Decreased WBC from chemo/immunosuppressive therapy

Organ Transplant

IV drub abus hx

44
Q

Prophylaxis is indicated when _____ is likely.

A

Bleeding

45
Q

If there is ______ bleeding, antibiotics are given immediately.

A

Unanticipated

46
Q

If a sequence of procedures is needed, a ________ day interval is recommended to minimize resistance.

A

9-14

47
Q

Premed is recommended in which dental procedures?

A

All involving manipulation of gingival tissue, perforation, or periapical region of teeth.

48
Q

T/F

Acute infections at distant sites (like oral cavity) increase risk of infection in PJI.

A

True

*includes perio infection

49
Q

How do most devices cause infection?

A

Contamination time of insertion

50
Q

T/F

If no complications after 2 years, premed is not indicated

A

True

*as well as pins, plates, screws, breast, dental, and corneal implants

51
Q

T/F
Complications following initial placement, recurrent pain, and history of previous joint replacement failures put one at high risk for joint infections.

A

True

52
Q

2014 task force High Risk pts identified with Prior Operation on Joint, Diabetes, Immunocompromised, and what 2 other major factors?

A

Wound draingage/hematoma after arthroplasy/or post op infection

Post-op UTI

53
Q

If not allergic to Penicillin, what is the premed regimen for pts with prosthetic implants?

(3 possibles)

A

Cephalexin (Keflex) 2 gm orally 1 hr prior

Cephradine (Velosef)

Amoxicillin (Amoxis, Trimox)

54
Q

If not allergic to Penicillin, but unable to take oral meds, what is the premed regimen for pts with prosthetic implants?

(2 possibles)

A

Cefazolin (Ancef) 1 gm IM or IV 1 hr prior

Ampicillin 2 gm IM or IV 1 hr prior

55
Q

If allergic to Penicillin, what is the premed regimen for pts with prosthetic implants?

A

Clindamycin (Cleosin) 600 mg oral 1 hr prior

56
Q

If allergic to Penicillin and unable to take oral meds, what is the premed regimen for pts with prosthetic implants?

A

Clindamycin (Cleosin) 600 mg IV 1 hr prior

57
Q

What is standard general prophylaxis for Adults?

Children?

A

Amoxicillin

Adults: 2 gm oral 1 hr prior

Children: 50 mg/kg oral 1 hr prior

58
Q

What is standard general prophylaxis for Adults/children if unable to take oral meds?

A

Ampicillin

Adults: 2 gm IM or IV 30 min prior

Children: 50 mg/kg IM or IV within 30 min

59
Q

If allergic to Penicillin, what are 4 options for general prophylaxis?

A

Clindamycin (Cleocin) A: 600mg 1hr prior C: 20 mg/kg 1 hr prior

Cephalexin (Keflex) A: 2 gm oral 1 hr prior C: 50 mg/kg 1 hr prior

Azithromycin (Zithromax) A: 500 mg oral 1 hr prior C: 15 mg/kg oral 1 hr prior

Clarithromycin (Biaxin) (same as azithromycin)

60
Q

Pediatric dose =

A

(weight of child/150) x adult dose

61
Q

If allergy to Penicillin is mild or in the distant past, what should replace?

If allergy was full blown Type 1 hypersensitivity?

A

Cephalosporin (6-8% chance allergic)

Clindamycin (azithromycin/clarithromycin secondarily)

*20% chance cephalosporin allergy w/ type 1

62
Q

If already taking tetracycline, what would be a good premed?

A

Macrolides: azithromycin and clarithromycin

*must be static

***wouldn’t use clindamycin b/c premed dose cidal

63
Q

T/F

If pt already on an antibiotic, a premed should come from a different class.

A

True

64
Q

If allergic to Penicillin and unable to take oral meds, name 3 options for General Prophylaxis:

A

clindamycin: A: 600 mg IV w/in 30 min C: 20 mg/kg IV w/in 30 min

cefazolin (Ancef/Kefzol/Zolicef) A: 1 gm IM/IV w/in 30 min C: 50 mg/kn IM/IV w/in 30 min

ceftriaxone (Rocephin) A: 1 gm IM/IV w/in 30 min C: 50 mg/kg IM/IV w/in 30 min

65
Q

Premed regimen for pts with Total Joint Replacement if not allergic to Penicilin:

A

Cephalexin (Keflex) or Cephradine (Velosef)

2 gm orally 1 hr prior

(Amoxicillin, general, is acceptable)

66
Q

Premed regimen for pts with Total Joint Replacement if not allergic to penicillin but unable to take oral meds:

A

Cefazolin (Ancef) 1 gm IM/IV 1 hr prior

(Ampicillin 2 gm IM/IV 1 hr prior acceptable) `

67
Q

Premed regimen for pts with Total Joint Replacement if allergic to penicillin

A

Clindamycin (Cleosin) 600 mg oral 1 hr prior

68
Q

Premed regimen for pts with Total Joint Replacement if allergic to penicillin and unable to take oral meds:

A

Clindamycin (Cleosin) 600 mg IV 1 hr prior

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