Final Flashcards
What is cholecystitis?
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.
Acute cholecystitis is caused by ___ and ___. It is present in ___% of the US population.
Gallstones
Obstruction
10-20%
Most of the gallstones in cholecystitis is made up of ___. Other pigmented gallstones are made from ___ or __.
Cholesterol
Bilirubinate
Hemolysis
Name five types of liver diseases that can progress on to cirrhosis
Fatty liver
Hepatitis
Biliary disease
Metabolic disease
Vascular disease
What is fatty liver caused by? (3 things)
Ethanol
Obesity
Diabetes
What causes hepatitis? (3 things)
Virus
Drugs
Autoimmune
What three things is the liver made up of?
Hepatocytes
Duct cells
Blood vessels
What makes up the portal triad?
Bile ducts
Portal veins (brings blood from gut with nutrients and recently consumed drugs)
Hepatic artery (blood from heart)
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 ___
Sinusoids
Central vein
Sinusoids
____ are the cell that do all of the metabolic work of the liver.
Hepatocytes
What is the number one cause of liver toxicity?
Drugs
What is steatosis?
Fatty liver
What is the worst kind of liver destruction?
Fibrosis. It leads to collagen scar and permanent injury. End stage is cirrhosis
What happens if hepatocytes die in large sheets?
The areas fill up with blood. Blood can build up due to heart failure and backflow
What happens if cannulicului in the liver fill with bile due to ___?
Cholestasis
The person becomes jaundiced
____ is inflammation of the liver. If caused by ___, it can be contagious and dentists must be very careful with these patients
Hepatitis
Viruses
Hepatitis can be caused by…
Viruses
Toxins
Drugs (ethanol and acetaminophen)
True or false… hepatitis can never resolve by itself
False.. acute can often resolve itself
Chronic less likely to recover (fibrosis often a part of this. Increases in fibrosis worsens prognosis)
Acute hepatitis is caused by __ and ___ viruses. They do not tend to go on to chronic condition.
hepatitis A and E
Hepatitis __ and ___ viruses start with acute hepatitis and frequently progress to chronic and can lead to cirrhosis and even hepatocelluar carcinoma.
B and C (rarely D)
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.
< 6
Lobular inflammation (surrounding hepatocytes)
No fibrosis seen
hepatitis A (picornavirus) Hepatitis E (calicivirus)
Chronic hepatitis lasts longer than __ months. It causes ___ inflammation. It causes ___ bridging to cirrhosis.
> 6 months
Portal inflammation (necroinflammatory and hepatocytes are the target)
Fibrosis
Chronic hepatitis is caused by __, ___, and ___ viruses.
hepatitis B (hepadnavirus)
Hepatitis C (flavivirus)
Hepatitis D (deltavirus) (rarely expressed)
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.
Blood and needles
Acute
170 million
Ribavirin
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.
Blood and needles
Asymptomatic
2-10%
One half
Lamivudine and adefovir
What is the most common blood-borne infection in health care workers?
Hepatitis B
What antiviral do you use to treat hepatitis C?
Ribavirin
What antivirals (2) do you use to treat hepatitis B?
Lamivudine
Adefovir
What is cirrhosis?
Regenerative hepatocyte nodules
Fibrosis surrounding nodules
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.
Unusual
Obese, middle-aged, female individuals
Responds well to steroids
Advanced fibrosis
Fatty liver disease is caused by what three things?
Ethanol
Obesity
Diabetes mellitus
In fatty liver disease the liver tends to be what color?
Yellow
Steatosis and steatohepatitis is associated with fatty liver disease. What are they?
Steatosis - fat accumulation in the liver is temporary, with no cellular damage
Steatohepatitis - damage to the liver with fibrosis present (chronic)
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.
Iron
Wilson’s disease
What is Wilson’s disease?
Copper metabolic defect that goes to hepatitis then cirrhosis
What is biliary disease?
Destruction of bile ducts, bile backs up into liver and causes inflammatory cells to surround ducts. May form granulomas
Hepatocellular injury causes accumulation of ___ pigment in liver ___ cells.
Ceroid (lipid residue of lysosomal digestion)
Kupffer
What is the the most significant occupational dental hazard? Why?
HBV infection
Vectors: blood, saliva, nasopharyngeal secretions
In the mouth, where is the highest concentration of HBV?
Gingival sulcus
What are the oral manifestations of HBV?
Lichen planus
Periodontal disease
Candidiasis
Increased oral bleeding
Increased incidence of type 2 diabetes
Sjögren’s syndrome
How do you manage a HBV exposure?
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
Define toxicology
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
Define toxicity
The ability of a material to damage a biological system, cause injury, or impair physiological function
What is the difference between a hazard and a risk?
Hazard - something that can cause harm
Risk - the chance, or probability, that harm will occur from an exposure to a specific hazard
What is always the first step in treating a toxicity?
Minimizing/eliminating exposure of the toxin is always first step in treatment
__, ___, and ___ may each guide treatment planning
Dose
Exposure route
Duration
What is pharmacokinetics (ADME)?
The study of what the body does to the drug or other substance
A-absorption
D - distribution
M - metabolism
E - excretion
What is clearance?
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
True or false… at toxic doses, normal kinetics may be altered to prolong half-life and increase toxicity (larger, unbound free fractions)
True
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.
First order kinetics
Zero order kinetics
What is volume of distribution?
The apparent volume in which a substance is distributed throughout the body
How does volume of distribution impact hemodialysis accessibility?
Large Vds make it difficult (substance is NOT easily accessible)
Small Vds are easier (substance is MORE accessible, thus are better candidates for hemodialysis)
What is bioaccumulation?
Accumulation of a contaminant within one individual organism over time
What is biomagnification?
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.
What are biocompatible materials?
They elicit an appropriate biological response, without toxic or adverse immunological response, when exposed to the body or bodily fluids
Why at very high blood concentrations normal kinetic properties of a drug or toxin can change?
Metabolism and protein binding becomes saturated and elimination become a zero order pattern
How do the apparent volumes of distribution for drug or toxin determine the effectiveness of hemodialysis at purifying them from the blood?
A large Vd implies a substance will not be easily accessible to purification attempts
What is the difference between bioaccumulation and biomagnification?
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
What defines some metals as “heavy”?
Naturally occurring elements with high atomic weight and density 5-times greater than water
What are the three most toxic substances? (In order)
Lead (#1)
Mercury (#2)
Arsenic (#3)
How are heavy metals toxic?
They interfere with normal biological processes by competing with normal substrates
The shorter the half life the [less/more] effective is the use of chelators to remove the heavy metal
More effective
All heavy metals are common toxins except for ___
Cyanide
What is the physiolgical value of lead?
No physiological value
What are the primary exposure sources of lead?
Building materials
Batteries
Lead pipes
Paint
Why is lead exposure particular detrimental to young children?
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.
What is the half-life of lead?
1-2 months
What are the effects of lead?
Headaches, neurocognitive deficits, kidney damage
Basophilic stippling of RBC (implies damage to bone marrow)
What is the main repository in the body for its lead burden?
It substitutes calcium in bone
What are burtonian lines?
Lead lines causing a darkening of the gingiva
What is the mechanism of lead’s toxicity?
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
What is the most sensitive target organ for lead poisoning?
Developing CNS
Can lead to encephalopathy
What is the treatment regimen for lead toxicity, particularly the recommended chelators?
Remove exposure
Administer a chelator such as EDTA (edetate calcium disodium). It removes lead from bone slowly and requires multiple cheating treatments
What is quicksilver?
Mercury
Liquid at room temperature
Primarily used in methylHg formed
What are the primary exposure sources of mercury?
Found in fish
Amalgam (no CDC-recognized evidence that it is a problem in dentistry)
Thermometers
Vaccines (thimerosal)
What is the mechanism of mercury toxicity?
Reacts with selenium (necessary for reducing oxidized vitamin C and E)
Can cause gingivostomatitis
Inhibits enzymes
Acute tubular necrosis
What do we know about mercury’s toxicokinetics?
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
What do we know about mercury symptomolgy?
Can cause neurological, psychiatric problems, and inflammation of the lungs
“Mad as a hatter” comes from the symptomology of mercury poisoning
What are the CDC’s conclusions regarding mercury exposure related to thimerosoal in flu vaccines and dental amalgam?
No convincing evidence that quantities of mercury from either source is significantly high to cause problems
What is the treatment regimen for mercury toxicity, particularly the recommended chelators?
Dimercaprol (can only use acutely)
Succimer
Why is dimercaprol contraindicated in chronic mercury intoxication scenarios?
Chronic use of dimercaprol can cause serious renal toxicity
What is the mechanism of cyanide poisoning? What is the antidote?
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)
What is hydroxycobalmin used for?
Antidote for cyanide poisoning
What is the most toxic form of cylinder?
Hydrogen cyanide
Cyanide inhibits ___ by interfering with ____ it prevents __ production in cells. But it does not cause __ even though it competes with oxygen on ___.
Cellular oxidation
Oxidative phosphorylation
ATP
Cyanosis
Hemoglobin
What are the primary exposure sources of arsenic?
Industrial contamination
Groundwater contamination
What do we know about the toxicokinetics of arsenic?
Absorbed through respiratory mucosa and GI tract, but not so much through the skin
Excreted primarily through the kidney
What is the symptomology of arsenic?
Fatigue, anemia, renal failure, hyperpigmentation
Peripheral neuropathy
Carcinogenic in lungs, skin and bladder
Hemolytic on RBC
What is the mechanism of arsenic toxicity?
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
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
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
How do chelators work on heavy metals?
They render heavy metal ions unavailable for covalent interactions
How does the half-life of the heavy metal affect the ability of a chelator to remove it from a target organ?
The longer the half life the less effective is the chelator
Is it better to treat with chelators quickly or take a wait and see approach when an exposure has occurred?
Usually effective when treated ASAP
Dimercaprol is FDA approved for which heavy metal poisonings as a monotherapy?
Used for arsenic and Hg, but not for Pb
Dimercaprol can be administered with CaNa2-EDTA for severe, chronic poisoning with what heavy metal?
Lead
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
True
It pulls lead from bone and it goes to brain and causes toxicity
Is dimercaprol water soluble?
No. It cannot be given orally.
The only way it can be administer is IM route
How does dimercaprol therapeutic index compare to succimer or unithiol?
It can be very toxic, especially on kidneys
Succimer has for the most part replaced dimercaprol
Succimer is a water soluble form of ___
Dimercaprol
Succimer is FDA approved for which heavy metal poisonings?
Used to treat Pb, As, and Hg poisoning
What is the main mechanism of succimer for removing heavy metals?
Binds to cysteine to form mixed disulfides which are excreted
Succimer is a water soluble derivative of what other chelator?
Dimercaprol
What is the half life of succimer?
2-4 hours
What is the only route of administration of succimer?
Oral use only
Based on their comparative adverse effects, why has succimer largely replaced dimercaprol use?
Succimer is much safer than dimercaprol
Edetate calcium disodium is FDA approved for which heavy metal poisonings?
Lead
Does edetate calcium disodium target intracellular or extracellular lead?
Only extracellular
What is edetate calcium disodium’ only route of administration?
IV
What is the half life of edetate calcium disodium?
One hour
How is edetate calcium disodium excreted?
100% by the kidneys
In which patient population is edetate calcium disodium contraindicated?
Anuric patients
Should never be used for more than 5 consecutive days due to nephrotoxicity
Unithiol (dimercaptopropanesulfonic acid) is a water soluble derivative of what other chelator?
Dimercaprol (succimer is usually preferred)
What are the routes of administration of unithiol?
Orally or IV
How does unithiol half life compare to other chelators?
20 hours
Unithiol is effective for what types of heavy metal poisoning?
Hg
As
Pb
**however, it is not FDA approved for any heavy metal poisonings
What are the four biocompatility criteria?
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
What are the most commonly reported allergic responses in dental offices?
Allergic contact dermatitis (most common occupational hazard)
Latex allergies
Allergies to denture base materials
Where is the greatest amount of mercury exposed to a patient in the dental office?
The greatest amount of mercury is released during dry polishing of an amalgam restoration (44mcg)
What steps can be taken to prevent pulpitis caused by unpolymerized monomers in resin composites used in deep fillings?
Use twice the recommended time of exposure and cure in increments to assure to complete curing
How can a dentist prevent lesions caused by zinc phosphate cement?
Use proper mix or use a resin-modified glass ionomer cement instead
How can dentists reduce cytotoxicity of acrylate bonding agents?
Cytotoxicity is decreased significantly if one adequately rinses with tap water between application of subsequent reagents
What is antrhacosis?
Inhalation of carbon dust
Causes chronic dry cough
What is the cause and effect of the pure food and drug act?
Caused by addiction to opium and cocaine
Requires labeling, patent medicines
What is the cause and effect of the modified food, drug, and cosmetic act?
Required safety
Caused by diethyleneglycol tragedy
What is the Durham-Humphrey amendment?
Rx vs OTC
What is the cause and effect of the Kefauver-Harris amendment?
Phocomelia caused by thalidomide tragedy
Requires safety and EFFICACY
What is the dietary supplement health and education act?
Regulated herbal products
Defines herbal products as “foods”
What are three reasons why some drugs must be Rx instead of OTC?
Addition/abuse liability
Relative safety
Intent of use - does it require professional input/control?
What are some things the FDA regulates?
Foods
Dietary supplements
Bottled water
Food additives
Drugs
Biological
Medical devices
Cosmetics
Veterinary products
Tabacco products
Advertising of products
Animal preclinical testing is controlled by ___
IACUC (institutional animal care committee)
What is phase 1 of drug testing?
Small group of healthy (usually subjects to test SAFETY, DOSES, administration and other kinetics (SIDE EFFECTS)
What is phase 2 of drug testing?
Small group of subjects with condition to be treated to test SAFETY (still) and EFFICACY
What is phase 3 of drug testing?
Extended clinical phase - large group of subjects, using double blind construct, placebos and multi-sites groups to test for statistical efficacy
What is phase 4?
Marketing phase
See how the product does in production
What is the IRB?
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
What is the NDA?
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.
What is the IND?
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)
What is the orphan drug act?
This act is designed to promote the research and development of therapeutics for rare diseases. (Less than 200,000 people)
What gives companies incentive to develop drugs for rare conditions in the orphan drug act?
Increased patent life
Tax incentives
Etc.
What is fast tracking?
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.
What is the switching policy
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.
What are the requirements for a drug to meet in order to switch from Rx to OTC?
Marketed as Rx for at least 3 years
Used frequently to demonstrate a need
Side effects minor (safe)
What are the three non-prescription drug categories?
1 - safe and effective
2 - unsafe or ineffective
3 - not sure, requires more studies
True or false… if a drug has been FDA approved for depression, it cannot be used for anything other than depression.
False. As long as it is FDA approved, you can prescribe it for non-FDA uses
What is the FDA policy regarding herbal products?
Herbal products are considered a food (dietary supplement). Not a drug.
What are the labeling requirements for herbals?
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)
How is labeling controlled by the FTC (federal trade commission)?
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”
What is oxymetazoline?
Its a decongestant
What is phenylephrine?
Decongestant
What is pseudopherdrine?
Decongestant
How do decongestants work?
They are either vasoconstrictors or sympathomimetics
What is the advantages and disadvantages of topical nasal sprays over systemic decongestants?
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.
What is rhinorrhea?
Runny nose. Thought to be a defensive function to shed the virus
What are the advantages and disadvantages of drying agents for treating rhinorrhea?
Advantage: convenience
Disadvantage: may prolong infection by diminishing cleaning action of secretions
True or false… antihistamines are effective in treating a runny nose due to a cold
False. They are useful for allergies not colds
Name three different antihistamines
Diphenhydramine (drowsiness)
Chlorpheniramine
Loratidine (Claritin) - less drowsiness
Are antitussives best for a productive or non-productive cough?
Non-productive
If its productive, its usually better to cough all the mucus out
Name three antitussives
Codeine (narcotic)
Diphenhydramine (structurally similar to codeine. Has less abuse potential than codeine)
Dextromethorphan
Name one expectorant. What is it used for?
Guaifenesin (mucinex)
Increases productive cough. Loosens gunk up so you can cough it up more readily
What are demulcents?
Cough drops
They coat the irritative surface of the throat for soothing
True or false… drinking lots of water and humidification is effective in treating a cough
True
It decreases viscosity of respiratory secretions
Antivirals such as ___ and ___ have some benefit for colds by shortening the infection by a couple days if taken early
Oseltamivir (tamiflu-not OTC)
Zanamivir (relenza-not OTC)
____ is an OTC used for cold sores. Its a herpes antiviral.
Docosanol (abreva)
Which can cause reye syndrome, aspirin or acetaminophen?
Aspirin
Which is longer duration naproxen or ibuprofen?
Naproxen
True or false… zinc is proven to be effective in killing cold viruses
False. There is little if any benefit in killing cold viruses
What is phenol?
Oral anesthetic/analgesic used for sore throat
Contraindicated if allergic to local anesthetics
What are the effects of caffeine?
Increase wakefulness
Stimulant
Increase flow of thoughts
Increase concentration
Cardiovascular: Increase HR
Gastric: stimulates gastric secretion
Kidneys: mild diuretic. Decreases bloating associated with mensturation
Name three xanthines
Theophylline
Theobromine (found in chocolate)
Caffeine
What are the uses of nicotine? What are the side effects?
Patches, lozenges, gum used to treat tobacco dependence
Side effects: dizziness, headaches, nausea
Xanthines are an ___ antagonist
Adenosine
Name two antihistamine sleep aids
Diphenhydramine
Doxylamine
What is miconazole?
Antifungal used to treat thrush, athletes foot, and vaginal infections
What is neosporin and polysporin?
Antibiotic ointments used as a first aid preventative on minor abrasions
What is hydrocortisone?
Topical Anti-inflammatory, anti itching. Used for dermal lesions, eczema, insect bites, poison ivy, etc.
What sedatives are OTC?
None. However there are OTC sleep aids
What is capsaicin?
Topical ointment used for pain-relief
Acts on TRPV channels to deplete substance P
Name two drugs that treat motion sickness. What are some side effects?
Scopolamine (anticholinergic)
Dimenhydrainate (anticholinergic)
Drymouth, constipation, blurred vision, reduced urinating,
What is minoxidil used for?
Hair growth (rogaine)
Its a vasodilator that causes rapid heart beat. Other side effects include itchy scalp, scaling, flaking. Light headedness
What drugs are used to treat hemorrhoids?
Vasoconstrictors such as phenylephrine HCl.
What is the DSHEA?
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
St. John’s Wort is promoted to treat ___
Depression
Echinacea is promoted to treat ___
Colds, although controversial
Aloe Vera is promoted for ___ and ___. Side effect is __
Skin care and wound healing
Constipation
Side effect is cramps and diarrhea (strong laxative).
Caution if diabetic, may lower blood sugar
What is cranberry used to prevent?
UTIs
What is garlic used for?
Slowly lowers cholesterol (must eat a TON of garlic though)
Some thinning of blood
What is ginkgo promoted for?
Improve memory
Can increase bleeding risk
What is ginseng promoted for? What’s a side effect?
Boost immune system
May lower blood sugar
What is ephedra? What is it used for?
Sympathomimetic: contains ephedrine
Used for anorexia and stimulant effects.
FDA require removal from most OTC products, although still will occasionally see in herbal preparations
What may happen if you are deficient in the following vitamins?
A D K B1 B2 B3 (niacin) B6 B12
A: night blindness D: rickets/osteomalacia K: bleeding B1: beriberi B2: glossitis B3 (niacin): pellagra B6: anemia B12: anemia
Sensitivity to ___ causes malabsorption associated with celiac disease
Gluten
Sjögren’s disease involves ___, ___, and can be connected with ___.
Xerostomia
Kerato conjunctivitis
Rheumatoid arthritis
What is the active ingredient in Marijuana?
THC
What is amotivational syndrome associated with marijuana?
Lose sense of ambition
What is the endogenous ligand of marijuana?
Anandamide (natural neurotransmitter)
Marijuana affects cannabinoid receptors. Namely CB1 and CB2. Describe these receptors.
CB1 mostly CNS and mediates abuse problems
CB2 mostly peripheral and mediates inflammatory effects
True or false… marijuana is a bronchoconstrictor and vasoconstrictor
False. It is a bronchodilator - causes reflex increase in heart contractions
It is a vasodilator not a constrictor
The legal status of marijuana is schedule ___ according to federal law but varies according from state to state.
1
What is an FDA approved cannabinoid agonist? What does it do?
Marinol (dronabinol)
Increases appetite
Anti-nausea
CB1 agonist
Synthetic TCH/prescription
What are the proposed THC/marijuana uses?
Anti-nausea
Increased appetite
Glaucoma-reduce intraocular pressure
Chronic pain
What is CBD (cannabidiol)?
Analog promoted as antiseizure, not as addicting as THC
What is rimonabant?
Approved in Europe, although was later withdrawn due to depression/suicide
CB1 antagonist
Used to treat obesity by reducing appetite
What are “spice” products?
Street drugs
Contain cannabinoid agonists/antagonists and other drugs
Originally ‘legal’ but has since been outlawed. The cannabinoid ingredients have been made schedule 1
What are the side effects of marijuana?
Withdrawals
Attention disruptions
Induced psychosis with strong marijuana
Anxiety disorders
What is MUD?
Marijuana use disorder
__% 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
9%
4-7times
4 million
What are teratogens?
Drugs that alter fetal development when used during pregnancy by the mother
What happens when the mother takes DES (diethylstilbesterol)?
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
What are the different FDA classifications for teratogens? Describe them.
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))
What is the mission of the DEA?
Enforce the controlled substance laws and regulations of the USA.
Address issues of illegal growing, manufacturing, or distribution both domestically and internationally
Drug czar heads up the ____. What is the drug czar?
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.
The DEA oversees programs that deal with illicit and prescribed scheduled drugs (1-4) such as…
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
What is a scheudule 1 drug?
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)
What is a schedule 2/2n drug?
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!
What are schedule 3/3n drugs?
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)
What are schedule 4 drugs?
Low potential for abuse
Alprazolam, diazepam, midazolam
What are schedule 5 drugs?
Low potential for abuse relative to substances listed in schedule 4 and consist primarily of preparations containing limited quantities of certain narcotics.
(Robitussin)
What schedule is tramadol (ultram)
Schedule 4
What schedule is hydrocodone?
Schedule 2
What is DOPL and the utah controlled substance database?
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
What is the purpose of DOPL and the utah controlled substance database (UCSD)?
Identify over-utilization, misuse, and over-prescribing of controlled substances throughout the state
Outpatient pharmacies report dispenseing of scheduled drugs within __ days and the data are posted within __ hours after recipes.
7 days
24 hours
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
False.. not required
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
True
1 out of ___ prescriptions in hospitals are done improperly
5
Improper prescriptions kill ~___ people per year in the US
7,000
A.c. (Ante cibum)
Before meals
Ad.lib (ad libitum)
Use freely
Aq (aque)
Water
Bis
Twice
Bid
Twice daily
C.f.
With food
Dc
Discontinue
H (hora)
Hour
Noct (nocta)
At night
P.c (post cibum)
After meals
Prn (pro re nata)
As needed
P.o (per os)
By mouth
Q (quaque)
Every
Q.h.
Every hour
Q.d.
Every day
Q.i.d (quates in die)
4 times a day
S (sina)
Without
Sig
Write on the label
Stat
Immediately
T.i.d
Three times daily
W
With
W/o
Without
