Clinical Pharm Antibacterial

Front 1

1. The therapeutic index of an antibacterial agent can be anticipated to be more favorable with which mechanisms of antibacterial action?

Back 1

-bacterial cell wall inhibitors

Front 2

2. Unless the patient has an allergy to beta-lactam antibacterial agents, what is the empirical drug of choice for the initial treatment of an odontogenic infection?

Back 2

-penicillin V 500mg 21tabs; 2 stat, 1 QID until gone

Front 3

3. What are the pharmacological properties characteristic of penicillin V?

Back 3

a. Bactericidal
b. Narrow spectrum:
A. Effective against Gram-positive cocci
B. Effective against most anaerobes
c. Beta-lactamase susceptible
d. Hypersensitivity reactions

Front 4

4. Which macrolid has an extended spectrum against facultative and some obligate anaerobes, has a once a day dosage schedule, and is the least likely macrolid to produce an adverse drug effect?

Back 4

azithromycin

Front 5

5. Which antibacterial agent is an inhibitor of nucleic acid synthesis, is beta-lactamase resistant, and has good activity against oral obligate anaerobes?

Back 5

Sulfonamides
metronidazole

Front 6

6. Which antibacterial agents target bacterial enzymes that synthesize protein from the mRNA code?

Back 6

-aminoglycosides, tetracyclines, clindamycin, macrolides

Front 7

7. Which antibacterial agents is the most effective empirical drug of choice for the treatment of an odontogenic infection in an otherwise healthy patient who is allergic (history of anaphylaxis) to beta-lactam antibacterial agents?

Back 7

-azithromycin, clindamycin & metronidazole

Front 8

8. When a patient presents with a severe odontogenic infection, what would be your empirical antibacterial drug?

Back 8

-penicillin or amoxicillin; clindamycin?

Front 9

9. Which antibacterial agent sequentially blocks the folate pathway, produces synergism, and is bacteriostatic?

Back 9

trimethoprim/Sulfonamide

Front 10

10. Which antibacterial agents are bactericidal?

Back 10

Quinolones
Metronidazole
Cephalosporins
Penicillins
Aminoglycosides
Vancomycin
Mnemonic: Quin Met Ceph (at the) Pen-Am Van (you Scallywag!)

Front 11

11. Which antibacterial agents are bacteriostatic?

Back 11

-sulfonamides, trimethoprim, tetracyclines, clindamycin, macrolides

Front 12

12. Which beta-lactam antibacterial agent is effective against Gram-positive and Gram-negative organisms, including anaerobes, and is mostly beta-lactamase resistant?

Back 12

-2nd generation cephalosporins (cefaclor)

Front 13

13. What are the characteristics of odontogenic infections and the strategies for the medical management of odontogenic infections?

Back 13

Caries
Pulpal infections
Periodontal infections
Pericoronal infections

After treating initial characteristics you may need to employ adjuvant antibacterial chemotherapy if:
• Infection fails to respond to debridement
– Infection spreads into anatomical spaces contiguous with fascial planes. Then:
» Patient should be admitted to a hospital for urgent or emergent care if:
– Signs of impending airway compromise
– Marked trismus (< 25 mm)
– Dehydration (e.g., malaise, disorientation, tachycardia, hypotension)
• Transient bacteremia may adversely affect the general health of the patient

Front 14

14. When treating an uncomplicated odontogenic infection with penicillin V and significant improvement is not noted within 48 to 72 hours, the empirical addition of which antibacterial agent is reasonable because it is beta-lactamase resistant.

Back 14

Clindamycin

Front 15

15. When a patient presents with an unresolved odontogenic infection following treatment with a full course of a beta-lactam agent, the administration of which antibacterial agent is reasonable because it is beta-lactamase resistant?

Back 15

-metronidazole, clindamycin, azithromycin

Front 16

16. Many oral Gram-negative anaerobes appear to be inherently resistant to erythromycin (a macrolide) because the structure of the outer bacterial cell membrane restricts entry of the drug. This drug resistance is an example of what type of drug resistance?

Back 16

-genetic causes

Front 17

17. What are the mechanisms of mutational drug resistance and how are they manifest clinically?

Back 17

1. Modify beta-lactam binding sites and prevent beta-lactam antibiotics from interacting with their receptors
2. Modify proteins associated with membrane permeability and prevent uptake of beta-lactam antibiotics
3. Synthesize beta-lactamases, widespread among both Gram-positive and Gram-negative bacteria

Front 18

18. What are the various mechanisms responsible for acquired forms of drug resistance?

Back 18

-transformation-acquired segments of free DNA from the surrounding environment
-transduction-transfer of DNA from a bacteriophage to a susceptible bacterium
-conjugation-most important because least species specific
Synthesis of drug inactivating enzymes
Changes in transport mechanisms
Structural changes to receptors and target enzymes

Front 19

19. Certain bacteria block ribosomal receptor sites, a mechanism responsible for macrolide resistance, and because macrolid-related microsomal receptor sites overlap with the receptor sites for another antibacterial agent, these bacteria will also be resistant to which other antibacterial agent important to dentists?

Back 19

-clindamycin

Front 20

20. Certain bacteria may develop macrolide resistance by activating efflux pumps. These activated efflux pumps can also affect the intracellular concentration of what other antibacterial agents?

Back 20

-beta-lactams, betalactamase inhibitors