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HD & T SG > Final > Flashcards

Final Flashcards

1
Q

What are two common causes of acute cholecystitis?

A

Gallstones and Obstruction

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2
Q

What percentage of the population in the US can become chronic cholecystitis patients?

A

10-20%

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3
Q

In cholecystitis patients, most gallstones are made of what?

A

Cholesterol

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4
Q

5 types of Liver diseases

A 
Fatty Liver
Hepatitis
Biliary Disease
Metabolic disease
Vascular
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5
Q

What can liver diseases lead to?

A

Cirrhosis

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6
Q

What is fatty liver caused by?

A

ETHOH, obesity and diabetes Mel.

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7
Q

What is hepatitis caused by?

A

virus, drug or autoimmune

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8
Q

What three things is the liver made of?

A

hepatocytes, duct cells and blood vessels

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9
Q

What does all the metabolic work of the liver?

A

Hepatocytes

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10
Q

What three things does the portal tract contain?

A

Bile ducts, portal veins, hepatic artery

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11
Q

What is the #1 cause of liver toxicity?

A

Drugs

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12
Q

What happens if hepatocytes die in large sheets?

A

the areas fill up with blood. Blood can build up due to heart failure and backflow

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13
Q

What happens if cannuliculi in liver fill with bile due to cholestasis?

A

Jaundice

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14
Q

Why do dentists need to be careful with Hepatitis patients?

A

If caused by viruses, it can be contagious

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15
Q

What is Hepatitis?

A

Inflammation of the liver

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16
Q

Acute hepatitis is cause by which two viruses?

A

A and E

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17
Q

Which kind of hepatitis can resolve itself?

A

Acute

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18
Q

Which hep viruses start acute and frequently progress to chronic and can lead to cirrhosis and even hepatocellular carcinoma?

A

B and C

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19
Q

Acute hepatitis lasts for less than:

A

6 months

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20
Q

(T or F) There is fibrosis in acute hepatitis patients

A

False

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21
Q

Hepatitis C is commonly transmitted by:

A

Blood and Needles

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22
Q

(T or F) In hep c, there are rarely symptoms in the acute stages

A

True

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23
Q

Which Hepatitis virus is more common in China, less common in the United States?

A

C

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24
Q

Are there immunizations available for Hepatitis C?

A

No

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25
Q

What is the most effective treatment for Hep C?

A

combination of antivirals (usually including ribavirin)

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26
Q

How is Hep B transmitted?

A

Blood and Needles

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27
Q

(T or F) Heb B rarely becomes chronic

A

False

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28
Q

What percentage of the population is infected with Hepatitis B?

A

2-10%

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29
Q

Hep C virus is found in how many carriers worldwide?

A

> 170 Million

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30
Q

What percentage of hepatocellular carcinoma are associated with Hep. B viral infections?

A

Half

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31
Q

What is Cirrhosis?

A

regenerative hepatocyte nodules; fibrosis surrounding nodules

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32
Q

Who is autoimmune hepatitis typically found in?

A

obese middle-aged females

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33
Q

Autoimmune hepatitis typically responds well to:

A

Steroids

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34
Q

In fatty liver patients, what color does the liver turn?

A

Yellow

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35
Q

What is steatosis?

A

fat accumulation in the liver that is temporary, with no cellular damage

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36
Q

What is steatohepatitis?

A

damage to the liver with fibrosis present (chronic)

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37
Q

What is Metabolic disease often associated with?

A

Iron overloads

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38
Q

What causes Wilson’s disease?

A

copper metabolic defect goes to hepatitis then cirrhosis

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39
Q

What is Biliary disease?

A

Destruction of bile ducts, bile backs up into the liver and causes inflammatory cells to surround ducts—may form granulomas

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40
Q

Why at very high blood concentrations normal kinetic properties of a drug or toxin can change?

A

metabolism and protein binding become saturated and elimination become a zero order pattern

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41
Q

How the apparent volume of distribution for drug or toxin determine the effectiveness of hemodialysis at purifying them from the blood?

A

a large Vd implies a substance will not be easily accessible to purification attempts.

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42
Q

What is the difference between bioaccumulation and biomagnification?

A
  • bioaccumulation: accumulation of a toxic agent when administration of the drug exceeds the body’s ability to metabolize and elimination
  • biomagnification: increases of toxin in a biological system as it passes up the food chain.
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43
Q

What defines some metals as “heavy”?

A

naturally occurring elements with high atomic weight and a density 5-times greater than water.

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44
Q

What are the most toxic substances?

A

lead (#1), mercury (#2) and arsenic (#3)

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45
Q

Heavy metals interfere with normal biological processes how?

A

By competing with normal substrates

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46
Q

The shorter the t1/2 the (more/ less) effective is the use of chelators to remove the heavy metal

A

More

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47
Q

What are the primary exposure sources of lead?

A

building materials/construction, batteries, lead pipes, paint

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48
Q

Why is lead exposure particularly detrimental to young children?

A

They often eat or suck on things that contain lead, such as things covered with lead paint, dirt etc.

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49
Q

What substance in a child’s body does lead compete with?

A

Their bodies absorb because lead competes with CALCIUM, and growing bodies require considerable Ca.

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50
Q

What percentage of lead does a child absorb as opposed to an adult?

A

Children absorb >50% consumed whereas adults absorb ~10-15%

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51
Q

What are the toxicokinetics of lead?

A

t1/2 = 1-2 months

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52
Q

Symptomology of lead?

A

Headaches, neurocognitive deficits, kidney damage

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53
Q

What is the main repository in the body for its lead burden?

A

It substitutes for Ca++ in bone

54
Q

What are Burtonian lines?

A

Lead lines causing a darkening of the gingiva

55
Q

What two things can lead cause in the body?

A

Anemia, immunosupression

56
Q

What is the most sensitive target organ for lead poisoning?

A

The developing CNS-can lead to encephalopathy

57
Q

What can lead cross in the body?

A

BBB and concentrates in gray matter, can cross placenta

58
Q

What is the treatment regimen for lead toxicity, particularly the recommended chelators?

A

Remove exposure
Administer a chelator such as EDTA (edetate calcium disodium). It removes Pb from bone slowly and requires multiple chelating treatments

59
Q

(T or F) Mercury is solid at room temperature

60
Q

What is the primary form of mercury used?

A

methylHg form

61
Q

What are the primary exposure sources of mercury?

A

Found in fish
Amalgam (no CDC-recognized evidence that it is a problem in dentistry)
thermometers

62
Q

What is the mechanism of mercury toxicity?

A

Reacts with selenium (necessary for reducing oxidized Vitamin C and E)
Can cause gingivostomatitis
Inhibits enzymes
Acute tubular necrosis

63
Q

What do we know about mercury symptomology?

A

Can cause neurological, psychiatric problems

64
Q

What were the CDC’s conclusions regarding mercury exposure related to (a) thimerosal in influenza vaccines and (b) dental amalgam?

A

No convincing evidence that quantities of mercury from either source is significantly high to cause problems.

65
Q

What is the treatment regimen for mercury toxicity, particularly the recommended chelators?

A

Dimercaprol (can only use acutely), succimer

66
Q

Why is dimercaprol contraindicated in chronic mercury intoxication scenarios?

A

Chronic use of dimercaprol can cause serious renal toxicity

67
Q

What are the primary exposure sources of arsenic?

A

industrial contamination

groundwater contamination

68
Q

What do we know about the toxicokinetics of arsenic?

A
  • absorbed through respiratory mucosa and GI tract, but not so much through the skin
  • excreted primarily through the kidney
69
Q

What do we know about the symptomology of arsenic?

A

Fatigue, anemia, renal failure, hyperpigmentation
Peripheral neuropathy
Carcinogenic in lungs, skin and bladder
Hemolytic on RBC

70
Q

What is the mechanism of arsenic toxicity?

A 
Increases ROS (reactive oxygen species)
Binds to sulfhydryl groups in keratinized tissue, where it is acts as a depot
Inhibits enzymes
Hemolytic action on RBCs
Can be carcinogenic on lung and skin.
71
Q

How does the treatment regimen, including the use of chelators (e.g., Unithiol or dimercaprol), differ for acute or chronic arsenic intoxication?

A

Chelators are useful for acute, but not chronic

72
Q

How do chelators work on heavy metals?

A

They render heavy metal ions unavailable for covalent interactions

73
Q

How does the half-life of the heavy metal affect the ability of a chelator to remove it from a target organ?

A

The longer the t1/2, the less effective is the chelator

74
Q

Is it better to treat with chelators quickly or take a wait and see approach when an exposure has occurred?

A

Usually most effective when treated ASAP

75
Q

What is FDA-approved for use as monotherapy in heavy metal poisonings?

A

Dimercaprol

76
Q

Why should dimercaprol not be given as a monotherapy after chronic exposure to lead?

A

It pulls Pb from bone and it goes to brain and causes toxicity

77
Q

How does dimercaprol’s therapeutic index compare to succimer or unithiol?

A

It can be very toxic, especially on kidneys—succimer has for most part replaced dimercaprol

78
Q

What is Succimer?

A

water-soluble form of dimercaprol

79
Q

What is succimer’s main mechanism for removing heavy metals?

A

Binds to cysteine to form mixed disulfides which are excreted

80
Q

What is the half-life of succimer?

81
Q

What is succimer’s only route of administration?

82
Q

Which is safer, succimer or dimercaprol?

83
Q

Edetate Calcium Disodium (CaNa2-EDTA) is FDA-approved for which heavy metal poisonings ?

84
Q

Does CaNa2-EDTA target intracellular or extracellular lead?

A

Extracellular

85
Q

What is only route of administration?

86
Q

What is ‘s half life?

87
Q

How is CaNa2-EDTA excreted?

A

100% by the kidneys

88
Q

In which patient population is CaNa2-EDTA contraindicated?

A

anuric patients

89
Q

Unithiol is a water soluble derivative of what other chelator?

A

Dimercaprol

90
Q

What are the routes of administration for unithiol?

A

Orally or i.v.

91
Q

Half life of unithiol?

92
Q

Is unithiol FDA approved for treatment of heavy metal poisonings?

93
Q

Pure Food and Drug Act

A

caused by addiction to opium and cocaine; requires labeling, patent medicines

94
Q

Modified Food, Drug and Cosmetic Act

A

required safety; caused by diethyleneglycol tragedy

95
Q

Durham-Humphrey Amendment

A

Rx vs. OTC

96
Q

Kefauver-Harris Amendment

A

phocomelia caused by thalidomide tragedy; requires safety and efficacy

97
Q

Dietary Supplement Health and Education Act

A

regulates herbal products; defines herbal products as “foods”

98
Q

What is the distinction between prescription and OTC drugs?

A

Addiction/abuse liability
Relative safety
Intent of use-does it require professional input/control

99
Q

What things does the FDA regulate?

A

Foods, dietary supplements, bottled water, food additives, drugs, biologics, medical devices, cosmetics, veterinary products, tobacco products, advertising of these products.

100
Q

What are the phases of drug testing?

A

Animal preclinical testing: controlled by IACUC (institutional animal care committee)

Phase I: small group of healthy (usually) subjects to test safety, doses, administration and other kinetics

Phase II: small group of subjects with condition to be treated to test safety (still) and efficacy

Phase III: extended clinical phase- large group of subjects, using double blind construct, placebos and multi-sites groups to test for statistical efficacy

Marketing (‘phase 4’): see how the product does in production

101
Q

What are the non-prescription drug categories?

A

I (safe and effective), II (unsafe or ineffective), III (not sure—requires more studies)

102
Q

Three types of decongestants

A

Oxymetazoline
Phenylephrine
Pseudophedrine (restricted sales)

103
Q

What is the difference between systemic and topical decongestants?

A

systemic (increase BP, but longer acting decongestant) vs. topical (less systemic problems, but more likely to cause dependence-tolerance; shorter acting but more effective as decongestant).

104
Q

3 types of antihistamines

A
  • Diphenhydramine (drowsiness)
  • Chlorpheniramine (Chlor-Trimeton)
  • Loratidine (Claritin) less drowsiness
105
Q

3 types of Antitussives

A
  • Codeine
  • Diphenhydramine
  • Dextromethorphan
106
Q

What is a common expectorant?

A

Guaifenesin

107
Q

What are Demulcents?

A

cough drops/syrupy products; coat the throat to reduce irritation

108
Q

What is the benefit of Water/humidification?

A

decrease viscosity of respiratory secretions

109
Q

Do Antivirals benefit colds?

A

shortens infection for 1-2 d if taken early

110
Q

3 common antivirals

A
  1. Oseltamivir (Tamiflu-not OTC)
  2. Zanamivir (Relenza-not OTC)
  3. Docosanol (Abreva)- cold sores (Herpes)-antiviral
111
Q

4 Analgesics

A
  • Aspirin
  • Acetaminophen
  • Ibuprofen
  • Naproxen
112
Q

What is used to treat cold sores?

113
Q

What is Phenol?

A

Oral Anesthetic

114
Q

What are the side effects of nicotine?

A

dizziness, headaches, nausea

115
Q

What is an antifungal used for vaginal infections?

A

Miconazole

116
Q

What are Diphenhydramine and Doxylamine?

A

antihistamine, sleep aid

117
Q

What is a first said antibiotic, preventive on minor abrasions

A

Neosporin/Polysporin

118
Q

What is hydrocortisone used for?

A

(anti-inflammatory, anti-itching) dermal lesions, eczema, insect bites, poison ivy

119
Q

What is Capsaicin?

A

(pain-relief); topical ointment, TRPV channels

120
Q

Name 2 anticholinergics, used for motion sickness

A

Scopolamine, Dimenhydrinate

121
Q

What are some side effects of Dimenhydrinate?

A

dry mouth, constipation, difficulty, blurred vision, reduced urinating

122
Q

What is Minoxidil for?

A

hair growth

123
Q

Herbal Products (can/ cannot) be promoted to diagnose, cure or prevent disease

124
Q

St. John’s Wort

A

Promoted to treat depression

125
Q

Echinacea

A

Promoted to treat colds, although controversial

126
Q

Aloe Vera

A

Promoted for skin care-help with wound healing

Dietary supplement to treat constipation

127
Q

Cranberry

A

Used to prevent urinary tract infection

128
Q

Garlic

A

Slowly lowers cholesterol (minor effect)

Some thinning of blood

129
Q

Ginko

A

Promoted to improve memory

Can increase bleeding risk

130
Q

Ginseng

A

Boost immune system

May lower blood sugar

131
Q

Ephedra

A

Sympathomimetic: contains ephedrine
Used for anorexia and stimulant effects
FDA require removal from most OTC products, although still will occasional seen in an herbal preparations

HD & T SG (12 decks)

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