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Transcript of DH206: Pharmacology Chapter 7: Antiinfective Agents Lisa Mayo, RDH, BSDH Copyright © 2011, 2007...
DH206: PharmacologyChapter 7:Antiinfective Agents
Lisa Mayo, RDH, BSDH
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Chapter 7 Antiinfective Agents
1. Definitions2. ABX & dentistry3. Adverse Effects4. Bactericidal Antibiotics5. Bacteriostatic Antibiotics6. Misc Antibiotics7. Infective Endocarditis8. TB
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1. Definition
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1. Definitions Antibiotics: substances produced by living
organisms which are harmful to other organisms◦Natural or semisynthetic◦BacteriCIDAL or bacterioSTATIC ◦Narrow-Spectrum or Broad-Spectrum Narrow = Gram (+) only PEN/MACROLIDE Broad = Gram (+) & (-) CLINDAMYCIN
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1. Definitions Synergism
◦Combination produces more than an additive effect (1 + 1 > 2)
◦Bactericidal combs are generally synergistic ◦Bacteriostatic combs usually additive
Antagonism◦Occurs when a combination produces less
effect than either agent alone◦(1 + 1 < 2)◦Bactericidal + bacteriostatic
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2. ABX & Dentistry
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2. ABX & Dentistry Perio Therapy
◦ Aggressive perio = systemic abx useful (bacteria invade soft tissues & cannot be removed through SCRP)
◦ Chronic perio = systemic abx NOT used (Arestin) Endo Therapy
◦ Uncomplicated = no abx◦ Lesion spread into soft tissue & is not draining, systemic
involvement = yes abx (PEN VK) Implants
◦ Pen VK + oral rinse if post-op infection occurs◦ Peri-implantitis = yes abx◦ Perio-mucositis = no abx DO NOT MEMORIZE
TABLE 7-1, TOO MUCH!
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3. Adverse Effects
1. Bacterial Resistance2. Superinfections & GI Effects (nausea,
vomiting, diarrhea)3. Allergic Reactions4. Photosensitivity5. Drug Interactions6. Pregnancy
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3. Adverse Effects1. Bacterial Resistance
Abx use promotes development of ABX-resistant bacteria
Increasing problem: culture & sensitivity tests should be performed before Rx given for an abx
Natural & acquired resistance Acquired: abx kills some but not all bacteria or
bact mutate Natural: bact always been resistant
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3. Adverse Effects
2. Superinfections & GI EffectsBroad-spectrum abx can eradicate organisms that
are a part of normal flora of GI, mouth, respiratory tract, vagina This can allow for growth of other organisms (fungi,
bacteria)Pseodomembranous colitis causes inflammation of
bowel (common with CLINDY)Tx for p.colitis: Vancomycin, Metronidazole
ERYTHROMYCIN most common for GI issues
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3. Adverse Effects
3. Allergic Reactions
4. Photosensitivity: Sensitivity to UV lightSunburn easilyCIPRO & DOXYCYCLINE most common
ABX ALLERGIC POTENTIAL
PenicillinCephalosporin
High
ErythromycinClindy
Low
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3. Adverse Effects
5. Drug InteractionsAll abx can interact with other drugs &
food consumption (can ↑ or ↓ effects)1) Oral Contraceptives: abx interfere with
metabolism of contraceptives2) Oral anticoagulants: Abx ↓ bacterial
flora that produce vitamin K (↑ anticoagulant effects) (EXCEPTION TO RULE: PEN & TETRACYCLINE)
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3. Adverse Effects
6. Pregnancy
ABX PREGNANCY USEPenicillin Erythromycin
Yes (no teratogenicity)
Metronidazole NoTetracycline No
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NBQ
A primary concern for using antibiotics for infections that are not bacterial in nature is that:
a. Drug-resistant microorganisms could developb. Drug-drug interactions increasec. Drug dependence will developd. Significant diseases could occur
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NBQ
A primary concern for using antibiotics for infections that are not bacterial in nature is that:
a. Drug-resistant microorganisms could developb. Drug-drug interactions increasec. Drug dependence will developd. Significant diseases could occur
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NBQ
Which of the following defines antimicrobial activity of an antibiotic that kills sensitive bacteria?
a. Narrow-spectrumb. Broad-spectrumc. Bactericidald. Bacteriostatic
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NBQ
Which of the following defines antimicrobial activity of an antibiotic that kills sensitive bacteria?
a. Narrow-spectrumb. Broad-spectrumc. Bactericidald. Bacteriostatic
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NBQ
All of the following are adverse reactions to antibiotics EXCEPT which one?
a. Superinfectionsb. GI issuesc. Allergic reactionsd. Inhibits bacterial growthe. Photosensitivity
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NBQ
All of the following are adverse reactions to antibiotics EXCEPT which one?
a. Superinfectionsb. GI issuesc. Allergic reactionsd. Inhibits bacterial growthe. Photosensitivity
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4. Bactericidal ABX
1. Penicillins2. Cephlosporins3. Nitroimadazoles4. Quinolones(Fluoroquinolones)5. Vancomycin6. Aminoglycosides
I USE DIFFERENT ORGANIZATION THAN BOOK – DIVIDED INTO CIDAL vs STATIC CATEGORIES
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4. Bactericidal ABX
1. Penicillin Discovered by Alexander Fleming Most all produced from a strain of penicillium
chrysogenumi Some produced semi-synthetically Protype: PEN G (most potent penicillin) Administration: oral, parental NEVER TOPICAL (allergic rxns)
P.75-77
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1. Penicillin: CHEMISTRYPenicillins structureoCan alter the structure by adding various
saltsoHow there are different pen drugsoMain differences in penicillins
1. Acid stability in the stomach2. Resistance to enzymatic destruction by
penicillinase & antibacterial spectrum
4. Bactericidal ABX
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1. Penicillin: CHEMISTRY◦β-lactam ring fused to a five-member, S-
containing thiazolidine ring Neither ring has antimicrobial action
◦Term beta-lactam used to classify penicillin, cephalosporin, carbapenem, monobactam antibiotics
◦Active pen made by adding different functions grps to position 6 (see next slide)
4. Bactericidal ABX
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1. Penicillin: CHEMISTRY: Beta-Lactam Ring◦Responsible for the antibacterial activity◦When the β-lactam ring broken = antimicrobial
action is lost◦Action
β-lactam ring inhibits bacterial enzymes (called pen-binding proteins=PBPs) located on bacterial cell walls= leads to cell death
Resistant bacteria to penicillin’s are able to produce enzymes (beta-lactamases) that break open the ring
4. Bactericidal ABX
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1. Penicillin: Spectrum of Activity◦ Gram (+) primarily (narrow-spectrum)◦ Some gram (-) (broad-spectrum)
4. Bactericidal ABX
Type of PEN Examples Notation
Narrow spectrum Pen GPen V
PROTYPEDental infections
Broad spectrum AmoxicillinAmpicillin
Premed Dental infections
Beta-lactamase inhibitors
Augmentin Refractory perio
Penicillinase-resistance penicillin
Not used in dentistry
Extended spectrum Not used in dentistry
KNOW THIS, NOT TABLE
7-2
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1. Penicillin: USESPen VK & AmoxoMild-Moderate dental infections (endo,
perio, oral surgery)oSalt of PEN V is called PEN VK: more
soluble than the free acid and better absorbed when taken orally
oAmox: Premed
4. Bactericidal ABX
P.77
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1. Penicillin: PEN RESISTANCECertain bacteria have the ability to produce
enzymes that inactivate penicillin’s (narrow & broad spectrum)
These enzymes are referred to as beta-lactamases
β-lactamases that inactivate penicillin's are referred to as penicillinases
Clavulanic acid can be added to AMOX to avoid destruction by β-lactamase enz = AugmentinClavulanic acid has NO antibacterial action, it
allows the β-lactamases to bind with it and this leave AMOX alone
4. Bactericidal ABX
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AUGMENTIN
Clavulanic Acid
β-lactamase Bacteria
β-lactamase
+ =
AMOX
Bacteria
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1. Penicillin: ADVERSE REACTIONS (have wide margin of safety)1) Allergic reactions: 10% population2) GI upset: can use lactobacillus acidophilus
4. Bactericidal ABX
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1. Penicillin: DRUG INTERACTIONS1) PEN + Bacteriostatic ABX = PEN not as
effective2) Birth control3) Probencid (gout drug) = ↑levels PEN in blood
by ↓ renal elimination
4. Bactericidal ABX
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4. Bactericidal ABX
1. Penicillin's2. Cephlosporins3. Nitroimadazoles4. Quinolones(Fluoroquinolones)5. Vancomycin6. Aminoglycosides
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4. Bactericidal ABX
2. CephalosporinsStructurally similar to penicillinsHave a β–lactam ringBroad spectrumX-hypersensitivity possible w/PENUses
Skin, bone, GI, Respiratory, ear infectionsNOT indicated for endo/perio infections (PEN
used)
P.77-78
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4. Bactericidal ABX2. Cephalosporins
Book correction: 4-generations, not 3Adverse rxns same as PENDrug interactions: same as PEN except add
WarfarinActions of Warfarin may be increased
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4. Bactericidal ABX
2. Cephalosporins
First generation cefadroxil(Duricef)cephalexin(Keflex)
Second generation
cefaclor(Ceclor)cefuroxime-axetil(Ceftin, Veftin)
Third generation omnicef(Cefdinir)cefixime(Suprax)ceftibuten(Cedax)
Fourth generation Only injectable
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NBQWhich of the following antibiotics is considered a broad-spectrum cephalosporin-type antibiotic?
a. Pen VKb. Cefaclor (Ceclor)c. Clindamycind. Erythromycin
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NBQWhich of the following antibiotics is considered a broad-spectrum cephalosporin-type antibiotic?
a. Pen VKb. Cefaclor (Ceclor)c. Clindamycind. Erythromycin
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4. Bactericidal ABX
1. Penicillin's2. Cephlosporins3. Nitroimadazoles4. Quinolones(Fluoroquinolones)5. Vancomycin6. Aminoglycosides
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4. Bactericidal ABX
3. Metronidazole(Flagyl)Effective against bacteria & protozoa
(NBQ)Can tx vaginal & resp infections
Antiinflammatory effectsUsed in tx of Pseudomembranous colitis
P.82-83
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4. Bactericidal ABX
3. Metronidazole(Flagyl): USESNUGPeri-implantitisRefractory/aggressive perio: can be used
in combo w/AMOX or AUGMENTINoGood against Aa and Pg
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4. Bactericidal ABX
3. Metronidazole(Flagyl): ADVERSE EFFECTS GI Metallic taste Dry mouth Darkened urine
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4. Bactericidal ABX
3. Metronidazole(Flagyl): DRUG INTERCATIONSAlcohol oProduces a reaction similar to when a
recovering alcoholic drinks while taking disulfiram (Antabuse)
oNO ALCOHOL for 3 days after abx stoppedLithium (bipolar)Cimetidine (antiulcer drug)Warfarin: cause ↑ bleeding
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NBQ
Which of the following drugs is contraindicated while a patient is taking metronidazole?
a. Penicillinb. Alcoholc. Aspirind. Mushrooms
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NBQ
Which of the following drugs is contraindicated while a patient is taking metronidazole?
a. Penicillinb. Alcoholc. Aspirind. Mushrooms
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4. Bactericidal ABX
1. Penicillin's2. Cephlosporins3. Nitroimadazoles4. Quinolones(Fluoroquinolones)5. Vancomycin6. Aminoglycosides
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4. Bactericidal ABX
4. Quinolones(Fluoroquinolones)Most common: CIPROFLOXACINInhibit bacterial DNA replicationFacultative gram (-) anaerobesUSESoSinusitis, acute bronchitisoSkin, eye infections, UTIoChronic perio
P.86
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4. Bactericidal ABX
4. Quinolones(Fluoroquinolones)Calcium products taken 4 hours before or
2 hours after CIPRODrug InteractionsoWarfarinoTheophylline (asthma drug)oCaffeine
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4. Bactericidal ABX
4. Quinolones(Fluoroquinolones)end in ~floxacin
Quinolones(Fluoroquinolones)ciprofloxacin(Cipro)
norfloxacin(Noroxin)
enoxacin(Pentrex)
lomefloxacin(Maxaquin)
ofloxacin(Floxin)
levofloxacin(Levaquin)
Moxifloxacin(Avelox)
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NBQWhich of the following is the mode of action for Cephalosporins?
a. Interfere with bacterial protein synthesisb. Affect bacterial cell wallc. Interfere with normal biosynthetic
pathways in bacteriad. None of the above
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NBQWhich of the following is the mode of action for Cephalosporins?
a. Interfere with bacterial protein synthesisb. Affect bacterial cell wallc. Interfere with normal biosynthetic
pathways in bacteriad. None of the above
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NBQWhich antibiotic/antimicrobial is associated with the highest incidence of drug allergy?
a. Ciprofloxacin (Cipro)b. Pen VKc. Clindamycind. Metronidazole (Flagyl)
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NBQWhich antibiotic/antimicrobial is associated with the highest incidence of drug allergy?
a. Ciprofloxacin (Cipro)b. Pen VKc. Clindamycind. Metronidazole (Flagyl)
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Levofloxacin (Levaquin) has which of the following modes of action?
a. Affects bacterial cell wallb. Affects bacterial DNAc. Interferes with bacterial protein synthesisd. Interferes with bacterial metabolic pathways
NBQ
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Levofloxacin (Levaquin) has which of the following modes of action?
a. Affects bacterial cell wallb. Affects bacterial DNAc. Interferes with bacterial protein synthesisd. Interferes with bacterial metabolic pathways
NBQ
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4. Bactericidal ABX
1. Penicillin's2. Cephlosporins3. Nitroimadazoles4. Quinolones(Fluoroquinolones)5. Vancomycin6. Aminoglycosides
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4. Bactericidal ABX
5. Vancomycin(Vancocin)Use is increasingGram (+)Adverse Effect: red-man syndrome (NBQ)Uses: pseudomembranous colitis (NBQ)
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4. Bactericidal ABX
1. Penicillin's2. Cephlosporins3. Nitroimadazoles4. Quinolones(Fluoroquinolones)5. Vancomycin6. Aminoglycosides
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4. Bactericidal ABX
6. AminoglycosidesBactericidal Gram (-) aerobicInhibits PRO-synthesis on 30S ribosomeUSES
Hospitalized patients with serious gram (-) infections
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4. Bactericidal ABX6. Aminoglycosides
Aminoglycoside USES
streptomycin TB tx when other drugs have failed
neomycin Topical
gentamycin Topical
tobramycin Injection
amikacin Injection
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Which of the following antibiotics are useful in treating odontogenic infections?
a. Azithromycin (Zithromax, Z-pak)b. Clindamycinc. Pen VKd. Cephalexin (Keflex)e. All the above
NBQ
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Which of the following antibiotics are useful in treating odontogenic infections?
a. Azithromycin (Zithromax, Z-pak)b. Clindamycinc. Pen VKd. Cephalexin (Keflex)e. All the above
NBQ
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5. Bacteriostatic ABX
1. Macrolides2. Lincomycins (Clindamycin)3. Tetracyclines4. Sulfanamides
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5. Bacteriostatic ABX
1. MacrolidesInhibit multiplication of bacteria by reversibly
binding to the 50S ribosomal subunit of bacteriaoThis action inhibits PRO synthesis of the
bacterial cellExcreted by bile, not urineMost common adverse effect: GI upsetUSEoSinusitis, ear infectionsoGonorrhea, community-acquired pneumonia,
PID, chlamydia, diphtheria
P.78
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5. Bacteriostatic ABX
1. Macrolides
Generation Macrolide Notations
First generation
Erythromycin • Gram (+) & (-)• Used when pt’s
allergic to PEN
Second generation
Clarithromycin(Biaxin)Azithromycin(Zithromax, Z-Pak)
• Broader spectrum than 1st generation
• Fewer adverse effects
• Azithro: useful in perio disease tx, antinflammatory
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5. Bacteriostatic ABX
1. Macrolides: DRUG INTERACTIONSPotential to inhibit drug metabolism of other
drugs through inactivation of P-450 enzyme system
Antacids ↓ effectiveness of macrolides
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5. Bacteriostatic ABX
1. Macrolides2. Lincomycins (Clindamycin)3. Tetracyclines4. Sulfanamides
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5. Bacteriostatic ABX2. Lincomycins
Clindamycin(Cleocin)Inhibits PRO synthesis of 50S ribosome
like MacrolidesUSESoPerio abscess or perio diseaseoChronic bronchitis, community-acquired
pneumonia, sinusitisoPremed
P.82
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5. Bacteriostatic ABX2. Lincomycins
Adverse effects: pseudomembranous colitisoMany dentists avoid Clindy as a 1st line
drug due to this side effectoDisease can be fatal (persistent diarrhea)
ContraindicationsoCrohn’s diseaseoUlcerative colitis
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NBQ
An overgrowth of which of the following organisms is responsible for antibiotic-associated diarrhea?
a. Streptococci mutansb. Mucobacterium tuberculosisc. Clostridium difficiled. Staphylococci aureus
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NBQ
An overgrowth of which of the following organisms is responsible for antibiotic-associated diarrhea?
a. Streptococci mutansb. Mucobacterium tuberculosisc. Clostridium difficiled. Staphylococci aureus
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5. Bacteriostatic ABX
1. Macrolides2. Lincomycins (Clindamycin)3. Tetracyclines4. Sulfanamides
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5. Bacteriostatic ABX3. Tetracyclines
Broad spectrumMechanism of Actiono Inhibit PRO synthesis at 30S ribosome (not
50S like macrolides, clindy)o Inhibit host production of collagenase in cells
such as PMNs Collagenase: enzyme that makes up
connective tissue of periodontiumoConcentrate in GCF & maintain high
substantivity on root surfaces oFound in saliva & breast milk
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5. Bacteriostatic ABX
3. Tetracyclines
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5. Bacteriostatic ABX
3. Tetracycline: ADVERSE EFFECTSoStain teethoMinocycline: blue/grayoTetracycline: yellow/brown
oSkin hyperpigmentationoMinocycline: dizziness
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5. Bacteriostatic ABX
3. TetracyclinesCANNOT take with milk (next slide)Take with full glass water to prevent ulcersUSESoChronic, refractory & aggressive perio
diseaseoChlamydia, syphilis, traveler’s diarrheaoHelicobacter pylorioAcne
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5. Bacteriostatic ABX
3. Tetracyclines: DRUG INTERACTIONSoDairy products: tetracycline binds with calcium
& this will inhibit absorption of drugoAntacids delay absorption tetracyclinesoWarfarinoOral sulfonylureas – can lead to hypoglycemiaoDO NOT use during pregnancyoShould NOT be use in last ½ of pregnancy or in
kids <9yrs (NBQ) Mosby’s says 7-12yrs
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5. Bacteriostatic ABX
1. Macrolides2. Lincomycins (Clindamycin)3. Tetracyclines4. Sulfanamides
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5. Bacteriostatic ABX4. Sulfonamides
Bacteria have an essential requirement for paraaminobenzoic acid (PABA) which is folic acid
Sulfonamides are competitive antagonists of PABA
Block synthesis of folic acid↓
Inhibits bacterial growth↓
Produces bacteriostatic effect
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5. Bacteriostatic ABX4. Sulfonamides
USESoOtis mediaoUTIoPneumocystis carinii in AIDS patients
(pneumonia)DRUG INTERCATIONS
oWarfarinADVERSE EFFECTS
oStomatitisoSkin rashoSulfa allergy rxn
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5. Bacteriostatic ABX4. Sulfonamides
Sulfonamides
sulfisoxazole+trimethoprim(Bactrim) Most common
sulfadiazine(Microsulfron)
sulfamethoxazole(Gantanol)
sulfisoxazole(Gantrisin)
trimethoprim(Proloprim)
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Sulfonamides (also known as sulfa drugs) are structurally similar to:
a. Penicillinsb. Erythromycinsc. Salicylic acidd. Para-aminobenzoic acid (PABA)
NBQ
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Sulfonamides (also known as sulfa drugs) are structurally similar to:
a. Penicillinsb. Erythromycinsc. Salicylic acidd. Para-aminobenzoic acid (PABA)
NBQ
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NBQ
All of the following antibiotics have been used in the treatment of aggressive periodontitis EXCEPT which one?
a. Clindamycinb. Ciprofloxacinc. Erythromycind. Doxycycline
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NBQ
All of the following antibiotics have been used in the treatment of aggressive periodontitis EXCEPT which one?
a. Clindamycinb. Ciprofloxacinc. Erythromycind. Doxycycline
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NBQ
Which of the following is the mode of action of the Tetracyclines?
a. Bacterial cell wall destructionb. Prevent protein synthesis in the bacterial cellc. Interfere with nucleic acid syntheiss in the
bacterial celld. Cause mutations within bacterial DNA
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NBQ
Which of the following is the mode of action of the Tetracyclines?
a. Bacterial cell wall destructionb. Prevent protein synthesis in the bacterial cellc. Interfere with nucleic acid syntheiss in the
bacterial celld. Cause mutations within bacterial DNA
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NBQ
Which antibiotic below is associated with the adverse effect of pseudomembranous colitis?
a. Pen VKb. Erythromycinc. Tetracyclined. Cephalexin (Keflex)e. Clindamycin
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NBQ
Which antibiotic below is associated with the adverse effect of pseudomembranous colitis?
a. Pen VKb. Erythromycinc. Tetracyclined. Cephalexin (Keflex)e. Clindamycin
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NBQ
Which antimicrobial is associated with photosensitivity?
a. Tetracyclineb. Pen VKc. Metronidazole (Flagyl)d. Clindamycin
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NBQ
Which antimicrobial is associated with photosensitivity?
a. Tetracyclineb. Pen VKc. Metronidazole (Flagyl)d. Clindamycin
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NBQWhich of the following rugs can be used in a pregnant patient?
a. Tetracyclineb. Pen VKc. Doxycyclined. Minocycline
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NBQWhich of the following rugs can be used in a pregnant patient?
a. Tetracyclineb. Pen VKc. Doxycyclined. Minocycline
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7. Prevention of Infective Endocarditis
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7. Prevention of Infective Endocarditis
CONDITIONS REQUIRING PREMED PER AHA1. Artificial heart valves2. Hx IE3. Congenital heart conditions4. Cardiac transplant that develops a problem in
a heart valve
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7. Prevention of Infective Endocarditis
Premed drugs: taken 30-60min prior to dental appt
Alpha-hemolytic streptococci most common agent that causes IEo Reason why AMOX best drug to prevent IE
Recommended 7 days between dental appts for patients that need premed
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7. Prevention of Infective Endocarditis
SITUATION DRUG DOSE ADULTS
DOSE KIDS
Oral AMOX 2g 50mg
Unable to take oral meds
AmpicillinCephalosporins (cefazolin, ceftriaxone)
2g parental1g parental
50mg50mg
Allergic to pen/ampicillin
Cephalexin(Keflex)ClindamycinAzithromycin or clarithromycin
2g600mg500mg
50mg20mg15mg
Allergic to pen/ampicillin & unable to take oral meds
Cephalosporins (cefazolin, ceftriaxone)Clindamycin
1g600mg
50mg20mg
HAVE TO KNOW EVERYTHING ON THIS GRAPH!!
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NBQ
Which of the following 2 penicillins are recommended by the AHA to prevent endocarditis in patients undergoing invasive dental procedures?
a. Penicillin VKb. Ampicillin (Polycillin)c. Cloxacillind. Amoxicillin (Amoxil)
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NBQ
Which of the following 2 penicillins are recommended by the AHA to prevent endocarditis in patients undergoing invasive dental procedures?
a. Penicillin VKb. Ampicillin (Polycillin)c. Cloxacillind. Amoxicillin (Amoxil)
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NBQ
Your patient is taking erythromycin twice daily for 1 month for an upper respiratory tract infection. She has a history that requires antibiotic prophylaxis prior to probing/scaling. She is allergic to penicillin. Which of the following antibiotics could be used is you had to premedicate while taking erythromycin?
a. Ampicillinb. Cephalexin (Keflex)c. Azithromycin (Zithromax)d. Pen VK
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NBQ
Your patient is taking erythromycin twice daily for 1 month for an upper respiratory tract infection. She has a history that requires antibiotic prophylaxis prior to probing/scaling. She is allergic to penicillin. Which of the following antibiotics could be used is you had to premedicate while taking erythromycin?
a. Ampicillinb. Cephalexin (Keflex)c. Azithromycin (Zithromax)d. Pen VK
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NBQ
Which of the following antibiotics can be used for prophylaxis against IE if a patient is allergic to penicillin?
a. Ampicillinb. Erythromycinc. Azithromycin d. Doxycycline
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NBQ
Which of the following antibiotics can be used for prophylaxis against IE if a patient is allergic to penicillin?
a. Ampicillinb. Erythromycinc. Azithromycin d. Doxycycline
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8. Tuberculosis
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8. Tuberculosis
TB is caused by the acid-fast bacterium Mycobacterium tuberculosis
Treatment is difficult for several reasons1. Patient inadequate defense mechanisms2. Tubercle bacilli resistant strains 3. Most of the drugs available are not
bactericidal 4. Drugs toxic so cannot be used in sufficient
doses5. Patient compliance: long-term tx, 3-4 drugs
for tx
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8. Tuberculosis
Drugs 1. isoniazid(INH)2. rifampin(Rifadin)3. pyrazinamide(PZA)4. ethambutol(Myambutol) 5. Streptomycin
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8. Tuberculosis isoniazid(INH)
Drug of choice1st drug used and taken for 9 months
rifampin(Rifadin) + pyrazinamide(PZA)Taken for 2 months in combo with each other &
INHrifampin used alone for 4 months ONLY (resistance
develops quicklyethambutol(Myambutol)
Use for 1st 2moResistance develops quicklyLast resort drug
Aminoglycoside: StreptomycinUsed when other ABX have failed
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8. Tuberculosis
DRUG ADVERSE EFFECTS (NBQ) isoniazid(INH)
Hepatitis: ↑ risk with alcohol & acetaminophen use
AnemiaPyridoxine(B6) deficiency: causes peripheral
neuropathy (numbness fingers/toes)
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All of the following drugs are useful for treating tuberculosis EXCEPT which one?
a. Isoniazidb. Streptomycinc. Rifampind. Erythromycine. Ethambutolf. Pyrazinamide
NBQ
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
All of the following drugs are useful for treating tuberculosis EXCEPT which one?
a. Isoniazidb. Streptomycinc. Rifampind. Erythromycine. Ethambutolf. Pyrazinamide
NBQ
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Which of the following serum-level parameters should be monitored in the tuberculosis patient taking INH?
a. Liver enzymesb. Sodium chloridec. Calcium ionsd. Potassium
NBQ
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Which of the following serum-level parameters should be monitored in the tuberculosis patient taking INH?
a. Liver enzymesb. Sodium chloridec. Calcium ionsd. Potassium
NBQ
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Which of the following is also referred to as INH?a. Rifaminb. Isoniazidc. Ethambutold. Fluroquinolonee. Pyrazinamide
NBQ
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Which of the following is also referred to as INH?a. Rifaminb. Isoniazidc. Ethambutold. Fluroquinolonee. Pyrazinamide
NBQ
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Which of the following TB drugs cause red/orange saliva?
a. Rifaminb. Isoniazidc. Ethambutold. Fluroquinolonee. Pyrazinamide
NBQ
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Which of the following TB drugs cause red/orange saliva?
a. Rifaminb. Isoniazidc. Ethambutold. Fluroquinolonee. Pyrazinamide
NBQ
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
A MAJOR problem with anti-TB drugs is:a. Many drugs are toxic to normal cells in the bodyb. Many drugs are not specific enough to kill the bacteriac. Drug resistanced. Drug dependence
NBQ
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
A MAJOR problem with anti-TB drugs is:a. Many drugs are toxic to normal cells in the bodyb. Many drugs are not specific enough to kill the bacteriac. Drug resistanced. Drug dependence
NBQ