EXAM I Systemic Antibiotics Flashcards

1
Q

what are the clinical benefits of chemotherapeutic agents?

A
  • antimicrobial actions
  • ability to increase the host’s resistance
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2
Q

what are 3 categories of chemotherapeutics?

A
  • systemic antibiotics
  • controlled drug delivery systems
  • drugs that modulate host response
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3
Q

there is no evidence that antibiotics alone can arrest periodontal disease. systemic antibiotics have the greatest benefit in what 4 areas?

A
  • the presence of systemic disease
  • immunocompromised patients
  • aggressive forms of periodontal disease
  • patients who are not good candidates for more complex and invasive treatment
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4
Q

what are the 5 guidelines for the use of antibiotics in periodontal therapy?

A
  1. the clinical diagnosis and situation dictate the need for possible antibiotic therapy as an adjunct in controlling active periodontal disease
  2. chronic periodontitis can and should be treated initially without systemic antibiotics
  3. antibiotics are selected based on the microbial composition of the plaque, patients medical status, and current medications
  4. the use of culture sensitivity testing provides valuable information regarding the appropriate selection of antibiotics
  5. antibiotic therapy should not be used as a monotherapy. it should be a part of a comprehensive periodontal treatment plan
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5
Q

periodontal disease is predominantly a gram positive or negative infection? aerobic or anaerobic?

A

gram negative anaerobic infection

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6
Q

in periodontal disease, antimicrobials targeting which spectrum are beneficial?

A

gram negative anaerobic bacteria

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7
Q

what is a disadvantage of culture and sensitivity tests for periodontal disease?

A

they are expensive

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8
Q

in a study of chronic periodontitis with the use of antibiotics, microbiologic testing yielded excellent clinical results regardless of the presence or absence of which six classic periodontal periopathogens prior to treatment?

A
  • Aggregatibacter actinomycetemcomitans [previously Actinobacillus actinomycetemcomitans]
  • Fusobacterium nucleatum spp.
  • Porphyromonas gingivalis
  • Prevotella intermedia
  • Treponema denticola
  • Tannerella forsythia [previously T. forsythensis]
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9
Q

what are some general indications for the use of antibiotics in periodontal therapy?

A
  • patients nonresponsive to conventional therapy
  • acute periodontal infections with systemic manifestations
  • prophylaxis in medically compromised patients
  • adjunct to surgical and nonsurgical periodontal therapy
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10
Q

in what 7 situations should you consider the use of systemic antibiotics during periodontal therapy?

A
  • aggressive periodontitis
  • necrotizing ulcerative periodontal disease
  • refractory periodontitis, or patients who are considered to be high risk
  • generalized severe chronic periodontitis
  • periodontal patients who are immunocompromised
  • heavy smokers
  • in conjunction with certain surgical procedures (implants, bone grafting, sinus lifts, guided tissue regeneration)
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11
Q

what is the mechanicms of action, spectrum, and effect of penicillins?

A
  • mechanism of action: inhibits cell wall synthesis
  • spectrum: narrow
  • effect: bacteriocidal
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12
Q

which 3 penicillins are frequently use in periodontal therapy?

A
  • amoxicillin
  • pen VK
  • amoxicillin with clavulanic acid (augmentin)
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13
Q

what is the mechanicms of action, spectrum, and effect of tetracyclines?

A
  • mechanism of action: inhibits protein synthesis
  • spectrum: broad spectrum
  • effect: bacteriostatic
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14
Q

what are indications for the use of tetracyclines?

A
  • refractory periodontitis
  • aggressive periodontitis (EOP)
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15
Q

what are 2 advantages of tetracyclines?

A
  • ability to concentrate in the tissues and destroy A.a.
  • anticollegenase activity
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16
Q

what are 3 contraindications of tetracyclines?

A
  • should not be given with milk and dairy products, FE++ containing vitamins and minerals, or antacids
    • absorption of tetracyclines is impaired by Ca++, Fe++, Mg++, and Al+++
  • photosensitivity (sensitivity to light)
  • avoid use in children, pregnant/nursing mothers (may cause discoloration of teeth)
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17
Q

what are the 2 forms of tetracyclines used in periodontal therapy?

A
  • doxycycline
  • minocycline
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18
Q

describe doxycycline

A
  • semi-synthetic tetracycline
  • easier on the stomach than minocycline or tetracycline
  • can take with dairy products
  • decreased side effects vs. tetra- or minocycline
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19
Q

what is the common regimen for doxycycline?

A
  • Rx: doxycycline 100 mg
  • disp: #22
  • sig: 2 caps stat, then 1 cap QD for 21 days
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20
Q

describe metronidazole

A
  • bacteriocidal against anaerobic bacteria
  • brand name: flagyl
  • inhibits DNA synthesis
  • effective against obligate anaerobes
21
Q

can metronidazole be used alone?

A

yes, but most of the time is used with another antibiotic

22
Q

metronidazole is ineffective by itself against which bacteria?

it has a synergistic effect when used in conjunction with which antibiotic?

A

facultative A.a.

one of the penicillins

23
Q

what are the 5 significant side effects of metronidazole?

A
  • antabuse type reaction
  • metallic after-taste
  • discolored urine - orange
  • nausea and vomiting
  • peripheral neuropathy (infrequent)
24
Q

what is the common regimen of metronidazole?

A
  • Rx: metronidazole 500mg
  • disp: 21 caps
  • sig: 1 cap TID for 7 days
25
Q

metronidazole is commony prescribed with which other 2 antibiotics? what are the common regimens?

A
  • amoxicillin or augmentin
26
Q

describe clindamycin

A
  • good anaerobic coverage
  • inhibits protein synthesis
  • bacteriostatic
27
Q

what are 2 significant side effects of clindamycin?

A
  • risk of pseudomembranous colitis due to over growth of clostridium difficile
  • skin rash
28
Q

what is the common regimen for clindamycin?

A
  • Rx: clindamycin 300mg
  • disp: #30 capsules
  • sig: 1 cap TID for 10 days
29
Q

describe azithromycin

A
  • effective against anaerobes and gram negative bacilli
  • penetrates fibroblasts and phagocytes
  • concentrations are significantly higher in periodontal lesions compared to normal gingiva
30
Q

what is the recommended regimen for azithromycin?

A

recommended regimen:

  • Rx: azithromycin 500mg
  • disp: 3 capsules
  • sig: take 1 cap qd for 3 days

OR:

  • z-pak (6 capsules of 250mg)
  • 500mg on day 1 and 250mg once a day for 4 days
31
Q

if systemic antimicrobials are indicated as part of peridontal therapy, they should be adjunctive to what?

A

mechanical debridement

32
Q

there is ___ evidence to recommend a specific protocol for the use of adjunctive systemic antimicrobials with non-surgical mechanical debridement. there is ___ evidence that suggests that antibiotic intake should start on the day of debridement completion; debridement should be completed within a short time (preferably <1 week). however, there are some that recommend antibiotic therapy both during and after ___

A
  • no direct
  • indirect
  • perio therapy
33
Q

what are 4 disadvantages of using systemic antibiotics?

A
  • inability of systemic drugs to achieve high GCF concentrations
  • increased risk of adverse reactions
  • increased selection of antibiotic resistant microorganisms
  • uncertain patient compliance
34
Q

T or F:

there is evidence that, for specific groups of periodontal disease susceptible individuals, the use of HMT (host modulated therapy) in conjunction with antibiofilm treatments may prove to be advantageous

A

true

however, this concept needs to be validated in controlled clinical trials

35
Q

what are 2 drugs that modulate host response?

A
  • NSAIDs
  • subantimicrobial dose of doxycycline (periostat)
36
Q

very few studies show any significant benefit of ___ as an adjunct to scaling and root planing

A

NSAIDs

37
Q

has ibuprofen (an NSAID) been demonstrated to be an effective adjunct to scaling and root planing?

A

no

38
Q

which NSAID has been shown to produce positive results in patients with aggressive periodontitis?

A

NSAIDs such as meclofenamate sodium

39
Q

which NSAID has been reported to be an effective adjunct in perio therapy after mechanical debridement?

A

acetylsalicylic acid (aspirin)

40
Q

what is the normal dosage for periostat, and what is the significance?

A
  • 20 mg dose
  • way below dose used for infections
  • the mechanism is for the anticollagenase activity alone, without inhibiting protein synthesis in bacteria cells
  • minimal risk of bacterial resistance to tetracyclines
41
Q

periostat 20mg twice daily, taken at ___ hour intervals, may be administered for up to ___ months

A
  • 12
  • 9
42
Q

what are the recommendations for taking periostat near meal times?

A

allow at least one hour prior to meals, or two hours after meals

43
Q

for periostat, safety beyond ___ months, and efficacy beyond ___ months have not been established

A
  • 12
  • 9
44
Q

T or F

the use of periostat is considered routine treatment

A

false:

at this time, it is not considered as routine treatment. it is an adjunct that has potential benefits to certain individuals and should only be considered in select cases

45
Q

in which 4 cases should you consider prescribing periostat?

A
  • patients who are considered to be at “high risk” and appear to be non responsive to conventional therapy despite adequate treatment and plaque control
  • patients who have severe periodontitis and can not undergo invasive or extensive surgical procedures
  • patients with aggressive periodontitis
  • patients who are heavy smokers
46
Q

the decision to use adjunctive systemic agents should be based on what 4 things?

A
  • clinical findings
  • patient susceptibility
  • level of risk
  • response to conventional mechanical therapy
47
Q

what is the common regimen for penVK?

A
  • Rx: penVK 250mg or 500mg
  • disp: #28 capsules
  • sig: 1 cap QID for 7 days
48
Q

what is the common regimen for amoxicillin?

A
  • Rx: amoxicillin 500mg
  • disp: 21 capsules
  • sig: 1 capsule PO, TID for 7 days
49
Q

what is the common regimen for augmentin?

A
  • Rx: augmentin 250mg
  • disp: #21 capsules
  • sig: 1 capsule TID for 7 days