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Pharmocology > Chapter 7 > Flashcards

Chapter 7 Flashcards

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1
Q

Second only to pain management as the dental problem for which drugs are prescribed

A

Dental infections

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2
Q

Common dental infections include

A

Caries
Periodontal disease
Localized dental infections
Systemic infections

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3
Q

Dental infection progression

A 
Gram positive cocci
Mixed infection (gram + and gram -)
Anerobic ( doesnt like oxygen - gram -)
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4
Q

Gram positive cocci

A

Streptococcus viridans

a-hemolytic streptococci

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5
Q

Mixed infection

A

Peptostreptococcus (peptococcus)

Bacteroides ( porphyromonas and prevotella)

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6
Q

Antibiotcs used in progression of infections

A

Penicillin/Amoxicillin
Macrolid (Erythomycin)
Clindamycin
Metronidazole

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7
Q

The factors that determine the likelihood of a microorganism causing an infection

A

Virulence
inoculum
immunologic response

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8
Q

Culturing

A

Growing the bacteria from a sample of infective exudate

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9
Q

Sensitivity testing

A

Exposing the organism to certain test antibiotics and determing whether the organism is sensitive or resistant

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10
Q

Indications for testing

A

Serious infection
Infection in a compromised patient
Infection that is not responding to treatment

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11
Q

Two types of resistance

A

Natural and acquired

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12
Q

Acquired resistance

A

Decrease in bacterial permeability
Production of bacterial enzymes
Alteration in target site

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13
Q

When prescribing antibiotics

A

Only when necessary

Only prescribe one unless two is absolutely necessary

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14
Q

Indications for antimicrobial agents

A

Therapeutic indications

Prophylactic indications

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15
Q

Disadvantages of antimicrobial agents

A 
Superinfection
Allergic reactions
Drug interactions
GI complaints
Pregnancy
Dose forms
Cost
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16
Q

Drug interactions of antimicrobial agents

A

oral contraceptives and oral anticoagulants

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17
Q

Four major groups of penicillins

A

Penicillin G and V
Pennicillinase-resistant penicillians
Amoxicillin
Extended spectrum penicillins

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18
Q

Advantages of oral administration of penicillins

A

Convenience

Less likelihood of life threatening allergic reaction

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19
Q

Disadvantages of oral administration of penicillins

A

Blood levels rise more slowly
Blood levels are less predictable
Lack of patient compliance
Degraded by gastric acid

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20
Q

Pharmacokinetics of penicillins

A

Distributed throughout body except cerebrospinal fluid, bone and assesses
Crosses the placenta; appears in breast milk
Metabolized by hydrolysis in liver
Undergoes tubular secretion in kidneys
Bactericidal agent that attaches to penicillin-binding proteins on the bacterial cell membrane

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21
Q

Adverse reactions to penicillins

A 
Toxicity
Convulsions
Renal damage
Hemolytic damage
Bone marrow depression
Penicillinase resistance
GI irritation
Sterile absesses
Thrombophlebitis
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22
Q

Allergy and hypersensitivity to penicillins

A 
Anaphylatic reactions
Rash
Delayed serum sickness
Oral lesions
Interstital nephritis
Hemolytic anemia
Eosinophilia
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23
Q

Uses of penicillin

A

Treatment of dental infections

Effective against many aerobic and anerobic bacteria

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24
Q

Used for specific prophylactic indications

A

Amoxicillin

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25
Ampicillins
Penicillinase-susceptible agents
26
Advantages of amoxicillin
Produces higher blood levels Better absorbed Requires less frequent dosing Absorption is not impaired by food
27
Cephalosporins
Structually related to penicillins Active against gram + and gram - organisms True antibiotics Adminstered orally, IV and IM
28
Pharmacokinetics of cephalosporins
Well absorbed orally Excreted by glomerular filtrations and tubular secretion in the urine Half-lives vary between 50 to 240 minutes Inhibition of cell wall synthesis
29
Adverse reactions of cephalosporins
``` GI Nephtotoxicity Superinfection Local reaction Hemostasis and disulfiram-like reactions Allergy ```
30
Macrolides
Erythomycin Clarithomycin Azithomycin
31
Interferes with protein synthesis by inhibiting the enzyme peptide transferase at the P site of the 50S ribosomal subunit
Erythomycin
32
Erythomycin is not effective against many infections caused by
obligate anaerobes ( bacteroides species) involved in some dental infections
33
Adverse reactions of erythomycin
GI Cholestatic jaundice May inhibit hepatic metabolism of some drugs Increase serum concentrations of some drugs > toxicity
34
Azithromycin and Clarithromycin
Inhibit RNA-dependant protein synthesis by binding to the 50S ribosomal subunit
35
Adverse reactions of Azithromycin
Elevate liver function tests GI Drug interactions
36
Adverse reactions of Clarithromycin
Produce metallic taste GI Drug interactions
37
Tetracyclines
Broad-spectrum antibiotics affection a wide range of microorganisms
38
First isolated from a strain of Streptomyces
Tetracyclines
39
Secreted in the saliva and breast milk
Tetracyclines
40
Stored in dentin and enamel of unerupted teeth
Tetracyclines
41
Where is tetracycline concentrated
Gingival crevicular fluid
42
All tetracyclines cross
the placenta and enter fetal circulation
43
Tetracycline (broad spectrum)
Effective against a wide variety of gram + and gram - bacteria
44
Adverse reactions of tetracyclines
GI Diarrhea Yellowish-brown discoloration of tongue Candidiasis
45
Diarrhea with tetracycline
Staphylococcal enterocolitis Intestinal candidiasis Pseudomembranous colitis
46
Effects of teeth and bones with tetracycline
Produce permanent discoloration and enamel hypoplasia Decrease in growth rate of bones Minocycline can cause black pigmentation of mandibular and maxillary alveolar bone and the hard palate
47
Drug interactions of tetracycline
Drug enhancement | Increase effectiveness of oral coagulants
48
Uses for tetracycline
``` Chlamydial and rickettsia infections Treat acne COPD Travelers diarrhea Perio conditions ```
49
Clindamyciin (Cleocin)
Bacteriostatic Effective primarily against gram + organisms and anaerobic Bacteroides species Derived from lincomycin
50
Distribution of Clindamycin
Throughout most of the body tissues, including bone, but not the CSF Crosses the placenta barrier
51
Adverse reactions of clindamycin
``` GI Glossitis and stomatitis Pseudomembranous colitis Superinfections by C. albicans Affect elements in blood Allergy Morbilliform ```
52
Uses of clindamycin
Infections caused by anaerobic organisms especially Bacteroides species Some staphylococcal infections when the patient is allergic to pencillin
53
Metronidazole
An antiinfective agent with trichomonacidal, amebicidal, and bactericidal action Also has antiinflammatory effects
54
Inhibits nucleic acid synthesis leading to death of the organism
Metronidazole
55
Adverse reactions of metronidazole
``` GI CNS Renal toxicity Transient neutropenia Oral effects ```
56
Oral effects of metronidazole
``` Dry mouth Unpleasant or metallic taste Altered taste of alcohol Glossitis Stomatitis Black hair tongue ```
57
Drug interactions of metronidazole
Can potentiate the effect of Warfarin | Phenobarbital and phenytoin can reduce plasma levels of metronicazole
58
Uses of metronidazole
Anaerobic spectrum | Treatment of trichomoniasis, giardiasis, amebiasis, and susceptible anaerobic bacterial infections
59
Treatment of peio infections EXCEPT against A. actinomycetemcomitans
Metronidazole
60
Stage 1 of dental infections
Gram + - acute abscesses Penicillin V ( not allergic to penicillin) Amoxicillin Erythomycin (for pts allergic to penicllin) Clindamycin (for pts allergic to penicillin)
61
Stage 2 of dental infections
``` Gram + organisms --> Penicillin or amoxicillin -->Erythomycin or clindamycin Anaerobes -->Clindamycin -->Metronidazole --> Penicillin V ```
62
Stage 3 of dental infection
Anaerobic Most often incision and drainage are sufficient If chronic infection persists or the pt is immunocompromised, use of antibiotic with anaerobic coverage is warranteed
63
Rationale for use of antiinfective agents in dentistry
``` Pt compliance Ineffective antibiotic Poor debridement Resistant organism Concentration did not reach site of infection Host defenses inadequate ```
64
Uses of sulfonamides
Chronic bronchitis | UTIs
65
Antituberculoni agent
Isoniazid
66
How to decide if patient needs antibiotic prophylaxis
``` Prevention of infective endocarditis Prosthetic joint prophylaxis Noncardiac medical conditions Prosthetic cardiac valve Previous infective endocarditis Congenital heart disease ```

Pharmocology (12 decks)

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