Therapeutics Flashcards
Which drugs raise serotonin levels and noradrenaline synaptic levels?
MAD
Mirtazapine
Amitryptulin
Dukoxetine
How do TCA work?
Indirect neuromodulatji on CNS opioid system
Which immunosuppressants are used in OM?
Steroid and non steroid
Which non steroid drugs are commonly used as immunosuppressants?
Tacrolimus
Azothiarpine
Mycophenalate mofetil
Infliximab
How does tacrolimus work?1
It is a calcineurin inhibitor
Targets T cell response via inhibition of IL-2
No affect on B cells
Which immunosuppressantsminterfer with purine and pyramidine synthesis?
Mycophenalte mofetil: inhibits synthetis of guanine and inhibited proliferation of B and T cell response to antigen stimulation
Azothiarpine : need to test levels of TPMT
What is infliximab?
Type of monoclonal antibodies
It is a chimeric mouse and human antibody with human IGg1 and mouse binding site for TNF alpha
HIGH AFFINITY FOR TNF ALPHA
What is an example of polyclonal antibodies and when are they used? Give an example of a disease
- IVIG
- used in patients that have AI disease and administered at high dose to reduce the severity
Eg pemphigus vulgaris
What is an example of a non TNF alpha monoclonal AB?
Rituximab
T/F, Rituximab is a chimeric monoclonal AB?
T
T/F Rituximab targets the CD20 protein on T cells?
F
Cd20 on B cells
T/F Rituximab can be used in lymphoma?
T
Since it targets B cells can be used in any diseases where there is over active B cells
Eg lymphoma, leukaemia, transplant rejection, AI, RA
Give examples of commonly used immune modulator drugs?
Dapson
Minocycline
Give an example of a topical immunosuppressant?
Calcineurin
What is an example of a immunosuppressant sialogogue drug use in dry mouth?
Cevimeline
Pilocarpine
Give an example of drugs used in oral candidiasis?
Daktarin
Fluconazzole
Give an example of drugs used in bacteria infections.
Metronidazole
Give an example of drugs used in viral infections?
Acilovir
Penciclovir
Valciclovir
Give an example of a barrier preparation used in OM?
Orabase
Gelckair
What are the implications of immunosuppressant for dentist?
- Poor wound healing
- Risk of opportunistic infections
- AB cover when WBC less than 3* 10^9
- Increases risk of malignancy eg skin and lip and lymphoma
At what level is AB cover needed?
WBC less than 3 x 10^9
Which drugs can use gingival overgrowth?
Calcium channel blockers
Ciclosporin
How frequent is cyclosporin induced over growth?
30% prevelence
T/F Ciclopsrin induced over growth is worse in adolescents than adults?
T
T/F Ciclopsrin induced overgrowth occurs in all of the gingiva?
F
Mainly effect anterior
At what month after taking Ciclopsrin will you see increase in gingiva?
3 months
T/F Ciclopsrin induced gingival hyperplasia has a low recurrence rate?
F
High
What is the CYP3A?
A gene locus that codes for 3A family of p450
Which drugs inhibit the CYP3A?
Azoles
Which drugs promote the CYP3A?
Anticonvulsants
What is the effect of broad spectrum AB on OC?
Pharmacokinetic interactions.
Which may increase breakdown of pill
What can you do with people on OC when you want to prescribe AB?
- Advise additional contraception
- Can consider additional non hormonal contraception which may be justified at initiation and until after 1 week after AM therapy
How is alcohol metabolised ?
Ethyl alcohol is broken down via alcohol hydrogenase to produce acetaldehyde. Acetaldehyde is then broken down by aldehyde dehydrogenase to produce water and CO
T/F metronidazole influences alcohol metabolism?
T
Which enzyme does metronidazole inhibit?
Aldehyde dehydrogenase
What is the effect of inhibition of aldehyde dehydrogenase?
The level of acetaldehyde rises in the body and this can lead to unpleasant symptoms which are said to be that of ‘disulfram’
What is the effect of St. John’s wort on serotonin inhibitors and antidep?
Leads too serotonin syndrome which can be life threatening leading to agitation fever, sweating,rapid heart rate, seizure
What is an immunosuppressant ?
Drugs which differentials block or suppress various aspects of the bodies immune system
