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I&D > Week 2 Pharmacology > Flashcards

Week 2 Pharmacology Flashcards

1
Q

Name two drug reference database found on the Health Sciences Library’s Dental Toolkit page?

A

Micromedex (also on Care Provider Toolkit page) and Mosby’s Dental Drug Reference

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2
Q

Name 4 databases she pointed out in the Care Provider Toolkit page?

A
  1. Lexicomp within UptoDate
  2. Basic and Clinical Pharmacology with in Access Pharmacy
  3. Sanford Guide to Antibiotics
  4. Pediatric Infectious Disease: Red Book
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3
Q

Name 4 general/all drug reference guides?

A
  1. Lexicomp within UptoDate
  2. Basic and Clinical Pharmacology with in Access Pharmacy
  3. Micromedex (also on Care Provider Toolkit page)
  4. Mosby’s Dental Drug Reference
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4
Q

Which guide is good for just antibiotics?

A

Sanford Guide

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5
Q

Name 3 classes of antibiotics based on their mechanism of action?

A
  1. Cell wall disruptors- Bacteriocidal
  2. Protein synthesis inhibitors- Bacteriostatic
  3. DNA/RNA function disruptors- Bacteriocidal
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6
Q

Name some “Cell wall disruptors” ?

A

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

  1. Anti-TB Agents- isoniazid and ethambutol
  2. Polymyxins- toxic and hardly used
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7
Q

Name some Protein synthesis inhibitors?

A

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)

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8
Q

Name some DNA/RNA function disruptors?

A

Know:
– Trimethoprim/Sulfamethoxazole
– Nitroimidazoles- Metronidazole

Familiar:
– Fluoroquinolones- levofloxacin
–Mupirocin- mupirocin
–Anti-TB Agents- rifampin
–Nitrofurantoin- nitrofurantoin

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9
Q

Which drugs on the Drug Class one pager are highlighted as being for Dental and what do they cover?

A

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

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10
Q

Do all drugs in a class always have the same coverage?

A

No they can vary such as with penicillins and gram negative anaerobes

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11
Q

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?

A
  1. Penicillin/Amox, Cephalosporins and Clindamycin, Metronidazole
  2. Doxycycline, Z-Pack
  3. Nitrofurantoin- UTI, TMP-SMX- Immune prophy/UTI, MRSA
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12
Q

Name 4 major mechanisms of resistance to antibiotic?

A
  1. Limit uptake of antibiotic- Cell wall mutation in porins (Enterobacteriaceae), thicker (Vancomycin and S. Aureus, or high lipid content (mycobacteria)
  2. Modify intracellular drug target- Mutations that inhibit binding (penicicillin binding proteins) (Ribosome mutations or methylation)or enzymes (folate biosynth and TMP/SMX)
  3. Inactivate the drug- beta lactamases cleave beta lactam rings
  4. Drug efflux pumps- gram+ pump out fluoroquinolones
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13
Q

How is resistance acquired?

A

Via mutation after exposure to drug if not killed

Can be transferred to other bacteria

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14
Q

Strategies to reduce resistance?

A

Use less

Combination- ie Clavulanate which inactivate beta lactamases

Use a different class- work when know the bacteria and what it is susceptible to

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15
Q

How fast are resistant organism developed after introduction of a new antibiotic?

A

Usually 2 years

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16
Q

Two bacterial genes that confer resistance, what antibiotics dont work and what to use instead?

A

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

17
Q

Worrisome drug allergies?

A

Biggies

Anaphylaxis

SCARS

Others

DRESS, Acute generalized Exanthematous Pustulosis, Aspirin/NSAID Exacerbated Respiratory Disease, Thrombocytopenia and Anemia

18
Q

When do you refer to an allergist for testing?

A

Urticaria or angioedema rashes or anything else on the worrisome list

19
Q

Drugs that are common allergy masqueraders?

A

Opioids (dose related selective histamine release to skin),

Vancomycin (dose related histamine release from mast cells),

Amoxicillin (non allergic one time rash)

20
Q

Viruses that are common allergy masqueraders?

A

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

21
Q

4 most common antibiotics in dentistry?

A

Penicillin

Amox or Amox/Clav

Clindamycin

Metronidazole

22
Q

2 additional antibiotics that dentists may encounter or possibly use?

A

Doxycycline and Z-pack

23
Q

Penicillin

MOA – Spectrum – Typical dose – Adverse drug reactions – Drug interactions – Comments

A

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.

24
Q

Amoxicillin/Amoxicillin-Clavulanate

MOA – Spectrum – Typical dose – Adverse drug reactions – Drug interactions – Comments

A

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

25
Q

Clindamycin

MOA – Spectrum – Typical dose – Adverse drug reactions – Drug interactions – Comments

A

MOA- Binds to bacterial 50S ribosomal subunit, inhibiting protein synthesis

Spectrum- Excellent anti-Strep agent and good coverage for both gm (+) and gm (-) anaerobes

Typical dosing- Dosing ranges from 150 mg to 450 mg TID to QID, with max 1.8 g/day. A dose of 300 mg TID is not
uncommon.

Adverse drug reactions- Clostridioides difficile-associated diarrhea is the one to watch for. Otherwise, nausea,
headache, taste disturbance

Drug interactions- Uncommon. St. John’s wort can decrease

Comments- Most commonly used agent in the penicillin-allergic patient

26
Q

Metronidazole

MOA – Spectrum – Typical dose – Adverse drug reactions – Drug interactions – Comments

A

MOA- Destabilizes anaerobic cell DNA

Spectrum- No aerobic organism coverage. Excellent coverage of anaerobic gm (-) organisms and some coverage of anaerobic gm (+) organisms.

Typical dosing- 250 – 500 mg BID - TID

Adverse drug reactions- Metallic taste, “furry” tongue, nausea (> 10%); neuropathy rare

Drug interactions- Disulfiram reactions (nausea, vomiting, flushing, tachycardia) with alcohol

Comments- Can use in tandem with agent that has good Strep and some gm (+) anaerobe coverage, e.g., penicillin
or, if penicillin allergy, cefaclor

27
Q

Two common DD interactions to be aware of?

A

CYP interations- some inhibit thereby increasing level of another drug -danger when that drug has narrow non- toxic window

QT Prolongation- 1 usually ok 2 not good

I&D (19 decks)

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