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DEN4SKE > Oral Medicine - Pharmacology > Flashcards

Oral Medicine - Pharmacology Flashcards

1
Q

What are the 5 classes of antibiotics?

A

Beta-lactams
Macrolides
Lincosamides
tetracycline
nitroimidazole

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2
Q

Mechanism of action of beta lactams

A

Inhibit cell wall synthesis

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3
Q

Which bacterial enzyme facilitates antibiotic resistance to beta-lactams?

A

Beta lactamase

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4
Q

What is the name of a beta lactamase inhibitor?

A

Clavulanic Acid

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5
Q

What is the dosage for amoxycillin + clavulanic acid?

A

500mg +250mg 8 hourly for 5 days

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6
Q

What type of bacteria are beta lactams active against?

A

Broad spectrum gram positive and negative bacteria

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7
Q

What is the mechanism of action of macrolide antibiotics?

A

inhibits protein synthesis

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8
Q

List 3 macrolide antibiotics

A

erythromyxin, roxithromyxin, clarithromycin

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9
Q

What is a possible side effect of macrolide antibiotics?

A

Increase risk of cardiac arrhythmias due to QT prolongation
QT is the time for ventricular repolarisation. Elongation = tachycardia

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10
Q

What is a problem with the use of macrolide antibiotics in the dental setting?

A

There is little activity against periodontal pathogens and declining activity against strep sp.

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11
Q

What is an example of a lincosamide antibiotic?

A

Clindamycin

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12
Q

When are lincosamides used?

A

If ptn is non-responsive to amoxycillin + clavulanic acid

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13
Q

What is the dosage for clindamycin?

A

150mg 4/day

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14
Q

Why are tetracyclines the first line of treatment for periodontal infections?

A

Active against periodontal pathogens
increased bioavailability in the gingival sulcus

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15
Q

2

What are the side effects of tetracycline?

A

Staining - dental, oral , skin
hypersensitivity to sun

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16
Q

What is an example of a nitroimidazole antibiotic?

A

Metronidazole

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17
Q

What is a common dental use for metronidazole?

A

ANUG
Pericorinitis
adjunct to amoxycillin for spreading infection

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18
Q

What is the dosage for metronidazole?

A

200mg 3/day for 3 days
severe: 400mg 2/day for 5 days

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19
Q

What is the mechanism of action of metronidazole?

A

Pro-drug - when metabolised by anaerobic bacteria it becomes bacterocidal

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20
Q

What is the interaction between metronidazole and warfarin?

A

Metronidazole delays the metabolism of warfarin and therefore should be avoided in ptn on warfarin

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21
Q

What is the mechanism of action of chlorhexidine?

A

Bacterostatic (0.02%-0.06%)
Bacterocidal (>0.12%)

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22
Q

What is chlorhexidine active against?

A

gram positive bacteria, fungi, some viruses (HIV, HSV, CMV, Influeza)

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23
Q

What are the risks of chlorhexidine?

A

Brown discolouration of teeth and tongue
temporary taste alteration
mucosal burn in high concentration
allergic reraction

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24
Q

What is the protocol for chlorhexidine mouthwash?

A

0.12-0.2% 15ml for 30 sec 2/day

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25
Q

What does the addition of povidone to iodine achieve?

A

Organic carrier that controls the release of iodine

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26
Q

What is povidone iodine active against?

A

Perio pathogens, mycobacteria, virus, protozoa

i.e bacteria, fungus, virus

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27
Q

Which antiseptic agent shouldn’t be used if ptn has a history of thyroid dysfunction?

A

Povidone Iodine

28
Q

What is the difference between hyposalivation and xerostomia?

A

Hyposalivation = objective measurement
Xerostomia = subjective feeling

29
Q

What conditions can contribute to xerostomia? (5)

A

Sjogrens
Head and neck radiation
Type II diabetes
mental health and stress
medications

30
Q

What are non-pharmacological options for treatment of xerostomia?

A

increased water intake
xylitol gum
decreased caffeine
decreased alcohol
natural lubricants e.g olive oil

31
Q

What is a commercial oral lubricant?

A

carboxymethylcellulose

32
Q

what is added to commercial lubricants to increase effectiveness?

A

Antimicrobials:
lactoferin
lysozyme (in natural saliva)
lactoperoxidase (biotene)

33
Q

What is a sialogogue?

A

an agent promoting secretion of saliva

34
Q

What is a non-pharmocological sialogogue?

A

Chewing gum

35
Q

What is a topical pharmacological sialogogue?

A

1% Malic acid

36
Q

What is an example of a systemic sialogogue?

A

Pilocarpine

37
Q

What is the dosage of pilocarpine?

A

5mg 3/day for atleast 3 months

38
Q

What are the risks of pilocarpine?

A

GI upset
blurred vision
stimulation of other exocrine glands e.g lacrimal

39
Q

What are underlying risk factors for oral candidiasis?

A

Diabetes
Anaemia
HIV
Immunosuppression or deficiency
cancer
Denture wearers (poor hygiene)

40
Q

What is the most important factor in managing oral candidosis?

A

manage underlying risk factor

41
Q

What are the 3 groups of antifungals?

A

Polyenes
Ergosterol Biosynthesis inhibitors
Newer agents

42
Q

2

Example of polyene antifungals?

A

Nystatin
Amphotericin B

43
Q

Example of ergosterol biosynthesis inhibitors

A

“azole”
miconazole
clotrimazole
itraconazole
fluconazole

44
Q

Which antifungal should be avoided in diabetes and why?

A

Nystatin
contains sucrose

45
Q

Why shouldn’t clotrimazole be taken systemically?

A

GI and neurolgical side effects

46
Q

A ptn on warfarin shouldn’t take this class of antifungal. Why?

A

Ergosterol Biosynthesis inhibitors
“azole”
decreases metabolism of warfarin = increased effect of warfarin = risk of bleeding

47
Q

What is the protocol for miconazole in the treatment of oral candidiasis?

A

Gel 2% 2.5ml 3/day for 7-14 days and 7 days after symptoms resolve

48
Q

What is the protocol for nystatin in the treatment of oral candidiasis?

A

100,000units/ml 1ml 4/day for 7-14 days, 2-3 days after symptoms resolve

49
Q

What are the 3 aims of antiviral medications?

A
  1. block viral replication
  2. shorten duration of symptoms
  3. accelerate healing of lesions
50
Q

Which HSV virus type is herpes labialis associated with?

A

HSV1

51
Q

What are the 3 drug classes of antivirals?

A
  1. Acyclic Guanosine Anologues “clovir”
  2. Acyclic Neucleotide Analogues “fovir”
  3. pyrophosphate anologue “forscanet”
52
Q

Which virus type is acyclovir active against?

A

Herpes virus

53
Q

Why does acyclovir required early administration to be effective?

A

Targets viral replication which occurs in the first 48hours of infection. After this viral replication decreases so medication is less effective.

54
Q

What is the use of forscarnet?

A

CMV or acyclovir resistance HSV in immunocompromised patients

55
Q

What are glucocorticoids?

A

Synthetic anologue of cortisol hormone produced by adrenal glands.

56
Q

When is the peak production of natural cortisol? How does this affect dosage/prescription?

A

Morning
Ptn should take corticoids in morning for maximal effect

57
Q

How much cortisol does the body naturally produce?

A

20-30mg

58
Q

What are the side effects of glucocorticoids?

A

Weight gain
osteoporosis
increased blood glucose

59
Q

List 5 common glucocorticoids?

A

Betamethasone
Dexamethasone
Methylprednisolone
Prednisolone
Deflazacort

60
Q

What are the symptoms of corticosteroid withdrawl syndrome?

A

Arthralgia
myalgia
mood changes and fatigue
headache
GI problems

61
Q

What is a method for increasing the contact time of topical corticosteroids with the oral mucosa?

A

Use in conjunction with an adhesive gel e.g orabase

62
Q

what are the instructions given to patients for topical corticosteroids?

A

contact time = 4-30 min 2-3/day (depends on type)
avoid talking, eating, drinking rinsing during this time

63
Q

What are 3 types of corticosteroid based mouthwashes?

A

Klobetasol proprionate
dexamethasone proprionate
betamethason proprionate

64
Q

What is the benefit of intralesion corticosteroid injections?

A

decreased side effect
increased concentration of corticosteroid at injection site

65
Q

Describe what corticosteroid sparing is

A

prescription of immunosuppresive or anti-inflammatory agnets to decrease the ptn’s cumulative exposure to systemic corticosteroids

DEN4SKE (8 decks)

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