Pharmacology 3 Flashcards by Tim Agee

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

Infective endocarditis

Prosthetic joint infections

How well did you know this?

Not at all

Perfectly

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

True

How well did you know this?

Not at all

Perfectly

The introduction of bacteria in the bloodstream is called?

Bacteremia

How well did you know this?

Not at all

Perfectly

T/F

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

False

How well did you know this?

Not at all

Perfectly

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

viridans Streptococci

Staph aureus

How well did you know this?

Not at all

Perfectly

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

400

How well did you know this?

Not at all

Perfectly

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

True

How well did you know this?

Not at all

Perfectly

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

Prosthetic cardiac valve

Previous history of Infective Endocarditis

Congenital heart disease

Cardiac Transplantation

How well did you know this?

Not at all

Perfectly

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

First 6 months

How well did you know this?

Not at all

Perfectly

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

Unrepaired

Palliative

*means vessels swapped, defective valves, vessels

How well did you know this?

Not at all

Perfectly

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.

True

How well did you know this?

Not at all

Perfectly

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

True

How well did you know this?

Not at all

Perfectly

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

Residual Defects

How well did you know this?

Not at all

Perfectly

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

vavulopathy

How well did you know this?

Not at all

Perfectly

T/F

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

False

*bypass with tubing, limited life-span

How well did you know this?

Not at all

Perfectly

T/F

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

True

79% placebo
56% amoxicillin
28% toothbrushing

How well did you know this?

Not at all

Perfectly

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?

How well did you know this?

Not at all

Perfectly

Viridans strept were found in ____% in brushing group

____% extraction/amoxicillin

____% extraction/placebo

48%

49%

70%

How well did you know this?

Not at all

Perfectly

T/F

Amoxicillin significantly reduces viridans Strept.

True

How well did you know this?

Not at all

Perfectly

Why is antibiotic prophylaxis so contentious with joint replacements?

Infection 2nd common cause failure

*aseptic loosening primary

How well did you know this?

Not at all

Perfectly

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

True

How well did you know this?

Not at all

Perfectly

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

Bacteremia

Staph aureus

How well did you know this?

Not at all

Perfectly

T/F

Chewing causes transient bacteremia in 40% of episodes

True

How well did you know this?

Not at all

Perfectly

____ are rarely implicated in bacteremia

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

Staph

Viridans

Most common

How well did you know this?

Not at all

Perfectly

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

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

much lower levels | basically, dental procedures couldn't cause

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

Several times Higher

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

True *other studies counter claim

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.

True True

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

Good oral hygiene

Cultures from infected joints are most often ______, according to Mayo study What species are associated with dental procedures?

Staph viridans Strept, beta hemolytic strept, G+ anaerobes

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.

True

Why do orthopedic surgeons prefer cephalosporins to amoxicillin?

Cephalosporins enter synovial fluid *Amoxicillin still ok though

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

Not Risk

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

No need to treat prophylactically *moderate certainty of no association

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

True

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

True

T/F | In general, pts with prosthetic joint implants are NOT recommended to have prophylactic antibiotics

True

What are 2 other conditions that may require prophylactic antibiotics?

Penile implants hx drug abuse and valve damage

Is there premed recommended for stents?

What 3 methods of dialysis would require premed? What 1 method doesn't?

A/V shunts, tunneled catheter, periotoneal port fistula access

T/F | Picc line, Hickman catheter, Portacath, and CSF shunts don't require premed

False

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

Fen-Phen hx Decreased WBC from chemo/immunosuppressive therapy Organ Transplant IV drub abus hx

Prophylaxis is indicated when _____ is likely.

Bleeding

If there is ______ bleeding, antibiotics are given immediately.

Unanticipated

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

9-14

Premed is recommended in which dental procedures?

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

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

True *includes perio infection

How do most devices cause infection?

Contamination time of insertion

T/F | If no complications after 2 years, premed is not indicated

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

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

True

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

Wound draingage/hematoma after arthroplasy/or post op infection Post-op UTI

If not allergic to Penicillin, what is the premed regimen for pts with prosthetic implants? (3 possibles)

Cephalexin (Keflex) 2 gm orally 1 hr prior Cephradine (Velosef) Amoxicillin (Amoxis, Trimox)

If not allergic to Penicillin, but unable to take oral meds, what is the premed regimen for pts with prosthetic implants? (2 possibles)

Cefazolin (Ancef) 1 gm IM or IV 1 hr prior Ampicillin 2 gm IM or IV 1 hr prior

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

Clindamycin (Cleosin) 600 mg oral 1 hr prior

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

Clindamycin (Cleosin) 600 mg IV 1 hr prior

What is standard general prophylaxis for Adults? Children?

Amoxicillin Adults: 2 gm oral 1 hr prior Children: 50 mg/kg oral 1 hr prior

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

Ampicillin Adults: 2 gm IM or IV 30 min prior Children: 50 mg/kg IM or IV within 30 min

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

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)

Pediatric dose =

(weight of child/150) x adult dose

If allergy to Penicillin is mild or in the distant past, what should replace? If allergy was full blown Type 1 hypersensitivity?

Cephalosporin (6-8% chance allergic) Clindamycin (azithromycin/clarithromycin secondarily) *20% chance cephalosporin allergy w/ type 1

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

Macrolides: azithromycin and clarithromycin *must be static ***wouldn't use clindamycin b/c premed dose cidal

T/F | If pt already on an antibiotic, a premed should come from a different class.

True

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

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

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

Cephalexin (Keflex) or Cephradine (Velosef) 2 gm orally 1 hr prior (Amoxicillin, general, is acceptable)

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

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

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

Clindamycin (Cleosin) 600 mg oral 1 hr prior

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

Clindamycin (Cleosin) 600 mg IV 1 hr prior