Week 2 Pharmacology Flashcards
Name two drug reference database found on the Health Sciences Library’s Dental Toolkit page?
Micromedex (also on Care Provider Toolkit page) and Mosby’s Dental Drug Reference
Name 4 databases she pointed out in the Care Provider Toolkit page?
- Lexicomp within UptoDate
- Basic and Clinical Pharmacology with in Access Pharmacy
- Sanford Guide to Antibiotics
- Pediatric Infectious Disease: Red Book
Name 4 general/all drug reference guides?
- Lexicomp within UptoDate
- Basic and Clinical Pharmacology with in Access Pharmacy
- Micromedex (also on Care Provider Toolkit page)
- Mosby’s Dental Drug Reference
Which guide is good for just antibiotics?
Sanford Guide
Name 3 classes of antibiotics based on their mechanism of action?
- Cell wall disruptors- Bacteriocidal
- Protein synthesis inhibitors- Bacteriostatic
- DNA/RNA function disruptors- Bacteriocidal
Name some “Cell wall disruptors” ?
Know:
1. Beta Lactams such as- Penicillins- Oral and IV, Cephalosporins-Oral and IV, Carbapenems-IV
Be familiar:
2. Anti-Staph Agents- Glycopeptides (Vancomycin-oral for C-dif) and Lipopeptides (daptomycin) both IV only
- Anti-TB Agents- isoniazid and ethambutol
- Polymyxins- toxic and hardly used
Name some Protein synthesis inhibitors?
Know:
Macrolides- Z-Pack (interactions), Tetracycline- Doxy, Clindamycin (C-dif assoc), Aminoglycosides- Gentamycin (toxic-rare use)
Familiar:
Pleuromutilins-lefamulin
Anti-Staph: Oxazolidinones- linezolid, Streptogramins- quinupristan, dalfopristin (IV)
Name some DNA/RNA function disruptors?
Know:
– Trimethoprim/Sulfamethoxazole
– Nitroimidazoles- Metronidazole
Familiar:
– Fluoroquinolones- levofloxacin
–Mupirocin- mupirocin
–Anti-TB Agents- rifampin
–Nitrofurantoin- nitrofurantoin
Which drugs on the Drug Class one pager are highlighted as being for Dental and what do they cover?
Beta Lactams-
- *Penicillin**- Gram + Strep (++) and both Gram + (+-)and gram - (+) anaerobes,
- *Amox** and Cephalosporins- Gram + Strep (+) and gram - (+) anaerobes,
Lincosamides- Clindamycin: Gram + Strep (+) and both Gram + (+)and gram - (+) anaerobes
Nitroimidazoles- Metronidazole: both Gram + (+)and gram - (+) anaerobes
Do all drugs in a class always have the same coverage?
No they can vary such as with penicillins and gram negative anaerobes
What agents might be used for infectious disease prophylaxis or prescribed for dental infections by health care providers who are not oral health care experts?
- Penicillin/Amox, Cephalosporins and Clindamycin, Metronidazole
- Doxycycline, Z-Pack
- Nitrofurantoin- UTI, TMP-SMX- Immune prophy/UTI, MRSA
Name 4 major mechanisms of resistance to antibiotic?
- Limit uptake of antibiotic- Cell wall mutation in porins (Enterobacteriaceae), thicker (Vancomycin and S. Aureus, or high lipid content (mycobacteria)
- Modify intracellular drug target- Mutations that inhibit binding (penicicillin binding proteins) (Ribosome mutations or methylation)or enzymes (folate biosynth and TMP/SMX)
- Inactivate the drug- beta lactamases cleave beta lactam rings
- Drug efflux pumps- gram+ pump out fluoroquinolones
How is resistance acquired?
Via mutation after exposure to drug if not killed
Can be transferred to other bacteria
Strategies to reduce resistance?
Use less
Combination- ie Clavulanate which inactivate beta lactamases
Use a different class- work when know the bacteria and what it is susceptible to
How fast are resistant organism developed after introduction of a new antibiotic?
Usually 2 years
Two bacterial genes that confer resistance, what antibiotics dont work and what to use instead?
vanA- cell wall modifying enzyme,
DONT WORK
vancomycin
teicoplanin
dalbavancin
USE
linezolid
daptomycin
ampC- penicillinase, Ambler Class C cephalosporinases
DONT WORK
penicillins
most cephalosporins
USE
cefepime
ceftolozane-tazobactam
ertapenem
imipenem-cilastatin
meropenem
aminoglycosides
TMP-SMX
fluoroquinlones
Worrisome drug allergies?
Biggies
Anaphylaxis
SCARS
Others
DRESS, Acute generalized Exanthematous Pustulosis, Aspirin/NSAID Exacerbated Respiratory Disease, Thrombocytopenia and Anemia
When do you refer to an allergist for testing?
Urticaria or angioedema rashes or anything else on the worrisome list
Drugs that are common allergy masqueraders?
Opioids (dose related selective histamine release to skin),
Vancomycin (dose related histamine release from mast cells),
Amoxicillin (non allergic one time rash)
Viruses that are common allergy masqueraders?
Viral exanthem- rashes caused by variety of viruses discrete often with fever and lymphadenopathy or recent respiratory tract infection
Pityriases Rosea- unknown origin prolly viral herald patch followed by mild rash
Epstein Barr Virus get rash with amox often
4 most common antibiotics in dentistry?
Penicillin
Amox or Amox/Clav
Clindamycin
Metronidazole
2 additional antibiotics that dentists may encounter or possibly use?
Doxycycline and Z-pack
Penicillin
MOA – Spectrum – Typical dose – Adverse drug reactions – Drug interactions – Comments
MOA- Lysis of bacterial cell walls
Spectrum- Most aerobic gm (+) Strep and most anaerobic gm (+) bacteria. Not great for anerobic gm (-) organisms.
Typical dosing- 500 mg TID or QID, depending on symptom severity
Adverse drug reactions- ADRs rare: potentially nausea.
Drug interactions- Uncommon
Comments- Drug of choice for acute Strep pharyngitis. Will need rapid Strep test to confirm.
Amoxicillin/Amoxicillin-Clavulanate
MOA – Spectrum – Typical dose – Adverse drug reactions – Drug interactions – Comments
MOA- Lysis of bacterial cell walls
Spectrum- Most aerobic gm (+) Strep and most anaerobic gm (+) bacteria. Clavulanate will add anaerobic gm (-)
coverage and sinus organism H flu over amoxicillin alone.
Typical dosing- Amoxicillin 500 mg TID - 1000 mg BID. Amoxicillin-clavulanate 500 mg/125 mg TID or 875 mg/125
mg BID
Adverse drug reactions- Diarrhea most common (10% +), nausea (2-3%)
Drug interactions- Uncommon
Comments- Spectrum does not offer advantages over penicillin
