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Textbook > 17 - Systemic Chemotherapeutics > Flashcards

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
Q

Erythromycin drug class

Static/cidal?

MOA?

A

Macrolide

Cidal

Bind 50s ribosome to block protein production

26
Q

Shortcomings of Erythromycin

A

AA, E. corrodens, Bacteroides, and Fusobacterium are HIGHLY resistance

27
Q

Metronidazole drug class

Static/cidal?

MOA?

A

Nitroimidazole

Cidal

Inhibit nucleic acid synthesis

28
Q

Metronidazole is useful against

A

Anaerobes

Spirochetes

29
Q

What is Periostat

A

Subantimicrobial dose doxycycline (SDD)

20mg BID 6-9 months

30
Q

Periostat MOA

A

Down-regulate MMP that are active during ChP

31
Q

Is Periostat useful with SRP?

A

As an adjunct to SRP, SS gains in attachment levels and probe depth reduction compared to SRP alone

32
Q

What does Ibuprofen do in the tissue during healing

A

Inhibit PGE2

33
Q

Is Ibuprofen useful with SRP?

A

No

34
Q

What NSAID was useful for AgP

A

Meclomen

35
Q

What is also a useful adjunct in periodontal therapy

A

Aspirin

36
Q

What ABC can discolor bone?

A

Minocycline

37
Q

Penicillin dosing

A

250-500mg 3-4X

38
Q

Doxycycline dosing

A

200mg day 1

100mg 1x/day

39
Q

Metronidazole dosing

A

250mg tid

OR

500mg bid

40
Q

Erythromycin dosing

A

250mg bid

OR

300mg tid

41
Q

Clindamycin dosing

A

300mg tid

42
Q 
Rank in order of best to worst GI absorption:
Penicillin
Tetracycline
Metronidazole
Erythromycin
Clindamycin
A

Tetracycline Metronidazole/Clindamycin
Penicillin
Erythromycin

43
Q

ABC for AgP (source)

A

Guerrero

500mg Metronidazole and Amoxicillin TID for 8 days

44
Q

Who came up with the 24 hour initial therapy protocol?

What is it?

A

Quirynen

Antibiotics pre-op + NST in 24 hours

45
Q

Who tested SDD + SRP

A

Caton

46
Q

Results of SDD + SRP

A

4-6mm pockets: 18% CAL gain

7+mm pockets: 33% CAL gain, 40% PD reduction

47
Q

Doxycycline side effect

A

Ulcers in esophagus

Textbook (17 decks)

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