Penicillins, cephalosporins, macrolides (azythromycin, clarithromycin), tetracycline, clindamycin, metronidazole are all ______ most commonly used in dental health care.
Antibiotics
What are 2 types of dental infections?
Caries and periodontal disease
______ are not used to treat or prevent caries.
Antibiotics
Treatments for periodontal disease include the use of _____ or ______ antibiotics.
Local or systemic
True or false: Infections do not need to be treated with antibiotics if drainage can be obtained and patient is not immuno-comprimised.
True
What type of infection produces fever, malaise, and tachycardia?
Systemic
When would systemic infections especially need antibiotics?
If the lesion associated cannot be drained
What was produced from mold in 1928 but was 1st reported and introduced in the 1940s?
Penicillin
Who founded Penicillin?
Fleming
What is a substance that act against or destroy infections?
Antiinfective agents
What are substances that destroy or suppress the growth or multiplication of bacteria?
Antibacterial agents
What are chemical substances produced by living microorganisms that have the capacity, in dilute solutions, to destroy or suppress the growth or multiplication of organisms or prevent their action?
Antibiotic agents
What are substances that destroy or suppress the growth or multiplication of microorganisms?
Antimicrobial agents
What are substances that destroy or suppress the growth or multiplication of fungi?
Antifungal agents
What are substances that destroy or suppress the growth or multiplication of viruses?
Antiviral agents
What is the ability to kill bacteria?
Bacteriocidal
What is the concentration of the antiinfective agent present in the blood or serum?
Blood (serum) level
What is the lowest cencentration needed to inhibit visible growth of an organism on media after 18 to 24 hours of incubation?
Minimum inhibitory concentration
What is the range of actitivty of a drug?
Spectrum
What is an infection caused by the proliferation of microorganisms different from those causing the original infection?
Superinfection
What is an invasion of the body by pathogenic microorganisms and a reaction of the tissues to their presence?
Infection
What occurs when the combination of two antibiotics produces more effect than would be expected if their individual effects were added?
Synergism
What occurs when a combination of two agents produces less effect than either agent alone?
Antagonism
What should be done ideally before beginning antibiotic therapy?
Culture
What are 3 indications for antimicrobials?
Therapeutic, prophylactic,and empirical
What is treatment of infection before specific culture information has been obtained?
Empirical therapy
What are 4 adverse reactions of antibiotics?
Superinfection, allergy, durg interactions, and gastrointestinal complaints
The wider the specturm of the antibiotic, the _______ the risk for superinfection.
Higher
How can superinfection be minimized when giving antibiotics?
Give the most narrow spectrum antibiotic as possible
What type of antibiotics are most allergenic?
Penicillins
True or false: Penicillin and erythromycin are acceptable during pregnancy.
True
Antibiotics can increase ________ of oral contraceptives in the body.
Clearance
Oral anticoagulants are Vitamin K ______.
Inhibitors
Antibiotics reduce the bacterial flora that produce what?
Vitamin K
Penicillin G, and penicillin V potassium are what type of penicillins?
Natural penicillins
Methicillin, nafcillin, and oxacillin are what type of penicillins?
Penicillinase-resistant penicillins
Ampicillin, amoxicillin, and augmentin are what type of penicillins?
Aminopenicillins
Carbenicillin, piperacillin, and ticarcillin are what type of penicillins?
Extended-spectrum penicillins
True or false: Penicillins are bactericidal.
True
What type of antibiotics inhibit cell wall synthesis?
Bactericidal
Penicillins kill a _____ variety of bacteria.
Wide
Penicillins are also called what?
Beta-lactams
What are 2 routes of penicillins?
Oral or parenteral
Why can't penicillins be given topically?
Allerginicity created by this route
Penicillins are distributed throughout the body except what 3 areas?
Abscesses, bone, and cerebrospinal fluid
What is the half life of penicillins?
1/2 hour
Penicillin is out of the body in ___ hours.
2.5
Penicillins treat primarily gram _____ bacteria, and spirochetes.
Positive
Some bacteria produce enzymes capable of destroying penicillins, these enzymes are known as what?
Beta-lactamases
What is a chemical that binds with beta-lactamases to prevent the enzyme from breaking down the penicillin?
Clavulanic acid
Amoxicillin + Clavulanic acid =
Augmentin
What are 4 common side effects of penicillin?
Nausea, vomiting, diarrhea, and abdominal pain
What are some toxic reactions to penicillin?
Almost non-existent
Allergic reactions to penicillin are high and __% are life threatening.
10
True or false: Allergic reactions to penicillin can display all 4 types of hypersensitivity.
True
Penicillin G-the prototype is usually administed how?
Parenteral
Why is penicillin G usually given the parenteral route?
Rapidly degraded in stomach acid
What type of penicillin is of choice for common dental infections?
Penicillin V
Pen V has ____ blood levels than the equivalent Pen G.
Higher
What type of penicillin is more soluable and absorbed better?
Pen V-K
What is the dose of penicillin?
500mg 4 times a day for a minimum of 5 days
What type of penicillin should be given for gonococcal infections?
Ampicillin
What type of penicillin is given for SBE (subacute bacterial endocarditis) infections, otitis media, and upper respiratory infections?
Amoxicillin
What type of penicillin is absorbed better and lasts longer than ampicillin?
Amoxicillin
What type of antibiotic is given if the patient has a penicillin allergy but works the same (a poor 2nd choice)?
Erythromycin
Erythromycin is _______ against many anaerobic bacterial in dental infections.
Ineffective
What is the half life of erythromycin?
2 hours
True or false: Erythromycin is bacteriostatic.
True
What is the dose for erythromycin?
250-500mg 4 times a day for a minimum of 5 days
True or false: Azithromycin and clarithromycin are bactercidal.
False
Azithromycin and clarithromycin have better tissue ______.
Penetration
Z pack is an example of what type of antibiotic?
Azithromycin
Strep infections, mild to moderate URI, spirochetal infections, gonorrhea, clamydia, and mycoplasma are all therapeutic used for what?
Macrolides
Nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, and anorexia are all side effects of what?
Macrolides
Atridox is a topical gel form of what?
Tetracycline
Minocycline (arestin) are topical granules, a form of what?
Tetracycline
What was isolated from Streptomyces strain in 1948?
Tetracycline
Tetracyclines are _____ spectrum.
Broad
True or false: Tetracyclines are bacteriostatic?
True
Acne, pulmonary infections and rickettsaie can be treated by what?
Tetracycline
Hepatotoxicity can occur with tetracycline if given what route?
IV
What antibiotic may retard fetal skeletal development if given during pregnancy?
Tetracycline
What is the most common allergy to opiod analgesics?
Itching/rash
What is a common name for Merperidine?
Demorol
Drugs _______ each others effects.
Potentiate
What does potentiate mean?
To make potent or powerful
True or false: Codiene is a strong analgesic.
False
What type of medication should be started with for dental pain?
NSAID
If NSAIDS not helping dental pain, what medicaton should be tried next?
Vicodin
What does bacteriostatic mean?
Inhibits the growth of susceptible bacteria
What type of hypersensitivity is most common with penicillin?
Type I and IV
True or false: Z pack is bacteriostatic.
True
True or false: An adverse effect of tetracycline is photosensitivity--exaggerated sunburn.
True
What should not be consumed while taking tetracycline?
Calcium
Pseudomembranous colitis has been a problem with what antibiotic?
Clindamycin
If _____ is ingested while a person is taking ______, will have nausea and vomiting.
Metronidazole
What is the main reason prescribed antibiotics are not effective?
Compliance
Is restorative dentistry, local anesthetic injections, intracanal endodontics and post placcement, rubber dams, and suture removal associated wth bacteremias?
No
What is the standard pre med dose for amoxicillin?
2000 mg (2g) 1 hour before the procedure
What is the standard pre med dose for clindamycin?
600 1 hour before the procedure
True or false: Patients already taking an antibiotic for another problem should be prescribed a different antibiotic for a dental problem.
True
Mycoses is another term for what?
Fungi
What is broken down in yeasts and molds?
Fungi
______ are single cell fungi.
Yeasts
How do yeasts reproduce?
budding
True or false: Molds are multicellular.
True
Molds are characterized by long branching filaments called ______.
Hyphae
What are 2 general types of mycotic infections?
Mucocutaneous and systemic
What are 3 types of mucocutaneous mycotic infections?
Superficial, cutaneous, and subcutaneous
Outer layers of skin and hair
Superficial
Deeper in the dermis, hair and nails
Cutaneous
Dermis, subcutaneous tissue, and muscles
Subcutaneous
What type of myocotic infection can be life threatening?
Systemic
Systemic mycotic infection usually occurs in what type of person?
Immuno-compromised
Candida albicans such as thrush and moniliasis are what type of infection?
Mucocutaneous fungal infection
Coccidomycosis, histoplasmosis, cryptococcosis, mucomycosis, and aspergillosis are examples of what type of infection?
Systemic fungal infection
What are 3 causes of vaginal candidiasis?
Pregnancy, diabetes mellitus, or oral contraceptives
Polyene macrolides, imidazoles, griseofluvin, and flucytosine are 4 major groups of what type of agents?
Antifungal
Polyene macrolide works by binding to sterols in the fungal cell membrane which allows ______ and ______ to leak out altering fungal cell metabolism causing cell death.
Potassium and magnesium
Suspensions and pastilles of polyene macrolides have a lot of ______.
Sugar
Imidazoles work by binding to ______ in membrane, causing cell membrane to leak causing fungal cell death.
Phospholipid
Nystatin and Amphoericin B are what type of antifungal medication?
Macrolides
Ketoconazole, Clotrimazole, and Miconazole are what type of antifungal medication?
Imidazoles
What type of antifungal medication should be used for serious systmeic fungal infections?
Amphoericin B
What type of antifungal medication has a side effect like "shake and bake"?
Amphoericin B-Amphoterrible!
Mycelex is a synthetic form of what type of Imidazole?
Clotrimazole
Nizoral is a form of what type of Imidazole?
Ketoconazole
What type of antifungal medication comes in the form of a tablet and needs an acidic enviornment in the gut?
Ketoconazole
Can you take tums or prilosec with Ketoconazole?
No
Rapidly absorbed in stomach and small intestine-peak effect is 30 min.
Aspirin
Delayed because absorbed in small intestine (if have stomach sensitivities) Do not crush or chew..
Enteric coated ASA
Buffered with magnesium carbonate, etc. 20 minutes
Buffered ASA ( Bufferin)
Dosage for Aspirin as a pain reliever, fever reducer..
325-650 mg 2 tablets every 4 hours
Dosage for Aspirin to prevent myocardial infarct:
75-325 mg per day
Dosage for Aspirin for arthritis
3000-6000 mg per day
Children's dose of Aspirin
10-15 mg per day
Large and chemically diverse group of drugs, similar to Aspirin - analgesic, anti-inflammatory, and antipyretic. They block the arachidonic acid pathway which decreases production of prostaglandin and other inflammatory mediators..
NSAIDS (Nonsteroidal Anti-inflammatory Drugs)
Therapeutic Uses to help with these conditions: relief of mild/moderate pain, acute gout, various bone, joint, and muscle pain, osteoarthritis, juvenile rheumatoid arthritis, dysmenorrhea, fever
NSAIDs
What are the six structurally related groups of NSAIDs?
Propionic acid derivatives - most common
Acetic acid derivatives
non-acidic agents
Fenamic acid derivatives
Salicylates
Oxicams
NSAIDs Propionic Acids:
ibuprofen (Motrin,Advil)
flubiprofen (Ansaid)
naproxen (Naprosyn)
fenoprofen (Nalfon)
ketoprofen (Orudis)
ketorlac (Toradol)
oxaprozin (Daypro)
What are some NSAIDs adverse effects?
Blood clotting- reversible affect on platelets- only as long as taking the drug, not for the life of the platelet- so affects only 1 day for ibuprofen.
Why cant an asthmatic take NSAIDs?
Increases the risk of bronchospasm
Cautions for NSAIDs?
persons with cardiovascular or renal diseases with fluid retention, coagulopathies, ulcers
True or false? Aspirin PERMANENTLY affects platelets, would have to flush out for 5 days to get new ones.
True
True or false? IBU does not affect platelets PERMANENTLY, clotting can occur 1 day after discontinued.
True
How long do platelets last?
5 days
Onset and duration for ibuprofen (Motrin,Advil)?
Onset 30 minutes, Duration 4-6 hours
Maximum daily dose for ibuprofen?
3.2 grams (four 800 mg tabs)
NSAIDs: other agents include:
Naproxen (Naprosyn, Anaprox)
Flurbiprofen (Ansaid)
COX-2 Inhibitors (less adverse reactions)
Celecoxib (Celebrex)
Removed from the market in 2005 - associated with increased heart attacks
Rofecoxib (Vioxx)
What effect does Naproxen have on Lithium?
Increases the effects of Lithium
Acetaminophen (Tylenol) Drug Effects?
Analgesic and anti-pyretic (Achieved by same dosage as Aspirin, equal potency and equal effectiveness)
This drug has NO SIGNIFICANT anti-inflammatory effect and NO platelet inhibition -OK for BLEEDERS!
Acetominophen (Tylenol)
Large doses result in toxic metabolite-leads to hepatic (liver) necrosis-single dose of 20-25 grams (2000-2500 mg) may be fatal (usually manifests 2-3 days later).
Acetaminophen (Tylenol)
Tylenol Dosage for pain/fever:
325-650 mg (2 reg tabs) 3-4 times per day
Tylenol peak:
1-3 hours, half life 1-4 hours
Tylenol maximum adult dose
4gm in 24 hours
Tylenol Elixir for children dosage:
120 mg/5 ml (5ml=1tsp)
Tylenol children's dose
10-15 mg/kg
Uric acid (tophi) in joints
Gout
prevents excessive uric acid from forming (used in patients with malignancy)
Allopurinol
Increase excretion of uric acid?
Probenecid
For pain meds what should the Dental Hygienist implicate?
Educate patients!!! Educate them about the various side effects, contraindications, and adverse reactions of these medications. Their physician should be notified if any effects become severe or if bleeding or GI pain should occur.
Yawning, lacrimation (tearing), perspiration, irritability, nausea, vomiting, tachycardia, fever, and chills, are all signs for what?
Withdrawal symptoms from opioid drugs
Treatment options for Opioid addicts (ways to quit)...
Methadone (oral) substitute, cold turkey, Methadone maintenance
What is an Opiate Antagonist?
Naloxone (Narcan)
What is given for overdose to reverse respiratory depression, it also binds to opiate receptors and prevent a response, known as reversal agents?
Naloxone (Narcan)
Most common allergic reaction from an opioid Analgesic?
Skin rashes/ urticaria
Combining an opioid with a nonopioid analgesic produces?
An additive analgesic effect with fewer adverse reactions.
In Opioid Analgesics, which what is the most common effect of drug interactions?
Additive effect caused by alcohol and other CNS depressants
Standard dose for Morphine?
10 mg
Prototype opioid against which all others are measured?
morphine
This drug can be alone or in combination with aspirin(Percodan), or acetaminophen (Percocet), Tylox). The combination gives additive effect with less side effects.
Oxycodone
Vicodin is an example of this?
Hydrocodone (combined with acetaminophen)
Most common dosage of Hydrocodone for dental pain?
5/500, 5mg ......5mg hydrocodone with 500 mg acetaminophen
T/F Alone, codeine is a strong analgesic?
False, it is weak alone :(
30mg of codeine combined with acetaminophen?
Tylenol #3
t/f ibuprofen has been shown to be MORE effective than Tylenol #3?
True :)
Propoxyphene is also known as?
Darvon, Davocet-N
Meperidine is better known as?
Demerol
100mg demoral = ____________morphine?
10mg
Opioid used for severe dental pain - more potent than morphine?
Hydromorphine (Dilaudid)
Short acting Opioid used to supplement regional or general anesthesia?
Fentanyl
For dental pain should start with what kind of drug?
NSAIDs
If need a stronger drug, how should it be prescribed?
low doses for short periods with NO REFILLS!!
What should be avoided when taking Tetracycline?
Milk products (Ca), iron preparations, antacids (Mg), and other dairy products because of the chelation and drug binding that occurs-REDUCES ABSORPTION of the drug.
What should be avoided due to photo-sensitivity?
Sunlight and tanning beds
Antibiotic that is distributed to bone but not cerebrospinal fluid?
Clindamycin (Cleocin)
In the GI-pseudo membranous colitis has been a problem from this antibiotic?
Clindamycin
Uses for Clindamycin include:
Endocarditis prophylaxis (if penicillin allergy)
If allergic to penicillin what antibiotic is used?
Clindamycin
How many mg of clindamycin is prescribed?
150 - 300 mg every 6 hours
If periodontitis pt does not respond to mechanical therapy, what drug can be used?
Metronidazole (Flagyl)
Why would Metronidazole be used in periodontitis case?
Because it is affective against many obligate anaerobes, including Bacteroides.
Is Metronidazole effective against Actinobacillus actinomycetimcomitans?
Nope..
If _______________is ingested while taking Metronidazole, will have nausea, vomiting.
Alcohol (including, food, drink, mouth rinses)
A antibiotic that is structurally and pharmacologically related to penicillins?
Cephalosporins, ex: Keflex
Antibiotic used for acute infection that is gram + aerobes prdominate, anaerobes are absent?
Penicillin
For Mixed infection this is a Gram + aerobes decreasing, anaerobes increasing?
Clindamycin Metronidazole
Anbiotics used for chronic infection with gram + aerobs absent, and anaerobes predominate?
Clindamycin, Metrodazole
Reasons a prescribes antibiotic may not be effective?
Failure to buy, wrong antibiotic, resident organism, patient compliance, failed to buy, take, or complete.
Antibiotic used for topical treatment?
neosporin
What is neosporin composed of?
Neomycin (gram -), Polymixin and Bacitracin (Gram +)
Anti-tuberculosis Agents used chemotherapy with?
Isoniazid (INH)
Microbial infection of heart valves or endocardium is what type of infection?
Subacute Bacterial Endocarditis (infective endocarditis)
Causes of infective endocarditis include:
Rapid onset - Staphylococcus Aureus
Insidious onset - Streptococcus Viridans
Weakness, Fatigue, Weight loss, Fever, Chills, Night sweats, Anorexia, Arthralgia are all symptoms of what infection?
Infective Endocarditis
Petechial Hemorrhages, Linear Hemorrhages, Retinal Hemorrhages, Heart Murmur are all signs for and the OUTCOME is Fatal 10-70% of cases...
infective endocarditis
The Streptococcus Viridans in bacteremia are..
S. Mutans
S. Mitis
t/f Risk of bacteremia from daily activities,
homecare & eating is 1000 times greater than risk from dental treatment.
TRUE!!
Prophylaxis with dental procedure is recommended for?
All dental procedures that involve manipulation of the gingival tissues or the periapical region of the teeth or perforation of the oral mucosa.
Prophylaxis reasonable for:
Prosthetic cardia valve, previos infective edocarditis, congenital heart disease, unrepaired cyanotic CHD, including palliative shunts and conduits, completely repaired congenital heart defect with prosthetic material or device.
Antimicrobial Prophylaxis Not Recommended after how long?
2 years
Dental Procedures Associated with Bacteremias
Periodontal Procedures
surgery
scaling and root planing
probing and recall maintenance
subgingival placement of antibiotic fibers or strips
Prophylactic cleaning where bleeding is anticipated,Extractions
Implant placement
Reimplantation of avulsed teeth
E
Dental Procedures NOT Associated with Bacteremias
Restorative dentistry
Local anesthetic injections
Intracanal endodontics and post placement
Rubber dams
Suture removal
Removal of prosthodontic or orthodontic appliances
Oral impressions
Fluoride treatments
Radiographs
Orthodontic appliance adjustment
She
Antimicrobial Prophylaxis Regimens ADA/AHA
Standard general prophylaxis:
Amoxicillin
Adults: 2.0 grams; Children: 50mg/kg orally 1 hour before procedure
Allergic to penicillin?
Clindamycin:
Adults: 600mg; Children: 20mg/kg orally 1 hour before procedure
Allergic to penicillin?
Cephalexin or cefadroxil, but not recommended for use in patients with immediate-type hypersensitivity to PCN
Dosage: Adults: 2.0 grams; Children: 50mg/kg orally 1 hour before procedure
Allergic to penicillin?
Azithromycin or clarithromycin
Dosage: Adults: 500mg; Children: 15mg/kg orally 1 hour before procedure
Allergic to penicillin and unable to take oral medications:
Clindamycin:
Dosage:
Adults: 600mg; Children: 20mg/kg IV within 30 min before the procedure
Effective against oral and esophageal Candida and serious systemic Candidial infections, including systemic fungi (blastomycosis, histoplasmosis)
Vaginal candiasis (1 tablet)
Side Effects - nausea, vomiting, diarrhea, abdominal pain.
Diflucan
Another name for Imidazoles: Fluconazole
Diflucan
Antifungal agent that if taken with fatty foods it has better absorption?
Griseofulvin
Fulvacin is for?
Tinea....NOT candida Over gowth of candida is actually a side effect.
Difficult to kill because they live inside cells, so any drug that kills this may also kill the cells.
Viruses
Cannot replicate on its own. It must attach to and enter a host cell. It then uses the host cell's energy to synthesize protein, DNA, and RNA.
Virus
Antiviral Agents
...