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pom > pom- ie prophy > Flashcards

pom- ie prophy Flashcards

1
Q

definition of ie

A

microbial infection of heart valves or endocardium

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2
Q

lesion of ie

A

vegetation on a heart valvue, or eslsewhere on endocardium

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3
Q

ie is higher among…?

A

ie drug users- usually leion on mitral but in drug users , tricuspid

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4
Q

2-6% risk for ie for pt with ?

A

hemodialysis

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5
Q

2-31% risk for pt with?

A

previous ie

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6
Q

amphotocerin b can cause

A

renal toxicity

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7
Q

renal toxicity can lead to

A

anemia

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8
Q

put pt on ? for fungal ie

A

amphotocerin b

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9
Q

if put pt on amphotocerin b for ie what might happen?

A

renal toxicity and anemia

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10
Q

ie is more common in men or women?

A

men

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11
Q

median age of onset of ie?

A

50

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12
Q

ie is more common in??

A

elderly- 25% cases

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13
Q

endocarditis etiology

A

bac infect damed endocardium or endothelial tissue located near high flow shunts between arterial/ venous channels

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14
Q

80% of ie cases caused by

A

staph

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15
Q

% caused by what is decreasing?

A

strep

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16
Q

what is a major risk of ie in hiv infected pt?

A

continued iv drug use

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17
Q

3 groups of ie lesions

A

cardiac, embolic, general

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18
Q

cardiac lesion describe

A

usually on valvue it self- mitral valve- but no longer required to prophy
can occur at contact area of jet flow, non bacterial thrombotic endocarditis (NBTE)

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19
Q

NBTE

A

nonbac thrombotic endocarditis

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20
Q

jet flow

A

area where blood keeps pulstaing and bringing bacteria back in

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21
Q

embolic lesion

A

vegetasions become friable and dtach

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22
Q

petichial hemorrhages on skin and mucous membranes in embolic lesions?

A

osler’s nodes, splinter hemorrhages

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23
Q

splinter hemmorage

A

look like got spliner onder fingernail

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24
Q

oslers nodes

A

on lower extremeity

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25
Q

general lesion

A

enlarged spleen, club fingers, arthritis, systemic dz, organ failure, morbidity mortality is 10-80%

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26
Q

classic findings of ie? 4

A

fever, anemia, + blood cultures, heart murmur

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27
Q

diagnostic triad of ie?

A

fever, cardiac murmur, + blood cultures- not always present!

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28
Q

2 types of ie we need to know

A

sbe, abe

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29
Q

abe

A

acute bacterial endocarditis- usually by staph

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30
Q

clinical appearance of abe

A 
dev over days or 1-2 week
complications dev
death in 6 wk w/o tx
staph aureas
preceded by suppurative infection
NOT oral bc staph doesnt live in oral cavity
31
Q

sbe clincial appearance

A

MORE IMPORTNAT TO DENTIST, MAY OCCUR AFTER ORAL PROCEDURE BC SCAUSE BY ALPHA HEMOLYTIC STREPH
symptoms in 2 weeks
progress over weeks to months

32
Q

more immature neutraphils means

A

acute infection

33
Q

lab findings in ie

A

cbc - elevated wbc, neutraphil
esr- elevated in 90%
c- reactive protein is positive
serum ig is increased

34
Q

s aureus causes

A

abe

35
Q

s viridans causes

A

sbe

36
Q

electrocardiogram

A

if infection goes into myocardium-disturbance of conduction

37
Q

tte

A

test for diag of ie- transthoracic echocardiogram- put over sternum

38
Q

tee

A

more accurate echocardiogram for diag ie- but more invasive (transesophogeal echocardiogram)

39
Q

other imaging studies for ie

A

chest x ray, ct, mri, angiography

40
Q

how to tx ie?

A

early, antibiotics via iv for awhile

41
Q

tx of s viridans endo? (remember sbe)

A

penni G- 4 million units iv for 4 week

42
Q

tx pcn resistant strep?

A

penni g IV and Gentimicin IV for 6 wk

43
Q

s aureus endo- tx if infection doesnt involve prosthetic material and is methicillin susceptible

A

naficillin iv

44
Q

s aureus assoc with prosthetic materials and methicillin susceptible

A

naficillin iv and gentamicin iv, 6 wk

45
Q

methi resistant s aureus ie?

A

vancomycin iv + gentimicin iv + rifampin 300 mg po for 6 wk or longer

46
Q

when to operate?

A

debride if fungus, valve replacement, , heart failure

47
Q

aha designations made in 1997?

A

high, mod, neg

NEED TO PREMED MOD AND HIGH

48
Q

who to premed? 4 categories

A

prosthetic cardiac valve or prosthetic material used for cardiac valve repair, previous infective endocarditis, congentital heard disease, cardiac transplantation recipients who develop cardiac valvulopathy

49
Q

which types of CHD do we premed?

A

unrepaired cyanoic CHD (pallitave shunts and conduits), completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention during the first six months after the procedure, and repaired chd with residual defects at the site or adj to site of prosthetic pattch or prosthetic deice

50
Q

cyanotic congenital heart dz- cyanosis?

A

results from mixing of unoxygenated blood in the systemic circ caued by intracardiac shunting of blood from rigt to left side of heart

51
Q

is prophy rec for cabg or coronary artery stent?

A

NO

52
Q

bleeding during dental work can result in

A

transient bacteremia

53
Q

when else can transient bacteremia occur?

A

brushing, flossing

54
Q

how likely for TB to occur during perio, ext?

A

perio-88, ext- 85

55
Q

do dental procedure cause ie?

A

it’s not really that likely- 3-20% likely

56
Q

how effective is prophy?

A

49-91%

57
Q

what are we prophying against in dental prophy

A

alpha hemo strep

58
Q

what do we use to prophy?

A

amox

59
Q

is prophy helpful?

A
  • sometimes, but condition would occur 47 times in 10 million if not prophy- v small, but v bad dz so worth it? but no prophy leads to 5 cases ie and no death, prophy leads to 2 cases of death, 175 allergy
60
Q

why do we prophy?

A

CYA

61
Q

what procedure should you prophy for?

A

if you’re gonna manip the gum, prophy

62
Q

what are we giving

A

amox 2 g 1 hour before procedure

63
Q

children prophy? what do we give?

A

50 mg 1 hour before

64
Q

what if allergic to amox?

A

clinda 600mg for adult, 20 mg/kg for kid
or
cephalexin 2 g adult, 50 m/kg kid
or
azithromycin or clarithromycin 500mg adult, 15 mg/kg kid

65
Q

what if allergic to penni or ampi and can’t take oral?

A

cefazolin or ceftraxone , 1 gm IM or IV adult, 50 mg/kg IM or IV for kid
OR
clinda 600 mg IM or IV , kid- 20 mg/kg IM < IV

66
Q

if pt bleeds during procedure and you didnt have them prophy?

A

do prophy within 2 hrs

67
Q

if pt is taking oral penni already, what should you do?

A

give clinda

68
Q

what else can we do to dec chance of bacteremia?

A

chlorohexidine, OH, peiro maint, max dental tx at each appt

69
Q

how long should you wait between prophy visits?

A

10 day

70
Q

how long before appt to prophy-?

A

30-60 min

71
Q

1st of 3 new prosthetic prophy recs?

A

you can maybe discontinue prophy prostethic pt, just be mindful and involve pt in decisin (silly)

72
Q

2nd of 3 recs for prosthetic prophy

A

chlorohexidine rinse, inconclusive, use your judgement

73
Q

3rd of 3 recs for prosthetic prophy

A

about oral hygiene- what is appropriate is different for everyone- you decide

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