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Flashcards in Pharmacology II Deck (143):
1

If an antibiotic has the ability to kill bacteria, it is _______.

If an antibiotic inhibits bacterial growth, it is ______.

Bactericidal

Bacteriostatic

2

Antibiotics that are effective against a small number of bacteria are _______.

What is an example of an antibiotic that is only effective against G+ and a few G- bacteria?

Narrow Spectrum

Penicillin

3

Antibiotics that are effective against many bacteria are ______.

What is the antibiotic with that kills the most variety?

Broad Spectrum

Tetracycline (kills G+ and G-, rickettsia, and some viruses)

4

What type of microbe dominates 90-95% the oral microbiome?

G+ strep or staph

5

T/F
All oral and facial infections occur from microorganisms already in the mouth

True

6

What can introduce "outside" oral infections?

Trauma

7

What would be the most likely culprit causing an oral infection?

G+ strep or staph

8

______ is the drug of choice for orofacial infections.

Penicillin

9

What type of Penicillin is the best choice for orofacial infections?

Penicillin V

10

10% of penicillin is removed from the body via _______.

90% is eliminated via ________.

Glomerular filtration (passive)

Tubular Secretion (active)

11

T/F
Penicillin stays in the body a long time

False

*excreted rapidly

12

____% of an oral dose of penicillin is excreted within ____ hrs.

70%

4 hrs

13

T/F
Penicillin is excreted unchanged

True

14

What drug, used to treat gout, is often given before penicillin?

How does it treat gout?

Probenecid (benemid)

Prevents uric acid reabsorption into blood stream

15

How does Probenecid (benemid) compete with penicillin?

Excretory Active Transport system

*Probenecid has higher affinity for excretory process

16

Giving Probenecid (benemid) prior to Penicillin will elevate the serum blood levels of Penicillin by _____.

3-4 times

*prolongs effect of penicillin

17

What enzyme breaks dow the beta lactam ring of the Penicillin molecule?

Penicillinase

18

What type of Penicillin has the following profile:
Bactericidal
Narrow Spectrum
Acid-labile (70-80% broken down by gastric acid)
Penicillinase-labile

Penicillin G

19

T/F
Procain Penicillin G is Penicillin-ase labile

True

20

What type of Penicillin is given either as a repository or IM, is dissolved in oil, and is Penicillinase-labile?

Procain Penicillin G

21

Name 3 types of Penicillin G.

Penicillin G

Procain Penicillin G

Benzathine Penicillin G

22

What type of Penicillin is dissolved in oil and given as a repository or IM, is Penicillinase-labile and is the longest lasting form of penicillin?

Benzathine Penicillin G

23

Given a ______ IM dose after aqueous penicillin, this is the longest lasting form because of no GI absorption.

Benzathine Penicillin G

24

How long does Benzathine Penicillin G last in the plasma?

3 weeks

25

What is the improved, acid stable version of Penicillin G?

aka?

Penicillin V

sodium penicillin V

26

How is Penicillin V taken?

Orally

***not broken down by gastric acid

27

What increases the bioavailability of Penicillin V?

Potassium salt

28

Does penicillinase break down Penicillin V?

Yes

*penicillin-ase labile

29

Name 4 Penicillinase resistant drugs:

(these are only given for infections with penicillinase producing bacteria)

Cloxacillin (canadian)

Dicloxacillin (canadian)

Piperacillin and tazobactam sodium

Ticarcillin and clavulanate potassium

30

What is a Bactericidal, broad spectrum, acid stable, but penicillinase-labile form of Penicillin?

Ampicillin

31

Principen with Probenecid is a ______ spectrum form of penecillin

Broad Spectrum

32

Describe Amoxicillin (Amoxil)

2 things

Broad Spectrum

Penicillinase-labile

33

______ is added to Amoxicillin to make ______

Clavulanic Acid

Augmentin

34

T/F
Augmentin is peniccillinase labile

False

*inhibits beta lactamase

35

Name 4 Narrow Spectrum forms of Penicillin:

Penicillin G

Procain Penicillin G

Benzathine Penicillin G

Penicillin V

36

Name 4 Broad Spectrum forms of Penicillin:

Ampicillin

Principen with Probenecid

Amoxicillin

Augmentin

37

What is the synthetic, beta lactamase inhibiting, broad spectrum antibiotic?

What is it a combination of?

Augmentin

Clavulanic acid and Amoxicillin

38

Name are 3 general adverse affects of penicillin:

Oral Candidiasis

Black hairy tongue

Allergy

39

What type of reaction can Amoxicillin-toxicity induce?

Maculopapular rash

40

What type of reaction can Augmentin induce?

Diarrhea

41

Name 2 types of Repository Penicillin:

Procaine Penicillin G

Benzathine Penicillin G

42

How does Penicillin work?

Structural glycopeptide interference in bacterial cell wall synth.

Cell lysis

(bactericidal)

43

The bacterial spectra of Penicillins can be _____ or ______.

The bacterial spectra of Cephalosporins are _____ in the 1st Generation and _______ in the higher generations.

Narrow, broad

Narrow, Broad

44

Match the following toxicity rxns:

Oral candidiasis, black hairy tongue, maculopapular rash, diarrhea, allergy

Anaphylaxis, fever, rash, eosinophilia, GI upset, glossitis, stomatitis, candidiasis, nephrotoxicity

Penicillins

Cephalosporins

45

T/F
Pts that are intolerant to penicillin may be intolerant to cephalosporins

True

46

Describe Cephalosporins mechanism of action:

What kind of bacteria are most susceptible to Cephalosporins?

similar to penicillin - inhibit bacterial cell wall synthesis

Rapidly dividing bacteria most susceptible

47

Most Cephalosporin absorption occurs in the ______.

This is efficient because...

GI tract

Acid stable (no destruction is stomach like penicillin)

48

T/F
Most penicillins are acid labile so are destroyed by gastric juices

True

49

What type of penicillin is more acid stable and therefore has more uniform absorption?

Penicillin V

50

Name 3 1st generation Cephalosporins (with generic names)

Cephalexin (keflex)

Cefadroxil (duricef)

Cephradine (velosef)

51

Name the Second Generation Cephalosporin we need to know (including generic)

Cefaclor (raniclor)

52

Name 3 macrolide antibiotics:

Erythromycin

Azithromycin

Clarithromycin

53

Name the 6 side effects of Macrolide antibiotics

(erythromycin, azithromycin, clarithromycin)

GI

Cholestatic jaundice (hepatitis)

Allergic rxns

Fever

Eosinophilia

Skin eruptions

54

Name 4 GI side effects of Macrolide antibiotics (erythromycin, azithromycin, clarithromycin)

Stomach pain

Nausea/vomiting

Cramps

Diarrhea

55

Erythromycin is usually _____, but ______ at high doses or when used against susceptible organisms.

Bacteriostatic

Bactericidal

56

Erythromycin is only effective against ________ organisms.

Actively Dividing

57

How does Erythromycin attack bacteria?

(what does it bind? near what? inhibits?)

Binds 50S ribosomal subunit

near peptidyltrasferase

peptide bond formation

***suppresses bacterial growth due to lack of protein production

58

Where is Erythromycin absorbed?

Upper part of intestine

59

T/F
Food reduces the absorption of Erythromycin

True

60

T/F
The effectiveness of Erythromycin is dependent on derivative, dosage, acid stability, and gastric emptying

True

61

T/F
Erythromycin is absorbed topically through mucous membranes

False

*Unknown

62

Describe 2 Aspects of Erythromycin distribution:

Crosses placenta

Distributed to most body tissues (diffuses readily)

63

Most Erythromycin is excreted _______ due to ______.

in Feces

its large size

64

Erythromycin is absorbed from the _____ to the Liver and excreted in the bile.

How can this affect the Bile Duct?

Stomach

Smooth muscles constrict = Cholestatic Hepatitis

65

Erythromycin is excreted primarily in the _____ and secondarily in the ______.

Feces

Urine

66

________ is the primary Macrolide used for antibiotic premedication in Dentistry

________ and ______ are the alternative macrolide antibiotics. (with Brand names)

Erythromycin

Clarithromycis (Biaxin) and Azithromycin (Zithromax)

67

What antibiotic has a similar mechanism to Erythromycin?

(interferes with bacterial protein synth)

Clindamycin

68

Clindamycin is used for infections caused by ________ organisms.

Anaerobic

69

What is the drug of choice if penicillin resistant and have an orofacial infection?

Clindamycin

70

What are 3 cases that would indicate Clindamycin use?

Periodontal/orofacial infections by anaerobes

Anaerobic osteomyelitis (oral bone infection)

Endodontic infections caused by Bacteroides

71

T/F
Clindamycin is effective at penetrating bone and therefore prescribed for Anaerobic Osteomyelitis

True

72

What 2 classes of Antibiotics are most often associated with C. diff?

Clindamycin

Cephalosporins

(C, C, C)

73

What drug is affected by divalent cations in GI absorption?

Tetracycline

74

Why do divalent cations affect Tetracycline so much?

What is this process called?

4 ring structure with OH and O groups

Chelation

75

Ca, Mg, Fe, and Al chelated Tetracycline when _____ is consumed.

Dairy

76

What conditions are contraindicated for Tetracycline administration?

Children developing teeth/bone

Pregnancy

77

What can be incorporated into teeth/bone through chelation?

*causes pitting and yellowing

Tetracycline

78

Tetracyclines are Category _____ and cross the Placenta.

D

79

Why do the chelating effects of Tetracycline incorporating into the enamel become permanent?

Enamel doesn't remodel like bone

80

T/F
Teeth exposed to Tetracycline fluoresce under a black light.

True

81

What is a reversible effect of Tetracycline exposure in children?

What is an irreversible effect?

Bone deposition

May inhibit skeletal growth

82

Name 3 Tetracycline preparations:

Doxycycline

Minocycline

Tetracycline

83

Doxycycline _____, aka ______, inhibits collagenase only (doesn't kill bacteria) at a subantimicrobial dose.

Hyclate

Periostat

84

Tetracyclines are contraindicated with _______/_______.

Penicillin/Amoxicillin

85

Tetracycline is bacterio_______, while penicillin is bacterio______.

Static

Cidal

86

What is an example of another antibiotic that can be prescribed if a patient is already taking Tetracycline?

What kind of antibiotic must be prescribed?

Clindamycin

Bacteriostatic

*static and cidal have antagonistic effects

87

What are 3 Contraindications for Tetracycline?

Pregnancy

Child

Penicillin/Amoxicillin use

88

What are 3 medical indications for Quinolones?

Respiratory infections

Bronchitis, community acquired pneumonia

Urinary tract infections

89

What is a Dental indication for Quinolones?

Periodontal disease when other agents ineffective

***rarely used in Dentistry

90

Quinolones target _______.

DNA topoisomerases

91

The enzyme that relieves tension in DNA as it uncoils is a _______.

________'s target these enzymes to block bacterial replication, transcription, and repair.

Topoisomerase

Quinolones

92

Quinolones are Bacteri_____ and _____ spectrum.

Bactericidal

Broad

93

Describe 3 Adverse events broght on by Quinolones.

GI - Nausea/vomiting, diarrhea, xerostomia

CNS - headache, dizzy, vertigo syncope

Allergy - pruritis (itching), urticaria (hives)

94

What drug deactivates critical enzymes in Anaerobic Bacteria through a cascade of reduction (ferredoxin, pyruvate oxido-reductase, nitroso intermediates) that creates Sulfinamides?

150 enzymes affected

Metronidazole

95

Metronidazole metabolites can also be taken up into ________ and form unstable molecules.

Why does this have little effect on human cells?

Anaerobic Bacterial DNA

Partial reduction of Metronidazole only happens in anaerobic cells

96

T/F
Metronidazole is used to supplement other antibiotics when a perio condition isn't responding to other treatments.

True

97

3 Common adverse side effects of antibiotics:

Candidiasis (black hairy tongue)

Stomatitis (sore mouth)

Glossitis (tongue inflammation)

98

How do antibiotics interfere with oral contraceptives?

Oral contraceptives activated by gut flora

If gut flora damaged, possible ovulation

***use alternative birth control until next cycle

99

Where is the site of antibiotic/oral contraceptive interaction?

Small intestine

100

Warfarin/coumadin (anticoagulant) is affected by antibiotics how?

Antibiotics kill Warfarin's competition - gut flora gobbling up VitaK.

***can experience excessive anticoagulation

101

What class of antibiotics is particularly harmful to gut bacteria and therefore compounds effects of Warfarin/coumadin due to lack of Vitamin K?

Quinolones (cipro)

102

Histamines cause ______, which drops bp

Vasodilation

103

T/F
Tachycardia and reddening of the skin due to vasodilation are consequences of Histamine

True

104

What receptors does Histamine react with in the CV system?

H1

105

What receptors does Histamine react with in the Respiratory tract?

H1

106

Describe Histamines actions in the Respiratory tract:

4 things

Constriction resp smooth muscle

Difficulty breathing

Prostaglandin formation

Inflames airways

107

In the GI tract Histamine acts on Gastric Acid secretion (HCl) through ____ receptors.

Contracts the Ileum through _____ receptors.

H2

H1

108

What do Antihistamines block?

Histamine Receptors (H1 or H2)

*antagonists

109

T/F
Both H1 and H2 mechanism of action for Antihistamines is competitive blockage of receptors

True

110

What is the primary and 2 secondary adverse side effect of antihistamines?

primary - sedation

secondary - xerostomia and CNS

111

T/F
Antihistamines affect children and the elderly differently

True

*stimulation instead of drowsiness (also convulsions)

**also seen in very large doses

112

H1 antihistamine mechanism is competitive blockage. H2 is competitive blockage that reduces what? where? consequence?

cAMP, protein kinase, H/K pump

stomach

inhibits basal/nocturnal HCl (gastric acid) secretion

113

What are the clinical uses of H2 Antihistamines?

GI disorders

*ulcers, GERD, gastric acid hypersecretion, Zollinger-Ellison syndrome

114

What is Zollinger-Ellison syndrome?

Gastrin producing tumor

*hypersecretion HCl

115

H1 antihistamine clinical use includes allergy, pollinosis, urticaria (localized with wheals), anaphylaxis - what are the off-label uses (5)?

Motion sickness

Nausea/vomiting

Dizziness

Sleep

Local anesthetics

116

In oral form antihistamines reverse ______.

In injected form antihistamines reverse _______.

In liquid form antihistamines are for _______.

minor allergic rxns (or pre-op sedation)

major allergic rxns

topical anesthetic (injected in rare cases, used for pts allergic to other locals)

117

What are 3 non-sedating antihistamines?

loratadine (Claritin)

fexofenadine (Allegra)

desloratadine (Clarinex)

118

What is the major side effect of laratadine, fexofenadine, and desloratatine? (Claratin, Allegra, Clarinex)?

Headache

*have long half lives

119

Name 3 Sedating Antihistamines:

Ehanolamines (dophenhydramine/Benadryl)

Alkylaminies (chlorpheniramine/Clor-Trimeton)

cetirizine (Zyrtec)

120

If you have to inject benadryl (ethanolamine) in emergency, how much?

Daily max?

10-50 mg

400 mg

121

What is the primary ingredient in non-habit forming sleep aids like Sminex and Nytol?

Ethanolamine (diphenhydramine/Benadryl)

122

T/F
Off label use of Ethanolamine, unapproved by the FDA, includes insomnia, motion sickness (like Dramamine), nausea, and vomiting

True

123

Alkylamines can be injected in dental emergencies/anaphylaxis at ____ mg and max ____mg daily

10

40

124

What popular OTC antihistamine is approved for treatment of all types of allergens and causes sedation?

cetirazine (Zyrtec)

125

What are 4 H2 receptor blockers used for ulcers/heartburn?

Most dangerous?

Safest?

cimetadine (Tagamet) *most adverse rxns - inhibits cytoP450

famotidine (Pepcid)

nizatidine (Axid)

ranitidine (Zantac) *safest

126

T/F
Immunosuppression, systemic disease, chemo, antibiotics, and hormones can all lead to fungal infections

True

*opportunistic = candida albicans

127

"cottage cheese", pseudomembanous, atrophic tongue, hyperkeratotic appearance, symptomatic geographic tongue, and angular chelitis are all what?

Oral fungal infections

128

Name 3 antifungal agents useful agains Candida albicans:

nystatin (Mycostatin)

clotrimazole (Mycelex)

amphotericin (Amphocin, Fungizone)

129

T/F
Topical vs systemic therapy is preferred for fungal infection

True

130

T/F
Systemic fungal drugs suck b/c they cause dangerous DDI's, promote resistance, and are toxic

True

131

Troches, Pastilles, liquids, and powders are all _____ treatments.

Topical

132

Chorhexidine/Listerine kill ____ species of Candida

7

133

Nystatin binds ____ in fungal cell membrane

Sterols

*changes cell permeability and leaks cell contents

134

What azole has severe CV side effects including neuropathy?

Itraconazole

135

Topical treatment of oral fungal infections is used for minimum of ____ hours after symptoms subside, and the usual treatment is ____ weeks.

*reevaluated?

48 hours

1-2 weeks

*14 days after therapy

136

Because topical agents must be used 5 times/day for 1-2 weeks, what can be a problem?

Compliance

137

What drug is incorporated into viral DNA and inhibits DNA polymerase preferentially?

acyclovir (Zovirax)

138

5 antivirals used to manage Herpes?

acyclovir (Zovirax)

valacyclovir (Valtrex)

penciclovir (Denavir)

docosanol (Abreva)

alcohol/benzalkonium chrolide (Viroxyn)

139

What antiviral treats both HSV1 and HSV2?

acyclovir (Zovirax)

*every 3 hrs apply or no result

140

What antiviral treats HSV2 only (genital)?

valacyclovir (Valtrex)

141

What 3 antivirals treat HSV1 only?

penciclovir (Denavir)

docosanol (Abreva)

alcohol/benzalkonium chloride (Viroxyn)

142

What antiviral must be applied every 3 hrs or no results?

What antiviral is given in 2 doses?

what antiviral is applied every 2 hrs for 4 days?

what antiviral is applied 5 times/day? (never around eyes)

what antiviral is cauterizing and stings?

acyclovir (Zovirax)

valacyclovir (Valtrex)

penciclovir (Denavir)

docosanol (Abreva)

alcohol/benzalkonium chrolide (Viroxyn)

143

Name 2 side effects of systemic antivirals:

Bone marrow suppression

Blood dyscrasias (thrombocytopenia, leukopenia, aplastic anemia)

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