2Pharm II Flashcards
The Thyroid synthesizes ______ and ______ from ______
thyroxin (T4)
triiodothyronine (T3)
iodine
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)
True
Thyroid feedback loop: the hypothalamus secretes ______, the Anterior Pituitary secretes ______, and the Thyroid secretes _______
TRH
TSH
T4 and T3
Primary hypo/hyperthyroidism is a disease of the ______
Secondary hypo/hyperthyroidism is a disease of the ______
thyroid gland
hypothalamus or anterior pituitary
L-tyrosine is the precursor to ____ and _____
T4/T3 and epinephrine
Without iodine, there is a build up in the TH precursor, resulting in ______
goiter
What large glycoprotein integral to the synthesis of T4/T3 is NEVER secreted into the bloodstream?
Thyroglobulin
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 ____
Cuboidal
iodotyrosyl
T3, T4
What are the 2 synthetic thyroid preparations?
Which TH are they?
sodium levothyroxine (Synthroid, Levoxyl) T4
sodium liothyronin (Cytomel) T3
Why is sodium liothyronine (T3) less preferred than sodium levothyroxine (T4)?
Absorption more erratic
Synthroid is usually taken _____
It _____ the basal metabolic rate
in the morning/on an empty stomach
increases
T/F
Synthroid promotes gluconeogenesis, mobilizes glycogen stores, and stimulates protein synthesis
True
T/F
overuse of sodium levothyroxine (Synthroid) mimics hyperthyroidism and includes tachycardia, nervousness, increased appetite, and weight loss
True
Hyperthyroidism, aka _____ disease
Grave’s
The abuse of Synthroid is called _______ hyperthyroidism
Fictitious
What is the name of the Canadian drug used as palliative Tx of hyperthyroidism in preparation for radioactive iodine therapy?
Nickname?
Propylthiouracil
PTU
What are the side effects of propylthiouracil (iodination blocking drug for hyperthyroidism)?
Rash
Nausea
Agranulocytosis
What therapy is used in conjuction with propylthiouracil to prepare pts for surgery?
Saturated solution Potassium Iodide
*mechanism unclear
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?
Methimazole (Tapazole)
Tast alteration, salivary gland swelling
What is used to estimate the activity of the Thyroid Gland and irradiate/destroy it over a period of 3 months?
Radioactive Iodide I 131
What is easier from a Dental management perspective - hypo or hyperthyroidism?
Hypothyroid
In context of Dental considerations, Hypothyroid pts are more sensitive to what?
CNS depressants
*must lower dose of sedatives/opioids
Hyperthyroid pts have an Absolute contraindication to what?
Epinephrine
Hyperthyroid pts are less sensitive to what drug administered in Dental clinic?
CNS depressants
*may require higher dose.
**also may be mislabeled as “drug-seeking behaviors”
Type I Diabetes is an autoimmune disease that destroys ______ cells
Type II Diabetes occurs when ____ become blocked/insensitive
Beta (pancreatic)
insulin receptors
T/F
In Type I Diabetes the body destroys the beta cells, but the receptors are just fine.
True
_____% of diabetes is type I
____ is the only effective drug in treating Type 1 diabetes
10%
Insulin
*long ago was called Juvenile Diabetes
T/F
Insulin is a polypeptide, 5600 dalton mw, 2 chans connected by sulfide bridge
False
disulfide bridge
Older Insulin preparations came from cows/pigs, but this is no longer used because of ______ technology
recombinant
All insulins must be injected how?
SC
*although now we have a new inhalable form
In what 3 ways is insulin classified?
Onset
Peak
Duration
What are the 2 most popular insulins?
insulin Regular (HumuLIN R)
insulin Aspart (NovoLOG)
insulin Regular (HumuLIN R) is ____ acting
insulin Aspart (NovoLOG) is _____ acting
what are 3 additional categories of insulin?
short
rapid
intermediate, intermediate to long, long
(acting for all)
What is a long-acting insulin used for both type I and type II diabetes?
What are its oral complications?
insulin glargine (Lantus Solostar)
numb mouth
T/F
Some Type II diabetes interventions improve receptor function and control the insulin spike, but without lifestyle changes the pancreas will burn out.
True
It used to be that Type II diabetes was very rare before age ____
35
Why is there a lot of insulin in the blood of a Type 2 diabetic?
Target cells insensitive
What is the intervention for insensitive insulin target cells?
More insulin
*needed to get glc into cells
What is the outcome of Type 2 diabetes?
Hyperglycemia
T/F
Tx for Type 2 diabetes is Oral drugs, non-pharmacological intervention (weight, exercise, diet), and insulin
True
If a Type 2 diabetic is taking insulin, the pt is most likely poorly controlled
True
What are the 3 goals of drug therapy for Type2 diabetics?
***What is the risk for all of these interventions?
Increase insulin (w/ glc)
Suppress hepatic gluconeogenesis
Improve insulin sensitivity
***hypoglycemia
5 Drug classes to treat Type2 diabetes:
Sulfonylureas
Biguanides
Alpha-glucosidase inhibitors
Thiazolidinediones (TZD’s)
Incretins
What class of drugs promotes insulin release from pancreatic beta cells?
(type II intervention)
Sulfonylureas
The 2nd generation Sulfonylureas are more _____ but not more _____
potent
effective
What is a 1st generation Sulfonylurea?
*Tx Type II - promotes insulin release from beta cells
tolbutamide (Orinase)
*all end in “amide”
What is a 2nd generation Sulfonylurea?
glipizide (Glucotrol)
*all end in “ide”
What is the major distinction between 1st and 2nd generation Solfonylureas?
Potency
Sulfonylureas increase ______ mortality and are contraindicated in pts who are _______
Use caution in severe _____ disease
cardiovascular
allergic
hepatic
What is the main DDI to be concerned with when using Solfonylureas?
What does this drug do?
Aspirin
displaces sulfonylurea - resulting in hypoglycemia
Aspirin has 2 mechanisms to disrupt Sulfonylureas, what are they?
displace sulfonylurea - resulting in hypoglycemia
Inhibit prostaglandin E synth - PGE inhibits insulin secretion = too much secretion = hypoglycemia
What class of drugs is so well tolerated that it is regularly combined with other drugs?
What is the drug?
Biguanides
metformin (Glucophage)
metformin (Glucophage) has what 4 mechanisms?
Inhibit glc gut absorption
decrease hepatic glc production
increase insulin sensitivity at receptor
increase peripheral glc uptake/utilization
What drug is most effective at reducing glycemic level, creating fewer episodes of hypoglycemia, decreasing weight, reducing LDL, CV mortality, and Cancer?
metformin (Glucophage)
What occurs if there is renal impairment in pts taking metformin (Glucophage)
Who should not take this drug?
other side effect?
Lactic acidosis
Alcoholics (hepatic probs)
GI
acarbose (Precose) and miglitol (Glyset) are __________ enzyme inhibitors that normally degrade _____ in the gut
*this creates delay in blood glc concentrations after meal
Alpha-glucosidase
complex carbs
What class of drugs used to treat Type 2 diabets “resets” insulin receptors?
*improving target cell response/reducing insulin resistance
Thiazolidinediones
Name 2 Thiazolidinediones:
pioglitazone (Actos)
rosiglitazone (Avandia)
pioglitazone and rosiglitazone (thiazolidinediones) have been associated with more than 30 deaths due to _____, and there is an increased risk of _______
liver failure
heart failure
Thiazolidinediones like pioglitazone and rosiglitazone are contraindicates in what pts?
serious heart failure
they increase the risk
What class of drugs better regulates the release of insulin but are pro-inflammatory and may cause pancreatic cancer?
Incretins
Incretins mimic _______ to stimulate insulin release
hormones
What are 2 types of Incretin
GLP-1 (Glucagon Like Peptide -1) receptor agonists
DPP-4 (dipeptydyl peptidase-4) inhibitors
What is the normal blood sugar range?
What is fasting blood glc?
70-120 mg/dL
70-110 mg/dL
What is the gold standard in measuring blood glc (and monitoring diabetics)?
glycated hemoglobin (HbA1c)
What is the normal value for HbA1c?
What is the diabetic diagnosis?
What is the goal for diabetics?
less than 6%
above 6.5%
less than 7%
American College of Physicians 1st intervention for TypeII diabetes?
If fails, ________
If hyperglycemia persists, _______
lifestyle mods
metformin
more drugs
T/F
The endocrinologists algorithm suggests obesity management to lower glc and CV risk factor modification and glycemic controls
True
Natural estrogen is a steroid produced by the ovary, aka…
estradiol
Because estradiol is inactivated by the gut/liver, we must place a ______ group at C17 to make it orally active. This creates ______
ethinyl
ethinyl estradiol
Estrogen Replacement Drugs are of what 3 types?
Conjugated equine estrogens
Esterified estrogens
Estradiol preps
Conjugated equine estrogen:
This treats the ______ symptoms of menopause
It also might prevent _______
Premarin
vasomotor
bone loss (osteoporosis)
4 common side effects of Premarin:
Peripheral edema
Breast tenderness
Bloating
Headache
A serious side effect of Premarin if you have an intact uterus:
May also increase _____ cancer
Increased risk for endometrial (uterine) cancer)
breast
What are 2 Esterified Estrogens?
How are they different from Premarin (conjugated estrogen)?
Estratab
Menest
1/2 dose - 0.3mg daily
T/F Esterified Estrogens (Estratab, Menest) have the same effects as Premarin (conjugated estrogen)
True
Estrogen + progesterone =
adding progesterone does what?
Prempro
reduces risk of endometrial cancer
What is Prempro used for?
This is a combo of what 2 drugs?
menopause/osteoporosis
Premarin, Provera
*estrogen, medroxyprogesterone
In a large study (2800 w/ heart disease), women on HRT (estrogen) saw ____ go down and ______ go up with and no reduction is ______
cholesterol
blood clots
heart disease
Estrogen in combo with progestin may increase the risk of _________
*this outweighs long term use to prevent ________
stroke
osteoporosis
The PremPro study at the NIH was cancelled b/c it increased the risk of what 4 thing?
Heart disease
Stroke
Pulmonary embolism
Invasive breast cancer
What 2 benefits of PremPro aren’t enough to outweigh the risks of hear disease, stroke, pulmonary embolism, and breast cancer?
Reduced fractures
Reduced colorectal cancer
HRT (estrogen) is used on a ______ term basis to treat menopause, usually less than ____ years
short
5
Progesterone is a _____ produced by the _______.
It induces the secretory _______, affects uterine mobility, and cervical ______
steroid
corpus luteum
endometrium
mucous
Progesterone prevents the buildup of the ______
endometrial lining
Aside from contraception, Progesterone can be used to treat _______ and _______
endometriosis
menstrual disorders
Oral progesterone must be modified to be taken orally - what are 2 of them?
norethindrone (contraceptives)
medroxyprogesterone (Provera)
medroxyprogesterone (Provera) is used to treat what 3 things?
Abnormal uterine bleeding
secondary amenorrhea
endometrial cancer
Testosterone is a steroid that must be _____ before taken orally
methylated
Testosterone 4 Tx’s:
Delayed male puberty
Hypogonadism
Inoperable female breast cancer
Libido loss postmenopausal women
T/F
Male “menopause” beginning in 4th or 5th decades may be treated with testosterone, synthetic androgens, or estrogens
True
T/F - testosterone levels
250-800 mg/dl for men
15-40 ng/dl for women
0-20 ng/dl for postmenopausal women
True
Testosterone naturally diminished by 1% every year after ____, and common conditions observed are obesity, type 2 diabetes, _____, and ______
35
pain
depression
*these are just aging
Conditions that negatively impact T level are Metabolic syndrome, oteoporosis, COPD, Coronary heart disease, inflammatory conditions, cardiac, renal, and liver failure, and pituitary tumor
True
What syndrome entails both symptoms and biochemical evidence of T deficiency?
Hypogonadism
Testosterone is linked to the ______ of the male population and is a biomarker for occult diseases like atherosclerosis, _____, and early death
general health
cancer
Testosterone decreases fat, increases muscle, improves libido - and what 3 blood/diabetic/heart disease factors?
insulin resistance
Ha1C
lipid profiles
T/F
Exogenous testosterone can impair endogenous T, cause probs with fertility, increase the size of the prostate, and increase risk for blood clots
True
T can be administered many ways - including buccal which causes edema, irritation, and _____
dysgeusia
taste perversion
T/F
There is evidence that supports testosterone use for women
False
*no benefits as HRT
When can T be used for women?
postmenopausal hypoactive sexual desire
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
patch
What can be given for moderate to severe vasomotor symptoms associated with menopause (when not improved by estrogens alone)
Estrogen + methyltestosterone
What has more anabolic effects and no androgenic effects?
Anabolic steroids
Anabolic steroids can increase muscle mass by ____%
30
Oral contraceptives contain both _____ and _______
Estrogen
Progestin
*99% effective
Oral contraceptives are usually taken days ____ through ____ of the menstrual cycle, the other 7 days a _____ is taken
5
25
placebo
Most contraceptive preparations are ______, but some are ________ (in case of Plan B, etc)
sequential
single entity
The morning after pill (Plan B) is _______ alone
Estrogen
What is used for rape/incest cases?
DES - diethyl stilbestrol
RU-486 is a progesterone ______ called mifepristone (Mifeprex) for the medical termination of pregnancy
antagonist
What long-acting progestin is given in doses for 3 or 6 months?
This abolishes the menstrual cycle but leads to what?
IM (DepoProvera)
ovarian/endometrial atrophy
Depo Provera contains only….
synthetic progesterone
T/F
The patch contraceptive is a more concentrated dose and therefore has more risks
True
What is the mechanism of action for Oral Contraceptives?
Inhibit ovulation
How do Oral Contraceptives inhibit ovulation?
2 ways!!!
estrogen - inhibits FSH - no ovulatory stimulation
progesterone - inhibits LH
What is the function of Progesterone?
alters endometrium development
T/F
OC’s mimic the effect of pregnancy on the gingiva
True
How can antibiotics mess with OC’s?
No Flora to activate the OC Prodrug
What is the ADA recommendation for women on OC’s taking antibiotics?
Alternative birth control until next cycle
*although very rare
What 6 antimicrobials do NOT affect OC steroid levels when taken in combo?
tetracycline
doxycycline
ampicillin
metronidazole
fluconazole
fluoroquinolones
What class of drugs is good for bones and lowers the rates of breast cancer?
SERMS - selective estrogen receptor modulators
*designer estrogens
Name 3 bisphosphonates
Fosamax
Actonel
Boniva
What SERM activates estrogen receptors in bone but not the breast?
*women w/ osteoporosis at risk for breast cancer
raloxifene (Evista)
raloxifene (Evista) reduces risk of spinal fracture and invasive _____ cancer in postmenopausal women with osteoporosis
Its main effect is a _______ action in bone
breast
anti-resorptive
What are the 2 most common side effects of raloxifene (Evista)?
hot flashes
leg cramps
What are the best available bone building drugs?
What is their primary mechanism?
Bisphosphonates
inhibit osteoclasts
The low dose form of Bisphosphonate is for ______
The high dose form is for ______
osteoporosis
bone cancer
T/F
Bisphosphonates have good bioavailability and can be taken with food.
False
poor bioavailability - must take on empty stomach (morning)
The 3 main side effect of bisphosphonates:
oral complication:
***Erosive esophagitis
headache
GI distress
oral: Osteonecrosis of the jaw
Most cases of jaw necrosis in pts taking Bisphosphonates are associated with _______ combined with ______
chemo
steroids
What drug for osteoporosis has the greatest effect in pts with a rapid bone turnover?
Calcitonin (Miacalcin)
Calcitonin (Miacalcin) can be taken SubQ or _______, is often taken with calcium and _______
There are multiple adverse effects and risk of ______
intranasally
vitamin D
tolerance
What drug stimulates osteoblasts and increases GI and kidney absorption of Calcium?
teriparatide (Forteo)
Anything ending in _____ messes with the immune system
…mab
What new osteoporosis drug is a Monoclonal Antibody and NOT a bisphosphonate?
denosumab (Prolia, Xgeva)
Thought denosumab (Prolia, Xgeva) isn’t a bisphosphonate, it causes what?
osteonecrosis of the jaw
denosumab is injected 60mg every 6 months and blocks osteoclasts by getting between _____ and _______
RANKL and RANK
T/F
denosumab leads to decreased bone resorption and increased bone mass
True
T/F
Calcium supplements should begin over 51 and not exceed 2500 mg and has never been shown to reduce fracture
True
What increases bone mass, decreases fracture rates, decreases PTH, and potentiall increases bone formation?
ergocalciferol
vitamin D2; calciferol
Vitamin D test (fall/winter months) should be between ___ and ____ ng/mL
30
74
2 Vitamin D supplements and whence they were derived:
D2 = ergocalciferol (fungus)
D3 = cholecalciferol (animals - lanolin)
Which Vitamin D supplement is more effective (longer half life)
D3 = cholecalciferol
Hormones are produced by _____ glands
ductless
Only hypothalamic releasing hormone used as a drug:
Used for:
Analog drug:
GnRH (gonadotropin releasing hormone)
primary amenorrhea - ovulation induction
comiphene (Clomid) - ovulatory stimulant
GnRH stimulates what 2 hormones in the pituitary?
LH
FSH
GnRH is used for ______ in men
idiopathic hypogonadism
achieves spermatogenesis
ACTH from the Anterior Pituitary is used as a _______
diagnostic tool
adrenal dysfunction
GH is the least abundant drug found in the Ant Pituitary
False
*most abundant
The only reason to take GH is for ________, and it is now made from recombinant DNA techniques b/c the cadaver form transmitted ______ virus
dwarfism
Creutzfeld - Jakob
TSH is used as a diagnostic tool to differentiate between what?
preparation comes from ____ sources
pituitary and primary hypothyroidism
bovine
FSH promotes development of _____ in women and maintains _____ in men
Structurally it is a _____
ovarian follicles, spermatogenesis
glycoprotein
LH is a glycoprotein that induces ______ and regulates ______ in women and _____ in men
ovulation
progesterone secretion
testosterone secretion
What are the 2 Non-pituitary gonadotropins?
HMG - human menopausal gonadotropin (TWINS)
HCG - human chorionic gonadotropin
Aside from the pregnancy test, HCG is used to induce _______ and stimulate _______ of the testes to secrete ______
ovulation
interstitial cells
androgen (cryptorchidism)
What are the 2 Posterior Pituitary hormones?
Vasopressin (ADH)
oxytosin (Pitocin)
*similar chemicals and cross-over at high doses
What is the hormonal form of vitamin D
Calcitriol
What calcium regulating hormone does the Thyroid produce?
Calcitonin (thyrocalcitonin)
Calcitonin decreases plasma calcium and ________
phosphate
*treats hypercalcemia in medical setting
What is formed in the skin when exposed to UV light?
Vita D3 (cholecalciferol)
Compared to PTH, vitamin D exerts a _______ regulatory effect on calcium balance
slower
Vitamin D preparation
ergocalciferol
D2; calciferol
Increasing Vitamin D decreases ____ cancer
Decreasing VitaD increases _____, _____. _____ cancers
colon
prostate, breast, ovarian
Low sun exposure is associated with increased _________ diabetes
Type I
T/F
Hypertension increases with distance away from equator
True
Oxygen saturation is measured with a ______
pulse oximeter
Infections, Sinusitis, and Common cold are in the ______
Asthma, bronchitis, and emphysema are in the ______
Upper resp tract
lower resp tract
Sinusitis refers pain where?
teeth
Acute bacterial Sinusitis must be persistent for ____ days and have a purulent nasal discharge in the first _____ days
10
3-4
Most cases (98%) of Acute Rhinosinusitis are _____
***What is prescribed for this?
viral
***amoxicillin-clavulanate (Augmentin)
Tx Acute Rhinosinusitis, if allergic to penicillin (amoxicillin-clavulanate), use ______ or ______
levofloxacin
clindamycin
(then doxy)
Avoid ______ and _____ with Acute Rhinosinusitis
decongestants
antihistamines
Four drug classes for Sinusitis/Allergic Rhinitis
Pseudoephedrine
Antihistamines
Analgesics
Antibiotics
Decongestants tend to be ________, therefore use epi with caution
Sympathomimetics
What is the new “dry” nasal aerosol corticosteroid?
QNASL Nasal Aerosol (beclomethasone dipropionate)
Asthma and ______ are the 2 major types of inadequate alveolar ventilation.
COPD
What are 3 types of COPD?
Chronic bronchitis
Emphysema
Neoplastic diseases
Asthma is a recurrenct bronchial ________ spasm involving _______ of the bronchial mucosa and hypersecretion of ________
Smooth muscle
Inflammation
Mucous
The most common form of asthma is _______
Extrinsic
There is a _______ relationship between allergen and ______ mediated sensitization in Asthma
Dose response relationship
IgE
T/F
Asthma = IgG + Mast cells
(In bronchial tree)
False
IgE
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
True
Intrinsic Asthma represents ____% of cases
30%
Intrinsic asthma is seldom related to family Hx, pts aren’t responsive to skin testing, they have ____ IgE, are usually ____ aged
Normal
Middle
Intrinsic asthma is associated with what 2 factors?
Emotional stress
GERD
T/F
Asthma can be drug induced
True
If a pt has asthma, there is a ___% chance they will be hypersensitive to aspirin
5-15%
What is the Aspirin Hypersensitivity Triad?
Aspirin hypersensitivity
Asthma
Nasal polyps
Aspirin allergy mechanism inhibits bronchodilating ______ and forms _______, which are bronchoconstrictors
PGE2
Leukotrienes
What drug is contraindicated for Asthma?
Aspirin
Allergic rxn with aspirin mimics what?
Asthma attack
T/F
There is cross hypersensitivity with aspirin and NSAIDS
TRUE
Food substances and ________ found in vasoconstrictors serve as triggers for Asthma
Sulfite preservatives
Sulfite preservatives found in vasoconstrictors are a problem when _____ is low
This produces _______, which precipitates an acute Asthma attack
Sulfite oxidase
Sulfite dioxide
Viruses, bacteria, fungi, and mycoplasma can cause _____ asthma
Infectious
If an inhaler is over-used, the structural change in the airway can cause a persistent Life-Threatening bronchospasm called…
*can last 24 hours
Status Asthmaticus
Asthma involves Expiratory Wheezing, and when finished a ________
Productive cough (thick, stringy mucous)
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 ___%
Trigger, one hour, 80%
2x/week, sleep, 80%
60%
Asthma and other respiratory diseases are treated with _______ stimulants,
adrenal _______
_______ altering meds
_____ cell inhibitors
Expectorants
Anti-tussives
Beta adrenergic stimulants
Glucocorticoids
Leukotriene altering
Mast cell
Tx mild intermittent asthma:
Mild persistent:
Moderate persistent:
Severe persistent:
Rescue bronchodilator
Anti-inflammatory + low dose inhaled corticosteroid, anti-leukotriene
Medium dose inhaled corticosteroid
Daily meds - high dose inhaled corticosteroid
T/F
Asthma is overtreated
False
*undertreated
The preferred therapy for mild persistent asthma is ________, but providers often disregard due to risk/benefit perceptions
Inhaled corticosteroids
T/F
There is a lot of uncontrolled asthma
True
Asthma pts: within the last year ___% have been hospitalized and another _____% have been to the ER/urgentCare
5%
14.4%
“Inhalers” are ______ stimulants
They target ______ receptors in the airway
Beta adrenergic
Beta 2
What beta adrenergic stimulant is in every dental office emergency kit?
Albuterol
What are 2 long-acting Beta adrenergic stimulants?
Salmeterol (Serevent, Diskus)
Salmeterol with fluticasone (Advair Diskus)
*fluticasone contains a steroid
2 dental considerations for pts using inhalers:
What else should you ask them?
Taste alters, candidiasis
How often use? - overuse and inhaler does not give good response
What is the older class of asthma drugs (beta adrenergic stimulant)?
Methylxanthines
When would pts be using Methylxanthines (older beta adrenergics) ?
Uncontrolled - they haven’t responded to newer drugs
Methylxanthines are a _______ drug in dentistry.
2 major DDI’s
RED flag
Antibiotics, systemic azole antifungals
Methylxanthines block _______ which increases ______
Major preparation:
Phophodiesterase, cAMP
*theophylline
Leukotrienes produce similar effects to _______
Itchy, runny nose, runny eyes
Histamine
Leukotriene drugs either inhibit the synth of leukotrienes - What drug?
Or - blocks leukotriene receptors - What drug?
Zileutron (Zyflo)
Monelukast (Singulair)
What is the drug of choice for reducing inflammation?
Used to reduce inflammation and decrease freq/severity of asthma attacks
Steroids - adrenal glucocorticoids
What is the first OTC intranasal steroid?
Triamcinolone acetonide (Nasacort)
Aside from immune dysfunction and delayed wound healing, what are 2 dental considerations of Steroids?
Candidiasis
Adrenal suppression if used chronically (then needs more steroids)
Mast cell inhibitors are used for ______ allergies and ________ asthma.
What is the preparation we need to know?
Seasonal, Exercise-induced
Cromolyn
What is the drug of choice for emphysema?
Anticholinergics
What 3 anticholinergics (emphysema drugs) do we need to know?
Aclidinium (Tudorza Pressair)
Ipratropium (Atrovent)
Tiotropium (Spiriva Handihaler)
Mouthbreathing, an asthma side effect, can lead to what 4 problems of craniofacial develpment?
Vaulted palate
Increased anterior facial height
Overjet
Crossbite
Asthma leads to what 4 oral considerations?
Xerostomia
Enamel erosion (reflux from meds)
Candidiasis
Headache
What 2 drugs should be avoided when a pt is on theophylline for Asthma?
Erythromycin
Ciprofloxacin
Opiates release _______, and therefore should be avoided in pts with Asthma
Histamine
If a pt has an asthma attack, give what 3 things?
Epinephrine
Oxygen
Bronchodilators
Chronic Bronchitis entails smooth muscle hyperplasia, excess sputum, and collapse of _______
Peripheral airways
Chronic bronchitis is _______ related
But can be seen in non smokers as recurrent infection
Smoking
“Blue Bloaters”
Chronic Bronchitis
What expectorant is used to manage Chronic Bronchitis?
Anti-tussive drug?
Guaifenesin (Mucinex, Robitussin)
Dextromethorphan (Delsym, Vicks 44)
How does dextromethorphan (anti-tussive for Chronic Bronchitis) work?
Depresses cough center in medulla
*kind of like morphine - narcotic properties
“Pink Puffers”
Emphysema
What destroys the alveolar walls in emphysema
Elastase from neutrophils
*as a response to smoking
The obstruction in emphysema is caused by the collapse of unsupported spaces upon ________
Expiration
*no obstruction on inspiration
What do clubbed fingers and toes suggest?
Emphysema - lack of oxygen
What is the class of drug used for Emphysema (drug of choice)?
Drug?
Anticholinergic
Ipratropium (Atrovent)
What is the mechanism of ipratropium (Atrovent)?
Anticholinergic - blocks acetylcholine in bronchial smooth muscle causing bronchodilation
4 drugs used for Emphysema:
Ipratropium (Atrovent) - anticholinergic
Beta adrenergic agonists
Oral/inhaled corticosteroids
Xanthines
How must a pt with COPD be seated?
Semi-reclining position
The “red flag drugs” for COPD’s are ______ antibiotics and _______ if taking theophylline
*toxicity severe in the latter
Macrolides
Ciprofloxacin
COPD: ______ supplementation may be necessary for pts taking long term steroids
If given too much ______, induce resp failure
______ monitoring advised
Adrenal
Oxygen
Pulse oximeter
Limit oxygen given to COPD pts to less than _______
3 L/min
*2-3 L/min
T/F
Avoid nitrous oxide with COPD
True
Antacids are _______
Weak bases
T/F
Antacids inhibit HCl production by parietal cells
False
*need HCl for digestion
3 Antacids (like Tums)
*tums causes what?
Aluminum hydroxide
Magnesium hydroxide
Calcium carbonate (tums)
*constipation
2 Magnesium antacid products
Milk of magnesia (OH bind with HCl in stomach)
Maalox - slow acting, silica absorbs H+
Aluminum antacids stops what?
Bleeding
*good for ulcers - coats/protects
What really old antacid forms complexes with albumin, fibrinogen, and glubulin on ulcers?
Sucralfate (Carafate)
What Histamine H2 Receptor Antagonist is preferred by gastrointerologists to address many symptoms of indigestion?
Zantac
What class of drugs binds to H+/K+ ATPase enzyme system in Parietal Cells?
Proton pump inhibitors
5 proton pump inhibitors:
Nexium
Prevacid
Prilosec
Protonix
Aciphex
What drug is indicated for Tx of NSAID induced GI lesions?
Nexium
How do antacids interfere with many drugs?
Neutralize pH - stops absorption
Histamine antagonists (in antacids) decrease ______ and alter_______
Antifungals
Warfarin
GI meds can cause what 5 oral side effects?
Xerostomia
Taste alteration (metallic)
Aphtous stomatitis
Candidiasis
Excessive salivation (vagus response to gastric acid in oral cavity)
Peptic ulcer disease peaks at 30-50, and is higher in smokers, drinkers, hyper_________, renal dialysis, and chronic use of _______
Hyperparathyroidism
NSAIDS
Peptic ulcers caused by:
Helicobacter pylori
*90%
T/F
H. Pylori is widespread throughout the animal kingdom
False
Humans only known hosts
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
Prostaglandins
Stomach (than the duodenum)
H. Pylori is associated with what cancer?
Lymphoma
*cancer of gastric mucosa
Chronic use of what drug can cause Atrophic Gastritis and Stomach Cancer?
Proton pump inhibitors
What is the present Tx for ulcer caused by H.pylori?
How long does Tx last?
Combo: Antibiotics + proton pump inhibitor
(Or petp bismol)
2 week Tx
4 antibiotics used in combination with either proton pump inhibitors or H2 receptor blockers for H.pylori?
Amoxicillin
Metronidazole
Clarithromycin
Tetracycline
Amoxicillin, clarithromycin, and one of the following:
Nexium, Prevacin, Protonix, Aciphex, or Priolosec
One week triple therapy for what?
Eradicate H.pylori and allow ulcer to heal
What is used if H.pylori is clarithromycin resistant?
Levofloxacin (Levaquin)
When treating pt with ulcer, avoid what 2 drugs?
Aspirin
NSAIDS
Macrolide antibiotics used to Tx H.pylori cause GI distress, use caution with what pts?
Inflammatory bowel disease
Pseudomembranous colitis = 3 antibiotics
Macrolides, cephalosporins, clindamycin
2 forms of IBS:
Ulcerative colitis is found where?
Crohn’s disease is found where?
Large intestine/rectum
Entire bowel
Crohn’s disease differs from Ulcerative Colitis in that it is _________
Autoimmune
1st line Tx for IBS:
2nd line:
3rd line:
Anti-inflammatories, corticosteroids
Immunosuppresives, antibiotics
Monoclonal antibody, surgery
There is risk of _______ suppression when using corticosteroids to combat IBS
Adrenal
Immunosuppressive drugs used to Tx IBS can cause blood dyscrasias and damage liver
True
T/F
Elective dental procedures only done in remission if pt has IBS
True
What is a unique oral manifestationof Crohn’s?
Aphthous ulcerations
Pepto-Bismol, aka….
Use caution if have _____ allergy
Bismuth subsalicylate
Salicylate
What causes constipation as a side effect and is sometimes prescribed for severe diarrhea?
prescription Drug?
Opioids
Lomotil
What drug relieves spasm and decreases gut motility - used for diarrhea
Loperamide (Imodium)
