Final Flashcards
1
Q
What are two common causes of acute cholecystitis?
A
Gallstones and Obstruction
2
Q
What percentage of the population in the US can become chronic cholecystitis patients?
A
10-20%
3
Q
In cholecystitis patients, most gallstones are made of what?
A
Cholesterol
4
Q
5 types of Liver diseases
A
Fatty Liver Hepatitis Biliary Disease Metabolic disease Vascular
5
Q
What can liver diseases lead to?
A
Cirrhosis
6
Q
What is fatty liver caused by?
A
ETHOH, obesity and diabetes Mel.
7
Q
What is hepatitis caused by?
A
virus, drug or autoimmune
8
Q
What three things is the liver made of?
A
hepatocytes, duct cells and blood vessels
9
Q
What does all the metabolic work of the liver?
A
Hepatocytes
10
Q
What three things does the portal tract contain?
A
Bile ducts, portal veins, hepatic artery
11
Q
What is the #1 cause of liver toxicity?
A
Drugs
12
Q
What happens if hepatocytes die in large sheets?
A
the areas fill up with blood. Blood can build up due to heart failure and backflow
13
Q
What happens if cannuliculi in liver fill with bile due to cholestasis?
A
Jaundice
14
Q
Why do dentists need to be careful with Hepatitis patients?
A
If caused by viruses, it can be contagious
15
Q
What is Hepatitis?
A
Inflammation of the liver
16
Q
Acute hepatitis is cause by which two viruses?
A
A and E
17
Q
Which kind of hepatitis can resolve itself?
A
Acute
18
Q
Which hep viruses start acute and frequently progress to chronic and can lead to cirrhosis and even hepatocellular carcinoma?
A
B and C
19
Q
Acute hepatitis lasts for less than:
A
6 months
20
Q
(T or F) There is fibrosis in acute hepatitis patients
A
False
21
Q
Hepatitis C is commonly transmitted by:
A
Blood and Needles
22
Q
(T or F) In hep c, there are rarely symptoms in the acute stages
A
True
23
Q
Which Hepatitis virus is more common in China, less common in the United States?
A
C
24
Q
Are there immunizations available for Hepatitis C?
A
No
25
What is the most effective treatment for Hep C?
combination of antivirals (usually including ribavirin)
26
How is Hep B transmitted?
Blood and Needles
27
(T or F) Heb B rarely becomes chronic
False
28
What percentage of the population is infected with Hepatitis B?
2-10%
29
Hep C virus is found in how many carriers worldwide?
>170 Million
30
What percentage of hepatocellular carcinoma are associated with Hep. B viral infections?
Half
31
What is Cirrhosis?
regenerative hepatocyte nodules; fibrosis surrounding nodules
32
Who is autoimmune hepatitis typically found in?
obese middle-aged females
33
Autoimmune hepatitis typically responds well to:
Steroids
34
In fatty liver patients, what color does the liver turn?
Yellow
35
What is steatosis?
fat accumulation in the liver that is temporary, with no cellular damage
36
What is steatohepatitis?
damage to the liver with fibrosis present (chronic)
37
What is Metabolic disease often associated with?
Iron overloads
38
What causes Wilson's disease?
copper metabolic defect goes to hepatitis then cirrhosis
39
What is Biliary disease?
Destruction of bile ducts, bile backs up into the liver and causes inflammatory cells to surround ducts—may form granulomas
40
Why at very high blood concentrations normal kinetic properties of a drug or toxin can change?
metabolism and protein binding become saturated and elimination become a zero order pattern
41
How the apparent volume of distribution for drug or toxin determine the effectiveness of hemodialysis at purifying them from the blood?
a large Vd implies a substance will not be easily accessible to purification attempts.
42
What is the difference between bioaccumulation and biomagnification?
- bioaccumulation: accumulation of a toxic agent when administration of the drug exceeds the body’s ability to metabolize and elimination
- biomagnification: increases of toxin in a biological system as it passes up the food chain.
43
What defines some metals as “heavy”?
naturally occurring elements with high atomic weight and a density 5-times greater than water.
44
What are the most toxic substances?
lead (#1), mercury (#2) and arsenic (#3)
45
Heavy metals interfere with normal biological processes how?
By competing with normal substrates
46
The shorter the t1/2 the (more/ less) effective is the use of chelators to remove the heavy metal
More
47
What are the primary exposure sources of lead?
building materials/construction, batteries, lead pipes, paint
48
Why is lead exposure particularly detrimental to young children?
They often eat or suck on things that contain lead, such as things covered with lead paint, dirt etc.
49
What substance in a child's body does lead compete with?
Their bodies absorb because lead competes with CALCIUM, and growing bodies require considerable Ca.
50
What percentage of lead does a child absorb as opposed to an adult?
Children absorb >50% consumed whereas adults absorb ~10-15%
51
What are the toxicokinetics of lead?
t1/2 = 1-2 months
52
Symptomology of lead?
Headaches, neurocognitive deficits, kidney damage
53
What is the main repository in the body for its lead burden?
It substitutes for Ca++ in bone
54
What are Burtonian lines?
Lead lines causing a darkening of the gingiva
55
What two things can lead cause in the body?
Anemia, immunosupression
56
What is the most sensitive target organ for lead poisoning?
The developing CNS-can lead to encephalopathy
57
What can lead cross in the body?
BBB and concentrates in gray matter, can cross placenta
58
What is the treatment regimen for lead toxicity, particularly the recommended chelators?
Remove exposure
Administer a chelator such as EDTA (edetate calcium disodium). It removes Pb from bone slowly and requires multiple chelating treatments
59
(T or F) Mercury is solid at room temperature
False
60
What is the primary form of mercury used?
methylHg form
61
What are the primary exposure sources of mercury?
Found in fish
Amalgam (no CDC-recognized evidence that it is a problem in dentistry)
thermometers
62
What is the mechanism of mercury toxicity?
Reacts with selenium (necessary for reducing oxidized Vitamin C and E)
Can cause gingivostomatitis
Inhibits enzymes
Acute tubular necrosis
63
What do we know about mercury symptomology?
Can cause neurological, psychiatric problems
64
What were the CDC’s conclusions regarding mercury exposure related to (a) thimerosal in influenza vaccines and (b) dental amalgam?
No convincing evidence that quantities of mercury from either source is significantly high to cause problems.
65
What is the treatment regimen for mercury toxicity, particularly the recommended chelators?
Dimercaprol (can only use acutely), succimer
66
Why is dimercaprol contraindicated in chronic mercury intoxication scenarios?
Chronic use of dimercaprol can cause serious renal toxicity
67
What are the primary exposure sources of arsenic?
industrial contamination
| groundwater contamination
68
What do we know about the toxicokinetics of arsenic?
- absorbed through respiratory mucosa and GI tract, but not so much through the skin
- excreted primarily through the kidney
69
What do we know about the symptomology of arsenic?
Fatigue, anemia, renal failure, hyperpigmentation
Peripheral neuropathy
Carcinogenic in lungs, skin and bladder
Hemolytic on RBC
70
What is the mechanism of arsenic toxicity?
```
Increases ROS (reactive oxygen species)
Binds to sulfhydryl groups in keratinized tissue, where it is acts as a depot
Inhibits enzymes
Hemolytic action on RBCs
Can be carcinogenic on lung and skin.
```
71
How does the treatment regimen, including the use of chelators (e.g., Unithiol or dimercaprol), differ for acute or chronic arsenic intoxication?
Chelators are useful for acute, but not chronic
72
How do chelators work on heavy metals?
They render heavy metal ions unavailable for covalent interactions
73
How does the half-life of the heavy metal affect the ability of a chelator to remove it from a target organ?
The longer the t1/2, the less effective is the chelator
74
Is it better to treat with chelators quickly or take a wait and see approach when an exposure has occurred?
Usually most effective when treated ASAP
75
What is FDA-approved for use as monotherapy in heavy metal poisonings?
Dimercaprol
76
Why should dimercaprol not be given as a monotherapy after chronic exposure to lead?
It pulls Pb from bone and it goes to brain and causes toxicity
77
How does dimercaprol's therapeutic index compare to succimer or unithiol?
It can be very toxic, especially on kidneys—succimer has for most part replaced dimercaprol
78
What is Succimer?
water-soluble form of dimercaprol
79
What is succimer's main mechanism for removing heavy metals?
Binds to cysteine to form mixed disulfides which are excreted
80
What is the half-life of succimer?
2-4 hours
81
What is succimer's only route of administration?
Oral
82
Which is safer, succimer or dimercaprol?
Succimer
83
Edetate Calcium Disodium (CaNa2-EDTA) is FDA-approved for which heavy metal poisonings ?
Lead
84
Does CaNa2-EDTA target intracellular or extracellular lead?
Extracellular
85
What is only route of administration?
IV
86
What is 's half life?
1 Hour
87
How is CaNa2-EDTA excreted?
100% by the kidneys
88
In which patient population is CaNa2-EDTA contraindicated?
anuric patients
89
Unithiol is a water soluble derivative of what other chelator?
Dimercaprol
90
What are the routes of administration for unithiol?
Orally or i.v.
91
Half life of unithiol?
20 hours
92
Is unithiol FDA approved for treatment of heavy metal poisonings?
No
93
Pure Food and Drug Act
caused by addiction to opium and cocaine; requires labeling, patent medicines
94
Modified Food, Drug and Cosmetic Act
required safety; caused by diethyleneglycol tragedy
95
Durham-Humphrey Amendment
Rx vs. OTC
96
Kefauver-Harris Amendment
phocomelia caused by thalidomide tragedy; requires safety and efficacy
97
Dietary Supplement Health and Education Act
regulates herbal products; defines herbal products as “foods”
98
What is the distinction between prescription and OTC drugs?
Addiction/abuse liability
Relative safety
Intent of use-does it require professional input/control
99
What things does the FDA regulate?
Foods, dietary supplements, bottled water, food additives, drugs, biologics, medical devices, cosmetics, veterinary products, tobacco products, advertising of these products.
100
What are the phases of drug testing?
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
101
What are the non-prescription drug categories?
I (safe and effective), II (unsafe or ineffective), III (not sure—requires more studies)
102
Three types of decongestants
Oxymetazoline
Phenylephrine
Pseudophedrine (restricted sales)
103
What is the difference between systemic and topical decongestants?
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).
104
3 types of antihistamines
- Diphenhydramine (drowsiness)
- Chlorpheniramine (Chlor-Trimeton)
- Loratidine (Claritin) less drowsiness
105
3 types of Antitussives
- Codeine
- Diphenhydramine
- Dextromethorphan
106
What is a common expectorant?
Guaifenesin
107
What are Demulcents?
cough drops/syrupy products; coat the throat to reduce irritation
108
What is the benefit of Water/humidification?
decrease viscosity of respiratory secretions
109
Do Antivirals benefit colds?
shortens infection for 1-2 d if taken early
110
3 common antivirals
1. Oseltamivir (Tamiflu-not OTC)
2. Zanamivir (Relenza-not OTC)
3. Docosanol (Abreva)- cold sores (Herpes)-antiviral
111
4 Analgesics
- Aspirin
- Acetaminophen
- Ibuprofen
- Naproxen
112
What is used to treat cold sores?
Docosanol
113
What is Phenol?
Oral Anesthetic
114
What are the side effects of nicotine?
dizziness, headaches, nausea
115
What is an antifungal used for vaginal infections?
Miconazole
116
What are Diphenhydramine and Doxylamine?
antihistamine, sleep aid
117
What is a first said antibiotic, preventive on minor abrasions
Neosporin/Polysporin
118
What is hydrocortisone used for?
(anti-inflammatory, anti-itching) dermal lesions, eczema, insect bites, poison ivy
119
What is Capsaicin?
(pain-relief); topical ointment, TRPV channels
120
Name 2 anticholinergics, used for motion sickness
Scopolamine, Dimenhydrinate
121
What are some side effects of Dimenhydrinate?
dry mouth, constipation, difficulty, blurred vision, reduced urinating
122
What is Minoxidil for?
hair growth
123
Herbal Products (can/ cannot) be promoted to diagnose, cure or prevent disease
Cannot
124
St. John’s Wort
Promoted to treat depression
125
Echinacea
Promoted to treat colds, although controversial
126
Aloe Vera
Promoted for skin care-help with wound healing
| Dietary supplement to treat constipation
127
Cranberry
Used to prevent urinary tract infection
128
Garlic
Slowly lowers cholesterol (minor effect)
| Some thinning of blood
129
Ginko
Promoted to improve memory
| Can increase bleeding risk
130
Ginseng
Boost immune system
| May lower blood sugar
131
Ephedra
Sympathomimetic: contains ephedrine
Used for anorexia and stimulant effects
FDA require removal from most OTC products, although still will occasional seen in an herbal preparations
