Antibiotic Premedication Exam 3

Question 1

Standard General prophylaxis:

Answer 1

Amoxicillin

- Adults: 2 gm orally 1 hr before procedure

Question 2

If unable to take standard general prophylaxis:

Answer 2

Ampicillin

- Adults: 2 gm IM or IV within 30 min before procedure

Question 3

If allergic to penicillin, what four things are prescribed for prophylaxis;

Answer 3

1. clindamycin (Cleocin)
2. cephalexin (Keflex)
3. azithromycin (Zithromax)
4. clarithromycin (Biaxin)

Question 4

When allergic to penicillin, how do you prescribe clindamycin (Cleocin)

Answer 4

Adults:

- 600 mg orally 1 hr before procedure

Question 5

When allergic to penicillin, how do you prescribe cephalexin (Keflex)

Answer 5

Adults:

- 2 gm orally 1 hr before procedure

Question 6

When allergic to penicillin, how do you prescribe azithromycin (Zithromax)

Answer 6

Adults:

- 500 mg orally 1 hr before procedure

Question 7

When allergic to penicillin, how do you prescribe clarithromycin (Biaxin)

Answer 7

Adults:

- 500 mg orally 1 hr before procedure

Question 8

What is prescribed if allergic to penicillin and unable to take oral medications for prophylaxis:

Answer 8

Clindamyin
Cefazolin (Ancef, Kefzol, Zolicef)
ceftriaxone (Rocephin)

Question 9

When allergic to penicillin and unable to take oral medications, how do you prescribe Clindamycin

Answer 9

Adults:

- 600 mg IV within 30 min before procedure

Question 10

When allergic to penicillin and unable to take oral medications, how do you prescribe cefazolin (Ancef, Kefzol, Zolicef)

Answer 10

Adults:

- 1 gm IM or IV within 30 min before procedure

Question 11

When allergic to penicillin and unable to take oral medications, how do you prescribe ceftriaxone (Rocephin)

Answer 11

Adults:

- 1 gm IM or IV within 30 min before procedure

Question 12

Describe risk factors that assist with identification of patients who are most likely to develop a prosthetic joint infection caused by microorganisms found in the oral cavity

Answer 12

1. Prior joint surgery
2. Failure to give antimicrobial prophylaxis during surgery
3. Immunosuppression
4. Preoperative wound complications
5. High ASA score (higher score = more problems)
6. Prolonged operative time
7. History of prosthetic joint infection

Question 13

The big four used to identify patients with prosthetic devices who require antibiotic premedication prior to receiving dental treatment in prevention of bacterial endocarditis?

Answer 13

1. Prosthetic cardiac valve
2. Previous history of infective endocarditis
3. Congenital heart disease (CHD)
4. Cardiac transplantation

Question 14

When talking about congenital heart disease as an indication for antibiotic premedication, what all is involved in this category

Answer 14

1. Unprepared cyanotic CHD, including palliative shunts and conduits
2. 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
3. Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
4. Transposition of the great arteries

Question 15

T or F, Cardiac shunt is not the same as AV shunt

Answer 15

True

Question 16

Under ADA guidelines of 2003, consider premed all of the time for the following patients:

Answer 16

1. Immunocompromised/immunosuppressed
2. Previous prosthetic joint infections
3. Malnourishment
4. Hemophilia
5. HIV infection
6. Insulin-dependent (Type I) diabetes
7. Malignancy

Question 17

Describe risk factors that assist with the identification of patients who are most likely to develop a prosthetic joint infection independent of dental procedures

Answer 17

1. wound drainage or wound hematoma after arthroplasty
2. Postoperative urinary tract infection
3. Prior operation/arthroplasty on index joint
4. Diabetes mellitus
5. Immunocompromised

Question 18

Is Premed needed for one with Diabetes Mellitus

Answer 18

Yes

Question 19

Is Premed needed for Postoperative urinary tract infection

Answer 19

Yes

Question 20

Is Premed needed for Penile implant

Answer 20

Maybe..

Question 21

Is Premed needed for coronary stents

Answer 21

No

Question 22

Is Premed needed for History of Fen-Phen

Answer 22

Yes

Question 23

Is Premed needed for Breast, dental or corneal implants

Answer 23

No

Question 24

Is Premed needed for pacemakers, defibrillators

Answer 24

No

Question 25

Is Premed needed for pins, plates, screws

Answer 25

No

Question 26

Is Premed needed for Organ transplant patients

Answer 26

Yes

Question 27

How do you configure a pediatric dose for premedication?

Answer 27

1 g = 1000mg 1 lb =2.2kg (Weight of child/150) x Adult dose = pediatric dose

Question 28

If patient is allergic to penicillin which is mild or in distant past, what is recommended for premedication

Answer 28

Cephalosporin (6-8 % chance of cross-allergy)

Question 29

If patient had full blown Type I hypersensitivity anaphylaxis, what is recommended for premedication

Answer 29

Use clindamycin Also azithromycin & clarithromycin (20% chance of cross-allergy with cephalosporin)

Question 30

What is recommended for patients requiring antibiotic premedication for those who are already taking tetracycline

Answer 30

- Macrolides (Azithromycin & Clarithromycin) | - Must be bacteriostatic antibiotic

Question 31

Why don't you use clindamycin for a patient's premed if already taking tetracycline?

Answer 31

because premed dose of clindamycin is bactericidal

Question 32

T or F, Strep are rarely implicated in bacteremia following dental procedures

Answer 32

False, Staph

Question 33

What is most common cause of transient bacteremia after dental procedures that result in trauma to gingiva or oral mucosa

Answer 33

Viridans-group Strep

Question 34

T or F, Cumulative exposure to transient bacteremia through daily activities is several times higher than following a single exposure during a dental procedure

Answer 34

True

Question 35

Other factors indicating use of Premeds

Answer 35

1. History of IV drug abuse if valve damage 2. Dialysis 3. PICC line, hickman catheter, Portacath, CSF shunts 4. History of Fen-Phen 5. Decreased WBC 6. Organ transplant patients