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ME Pharm test 7

aerobic organism lives only in presence of oxygen
anaerobic organism that can live in absence of oxygen
antibacterial drug used to kill/suppress growth of bacteria
antibiotic used to treat bacteria, viruses, fungus
antibiotic drug resistance acquired through genetic mutation or acquisition of genetic material from other organisms
autogenous infection caused by normal flora bacteria
bactericidal kills bacteria
bacteriostatic suppresses growth of bacteria
facultative organisms able to live in presence or absence of oxygen
loading dose initial dose of drug (large) used to achieve therapeutic levels quickly
suprainfection opportunistic infection caused by overgrowth of microorganisms that aren't susceptible to antibacterial therapy
IE infective endocarditis
TJR total joint replacement
commensal agents agents that live in an environment without causing harm
mycotic infection caused by fungi or molds
neonate infant younger than 1 month
parasitism evolution from commensal status to causing disease
saprophytic ability to live on decaying organic matter
subacute disease development without overt clinical signs and symptoms
HIV human immunodeficiency virus
HIVD human immunodeficiency viral disease
HSV herpes simplex virus
antibacterial agent destructive to or prevents growth of bacteria
antibacterial agents are used to treat infection (usually odontogenic) and antibiotic prophylaxis (to prevent bacteremia)
adult body harbors an indigenous flora that includes bacteria, viruses, fungi, protozoa
infection invasion and multiplication of microorganisms in body tissues, resulting in local cellular injury
cross-infection obtained from other humans, animals, environment
the strategy in treating bacterial infections is to target differences between bacterial (prokaryotic) and host/body (eukaryotic) cells
drugs have the least toxicity to host when have more unique pathways
drugs have more toxicity to host when target shared pathways
when you have to use a drug that may injure host cells, you take _________ into account therapeutic index
in TI, a higher number means the drug is safer
what is essential for resolution of an infection debridement and host immune response
debridement removes infection debris
for a compromised immune response you would use what kind of drug bactericidal
when a broad spectrum antibacterial is used it can kill/inhibit harmless bacteria in normal flora
use of a broad spectrum antibacterial can result in suprainfection
oral infections are caused by gram+ facultative cocci gram- bacilla (strict anaerobes)
by the time a antibacterial is indicated (fever, lymphadenopathy) what bacteria dominates anaerobic gram- bacilli
spectrum relative range of drug's antibacterial action
narrow spectrum effective in limited bacterial species
extended effective on greater number of microorganisms
broad can kill/suppress growth of wide variety (most)
narrow, extended, and broad spectrum antibacterials are effective on gram+, gram-, aerobic, facultative, anaerobic organisms
most odontogenic infections are polymicrobial (mixed)
most common organism responsible for odontogenic infections include viridians streptococci
what organisms predominate in odontogenic infections facultative gram+ cocci anaerobic gram+ cocci gram-bacilli
what effects plasma concentration absorption, distribution, elimination of agents
what happens to bacteria in a more acidic enviornment number of species declines, is an increase in number of ones left
as an infection matures it becomes acute or chronic
acute infection spreads
chronic infection localized
what infections can become "walled-off" by fibrous connective tissue low-grade chronic infections
to make it easier for antibacterials to reach a "walled-off" infection, you must remove infected fibrous tissue through debridement
debridement often... eliminates the need for antibacterial agents
antibacterial can't destroy all bacteria, they enhance the immune response
host defense mechanism can be adversely affected by some diseases and medications
in a suppressed immune system, use bactericidal drugs
antibacterials work in what ways 1. interrupt bacterial wall synthesis (cidal) 2. interrupt bacterial DNA replication/repair (cidal) 3. interrupt protein (RNA) synthesis (static)
Antibacterials that inhibit cell wall synthesis: penicillins cephalosporins bacitracin vancomycin
antibacterials that inhibit protein synthesis macrolides clindamycin tetracyclines (doxycycline, minocycline) neomycin
antibacterials that inhibit DNA synthesis metronidazole fluoroquinolones
what kind ofdrug do you use with an immunocompromised patient bactericidal
combining a static and cidal can result in antagonistic effects
which kind of drug works best in rapid cell growth bactericidal
if given and cidal and a static it will slow growth of cell and impede cidal drug effects
pencillins (narrow spectrum - pen VK) are beta-lactamase susceptible
penicillinase-resistant penicillins (dicloxacillin) are beta-lactamase resistent
broader-spectrum penecillins (ampicillin, amoxicillin, amoxicillin with clavulanic acid) are beta-lactamase susceptible - with clavulanic adic, mostly resistant
cephalosporins first generation are beta-lactamase susceptible
cephalosporins second generation are beta-lactamase resistant(some)
cephalosporins third generation are beta-lactamase resistant (Greater)
beta-lactam antibiotics interfere with... cell wall synthesis (repair of cell)
most common penicillin used it pen VK
pencillin is a prototype drug of beta-lactamase
penicillinase enzyme that degrades penicillin molecule, eliminated therapeutic effect
dicloxacillin is prototype penicillinase-resistant agent
clavulanic acid added to some penicillins (ex. amoxicillin) to make penicillin combo penicillinase-resistant
Cephalosporins cause an allergic reaction to 10% of people with penicillin allergies
oral dose forms of cephalosporin are resistant to penicillinase
oral dose forms of cephalosporin are destroyed by cephalosporinase
antibiotic drug resistance can be genetic or nongenetic, natural or intrinsic, arise from chromosomal mutations
vertical transmission - (daughter cells) of genes that effect altered drug: targets, transport, metabolic pathways
horizontal transmission gaining genetic material from other bacteria
#1 reason for development of antibiotic resistance is indiscriminate use
indiscriminate use causes mutation of chromosomes of bacteria
indiscriminate use is ______________ transmission vertical
genetic drug resistance organisms with natural or intrinsic resistance
acquired drug resistance acquire resistance by gaining genetic material from other bacteria
acquired drug resistance is ___________ transmission horizontal
what is the main mode of drug resistance? acquired drug resistance
biolfilm-related drug resistance bacteria that are stacked and encased in hydrated mix of polysaccharides and protein, form towerlike structures
once in a biofilm, bacteria are protected from antibodies and leukocyte phagocytosis
pharmokinetic condiserations refer to issues related to absorption, distribution, bioavailability, metabolism, elimination of drugs
access of antibiotics to site of infection depends on: 1. route of administration 2. degree of plasma protein-binding in circulation 3. concentration of free drug in plasma/extracellular fluid 4. passive diffusion into area of infection
periodontal infections are... polymicrobial
what organisms predominate in a periodontal infection gram- and anaerobic
odontogenic infections are usually... autogenous
odontogenic infections primarily affect teeth (caries), pulpal, periodontal, pericoronal tissues
formation of purulent exudate can... block antibacterials from reaching infection
antibiotics are indicated when patient presents with malaise, chills (fever), trismus, lymphadenopathy, swelling or if they are compromised
DOC for uncomplicated odontogenic infection is pen VK
if no improvement in infection after 2-3 days empirical addition of metronidazole (7 days) while continuing penicillin
empirical affects most bugs so is prescribed
many gram- anaerobes have natural/intrinsic resistance to erythromycin
if resistant to erythromycin, will also be resistant to clindamycin
clindamycin is associated with pseudomembranous collitis
pseudomembranous collitis caused by C.difficle liberating toxins that desquamate epithelial lining of intestines, causing bloody diarrhea and systemic infection
Treatment of odontogenic infection: primary line pen VK, 500mg
Treatment of odontogenic infection: secondary metronidazole or azithromycin 250mg
Treatment of odontogenic infection: tertiary clindamycin 300mg
antibacterial agent should be taken ______ before treatment 30 minutes to 1 hour
premed: if patient forgets to take premed, can be taken up to 2 hours after
premed: if patient is already on an antibiotic, give drug from different class, unless it has been 10 days (then can use same)
premed: if patient is taking anticoagulants don't give IM or IV, only oral meds
premed: coronary artery bypass grafts/stents after initial 3 months of healing, don't need premed
premed: removal of spleen may need to premed if done in last 2 years or is a child
premed: uncontrolled diabetes refer for med consult, don't treat
premed: end-stage renal disease premed patients with underlying cardiac risk (check with doc about cleaning before or after dialysis)
premed: HIV considered if <500PMN/mm3 (delay elective treatment)
premed: organ transplant check with doctor
premed: hydrocephalus shunt yes if drains into heart
metronidazole interacts with ___________ and produces what adverse effect alcohol, antabuse effect: nausea, vomiting, abdominal cramps
oral antibacterial agents, especially ______________ often cause nausea, vomiting, retching, diarrhea macrolides
metronidazole causes reddish color in urine
tetracycline causes intrinsic tooth staining (if taking during pregnancy or under 9 years old)
minocycline causes black pigmentation in mucosa and bone
superinfections with _________________ commonly occur in association with antibacterial chemotherapy c. albicans
in immunocompromised patients, oral candidiasis may spread systemically via bloodstream
oral candidiasis is treated with antifungals
most allergenic drug is penicillin
are ___________ fungal species 100,000
______ fungal species are pathogenic to humans a few
commensals obtain benefit without causing harm
commensals are found on oral, vaginal, GI mucosa, harmless residents of skin, respiratory epithelium
paratism/superfection overgrowth of numbers of commensal organisms, disease develops
mycotic infections are associated with opportunistic infection due to impaired immune system
mycotic infections usually affect people with compromised immune system, such as hiv, use of immunosuppression drugs, treatment of malignant disease (oncology treatment)
mycotic infections present as superficial, cutaneous (skin, mucosa), subcutaneous, systemic
most common fungal infections candida albicans (candidiasis, thrush) and tinea
amphotericin B and nystatin are ergosterol binding
amphotericin B treats systemic fungal infections, fungal meningitis, fungal UTIs
nystatin treats oral and intestinal candidiasis, thrush
fluconazole treats systemic histoplasmosis, opportunistic candidiasis
antifungal agents work by inhibiting ergosterol synthesis, disrupting plasma membrane by binding to ergosterol
ergosterol is synthesized within fungal cells
ergosterol is necessary for cellular activity
ergosterol blocks cytochrome P450 (CYP450)enzyme
major adverse effect of all systemic azole antifungals? hepatotoxicity
nystatin is an antifungal that binds to ergosterol in fungal plasma membrane
nystatin increases membrane permeability, resulting in leakage of cellular components, leading to cell death
nystatin use is limited to treatment of superficial candidial infections of skin, oral, vaginal mucosa with topicals
nystatin must stay in contact with skin for 5-7 minutes
the most common fungal infection is by candida species
oral candidial infections: presence of blastosphores without hyphae is commonsal
oral candidial infections: presence of blastosphores with hyphae is opportunistic infection
C. albicans is an opportunistic organism
Oral candidiasis is a __________ infection with potential for_______________ localized, systemic dissemation
pseudomembranous candidiasis is a white psuedomembrane, can be wiped away, leaves painful, red, sometimes bleeding area
pseudomembranous candidiasis can be acute or chronic
pseudomembranous candidiasis is observed in neonates (thrush) and immunosuppressed patients
Erythematous Candidiasis is a red patch, usually on palate or dorsum of tongue
Erythematous Candidiasis symptoms loss of filiform papilla, burning sensation
Erythematous Candidiasis can be acute or chronic
hyperplastic candidiasis is also known as candida leukoplakia
hyperplastic candidiasis is a persistent (chronic)white plaque
hyperplastic candidiasis is _______ common least
denture stomatitis is erythematous area beneath denture, can get into acrylic of denture
when treating denture stomatitis treat person and denture with nystatin
median rhomboid glossitis is erythematous patch with loss of filiform papilla on dorsum of tongue
angular chelitis is erythematous fissures at commissures of lips
angular chelitis is an infection of c. albicans and staphylococcus aureus
angular chelitis is caused by poor OH, decrease in intermaxillary space, nutritional deficiencies
diagnosis of oral candidiasis is based on clinical signs and symptoms
additional test to diagnose oral candidiasis are exfoliative cytology, culture, biopsy
exfoliative cytology scraping suspected lesion with sterile instrument/tongue blade, smearing on glass slide
primary line of antifungal therapy includes topicals: nystatin, clotrimazole
nystatin in DOC for treatment of oral candidiasis
nystatin comes in what forms pastilles or rinses
treatment with nystatin should continue for how long after elimination of signs/symptoms? at least 48 hours
is nystatin absorbed in GI tract? no
what form of nystatin doesn't contain sucrose? vaginal tablets
when would you use nystatin vaginal tablets as oral lozenges? with caries-prone patients
does nystatin have side effects? no
clotrimazole is not recommended for treatment of candidiasis in pregnant, children under 3
secondary line of antifungal therapy includes systemic, fluconazole
adverse effect of systemic azoles and warfarin is? may increase blood levels of warfarin, increasing risk of bleeding
antiviral agents are likely to be toxic to host cells as well as virus
most common viral infection? HSV-1
transmission of HSV-1&2 occurs via direct contact with contaminated secretion of infected person
HSV-1 in transmitted by contact with oral secretions, vesicular fluid
HSV-2 transmitted sexually, can be translocated to oral cavity
to differentiate between HSV-1&2 you need an antigen-specific test
primary infections of HSV-1 occur primarily in children between 2-3
prodromal stage tingling felt before lesion erupts
primary line of HSV-1 antifungals include topicals: penciclovir (Rx), docosanol (OTC)
in cases of complicated primary herpetic gingivostomatitis and immunocompromised patients ____________ should be added to primary line of treatment systemic antivirals, such as acyclovir
topical antifungals are most effective if applied during prodromal stage
penciclovir reduces duration, pain. speeds healing
docosanol shortens healing time, reduces symptoms and pain
docosanol is not indicated for intraoral use
infection begins when a virion attaches to a host cell
most common hepatitis infections are B and C
hepatitis infection results in reduced liver function
reduced liver function results in increased bleeding due to reduction of vitamin K clotting factors
manifestation of hepatitis? jaundice
enfuvirtide inhibits viral entry into host cells
HIV is a ______ retrovirus
what is essential for HIV replication? reverse transcriptase
HIV is treated with a multi-drug regime
hepatitis: delay elective procedure if _______ <50,000 platelets mm3
Created by: mnerion