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Keeling Spring Textbook > 6. Chemo theraputic agents > Flashcards

6. Chemo theraputic agents Flashcards

1
Q

What are the indications for locally derived anti microbials

A
  1. Unresponsive sites
  2. Pt cannot have complex surgery
  3. Localized diseased sites
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2
Q

What are the desirable traits for anti microbials

A
  1. Sustainable in the site
  2. Cost effective
  3. Low toxicity
  4. High potency
  5. Good permeability
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3
Q

What is the Keys technique

A
  1. SRP
  2. Homecare - baking soda, salt, H202
  3. Oral tetracyclines - in the presence of Spirochaetes
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4
Q

How effective is the Keys technique

A

As effective as conventional therapy

Now discredited

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5
Q

What is the Rosen protocol

A

50/50 mix of H202 and water

Brush after treatment

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6
Q

What is Chlorohexidine

A

Cationic Bisbiguanide - binds to the protein in the pellicle

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7
Q

How does Chlorohexidine work

A

Ruptures cell membrance

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8
Q

What is the advantage of Chlorohexidine

A
  • High substantivity
  • 50% decrease in plaque
  • 45% decrease in gingivitis
  • Released over 6 hours
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9
Q

What are the side effects of Chlorohexidine

What do you need to warn the patient about

A
  1. Increased calculus formation
  2. Chlorohexidine Staining
  3. Alteration in taste
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10
Q

What are the different concentrations of Chlorohexidine

A

USA - 0.12%

Europe - 0.2%

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11
Q

How should patients use Chlorohexidine

A

15ml bid

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12
Q

When should we use Chlorohexidine

A

Before surgery- Reduced pre trt bacterial load by 97%

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13
Q

What effect do the essential oils in Listerine do to reduce gingival inflammation

A

Reduce inflammation by 34%

Affects cell wall

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14
Q

What is Povidone Iodine

Any Issues with it

A
  • Elemental Iodine with Polyvinyl Pyrolidone
  • Broad Spectrum
  • Can stain
  • Combined with H202 to max effectiveness
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15
Q

When use Povidone Iodine

A

NUG in HIV pt

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16
Q

Concerns with Povidone Iodine

A
  • Stain with chronic use
  • Toxic with chronic use
  • not for ladies breast feeding
  • look out for ppl with Shell fish allergies
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17
Q

What are quaternary ammonia compounds

A

Cepacol - Cetylpyridium Chloride

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18
Q

How do quaternary ammonia compounds function

A

Ruptures cell wall

Not as effective as Listerine

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19
Q

What are the problems with quaternary ammonia compounds

A

Low substantivity due to low binding

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20
Q

What is Sanquinairine used for

A
  • Herbal alkaloid from blood root plant

- May reduce plaque and gingivitis

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21
Q

Why do we not use Sodium Hypo

A
  • Bad odor and taste
  • Corrosive
  • Better products available
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22
Q

Is Sodium Hypo effective

A

Yes

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23
Q

Functions of Stannous Flouride

A

Has tin in it
Treats caries
Reduces gingivitis

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24
Q

What is Tricolsan

A

Bisphenol broad spectrum antimicrobial

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25
Q

How does Triclosan function

A
  1. Reduces gingivitis by 20%
  2. Reduce plaque by 25%
  3. Reduce bacterial adhesion
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26
Q

How effective are local agents

A
  • 2 mm in 30-40% of sites
  • range 0.95 - 1.90 mm
  • Hard to know which patients it works in
  • Benefits modest
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27
Q

What is Actisite

A
  • 25% Tetracycline
  • Place 1 mm subging seal with cyanoacrylate

Not available anymore

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28
Q

How does Actisite work

A
  • Reduced PD
  • Reduces BOP
  • Reduces perio pathogens
  • reduces CAL
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29
Q

What is Periochip

A

Chlorohex in a hydrolyzed gel

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30
Q

How is Periochip used

A

Chip put in pocket after initial treatment

When used with SRP improves PD and CAL

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31
Q

What is Atridox

A

Doxycycline Gel 42.5 mg

32
Q

How does Atridox work

A

Placed in pocket and it hardens

Degrades on its own

33
Q

What is Arrestin

A

Minocycline - 1 mg 1 site

34
Q

How do you use Minocycline

A

Its is bioadhesive / Bioabsorbable

Dont brush for 12 h after use
No flossing for 10 days

35
Q

What is metronidazole gel

A

25% Metronidazole in a seasame oil base

36
Q

What about Minocycline ointment

A

2% minocycline

Not available in USA

37
Q

Why do subgingival antibiotics not always work

A
  1. Irregular root surface
  2. Furcation Involvement
  3. Microbes in the periodontal tissue eg P ging, AA.
38
Q

Why dont we do antibiotic testing

A
  • Its very expensive

- But we do not know the causative bacteria

39
Q

What are the disadvantages of systemic A/B

A
  1. Drug interactions
  2. Adverse effects
  3. Allergies
  4. A/B resistance
  5. Disrupt commensal bacteria in body
40
Q

How does systemic A/B reach the sulcus

A

Via transudate

41
Q

Which A/B assoc with photosensitivity

A

The cyclins

42
Q

What A/B interacts with alcohol

A

Metronidazole

43
Q

What A/B contraindications to avoid in pregnancy

A
  1. Cyclins
  2. Metronidazole
  3. Erythromycin
44
Q

What is the risk of systemic A/B in the elderly

A
  1. Drug interaction
  2. Hypersensitivity reaction
  3. Altered metabolic activity
45
Q

What do you need to consider when prescribing AB

A
  1. Route of administration
  2. Frequency of Admin
  3. Dosage
  4. Degree of absorption
  5. Duration of concentration in blood
  6. Metabolism
  7. Excretion
46
Q

What A/B interacts with Warfarin

A

Metronidazole and Erythromycin

47
Q

What A/B interacts with Digoxin

A

Tetracyclines

48
Q

What is the effect of Antacids

A

-Increase absorption of clindamycin and tetracycline

49
Q

What antibiotic used for Spirochetes

A

Metronidazole

50
Q

What is the prescription of AB for perio dx

A
  • 500 mg of Amox
  • 200 mg of Metro
    Each TDS for 8/7
51
Q

What antibiotic for aggressive disease

A

Tetracyclines

52
Q

Who described 2 appointment SRP in 24 hours

A
  • Quirinin

- Reduce colonization from diseased site

53
Q

What compound is Penicillin

A
  • Beta Lactam Ring

- Inhib bacterial wall formation

54
Q

What percentage of adults have Penicillin allergies

A

15%

55
Q

What is Augmentin

A

Amoxicillin and Clavanic Acid

56
Q

How do Tetracyclines work

A

Inhibit protein synthesis

57
Q

What are the advantage of Tetracyclines

A
  • Active against AA
  • Higher concentrations in GCF
  • Anti Collagenase activity
  • Inhibit MMP - Doxy
58
Q

How do Clindamycin and Erythromycin work

A

Attack the 50S sub unit

59
Q

Clindamycin and Erythromycin are what type of AB

A

Macrolides

60
Q

Side effects of Clindamycin and Erythromycin

A

Increased risk of GI issues

61
Q

What anti biotic has good bone penetration

A

Clindamycin

62
Q

How does Metronidazole work

A

Inhibits DNA synthesis

63
Q

Advantages of Metronidazole

A

Good versus anaerobes

Good in NUG/ NUP because good against Spirochetes

64
Q

What is Periostat

How effective is it

A

20mg of Doxycycline

Negative clinical significance
Anti Collagenase
Example of host modulation

18% attachment gain - less than 0.5 mm

65
Q

What are the proposed benefits of NSAID’s in periodontal disease

A

Reduce arachadonic acid and reduce bone resorption along with other aspects of disease processes

Really theoretical

A form of host modulation.

66
Q

Issues with NSAIDs

A

Do not use in renal patients

67
Q

Dose of Amox

A

500 mg tds 8 days

68
Q

Dose of Metro

A

200 - 500 mg tds 8 days

69
Q

Dose of Clindamycin

A

300 mg tds for 8 days

70
Q

Dose of Doxycycline

A

100 mg qds 10-14 days

71
Q

Dose of Cipro

A

500 mg bid 8 days

72
Q

What does the term anti infective therapy mean

A

Indicates both mechanical and chemotheraputic management of patients.

73
Q

What is the Rosen Protocol

A

50/50 mix of H202 and water

Brush after treatment

74
Q

Who gets Atridox

A
  • Pt excellent OH
  • who has has Non Surg Trt
  • Diabetic
  • Used in WHOLE mouth
75
Q

What are the indications for local acting agents

A
  1. Non Responsive sites
  2. BOP
  3. Pockets below 5.5 mm
  4. Pt not good surgical candidates
76
Q

What is control release

A
  • Released over time at a constant concentration continuously

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