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2nd yr- CSA - Antimicrobials for perio > Local delivery antimicrobials in the treatment of chronic perio > Flashcards

Local delivery antimicrobials in the treatment of chronic perio Flashcards

1
Q

What are the main difference between th 1999 and 2018 disease classification

A
  1. Gingival diseases has been changed to gingival health, periodontal health and disease
  2. chronic and aggressive priodonttiis has now ben changed into stages 1-4, grades A-C and molar incisor patterns are observe
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2
Q

What are the stages of periodontitis?

A

Stage I
Stage II
Stage III
Stage IV

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3
Q

Describe stage I of periodontitis

A

Initial periodontitis

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4
Q

Describe stageII of periodontitis

A

Moderate periodontitis

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5
Q

Describe stage III of periodontitis

A

Severe periodontitis with potential for additional tooth los

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6
Q

Describe stage IV of periodontitis

A

Severe periodontitis with potential for loss of dentition

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7
Q

Describe the 3 steps we take to classify periodontitis according to the 2018 classification

A
  1. Determine the stage I-IV
  2. Determine the extent and distribution
  3. Determine the grade A-C
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8
Q

How do we describe the extent and distribution of perio

A

Localised or generalised

We can use the molar incisor distribution

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9
Q

Describe grade A of periodontitis

A

Slow rate of progression

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10
Q

Describe Grade B o periodontitis

A

Moderate rate of perio progression

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11
Q

Describe grade C of periodontitis

A

Rapid rate of progression of perio

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12
Q

What are antibiotics?

A

Drugs that kill or halt the multiplication of bacterial cells at concentrations that are relatively harmless to host tissues

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13
Q

What are antibiotics sued to treat?

A

Infections caused by bacteria

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14
Q

What is an infection?

A

Invasion of micro organisms into the host.

The reaction of the most to the microorgaisnsm is the infection

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15
Q

What type of infection is periodontitis?

A

Polymicrobial

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16
Q

Name the three plaque hypotheses

A
  1. Non specific
  2. Specific
  3. Ecological
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17
Q

Which of the three plaque hypotheses are themes accepted?

A

Ecologicalplaque hypothesis

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18
Q

Give some classifications of antibiotics

A
  1. Beta lactams
  2. Aminoglycosides
  3. Sulphonamides
  4. Tetacyclines
  5. Azoles
  6. Quinolones
  7. Macrolides
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19
Q

Give an example of a beta lactams

A

Penicillin

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20
Q

Give an example of an aminoglycoside

A

Gentamycin

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21
Q

Give an example of an azoles

A

Metronidazole

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22
Q

Give an example of a quinolone

A

Ciprofloxacin

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23
Q

Give an example of a macrolide

A

Erythromycin

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24
Q

Give some headings that can be used to classify antibiotics

A
  1. Based on spectrum of activity

2. Based on the action

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25
Q

What are the 2 categories antibiotics can be split into when they are classified based on spectrum

A
  1. Narrow spectrum

2. Broad spectrum

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26
Q

Wha does it mean if a bacteria has a narrower spectrum of activity?

A

That it only targets a certain group of bacteria

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27
Q

Wha does it mean if a bacteria has a broad spectrum of activity?

A

That it can target a wide range of bacteria species

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28
Q

When making antibiotics what type of spectrum activity do we want?

A

Narrow spectrum so neighbouring cells aren’t damaged

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29
Q

Name the 2 categories antibiotics can be placed in when categorised based on aciton

A
  1. Bacteriostatic

2. Bactericidal

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30
Q

What does bactericidal mean?

A

Antibiotics that kills bacteria

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31
Q

What does bacteriostatic mean?

A

Antibiotics that stop or inhibit the multiplication of bacteria

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32
Q

When choosing an antibiotic do you close a bacteriostatic or bactericidal one? Why?

A

Bactericidal as it will kill the bacteria

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33
Q

Name the 5 mode of actions of systemic antibiotics

A
  1. Inhibition of cel wall synthesis
  2. inhibition of cytoplasmic membrane function
  3. inhibition of nucleic acid synthesis
  4. Inhibition of ribosomal function and hence protein synthesis
  5. Inhibition of folate metabolism
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34
Q

What does systemic mean?

A

Affects the whole body not just a targeted area

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35
Q

What does amoxycillin do?

A

Inhibits the cell wall synthesis

36
Q

What does metronidazole do?

A

Inhibits nucleic acid synthesis by breaking down strands of DNA

37
Q

What do tetracyclines and macrocodes do?

A

Inhibits protein synthesis

38
Q

What are some of the disadvantages of the use of antibiotics

A
  1. Hypersensitivity
  2. Gastrointestinal disturbances
  3. Alterations in the commensal flora
  4. Drug-drug interactions, Drug- alcohol interactions
  5. Bacterial resistance
39
Q

How many deaths in the EU per year are taught to be due to multiple drug resistant bacteria?

A

Estimated 25,000

40
Q

What does the antimicrobial stewardship programs organised by NICE do?

A

A organisational or healthcare system wide approach to promote monitoring of judicious use of antimicrobials to preserve their future effectiveness

41
Q

What are some steps antimicrobial stewardship has played ou to try and reduce the risk of bacterial resistance?

A
  1. Evidence based optimal standards for routine antimicrobial prescribing
  2. Ensuring competency and education for prescribers
  3. Communication of issue to all stakeholders
  4. Auditing the impact and uptake of processes above
    Optimising outcome for patients prescribed antimicrobials
42
Q

What 3 things does public health England tell patients to do/ not to do?

A
  1. Don’t demand antibiotics
  2. Take antibiotics as they are prescribed
  3. Spread the word among friends and relatives
43
Q

What does efficacy mean

A

Ability of a drug to produce a desired effect

44
Q

Give some factors that affect efficacy

A
  1. Blinding of drug to tissue
  2. Protection of key organisms by non target organisms binding or consuming drug
  3. Bacterial tissue invasion
  4. Total bacterial load
  5. Previous drug therapy
  6. Non pocket infected sites
  7. Presence of biofilm
  8. Beta lactase production
45
Q

What is beta lactamase?

A

They are enzymes that can cleave an inactivate beta lactic drugs

46
Q

Name something that can inhibit beta lactamase

A

Clavulanic acid

47
Q

Give some reasons for failure of antimicrobial therapy

A
  1. Lack of culture and sensitivity
  2. Failure to achieve drainage
  3. Non bacterial causative agent
  4. Incorrect drug duration to dose
  5. Lack of compliance
  6. Defective host response
  7. Persistent risk factors
  8. Lack of substantivity of local agents
  9. Drug resistance
48
Q

How do we prescribe antibiotics?

A

Empirically

49
Q

What is the ideal way of determine which antibiotics should be prescribed?

A

Using culture and sensibility

But theres isn’t that much the to do this

50
Q

What is it called when when we prescribe one antibiotic?

A

Mono therapy

51
Q

What is it called when when we prescribe more than one antibiotic?

A

Combination therapy

52
Q

What is the most common combination of drugs prescribed in dentistry?

A

amoxicillin and metronidazole

53
Q

Should we prescribe antibiotics for chronic periodontitis?

A

NO

54
Q

Should we prescribe antibiotics for aggressive periodontitis ?

A

Can be used

55
Q

What is the cause offer periodontitis?

A

calcification of the biofilm-> calculus

56
Q

How dow e treat chronic periodontitis?

A

Scaling and RSD

57
Q

Should we prescribe antibiotics for periodontitis is manifested due to a systemic disease?

A

Don’t need it just need t remove calculus

58
Q

Should we prescribe antibiotics for necrotising periodontal disease?

A

YES

59
Q

If you want to prescribe antibiotics what should you do?

A

Refer your patient to a specialist

60
Q

Should we prescribe antibiotics for abscesses of periodontium

A

Maybe

61
Q

Should we prescribe antibiotics for periodontitis associated with endodontic lesions

A

No

62
Q

What should antimicrobials be used in conduction with when treating periodontitis

A

Mechanical therapy

63
Q

Give some rationale fo systemic therapy

A
  1. Panoral infection in aggressive perio
  2. Other oral niches colonised with periodontal pathogens
  3. Drugs are concentrated in GCF
  4. Maintains minimal inhibitory concentration for long duration
64
Q

Give some examples of possible antibiotic regimens for aggressive periodontitisq

A
  1. Penicillins with or without clavulanic acid
  2. Tetracyclines
  3. Macroides
  4. Nitroimidazole
65
Q

What instructions do you give to a patient when you prescribe them amoxicillin?

A

Take 500mg 2-3 times a week for 8 days

66
Q

What does amoxicillin target?

A

Gram positive agn gram negative bacteria

67
Q

How does amoxicillin affect bacteria?

A

It is bactericidal

68
Q

What is amoxicillin sensitive to?

A

Penicillinase

69
Q

What instructions do you give to a patient when you prescribe them amoxicillin and clavulanic acid?

A

Take 500mg 2-3 times for 8 days

70
Q

How does amoxicillin and clavulanic acid affect bacteria?

A

It is bactericidal

71
Q

Give some side effects of amoxicillin and clavulanic acid?

A

Diarrhea
Colitis
Nausea

72
Q

What instructions do you give to a patient when you prescribe them tetracycline?

A

Take 500mg 4 times for 21 days

73
Q

How does tetracycline affect bacteria?

A

Bacteriostatic

74
Q

What does tetracycline target?

A

Gram positive bacteria more than gram negative

75
Q

Give some side effects of tetracycline

A

Can cause severe sunburn if exposure to bright sunlight
Severe stomach pain
Nausea

76
Q

What instructions do you give to a patient when you prescribe them minocycline?

A

Tale 100-200mg 1 time a day for 21 days

77
Q

How does minocycline affect bacteria?

A

it is bacteriostatic

78
Q

What does minocycline target?

A

Gram positive bacteria more than gram negative

79
Q

What instructions do you give to a patient when you prescribe them doxycycline?

A

take 100-200mg once a day for 21 days

80
Q

How does doxycycline affect bacteria?

A

It is bactericidal

81
Q

What does doxycycline target?

A

Affects Gram positive bacteria more than gram negative

82
Q

What instructions do you give to a patient when you prescribe them ciprofloxacin?

A

Take 100-200mg twice a day for 8days

83
Q

How does ciprofloxacin affect bacteria?

A

It is bactericidal

84
Q

What does ciprofloxacin target?

A

Gram negative rods

85
Q

Give some side effects of ciprofloxacin?

A

Nausea

Gastrointestinal discomfort

2nd yr- CSA - Antimicrobials for perio (2 decks)

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