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antimicrobials Flashcards

1
Q

which antibiotics’s mechanism of action is inhibiting cell wall synthesis or function?

A

beta lactams

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2
Q

common antibiotics prescribed in dentistry

A

beta lactams group
- penicillin v
- amoxicillin

macrolide group
- clarithromycin

  • metronidazole
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3
Q

is beta lactams penicillin related

A

yes

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4
Q

members of the beta lactam housing tree

A
  1. penicillins
  2. penicillinases resistant
  3. cephalosporins
  4. carbapenems
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5
Q

how do beta lactams work?

A

they work against the peptidoglycan layer in gram positive bacteria

they interfere with penicillin binding proteins which are needed for making the peptidoglycan layer

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6
Q

PBP

A

penicillin binding proteins

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7
Q

what is the name of the enzyme that breaks down beta lactams?

A

beta lactamases (antibiotic resistance)

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8
Q

what micrograms produces beta lactamases

A

prevotella
fusobacteria
mostly gram negative

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9
Q

what is the function of clavulanic acid?

A

beta lactamase inhibitor,

thus protecting the beta lactams from getting broken down before it gets the chance to work

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10
Q

augmentin contains what

A

amoxicillin and clavulanic acid

the clavulanic acid protects amxocillin

little use in dentistry tho

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11
Q

what is ABR?

A

when microorganisms change in ways that render medications used to cure the infections they cause ineffective

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12
Q

basically

antibiotic => penicillin, beta lactams

ABR from bacteria => penicillinases and beta lactamases

A
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13
Q

relevance of klebsiella pneumoniae in dentistry

A

this bacteria is present in ESBL infections

this bacteria is resistant to MANY antibiotics, hard to treat

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14
Q

ESBL full name

A

Extended-spectrum beta-lactamases

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15
Q

how to treat ESBL infections?

A

carbapenems

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16
Q

carbapenems function

A

ultimate beta lactam

they are able to fight against extended spectrum beta lactamases

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17
Q

Enterobacteriaceae structure

A

intestinal bacteria of the small rod family

plasmid encoded

thick capsule

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18
Q

other names of Enterobacteriaceae

A

coliforms
enteric rods

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19
Q

why is it so hard to get rid of Enterobacteriaceae with antibiotics?

A

surrounded by thick capsule that antibiotics have trouble penetrating

they are resistant to very many antibiotics

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20
Q

what enzyme does Enterobacteriaceae produce

A

carbapenemase

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21
Q

CPE

A

carbapenemase producing enterobactericeae

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22
Q

why do we need to worry about CPE?

A
  • carbapenem antibiotics are seen as the last therapeutic option to treat complex infections, and yet CPE can fight these antibiotics, no “higher” antibiotic available
  • transmitted easily in healthcare facilities
  • plasmids can transfer resistance to other strains and species
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23
Q

can we find Enterobacteriaceae in the oral cavity? where else

A

yes, can be carried in the oral cavity

dental relevance also in maxillofacial surgery

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24
Q

how to screen for CPE?

A

rectal swab

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25
what are the CPE protocols for a positive patient in dental hospital?
SIPCEPs
26
mode of transmission of CPE
pets travels household members food
27
what is the mechanism of action of macrolides and clindamycin?
inhibits protein synthesis and inhibits 50S subunit
28
what family does erythromycin and clarithromycin come under
macrolide
29
what is the mechanism of action of tetracyclines?
inhibit 30S subunit inhibit protein synthesis
30
what is the mechanism of action of metronidazole?
inhibits nucleic acid synthesis or function creates free radicals which interfere with the structure and function of bacteria dna PFOR enzyme in anaerobes adds an electron, making metronidazole a reactive anion species that can destroy dna
31
drugs that interferes with 30s subunit on bacteria ribosome?
tetracyclines
32
drugs that interferes with 50s subunit on bacteria ribosome?
macrolides and clindamycin
33
what is metronidazole effective against?
strictly anaerobes
34
which pathogens are strict anaerobes?
anerobic streptococci prevotella species (can be found in acute dental abscess and perio disease)
35
key system in anaerobes that metronidazole acts on?
PFOR system = pyruvate ferredoxin oxido reductase
36
NIM genes
nitro imidazole reductases
37
what happens when bacteria gets the NIM genes
they add two electrons and hydrogen to metronidazole so it bypass the PFOR system to render metronidazole inactive
38
why has there been a 17% increase in dental amoxicillin since 2019?
penicillin v is now recommended as a first line antibiotics for acute dentoalveolar infections
39
how is resistance defined from a biological perspective?
minimum inhibitory concentration MIC disc diffusion testing automated susceptibility testing system - vitek
40
disc diffusion testing measures?
measures zone of inhibition
41
breakpoint
chosen conc of an antibiotic which defines whether a species of bacteria is susceptible or resistant to the antibiotic
42
clinical resistance (EUCAST def)
when infection is highly unlikely to respond even to maximum doses of antibiotics
43
MIC
minimum inhibitory concentration
44
what are some confounding variables, ie variables that affect how an antibiotics performs?
- co morbidities (can affect metabolism of antibiotics) - pus collection (antibiotic cannot penetrate to the center of a pus) - foreign bodies - site of infection (some AB has poor penetration of bone)` - biofilms
45
susceptible vs resistant
susceptible = high likelihood of therapeutic success using a standard dosing regimen resistant = high likelihood of therapeutic failure even when there is increased exposure
46
what does it mean to increase exposure to antibiotics
increase dosage dosing intervals shorter mode of administration distribution of antibiotic interactions with bacteria at site of infection
47
why is pen v recommended over amoxicillin
because amxoxicillin is a broader spectrum antibiotics than can disrupt the commensal flora and cause more harm, example c.diff infection or candidasis
48
does pen v or amxoxicillin have better oral absorption
amox has a higher peak, better oral absorption
49
why do you need to dose more frequently for pen v?
lower peak conc less time above MIC
50
how to determine the killing effect of beta lactams?
killing effect dependent on time ABOVE MIC
51
is beta lactam activity concentration dependent?
no
52
is anginosus streptococci sensitive to pen v and amoxicillin?
yes!
53
is the choice of antibiotics important in treating dental abscess?
all equally as effective once drained, local surgical interventions more important
54
colonization resistance def
Protection against growth of opportunistic microorganism like c diff and candida
55
antimicrobial stewardship
limiting unintended consequences of antimicrobial use
56
does antibiotics cure toothache
no
57
first line therapy in treating dental abscess
pen v
58
recommended dosage for pen v
500mg 6h 5 days
59
does giving a larger dose improve success
larger doses less frequently improves success
60
effect of antibiotic is dependent on what for success
concentration and time **but rmb that pen v and amoxicillin is not dependent on concentration, only time above the MIC
61
does increasing dose increase efficacy ?
increasing dose to achieve higher concentration does NOT increase efficacy once above MIC
62
peak conc of amox and pen v
peak conc amox is 7.5ug/ml peak conc pen v is 4ug/ml

BDS2 BAMS (27 decks)

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