robbypowell's version from 2016-09-19 00:31

"antimicrobials" (really orofacial infections and antibiotics in dentistry)

Question Answer
Periodontitis, abscess and pericoronitis are 3 examples of (acute/chonic) orofacial infectionsChronic
NUG, Cellulitis, Osteomyelitis, Space infections and Ludwig's Angina are examples of (acute/chronic) infections"Intensely" Acute
T/F: Bacteria from gingival sulci can cause bacteremia and/or septicemiaTrue
T/F: Orofacial infections are mixed between facultative anaerobes and obligate aerobesFalse (obligate Anaerobes)
T/F: Orofacial infections are mixed between facultative anaerobes and obligate anaerobesTrue
Orofacial infections are primarily Gram _____ (+/-) ____ (morphology) such as strep, but can also can be mixed between gram negative and positive, cocci and rodsGram Positive Cocci
Is culture sensitivity testing recommended for orofacial infections?No, takes too long to get results (usually resolved by then)
T/F: Antibiotics readily travel into infected areasFalse
T/F: Anibiotics do not diffuse well into infected areasTrue (hence need for drainage and louvage)
T/F: Some antibiotics are not active in abscesses because of the acidic pHTrue
T/F: Some antibiotics are not active in abscesses because of the basic pHFalse (abscesses are acidic)
T/F: Many antibiotics target actively growing and dividing bacteria and so are not nearly as effective in abscesses, where bacteria may have lo metabolic stateTrue
T/F: Antibiotics are more effective against abscesses because bacteria have a high metabolic state under these conditions and are growing rapidlyFalse (most often, low metabolic state)
T/F: Odontogenic infections in medically compromised individuals and healthy individuals with inadequate improvement should be consulted or referredTrue
T/F: Odontogenic infections usually resolve themselves and so don't need follow-up or referral.False (follow-up... if unresolved, consult or referral)
T/F: a major limitation of dosing guidelines is that they don’t take into consideration issues related to microbial virulence, anatomic location of infec, whether I&D can be done, status of host defensesTrue
Incision and Drainage can create high ______ and low ______ volume... which prompts better situation for Antibiotic penetrationhigh Vascularity; Low Infection volume
1 mg pen G = ______ units1600 (this is important for some reason)
______ and _______ are more preferable penicillins because they have better oral bioavailability (not acid labile)Pen VK & Amoxicillin
______ has higher plasma concentration, lasts longer, has a better pharmacokinetic profile, and more favorable anaerobic coverage than Penicillin VKAmoxicillin
T/F: If a patient is not responding to prescribed antibiotics then you should switch to a different antibiotic or treatmentTrue
The objective of _____ therapy is to give body’s defenses a helping hand by achieving levels that are equal or greater than minimum inhibitory concentrationsAntibiotic
Most antibiotics used in dentistry have a _____ course, except for ______ which has a _____ day course7 day; Azithromycin; 5 day
T/F: Prolonged antibiotic duration destroys resistant organismsFalse (they're resistant... doesn't matter how long you use it doesn't kill... in fact it wipes out their competition and they take over)
T/F: Prolonged antibiotic treatment is needed to prevent rebound infectionFalse (orofacial infections rarely rebound, esp if source is eradicated)
T/F: Antibiotic prescribers know how long infections will lastFalse (variable)
T/F: combining antibiotics is not usually recommended because the disadvantages outweigh the benefitsTrue (greater chance of dev resistance, adverse rxn's, greater cost)
T/F: combining antibiotics is usually recommended because there is a better chance it will be effectiveFalse (disadvantages outweigh benefits... some AB's are even antagonistic toward each other)
T/F: There is no true interaction between AB in dentistry and unwanted pregnancy due to potential interaction with oral contraceptivesTrue (tell patients though)
T/F: Orofacial infections have rapid onset and prompt resolution with elimination of sourceTrue
T/F: Orofacial infection are chronic in nature and take a long time to overcome and clear after source is removedFalse (on both counts)
T/F: If treated properly and with effective AB, most orofacial infec are in remission before results of culture/sensitivity testing are availableTrue
T/F: Some agents aren’t used routinely in dentistry (via oral route) because they don’t have activity against causative microorganisms, poor/no oral bioavilability, toxic/adverse effects True
T/F: All antibiotics that are used for systemic or conditions elsewhere are applicable to dental needsFalse
Aminoglycosides, monobactams (IV), Cabapenems (IV), sulfonamides, & Fluoroquinolones (are/are not) used in dental antibiotic treatmentsARE NOT
Most antibiotics are given 3-4 times a day except for ______ which is given in 500 mg doses every _____ hoursClarithromycin; every 12 hours (2x day)
completely repaired heart defect with prosthetic device (surgery or catheter intervention) should be given antibiotic prophylaxis before dental treatment during first ___ months following procedure6 months
T/F: Dental procedures rarely cause bacteremia that leads to infective endocarditis or prosthetic joint infectionsTrue
What is the one FDA Class B antibiotic that you shouldn't prescribe to pregnant women (b/c its safety is controversial)Metronidazole
FDA Class ____ is the most safe... but in general antibiotics should be avoided when possible for women during what stage of pregnancy?Class B; First Trimester
What are the 2 FDA Class C antibiotics that can be used with pregnant women.. but with caution?gentamycin and vancomycin
Name 4 antibiotics that should be avoided with pregnant patients (FDA Class D... okay and one is a B that should be avoided)tetracycline, ciprofloxacin, clarithromycin & metronidazole (the Class B)
What is a predisposing factor for Osteomyelitis?Alcoholism
What class of antibiotics stains dentition?Tetracycline
What class of antibiotics chelate Ca ions?Tetracycline
What class of antibiotics inhibit collegians activity of MMP's?Tetracycline
Actisite (tetracycline), Arestin (minocycline) and Atridox (doxycycline) are used for _____ periodontitis and ______ periodontitisrefractory periodontitis; juvenile periodontitis

modification and special situations

Question Answer
Patients already taking antibiotics (such as for sinus infection)clindaymycin or macrolides (NO cephalosporins)
how should you modify if proceduret has potential to outlast antibiotic courseprolong dosing or increase dosing
for multiple appointments, you should allow at least ____ days between treatments so that penicillin resistant organisms can clear from oral flora10 days
Penicillin, cephalosporins, aminoglycosides, erythromycin are or are not safe for pregnant women?YES (they are FDA class B, so safe)
A person treated for Osteomyelitis should be on antibiotic therapy for how long?At least 6 weeks
What is the single antibiotic best prescribed for treating Osteomyelitis (in conjunction with procedure) and what is the two drug combo that is also commonly used?(single) CLindamycin (penetrates bone well) OR (combo) Penicillin & Metronidazole
Antibiotics for Osteomyelitis should be effective against what two bacterial families?Strep & Staph
What antibiotic therapy would be good for Mild Pericoronitis?NONE
What are the three choices for antibiotic management of severe Pericoronitis?Penicillins, Cephalexin, & Clarithromycin2
2 choices for antibiotic management of sinus perforationpenicillins or Clarithromycin
2 choices for antibiotic management of "Avulsed teeth" (taken out and now we're putting them back in... maybe from trauma)Penicillins or Clarithromycin
Should patients be prescribed oral antibiotics for dry socket?No
Antibiotic of choice for Implant related infectionsMetronadizole (and one other of same -azole family)

Antibiotic prophylaxis table (oooh boy) all taken 30-60 min before procedure (ADULTS)

Question Answer
Oral delivery is fine and no penicillin allergyAmoxicillin 2g
Unable to take oral delivery but no penicillin allergyAmpicillin 2g (IM or IV) Cefazolin or Ceftriaxone (1g IM or IV for both)
Allergic to penicillins but can take oral medicationsCephalexin 2g, Clindamycin 600mg, Azithromycin 500mg or Clarithromycin 500mg
Allergic to penicillin and unable to take oral medsCefazoline 1g, Ceftriaxone 1g, or Clindamycin 600mg

dosages of antibiotics for prophylaxis (30-60 min before procedure in adults)

Question Answer
Amoxicillin (oral)2g
Ampicillin (IM or IV)2g
Cefazolin (IM or IV)1g
Ceftriaxone (IM or IV)1g
Cephalexin (oral)2g
Clindamycin (oral)600mg
Azithromycin (oral)500mg
Clarithromycin (oral)500mg

Effective drug combos (exceptions to the don't prescribe multiple rule)

Question Answer
Amoxicillin & ______Metronidazole
Metronidazole & _______Amoxicillin
Ampicillin & _________Gentamycin (or streptomycin) (amp targets GM+, the possible pairs target GM-)
Gentamycin (or Streptomycin) & ________Ampicillin
B-lactams & _________B-Lactamase inhibitors
B-lactams inhibitors & __________B-Lactams
Sulfonamides & ________Trimetropim
Trimetropim & _________Sulfonamides

appropriate or not appropriate situation for antibiotic treatment/prophylaxis

Question Answer
post-surgery tx to prevent unlikely infectionNOT
post-RCT antibioticsNOT
treatment of chronic periodontitisNOT
antibiotic therapy before and after I&DNOT
Chronic well-localized abscessNOT
Minor Vestibular AbscessNOT
Root canal sterilizationNOT
Mild PericoronitisNOT
Acute Onset infectionYES
Diffuse swelling (involving facial spaces)YES
Immunocompromised patientYES
Uncontrolled diabeticYES
Severe PericoronitisYES (resolve before extraction)
Artificial heart valvesYES
history of infective endocarditisYES
"serious" congenital heart conditionsYES

match the general mechanism of antimicrobial action

Question Answer
Nucleic Acid Synthesis/damageAntiviral agents, Metronidazole, & Fluoroquinolones
Cell Membrane DisruptorsNystatin & Azoles
Cell Wall synthesis inhibitorsPenicillins & Cephalosporins
Protein Synthesis InhibitorsMacrolides, Clindamycin, & Tetracycline
Folic Acid synthesis inhibitorsSulfonamides

match the adverse outcome with the associated antibiotics

Question Answer
Allergic rxnpenicillin & sulfa drugs
AB-induced diarrhea + colitisclindamycin & amoxicillin
AB associated photosensitivity, phototoxicity, photo allergysulfonamides & tetracycline
Disturbance of endogenous flora and superinfection tetracyclines & vancomycin
AB induced agranulocytosissulfonamides, B-lactams, aminoglycosides, & macrolides
Long QT interval syndromefluoroquinolones, macrolides, and clindamycin
AB-associated maniaclarithromycin & fluoroquinolones

characteristic of Cellulitis or Abscess?

Question Answer
Acute DurationCellulitis
Severe and generalized painCellulitis
Large sizeCellulitis
Diffuse bordersCellulitis
Doughy/indurated to palpationCellulitis
No pus present (exudate)Cellulitis
Greater seriousnessCellulitis
Facultative anaerobes primarilyCellulitis
Chronic DurationAbscess
Localized painAbscess
Small sizeAbscess
Well-circumscribed bordersAbscess
Fluctuant to PalpationAbscess
Pus presentAbscess
Less seriousAbscess
Obligate anaerobes primarilyAbscess

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