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83 Cards in this Set

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