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Pharm 2 > ABX 2 > Flashcards

ABX 2 Flashcards

1
Q
  • Most beta-lactamases do not reduce activity
  • Active against Gram negatives producing b-lactamase
  • Several “Generations”
  • Each successive generation includes more Gram-negative activity
  • Limited side effect profile
  • Safely tolerated in penicillin intolerance history
  • Poor against anaerobes
A

Cephalosporins

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2
Q
  • Excellent GRAM POSITIVE Coverage – Strep. spps. & Staph aureus
  • some gram negative activity:
  • Proteus, E. coli, and Klebsiella (PEcK)
  • Limited oral gram negatives
A

1st gen cephalosporins

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3
Q
  • Still excellent GRAM POSITIVE Coverage – Strep. spps.
  • Some additional gram negatives:
  • Morexella, Haemophilus, Enterobacter, Neisseria
    (More HEN PEcK)
  • Still overall limited oral gram negative
A

2nd gen cephalosporins

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4
Q

Which gen of ceph have highest risk of C diff?

A

3rd gen ceph

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5
Q

What is the normal dose and frequency of ceflex?

A

500 4x a day for 5 days

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6
Q

Metronidazole is bactericidal against ____ bacteria

A

obligate anaerboes

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7
Q

●Bactericidal against all obligate ANAEROBES
Bacteroides spps. and Fusobacterium
●Breaks DNA structure directly through production of free radicals
●Antiprotozoal: amoeba (Entamoeba), Trichomonas, Giardia.

A

Metronidazole (flagyl)

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8
Q

What is the main bacteria that metronidazole acts against?

A

Bacteroides

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9
Q

Adverse Reactions:
●Metallic taste, dry mouth
●Dark urine
●Skin rashes
●Use of alcohol leads to “Antabuse”-type reaction: headache, flushing, NAUSEA
AVOID ALL ALCOHOL, incl. mouthwashes
CYP2C9 Inhibitor: DRUG INTERACTIONSWarfarin (Coumadin)
Lithium
Phenytoin (Dilantin)

A

Metronidazole

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10
Q

Bactrim, Metronidazole and Fluconazole all have what effect on warfarin?

A

Increase conc of active warfarin

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11
Q

●General Medical Uses:
Deep space abscesses
Gastrointestinal infections
●Resistance is not a problem. Given IV or orally.
DENTAL USES:
●Combined w/ -Lactams - 1st Line for serious orofacial
infections“poor man’s Augmentin”
●Management of refractory or progressive periodontitis.
●Rx: Metronidazole 500mg po Q8h x 5days, #15

A

Metronidazole

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12
Q

What are the 3 protein synthesis inhibitor ABX?

A

Clindamycin, macrolides, and tetracyclines

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13
Q

Activity for Gram Positives and Anaerobes
* Strep. & Staph. including MRSA
* Anaerobic gram negatives: Actinomyces, Bacillis, Bacteroides (increasing resistance)
* No aerobic gram-negatives
Clinical advantages
* PVL toxin inhibition
* Biofilm inhibition/penetration
Disadvantages
* C. difficile infection
* Clindamycin oral suspension unpleasant taste
* High doses of oral clindamycin (>450 mg Q6H) may cause esophagitis

A

Clindamycin

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14
Q

Is clinda recommended for ABX prophy for a dental procedure?

A

No

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15
Q

What is the dosage of clinda?

A

150 mg 2x a day for 5 days

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16
Q

What type of drug can enhace risk of c diff?

A

Proton pump inhibitors

17
Q
  • MOA: Bind to 30S subunit of Ribosome
    ● Bacteriostatic
    ● Broad spectrum activity but mostly for gram positives
    ● Requires active transport into cells- source of resistance
    ● Chelate/Bind divalent cations.
    ● Binds with Ca++, Mg++, antacids, iron or multivitamins.
    ● No renal or hepatic adjustment
    ● cleared totally unchanged in fecal excretion
A

Tetracyclines

18
Q

●No longer used for odontogenic infections due to resistance:
■Management of localized juvenile periodontitis (Aggressive Periodontitis) – Aggregatibacter
actinomycetemcomitans (AA) –make -lactamase
■AA sensitive to Tetracyclines, Fluoroquinolones, Bactrim™… ?Augmentin.
■Additive Effects:Concentrates in the gingival crevice extremely well, 7–20 times more than any other drug
Anticollagenase
Anti-inflammatory
Inhibition of bone resorption
Promotes reattachment
Low-dose systemic doxycycline for refractory agg. periodontitis
● Periostat™ (100 mg daily)
● Local application in adjunctive tx for resistant periodontitis:
 Atridox™ gel (doxycycline)
 Arestin™ (minocycline microspheres)

A

Tetracyclines

19
Q

What type of drug is azithromycin?

A

Macrolides

20
Q

What macrolide is. not used?
●Narrow spectrum: LOTS of resistance
■ Adverse effects: Prokinetic, GI disturbances, diarrhea, cramping
■ Strong inhibitor of CYP3A –many drug interactions.
■ Highest QTc prolongation risk among antimicrobials

A

Erthryomycin

21
Q

Which macrolide is not metabolized thru 3a4?

A

Azithromycin

22
Q

● Improved infected tissue penetration and half life
● Concentrates in tissues, phagocytes, & fibroblasts giving it a long half-life.
● No phase I metabolism.
● Eliminated unmetabolized – no drug interactions - no cytochrome inhibition.
● CYP 3A4 interactions: ERY, Clarithromycin&raquo_space;> Azithromycin
● Long half-life (60hrs) - qday dosing. Must use loading dose. (2x)
● Alternative agent for dental/perio infections
Orofacial Infection: 500mg, then 250mg PO Daily x 4 days.Perio Infection: 500mg PO Daily x 5 days
Side Effects:
* Possible reversible tinnitus with large doses
* Liver reports – jaundice, necrosis, failure

A

Azithromycin (zpack)

23
Q

Dental uses: Used in odontogenic and periodontal infections in early, non-abscess
infections as 2nd alternative or in penicillin allergies
■ No activity against Bacteroides, common in dental abscesses
■ Alternative antibiotic in odontogenic infections.
■ Less effective than - Lactams (2nd choice)
■ Overall limit use due to already high resistance rates.

A

Macrolides

24
Q
  • MOA: Inhibit DNA gyrase and topoisomerases
    – Blocks transcription/replication
    – Bactericidal
    – Concentration-dependent killing
    TOns of side effects
A

Fluoroquinolones

25
Q

Joint and tendon toxicity is noted in which abx?

A

Fluoroquinolones

26
Q

agent that can potentially cause a birth defect or negatively alter
cognitive and behavioral outcomes

A

Teratogen

27
Q

What time period of development has the highest potential of teratogenicity for fetus?

A

1st trimester

28
Q

Are the following good or bad for preg?
* Cephalosporins, penicillins, clindamycin, azithromycin

A

Good

29
Q

Good or bad for preg?
* Doxycycline – Ca++ chelation
* Fluoroquinolones – kidneys/cartilage
* Sulfamethoxazole/trimethoprim – various/kernicterus
* Metronidazole in 1st Trimester – limited data

A

Bad

30
Q

ABX indicated?
* NUG – systemic sxs or
immunocompromised
* Aggressive Periodontitis
* Fascial space infection
* Endo/Perio with systemic sxs

A

Yes

31
Q

ABX indicated?
* Endodontic conditions
* Chronic Periodontitis/Gingivitis
* Periodontal Abscess
* NUG – no systemic sxs

A

No

32
Q

Infection of endocardium or valves from blood born bacteria.
85% are staphylococci spps & streptococci spps
~5% caused by HACEK group Gram-Neg’s
(Haemophilus spps, A. actinomycetemcomitans,
Cardiobacterium hominis, Eikenella corrodens,
Kingella kingae)
* HACEK are oral flora with potential for infection.

A

Bacterial infective endocarditis

33
Q

What bacteria is necessary to have activity against ABX prophy?

A

Strep viridans

34
Q

What is the main abx prophy drug?

A

2 g amox

35
Q

What 3 drugs can be used for abx prophy?

A

Amox, cephalexin, and azithromycin

36
Q

Are PJIs a. need for ABX prophy?

A

No

Pharm 2 (12 decks)

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