antibiotics CU dental micro exam 3

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Penicillin mechanism of action: inhibits cell wall synthesis by binding to PBPs on cell surface
3 antibiotics to consider first: Penicillin G, V and Amoxicillin
Advantages of Pen G, V, Amoxicillin: selective toxicity, bactericidal, potent, wide toxic-theraputic ratio, active over broad pH, not inactivated by pus, can be "forced" into inaccessible areas, many routes, inexpensive
T or F Penicillin is inactivated by pus and a low pH: FALSE
T or F Penicillin is bacteristatic: FALSE bacteriocidal
T or F Pen G and ampicillin are absorbed well from the GI: FALSE
T or F Pen V and amoxicillin are the of choice PO: TRUE
Where are penicillins not easily distributed systemically: CNS, and humors of the eye
____ to ____ % protein binding occurs with Pen: 25-45 % = good, greater affinity would inhibit distribution
Pen is excreted by the _______: kidneys
Why do Procain Pen G and Benzathine Pen G maintain high concentrations: crystaline formation = extended release others use Na+/K+ salts
List in arder from highest to lowest transient concentration after administration - Pen G (PO) - Pen G (IM) - Pen V (PO): Pen G (IM), Pen V (PO), Pen G (PO)
Pen V (PO) and Pen G (PO) are in for about 4 days T or F: TRUE
Pen G (IM) is excreted fastest T or F: TRUE
Pen G and V aerobic spectrum: G+, beta-lactamase negative
Pen G, V anaerobic spectrum: G+ and G -, b-lac neg (cocci, spirochetes, Clostridium) *B fragilis is resistant
Pen __ is used for mild infections while Pen __ is used for severe infections: Pen V = mild, Pen G = serious
How do beta-lactamase resistant Pen.'s work: bulky side chains hinder beta-lac
Methicilin, nafcilin, oxacilin, cloxacilin, dicloxacilin are all __________ Pen.s: beta-lactamase-resistant
Beta-lactamase-resistant spectrum: G+ cocci and bacilli
Aminopenicillins have better penetration of the _______ _______ which enhances _______ activity: outer membrane, G -
List two common aminopenicillins: ampicillin (PO/IV), amoxicillin (PO)
Amoxicillin (PO) is better absorbed in the GI than Ampicillin T or F: True (only 40% of ampicilin is absorbed --> resistance of intestinal flora)
Aminopen spectrum: G+, G-, beta-lac negetive anaerobes
Amoxicillin is commonly used for prophylaxis T or F: True kills both G+,-, in 1 office dose
Carboxypen.s have greater G- spectrum including pseudomonas, are parenteral and used in hospital name two: Carbenicillin and Ticarcillin both IM/IV
Augmentin is a common Pen+beta-lac combination of which two: Amoxicillin + claulanate (kills B fragilis)
Pen adverse effects: Allergy (IgE 1% pop), superinfections, Rare - seizures (don't inject on nerve), hepatic and hematologic (bleeding/neutropenia) probs
Cephalosporins are bactericidal T or F: TRUE
Cef.s spectrum (1st gen. Cefazolin, Cefadroxil, Cephalexin): aerobic G +
Which 1st generation Cef is used for surgical prophy: Cefazolin
Which 1st generation Cef is commonly used PO: Cephalexin
Most Cef's are semi-synthetic, not easily hydrolyzed by staph penicillinase and very expensive T or F: TRUE
Older Pen.s are less potent than Cef.s to bacteria which are susceptible to both T/F: False Pen.s are more potent
Most studies show __ to __ % of Cef.s cross-allergy w/ Pen: 5-15%
Bleeding may be a side effect of Cef.s due to interference with _________ or prevention of _______ __________: prothrombin (due to NMTT side chain, tx = VitK) or platelet aggregation
Pen is the most over-used Rx T or F: FALSE Cephalosporins are most used and abused
Side effects of Cef.s: Allergy, bleeeding, disulfiram rxn (antabuse-like), rash
List 3 indications for systemic antibiotics: cure established inf., localize (prevent spread) of inf., prophy
List settings for prophy (4): major oral surgery, trauma, minor surgery on immunocomp, risk of SBE
Which macroglides are indicated for SBE prophy if allergic to Pen: Azithromycin or Clarythromycin
Which Cef.s indicated for SBE prophy if allergic to Pen: Cephalexin or Cephadroxil
Clindamycin, cephalexin, cefadroxil, azithromycin and clarithromycin are all alternitives to Pen used for SBE prophy T or F: TRUE
Settings for parenteral SBE prophy (4): patient unable to take oral, past SBE, artificial valves, previous RF (latter 3 = high risk)
Drugs for parenteral prophy include _________(IM/IV) or for Pen allergies _____ (IV) or _________(IM/IV): ampicillin, clindamycin, cefazolin
Timing of prophy oral ______ before, IV ______ before, IM ______ before procedure: oral = 1 hr, IV = just before, IM = 30 min
T or F macroglides can be administered parenterally: FALSE
A combination bactericidal and bacteristatic antibiotics will cause a positive synergistic effect T or F: FASLE they will hinder each other
Vitamins containing PABA will ________ the effect of sulfonamides: decrease
Topical neomycin supplemented with gentimycin will cause aminoglycoside ________.: toxicity
Taking Fe supplements will _________ the effect of tetracylclines: decrease
Kidney problems facilitate the removal of from the T or F: Fasle concentrations will
Checklist: What (3): what organism (G+,- aerobe ect), penetration/distribution, patient modifiers
If does not work one should recheck patients HX, and look for ______, _______ _____and ______ __ _____: abscess, foreign bodies, obstruction to drainage
Clindamycin must be used to treat chronic osteomyelitis because it is bectericidal. T or F 2 statements: 1st true, 2nd false Clindamycin is bacteristatic (it is used for its penetrating properties)
Chronic osteomyleitis is caused by: Staph
Imipenem, Meropenem and Ertapenem are part of which family: beta-lactam (carbopenems)
Vancomycin and Gentimicin are toxic to what (2): nephrotoxic and ototoxic
Vancomycin is bactericidal and is used for treating highly resistant G+ including MRSA T or F: TRUE
Other than Vanc what other are used to treat MRSA: Clindamycin, Tigecycline
Vancomycin routes of administration: PO, IV
Pen.s, Cef.s, beta lactams and Vancomycin are bactericidal how?: inhibit cell wall biosynthesis
Aminoglycosides are bacteristatic T or F: False Aminoglycosides are bactericidal
Aminoglycosides are bactericidal, how?: Inhibit protein synthesis by atttaching to ribosomes
Chloramphenicol is bacteriostatic against G+ and G- but may cause serious side effects which include ___ and ____: bone marrow supression and 1:40K
Gentimicin and Neomycin are both classified as: Aminoglycosides
Aminoglycoside spectrum: G - bacilli, primary choice for nosocomial G- inf
What is wrong with prescribing gentimycin if a patient is using neomycin (topical): Aminoglycoside toxicity (neomycin is extremely potent and diffuses into system)
Tetracyclines are bactericidal and inhibit protein synthesis T/F 2 statements: F (tetracyclines are bacteristatic is correct), True
Tetracycline spectrum: G+,-, effective against bacteria w/o cell wall
Tetracylcine side effects: dysgenesis (skeletal dev.), tooth staining, photosensitivity, nausea, expired Rx = nephrotoxic
Tige-, Mino-, Doxy-, and Tetracylcine are all ______: bacteriostatic
Macroglides are bacteriostatic T or F: TRUE
List 3 Macroglides: Erythromycin, Clarithromycin, Azithromycin
Erythromycin, Clarithromycin and Azithromycin can all be taken orally T/F: TRUE
Macroglide spectrum: G+ staph and resp inf
Macroglides often cause liver damage and/or gastric disturbances T/F: FALSE
Clindamycin is bacteriostatic and inhibits cell wall synthesis T/F 2 statements: T, F (Clindamycin = inhibits protein synth)
Clindamycin spectrum: G+, anaerobes
Clidamycin is effective against B fragilis, MRSA and staph induced chronic osteomyelitis T/F: TRUE (3 reasons to use clidamycin vs macroglides)
Clindamycin may cause __________ ______ due to the proliferation of C difficile: pseudomembranous colitis
________ are bactericidal inhibitors or membrane function (neurotoxic).: Polymixins
Polymixins are used _____ in combination with neomycin.: topically
Polymixin spectrum: G-
CHX used for perio is a ________: Polymixin
Fluoroquinolones suffix _______: floxacin
How are fluoroquinolones bactericidal: intefere with DNA gyrase/topoisomerase
Why are fluoroquinolones not indicated for children: may interfere with collagen formation in joints
fluoroquinolone spectrum: G+,-
_____ is bactericidal and used to treat aggressive (juvenile) perio = anaerobic bacteria: Metronidazole
List used to treat TB (4): Rifampin, Isoniazid, Ethambutol, Paraaminosalicylic acid
Rifampin is bacteriostatic by inhibiting ________: DNA dependant RNA polymerase
Aminoglycosides and Polymixin are effect against G__ inf: G-
Pen.s, Cef.s, Vancomycin, Macroglides, Clindamycin and Rifampin are effective against G__: G+
Drugs effective against both G+ and - include Carbopenems, fluoroquinolones, beta-lactams, ________ and _______: Amoxicillin , Tetracyclines
Pen.s, Cef.s, beta-lactlms, Vancomycin, Aminoglycosides, Polymyxixns, Fluoroquilinones and Metronidazole are all _______: bactericidal
Tetracylcines, Chloramphenicol, Macroglides, Clindamycin and Rifampin are all _________: bacteriostatic
List inhibitors or cell wall synthesis: Pen.s, Cef.s, beta-lactams and Vancomycin
Aminoglycosides, Tetracycline, Chloramphenicol, Macroglides and Clindamycin all inhibit ______ ________: protein synthesis
Polymixins inhibit _______ ________: membrane synthesis
________ interfere with w/ DNA: fluoroquinolones
Rifampin inhibits ________: RNA polymerase

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