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Lecture 2 Flashcards

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1
Q

Bactericidal or Bacteriostatis preferable?

A

Bactericidal

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2
Q

Antibiotic type that:
Relies less on host immune system
Takes effect more quickly
Maintains effect longer

A

Bactericidal

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3
Q

-Cidal or -Static for Prophylaxis?

A

Bactericidal

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4
Q

See post-antibiotic effects with -cidal or -static?

A

Post antibiotic effects seen with bacterioSTATIC drugs

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5
Q

The persistent suppression of bacterial growth after brief exposure to an antibiotic even in the absence of host defense mechanism

A

Post Antibiotic Effect - might be related to DNA alteration

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6
Q

Why are Z-Packs very good at treating Chronic Bronchitis?

A

Post-Antibiotic Effect! Azithromycin is a -static drug

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7
Q

Want Narrow or Broad Spectrum?

A

NARROW - kills only bacteria we want to kill- less super infection and alteration of normal flora; and often more effective

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8
Q

Penicilllin VK vs Amoxicillin: Broad of narrow?

A

Penicillin VK - narrow; Amoxicillin - broad

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9
Q

If MIC is high or half-life is long, how should you dose the antibiotic?

A

Give a Loading Dose!- 2-4x the therapeutic dose

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10
Q

Dosage is more critical for -static or -cidal?

A

More critical for -Static!!!

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11
Q

Minimum conc. of drug that will prevent visible growth of bacteria in culture after overnight incubation?

A

MIC

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12
Q

How long to take antibiotic?

A

Terminate antibiotic when sure patient is on the way to recovery based on clinical evidence

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13
Q

Adverse effects of antibiotics

A

Toxicity, Allergy, Super Infection

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14
Q

Allergy vs Toxicity

A

Toxicity is DOSE related

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15
Q

GI distress

A

Is a Toxicity of antibiotics

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16
Q

Antibiotics that most often cause Pseudomembranous Colitis

A

Cephalosporins, Ampicillin, Clindamycin

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17
Q

What bacteria causes P. Colitis?

A

C Difficile

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18
Q

Optimal Antibiotic

A

Pencillin

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19
Q

Characteristics of Optimal Antibiotic

A 
Active against pathogens, 
reaches effective concentration, 
low toxicity
Doesn't cause resisitance
Desirable route
Economical
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20
Q

About organisms involved in Orofacial infections

A

Oral bacteria are rarely the primary pathogens

And, generally several organisms, not just one

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21
Q

Type of antibiotic is the widest spectrum

A

Beta-Lactam Antibiotics

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22
Q

Penicillins, Cephalosporins, Carbapenems, monobactams, Carbacephems

A

Beta-Lactam Antibiotics

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23
Q

B-Lactamase resistant Penicillins

A

Oxacillin and Dicloxacillin

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24
Q

Mechanism of action of Penicillins

A

Disruption of cell wall synthesis - prevents cross linking in cell walls- which are only in humans, not bacteria

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25
Good traits of Penicillin V
``` Stable in gastric pH so orally effective Low toxicity Narrow spectrum specific to oral microbes Cidal Inexpensive ```
26
Penicillin G
IV or IM Only!! | Formulated as Aqeous, procaine, or benzathine
27
Drug of Choice for Most Odontogenic Infections
Penicillin
28
Typical Dose for Penicillin
Load w/ 2 grams, then 500mg ever 6 hours
29
Indications for B-Lactamase Resistant Penicillins
Only for proven staphylococcal infections | AKA "Anti-Staph" penicillins
30
B-Lactamase Ressitant Penicillins - reasons we don't use them
Less activity against oral bacteria, | expensive
31
Uses for Amoxicillin
``` Otitis Media, UTI SBE Prophylaxis NOT First line DOC for odontogenic NOT B-lactamase resistant ```
32
Extended spectrum Penicillins
Ampicillin - parenteral Amoxicillin - oral Use for strep, oral anaerobes, H. influenza, E. coli, salmonella, shigella, proteus
33
Best Antibiotic for Prophylaxis
Amoxicillin
34
Advantages of Amoxicillin over Penicillin for Prophylaxis
More predictable absorption- important since only taking once! Longer half life than PCN Higher plasma conc than PCN NOT used for prophylaxis because it is broader spectrum though
35
What is NOT a reason to use Amoxicillin over Penicillin for prophylaxis?
Amox is broader spectrum
36
Extended Spectrum Penicillins
NOT indicated for oral bacteria or head and neck infections | Carbenicillin, Ticarcillin, Piperacillin
37
B-Lactamase action
Cleaves the B-Lactam ring
38
How to combat B-Lactamase
Add R chains or by competitive inhibition
39
The three B-Lactam Inhibitors
Clavulonic Acid Sulbactam Tazobactam
40
Augmentin
Amoxicillin + Clavulonic Acid | Improved staph and H. flu coverage
41
Indications for Augmentin
Otitis Sinus infections not caused by a tooth Bite wounds UTI
42
Unasyn
Ampicillin + Sulbactam | Parenteral
43
Penicillins- Adverse effects
Allergy- 2% of people allergic Antagonistic with -static drugs Decreased excretion in very young and very old
44
DOC for odontogenic infection
Penicillin V
45
Which antibiotic is limited to prophylaxis in dentistry
Amoxicillin because better absorption, but negatively has broader spectrum
46
Which antibiotic reserved for more serious infection
PCN G
47
If significant anaerobic component, may need...
B-lactamase inhibitor or metronidazole
48
Bites, non-odontogenic sinusititis, and otitis require...
Augmentin or other B-lactamase inhibitors
49
Cephalosporins
Four generations, we only use the FIRST GEN
50
Cephalosporins Pharmacology
``` -Cidal - cell wall inhibition B-lactam configuration Low toxicity broad spectrum expensive Don't have as good post-antibiotic effect ```
51
Cephalosporins very good against
Streptococcus and Oral Anaerobes
52
Cephalosporins Indications
Community acquired Staph infection Surgical wound prophylaxis Odontogenic infection in PCN allergic pt
53
1-10% of PCN allergic patients also allergic to
Cephalosporins
54
Avoid if have Cephalosporin allergy
PCN
55
If have PCN allergy avoid
Cephalosporin if PCN allergy is severe | IF its mild, Cephalosporin probably okay
56
Macrolides: Mech
Irreversibly bind 50s ribosomal unit - STATIC | - Inhibit RNA dependent protein synthesis
57
What antibiotics should immunocompromised people not take
-static!!
58
Clarithromycin - when to use in relation to other antibiotics
For if pt allergic to PCN and gets GI problems from clindamycin
59
Clarithromycin: traits
Similar to erythromycin but less resistance, better H. Influenza coverage, less GI distress, expensive
60
Clarithromycin Indications
Sinus infection Mild/moderate odontogenic infection in PCN allergic pts w/ GI sensitive Pneumonia or bronchitis Can use for prophylaxis too
61
Azithromycin - when to use
Should be reserved for URI
62
Azithromycin traits
Similar to Clarithromycin but better against strep and g-anarobes Don't need to time with meals Less GI distress Expensive
63
Marcolides (-mycins) Adverse Effects
``` GI distress (worst with Erythromycin) Ototoxicity Cholestatic jaundice with Erythrmycin Long QT interval/Torsade de Pointes Increased activity of Digitalis Potentiation of oral anticoagulants like Warfarin Adverse reaction with statins - myopathy ```
64
Lincosamides
Clindamycin is the only one we use
65
Clindamycin: Mech
Binds 50s ribosome leading to inhibition of protein synthesis --> -static!
66
2nd line Antibiotic
Clindamycin
67
Clindamycin indications
Chronic recurrent infection Osteomyelitis Odontogenic infection in immunocompromised pt w/ severe PCN allergy
68
Disulfuram Effect seen with what Antibiotics
Metronidazole - make you nauseated with alcohol
69
Metronidazole
``` -cidal - disrupts DNA synthesis Mild toxicity Inexpensive Disrupts Anaerobic bacteria + penicilln for severe infections Effective bone penetration ```
70
Metronidazole Indications
Chronic anaerobic infection | In combo w/ PCN or cephalo for serious odontogenic infections
71
Tetracyclines
Inhibit 30s ribosome --> -static Broad spectrum High resistance Inexpensive
72
Tetracyclines
``` good for resistant bacteria H.bactor related gastric and peptic ulcers For topical therapy Dry socket prevenetion NO indication for odontogenic infection ```
73
Problems w/ tetracycline
Stain teeth permanently | Photosensitivity to sun

Pharm 2 (11 decks)

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