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150 Cards in this Set
- Front
- Back
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Dental infections can be divided into several types as follows:
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Caries, periodontal disease, localized dental infections and systemic infections
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Most dental infections are initially due to these organsisms?
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Gram-positive cocci, like Streptococcus viridans, or alpha-hemolytic streptococci
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Initial gram-positive infections often change to include both gram-positive organisms and _____-______ _______ organisms
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Gram-negative anaerobic
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Over time dental infections progress to include almost nothing but ________ organisms
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Anaerobic
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Initial dental infections are usually treated with ______ or ________
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Penicillin or ampicillin
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If someone is allergic to penicillin an alternative antibiotic would be ______ or _________
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Erythromycin or clindamycin
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If an anaerobic infection is suspected one should add __________
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Metronidazole (Flagyl)
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Clindamycin is effective against these organisms but may lead to ________ ________
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Gram-positive cocci and gram-positive/negative anaerobes. Pseudomembranous colitis
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The antibiotic Prontosil was found to protect mice from infection by streptococci in ____.
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1932
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In ______, Fleming found that the mold Penicillium notatum, inhibited bacterial growth
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1928
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Substances from any source that act against or destroy organisms that cause infections
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Antiinfective agents
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Substances from any source that destroy or suppress the growth or multiplication of bacteria
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Antibacterial agents
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Chemical substances made by microorganisms that can destroy or suppress the growth of organisms
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Antibiotic agents
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Substances that destroy or suppress the growth or multiplication of microorganisms
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Antimicrobial agents
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Substances that destroy or suppress the growth or multiplication of fungi
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Antifungal agents
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Substances that destroy or suppress the growth or multiplication of viruses
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Antiviral agents
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The ability to kill bacteria even if bacteria removed from drug after exposure
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Bactericidal
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The ability to inhibit or retard the multiplication or growth of bacteria that is reversible if bacteria removed from the drug
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Bateriostatic
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Concentration of the antiinfective agent in the blood
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Blood (serum) level
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Invasion of the body by microorganisms and tissue reaction to their presence
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Infection
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Lowest concentration of drug needed to inhibit visible growth of an organism in media after 18-24 hours of incubation
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MIC (minimum inhibitory concentration)
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Range of activity of a drug against various microorganisms
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Spectrum
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Infection caused by the proliferation of organisms different from what caused the original infection
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Superinfection
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A combination of two antibiotics produces more effect than either would alone
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Synergism
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A combination of two antibiotics produces less effect than either agent alone
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Antagonism
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Infection factors:
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Virulence, Inoculum, Resistance of the host
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Growing bacteria on a media from a sample of infective exudate.
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Culturing
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Exposing organisms to certain antibiotics to test sensitivity or resistance of organism to antibiotics
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Sensitivity testing
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Why is it difficult to get good information from dental cultures?
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Anaerobic bacteria difficult to culture and many infections are mixed making interpretation of culture difficult
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How do we obtain cultures from dental patients?
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aspiration with a needle, a swab, or absorbent points
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Care must be taken when culturing patients to not contaminate the sample with ____________
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Supragingival plaque
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How many days does it usually take to get sensitivity results from cultures
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1-3 days
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The natural or acquired ability of an organism to be immune or resist the effects of an antiinfective agent
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Resistance
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When an organism has always been resistant to an antimicrobial agent because of the bacteria's normal properties
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Natural resistance
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An organism that was previously sensitive to an antimicrobial agent develops resistance
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Acquired resistance
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How does resistance develop in microorganisms?
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Spontaneous mutations, increase in antibiotic use, or transfer of DNA from one organism to another via transduction, transformation, or bacterial conjugation
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What changes tend to occur in bacteria that causes acquired resistance?
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A decrease in bacterial permeability, production of bacterial enzymes, and an alteration in the target site for the antibiotic
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The best defense against a pathogen is the _____ _______
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Host response
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What type of infection should be treated with an antibiotic?
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Acute, severe, rapidly spreading infection
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What type of infection may not need treatment?
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Mild, localized infection where drainage is obtained
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When is prophylactic antibiotic therapy recommended?
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With history of infective endocarditis, valve prosthesis, or congenital heart disease
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If an antibiotic kills off some organisms allowing the overgrowth of others this is called a _______________
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Superinfection
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What antibiotics tend to be the most allergenic?
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Penicillins and cephalosporins
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If a woman of child-bearing age is taking these antibiotics and oral contraceptives the contraceptives may fail.
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Ampicillin and tetracycline
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What antibiotics may prolong the INR of a patient?
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Tetracycline and erythromycin
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These two antibiotics work on the same receptor so should not be given together.
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Erythromycin and clindamycin
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These two classes of antibiotics should not be given together
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Bacteriostatics and bactericidal
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What antibiotic has the highest incidence of GI side effects
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Erythromycin
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What antibiotics can generally be used in pregnant patients?
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Penicillin and erythromycin
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An important factor to consider in prescribing antibiotics is the patients ___________ status
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Socioeconomic status
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Name the four major Penicillin groups.
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Penicillin G&V, Penicillinase Resistant, Ampicillins, and Extended Spectrum
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What mold naturally produces penicillin
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Penicillium notatum
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Penicillin contains this type of "ring" that can be broken by penicillinase enzyme secreted by bacteria rendering the drug ineffective
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Beta-lactam
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What route of administration should NOT be used for penicillins?
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Topical because allergies are more likely with this route
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The half-life of penicllin G and V is __________
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30 minutes
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Penicillin works by binding to these proteins on the bacterial cell membrane
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PBPs (penicillin-binding proteins)
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Penicllin works by inhibiting the formation of ________
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Cross-linkages that form the cell wall of the bacteria
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Penicllin is effective against many of the microbes responsible for _______ infections
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Periodontal
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Toxicity with penicillin's is _____________ (likely or unlikely)
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Unlikely
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What percent of patients getting penicillin will have some type of reaction?
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5 - 10%
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Name four types of allergic reactions to penicillins
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Anaphylaxis, Rash, Delayed serum sickness, and oral lesions
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What percent of patients receiving penicillin develop an anaphylactic reaction?
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0.05%
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If patients are allergic to penicillins what are two other drugs that may be used for oral infections?
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Erythromycin or Clindamycin
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What type of penicillin G should be avoided in cardiac patients?
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Sodium penicillin G
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What are the two drugs of choice in treating a penicillinase secreting bacteria?
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Cloxacillin and dicloxacillin
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The drug of choice for prophylaxis for bacterial endocarditis prior to a dental procedure is ___________
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Amoxicillin
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The enzyme penicillinase can be blocked by adding this drug to amoxicillin
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Clavulanic acid
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An extended-spectrum penicillin that is effective against Pseudomonas aeruginosa and some strains of Proteus is ____________
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Carbenicillin
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Name the three macrolide antibiotics
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Erythromycin, charithromycin and azithromycin
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Is erythromycin bacteriostatic or bactericidal
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Bacteriostatic
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In addition to treating Gm+ infections due to Staph. and Strept., erythromycin is also effective against these organisms
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Bordetella, Legionella, Actinomyces, Mycoplasma pneumoniae, Entamoeba histolytica, and some Chlamydia species
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The main side effect with erythromycin is _______
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GI upset, stomatitis, abdominal cramps, N/V, and diarrhea
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Erythromycin may increase the blood levels (toxicity) of these drugs
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Theophylline, digoxin, triazolam, warfarin, carbamazepine, and cyclosporine
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This is the drug of choice to use in penicillin allergic patients
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Erythromycin
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Two newer macrolide antibiotics like erythromycin are ______ & _______
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Azithromycin (Zithromax, A-Pak) & Clarithromycin (Biaxin)
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Azithromycin and Clarithromycin are effective against these bacteria
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Aerobic Gram+ cocci and aerobic Gram - bacteria
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This broad-spectrum antibiotic may also have adverse effects on developing teeth
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Tetracycline
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What bacteria were the early tetracyclines isolated from
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Streptomyces
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Tetracyclines are stored in the _____ and ______ of unerupted teeth and concentrated in the ____ _____ fluid
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Dentine, enamel, gingival crevicular fluid
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Are tetracyclines bacteriostatic or bactericidal
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Bactriostatic
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Tetracyclines work by bining to this subunit of bacterial ribosomes inhibiting protein synthesis
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30S
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Resistance to tetracyline is caused by this mechanism
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Decreased uptake of tetracycliine by the organism
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Are S. viridans and S. aureus resistant to tetracycline?
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3/5th of S. viridans and 2/5ths of S. aureus are resistant to tetracycline
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Most common reaction to tetracyclines is ____________
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Gastrointestinal effects
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Diarrhea in a patient taking tetracycline may be due to one of these three causes
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Staphylococcal enterocolitis, intestinal candidiasis, or pseudomembranous colitis
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Due to effects on teeth tetracyclines should not be used in these patients
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Last 1/2 of pregnancy or children under 9 years old
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Name some other adverse effects of tetracyclines
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Hepatotoxicity, nephrotoxicity, hematologic effects, superinfection, photosensitivity, CNS and rarely allergic reactions
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How do divalent and trivalent cations affect tetracycline absorption?
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Form nonabsorbable chelates with dairy products, mineral supplements, antacids (Ca+2, Mg+2, Fe+2, Zn+2, and Al+3)
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Name some other drug interactions with tetracyclines.
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Enhanced blood levels of sulfonylureas, digoxin, lithium, theophylline, and warfarin.
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Although not used often for dental infections, tetracyline can be used as plastic strips, hollow fibers, or collars placed into this area of the mouth.
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Gingival crevice
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Clindamycin is a bacteriostatic antibiotic primarily effective against these organisms
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Gm+ organisms and anaerobic Bacteroides species
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Clindamycin is effective against these anaerobic bacteria.
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Bacteroides fragilis, Fusobacterium species, Peptostreptococcus and Peptococcus species, and Actinomyces israelii
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Most common side effect of clindamycin is ___________
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GI effects
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Incidence of diarrhea with clindamycin is ____
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10%
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This disease is associated with overgrowth of Clostridium difficile while or after taking clindamycin
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Pseudomembranous colitis
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Is clindamycin the drug of choice for Gm+ organisms
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No, other better ones are available which do not cause pseudomembranous colitis
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The other name for metronidazole is ________
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Flagyl
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Metronidazole is effective against these organisms
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Trichomonas vaginalis, Entamoeba histolytica, and obligate anaerobes such as the Bacteroides species
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Is metronidazole bacteriostatic or bactericidal
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Bactericidal
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Like almost all the other antibiotics the most common side effect of metronidazole is __________ and it also can cause problems with these areas as well.
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GI effects, CNS, Renal, Oral (dry mouth, metallic taste, glossitis, stomatitis, black-furred tongue), and Hematologic effects
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Is metronidazole ok to give to a pregnant or nursing patient
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Contraindicated in pregnancy due to teratogenicity and if given when nursing breast milk should be pumped and discarded while taking and 48 hours after stopping
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Can one drink alchohol when taking metronidazole
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No, it turns into an (Antabuse) like substance in the body
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Metronidazole is especially useful in treating infections due to this type of bacteria
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Anaerobes
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One anaerobe that metronidazole will not treat is _________
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A. actinomycetemcomitans
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This group of antibiotics is similar to penicillins and is divided into 4 generations
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Cephalosporins
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Cephalosporins were isolated from this bacterium found in a sewer outlet near Sardinia, Italy
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Cephalosporium acremonium
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Although cephalosporins are resistant to penicillinase they may be broken down by this microbial enzyme
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Cephalosporinase
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The generation of cephalosporin indicates the width of antimicrobial action. The first-generation drugs are effective against ______ & few ________
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Gm+ organisms, few Gm- organisms
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By the third generations, cephalosporins work against these organisms
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Few Gm+, many Gm- and anaerobes
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Cephalosporins, like penicillins work by inhibiting ___________
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Cell wall synthesis
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Adverse reactions of cephalosporins
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GI most common, nephrotoxicity, superinfection, localized reaction when used IM or IV: Some cause bleeding problems or produce a disulfiram (Antabuse) like reaction when given parenterally
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Percent of hypersensitivity reactions in patients getting cephalosporins
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5%
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Cross-hypersensitivity may occur with cephalosporins and ____________
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Penicillins (10% incidence)
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List uses of cephalosporins
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Penicillinase producing Gm+ organisms, Gm- Klebsiella, dental prophylaxis in patients with "at risk" joints
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Drug of choice for Stage 1 dental infection is:
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PCN V 500mg q 6 hr until symptoms gone for 2-3 days. If allergy: Erythromycin or clindamycin
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Stage 2 infection treatment:
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PCN V with or without metronidazole or clindamycin
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Stage 3 infection treatment
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Metronidazole or clindamycin
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Reasons antibiotic treatment may fail:
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Patient compliance, ineffective antibiotic, poor debridement, drug did not reach the site of infection or host defenses inadequate
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This antibiotic is made by Streptomyces orientalis, and is used to treat drug resistant Gm+ cocci
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Vancomycin
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Name four aminoglycoside antibiotics
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Neomycin, Gentamicin, Tobramycin, Amikacin
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Aminoglycosides are used primarily to treat ________ infections
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Gm- aerobic
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Major side effects of aminoglycosides include _______ & ________
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Ototoxicity, Nephrotoxicity; Peak and trough drug levels must be measured to prevent high levels and toxicity to these drugs
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This antibiotic is bacteriostatic, inhibits protein synthesis by acting on the 50S ribosomal unit and is active against many Gm+ and Gm- organisms, rickettsiae, Chlamydia, and Salmonella typhi
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Chloramphenicol
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Chloramphenicol is rarely used and is of no use in dentistry due to the serious blood problems such as :
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aplastic anemia, agranulocytosis, hypoplastic anemia, and thrombocytopenia
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Sulfonamide antibiotics work by inhibiting bacterial synthesis of __________
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Folic acid
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The most common adverse reaction to sulfonamides is ___________a/an
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Allergic skin reaction
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Sulfisoxazole, trimethoprim is used prophylactically in HIV patients to prevent __________
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Pneumocystis carinii pneumonia
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Sulfamethoxazole plus trimethoprim is called __________
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Bactrim, Septra, or SMX-TMP
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In Bactrim both drugs inhibit steps in the synthesis of ___________
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Folic acid
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Sulfamethoxazole-trimethoprim is indicated in the treatment of these disorders.
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Urinary tract infections, Otitis media, some respiratory and GI infections and prophylaxis in HIV patients against P. carinii pneumonia
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This drug is bacteriostatic against many common urinary tract pathogens, may cause brown discoloration of urine and is used to treat or prophylaxis against urinary tract infections
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Nitrofurantoin (Macrodantin)
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These agents are the first orally active agents against certain Pseudomonas species, antagonizes the A subunit of DNA gyrase which is needed to make DNA
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Quinolones (Ciprofloxacin, Norfloxacin, etc. all end in "-floxacin")
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Ciprofloxacin is used for these conditions:
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Lower respiratory tract, skin, bone, joint, and urinary tract infections. Maybe periodonal disease
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Why is TB (tuberculosis) difficult to treat?
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TB patients often immunocompromised already, resistant TB strains, dormant periods, only bacteriostatic but toxic drugs available, poor patient compliance with long treatment period
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What three drugs are used to treat TB and what is the treatment regimen?
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Isoniazid and rifampin q day for 9-12 months, and pyrazinamid q day for 2 months
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How long before a TB patient may become noninfective with treatment?
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2-3 weeks
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If you suspect a patient may have TB what should you do?
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Contact patients Dr. and delay treatment until disease no infectious
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What types of patients have an autosomal dominant trait that may cause them to metabolize isoniazid quickly?
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Eskimos, Japanese are fast acetylators as well as 50% of blacks and whites
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Isoniazid may cause CNS problems by depleting this vitamin.
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Vitamin B6
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Vitamin B6 is also known as __________ and is given along with isoniazid to prevent depletion of Vitamin B6
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Pyridoxine
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This drug is used along with isoniazid to prevent TB resistance and works by inhibiting DNA-dependent RNA polymerase
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Rifampin
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This TB drug will turn the body fluids (urine, tears, feces, saliva, and sweat) a red-orange color
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Rifampin
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This TB drug is given for 2 months along with INH and rifampin
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Pyrazinamide
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When other antiTB drugs cannot be used or resistance is encountered this drug is used
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Ethambutol
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A combination of an aminoglycoside (neomycin) and two polypeptide antibiotics (polymixin and bacitracin) is available as an OTC ointment called _________
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Neosporin or triple antibiotic ointment
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In the triple antibiotic ointment Neosporin the neomycin affects Gm ______ organisms and the other two affect Gm ______ organisms
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Negative, positive`
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This topical antibiotic is made by Pseudomonas fluorescens, is active against Strept. and Staph bacteria and is used for the topical treatment of impetigo
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Mupirocin (Bactroban)
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Prophylaxis for dental procedures involving __________ or _________ or _________ is required in patients having certain cardiac conditions.
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Manipulation of gingival tissue or periapical region of the teeth or perforation of the oral mucosa
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What cardiac conditions predispose patients to the highest risk of endocarditis following certain dental procedures
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Prosthetic cardiac valve, previoius infective endocarditis, certain types of congenital heart disease
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Patients who have had total joint replacements should have antibiotic prophylaxis for how long after the joint replacement
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2 years
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