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83 Cards in this Set
- Front
- Back
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a disease caused by microbial infection of the heart valves or endocardium, in proximity to congenital or acquired defects
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infective endocarditis (IE)
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most common bacteria to cause IE
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alpha-hemolytic streptococcus viridans
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symptoms of IE
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flue-like: weakness, weight loss, fatigue, fever, chills, night sweats, joint and muscle pain
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IE may not be diagnosed until when?
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2nd visit to physician
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what tests need to be done to test for IE?
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blood tests, echocardiogram
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IE favors what ages of the population?
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40-60
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is IE more common in males or females?
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makes
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recurrence rates for IE
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33% recurrence rate
47% for IV drug users |
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which type of endocarditis has a slower onset and can be fatal in months if not treated?
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subacute bacterial endocarditis (SBE)
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SBE is caused by what?
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S. viridans infecting heart valves
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which type of endocarditis is a bacterial infection of the heart valves or endocardium?
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bacterial endocarditis (BE)
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BE is caused by what?
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fungi (candida albicans) and G- bacteria
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which type of endocarditis has a sudden onset, is fatal in less than 6 weeks if untreated, and involves normal heart valves?
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acute bacterial endocarditis (ABE)
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ABE is caused by what?
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Staphylococcus aureus
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microbial infection of the endothelium of arteries
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infective endarteritis (IEA)
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infection of prosthetic heart valves
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prosthetic valve endocarditis (PVE)
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treatment for IE usually lasts how long?
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4-6 weeks
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endocarditis occurs when bacteria enter the bloodstream and do what?
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infect damaged endocardium, valves, or endothelial tissue near high-flow shunts b/w arterial and venous channels
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BE from S. viridans causes many soft, friable vegetations where in the heart?
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mitral valve leaflet and chordae tendineae
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what are the 9 AHA guidelines for antibiotic prophylaxis?
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1. concern for worldwide antibiotic resistance
2. role of antibiotic use promoting microbial resistance 3. decrease in dental use of pre-med 4. better define medical indications 5. decrease duration of use 6. address risk vs cost benefit 7. address medico-legal concerns 8. emphasize importance of dental health 9. emphasize clinical judgment |
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medication most commonly given as pre-med
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amoxicillin
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dosage for amoxicillin premed
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500 mg x 4 capsules = 2g
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why is amoxicillin preferred over ampicillin or penicillin?
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better absorption from GI, increased and sustained serum level for hours, less GI side effects
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until 1997, guidelines required a 2nd dose given for premed. how much and when should it be taken?
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6 hours later - half of first dose
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who should take a 2nd dose of premed now?
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high risk pts - those with a PMH of IE or heart valve replacement or all day appoints
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what drug is most commonly given for a penicillin allergy and how much?
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clindamycin - 600mg
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Name the other major drugs given for a penicillin allergy
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cephalexin (Keflex), cefadroxil (Duricef), azithromycin (Zithromax) or clarithromycin (Biaxin)
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What is the dosage for cephalexin/Keflex and cefadroxil/Duricef?
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2g 1 hr prior to procedure
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What is the dosage for azithromycin/Zithromax and clarithromycin/Biaxin?
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500mg 1hr prior to procedure
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If a pt can't swallow or absorb meds, what do you give them?
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IV antibiotics
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if oral antibios does not give a high enough dose, what do you give them?
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IV or IM ampicillin
IV clindamycin IV or IM cefazolin |
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what is the interval needed between dental appts for pre-med pts?
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9-14 days
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what antiseptic mouth rinses are recommended to reduce bacteremias and how long do their effects last?
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peridex - 4-6hrs
listerine - 45min-1hr viadnt - 1-2hrs |
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what category of pts may need to get a medical consult prior to dental tx?
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high risk category
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what conditions fall under the high risk category?
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prosthetic cardiac valves
previous BE complex cyanotic congenital heart disease surgically constructed systemic pulmonary shunts |
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ventricular septal defect, atrial septal defect, Tetralogy of Fallot, transposition of greater vessels all fall under what category of heart disease?
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complex cyanotic congenital heart disease
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what conditions fall under moderate risk category?
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acquired valvular dysfunction
hypertrophic cardiomyopathy mitral valve prolapse with valvular regurgitation and/or thickened valve leaflets |
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scarring from RHD may result in what?
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stenosis or regurgitation of blood flow
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enlarged heart with heart disease is called what?
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hypertrophic cardiomyopathy
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what conditions would fall under negligible risk category and, therefore, endocarditis prophylaxis is not recommended?
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isolated secundum atrial septal defect
surgical repair of atrial septal defect, ventricular septal defect or patent ductus arteriosus beyond 6 months previous CABG MVP w/o regurgitation functional/innocent murmers Kawasaki disease w/o valve dysfunction Rheumatic fever w/o valve dysfunction cardiac pacemakers implanted defibrillators |
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how long do bacteremias produced by dental procedures last?
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15-30 min
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is prophylaxis indicated for dental extractions?
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yes
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is prophylaxis indicated for perio procedures?
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yes
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is prophylaxis indicated for dental implant placement?
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yes
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is prophylaxis indicated for re-implantation of avulsed tooth?
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yes
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is prophylaxis indicated for endo instrumentation beyond apex?
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yes
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is prophylaxis indicated for subgingival placement of antibiotic fibers or strips?
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yes
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is prophylaxis indicated for initial placement of ortho bands /brackets?
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bands - yes
brackets - no |
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is prophylaxis indicated for intraligamentary local anesthetic injections?
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yes
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is prophylaxis indicated for prophy cleaning of teeth where bleeding is anticipated?
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yes
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is prophylaxis indicated for restorative dentistry w/ or w/o retraction cord?
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no
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is prophylaxis indicated for local anesthesia injections?
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no
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is prophylaxis indicated for intracanal endo tx; post placement and core buildup?
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no
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is prophylaxis indicated for placement of rubber dam?
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no
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is prophylaxis indicated for post-op suture removal?
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no
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is prophylaxis indicated for placement of removable prosthodontic or orthodontic appliances?
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no
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is prophylaxis indicated for making oral impressions?
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no
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is prophylaxis indicated for fluoride tx?
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no
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is prophylaxis indicated for exposing radiographs?
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no
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is prophylaxis indicated for ortho appliance adjustment?
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no
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is prophylaxis indicated for shedding of primary teeth?
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no
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is prophylaxis indicated for pts with total joint replacements?
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yes
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what type of prosthetic joint infections occur after microbial contamination of the surgical site during placement of prosthesis?
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early onset
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late prosthetic joint infections occur how long after surgery?
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3+ months
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use of antibiotic prophylaxis is recommended for pts with total joint replacements w/in how long after surgery?
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2 years
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would pts with pins, screws or plates be recommended for antibiotic prophylaxis?
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no
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what conditions would cause a pt to be immune compromised and would require pre-med along with their total joint replacement?
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inflammatory arthropathies, rheumatoid arthritis, systemic lupus erythematosus, drug (steroid therapy), or radiation-induced immunosuppression
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what are some other types of potential high risk pt conditions for total joint infection?
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type 1 diabetes mellitus, previous prosthetic joint infections, malnourishment, hemophilia
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in cardiac pts w/ newly placed coronary artery shunts, why is premed NOT needed after 2 weeks?
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bc the epithelial layer forms and lowers the risk
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what is used for pts with renal disease undergoing hemodialysis? do these people need premed?
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AV shunt - yes
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do pts receiving continuous peritoneal dialysis need premed?
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no
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what is used for pts with hydrocephaly to aid in drainage of CSF from lateral ventricles to venous circulation? do these pts need premed?
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VA shunt - yes
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do pts with ventriculoperitoneal shunts need premed?
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no
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when do HIV/AIDS pts do/do not need premed?
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do - extraction of teeth with abscesses
do not - absence of bacterial infection |
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when do diabetes pts do/do not need premed?
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do - invasive procedures
do not - well controlled or not insulin dependent |
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where do 50% of lupus pts have lesions?
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on heart valves
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condition that requires premed that is an inheritable disorder of connective tissue, that affects skeleton, lungs, eyes, heart and bv's.
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marfan syndrome
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what is the most serious problem related to marfan syndrome?
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MVP with leakage of mitral valve or irregular heart rhythm
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what is the most common bacterial cause of endocarditis in IV drug users?
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Staph aureus
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most frequent human chromosomal abnormality? does it require premed?
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down's syndrome - yes
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is premed recommended for pts with a splenectomy?
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yes
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when is premed not required for pts who have taken fen-phen, pondimin, or redux?
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when cleared by physician
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why is cephalosporin avoided for those on current or recent penicillin therapy?
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possible cross resistance
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