Pharmacology - Chapter 7 - Anti-Infective Agents
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candicegaud Plus on June 4, 2012
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Pharmacology - Chapter 7 - Anti-Infective Agents
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Wytheville Dental Hygiene Class of 2013
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159 terms
Terms | Definitions |
|---|---|
 1. Caries2. Periodontal disease 3. Localized Dental infection a. Periodontal b. Endodontic 4. Systemic Infections | Types of dental infections are: |
| 1. Penicillins 2. Macrolides 3. Tetracyclines 4. Clindamycin 5. Metronidazole 6. Cephalosporins | Antiinfective agents include: |
| postive; negative | A dental infection typically starts as gram ___ and then becomes gram __? |
| abcess | Inflammation = |
| systemic | Localized = |
| Substances from a source that kills or inhibits organisms that produce infection | Anti-infective agents = |
| A drug used to kill or suppress the growth of bacteria | Anti-bacterial agents = |
| A chemical substance produced by one microorganism that is capable of killing or suppressing the growth of other microorganisms | Antibiotic agents = |
| Substances that destroy or suppress the growth or multiplication of microorganisms | Antimicrobial agents = |
| Substances that destroy or suppress the growth or multiplication of fungi | Antifungal agents = |
| Substances that destroy or suppress the growth of viruses | Antiviral agents = |
| The ability to kill bacteria | Bactericidal = |
| The ability to inhibit the growth of bacteria | Bacteriostatic = |
| Concentration of the anti-infective agent in the blood | Blood serum level |
| an invasion of the body by pathogenic microorganisms and a reaction of the tissues to their presence | Infection |
| Resistance-ability of an organism to be immune to or resist the effects of an anti-infective agent. | Minimum inhibitory concentration ( MIC ) |
| range of activity - broad vs narrow | Spectrum = |
| caused by overgrowth of microbes that were not susceptible to the original treatment | Super-infection = |
| Occurs when the combination of two antibiotics produces more effect than expected if individual effects were added | Synergism = |
| Occurs when a combination of 2 agents produce less effect than either agent alone | Antagonism = |
| using a petri dish to see what something is sensitive to. (i.e. growing bacteria) | A culture is __? |
| Therapeutic Prophylactic | What are the two categories of antimicrobials? |
| 1. Patients w/o immune problems- 2. The patient 3. The nature of the infection a. Acuteness b. Severity c. Localized or spreading | Therapeutic Indications for Antimicrobials include? |
| 1. Heart valve prosthesis 2. Dental professionals produce bacteremia 3. Check risk-to-benefit ratio | Prophylactic Indications for antimicrobials? |
| 1. Superinfections 2. Allergic Reactions a. Penicillin & cephalosporins b. Erythromycin & clindamycin 3.Drug Interactions a. Oral contraceptives b. Oral Anticoagulants c. Other antiinfectives in combination 4. GI complaints 5. Pregnancy | Adverse reactions with antimicrobials include __? |
| Cost of drug Dosage forms | Considerations with antimicrobials include __? |
| 1. Penicillin G & V 2. Penicillinase-resistant penicillins 3. Ampicillins 4. Extended spectrum penicillins | The four groups of penicillins are __? |
| 1. Mold penicillin notatum produce naturally occurring penicilins 2. Semisynthetic penicillins | What ways are penicillins made? |
| Orally or parenterally Oral-absorption depends on type Penicillin crosses placenta & is in breast milk Metabolized in ____________ | The Pharmacokinetics of Penicillins includes: |
| Bactericidal agent-inhibits cell wall synthesis Most effective against ______________ | Mechanism of action for Penicillins includes: |
| narrow | Pen G & Pen V have a very __ spectrum |
| Gram + cocci & certain gram-cocci | What type of cocci are found in Pen G & V? |
| spirochetes & anaerobes | Pen G & V are effective against cocci as well as __? |
| IU | Antibacterial activity of penicillin is standardized into __? |
| ... | Penicillin reisistance ... |
| 1. Toxic Almost nonexistent Large margin of safety 2. Allergy and Hypersensitivity Penicillins Delayed reactions show up in the mouth 5-10% of pts 100-300 deaths per year in US | Adverse Reactions of Pencillins include: |
| Penicillin G Penicillin V Penicillinase-resistant penicillins Amoxcicillin Extended-spectrum penicillins | Some specific types of penicillins are __? |
| Pen G | Pen V has a spectrum similar to __? |
| Pen V | Pen G when taken orally produces lower blood levels than |
| True | T/F Pen VK is better absorbed than Pen V. |
| streptococcus mutans | What type of bacteria causes caries? |
| AA or acitomycomitans.. | What type of bacteria cause perio dx? |
| antibiotic | If a localized dental infection is draining, then ___ is NOT needed. |
| entire prescription | When a systemic infection occurs, it is neccesary to take the __? |
| gram positive | Cocci are __? |
| gram negative | Spirochetes are __? |
| systemic | An untreated localized infection can become __? |
| irreversible | A Bactericidal is ___? |
| reversible | A Bacteriostatic is ___? |
| The lowest concentration thats needed to inhibit growth of an organism. | The minimum inhibitory concerntration or the MIC is __? |
| 18-24 hours | A typical MIC timeline is about __? |
| The organism that has this will never be suceptible to the infective agent (usually meaning the lipid structure or cell membrane is incompatible) | Natural resistance states that __? |
| determining which drug a bacteria is sensitive to. (usually takes 1-2 days) | Sensitivity is: |
| best line of defense | A patients host response is their __ against antimicrobials |
| Strep A: Flesh-eating bacteria | An example of a severe microbial infection would be __? |
| 1. Flossing 2. Brushing teeth 3. Deeper cleaning - Cavitron etc.. 4. Hand instrumentation | Dental professionals or the patient can create bacteremia by what means? |
| 1. Use specific rather than broad spectrum agents 2. Give the correct dose 3. Use the agent for the shortest duration possible. | How do you prevent a superinfection? |
| penicillin | Which antibiotic has the greatest chance of the patient having an allergy? |
| use a backup method | When using an antibiotic and birth control it is important to always do what? |
| increase the effects of the anticoagulant (ie makes you MORE likely to bleed) | Taking an antibiotic with an anticoagulant like coumadin will do what? |
| 1. Nausea 2. vomiting | Eurythromycins' adverse reactions are __? |
| tetracycline | Which antibiotic is a MAJOR NO NO to take while pregnant? |
| PenVK or Clyndamycin | Which antibiotics are typically given to preganant women in need of them? |
| 1. diarrea 2. kills normal flora 3. can develop Thrush 4. Hairy tongue | What are some common GI complaints when taking antimicrobials? |
| 1. Cost of the drug (exam. periostat is $180 in liquid but only $5 in capsule form. 2. Dosage forms: Children may not be able to swallow pills - liquid form may be neccesary | Some consideration to think about for you patient prior to prescribing an antimicrobial would be __? |
| Fleming in 1928 | Who developed Penicillin and when? |
| man-made | Semisynthetic penicillins are __? |
| mold penicillin notatum | This is the source of penicillin which is naturally occurring. |
| liver by hydrolysis | Penicillin is metabolized in the __ by __? |
| rapidly growing organisms | The use of penicillins are most effective against __? |
| narrow | The spectrum of Penicillin G & V is very __? |
| IU or international units | Antibacterial activity of penicillin is standardized into what measurement type? |
| proportional to its use. | Resistance to penicillin is ___? |
| the less effective it is | The longer you take penicillin __? |
| almost nonexistant have a large margin of safety | Toxic adverse reactions to penicillin are __? |
| a delayed reaction - Type IV - (example: may show in the form of glossitis or stomatitis in the mouth) | The most common type of penicillin allergy related to dental __? |
| 5-10% | What percentage of patients will have a allergy to penicillin? |
| 100-300 | How many deaths occur in the US due to penicillin allergies each year? |
| 1. Prophylactic (premed) 2. Infection | What are some dental uses for penicillin? |
| PenVK - penicillin v with potassium | What would be the penicillin drug of choice if no allergy exists? |
| Pen V produces higher blood levels | What is the difference between pen V vs Pen G? |
| absorbs faster | What makes Pen VK better then just PenV? |
| 500mg QID for 7-10 days | What is the common dose for PenVK? |
| Bacteria can produce enzyme called penicillinase | Penicillinase-resistance penicillins are caused by __? |
| Penicillinase-resistance penicillins | These penicillins are not inactivated by the enzyme |
| Used only against penicillinase-producing staphylococci | When are Penicillinase-resistance penicillins used? |
| Penicillinase resistant | Which has moew side effects Pen V or Penicillinase-resistant penicillins? |
| Cloxacillin & dicloxacillin | Which types of Penicillinase-resistance penicillins are better absorbed? |
| broader spectrum | Ampicillin + Amoxcicillin are __ than Pen VK |
| gram positive cocci | Ampicillin + Amoxcicillin fight primarily what type of bacteria? |
| Ampicillin | Amoxcicillin is better absorbed and produces higher blood levels than |
| amoxicillin and ampicillin | If you allergic to PenVK its likely you will also be allergic to __? |
| rash | Ampicillin sometimes causes a __ so it is less prescribed then other penicillin types. |
| Extended-spectrum penicillins | These are Available parentally to treat systemic infections; not effective orally |
| F | T/F Extended-spectrum penicillins have a narrow spectrum. |
| 1. Erythromycin 2. Clarithromycin 3. Azithromycin | Name some Macrolides? |
| Erythromycin | This is typically used for treating gonorrea or syphillis. |
| 2 hrs before/2 hrs after meals not on an empty stomach | When must you take Erythromycin ? |
| 1. Bacteriostatic 2. Gram + aerobes, gram - anaerobes 3. Not good against dental infections | What is the Mechanism of action and Spectrum for macroglides? |
| Which macroglide is not good against dental infections? | Erythromycin |
| Erythromycin | Allergy-uncommon; GI effects; cholestatic jaundice are all side effects of this macroglide? |
| 1. Theophylline, 2. digoxin, 3. triazolam, 4. warfarin | Erythromycin cannot be taken with any of these. |
| 250-500 mg qid | The typical dosage for Erythromycin is __? |
| it causes an increase in liver enzymes | Why is jaundice a side effect of taking Erythromycin? |
| 1. Azithromycin (Zithromax) & 2. Clarithromycin (Biaxin) | This type of macroglide is not meal dependant. |
| Azithromycin (Zithromax) & clarithromycin (Biaxin) | This bacteriostatic macroglide can be used against gram + cocci, gram - aerobes, & certain anaerobes |
| Azithromycin (Zithromax) | This macroglide is also known as a Z-pack. |
| 500 mg 1 hr before procedure | When used for prophylaxis, what is the dose for Azithromycin (Zithromax) & clarithromycin (Biaxin?) |
| Erythromycin | This is the drug of choice for patients that are allergic to penicillin? |
| Azithromycin (Zithromax) or clarithromycin (Biaxin) | This is the drug of choice for patients that are allergic to Erythromycin? |
| acne | Tetracyclines are best for treating what? |
| 1. Differ in duration, 2. % absorbed & 3. mechanism of elimination | The Pharmacokinetics of Tetracyclines are difficult to assign because they __? |
| broad | Tetracyclines are of what spectrum? |
| both gram positive & gram negative bacteria | Tetracyclines are effective against what type of bacteria? |
| 1. GI problems 2. Discoloration of tongue - brown 3. Incorporated into calcifying tissues 4. Lg dose- (can reduce the rate of bone growth & stunt growth overall) 5. Liver damage 6. Photosensitivity 7. Superinfection | What are some common adverse reactions to Tetracyclines? |
| Tetracycline | This drug can cause Photosensitivity & a brown discoloration of the tongue |
| a Superinfection | All antibiotics have the potential to cause __? |
| 1. COPD ( the occurrence of chronic bronchitis; lung dx) 2. Periodontitis 3. ANUG 4. ACNE | What are the uses for Tetracycline? |
| Periostat, Atridox (doxycycline hydrate) | Some derivatives of tetracycline are? |
| crevicular fluid | What makes tetracycline great for dental issues is that is gets into the __? |
| Clindamycin | This bacteriostatic drug treats periodontitis and is effective against both gram positive as well as anaerobic bacteria. |
| cleocin | The brand name for clyndamycin is __? |
| Well absorbed orally, can also be given with an IV or intramuscularly 2. | The Pharmacokinetics of Clindamycin are? |
| 1. GI upset, 2. diarrhea, 3. nausea, 4. vomiting, 5. abdominal cramps, 6. stomatitis 7.colitis. 8. Antibiotic associated colitis 9. C. albicans may result as a superinfection 10. Neutropenia, 11. thrombocytopenia, 12. agranulocytosis, 13. liver disease | The following are Adverse Reactions of Clindamycin. |
| Type: IV - MILD Type I - SEVERE | The most common types of allergy categories for Clindamycin are __? |
| Skin rash, glossitis, stomatitis | A mild reaction to clindamycin may cause __? |
| urticaria, angioneurotic edema, Serum sickness and anaphylaxis | A severe reaction to clyndamycin may cause __? |
| Metronidazole | This is also known as Flagyl. |
| 1. Trichomonis ( trichomonacidal ) 2. Amoeba ( Amebicidal ) 3. Bacteria ( Bacteriocidal ) | Metronidazole protects against the following bacteria types. |
| Causes pathogen's DNA to lose it's cyclic structure and inhibits nucleic acid synthesis (targets bacteria in the cell wall) | What is the action of Metronidazole? (ie how does it work?) |
| drinking dirty water | Why might one be prescribed metronidazole? |
| 1. Concentrates in the gingival crevicular fluid 2. Well absorbed when taken orally 3. has a Half life 8 hours | What are the Pharmacokinetics of Metronidazole? |
| 1. GI upset: stomach distress, nausea, diarrhea 2. CNS: depression, insomnia, convulsive seizures 3. Renal Toxicity: polyuria, dysuria, incontinence 4. Oral effects: dry mouth, metalic taste, black tongue 5. Other effects: Transient neutropenia Fetal toxicity.... | Some Adverse Reactions to Metronidazole are __? |
| painful urination | Dysuria is __? |
| increased urination | Polyuria is __? |
| 1. Alcohol which causes nausea, abdominal cramps, vomiting 2. Warfarin action can be potentiated (aka increased) | Metronidazole drug interactions are most common with __? |
| Used to treat: 1. Trichomoniasis: A parasite best known in medicine because one species causes vaginitis (vaginal inflammation). 2. Giardiasis: is a parasite responsible for a common form of infectious diarrhea 3. Amebiasis: The state of being infected with amebae 4. Anaerobic bacteria: 5. Periodontitis: | Name some of the more common uses for Metronidazole? |
| Cephalosporins | These are highly resistant to penicillinase but susceptible to cephalosporinase? |
| orally or parenterally. | Cephalosporins can be administered __ or __? |
| Keflex | An example of a brand name cephalosporin is __? |
| Gram + and Gram - bacteria | Cephalosporins are effective against __? |
| 1. Can be taken orally, IM or IV 2. Is Excreted in the urine 3. Has a Half life 50-240 minutes ( 1- 4 hours ) 4. Can be absorbed well orally | The pharmokinetics of Cephalosporins are? |
| 1. Gram + cocci 2. Penicillinase-producing staphlococci 3. Some gram - bacteria 4. Salmonella, 5. E. coli 6. Early cephs ( narrow range ) 7. Later cephs (wider range ) | Cephalosporins are good at fighting off which bacteria? |
| Cephalosporins | Which antibiotic category fights off salmonella and E. Coli bacteria well? |
| 1. Inhibit cell wall systhesis leading to cell lysis. 2. More effective in rapidly growing organisms | How does a cephalosporin work? |
| rapidly growing | Cephalosporins are most effective in which type of organisms? |
| 1. GI upset ( nausea, vomiting, abdominal cramps, anorexia, stomatitis 2. Nephrotoxicity (liver toxicity) 3. Superinfection ( by resistant Gram - ) 4. Local reaction at injection site 5. Hemostasis & Disulfiram-like reaction 6. Allergy... about 5% of pop. | Adverse reactions to Cephalosporins include __? |
| Fever, eosinophilia, anaphylaxsis | Cephalosporins may cause this kind of allergic reaction. |
| cephalosporins | This type of antibiotic can cause nephrotoxicity or a local reaction at the injection site. |
| penicillin | 10% of the ___ allergic population may also be allergic to cephalosporins? |
| Treatment of: 1. Penicillin-resistant organisms 2. Gram negative organisms | The uses for cephalosporins include: |
| 1. Stage 1-cellutlitis-Gram +-Pen VK 2. Stage 2-Mixed gram + and - Clindamycin or Metronidazole 3. Stage 3-mostly anaerobes | What are the stages of Infection in Dentistry? |
| Cellulitis | Stage 1 of infections in dentistry: |
| Mixed gram positive and negative clyndamycin or metronidazole | Stage II of infection in dentistry: |
| mostly anaerobes | Stage III of infection in dentistry: |
| 1. Patient compliance 2. Wrong antibiotic 3. Poor Debridement 4. Resistant organisms 5. Concentration did not reach site 6. Host defenses not adequate | What are some of the Reasons anti-infective agents are not effective? |
| 1. Vancomycin 2. Aminoglycosides 3. Chloramphnicol 4. Sulfonamides 5. Sulfamethoxazole-Trimethoprin 6. Nitrofurantoin 7. Quinolones ( Fluoroquinolones ) | Other Antiinfective Agents include: |
| 1. Narrow Spectrum 2. Adverse Reactions of: GI, nausea, vomiting, bitter taste in mouth | Vancomycin's characteristics include: |
| vancomycin | This antibiotic is unrelated to any other antibiotic |
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