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Final Material Flashcards

1
Q

s

A

(sina) without

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2
Q

What is fast tracking?

A

-Shorten FDA approval time for urgent situations

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3
Q

What is the DOPL and the UCSD, and their purpose?

A
  • Division of Occupational and Professional Licensing, and Utah Controlled Substance Database
  • This is a legislatively created database to track and collect data on dispensing of Schedule II-V drugs by retail, institutional and outpatient hospital pharmacies
  • Purpose: identify over-utilization, misuse and over-prescribing of controlled substances throughout the state.
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4
Q

Succimer:

A

Succimer (water-soluble form of Dimercaprol):

  • Used to treat Pb, As, and Hg poisoning
  • Urinary excretion (main mechanism for removal)
  • Water soluble derivative of dimercaprol
  • T1/2 – 2-4 hours
  • Route of administration -> ORAL USE ONLY
  • Succimer has less side effects (GI and mild rashes) as compared to hypertension, tachycardia, nausea, vomiting, salivation, pain
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5
Q

Doxylamine

A

Antihistamine

OTC sleep aide

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6
Q

What three groups are not required to report to the UCSD?

A
  • Prescriptions at federal facitilies (e.g. VA, military)
  • Out-of-state pharmacies
  • Pharmacies servicing in-patient populations (i.e. hospital)
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7
Q

What was the case and effect of the Modified Food, Drug, and Cosmetic Act?

A

Caused by the diethyleneglycol tragedy. Requires drug safety.

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8
Q

Unithiol is effective for what types of heavy metal poisoning?

A

Hg, As, and Pb poisoning

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9
Q

In which patient population is EDTA contraindicated and why?

A

Contraindicated in Anuric patients

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10
Q

What is Succimer’s only route of administration?

A

Oral use only

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11
Q

What is the mechanism of mercury toxicity?

A
  • Reacts with selenium (necessary for reducing oxidized Vitamin C and E)
  • Can cause gingivostomatitis
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12
Q

What are the three primary exposure sources of Mercury?

A
  • Found in fish
  • Amalgam (no CDC-recognized evidence that it is a problem in dentistry)
  • thermometers
  • Vaccines?
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13
Q

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

A

The longer the t1/2 of the heavy metal, the less effective is the chelator

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14
Q

Diphenhydramine

A

Antihistamine, not effective for colds. Has a lot of drowsiness. Also used as an anti-tussive. OTC sleep aide as well

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15
Q

Guaifenesin

A

Expectorant, increases productive cough, mucus formation, thins mucus.

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16
Q

There are no over-the-counter sedatives available. True or False?

A

True

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17
Q

What is the definition of a schedule III drug?

A
  • Have potential for abuse – may lead to moderate or low physical dependence or high psychological dependence
  • [Codeine, buprenorphine, ketamine]
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18
Q

What does the DEA oversee specifically?

A
  1. DEA oversees programs that deal with illicit and prescribed Scheduled drugs (Schedules 1-V) 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
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19
Q

What are the symptoms of Arsenic poisoning?

A
  • Fatigue
  • Anemia
  • Renal Failure
  • Hyperpigmentation
  • Carcinogenic in lungs, skin, and bladder
  • Hemolytic on RBC
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20
Q

What is a productive cough?

A

Removes mucous and cellular debri, don’t need to treat

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21
Q

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

A
  • Narrow therapeutic index
    • Can be very toxic – especially on the kidneys
    • Succimer has for most replaced dimercaprol
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22
Q

p.o.

A

(per os) by mouth

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23
Q

What was the cause and effect for the Pure Food and Drug Act?

A

Caused by addiction to opium and cocaine; requires labeling and naming ingredients, patent medicines

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24
Q

Why is lead exposure particularly detrimental to young children?

A
  • Their bodies absorb because Pb competes with Ca, and growing bodies require considerable Ca. Children absorb >50% consumed whereas adults absorb ~10-15%
  • They often eat or suck on things that contain Pb, such as things covered with Pb-containing paint, dirt etc.
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25
Q

Neosporin/Polysporin

A
  • Antibiotic
  • First aid – preventative on minor abrasions
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26
Q

Nicotine

A

Patches, lozenges, gum

Treat tobacco dependence

Side effects:

  • Dizziness
  • Headach
  • Nausea
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27
Q

What is the mechanism of cyanide poisoning?

A

Cyanide is not a heavy metal

  • Prevents cells of the body from getting oxygen and ATP causeing cell death
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28
Q

What was the cause and effect of the Durham Humphrey Amendment?

A

Many new drugs that needed to be regulated. Effect was Prescription vs Other the Counter (OTC)

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29
Q

What is the activite ingredient in Marijuana?

A

THC - Tetrohydrocannabinol

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30
Q

Unithiol is the water soluble derivative of what other chelator?

A

Dimercaprol—succimer is usually preferred

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31
Q

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

A
  • (coronal pulp tissue lesion due to phosphoric acid)
    • Use proper mix – don’t thin
    • Alternatiely use a resin modified glass ionomer cement
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32
Q

When using amalgam in filings, what step results in the greatest release of mercury?

A

The greatest amount of mercury is released during dry polishing of an amalgam restoration

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33
Q

What is phenylephrine also used to treat besides being used as a decongestant?

A

Treats hemorrhoids. Is a good vasoconstrictor.

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34
Q

What are the phases of drug testing?

A
  • Phases of Drug Testing (for example, preclinical; also phases I, II & III)
  • 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
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35
Q

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

A

Most effective administration is ASAP after exposure

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36
Q

What is a non-productive cough?

A

Dry hacking, non cleansing. Need treatment.

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37
Q

What is biocompatability?

A
  • Materials ability to perform with an appropriate host response
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38
Q

What is the definition of clearance?

A
  • Measure of the plasma cleared per unit time
  • Sum of both the RENAL and HEPATIC contributions
  • 1st order vs Zero Order kinetics
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39
Q

What is the mechanism of Arsenic’s toxicity?

A
  • Interferes with ezyme function
  • Interfere with signal transduction
  • Hemolytic effects on RBCs
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40
Q

What is the definition of hazard?

A
  • Ability of an agent to cause toxicity
  • Depends on inherent properties of the agent and exposure liability
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41
Q

What are the therapeutic considerations and proposed uses of marijuana?

A
  • Legal status: Schedule I Federal laws; variable according to state laws (range from illegal, medical marijuana, to legalization [e.g., Colorado])
  • Marinol (dronabinol)-FDA Rx approved agonist
  • Proposed uses:
    • nausea
    • appetite
    • glaucoma
    • chronic pain

* CBD (cannabidiol)- analog promoted as antiseizure, not as addicting as THC

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42
Q

noct

A

(nocta) at night

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43
Q

What are the non-prescription drug categories?

A

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

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44
Q

Loratidine

A

Antihistamine, not effective for colds. Less drowsiness. Claritin.

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45
Q

What are the three most toxic substances?

A

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

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46
Q

How does Unithiol’s half-life compare to other chelators?

A
  • T1/2 – 20 hours
  • Much longer than other chelating agents
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47
Q

What schedule drug is hydrocodone?

A

Schedule II drug

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48
Q

What are the characteristics of Mercury? Sources? Toxicity? Symptoms? CDC? Treatment?

A

Liquid at room temp

Primarily used in methylHg form

Sources:

  • Fish
  • Amalgam
  • Thermometers
  • Vaccines

Mercury toxicity:

  • Reacts with selenium

Symptoms:

  • Cause gingivostomatitis
  • Neurological
  • Psychiatric
    • “MAD HATTER” – hat makers used Hg
    • Memory loss, depression, confusion

CDC

  • No evidene of harm from vaccines
  • No health hazard from dental amalgams

Treatment:

  • Dimercaprol
    • Chronic use can cause serious renal toxicity
  • Succimer
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49
Q

Dimercaprol:

A
  • Used for arsenic and Hg, but not for Pb alone
  • Can be administered with CaNa2-EDTA for severe, chronic poisoning for LEAD POISONING
    • It pulls Pb from bone and it goes to brain and causes toxicity—contraindicated to use for lead poisoning alone
  • Not water soluble
  • Rout of administration = IM
  • Narrow therapeutic index
    • Can be very toxic – especially on the kidneys
  • Succimer has for most replaced dimercaprol
  • Half-life is 4-8 hours
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50
Q

w

A

with

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51
Q

Caffeine

A

Xanthine (caffeine, theobromine, theophylline)

  • Adenosine antagonist

Stimulant

  • Diminish fatigue and sleepiness
  • Minor CVS effects
  • Simulates gastric secretion
  • Mild diuretic
  • Decreases bloating with menstruation
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52
Q

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

A
  • Under normal concentration elimination of most drugs is proportional to their plasma concentration – 1st order kinetics
    • As plasma levels increase and become very high, protein binding and normal metabolism can become saturated and the rate of elimination becomes fixed – zero order kinetics

At toxic doses normal kinetics may be altered, reflects a prolonged half life and increases toxicity (high concentration of unbound free fractions)

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53
Q

Garlic

A

Herbal. Slowly LOWERS CHOLESTEROL.

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54
Q

What does ADME stand for?

A
  • Absorption
  • Distribution
  • Metabolism
  • Excretion
  • Of toxic substances and their metabolites
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55
Q

What is the switching policy of the FDA (Rx to OTC)?

A
  • Based on the need to reduce cost,
  • New drugs are always made prescription for at least 3 years before considering their conversion to OTC status
  • Good safety record
  • Used frequently to demonstrate a need.
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56
Q

w/o

A

without

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57
Q

How can dentists reduce cytotoxicity of acrylate bonding agents?

A

Rinse with tap water between applications

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58
Q

Phenol

A

Oral anesthetic

Do not use if patient is allergic to local anesthetic

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59
Q

What is the mechanism of lead’s toxicity?

A
  • Interferes with Ca++ use
  • Causes anemia
  • Causes immunosuppression
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60
Q

What are the main things that the FDA regulates?

A

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

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61
Q

What is the distinction between prescription and OTC drugs?

A
  • Addiction/abuse liability
    • RX – addictive potential
  • Relative safety
    • RX – more toxic, serious indication
  • Intent of use-does it require professional input/control (OTC)
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62
Q

Why is adequate ventilation and use of exhaust fans essential if working with metals in the laboratory?

A

Exposure of beryllium dust, nickel dust, and or beryllium vapors

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63
Q

prn

A

(pro re nata) as needed

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64
Q

What is the definition of route of exposure?

A

Route of entry into the body

  • Inhalation (most common)
  • Transdermal
  • Oral
  • Mucosal
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65
Q

What is 1st order kinetics?

A
  • Elimination of most drugs/chemicals is proportional to their plasma concentration
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66
Q

Oseltamivir

A

Antiviral, have some benefit for colds (shortens infection for 1-2 days if taken early. Not OTC. This is Tamiflu.

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67
Q

What is the antidote for cyanide poisoning?

A

Hydroxycobalamin

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68
Q

What is the FDA policy regarding herbal products?

A
  • Regulates herbal products like food
  • * Label regulations à name of mandufacturer, list of ingredients, contents, servings
  • * Manufacture is is responsible for ensuring the dietary supplement is safe
  • * FDA “approves”
  • * Full disclosure to FDA or consumer is regulated
  • * Consumers must demonstrate that the herbal supplement is safe to the FDA
  • * Labeling controlled by FTC (Federal Trade Commission). This category of products cannot be promoted to diagnose, treat or prevent disease
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69
Q

a.c.

A

(ante cibum) before meals

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70
Q

Cyanide is not a heavy metal. True or False?

A

True

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71
Q

What is the definition of volume of distribution?

A
  • Apparent volume into which a substance is distributed in the body
  • Large Vd = Substances will not be easily accessible to purification attemtps (hemodialysis)
    • Antidepressants, antipsychotics, antimalarials, opioids
  • Small Vd = better candidates
    • Salicylates, ethanol, phenobarbital
  • Harder to remove a substance with a larger Vd than a smaller Vd
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72
Q

What is the definition of duration of exposure?

A
  • May effect selection of treatment
  • Acute vs Chronic
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73
Q

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

A

severe, chronic poisoning for LEAD POISONING

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74
Q

c.f.

A

with food

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75
Q

What is the definition of risk?

A

The expected frequency of exposure to a hazardous agent

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76
Q

q.d.

A

every day

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77
Q

dc

A

discontinue

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78
Q

Mercury is primarily solid at room temp. True or False?

A

False, liquid, and primarily used in methyl Hg form

79
Q
  • How does the treatment regimen, including the use of chelators, differ for each of the following conditions:
    • acute arsenic intoxication
    • chronic arsenic intoxication
    • acute arsenic gas intoxication
A
  • Acute Arsenic Intoxication:
    • Decontamination
    • Unithiol (IV)
    • Dimercaprol (IM)
  • Chronic Arsenic Intoxication
    • Folate dietary supplement
    • NO CHELATORS – no therapeutic benefit
    • Irreversible damage has already occurred
  • Acute Arsine Gas Intoxication
    • Hemodialysis and transfusions
    • Aggressive hydration
    • NO CHELATORS – no benefit
80
Q

Unithiol has been FDA-approved for which heavy metal poisonings?

81
Q

What does NDA stand for?

A

New Drug Application

82
Q

Once marketed, who is responsible for assuring herbal products are safe?

A

The FDA. Cannot be promoted to diagnose, cure, or prevent disease.

83
Q

sig

A

write on the label

84
Q

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

A

It substitutes for Ca++ in bone

85
Q

Does EDTA target intracellular or extracellular lead?

A

Only chelates EXTRACELLULAR Pb

86
Q

What schedule drug is Tramadol?

A

Schedule IV drug

87
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
88
Q

What is EDTA’s half life?

89
Q

What defines some metals as “heavy”?

A

HEAVY METALS:

  • High atomic weight
  • Density is 5x greater than water , >5 g/cm3

Lead (1), Mercury (2), Arsenic (3), Cadmium (7)

90
Q

What is biocompatibility?

A

Biocompatibility = The ability of a material to elicit an appropriate biolgocial response in a given application in the body

91
Q

What is the definition of a schedule II drug?

A
  • High potential for abuse – may lead to sever psychological or physical dependence
  • [Hydromorphone, methadone, meperidine, fentanyl, hydrocodone, codeine]
92
Q

How do heavy meatls interfere with normal biological processes?

A

Heavy metals (high atomic weight), interfere with normal biological processes by competing with normal substrates

93
Q

What is Succimer’s half-life compare to dimercaprol?

A

T1/2 – 2-4 hours, whereas dimercaprol is 4-8 hours

94
Q

h

A

(hora) hour

95
Q

Why is dimercaprol contraindicated in chronic mercury intoxication scenarios?

A

Chronic use of dimercaprol can cause serious renal toxicity

96
Q

Edetate Calcium Disodium (CaNa2-EDTA):

A
  • Used to treat Pb poisoning
  • Only chelates EXTRACELLULAR Pb
  • Route of administration à IV
  • T1/2 – 1 hour
  • 100% by the kidneys
  • Contraindicated in Anuric patients
    • Should not be used > 5 days due to nephrotoxicity
97
Q

What are the characteristics of Rhinorrhea?

A
  • Theory-it has a defensive function
  • Drying agents are for convenience, but may prolong infection by diminishing cleansing action of secretions
98
Q

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

A

Dimercaprol, succimer

99
Q

t.i.d.

A

three times daily

100
Q

What is biomagnification?

A
  • Increases in the relative amount of a contaminant in a biological system as it passes up the food chain
  • Mercury – increases up the food chain
101
Q

What are Unithiol’s routes of administration?

A

ORALLY or IV

102
Q

What are the symptoms of mercury?

A
  • Cause gingivostomatitis
  • Neurological
  • Psychiatric
    • “MAD HATTER” – hat makes used Hg
    • Memory loss, depression, confusion
103
Q

What is lead’s symptoms?

A

Headaches, neurocognitive deficits, kidney damage, etc.

104
Q

aq (aque)

105
Q

What is the defintion of a schedule V drug?

A
  • Low potential for abuse
  • Limited quantities
  • Cough preparations - robitussin
106
Q

Dimercaprol is water soluble. True or False?

A

False, it is not water soluble

107
Q

Unithiol:

A
  • Used to treate Hg, As, and Pb poisoning
  • Water soluble derivative of Dimercaprol—succimer is usually preferred
  • Route of administration = ORALLY or IV
  • T1/2 – 20 hours
    • Much longer than other chelating agents
  • Not FDA approved for any heavy metal poisonings
108
Q

What is lead’s half-life?

A

1-2 months

109
Q

p.c.

A

(post cibum) after meals

110
Q

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

A

Used for arsenic and Hg, but not for Pb by itself because it resdistributes larger doses to the CNS and brain

111
Q

What twelve items are found on a prescription slip?

A
  1. DEA No.
  2. Name
  3. Age
  4. Address
  5. Date
  6. Drug name
  7. Brand name of drug
  8. Form (tabs, pills, etc)
  9. Dosage (200mg, 100mg, etc)
  10. Disp: (how many tablets, 20 tabs, etc)
  11. Sig: (1 tab qrh prn pain)
  12. Signature
112
Q

St. John’s Wort

A

Herbal. Promoted to treat DEPRESSION.

113
Q

What are the physiological effects of marijuana?

A
  • Activates cannabinoid receptors
  • Bronchodilator
  • Vasodilator
  • Tolerance and dependence
  • Many cannabinoid agonists developed for street drugs; e.g., ‘Spice”
  • Cannabidiol receptors
  • -Heavy concentration in cerebellum - impaired motor control
  • -Cortex - impaired executive decision making
  • -Mesolimbic system - pleasure is given through dopamine release
  • -Hypothalamus - the munchies
114
Q

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

A

To prevent pulpitis – use twice the recommended curing time and cure in increments for composite restorations

115
Q

What is Zero order kinetics?

A
  • Plasma levels become very high – protein binding and normal metabolism can both become saturated and the rate of elimination can become fixed
  • Not dependent on plasma concentration (fixed rate)
  • More drug is delivered into circulation in unbound fraction – easier to become toxic
116
Q

Aloe Vera

A

Herbal.

  • Promoted for SKIN CARE – helps with wound healing
  • Dietary supplement to treat constipation (very effective!)
117
Q

bis

118
Q

What is the definition of a schedule IV drug?

A
  • Low potential for abuse
  • Alprazolam (Xanax), diazepam (Valium), Triazolam, Tramadol
119
Q

Miconazole

A
  • Antifungal
  • Thrush
  • Vaginal infections
120
Q

What is the endogenous ligand of marijuana?

A

Anandamide (natural neurotransmitter)

121
Q

What does the IRB stand for?

A

Institutional Review Board

122
Q

What does an expectorant do?

A
  • Increases productive cough
  • Increases mucus formation
  • Thin the mucus
123
Q

What are the pros and cons of Aspirin?

A
  • Pros:
    • Good analgesic
    • Anti-pyretic
    • Anti-inflammatroy
  • Cons:
    • Reyes Syndrome – DO NOT GIVE TO CHILDREN
    • GI irritation
    • Acetylsalicyclic
    • Anti-clotting (do not take before surgery)
124
Q

Docosanol

A

Antiviral, have some benefit for colds (shortens infection for 1-2 days if taken early. Not OTC. This is for cold sores (herpes)

125
Q

What are the characteristics of Arsenic? Sources? Toxicokinetics? Arsenic Toxicity? Symptoms? Treatment?

A

Sources:

  • Industrial contamination
  • Groundwater contamination
  • Arsenite

Toxicokinetics:

  • Absorbed via respiratory and GI
  • POOR ABSORPTION THROUGH SKIN
    • Binds to keratin
  • Excreted though kidney’s

Arsenic toxicity:

  • Interferes with ezyme function
  • Interfere with signal transduction
  • Hemolytic effects on RBCs

Symptoms:

  • Fatigue
  • Anemia
  • Renal Failure
  • Hyperpigmentation
  • Carcinogenic in lungs, skin, and bladder
  • Hemolytic on RBC

Treatment:

  • Acute Arsenic Intoxication:
    • Decontamination
    • Unithiol (IV)
    • Dimercaprol (IM)
  • Chronic Arsenic Intoxication
    • Folate dietary supplement
    • NO CHELATORS – no therapeutic benefit
    • Irreversible damage has already occurred
  • Acute Arsine Gas Intoxication
    • Hemodialysis and transfusions
    • Aggressive hydration
    • NO CHELATORS – no benefit
126
Q

Codeine

A

Antitussive

127
Q

What is the only route of administration of Dimercaprol?

128
Q

Capsacin

A
  • Pain relief
  • Topical ointment
  • Targets TRPV channels
  • Decreases substance P
129
Q

What does water/humidification do to colds, etc.?

A

Decreases viscosity of respiratory secretions

130
Q

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

A
  • Volume of distribution = apparent volume into which a substance is distributed in the body
    • Large Vd – implies a substance will not be easily accessible to purification attempts [Antidepressants, antipsychotics, antimalarials, opiods]
    • Small Vd – easier to extract [salicylates, ethanol, phenobarbital]
131
Q

Dimenhydrinate

A

Anti-cholinergic

Treats motion sickness

Side effects:

  • Dry mouth,
  • constipation,
  • blurred vision,
  • reduced urinating
132
Q

What are demulcents?

A

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

133
Q

What is the definition of toxicity?

A
  • The ability of a material to damage a biological system, cause injury, or impair function
  • Dose, Route of exposure, and chemical species, age, gender, genetics, and nutritional status of exposed individuals all affect the degree of toxicity
134
Q

Echinacea

A

Herbal. Promoted to treat COLDS.

135
Q

The longer the half life, the more effective is the use of chelators to remove the heavy material. True or False?

A

False. The shorter the half-life the more effective.

136
Q

Zanamivir

A

Antiviral, have some benefit for colds (shortens infection for 1-2 days if taken early. Not OTC.

137
Q

Phenylephrine

A

Decongestant, vasoconstrictor, sympathomimetics, alpha-1 agonist

138
Q

How do chelators work on heavy metals?

A

They render heavy metal ions unavailable for covalent interactions

139
Q

bid

A

twice daily

140
Q

q

A

(quaque)every

141
Q

Zinc

A

Little benefit – if any in killing cold viruses

Ma have permanent damage to sense of smell

142
Q

Docosanol

A

Cold Sores

Ant-viral

143
Q

What type of person heads up the ONDCP (Office of National Drug Control Policy), and what do they do?

A

Drug Czar

  • 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 & NIAAA (from NIH) activities and budget
144
Q

Chlorpheniramine

A

Antihistamine, not effective for colds. Chlor-Trimeton.

145
Q

What are the characteristics of Lead?

A

No physiological value

Sources:

  • Building materials
  • Batteries
  • Lead pipes
  • Paint

Lead toxicity:

  • Interferes with Ca
  • Causes anemia
  • Cause immunosuppression

Detrimental to young children:

  • Absorbed because it competes with Ca
  • Growing bodies require Ca
  • Absorbed > 50%, adults absorb only 10-15%
  • Eat or suck on things containing Pb

SUBSTITUTES CA IN BONE

T1/2 = 1-2 months in soft tissues, years in bone

Symptoms:

  • Headaches
  • Neurocognitive deficits
  • Kidney damage
  • Burtonian Lines:
    • Lead lines causing a darkening of the gingiva

Treatment:

  • Remove exposure
  • EDTA (edetate calcium disodium) chelator
    • Removes Pb from bone slowly and requires multiple chelating treatments
146
Q

What is the positive aspect of Naproxen?

A

Long-acting!

147
Q

What is the Orphan Drug Act?

A
  • for rare disease to encourage drug development
  • Illnesses involving less than 200,000 individual
  • -Tax incentives
  • -Extend patent
148
Q

Dextromethorphan

A

Antitussive (robotussin)

149
Q

What are the common allergic reaction observed in dental practices and the steps that can be taken to prevent or minimalize them?

A
  • Allergic contact dermatitis
    • Common on distal fingers and finger tips
    • Avoid direct contact (wear gloves)
  • Latex allergies
  • Allergies to denture base materials
    • Methyl methacrylate monomer
150
Q

What is amotivational syndrome?

A

Loss of sense of ambition, thinking dulled

151
Q

What are the main four sources of lead?

A

Sources:

  • Building materials
  • Batteries
  • Lead pipes
  • Paint
152
Q

What is the definition of a schedule I drug?

A
  • No current acceptable medical use in US
  • Lack accepted safety for use under medical supervision
  • HIGH potential for abuse
  • [Heroin, LSD, Cannabis, meth]
153
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—contraindicated to use for lead poisoning alone

154
Q

What does IND stand for?

A

Investigational New Drug

155
Q

What is the difference between bioaccumulation and biomagnification?

A
  • Bioaccumulation – accumulation of a toxic agent when the uptake of the agent exceeds the organism’s ability to metabolize excrete it
    • 1st metabolism can be overwhelmed – increased levels in blood and kidney

Biomagnification – increase in the relative amount of a contaminant in a biological system as it passes up the food chain

156
Q

What is the mission of the DEA?

A
  • Mission: enforce the controlled substances laws and regulations of the USA
  • Address issues of illegal growing, manufacturing or distribution both domestically and internationally
157
Q

What is bioaccumulation?

A
  • Accumulation of toxic agent when the uptake of the agent exceeds the organism’s ability to metabolize/excrete it
158
Q

How is EDTA excreted?

A

100% by the kidneys

159
Q

q.i.d.

A

(quates in die) 4 times a day

160
Q

What are the four biocompatibility criteria for the ideal dental material?

A
  • Sould not be harmful to pulp or soft tissue
  • Should not contain toxic diffusible substances that may be released and absorbed into the circulatory system to cause systemic toxicity
  • Free of potentially sensitizing agents that may cuase allergic reactions
  • NO carcinogenic potential
161
Q

Oxymetazoline

A

Decongestant, vasoconstrictor, sympathomimetics.

162
Q

What is the on and off label use of prescriptions?

A

Not FDA approved, but confirmed by research and clinical experience

163
Q

What are the differences betwen a systemic and topical decongestant?

A
  1. systemic

* increase BP and HR

* longer acting

  1. topical

* NASAL SPRAYS

* less systemic problems

  • Sprays have a much faster effect, but you can get rebound congestion because it doesn’t last 6-8 hours sometimes and they use it too much, even though the cold is gone, they should be feeling better, but they still feel congested because they are dependent.
  • If you take these drugs orally, you could get an increase in blood pressure because of the vasoconstriction
  • The sprays have less peripheral effects and are less likely to increase blood pressure
  • The sprays are actually probably more effective.

* dependence-tolerance

* Short acting – but MORE EFFECTIVE

164
Q

What are the characteristics of CBD (Cannabidiol)?

A
  • Ø One of more than 80 active cannabinoid chemicals in the marijuana plant
  • Ø Unlike THC, CBD does not produce euphoria or intoxication
  • Ø CBD has a very low affinity for cannabinoid receptors (100-fold less) Ø CBD may acts on other brain signaling systems (serotonin??)
  • Ø CBD may have anti-seizure, antioxidant, neuroprotective, anti- inflammatory, analgesic, anti-tumor, anti-psychotic, anti-anxiety properties.
  • Ø NIH is currently supporting a number of studies effects as well as the health risks of cannabinoids.
165
Q

Scopolamine

A

Anti-cholinergic

Treats Motion sickness

Side effects:

  • Drowsiness,
  • disorientation,
  • dry mouth,
  • blurred vision,
  • dilated pupils,
  • constipation
166
Q

What is a dietary supplement?

A
  • Congress defined the term “dietary supplement” as a product taken by mouth that contains a “dietary ingredient” intended to supplement the diet. The “dietary ingredients” in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites.
167
Q

What is the process of DOPL and UCSD?

A
  • Outpatient pharmacies report dispensing of scheduled drugs within 7 days and the data are posted within 24 hours after receipt.
168
Q

What was the cause and effect of the Kefauver-Harris Amendment?

A

The phocomelia caused by thalidomide (morning sickness) tragedy. Required testing for safety and efficacy.

169
Q

Succimer is FDA-approved for which heavy metal poisonings?

A

Used to treat Pb, As, and Hg poisoning

170
Q

Hydrocortisone

A
  • Anti-inflammatory
  • Anti-itching
  • Dermal lesions
  • Eczema
  • Insect bites
171
Q

What is the DEA?

A

Drug Enforcement Administration

172
Q

What are Burtonian lines?

A

Lead lines causing a darkening of the gingiva

173
Q

What is the definition of toxicology?

A

Study of the adverse effects of a chemical, physical, or biological agent on living organisms and the ecosystem.

Includes prevention of such adverse effects in

  • Occupational
  • Environmental
  • Ecological
174
Q

EDTA has been FDA-approved for which heavy metal poisonings?

A

Pb poisoning

175
Q

stat

A

immediately

176
Q

What do we know about Arsenic’s toxicokinetics?

A
  • Absorbed via respiratory and GI
  • POOR ABSORPTION THROUGH SKIN
    • Binds to keratin
  • Excreted though kidney’s
177
Q

Pseudoephedrine

A

Decongestant, vasoconstrictor, sympathomimetics, restricted sales

178
Q

q.h.

A

every hour

179
Q

What are the three primary exposure sources of arsenic?

A
  • Industrial contamination
  • Groundwater contamination
  • Arsenite
180
Q

Ginko

A

Herbal. Promoted to IMPROVE MEMORY. Uncooked ginko seeds contain ginkotoxin and can cause seizures.

181
Q

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

A

Succimer has less side effects (GI and mild rashes) as compared to hypertension, tachycardia, nausea, vomiting, salivation, pain

182
Q

ad.lib.

A

(ad libitum) use freely

183
Q

What is the water soluble form of Dimercaprol?

184
Q

Minoxidil

A
  • Hair Growth (Rogaine)
  • Vasodilator – Causes rapid HR
185
Q

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

A
  • No evidene of harm from vaccines
  • No health hazard from dental amalgams
186
Q

What regulates the herbal products?

A
  • DSHEA, -Dietary Supplement Health and Education Act.
  • Regulates herbal dietary supplements: defined as taken by mouth and contains a ‘dietary’ ingredient to supplement diet. May include vitamins, minerls, herbs or other botanical and nutrients.
187
Q

What was the cause and effect of the Dietay Supplement Health and Education Act?

A

Little regulation lead to regulating herbal products like food, servign size, structure, functions, claims, with the big statement = These statements have not been evaluated by the FDA. Not intended to diagnose, treat, cure, or prevent any disease.

188
Q

Succimer is the water soluble derivative of what other chelator?

A

Dimercaprol

189
Q

What are the pros and cons of Ibuprofen?

A
  • Pros:
    • Good analgesic
    • Antipyretic
    • Anti-inflammatory
    • No reyes syndrome
  • Cons:
    • GI irritation
    • Anti-clotting
190
Q

What are the pros and cons of Acetaminophen?

A
  • Pros:
    • Anti-pyretic
    • Analgesic
    • Not irritating to stomach
    • Give to children
  • Cons:
    • NOT an anti-inflammatory
    • LIVER toxic
191
Q

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

A

Urinary excretion

192
Q

Ginseng

A

Herbal. Boosts immune system, may lower blood sugar.

193
Q

What is EDTA’s only route of administration?

Human Diseases & Therapeutics (16 decks)

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