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Pharmacology DEH2300 > CH8 Anti-infective Pharmacology > Flashcards

CH8 Anti-infective Pharmacology Flashcards

1
Q

_______: Synthetic (made in a laboratory)

(ex: Sulfonamides)

A

Antibacterial agents

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2
Q

______: Derived from microorganisms

ex: penicillin

A

Antibiotics

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3
Q

_______: Ability to kill bacteria

A

Bactericidal

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4
Q

______: Range of anti-infective properties

A

Spectrum

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5
Q

______: Ability of organism to be unaffected by an anti-infective agent.

A

Resistance

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6
Q

________: Appearance of a new infection with other than the original organism while the patient is taking an antimicrobial agent.

An example of this would be candidiasis as a result of taking tetracycline.

A

Suprainfection (superinfection)

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7
Q

_______: Ability to inhibit the growth of bacteria.

Spectrum: Range of anti-infective properties

Resistance: Ability of organism to be unaffected by an anti-infective agent.

Suprainfection (superinfection): Appearance of a new infection with other than the original organism while the patient is taking an antimicrobial agent

A

Bacteriostatic

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8
Q

_____: Effect of two agents used together is greater

A

Synergism

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9
Q

_____: Effect of two agents used together is lesser.

A

Antagonism

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10
Q

_________ develop first during the early stages of dental infection. These aerobes are easy to kill.

A

Gram-positive aerobes

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11
Q

The 1st Choice of antibacterial agents: are _____ and _____.

A

Penacillin, Amoxicillin

  • alternate agent: clindamycin*
  • adjunctive agent: metronidazole*
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12
Q

An antibacterial that is a second-line treatments for dental infection is _______

A

Azithromycin

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13
Q

Drug interactions:

Vitamin K increases the effect of ______.

A

warfarin

aka coumadin

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14
Q

______ reduce gastrointestinal flora that

make vitamin K.

****Is coumadin the antibiodic that does this?***

A

Antibiotics

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15
Q

The mechanism of action for ______ inhibits bacterial cell wall synthesis so it is _______.

A

penicillin; bacteriocidal

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16
Q

Which of the following agents is the drug of choice for an early dental infection unless the patient is allergic to it?

a. Erythromycin
b. Clindamycin
c. Penicillin
d. Metronidazole

A

c. Penicillin
* Penicillin is the drug of choice unless the patient is allergic to it. Amoxicillin is most often used because it is less irritating to the stomach than other drugs and can be taken with food or milk. In patients allergic to penicillin, alternatives might include erythromycin or clindamycin. When the infection is at the mixed stage, agents effective against either gram-positive or anaerobic organisms may be successful. Metronidazole is effective for anaerobic organisms.*

DIF: Comprehension REF: Dental Infection “Evolution” | p. 68 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology

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17
Q

An _____ agent is a substance that destroys or suppresses the growth or multiplication of bacteria.

a. antiinfective
b. antibacterial
c. antibiotic
d. antimicrobial

A

b. antibacterial
* An antibacterial is a broader category than an antibiotic. There are antibacterial agents that are not antibiotics that can act against bacterial infections. Historically, an antibiotic was a chemical substance produced by a microorganism that has the capacity, in dilute solutions, to destroy or suppress the growth or multiplication of another organism or to suppress its action. Although many early antibiotics were derived from natural sources, most are synthesized in laboratories. This difference is largely ignored in general conversation, and antiinfectives and antibacterial agents are often called antibiotics.*

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18
Q

Which of the following choices is the dental hygienist’s biggest dental problem in the adult patient?

A) Caries

B) Periodontal disease

C) Localized dental infection

D) Systemic dental infection

A

B) Periodontal disease
Periodontal disease is the dental hygienist’s biggest dental problem in the adult patient. Current research suggests that periodontal disease may be associated with coronary heart disease. With an increase in knowledge about antiinfective agents, the dental hygienist and dentist will be better able to understand and properly administer the appropriate drug therapy. Use of fluoridated water, local physical removal of bacterial plaque biofilm from teeth on a regular basis, and sealants have reduced the rate of caries. While it certainly is true that local and systemic dental infections are of great concern, they are not the biggest problem in an adult patient for a dental hygienist to manage.

DIF: Recall REF: Introduction | p. 68 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology

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19
Q

Which of the following statements is true of the cephalosporins?

A) They are active against gram-positive but not gram-negative organisms.

B) Those available for oral use are susceptible to penicillinase.

C) They are bacteriostatic.

D) Their mechanism of action is inhibition of cell wall synthesis.

A

D) Their mechanism of action is inhibition of cell wall synthesis.
The mechanism of action of the cephalosporins is like that of the penicillins: inhibition of cell wall synthesis. Cephalosporins are active against a wide variety of both gram-positive and gram-negative organisms. Those available for oral use are relatively acid stable and highly resistant to penicillinase. The cephalosporins, which are bactericidal, are active against most gram-positive cocci, penicillinase-producing staphylococci, and some gram-negative bacteria.

DIF: Comprehension REF: Cephalosporins (Mechanism of Action) | p. 75 OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

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20
Q

A cephalosporin would be most closely related to which of the following agents?

A) Penicillin VK

B) Clarithromycin

C) Ciprofloxacin

D) Doxycycline

E) Clindamycin

A

A) Penicillin VK
Cephalosporins and penicillins have similarities in structure; they are both -lactam antibiotics. They also have the same mechanism of action. Clarithromycin is a macrolide, ciprofloxacin is a fluoroquinolone, doxycycline is a tetracycline, and clindamycin is an analogue of lincomycin, not structurally related to any others. Its mechanism of action is similar to that of macrolides.

DIF: Comprehension REF: Cephalosporins | p. 75

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21
Q

Unlike other antiinfective agents, an additive action may result when _____ is combined with other antimicrobial agents.

a. vancomycin
b. chloramphenicol

c. nitrofurantoin
d. ciprofloxacin

A

d. ciprofloxacin

An additive action may result when ciprofloxacin is combined with other antimicrobial agents. The emergence of organisms resistant to the fluoroquinolones and the cross-resistance among the fluoroquinolones is increasing. Use of fluoroquinolones in chickens may be partially responsible for increasing resistance. The other choices do not have an additive action when combined with other antimicrobial agents.

DIF: Recall
REF: Antimicrobial Agents for Nondental Use (Quinolones (Fluoroquinolones) [Spectrum]) | p. 83 OBJ: 7 TOP: NBDHE, 6.0. Pharmacology

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22
Q

Which of the following are true about sulfamethoxazole (SMX) and trimethoprim (TMP)? (Select all that apply.)

A) They are bactericidal.

B) They act by sequential inhibition of folic acid synthesis.

C) They are used to treat urinary tract infections (UTIs).

D) They are often used to treat refractory periodontitis.

A

A) They are bactericidal.

B) They act by sequential inhibition of folic acid synthesis.

Sulfamethoxazole and trimethoprim are folate synthesis inhibitors. They are commonly used in combination as co-trimoxazole, SMX-TMP, Bactrim, or Septra. This drug is indicated for the treatment of selected urinary tract infections and selected respiratory and gastrointestinal infections. It is used to treat acute otitis media in children. SMX-TMP is bacteriostatic against a wide variety of gram-positive bacteria and some gram-negative bacteria. SMX-TMP has no documented use in dentistry. Pediatric patients coming to the dental office may be taking it to prevent chronic ear infections.

DIF: Recall
REF: Antimicrobial Agents for Nondental Use (Sulfamethoxazole-Trimethoprim) | p. 83 OBJ: 7 TOP: NBDHE, 6.0. Pharmacology

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23
Q

Which of the following combinations of three drugs are administered concurrently in active cases of pulmonary tuberculosis (TB)?

A) Pyrazinamide (PZA), rifapentine, and Rifater

B) Isoniazid (INH), rifampin, and pyrazinamide

C) Ethambutol, isoniazid (INH), and Rifater

D) Rifampin, PZA, and streptomycin

A

B) Isoniazid (INH), rifampin, and pyrazinamide

  • INH, rifampin, and PZA are combined for the treatment of pulmonary TB. INH and rifampin are continued every day for 9 to 12 months. PZA is continued for 2 months. With susceptible organisms, a patient, if compliant, usually becomes noninfective within 2 to 3 weeks. These choices do not represent the combination of three drugs that are administered in active cases of tuberculosis.*
  • DIF: Recall REF: Antituberculosis Agents | p. 84 OBJ: 8 TOP: NBDHE, 6.0. Pharmacology*
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24
Q

If a person with active TB seeks oral health care

A) use standard precautions and treat him or her just as everyone else is treated.

B) schedule him or her as the last patient of the day.

C) contact that person’s physician and delay health care until the disease is no longer in the active state.

D) refer the patient to a hospital with a dental suite for treatment.

A

C) contact that person’s physician and delay health care until the disease is no longer in the active state.
Contact that person’s physician and delay health care until the disease is no longer in the active state. This person should be in the dental office only for evaluation of his or her dental condition and in order to make a referral. These choices do not represent Centers for Disease Control (CDC) recommendations for management of a patient with active tuberculosis.

DIF: Recall REF: Antituberculosis Agents | p. 84 OBJ: 8 TOP: NBDHE, 6.0. Pharmacology

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25
Q

Which of the following agents has poor oral absorption?

a. Nystatin
b. Itraconazole
c. Terbinafine
d. Griseofulvin

A

a. Nystatin
* Nystatin is not absorbed from the mucous membranes or through intact skin; taken orally, it is poorly absorbed from the gastrointestinal tract. Itraconazole, terbinafine, and griseofulvin all have good oral bioavailability.*

DIF: Comprehension REF: Antifungal Agents (Nystatin) | p. 90 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology

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26
Q

Which antifungal agent for oral candidiasis is available as an aqueous suspension?

a. Clotrimazole
b. Ketoconazole
c. Fluconazole
d. Nystatin

A

d. Nystatin
* Nystatin is available as an aqueous suspension, and also as vaginal tablets, cream, ointment, or pastilles. Clotrimazole is available as a troche, ketoconazole, and fluconazole are available as oral tablets.*

DIF: Recall
REF: Antifungal Agents (Nystatin) | p. 90 | Antifungal Agents (Imidazoles [Clotrimazole]) | p. 91 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology

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27
Q

Why would a patient ever take a vaginal tablet of nystatin orally?

The vaginal tablet is dosed once per day, which is less frequently than the oral pastille.

A) The vaginal tablet does not contain sugar.

B) The vaginal tablet does not require a prescription.

C) The vaginal tablet has better flavor than the oral tablet.

D) Only if they did not read the directions and did not know any better.

A

B) The vaginal tablet does not require a prescription.

  • The vaginal tablet does not contain sugar. The aqueous suspension contains 50% sucrose. This can be important for a diabetic patient. The vaginal tablet for oral use is dosed 4 times per day. Nystatin requires a prescription regardless of the delivery form. The vaginal tablet is not flavored for oral use.*
  • DIF: Application REF: Antifungal Agents (Nystatin) | p. 90 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
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28
Q

All of the following are antifungal agents that are useful in dentistry except

a. miconazole.
b. docosanol.
c. clotrimazole.
d. ketoconazole.

A

b. docosanol.
* Docosanol is an antiviral used to treat recurrent orolabial herpes. The other choices listed are used in dentistry.*

DIF: Recall REF: Antifungal Agents (Imidazoles) | p. 90 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology

29
Q

Which of the following statements is true concerning antibiotic resistance?

Natural resistance occurs when an organism that was previously sensitive to an

antimicrobial agent develops resistance.

An increase in the use of an antibiotic in a given population decreases the

proportion of resistant organisms in that population.

Bacterial resistance can occur by the transfer of deoxyribonucleic acid (DNA)

genetic material from one organism to another.

The transfer of genetic material from one organism to another may only occur

among organism of the same species.

A

ANS: C

Bacterial resistance can occur by the transfer of DNA genetic material from one organism to

another via transduction, transformation, or bacterial conjugation. Natural resistance occurs

when an organism has always been resistant to an antimicrobial agent because of the

bacteria’s normal properties, such as lipid structure in the cell wall. Acquired resistance

occurs when an organism thaNt waRs pIreviGouslBy.seCnsiMtive to an antimicrobial agent develops USNT O

resistance. An increase in the use of an antibiotic in a given population increases the proportion of resistant organisms in that population. The transfer of genetic material from one organism to another may occur among very different microorganisms, including transfer from nonpathogenic bacteria to pathogenic bacteria.

DIF: Comprehension REF: Resistance | p. 70 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology

30
Q

Which of the following agents is a nonnucleoside reverse transcriptase inhibitor used to treat HIV infection?

a. Saquinavir
b. Nevirapine
c. Zidovudine
d. Raltegravir

A

b. Nevirapine
* Nevirapine is a nonnucleoside reverse transcriptase inhibitor specific for HIV-1. It inhibits the same enzymes as the nucleoside analogues but does not require bioactivation. Saquinavir is an HIV protease inhibitor. Zidovudine is a nucleoside reverse transcriptase inhibitor. Raltegravir is an integrase inhibitor.*

DIF: Recall
REF: Antiviral Agents (Acquired Immunodeficiency Syndrome [Nonnucleoside Reverse

Transcriptase Inhibitors]) | p. 94 OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

31
Q

Which of the following groups of drugs used to treat HIV can interfere with the action of the HIV-infected cells?

A) Nucleoside reverse transcriptase inhibitors

B) Nonnucleoside reverse transcriptase inhibitors

C) Protease inhibitors

D) Both A and B

E) Both B and C

A

C) Protease inhibitors
The difference between the protease inhibitors and the nucleoside analogs or nucleoside/nucleotide reverse transcriptase inhibitors is that the protease inhibitors can interfere with the action of the HIV-infected cells. Its adverse reactions include rash, hyperglycemia, and paresthesias. The remaining groups of drugs used to treat HIV do not interfere with the action of HIV-infected cells.

DIF: Application
REF: Antiviral Agents (Acquired Immunodeficiency Syndrome [Protease Inhibitors]) | p. 95 OBJ: 3 TOP: NBDHE, 6.0. Pharmacology

32
Q

Which of the following types of HIV drugs are also used to treat hepatitis B? (Select all that apply.)

A) Nucleoside analog or nucleoside/nucleotide reverse transcriptase inhibitors

B) Nonnucleoside analogs or nonnucleoside reverse transcriptase inhibitor

C) Protease inhibitor

D) Fusion/entry inhibitor

E) ntegrase inhibitor

A

A) Nucleoside analog or nucleoside/nucleotide reverse transcriptase inhibitors

Several oral nucleoside/nucleotide analogs are available for the treatment of chronic hepatitis B. The protease inhibitors boceprevir and telaprevir were approved by the Food and Drug Administration (FDA) for use in combination with peginterferon and ribavirin for the treatment of chronic hepatitis C genotype1 infection. The remaining types of HIV drugs are not currently used to treat hepatitis B.

DIF: Application
REF: Antiviral Agents (Chronic Hepatitis [Nucleoside/Nucleotide Analogs]) | p. 97 OBJ: 4 TOP: NBDHE, 6.0. Pharmacology

33
Q

____ is an irrevesible process of killing bacteria, whereas _____ is reversible.

A

bactericidal; bacteriostatic

34
Q

A ____ may be narrow or wide.

A

spectrum

35
Q

_____ is the ability of an organism to be unaffected by an anti-infective agent. It may be natural or acquired.

A

Resistance

36
Q

In the ______ and _____ stages gram-positive and gram-negative anaerobic organisms increase until they coalesce into an absess. At this stage the microorganisms become more ____ to kill.

A

middle and later; difficult

37
Q

_____ are used to treat abscesses and for endocarditis prophylaxis. Rasha nd GI distress are possible adverse effects when using this medication.

___ is a patient care consideration.

A

Penicillins; anaphylaxis

38
Q

______(Cleocin) is an antibacterial agent used in patients who are penicillin-allergic. Its mechanism of action is ______ or ____ depending on the dose.

It _____ bacterial protein synthesis and retards bacterial growth and reproduction.

A

Clindamycin; bacteriacidal or bacteriistatic; inhibits

39
Q

A major adverse effect for clindamycin is ________. Because of this, patient care considerations are severe, persistent diarrhea (C. dif.). If patients experience this they should discontinue drug use.

Patients who are taking this antibacterial agent not use

A

GI distress; anti-diarrheals

40
Q

______ is an antibacterial agent. It causes bacterial DNA to lose its structure so it is _______.

A

Metronidazole; bactericidal

41
Q

______ can be bactericidal or bacteriostatic depenting on the dose. The mechanism of action for this antibacterial agent is the inhibition of bacterial protein synthesis.

It is used in the treatment of upper respiratoy infections.

An example of this agent is ___________ (Zithromax).

A

Macrolide; azithromycin

42
Q

_____ are bacteriostatic agents that inhibit bacterial protein synthesis. It is used to treate dermatologic conditions and periodontitis.

Doxycycline and minocycline are examples of this agent.

(Not really used in dentistry anymore)

A

Tetracyclines

43
Q

Permanent tooth discoloration for children is a patient consideration for patients who take _____

A

Tertracycline

44
Q

___ and periostate are examples of tetracyclines used in dentistry.

A

Arestin

(minocycline microspheres)

45
Q

_____ are antibacterial agents that are very similar to penicllin. It inhibits bacteria cell wall synthesis, therefore, it is _____.

It is organized into “generations” based on its width of spectrum.

A

Cephalosporins; bactericidal

46
Q

_____ have a 10% cross-sensitivity with penicillin.

A

Cephalosporins

47
Q

_______ are used to treat UTIs, otitis media and respiratory infections.

A

Cephalosporins

48
Q

______ are bacteriacidal agents taht antagonize bacterial DNA and promotes breakage of the DNA molecule.

A

Fluoroquinolones

49
Q

Ciproflaxacin (Cipro) and Levoflaxacin are both ______.

A

Fluroquinolones

50
Q

Fluoroquinolones are antibacterial agents that are used to treat upper and lower respiratory infections, and UTIs.

Notable advese effect associated with this drug is spontaneous rupture of the ______,and psychosis

A

achilles tendon

51
Q

____ is a _____antibacterial agent that inhibits bacterial folic acid synthesis.

It is not as effective when compared to other agents

A

Sulfonamides; bacteriostatic

52
Q

_____ is when 2 antibodies are used together to increase_____.

An example of this is Bactrim/Septra.

A

Synergism

53
Q

Adequate fluid intake to prevent crystalluria is a patient consideration for those who take ______

A

Sulfanoamides

54
Q

“RIPE” is an acronym used to help recall drugs associated with what condition?

A

tuberculosis

55
Q

What does RIPE stand for?

A

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

56
Q

The mechanism of action for ______ is bactericidal. A patient consideration when using this drug is red-orange color to ______.

A

Rifampin; bodily fluids

57
Q

_____ is an antituberculosis agent whose bactericidal mechanism of action disupts the cell wall. An adverse side effect of this drug is ______ neuropathy.

If exposed to TB, this drug must be taken for ___ months.

A

Isoniazid; peripheral; 9

58
Q

_____ is used for 2 months in combination with isoniazid and rifampin. This drug is metabolized in the liver so a patient consideration for this drug is _____.

A

Pyrazinamide; hepatotoxicity

59
Q

____ is an ____ antituberculosis agent that impairs bacterial cellular metabolism.

A

Ethambutol; bactericidal

60
Q

_____ are not susceptible to drugs used for other types of infections, so unique agents are required.

A

Fungi

61
Q

____ is an antifungal agent whose mechanism of action is to bind to ergosterol in membranes. It is not absorbed into general circulation.

It is used to treat skin, oral, and vaginal _____.

A

Nystatin; candidiasis

62
Q

Azoles are antifungal agents that inhibit ergosterol via fungal ___ enzymes. An example of an Azole is _____ (fluconazole).

A

P450; Diflucan

63
Q

Azoles ____ the function of the liver.

(Diflucan)

A

slows down

64
Q

____ are obligate intracellular parasites that depend on host cell enzymes for their propagation.

A

Viruses

65
Q

______ are used in the treatment of herpes siplex infections and varicella zoster infections. Its mechanism of action terminates viral DNA. Examples of this type of agent are acyclovir are Valtrex.

A

Antiviral agents

66
Q

____ are used for the treatment of HIV viral infections. The mechanism of action inhbits the enzyme converting viral RNA to DNA.

*Has no effect on cells already infected*

A

RT Inhibitors

67
Q

Nucleoside Reverse Transcriptase Inhibitors and Non-Neucleoside Reverse Transcriptase Inhibitors are antiviral agents used to treat _____.

A

HIV infection

68
Q

_____ inhibitors decrease the production of viral proteins in an HIV postive host.

_____ and hyperlipidemia are both adverse side effects associated with this drug.

A

Protease; hyperglycemia

69
Q

Neuraminidase Inhibitors areused to treat ______. This antiviral agent is moderately effective.

An example of this is Tamiflu.

A

influenza

Pharmacology DEH2300 (23 decks)

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