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93 Cards in this Set
- Front
- Back
Substances from any source which act against or destroy infections (bacteria, fungi, virus)
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Anti-infective Agents
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Destroys or surpresses the growth or multiplication of bacterial only (topical or systemic forms)
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Antibacterial
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Chemical substances produced by microorganisms which destroy or suppress growth or multiplication of organisms
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Antibiotic
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Substances that destroy or suppress the growth of "ANY" microorganism
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Antimicrobial
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Which agents are both BROAD?
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Anti-infective agents and Antimicrobial Agents
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Which agent acts against or destroys?
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Anti-infective Agents
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Which agent destroys or suppresses growth?
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Antimicrobial Agents
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What are the 2 reasons we use Antibiotics in dentistry?
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Dental Infections and Premedication for Infective Endocarditis
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What are the two types of abcesses?
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Endodontic and Perio or Gingival abcesses
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What are classified as Dental Infections?
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Caries, Periodontal Disease, Localized dental infections (perio or endo related abcesses), Systemic Infections (lesions with systemic symptoms such as fever, malaise, tachycardia) (think bacteremia)
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TRUE or FALSE
The latest thinking in regards to Pre-medication is that the risk of taking preventative Antibodies outweighs the benefits for most patients. |
TRUE
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What are some of the reasons the risk outweight the benefits when taking preventative antibiotics?
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1. Adverse reaction to Antibodies
2. Development of drug resistant strains 3. Hearts are exposed to bacteremia on a daily basis |
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Only the highest risk patients should be premedicated for dental procedures that involve WHAT?
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-Dental Extractions
-Periodontal Procedures (surgery, sub-g placement of antimicrobial, S/RP, probing, cleaning (bleeding expected)) -Placement of dental implant or avulsed teeth - |
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What are the High Risk Areas in the heart for IE?
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Heart chambers and Valves
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What is the sequence of events leading up to IE
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1. Turbulent Blood Flow traumatizes endothelium around the heart
2. Platelets and Fibrin are deposited on the surface of the endothelium. 3.Formation of ninbacterial thrombotic endocarditis (NBTE) on the surface of damaged area (valve, etc.) |
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Why doesnt EVERYONE with a yuck mouth need to be premedicated?
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A normal person's heart lining/valves and immune system are designed to deal with this onslaught of bacteria
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What is the damage that bacteria can do to the valves?
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The already damaged body part now allows bacteria/fungi to collect, grow, colonize causing prolapse, stenosis, blockage, thickening (redundant), and regurgitation
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Means narrowed, wont open as much, could be caused by a blockage or thickening by trauma.
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Stenosis
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Means the flow thats suppose to go through and shut off starts coming back up and pooling.
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Regurgitation
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What are the signs and symptoms of IE.
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-Flu-like symptoms w/ chest pain
-Abdominal pain -Heart palpations -Petechiae of skin and mucosal tissue -Anemic (Pale) Complexion -Blue ro purplish lesions of the skin -Janeway lesions |
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What should you do if IE occur within 2 weeks?
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Go to the emergency room immediately
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What are broken blood vessels manifested as little red dots on the skin and mucosa?
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Petechiae
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Red, flat maucules on the palms of hands and soles of feet.
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Janeway lesions
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What are the 3 things you need to PRE-MEDICATE for?
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1. Prosthetic Cardiac Valve
2. History of Infective Endocarditis 3. Cardiac Transplant which develops a valve problem (valvulopathy, RHD, MVP, etc.) |
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What are the main reasons that people with Systemic to Pulmonary Shunts are still at risk for IE?
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1. Because the shunts are surgically-created connections between aorta and a pulmonary artery
2. These babies are not getting enough blood to the lungs to be oxiginated 3. The shunts increase the blood supply to the lungs and the arterial oxygen saturation 4. Pallative (temporary) measure until surgery is performed |
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What type of heart valve replacement still has to be premedicated?
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Tissue and Mechanical
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This heart valve replacement last longer, and requires coagulation therapy to prevent blood clots, so they have to be on blood thinners such as Coumadin
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Mechanical Valve replacement
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What are the Moderate Risk Conditions that NO LONGER require premedication?
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-Most other congenital cardiac malformations
-Acquired valvular dysfunction (RHD) -Hypertropic cardiomyopathy -Mitral Valve Prolapse |
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What may happen to people with MVP that were previously premedicated?
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A small number may experience IE symptoms after a dental appointment, be sure to review the signs and symptoms of this with the patient.
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TRUE or FALSE
IE is more likely to result form FREQUENT exposure to random bacteremias associated with daily activities rather than from dental appt. |
TRUE
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TRUE or FALSE
The risk from taking Antibiotics is HIGHER or EXCEEDS the benefit. |
TRUE
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TRUE or FALSE
Good Oral Hygiene (plaque control) may reduce the incidence of bacteremias and is more important than premedication |
TRUE
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TRUE or FALSE
Premedication in regards to Prosthetic Joint Replacement is on case by case basis and you need to ALWAYS contact the physician first before prescribing and antibiotic no matter how long the replacement has been |
TRUE
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What is the STANDARD REGIMEN?
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Amoxicillin-2 grams P.O. 30-60 Minutes prior to procedure (child 50mg/kg)
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What is the Standard Regimen for patients ALLERGIC to penicilin/amoxicillin?
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Clindamycin, Cephalexin or Cefadroxil and/or Azitrhomycin or Clarithromycin.
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What is the Regimen for Clindamycin?
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600 mg. orally 30-60 minutes prior to procedure (child 20 mg/kg)
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What is the Regimen for Cephalexin or Cefadroxil?
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2 grams orally 30-60 minutes prior to procedure (child 50mg/kg)
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What is the Regimen for Azithromycin or Clarithromycin
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500 mg orally 30-60 minutes prior to procedure (child 15 mg/kg)
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What does the 2 grams of Amoxicillin equal to?
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4-500 mg capsules
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What does the 600 mg of Clindamycin equal to?
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4-150 mg capsules
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What does the 2 grams of Cephalexin or Cefadroxil equal to?
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4-500 mg capsules
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What does the 500 mg of Azithromycin equal to?
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2-250 mg tablets
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What does the 500 mg of Clairithromycin equal to?
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1-500 mg tablet
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When can Cephalexin or Cefadroxil NOT be given to patients with penicillin/amoxicillin allergies?
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When the allergic reaction is a Type I allergic reaction to penicillin/amoxicillin
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What class do penicillins belong too?
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Class I B-Lactam Antibiotics
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Are B-lactam penicillins Bacteriocidal or Bacterialstatic
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Bacteriocidal
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What are the bacteriocidal effects of penicicillins?
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Inhibits mucopeptide synthesis in cell wall, works on the dividing organism
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What class do cephalosporins belong too?
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Class I B-Lactam Antibiotics
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What is a first generation Cephalosporin that is used in dentistry?
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Cephalexin
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What is class III?
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Tetracycline
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What makes up the class III tetracycline group?
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Tetracycline, Doxycycline and Minocycline.
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Is class III-Tetracyclines bacteriocidal or bacteriostatic?
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Bacteriostatic
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Prevents bacteria from growing-inhibits protein synthesis, it doesnt kill it.
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Bacteriostatic
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Why would you not give Penicillin and Tetracycline together?
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Because tetracycline prevents organism from growing and negates the activity of Penicillin which works on the growing/dividing organisms
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What class does Azithromycin belong to?
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Class IV. Macrolides
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What class does Clindamycin belong too?
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Miscellaneous
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What is the first choice for patients allergic to penicillin?
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Clyndamycin
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What is the percentage that may be at risk for Infective Endocarditis?
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Less than 5% of the US population
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What is the percentage of people who take Antibiotics and have a reaction of some type (rash, etc.)?
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5-10% and .04-.14% have anaphylactic Shock
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What percent of people with anaphylactic reaction dies?
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10% about 400-800 per year.
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What are other factors that may be considered?
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-May be more than 1 organism involved in IE
-IE and LPJI are rare -Patients can cause a bacteremia by themselves -Cost to patient of Ab -Super infections -Toxicity -Bacterial resistance problem are on the rise |
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The natural or acquired ability of an organism to be immune or to resist the effects of an anti-infective agent.
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Resistance
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Generally affect many different types of bugs, but are not lethal. (They are usually bacteriostatic)
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Broad Spectrum
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Selective and usually lethal (bacteriocidal)
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Narrow Spectrum
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TRUE or FALSE
FREQUENT exposure to an antibiotic within a short time frame is likely to produce resistant strains of bacteria |
TRUE
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If an antiobiotic is taken either too often or not long enough to kill a whole family of bacteria--all you do is vaccinate the bacteria against the antibiotic. Then the antibiotic may not work at all. What is this called?
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Bacterial Resistance
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Why premedicate if so many problems with it?
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The AHA (2007) and the ADA still recommend Ab prophylaxis to high risk groups. This is currently the Standard of Care for dentistry in the US.
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What does Standard of Care mean?
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Current Accepted Protocol
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How many requirments/elements do you need to have in the case of anaphylatic reaction that comes to a lawsuit?
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You need to be able to point to the 4 elements/requirements in the chart as reason why you prescribed antibiotic prophylaxis.
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B Lactam antibiotic Penicillin G is bacteriocidal against what common bacteria
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gram- and gram + bacteria.
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What type of penicillin is the 1st choice for abcesses?
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Penicillin V
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What other bacteria is Penicillin G effective on?
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Cocci (strep); spirochetes (syphilis); gram- (gonorrhea)
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Which Penicillin is given orally, producecs higher blood levels than an equivilent amount of the other; more commonly used for the treatment of dental infections.
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Penicillin V
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Which penicillin is better absorbed when taken orally due to the Potassium salt?
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Potassium VK
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What is the most common reaction to Penicillins?
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Rash
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What are the Adverse reaction to Penicillins?
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-Rash
-Anaphylactic Reactions -Delayed Serum Sickness -Oral Lesions |
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What are some of the oral lesions affiliated with adverse reactions of penicillins?
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-Stomatitis
-Furred Tongue -Black tongue -Glossitis -Chelitis |
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What cillin is the preferred prphylaxis by the AHA
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Amoxicilin
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What B-Lactam is more expensive, has a lower incidence of side effects, and is prescribed more by orthopedic surgeions for joint replacement premedication?
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Cephalosporins
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What are the side effects of Tetracycline?
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Tooth staining, GI upset, fungal infection, chemical photosensitivity, contraindications:renal disease
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What tetracyclines are used for Periodontal Disease?
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Acisite-tetracycline cord; Atridox-doxycycline glue; Arestin-minocycline powder; and Periostat-doxycycline low dose pill
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What is Clindamycin used alot for in children?
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Ear infections
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What is the primary alternative to penicillin?
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Clindamycin
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What are some adverse reactions to Clindamycin?
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Pseudomembranous colitis, GI distress to include diarrhea, nausea, vomitting, cramps
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What is the percentage of Chlorhexidine Gluconate in antimicrobial rinses ie:Peridex, Perioguard, Periochip, Handsoap.
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.12%
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What bacterias do Chlorhexadine Gluconate have a bacteriostatic effect on?
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Gram- and Gram +
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What is the side effect of Chlorhexadine Gluconate.
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Teeth Staining
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What is the evolution of Dental Infections?
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-Beginning Gram+ cocci to variety of gram + and gram- anaerobic which equals mixed infection, with time and no treatment the infection consists of predominantly anaerobic flora.
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Choice of Antibiotic
Beginning: Gram + cocci |
Penicillin VK, Amoxicillin
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Choice of Antibiotic
Allergy |
Clindamycin or azithromycin
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Choice of Antibiotic
Mixed Stage: |
Flagyl for gram- anaerobic and Penicillin VK for gram +
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TRUE or FALSE
Clindamycin affects both gram+ cocci and gram+ and gram- anaerobes |
TRUE
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Why would oral contraceptives not work when taking an antibiotic?
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Because the # of bacteria in the intestine falls, making the pill not break down properly and the free estrogen not being released properly.
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