Exam 3 immune modulators/antifinflammatory agents for AI

Question 1

MOA of what drug is: reduce inflammation, pain and fever

Answer 1

Aspirin and NSAIDS (cornerstones of tx)

Question 2

MOA of what drug is: interferes with prostaglandin synthesis

Answer 2

sulfasalazine (Azulfidine) (Used for tx of RA when NSAIDS are inadequate)

Question 3

MOA of what drug is: Inhibits pyrimidine synthesis, resulting in anti-proliferatice and anti-inflammatory effects

Answer 3

lefunomide (Arava)

Question 4

MOA of what 3 drugs is an TNF alpha blocker - binds to TNF molecules and blocks interaction with cell surface receptors

Answer 4

entanercept (Enbrel)
inflizimab (Remicade)
adalimumab (Humira)

Question 5

MOA of what drug is an interleukin 1-receptor antagonist (blocker)

Answer 5

anakinra (Kineret)

Question 6

5 categories that make up DMARDS (disease modifying anti-rheumatic drugs)

Answer 6

1. Immune modulators
2. Anticytokine therapies
3. Antimalarials
4. Penicillamine
5. Gold (unknown mechanism, many possibilities)

Question 7

When are DMARDS used?

Answer 7

On pts who do not respond to cox2 inhibitors - slows course of disease (RA/OA) may induce remission and prevent further destruction of joints/tissue

Question 8

Which drug depresses circulating IgM rheumatodi factor, and depresses Tcell activity?

Answer 8

Penicillamine

Question 9

2 classes of immunosuppressants used to treat AI diseases

Answer 9

1. cyclosporine

2. steroids

Question 10

Which drug inhibits the production and release of interleukin II and inhibits interleukin II induced activation of resting T lymphocytes?

Answer 10

cyclosporine (Sandimmune, Gengraf, Neoral, Restasis)

Question 11

Which drug Increase in concentration in neutrophils and decrease in lymphocytes, monocytes, eosinophils, and basophils. It also inhibits phospholipase A, IL-2 migration, and decrease production of both prostaglandins and leukotrienes from arachidonic acid

Answer 11

Steroids

Question 12

4 Aspirin side effects

Answer 12

1, GI ulceration and bleeding

2. Kidney retention of sodium and water - may cause hyperkalemia and edema
3. Tinnitus (sign of toxicity)
4. respiratory acidosis (toxicity)

Question 13

4 side effects of sulfasalazine (Azulfidine)

Answer 13

1. headache
2. photosensitivity
3. GI distress
4. anorexia

Question 14

5 side effects of celebrex (cox2 inhibitor)

Answer 14

1. stroke
2. decreases effectiveness of BP meds
3. MI
4. Bleeding - asses when using warfarin
5. cross sensitivity with NSAIDS allergy
6. contraindicated with sulfonamide allergy

Question 15

What drug can cause prolonged bleeding and oral aphthous ulcerations/aphthous stomatitis?

Answer 15

aspirin and NSAIDS

Question 16

What drug can cause mucosal ulcerations?

Answer 16

methotrexate (Rheumatrex, Trexall)

Question 17

What 2 drugs can cause blue black intraoral pigmentation?

Answer 17

1. chloroquine (Aralen)

2. hydroxychloroquine (Plaquenil)

Question 18

4 oral side effects of penicillamine

Answer 18

1. infection
2. delayed healing
3. prolonged bleeding
4. oral ulceration

Question 19

What drug causes dermatitis with mucosal ulcerations, infection, delayed healing, prolonged bleeding, glossitis, aphthous stomatitis, blue black intraoral pigmentation

Answer 19

Gold compounds

Question 20

What immunosuppressive drug can cause gingival hyperplasia

Answer 20

cyclosporine

Question 21

Important dental practice considerations for patients taking immune modulators

1. Vital signs taken - ____ ___ may be due to chronic pain or medication-induced _____ _____ from antihypertensives.
2. Obtain recent ___ ___ - checks if predisposed to other infections, multiple ____ = affects liver and kidneys (organ dysfunction)
3. Most do not require _____ ___- consult physician if cardiac/kidney involvement, will need a pre-med if pt has AI plus a ____ ____ ____.
4. Stress caused by anxiety, anticipation of pain, infections or surgical procedures significantly raises ____ and ____ of ____.

Answer 21

elevated BP
orthostatic hypotension
blood studies
medications
antibiotic premed
prosthetic joint replacement
production
secretion
cortisol

Question 22

4 stress reduction procedures

Answer 22

1. Increased communication
2. anti-anxiety meds and nitrous oxide
3. behavioral interventions
4. good pain control

Question 23

More important dental practice considerations for patients taking immune modulators.

1. Have emergency ___/____
2. Create ____ envirnoment
3. Xerostomia - susceptibility to _____
4. oral ____
5. Difficulty eating, speaking, _____
6. ____ challenges
7. Depression: ___ of ___ ___

Answer 23

plan/prevention
safe
infections
lesions
swallowing
dexterity
lack of self care

Question 24

4 dental interventions to help a pt with AI diseases

Answer 24

1. hydration/lubricants
2. fluorides/remineralization/xylitol
3. antimicrobial rinses
4. power assisted devices