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Human Disease And Therapeutics > Final > Flashcards

Final Flashcards

1
Q

What is cholecystitis?

A

Inflammation of the gall bladder

Acute often caused by gallstones and obstruction. Present in 10-20% population in US. Can become chronic. Most of the gallstones made of cholesterol; other variety included pigmented (made from bilirubinate or hemolysis) types.

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2
Q

Acute cholecystitis is caused by ___ and ___. It is present in ___% of the US population.

A

Gallstones

Obstruction

10-20%

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3
Q

Most of the gallstones in cholecystitis is made up of ___. Other pigmented gallstones are made from ___ or __.

A

Cholesterol

Bilirubinate

Hemolysis

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4
Q

Name five types of liver diseases that can progress on to cirrhosis

A

Fatty liver

Hepatitis

Biliary disease

Metabolic disease

Vascular disease

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5
Q

What is fatty liver caused by? (3 things)

A

Ethanol

Obesity

Diabetes

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6
Q

What causes hepatitis? (3 things)

A

Virus

Drugs

Autoimmune

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7
Q

What three things is the liver made up of?

A

Hepatocytes

Duct cells

Blood vessels

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8
Q

What makes up the portal triad?

A

Bile ducts

Portal veins (brings blood from gut with nutrients and recently consumed drugs)

Hepatic artery (blood from heart)

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9
Q

In the liver, blood goes to the ___ and enriches hepatocytes. Then it goes to ____ and drains back to the heart to be recycled. Blood from different sources mix in the ___

A

Sinusoids

Central vein

Sinusoids

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10
Q

____ are the cell that do all of the metabolic work of the liver.

A

Hepatocytes

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11
Q

What is the number one cause of liver toxicity?

A

Drugs

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12
Q

What is steatosis?

A

Fatty liver

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13
Q

What is the worst kind of liver destruction?

A

Fibrosis. It leads to collagen scar and permanent injury. End stage is cirrhosis

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14
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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15
Q

What happens if cannulicului in the liver fill with bile due to ___?

A

Cholestasis

The person becomes jaundiced

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16
Q

____ is inflammation of the liver. If caused by ___, it can be contagious and dentists must be very careful with these patients

A

Hepatitis

Viruses

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17
Q

Hepatitis can be caused by…

A

Viruses

Toxins

Drugs (ethanol and acetaminophen)

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18
Q

True or false… hepatitis can never resolve by itself

A

False.. acute can often resolve itself

Chronic less likely to recover (fibrosis often a part of this. Increases in fibrosis worsens prognosis)

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19
Q

Acute hepatitis is caused by __ and ___ viruses. They do not tend to go on to chronic condition.

A

hepatitis A and E

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20
Q

Hepatitis __ and ___ viruses start with acute hepatitis and frequently progress to chronic and can lead to cirrhosis and even hepatocelluar carcinoma.

A

B and C (rarely D)

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21
Q

Acute hepatitis lasts for less than __ months. It causes ___ inflammation. No ___ is seen. It is caused by ___ and ___ viruses. These viruses do not go on to chronic hepatitis.

A

< 6

Lobular inflammation (surrounding hepatocytes)

No fibrosis seen

hepatitis A (picornavirus)
Hepatitis E (calicivirus)
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22
Q

Chronic hepatitis lasts longer than __ months. It causes ___ inflammation. It causes ___ bridging to cirrhosis.

A

> 6 months

Portal inflammation (necroinflammatory and hepatocytes are the target)

Fibrosis

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23
Q

Chronic hepatitis is caused by __, ___, and ___ viruses.

A

hepatitis B (hepadnavirus)

Hepatitis C (flavivirus)

Hepatitis D (deltavirus) (rarely expressed)

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24
Q

Hepatitis C is easily transported by ___ and ___. During the __ stage there usually are no symptoms. There is a low incidence in US but high in places such as china. Hepatitis is found in >__ carriers worldwide. Treatment is very effective (and expensive) with combination of antivirals usually including ___. No immunizations are available to prevent it.

A

Blood and needles

Acute

170 million

Ribavirin

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25
Q

Hepatitis B is transported by ___ and ___. Its acute stage is [symptomatic/asymptomatic]. It frequently goes on to chronic. About __% of the population is infected, making it the most common blood-borne infection in health care workers. __ of the hepatocelluar carcioma are associated with hep. B viral infections. Treat with pre/post exposure to immunization to prevent and antivirals such as ___ and ___. It is important to get vaccinated for hep B.

A

Blood and needles

Asymptomatic

2-10%

One half

Lamivudine and adefovir

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26
Q

What is the most common blood-borne infection in health care workers?

A

Hepatitis B

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27
Q

What antiviral do you use to treat hepatitis C?

A

Ribavirin

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28
Q

What antivirals (2) do you use to treat hepatitis B?

A

Lamivudine

Adefovir

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29
Q

What is cirrhosis?

A

Regenerative hepatocyte nodules

Fibrosis surrounding nodules

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30
Q

Autoimmune hepatitis is [common/unusual]. It is predominantly found in ___ individuals. It [responds well/does not respond] to steroids. It often goes on to ___ fibrosis.

A

Unusual

Obese, middle-aged, female individuals

Responds well to steroids

Advanced fibrosis

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31
Q

Fatty liver disease is caused by what three things?

A

Ethanol

Obesity

Diabetes mellitus

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32
Q

In fatty liver disease the liver tends to be what color?

A

Yellow

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33
Q

Steatosis and steatohepatitis is associated with fatty liver disease. What are they?

A

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

Steatohepatitis - damage to the liver with fibrosis present (chronic)

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34
Q

Metabolic disease of the liver is often associated with __ overloads which can progress on to cirrhosis. ___ disease is a copper metabolic defect that goes to hepatitis then cirrhosis.

A

Iron

Wilson’s disease

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35
Q

What is Wilson’s disease?

A

Copper metabolic defect that goes to hepatitis then cirrhosis

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36
Q

What is biliary disease?

A

Destruction of bile ducts, bile backs up into liver and causes inflammatory cells to surround ducts. May form granulomas

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37
Q

Hepatocellular injury causes accumulation of ___ pigment in liver ___ cells.

A

Ceroid (lipid residue of lysosomal digestion)

Kupffer

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38
Q

What is the the most significant occupational dental hazard? Why?

A

HBV infection

Vectors: blood, saliva, nasopharyngeal secretions

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39
Q

In the mouth, where is the highest concentration of HBV?

A

Gingival sulcus

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40
Q

What are the oral manifestations of HBV?

A

Lichen planus

Periodontal disease

Candidiasis

Increased oral bleeding

Increased incidence of type 2 diabetes

Sjögren’s syndrome

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41
Q

How do you manage a HBV exposure?

A

Carefully wash out wound (dont rub because that embeds the virus)

Use antiviral disinfectant (iodine or chlorine formulations)

Initiate HBV vaccine series

Don’t be judgmental (??)

Oral infection management - periodontal disease

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42
Q

Define toxicology

A

The study of the adverse effects of a chemical, physical, or biological agent on living organisms or the ecosystem, including phsyilogical, occupational, environmetnal, or ecological settings

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43
Q

Define toxicity

A

The ability of a material to damage a biological system, cause injury, or impair physiological function

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44
Q

What is the difference between a hazard and a risk?

A

Hazard - something that can cause harm

Risk - the chance, or probability, that harm will occur from an exposure to a specific hazard

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45
Q

What is always the first step in treating a toxicity?

A

Minimizing/eliminating exposure of the toxin is always first step in treatment

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46
Q

__, ___, and ___ may each guide treatment planning

A

Dose

Exposure route

Duration

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47
Q

What is pharmacokinetics (ADME)?

A

The study of what the body does to the drug or other substance

A-absorption
D - distribution
M - metabolism
E - excretion

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48
Q

What is clearance?

A

Plasma cleared per unit time.

Occurs in two ways..

Metabolism - drug or toxin is metabolized into other chemical species that may or may not be active

Elimination - drug or toxin is removed from body by elimination by a specific organ

Renal and/or hepatic contributions important to be aware of for toxicants

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49
Q

True or false… at toxic doses, normal kinetics may be altered to prolong half-life and increase toxicity (larger, unbound free fractions)

A

True

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50
Q

Under normal conditions, elimination of most drugs is proportional to their plasma concentration (__ order kinetics. When plasma levels become high, protein binding and normal metabolism saturate. Once saturated, the rate of elimination can become fixed (___ order kinetics) and more drug will be delivered directly into the circulation in unbound fraction that is not readily able to be metabolized and cleared by renal and hepatic mechanisms.

A

First order kinetics

Zero order kinetics

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51
Q

What is volume of distribution?

A

The apparent volume in which a substance is distributed throughout the body

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52
Q

How does volume of distribution impact hemodialysis accessibility?

A

Large Vds make it difficult (substance is NOT easily accessible)

Small Vds are easier (substance is MORE accessible, thus are better candidates for hemodialysis)

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53
Q

What is bioaccumulation?

A

Accumulation of a contaminant within one individual organism over time

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54
Q

What is biomagnification?

A

Acquisition of increasing levels of a contaminant in higher trophic-level organisms such as fish to seal to bear.

Levels of contaminant increase as you move up the food chain.

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55
Q

What are biocompatible materials?

A

They elicit an appropriate biological response, without toxic or adverse immunological response, when exposed to the body or bodily fluids

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56
Q

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

A

Metabolism and protein binding becomes saturated and elimination become a zero order pattern

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57
Q

How do the apparent volumes 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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58
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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59
Q

What defines some metals as “heavy”?

A

Naturally occurring elements with high atomic weight and density 5-times greater than water

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60
Q

What are the three most toxic substances? (In order)

A

Lead (#1)

Mercury (#2)

Arsenic (#3)

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61
Q

How are heavy metals toxic?

A

They interfere with normal biological processes by competing with normal substrates

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62
Q

The shorter the half life the [less/more] effective is the use of chelators to remove the heavy metal

A

More effective

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63
Q

All heavy metals are common toxins except for ___

A

Cyanide

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64
Q

What is the physiolgical value of lead?

A

No physiological value

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65
Q

What are the primary exposure sources of lead?

A

Building materials

Batteries

Lead pipes

Paint

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66
Q

Why is lead exposure particular detrimental to young children?

A

Their bodies absorb lead more because lead competes with Ca and growing bodies require considerable calcium.

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

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

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67
Q

What is the half-life of lead?

A

1-2 months

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68
Q

What are the effects of lead?

A

Headaches, neurocognitive deficits, kidney damage

Basophilic stippling of RBC (implies damage to bone marrow)

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69
Q

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

A

It substitutes calcium in bone

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70
Q

What are burtonian lines?

A

Lead lines causing a darkening of the gingiva

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71
Q

What is the mechanism of lead’s toxicity?

A

Interferes with calcium use

Causes anemia

Causes immunosuppression

Binds sulhydryl groups found on any enzyme and co-factors (interferes with things such as enzymes, DNA management, increases free radicals)

Crosses BBB and concentrates in grey matter, can cross placenta

The developing CNS is most sensitive target organ for lead poisoning can lead to encephalopathy

Can be harmful to immune system

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72
Q

What is the most sensitive target organ for lead poisoning?

A

Developing CNS

Can lead to encephalopathy

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73
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 lead from bone slowly and requires multiple cheating treatments

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74
Q

What is quicksilver?

A

Mercury

Liquid at room temperature

Primarily used in methylHg formed

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75
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

Vaccines (thimerosal)

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76
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

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77
Q

What do we know about mercury’s toxicokinetics?

A

Elemental Hg vapor (dust) is well absorbed by the lungs but poorly absorbed by the gut.

Inorganic mercury are well absorbed by the gut, skin, and lungs

Oral ingestion of methyl-mercury contaminated food is currently the main cause of most cases of mercury poisoning in humans

Organic forms of mercury are extremely well absorbed across the gut, but dermal and skin absorption are poor

Excretion occurs in both urine and feces

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78
Q

What do we know about mercury symptomolgy?

A

Can cause neurological, psychiatric problems, and inflammation of the lungs

“Mad as a hatter” comes from the symptomology of mercury poisoning

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79
Q

What are the CDC’s conclusions regarding mercury exposure related to thimerosoal in flu vaccines and dental amalgam?

A

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

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80
Q

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

A

Dimercaprol (can only use acutely)

Succimer

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81
Q

Why is dimercaprol contraindicated in chronic mercury intoxication scenarios?

A

Chronic use of dimercaprol can cause serious renal toxicity

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82
Q

What is the mechanism of cyanide poisoning? What is the antidote?

A

cyanide is NOT a heavy metal, but is one of the most commonly used chemicals worldwide in numerous industries

Mechanism: prevents the cells of the body from getting oxygen and ATP causing them to die. Inhibits cytochrome C oxidase in the electron transport chain in mitochondria.

Antidote: hydroxycobalamin (reacts with cyanide to form cyanocobalamin which can be safely eliminated by the kidneys)

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83
Q

What is hydroxycobalmin used for?

A

Antidote for cyanide poisoning

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84
Q

What is the most toxic form of cylinder?

A

Hydrogen cyanide

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85
Q

Cyanide inhibits ___ by interfering with ____ it prevents __ production in cells. But it does not cause __ even though it competes with oxygen on ___.

A

Cellular oxidation

Oxidative phosphorylation

ATP

Cyanosis

Hemoglobin

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86
Q

What are the primary exposure sources of arsenic?

A

Industrial contamination

Groundwater contamination

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87
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

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88
Q

What is the symptomology of arsenic?

A

Fatigue, anemia, renal failure, hyperpigmentation

Peripheral neuropathy

Carcinogenic in lungs, skin and bladder

Hemolytic on RBC

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89
Q

What is the mechanism of arsenic toxicity?

A

Increases reactive oxygen species

Binds to sulfhydryl groups in keratinized tissue, where it acts as a depot

Inhibits enzymes

Hemolytic action on RBCs

Can be carcinogenic on lung and skin

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90
Q

How does the treatment regimen, including the use of chelators (unithiol or dimercaprol) differ for each of the following conditions:

Acute arsenic intoxication

Chronic arsenic intoxication

Acute arsine gas intoxication

A

Acute arsenic intoxication - chelators useful

Chronic arsenic intoxication - chelators are not helpful

Acute arsine gas intoxication - chelators of no values, can use blood exchange hemodialysis

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91
Q

How do chelators work on heavy metals?

A

They render heavy metal ions unavailable for covalent interactions

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92
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 half life the less effective is the chelator

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93
Q

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

A

Usually effective when treated ASAP

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94
Q

Dimercaprol is FDA approved for which heavy metal poisonings as a monotherapy?

A

Used for arsenic and Hg, but not for Pb

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95
Q

Dimercaprol can be administered with CaNa2-EDTA for severe, chronic poisoning with what heavy metal?

A

Lead

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96
Q

True or false… you should never use dimercaprol as a monotherapy after chronic exposure to lead, since it redistributes larger doses of lead to CNS

A

True

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

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97
Q

Is dimercaprol water soluble?

A

No. It cannot be given orally.

The only way it can be administer is IM route

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98
Q

How does dimercaprol therapeutic index compare to succimer or unithiol?

A

It can be very toxic, especially on kidneys

Succimer has for the most part replaced dimercaprol

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99
Q

Succimer is a water soluble form of ___

A

Dimercaprol

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100
Q

Succimer is FDA approved for which heavy metal poisonings?

A

Used to treat Pb, As, and Hg poisoning

101
Q

What is the main mechanism of succimer for removing heavy metals?

A

Binds to cysteine to form mixed disulfides which are excreted

102
Q

Succimer is a water soluble derivative of what other chelator?

A

Dimercaprol

103
Q

What is the half life of succimer?

A

2-4 hours

104
Q

What is the only route of administration of succimer?

A

Oral use only

105
Q

Based on their comparative adverse effects, why has succimer largely replaced dimercaprol use?

A

Succimer is much safer than dimercaprol

106
Q

Edetate calcium disodium is FDA approved for which heavy metal poisonings?

A

Lead

107
Q

Does edetate calcium disodium target intracellular or extracellular lead?

A

Only extracellular

108
Q

What is edetate calcium disodium’ only route of administration?

A

IV

109
Q

What is the half life of edetate calcium disodium?

A

One hour

110
Q

How is edetate calcium disodium excreted?

A

100% by the kidneys

111
Q

In which patient population is edetate calcium disodium contraindicated?

A

Anuric patients

Should never be used for more than 5 consecutive days due to nephrotoxicity

112
Q

Unithiol (dimercaptopropanesulfonic acid) is a water soluble derivative of what other chelator?

A

Dimercaprol (succimer is usually preferred)

113
Q

What are the routes of administration of unithiol?

A

Orally or IV

114
Q

How does unithiol half life compare to other chelators?

A

20 hours

115
Q

Unithiol is effective for what types of heavy metal poisoning?

A

Hg

As

Pb

**however, it is not FDA approved for any heavy metal poisonings

116
Q

What are the four biocompatility criteria?

A

Should not be harmful to pulp or soft tissues

Should not contain toxic diffusable substances that may be released and absorbed into the circulatory system to cause systemic toxicity

Should be free of potentially sensitizing agents that may promote reactions

Should have no carcinogenic potential

117
Q

What are the most commonly reported allergic responses in dental offices?

A

Allergic contact dermatitis (most common occupational hazard)

Latex allergies

Allergies to denture base materials

118
Q

Where is the greatest amount of mercury exposed to a patient in the dental office?

A

The greatest amount of mercury is released during dry polishing of an amalgam restoration (44mcg)

119
Q

What steps can be taken to prevent pulpitis caused by unpolymerized monomers in resin composites used in deep fillings?

A

Use twice the recommended time of exposure and cure in increments to assure to complete curing

120
Q

How can a dentist prevent lesions caused by zinc phosphate cement?

A

Use proper mix or use a resin-modified glass ionomer cement instead

121
Q

How can dentists reduce cytotoxicity of acrylate bonding agents?

A

Cytotoxicity is decreased significantly if one adequately rinses with tap water between application of subsequent reagents

122
Q

What is antrhacosis?

A

Inhalation of carbon dust

Causes chronic dry cough

123
Q

What is the cause and effect of the pure food and drug act?

A

Caused by addiction to opium and cocaine

Requires labeling, patent medicines

124
Q

What is the cause and effect of the modified food, drug, and cosmetic act?

A

Required safety

Caused by diethyleneglycol tragedy

125
Q

What is the Durham-Humphrey amendment?

A

Rx vs OTC

126
Q

What is the cause and effect of the Kefauver-Harris amendment?

A

Phocomelia caused by thalidomide tragedy

Requires safety and EFFICACY

127
Q

What is the dietary supplement health and education act?

A

Regulated herbal products

Defines herbal products as “foods”

128
Q

What are three reasons why some drugs must be Rx instead of OTC?

A

Addition/abuse liability

Relative safety

Intent of use - does it require professional input/control?

129
Q

What are some things the FDA regulates?

A

Foods

Dietary supplements

Bottled water

Food additives

Drugs

Biological

Medical devices

Cosmetics
Veterinary products
Tabacco products
Advertising of products

130
Q

Animal preclinical testing is controlled by ___

A

IACUC (institutional animal care committee)

131
Q

What is phase 1 of drug testing?

A

Small group of healthy (usually subjects to test SAFETY, DOSES, administration and other kinetics (SIDE EFFECTS)

132
Q

What is phase 2 of drug testing?

A

Small group of subjects with condition to be treated to test SAFETY (still) and EFFICACY

133
Q

What is phase 3 of drug testing?

A

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

134
Q

What is phase 4?

A

Marketing phase

See how the product does in production

135
Q

What is the IRB?

A

Institutional review board

This is like the human equivalent of IUCUC. This is an evaluation of exactly what the experiment is going to do with the human studies

136
Q

What is the NDA?

A

New drug application

This is the last step. Once the drug has gone through all the phases successfully, it can be submitted to the to FDA for review. If the NDA is approved then it can go to the market.

137
Q

What is the IND?

A

Investigational new drug designation

This is the first time that the drug companies are interacting with the FDA. The IND must be approved be before moving to phase 1 (clinical trials)

138
Q

What is the orphan drug act?

A

This act is designed to promote the research and development of therapeutics for rare diseases. (Less than 200,000 people)

139
Q

What gives companies incentive to develop drugs for rare conditions in the orphan drug act?

A

Increased patent life

Tax incentives

Etc.

140
Q

What is fast tracking?

A

Streamline the process for urgent situations (such as Ebola virus)

Certain phases may be skipped or not as much data is required to move to the next phase in order to expedite the process.

141
Q

What is the switching policy

A

This is when Rx drugs can be changed to OTC drugs.

Advantage is easier accessibility and the need to reduce cost. Disadvantage is misuse of drug.

142
Q

What are the requirements for a drug to meet in order to switch from Rx to OTC?

A

Marketed as Rx for at least 3 years

Used frequently to demonstrate a need

Side effects minor (safe)

143
Q

What are the three non-prescription drug categories?

A

1 - safe and effective

2 - unsafe or ineffective

3 - not sure, requires more studies

144
Q

True or false… if a drug has been FDA approved for depression, it cannot be used for anything other than depression.

A

False. As long as it is FDA approved, you can prescribe it for non-FDA uses

145
Q

What is the FDA policy regarding herbal products?

A

Herbal products are considered a food (dietary supplement). Not a drug.

146
Q

What are the labeling requirements for herbals?

A

Herbals aren’t drugs so you cant say “dose”

Must give…

Serving size
Where it was obtained (stem, leaf, root)
Calories
Weights of different ingredients (proprietary blend)

147
Q

How is labeling controlled by the FTC (federal trade commission)?

A

This category of products cannot be promoted to diagnose, treat, or prevent disease. But they can make structural claims.

For example… they may say “calcium builds strong bones”, but they cannot say “this prevents osteoporosis”

148
Q

What is oxymetazoline?

A

Its a decongestant

149
Q

What is phenylephrine?

A

Decongestant

150
Q

What is pseudopherdrine?

A

Decongestant

151
Q

How do decongestants work?

A

They are either vasoconstrictors or sympathomimetics

152
Q

What is the advantages and disadvantages of topical nasal sprays over systemic decongestants?

A

Topical: faster onset. Less side effects. Problem is that it can cause rebound congestion (the body grows tolerant/dependent and once its off of it it will cause worse congestion).

Systemic: slower onset. Causes systemic effects such as raise in BP and anxiousness. Longer lasting effects.

153
Q

What is rhinorrhea?

A

Runny nose. Thought to be a defensive function to shed the virus

154
Q

What are the advantages and disadvantages of drying agents for treating rhinorrhea?

A

Advantage: convenience

Disadvantage: may prolong infection by diminishing cleaning action of secretions

155
Q

True or false… antihistamines are effective in treating a runny nose due to a cold

A

False. They are useful for allergies not colds

156
Q

Name three different antihistamines

A

Diphenhydramine (drowsiness)

Chlorpheniramine

Loratidine (Claritin) - less drowsiness

157
Q

Are antitussives best for a productive or non-productive cough?

A

Non-productive

If its productive, its usually better to cough all the mucus out

158
Q

Name three antitussives

A

Codeine (narcotic)

Diphenhydramine (structurally similar to codeine. Has less abuse potential than codeine)

Dextromethorphan

159
Q

Name one expectorant. What is it used for?

A

Guaifenesin (mucinex)

Increases productive cough. Loosens gunk up so you can cough it up more readily

160
Q

What are demulcents?

A

Cough drops

They coat the irritative surface of the throat for soothing

161
Q

True or false… drinking lots of water and humidification is effective in treating a cough

A

True

It decreases viscosity of respiratory secretions

162
Q

Antivirals such as ___ and ___ have some benefit for colds by shortening the infection by a couple days if taken early

A

Oseltamivir (tamiflu-not OTC)

Zanamivir (relenza-not OTC)

163
Q

____ is an OTC used for cold sores. Its a herpes antiviral.

A

Docosanol (abreva)

164
Q

Which can cause reye syndrome, aspirin or acetaminophen?

A

Aspirin

165
Q

Which is longer duration naproxen or ibuprofen?

A

Naproxen

166
Q

True or false… zinc is proven to be effective in killing cold viruses

A

False. There is little if any benefit in killing cold viruses

167
Q

What is phenol?

A

Oral anesthetic/analgesic used for sore throat

Contraindicated if allergic to local anesthetics

168
Q

What are the effects of caffeine?

A

Increase wakefulness
Stimulant
Increase flow of thoughts
Increase concentration

Cardiovascular: Increase HR

Gastric: stimulates gastric secretion

Kidneys: mild diuretic. Decreases bloating associated with mensturation

169
Q

Name three xanthines

A

Theophylline

Theobromine (found in chocolate)

Caffeine

170
Q

What are the uses of nicotine? What are the side effects?

A

Patches, lozenges, gum used to treat tobacco dependence

Side effects: dizziness, headaches, nausea

171
Q

Xanthines are an ___ antagonist

A

Adenosine

172
Q

Name two antihistamine sleep aids

A

Diphenhydramine

Doxylamine

173
Q

What is miconazole?

A

Antifungal used to treat thrush, athletes foot, and vaginal infections

174
Q

What is neosporin and polysporin?

A

Antibiotic ointments used as a first aid preventative on minor abrasions

175
Q

What is hydrocortisone?

A

Topical Anti-inflammatory, anti itching. Used for dermal lesions, eczema, insect bites, poison ivy, etc.

176
Q

What sedatives are OTC?

A

None. However there are OTC sleep aids

177
Q

What is capsaicin?

A

Topical ointment used for pain-relief

Acts on TRPV channels to deplete substance P

178
Q

Name two drugs that treat motion sickness. What are some side effects?

A

Scopolamine (anticholinergic)

Dimenhydrainate (anticholinergic)

Drymouth, constipation, blurred vision, reduced urinating,

179
Q

What is minoxidil used for?

A

Hair growth (rogaine)

Its a vasodilator that causes rapid heart beat. Other side effects include itchy scalp, scaling, flaking. Light headedness

180
Q

What drugs are used to treat hemorrhoids?

A

Vasoconstrictors such as phenylephrine HCl.

181
Q

What is the DSHEA?

A

Dietary supplemental health and education act

Regulates herbal dietary supplements: defined as taken by mouth and contains a dietary ingredient to supplement diet. May include vitamins, minerals, herbs, or other botanical and nutrients.

Once marketed, the FDA is responsible for assuring dietary supplement is safe

Products cannot be promoted to diagnose, cure or prevent disease

Advocates for the use herbals as dietary supplements, not drugs.

Consequences: little regulation unless someone gets hurt

182
Q

St. John’s Wort is promoted to treat ___

A

Depression

183
Q

Echinacea is promoted to treat ___

A

Colds, although controversial

184
Q

Aloe Vera is promoted for ___ and ___. Side effect is __

A

Skin care and wound healing

Constipation

Side effect is cramps and diarrhea (strong laxative).

Caution if diabetic, may lower blood sugar

185
Q

What is cranberry used to prevent?

A

UTIs

186
Q

What is garlic used for?

A

Slowly lowers cholesterol (must eat a TON of garlic though)

Some thinning of blood

187
Q

What is ginkgo promoted for?

A

Improve memory

Can increase bleeding risk

188
Q

What is ginseng promoted for? What’s a side effect?

A

Boost immune system

May lower blood sugar

189
Q

What is ephedra? What is it used for?

A

Sympathomimetic: contains ephedrine

Used for anorexia and stimulant effects.

FDA require removal from most OTC products, although still will occasionally see in herbal preparations

190
Q

What may happen if you are deficient in the following vitamins?

A
D
K
B1
B2
B3 (niacin)
B6
B12
A 
A: night blindness
D: rickets/osteomalacia 
K: bleeding
B1: beriberi
B2: glossitis
B3 (niacin): pellagra
B6: anemia
B12: anemia
191
Q

Sensitivity to ___ causes malabsorption associated with celiac disease

A

Gluten

192
Q

Sjögren’s disease involves ___, ___, and can be connected with ___.

A

Xerostomia

Kerato conjunctivitis

Rheumatoid arthritis

193
Q

What is the active ingredient in Marijuana?

A

THC

194
Q

What is amotivational syndrome associated with marijuana?

A

Lose sense of ambition

195
Q

What is the endogenous ligand of marijuana?

A

Anandamide (natural neurotransmitter)

196
Q

Marijuana affects cannabinoid receptors. Namely CB1 and CB2. Describe these receptors.

A

CB1 mostly CNS and mediates abuse problems

CB2 mostly peripheral and mediates inflammatory effects

197
Q

True or false… marijuana is a bronchoconstrictor and vasoconstrictor

A

False. It is a bronchodilator - causes reflex increase in heart contractions

It is a vasodilator not a constrictor

198
Q

The legal status of marijuana is schedule ___ according to federal law but varies according from state to state.

A

1

199
Q

What is an FDA approved cannabinoid agonist? What does it do?

A

Marinol (dronabinol)

Increases appetite

Anti-nausea

CB1 agonist

Synthetic TCH/prescription

200
Q

What are the proposed THC/marijuana uses?

A

Anti-nausea

Increased appetite

Glaucoma-reduce intraocular pressure

Chronic pain

201
Q

What is CBD (cannabidiol)?

A

Analog promoted as antiseizure, not as addicting as THC

202
Q

What is rimonabant?

A

Approved in Europe, although was later withdrawn due to depression/suicide

CB1 antagonist

Used to treat obesity by reducing appetite

203
Q

What are “spice” products?

A

Street drugs

Contain cannabinoid agonists/antagonists and other drugs

Originally ‘legal’ but has since been outlawed. The cannabinoid ingredients have been made schedule 1

204
Q

What are the side effects of marijuana?

A

Withdrawals

Attention disruptions

Induced psychosis with strong marijuana

Anxiety disorders

205
Q

What is MUD?

A

Marijuana use disorder

206
Q

__% of marijuana users have some sort of MUD

If the begin use of marijuana ,18 years old, likelihood of MUD increases ___ times

__ million persons in USA had MUD in 2015

A

9%

4-7times

4 million

207
Q

What are teratogens?

A

Drugs that alter fetal development when used during pregnancy by the mother

208
Q

What happens when the mother takes DES (diethylstilbesterol)?

A

If used during pregnancy it dramatically increases the likelihood that female offspring would develop cervical cancer especially when young. However, incidence is still quite rare

209
Q

What are the different FDA classifications for teratogens? Describe them.

A

A - no evidence drug is a teratogen in either humans or lab animals

B - no animal evidence, not well tested in humans

C - no good animal or human testing done

D - animal testing suggests, but not well studied in humans

X - definitely shown to be teratogen in humans (isoteretenoin (acutane))

210
Q

What is the mission of the DEA?

A

Enforce the controlled substance laws and regulations of the USA.

Address issues of illegal growing, manufacturing, or distribution both domestically and internationally

211
Q

Drug czar heads up the ____. What is the drug czar?

A

Office of national drug control policy (ONDCP)

As part of the executive branch, the drug czar and ONDCP evaluates, coordinates, and oversees both international and domestic anti-drug efforts. Oversees DEA, NIDA and NIAAA (from NIH) activities and budget.

212
Q

The DEA oversees programs that deal with illicit and prescribed scheduled drugs (1-4) such as…

A

Drug eradication

Drug education

Assist state and local agencies, civic groups, school systems, and officials to combat drug abuse

Help secure borders against drug trafficking

213
Q

What is a scheudule 1 drug?

A

These controlled substances have no currently accepted medical use in the USA.

Lack of accepted safety for use under medical supervision

High potential for abuse

(Heroin, LSD, marijuana, ecstasy)

214
Q

What is a schedule 2/2n drug?

A

Substances have a high potential for abuse which may lead to severe psychological or physical dependence.

Approved medical use

(Fentanyl, adderall)

Hydrocodone’s addition has an impact on dentists!

215
Q

What are schedule 3/3n drugs?

A

Have a potential for abuse less than substances in schedules 1 or 2 and abuse may lead to moderate or low physical dependence or high psychological dependence.

Products containing not more than 90mg of codeine per dosage unit. (Buprenorphine, ketamine)

216
Q

What are schedule 4 drugs?

A

Low potential for abuse

Alprazolam, diazepam, midazolam

217
Q

What are schedule 5 drugs?

A

Low potential for abuse relative to substances listed in schedule 4 and consist primarily of preparations containing limited quantities of certain narcotics.

(Robitussin)

218
Q

What schedule is tramadol (ultram)

A

Schedule 4

219
Q

What schedule is hydrocodone?

A

Schedule 2

220
Q

What is DOPL and the utah controlled substance database?

A

This is a legislatively created database to track and collect data on dispensing of schedule 2-5 drugs by retail, institutional and outpatient hospital pharmacies

221
Q

What is the purpose of DOPL and the utah controlled substance database (UCSD)?

A

Identify over-utilization, misuse, and over-prescribing of controlled substances throughout the state

222
Q

Outpatient pharmacies report dispenseing of scheduled drugs within __ days and the data are posted within __ hours after recipes.

A

7 days

24 hours

223
Q

True or false.. the following is required to report to the UCSD….

Prescriptions at federal facilities

Out of state pharmacies

Pharmacies servicing in-patient populations

A

False.. not required

224
Q

True or false… DOPL also controls dental licensing and manages things such as unprofessional conduct (false advertising and maintains proper conditions related to practice), and manage proper CE observance

A

True

225
Q

1 out of ___ prescriptions in hospitals are done improperly

A

5

226
Q

Improper prescriptions kill ~___ people per year in the US

A

7,000

227
Q

A.c. (Ante cibum)

A

Before meals

228
Q

Ad.lib (ad libitum)

A

Use freely

229
Q

Aq (aque)

A

Water

230
Q

Bis

A

Twice

231
Q

Bid

A

Twice daily

232
Q

C.f.

A

With food

233
Q

Dc

A

Discontinue

234
Q

H (hora)

A

Hour

235
Q

Noct (nocta)

A

At night

236
Q

P.c (post cibum)

A

After meals

237
Q

Prn (pro re nata)

A

As needed

238
Q

P.o (per os)

A

By mouth

239
Q

Q (quaque)

A

Every

240
Q

Q.h.

A

Every hour

241
Q

Q.d.

A

Every day

242
Q

Q.i.d (quates in die)

A

4 times a day

243
Q

S (sina)

A

Without

244
Q

Sig

A

Write on the label

245
Q

Stat

A

Immediately

246
Q

T.i.d

A

Three times daily

247
Q

W

A

With

248
Q

W/o

A

Without

Human Disease And Therapeutics (13 decks)

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