Dh--Oral Biology-Antimicrobial, Antibacterial, Anti-Infective And Antibiotic Agents

Front 1

Substances from any source which act against or destroy infections (bacteria, fungi, virus)

Back 1

Anti-infective Agents

Front 2

Destroys or surpresses the growth or multiplication of bacterial only (topical or systemic forms)

Back 2

Antibacterial

Front 3

Chemical substances produced by microorganisms which destroy or suppress growth or multiplication of organisms

Back 3

Antibiotic

Front 4

Substances that destroy or suppress the growth of "ANY" microorganism

Back 4

Antimicrobial

Front 5

Which agents are both BROAD?

Back 5

Anti-infective agents and Antimicrobial Agents

Front 6

Which agent acts against or destroys?

Back 6

Anti-infective Agents

Front 7

Which agent destroys or suppresses growth?

Back 7

Antimicrobial Agents

Front 8

What are the 2 reasons we use Antibiotics in dentistry?

Back 8

Dental Infections and Premedication for Infective Endocarditis

Front 9

What are the two types of abcesses?

Back 9

Endodontic and Perio or Gingival abcesses

Front 10

What are classified as Dental Infections?

Back 10

Caries, Periodontal Disease, Localized dental infections (perio or endo related abcesses), Systemic Infections (lesions with systemic symptoms such as fever, malaise, tachycardia) (think bacteremia)

Front 11

TRUE or FALSE
The latest thinking in regards to Pre-medication is that the risk of taking preventative Antibodies outweighs the benefits for most patients.

Back 11

TRUE

Front 12

What are some of the reasons the risk outweight the benefits when taking preventative antibiotics?

Back 12

1. Adverse reaction to Antibodies
2. Development of drug resistant strains
3. Hearts are exposed to bacteremia on a daily basis

Front 13

Only the highest risk patients should be premedicated for dental procedures that involve WHAT?

Back 13

-Dental Extractions
-Periodontal Procedures (surgery, sub-g placement of antimicrobial, S/RP, probing, cleaning (bleeding expected))
-Placement of dental implant or avulsed teeth
-

Front 14

What are the High Risk Areas in the heart for IE?

Back 14

Heart chambers and Valves

Front 15

What is the sequence of events leading up to IE

Back 15

1. Turbulent Blood Flow traumatizes endothelium around the heart
2. Platelets and Fibrin are deposited on the surface of the endothelium.
3.Formation of ninbacterial thrombotic endocarditis (NBTE) on the surface of damaged area (valve, etc.)

Front 16

Why doesnt EVERYONE with a yuck mouth need to be premedicated?

Back 16

A normal person's heart lining/valves and immune system are designed to deal with this onslaught of bacteria

Front 17

What is the damage that bacteria can do to the valves?

Back 17

The already damaged body part now allows bacteria/fungi to collect, grow, colonize causing prolapse, stenosis, blockage, thickening (redundant), and regurgitation

Front 18

Means narrowed, wont open as much, could be caused by a blockage or thickening by trauma.

Back 18

Stenosis

Front 19

Means the flow thats suppose to go through and shut off starts coming back up and pooling.

Back 19

Regurgitation

Front 20

What are the signs and symptoms of IE.

Back 20

-Flu-like symptoms w/ chest pain
-Abdominal pain
-Heart palpations
-Petechiae of skin and mucosal tissue
-Anemic (Pale) Complexion
-Blue ro purplish lesions of the skin
-Janeway lesions

Front 21

What should you do if IE occur within 2 weeks?

Back 21

Go to the emergency room immediately

Front 22

What are broken blood vessels manifested as little red dots on the skin and mucosa?

Back 22

Petechiae

Front 23

Red, flat maucules on the palms of hands and soles of feet.

Back 23

Janeway lesions

Front 24

What are the 3 things you need to PRE-MEDICATE for?

Back 24

1. Prosthetic Cardiac Valve
2. History of Infective Endocarditis
3. Cardiac Transplant which develops a valve problem (valvulopathy, RHD, MVP, etc.)

Front 25

What are the main reasons that people with Systemic to Pulmonary Shunts are still at risk for IE?

Back 25

1. Because the shunts are surgically-created connections between aorta and a pulmonary artery
2. These babies are not getting enough blood to the lungs to be oxiginated
3. The shunts increase the blood supply to the lungs and the arterial oxygen saturation
4. Pallative (temporary) measure until surgery is performed

Front 26

What type of heart valve replacement still has to be premedicated?

Back 26

Tissue and Mechanical

Front 27

This heart valve replacement last longer, and requires coagulation therapy to prevent blood clots, so they have to be on blood thinners such as Coumadin

Back 27

Mechanical Valve replacement

Front 28

What are the Moderate Risk Conditions that NO LONGER require premedication?

Back 28

-Most other congenital cardiac malformations
-Acquired valvular dysfunction (RHD)
-Hypertropic cardiomyopathy
-Mitral Valve Prolapse

Front 29

What may happen to people with MVP that were previously premedicated?

Back 29

A small number may experience IE symptoms after a dental appointment, be sure to review the signs and symptoms of this with the patient.

Front 30

TRUE or FALSE
IE is more likely to result form FREQUENT exposure to random bacteremias associated with daily activities rather than from dental appt.

Back 30

TRUE

Front 31

TRUE or FALSE
The risk from taking Antibiotics is HIGHER or EXCEEDS the benefit.

Back 31

TRUE

Front 32

TRUE or FALSE
Good Oral Hygiene (plaque control) may reduce the incidence of bacteremias and is more important than premedication

Back 32

TRUE

Front 33

TRUE or FALSE
Premedication in regards to Prosthetic Joint Replacement is on case by case basis and you need to ALWAYS contact the physician first before prescribing and antibiotic no matter how long the replacement has been

Back 33

TRUE

Front 34

What is the STANDARD REGIMEN?

Back 34

Amoxicillin-2 grams P.O. 30-60 Minutes prior to procedure (child 50mg/kg)

Front 35

What is the Standard Regimen for patients ALLERGIC to penicilin/amoxicillin?

Back 35

Clindamycin, Cephalexin or Cefadroxil and/or Azitrhomycin or Clarithromycin.

Front 36

What is the Regimen for Clindamycin?

Back 36

600 mg. orally 30-60 minutes prior to procedure (child 20 mg/kg)

Front 37

What is the Regimen for Cephalexin or Cefadroxil?

Back 37

2 grams orally 30-60 minutes prior to procedure (child 50mg/kg)

Front 38

What is the Regimen for Azithromycin or Clarithromycin

Back 38

500 mg orally 30-60 minutes prior to procedure (child 15 mg/kg)

Front 39

What does the 2 grams of Amoxicillin equal to?

Back 39

4-500 mg capsules

Front 40

What does the 600 mg of Clindamycin equal to?

Back 40

4-150 mg capsules

Front 41

What does the 2 grams of Cephalexin or Cefadroxil equal to?

Back 41

4-500 mg capsules

Front 42

What does the 500 mg of Azithromycin equal to?

Back 42

2-250 mg tablets

Front 43

What does the 500 mg of Clairithromycin equal to?

Back 43

1-500 mg tablet

Front 44

When can Cephalexin or Cefadroxil NOT be given to patients with penicillin/amoxicillin allergies?

Back 44

When the allergic reaction is a Type I allergic reaction to penicillin/amoxicillin

Front 45

What class do penicillins belong too?

Back 45

Class I B-Lactam Antibiotics

Front 46

Are B-lactam penicillins Bacteriocidal or Bacterialstatic

Back 46

Bacteriocidal

Front 47

What are the bacteriocidal effects of penicicillins?

Back 47

Inhibits mucopeptide synthesis in cell wall, works on the dividing organism

Front 48

What class do cephalosporins belong too?

Back 48

Class I B-Lactam Antibiotics

Front 49

What is a first generation Cephalosporin that is used in dentistry?

Back 49

Cephalexin

Front 50

What is class III?

Back 50

Tetracycline

Front 51

What makes up the class III tetracycline group?

Back 51

Tetracycline, Doxycycline and Minocycline.

Front 52

Is class III-Tetracyclines bacteriocidal or bacteriostatic?

Back 52

Bacteriostatic

Front 53

Prevents bacteria from growing-inhibits protein synthesis, it doesnt kill it.

Back 53

Bacteriostatic

Front 54

Why would you not give Penicillin and Tetracycline together?

Back 54

Because tetracycline prevents organism from growing and negates the activity of Penicillin which works on the growing/dividing organisms

Front 55

What class does Azithromycin belong to?

Back 55

Class IV. Macrolides

Front 56

What class does Clindamycin belong too?

Back 56

Miscellaneous

Front 57

What is the first choice for patients allergic to penicillin?

Back 57

Clyndamycin

Front 58

What is the percentage that may be at risk for Infective Endocarditis?

Back 58

Less than 5% of the US population

Front 59

What is the percentage of people who take Antibiotics and have a reaction of some type (rash, etc.)?

Back 59

5-10% and .04-.14% have anaphylactic Shock

Front 60

What percent of people with anaphylactic reaction dies?

Back 60

10% about 400-800 per year.

Front 61

What are other factors that may be considered?

Back 61

-May be more than 1 organism involved in IE
-IE and LPJI are rare
-Patients can cause a bacteremia by themselves
-Cost to patient of Ab
-Super infections
-Toxicity
-Bacterial resistance problem are on the rise

Front 62

The natural or acquired ability of an organism to be immune or to resist the effects of an anti-infective agent.

Back 62

Resistance

Front 63

Generally affect many different types of bugs, but are not lethal. (They are usually bacteriostatic)

Back 63

Broad Spectrum

Front 64

Selective and usually lethal (bacteriocidal)

Back 64

Narrow Spectrum

Front 65

TRUE or FALSE
FREQUENT exposure to an antibiotic within a short time frame is likely to produce resistant strains of bacteria

Back 65

TRUE

Front 66

If an antiobiotic is taken either too often or not long enough to kill a whole family of bacteria--all you do is vaccinate the bacteria against the antibiotic. Then the antibiotic may not work at all. What is this called?

Back 66

Bacterial Resistance

Front 67

Why premedicate if so many problems with it?

Back 67

The AHA (2007) and the ADA still recommend Ab prophylaxis to high risk groups. This is currently the Standard of Care for dentistry in the US.

Front 68

What does Standard of Care mean?

Back 68

Current Accepted Protocol

Front 69

How many requirments/elements do you need to have in the case of anaphylatic reaction that comes to a lawsuit?

Back 69

You need to be able to point to the 4 elements/requirements in the chart as reason why you prescribed antibiotic prophylaxis.

Front 70

B Lactam antibiotic Penicillin G is bacteriocidal against what common bacteria

Back 70

gram- and gram + bacteria.

Front 71

What type of penicillin is the 1st choice for abcesses?

Back 71

Penicillin V

Front 72

What other bacteria is Penicillin G effective on?

Back 72

Cocci (strep); spirochetes (syphilis); gram- (gonorrhea)

Front 73

Which Penicillin is given orally, producecs higher blood levels than an equivilent amount of the other; more commonly used for the treatment of dental infections.

Back 73

Penicillin V

Front 74

Which penicillin is better absorbed when taken orally due to the Potassium salt?

Back 74

Potassium VK

Front 75

What is the most common reaction to Penicillins?

Back 75

Rash

Front 76

What are the Adverse reaction to Penicillins?

Back 76

-Rash
-Anaphylactic Reactions
-Delayed Serum Sickness
-Oral Lesions

Front 77

What are some of the oral lesions affiliated with adverse reactions of penicillins?

Back 77

-Stomatitis
-Furred Tongue
-Black tongue
-Glossitis
-Chelitis

Front 78

What cillin is the preferred prphylaxis by the AHA

Back 78

Amoxicilin

Front 79

What B-Lactam is more expensive, has a lower incidence of side effects, and is prescribed more by orthopedic surgeions for joint replacement premedication?

Back 79

Cephalosporins

Front 80

What are the side effects of Tetracycline?

Back 80

Tooth staining, GI upset, fungal infection, chemical photosensitivity, contraindications:renal disease

Front 81

What tetracyclines are used for Periodontal Disease?

Back 81

Acisite-tetracycline cord; Atridox-doxycycline glue; Arestin-minocycline powder; and Periostat-doxycycline low dose pill

Front 82

What is Clindamycin used alot for in children?

Back 82

Ear infections

Front 83

What is the primary alternative to penicillin?

Back 83

Clindamycin

Front 84

What are some adverse reactions to Clindamycin?

Back 84

Pseudomembranous colitis, GI distress to include diarrhea, nausea, vomitting, cramps

Front 85

What is the percentage of Chlorhexidine Gluconate in antimicrobial rinses ie:Peridex, Perioguard, Periochip, Handsoap.

Back 85

.12%

Front 86

What bacterias do Chlorhexadine Gluconate have a bacteriostatic effect on?

Back 86

Gram- and Gram +

Front 87

What is the side effect of Chlorhexadine Gluconate.

Back 87

Teeth Staining

Front 88

What is the evolution of Dental Infections?

Back 88

-Beginning Gram+ cocci to variety of gram + and gram- anaerobic which equals mixed infection, with time and no treatment the infection consists of predominantly anaerobic flora.

Front 89

Choice of Antibiotic
Beginning: Gram + cocci

Back 89

Penicillin VK, Amoxicillin

Front 90

Choice of Antibiotic
Allergy

Back 90

Clindamycin or azithromycin

Front 91

Choice of Antibiotic
Mixed Stage:

Back 91

Flagyl for gram- anaerobic and Penicillin VK for gram +

Front 92

TRUE or FALSE
Clindamycin affects both gram+ cocci and gram+ and gram- anaerobes

Back 92

TRUE

Front 93

Why would oral contraceptives not work when taking an antibiotic?

Back 93

Because the # of bacteria in the intestine falls, making the pill not break down properly and the free estrogen not being released properly.