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Pharmocology > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

Second only to pain management as the dental problem for which drugs are prescribed

A

Dental infections

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2
Q

Common dental infections include

A

Caries
Periodontal disease
Localized dental infections
Systemic infections

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3
Q

Dental infection progression

A 
Gram positive cocci
Mixed infection (gram + and gram -)
Anerobic ( doesnt like oxygen - gram -)
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4
Q

Gram positive cocci

A

Streptococcus viridans

a-hemolytic streptococci

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5
Q

Mixed infection

A

Peptostreptococcus (peptococcus)

Bacteroides ( porphyromonas and prevotella)

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6
Q

Antibiotcs used in progression of infections

A

Penicillin/Amoxicillin
Macrolid (Erythomycin)
Clindamycin
Metronidazole

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7
Q

The factors that determine the likelihood of a microorganism causing an infection

A

Virulence
inoculum
immunologic response

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8
Q

Culturing

A

Growing the bacteria from a sample of infective exudate

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9
Q

Sensitivity testing

A

Exposing the organism to certain test antibiotics and determing whether the organism is sensitive or resistant

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10
Q

Indications for testing

A

Serious infection
Infection in a compromised patient
Infection that is not responding to treatment

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11
Q

Two types of resistance

A

Natural and acquired

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12
Q

Acquired resistance

A

Decrease in bacterial permeability
Production of bacterial enzymes
Alteration in target site

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13
Q

When prescribing antibiotics

A

Only when necessary

Only prescribe one unless two is absolutely necessary

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14
Q

Indications for antimicrobial agents

A

Therapeutic indications

Prophylactic indications

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15
Q

Disadvantages of antimicrobial agents

A 
Superinfection
Allergic reactions
Drug interactions
GI complaints
Pregnancy
Dose forms
Cost
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16
Q

Drug interactions of antimicrobial agents

A

oral contraceptives and oral anticoagulants

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17
Q

Four major groups of penicillins

A

Penicillin G and V
Pennicillinase-resistant penicillians
Amoxicillin
Extended spectrum penicillins

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18
Q

Advantages of oral administration of penicillins

A

Convenience

Less likelihood of life threatening allergic reaction

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19
Q

Disadvantages of oral administration of penicillins

A

Blood levels rise more slowly
Blood levels are less predictable
Lack of patient compliance
Degraded by gastric acid

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20
Q

Pharmacokinetics of penicillins

A

Distributed throughout body except cerebrospinal fluid, bone and assesses
Crosses the placenta; appears in breast milk
Metabolized by hydrolysis in liver
Undergoes tubular secretion in kidneys
Bactericidal agent that attaches to penicillin-binding proteins on the bacterial cell membrane

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21
Q

Adverse reactions to penicillins

A 
Toxicity
Convulsions
Renal damage
Hemolytic damage
Bone marrow depression
Penicillinase resistance
GI irritation
Sterile absesses
Thrombophlebitis
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22
Q

Allergy and hypersensitivity to penicillins

A 
Anaphylatic reactions
Rash
Delayed serum sickness
Oral lesions
Interstital nephritis
Hemolytic anemia
Eosinophilia
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23
Q

Uses of penicillin

A

Treatment of dental infections

Effective against many aerobic and anerobic bacteria

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24
Q

Used for specific prophylactic indications

A

Amoxicillin

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25
Q

Ampicillins

A

Penicillinase-susceptible agents

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26
Q

Advantages of amoxicillin

A

Produces higher blood levels
Better absorbed
Requires less frequent dosing
Absorption is not impaired by food

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27
Q

Cephalosporins

A

Structually related to penicillins
Active against gram + and gram - organisms
True antibiotics
Adminstered orally, IV and IM

28
Q

Pharmacokinetics of cephalosporins

A

Well absorbed orally
Excreted by glomerular filtrations and tubular secretion in the urine
Half-lives vary between 50 to 240 minutes
Inhibition of cell wall synthesis

29
Q

Adverse reactions of cephalosporins

A 
GI
Nephtotoxicity
Superinfection
Local reaction
Hemostasis and disulfiram-like reactions
Allergy
30
Q

Macrolides

A

Erythomycin
Clarithomycin
Azithomycin

31
Q

Interferes with protein synthesis by inhibiting the enzyme peptide transferase at the P site of the 50S ribosomal subunit

A

Erythomycin

32
Q

Erythomycin is not effective against many infections caused by

A

obligate anaerobes ( bacteroides species) involved in some dental infections

33
Q

Adverse reactions of erythomycin

A

GI Cholestatic jaundice
May inhibit hepatic metabolism of some drugs
Increase serum concentrations of some drugs > toxicity

34
Q

Azithromycin and Clarithromycin

A

Inhibit RNA-dependant protein synthesis by binding to the 50S ribosomal subunit

35
Q

Adverse reactions of Azithromycin

A

Elevate liver function tests
GI
Drug interactions

36
Q

Adverse reactions of Clarithromycin

A

Produce metallic taste
GI
Drug interactions

37
Q

Tetracyclines

A

Broad-spectrum antibiotics affection a wide range of microorganisms

38
Q

First isolated from a strain of Streptomyces

A

Tetracyclines

39
Q

Secreted in the saliva and breast milk

A

Tetracyclines

40
Q

Stored in dentin and enamel of unerupted teeth

A

Tetracyclines

41
Q

Where is tetracycline concentrated

A

Gingival crevicular fluid

42
Q

All tetracyclines cross

A

the placenta and enter fetal circulation

43
Q

Tetracycline (broad spectrum)

A

Effective against a wide variety of gram + and gram - bacteria

44
Q

Adverse reactions of tetracyclines

A

GI
Diarrhea
Yellowish-brown discoloration of tongue
Candidiasis

45
Q

Diarrhea with tetracycline

A

Staphylococcal enterocolitis
Intestinal candidiasis
Pseudomembranous colitis

46
Q

Effects of teeth and bones with tetracycline

A

Produce permanent discoloration and enamel hypoplasia
Decrease in growth rate of bones
Minocycline can cause black pigmentation of mandibular and maxillary alveolar bone and the hard palate

47
Q

Drug interactions of tetracycline

A

Drug enhancement

Increase effectiveness of oral coagulants

48
Q

Uses for tetracycline

A 
Chlamydial and rickettsia infections
Treat acne
COPD
Travelers diarrhea
Perio conditions
49
Q

Clindamyciin (Cleocin)

A

Bacteriostatic
Effective primarily against gram + organisms and anaerobic Bacteroides species
Derived from lincomycin

50
Q

Distribution of Clindamycin

A

Throughout most of the body tissues, including bone, but not the CSF
Crosses the placenta barrier

51
Q

Adverse reactions of clindamycin

A 
GI
Glossitis and stomatitis
Pseudomembranous colitis
Superinfections by C. albicans
Affect elements in blood
Allergy
Morbilliform
52
Q

Uses of clindamycin

A

Infections caused by anaerobic organisms especially Bacteroides species
Some staphylococcal infections when the patient is allergic to pencillin

53
Q

Metronidazole

A

An antiinfective agent with trichomonacidal, amebicidal, and bactericidal action
Also has antiinflammatory effects

54
Q

Inhibits nucleic acid synthesis leading to death of the organism

A

Metronidazole

55
Q

Adverse reactions of metronidazole

A 
GI
CNS
Renal toxicity
Transient neutropenia
Oral effects
56
Q

Oral effects of metronidazole

A 
Dry mouth
Unpleasant or metallic taste
Altered taste of alcohol
Glossitis
Stomatitis
Black hair tongue
57
Q

Drug interactions of metronidazole

A

Can potentiate the effect of Warfarin

Phenobarbital and phenytoin can reduce plasma levels of metronicazole

58
Q

Uses of metronidazole

A

Anaerobic spectrum

Treatment of trichomoniasis, giardiasis, amebiasis, and susceptible anaerobic bacterial infections

59
Q

Treatment of peio infections EXCEPT against A. actinomycetemcomitans

A

Metronidazole

60
Q

Stage 1 of dental infections

A

Gram + - acute abscesses
Penicillin V ( not allergic to penicillin)
Amoxicillin
Erythomycin (for pts allergic to penicllin)
Clindamycin (for pts allergic to penicillin)

61
Q

Stage 2 of dental infections

A 
Gram + organisms
--> Penicillin or amoxicillin
-->Erythomycin or clindamycin
Anaerobes
-->Clindamycin
-->Metronidazole
--> Penicillin V
62
Q

Stage 3 of dental infection

A

Anaerobic
Most often incision and drainage are sufficient
If chronic infection persists or the pt is immunocompromised, use of antibiotic with anaerobic coverage is warranteed

63
Q

Rationale for use of antiinfective agents in dentistry

A 
Pt compliance
Ineffective antibiotic
Poor debridement
Resistant organism
Concentration did not reach site of infection
Host defenses inadequate
64
Q

Uses of sulfonamides

A

Chronic bronchitis

UTIs

65
Q

Antituberculoni agent

A

Isoniazid

66
Q

How to decide if patient needs antibiotic prophylaxis

A 
Prevention of infective endocarditis
Prosthetic joint prophylaxis
Noncardiac medical conditions 
Prosthetic cardiac valve
Previous infective endocarditis
Congenital heart disease

Pharmocology (12 decks)

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