Flashcards in Exam 2: Antibiotics-Chephalosporins, Macrolindes) Deck (66):
What class of drug is said to be the 'sister' drug to penicillin?
Good news! Cephalosporins are resistant to penicillinases! Bad news, they are still broken down by ______ :(
Cephalosporins are synthesized from ______ _____ mold in seawater!
Since Cephalosporins are like penicillin, they kill bacteria by inhibiting _______ synthesis.
PharmacoKinetics of Cephalosporin: Absorption-Most absorbed well through _____, Some may be delayed by _____ in stomach = results in lower and delayed peak conc....Distribution-Cross the _______; found in high conc in synovial and pericardial fluids...Excretion-Do not undergo appreciable metabolism, Most are excreted in _____
________ reactions are most common for Cephalosporins.
What are two ORAL inflammations that can because by Cephalosporins?? _______ = inflamed tongue; smooth, shiny red.... _______ = inflammation, ulcerations on buccal mucosa
What are our 2 main concerns for adverse reactions with Cephalosporins?!
1.Superinfection (candidiasis) 2.Nephrotoxicity
While unlikely, it is probably wise to not give cephalosporin someone with an allergy to penicillin: If patient had full blown Type I (IgE) mediated allergic reaction (anaphylaxis) = contraindicated (up to ____% of these patients will be cross-sensitive)..SO STEER CLEAR
Cephalosporins are _____ the first choice for an oral facial infection! (although it is effective against: gram ____, gram ____, and _____ bacteria)
NEVER...gram +, gram -, and anaerobic
For Cephalosporin, the spectrum of kill depends on its Generation. The higher the generation, the more _____ the spectrum of kill.
What are the two cephalosporin drugs we need to know?
cephal-exin (Ke-flex), cef-a-droxil
What do all cephalosporin drugs begin with?
cef or ceph
What class of antibiotics is Erythromycin? It is ____ in size, and is synthesized by _______ ______.
Its a Macrolide...large size..Strep Erythraeus (bacteria in soil)
Erythromycin is bactri_____. So its only effective against _______ dividing organisms.
bacterioStatic...actively (can be bactericidal at high doses)
What is the mechanism of action for Erythromycin?
Inhibits protein synthesis by binding to 50s ribosomal subunit
Erythromycin penetrates the cell wall of gram ______ bacteria more readily than that of gram _______ bacteria
Erythromycin is most effective against gram + ______ and gram + _____.
cocci & bacilli, but also effective against some gram negative cocci (Neisseria species) and some gram negative bacilli
PharmoKinetics of Erythromycin-Absorbed from the stomach to the ____, Metabolized and excreted into the
_____, As it goes through the duct, it causes the smooth muscle to constrict, causing ____ back up into the liver, Results in the POTENTIALLY FATAL: cholestatic hepatitis
liver...bile...bile...cholestatic hepatitis (chole=bile, static=stop)
What is the primary excretion of erythromycin?
feces (large molecule!)
As erythromycin passes through the GI tract, it kills bacteria and causes ______, which affects Pt compliance.
Erythromycin is no longer effective against oral organisms due to _______!! It is NO LONGER USED IN the field of ______.
1.Tetnaus 2.Syphilis 3.gonorrhea 4.Acne
Erythromycin is a "_____" drug in dentistry, it adversely interacts with many drugs.
What are 3 reasons why we don't use erythromycin in dentistry?
1.Oral bugs are resistant to the drug 2.GI side effects 3.dangerous drug interactions
Who am I? Bacteriostatic in low doses,Bactericidal at doses used for SBE prophylaxis, An alternative drug to use for antibiotic premedication (see AHA guidelines), Primary indication: used to treat Helicobacter pylori (bacteria that causes gastric and duodenal ulcers)
Who am I? Drug of choice for upper respiratory tract infections; also used for STDs, Alternate drug for antibiotic premedication (see AHA guidelines), Half-life of 70 hours = because of half-life, drug can be taken for only 5 days instead of usual 7-10 days (dose form = _____). Time to reach peak blood level = 4 hours
AZithromycin (Zithromax)....(Z PACK)
What drug comes from the family of Lincosamide? How is it made?
Clindamycin..from Strepomyces lincolnesis (lincoln, NE)
Is clindamycin a macrolide?
NO, its a linocsamide
Cindamycin is produced by adding a ______ group to lincomycin.
What is the mechanism of action for Clindamycin?
bacterial protein synthesis (like erythromycin)
Who am I? Alternative if penicillin-allergic...Alternative drug of choice for mild to early odontogenic infections, Highly effective against most oral pathogens, Most aerobic gram-positive cocci, Staphylococci, Streptococci, Anaerobic gram-negative and gram-positive organisms- Bacteroides...Not effective against gram-negative aerobes or mycoplasma
Clindamycin-indications: infections caused by ______ organisms therefore Orofacial infections and ______ infections caused by anaerobic bacteria..Anerobic ________ (bone infections of the oral cavity)
WHAT IS THE DRUG OF CHOICE FOR DENTAL PATIENTS ALLERGIC TO PENICILLIN???
What is the name of the Clindamycin drug we need to know?
clindamycin HCL (Cleosin)
Who am I? Broad spectrum (some say intermediate)...Primarily effective against gram positive
organisms... Bacteriostatic at therapeutic doses....Potential to be bactericidal...Acid stabile...Absorbed into bone
Clindamycin has no problem being absorbed with _____, and is mainly excreted in ______.
Which drug is associated with pseudomembranous colitis (C.DIFF)?
Clindamycin (& cephalosporin)
When does pseudomembranous colitis caused by antibiotics appear?
weeks/months after antibiotic exposure
80% of C Diff cases are ______ aqured.
In pseudomembranous colitis, ______ _______ acts as an opportunistic pathogen and takes over the GI. It produces a ______.
In C. Diff, should the Pt just take some anti-dirrheals and stop bitching?
NO! C Diff still makes its exotoxin and could ultimately cause perforation of the GI!
What do you recommend to the Pt if you suspect C Diff? (3)
STOP the antibiotic, Wait 72 hours, call physician if it don't stop.
Which antibiotic is associated with raised Wheals?
Which antibiotic Chelates divalent cations? So don't eat/drink ______, _____, or ______!
Tetracycline....dairy, iron, antacids
What is the distinguishing feature of tetracycline's structure?
What is the mechanism of action of tetracycline?
binds to 30s ribosomes and inhibits bacterial protein synthesis
What 2 processes are needed for Tetracycline to reach the ribosome?
1. diffusion through outer cell membrane 2. active transport through inner membrane
Tetracycline is ______ spectrum and bacteri______.
Who am I? Bound to plasma proteins, Widely distributed, Cross placenta, Stored in gingival crevicular fluid, dentin and enamel of unerupted teeth (teratogenic effect)
Tetracycline is primarily excreted in ______.
What are the three main adverse events of tetracycline? What is the FDA teratogen category?
1.Photosensitivity 2.Hepatotoxicity 3.Renal Toxicity (FDA pregnancy category D
Because of Tetracycline's chelating effects, it is incorporated into ______ and ______.
teeth and bone
In tetracycline staining teeth become _____/____ in color. This stain is ______ and cannot be removed.
Dental indication for the use of tetracycline:
What are the three tetracycline drugs to know?
De-oxy-cycline, Mino-cycline, tetra-cycline
What is the most used tetracycline used in dentistry?
Deoxycycline inhibits ________, the enzyme that
breaks down connective tissue and bone.
________ ______ (______) is a subantimicrobial dose that only inhibits collagenase but doesn’t kill bacteria.
doxycycline hyclate (Periostat)
Doxycycline hyclate (Periostat) is a _________ dose that only inhibits collagenase but doesn’t kill bacteria
What is the tetracycline that is applied subgingivally? (2)
Deoxycycline-Atridox, Arestin (minocycline)
What is the most potent tetracycline?
Minocycline causes staining in adult teeth! It travels up the dentinal tubules and is deposited at the _____...exposure to light causes the actual staining because it _______ the molecule..._____-dependent response (not duration)
DEJ...oxidizes (thank you Dr. W!)...DOSE
Which tetracycline is distributed by microsphere sub gingival?
Tetracyclines are CONTRAINDICATED with _______/_______.