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Pharm 2 > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

Bactericidal or Bacteriostatis preferable?

A

Bactericidal

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2
Q

Antibiotic type that:
Relies less on host immune system
Takes effect more quickly
Maintains effect longer

A

Bactericidal

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3
Q

-Cidal or -Static for Prophylaxis?

A

Bactericidal

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4
Q

See post-antibiotic effects with -cidal or -static?

A

Post antibiotic effects seen with bacterioSTATIC drugs

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5
Q

The persistent suppression of bacterial growth after brief exposure to an antibiotic even in the absence of host defense mechanism

A

Post Antibiotic Effect - might be related to DNA alteration

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6
Q

Why are Z-Packs very good at treating Chronic Bronchitis?

A

Post-Antibiotic Effect! Azithromycin is a -static drug

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7
Q

Want Narrow or Broad Spectrum?

A

NARROW - kills only bacteria we want to kill- less super infection and alteration of normal flora; and often more effective

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8
Q

Penicilllin VK vs Amoxicillin: Broad of narrow?

A

Penicillin VK - narrow; Amoxicillin - broad

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9
Q

If MIC is high or half-life is long, how should you dose the antibiotic?

A

Give a Loading Dose!- 2-4x the therapeutic dose

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10
Q

Dosage is more critical for -static or -cidal?

A

More critical for -Static!!!

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11
Q

Minimum conc. of drug that will prevent visible growth of bacteria in culture after overnight incubation?

A

MIC

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12
Q

How long to take antibiotic?

A

Terminate antibiotic when sure patient is on the way to recovery based on clinical evidence

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13
Q

Adverse effects of antibiotics

A

Toxicity, Allergy, Super Infection

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14
Q

Allergy vs Toxicity

A

Toxicity is DOSE related

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15
Q

GI distress

A

Is a Toxicity of antibiotics

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16
Q

Antibiotics that most often cause Pseudomembranous Colitis

A

Cephalosporins, Ampicillin, Clindamycin

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17
Q

What bacteria causes P. Colitis?

A

C Difficile

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18
Q

Optimal Antibiotic

A

Pencillin

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19
Q

Characteristics of Optimal Antibiotic

A 
Active against pathogens, 
reaches effective concentration, 
low toxicity
Doesn't cause resisitance
Desirable route
Economical
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20
Q

About organisms involved in Orofacial infections

A

Oral bacteria are rarely the primary pathogens

And, generally several organisms, not just one

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21
Q

Type of antibiotic is the widest spectrum

A

Beta-Lactam Antibiotics

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22
Q

Penicillins, Cephalosporins, Carbapenems, monobactams, Carbacephems

A

Beta-Lactam Antibiotics

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23
Q

B-Lactamase resistant Penicillins

A

Oxacillin and Dicloxacillin

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24
Q

Mechanism of action of Penicillins

A

Disruption of cell wall synthesis - prevents cross linking in cell walls- which are only in humans, not bacteria

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25
Q

Good traits of Penicillin V

A 
Stable in gastric pH so orally effective
Low toxicity
Narrow spectrum specific to oral microbes
Cidal
Inexpensive
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26
Q

Penicillin G

A

IV or IM Only!!

Formulated as Aqeous, procaine, or benzathine

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27
Q

Drug of Choice for Most Odontogenic Infections

A

Penicillin

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28
Q

Typical Dose for Penicillin

A

Load w/ 2 grams, then 500mg ever 6 hours

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29
Q

Indications for B-Lactamase Resistant Penicillins

A

Only for proven staphylococcal infections

AKA “Anti-Staph” penicillins

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30
Q

B-Lactamase Ressitant Penicillins - reasons we don’t use them

A

Less activity against oral bacteria,

expensive

31
Q

Uses for Amoxicillin

A 
Otitis Media, 
UTI
SBE Prophylaxis
NOT First line DOC for odontogenic
NOT B-lactamase resistant
32
Q

Extended spectrum Penicillins

A

Ampicillin - parenteral
Amoxicillin - oral
Use for strep, oral anaerobes, H. influenza, E. coli, salmonella, shigella, proteus

33
Q

Best Antibiotic for Prophylaxis

A

Amoxicillin

34
Q

Advantages of Amoxicillin over Penicillin for Prophylaxis

A

More predictable absorption- important since only taking once!
Longer half life than PCN
Higher plasma conc than PCN
NOT used for prophylaxis because it is broader spectrum though

35
Q

What is NOT a reason to use Amoxicillin over Penicillin for prophylaxis?

A

Amox is broader spectrum

36
Q

Extended Spectrum Penicillins

A

NOT indicated for oral bacteria or head and neck infections

Carbenicillin, Ticarcillin, Piperacillin

37
Q

B-Lactamase action

A

Cleaves the B-Lactam ring

38
Q

How to combat B-Lactamase

A

Add R chains or by competitive inhibition

39
Q

The three B-Lactam Inhibitors

A

Clavulonic Acid
Sulbactam
Tazobactam

40
Q

Augmentin

A

Amoxicillin + Clavulonic Acid

Improved staph and H. flu coverage

41
Q

Indications for Augmentin

A

Otitis
Sinus infections not caused by a tooth
Bite wounds
UTI

42
Q

Unasyn

A

Ampicillin + Sulbactam

Parenteral

43
Q

Penicillins- Adverse effects

A

Allergy- 2% of people allergic
Antagonistic with -static drugs
Decreased excretion in very young and very old

44
Q

DOC for odontogenic infection

A

Penicillin V

45
Q

Which antibiotic is limited to prophylaxis in dentistry

A

Amoxicillin because better absorption, but negatively has broader spectrum

46
Q

Which antibiotic reserved for more serious infection

A

PCN G

47
Q

If significant anaerobic component, may need…

A

B-lactamase inhibitor or metronidazole

48
Q

Bites, non-odontogenic sinusititis, and otitis require…

A

Augmentin or other B-lactamase inhibitors

49
Q

Cephalosporins

A

Four generations, we only use the FIRST GEN

50
Q

Cephalosporins Pharmacology

A 
-Cidal - cell wall inhibition
B-lactam configuration
Low toxicity
broad spectrum
expensive
Don't have as good post-antibiotic effect
51
Q

Cephalosporins very good against

A

Streptococcus and Oral Anaerobes

52
Q

Cephalosporins Indications

A

Community acquired Staph infection
Surgical wound prophylaxis
Odontogenic infection in PCN allergic pt

53
Q

1-10% of PCN allergic patients also allergic to

A

Cephalosporins

54
Q

Avoid if have Cephalosporin allergy

A

PCN

55
Q

If have PCN allergy avoid

A

Cephalosporin if PCN allergy is severe

IF its mild, Cephalosporin probably okay

56
Q

Macrolides: Mech

A

Irreversibly bind 50s ribosomal unit - STATIC

- Inhibit RNA dependent protein synthesis

57
Q

What antibiotics should immunocompromised people not take

A

-static!!

58
Q

Clarithromycin - when to use in relation to other antibiotics

A

For if pt allergic to PCN and gets GI problems from clindamycin

59
Q

Clarithromycin: traits

A

Similar to erythromycin but less resistance, better H. Influenza coverage, less GI distress, expensive

60
Q

Clarithromycin Indications

A

Sinus infection
Mild/moderate odontogenic infection in PCN allergic pts w/ GI sensitive
Pneumonia or bronchitis
Can use for prophylaxis too

61
Q

Azithromycin - when to use

A

Should be reserved for URI

62
Q

Azithromycin traits

A

Similar to Clarithromycin but better against strep and g-anarobes
Don’t need to time with meals
Less GI distress
Expensive

63
Q

Marcolides (-mycins) Adverse Effects

A 
GI distress (worst with Erythromycin)
Ototoxicity
Cholestatic jaundice with Erythrmycin
Long QT interval/Torsade de Pointes
Increased activity of Digitalis
Potentiation of oral anticoagulants like Warfarin
Adverse reaction with statins - myopathy
64
Q

Lincosamides

A

Clindamycin is the only one we use

65
Q

Clindamycin: Mech

A

Binds 50s ribosome leading to inhibition of protein synthesis –> -static!

66
Q

2nd line Antibiotic

A

Clindamycin

67
Q

Clindamycin indications

A

Chronic recurrent infection
Osteomyelitis
Odontogenic infection in immunocompromised pt w/ severe PCN allergy

68
Q

Disulfuram Effect seen with what Antibiotics

A

Metronidazole - make you nauseated with alcohol

69
Q

Metronidazole

A 
-cidal - disrupts DNA synthesis
Mild toxicity
Inexpensive
Disrupts Anaerobic bacteria 
\+ penicilln for severe infections
Effective bone penetration
70
Q

Metronidazole Indications

A

Chronic anaerobic infection

In combo w/ PCN or cephalo for serious odontogenic infections

71
Q

Tetracyclines

A

Inhibit 30s ribosome –> -static
Broad spectrum
High resistance
Inexpensive

72
Q

Tetracyclines

A 
good for resistant bacteria
H.bactor related gastric and peptic ulcers
For topical therapy
Dry socket prevenetion
NO indication for odontogenic infection
73
Q

Problems w/ tetracycline

A

Stain teeth permanently

Photosensitivity to sun

Pharm 2 (11 decks)

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