Study Guide for Final (The most recent stuff) Flashcards
1
Q
Toxicology
A
the study of the adverse effects of a chemical, physical, or biological agent on living organisms and the ecosystem, including the prevention of such adverse effects in
- Occupational settings
- Environmental settings
- Ecological settings
2
Q
Toxicity
A
the ability of a material to damage a biological system, cause injury, or impair function.
-The dose, route of exposure, and chemical species, as well as the age, gender, genetics, and nutritional status of exposed individuals all effect the degree of toxicity.
3
Q
Hazard
A
ability of an agent to cause toxicity;
-depends on the inherent properties of the agent & exposure liability.
4
Q
Risk
A
the expected frequency of exposure to a hazardous agent.
-quality & suitability of the -dose-response data used for extrapolation limits risk assessment accuracy
5
Q
Route of exposure
A
- Route of entry into the body;
- inhalation, transdermal, oral, mucosal, etc.
6
Q
Duration of Exposure
A
- May effect selection of treatment.
- Acute vs Chronic
7
Q
ADME
A
The Adsorption, Distribution, Metabolism, and Excretion of toxic substances and their metabolites.
8
Q
Clearance
A
1st vs 0 order clearance
measure of the plasma cleared per unit time;
-sum of both the renal and hepatic contributions
When exposed to very high concentrations (toxic doses), normal kinetic properties can change:
- under normal conditions, elimination of most drugs/chemicals is proportional to their plasma concentration (1st order kinetics)
- When plasma levels become very high, protein binding and normal metabolism can both become saturated and the rate of elimination can become fixed (zero order kinetics) and more drug will be delivered into the circulation in unbound fraction.
- This is why at toxic doses of a drug or a toxin, normal kinetics may be altered to reflect prolonged a half-life and increases toxicity (larger, unbound free fractions)
9
Q
Volume of Distribution
A
more difficult to remove a substance with a large Vd than one with a small Vd
apparent volume into which a substance is distributed in the body
- A large Vd implies a substance will not be easily accessible to purification attempts (e.g., hemodialysis***);
- Examples include antidepressants, antipsychotics, antimalarials, and opioids
- A small Vd, better candidates;
- Examples include salicylates, ethanol, and phenobarbital.
phenyotin follows 0 order kinetics
10
Q
Bioaccumulation
A
accumulation of an toxic agent when the uptake of the agent exceeds the organism’s ability to metabolize/excrete it.
-in large exposures, capacity of 1st pass metabolism can be overwhelmed resulting in increased levels in blood and/or kidney.
Bioaccumulation refers to accumulation of higher and higher amounts of material within one specificorganism’s body such as one fish where as biomagnificationrefers to acquiring increasing levels of a substance in bodies of higher trophic-level organisms such as fish, seal, bear.
11
Q
Biomagnification
A
increases in the relative amount of a contaminant in a biological system as it passes up the food chain.
-polychlorinated biphenyls (PCB’s) in exposed plankton eaten by fish; fish eaten by people
Acquisition of increasing levels of a substance in bodies of higher trophic-level organisms such as fish, seal, bear as you go up the food chain.
12
Q
Biocompatibility
A
the ability of a material to elicit an appropriate biological response in a given application in the body.
- 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 cause allergic reactions
- Should have NO carcinogenic potential
13
Q
What defines some metals as “heavy”?
A
Naturally occurring elements defined as “heavy” due to their high atomic weight and having a density at least five times greater than that of water (i.e., specific density >5 g/cm3).
14
Q
The most toxic substances are
A
lead (#1), mercury (#2) and arsenic (#3)
15
Q
Heavy metals (high atomic weight), interfere with normal biological processes by
A
competing with normal substrates
16
Q
The shorter the t1/2 the more
A
effective is the use of chelators to remove the heavy metal
17
Q
Lead
A
( has no physiological value):
18
Q
What are the primary exposure sources? for lead
A
These include building materials/construction, batteries, lead pipes, paint etc.
19
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.
20
Q
What do we know about its toxicokinetics? of lead
A
t1/2 = 1-2 months
21
Q
What do we know about its symptomology? of lead
A
Headaches, neurocognitive deficits, kidney damage, etc.
22
Q
Lead
What is the main repository in the body for its lead burden?
What are Burtonian lines?
What is the mechanism of lead’s toxicity?
What is the treatment regimen for lead toxicity, particularly the recommended chelators?
A
- It substitutes for Ca++ in bone
- Lead lines causing a darkening of the gingiva
- Interferes with Ca++ use
- Causes anemia Causes immunosuppression
- Remove exposure
- Administer a chelator such as EDTA (edetate calcium disodium). It removes Pb from bone slowly and requires multiple chelating treatments
23
Q
Mercury (quicksilver) :
- Properties?
- What are the primary exposure sources?
- What is the mechanism of mercury toxicity?
A
-liquid at room temperature -primarily used in the methylHg form
- Found in fish
- Amalgam (no CDC-recognized evidence that it is a problem in dentistry)
- thermometers
- Reacts with selenium (necessary for reducing oxidized Vitamin C and E)
- Can cause gingivostomatitis
24
Q
Mercury quicksilver
What do we know about its toxicokinetics?
What do we know about its symptomology?
Explain the phrase “Mad as a hatter.”
What is the treatment regimen for mercury toxicity, particularly the recommended chelators?
Why is dimercaprol contraindicated in chronic mercury intoxication scenarios?
A
highly reactive with selenium, an essential dietary element required for thioredoxin reductase to prevent & reverse oxidative damage.
- Can cause neurological, psychiatric problems
Mad hatter means mercury was used in process of curing pelts used in hats making it impossible for hatters to avoid inhaling mercury fumes given off the hat making process. They suffered poisoning..causing conufsed speech, vision and neuro damage
Dimercaprol, succimer
Chronic use of dimercaprol can cause serious renal toxicity
25
• What do we know about its symptomology?
| Arsenic
* Fatigue, anemia, renal failure, hyperpigmentation
* Carcinogenic in lungs, skin and bladder
* Hemolytic on RBC
26
• What do we know about its toxicokinetics? (arsenic)
-absorbed through respiratory mucosa and GI tract, but so much through the skin
27
Arsenic primay exposure sources
-industrial contamination from the production of semiconductors, wood preservatives, alloys, glass, insecticidals, veterinary-grade antibacterials,
groundwater contamination by natural arsenic containing mineral deposits;
Arsenite (As3+): used in chemotherapeutics for various forms of leukemia.
28
Arsenic mechanism
-absorbed via respiratory & GI tract,
poor absorption through skin;
**binds to sulfhydryl groups in keratinized tissues (hair, nails, skin) where it acts a depot;
excreted primarily through kidney, but small amounts also in lost in sweat and feces.
29
• How does the treatment regimen, including the use of chelators, differ for each of the following conditions:
o acute arsenic intoxication
o chronic arsenic intoxication
o acute arsine gas intoxication
Treatment:
Decontamination & supportive care
Chelation with Unithiol (i.v.) or Dimercaprol (i.m.) for 4-6 hours;
If exposure is even suspected, empiric chelation should be started
Treatment:
supportive care,
dietary supplementation with folate promotes methylation & excretion,
chelators offer no therapeutic benefit since chronic arsenosis leads to irreversible damage to several vital organs and is an established carcinogen.
Treatment: Blood exchange hemodialysis and transfusions, aggressive hydration, chelators of no benefit
30
* How do chelators work on heavy metals?
* How does the half-life of the heavy metal effect the ability of a chelator to remove it from a target organ?
* Is it better to treat with chelators quickly or take a wait and see approach when an exposure has occurred?
* They render heavy metal ions unavailable for covalent interactions
* The longer the t1/2, the less effective is the chelator
-Generally, most effective if administered A.S.A.P. after exposure.
So expose chelator quick
31
Dimecaporol
• FDA-approved for which heavy metal poisonings as a monotherapy?
* Can be administered with CaNa2-EDTA for severe, chronic poisoning with what heavy metal?
* Why should it not be given as a monotherapy after chronic exposure to lead?
Water soluble?
• What is its only route of administration?
• How does its therapeutic index compare to succimer or unithiol?
FDA approved:
Monotherapy for acute arsenic and/or mercury poisoning
Combination therapy with edetate calcium disodium (CaNa2-EDTA) for severe LEAD poisoning
note:Contraindicated for use alone after chronic exposure to lead, since it redistributes larger doses of lead to CNS.
• It pulls Pb from bone and it goes to brain and causes toxicity
- Not water-soluble (cannot be given orally)
- Administered via i.m. route only
• It can be very toxic, especially on kidneys—succimer has for most part replaced dimercaprol
32
• What is the mechanism of arsenic toxicity? Acute
Acute Intoxication: abrupt gastroenteritis, hypotension, metabolic acidosis, cardiac dysfunction, pancytopenia, and peripheral neuropathy
Treatment:
Decontamination & supportive care
Chelation with Unithiol (i.v.) or Dimercaprol (i.m.) for 4-6 hours;
If exposure is even suspected, empiric chelation should be started
33
• What is the mechanism of arsenic toxicity? Chronic
fatigue, anorexia, anemia, weakness, GI complaints, peripheral neuropathy (dyesthesia); hyperpigmentation & hyperkeratoses of the skin of hands and feet, prolonged QT interval, cancer of lung, skin, bladder
Treatment:
supportive care,
dietary supplementation with folate promotes methylation & excretion,
chelators offer no therapeutic benefit since chronic arsenosis leads to irreversible damage to several vital organs and is an established carcinogen.
34
• What is the mechanism of arsenic toxicity? Acute arsine gas intoxication
causes hemolysis, headache, nauseau, vomitting, diarrhea, dypsnea, abdominal pain, jaundice and renal failure 1-3 days later.
Treatment: Blood exchange hemodialysis and transfusions, aggressive hydration, chelators of no benefit
35
Succimer (water-soluble form of dimercaprol)oral use only:
• FDA-approved for which heavy metal poisonings ?
• What is its main mechanism for removing heavy metals?
* Water soluble derivative of what other chelator?
* What is its half-life compare to dimercaprol?
* What is it’s only route of administration?
* Based on their comparative adverse effects, why has it larger replaced dimercaprol use?
in children & adults with [lead]blood >45 mcg/dL,
Also effective in arsenic and mercury intoxication.
• Used to treat Pb, As, and Hg poisoning
- Binds to cysteine to form mixed disulfides which are excreted by the kidney; half-life 2-4 hours.
- dimecaporol
- 2-4 hrs
- oral use only
- Very safe: Only adverse effects are diarrhea/GI upset (~10%) patients and mild rashes in
36
Edetate Calcium Disodium (CaNa2-EDTA):
* FDA-approved for which heavy metal poisonings ?
* Does it target intracellular or extracellular lead?
* What is it’s only route of administration?
* What is it’s half life?
* How is it excreted?
* In which patient population is it contraindicated and why?
- FDA-Indicated for chelation of lead
(Pb poisoning)
- Only chelates extracellular lead
- Only recommended via the i.v. route of administration
- Half-life of 1 hour;
- excreted 100% by kidney
-Contraindicated in anuric patients
Should not be used more than 5 consecutive days due to nephrotoxicity
37
Unithiol
• Water soluble derivative of what other chelator?
* What is are its routes of administration?
* How does it’s half-life compare to other chelators?
* Effective for what types of heavy metal poisoning?
* FDA-approved for which heavy metal poisonings?
-Other water-soluble • Dimercaprol—succimer is usually preferred
- Can be administered orally or i.v.
- Half-life of ~20 hours.
- Hg., As, Pb
- None
Has been shown to increase renal excretion of mercury, arsenic, and lead.
**
Peak blood levels by 4 hours;
**
38
Cyanide
• What is the mechanism of cyanide poisoning?
• What is the antidote?
-Mechanism of Toxicity: prevents the cells of the body from getting oxygen and ATP causing them to die.
Inhibits cytochrome c oxidase in the the electron transport chain in mitochondria membranes, preventing transport of electrons from cytochrome c to oxygen.
Cells can no longer aerobically produce ATP.
Tissues that depend highly on aerobic respiration, such as the CNS and the heart, are particularly affected.
-Antidote: Hydroxycobalamin reacts with cyanide to form cyanocobalamin, which can be safely eliminated by the kidneys.
39
CN is a heavy metal true or false?
Hydrogen cyanide properties
CN is NOT a heavy metal, but is one of the most commonly used chemicals worldwide in numerous industries:
pharmaceuticals, cigarettes, paper, plastics, gold mining, textiles, dyes, etc. (bitter almond smell)
Hydrogen cyanide (most toxic)
gas at ambient room temperatures & pressure and can therefore be inhaled.
Produced in the combustion of polyurethanes.
Oral ingestion of as little as 200 mg cyanide or to airborne cyanide of 270 ppm is sufficient to cause death within minutes.
40
* What is biocompatibility?
| * What are the four biocompatibility criteria for the ideal dental material?
the ability of a material to elicit an appropriate biological response in a given application in the body.
1. Should not be harmful to pulp or soft tissues
2. Should not contain toxic diffusable substances that may be released and absorbed into the circulatory system to cause systemic toxicity
3. Should be free of potentially sensitizing agents that may cause allergic reactions
4. Should have NO carcinogenic potential
41
• What are the common allergic reaction observed in dental practices and the steps that can be taken to prevent or minimalize them?
Allergic contact dermatitis: most common occupational hazard.
--Most common in distal fingers and finger tips after repeated exposures to monomers of bonding agents.
Avoid direct contact (wear gloves); wash hands often.
Latex Allergies: hypersensitivity to latex gloves and dams.
--use non-latex products.
Allergies to denture base materials:
- -Methyl methacrylate monomer in auto-polymerized dentures/appliances should be soaked in water for 24 hours before being worn the first time to avoid reactions by patients.
- -Hypersensitivity reactions to monomers and curing agents also observed in staff after repeated exposures to unreacted components.
42
• When using amalgam in filings, what step results in the greatest release of mercury?
-Mercury in Amalgam: The greatest amount of mercury is released during dry polishing of an amalgam restoration (44 mcg), followed by placement (6-8 mcg), wet polishing (2-4 mcg), and trituration (1-2 mcg)
43
• What steps can be taken to prevent pulpitis caused by unpolymerized monomers in resin composites used in deep fillings?
the addition of mineral fillers to chemically cures for resin composites has caused pulpitis, if curing is left incomplete in deep cavities;
- higher concentrations of unpolymerized monomer may reach pulp causing adverse reactions
- use twice the recommended time of exposure and cure in increments to assure to complete curing.
44
• How can a dentist prevent lesions caused by zinc phosphate cement?
Safe when used as a base for dental restorations, but if too thin of a mix of this cement is used with crowns or inlays, the patient may release phosphoric acid from the mix into the dentinal tubules when they bite down to seat the restoration.
3-4 days later a three dimensional lesion may form in the coronal pulp tissue.
Use proper mix or alternatively use a resin-modified glass ionomer cement
45
• How can dentists reduce cytotoxicity of acrylate bonding agents ?
```
cytotoxicity of these reagents is decreased significantly when adequately rinsed with tap water between applications of subsequent reagents.
Hydroxyethyl methacrylate (HEMA) is 100x less cytotoxic in vitro than than Bis-GMA resins.
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46
• Why is adequate ventilation and use of exhaust fans essential if working with metals in the laboratory?
Use exhaust fans for any laboratory techniques performed with metals since these can lead to exposure to beryllium dust, nickel dust, and/or beryllium vapors.
47
- Pure Food and Drug Act
caused by addiction to opium and cocaine; requires labeling, patent medicines
reason: Problem of addiction
content: require manufacturere to name products on
Labels (this didn’t help solve the issue of addiciton)
48
- Modified Food, Drug and Cosmetic Act
(required safety; caused by diethyleneglycol tragedy)
reason: this law is consequence of a tragedy (Ex. Sulfa drugs- used for abx, but early ones didn’t dissolve in water so cant be injected in vein) ended up putting them in diethylene glycol (antifreezE) and killed a ton of ppl
content: req that drugs must be safe for intake
49
- Durham-Humphrey Amendment
(Rx vs. OTC)
reason: many new drugs available. Rx or OTC
content: Perscription only: addictive drugs, safety (ones that have more toxicity) ,indication (illness being tX)
50
- Kefauver-Harris Amendment
(phocomelia caused by thalidomide tragedy; requires safety and efficacy)
reason: thalidomide was drug available in US
Phocomelia “flipper limb”
content: required safely and efficacy
51
- Dietary Supplement Health and Education Act
(regulates herbal products; defines herbal products as “foods”)
52
Distinction between prescription and OTC drugs
• Addiction/abuse liability
• Relative safety
• Intent of use-does it require professional input/control
Switched to OTC because
Requirements : Rx 3 years
-adverse events havent increased
Widely used
Results: Save $
c. Concernssometimes misused
53
C. FDA regulates:
• Foods, dietary supplements, bottled water, food additives, drugs, biologics, medical devices, cosmetics, veterinary products, tobacco products, advertising of these products.
54
III. DOPL and the Utah Controlled Substance Database (UCSD)
A. 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
55
purpose and details of DOPL
B. Purpose: identify over-utilization, misuse and over-prescribing of controlled substances throughout the state.
C. Details:
• Outpatient pharmacies report dispensing of scheduled drugs within 7 days and the data are posted within 24 hours after receipt.
• The following are not required to report to the UCSD
-prescriptions at federal facilities (e.g., VA, military)
-out of state pharmacies
-pharmacies servicing in-patient populations (i.e., hospitals)
56
D. Know the definitions of Schedule I-V drugs.
1. Schedule I Controlled Substances
Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.
2. Schedule II/IIN Controlled Substances (2/2N)
Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.
3.Schedule III/IIIN Controlled Substances (3/3N)
Substances in this schedule have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence
Schedule IV Controlled Substances
Substances in this schedule have a low potential for abuse relative to substances in Schedule III.
Schedule V Controlled Substances
Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.
57
• Know classification of Tramadol and Hydrocodone
Tramadol schedu 4
Hydrocodone Schedule 2
58
C. 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
59
II. DEA (Drug Enforcement Administration), and other oversight organizations
mission:
enforce the controlled substances laws and regulations of the USA
• Address issues of illegal growing, manufacturing or distribution both domestically and internationally
60
B. Drug Czar heads up the ONDCP (Office of National Drug Control Policy)
• 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.
61
Phases of drug testing
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
62
What were the CDC’s conclusions regarding mercury exposure related to (a) thimerosal
in influenza vaccines and (b) dental amalgam?
“There is no convincing evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site.
“U.S. government summaries on the effects of dental amalgam conclude that there is no apparent health hazard to the general population, but that further study is needed
63
- IRB
- NDA
- IND
- Orphan Drug Act
- Fast tracking
- IRB (institutional review board)
- NDA (new drug application)
- IND (investigational new drug)
- Orphan Drug Act (for rare disease to encourage drug development) there are illnesses but if not enough ppl have it, not worth the money since cant make a buck off it. Illnesses
64
- Switching Policy of FDA (Rx to OTC)
* 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.
65
Non-prescription drug categories
(I (safe and effective), II (unsafe or ineffective), III (not sure—requires more studies) )
66
- Know “on-” and “off (
not FDA approved, but confirmed by research and clinical experience)-” label use of prescriptions
67
- Know FDA policy regarding herbal products
“ dietary supplement
| food
68
• Labeling controlled by FTC (Federal Trade Commission).
Know this statement!
If it says its preventing a disease or treating a disease it’s a drug!
This category of products cannot be promoted to diagnose, treat or prevent disease
69
V. Over-the-Counter Agents
. Decongestants (know mechanism of action, pros and cons concerning topical vs. systemic administration)
- Oxymetazoline
- Phenylephrine
- Pseudophedrine (restricted sales)
1. systemic (increase BP, but longer acting decongestant) vs. topical (less systemic problems, but more likely to cause dependence-tolerance; shorter acting but more effective as decongestant).
vasoconstriction/sympathomimetics
Can be taken topically or systemic: nasal topical spray is faster since its immediately right there.
Disadvantage: If you take sympathomimetic systemically via oral you get increase in blood pressure, but lasts longer
Disadvantage: you can get rebound congestion dependence if taken topically, but its faster and less peripheral effects, and more effective overall
70
Rhinorrhea
* Theory-it has a defensive function
* Drying agents are for convenience, but may prolong infection by diminishing cleansing action of secretions
1. Annoyance – means of spreading
- Wash out viruses
2. Cause- mucus gland
4. Antihistamines (H1)
- Effective for tx runny nose if cause is allergy
71
Antihistamines
Antihistamines (know what this are used to treat (allergies vs. colds))
- Diphenhydramine (drowsiness)
- Chlorpheniramine (Chlor-Trimeton)
- Loratidine (Claritin) less drowsiness
- Codeine
- Diphenhydramine –anthistamine
suppressed cough
- Dextromethorphan (robotussin DM) – less abuse libailty vs codein
- non-productive –smoker hacky dry cough : no cleansing
- productive – move mucus and cellular debris so it moves out
Don’t tx when productive
72
Expectorant
- makes you cough, increases productive cough, and mucus formation and this mucus.
- Guaifenesin (Mucinex)
73
Demulcents
cough drops/syrupy products; coat the throat to reduce irritation
74
Water/humidification
decrease viscosity of respiratory secretions
75
Antivirals
I.- have some benefit for colds (shortens infection for 1-2 d) if taken early
1. Oseltamivir (Tamiflu-not OTC)
2. Zanamivir (Relenza-not OTC)
3. Docosanol (Abreva)- cold sores (Herpes)-antiviral
76
Analgesics
- Aspirin (acetosalyclic acid) –reyes syndrome ( don’t give to children) , causes GI irritation,
- Acetaminophen (NOT antiinflamm)
- Ibuprofen
- Naproxen – longer acting
77
Caffeine
* Xanthine- adenosine antgonist
* Stimulant (Vivarin)-diminish fatigue and sleepiness
* Minor CVS effects, but some constriction of cerebral vessels
* Gastric: stimulates gastric secretion
* Kidneys: mild diuretic—Decrease bloating associated with menstruation
78
Nicotine
* Patches, lozenges, gum to treat tobacco dependence
| * Side effects: dizziness, headaches, nausea
79
zinc
2. Docosanol
3. Phenol )
: little if any benefit in killing cold viruses
(cold sores)
(oral anesthetic
80
Diphenhydarmine
Doylamine
Miconazole
Neosporin
Diphenhydramine (antihistamine; sleep aid)
7. Doxylamine (antihistamine, sleep aid)
8. Miconazole (antifungal)-thrush, vaginal infections
9. Neosporin/Polysporin (antibiotic)
• First aid, preventive on minor abrasions
81
```
Hydrocortisone
Capsaicicn
Scopalmine
Dimenhydrinate
Minoxidil
```
10. Hydrocortisone (anti-inflammatory, anti-itching) dermal lesions, eczema, insect bites, poison ivy
11. Capsaicin (pain-relief); topical ointment, TRPV channels
12. Scopolamine (anticholinergic, motion sickness)
13. Dimenhydrinate (anticholinergic, motion sickness); dry mouth, constipation, difficulty, blurred vision, reduced urinating
14. Minoxidil (hair growth) (Rogaine)
• Vasodilator-causes rapid heart beat
82
hemorrhoids
hemorrhoids
| • Phenylephrine-vasoconstriction
83
Marijuana
. Marijuana (know active ingredient, anandamide, proposed uses, physiological effects)
1. amotivation syndrome—loose a sense of ambition
2. Endogenous ligand is anandamide (natural neurotransmitter)
2. Systems:
• Activates cannabinoid receptors
• Bronchodilator-causes reflex increase in heart contractions
• Vasodilator
• Tolerance and dependence
• Many cannabinoid agonists developed for street drugs; e.g., ‘Spice”
3. Therapeutic considerations:
• Legal status: Schedule I Federal laws; variable according to state laws (range from illegal, medical marijuana, to legalization [e.g., Colorado])
• Marinol (dronabinol)-FDA approved cannabinoid agonist
• Proposed uses:
-nausea
-appetite
-glaucoma
-chronic pain
• CBD (cannabidiol)- analog promoted as antiseizure, not as addicting as THC
84
DSHEA herbal products
.DSHEA—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.
a. Once marketed, the FDA is responsible for assuring dietary supplement is safe
b. Products cannot be promoted to diagnose, cure or prevent disease
85
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Herbs
St johns wart
Echinacie
Aloe vera
Garlic
Ginko
Ginseng
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a. St. John’s Wort
• Promoted to treat depression
b. Echinacea
• Promoted to treat colds
c. Aloe Vera
• Promoted for skin care-help with wound healing
• Dietary supplement to treat constipation
d. Garlic
• Slowly lowers cholesterol (minor effect)
e. Ginko
• Promoted to improve memory
f. Ginseng
• Boost immune system
• May lower blood sugar
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