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55 Cards in this Set
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- Back
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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?
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15 minutes
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What three factors should be considered for endocarditis prophylaxis?
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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 |
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The incidence and magnitude of bacteremias are directly proportional to what?
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to the degree of oral inflammation and infection.
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How is chlorhexidine indicated to reduce the incidence or magnitude of bacteremia?
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15 mm of Chlorhexidine via gentle oral rinsing for about 30 seconds prior to dental treatment
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T/F: sustained or repeated frequent interval use of chlorhexidine is NOT indicated when trying to reduce the incidence of bacteremia,
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TRUE. - it may result in selection of resistant microorganisms
DOSE: 15 mm in 30 seconds |
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Prophylactic administration of abx within how many hours of a procedure has been shown to be effective prophylaxis?
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2 hours
- abx administered 4 hrs after the procedure probably have no effect |
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What bacteria is the most common cause of endocarditis following dental procedures?
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streptococcus viridans
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What is the recommended standard prophylactic regimen to prevent endocarditis?
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one dose of amoxicillin
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what advantages does amoxicillin have over ampicillin and penicillin?
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Amoxicillin is equally effective against hemolytic strep but it is better absorbed from the gastrointestinal tract and provides higher and more sustained serum levels.
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What is the recommended adult dose for prophylaxis with amoxicillin?
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2.0 grams 1 hour before the anticipated procedure
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For individuals unable to take or absorb oral medications for endocarditis prophylaxis , what abx is recommended?
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Ampicillin sodium
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What abxs can be given to pts allergic to penicillins for endocarditis prophylaxis?
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- 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 |
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What abx can be given to a pt that is allergic to penicillin and can't have oral administration?
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Clindamycin phosphate
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Why is Erithromycin not preferred over azithro or claritho - mycin?
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because of gastrointestinal upset and complicated pharmacokinetics
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Is endocarditis prophylaxis recommended in reimplantation of avulsed teeth?
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yes!
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Is endocarditis prophylaxis recommended in root canal tx and SRP?
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yes!
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Is endocarditis prophylaxis recommended initial placement of ortho bands?
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yes! but not brackets
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Is endocarditis prophylaxis recommended intracanal endo tx?
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no!
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Is endocarditis prophylaxis recommended in postoperative suture removal?
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no!
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Is endocarditis prophylaxis recommended in restorative dentistry with retraction cord?
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no!
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During what kind of injection is prophylactic abx recommended ?
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INTRALIGAMENTARY.
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What is the dose of clindamycin given to adults allergic to penicillin?
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Clindamycin - 600 mg 1 hr before procedure
or 20 mg/kg in children 1 hr before procedure |
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What is the dose of azithromycin given to adults allergic to penicillin?
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500 mg 1 hr before procedure
or 15 mg/kg orally 1 hr before procedure in children |
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The systemic fungal infections are classified into what ?
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Opportunistic and Endemic Mycoses
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What is the difference between opportunistic mycoses and systemic mycoses?
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opportunistic - pts who are immunocompromised
endemic- distributed UNEVENLY throughout the the world and have low incidence in temperate climates (blastomycoses, histoplasmosis, coccidiomycoses, sporotrichosis) |
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What is the MOA of Amphotericin B and nystatin?
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forms pores by interacting with ergosterol (major fungal lipid_ to form pores, thus rendering the cell membrane permeable to Na+ K+, and H+ ions.
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What are the clinical uses for Amphotericin B?
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-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 |
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Can Nystatin be given orally?
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yes! but NEVER GIVE PARENTERALYLLY
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What is the DOC for oral monoliasis, thrush, and denture stomatitis?
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topical nystatin
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What is the dosage for Nystatin in the tx of oral candidiasis?
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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 |
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What is the dosage of nystatin for denture stomatitis?
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topically every 6 hours to tissue surface of the denture
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What is the clinical use of Nystatin?
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topical for oral candidiasis (oral monoliasis, thrush, denture stomatitis) and for intestinal candidiasis (esophageal and gastric treatment of candida)
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What is the mechanism of action of Flucytosine?
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It is a base analog that gets converted to fluorouracil by cytosine deaminase and inhibits thymidylate synthase and is fungistatic
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What are the adverse effects of nystatin?
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too toxic parenternally, TERRIBLE FOUL TASTE, mild and transient GI disturbances
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What antifungal is too toxic to be given parenterally and has a terrible foul taste?
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Nystatin
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What are the clinical uses of Flucytosine?
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Systemic candidiasis and cryptococcal infections (AIDS pts)
- In cryptococcal meningitis in combination with amphotericin B in severe infections. |
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What is the adverse side effect of Flucytosine?
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reversible bone marrow suppresion
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What is the mechanism of action of Griseofulvin?
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inhibits mitosis by disrupting spindle formation (microtubule).
- fungistatic - deposits in keratin precursor cells |
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What is the clinical use of Griseofulvin?
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systemic drug in disease of skin, hair, and nails due to microsporum, epidermophyton, and trichopyton
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What is the mechanism of action of imidazoles and triazoles?
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Inhibit ergosterol synthesis and interferes with membranes permeability
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What is the clinical use of clotrimazole?
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topical agent for mucosal and cutaneous infections
- dissolved in mouth 5/day for 2 weeks for oropharyngeal candidiasis (AIDS pts) |
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Which triazole can be given topically and and parenternally?
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Miconazole
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What antifungal is used for the tx of cutaneous candidiasis and vulvovaginitis caused by c.albicans?
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Miconazole
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What is the main use of itraconazole?
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used in the suppressive therapy of histoplasmosis in HIV seropositive patients.
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What antifungal is used in suppresive tx and primary treatment of cryptococcal meningitis in aids pts?
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Fluconazole
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What are the clinical uses of Fluconazole?
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- 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 - |
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What effect do drugs like antacids that reduce gastric pH have on ketoconazole?
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reduce its absorption
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What is the main clinical use of ketoconazole?
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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 |
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What antifungal has adverse effects that include.. gynecomastia, blunts response to ACTH, hepatotoxicity
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Ketoconazole
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What is the mechanism of action of anidulafungin?
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inhibits glucan synthesis (NZ important for formation of B(1,3)-D-Glucan, a major cell wall component
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What is the use of tolnaftate?
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-cream powder or powder aerosol for dermatophyte infections
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What is the MOA of Naftifine?
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an allylamine that inhibits squalene epoxidase.
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What is the use of Terbinafine?
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1% cream that is available orally and locally for onychomucosis
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Therapy of oral candidiasis is carried for how long usually?
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two weeks.
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In patients with liver disease, what form of oral candidiasis tx is preferred?
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nystatin pastilles
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