7a Antibacterial Agents

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  1. What are antibiotics
    substances produced by living organisms (e.g., microorganisms) that are harmful to other organisms
  2. What are the Two broad classifications of antibiotics
    • Bactericidal
    • Bacteriostatic
  3. Bacteriostatic work by
    inhibiting bacterial multiplication
  4. Bactericidal work by
    actually killing the bacteria
  5. What is the Spectrum of activity and what are the three categories
    • the range of an antibiotic’s anti-infective properties
    • Narrow spectrum–acting on a few types of organisms (some gram positive pathogens)
    • Wide or Broad spectrum- act on a wider range of organisms (gram positive and some gram negative
    • Extended spectrum- is one that, as a result of chemical modification, affects additional types of bacteria, usually those that are gram-negative
  6. What are some Adverse Effects of Antibiotics
    • Bacterial resistance to the antibiotic
    • Superinfections
    • Gastrointestinal (nausea, vomiting, diarrhea)Allergic reactions
    • Photosensitivity
    • Drug interactions
  7. What is Inherent resistance
    a natural resistance of the bacteria to the antibiotic – ex. the bacterial cell membrane is impermeable to a particular antibiotic
  8. What is Antimicrobial resistance
    Antibiotic use promotes development of antibiotic-resistant bacteria
  9. What is Acquired resistance
    microorganism obtains the ability to resist the activity of a particular antimicrobial agent to which it was previously susceptible. This can result from the mutation of genes, or from the acquisition of foreign resistance genes or from a combination of these two mechanisms
  10. What is Treatment resistance:
    • –Improper diagnosis was made
    • –Inadequate doses were prescribed
    • –Patient did not take the prescribed antibiotic for the prescribed amount of time and/or discontinued the drug early (the patient must take the antibiotic for the full course of treatment)
  11. What is Misuse resistance
    indiscriminate use, taken for something it is not going to help, such as a cold, flu, sore throat
  12. What are Superinfections
    Broad-spectrum antibiotic causes the eradication of microorganisms that are part of the normal flora (bacteria that normally live in these areas) of the gastrointestinal (GI) tract, oral cavity, respiratory tract, or vaginal area and the growth of candidiasis (fungal).
  13. Oral superinfections include _______ or _________
    sore mouth (stomatitis) or tongue (glossitis).
  14. Antibiotics cause direct irritation of the GI tract or caused indirectly by upsetting the normal GI flora, resulting in
    GI distress, including nausea, vomiting, and/or diarrhea
  15. Antibiotic-associated _________ has been reported with all antibiotics, but especially with ________This occurs when there is an overgrowth of the bacteria __________. Characterized by __________ and _________
    • pseudomembranous colitis
    • clindamycin (Cleocin).
    • Clostridium difficile
    • watery diarrhea and abdominal cramping
  16. Avoid sun while taking __________ and ________
    ciprofloxacin (Cipro) and doxycycline
  17. In dental practice antibiotics are indicated for what three primary purposes
    • –Acute odontogenic/orofacial infections
    • –Prophylaxis against infective endocarditis
    • –Prophylaxis for patients at risk for infection because of compromised host defense mechanisms resulting from disease
  18. Topical antimicrobial agents (________ and ________) should be used in chronic localized periodontitis
    Atridox and Arestin
  19. ________ are used in conjunction with periodontal debridement and surgery and treating aggressive periodontitis
    Systemic antibiotics
  20. Antibiotics are NOT indicated in an __________ endodontic infection or if there is ________ without systemic signs of infection such as _________
    • uncomplicated
    • well-localized soft tissue swelling
    • fever, lymphadenopathy, or cellulitis
  21. Systemic antibiotics are indicated when there is an endodontic lesion with __________ and ________ or _______
    • soft tissue swelling
    • systemic involvement or spread of the infection
  22. Penicillins  are ________ and act by _________
    • bactericidal
    • inhibiting bacterial cell wall synthesis
  23. Penicillins are primarily effective against _________ like ________ but also some _________
    • Gram-positive cocci and bacilli bacteria
    • Streptococcus pneumonia
    • gram-negative bacteria
  24. What are two narrow spectrum or natural penicillins
    –Penicillin V and Penicillin G injectable
  25. What are some broad spectrum penicillins
    • –Aminopenicillins (amoxicillin and ampicillin)
    • - Antipseudomonal penicillins
  26. –95% of Staphylococcus aureus produce _________, an enzyme, making penicillins ineffective.
  27. The Augmentin drug is _________ + _________
    Amoxicillin+clavulanic acid
  28. Absorption is greatest when penicillins are taken ________ except for ________ which should be taken ______
    • on an empty stomach
    • Amoxicillin
    • with food
  29. Penicillins are eliminated by excretion through the
  30. __________ and _______ are used in dentistry only for mild to moderate odontogenic infections (periodontal, endodontic, oral surgery).
    Penicillin VK and amoxicillin (Amoxil)
  31. Amoxicillin is effective against __________, which is found in periodontitis sites
  32. What are the adverse effects of penicillin
    • Allergic reaction: Allergic reactions occur in more than 10% of the population. Can range from mild rash and fever to severe anaphylaxis (low incidence)
    • 2.) Pseudomembranous colitis
    • 3.)Gastrointestinal upset–Most common adverse side effect–Nausea, vomiting, and diarrhea Oral penicillins may be taken with Lactobacillus acidophilus (gel caps) to help replace normal flora and reduce GI distress
    • 4. Superinfection–more likely with the broad-spectrum penicillins (e.g., amoxicillin)
    • 5. Seizure activity: associated with very high levels of penicillin
  33. It must be noted that the first antibiotic proven to interfere with oral contraceptives was _______ that is taken for ________.
    • rifampin
    • tuberculosis
  34. _________ is a drug of choice in the treatment of necrotizing ulcerative gingivitis (NUG).
    Penicillin VK
  35. Penicillins have a Pregnancy category of
  36. Augmentin is used for _________ strains of bacteria especially for periodontal patients that are _________ and can cause _________
    • resistant
    • refractory to treatment or have aggressive forms
    • severe GI upset because of the “acid”
  37. If concurrent use of penicillin plus a bacteriostatic antibiotic is necessary, then the penicillin should be given _________ the bacteriostatic antibiotic is given
    a few hours before
  38. What are three examples of Cephalosporins
    • Cephalexin (Keflex)
    • Cefuroxime (Ceftin)
    • Cephradine (Velosef, Anspor)
  39. What is the chemistry of Cephalosporins and what is the mechanism of action
    • similar to penicillins
    • Bactericidal; kill bacteria by inhibiting cell wall synthesis by the same mechanism as penicillins
  40. What is the spectrum and indications of Cephalosporins
    • effective against many gram-positive and gram-negative bacteria; there are four generations, and the newest fourth generation have the widest spectrum of activity
    • generally used for skin, bone, genitourinary, and respiratory tract infections; otitis media (middle ear infection); and acute prostatitis
  41. Cephalosporins have a 10% ________ with penicillins
    cross-hypersensitivity reaction
  42. Additionally, even though cephalosporins are broader spectrum than penicillins, penicillins are effective against the ___________ that are usually found in ___________
    • anaerobic organisms 
    • dental infections
  43. Metronidazole (______) is effective against ________ and found in ___________
    • Flagyl
    • obligate or strict anaerobic
    • GCF (gingival crevicular fluid) in the periodontal pocket
  44. ___________ and _________ is a good combination against anaerobic infections found in ________ and _________
    • Metronidazole (Flagyl)+ amoxicillin
    • aggressive periodontitis and nonresponding periodontitis
  45. What are some of the adverse reactions of Metronidazole
    • GI upset; OK with food
    • Metallic taste; dry mouth
    • Dark urine
    • No alcohol – if the patient has alcohol once, they won’t a second time, or they’ll stop the antibiotic….one or the other
    • OK in renal disease
  46. What are some Drug Interactions with metronidazole (Flagyl)
    • Alcohol – with flagyl causes a disulfiram (Antabuse) like reaction headache, nausea, vomiting
    • Lithium – flagyl is contraindicated in patients taking lithium (drug for bipolar) and cimetidine (anti-ulcer drug)
    • Anticoagulants (warfarin)–Increased bleeding
  47. For patients that are taking Flagyl what precautions should be mentioned
    • –Alcoholic beverages are contraindicated–Mouth rinses containing alcohol contraindicated
    • –Change in taste perception
    • –Dry mouth; metallic taste
  48. ____________ and _________ are good alternatives if patient is allergic to penicillin. They are not actually an antibiotic because they are _________ produced. They are frequently referred to as __________. These drugs fall into the category of drugs called ________
    • Ciprofloxacin (Cipro) & Levofloxacin (Levaquin)
    • totally synthetically
    • broad-spectrum antimicrobials
    • Fluoroquinolones
  49. What are the Indications for Fluoroquinolones
    • Chronic periodontitis- (FDA unapproved indication)
    • Bacterial sinusitis, acute bacterial chronic bronchitis, pneumonia, skin infections, bacterial conjunctivitis (use eye drops), urinary tract infections
  50. What are the Adverse Effects of Fluoroquinolones
    • Phototoxicity (exaggerated sunburn)Abdominal pain, nausea, vomiting, diarrhea
    • Rash, urticaria, angioedema
    • Ciprofloxacin (Cipro) should not be given to children younger than 18 years of age. Pregnancy: C
  51. What are the Drug Interactions with Quinolones
    • Warfarin (anticoagulant), theophylline (antiasthma), and caffeine – these inhibit it’s metabolism causing increased blood levels
    • Dairy products (calcium), sodium bicarbonate, iron, and antacids (magnesium, aluminum) delay absorption so these products should be given four hours before or two hours after giving the drug
  52. The majority of dental patients taking a quinolone will most likely be taking it for ___________. The air polishing system (Cavitron) should not be used since ________ delays absorption of the drug
    • chronic bronchitis
    • sodium bicarbonate
  53. What are Macrolides and what drug falls in that category
    • Macrolides inhibit the multiplication of bacteria by binding to the 50S ribosomal subunit of susceptible bacteria and consequently inhibiting protein synthesis within the bacterial cell
    • Erythromycins
  54. What are some characteristics of Erythromycins
    • –Erythromycins are most effective against Gram-positive bacteria and some Gram-negative strains.
    • –Useful in patients allergic to penicillin
    • Resistance to erythromycin is generally not a problem in short-term therapy
  55. What are Azalides and what drugs fall in that category
    • second-generation erythromycins that have a broader spectrum of action with fewer adverse side effects than the erythromycins
    • azithromycin (Zithromax) and clarithromycin (Biaxin).
  56. Azithromycin has several useful features in treatment of periodontal disease including
    • –Azithromycin concentrates in phagocytes such as PMNs (polymorphonuclear neutrophils)  and macrophages, which contributes to it‘s distribution into inflamed periodontal tissues (gingival connective tissue) in greater amounts than in plasma
    • –Post –antibiotic effect: high antibiotic levels remain after drug is discontinued
    • –Has anti inflammatory effects
  57. Erythromycins are Absorbed primarily in the _________ and _________ except the _______. They are Partly metabolized in the ______; primarily excreted ________ via the _______
    • duodenum
    • widely distributed to most body tissues
    • brain
    • liver
    • unchanged via the bile
  58. Erythromycin is not used in the management of _________ because it is primarily effective against _________. ___________ is used in the treatment of periodontal diseases
    • more severe periodontal/endodontic infections
    • Gram-positive bacteria
    • Azithromycin
  59. What are the Indications for Erythromycin
    • Mild upper and lower respiratory tract infections
    • Pharyngitis
    • Tonsillitis
    • Community-acquired pneumonia
    • Gonorrhea
    • Legionnaires’ disease
    • Chlamydia infections
  60. What are the Adverse Effects of Erythromycins
    • Gastrointestinal disturbances (e.g., abdominal pain, diarrhea, nausea, vomiting)
    • Take with food to decrease
    • Hepatotoxicity
  61. Erythromycin and clarithromycin have the potential to inhibit _________ through the inactivation of _________
    • drug metabolism in the liver
    • inactivation of Cytochrome P450 liver enzymes
  62. _________ is metabolized by the CYP3A4 enzymes and when taken with erythromycin this drug will not be __________
    • Theophylline (an antiasthma drug),
    • metabolized, resulting in increased blood levels
  63. What is the pregnancy category of Erythromycin, Clarithromycin (Biaxin) and Azithromycin
    • B
    • C
    • B
  64. Clindamycin (Cleocin) inhibit protein synthesis by binding to the _________ on the bacteria
    50S ribosomal subunit
  65. Clindamycin (Cleocin) is primarily ___________ but can be _________ in high doses. Often dental patients will be taking clindamycin for a dental infection such as __________ or _________
    • bacteriostatic but can be bactericidal in high doses
    • periodontal abscess or periodontal disease
  66. What are the indications of Clindamycin
    • Acute bacterial exacerbation of chronic bronchitis, acute bacterial sinusitis and community-acquired pneumonia,
    • Dental use - certain anaerobic infections caused by Bacteroides species
    • Refractory periodontitis - periodontitis that is resistant to treatment (FDA off-label use)
  67. What are the Adverse Effects of Clindamycin and what is the pregnancy category
    • Pseudomembranous colitis (characterized by severe watery diarrhea or blood in the stools)
    • Do not give to patients with Crohn’s disease, pseudomembranous enterocolitis, or ulcerative colitis
    • Pregnancy category: B
  68. clindamycin (Cleocin) may be taken with ________ to minimize stomach upset and a full glass of water to prevent _________
    • food
    • esophagitis
  69. ___________ and ___________ are two semisynthetic analogues of tetracycline
    Doxycycline hyclate and minocycline HCl
  70. Tetracyclines can cause both ________ and ________ if taken during enamel development; primary teeth affected from _____ to ______; permanent teeth are affected from age _________ to _________
    • hypoplasia and intrinsic stain
    • the last half of pregnancy to age 4 to 6 mos
    • 2 months to 8 to 12 years
  71. What are the adverse effects of Tetracycline
    • Risk of superinfections due to candida
    • –Take with acidophilus in the form of yogurt or gelcaps
    • Causes photosensitivity, which may occur within a few minutes to hours after sun exposure
    • Decreases effectiveness of oral contraceptives (M and M)
  72. Tetracyclines should not be taken with _________ but ___ and ______ are okay with it
    • milk, other dairy products, iron, magnesium-containing products, antacids
    • Doxycycline and minocycline
  73. Tetracycyline concentrates higher in the _________than in the blood
    GCF (gingival crevicular fluid) in the pocket
  74. What are the Drug Interactions of Tetracycline and what is the pregnancy category
    • Oral contraceptives
    • Bactericidal antibiotics – ex. penicillin Pregnancy category: D
    • –Contraindicated in pregnant and lactating women and children ≤ eight years old to twelve
    • –May cause fetal harm and permanent tooth discoloration during tooth development in last half of pregnancy
  75. What are Sulfonamides and when are they used
    • Synthetic analogue of para-aminobenzoic acid (PABA) that inhibits the synthesis of folic acid from PABA in bacteria
    • Not used for dental infections
    • Used in HIV/AIDS patients for Pneumocystis carinii pneumonia (PCP)
  76. Vancomycin is primarily active against _________ and is indicated for ________
    • Gram-positive bacteria (e.g, Clostridium difficile)
    • antibiotic-associated pseudomembranous colitis
  77. Antibiotics primarily used in dentistry are
    penicillin V, amoxicillin, azithromycin, metronidazole, tetracyclines, and clindamycin
  78. The most common route for the supragingival topical delivery of antimicrobial agents is by
    a mouth rinse, a dentifrice, or an oral irrigator
  79. In order for mouthrinses to have success in the antimicrobial therapy it must have _______ which is ________
    • substantivity
    • the ability of the drug to adsorb or bind to intraoral surfaces such as teeth and soft tissues – then release of the drug in its active form
  80. What are the alcohol free rinses
    • GUM® chlorhexidine 0.12%
    • Crest Pro-Health
    • Listerine Zero
  81. Name some antimicrobial mouthrinses
    Image Upload 1
  82. Chlorhexidine Gluconate (Peridex®, PerioGard) has a ___% concentration with an alcohol concentration of ____% and is used for the treatment of ________
    • 0.12%
    • 11.6
    • Gingivitis, peri-implantitis
  83. Chlorhexidine Gluconate has a ____ substantivity and it is best to rinse ______ before or after toothbrushing because
    • high
    • 30 minutes
    • The positive charge of chlorhexidine causes it to bind to the negatively charged molecules in toothpastes such as fluorides and sodium lauryl sulfate (a detergent) and thus inactivates them
  84. What are the Side Effects of Chlorhexidine
    • Supragingival calculus formation
    • Temporary impaired taste perception
    • Tooth and tongue stains – most common adverse
  85. Original formula Listerine contains ____% alcohol, whereas the Cool Mint, Fresh Burst Listerine, and Natural Citrus contain _____% alcohol and has a ____  substantivity
    • 26.9%
    • 21.6%
    • low
  86. Long term use of 3% hydrogen peroxide results in
    gingival irritation, delayed tissue healing, and black hairy tongue
  87. What are the three Controlled-Release Devices (Resorbable) and what directions should we give patients
    • Chlorhexidine gluconate 2.5 mg (PerioChip )Doxycycline hyclate 10% gel (Atridox)Minocycline HCl (1mg) (Arestin)
    • No brushing x 12 h; flossing x 10 d
Card Set:
7a Antibacterial Agents
2018-01-17 20:10:46
7a Antibacterial Agents
7a Antibacterial Agents
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