THE THIRD MIDTERM Flashcards

Question

What are the two main synthetic estrogens?

Answer 1

* Steroidal: ethinyl estradiol * Non-steroidal: diethylstilbesterol

Answer 2

1. Sexual maturity 2. Increased CNS excitability (seizure inducing?) 3. Increased endometrial and uterine growth 4. Maintain skin elasticity 5. Reduce bone adsorption 6. Increase blood coagulability

Answer 3

* Primary hypogonadism * Postmenopausal (1) Guidelines for use * Always use the smallest dose for the shortest period of time possible * Sometimes local creams are preferred to minimize exposure

Answer 4

* Postmenopausal bleeding * Nausea, breast tenderness * Migraines * Hypertension * Hyperpigmentation (especially around eyes) * Increases some cancers (e.g.. breast and endometrial)

Answer 5

* Liver disease (slows metabolism) * Breast/endometrial cancers * Thrombolytic disorders

Answer 6

* Made from cholesterol * Present in males, but less than females a. Progesterone (natural)—most important progestin in human • Precursor to estrogen, androgen and adrenalcortical steroids (e.g., cortisol) • Also precursor to testosterone and estradiol c. Half life= 5 min. (very short acting)

Answer 7

1. Increase fat deposition 2. Decrease CNS excitability (e.g., antiseizure—opposite of estrogen) 3. Increase aldosterone---increase Na+ retention—increase BP—increase water retention and blood volume 4. Increase body temperature

Answer 8

* Replacement therapy * Oral contraception * Long-term ovarian suppression (e.g., dysmenorrhea or endometriosis)—in contrast to estrogens, no problem with bleeding or clotting * Contraindications: * Breast cancer is a risk * Severe hypertension or heart disease is risk

Answer 9

* Decreases ovulation (approaching 100%) * Decreases conception and implantation

Answer 10

Progestin only (less effective, ~80-90%) * Decreases ovulation 50-80% * Thickens mucus and reduces sperm penetration * Impairs implantation

Answer 11

• Combinations: * • Monophasics- constant doses of both estrogen and progesterone * • Biphasic- dosage of one or both change one time during cycle * • Triphasic-dosages change 2 times * Progestin only—referred to as the “minipill” (no estrogen); fewer side effects, but less effective * Implantable * Injections (i.m., sustained effects) * Intravaginal rings * IUDs with and without estrogen/progestin * Transdermal combinations

Answer 12

* Reduced ovarian functions and size * Increased breast size and tenderness * Increased thromboembolytic events (clotting) * Increased heart rate and BP * Hyperpigmentation, especially around the eye * Mild nausea, breakthrough bleeding, headaches * May interact with antibiotics that disrupt G.I. normal flora (e.g., wide spectrum antibiotics such as amoxicillin)—normal absorption of contraceptives from GI system is dependent on these flora

Answer 13

* Oral contraception * Menstrual disorders, irregularity, heavy discharge * Acne

Answer 14

Estrogen receptor antagonist. Blocks actions of estrogen in breast-used to treat breast cancers.

Answer 15

Mifepristone is a synthetic, steroidal anti-progestogen and anti-glucocorticoid pharmaceutical drug. Morning after contraceptive: blocks progesterone and glucocorticoid receptors. Ends a pregnancy that is less than 7 weeks along (49 days or less since the start of your last menstrual period). Also used to control high blood sugar in patients with Cushing syndrome who also have type 2 diabetes and have failed surgery or are not candidates for surgery.

Answer 16

Danazol is a derivative of the synthetic steroid ethisterone that suppresses the production of gonadotrophins and has some weak androgenic effects. Suppresses ovarian function (has a masculinizing effect). Treats endometriosis, fibrocystic breast disease, and hereditary angioedema.

Answer 17

Clomifene or clomiphene is a selective estrogen receptor modulator that has become the most widely prescribed drug for ovulation induction to reverse anovulation or oligoovulation. Ovulation-inducing; for promoting fertilization and pregnancy (increased risk of multiple births—e.g., twins). Clomed.

Answer 18

It is an androgen, causes male puberty. * Converts to estradiol * Replacement therapy for males * Gynecological disorders—reduces breast size (gynecomastia) * Has protein anabolic effects—helps replace muscle loss * Growth stimulation—can prematurely close growth plates in growing adolescents * Counter some age-related loss of muscle mass * Adverse effects in women especially—masculinization * Testosterone analogs abused for muscle and strength building—can cause acne, aggressiveness and “roid rage”, although this is controversial.

Answer 19

* 99% Calcium stored in bones * In adult, the bones are the primary site of hematopoeises * Constantly remodeling * Medullary bone resists compression forces, Cortical bone is thick and resists bending forces * Periosteum is tough fibrous membrane—covers bone surfaces except at joints—well innervated

Answer 20

1. Osteogenesis imperfecta a. Deficient or defective type 1 collagen—too little bone b. Generalized osteopenia * Multiple fractures and bone deformities * Malformed teeth (dentin deficiency)

Answer 21

1. Vitamin deficiencies : scurvy (vit. C), rickets (vit. D) 2. Endocrine factors—hyperparathyroidism 3. Osteoporosis—common in elderly women, after menopause 4. Osteomalacia—vitamin D deficiency

Answer 22

Genetic: age, low estrogen, fair hair and skin, tall and thin Behavior: inactivity, smoking/alcohol, malnutrition, medication (chronic corticosteroids)

Answer 23

* 10 million have osteoporosis in US, mostly women * 1/3 women \>50 years old have at least one osteoporitic fracture

Answer 24

Abnormal forward curvature of spine

Answer 25

Abnormal lateral curvature of spine

Answer 26

* Complete * Closed (overlying tissue intact) * Commuted—bone splintered * Displaced

Answer 27

Osteomyelitis (inflammation of bone/marrow) a. blood-born or direct b. trauma from compound fractures c. pyogenic infections (e.g., staph aureus or salmonella) d. granulomatous (TB or fungal)- called “Pott disease” when associated with TB e. Diabetes—due to poor circulation in the extremities-if chronic can form a drainage site and can even become osteosarcoma

Answer 28

a. Loss of articular cartilage with secondary changes in bone b. Presents in some degree in most persons \>65 years of age. Symptoms worsen with excessive use. c. Due to wear and tear d. No inflammatory changes

Answer 29

a. Autoimmune- 1% prevalence b. Most common in Caucasians/ uncommon in Asians c. Onset age: 25-50 yrs.-75% female/ can have juvenile RA d. Joint swelling, pain and tenderness—often cause extreme distortions of joints and surrounding bone—deforming and debilitating e. Other areas also affected: • Ulcers • Pulmonary nodules and fibrosis • Carditis and pericarditis • Vasculitis

Answer 30

a. Psoriatic (psorias) arthritis b. Other autoimmune diseases (e.g., lupus [erythematosus], scleroderma) c. Postinfections (e.g., rheumatic fever) d. Infectious—staph/strep, TB e. Gout (crystallized uric acid) f. Lyme disease, if not treated—arthritis and neurological consequences

Answer 31

a. Primary cause by reduced renal excretion of purine b. A primary treatment is with allopurinol—decreases the synthesis of purines c. Symptoms: • Hot, swollen, pain in joints---progressive joint destruction—gouty tophi (crystalized aggregates of uric acid) d. Pseudo-gout—crystal deposits of calcium pyrophosphate

Answer 32

Ganglion cysts—a cyst resulting from connective tissue around joints—often painful

Answer 33

• Cell types include: squamous cells, basal cells, melanocytes

Answer 34

• Appendages include: apocrine (sweat milky with odors-located near hair follicles), eccrine (found widely distributed, and sweat is watery for thermo control), sebaceous (also located near hair follicles—secrets oily sebum for lubrication and to prevent water loss).

Answer 35

* Macule- flat, circumscribed (5 mm) * Plaque-elevated flat-topped lesion (\> 5mm) * Lichenfication-thickened skin due to repeated rubbing * Pustule-discrete, pus-filled raised lesion * Scale-dry, plate-like excrescence, imperfect cornification * Vesicle-fluid filled raised area, 5 mm * Dyskeratosis—abnormal keratization, deeper in epidermis * Hyperkeratosis—hyperplasia of stratum cornum * Spongiosis-intercellular edema of epidermis

Answer 36

1. Urticaria (hives) 2. Eczematous dermatitis 3. Allergic contact dermatitis 4. Erythema multiforma

Answer 37

* urticaria (hives), hypersensitivity mediated by antigens (e.g., pollen, food, drugs; mediated by IgE) * eczematous dermatitis (e.g, contact dermatitis most common, delayed hypersensitivity reaction, can be pruritic, edematous or oozing plaques/vesicles), * Allergic contact dermatitis—cellular memory of the reaction so that future contacts cause an increased dermatitis reaction * Erythema multiforma (hypersensitivity to infections and drugs-dermal edema-can have blisters and necrosis)-wide range of expressions and severity -can be severe life-threatening reaction known as Stevens-Johnson Syndrome—generalized all over the body—reaction to medicines (e.g., sulfonamides, salicylates)—can also be a reaction to infections such as herpes virus or fungal infections

Answer 38

1. Psoriasis 2. Lichen Planus

Answer 39

* psoriasis, inciting antigen—auto-rejection or environmentally induced -1-2% in US -can be accompanied by increased heart attacks and arthritis -treatment includes NSAIDS and immunosuppressant drugs -well-marked by pink to salmon colored plaques -regular acanthosis in epidermis * lichen planus; -middle age -extremities and oral cavity -lace-like white markings. -resolve after 1-2 years although often persists in oral cavity Hyperkerotosis, and epidermal hyperplasia -Unknown inciting mechanisms

Answer 40

- bacterial (e.g., impetigo: staph and strep infections superficial) on face and extremities, contagious through contact, --primarily kids; honey color crust-pustules - fungal (tinea [ring worm] or candida); often infections in immunocompromised patients - viral (wart pathology-human papillomavirus-HPV; verrucae); contagious by direct contact; can auto-innoculate and spread/epidermal hyperplasia, papillo mitosis • Bulbous blistering prominent feature: pemphigus (painful flaccid blister like-deep erosions and crust after rupture-hypersensitivity reaction), dermatitis herpetiformis-use immunosuppressive treatment -tend to be auto-immune responses

Answer 41

* Oral expression: HSV 1 (cold sores) Genital: HSV 2 * Expressions: -group vesicles—epidermal acantholysis—vesicles—sloughing * Zoster: -dermatomal distribution (can get trigeminal nerve involvement and can be very dangerous spreading to surrounding tissue such as eye or brain) - Varicella Zoster Virus (VZV) can cause shingles usually later in life in those who experienced chicken pox (i.e., exposed to the VZV when young) * Unilateral, dermatomal distribution * Expresses as a band of rash that often itches, burns or throbs. It may persist for weeks to months. Usually is relieved by anti-inflammatories or opioid analgesics * In extreme cases it becomes like an intense neuralgia and does not respond to traditional analgesics * Not contagious, typically does not repeat, but can in some cases.

Answer 42

* Opened comodones (blackheads) * Closed comodones (white heads) * Cysts, pustules and abscesses

Answer 43

* Hormone changes (i.e., sex hormones)-increases testosterone influence * Blocks hair follicle and sebaceous gland * Hair follicle have proliferation of lining cells and cellular sloughing—forms a cellular plug and traps bacteria, cellular debris and sebum * Gland ruptures and contents spreads to form cysts, abscesses and scarring—area is inflamed and swollen * Treatments: -antibiotics -keratolytics -drying agents -vitamin A (topical and systemic-Accutane)

Answer 44

* Young women * Long-term steroid use or cosmetic use * Follicular papules, vesicles and pustules

Answer 45

• Seborrhea keratosis (elderly, middle age-coin-like plaques;stuck-on appearance, tan to dark brown-granular surface)

Answer 46

Malignant (most are UV-induced especially in fair skinned persons)-most common cancers * Basal cell-most common, least aggressive/ most common malignancy worldwide. Slow growing. -remove with local incision—does not metastasize * Squamous cell- next most common, intermediate aggression, no metastasis -red scaling plaques—locally aggressive * Melanoma- least likely, typically aggressive and metastasizes -warnings: rapid enlargement of nevus; new pigmented lesion-not from pre-existing nevi; irregular borders; irregular surface and colors -caused by UV exposure and genetics -prognosis: poor if metastasized (common sites are lungs, liver and brain) * High mitotic rate, lack of immune response to slow spread especially once it hits lymph nodes

Answer 47

* Cancers * Pulmonary diseases * Cardiovascular diseases * Diabetes * Alzheimer’s disease * Oral diseases (periodontal tissues) * Neurological disease * Arthritis

Answer 48

* Decrease pain and inflammation * Cox I (GI, bleeding and kidney side effects) and Cox II (MI and stroke and hypertension side effects) inhibitors * Aspirin, ibuprofen, naproxen are non-selective COX I and II inhibitors * Celecoxib is COX II inhibiton Side Effects * (a) CNS-tinnitis * (b) CVS-hypertension * (c) GI-nausea, ulcers or bleeding * (d) Hepatic-altered liver functions * (e) Pulmonary-asthma * (f) Skin-rashes * (g) Renal- insufficiency, in extreme can have failure

Answer 49

* Rapidly acting * Dramatic effect on inflammation and slowing bone erosions in rheumatoid arthritis * Side effect: loss of muscle mass, osteoporosis, diabetogenesis, peptic ulcers, round face, buffalo hump * Drugs: -dexamethasone: long-acting -cortisone, prednisone: short- to medium-acting

Answer 50

DMARDS (Disease modifying anti-rheumatic drugs) and other Immunosuppressants * E.g., methotrexate, sulfasalazine * Decrease inflammation and slow bone damage in rheumatoid arthritis * Potentially more toxic than other options -severe hepatotoxicity -stomatitis -immunosuppression

Answer 51

Is a keratolytic used for acne vulgaris. Topical keratolytics-removes keratin layer and opens sebaceous glands (also used as wart removers). has been extensively used in dermatologic therapy . Salicylic acid works as a keratolytic, comedolytic, and bacteriostatic agent, causing the cells of the epidermis to shed more readily, opening clogged pores and neutralizing bacteria within, preventing pores from clogging up again by constricting pore diameter, and allowing room for new cell growth.

Answer 52

Is a keratolytic used for acne vulgaris. Topical keratolytics-removes keratin layer and opens sebaceous glands (also used as wart removers). containing preparations also work as peeling agents to increases skin turnover, clearing pores (comedolytic) and reducing the bacterial count (P. acnes) as well as acting directly as an antimicrobial.

Answer 53

Antibiotic used for acne. macrolide antibiotic used to treat P. acnes.; antibiotic resistant strains are an ongoing complication of macrolides, especially when exposed to staphylococci. – Broad spectrum, generally well-tolerated – Local adverse effects include burning sensation, drying, & irritation.

Answer 54

Antibiotic used for acne. antiribosomal antibiotic useful against gram positive and anaerobic bacteria; only ~10% absorbed topically. – Common side effects include GI upset and diarrhea. Rarely bloody diarrhea and colitis have been reported, even with topical application.

Answer 55

Antibiotic used for acne. nitroimidazole antibiotic for anaerobic bacterial & parasitic infections and the inhibition of Demadex brevis (parasitic mites) – Demodex mites are ~3x more prevalent in acne vulgaris paDents than in healthy controls. – Anti-inflammatory effect (inhibits neutrophils) – Common adverse effects include local dryness, burning and stinging. – Contraindicated during pregnancy, in nursing mothers, or in children due to risk of carcinogenesis.

Answer 56

Antibiotic used for acne. 5% gel, sulfone antibiotic for Acne vulgaris, antibacterial mechanism unclear, anti-inflammatory effects. – Should not be used orally in patients with glucose-6-phosohatedehydrogenase(G6PD) deficiency due to risk of hemolysis, but risk is minimal with topical preparaDons. – Adverse effects include Dryness, redness, skin peeling. – Dapsone + benzoyl peroxide may temporarily discolor skin and hair yellow.

Answer 57

Retinoid (vitamin A) used for acne. Tretinoin (Retin-A) topical retinoid cream available at 0.025%, 0.05% and 0.1% concentrations. * promotes epithelial cell turnover, causing the extrusion of the plugged material from the follicle and preventing the formation of new comedones * may cause dryness and increased sensitivity to sunlight, redness, scaling, itching, and burning.

Answer 58

Retinoid (Vitamin A) used for acne. Isotretinoin (Accutane) – oral retinoid used for severe cystic acne and acne that has not responded to other treatments. * Considered the only true “cure” for acne. It also reduces the amount of oil secreted by glands in the skin. * Isotretinoin has been associated with bowel diseases (Crohn’s disease), liver damage, depression, teratogenicity and miscarriage. * contraindicated during pregnancy as they have been shown to cause CNS, craniofacial, cardiovascular and other birth defects. – At least two negative pregnancy tests are required and either signed statement of abstinence (iPledge contract) or confirmation of 2 forms of contraception is required to obtain a prescription.

Answer 59

Antibiotics for Acne Vulgaris. Minocycline is more lipophilic (may accumulate in sebaceous gland). * Chelated by dairy products, calcium, and magnesium so passes though gut without absorbtion with wrong foods/drinks. * has higher incidence of inner ear disturbances with associated dizziness, ataxia, vertigo and Tinnitus (especially in women), and is more expensive than doxycycline. * Doxycycline may be associated with more GI upset than minocycline. – Harder to chelate thus beNer absorbed with food. – All tetracycline antibiotics are associated with increased risk of irritable bowel syndrome. – If tetracyclines aren’t tolerated or effective, then 3rd line opDon is trimethaprim or trimethaprim-sulfamethoxazole (TMP-SMZ). - Category D pregnancy Risk

Answer 60

Diet therapy: avoidance of fatty “junk foods”. • UV Phototherapy- P. acnes bacteria produce a natural byproduct of metabolism called porphyrins. Porphyrins are light sensitive and thus vulnerable to UV and narrow band visible blue light.

Answer 61

They enhance levels of inhibition, usually via CNS (GABA-mediated). Uses include Surgical relaxation – esp., intra-abdominal & intrathoracic surgery * Endotracheal intubation – relaxes pharyngeal and laryngeal muscles * Control of Ventilation – reduce chest wall resistance during intubation * Anticonvulsant – relax the motor manifestations of status epilepticus or motor seizures due to local anesthetic toxicity.

Answer 62

1. Spasmolytics (reduce spasticity by modifying the stretch reflex arc and/ or interfering directly with excitation-contraction coupling of the skeletal muscles. (Diazepam, Baclofen, Tizanidine, Dantrolene) 2. Non-depolarizing blocking (produce muscle paralysis by either nondepolarizing blockade (d-tubocurarine)) 3. Depolarizing blocking (paradoxical depolarizing blockade (desensitization) (succinylcholine) of the ganglionic nicotinic ACh receptor)

Answer 63

- An anti-spasmotic that is used as a muscle relaxant. is a postsynaptic muscle relaxant that lessen excitation-contraction coupling in muscle cells by inhibiting Ca2+ ions release from sarcoplasmic reticulum stores by antagonizing ryanodine receptors. - It is the primary drug used for the treatment and prevention of malignant hyperthermia, a rare, life-threatening disorder triggered by general anesthesia. - Its direct effect is peripheral only.

Answer 64

An anti-spasmotic used as a muscle relaxant. Diazepam -Facilitates (Increases frequency of opening) GABAA receptor; central acting -Increased interneuron inhibition; central sedation -Spasms related to CP, stroke, spinal cord injury, acute muscle injury =Hepatic metabolism; 12-24h duraDon; sedaDon, depression, suppression of REM sleep

Answer 65

An anti-spasmotic used as a muscle relaxant. GABA B agonist. -GABAB agonist; central acting -Pre- and post- synaptic inhibition of motor output -Severe spasticity due to CP, MS, stroke -p.o., i.t.; sedation, weakness

Answer 66

An anti-spasmotic used as a muscle relaxant. - Alpha2 adrenoreceptor agonist (spinal cord) ; central acting - Pre- and post- synaptic inhibition of reflex motor output - Spasms related to ALS, stroke, MS - Renal and hepatic elimination; 3-6h duration; weakness, sedation, hypotension

Answer 67

Muscle relaxant/sedative; may have some dependence problems, works by blocking pain sensations.

Answer 68

Is a non-depolarizing neuromuscular blocker. Blocks ganglionic nicotinic receptor.

Answer 69

Non-depolarizing blockers are reversed by acetylcholinesterase (AChE) inhibitors, since they are competitive antagonists at the ACh receptor.

Answer 70

Depolarizing neuromuscular blocker. Blocks ganglionic nicotinic receptors by desensitizing (overstimulating?) - fast acting, get initial twitching before paralysis - rapid onset (30sec) but very short duration of action (5–10 min); agonist at nicotinic ACh receptors, depolarizes the muscle fiber (similar to ACh), but in a biphasic manner: – Phase I (depolarizing phase) muscle twitches occur while depolarizing the muscle fibers. – Phase II (desensitizing phase) aqer sufficient depolarization has occurred the muscle is no longer responsive to ACh released by the motor neurons. At this point, full neuromuscular block (paralysis) has been achieved. * Effects are sustained under the influence of AChE inhibitor.(not reverse by administering the AChE inhibitor) * Adverse effects: Postoperative myalgia and fatigue, arrhythmia, hyperkalemia (burn patients), increased ocular pressure, increased risk of regurgitation/aspiration (obese patients, diabetic patients). – Rare, inheritable risk for interaction with volatile anesthetics causing malignant hyperthermia (abnormal release of Ca2+ from skeletal muscle stores.) – Treated with dantrolene.

Answer 71

- (Zovirax, Denavir ointments): most effective for herpes simples virsus (HSV-1 and HSV-2) - cold sores on mouth and nose; less potent on Varicella-zoster virus (VZV-chickenpox--shingles). - Requires activation by the HSV thymidine kinase enzyme.

Answer 72

- Effective against VZV virus and shingles and herpes viruses. Longer acting than acyclovir - Requires activation by the HSV thymidine kinase enzyme.

Answer 73

Used for shingles and herpes. selectively inhibits viral DNA polymerase enzymes (not kinases). - Unlike acyclovir and ganciclovir, foscarnet is not activated by viral protein kinases, making it useful in acyclovir- or ganciclovir-resistant HSV and CMV infections. - Do not require activation by viral thymidine kinase and thus have preserved activity against acyclovir-resistant strains of HSV and VZV.

Answer 74

Potency is effected by the topical formulation selected, since ointments are absorbed more effectively than creams. Thus, at the same dosage, most topical preparations will be considered “stronger” (more potent) when packaged as an ointment than as a cream although patients prefer creams as they spread more easily due to higher water/oil ratio.

Answer 75

Lidocaine (FDA Category B): most commonly used drug for dental work. Since it crosses the placenta after administration, the amount of anesthesia administered should be minimal dose sufficient to make patient comfortable.

Answer 76

It is a skin infection like a pimple on eyelid-mostly external

Answer 77

* basal and squamous cell carcinomas of eyelid—usually slow growing * melanoma-varying colors and potentially aggressive—usually occurs in older people

Answer 78

It is high intraocular pressure in anterior chamber: Increased pressure within eye due to increased production or decreased outflow of aqueous humor (replaced every 2 hours; supplies nutrients and removes waste). Can damage optic nerve and cause blindness.

Answer 79

Closed-angle glaucoma: iris fused to cornea * * Rapid closure of drainage canals * Symptoms typically noticeable * Surgery usually necessary

Answer 80

Open-angle glaucoma: wide space between iris and cornea * most common-90% * slow clogging of drainage canals * symptoms subtle and often undetected * 3 million cases in US * African Americans especially vulnerable * Increased risk with diabetes and HP

Answer 81

It measures the anterior chamber angle in the eye

Answer 82

It measures intraocular pressure

Answer 83

Treats glaucoma. Cholinomimetic-contract ciliary muscle and increases outflow of aqueous humor. ACh1 agonist.

Answer 84

Treats glaucoma. Beta blocker-decreases aqueous humor secretion (popular for open angle glaucoma).

Answer 85

Alpha-agonist non-selective that can help treat glaucoma.

Answer 86

Treats glaucoma. Prostaglandin-increase outflow of aqueous humor (popular for Open angle glaucoma).

Answer 87

Anticholinergics and stimulants (amphetamines)

Answer 88

Helps treat glaucoma. Carbonic anhydrase inhibitor. Reduces aqueous humor secretion.

Answer 89

Opacification of the lens

Answer 90

* Causes include: -diabetes -UV exposure -aging * Treatment is typically surgical removal

Answer 91

- associated with hemorrhaging and ischemic spots (expressed as cottonwool spots) - hypertension causes similar retinopathies as diabetes

Answer 92

* \>10% of patients \> 80 years old * Most common cause of severe loss of sight in 60+ pts. * Almost never occurs in individuals \> 50 years of age * Smoking is a risk factor * Associated with gene polymorphisms, smoking, cardiovascular disease * Loss of central vision * Progress of disease faster in wet (hemorrhage and fluid present) than dry (large majority) macular degeneration * Pharmacological options minimal; some evidence that antioxidants (e.g., vit. C or zinc oxide may help reduce development, but benefit is minimal) for wet AMD. No treatment for dry AMD. * Treatment: monoclonal Ab (anti-angiogenic Ab)- e.g., bevacizumab (Avestatin) -inject into vitreous humor; 1-2x/ month, for wet AMD

Answer 93

• Usually a retinal tear resulting from trauma

Answer 94

It is the most common tumor in children

Answer 95

Because both are innervated by the trigeminal complex

Answer 96

a. Symptoms: vertigo, hearing loss, nausea, sometimes migraine headaches, hearing loss, swimming feeling, tinnitus, balance problems b. Pathology: endolymphatic hydrops—swelling/excess fluid in labyrinth • Risks- • Improper inner ear fluid drainage • Allergies • Viral infections • Head trauma • Migraines c. Diagnostic tests: • Hearing and balance assessments d. Some surgical interventions, but extreme

Answer 97

Treats Meniere disease. H1 blocker, anticholinergic, CNS depressant-antimotion sickness medication, causes xerostomia.

Answer 98

Treats Meniere disease. It is an anxiolytic.

Answer 99

Treats Meniere disease. H1 blocker, anticholinergic, antinausea and motion sickness, xerostomia.

Answer 100

Treats Meniere disease. Diuretic-regulate fluid volume and pressure in inner ear.

Answer 101

Treats Meniere disease. Long-acting steroid/inject into the ear—it reduces fluid.

Answer 102

* Typically associated with blockage of the Eustachian tube * Often associated with infections by strep. Pneum. Or Haemophilus influe. a. Symptoms: pain, ear discharge, headache, hearing loss, tinnitus, vertigo, immobile eardrum (swollen and inflamed), fever

Answer 103

Antibiotics used to treat acute otitis media. Second level drugs include Trimethoprim or macrolides.

Answer 104

• Caused by accumulation of DNA mutations in cells acquired spontaneously or induced-usually multiple mutations

Answer 105

* Non-responsive to normal physiologic cues * Lack of response to growth inhibitory signals * Avoid normal cell cycle mediated death * Develops own angiogenesis * Evades immune detection

Answer 106

1. Uncontrolled growth of cells, progeny of a single cell 2. Names usually end in –oma 3. Benign epithelial tumor is adenoma (if glandular), a papilloma (if papillary) 4. Malignant tumor (metastasizes) * Epithelial= carcinoma * Mesenchymal= sarcoma * Lymphoid= lymphoma * Melanocytic tumor=melanoma * Hematopoietic= leukemia * Squamous cell carcinomas * Adenosarcomas-grandular epithelium * Lipoma-benign * Liposarcoma-malignant * Osteosarcoma-malignant bone cancer * Rhabdomyosarcoma-malignant skeletal muscles, usually kids * Rhabdomyoma-benign * Leiomyosarcoma-malignant tumor of smooth muscle * Leiomyoma- benign tumor

Answer 107

* Granulomas are an inflammatory mass-not a neoplasm * Hemartoma: mal-developed tissue native to site (e.g., nodular tongue) * Choristoma: mal-developed tissue in other organs

Answer 108

Lung cancer, followed by prostate in men and breast in females.

Answer 109

Environment. Just a subset are hereditary.

Answer 110

They are next generation sequencing used for solid tumor tissue and assessed for multiple potential targets for therapeutic responses, can sometimes predict prognosis.

Answer 111

* Deletions * Translocations * Duplications * Amplifications * Abnormal number of chromosomes

Answer 112

PCR, microarrays, really just cytogenetics is used to look for these abnormalities. For example, there is a 9:22 translocation on chromosome 22, called the Philadelphia chromosome, that leads to chronic myelocytic leukemia.

Answer 113

* Develop a signal to proliferate * Avoid apoptosis * Invade stroma (if carcinoma) * Metastasize * Induce angiogenesis * Alter DNA in order to allow continued mitosis (normally cells stop dividing after 15X doubling) * Develop telomerase to prevent cellular senescence

Answer 114

* Oncogenes (promote proliferation)-e.g. growth factors or corresponding receptors * Tumor suppressor genes (inhibit tumor growth-e.g., BRCA-1 and BRCA-2 (breast and ovary) * P53 gene is most common suppressor gene mutation (lost in 50% of malignancies) * WT-1 gene- regulates apoptosis such as in Wilms tumor * APC-adenomatous polyposis coli-tumors in bowel and pancreas * Apoptosis regulating genes (P53 gene also affects apoptosis) * DNA repair genes * Mismatched repair genes- e.g., HNPCC gene (hereditary nonpolyposis colon cancer) * Angioneogenesis (tumors release vascular endothelial growth factor) * Develop properties for invasiveness

Answer 115

Proliferating cells. Consequently, good for killing fast growing tumors, not so good for slow or non-growing tumor cells. Injure rapidly proliferating normal cells such as bone marrow, intestinal mucosa, hair.

Answer 116

False. They vary due to varying growth factors.

Answer 117

* Mutation (e.g., chemical carcinogens-alkylating agents or nitrosamines in food, UV light-skin cancers, radiation)- * Ames test measures if a chemical alters genetic changes in bacteria and would be a carcinogen * Tumor viruses • HPV-human papilloma virus-carcinoma of cervix and oropharyngeal * Epstein-Barr: mononucleosis * Hep B & C viruses: hepatocellular carcinoma * HHV 8 herpes virus- Kaposi sarcoma (often linked with AIDS) * Bacteria and inflammation (H. pylori [gastric adenocarcinoma], and asbestosis) * Chemical carcinogens * Reactive chemical (e.g., free radicals) alter DNA * Alkylating agents—some of which are used to tx cancer * Polycarbon aromatics: e.g., benzopyrene in smoke and cooked meat * Aflatoxin- fungus on peanuts and other foods- not so much in US * Nitrosamine/nitates in foods * Metal ions: nickel, arsenic * Hormonal activation (sex hormones) * Lack of immune responses (i.e., immunocompromised) - altered host response to tumor can interfere with natural defense mechanisms -immunosuppressed children have 200X increased risk for cancer * Genetic predisposition * Variation in hepatic susceptibility of CYP1A1 and glutathione activity * Radiation: -skin cancer caused by UV rays * X-rays/gamma radiation -leukemias -papillary thyroid and breast cancers

Answer 118

• Ames test measures if a chemical alters genetic changes in bacteria and would be a carcinogen

Answer 119

a. Growth and metastasis b. Involve vital organs c. Get a flood of cytokines that shut down organ functions d. Cachexia

Answer 120

* Metastasis of intestinal carcinoid * Flushing and diarrhea * Right heart fibrosis

Answer 121

Carcinoma—epithelium/endothelium • Most common type of malignancy a. Most often metastasizes to regional lymph nodes, but can spread through blood-dependent on type b. Squamous cell Carcinoma • similar appearance regardless of primary site • usually slow growing in the skin • associated with lips or lung more dangerous • can form keratin whirls c. Adenocarcinoma (eg, colon or breast adenocarcinoma) • forms glands • tumors of cuboidal or columnar cells • types include: ➢ colon ➢ prostate-fairly innocuous looking ➢ breast-many positive for estrogen receptors ➢ lung-small cell carcinomas are aggressive with poor prognosis -large cell carcinomas are slower with better prognosis d. neuroendocrine tumors-carcinoids of GI tract and lung

Answer 122

➢ sarcomas-Kaposi’s sarcoma [linked with AIDS], ➢ angiosarcoma, malignant tumor of endothelial tissue (vessels); can result from radiation therapy ➢ chondrosarcoma-malignant tumor of cartilage (chondrocytes). ➢ osteosarcoma, ➢ leiomyosarcoma (vs. benign leiomyoma) - malignant tumor of smooth muscle ➢ liposarcoma • Pushing, rather than an invasive cancer

Answer 123

➢ Hodgkins lymphoma -younger patients -usually good prognosis -sometimes characterized by Reed Sternberg cells (large, multinucleated B lymphocytes) ➢ Non-Hodgkin’s lymphoma -various levels of aggressiveness/sometimes poor prognosis - Burkitt’s Lymphoma- a type of non-Hodgkin’s lymphoma; very aggressive from B lymphocytes. Prognosis can be poor.

Answer 124

• Incidence: newly diagnosed cases/time

Answer 125

• Mortality: death/time period

Answer 126

• Prevalence: # new and pre-existing cases at one moment

Answer 127

* TNM grading -T, size and extent of primary tumor -N, presence and number of lymph node metastases -M, presence of distant mestatses * Serological tests- most useful for assessing cancer recurrence after treatment -PSA: prostate specific antigen -CBA: carcinoembryonic antigen-colon carcinoma -CA-125: serous ovarian carcinoma -HCG: choriocarcinoma

Answer 128

Liver cell carcinoma most common in Africa due to link with viral hepatitis.

Answer 129

Breast cancer more common in US and Europe than in other countries

Answer 130

BRCA 1 & 2 genes

Answer 131

a. Surgical removal b. Radiation therapy-maximize exposure of tumor and minimize exposure of normal tissue c. Chemotherapy * • most damage to rapidly proliferating cells * • treats whole body * • tumor can develop resistance * • often multiple drugs required * • can cause cancer later

Answer 132

1. 1/3 patients cured with local treatment (surgery, radiotherapy) 2. Chemotherapy used for advanced disease or as an adjuvant (administered after primary treatment (e.g., surgery or radiation) to prevent secondary tumor development or spread) 3. Anticancer drugs usually exert action on cells in cell cycle 4. Typically requires combination of drugs: Combine chemo/radiation tx in locally advanced disease 5. Need maximal cell kill within the range of toxicity tolerated by host 6. Adjust scheduling and overlapping toxicities to protect the patient.

Answer 133

• P53 is a mutation that occurs in up to 50% of all human tumors-leads to resistance to radiation therapy and anticancer agents

Answer 134

Cancer treatment strategy. Tyrosine hydroxylase inhibitor used for multiple types of cancers such as myelogenous leukemia.

Answer 135

Cancer treatment strategy. Blocks ECGR (epidermal growth factor receptor): treatment, non-small cell lung and pancreatic cancer.

Answer 136

Hormones for breast and prostate cancers

Answer 137

• Retinoic acid-induced differentiation of some leukemias (e.g., promyelocytic leukemia)

Answer 138

False. Need a combination.

Answer 139

• Design optimal scheduling-e.g., maintain constant intervals with treatment free interval as short as possible, while allowing most sensitive tissue adequate time to recover (e.g., bone marrow).

Answer 140

* Melanoma: exhibits primary resistance on initial exposure (lack of tumor response)-need multiple exposures to treatment to get response of tumor * Sometimes tumor acquires resistance during treatment

Answer 141

Treats cancer, is an alkylating agent. 1. E.g, Cyclophosphamide • Hodgkin’s lymphoma • Multiple myeloma • Leukemia • Breast cancer 2. Mechanism: Transfer their alkyl groups to various cell constituents such as DNA, alkylation of DNA in nucleus—cause miscoding—can break DNA strands 3. Resistance: increased capacity to repair damaged DNA 4. Adverse effects: • Nausea, vomiting • Damage to rapidly growing tissues (bone marrow, G.I. tract, reproductive tissue) • Carcinogenic in nature (increases risk of secondary cancer)

Answer 142

Treats cancer, is a nitrosourea. Used for combination regimens for Hodgkin's Lymphoma. Passes blood brain barrier and used to treat brain tumors.

Answer 143

Treats cancer, is a platinum analog. Used for broad range of solid tumors. Is nephrotoxic.

Answer 144

Treats cancer, is an antimetabolite, anti-inflammatory. 1. Acts on intermediary metabolism of proliferating cells 2. E.g., methyltrexate-folic acid analog * Inhibits tetrahydrofolate--Interferes with formation of DNA, key proteins * Treats head and neck cancers, breast cancer * Toxicity: mucositis, diarrhea

Answer 145

Treats cancer. 1. Inhibits thymidine synthase, decreases NDA synthase and decreases DNA synthesis and function 2. treats: colorectal, anal, breast, head neck, and hepatocellular cancers

Answer 146

Is a natural product cancer, chemotherapy drug. 2. Inhibits tubulin polymerization-cytoskeleton component—arrests in cell division and causes cell death 3. Toxicity: mucositis, myelosuppression 4. Treat: breast cancer and Kaposi’s lymphoma

Answer 147

Is an antitumor antibiotic, in the class of anthracyclines, that treat breast cancer. * Mechanism: formation of free radicals that bind to DNA, causing breaks * Treat: lymphomas, breast cancer and thyroid cancer * Toxicity: nausea and red (not blood) urine

Answer 148

Is an antitumor antibiotic, in the class of anthracyclines, that treat breast cancer. * Mechanism: formation of free radicals that bind to DNA, causing breaks * Treat: lymphomas, breast cancer and thyroid cancer * Toxicity: nausea and red (not blood) urine

Answer 149

Acute Lymphoblast Leukemia (ALL)

Answer 150

Acute Myelogenous Leukemia (AML). Cytarabine is the most single active agent.

Answer 151

* Hodgkin’s lymphoma much better controlled today * B-cell neoplasm (Reed-Sternberg cell) * EBV virus found in ~80% * Tx: anthracycline, doxorubicin, bleomycin, vinblastine

Answer 152

1. Plasma cell malignancy, primarily in bone marrow 2. Symptoms: • Bone pain • Fractures • Anemia • Tx: alkylating agent; prednisone

Answer 153

* Stage I: small, primary tumor --surgery alone is an 80% cure * Stage II: positive node; post-operative use of chemo (e.g., 6 cycles of cyclophosphamide, methotrexate and fluorouracil). * Stage III-IV: a major challenge * Breast cancer-much more effective resolution due to early treatments

Answer 154

* 1 in 8 men, Elevates PSA and acid phosphatase * Treat by eliminating testosterone production through surgical castration * LH-releasing hormone agonists

Answer 155

* Colorectal cancer most common GI malignancy * Tx: 5-fluorouracil (40-50% response rates)

Answer 156

* Late complication of alkylating agents * Most frequent is acute myelogenous leukemia—observed as early as 2-4 years after; also see Non-Hodgkin’s lymphoma and bladder cancer

Answer 157

Irritants to squamous mucosa. • corrosives, smoking, alcohol, chemotherapy. Acute inflammation and possible ulceration.

Answer 158

Usually immunosuppressed (often Herpes, Candida, and cytomegalovirus [CMV]) * Often ulcers * CMV: * • Affects entire GI tract * • Neonates acquire thru birth canal or infected breast milk * • Adults acquire through sexual transmission or needles * • Multiple discrete, well-circumscribed superficial ulcers.

Answer 159

Cytomegalovirus (CMV) affects entire GI tract-elderly or immunocompromised-multiple discrete, well-circumscribed superficial ulcers.

Answer 160

a. Relaxation of gastroesophageal sphincter b. Symptoms: Burning, Excessive salivation, Choking c. Aggravating factors: obesity, pregnancy, (decrease esophageal pressure: alcohol/tobacco, narcotics, nicotine patch) use d. Medical treatment: antacids, H2 blockers, PPI -lose weight, stop smoking/drinking e. lifestyle treatment: lose weight, stop smoking and drinking f. Complications: ulceration, stricture, Barrett esophagus (long tongues of extended columns of epithelium cells into esophagus

Answer 161

1. Reactive (erosive gastritis) gastropathy a. Induced by: alcohol, NSAIDS, iron, Stress, bile reflux 2. Acute injury a. Acute gastritis—asymptomatic with possible significant blood loss 3. Acute peptic ulceration a. Nausea, vomiting, NSAIDs, stress 4. Chronic gastritis a. H. pylori gastritis-duodenal and pyloric ulcers; may lead to cancer b. Autoimmune gastritis 5. Peptic Ulcer Disease a. H. pylori and NSAIDs causative b. Increased acid c. Punched our ulcers-potential for perforation and hemorrhage d. Likely also involved in adenocarcinoma development 6. Polyps a. Hyperplastic, sporadic • Response to gastric injury, around ulcers 7. Gastric carcinoma • Looks like intestinal tissue, and diffuse • Some have hereditary connection 8. Autoimmune atrophic gastritis • Genetic factors • No ulcers • Decreased gastric acid • Intestinal metaplasia • Long-term effects relate to malabsorption of B12 (pernicious anemia)

Answer 162

a. Usually mechanical (80%) b. Neoplasm and infarction (20%)

Answer 163

* Relapsing pain, bloating, constipation/diarrhea * Diet, abnormal motility and stress are factors * No gross microscopic abnormalities

Answer 164

• Caused by microorganisms such as salmonella, E. coli, shigella, clostridium

Answer 165

• Cells Slough Off * Usually caused by clostridium difficile * Spread via person to person * Often follows antibiotic therapy * Most common nosocomial infection in older adults

Answer 166

a. Crohn disease: • Similar to ulcerative colitis • It skips lesion and has intermediate constrictures • Granulomas • Fistulas and perianal disease • Also affects upper GI tract • Transmural inflammation • Fistulas, perianal • Oral manifestation: ➢ 0.5% have oral lesions ➢ Usually males ➢ Linear and deep ulcerations b. Ulcerative colitis • More continuous especially in the colon • No transmural inflammation • No fistulas and not perianal • Oral manifestation: ➢ Less common than in CD ➢ Usually males ➢ Edematous oral submucosa

Answer 167

Hirschsprung disease * Congenital defect in colonic innervation * Failure to pass meconium The small bowel, colon.

Answer 168

a. Celiac sprue • Immune mediated—triggered by ingestion of gluten • Malnutrition: • Fe, B12 malabsorption • Atrophic glossitis • Dental effects: enamel defects, delayed tooth eruption, recurrent aphthous ulcers, cheilosis, b. Lymphocytic colitis • Increased intraepithelial lymphocytes c. Irritable bowel syndrome • Relapsing pain, bloating, relapsing and alternating constipation/diarrhea • Diet, abnormal motility and stress are factors • No gross microscopic abnormalities d. Infectious self-limiting colitis • Caused by microorganisms such as salmonella, E. coli, shigella, clostridium e. Pseudomembranous colitis, cells slough off • Usually caused by clostridium difficile • Spread via person to person • Often follows broad spectrum antibiotic therapy • Most common nosocomial infection in older adults

Answer 169

Colonic polyps * Hyperplastic polyps- no malignant potential * Adenoma- precursor to adenocarcinoma

Answer 170

Invasive colonic adenocarcinoma * Responsible for 15% of all cancer related deaths in USA * Dietary features: increased risk with low fiber, high intake carbohydrates/fats Affects small bowel/colon

Answer 171

So amazing

Answer 172

Burkitt’s Lymphoma- a type of non-Hodgkin’s lymphoma linked to Epstein-Barr infection and can affect maxilla and mandible; very aggressive from B lymphocytes. Prognosis can be poor.

Answer 173

Acute leukemia principally affects bone marrow

Answer 174

Cholecystitis (bile is common mechanism for excretion of toxins and drugs) * Acute often caused by gallstones and obstruction. Can become chronic * Cholestasis causes jaundice

Answer 175

Liver diseases-summary-these diseases can go on to cirrhosis 1. Fatty liver • Caused by ETHOH, obesity and diabetes Mel. 2. Hepatitis • Caused by virus, drug or autoimmune 3. Biliary disease 4. Metabolic disease 5. Vascular

Answer 176

* Liver made up of hepatocytes, duct cells and blood vessels * Organization: Portal tracts contain the triad (portal triad) of (i) bile ducts, (ii) portal veins (bring blood from gut with nutrients and recently consumed drugs), and (iii) hepatic artery from the heart. Blood goes to the sinusoids and enriches hepatocytes, then goes to central vein and drains back to the heart to be recycled. Blood from different sources mix in the sinusoids drains into the “central veins” and exits to the hepatic vein that goes to the heart * Hepatocytes do all of the metabolic work of the liver and absorb nutrients and drugs. * Most hepatotoxic events occur around the ‘central vein’ • Drugs are the #1 cause of liver toxicity! * Biopsy of liver can be potentially dangerous due to major hemorrhaging

Answer 177

1. Fatty (fat globules in hepatocytes) liver-steatosis • Worst destruction is fibrosis. It leads to collagen scar and permanent injury. End stage is cirrhosis • Causes—alcohol, obesity and diabetes (known as the metabolic syndrome) 2. If hepatocytes die in large sheets, the areas fill up with blood. Blood can build up due to heart failure and cause backflow around the central vein 3. If cannuliculi in liver fill with bile due to cholestasis, the person becomes jaundiced (often caused by drugs) 4. Acute more lobular, chronic is more portal with fibrosis and collagen bridges 5. Hepatitis is inflammation of liver. If caused by viruses can be contagious and dentists must be very careful with these patients • Can also be caused by toxins and drugs • Acute can often resolve itself. Chronic less likely to recover (fibrosis often a part of this) • Acute caused by Hepatitis A and E viruses (1-3 months) • Hep B and C viruses start with acute hepatitis and progress to chronic with fibrosis progressing to cirrhosis and hepatocellular carcinoma: tend to be the more severe

Answer 178

Source: Feces Route of Transmission: Fecal/oral Chronic Infection: No Prevention: pre/post exposure, immunization

Answer 179

Source: blood body fluids Route of Transmission: Percutaneous, permucosal Chronic Infection: Yes Prevention: pre/post exposure, immunization * Heb B virus, 2 billion chronically exposed in world, 350 infected. 15-25% of infected will go into chronic phase and most will die from complications. Can lead to cancer of liver (hepatocarcinoma) -important to get vaccinated. * • Caused by DNA virus * • Cirrhosis (chronic phase)= portal hypertension; causes ascites 85% of time in chronic phase with cirrhosis

Answer 180

Source: blood body fluids Route of Transmission: Percutaneous, permucosal Chronic Infection: Yes Prevention: blood screening, risk behavior modification 6. Hep C virus found in \>170 million carriers worldwide • Acute phase usually asymptomatic and not diagnosed • Chronic phase, Ab present at 5-20 weeks • 60% related to parenteral exposure • Caused by RNA virus • Can lead to hepatocarcinoma • No vaccines

Answer 181

Source: blood body fluids Route of Transmission: Percutaneous, permucosal Chronic Infection: Yes Prevention: pre/post exposure immunization, blood screening, risk behavior modification

Answer 182

Source: feces Route of Transmission: fecal/oral Chronic Infection: oral Prevention: ensure safe drinking water

Answer 183

Autoimmune hepatitis unusual- found in obese females predominantly * Rapid response to steroids * 80% have extensive fibrosis

Answer 184

False. It is not. • Caused by ETOH, obesity, diabetes mellitus etc.

Answer 185

Metabolic disease: * Often associated with iron overloads * Wilson’s disease: copper metabolic defect goes to hepatitis then cirrhosis

Answer 186

Evaluation of hepatitis severity: * Grade= degree of inflammation * Stage= degree of fibrosis-this is the most important for prognosis-extreme if it progresses to cirrhosis that includes collagen surrounding hepatic nodules (hepatocytes)

Answer 187

Hepatocellular carcinoma * Most deadly cancer * It has been increasing due to increases in the incidence of Hep B and C

Answer 188

Gastroesophageal reflux disease (GERD) is chronic; ‘acid reflux” is acute (isolated incidents) 1. Episodes referred to as heartburn and occurs daily in 7% of population 2. Aggravating factors: empty stomach, inclined, increased age, obesity, fatty foods, caffeine/alcohol/smoking, large meals, some drugs 3. Relief: small meals, reduced fat, reduced weight, elevate head of bed, avoid aspirin/NSAIDs 4. Dental tips: • Protect teeth from erosion by gastric acids (i.e., mouth guard, neutralize acid with basic solution, don’t brush teeth after gastric juices are in mout-i.e., acidic

Answer 189

Used for GERD. Antacids-neutralize gastric HCl • Types: magnesium salts (can cause diarrhea); bicarbonate (causes gas); calcium carbonate (chalky and constipation); aluminum salts (not very effective)

Answer 190

Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut. • Side effects: headaches, diarrhea, drowsiness.

Answer 191

Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut. • Side effects: headaches, diarrhea, drowsiness.

Answer 192

Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut. • Side effects: headaches, diarrhea, drowsiness.

Answer 193

Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx * Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut. * Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers * Often combined with H2 blockers - Can also add sodium bicarbonate for fast release.

Answer 194

Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx * Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut. * Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers * Often combined with H2 blockers

Answer 195

Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx * Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut. * Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers * Often combined with H2 blockers

Answer 196

1. Includes gastric and duodenal ulcers a. Causes: (1) Inflammation of epithelium (2) Errosion (3) Infection by H. pylori (70-80% incidence) b. Symptoms: • Epigastric burning, alleviated by eating or antacids • Pain worse on empty stomach and at nigh • Pain often mistaken for a heart attack and vice versa - One treatment includes suppressing acidity to heal sores (but not cure) • Antacids, PPIs, H2 blockers

Answer 197

Used to treat peptic ulcer disease. Cure if H pylori-related –H pyloria is contagious especially within family members • Prevpac; combination of lansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin

Answer 198

Used to treat peptic ulcer disease. Cure if H pylori-related –H pyloria is contagious especially within family members * Prevpac; combination of lansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin * Milk of Magnesia (magnesium based) may also help kill bacteria

Answer 199

Water, alcohol

Answer 200

Fe, Ca, Mg, Na, Fats, water, proteins, vitamins,

Answer 201

carbohydrates, proteins

Answer 202

Bile salts, B12, Cl

Answer 203

Water, electrolytes

Answer 204

Laxative used for constipation. * Stimulant of smooth muscles * Fast acting * OTC * Suppository/oral * Cramps

Answer 205

Laxative used for constipation. * Water retention in stools, softens stools * OTC (e.g., Dulcelax)

Answer 206

Treats diarrhea. Imodium; mild opioid agonist: if severe, can use strong opioid agonists

Answer 207

Treats diarrhea. Is Pepto-Bismol. Anti-cholinergics such as atropine can also be used to treat diarrhea.

Answer 208

* No structural defect –not sure of the exact cause * Typically episodic pain and bloating * Could be 5HT-dependent neuromuscular disorder * 20% of population have suffered (most common GI disorder) * Most common in young adults and ~50 Years old—possible association with stress and poor diet

Answer 209

Used for irritable bowel syndrome. b. Treatment: (1) Typically symptomatic (i.e., deal with diarrhea or constipation with diet and anti-stress changes) (2) Drugs: only linaclotide (Linzess) is FDA-approved for IBS with constipation • It is a guanylate cyclase-C agonist-it increases bowel movement, fluid secretion and reduces pain • Side effects: diarrhea, gas

Answer 210

Less than 1%

Answer 211

Crohn's is an IBS. (1) Crohn’s disease (a) Symptoms: • Chronic diarrheal problems • Can affect entire GI, but more intense in ileum and colon and intermittent areas with strictures between -ulcerations -swelling and scarring • Hypogastric pain • Perianal fissures/fistules • Higher incidence of arthritis • Fatty liver • Possible genetic link • Perhaps abnormal inflammatory response to normal flora • Has remission • Increase incidence of colon cancer

Answer 212

Used for Crohn's disease. Is an anti-inflammatory. Corticosteroids-act systemically and Metronidazole has an antibiotic mechanism and they can also be used for Crohn's. b. Ulcerative colitis • Similar to Crohn’s disease but limited to colon and more generalized (no strictures) • Medications are similar to Crohn's disease

Answer 213

a. HBV infection most significant occupational dental hazard (vectors: blood, saliva, nasopharyngeal secretions) b. In mouth, highest concentration is gingival sulcus c. Manifestations (infections and bleeding based): • Lichen planus • Periodontal disease • Candidiasis • Increased oral bleeding • Increased incidence of type II diabetes • Sjogrens syndrome

Answer 214

* Accidental exposure: * Carefully wash wound-don’t rub (embeds viruses) * Use antiviral disinfectant (e.g., iodine or chlorine formulations) * Initiate HBV vaccine series * Don’t be judgmental

Answer 215

Estrogen receptor antagonist. Blocks actions of estrogen in breast-used to treat breast cancers.

Answer 216

Mifepristone is a synthetic, steroidal anti-progestogen and anti-glucocorticoid pharmaceutical drug. Morning after contraceptive: blocks progesterone and glucocorticoid receptors. Ends a pregnancy that is less than 7 weeks along (49 days or less since the start of your last menstrual period). Also used to control high blood sugar in patients with Cushing syndrome who also have type 2 diabetes and have failed surgery or are not candidates for surgery.

Answer 217

Danazol is a derivative of the synthetic steroid ethisterone that suppresses the production of gonadotrophins and has some weak androgenic effects. Suppresses ovarian function (has a masculinizing effect). Treats endometriosis, fibrocystic breast disease, and hereditary angioedema.

Answer 218

Clomifene or clomiphene is a selective estrogen receptor modulator that has become the most widely prescribed drug for ovulation induction to reverse anovulation or oligoovulation. Ovulation-inducing; for promoting fertilization and pregnancy (increased risk of multiple births—e.g., twins).

Answer 219

Is a keratolytic used for acne vulgaris. Topical keratolytics-removes keratin layer and opens sebaceous glands (also used as wart removers). has been extensively used in dermatologic therapy . Salicylic acid works as a keratolytic, comedolytic, and bacteriostatic agent, causing the cells of the epidermis to shed more readily, opening clogged pores and neutralizing bacteria within, preventing pores from clogging up again by constricting pore diameter, and allowing room for new cell growth.

Answer 220

Is a keratolytic used for acne vulgaris. Topical keratolytics-removes keratin layer and opens sebaceous glands (also used as wart removers). containing preparations also work as peeling agents to increases skin turnover, clearing pores (comedolytic) and reducing the bacterial count (P. acnes) as well as acting directly as an antimicrobial.

Answer 221

Antibiotic used for acne. macrolide antibiotic used to treat P. acnes.; antibiotic resistant strains are an ongoing complication of macrolides, especially when exposed to staphylococci. – Broad spectrum, generally well-tolerated – Local adverse effects include burning sensation, drying, & irritation.

Answer 222

Antibiotic used for acne. antiribosomal antibiotic useful against gram positive and anaerobic bacteria; only ~10% absorbed topically. – Common side effects include GI upset and diarrhea. Rarely bloody diarrhea and coliDs have been reported, even with topical application.

Answer 223

Antibiotic used for acne. nitroimidazole antibiotic for anaerobic bacterial & parasitic infections and the inhibition of Demadex brevis (parasitic mites) – Demodex mites are ~3x more prevalent in acne vulgaris paDents than in healthy controls. – AnD-inflammatory effect (inhibits neutrophils) – Commonadverseeffectsincludelocaldryness,burningandsDnging. – Contraindicatedduringpregnancy,innursingmothers,orinchildrenduetoriskof carcinogenesis.

Answer 224

Antibiotic used for acne. 5% gel, sulfone antibiotic for Acne vulgaris, antibacterial mechanism unclear, anti-inflammatory effects. – ShouldnotbeusedorallyinpaDentswithglucose-6-phosohatedehydrogenase(G6PD) deficiency due to risk of hemolysis, but risk is minimal with topical preparaDons. – AdverseeffectsincludeDryness,redness,skinpeeling. – Dapsone+benzoylperoxidemaytemporarilydiscolorskinandhairyellow.

Answer 225

Retinoid (vitamin A) used for acne. Tretinoin (Retin-A) topical retinoid cream available at 0.025%, 0.05% and 0.1%concentrations. • promotes epithelial cell turnover, causing the extrusion of the plugged material from the follicle and preventing the formaDon of new comedones • may cause dryness & increased sensitivity to sunlight, redness, scaling, itching, and burning.

Answer 226

Retinoid (Vitamin A) used for acne. Isotretinoin (Accutane) – oral retinoid used for severe cystic acne and acne that has not responded to other treatments. • Considered the only true “cure” for acne. It also reduces the amount of oil secreted by glands in the skin. • Isotretinoin has been associated with bowel diseases (Crohn’s disease), liver damage, depression, teratogenicity and miscarriage. • contraindicated during pregnancy as they have been shown to cause CNS, craniofacial, cardiovascular and other birth defects. – At least two negative pregnancy tests are required and either signed statement of abstinence (iPledge contract) or confirmation of 2 forms of contraception is required to obtain a prescription.

Answer 227

Antibiotics for Acne Vulgaris. Minocycline is more lipophilic (may accumulate in sebaceous gland). • Chelated by dairy products, calcium, and magnesium so passes though gut without absorbtion with wrong foods/drinks. • hashigherincidenceofinnereardisturbanceswithassociated dizziness, ataxia, vertigo and Tinnitus (especially in women), and is more expensive than doxycycline. • Doxycycline may beassociated with more GI upset than minocycline. – Harder to chelate thus beNer absorbed with food. – All tetracycline antibiotics are associated with increased risk of irritable bowel syndrome. – If tetracyclines aren’t tolerated or effective, then 3rd line opDon is trimethaprim or trimethaprim-sulfamethoxazole (TMP-SMZ). - Category D pregnancy Risk

Answer 228

-An anti-spasmotic that is used as a muscle relaxant. is a postsynaptic muscle relaxant that lessen excitation-contraction coupling in muscle cells by inhibiting Ca2+ ions release from sarcoplasmic reticulum stores by antagonizing ryanodine receptors. -It is the primary drug used for the treatment and prevention of malignant hyperthermia, a rare, life-threatening disorder triggered by general anesthesia. -Its direct effect is peripheral only.

Answer 229

An anti-spasmotic used as a muscle relaxant. Diazepam -Facilitates (Increases frequency of opening) GABAA receptor; central acting -Increased interneuron inhibition; central sedation -Spasms related to CP, stroke, spinal cord injury, acute muscle injury =Hepatic metabolism; 12-24h duraDon; sedaDon, depression, suppression of REM sleep

Answer 230

An anti-spasmotic used as a muscle relaxant. GABA B agonist. -GABAB agonist; central acting -Pre- & post- synaptic inhibition of motor output -Severe spasticity due to CP, MS, stroke -p.o., i.t.; sedation, weakness

Answer 231

An anti-spasmotic used as a muscle relaxant. -Alpha2 adrenoreceptor agonist (spinal cord) ; central acting -Pre- & post- synaptic inhibition of reflex motor output -Spasms related to ALS, stroke, MS -Renal & hepatic elimination; 3-6h duration; weakness, sedation, hypotension

Answer 232

Muscle relaxant/sedative; may have some dependence problems, works by blocking pain sensations.

Answer 233

Is a non-depolarizing neuromuscular blocker. Blocks ganglionic nicotinic receptor.

Answer 234

Depolarizing neuromuscular blocker. Blocks ganglionic nicotinic receptors by desensitizing (overstimulating?) - fast acting, get initial twitching before paralysis -rapid onset (30sec) but very short duration of action (5–10 min); agonist at nicotinic ACh receptors, depolarizes the muscle fiber (similar to ACh), but in a biphasic manner: – Phase I (depolarizing phase) muscle twitches occur while depolarizing the muscle fibers. – Phase II (desensitizing phase) aqer sufficient depolarization has occurred the muscle is no longer responsive to ACh released by the motor neurons. At this point, full neuromuscular block (paralysis) has been achieved. • Effects are sustained under the influence of AChE inhibitor.(not reverse by administering the AChE inhibitor) • Adverse effects: Postoperative myalgia and fatigue, arrhythmia, hyperkalemia (burn patients), increased ocular pressure, increased risk of regurgitation/aspiration (obese patients, diabetic patients). – Rare, inheritable risk for interaction with volatile anesthetics causing malignant hyperthermia (abnormal release of Ca2+ from skeletal muscle stores.) – Treated with dantrolene.

Answer 235

-(Zovirax, Denavir ointments): most effective for herpes simples virsus (HSV-1 and HSV-2)-cold sores on mouth and nose; less potent on Varicella-zoster virus (VZV-chickenpox--shingles). -Requires activation by the HSV thymidine kinase enzyme.

Answer 236

-Effective against VZV virus and shingles and herpes viruses. Longer acting than acyclovir -Requires activation by the HSV thymidine kinase enzyme.

Answer 237

Used for shingles and herpes. selecDvely inhibits viral DNA polymerase enzymes (not kinases). -Unlike acyclovir and ganciclovir, foscarnet is not activated by viral protein kinases, making it useful in acyclovir- or ganciclovir-resistant HSV and CMV infections. -Do not require activation by viral thymidine kinase and thus have preserved activity against acyclovir-resistant strains of HSV and VZV.

Answer 238

Treats glaucoma. Cholinomimetic-contract ciliary muscle and increases outflow of aqueous humor. ACh1 agonist.

Answer 239

Treats glaucoma. Beta blocker-decreases aqueous humor secretion (popular for open angle glaucoma).

Answer 240

Alpha-agonist non-selective that can help treat glaucoma.

Answer 241

Treats glaucoma. Prostaglandin-increase outflow of aqueous humor (popular for Open angle glaucoma).

Answer 242

Helps treat glaucoma. Carbonic anhydrase inhibitor. Reduces aqueous humor secretion.

Answer 243

Treats Meniere disease. H1 blocker, anticholinergic, CNS depressant-antimotion sickness medication, causes xerostomia.

Answer 244

Treats Meniere disease. It is an anxiolytic.

Answer 245

Treats Meniere disease. H1 blocker, anticholinergic, antinausea and motion sickness, xerostomia.

Answer 246

Treats Meniere disease. Diuretic-regulate fluid volume and pressure in inner ear.

Answer 247

Treats Meniere disease. Long-acting steroid/inject into the ear—it reduces fluid.

Answer 248

Antibiotics used to treat acute otitis media. Second level drugs include Trimethoprim or macrolides.

Answer 249

Cancer treatment strategy. Tyrosine hydroxylase inhibitor used for multiple types of cancers such as myelogenous leukemia.

Answer 250

Cancer treatment strategy. Blocks ECGR (epidermal growth factor receptor): treatment, non-small cell lung and pancreatic cancer.

Answer 251

Treats cancer, is an alkylating agent. 1. E.g, Cyclophosphamide • Hodgkin’s lymphoma • Multiple myeloma • Leukemia • Breast cancer 2. Mechanism: Transfer their alkyl groups to various cell constituents such as DNA, alkylation of DNA in nucleus—cause miscoding—can break DNA strands 3. Resistance: increased capacity to repair damaged DNA 4. Adverse effects: • Nausea, vomiting • Damage to rapidly growing tissues (bone marrow, G.I. tract, reproductive tissue) • Carcinogenic in nature (increases risk of secondary cancer)

Answer 252

Treats cancer, is a nitrosourea. Used for combination regimens for Hodgkin's Lymphoma. Passes blood brain barrier and used to treat brain tumors.

Answer 253

Treats cancer, is a platinum analog. Used for broad range of solid tumors. Is nephrotoxic.

Answer 254

Treats cancer, is an antimetabolite, anti-inflammatory. 1. Acts on intermediary metabolism of proliferating cells 2. E.g., methyltrexate-folic acid analog • Inhibits tetrahydrofolate--Interferes with formation of DNA, key proteins • Treats head and neck cancers, breast cancer • Toxicity: mucositis, diarrhea

Answer 255

Treats cancer. 1.Inhibits thymidine synthase, decreases DNA synthase and decreases DNA synthesis and function 2. treats: colorectal, anal, breast, head & neck, and hepatocellular cancers

Answer 256

Is a natural product cancer, chemotherapy drug. 2. Inhibits tubulin polymerization-cytoskeleton component—arrests in cell division and causes cell death 3. Toxicity: mucositis, myelosuppression 4. Treat: breast cancer and Kaposi’s lymphoma

Answer 257

Is an antitumor antibiotic, in the class of anthracyclines, that treat breast cancer. • Mechanism: formation of free radicals that bind to DNA, causing breaks • Treat: lymphomas, breast cancer and thyroid cancer • Toxicity: nausea and red (not blood) urine

Answer 258

Is an antitumor antibiotic, in the class of anthracyclines, that treat breast cancer. • Mechanism: formation of free radicals that bind to DNA, causing breaks • Treat: lymphomas, breast cancer and thyroid cancer • Toxicity: nausea and red (not blood) urine

Answer 259

Used for GERD. Antacids-neutralize gastric HCl • Types: magnesium salts (can cause diarrhea); bicarbonate (causes gas); calcium carbonate (chalky and constipation); aluminum salts (not very effective)

Answer 260

Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut. • Side effects: headaches, diarrhea, drowsiness.

Answer 261

Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut. • Side effects: headaches, diarrhea, drowsiness.

Answer 262

Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut. • Side effects: headaches, diarrhea, drowsiness.

Answer 263

Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx • Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut. • Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers • Often combined with H2 blockers - Can also add sodium bicarbonate for fast release.

Answer 264

Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx • Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut. • Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers • Often combined with H2 blockers

Answer 265

Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx • Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut. • Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers • Often combined with H2 blockers ## Footnote **-Protein Pump Inhibitors take a while to kick in, at least a few days, not immediate!!!**

Answer 266

Used to treat peptic ulcer disease. (2) Cure if H pylori-related –H pyloria is contagious especially within family members • Prevpac; combination of lansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin

Answer 267

Used to treat peptic ulcer disease. (2) Cure if H pylori-related –H pyloria is contagious especially within family members • Prevpac; combination of lansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin • Milk of Magnesia (magnesium based) may also help kill bacteria

Answer 268

Laxative used for constipation. • Stimulant of smooth muscles • Fast acting • OTC • Suppository/oral • Cramps

Answer 269

Laxative used for constipation. • Water retention in stools, softens stools • OTC (e.g., Dulcelax)

Answer 270

Treats diarrhea. Imodium; mild opioid agonist: if severe, can use strong opioid agonists

Answer 271

Treats diarrhea. Is Pepto-Bismol. (3) Anti-cholinergics such as atropine can also be used to treat diarrhea.

Answer 272

Used for irritable bowel syndrome. b. Treatment: (1) Typically symptomatic (i.e., deal with diarrhea or constipation with diet and anti-stress changes) (2) Drugs: only linaclotide (Linzess) is FDA-approved for IBS with constipation • It is a guanylate cyclase-C agonist-it increases bowel movement, fluid secretion and reduces pain • Side effects: diarrhea, gas

Answer 273

Used for Crohn's disease. Is an anti-inflammatory. Corticosteroids-act systemically and Metronidazole has an antibiotic mechanism and they can also be used for Crohn's. b. Ulcerative colitis • Similar to Crohn’s disease but limited to colon and more generalized (no strictures) • Medications are similar to Crohn's disease

Answer 274

Treatment of orofacial granulomatosis (an oral lesion from IBD). TNF-alpha blocker. ## Footnote Treatmentofgranulomatosis: not well established, but some success with infliximab— TNF-α blocker -blocks inflammatory reactions to mycobacterial infections (exclude TB as cause)