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Pharmocology Pt. 2 - Coggle Diagram

- - - - Penicillan
        
        Narrow spectrum
        
        Pen. V (phenoxymethylpenicillin) & Flucloxacillin
        
        Moderate spectrum
        
        Amoxycillin
        
        Activity: gram - ve and gram +ve
        
        Adoprtion: stable in presence of gastric acid, orally
        
        Distribution: rapid diffusion into most body tissues
        
        Exretion: Half life of ~60mins
        
        500mg TDS
        
        Broad sepctrum
        
        Augmentin (Amox + Clavulanic)
      - Cephalsporins
        
        First Gen
        
        Cefalexin (moderate spectrum)
        
        Second Gen
        
        Cefaclor
      - Beta-lactam resistance
        
        Acid liable (empty stomach)
        
        Beta-lactamse produced by the bacteria
        
        MRSA = false beta lactam targets
        
        Gram -ve bacteria have an outerlayer of LPS which makes them more resistant to beta-lactams
        
        Clavulanic acid = produces a false binding site for betalactamse inhibitors
    - - Vancomycin
        
        Activity: gram postive cocci (multi resistant staph and strep)
        
        ie MRSA infections
  - - - Ciprofloxacin
        
        broad spectrum: gram postive/negative
        
        NB: prolongation of the QT interval in susceptible patients (cardiac arrythmia) and tendinitis and tendon rupture (Achilles)
    - - Metronidazole
        
        Activity: narrow spectrum: protozoa and anaerobic bacteria
        
        Uses in ANUG and pericoronitis
        
        Interacts w/ alcohol to cause negative nausea/hedaches
  - - - Macrolides
        
        Erythromycin
        
        Clarithromycin
        
        Clindamycin
        
        Activity: broad specrtum, gram pos/negative (>> anerobes)
        
        Safe alternative for people w/ penicillin allergies, first choice use for ANUG (no alcohol interaction)
        
        Adverse effcects: C. Diff = results in pseudomemranous colitis
        
        300mg TDS
    - - Aminoglycosides
        
        Gentamycin
        
        Activity: narrow spectrum, gram negative, uses in spesis or Ludwigs Angina
        
        Nb: contraindicated during pregnancy
      - Tetracyclines
        
        Tetra, doxy and minocycline
        
        Activity: broad spectrum, uses in localised periodontitis or pemphigoid
        
        nb: contraindicated for children under 8 due to incorporation into teeth
- - - - Hypertrophic (White)
        
        pseudo-membranous candidiasis (Thursh)
        
        Management: systemic antifungal agents (ie Fluconazole, Itraconazole)
      - Atrophic (red)
        
        atrophic candidiasis (of HIV)
    - - Atrophic (red)
        
        Chronic atrophic Candidaisis (denture)
        
        Management: denture hygiene, topical antifungal agents (ie miconazole)
        
        Papillary hyperplasia Candidaisis (denture)
        
        Candida- associated angular chelitis
        
        Management combination agent: topical anti-fungal + topical corticosteroid: HYDROZOLE CREAM
        
        Median rhomoid glossitis
        
        Management: Topical antifungal agents (ie miconazole)
      - Hypertrophic (white)
        
        Candidal luekoplakia (PMOD)
  - - - ABT, Inhaled corticosteroids, Xerostomia, Smoking, Sugary diet
    - - Age extreems, malnutrition, DM, Pancutopenia, HIV
  - - - Nystatin (drops)
        
        Binds ergosterol - unique to fungi = cell lysis
      - Amphotericin B (lozenge)
        
        Binds ergosterol - unique to fungi - cell lysis
      - QID, for 7-14 days + remove underlying factors (drugs, hygiene, HIV?)
    - - Imidazole
        
        Miconazole (gel)
        
        inhibits the sythesis of ergosterol via CYP450
        
        CYP450 enzyme interaction = Warfarin interactio
        
        Ketoconazole (oral)
        
        inhibits the sythesis of ergosterol via CYP450
        
        CYP450 inhibtion = Possible risk w/ hepatotoxicity/adrenal insuffiency
      - Triazole
        
        Fluconazole (oral)
        
        inhibits the sythesis of ergosterol via CYP450
        
        Possible prolonged QT interval side effect
- - - - Pre-existing damage to valves
        
        ○ Congenital – bicuspid valves, aortic stenosis, Marfan's syndrome
        
        ○ Infection – infective endocarditis hx, Rheumatic fever, SLE
        
        ○ Trauma - valvotomy
        
        ○ Degenerative – Ageing, stenosis/regurgitation
        
        Iatrogenic – pulmonary shunts, heart transplants
      - Adherance of bacteria to damaged endothelium --> colonization = forms fribale vegetations on valve --> local effects on the valve or possible embolisation of vegtations
    - - prosthetic cardiac valves, or implanted protheis, previous IE infection, congenital valve defects, Rh herat disease
      - Always for EXO, perio procedures (bleeding procedures)
      - Sometimes for tx if risk of breaking surface mucosa, NOT for exams or restorative treatment
      - 60 mins prior to Tx
        
        Amox 2g, Clinda 600mg, Cephalexin 2g
  - - - Surgical removal of a bone-impacted tooth or periapical surgery in a patient with a history of recurrent infections
      - Dentoalveolar surgery in immunocompromised patients could be considered case-by-case
        
        Ie RA or poorly controlled diabetes
- - - - Use on work surfaces in the dental clinic
  - - - Broad spectrum
        
        Chlorhexidine
        
        Uses
        
        in endodonic canal medicaments for children due to reduced toxicity in open apices
        
        Replace mechanical toothbrushing when its otherwise not possible (IMF, ICU pts, acute oral pain)
        
        Antiseptic mouth rinse (preprocedural, adjunct for MRONJ & Antifungal)
        
        Activity: Gram +ve and –ve bacteria, anerobes, aerobes and antifungals
        
        Good substanstivity
        
        ~30% may be retained in mouth for 24hrs after a 1 min rinse
        
        Slow release from dental pellicle
        
        Side effects: altered taste, staining teeth
        
        Triclosan toothpaste (antibacterial)
        
        Idoform (Alvogel)
        
        Thymol/phenol + essential oils (Listernine)
        
        Activity: Gram-ve bacteria for anti-LPS activity
        
        Inhibits neutrophils chemotaxis, and increase prostaglandin synthetase production
        
        POOR SUBSTANSTIVITY
      - Narrow spectrum
        
        Fluoride toothpaste or m/w (anticariogenic)
  - - - Ideally properties
        
        Substanstivity (absorbed and released over a prolonged period)
        
        Inhibits plaque calcification, reduces gingivitis
      - Examples: EO, CHX, Sodium lauryl sulfate
- - - - Acyclovir (topical or oral)
        
        Guanine nucleoside (false nucleotide) analogue
        
        MOA
        
        Specific for viral Thymidine kinase = phosphorylates Acyclovir
        
        cleaved by viral DNA polyermase and inserted into the DNA chain ---> preventing elongation to to false nucleotide
        
        Resistance via impaired viral thymidine kiase, or altered specificity and altered DNA polyermase
        
        Tx and prophylaxis of HSV (HSV-1) and VZV
        
        Needs to be introduced early, otherwise viral cells have had time to propogate
      - Tamiflu (oseltamivir)
        
        Tx/prophylaxis for influenza A and B virus neuraminidases
      - Sites for action:
        
        a. Inhibit viral replication
        
        b. Reduce viral attachment to host cells
        
        c. Prevent uncoating of viral genome
        
        d. Reduce assembly of progeny virions
        
        Inhibits virus macromecular synthesis
    - - Live attenuated vaccines
        
        The virus or bacteria is functional/alive but has been weakened so it can replicate in the body several times and generate an immune response without causing the disease
        
        Examples: chickenpox, measles, mumps and rubella, rotavirus, and shingles vaccine viruses
      - Inactivated or dead vaccines
        
        Viruses in these vaccines are inactivated or split
        
        Example: Hepatitis A, influenza and polio vaccines
      - Subunit vaccines
        
        These vaccines present proteins or sugars derived from the disease-causing organism.
        
        Protein vaccines: hepatitis B and human papillomavirus (HPV) vaccines
        
        Nucleic acid-based vaccines
        
        mRNA vaccine: COVID-19 [Pfizer]
  - - - Herpes-1&2, Varicella, EBV, CMV
      - Adenovirus
      - Papilloma virus
      - Hepatitis B
    - - Hepatitis A, C
      - Influenza
        
        Hemoagglutin (H) [entry] and neuramindase (N) [exit] are type-specific antigens
        
        Ex. H1N1
        
        Binds the sialic acid receptors in respiratory epithelia
      - Sars-CoV-2
  - - - Ex. Influenza
        
        small mutation in H & N antigens allow for evasion of surveillance, and reinfect w/ new sub types
    - - Ex. Influenza
        
        Major shift in antigencity = can infect all people, as different to previosuly immuinizable strain