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Pharmacology > Antibiotics Lecture Part 4 > Flashcards

Antibiotics Lecture Part 4 Flashcards

1
Q

Quinolones spectrum of kill:
Bactericidal or Bacteriostatic
Narrow or Broad spectrum

A

Bactericidal
Broad spectrum

  • Like an explosive device! Kills everything
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2
Q

Mechanism of action for quinolones

A

Inhibit DNA synthesis during bacterial replication

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3
Q

T or F, human cells are unaffected by quinolones

A

True

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4
Q

Would drugs like Ciprofloxacin (Cipro), levofloxacin (Levaquin) and norfloxacin (Noroxin) be go-to drugs for orofacial infections?

A

No, these would be quite overkill for typical oral infections

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5
Q

Indications for Quinolones:

A

Medical: to treat resistant organisms

  • Respiratory infections like Bronchitis, community-acquired pneumonia
  • Urinary tract infections

Dentistry: Rarely used in dentistry
- Used to treat periodontal disease when other agents are not effective

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6
Q

Two main drugs in Quinolone family

A

ciprofloxacin (Cipro)

levofloxacin (Levaquin)

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7
Q

Describe the spectrum of kill for Metronidazole

A

Bactericidal
Broad spectrum
Synthetic drug

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8
Q

Why is metronidazole sometimes referred to as an antimicrobial rather than an antibiotic?

A

It is effective against other things than just bacteria.

- Effective as an antibiotic, amebicide, antiprotozoal

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9
Q

Metronidazole is used for what?

A

Used to supplement other antibiotics when periodontal condition is not responding

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10
Q

Is metronidazole susceptible to penicillinase?

A

No

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11
Q

metronidazole is very effective against what type of pathogens?

A

Periodontal pathogens

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12
Q

What are the adverse events of metronidazole?

- Very important!

A
  1. Hematopoietic system
    - leukopenia, thrombocytopenia, aplastic anemia
  2. Metallic taste
  3. Circumoral paresthesia
  4. Oral ulcerations
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13
Q

What is a very dangerous drug interaction with metronidazole?

A

Avoid drinking alcohol while taking metronidazole
- You will get a disulfiram-like reaction used to help people break desire to drink. Symptoms following include nausea, vomiting, flushing, headache, sweating, tachycardia

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14
Q

What should be avoided if a patient is on metronidazole

A

Alcohol-containing mouthwashes should be avoided

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15
Q

Vancomycin belongs to what drug family

A

“miscellaneous” antibiotic

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16
Q

Mechanism of action for Vancomycin

A

Inhibits bacterial cell wall synthesis, but with a different mechanism than the penicillin

  • Used for resistant staph infections, strep infections, enterococcal infections
  • Used to treat antibiotic-induced pseudomembranous colitis caused by C diff
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17
Q

What drug used to be considered one of the last lines of antibiotic defense?

A

Vancomycin

- This prompted the development of new classes of antibiotics in U.S.

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18
Q

Amino glycosides are used for what?

A

Used for severe hospital-acquired infections, antibiotic-resistant infections

19
Q

Are ahminoglycosides used in dentistry?

A

No indication

20
Q

Mechanism of Aminoglycosides

A

Bacterial ribosome is target. Bind to the 30S subunit of the bacterial ribosome and interfere with the formation of the initiation complex, and cause misreading of the mRNA

21
Q

What are the issues with Clarithromycin/Azithromycin

A
  1. Caution in liver disease = hepatotoxic

2. Alters QT interval of the heart = caution with vasoconstrictor

22
Q

Drugs that prolong the QT interval:

A 
Fluoroquinolone antibiotics
- moxifloxacin, ciprofloxacin, levofloxacin
Macrolide antibiotics 
- azithromycin
- clarithromycin
Azole antifungals
- fluconazole
- ketoconazole
- itraconazole
Epinephrine
23
Q

In children, most common medication errors occur how?

A

With incorrect dosing

- Must calculate dose based upon mg/kg body weight

24
Q

What drug interaction should be avoided or wait a minimum of 2 hours between use with tetracycline?

A

Tetracyclines and iron/dairy/antacids

- Chelation reaction, both drugs will pass through GI tract unchanged; no clinical effects

25
Q

Describe how you should respond when a women who is on a hormonal contraceptive needs antimicrobial therapy

A

Consider additional non-hormonal contraception at initiation and for duration of antimicrobial therapy (or for 14 days, which ever is longer), plus 7 more days after completion of antimicrobial therapy.

26
Q

What is the mechanism of why oral contraceptives and antibiotic relationships may not always work together

A

Oral contraceptives are prodrugs. They are hormones activated by gut flora. If an antibiotic is taken and decreases flora, this decreases active hormone, and possible ovulation will occur

27
Q

How common is antimicrobial-induced oral contraceptive failure?

A

in 1% to 3% normal rate of pregnancy. Very RARE

28
Q

T or F, Most of the common drugs like tetracycline, doxycline, ampicillin, metronidazole, etc. do not affect OC steroid levels in women taking combination OC

A

True- but the carious approach is to recommend second form of contraception

29
Q

Warfarin (Coumadin) competes with what in the body?

A

Vitamin K for synthesis of prothrombin or clotting factors in blood which takes place in the liver. Vitamin K is synthesized by gut bacteria.

30
Q

Why is Coumadin not indicated with antimicrobials

A

Because vitamin K is synthesized by gut bacteria, antimicrobials will kill these bacteria, causing decreased levels of Vitamin K. Warfarin then has no competitor, and causes excessive anticoagulation (very thin blood)

31
Q

What are red flag drugs

A

Macrolides
Azole antifungals
- Always check for compatibility prior to prescribing these drugs to medicated patients

32
Q

60% of what infections are caused by drug-resistant microorganisms

A

Hospital-acquired infections or nosocomial infections

33
Q

Genetic origin mechanisms of microbial resistance

A
  1. Chromosomal mutations
    - mutations in genes that code for the drug target; or in the genes that code for drug transport or metabolism
  2. Exchange of genetic material
    - alterations in DNA are transferred from one organism to another
    - occurs with organisms that are in close proximity to one another
34
Q

What are some mechanisms that have been developed in pathogens for microbial resistance

A
  1. developed mechanisms to inactivate drugs before drugs can bind to their targets
  2. Can develop mutations that prevent the uptake of a drug into the cell
  3. Acquire ability to cause active drug efflux from the cell.; activates membrane pumps that push the drug out of the cell
35
Q

T or F, People infected with drug-resistant organisms are less likely to have longer and more expensive hospital stays and less likely to die as a result of the infection

A

False, More likely

36
Q

What is MRSA

A

Methicillin-resistant Staphylococcus aureus

  • Resistant to certain antibiotics
  • Observed with increasing frequency in persons with no links to healthcare systems
37
Q

Name URGENT threat level resistant organisms

A

C difficile

N gonorrhoeae

38
Q

Name SERIOUS threat level resistant organisms

A 
azole resistant Candida
MRSA
S pneumoniae
Salmonella
multidrug resistant tuberculosis
39
Q

Name CONCERNING threat level resistant organisms

A

Vancomcin resistant S aureus (VRSA)

40
Q

Antimicrobial stewards seek to:

A
  1. Achieve optimal clinical outcomes related to antimicrobial use
  2. Minimize toxicity and other adverse events
  3. Reduce the costs of health care for infections
  4. Limit the selection for antimicrobial resistant strains
41
Q

CDC Four Core actions to fight antibiotic resistance

A
  1. Preventing infections, preventing the spread of resistance
  2. Tracking resistance resistance patterns
  3. Improving use of today’s antibiotics (antibiotic stewardship)
  4. Developing new antibiotics and diagnostic tests
42
Q

What is most important action to for improving antibiotic use:

A
  1. Change the way antibiotics are used.

- Up to 50% of all the antibiotics prescribed are not needed or are not prescribed appropriately

43
Q

What are 4 ways we can minimize antibiotic resistance in dentistry

A
  1. Give an adequate dose
  2. Take for an adequate duration
  3. Avoid repeated administration
  4. Avoid topical administration

Pharmacology (24 decks)

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