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Tim's Cards > Pharmacology II > Flashcards

Pharmacology II Flashcards

1
Q

If an antibiotic has the ability to kill bacteria, it is _______.

If an antibiotic inhibits bacterial growth, it is ______.

A

Bactericidal

Bacteriostatic

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2
Q

Antibiotics that are effective against a small number of bacteria are _______.

What is an example of an antibiotic that is only effective against G+ and a few G- bacteria?

A

Narrow Spectrum

Penicillin

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3
Q

Antibiotics that are effective against many bacteria are ______.

What is the antibiotic with that kills the most variety?

A

Broad Spectrum

Tetracycline (kills G+ and G-, rickettsia, and some viruses)

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4
Q

What type of microbe dominates 90-95% the oral microbiome?

A

G+ strep or staph

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5
Q

T/F

All oral and facial infections occur from microorganisms already in the mouth

A

True

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6
Q

What can introduce “outside” oral infections?

A

Trauma

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7
Q

What would be the most likely culprit causing an oral infection?

A

G+ strep or staph

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8
Q

______ is the drug of choice for orofacial infections.

A

Penicillin

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9
Q

What type of Penicillin is the best choice for orofacial infections?

A

Penicillin V

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10
Q

10% of penicillin is removed from the body via _______.

90% is eliminated via ________.

A

Glomerular filtration (passive)

Tubular Secretion (active)

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11
Q

T/F

Penicillin stays in the body a long time

A

False

*excreted rapidly

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12
Q

____% of an oral dose of penicillin is excreted within ____ hrs.

A

70%

4 hrs

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13
Q

T/F

Penicillin is excreted unchanged

A

True

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14
Q

What drug, used to treat gout, is often given before penicillin?

How does it treat gout?

A

Probenecid (benemid)

Prevents uric acid reabsorption into blood stream

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15
Q

How does Probenecid (benemid) compete with penicillin?

A

Excretory Active Transport system

*Probenecid has higher affinity for excretory process

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16
Q

Giving Probenecid (benemid) prior to Penicillin will elevate the serum blood levels of Penicillin by _____.

A

3-4 times

*prolongs effect of penicillin

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17
Q

What enzyme breaks dow the beta lactam ring of the Penicillin molecule?

A

Penicillinase

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18
Q

What type of Penicillin has the following profile:
Bactericidal
Narrow Spectrum
Acid-labile (70-80% broken down by gastric acid)
Penicillinase-labile

A

Penicillin G

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19
Q

T/F

Procain Penicillin G is Penicillin-ase labile

A

True

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20
Q

What type of Penicillin is given either as a repository or IM, is dissolved in oil, and is Penicillinase-labile?

A

Procain Penicillin G

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21
Q

Name 3 types of Penicillin G.

A

Penicillin G

Procain Penicillin G

Benzathine Penicillin G

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22
Q

What type of Penicillin is dissolved in oil and given as a repository or IM, is Penicillinase-labile and is the longest lasting form of penicillin?

A

Benzathine Penicillin G

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23
Q

Given a ______ IM dose after aqueous penicillin, this is the longest lasting form because of no GI absorption.

A

Benzathine Penicillin G

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24
Q

How long does Benzathine Penicillin G last in the plasma?

A

3 weeks

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25
Q

What is the improved, acid stable version of Penicillin G?

aka?

A

Penicillin V

sodium penicillin V

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26
Q

How is Penicillin V taken?

A

Orally

***not broken down by gastric acid

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27
Q

What increases the bioavailability of Penicillin V?

A

Potassium salt

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28
Q

Does penicillinase break down Penicillin V?

A

Yes

*penicillin-ase labile

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29
Q

Name 4 Penicillinase resistant drugs:

these are only given for infections with penicillinase producing bacteria

A

Cloxacillin (canadian)

Dicloxacillin (canadian)

Piperacillin and tazobactam sodium

Ticarcillin and clavulanate potassium

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30
Q

What is a Bactericidal, broad spectrum, acid stable, but penicillinase-labile form of Penicillin?

A

Ampicillin

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31
Q

Principen with Probenecid is a ______ spectrum form of penecillin

A

Broad Spectrum

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32
Q

Describe Amoxicillin (Amoxil)

2 things

A

Broad Spectrum

Penicillinase-labile

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33
Q

______ is added to Amoxicillin to make ______

A

Clavulanic Acid

Augmentin

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34
Q

T/F

Augmentin is peniccillinase labile

A

False

*inhibits beta lactamase

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35
Q

Name 4 Narrow Spectrum forms of Penicillin:

A

Penicillin G

Procain Penicillin G

Benzathine Penicillin G

Penicillin V

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36
Q

Name 4 Broad Spectrum forms of Penicillin:

A

Ampicillin

Principen with Probenecid

Amoxicillin

Augmentin

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37
Q

What is the synthetic, beta lactamase inhibiting, broad spectrum antibiotic?

What is it a combination of?

A

Augmentin

Clavulanic acid and Amoxicillin

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38
Q

Name are 3 general adverse affects of penicillin:

A

Oral Candidiasis

Black hairy tongue

Allergy

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39
Q

What type of reaction can Amoxicillin-toxicity induce?

A

Maculopapular rash

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40
Q

What type of reaction can Augmentin induce?

A

Diarrhea

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41
Q

Name 2 types of Repository Penicillin:

A

Procaine Penicillin G

Benzathine Penicillin G

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42
Q

How does Penicillin work?

A

Structural glycopeptide interference in bacterial cell wall synth.

Cell lysis

(bactericidal)

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43
Q

The bacterial spectra of Penicillins can be _____ or ______.

The bacterial spectra of Cephalosporins are _____ in the 1st Generation and _______ in the higher generations.

A

Narrow, broad

Narrow, Broad

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44
Q

Match the following toxicity rxns:

Oral candidiasis, black hairy tongue, maculopapular rash, diarrhea, allergy

Anaphylaxis, fever, rash, eosinophilia, GI upset, glossitis, stomatitis, candidiasis, nephrotoxicity

A

Penicillins

Cephalosporins

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45
Q

T/F

Pts that are intolerant to penicillin may be intolerant to cephalosporins

A

True

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46
Q

Describe Cephalosporins mechanism of action:

What kind of bacteria are most susceptible to Cephalosporins?

A

similar to penicillin - inhibit bacterial cell wall synthesis

Rapidly dividing bacteria most susceptible

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47
Q

Most Cephalosporin absorption occurs in the ______.

This is efficient because…

A

GI tract

Acid stable (no destruction is stomach like penicillin)

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48
Q

T/F

Most penicillins are acid labile so are destroyed by gastric juices

A

True

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49
Q

What type of penicillin is more acid stable and therefore has more uniform absorption?

A

Penicillin V

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50
Q

Name 3 1st generation Cephalosporins (with generic names)

A

Cephalexin (keflex)

Cefadroxil (duricef)

Cephradine (velosef)

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51
Q

Name the Second Generation Cephalosporin we need to know (including generic)

A

Cefaclor (raniclor)

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52
Q

Name 3 macrolide antibiotics:

A

Erythromycin

Azithromycin

Clarithromycin

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53
Q

Name the 6 side effects of Macrolide antibiotics

erythromycin, azithromycin, clarithromycin

A

GI

Cholestatic jaundice (hepatitis)

Allergic rxns

Fever

Eosinophilia

Skin eruptions

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54
Q

Name 4 GI side effects of Macrolide antibiotics (erythromycin, azithromycin, clarithromycin)

A

Stomach pain

Nausea/vomiting

Cramps

Diarrhea

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55
Q

Erythromycin is usually _____, but ______ at high doses or when used against susceptible organisms.

A

Bacteriostatic

Bactericidal

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56
Q

Erythromycin is only effective against ________ organisms.

A

Actively Dividing

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57
Q

How does Erythromycin attack bacteria?

what does it bind? near what? inhibits?

A

Binds 50S ribosomal subunit

near peptidyltrasferase

peptide bond formation

***suppresses bacterial growth due to lack of protein production

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58
Q

Where is Erythromycin absorbed?

A

Upper part of intestine

59
Q

T/F

Food reduces the absorption of Erythromycin

A

True

60
Q

T/F

The effectiveness of Erythromycin is dependent on derivative, dosage, acid stability, and gastric emptying

A

True

61
Q

T/F

Erythromycin is absorbed topically through mucous membranes

A

False

*Unknown

62
Q

Describe 2 Aspects of Erythromycin distribution:

A

Crosses placenta

Distributed to most body tissues (diffuses readily)

63
Q

Most Erythromycin is excreted _______ due to ______.

A

in Feces

its large size

64
Q

Erythromycin is absorbed from the _____ to the Liver and excreted in the bile.

How can this affect the Bile Duct?

A

Stomach

Smooth muscles constrict = Cholestatic Hepatitis

65
Q

Erythromycin is excreted primarily in the _____ and secondarily in the ______.

A

Feces

Urine

66
Q

________ is the primary Macrolide used for antibiotic premedication in Dentistry

________ and ______ are the alternative macrolide antibiotics. (with Brand names)

A

Erythromycin

Clarithromycis (Biaxin) and Azithromycin (Zithromax)

67
Q

What antibiotic has a similar mechanism to Erythromycin?

interferes with bacterial protein synth

A

Clindamycin

68
Q

Clindamycin is used for infections caused by ________ organisms.

A

Anaerobic

69
Q

What is the drug of choice if penicillin resistant and have an orofacial infection?

A

Clindamycin

70
Q

What are 3 cases that would indicate Clindamycin use?

A

Periodontal/orofacial infections by anaerobes

Anaerobic osteomyelitis (oral bone infection)

Endodontic infections caused by Bacteroides

71
Q

T/F

Clindamycin is effective at penetrating bone and therefore prescribed for Anaerobic Osteomyelitis

A

True

72
Q

What 2 classes of Antibiotics are most often associated with C. diff?

A

Clindamycin

Cephalosporins

(C, C, C)

73
Q

What drug is affected by divalent cations in GI absorption?

A

Tetracycline

74
Q

Why do divalent cations affect Tetracycline so much?

What is this process called?

A

4 ring structure with OH and O groups

Chelation

75
Q

Ca, Mg, Fe, and Al chelated Tetracycline when _____ is consumed.

A

Dairy

76
Q

What conditions are contraindicated for Tetracycline administration?

A

Children developing teeth/bone

Pregnancy

77
Q

What can be incorporated into teeth/bone through chelation?

*causes pitting and yellowing

A

Tetracycline

78
Q

Tetracyclines are Category _____ and cross the Placenta.

A

D

79
Q

Why do the chelating effects of Tetracycline incorporating into the enamel become permanent?

A

Enamel doesn’t remodel like bone

80
Q

T/F

Teeth exposed to Tetracycline fluoresce under a black light.

A

True

81
Q

What is a reversible effect of Tetracycline exposure in children?

What is an irreversible effect?

A

Bone deposition

May inhibit skeletal growth

82
Q

Name 3 Tetracycline preparations:

A

Doxycycline

Minocycline

Tetracycline

83
Q

Doxycycline _____, aka ______, inhibits collagenase only (doesn’t kill bacteria) at a subantimicrobial dose.

A

Hyclate

Periostat

84
Q

Tetracyclines are contraindicated with _______/_______.

A

Penicillin/Amoxicillin

85
Q

Tetracycline is bacterio_______, while penicillin is bacterio______.

A

Static

Cidal

86
Q

What is an example of another antibiotic that can be prescribed if a patient is already taking Tetracycline?

What kind of antibiotic must be prescribed?

A

Clindamycin

Bacteriostatic

*static and cidal have antagonistic effects

87
Q

What are 3 Contraindications for Tetracycline?

A

Pregnancy

Child

Penicillin/Amoxicillin use

88
Q

What are 3 medical indications for Quinolones?

A

Respiratory infections

Bronchitis, community acquired pneumonia

Urinary tract infections

89
Q

What is a Dental indication for Quinolones?

A

Periodontal disease when other agents ineffective

***rarely used in Dentistry

90
Q

Quinolones target _______.

A

DNA topoisomerases

91
Q

The enzyme that relieves tension in DNA as it uncoils is a _______.

________’s target these enzymes to block bacterial replication, transcription, and repair.

A

Topoisomerase

Quinolones

92
Q

Quinolones are Bacteri_____ and _____ spectrum.

A

Bactericidal

Broad

93
Q

Describe 3 Adverse events broght on by Quinolones.

A

GI - Nausea/vomiting, diarrhea, xerostomia

CNS - headache, dizzy, vertigo syncope

Allergy - pruritis (itching), urticaria (hives)

94
Q

What drug deactivates critical enzymes in Anaerobic Bacteria through a cascade of reduction (ferredoxin, pyruvate oxido-reductase, nitroso intermediates) that creates Sulfinamides?

150 enzymes affected

A

Metronidazole

95
Q

Metronidazole metabolites can also be taken up into ________ and form unstable molecules.

Why does this have little effect on human cells?

A

Anaerobic Bacterial DNA

Partial reduction of Metronidazole only happens in anaerobic cells

96
Q

T/F

Metronidazole is used to supplement other antibiotics when a perio condition isn’t responding to other treatments.

A

True

97
Q

3 Common adverse side effects of antibiotics:

A

Candidiasis (black hairy tongue)

Stomatitis (sore mouth)

Glossitis (tongue inflammation)

98
Q

How do antibiotics interfere with oral contraceptives?

A

Oral contraceptives activated by gut flora

If gut flora damaged, possible ovulation

***use alternative birth control until next cycle

99
Q

Where is the site of antibiotic/oral contraceptive interaction?

A

Small intestine

100
Q

Warfarin/coumadin (anticoagulant) is affected by antibiotics how?

A

Antibiotics kill Warfarin’s competition - gut flora gobbling up VitaK.

***can experience excessive anticoagulation

101
Q

What class of antibiotics is particularly harmful to gut bacteria and therefore compounds effects of Warfarin/coumadin due to lack of Vitamin K?

A

Quinolones (cipro)

102
Q

Histamines cause ______, which drops bp

A

Vasodilation

103
Q

T/F

Tachycardia and reddening of the skin due to vasodilation are consequences of Histamine

A

True

104
Q

What receptors does Histamine react with in the CV system?

A

H1

105
Q

What receptors does Histamine react with in the Respiratory tract?

A

H1

106
Q

Describe Histamines actions in the Respiratory tract:

4 things

A

Constriction resp smooth muscle

Difficulty breathing

Prostaglandin formation

Inflames airways

107
Q

In the GI tract Histamine acts on Gastric Acid secretion (HCl) through ____ receptors.

Contracts the Ileum through _____ receptors.

A

H2

H1

108
Q

What do Antihistamines block?

A

Histamine Receptors (H1 or H2)

*antagonists

109
Q

T/F

Both H1 and H2 mechanism of action for Antihistamines is competitive blockage of receptors

A

True

110
Q

What is the primary and 2 secondary adverse side effect of antihistamines?

A

primary - sedation

secondary - xerostomia and CNS

111
Q

T/F

Antihistamines affect children and the elderly differently

A

True

*stimulation instead of drowsiness (also convulsions)

**also seen in very large doses

112
Q

H1 antihistamine mechanism is competitive blockage. H2 is competitive blockage that reduces what? where? consequence?

A

cAMP, protein kinase, H/K pump

stomach

inhibits basal/nocturnal HCl (gastric acid) secretion

113
Q

What are the clinical uses of H2 Antihistamines?

A

GI disorders

*ulcers, GERD, gastric acid hypersecretion, Zollinger-Ellison syndrome

114
Q

What is Zollinger-Ellison syndrome?

A

Gastrin producing tumor

*hypersecretion HCl

115
Q

H1 antihistamine clinical use includes allergy, pollinosis, urticaria (localized with wheals), anaphylaxis - what are the off-label uses (5)?

A

Motion sickness

Nausea/vomiting

Dizziness

Sleep

Local anesthetics

116
Q

In oral form antihistamines reverse ______.

In injected form antihistamines reverse _______.

In liquid form antihistamines are for _______.

A

minor allergic rxns (or pre-op sedation)

major allergic rxns

topical anesthetic (injected in rare cases, used for pts allergic to other locals)

117
Q

What are 3 non-sedating antihistamines?

A

loratadine (Claritin)

fexofenadine (Allegra)

desloratadine (Clarinex)

118
Q

What is the major side effect of laratadine, fexofenadine, and desloratatine? (Claratin, Allegra, Clarinex)?

A

Headache

*have long half lives

119
Q

Name 3 Sedating Antihistamines:

A

Ehanolamines (dophenhydramine/Benadryl)

Alkylaminies (chlorpheniramine/Clor-Trimeton)

cetirizine (Zyrtec)

120
Q

If you have to inject benadryl (ethanolamine) in emergency, how much?

Daily max?

A

10-50 mg

400 mg

121
Q

What is the primary ingredient in non-habit forming sleep aids like Sminex and Nytol?

A

Ethanolamine (diphenhydramine/Benadryl)

122
Q

T/F
Off label use of Ethanolamine, unapproved by the FDA, includes insomnia, motion sickness (like Dramamine), nausea, and vomiting

A

True

123
Q

Alkylamines can be injected in dental emergencies/anaphylaxis at ____ mg and max ____mg daily

A

10

40

124
Q

What popular OTC antihistamine is approved for treatment of all types of allergens and causes sedation?

A

cetirazine (Zyrtec)

125
Q

What are 4 H2 receptor blockers used for ulcers/heartburn?

Most dangerous?

Safest?

A

cimetadine (Tagamet) *most adverse rxns - inhibits cytoP450

famotidine (Pepcid)

nizatidine (Axid)

ranitidine (Zantac) *safest

126
Q

T/F

Immunosuppression, systemic disease, chemo, antibiotics, and hormones can all lead to fungal infections

A

True

*opportunistic = candida albicans

127
Q

“cottage cheese”, pseudomembanous, atrophic tongue, hyperkeratotic appearance, symptomatic geographic tongue, and angular chelitis are all what?

A

Oral fungal infections

128
Q

Name 3 antifungal agents useful agains Candida albicans:

A

nystatin (Mycostatin)

clotrimazole (Mycelex)

amphotericin (Amphocin, Fungizone)

129
Q

T/F

Topical vs systemic therapy is preferred for fungal infection

A

True

130
Q

T/F

Systemic fungal drugs suck b/c they cause dangerous DDI’s, promote resistance, and are toxic

A

True

131
Q

Troches, Pastilles, liquids, and powders are all _____ treatments.

A

Topical

132
Q

Chorhexidine/Listerine kill ____ species of Candida

A

7

133
Q

Nystatin binds ____ in fungal cell membrane

A

Sterols

*changes cell permeability and leaks cell contents

134
Q

What azole has severe CV side effects including neuropathy?

A

Itraconazole

135
Q

Topical treatment of oral fungal infections is used for minimum of ____ hours after symptoms subside, and the usual treatment is ____ weeks.

*reevaluated?

A

48 hours

1-2 weeks

*14 days after therapy

136
Q

Because topical agents must be used 5 times/day for 1-2 weeks, what can be a problem?

A

Compliance

137
Q

What drug is incorporated into viral DNA and inhibits DNA polymerase preferentially?

A

acyclovir (Zovirax)

138
Q

5 antivirals used to manage Herpes?

A

acyclovir (Zovirax)

valacyclovir (Valtrex)

penciclovir (Denavir)

docosanol (Abreva)

alcohol/benzalkonium chrolide (Viroxyn)

139
Q

What antiviral treats both HSV1 and HSV2?

A

acyclovir (Zovirax)

*every 3 hrs apply or no result

140
Q

What antiviral treats HSV2 only (genital)?

A

valacyclovir (Valtrex)

141
Q

What 3 antivirals treat HSV1 only?

A

penciclovir (Denavir)

docosanol (Abreva)

alcohol/benzalkonium chloride (Viroxyn)

142
Q

What antiviral must be applied every 3 hrs or no results?

What antiviral is given in 2 doses?

what antiviral is applied every 2 hrs for 4 days?

what antiviral is applied 5 times/day? (never around eyes)

what antiviral is cauterizing and stings?

A

acyclovir (Zovirax)

valacyclovir (Valtrex)

penciclovir (Denavir)

docosanol (Abreva)

alcohol/benzalkonium chrolide (Viroxyn)

143
Q

Name 2 side effects of systemic antivirals:

A

Bone marrow suppression

Blood dyscrasias (thrombocytopenia, leukopenia, aplastic anemia)

Tim's Cards (140 decks)

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