6. Chemo theraputic agents Flashcards by Francis Keeling

What are the indications for locally derived anti microbials

Unresponsive sites
Pt cannot have complex surgery
Localized diseased sites

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What are the desirable traits for anti microbials

Sustainable in the site
Cost effective
Low toxicity
High potency
Good permeability

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What is the Keys technique

SRP
Homecare - baking soda, salt, H202
Oral tetracyclines - in the presence of Spirochaetes

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How effective is the Keys technique

As effective as conventional therapy

Now discredited

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What is the Rosen protocol

50/50 mix of H202 and water

Brush after treatment

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What is Chlorohexidine

Cationic Bisbiguanide - binds to the protein in the pellicle

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How does Chlorohexidine work

Ruptures cell membrance

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What is the advantage of Chlorohexidine

High substantivity
50% decrease in plaque
45% decrease in gingivitis
Released over 6 hours

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What are the side effects of Chlorohexidine

What do you need to warn the patient about

Increased calculus formation
Chlorohexidine Staining
Alteration in taste

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What are the different concentrations of Chlorohexidine

USA - 0.12%

Europe - 0.2%

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How should patients use Chlorohexidine

15ml bid

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When should we use Chlorohexidine

Before surgery- Reduced pre trt bacterial load by 97%

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

Reduce inflammation by 34%

Affects cell wall

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What is Povidone Iodine

Any Issues with it

Elemental Iodine with Polyvinyl Pyrolidone
Broad Spectrum
Can stain
Combined with H202 to max effectiveness

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When use Povidone Iodine

NUG in HIV pt

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Concerns with Povidone Iodine

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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What are quaternary ammonia compounds

Cepacol - Cetylpyridium Chloride

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How do quaternary ammonia compounds function

Ruptures cell wall

Not as effective as Listerine

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What are the problems with quaternary ammonia compounds

Low substantivity due to low binding

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What is Sanquinairine used for

Herbal alkaloid from blood root plant

- May reduce plaque and gingivitis

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Why do we not use Sodium Hypo

Bad odor and taste
Corrosive
Better products available

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Is Sodium Hypo effective

Yes

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Functions of Stannous Flouride

Has tin in it
Treats caries
Reduces gingivitis

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What is Tricolsan

Bisphenol broad spectrum antimicrobial

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How does Triclosan function

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

How effective are local agents

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

What is Actisite

- 25% Tetracycline - Place 1 mm subging seal with cyanoacrylate Not available anymore

How does Actisite work

- Reduced PD - Reduces BOP - Reduces perio pathogens - reduces CAL

What is Periochip

Chlorohex in a hydrolyzed gel

How is Periochip used

Chip put in pocket after initial treatment When used with SRP improves PD and CAL

What is Atridox

Doxycycline Gel 42.5 mg

How does Atridox work

Placed in pocket and it hardens | Degrades on its own

What is Arrestin

Minocycline - 1 mg 1 site

How do you use Minocycline

Its is bioadhesive / Bioabsorbable Dont brush for 12 h after use No flossing for 10 days

What is metronidazole gel

25% Metronidazole in a seasame oil base

What about Minocycline ointment

2% minocycline Not available in USA

Why do subgingival antibiotics not always work

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

Why dont we do antibiotic testing

- Its very expensive | - But we do not know the causative bacteria

What are the disadvantages of systemic A/B

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

How does systemic A/B reach the sulcus

Via transudate

Which A/B assoc with photosensitivity

The cyclins

What A/B interacts with alcohol

Metronidazole

What A/B contraindications to avoid in pregnancy

1. Cyclins 2. Metronidazole 3. Erythromycin

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

1. Drug interaction 2. Hypersensitivity reaction 3. Altered metabolic activity

What do you need to consider when prescribing AB

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

What A/B interacts with Warfarin

Metronidazole and Erythromycin

What A/B interacts with Digoxin

Tetracyclines

What is the effect of Antacids

-Increase absorption of clindamycin and tetracycline

What antibiotic used for Spirochetes

Metronidazole

What is the prescription of AB for perio dx

- 500 mg of Amox - 200 mg of Metro Each TDS for 8/7

What antibiotic for aggressive disease

Tetracyclines

Who described 2 appointment SRP in 24 hours

- Quirinin | - Reduce colonization from diseased site

What compound is Penicillin

- Beta Lactam Ring | - Inhib bacterial wall formation

What percentage of adults have Penicillin allergies

15%

What is Augmentin

Amoxicillin and Clavanic Acid

How do Tetracyclines work

Inhibit protein synthesis

What are the advantage of Tetracyclines

- Active against AA - Higher concentrations in GCF - Anti Collagenase activity - Inhibit MMP - Doxy

How do Clindamycin and Erythromycin work

Attack the 50S sub unit

Clindamycin and Erythromycin are what type of AB

Macrolides

Side effects of Clindamycin and Erythromycin

Increased risk of GI issues

What anti biotic has good bone penetration

Clindamycin

How does Metronidazole work

Inhibits DNA synthesis

Advantages of Metronidazole

Good versus anaerobes | Good in NUG/ NUP because good against Spirochetes

What is Periostat How effective is it

20mg of Doxycycline Negative clinical significance Anti Collagenase Example of host modulation 18% attachment gain - less than 0.5 mm

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

Reduce arachadonic acid and reduce bone resorption along with other aspects of disease processes Really theoretical A form of host modulation.

Issues with NSAIDs

Do not use in renal patients

Dose of Amox

500 mg tds 8 days

Dose of Metro

200 - 500 mg tds 8 days

Dose of Clindamycin

300 mg tds for 8 days

Dose of Doxycycline

100 mg qds 10-14 days

Dose of Cipro

500 mg bid 8 days

What does the term anti infective therapy mean

Indicates both mechanical and chemotheraputic management of patients.

What is the Rosen Protocol

50/50 mix of H202 and water | Brush after treatment

Who gets Atridox

- Pt excellent OH - who has has Non Surg Trt - Diabetic - Used in WHOLE mouth

What are the indications for local acting agents

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

What is control release

- Released over time at a constant concentration continuously