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Pharm 2 final > Contemporary Antibiotics > Flashcards

Contemporary Antibiotics Flashcards

1
Q

why should you start with empiric therapy instead of definitive therapy for odontogenic infections?

A

b/c fairly predictable for odontogenic infections and inadequate time for cultures to grow

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2
Q

what is bacteriCIDAL more preferable than bacterioSTATIC abx?

A

cidal drugs…

  1. rely less on host immune system
  2. take effect more quickly
  3. maintain their effect longer, making exact dosing interval less critical
  4. very important for prophylaxis since the goal is to destroy all bacteria
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3
Q

post antibiotic effect (PAE)

A

persistent suppression of bacterial growth after a brief exposure (1 or 2 hours) of bacteria to an abx even in the absence of host defense mechanisms

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4
Q

what may be related to post antibiotic effect (PAE)?

A

DNA alteration

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5
Q

why is a narrow spectrum abx better?

A
  1. often more effective

2. less alteration of normal flora so less super infection

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6
Q

examples of narrow spectrum abx

A
  1. penicillin VK

2. penicillin G +metronidazole

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7
Q

examples of broad spectrum abx

A
  1. amoxicillin
  2. cephalexin
  3. unasyn
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8
Q

dosage of abx are determined by what?

A

minimum inhibitory concentration (MIC)

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9
Q

what happens if abx dosage is too high?

A

toxicity

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10
Q

what happens if abx dosage is too low?

A

resistence

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11
Q

T/F: there has been increasing evidence that “loading dose” is helpful (2-4x’s therapeutic dose)

A

true

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12
Q

how is minimum inhibitory concentration (MIC) measured?

A

in vitro

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13
Q

T/F: minimum inhibitory concentration (MIC) only serves as a guide to abx dosing therapy since we cannot tell what concentration is at infection

A

true

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14
Q

what is minimum inhibitory concentration (MIC)?

A

minimum concentration of a drug that will prevent visible growth of bacteria in culture after an overnight incubation

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15
Q

T/F: rebound of infection is common in oral/facial infection of odontogenic origin

A

false, rare

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16
Q

what is the general rule of thumb when it comes to duration of abx?

A

terminate abx when sure patient is on the way to recover based on clinical evaluation

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17
Q

adverse effects of abx

A
  1. toxicity
  2. allergy
  3. super infection
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18
Q

which drugs in particular causes hepatotoxicity?

A

antifungals

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19
Q

which drugs causes nephrotoxicity?

A
  1. penicillin

2. aminoglycosides

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20
Q

which drugs causes neurotoxicity?

A

aminoglycosides

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21
Q

which drug causes blood and blood forming organs?

A

chloramphenicol

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22
Q

how does chloramphenicol cause blood and blood forming organs?

A

destruction of normal flora needed for vitamin K absorption

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23
Q

what does an allergy serve as?

A

haptans binding with host protein

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24
Q

which category of drugs are more prone to allergies?

A

penicillin

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25
Q

what percent of the population has a cross-allergy to penicillin and cephalosporin?

A

10-15%

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26
Q

what is often confused with true allergy?

A

toxicity or side effect

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27
Q

superinfection is more common with what?

A

broad spectrum therapy

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28
Q

examples of superinfection?

A
  1. pseudomembranous colitis (Clostridium difficile)

2. candida

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29
Q

what can increase or decrease effectiveness of abx?

A

birth control pills

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30
Q

which abx may cause pseudomembranous colitis (Clostridium difficile)?

A
  1. cephalosporins
  2. ampicillin
  3. clindamycin
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31
Q

what is no longer used to treat pseudomembranous colitis (Clostridium difficile)?

A

oral vancomycin

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32
Q

what is now used to treat pseudomembranous colitis (Clostridium difficile)?

A

metronidazole

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33
Q

what makes an optimal abx?

A
  1. active against pathogen
  2. reaches effective concentration
  3. low toxicity
  4. not cause resistence
  5. desirable route
  6. economical
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34
Q

T/F: oral bacteria are rarely primary pathogens causing orofacial infection

A

true, there are several organisms not just one

35
Q

beta-lactam abx

A
  1. penicillins
  2. cephalosporins
  3. carbapenems
  4. monobactams
  5. carbacephems
36
Q

what is the widest spectrum of activity of all antibacterials?

A

beta-lactam antibiotics

37
Q

which are natural penicillins?

A

PCN V and G

38
Q

which are B-lactamase resistant penicillins?

A
  1. oxacillin

2. dicloxacillin

39
Q

which are extended spectrum penicillins?

A
  1. amoxicillin group (i.e. ampicillin)

2. anti-pseudomonas group (i.e carbenicillin)

40
Q

which are extended spectrum PCN with B-lactamase inhibitors?

A
  1. Augmentin

2. Unasyn

41
Q

mechanism of action of penicillins

A

cell wall synthesis disruption by preventing cross linking

42
Q

penicillin V is a combination of what?

A

potassium or sodium to make a salt

43
Q

what is the most common penicillin V?

A

PCN VK

44
Q

pros of penicillin V

A
  1. stable in gastric pH so orally effective
  2. low toxicity
  3. narrow spectrum specific to oral microbes
  4. cidal
  5. inexpensive
45
Q

T/F: penicillin V has less activity against gram negative bacilli than extended spectrum penicillins

A

true

46
Q

how is penicillin G administrated?

A

IV or IM only since unstable in gastric contents

47
Q

what is the drug of choice for most odontogenic infections?

A

penicillion

48
Q

dosage of penicillin

A

may load with up to 2 grams followed by 500mg every 6 hours

49
Q

dosage of penicillin may need to be decreased in who?

A

patients with renal compromise and infants

50
Q

B-lactamase resistant penicillins are also known as what?

A

“anti-staph” penicillins

51
Q

which B-lactamase resistant penicillin is the prototype?

A

methicillin hence term “methicillin resistant staph” or MRSA

52
Q

how is oxacillin given?

A

parenteral

53
Q

how is dicloxacillin given?

A

oral

54
Q

cons of B-lactamase resistant penicillins

A
  1. less activity against oral bacteria

2. expensive

55
Q

when are B-lactamase resistant penicillins indicated?

A

for proven staphylococcal infections

56
Q

how is ampicillin given?

A

parenteral

57
Q

how is amoxicillin given?

A

oral

58
Q

extended spectrum penicillins (amoxicillin group) are given for which type of bacteria?

A
  1. streptococcus
  2. oral anaerobes
  3. H. influenza
  4. E. coli
  5. salmonella
  6. shigella
  7. proteus
59
Q

when is amoxicillin indicated?

A
  1. otitis media
  2. UTI
  3. SBE prophylaxis
  4. maybe for odontogenic infection if culture and specifity indicates use
60
Q

T/F: amoxicillin is B-lactamase resistant

A

false, is NOT

61
Q

why is amoxicillin given for SBE prophylaxis instead of PCN VK?

A
  1. more predictable absorption
  2. longer half life
  3. higher plasma concentration than PCN VK
  4. PCN VK not used because of broader spectrum
62
Q

dosage regimen for amoxicillin and SBE prophylaxis

A

500 mg q 8h

63
Q

examples of extended spectrum penicillins (anti-pseudomonas penicillins)

A
  1. carbenicillin
  2. ticarcillin
  3. piperacillin
64
Q

T/F: extended spectrum penicillins (anti-pseudomonas penicillins) are effective against oral bacteria

A

false

65
Q

when is extended spectrum penicillins (anti-pseudomonas penicillins) not indicated?

A

for any head and neck infection as DOC

66
Q

B-lactamase fxn

A

enzyme that cleaves B-lactam ring

67
Q

how is B-lactamase combated?

A

by increasing “R” chains or by competitive inhibition

68
Q

B-lactam inhibitors currently available

A
  1. clavulonic acid
  2. sulbactam
  3. tazobactam
69
Q

mechanism of action of B-lactam inhibitors

A

bind to active site of B-lactamase

70
Q

augmentin

A

amoxicillin + clavulonic acid

71
Q

how is augmentin given?

A

oral

72
Q

augmentin improved coverage of what?

A

staph and H. flu

73
Q

indications for augmentin

A
  1. otitis
  2. bite wounds
  3. sinusitis (non-odontogenic)
  4. UTI
74
Q

unasyn

A

ampicillin + sulbactam

75
Q

how is unasyn given?

A

parenteral

76
Q

T/F: unasyn has a similar spectrum as augmentin

A

true

77
Q

due to increasing resistance to PCN G, what is now the DOC (drug of choice) for serious infections being treated in a hospital setting

A

unasyn

78
Q

adverse effects of penicillins are antagonized by what?

A

bacteriostatic drugs

79
Q

adverse effect of penicillin in very young, old or compromised renal fxn

A

decreased excretion

80
Q

what is the most frequent drug of choice for odontogenic infection?

A

PCN V

81
Q

what is a suitable alternative to PCN VK?

A

amoxicillin

82
Q

why is amoxicillin a suitable alternative to PCN VK?

A

better absorption and blood levels and dosing regimen

83
Q

if patient has a significant anaerobic component, which abx may be indicated?

A

metronidazole

84
Q

bites, non-odontogenic sinusitis, otitis require what?

A

B-lactamase inhibitors such as in augmentin

Pharm 2 final (10 decks)

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