Exam 3 immune modulators/antifinflammatory agents for AI Flashcards Preview

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Flashcards in Exam 3 immune modulators/antifinflammatory agents for AI Deck (24):
1

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

Aspirin and NSAIDS (cornerstones of tx)

2

MOA of what drug is: interferes with prostaglandin synthesis

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

3

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

lefunomide (Arava)

4

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

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

5

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

anakinra (Kineret)

6

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

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

7

When are DMARDS used?

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

8

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

Penicillamine

9

2 classes of immunosuppressants used to treat AI diseases

1. cyclosporine
2. steroids

10

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

cyclosporine (Sandimmune, Gengraf, Neoral, Restasis)

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

Steroids

12

4 Aspirin side effects

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)

13

4 side effects of sulfasalazine (Azulfidine)

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

14

5 side effects of celebrex (cox2 inhibitor)

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

15

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

aspirin and NSAIDS

16

What drug can cause mucosal ulcerations?

methotrexate (Rheumatrex, Trexall)

17

What 2 drugs can cause blue black intraoral pigmentation?

1. chloroquine (Aralen)
2. hydroxychloroquine (Plaquenil)

18

4 oral side effects of penicillamine

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

19

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

Gold compounds

20

What immunosuppressive drug can cause gingival hyperplasia

cyclosporine

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 ____.

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

22

4 stress reduction procedures

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

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 ___ ___

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

24

4 dental interventions to help a pt with AI diseases

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