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73 Cards in this Set

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Aerobic Gram (+) cocci

Streptococci


-pneumococcus


-viridians


-group A


Enterococci


Staphylococci


-aureus


-epidermidis

Anaerobic Gram (+) rods

Clostridia


-difficile


-tetani




(C. diff overgrowth --> pseudomembranous


colitis with clindamycin/ciprofloxicin)

Aerobic Gram (-) rods

Pseudomonas


- easily fatal, resistant, nosocomial


Helicobacter


- PUD (duodenal, gastric = NSAIDs)


E. coli


- UTIs


Klebsiella


-UTI, pneumonia

CNS infections (meningitis) are normally gram (?)

(+)

Anaerobic Gram (-) rods

Bacteroides

β-Lactams

1. Bactericidal


2. Work on bacterial cell wall


--> Inhibit the synthesis of the cell wall


3. Time dependent pharmacodynamics


(need more frequent doses)

β-Lactams




Penicillins

1. Penicillin


2. Ampicillin


3. Amoxicillin


4. Nafcillin


5. Amox-clavulanate

β-Lactams




Penicillins


MSSA coverage

Penicillin/Ampicillin = +




Nafcillin/Amoxi-clav = ++++




Piperacillin-tazo = ++++ (hospital)

β-Lactams




Penicillins


Streptococcal (nonpneumococcal) coverage

Penicillin, Ampicillin, Amoxi-clav, Nafcillin




ALL are ++++




This grip is very important for dentists

β-Lactams




Penicillins


Enterococcal coverage

Penicillin, Ampicillin, Amoxi-clav = ++




Nafcillin = NO coverage

β-Lactams




Penicillins


E.coli (non ESBL+) coverage

Ampicillin = ++




Amoxi-clav = +++




Piperacillin-tazo = ++++

β-Lactams




Penicillins


Klebsiella coverage

Amoxi-clav = ++




Piperacillin-tazo = ++++




Ampicillin = NO coverage

β-Lactams




Penicillins


Pseudomonal coverage

Ampicillin, Amoxi-clav = NO coverage




Piperacillin-tazo = ++++

β-Lactams




Penicillins


Anaerobic coverage

Penicillin, Ampicillin = ++




Piperacillin tazo, Amoxi-clav = ++++

β-Lactams




Penicillins


ADRs

Allergic type 1 hypersensitivity


Diarrhea (ampicilllin, amoxi-clav)


Nephritis


Ampicillin rash (histamine release, not allergic)

β-Lactams




Cephalosporins




1st generation

Cefazolin


Cephalexin

β-Lactams




Cephalosporins




2nd generation

Cefuroxime

β-Lactams




Cephalosporins




3rd generation

Cefixime


Ceftizoxime


Cefdinir

β-Lactams




Cephalosporins




4th generation

Cefepime

β-Lactams




Cephalosporins




5th generation

Ceftaroline




(the ONLY β-Lactam which covers MRSA)

β-Lactams




Cephalosporins


Staph. aureus (non-MRSA) coverage

Cephalexin, Cefazolin, Cefuroxime = ++++

β-Lactams




Cephalosporins


Streptococci (non-pneumococcal) coverage

Cefazolin, Cephalexin, Cefuroxime, Cefepime




ALL are ++++

β-Lactams




Cephalosporins


Pneumococcal coverage

NOT that great (we aren't really worried about)




Cefexime, Ceftriaxone = +++

β-Lactams




Cephalsoporins


E.coli (non ESBL+) coverage

Cefazolin, Cephalexin, Cetriaxone = +++




Ceftazidime = ++++

β-Lactams




Cephalosporins


Pseudomonal coverage



Cefepime, Ceftazidime = ++++




Cefazolin, Cefuroxime = NO coverage

β-Lactams




Cephalosporins


MRSA coverage

Ceftaroline (ONLY)

β-Lactams




Cephalosporins


ADRs

Cross-reactivity with penicillins




(low chance, 6-8%, even lower in higher gens)

β-Lactams




Carbapenems




Drug(s), indications

Imipenem, Meropenem, Doripenem




Very Broad Spectrum




Used for very severe nosocomial infections




See slide 26 for efficacy (good except no MRSA)

Drug Allergy




Criteria

1. Rxn occurs in small # of pts


2. Rxn does NOT resemble pharm effects


3. Rxn occurs even with small amt of drug


4. Rxn occurs in drugs w/ similar structure


5. Presence of eosinophilia


6. Rxn resolves on discontinuation

Cross-Reactivity




PCN allergy info

10-20% pt report PCN allergy


(BUT 80-90% negative skin test) -- Ask Q's




Less than 10% cross-reactivity between PCNs and Cephalosporins in gen pop.

True Allergic Reaction




Symptoms

Skin rash, hives, difficulty breathing (wheezing), dizziness and hypotension (severe)




Hypotension due to histamine release, PG and Leukotrienes

Macrolides




Drug(s) & MOA

Azithromycine, Clarithromycin, Erythromycin




Binds to 50s Ribosomal subunit --> inhibit


protein synthesis

Macrolides




Coverage




Gram (+): MSSA, MRSA, Strep (np), Entercocci, pneumococci

MSSA = ++


MRSA = NONE


Streptococci (non pneumococcal) +++


Enterococci = NONE


Pneumococci = ++

Macrolides




Coverage




Gram (-), Anaerobes

Minimal Gram (-),


NO anaerobic coverage

Quninolones




Drugs(s), MOA, Bacterio________,


pharmacodynamics

Ciprofloxacin, Levofloxacin, Moxifloxacin &


Gemifloxacin




Cause DNA breakage


Bactericidal


Concentration dependent pharmacodynamics


(only need one big dose vs. β-Lactams)

Vancomycin




MOA, spectrum, Dosage form

Inhibits Gram (+) cell wall synthesis




Broad Gram (+) coverage, including MRSA




IV only, except PO for C. diff colitis


(no abs needed)

Vancomycin




ADRs

Nephrotoxicity (dose and duration)


Redman syndrome (related to infusion time)


Phlebitis (concentration)

Clindamycin




Class, MOA, ADR

Lincosamide




Binds to 50s ribosomal subunit --> inhibits


protein synthesis




May cause pseudomembranous colitis (C. diff overgrowth)





Clindamycin




Coverage




Gram (+): Enterococci, MRSA, Strep (np), MSSA


Gram (-), Anaerobes

Enterococci __, MRSA +, Streptococci, +++,


MSSA ++++




No Gram (-) coverage




Anaerobic coverage +++

Trimetoprim-sulfomethoxazole




Pt population?

Seen in post-transplant pts prophylaxis

Trimetoprim-sulfomethoxazole




ADRs

Photosensitivity (big one!)




Rash (rarely SJS)


Hyperkalemia,


Neutropenia,


Thrombocytopenia,


Cholestasis


GI (N/D)

Tetracyclines




Drug(s), coverage

Doxycycline, Minocycline, Tigecycline (mp)




Gram (+) +++ (including MRSA, VRE)


Gram (-) +++


Anaerobic +++




NO Pseudomonas coverage

Tetracyclines




ADRs

Allergic rxn


Photosensivity


GI (N/V)


Tooth discoloration in children

Infective endocarditis

An infection of heart chambers or valves




(Vegetation = hallmark)

ABX Prophylaxis against Endocarditis




Cardiac conditions w/ high risk of IE

1. Prosthetic cardiac valve


2. Prosthetic material for cardiac-valve repair


3. Previous hx of IE


4. Congenital Heart dz (CHD)


(unrepaired, repaired within 6 months, repaired with residual defects)


5. Cardiac transplant recipients with


valvulopathy

ABX Prophylaxis against Endocarditis




Prophylaxis NOT required

1. Mitral valve prolapse


2. Rheumatic heart disease


3. Bicuspid valve disease


4. Calcified aortic stenosis


5. CHD: VSD, ASD, hyptertrophic cardiomyopathy

ABX Prophylaxis against Endocarditis




Dental treatments requiring prophylaxis

All dental procedures involving manipulation of gingival tissue or the PA region of teeth or perforation of oral mucosa




Extraction, routine cleaning, SRP, RCT, orthodontic bands, sub gingival medications, biopsy,


suture removal

ABX Prophylaxis against Endocarditis




Prophylactic Regimin

 see slide 52

see slide 52

Advantage of Minocycline




Subgingival ABX insertion

Localized, therefore, no systemic toxicity and less resistance




Better pt compliance

Chlorhexidine Gluconate




Uses

Antibacterial dental/oral rinse




Periodontal pocket chip



Chlorhexidine Gluconate




Coverage

Covers gram (+), gram (-) and anaerobic bacteria

Chlorhexidine Gluconate




ADRs

With long term use, causes discoloration of restorations, which may be permanent




May cause oral mucosal irritation

Chlorhexidine Gluconate




Rinse, directions

15 ml of 0.12% solution rinsed and expectorated for 30 seconds BID


Chlorhexidine Gluconate




Periodontal chip

Up to 8 chips per visit, no need for removal




If dislodgment happens after 7 days, the tx is complete




IF dislodgment happens within 1st 48 hrs --> needs reinsertion

Amphotericin B, (IV)




Class, Coverage

Broad spectrum fungicidal agent




Covers Candida and Aspergillus

Amphotericin B, (IV)




ADRs

Nephrotoxcity


Hypo Mg


Hypo K

Amphotericin B, (IV)




Infusion related ADRs




How to avoid?

Rigor, hypotension, fever, nausea




Premedicate with meperidine, hydrocortisone, acetaminophen, diphenhydramine, respectively.

"Azole" Antifungals




Drug(s)

Itraconazole (PO)


Fluconazole (PO/IV)


Ketoconazole (PO/topical)


Voriconazole (PO/IV)


Posaconazole (PO/IV)

Fluconazole (PO/IV)

Candida infections

Ketoconazole (PO/topical)

Mostly used as an ANTI-ANDROGENIC agent




Topical antifungal uses

Voriconazole (PO/IV)

Broad spectrum


ADRs: visual changes, photophobia

"Azole" antifungals




CYP activity

All "azoles" are CYP 450 INHIBITORS




Many drug interactions




Electrolyte imbalance --> Hypokalemia




Can lead to increase risk of bleeding

Oropharyngeal Candidiasis




Treatment Options

Clotrimazole troches (10mg) desolved swollen mouth 5x/day for 7-14 days




Nystatin 500,000 units suspension swish --> spit/swallow 4x/day for 7-14 days




Fluconazole 100-200mg PO 1x/day for 7-14 days

Herpes Simplex Labialis




(Cold sores/fever blisters)

-HSV-1 primarily labial infection


-HSV can be latent and reactivated


-HSV is contagious and transmitted through direct contact (kissing, sharing utensils, etc)


-Virus is also viable on the surface of objects for few hours


-HSV enters host though skin/mucous membrane and becomes latent in trigeminal ganglia

Herpes Simplex Labialis




Triggers

Ultraviolet radiation


Stress


Cold


Fatigue


Any factor that depresses the immune system

Herpes Simplex Labialis




When should it be treated?

Prodromal phase with tingling, burning


sensation

Herpes Simplex Labialis




Pharmacological treatment

Benzocaine


Dibucaine


Benzyl alcohol


Camphor




Skin protectant to keep surface from dryness

Herpes Simplex Labialis




Pharmacological treatment (OTC)

Docosanol 10%




The only FDA approved OTC


Must apply soon in prodromal


5x/day application




IF secondary infection, use triple bio ointment (not directly over the other)

Herpes Simplex Labialis




Pharmacological considerations

Avoid topical/systemic steroids




NSAIDs and acetaphinophen may be used for pain relief

Pharmacological treatment




Natural supplements

Tea tree oil




(proven anti-viral)

Halitosis

Oral malodor/bad breath




90% are due to poor OH --> dental caries, gingival infection, tongue coating, impacted food, mucosal irritation, xerostomia

Halitosis




Nonpharmacological care

Most bad breath is due to Volatile Sulfur Compounds (VSCs) after the break down of food debris by bacteria




Prevent by removal of plaque-->caries




Brushing/Flossing/Tongue blade

Halitosis




Pharmacological care

Zinc Salts and chlorine dioxide


(antibacterial, prevent VSC production by inhibiting metabolism to form sulfur compounds)




"Smart Mouth" combines them both


"CloSYS" does not