Exam 2:Antibiotics Part 1 (background, sulfa, penicillin) Flashcards by Austin Shackelford

A _______ antibiotic is only effective against a

small number of bacteria…_______ is a prime example!

Narrow Spectrum…Penicillin

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A _______ antibiotic is effective against MANY bacteria. A great example of this is ______.

broad spectrum….tetracycline

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Never combine bacteri_____ and bacteri_____ antibiotics, the _________ antibiotic (antagonist) will inhibit or diminish the effects of the _______ antibiotic!!

the bacterioStatic will inhibit the effects of the bacteriCidal

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Why would we never give penicillin with tetracycline?

tetracycline = bacteriostatic (antagonist)….penicillin = bactericidal,,,,if given together, penicillin will not be effective

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ALL antibiotics are bacteri_____, but not all antibiotics are bacteri______!!!

All antibiotics are bacteriostatic….Not all antibiotics are bactericidal at therapeutic doses

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What is used to determine the bactericidal concentration of an antibiotic?

MIC-Minimum Inhibitory Concentration (concentration of antibiotic that kills 100% of a bug in a test tube)

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If we gave the MIC of an antibiotic it might be toxic to the human taking the drug, therefore we lessen the dose and it becomes more bacteri_____.

bacteriostatic

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Antibiotic _______ can happen when 2 antibiotics work together for a more positive effect when given to the same patient.

synergism

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Choosing an antibiotic-ID the bastard…the predominant microorganism in the ORAL CAVITY is going to be gram ___, _____ or ______. This occurs ___-___% of the time.

gram + strep or staph..90-95%

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Choosing an antibiotic-ID the bastard…All oral/facial infections occur from ________ microorganisms which are already in the mouth. UNLESS the Pt has experienced ______ that introduced new microbes.

RESIDENT…trauma

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Choosing an antibiotic-most effective antibiotic for THAT organism…._______=MOST EFFECTIVE ANTIBIOTIC AGAINST GRAM + STREP OR STAPH.

penicillin

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Choosing an antibiotic-low host toxicity…._______ is the least toxic antibiotic, it cannot kill the host at ANY ________, and ___% of the population is allergic to it but it is NOT TOXIC to them.

Penicillin, concentration..10%

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Choosing an antibiotic-bactericidal…we use a bactericidal so we don’t have to rely on the patient’s ________. Penicillin is bacteri_____.

defense mechanisms…bactericidal

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Choosing an antibiotic-low resistance…What are the 4 ways to minimize resistance?

give an adequate dose 2.take for an adequate duration 3.avoid repeated administration 4.avoid topical administration

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Choosing an antibiotic-low resistance…we give an adequate dose that will _____ the bacteria, don’t worry about allergy if giving a high dose, because allergies are not _____ dependent.

KILL….dose

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Choosing an antibiotic-low resistance…TAKE FOR adequate time, many patients stop taking their antibiotics when their ______ go away. Write “__________” on EVERY Rx!!! and then educate the patient with the _______ method.

symptoms….”take until gone”….teach back

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Choosing an antibiotic-low resistance…avoiding repeated administration. Bacteria develop mechanisms to become _______. Do NOT give the patients same ________ week after week. This will also help Pt’s from _____-medicating.

resistant…antibiotic…self-medicate

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Choosing an antibiotic-low resistance…avoid _______ administration, like ointments applied to the face. Bacteria can get “_______” the presence of the antibiotic.

topical….”used to”

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BIG PICTURE: What are the 9 Classes of Antibiotics?

1.Sulfa 2.Penicillin 3.Cephalosporins 4.Macrolide 5.Tetracycline 6.Quinolones 7. MetroNiDazole 8.Miscellaneous 9.AminoGlycoSides

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Sulfa Drugs have no indications for use in _______, but they are used primarily for ________.

dentistry…Urinary Tract Infections

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________ was the FIRST ANTIBACTERIAL AGENT!!!!

Sulfanil-Amide

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Sulfa Drugs-block the final step in the conversion of _____ to _______, thus blocking nucleotide and protein synthesis in bacteria.

PABA to folic acid

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What is an example of a generic sulfa drug?

tri-meth-o-prim

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Penecillin is produced by the mold _______ _______.

Penicillium ChrysoGenum

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All Penicillin is bacteri_____!

bacteriCidal

Penicillin blocks _________ synthesis by interfering with structural glycopeptides. And bacterial cell death results from ______.

bacterial cell wall...lysis

What is the MAIN structural component of Penicillin?

Beta-Lactam Ring

What is the enzyme secreted by penicillin-resistant bacteria?

beta-lactamase

Penicillin-the beta-lactam antibiotics bind to and inhibit ______ needed for the synthesis of the peptidoglycan wall. Therefore they have little effect on bacteria that are _______, but they are effective against bacteria that are ________.

enzymes! ....resting...dividing

Which bond does the penicillinase/beta-lactamase break?

the C-N bond in the beta-lactam ring

____% of the normal, healthy ambulatory population does not have penicillinase- producing microorganisms!!! So its usually limited to immunocompromised, immuno-supressed, malnourished, and institutionalized people.

99%

Absorption of Penicillin-Oral absorption of Natural penicillins (penicillin ___) is incomplete and variable due to destruction by _______ (given parenterally). But semi-synthetic is more acid stable (penicillin __).

Penicillin G.....gastric juices....Penicillin V

Does Penicillin enter the cerebrospinal fluid?

yes

Penicillin is excreted very quickly, 70% is excreted in ___ hours. In the kidney is it mainly active, tubular secretion or passive, glomerular filtration?

4 hours..90% tubular secretion (active transport)...think size of penicillin. prob too big to be filtered in the glomerulus

What can we use to TRICK the kidneys and SLOW down the excretion of Penicillin? How much does this drug elevate the blood level of penicillin?

Pro-ben-e-cid (Bene-mid)...It out competes penicillin for secretion in to the blood....3-4x elevation

For ORALFACIAL infections, _______ is the drug of choice.

Penicillin

What are the two prophylactic uses for penicillin?

Bacterial Endocarditis y Prosthetic Joints & Valves

What was the first penicillin produced, is the only NATURAL penicillin commercially available? What is its spectrum? Bacteriostatic or cidal?

Penecillin G (green like nature!) Narrow Spectrum. bactericidal (ALL FREAKING PENICILLIN)

Penicillin G is considered _____-labile because it can be broken down by gastric acid and ______-labile because is can be broken down by penecillinase. Indications-used for ______!

acid-labile...penicillinase-labile... STDs!!

Penicillin given IM makes blood levels rise _____.

rapidly

_______ penicillin G = bond penicillin molecule to ______ molecule, which is an oil base. This will slow down penicillin release over a ___-___ hour period. Best used for the treatment of ______.

Pro-Caine...12-24 hour...ANTHRAX

Which penicillin has the trade name Bi-Cillin? How long does this drug last in the blood? Where is this administered?

Benzathine Penicillin G...3 freggin WEEKS!..Bicillin=Buttocks

What helps Benzathine Penicillin G's slow release?

its dissolved in oil!

What is the primary indication for Benzathine Penicillin G?

STDs!

Which penicillin produces the LONGEST therapeutic blood level after parenteral administration?

Benzathine penicillin G (3 freggin weeks yo)

What is the semi-synthetic penicillin? What was INITIALLY added to it to make it more acid tolerable (and therefore Oral admin?)

Penicillin V...Sodium

Penicillin has better bioavailabiliy when paired with _____ instead of sodium.

K+

When you write "penicillin V" on the script, the pharmacist will fill it with the ______ form.

potassium

If you write the prescription for penicillin VK, the pharmacist has to fill the prescription with that _______ drug. SO just write the Rx for ______.

brand name,,,(cannot substitute with a generic).."penicillin V"

Penicillin ___: Bactericidal, Narrow spectrum, Acid stabile, Penicillinase labile, Better bioavailability in potassium form

Penicillin V

the CDC says USE the MOST _______ spectrum antibiotic available for the infection... therefore ________ IS THE BEST CHOICE FOR OROFACIAL INFECTIONS!!!

NARROW....PENICILLIN V

Big Gun Penicillins: Do NOT use penicillinase-resistant drugs all of the time because: Promotes _______ microorganisms (e.g. methicillin resistant staph aureus), More expensive, More toxic, Not as effective as penicillin V, Only use these drugs when culture shows that microorganisms are producing ________.

resistant....penicllinase

What penicillin am I???Bactericidal, Acid stable, Not penicillinase-resistant. Spectrum includes more gram negative bacteria (BROAD), Available for oral administration in 250 mg and 500 mg capsules, Must be prescribed every 6 hours so that blood level does not drop below therapeutic blood level.

AMPicillin (amplify!) broad spectrum!

Which penicillin am I? One of the most commonly prescribed drugs in the United States, Better bioavailability than ampicillin, Not penicillinase-resistant Combined with _______ acid to broaden spectrum (drug known as _______)

Amoxicillin (Amoxil)....cla-vul-anic acid...(Augmentin)

How does Cla-vul-anic Acid work? When do you give Augmentin (clavulanic acid + amoxicillin)?

Acts as a shield against penicillinase..36-48 hours after no pt response to penicillin V

What are three factors why a pt might not be responding to Penicillin V?

1.Pt Compliance 2.Penicillinase 3. Spectrum too narrow

When prescribing Augmentin, a _____ dose is better. The more clavulanic acid, the more side effects (diarrhea).

smaller

In augmentin, the concentration of ______ remaines constant (___mg)while the concentration of amoxicillin can vary. So always prescribe less pills for less diarrhea!

clavulanic acid....125mg

____% of the population is allergic to penicillin!

10%

Chronic use of Penicllin is associated with opportunistic infections, especially _____ infections like ________ seen in the oral cavity and vagina. Then of coarse there is ______ in the mouth too...

fungal infections...candidiasis....black hairy tongue

If a Pt is freaking out about black hairy tongue what 3 things can you tell them that will calm them down? (assuming they are on antibiotics)

1. its just benign hyperkeritinization (and chromatic bacteria) 2. it can be improved with hygiene 3.subside when drug is over!

___% of the population has a TOXIC reaction to Amoxicillin! They will show a _______ on their forearms. Even though it is not an allergic reaction, it responds to ______. (If you are allergic to one penicillin, you are allergic to all)

10%....maculopapular rash...Benadryl