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17 - Systemic Chemotherapeutics Flashcards

1
Q

3 categories of systemic chemotherapeutic agents

A

Antimicrobials
Anti-inflammatory
Protease inhibitors

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2
Q

What makes up anti-infective therapy

A

Mechanical debridement

Chemotherapeutics

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3
Q

Concentration of ABC needed to kill bacteria within a biofilm

A

500X

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4
Q

Problems with SRP alone

A

Unfavorable root anatomy surface or pocket dimensions
Microbes enter dentinal tubules
Microbes enter periodontal tissue
Translocation of pathogens

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5
Q

ABC definition

A

Naturally occurring or synthetic organic substances that can, in low concentrations, kill selective microbes

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6
Q

What ABC can cause a rash

A

Penicillin

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7
Q

What ABC can cause photosensitivity

A

Tetracyclines

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8
Q

What ABC can affect liver cytochromes

A

Metronidazole

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9
Q

What ABC can have effects similar to Antabuse

A

Metronidazole

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10
Q

What ABC can discolor teeth during the calcification process before birth

A

Tetracyclines

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11
Q

What ABC can have teratogenic effects on fetuses

A

Metronidazole

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12
Q

What ABC can cause diarrhea or ulcerative colitis

A

Clindamycin

Erythromycin

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13
Q

6 key considerations to consider when giving a drug

A

1) Route of administration
2) Frequency
3) Dosage
4) Degree of absorption
5) Degree/duration of drug concentration in serum and site of action
6) Metabolism and excretion

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14
Q

ABC/anticoagulant drug interaction

A

Metronidazole + Warfarin

Increase anticoagulant effect

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15
Q

ABC/CHF drug interaction

A

Tetracycline + Digoxin

Tetracycline can increase serum levels of digoxin

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16
Q

3 times we use ABCs in perio

A

1) Therapeutic (ChP, AgP)
2) Prophylactic (Endocarditis)
3) Preemptive

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17
Q

ABC combo for advanced periodontitis cases

Effective against?

A

250-500mg Metronidazole and Amoxicillin tid 8 days

AA

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18
Q

Penicillin drug class

Static/cidal?

MOA

A

Beta lactam

Bactericidal

Inhibition of bacterial cell wall synthesis

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19
Q

2 issues with Penicillin

A

15% hypersensitivity reactions

Bacterial resistance due to beta-lactamases destroying ABC beta-lactam ring

20
Q

What is Augmentin

A

Amoxicillin + Clavulanic acid

21
Q

What does clavulanic acid do

A

Inhibitor of beta-lactamase

22
Q

Tetracycline static/cidal?

MOA

A

Bacteriostatic

Inhibit protein synthesis by blocking 30s subunit

23
Q

Most used tetracyclines in perio?

Why? 3 reasons

A

Minocycline + Doxycycline

1) Completely absorbed through intestine, less effect on gut flora
2) Inhibit tissue collagenase and other MMPs to aid in healing after periodontal therapy
3) More concentrated in GCF

24
Q

Clindamycin drug class

Static/cidal?

MOA?

Problem as Penicillin alternative?

A

Lincosamide

Cidal

Bind 50s ribosome to block protein production

May have sensitivity reaction

25
Erythromycin drug class Static/cidal? MOA?
Macrolide Cidal Bind 50s ribosome to block protein production
26
Shortcomings of Erythromycin
AA, E. corrodens, Bacteroides, and Fusobacterium are HIGHLY resistance
27
Metronidazole drug class Static/cidal? MOA?
Nitroimidazole Cidal Inhibit nucleic acid synthesis
28
Metronidazole is useful against
Anaerobes Spirochetes
29
What is Periostat
Subantimicrobial dose doxycycline (SDD) 20mg BID 6-9 months
30
Periostat MOA
Down-regulate MMP that are active during ChP
31
Is Periostat useful with SRP?
As an adjunct to SRP, SS gains in attachment levels and probe depth reduction compared to SRP alone
32
What does Ibuprofen do in the tissue during healing
Inhibit PGE2
33
Is Ibuprofen useful with SRP?
No
34
What NSAID was useful for AgP
Meclomen
35
What is also a useful adjunct in periodontal therapy
Aspirin
36
What ABC can discolor bone?
Minocycline
37
Penicillin dosing
250-500mg 3-4X
38
Doxycycline dosing
200mg day 1 | 100mg 1x/day
39
Metronidazole dosing
250mg tid OR 500mg bid
40
Erythromycin dosing
250mg bid OR 300mg tid
41
Clindamycin dosing
300mg tid
42
``` Rank in order of best to worst GI absorption: Penicillin Tetracycline Metronidazole Erythromycin Clindamycin ```
Tetracycline Metronidazole/Clindamycin Penicillin Erythromycin
43
ABC for AgP (source)
Guerrero 500mg Metronidazole and Amoxicillin TID for 8 days
44
Who came up with the 24 hour initial therapy protocol? What is it?
Quirynen Antibiotics pre-op + NST in 24 hours
45
Who tested SDD + SRP
Caton
46
Results of SDD + SRP
4-6mm pockets: 18% CAL gain | 7+mm pockets: 33% CAL gain, 40% PD reduction
47
Doxycycline side effect
Ulcers in esophagus

Textbook (17 decks)

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