2Pharm II Flashcards
1
Q
The Thyroid synthesizes ______ and ______ from ______
A
thyroxin (T4)
triiodothyronine (T3)
iodine
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
3
Q
Thyroid feedback loop: the hypothalamus secretes ______, the Anterior Pituitary secretes ______, and the Thyroid secretes _______
A
TRH
TSH
T4 and T3
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
5
Q
L-tyrosine is the precursor to ____ and _____
A
T4/T3 and epinephrine
6
Q
Without iodine, there is a build up in the TH precursor, resulting in ______
A
goiter
7
Q
What large glycoprotein integral to the synthesis of T4/T3 is NEVER secreted into the bloodstream?
A
Thyroglobulin
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
9
Q
What are the 2 synthetic thyroid preparations?
Which TH are they?
A
sodium levothyroxine (Synthroid, Levoxyl) T4
sodium liothyronin (Cytomel) T3
10
Q
Why is sodium liothyronine (T3) less preferred than sodium levothyroxine (T4)?
A
Absorption more erratic
11
Q
Synthroid is usually taken _____
It _____ the basal metabolic rate
A
in the morning/on an empty stomach
increases
12
Q
T/F
Synthroid promotes gluconeogenesis, mobilizes glycogen stores, and stimulates protein synthesis
A
True
13
Q
T/F
overuse of sodium levothyroxine (Synthroid) mimics hyperthyroidism and includes tachycardia, nervousness, increased appetite, and weight loss
A
True
14
Q
Hyperthyroidism, aka _____ disease
A
Grave’s
15
Q
The abuse of Synthroid is called _______ hyperthyroidism
A
Fictitious
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
17
Q
What are the side effects of propylthiouracil (iodination blocking drug for hyperthyroidism)?
A
Rash
Nausea
Agranulocytosis
18
Q
What therapy is used in conjuction with propylthiouracil to prepare pts for surgery?
A
Saturated solution Potassium Iodide
*mechanism unclear
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
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
21
Q
What is easier from a Dental management perspective - hypo or hyperthyroidism?
A
Hypothyroid
22
Q
In context of Dental considerations, Hypothyroid pts are more sensitive to what?
A
CNS depressants
*must lower dose of sedatives/opioids
23
Q
Hyperthyroid pts have an Absolute contraindication to what?
A
Epinephrine
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”
25
Type I Diabetes is an autoimmune disease that destroys ______ cells
Type II Diabetes occurs when ____ become blocked/insensitive
Beta (pancreatic)
insulin receptors
26
T/F
| In Type I Diabetes the body destroys the beta cells, but the receptors are just fine.
True
27
_____% of diabetes is type I
____ is the only effective drug in treating Type 1 diabetes
10%
Insulin
*long ago was called Juvenile Diabetes
28
T/F
| Insulin is a polypeptide, 5600 dalton mw, 2 chans connected by sulfide bridge
False
disulfide bridge
29
Older Insulin preparations came from cows/pigs, but this is no longer used because of ______ technology
recombinant
30
All insulins must be injected how?
SC
*although now we have a new inhalable form
31
In what 3 ways is insulin classified?
Onset
Peak
Duration
32
What are the 2 most popular insulins?
insulin Regular (HumuLIN R)
insulin Aspart (NovoLOG)
33
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)
34
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
35
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
36
It used to be that Type II diabetes was very rare before age ____
35
37
Why is there a lot of insulin in the blood of a Type 2 diabetic?
Target cells insensitive
38
What is the intervention for insensitive insulin target cells?
More insulin
*needed to get glc into cells
39
What is the outcome of Type 2 diabetes?
Hyperglycemia
40
T/F
| Tx for Type 2 diabetes is Oral drugs, non-pharmacological intervention (weight, exercise, diet), and insulin
True
41
If a Type 2 diabetic is taking insulin, the pt is most likely poorly controlled
True
42
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
43
5 Drug classes to treat Type2 diabetes:
Sulfonylureas
Biguanides
Alpha-glucosidase inhibitors
Thiazolidinediones (TZD's)
Incretins
44
What class of drugs promotes insulin release from pancreatic beta cells?
(type II intervention)
Sulfonylureas
45
The 2nd generation Sulfonylureas are more _____ but not more _____
potent
effective
46
What is a 1st generation Sulfonylurea?
*Tx Type II - promotes insulin release from beta cells
tolbutamide (Orinase)
*all end in "amide"
47
What is a 2nd generation Sulfonylurea?
glipizide (Glucotrol)
*all end in "ide"
48
What is the major distinction between 1st and 2nd generation Solfonylureas?
Potency
49
Sulfonylureas increase ______ mortality and are contraindicated in pts who are _______
Use caution in severe _____ disease
cardiovascular
allergic
hepatic
50
What is the main DDI to be concerned with when using Solfonylureas?
What does this drug do?
Aspirin
displaces sulfonylurea - resulting in hypoglycemia
51
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
52
What class of drugs is so well tolerated that it is regularly combined with other drugs?
What is the drug?
Biguanides
metformin (Glucophage)
53
metformin (Glucophage) has what 4 mechanisms?
Inhibit glc gut absorption
decrease hepatic glc production
increase insulin sensitivity at receptor
increase peripheral glc uptake/utilization
54
What drug is most effective at reducing glycemic level, creating fewer episodes of hypoglycemia, decreasing weight, reducing LDL, CV mortality, and Cancer?
metformin (Glucophage)
55
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
56
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
57
What class of drugs used to treat Type 2 diabets "resets" insulin receptors?
*improving target cell response/reducing insulin resistance
Thiazolidinediones
58
Name 2 Thiazolidinediones:
pioglitazone (Actos)
rosiglitazone (Avandia)
59
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
60
Thiazolidinediones like pioglitazone and rosiglitazone are contraindicates in what pts?
serious heart failure
| they increase the risk
61
What class of drugs better regulates the release of insulin but are pro-inflammatory and may cause pancreatic cancer?
Incretins
62
Incretins mimic _______ to stimulate insulin release
hormones
63
What are 2 types of Incretin
GLP-1 (Glucagon Like Peptide -1) receptor agonists
DPP-4 (dipeptydyl peptidase-4) inhibitors
64
What is the normal blood sugar range?
What is fasting blood glc?
70-120 mg/dL
70-110 mg/dL
65
What is the gold standard in measuring blood glc (and monitoring diabetics)?
glycated hemoglobin (HbA1c)
66
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%
67
American College of Physicians 1st intervention for TypeII diabetes?
If fails, ________
If hyperglycemia persists, _______
lifestyle mods
metformin
more drugs
68
T/F
The endocrinologists algorithm suggests obesity management to lower glc and CV risk factor modification and glycemic controls
True
69
Natural estrogen is a steroid produced by the ovary, aka...
estradiol
70
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
71
Estrogen Replacement Drugs are of what 3 types?
Conjugated equine estrogens
Esterified estrogens
Estradiol preps
72
Conjugated equine estrogen:
This treats the ______ symptoms of menopause
It also might prevent _______
Premarin
vasomotor
bone loss (osteoporosis)
73
4 common side effects of Premarin:
Peripheral edema
Breast tenderness
Bloating
Headache
74
A serious side effect of Premarin if you have an intact uterus:
May also increase _____ cancer
Increased risk for endometrial (uterine) cancer)
breast
75
What are 2 Esterified Estrogens?
How are they different from Premarin (conjugated estrogen)?
Estratab
Menest
1/2 dose - 0.3mg daily
76
```
T/F
Esterified Estrogens (Estratab, Menest) have the same effects as Premarin (conjugated estrogen)
```
True
77
Estrogen + progesterone =
adding progesterone does what?
Prempro
reduces risk of endometrial cancer
78
What is Prempro used for?
This is a combo of what 2 drugs?
menopause/osteoporosis
Premarin, Provera
*estrogen, medroxyprogesterone
79
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
80
Estrogen in combo with progestin may increase the risk of _________
*this outweighs long term use to prevent ________
stroke
osteoporosis
81
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
82
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
83
HRT (estrogen) is used on a ______ term basis to treat menopause, usually less than ____ years
short
5
84
Progesterone is a _____ produced by the _______.
It induces the secretory _______, affects uterine mobility, and cervical ______
steroid
corpus luteum
endometrium
mucous
85
Progesterone prevents the buildup of the ______
endometrial lining
86
Aside from contraception, Progesterone can be used to treat _______ and _______
endometriosis
menstrual disorders
87
Oral progesterone must be modified to be taken orally - what are 2 of them?
norethindrone (contraceptives)
medroxyprogesterone (Provera)
88
medroxyprogesterone (Provera) is used to treat what 3 things?
Abnormal uterine bleeding
secondary amenorrhea
endometrial cancer
89
Testosterone is a steroid that must be _____ before taken orally
methylated
90
Testosterone 4 Tx's:
Delayed male puberty
Hypogonadism
Inoperable female breast cancer
Libido loss postmenopausal women
91
T/F
| Male "menopause" beginning in 4th or 5th decades may be treated with testosterone, synthetic androgens, or estrogens
True
92
T/F - testosterone levels
250-800 mg/dl for men
15-40 ng/dl for women
0-20 ng/dl for postmenopausal women
True
93
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
94
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
95
What syndrome entails both symptoms and biochemical evidence of T deficiency?
Hypogonadism
96
Testosterone is linked to the ______ of the male population and is a biomarker for occult diseases like atherosclerosis, _____, and early death
general health
cancer
97
Testosterone decreases fat, increases muscle, improves libido - and what 3 blood/diabetic/heart disease factors?
insulin resistance
Ha1C
lipid profiles
98
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
99
T can be administered many ways - including buccal which causes edema, irritation, and _____
dysgeusia
| taste perversion
100
T/F
| There is evidence that supports testosterone use for women
False
*no benefits as HRT
101
When can T be used for women?
postmenopausal hypoactive sexual desire
102
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
103
What can be given for moderate to severe vasomotor symptoms associated with menopause (when not improved by estrogens alone)
Estrogen + methyltestosterone
104
What has more anabolic effects and no androgenic effects?
Anabolic steroids
105
Anabolic steroids can increase muscle mass by ____%
30
106
Oral contraceptives contain both _____ and _______
Estrogen
Progestin
*99% effective
107
Oral contraceptives are usually taken days ____ through ____ of the menstrual cycle, the other 7 days a _____ is taken
5
25
placebo
108
Most contraceptive preparations are ______, but some are ________ (in case of Plan B, etc)
sequential
single entity
109
The morning after pill (Plan B) is _______ alone
Estrogen
110
What is used for rape/incest cases?
DES - diethyl stilbestrol
111
RU-486 is a progesterone ______ called mifepristone (Mifeprex) for the medical termination of pregnancy
antagonist
112
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
113
Depo Provera contains only....
synthetic progesterone
114
T/F
| The patch contraceptive is a more concentrated dose and therefore has more risks
True
115
What is the mechanism of action for Oral Contraceptives?
Inhibit ovulation
116
How do Oral Contraceptives inhibit ovulation?
2 ways!!!
estrogen - inhibits FSH - no ovulatory stimulation
progesterone - inhibits LH
117
What is the function of Progesterone?
alters endometrium development
118
T/F
| OC's mimic the effect of pregnancy on the gingiva
True
119
How can antibiotics mess with OC's?
No Flora to activate the OC Prodrug
120
What is the ADA recommendation for women on OC's taking antibiotics?
Alternative birth control until next cycle
*although very rare
121
What 6 antimicrobials do NOT affect OC steroid levels when taken in combo?
tetracycline
doxycycline
ampicillin
metronidazole
fluconazole
fluoroquinolones
122
What class of drugs is good for bones and lowers the rates of breast cancer?
SERMS - selective estrogen receptor modulators
*designer estrogens
123
Name 3 bisphosphonates
Fosamax
Actonel
Boniva
124
What SERM activates estrogen receptors in bone but not the breast?
*women w/ osteoporosis at risk for breast cancer
raloxifene (Evista)
125
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
126
What are the 2 most common side effects of raloxifene (Evista)?
hot flashes
leg cramps
127
What are the best available bone building drugs?
What is their primary mechanism?
Bisphosphonates
inhibit osteoclasts
128
The low dose form of Bisphosphonate is for ______
The high dose form is for ______
osteoporosis
bone cancer
129
T/F
| Bisphosphonates have good bioavailability and can be taken with food.
False
poor bioavailability - must take on empty stomach (morning)
130
The 3 main side effect of bisphosphonates:
oral complication:
***Erosive esophagitis
headache
GI distress
oral: Osteonecrosis of the jaw
131
Most cases of jaw necrosis in pts taking Bisphosphonates are associated with _______ combined with ______
chemo
steroids
132
What drug for osteoporosis has the greatest effect in pts with a rapid bone turnover?
Calcitonin (Miacalcin)
133
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
134
What drug stimulates osteoblasts and increases GI and kidney absorption of Calcium?
teriparatide (Forteo)
135
Anything ending in _____ messes with the immune system
...mab
136
What new osteoporosis drug is a Monoclonal Antibody and NOT a bisphosphonate?
denosumab (Prolia, Xgeva)
137
Thought denosumab (Prolia, Xgeva) isn't a bisphosphonate, it causes what?
osteonecrosis of the jaw
138
denosumab is injected 60mg every 6 months and blocks osteoclasts by getting between _____ and _______
RANKL and RANK
139
T/F
| denosumab leads to decreased bone resorption and increased bone mass
True
140
T/F
| Calcium supplements should begin over 51 and not exceed 2500 mg and has never been shown to reduce fracture
True
141
What increases bone mass, decreases fracture rates, decreases PTH, and potentiall increases bone formation?
ergocalciferol
| vitamin D2; calciferol
142
Vitamin D test (fall/winter months) should be between ___ and ____ ng/mL
30
74
143
2 Vitamin D supplements and whence they were derived:
D2 = ergocalciferol (fungus)
D3 = cholecalciferol (animals - lanolin)
144
Which Vitamin D supplement is more effective (longer half life)
D3 = cholecalciferol
145
Hormones are produced by _____ glands
ductless
146
Only hypothalamic releasing hormone used as a drug:
Used for:
Analog drug:
GnRH (gonadotropin releasing hormone)
primary amenorrhea - ovulation induction
comiphene (Clomid) - ovulatory stimulant
147
GnRH stimulates what 2 hormones in the pituitary?
LH
FSH
148
GnRH is used for ______ in men
idiopathic hypogonadism
| achieves spermatogenesis
149
ACTH from the Anterior Pituitary is used as a _______
diagnostic tool
| adrenal dysfunction
150
GH is the least abundant drug found in the Ant Pituitary
False
*most abundant
151
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
152
TSH is used as a diagnostic tool to differentiate between what?
preparation comes from ____ sources
pituitary and primary hypothyroidism
bovine
153
FSH promotes development of _____ in women and maintains _____ in men
Structurally it is a _____
ovarian follicles, spermatogenesis
glycoprotein
154
LH is a glycoprotein that induces ______ and regulates ______ in women and _____ in men
ovulation
progesterone secretion
testosterone secretion
155
What are the 2 Non-pituitary gonadotropins?
HMG - human menopausal gonadotropin (TWINS)
HCG - human chorionic gonadotropin
156
Aside from the pregnancy test, HCG is used to induce _______ and stimulate _______ of the testes to secrete ______
ovulation
interstitial cells
androgen (cryptorchidism)
157
What are the 2 Posterior Pituitary hormones?
Vasopressin (ADH)
oxytosin (Pitocin)
*similar chemicals and cross-over at high doses
158
What is the hormonal form of vitamin D
Calcitriol
159
What calcium regulating hormone does the Thyroid produce?
Calcitonin (thyrocalcitonin)
160
Calcitonin decreases plasma calcium and ________
phosphate
*treats hypercalcemia in medical setting
161
What is formed in the skin when exposed to UV light?
Vita D3 (cholecalciferol)
162
Compared to PTH, vitamin D exerts a _______ regulatory effect on calcium balance
slower
163
Vitamin D preparation
ergocalciferol
D2; calciferol
164
Increasing Vitamin D decreases ____ cancer
Decreasing VitaD increases _____, _____. _____ cancers
colon
prostate, breast, ovarian
165
Low sun exposure is associated with increased _________ diabetes
Type I
166
T/F
| Hypertension increases with distance away from equator
True
167
Oxygen saturation is measured with a ______
pulse oximeter
168
Infections, Sinusitis, and Common cold are in the ______
Asthma, bronchitis, and emphysema are in the ______
Upper resp tract
lower resp tract
169
Sinusitis refers pain where?
teeth
170
Acute bacterial Sinusitis must be persistent for ____ days and have a purulent nasal discharge in the first _____ days
10
3-4
171
Most cases (98%) of Acute Rhinosinusitis are _____
***What is prescribed for this?
viral
***amoxicillin-clavulanate (Augmentin)
172
Tx Acute Rhinosinusitis, if allergic to penicillin (amoxicillin-clavulanate), use ______ or ______
levofloxacin
clindamycin
(then doxy)
173
Avoid ______ and _____ with Acute Rhinosinusitis
decongestants
antihistamines
174
Four drug classes for Sinusitis/Allergic Rhinitis
Pseudoephedrine
Antihistamines
Analgesics
Antibiotics
175
Decongestants tend to be ________, therefore use epi with caution
Sympathomimetics
176
What is the new "dry" nasal aerosol corticosteroid?
QNASL Nasal Aerosol (beclomethasone dipropionate)
177
Asthma and ______ are the 2 major types of inadequate alveolar ventilation.
COPD
178
What are 3 types of COPD?
Chronic bronchitis
Emphysema
Neoplastic diseases
179
Asthma is a recurrenct bronchial ________ spasm involving _______ of the bronchial mucosa and hypersecretion of ________
Smooth muscle
Inflammation
Mucous
180
The most common form of asthma is _______
Extrinsic
181
There is a _______ relationship between allergen and ______ mediated sensitization in Asthma
Dose response relationship
IgE
182
T/F
Asthma = IgG + Mast cells
(In bronchial tree)
False
IgE
183
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
184
Intrinsic Asthma represents ____% of cases
30%
185
Intrinsic asthma is seldom related to family Hx, pts aren't responsive to skin testing, they have ____ IgE, are usually ____ aged
Normal
Middle
186
Intrinsic asthma is associated with what 2 factors?
Emotional stress
GERD
187
T/F
| Asthma can be drug induced
True
188
If a pt has asthma, there is a ___% chance they will be hypersensitive to aspirin
5-15%
189
What is the Aspirin Hypersensitivity Triad?
Aspirin hypersensitivity
Asthma
Nasal polyps
190
Aspirin allergy mechanism inhibits bronchodilating ______ and forms _______, which are bronchoconstrictors
PGE2
Leukotrienes
191
What drug is contraindicated for Asthma?
Aspirin
192
Allergic rxn with aspirin mimics what?
Asthma attack
193
T/F
| There is cross hypersensitivity with aspirin and NSAIDS
TRUE
194
Food substances and ________ found in vasoconstrictors serve as triggers for Asthma
Sulfite preservatives
195
Sulfite preservatives found in vasoconstrictors are a problem when _____ is low
This produces _______, which precipitates an acute Asthma attack
Sulfite oxidase
Sulfite dioxide
196
Viruses, bacteria, fungi, and mycoplasma can cause _____ asthma
Infectious
197
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
198
Asthma involves Expiratory Wheezing, and when finished a ________
Productive cough (thick, stringy mucous)
199
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%
200
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
201
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
202
T/F
| Asthma is overtreated
False
*undertreated
203
The preferred therapy for mild persistent asthma is ________, but providers often disregard due to risk/benefit perceptions
Inhaled corticosteroids
204
T/F
| There is a lot of uncontrolled asthma
True
205
Asthma pts: within the last year ___% have been hospitalized and another _____% have been to the ER/urgentCare
5%
14.4%
206
"Inhalers" are ______ stimulants
They target ______ receptors in the airway
Beta adrenergic
Beta 2
207
What beta adrenergic stimulant is in every dental office emergency kit?
Albuterol
208
What are 2 long-acting Beta adrenergic stimulants?
Salmeterol (Serevent, Diskus)
Salmeterol with fluticasone (Advair Diskus)
*fluticasone contains a steroid
209
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
210
What is the older class of asthma drugs (beta adrenergic stimulant)?
Methylxanthines
211
When would pts be using Methylxanthines (older beta adrenergics) ?
Uncontrolled - they haven't responded to newer drugs
212
Methylxanthines are a _______ drug in dentistry.
2 major DDI's
RED flag
Antibiotics, systemic azole antifungals
213
Methylxanthines block _______ which increases ______
Major preparation:
Phophodiesterase, cAMP
*theophylline
214
Leukotrienes produce similar effects to _______
| Itchy, runny nose, runny eyes
Histamine
215
Leukotriene drugs either inhibit the synth of leukotrienes - What drug?
Or - blocks leukotriene receptors - What drug?
Zileutron (Zyflo)
Monelukast (Singulair)
216
What is the drug of choice for reducing inflammation?
| Used to reduce inflammation and decrease freq/severity of asthma attacks
Steroids - adrenal glucocorticoids
217
What is the first OTC intranasal steroid?
Triamcinolone acetonide (Nasacort)
218
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)
219
Mast cell inhibitors are used for ______ allergies and ________ asthma.
What is the preparation we need to know?
Seasonal, Exercise-induced
Cromolyn
220
What is the drug of choice for emphysema?
Anticholinergics
221
What 3 anticholinergics (emphysema drugs) do we need to know?
Aclidinium (Tudorza Pressair)
Ipratropium (Atrovent)
Tiotropium (Spiriva Handihaler)
222
Mouthbreathing, an asthma side effect, can lead to what 4 problems of craniofacial develpment?
Vaulted palate
Increased anterior facial height
Overjet
Crossbite
223
Asthma leads to what 4 oral considerations?
Xerostomia
Enamel erosion (reflux from meds)
Candidiasis
Headache
224
What 2 drugs should be avoided when a pt is on theophylline for Asthma?
Erythromycin
Ciprofloxacin
225
Opiates release _______, and therefore should be avoided in pts with Asthma
Histamine
226
If a pt has an asthma attack, give what 3 things?
Epinephrine
Oxygen
Bronchodilators
227
Chronic Bronchitis entails smooth muscle hyperplasia, excess sputum, and collapse of _______
Peripheral airways
228
Chronic bronchitis is _______ related
| But can be seen in non smokers as recurrent infection
Smoking
229
"Blue Bloaters"
Chronic Bronchitis
230
What expectorant is used to manage Chronic Bronchitis?
Anti-tussive drug?
Guaifenesin (Mucinex, Robitussin)
Dextromethorphan (Delsym, Vicks 44)
231
How does dextromethorphan (anti-tussive for Chronic Bronchitis) work?
Depresses cough center in medulla
*kind of like morphine - narcotic properties
232
"Pink Puffers"
Emphysema
233
What destroys the alveolar walls in emphysema
Elastase from neutrophils
*as a response to smoking
234
The obstruction in emphysema is caused by the collapse of unsupported spaces upon ________
Expiration
*no obstruction on inspiration
235
What do clubbed fingers and toes suggest?
Emphysema - lack of oxygen
236
What is the class of drug used for Emphysema (drug of choice)?
Drug?
Anticholinergic
Ipratropium (Atrovent)
237
What is the mechanism of ipratropium (Atrovent)?
Anticholinergic - blocks acetylcholine in bronchial smooth muscle causing bronchodilation
238
4 drugs used for Emphysema:
Ipratropium (Atrovent) - anticholinergic
Beta adrenergic agonists
Oral/inhaled corticosteroids
Xanthines
239
How must a pt with COPD be seated?
Semi-reclining position
240
The "red flag drugs" for COPD's are ______ antibiotics and _______ if taking theophylline
*toxicity severe in the latter
Macrolides
Ciprofloxacin
241
COPD: ______ supplementation may be necessary for pts taking long term steroids
If given too much ______, induce resp failure
______ monitoring advised
Adrenal
Oxygen
Pulse oximeter
242
Limit oxygen given to COPD pts to less than _______
3 L/min
*2-3 L/min
243
T/F
| Avoid nitrous oxide with COPD
True
244
Antacids are _______
Weak bases
245
T/F
| Antacids inhibit HCl production by parietal cells
False
*need HCl for digestion
246
3 Antacids (like Tums)
*tums causes what?
Aluminum hydroxide
Magnesium hydroxide
Calcium carbonate (tums)
*constipation
247
2 Magnesium antacid products
Milk of magnesia (OH bind with HCl in stomach)
Maalox - slow acting, silica absorbs H+
248
Aluminum antacids stops what?
Bleeding
*good for ulcers - coats/protects
249
What really old antacid forms complexes with albumin, fibrinogen, and glubulin on ulcers?
Sucralfate (Carafate)
250
What Histamine H2 Receptor Antagonist is preferred by gastrointerologists to address many symptoms of indigestion?
Zantac
251
What class of drugs binds to H+/K+ ATPase enzyme system in Parietal Cells?
Proton pump inhibitors
252
5 proton pump inhibitors:
Nexium
Prevacid
Prilosec
Protonix
Aciphex
253
What drug is indicated for Tx of NSAID induced GI lesions?
Nexium
254
How do antacids interfere with many drugs?
Neutralize pH - stops absorption
255
Histamine antagonists (in antacids) decrease ______ and alter_______
Antifungals
Warfarin
256
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)
257
Peptic ulcer disease peaks at 30-50, and is higher in smokers, drinkers, hyper_________, renal dialysis, and chronic use of _______
Hyperparathyroidism
NSAIDS
258
Peptic ulcers caused by:
Helicobacter pylori
*90%
259
T/F
| H. Pylori is widespread throughout the animal kingdom
False
Humans only known hosts
260
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)
261
H. Pylori is associated with what cancer?
Lymphoma
*cancer of gastric mucosa
262
Chronic use of what drug can cause Atrophic Gastritis and Stomach Cancer?
Proton pump inhibitors
263
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
264
4 antibiotics used in combination with either proton pump inhibitors or H2 receptor blockers for H.pylori?
Amoxicillin
Metronidazole
Clarithromycin
Tetracycline
265
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
266
What is used if H.pylori is clarithromycin resistant?
Levofloxacin (Levaquin)
267
When treating pt with ulcer, avoid what 2 drugs?
Aspirin
NSAIDS
268
Macrolide antibiotics used to Tx H.pylori cause GI distress, use caution with what pts?
Inflammatory bowel disease
269
Pseudomembranous colitis = 3 antibiotics
Macrolides, cephalosporins, clindamycin
270
2 forms of IBS:
Ulcerative colitis is found where?
Crohn's disease is found where?
Large intestine/rectum
Entire bowel
271
Crohn's disease differs from Ulcerative Colitis in that it is _________
Autoimmune
272
1st line Tx for IBS:
2nd line:
3rd line:
Anti-inflammatories, corticosteroids
Immunosuppresives, antibiotics
Monoclonal antibody, surgery
273
There is risk of _______ suppression when using corticosteroids to combat IBS
Adrenal
274
Immunosuppressive drugs used to Tx IBS can cause blood dyscrasias and damage liver
True
275
T/F
| Elective dental procedures only done in remission if pt has IBS
True
276
What is a unique oral manifestationof Crohn's?
Aphthous ulcerations
277
Pepto-Bismol, aka....
Use caution if have _____ allergy
Bismuth subsalicylate
Salicylate
278
What causes constipation as a side effect and is sometimes prescribed for severe diarrhea?
prescription Drug?
Opioids
Lomotil
279
What drug relieves spasm and decreases gut motility - used for diarrhea
Loperamide (Imodium)
