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55 Cards in this Set

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Some surgical and dental procedures and instrumentations involving mucosal surfaces or contaminated tissue case transient bacteremia that rarely persists for more than how long?
15 minutes
What three factors should be considered for endocarditis prophylaxis?
1. degree to which patient's underlying condition creates a risk for endocarditis

2. risk of bacteremia with the procedure, and potential adverse reactions of the prophylactic antimicrobial agent to be used

3. the cost-benefit aspect of the recommended prophylactic regime
The incidence and magnitude of bacteremias are directly proportional to what?
to the degree of oral inflammation and infection.
How is chlorhexidine indicated to reduce the incidence or magnitude of bacteremia?
15 mm of Chlorhexidine via gentle oral rinsing for about 30 seconds prior to dental treatment
T/F: sustained or repeated frequent interval use of chlorhexidine is NOT indicated when trying to reduce the incidence of bacteremia,
TRUE. - it may result in selection of resistant microorganisms

DOSE: 15 mm in 30 seconds
Prophylactic administration of abx within how many hours of a procedure has been shown to be effective prophylaxis?
2 hours

- abx administered 4 hrs after the procedure probably have no effect
What bacteria is the most common cause of endocarditis following dental procedures?
streptococcus viridans
What is the recommended standard prophylactic regimen to prevent endocarditis?
one dose of amoxicillin
what advantages does amoxicillin have over ampicillin and penicillin?
Amoxicillin is equally effective against hemolytic strep but it is better absorbed from the gastrointestinal tract and provides higher and more sustained serum levels.
What is the recommended adult dose for prophylaxis with amoxicillin?
2.0 grams 1 hour before the anticipated procedure
For individuals unable to take or absorb oral medications for endocarditis prophylaxis , what abx is recommended?
Ampicillin sodium
What abxs can be given to pts allergic to penicillins for endocarditis prophylaxis?
- Clindamycin hydrichloride
-1st generation cephalosporins like cephalexin or cefadroxil (as long as they haven't had an immediate IgE-mediated anaphylactic allergic reaction to penicillin)
- Azithromycin and Clarithromycin - more expensive
What abx can be given to a pt that is allergic to penicillin and can't have oral administration?
Clindamycin phosphate
Why is Erithromycin not preferred over azithro or claritho - mycin?
because of gastrointestinal upset and complicated pharmacokinetics
Is endocarditis prophylaxis recommended in reimplantation of avulsed teeth?
yes!
Is endocarditis prophylaxis recommended in root canal tx and SRP?
yes!
Is endocarditis prophylaxis recommended initial placement of ortho bands?
yes! but not brackets
Is endocarditis prophylaxis recommended intracanal endo tx?
no!
Is endocarditis prophylaxis recommended in postoperative suture removal?
no!
Is endocarditis prophylaxis recommended in restorative dentistry with retraction cord?
no!
During what kind of injection is prophylactic abx recommended ?
INTRALIGAMENTARY.
What is the dose of clindamycin given to adults allergic to penicillin?
Clindamycin - 600 mg 1 hr before procedure

or 20 mg/kg in children 1 hr before procedure
What is the dose of azithromycin given to adults allergic to penicillin?
500 mg 1 hr before procedure

or 15 mg/kg orally 1 hr before procedure in children
The systemic fungal infections are classified into what ?
Opportunistic and Endemic Mycoses
What is the difference between opportunistic mycoses and systemic mycoses?
opportunistic - pts who are immunocompromised

endemic- distributed UNEVENLY throughout the the world and have low incidence in temperate climates (blastomycoses, histoplasmosis, coccidiomycoses, sporotrichosis)
What is the MOA of Amphotericin B and nystatin?
forms pores by interacting with ergosterol (major fungal lipid_ to form pores, thus rendering the cell membrane permeable to Na+ K+, and H+ ions.
What are the clinical uses for Amphotericin B?
-any severe fungal infection against Candida, Histoplasma, Cryptococcus, Coccidiodes ect.

- IV in fungal meningitis and systemic infections.

- 3% cream is used in superficial candida infections
Can Nystatin be given orally?
yes! but NEVER GIVE PARENTERALYLLY
What is the DOC for oral monoliasis, thrush, and denture stomatitis?
topical nystatin
What is the dosage for Nystatin in the tx of oral candidiasis?
2-3 ml of 100,000 units are placed in each side of the mouth, swiched and held for at least 5 minutes before swallowing. repeat 6 hrs for at least 10 days or 48 hrs after remission

- OR 1-2 lozenges (troches or pastilles- 20,000 units) may be used 4-5 times per day
What is the dosage of nystatin for denture stomatitis?
topically every 6 hours to tissue surface of the denture
What is the clinical use of Nystatin?
topical for oral candidiasis (oral monoliasis, thrush, denture stomatitis) and for intestinal candidiasis (esophageal and gastric treatment of candida)
What is the mechanism of action of Flucytosine?
It is a base analog that gets converted to fluorouracil by cytosine deaminase and inhibits thymidylate synthase and is fungistatic
What are the adverse effects of nystatin?
too toxic parenternally, TERRIBLE FOUL TASTE, mild and transient GI disturbances
What antifungal is too toxic to be given parenterally and has a terrible foul taste?
Nystatin
What are the clinical uses of Flucytosine?
Systemic candidiasis and cryptococcal infections (AIDS pts)

- In cryptococcal meningitis in combination with amphotericin B in severe infections.
What is the adverse side effect of Flucytosine?
reversible bone marrow suppresion
What is the mechanism of action of Griseofulvin?
inhibits mitosis by disrupting spindle formation (microtubule).

- fungistatic

- deposits in keratin precursor cells
What is the clinical use of Griseofulvin?
systemic drug in disease of skin, hair, and nails due to microsporum, epidermophyton, and trichopyton
What is the mechanism of action of imidazoles and triazoles?
Inhibit ergosterol synthesis and interferes with membranes permeability
What is the clinical use of clotrimazole?
topical agent for mucosal and cutaneous infections

- dissolved in mouth 5/day for 2 weeks for oropharyngeal candidiasis (AIDS pts)
Which triazole can be given topically and and parenternally?
Miconazole
What antifungal is used for the tx of cutaneous candidiasis and vulvovaginitis caused by c.albicans?
Miconazole
What is the main use of itraconazole?
used in the suppressive therapy of histoplasmosis in HIV seropositive patients.
What antifungal is used in suppresive tx and primary treatment of cryptococcal meningitis in aids pts?
Fluconazole
What are the clinical uses of Fluconazole?
- suppresive therapy and tx of cryptococcal meningitis in AIDS pts

- mucosal candidiasis including oropharyngeal and esophageal candidiasis

- coccidial meningitis, blastomycosis, histoplasmosis

- more effective than nystatin in tx of oral candidiasis in immunocompromised children

-
What effect do drugs like antacids that reduce gastric pH have on ketoconazole?
reduce its absorption
What is the main clinical use of ketoconazole?
used systemically in oral candidiasis but should be reserved for refractory cases to more conventional topically applied agents.

- also effective against oral and pharyngeal candidiasis in pts with advanced AIDS
What antifungal has adverse effects that include.. gynecomastia, blunts response to ACTH, hepatotoxicity
Ketoconazole
What is the mechanism of action of anidulafungin?
inhibits glucan synthesis (NZ important for formation of B(1,3)-D-Glucan, a major cell wall component
What is the use of tolnaftate?
-cream powder or powder aerosol for dermatophyte infections
What is the MOA of Naftifine?
an allylamine that inhibits squalene epoxidase.
What is the use of Terbinafine?
1% cream that is available orally and locally for onychomucosis
Therapy of oral candidiasis is carried for how long usually?
two weeks.
In patients with liver disease, what form of oral candidiasis tx is preferred?
nystatin pastilles