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DS2102: Pharmacology > W4: Antimicrobial Therapy and LA in Dentistry > Flashcards

W4: Antimicrobial Therapy and LA in Dentistry Flashcards

1
Q

What are the most common odontogenic infections?

A

Abcess
Cellulitis

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2
Q

What is an abscess and what happens if the abscess is untreated?

A
  • Localized area of inflammation with purulent exudate
  • Pyogenic bacteria (e.g. Streptoccoi)
  • Resists phagocytosis (capsule)
    -Fibroblasts “wall it off”

Untreated abscess:
- Macrophage enzymes breakdown hard and soft tissues
- Treat surgically
* drain pus by extraction or root canal)
* incision to drain soft tissues

  • Cellulitis
  • inflammation of the connecitive tissue
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2
Q

What is maxillary sinusitis and of which origin?

A

Maxillary sinusitis of endodontic origin:
- spread from maxillary posterior teeth
- can be atypical infections
- often unilateral
- apical periodontitis -> periapical mucositis

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3
Q

What is oral candidiasis?

A

Oral candidiasis (thrush)
- endogenous infection
- overgrowth of the yeast *Candida albicans *
* less common C.glabrata, C. tropicalis
- opportunistic pathogen

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4
Q

What are the risk factors to develop oral candidiasis?

A
  • very old or very young
  • In poor health
  • Overuse of antibiotics
  • HIV infection or AIDs
  • Chemotherapy or immunosuppressuve drugs
  • Taking steriod medication
  • Diabetic with high blood sugar
  • Poorly fitting dentures
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5
Q

Define antimicrobial resistance

A

Antimicrobial reistance:

  • the strain of microorganism that is not inhibited or killed by that antimicorbial
  • Failure of a treatment to manage a patients infection
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6
Q

What is the relevance of antimicrobials to dentistry? What is the primary approach? When should antimicrobials be prescribed?

A

Significant portion of clincal work involved dealing with the impact of infection
* caries, periodontal disease, dental abscess, maxillary sinusitis of endodontic origin, candidiasis

Primary approach is surgical
* restorations, scaling and root planing, root canal therapy, properly fitting dentures

Antimicrobials are a useful ADJUNCT therapy but must be a clear need for them
* spreading infections, fever, risk groups

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7
Q

What are the two most common dental prescriptions?

A

Antibiotics
Antifungal

*from the 2021 data

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8
Q

Which bacteria in periodontal disease is developing antimicrobal resistance to which drug?

A

Prevotella resistant to Penicillin (Russia, Romania, Europe)

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9
Q

How can bacteria be reistant to anti-microbial drug?

A

Innate
Acquired

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10
Q

What is innate reistance?

A
  • No mechanism to transport drug into cell
  • Do not contain ore rely on the antibiotics target process or protein
  • example: gram-negative bacteria are naturally resistant to beta-lactams
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11
Q

What is acquired resistance?

A
  • Microorganisms develop genetic mutations that allow them to resist antibiotics
  • Develops with repeated exposure
  • Resistant strains can become dominant
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12
Q

When should antibiotics be used?

A
  • Infection is spreading
    cellulitits
  • Lymph node invovlement
  • Signs of inflammation
  • LA ineffective
  • Systemic involvement (fever malaise)
  • Periodontal disease
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13
Q

When should antibiotics be used with periodontal disease and what is the management?

A
  • Inflammation of the gingiva and periodontal tissues
  • bacteria in plaque
  • Surgical approach if SRP
  • Chlorhexidine mouth wash
  • Moderate to severe- SRP PLUS Amoxicillin/Metronidazole
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14
Q

When should antibiotics be used with prophylaxis?

A
  • Prophylaxis
  • Commonly used to reduce the risk of infective endocarditis
  • Side effect and risk of reistance
  • Prescribe for patients with cardiac conditions and high risk of adverse outcomes
  • Artificalheart valves, history of infective endocarditis, congenital heart conditions, transplant with problem in valve
  • Low SES also a factor
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15
Q

What is infective endocarditis?

A
  • Reapted Group A Strep infecton
  • Strep throat, impetigo, scabies
  • Acute rheumatic fever
  • Autoimmune response, damages heart valves
  • Rheumatic heart disease
  • Bacteremia following dental procedures
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16
Q

What and when is prophylactic therapy?

A
  • Recommended dose 2g amoxicilln orally 1 hour before procedure
  • clindamycin for patients with immediate hypersensitvity to penicillin or cefalexin for non-immediate hypersensitvities
  • Not all procedures
  • only ones with high bacteremia (extraction, SRP)
  • Oral health of patient (full mouth probing with periodontitis)
  • Not restorations, LA administration or probing healthy teeth

https://tgldcdp.tg.org.au/viewTopic?topicfile=infection-prevention-endocarditis&sectionId=abg16-c98-s2#toc_d1e251

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17
Q

What are examples narrow spectrum antibiotics?

A

Penicillin V
Amoxicilln

18
Q

What are examples broad spectrum antibiotics?

A

Co-amoxylav (Augmetin)
Azithromycin
Metronidazole
Clindamycin

*metronidazole is debateable?

19
Q

Which antibiotics are bacteriocidal?

A

Metronidazole
Penicillin

20
Q

Which antibiotics are bacteriostatic?

A

Trimethoprim
Sulfonamides
Tetracycline
Azithromycin

21
Q

Which antibiotics are used for odontogenic infections?

A
  • First line antibiotics
  • Amoxicillin or Penicillin V
  • Allergies (Clindamycin)
    *Second line if necessary
  • Allergy (?)
  • Unresponsive infection
  • Cellulitis
22
Q

Which type of antibiotics contributes to resistance?

A

Broad spectrum

23
Q

Which antibiotics should be used for unresponsive infections?

A
  • Metronidazole plus Amoxicillin or Penicillin V
  • Co-AmonyClav
24
Q

Which antibitoics should be used for:
Maxilliary Sinusitis?
Periocoronitis?
Candidiasis?
Patients on bicillin?

A

Maxilliary Sinusitis: Augmentin

Periocoronitis: Metronidazole or Amoxicillin

Candidiasi: Ampgotericin B

Patients on bicillin: Amoxicillin

25
Q

What is selective toxicity?

A
  • Drug work by disrupting metabolic processes
  • Need drugs that kill or inhibit the microorganism without damaging the host cells
  • side effects
  • Exploit the differences
  • Bacteria (prokaryotes)
  • Fungi, protozoa, helminths (eukaryotes)
  • Viruses (obligaet intracellular)
26
Q

What are adverse reactions?

A
  • Unexpected or unintended effect
  • range from headaches, comiting to liver or kidney injury
  • Dose-related
  • Extension effects or side effects
  • Allergic reaction
  • requires sensitization
  • penicillin
  • Idiosyncratic
  • Not really understood, but may have genetic causes
27
Q

What are the risks and side effects with antibiotics?

A
  • GI upsets are common
    -Nausea, vomitting, diarrhoea
  • Colitis
  • Clostridium dificile infections
    -Broad spectrum antibiotic use (Clindamycin, Co-Amoxyclav)
    -Health-care associated infection
    -Vulnerable people (elderly, history of GI disease)
  • Other infections
    -Fungal infections (on increase)
  • Hypersensitivity reactions
    *Known issue with beta-lactams and sulphonamides *
    -medical history is important
    -immediate hypersensitivity reactions
    anaphylaxis (trouble breathing, low BP, swelling of tongue, swelling of throat- ADRENALINE INJECTION NEEDED)
    -Delayed
    rashes (antihistamines)
28
Q

Which medications do antibiotics interact with?

A
  • Warfarin (clotting factors)
  • Oral contraceptives (enterohepatic cycling)
29
Q

What are risk and side effects of Tetracyclines?

A

Dental staining, enamel hypoplasia, bone deformation
NOT FOR CHILDREN UNDER 12, PREGNANT WOMEN

30
Q

What are the risks and side effects of Metronidazole?

A
  • “Dislfirum-like” reactions- nausea, vomiting, flushing of the skin, tachycardia, shortness of breath
    * AVOID ALCOHOL
31
Q

What are the target sites of antibacterial drugs?

A
  1. Cell wall synthesis
  2. Protein synthesis
  3. Nucleic acid synthesis
  4. Cell membrane function
32
Q

Which antibiotics affect cell wall synthesis?

A
  • Beta lactams and Cephalosporins
    -Example: Penicillin and Flucloxacillin
  • Glycopeptides
    -Exampl: Vancomycin (Gram-positive bacteria only)
  • Target peptidoglycan
  • Allergies
33
Q

Which antibiotics affect protein synthesis?

A
  • Aminoglycosides
  • Tetracyclines
  • Macrolides
  • Chloraphenicol
    *Clindamycin

-Prokaryote ribosomes are 70S
-These drugs interfere with the binding of mRNA to ribosome or translation

34
Q

What antibiotics affect nucleic acid synthesis?

A
  • Sulfonamides
  • Trimethoprim

-Structure of DNA is the same in prokaryotes and Eukaryotes
-Target process

*both of these drugs are BACTERIOSTATIC

35
Q

Which antibiotics target cell membrane function?

A
  • Polymixins
    -Example: Colistin
    -bind to LPS and interact with phospholipids in outer and inner membranes (catinic detergents)
    -Effective against MDR Gram-Negatives (Pseudomonas aeruginosa)
36
Q

What is the target of anti-fungal drugs?

A
  • Cell membrane: β-glucan synthesis
  • Amohotericin B
  • Azoles: Ergosterol
37
Q

What are the genetic aspects of antibiotics resistance?

A

Antibiotic resistance may arise by:
* Spontaneous chormosomal mutation
-alterged protein
-selective advantage
* Horizontal gene transfer
-acquire pieces of DNA from other bacteria

38
Q

What are the mechanisms antibiotic resistance?

A
  • Altered target
    -target enzyme may change sufficiently (by mutation to cause lowered affinity for the antimicrobial drug)
    -Example: mutations in DNA Gyrase and Quinilones
  • Alteration in access to the target site (altered reuptake)
    -Decreased permeability (Vancomycin and Gram-negative bacteria)
    -Active transport (E.Coli and Tetracycline, P.falciparum and Chloroquine, C.albicans and azoles)
  • Drug inactivation
    -production of enzymes that inactive the anti-nacterial agent
    -Example: Beta-lactamases inactivate beta lactams
  • Horizontal gene transfer
    -Plasmids containig reistance genes
39
Q

What is the mechanisms of reistance for Fungi?

A

Similar to bacteria
* efflux pumps
* Decreased permeabilty
* Altered drug targets
* Degradtive enzymes
* Overproduction of target

40
Q

What are local anaethetics sometimes described as?

A

“Membrane stablizers”

41
Q

What do local anaesthetics block?

A

Local anaesthetics are essentially voltage-gated sodium channel blockers

42
Q

What are commonly used local anaesthetics in dentistry and what are local anaesthetics typically delievered with?

A

Commonly used local anaesthetics in dentistry are aminoamides to be metabolized in the liver. These include lignocaine, mepivacaine, articaine, prilocaine. Typically local anaesthetics are delievered with a vasoconstrictor like adrenalne or fenylpressin.

43
Q

What is local anaesthetic ionization?

A

Ionization:

Most local anaesethics are weak bases and mostly ionized at physiological pH. Local anaesthetics usually exist as salts. Terminal amine can exist as tertiary (lipid soluble) or quaternary (ionized/water soluble forms). The degree of ionization changes as molecules cross the axon membrane. Non-ionized (tertiary amine) have a weak channel blocking activity. The local anaesthetics **act on cystosolic side on S6 transmembrane domain. The time of onset is dependent on the solubility. ** Those molecules that are highly lipid soluble cross the interstitial spaces slowly and may be sequestered in myelin and adipose tissues. Inflamed tissues have a lower pH and may therefore be more difficult in achieveing effective local anaesthesia.

DS2102: Pharmacology (6 decks)

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