midterm Flashcards
vWD
autosomal dominant, stabilizes factor VIII
desmopressin
procoagulent, like vasopressin, releases endogenous fVIII, vWF, plasminogen
aminocaproic acid, tranexamic acid
inhibits plasminogen from binding to fibrin, for surgeries on hemophiliac pt or large blood loss pt
vitamin K
procoagulant, warfarin antidote
protamine
procoagulant, heparin antidote
unfractionated heparin
anticoagulant, extracted from cow lung, pig intestines (so no animal allergies), tx of DVT, PE, and MI
enoxaparin, dalteparin
anticoagulant, LMWH
fondaparinux
like a LMWH, NO ANTIDOTE!
dabigatran
anticoag., no monitoring of INR/aPTT monitoring, idarucizimab is antidote
rivaroxaban and apixaban
anticoag., NO ANTIDOTE, no monitoring of INR/aPTT
warfarin
less consistent anticoag., LOTS of INXNS!, inhibits vit. K reductase, impactive by vit. K levels in liver, metabolized by CYP450 enzymes in liver, inxt with ABs, anti-fungals, NSAIDS, herbs, vit. K rich foods, must MONITOR INR/aPTT! antidote = vit. K
aspirin
platelet inhibitor, COX inhibitor
clopidogrel
platelet inhibitor, irreversible inhibition of P2Y12 receptor
use anticoagulants in dentistry?
NO!
safe INR for warfarin pts:
4.0 for simple OS, 3 for OS resulting in lots of blood loss
stop aspirin for OS?
Nope
who to consult before modifying anticoagulation therapy>
Prescribing physician or anticoag. clinic!
who has LPS
gram negative bacteria
who has thick cell wall
gram postitive bacteria
prevents cell growth or replication and limits spread of infection…
bacteriostatic
induces bacterial cell death
bactericidal
act on single or ltd group of bacteria, 1st choice
narrow spectrum, eg. isoniazid
effective against gram + and - bacteria
extended spectrum, ampicillin
active against wide variety of microbial species
broad spectrum, eg. tetracycline
what kills MRSA
NOT beta-lactam ABs, vancomyscin or ceftaroline preferred
acquired mechanism for beta-lactam resistance
bacteria produces beta-lactamases which hydrolyze beta-lactam ring!
clavulanic acid
beta lactamase inhibitor, given with amoxicillen –> AUGMENTIN
tazobactam
beta lactamase inhibitor, PIPERACILLIN
sulbactam
beta lactamase inhibitor, AMPICILLIN
narrow spectrum penicillins
Penicillin V and beta-lactamase resistant Dicloxacillin
extended spectrum penicillins
amoxicillin/clavaulanic acid, ampicillin/sulbactam, pipercillin/tazobactam
penicillin V
1st choice for tx of odontogenic infections, for moderate to severe gingivitis
Dicloxacillin
antistaphylococcal penicillin, rarely by dentists
Ampicillin with…
sulbactam
Amoxicillin with…
clavulanate
principle adverse effect of penicillins…
allergic rxn
1st gen. cephalosporins
cefazolin, cephalexin
2nd gen. cephalosporins
cefuroxime, cefprozil
3rd gen. cephalosporins
cefdinir, ceftriaxone –> penetrates CNS, both associate with c. dif. diarrhea
which cephalosporin penetrates CNS
ceftriaxone
4th gen. cephalosporin
cefepime –> beta lactamse resistant
5th gen. cephalosporin
ceftaroline –> MRSA
cephalosporins adverse rxns
allergic, not for pt with penicillin allergy bc cross hypersensitivity
drug ixn with cephalosporins
antacids, antihistamines, proton pump inhibitors, Fe supplements
monobactam
aztreonam –> IV for serious infectiosn
vancomycin
AB, inhibits cell wall synthesis, MRSA, S. pneumoniae, enterocolitis by C. dif., RED MAN SYNDROME!
Erythromycin, clarithromycin, azithromycin…
binds reversibly to 50s ribosomal subunit, bacteriostatic
Adverse effects of erythromycin, clarithromycin, an azithromycin
GI tract
Ototoxic (erythromycin) –> reversible tinnitus
arrhythmia
tx of H. pylori infections
clarithromycin
Clindamycin…
good for penicillin-resistant bacteria acute orofacial infections
used as bacterial endocarditis prophylaxis in pts with penicillin allergy
can CAUSE C. diff infections!
tetracycline/doxycycline
can cause permanent staining of teeth
adverse effects of tetracyclines
black furry tongue nephrotoxic hepatotoxic not for kids under 8 yoa not during pregancy tooth discoloration enamel hypoplasia photosensitivity superinfections (eg. C. albicans) drug/food ixns
drug/food ixns of tetracyclines
dairy Ca++ Mg++ Fe++ Al+++ antacids
gentamicin
bactericidal aminoglycoside, serious Gram Negative infection
adverse effects of aminoglycosides
nephrotoxic Ototoxic poor oral absorption poor CNS penetration narrow therapeutic index
Linezolid
oxazolidinone, tx of vancomycin-resistant E. faecium!
Sulfamethoxazole, trimethoprim
bactericidal sulfonamides, prevent folic acid synthesis
uses for sulfonamides
respiratory GI UTI not dentistry (can cause anemias)
Metronidazole
bactericidal anaerobes: C. diff. H. pylori parasitic infections NOT effective against aerobes !! used for JUVENILE / REFRACTORY PERIODONTITIS !! disulfiram rxn when taken with ethanol
Fluoroquinolones
ciprofloxacin, levofloxacin, moxiflocaxin
target DNA GYRASE in gnb
target TOPOISOMERASE IV in gpb
inhibits growth and DNA replication
adverse rxns of fluroquinolones
photoxicity
tendon rupture
arrhythmia
NSAID ixn –> convulsive seizures!
Isoniazid
tx of M. tuberculosis and M. kansasii
Rifampin
inhibits bacterial DNA-dependent RNA polymerase
tx of ACTIVE TB
common pathogens causing IE
viridans group streptococci (VGS)
Staph
Cardiac conditions for which prophylaxis is recommended
unrepaired cyanotic CHD
completely repaired congineital heart defeft with prosthetic in FIRST 6 MONTHS AFTER PROCEDURE
repaired CHD with residual defects
cardiac transplant pt with valvulopathy
how to administer AB prophylaxis for IE
single dose BEFORE procedure, or up to 2 hours after procedure if they forgot to take it before
RNA viruses rely on…
…enzymes in the virion to synthesize mRNA for synthesis of viral proteins
Amantadine
tx of influenza
inhibits fxn of M2 protein
prevents uncoating and release of viral RNA
Osteltamivir, zanamivir
inhibits viral neuraminidase
blocking release of progeny virus from infectd host cells
TAMIFLU
antiherpetic agents
acyclovir valacyclovir ganciclovir penciclovir foscarnet
antiherpetic agents not effective for treating CMV may be used for …
CMV prophylaxis in immune compromised pts
chronic hepatitis infections throughout world
HBV and HCV
NRTIs
treat HIV
require activation
!! TERATOGEN (efavirenz) NNRTI !!
zidovudine, lamivudine, emtricitabine, tenofovir
Protease inhibitors
ritonavir
ritonavir + lopinavir (fixed dose combination)
use of PI + 2 NRTIs is synergistic
Integrase Strand Inhibitors
Raltegravir, prevents HIV from multiplying in host
to prevent HIV from becoming drug resistant usually they are …
combined into a single product
typical anti-HIV regimen:
2 NNRTIs + PI or NRTI
how to monitor HIV
viral load and CD4+ cell count every 2-8 weeks
majority of HSV viral lesions treated by…
acyclovir
penciclovir
tx of herpes labialis
AIDS pt oral lesions
HPV
CMV
oral hairy leukoplakia
characteristics of fungi
eukaryotic
cell membrane has ergosterol
cell wall has chitin
fungal infection locations
superficial
subQ
systemic
most common site of fungal infection
superficial
skin, nails, mucous membranes
subcutaneous fungal infections
hair, nailbeds, skin
from puncture wounds with soil fungi
systemic fungal infectiosn
various internal organs
immunocompromised pts at high risk
high mortality
most common fungal infection orally
C. albicans
class of antifungals used topically for superficial infectiosn
polyene
amphotericin B
antifungal
detected for up to 4 wks in blood and 4-8 wks in urine after discontinuation of IV therapy
most toxic in use
REVERSIBLE ANEMIA
Nystatin
antifungal
DRUG OF CHOICE FOR TX OF ORAL CANDIDA INFECTIONS
Echinocandin antifungal
caspofungin
discrupts fungal cell wall
MC rxn –> phlebitis
Teratogenic
Ketoconazole
ORAL AND TOPICAL FORMULATIONS
teratogenic
gynecomastia in men
mentrual irregularities in women
Fluconazole
ORAL AND IV FORMULATIONS
EXCELLENT CNS PENETRATION (treat fungal meningitis)
Clotrimazole troche
tx oropharyngeal candidasis in pts with AIDS
Flucytosine
cytosine deaminase
ltd antifungal spectrum (candida and cryptococcus)
Terbinafine
highly lipophilic and keratophilic antifungal
remains in skin and nails for up to 3 mos
Griseofulvin
dermatophyte infections
CYP3A4 INDUCER !!
can reduce plasma cxn of warfarin, barbiturates, oral contraceptives
MC type of oral fungal infection and txs
Candidiasis topical txs: clotrimazole oral troches nystatin oral pastilles nystatin RINSE FOR PTS AT RISK FOR LIVER TOXICITY Miconazole tablets
systemic tx of oral candidiasis
oral therapy for AIDS
Ketoconazole (with topical nystatin)
Fluconazole
IV tx of oral candidiasis
amphotericin B
w or wo flucytosine bc high drug toxicity
tx of oral candidiasis with lichen planus
topical nystatin
or
clotrimazole with topical corticosteroid
Histamine derived from
diet or bacteria in GIT, synthesized by mast cells
histamine content of organs
highest in lung
skin
intestinal mucosa
highest cxn of histamine in
mast cells
leukocytes
ENTEROCHROMAFFIN CELLS OF GIT
tissue injury causes…
immediate release of histamine from mast cells
increase in vascular permeability
allergic rxns cause…
histamine release
causing mild symptoms to severe symptoms
H1 activation of histamines
increase in bronchiolar smooth muscle contraction
TARGET FOR ANTIHISTAMINES
H2 activation of histamines
increase gastric acid secretion
TARGET FOR H2 BLOCKERS
Histamine toxicity/shock treated by…
Epinephrine
1st gen H1 antagonists
diphenhydramine, promethazine, meclizine
sedative, anti-nausea, xerostomia
2nd gen H1 antagonists
loratadine, fexofenadine, cetirizine
do not cross BBB
less sedative
H1 receptor antagonists ixt with H1 receptors on target cell and …
competively inhibit
can beovercome by increasing cxn of histamine
are antihistamines used for anaphylactic shock or asthma?
no, EPI is
do 1st gen H1 antihistamines reduce gastric acid secretion?
no, 2nd gen H1 do
uses for antihistamines in dentistry
CNS actions, sedation
H2 receptor antagonists include…
cimetidine, ranitidine, famotidine
H2 receptor antagonists used for …
reduce gastric acid secretion
tx peptic ulcers
tx GERD
