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pharm 2 > unit 1 ABx coverages > Flashcards

unit 1 ABx coverages Flashcards

1
Q
A
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2
Q

Normal Flora of Mouth

A

Gram +
› Viridans Group Streptococci
› Other Strep spps.
› Lactobacillus
› Actinomyces spps.
Gram-
› Prevotella spps.

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3
Q

gram state of most oral bac
* morph?
* Oxygen tolerance?
* Cell wall?

A

Gram Positive organisms:
* Bulk of oral bacteria
* Primarily cocci or irregular shape (pleomorphic)
* Oxygen tolerance varies from facultative anaerobes to strict anaerobes
* Cell wall has thick peptidoglycan layer

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4
Q

Three important genera of gram +

A
  • Lactobacillus
  • Streptococcus
  • Actinomyces
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5
Q

Actinomyces: O2, where?

A

Actinomyces - facultative anaerobe; periodontal pockets, dental plaques, on carious teeth

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6
Q

Lactobacillus -O2, where?

A

Lactobacillus - facultative anaerobe; produce lactic acid; role in dentine caries rather than enamel caries

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7
Q

Streptococcus - O2, where?

A

Streptococcus - facultative anaerobic cocci; produce lactic acid some implicated in caries

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8
Q

Streptococci Species in the Oral Cavity

A

Oral streptococci are referred to as viridans streptococci (Streptococcus viridans)
› Isolated from all sights of the mouth, each species has specific properties for
colonizing different oral sites
› Large proportion of resident microflora

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9
Q

bad streptococci of the mouth

  • Acid?
  • Highly associated with?
  • Bacterial communities collected from dentin carious lesions contain?
A

Strep mutans:
* Acidogenic (acid producing) and aciduric (acid tolerant) species
* Highly associated with caries (+++)
* Bacterial communities collected from dentin carious lesions contain notorious
acidogenic and aciduric species, including S. mutans, Scardovia wiggsiae, Parascardovia
denticolens, and Lactobacillus salivarius

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10
Q

what Abx works for all oral bac

A

augmentin

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11
Q

what spp do penicillins not work on

A

lactobacillus
porphyromanas
bacteriodes
neiserria
aggrebacter

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12
Q

metronidazole works on what spp?

A

peptostreptococcus (only gram + one)
porphyromanas
prevotella
veillonella
fusobacterium
bacteriodies

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13
Q

Bactericidal Abx’s

A

Cell Wall Inhibitors
*Beta Lactams
*Penicillins
*Cephalosporins

Inhibit DNA
*Fluoroquinolones
*Metronidazole

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14
Q

Bacteriostatic abx

A

* Protein Synthesis Inhibitors
– Macrolides
– Clindamycin
– Doxycycline

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15
Q

penicillin are sensitive to?

A

beta lacatamase

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16
Q

Augmentin™-

A

Augmentin™- amoxicillin+clavulanate = more gram negatives, anaerobes, & Staph.:
●Dental infections with abscess or failed amoxicillin

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17
Q

B-lactamase Resistance (MSSA) Versus MRSA

A
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18
Q

penicillin typical spectrum

A

mainly gram + (strep, actino, peptostrep) some gram - but possible resistance

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19
Q

amoxicillin coverage

A

covers gram + (strep, lacto, actino, pepto)
good/SR with some gram -

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20
Q

metro coverage

A
  • mainly gram - except for neiserria and aggregibacter
  • also covers peptostrep
  • can be combined with penicillin for similar effect as augmentin
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21
Q

when should we use augmentin

A

when amox fails

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22
Q

what can be used for prohylaxis with G+ suspected

A

penicillin

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23
Q

natural penicillins

A

penicillin G and VK

24
Q

natty penicillins work on:

A

Primarily - gram-positive Strep. species: Strep. viridans, Group A Strep, and anaerobic (Peptostreptococcus, Peptococcus sp.); activity against Actinomyces spps.

25
Q

extended spectrum aminopenicillins

A

ampicillin and amxoicillin

26
Q

extended spectrum aminopenicillins work on?

A

same as natty but Improved Oral absorption and gram negative coverage

27
Q

can we use b lactams with mutated PBP (S. aureus)

A

no

28
Q

what gram - is not covered by penicillin

A

porphyromanas
bacterioides (anaerobes)
neiserria
aggregibacter

29
Q

what gram - can penicillin cover (possible R)

A
30
Q

what gram - can amox cover

A

neiserria

31
Q

what gram - is not covered by amox

A

bacterioides (anaerobes)
aggregibacter

32
Q

cephlexin coverage

A

viridans strep
strep spp
peptostrep
Lacto and actino are questionable

33
Q

does cephlexin have any gram - cover

A

NO
questionable with prevotella and fuso

34
Q

cefaclor spp coverage

A

viridans strep
peptostrep
strep spp
lacto
actino maybe
and gram - cover of fusobacterium and aggregibacter

35
Q

clindamyacin coverage

A
36
Q

what does clinda not cover

A

neiserria and aggregibacter

37
Q

doxy cover

A

covers gram + and - except for neiserria and veillonella

38
Q

Cephalosporins
* beta-lactamases?
* Active against?
* generations?
* Each successive generation includes?
* side effects?
* Safely tolerated in?
* Poor against?

A
  • Most beta-lactamases do not reduce activity of cephalosporins
  • Active against Gram negatives producing b-lactamase
  • Several “Generations”
  • Each successive generation includes more Gram-negative activity
  • Limited side effect profile
  • Safely tolerated in penicillin intolerance history
  • Poor against anaerobes (particularly gram-)
39
Q

1st Generation Cephalosporins
* Excellent coverage of?
* gram activity? spp?
* oral gram -?

A
  • Excellent GRAM POSITIVE Coverage – Strep. spps. & Staph aureus
  • some gram negative activity:
  • Proteus, E. coli, and Klebsiella (PEcK)
  • Limited oral gram negatives- NO P. gingivalis
40
Q

2nd gen cephs
* gram coverages?
* oral gram -?

A
  • Still excellent GRAM POSITIVE Coverage – Strep. spps.
  • Some additional gram negatives:
  • Morexella, Haemophilus, Enterobacter, Neisseria
    (More HEN PEcK)
  • Still overall limited oral gram negative- YES P. gingivalis
41
Q

how can we use 1st and 2nd gen ceph in mouth

A

: may be used for early odontogenic infections. (no perio indications)

42
Q

Metronidazole (Flagyl)
●Bactericidal against all?
 spp?
●MOA
●additional targets?

A

●Bactericidal against all obligate ANAEROBES
 Bacteroides spps. and Fusobacterium
●Breaks DNA structure directly through production of free radicals via redox rxns
●Antiprotozoal: amoeba (Entamoeba), Trichomonas, Giardia.

43
Q

metro coverage

A
44
Q

clinda coverage

A
45
Q

tetracycline cover

A

good aggrebacter acitivity= used for perio dx

46
Q

do we fw ERTHYROMYCIN?
●spectrum?
■ Adverse effects:
■ Strong inhibitor of?
■ Highest risk of?

A

NOT USED
●Narrow spectrum: LOTS of resistance
■ Adverse effects: Prokinetic, GI disturbances, diarrhea (can be used with gastroparesis, cramping
■ Strong inhibitor of CYP3A –many drug interactions.
■ Highest QTc prolongation risk among antimicrobials

47
Q

why are macrolides not top choice for odontogenic infections?
■ No activity against?
■ Alternative?
■ Less effective than?
■ Overall limit use due to?
■ % of viridans group Streptococci resistant? implications?

A

■ No activity against Bacteroides, common in dental abscesses
■ Alternative antibiotic in odontogenic infections.
■ Less effective than b- Lactams (2nd choice)
■ Overall limit use due to already high resistance rates.
■ 50% of viridans group Streptococci resistant, not good for prophylaxis

48
Q

Pregnancy and Lactation
* Good Safety abx

A
  • Cephalosporins, penicillins, clindamycin, azithromycin
49
Q

Pregnancy and Lactation bad abx

A
  • Doxycycline – Ca++ chelation
  • Fluoroquinolones – kidneys/cartilage
  • Sulfamethoxazole/trimethoprim – various/kernicterus
  • Metronidazole in 1st Trimester – limited data
50
Q

When Are Antibiotics Indicated/ Recommended in dentistry?
* NUG ?
* Periodontitis?
* infection where?
* Endo/Perio?

A
  • NUG – systemic symptoms or immunocompromised
  • Aggressive Periodontitis non responsive to debridement
  • Fascial space infection
  • Endo/Perio with systemic symptoms
51
Q

when are abx not needed in dentistry

A
  • Endodontic conditions
  • Chronic Periodontitis or Gingivitis
  • Periodontal Abscess
  • NUG – no systemic symptoms
52
Q

Antibiotics in Odontogenic Infections
Antimicrobial agents are indicated if what has is present? Or infection has spread beyond?

A

Antimicrobial agents are indicated if fever and regional lymphadenopathy are present, or when infection has perforated the bony cortex and spread into surrounding soft tissue.

53
Q

Early odontogenic Infection (< 3 days) abx
whatif there are allergies (mild/severe)?
what if there is no improvement?

A
54
Q

late odontogenic infection (>3 days) abx

A

continue for 2 days after resolution of systemic symptoms

55
Q

Bacterial Infective Endocarditis (BIE)
85% spp are?
~5% caused by?

A
  • Infection of endocardium or valves from blood born bacteria.
  • 85% are Staphylococci spps & Streptococci spps
  • ~5% caused by HACEK group Gram-Negatives
  • (Haemophilus spps, A. actinomycetemcomitans, Cardiobacterium
    hominis, Eikenella corrodens, Kingella kingae)
  • HACEK are oral flora with potential for infection.
56
Q

when would 1st and 2nd gen cephs be used in dentistry

A

1st gen more used for prophylaxis/allergies where as 2nd gen can be used for infections due to increased gram - coverage, however amoxicillin is preferred

pharm 2 (20 decks)

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