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Tim's Cards > 2Pharm II > Flashcards

2Pharm II Flashcards

1
Q

The Thyroid synthesizes ______ and ______ from ______

A

thyroxin (T4)

triiodothyronine (T3)

iodine

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2
Q

T/F
The control of secretion of T4 (thyroxin) and T3 (triiodothyronine) is determined by a negative feedback loop involving TRH (hypothalamus), TSH (anterior pituitary), and TH (thyroid)

A

True

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3
Q

Thyroid feedback loop: the hypothalamus secretes ______, the Anterior Pituitary secretes ______, and the Thyroid secretes _______

A

TRH

TSH

T4 and T3

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4
Q

Primary hypo/hyperthyroidism is a disease of the ______

Secondary hypo/hyperthyroidism is a disease of the ______

A

thyroid gland

hypothalamus or anterior pituitary

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5
Q

L-tyrosine is the precursor to ____ and _____

A

T4/T3 and epinephrine

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6
Q

Without iodine, there is a build up in the TH precursor, resulting in ______

A

goiter

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7
Q

What large glycoprotein integral to the synthesis of T4/T3 is NEVER secreted into the bloodstream?

A

Thyroglobulin

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8
Q

At the basement membrane, iodine is taken up by ______ epithelial cells

_____ precursors iodinate thyroglobulin

These are packaged into vesicles which are then fused with lysosomes and release the iodinated amino acids ____ and ____

A

Cuboidal

iodotyrosyl

T3, T4

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9
Q

What are the 2 synthetic thyroid preparations?

Which TH are they?

A

sodium levothyroxine (Synthroid, Levoxyl) T4

sodium liothyronin (Cytomel) T3

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10
Q

Why is sodium liothyronine (T3) less preferred than sodium levothyroxine (T4)?

A

Absorption more erratic

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11
Q

Synthroid is usually taken _____

It _____ the basal metabolic rate

A

in the morning/on an empty stomach

increases

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12
Q

T/F

Synthroid promotes gluconeogenesis, mobilizes glycogen stores, and stimulates protein synthesis

A

True

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13
Q

T/F
overuse of sodium levothyroxine (Synthroid) mimics hyperthyroidism and includes tachycardia, nervousness, increased appetite, and weight loss

A

True

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14
Q

Hyperthyroidism, aka _____ disease

A

Grave’s

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15
Q

The abuse of Synthroid is called _______ hyperthyroidism

A

Fictitious

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16
Q

What is the name of the Canadian drug used as palliative Tx of hyperthyroidism in preparation for radioactive iodine therapy?

Nickname?

A

Propylthiouracil

PTU

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17
Q

What are the side effects of propylthiouracil (iodination blocking drug for hyperthyroidism)?

A

Rash

Nausea

Agranulocytosis

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18
Q

What therapy is used in conjuction with propylthiouracil to prepare pts for surgery?

A

Saturated solution Potassium Iodide

*mechanism unclear

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19
Q

What drug is used in the palliative Tx of hyperthyroidism prior to thyroidectomy?

(Very expensive, inconvenient, serious adverse effects)

What oral side effects does it have?

A

Methimazole (Tapazole)

Tast alteration, salivary gland swelling

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20
Q

What is used to estimate the activity of the Thyroid Gland and irradiate/destroy it over a period of 3 months?

A

Radioactive Iodide I 131

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21
Q

What is easier from a Dental management perspective - hypo or hyperthyroidism?

A

Hypothyroid

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22
Q

In context of Dental considerations, Hypothyroid pts are more sensitive to what?

A

CNS depressants

*must lower dose of sedatives/opioids

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23
Q

Hyperthyroid pts have an Absolute contraindication to what?

A

Epinephrine

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24
Q

Hyperthyroid pts are less sensitive to what drug administered in Dental clinic?

A

CNS depressants

*may require higher dose.

**also may be mislabeled as “drug-seeking behaviors”

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25
Q

Type I Diabetes is an autoimmune disease that destroys ______ cells

Type II Diabetes occurs when ____ become blocked/insensitive

A

Beta (pancreatic)

insulin receptors

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26
Q

T/F

In Type I Diabetes the body destroys the beta cells, but the receptors are just fine.

A

True

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27
Q

_____% of diabetes is type I

____ is the only effective drug in treating Type 1 diabetes

A

10%

Insulin

*long ago was called Juvenile Diabetes

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28
Q

T/F

Insulin is a polypeptide, 5600 dalton mw, 2 chans connected by sulfide bridge

A

False

disulfide bridge

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29
Q

Older Insulin preparations came from cows/pigs, but this is no longer used because of ______ technology

A

recombinant

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30
Q

All insulins must be injected how?

A

SC

*although now we have a new inhalable form

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31
Q

In what 3 ways is insulin classified?

A

Onset

Peak

Duration

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32
Q

What are the 2 most popular insulins?

A

insulin Regular (HumuLIN R)

insulin Aspart (NovoLOG)

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33
Q

insulin Regular (HumuLIN R) is ____ acting

insulin Aspart (NovoLOG) is _____ acting

what are 3 additional categories of insulin?

A

short

rapid

intermediate, intermediate to long, long

(acting for all)

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34
Q

What is a long-acting insulin used for both type I and type II diabetes?

What are its oral complications?

A

insulin glargine (Lantus Solostar)

numb mouth

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35
Q

T/F
Some Type II diabetes interventions improve receptor function and control the insulin spike, but without lifestyle changes the pancreas will burn out.

A

True

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36
Q

It used to be that Type II diabetes was very rare before age ____

A

35

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37
Q

Why is there a lot of insulin in the blood of a Type 2 diabetic?

A

Target cells insensitive

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38
Q

What is the intervention for insensitive insulin target cells?

A

More insulin

*needed to get glc into cells

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39
Q

What is the outcome of Type 2 diabetes?

A

Hyperglycemia

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40
Q

T/F

Tx for Type 2 diabetes is Oral drugs, non-pharmacological intervention (weight, exercise, diet), and insulin

A

True

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41
Q

If a Type 2 diabetic is taking insulin, the pt is most likely poorly controlled

A

True

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42
Q

What are the 3 goals of drug therapy for Type2 diabetics?

***What is the risk for all of these interventions?

A

Increase insulin (w/ glc)

Suppress hepatic gluconeogenesis

Improve insulin sensitivity

***hypoglycemia

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43
Q

5 Drug classes to treat Type2 diabetes:

A

Sulfonylureas

Biguanides

Alpha-glucosidase inhibitors

Thiazolidinediones (TZD’s)

Incretins

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44
Q

What class of drugs promotes insulin release from pancreatic beta cells?

(type II intervention)

A

Sulfonylureas

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45
Q

The 2nd generation Sulfonylureas are more _____ but not more _____

A

potent

effective

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46
Q

What is a 1st generation Sulfonylurea?

*Tx Type II - promotes insulin release from beta cells

A

tolbutamide (Orinase)

*all end in “amide”

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47
Q

What is a 2nd generation Sulfonylurea?

A

glipizide (Glucotrol)

*all end in “ide”

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48
Q

What is the major distinction between 1st and 2nd generation Solfonylureas?

A

Potency

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49
Q

Sulfonylureas increase ______ mortality and are contraindicated in pts who are _______

Use caution in severe _____ disease

A

cardiovascular

allergic

hepatic

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50
Q

What is the main DDI to be concerned with when using Solfonylureas?

What does this drug do?

A

Aspirin

displaces sulfonylurea - resulting in hypoglycemia

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51
Q

Aspirin has 2 mechanisms to disrupt Sulfonylureas, what are they?

A

displace sulfonylurea - resulting in hypoglycemia

Inhibit prostaglandin E synth - PGE inhibits insulin secretion = too much secretion = hypoglycemia

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52
Q

What class of drugs is so well tolerated that it is regularly combined with other drugs?

What is the drug?

A

Biguanides

metformin (Glucophage)

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53
Q

metformin (Glucophage) has what 4 mechanisms?

A

Inhibit glc gut absorption

decrease hepatic glc production

increase insulin sensitivity at receptor

increase peripheral glc uptake/utilization

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54
Q

What drug is most effective at reducing glycemic level, creating fewer episodes of hypoglycemia, decreasing weight, reducing LDL, CV mortality, and Cancer?

A

metformin (Glucophage)

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55
Q

What occurs if there is renal impairment in pts taking metformin (Glucophage)

Who should not take this drug?

other side effect?

A

Lactic acidosis

Alcoholics (hepatic probs)

GI

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56
Q

acarbose (Precose) and miglitol (Glyset) are __________ enzyme inhibitors that normally degrade _____ in the gut

*this creates delay in blood glc concentrations after meal

A

Alpha-glucosidase

complex carbs

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57
Q

What class of drugs used to treat Type 2 diabets “resets” insulin receptors?

*improving target cell response/reducing insulin resistance

A

Thiazolidinediones

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58
Q

Name 2 Thiazolidinediones:

A

pioglitazone (Actos)

rosiglitazone (Avandia)

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59
Q

pioglitazone and rosiglitazone (thiazolidinediones) have been associated with more than 30 deaths due to _____, and there is an increased risk of _______

A

liver failure

heart failure

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60
Q

Thiazolidinediones like pioglitazone and rosiglitazone are contraindicates in what pts?

A

serious heart failure

they increase the risk

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61
Q

What class of drugs better regulates the release of insulin but are pro-inflammatory and may cause pancreatic cancer?

A

Incretins

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62
Q

Incretins mimic _______ to stimulate insulin release

A

hormones

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63
Q

What are 2 types of Incretin

A

GLP-1 (Glucagon Like Peptide -1) receptor agonists

DPP-4 (dipeptydyl peptidase-4) inhibitors

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64
Q

What is the normal blood sugar range?

What is fasting blood glc?

A

70-120 mg/dL

70-110 mg/dL

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65
Q

What is the gold standard in measuring blood glc (and monitoring diabetics)?

A

glycated hemoglobin (HbA1c)

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66
Q

What is the normal value for HbA1c?

What is the diabetic diagnosis?

What is the goal for diabetics?

A

less than 6%

above 6.5%

less than 7%

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67
Q

American College of Physicians 1st intervention for TypeII diabetes?

If fails, ________

If hyperglycemia persists, _______

A

lifestyle mods

metformin

more drugs

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68
Q

T/F
The endocrinologists algorithm suggests obesity management to lower glc and CV risk factor modification and glycemic controls

A

True

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69
Q

Natural estrogen is a steroid produced by the ovary, aka…

A

estradiol

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70
Q

Because estradiol is inactivated by the gut/liver, we must place a ______ group at C17 to make it orally active. This creates ______

A

ethinyl

ethinyl estradiol

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71
Q

Estrogen Replacement Drugs are of what 3 types?

A

Conjugated equine estrogens

Esterified estrogens

Estradiol preps

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72
Q

Conjugated equine estrogen:

This treats the ______ symptoms of menopause

It also might prevent _______

A

Premarin

vasomotor

bone loss (osteoporosis)

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73
Q

4 common side effects of Premarin:

A

Peripheral edema

Breast tenderness

Bloating

Headache

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74
Q

A serious side effect of Premarin if you have an intact uterus:

May also increase _____ cancer

A

Increased risk for endometrial (uterine) cancer)

breast

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75
Q

What are 2 Esterified Estrogens?

How are they different from Premarin (conjugated estrogen)?

A

Estratab

Menest

1/2 dose - 0.3mg daily

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76
Q 
T/F
Esterified Estrogens (Estratab, Menest) have the same effects as Premarin (conjugated estrogen)
A

True

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77
Q

Estrogen + progesterone =

adding progesterone does what?

A

Prempro

reduces risk of endometrial cancer

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78
Q

What is Prempro used for?

This is a combo of what 2 drugs?

A

menopause/osteoporosis

Premarin, Provera

*estrogen, medroxyprogesterone

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79
Q

In a large study (2800 w/ heart disease), women on HRT (estrogen) saw ____ go down and ______ go up with and no reduction is ______

A

cholesterol

blood clots

heart disease

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80
Q

Estrogen in combo with progestin may increase the risk of _________

*this outweighs long term use to prevent ________

A

stroke

osteoporosis

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81
Q

The PremPro study at the NIH was cancelled b/c it increased the risk of what 4 thing?

A

Heart disease

Stroke

Pulmonary embolism

Invasive breast cancer

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82
Q

What 2 benefits of PremPro aren’t enough to outweigh the risks of hear disease, stroke, pulmonary embolism, and breast cancer?

A

Reduced fractures

Reduced colorectal cancer

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83
Q

HRT (estrogen) is used on a ______ term basis to treat menopause, usually less than ____ years

A

short

5

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84
Q

Progesterone is a _____ produced by the _______.

It induces the secretory _______, affects uterine mobility, and cervical ______

A

steroid

corpus luteum

endometrium

mucous

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85
Q

Progesterone prevents the buildup of the ______

A

endometrial lining

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86
Q

Aside from contraception, Progesterone can be used to treat _______ and _______

A

endometriosis

menstrual disorders

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87
Q

Oral progesterone must be modified to be taken orally - what are 2 of them?

A

norethindrone (contraceptives)

medroxyprogesterone (Provera)

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88
Q

medroxyprogesterone (Provera) is used to treat what 3 things?

A

Abnormal uterine bleeding

secondary amenorrhea

endometrial cancer

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89
Q

Testosterone is a steroid that must be _____ before taken orally

A

methylated

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90
Q

Testosterone 4 Tx’s:

A

Delayed male puberty

Hypogonadism

Inoperable female breast cancer

Libido loss postmenopausal women

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91
Q

T/F

Male “menopause” beginning in 4th or 5th decades may be treated with testosterone, synthetic androgens, or estrogens

A

True

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92
Q

T/F - testosterone levels
250-800 mg/dl for men

15-40 ng/dl for women

0-20 ng/dl for postmenopausal women

A

True

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93
Q

Testosterone naturally diminished by 1% every year after ____, and common conditions observed are obesity, type 2 diabetes, _____, and ______

A

35

pain

depression

*these are just aging

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94
Q

Conditions that negatively impact T level are Metabolic syndrome, oteoporosis, COPD, Coronary heart disease, inflammatory conditions, cardiac, renal, and liver failure, and pituitary tumor

A

True

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95
Q

What syndrome entails both symptoms and biochemical evidence of T deficiency?

A

Hypogonadism

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96
Q

Testosterone is linked to the ______ of the male population and is a biomarker for occult diseases like atherosclerosis, _____, and early death

A

general health

cancer

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97
Q

Testosterone decreases fat, increases muscle, improves libido - and what 3 blood/diabetic/heart disease factors?

A

insulin resistance

Ha1C

lipid profiles

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98
Q

T/F
Exogenous testosterone can impair endogenous T, cause probs with fertility, increase the size of the prostate, and increase risk for blood clots

A

True

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99
Q

T can be administered many ways - including buccal which causes edema, irritation, and _____

A

dysgeusia

taste perversion

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100
Q

T/F

There is evidence that supports testosterone use for women

A

False

*no benefits as HRT

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101
Q

When can T be used for women?

A

postmenopausal hypoactive sexual desire

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102
Q

There are no FDA approved uses for Testosterone with women in the US, but in Europe there was a _____ that was withdrawn from the market in 2012 due to breast cancer concerns

A

patch

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103
Q

What can be given for moderate to severe vasomotor symptoms associated with menopause (when not improved by estrogens alone)

A

Estrogen + methyltestosterone

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104
Q

What has more anabolic effects and no androgenic effects?

A

Anabolic steroids

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105
Q

Anabolic steroids can increase muscle mass by ____%

A

30

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106
Q

Oral contraceptives contain both _____ and _______

A

Estrogen

Progestin

*99% effective

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107
Q

Oral contraceptives are usually taken days ____ through ____ of the menstrual cycle, the other 7 days a _____ is taken

A

5

25

placebo

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108
Q

Most contraceptive preparations are ______, but some are ________ (in case of Plan B, etc)

A

sequential

single entity

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109
Q

The morning after pill (Plan B) is _______ alone

A

Estrogen

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110
Q

What is used for rape/incest cases?

A

DES - diethyl stilbestrol

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111
Q

RU-486 is a progesterone ______ called mifepristone (Mifeprex) for the medical termination of pregnancy

A

antagonist

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112
Q

What long-acting progestin is given in doses for 3 or 6 months?

This abolishes the menstrual cycle but leads to what?

A

IM (DepoProvera)

ovarian/endometrial atrophy

113
Q

Depo Provera contains only….

A

synthetic progesterone

114
Q

T/F

The patch contraceptive is a more concentrated dose and therefore has more risks

A

True

115
Q

What is the mechanism of action for Oral Contraceptives?

A

Inhibit ovulation

116
Q

How do Oral Contraceptives inhibit ovulation?

2 ways!!!

A

estrogen - inhibits FSH - no ovulatory stimulation

progesterone - inhibits LH

117
Q

What is the function of Progesterone?

A

alters endometrium development

118
Q

T/F

OC’s mimic the effect of pregnancy on the gingiva

A

True

119
Q

How can antibiotics mess with OC’s?

A

No Flora to activate the OC Prodrug

120
Q

What is the ADA recommendation for women on OC’s taking antibiotics?

A

Alternative birth control until next cycle

*although very rare

121
Q

What 6 antimicrobials do NOT affect OC steroid levels when taken in combo?

A

tetracycline

doxycycline

ampicillin

metronidazole

fluconazole

fluoroquinolones

122
Q

What class of drugs is good for bones and lowers the rates of breast cancer?

A

SERMS - selective estrogen receptor modulators

*designer estrogens

123
Q

Name 3 bisphosphonates

A

Fosamax

Actonel

Boniva

124
Q

What SERM activates estrogen receptors in bone but not the breast?

*women w/ osteoporosis at risk for breast cancer

A

raloxifene (Evista)

125
Q

raloxifene (Evista) reduces risk of spinal fracture and invasive _____ cancer in postmenopausal women with osteoporosis

Its main effect is a _______ action in bone

A

breast

anti-resorptive

126
Q

What are the 2 most common side effects of raloxifene (Evista)?

A

hot flashes

leg cramps

127
Q

What are the best available bone building drugs?

What is their primary mechanism?

A

Bisphosphonates

inhibit osteoclasts

128
Q

The low dose form of Bisphosphonate is for ______

The high dose form is for ______

A

osteoporosis

bone cancer

129
Q

T/F

Bisphosphonates have good bioavailability and can be taken with food.

A

False

poor bioavailability - must take on empty stomach (morning)

130
Q

The 3 main side effect of bisphosphonates:

oral complication:

A

***Erosive esophagitis

headache

GI distress

oral: Osteonecrosis of the jaw

131
Q

Most cases of jaw necrosis in pts taking Bisphosphonates are associated with _______ combined with ______

A

chemo

steroids

132
Q

What drug for osteoporosis has the greatest effect in pts with a rapid bone turnover?

A

Calcitonin (Miacalcin)

133
Q

Calcitonin (Miacalcin) can be taken SubQ or _______, is often taken with calcium and _______

There are multiple adverse effects and risk of ______

A

intranasally

vitamin D

tolerance

134
Q

What drug stimulates osteoblasts and increases GI and kidney absorption of Calcium?

A

teriparatide (Forteo)

135
Q

Anything ending in _____ messes with the immune system

A

…mab

136
Q

What new osteoporosis drug is a Monoclonal Antibody and NOT a bisphosphonate?

A

denosumab (Prolia, Xgeva)

137
Q

Thought denosumab (Prolia, Xgeva) isn’t a bisphosphonate, it causes what?

A

osteonecrosis of the jaw

138
Q

denosumab is injected 60mg every 6 months and blocks osteoclasts by getting between _____ and _______

A

RANKL and RANK

139
Q

T/F

denosumab leads to decreased bone resorption and increased bone mass

A

True

140
Q

T/F

Calcium supplements should begin over 51 and not exceed 2500 mg and has never been shown to reduce fracture

A

True

141
Q

What increases bone mass, decreases fracture rates, decreases PTH, and potentiall increases bone formation?

A

ergocalciferol

vitamin D2; calciferol

142
Q

Vitamin D test (fall/winter months) should be between ___ and ____ ng/mL

A

30

74

143
Q

2 Vitamin D supplements and whence they were derived:

A

D2 = ergocalciferol (fungus)

D3 = cholecalciferol (animals - lanolin)

144
Q

Which Vitamin D supplement is more effective (longer half life)

A

D3 = cholecalciferol

145
Q

Hormones are produced by _____ glands

A

ductless

146
Q

Only hypothalamic releasing hormone used as a drug:

Used for:

Analog drug:

A

GnRH (gonadotropin releasing hormone)

primary amenorrhea - ovulation induction

comiphene (Clomid) - ovulatory stimulant

147
Q

GnRH stimulates what 2 hormones in the pituitary?

A

LH

FSH

148
Q

GnRH is used for ______ in men

A

idiopathic hypogonadism

achieves spermatogenesis

149
Q

ACTH from the Anterior Pituitary is used as a _______

A

diagnostic tool

adrenal dysfunction

150
Q

GH is the least abundant drug found in the Ant Pituitary

A

False

*most abundant

151
Q

The only reason to take GH is for ________, and it is now made from recombinant DNA techniques b/c the cadaver form transmitted ______ virus

A

dwarfism

Creutzfeld - Jakob

152
Q

TSH is used as a diagnostic tool to differentiate between what?

preparation comes from ____ sources

A

pituitary and primary hypothyroidism

bovine

153
Q

FSH promotes development of _____ in women and maintains _____ in men

Structurally it is a _____

A

ovarian follicles, spermatogenesis

glycoprotein

154
Q

LH is a glycoprotein that induces ______ and regulates ______ in women and _____ in men

A

ovulation

progesterone secretion

testosterone secretion

155
Q

What are the 2 Non-pituitary gonadotropins?

A

HMG - human menopausal gonadotropin (TWINS)

HCG - human chorionic gonadotropin

156
Q

Aside from the pregnancy test, HCG is used to induce _______ and stimulate _______ of the testes to secrete ______

A

ovulation

interstitial cells

androgen (cryptorchidism)

157
Q

What are the 2 Posterior Pituitary hormones?

A

Vasopressin (ADH)

oxytosin (Pitocin)

*similar chemicals and cross-over at high doses

158
Q

What is the hormonal form of vitamin D

A

Calcitriol

159
Q

What calcium regulating hormone does the Thyroid produce?

A

Calcitonin (thyrocalcitonin)

160
Q

Calcitonin decreases plasma calcium and ________

A

phosphate

*treats hypercalcemia in medical setting

161
Q

What is formed in the skin when exposed to UV light?

A

Vita D3 (cholecalciferol)

162
Q

Compared to PTH, vitamin D exerts a _______ regulatory effect on calcium balance

A

slower

163
Q

Vitamin D preparation

A

ergocalciferol

D2; calciferol

164
Q

Increasing Vitamin D decreases ____ cancer

Decreasing VitaD increases _____, _____. _____ cancers

A

colon

prostate, breast, ovarian

165
Q

Low sun exposure is associated with increased _________ diabetes

A

Type I

166
Q

T/F

Hypertension increases with distance away from equator

A

True

167
Q

Oxygen saturation is measured with a ______

A

pulse oximeter

168
Q

Infections, Sinusitis, and Common cold are in the ______

Asthma, bronchitis, and emphysema are in the ______

A

Upper resp tract

lower resp tract

169
Q

Sinusitis refers pain where?

A

teeth

170
Q

Acute bacterial Sinusitis must be persistent for ____ days and have a purulent nasal discharge in the first _____ days

A

10

3-4

171
Q

Most cases (98%) of Acute Rhinosinusitis are _____

***What is prescribed for this?

A

viral

***amoxicillin-clavulanate (Augmentin)

172
Q

Tx Acute Rhinosinusitis, if allergic to penicillin (amoxicillin-clavulanate), use ______ or ______

A

levofloxacin

clindamycin

(then doxy)

173
Q

Avoid ______ and _____ with Acute Rhinosinusitis

A

decongestants

antihistamines

174
Q

Four drug classes for Sinusitis/Allergic Rhinitis

A

Pseudoephedrine

Antihistamines

Analgesics

Antibiotics

175
Q

Decongestants tend to be ________, therefore use epi with caution

A

Sympathomimetics

176
Q

What is the new “dry” nasal aerosol corticosteroid?

A

QNASL Nasal Aerosol (beclomethasone dipropionate)

177
Q

Asthma and ______ are the 2 major types of inadequate alveolar ventilation.

A

COPD

178
Q

What are 3 types of COPD?

A

Chronic bronchitis

Emphysema

Neoplastic diseases

179
Q

Asthma is a recurrenct bronchial ________ spasm involving _______ of the bronchial mucosa and hypersecretion of ________

A

Smooth muscle

Inflammation

Mucous

180
Q

The most common form of asthma is _______

A

Extrinsic

181
Q

There is a _______ relationship between allergen and ______ mediated sensitization in Asthma

A

Dose response relationship

IgE

182
Q

T/F
Asthma = IgG + Mast cells

(In bronchial tree)

A

False

IgE

183
Q

T/F
Asthma etiology is a major biochemical assault involving bradykinins, histamine, leukotriene, eosiniphils, platelet activating factor, E-selectin, and leukocytes

This all leads to tissue edema, more mucous, and T-lymphocytes prolonging inflammatory response

A

True

184
Q

Intrinsic Asthma represents ____% of cases

A

30%

185
Q

Intrinsic asthma is seldom related to family Hx, pts aren’t responsive to skin testing, they have ____ IgE, are usually ____ aged

A

Normal

Middle

186
Q

Intrinsic asthma is associated with what 2 factors?

A

Emotional stress

GERD

187
Q

T/F

Asthma can be drug induced

A

True

188
Q

If a pt has asthma, there is a ___% chance they will be hypersensitive to aspirin

A

5-15%

189
Q

What is the Aspirin Hypersensitivity Triad?

A

Aspirin hypersensitivity

Asthma

Nasal polyps

190
Q

Aspirin allergy mechanism inhibits bronchodilating ______ and forms _______, which are bronchoconstrictors

A

PGE2

Leukotrienes

191
Q

What drug is contraindicated for Asthma?

A

Aspirin

192
Q

Allergic rxn with aspirin mimics what?

A

Asthma attack

193
Q

T/F

There is cross hypersensitivity with aspirin and NSAIDS

A

TRUE

194
Q

Food substances and ________ found in vasoconstrictors serve as triggers for Asthma

A

Sulfite preservatives

195
Q

Sulfite preservatives found in vasoconstrictors are a problem when _____ is low

This produces _______, which precipitates an acute Asthma attack

A

Sulfite oxidase

Sulfite dioxide

196
Q

Viruses, bacteria, fungi, and mycoplasma can cause _____ asthma

A

Infectious

197
Q

If an inhaler is over-used, the structural change in the airway can cause a persistent Life-Threatening bronchospasm called…

*can last 24 hours

A

Status Asthmaticus

198
Q

Asthma involves Expiratory Wheezing, and when finished a ________

A

Productive cough (thick, stringy mucous)

199
Q

MILD asthma - only when exposed to a ________, less than ______, FEV greater than ____%

Moderate asthma - more than ___x/week, affecting ______, requires emergency care, FEV greater than _____

Severe asthma - ongoing, at night, limits activity, emergency hospitalization, FEV less than ___%

A

Trigger, one hour, 80%

2x/week, sleep, 80%

60%

200
Q

Asthma and other respiratory diseases are treated with _______ stimulants,

adrenal _______

_______ altering meds

_____ cell inhibitors

Expectorants

Anti-tussives

A

Beta adrenergic stimulants

Glucocorticoids

Leukotriene altering

Mast cell

201
Q

Tx mild intermittent asthma:

Mild persistent:

Moderate persistent:

Severe persistent:

A

Rescue bronchodilator

Anti-inflammatory + low dose inhaled corticosteroid, anti-leukotriene

Medium dose inhaled corticosteroid

Daily meds - high dose inhaled corticosteroid

202
Q

T/F

Asthma is overtreated

A

False

*undertreated

203
Q

The preferred therapy for mild persistent asthma is ________, but providers often disregard due to risk/benefit perceptions

A

Inhaled corticosteroids

204
Q

T/F

There is a lot of uncontrolled asthma

A

True

205
Q

Asthma pts: within the last year ___% have been hospitalized and another _____% have been to the ER/urgentCare

A

5%

14.4%

206
Q

“Inhalers” are ______ stimulants

They target ______ receptors in the airway

A

Beta adrenergic

Beta 2

207
Q

What beta adrenergic stimulant is in every dental office emergency kit?

A

Albuterol

208
Q

What are 2 long-acting Beta adrenergic stimulants?

A

Salmeterol (Serevent, Diskus)

Salmeterol with fluticasone (Advair Diskus)

*fluticasone contains a steroid

209
Q

2 dental considerations for pts using inhalers:

What else should you ask them?

A

Taste alters, candidiasis

How often use? - overuse and inhaler does not give good response

210
Q

What is the older class of asthma drugs (beta adrenergic stimulant)?

A

Methylxanthines

211
Q

When would pts be using Methylxanthines (older beta adrenergics) ?

A

Uncontrolled - they haven’t responded to newer drugs

212
Q

Methylxanthines are a _______ drug in dentistry.

2 major DDI’s

A

RED flag

Antibiotics, systemic azole antifungals

213
Q

Methylxanthines block _______ which increases ______

Major preparation:

A

Phophodiesterase, cAMP

*theophylline

214
Q

Leukotrienes produce similar effects to _______

Itchy, runny nose, runny eyes

A

Histamine

215
Q

Leukotriene drugs either inhibit the synth of leukotrienes - What drug?

Or - blocks leukotriene receptors - What drug?

A

Zileutron (Zyflo)

Monelukast (Singulair)

216
Q

What is the drug of choice for reducing inflammation?

Used to reduce inflammation and decrease freq/severity of asthma attacks

A

Steroids - adrenal glucocorticoids

217
Q

What is the first OTC intranasal steroid?

A

Triamcinolone acetonide (Nasacort)

218
Q

Aside from immune dysfunction and delayed wound healing, what are 2 dental considerations of Steroids?

A

Candidiasis

Adrenal suppression if used chronically (then needs more steroids)

219
Q

Mast cell inhibitors are used for ______ allergies and ________ asthma.

What is the preparation we need to know?

A

Seasonal, Exercise-induced

Cromolyn

220
Q

What is the drug of choice for emphysema?

A

Anticholinergics

221
Q

What 3 anticholinergics (emphysema drugs) do we need to know?

A

Aclidinium (Tudorza Pressair)

Ipratropium (Atrovent)

Tiotropium (Spiriva Handihaler)

222
Q

Mouthbreathing, an asthma side effect, can lead to what 4 problems of craniofacial develpment?

A

Vaulted palate

Increased anterior facial height

Overjet

Crossbite

223
Q

Asthma leads to what 4 oral considerations?

A

Xerostomia

Enamel erosion (reflux from meds)

Candidiasis

Headache

224
Q

What 2 drugs should be avoided when a pt is on theophylline for Asthma?

A

Erythromycin

Ciprofloxacin

225
Q

Opiates release _______, and therefore should be avoided in pts with Asthma

A

Histamine

226
Q

If a pt has an asthma attack, give what 3 things?

A

Epinephrine

Oxygen

Bronchodilators

227
Q

Chronic Bronchitis entails smooth muscle hyperplasia, excess sputum, and collapse of _______

A

Peripheral airways

228
Q

Chronic bronchitis is _______ related

But can be seen in non smokers as recurrent infection

A

Smoking

229
Q

“Blue Bloaters”

A

Chronic Bronchitis

230
Q

What expectorant is used to manage Chronic Bronchitis?

Anti-tussive drug?

A

Guaifenesin (Mucinex, Robitussin)

Dextromethorphan (Delsym, Vicks 44)

231
Q

How does dextromethorphan (anti-tussive for Chronic Bronchitis) work?

A

Depresses cough center in medulla

*kind of like morphine - narcotic properties

232
Q

“Pink Puffers”

A

Emphysema

233
Q

What destroys the alveolar walls in emphysema

A

Elastase from neutrophils

*as a response to smoking

234
Q

The obstruction in emphysema is caused by the collapse of unsupported spaces upon ________

A

Expiration

*no obstruction on inspiration

235
Q

What do clubbed fingers and toes suggest?

A

Emphysema - lack of oxygen

236
Q

What is the class of drug used for Emphysema (drug of choice)?

Drug?

A

Anticholinergic

Ipratropium (Atrovent)

237
Q

What is the mechanism of ipratropium (Atrovent)?

A

Anticholinergic - blocks acetylcholine in bronchial smooth muscle causing bronchodilation

238
Q

4 drugs used for Emphysema:

A

Ipratropium (Atrovent) - anticholinergic

Beta adrenergic agonists

Oral/inhaled corticosteroids

Xanthines

239
Q

How must a pt with COPD be seated?

A

Semi-reclining position

240
Q

The “red flag drugs” for COPD’s are ______ antibiotics and _______ if taking theophylline

*toxicity severe in the latter

A

Macrolides

Ciprofloxacin

241
Q

COPD: ______ supplementation may be necessary for pts taking long term steroids

If given too much ______, induce resp failure

______ monitoring advised

A

Adrenal

Oxygen

Pulse oximeter

242
Q

Limit oxygen given to COPD pts to less than _______

A

3 L/min

*2-3 L/min

243
Q

T/F

Avoid nitrous oxide with COPD

A

True

244
Q

Antacids are _______

A

Weak bases

245
Q

T/F

Antacids inhibit HCl production by parietal cells

A

False

*need HCl for digestion

246
Q

3 Antacids (like Tums)

*tums causes what?

A

Aluminum hydroxide

Magnesium hydroxide

Calcium carbonate (tums)

*constipation

247
Q

2 Magnesium antacid products

A

Milk of magnesia (OH bind with HCl in stomach)

Maalox - slow acting, silica absorbs H+

248
Q

Aluminum antacids stops what?

A

Bleeding

*good for ulcers - coats/protects

249
Q

What really old antacid forms complexes with albumin, fibrinogen, and glubulin on ulcers?

A

Sucralfate (Carafate)

250
Q

What Histamine H2 Receptor Antagonist is preferred by gastrointerologists to address many symptoms of indigestion?

A

Zantac

251
Q

What class of drugs binds to H+/K+ ATPase enzyme system in Parietal Cells?

A

Proton pump inhibitors

252
Q

5 proton pump inhibitors:

A

Nexium

Prevacid

Prilosec

Protonix

Aciphex

253
Q

What drug is indicated for Tx of NSAID induced GI lesions?

A

Nexium

254
Q

How do antacids interfere with many drugs?

A

Neutralize pH - stops absorption

255
Q

Histamine antagonists (in antacids) decrease ______ and alter_______

A

Antifungals

Warfarin

256
Q

GI meds can cause what 5 oral side effects?

A

Xerostomia

Taste alteration (metallic)

Aphtous stomatitis

Candidiasis

Excessive salivation (vagus response to gastric acid in oral cavity)

257
Q

Peptic ulcer disease peaks at 30-50, and is higher in smokers, drinkers, hyper_________, renal dialysis, and chronic use of _______

A

Hyperparathyroidism

NSAIDS

258
Q

Peptic ulcers caused by:

A

Helicobacter pylori

*90%

259
Q

T/F

H. Pylori is widespread throughout the animal kingdom

A

False

Humans only known hosts

260
Q

The use of NSAIDS for 1 month directly damages mucosa, decreases mucosal _________, occur more in the _________, are compounded by use of aspirin, alcohol, steroids, anticoagulants

A

Prostaglandins

Stomach (than the duodenum)

261
Q

H. Pylori is associated with what cancer?

A

Lymphoma

*cancer of gastric mucosa

262
Q

Chronic use of what drug can cause Atrophic Gastritis and Stomach Cancer?

A

Proton pump inhibitors

263
Q

What is the present Tx for ulcer caused by H.pylori?

How long does Tx last?

A

Combo: Antibiotics + proton pump inhibitor

(Or petp bismol)

2 week Tx

264
Q

4 antibiotics used in combination with either proton pump inhibitors or H2 receptor blockers for H.pylori?

A

Amoxicillin

Metronidazole

Clarithromycin

Tetracycline

265
Q

Amoxicillin, clarithromycin, and one of the following:

Nexium, Prevacin, Protonix, Aciphex, or Priolosec

One week triple therapy for what?

A

Eradicate H.pylori and allow ulcer to heal

266
Q

What is used if H.pylori is clarithromycin resistant?

A

Levofloxacin (Levaquin)

267
Q

When treating pt with ulcer, avoid what 2 drugs?

A

Aspirin

NSAIDS

268
Q

Macrolide antibiotics used to Tx H.pylori cause GI distress, use caution with what pts?

A

Inflammatory bowel disease

269
Q

Pseudomembranous colitis = 3 antibiotics

A

Macrolides, cephalosporins, clindamycin

270
Q

2 forms of IBS:

Ulcerative colitis is found where?

Crohn’s disease is found where?

A

Large intestine/rectum

Entire bowel

271
Q

Crohn’s disease differs from Ulcerative Colitis in that it is _________

A

Autoimmune

272
Q

1st line Tx for IBS:

2nd line:

3rd line:

A

Anti-inflammatories, corticosteroids

Immunosuppresives, antibiotics

Monoclonal antibody, surgery

273
Q

There is risk of _______ suppression when using corticosteroids to combat IBS

A

Adrenal

274
Q

Immunosuppressive drugs used to Tx IBS can cause blood dyscrasias and damage liver

A

True

275
Q

T/F

Elective dental procedures only done in remission if pt has IBS

A

True

276
Q

What is a unique oral manifestationof Crohn’s?

A

Aphthous ulcerations

277
Q

Pepto-Bismol, aka….

Use caution if have _____ allergy

A

Bismuth subsalicylate

Salicylate

278
Q

What causes constipation as a side effect and is sometimes prescribed for severe diarrhea?

prescription Drug?

A

Opioids

Lomotil

279
Q

What drug relieves spasm and decreases gut motility - used for diarrhea

A

Loperamide (Imodium)

Tim's Cards (140 decks)

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