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Flashcards in Final Material Deck (193):
1

s

(sina) without

2

What is fast tracking?

-Shorten FDA approval time for urgent situations

3

What is the DOPL and the UCSD, and their purpose?

  • Division of Occupational and Professional Licensing, and Utah Controlled Substance Database
  • This is a legislatively created database to track and collect data on dispensing of Schedule II-V drugs by retail, institutional and outpatient hospital pharmacies
  • Purpose: identify over-utilization, misuse and over-prescribing of controlled substances throughout the state.

4

Succimer:

Succimer (water-soluble form of Dimercaprol):

  • Used to treat Pb, As, and Hg poisoning
  • Urinary excretion (main mechanism for removal)
  • Water soluble derivative of dimercaprol
  • T1/2 – 2-4 hours
  • Route of administration -> ORAL USE ONLY
  • Succimer has less side effects (GI and mild rashes) as compared to hypertension, tachycardia, nausea, vomiting, salivation, pain

5

Doxylamine

Antihistamine

OTC sleep aide

6

What three groups are not required to report to the UCSD?

  • Prescriptions at federal facitilies (e.g. VA, military)
  • Out-of-state pharmacies
  • Pharmacies servicing in-patient populations (i.e. hospital)

7

What was the case and effect of the Modified Food, Drug, and Cosmetic Act?

Caused by the diethyleneglycol tragedy.  Requires drug safety.

8

Unithiol is effective for what types of heavy metal poisoning?

Hg, As, and Pb poisoning

9

In which patient population is EDTA contraindicated and why?

Contraindicated in Anuric patients

10

What is Succimer's only route of administration?

Oral use only

11

What is the mechanism of mercury toxicity?

  • Reacts with selenium (necessary for reducing oxidized Vitamin C and E)
  • Can cause gingivostomatitis

12

What are the three primary exposure sources of Mercury?

  • Found in fish
  • Amalgam (no CDC-recognized evidence that it is a problem in dentistry)
  • thermometers
  • Vaccines?

13

How does the half-life of the heavy metal effect the ability of a chelator to remove it from a target organ?

The longer the t1/2 of the heavy metal, the less effective is the chelator

14

Diphenhydramine

Antihistamine, not effective for colds. Has a lot of drowsiness. Also used as an anti-tussive. OTC sleep aide as well

15

Guaifenesin

Expectorant, increases productive cough, mucus formation, thins mucus.

16

There are no over-the-counter sedatives available.  True or False?

True

17

What is the definition of a schedule III drug?

  • Have potential for abuse – may lead to moderate or low physical dependence or high psychological dependence
  • [Codeine, buprenorphine, ketamine]

18

What does the DEA oversee specifically?

  1. DEA oversees programs that deal with illicit and prescribed Scheduled drugs (Schedules 1-V)  such as:
  • Drug eradication
  • Drug education
  • Assist state and local agencies, civic groups, school systems and officials to combat drug abuse
  • Help secure borders against drug trafficking

19

What are the symptoms of Arsenic poisoning?

  • Fatigue
  • Anemia
  • Renal Failure
  • Hyperpigmentation
  • Carcinogenic in lungs, skin, and bladder
  • Hemolytic on RBC

20

What is a productive cough?

Removes mucous and cellular debri, don’t need to treat

21

How does Dimercaprol's therapeutic index compare to succimer or unithiol?

  • Narrow therapeutic index
    • Can be very toxic – especially on the kidneys
    • Succimer has for most replaced dimercaprol

22

p.o.

(per os) by mouth

23

What was the cause and effect for the Pure Food and Drug Act?

Caused by addiction to opium and cocaine; requires labeling and naming ingredients, patent medicines

24

Why is lead exposure particularly detrimental to young children?

  • Their bodies absorb because Pb competes with Ca, and growing bodies require considerable Ca. Children absorb >50% consumed whereas adults absorb ~10-15%
  • They often eat or suck on things that contain Pb, such as things covered with Pb-containing paint, dirt etc.

25

Neosporin/Polysporin

  • Antibiotic
  • First aid – preventative on minor abrasions

26

Nicotine

Patches, lozenges, gum

Treat tobacco dependence

 

Side effects:

  • Dizziness
  • Headach
  • Nausea

27

What is the mechanism of cyanide poisoning?

Cyanide is not a heavy metal

  • Prevents cells of the body from getting oxygen and ATP causeing cell death

28

What was the cause and effect of the Durham Humphrey Amendment?

Many new drugs that needed to be regulated.  Effect was Prescription vs Other the Counter (OTC)

29

What is the activite ingredient in Marijuana?

THC - Tetrohydrocannabinol

30

Unithiol is the water soluble derivative of what other chelator?

Dimercaprol---succimer is usually preferred

31

How can a dentist prevent lesions caused by zinc phosphate cement?

  • (coronal pulp tissue lesion due to phosphoric acid)
    • Use proper mix – don’t thin
    • Alternatiely use a resin modified glass ionomer cement

32

When using amalgam in filings, what step results in the greatest release of mercury?

The greatest amount of mercury is released during dry polishing of an amalgam restoration

33

What is phenylephrine also used to treat besides being used as a decongestant?

Treats hemorrhoids.  Is a good vasoconstrictor.

34

What are the phases of drug testing?

- Phases of Drug Testing (for example, preclinical; also phases I, II & III)

  • 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

35

Is it better to treat with chelators quickly or take a wait and see approach when an exposure has occurred?

Most effective administration is ASAP after exposure

36

What is a non-productive cough?

Dry hacking, non cleansing. Need treatment.

37

What is biocompatability?

  • Materials ability to perform with an appropriate host response

38

What is the definition of clearance?

  • Measure of the plasma cleared per unit time
  • Sum of both the RENAL and HEPATIC contributions
  • 1st order vs Zero Order kinetics

39

What is the mechanism of Arsenic's toxicity?

  • Interferes with ezyme function
  • Interfere with signal transduction
  • Hemolytic effects on RBCs

40

What is the definition of hazard?

  • Ability of an agent to cause toxicity
  • Depends on inherent properties of the agent and exposure liability

41

What are the therapeutic considerations and proposed uses of marijuana?

  • Legal status: Schedule I Federal laws; variable according to state laws (range from illegal, medical marijuana, to legalization [e.g., Colorado])
  • Marinol (dronabinol)-FDA Rx approved agonist
  • Proposed uses:
    • nausea
    • appetite
    • glaucoma
    • chronic pain

          * CBD (cannabidiol)- analog promoted as antiseizure, not as addicting as THC

42

noct

(nocta) at night

43

What are the non-prescription drug categories?

(I (safe and effective), II (unsafe or ineffective), III (not sure—requires more studies) )

44

Loratidine

Antihistamine, not effective for colds. Less drowsiness.  Claritin.

45

What are the three most toxic substances?

lead (#1), mercury (#2) and arsenic (#3)

46

How does Unithiol's half-life compare to other chelators?

  • T1/2 – 20 hours
  • Much longer than other chelating agents

47

What schedule drug is hydrocodone?

Schedule II drug

48

What are the characteristics of Mercury? Sources? Toxicity? Symptoms? CDC? Treatment?

Liquid at room temp

Primarily used in methylHg form

 

Sources:

  • Fish
  • Amalgam
  • Thermometers
  • Vaccines

Mercury toxicity:

  • Reacts with selenium

Symptoms:

  • Cause gingivostomatitis
  • Neurological
  • Psychiatric
    • “MAD HATTER” – hat makers used Hg
    • Memory loss, depression, confusion

 

CDC

  • No evidene of harm from vaccines
  • No health hazard from dental amalgams

 

Treatment:

  • Dimercaprol
    • Chronic use can cause serious renal toxicity
  • Succimer

 

49

Dimercaprol:

  • Used for arsenic and Hg, but not for Pb alone
  • Can be administered with CaNa2-EDTA for severe, chronic poisoning for LEAD POISONING
    • It pulls Pb from bone and it goes to brain and causes toxicity—contraindicated to use for lead poisoning alone
  • Not water soluble
  • Rout of administration = IM
  • Narrow therapeutic index
    • Can be very toxic – especially on the kidneys
  • Succimer has for most replaced dimercaprol
  • Half-life is 4-8 hours

50

w

with

51

Caffeine

Xanthine (caffeine, theobromine, theophylline)

  • Adenosine antagonist

 

Stimulant

  • Diminish fatigue and sleepiness
  • Minor CVS effects
  • Simulates gastric secretion
  • Mild diuretic
  • Decreases bloating with menstruation

52

Why at very high blood concentrations can normal kinetic properties of a drug or toxin change?

  • Under normal concentration elimination of most drugs is proportional to their plasma concentration – 1st order kinetics
    • As plasma levels increase and become very high, protein binding and normal metabolism can become saturated and the rate of elimination becomes fixed – zero order kinetics

At toxic doses normal kinetics may be altered, reflects a prolonged half life and increases toxicity (high concentration of unbound free fractions)

53

Garlic

Herbal.  Slowly LOWERS CHOLESTEROL.

54

What does ADME stand for?

  • Absorption
  • Distribution
  • Metabolism
  • Excretion
  • Of toxic substances and their metabolites

55

What is the switching policy of the FDA (Rx to OTC)?

  • Based on the need to reduce cost,
  • New drugs are always made prescription for at least 3 years before considering their conversion to OTC status
  • Good safety record
  • Used frequently to demonstrate a need.

56

w/o

without

57

How can dentists reduce cytotoxicity of acrylate bonding agents?

Rinse with tap water between applications

58

Phenol

Oral anesthetic

Do not use if patient is allergic to local anesthetic

59

What is the mechanism of lead’s toxicity?

  • Interferes with Ca++ use
  • Causes anemia
  • Causes immunosuppression

60

What are the main things that the FDA regulates?

Foods, dietary supplements, bottled water, food additives, drugs, biologics, medical devices, cosmetics, veterinary products, tobacco products, advertising of these products.

61

What is the distinction between prescription and OTC drugs?

  • Addiction/abuse liability
    • RX – addictive potential
  • Relative safety
    • RX – more toxic, serious indication
  • Intent of use-does it require professional input/control (OTC)

62

Why is adequate ventilation and use of exhaust fans essential if working with metals in the laboratory?

Exposure of beryllium dust, nickel dust, and or beryllium vapors

63

prn

(pro re nata) as needed

64

What is the definition of route of exposure?

Route of entry into the body

  • Inhalation (most common)
  • Transdermal
  • Oral
  • Mucosal

65

What is 1st order kinetics?

  • Elimination of most drugs/chemicals is proportional to their plasma concentration

66

Oseltamivir

Antiviral, have some benefit for colds (shortens infection for 1-2 days if taken early.  Not OTC.  This is Tamiflu.

67

What is the antidote for cyanide poisoning?

Hydroxycobalamin

68

What is the FDA policy regarding herbal products?

  • Regulates herbal products like food
  • * Label regulations à name of mandufacturer, list of ingredients, contents, servings
  • * Manufacture is is responsible for ensuring the dietary supplement is safe
  • * FDA “approves”
  • *  Full disclosure to FDA or consumer is regulated
  • * Consumers must demonstrate that the herbal supplement is safe to the FDA
  • * Labeling controlled by FTC (Federal Trade Commission). This category of products cannot be promoted to diagnose, treat or   prevent disease

69

a.c.

(ante cibum) before meals

70

Cyanide is not a heavy metal.  True or False?

True

71

What is the definition of volume of distribution?

  • Apparent volume into which a substance is distributed in the body
  • Large Vd = Substances will not be easily accessible to purification attemtps (hemodialysis)
    • Antidepressants, antipsychotics, antimalarials, opioids
  • Small Vd = better candidates
    • Salicylates, ethanol, phenobarbital
  • Harder to remove a substance with a larger Vd than a smaller Vd

72

What is the definition of duration of exposure?

  • May effect selection of treatment
  • Acute vs Chronic

73

Dimercaprol can be administered with CaNa2-EDTA for severe, chronic poisoning with what heavy metal?

severe, chronic poisoning for LEAD POISONING

74

c.f.

with food

75

What is the definition of risk?

The expected frequency of exposure to a hazardous agent

76

q.d.

every day

77

dc

discontinue

78

Mercury is primarily solid at room temp.  True or False?

False, liquid, and primarily used in methyl Hg form

79

  • How does the treatment regimen, including the  use of  chelators, differ for each of the following conditions:
    • acute arsenic intoxication
    • chronic arsenic intoxication
    • acute arsenic gas intoxication

  • Acute Arsenic Intoxication:
    • Decontamination
    • Unithiol (IV)
    • Dimercaprol (IM)
  • Chronic Arsenic Intoxication
    • Folate dietary supplement
    • NO CHELATORS – no therapeutic benefit
    • Irreversible damage has already occurred
  • Acute Arsine Gas Intoxication
    • Hemodialysis and transfusions
    • Aggressive hydration
    • NO CHELATORS – no benefit

80

Unithiol has been FDA-approved for which heavy metal poisonings?

None

81

What does NDA stand for?

New Drug Application

82

Once marketed, who is responsible for assuring herbal products are safe?

The FDA.  Cannot be promoted to diagnose, cure, or prevent disease.

83

sig

write on the label

84

What is the main repository in the body for its lead burden?

It substitutes for Ca++ in bone

85

Does EDTA target intracellular or extracellular lead?

Only chelates EXTRACELLULAR Pb

86

What schedule drug is Tramadol?

Schedule IV drug

87

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

88

What is EDTA's half life?

1 hour

89

What defines some metals as “heavy”?

HEAVY METALS:

  • High atomic weight
  • Density is 5x greater than water ,  >5 g/cm3

Lead (1), Mercury (2), Arsenic (3), Cadmium (7)

90

What is biocompatibility?

Biocompatibility = The ability of a material to elicit an appropriate biolgocial response in a given application in the body

91

What is the definition of a schedule II drug?

  • High potential for abuse – may lead to sever psychological or physical dependence
  • [Hydromorphone, methadone, meperidine, fentanyl, hydrocodone, codeine]

92

How do heavy meatls interfere with normal biological processes?

Heavy metals (high atomic weight), interfere with normal biological processes by competing with normal substrates

93

What is Succimer's half-life compare to dimercaprol?

T1/2 – 2-4 hours, whereas dimercaprol is 4-8 hours

94

h

(hora) hour

95

Why is dimercaprol contraindicated in chronic mercury intoxication scenarios?

Chronic use of dimercaprol can cause serious renal toxicity

96

Edetate Calcium Disodium (CaNa2-EDTA):

  • Used to treat Pb poisoning
  • Only chelates EXTRACELLULAR Pb
  • Route of administration à IV
  • T1/2 – 1 hour
  • 100% by the kidneys
  • Contraindicated in Anuric patients
    • Should not be used > 5 days due to nephrotoxicity

97

What are the characteristics of Rhinorrhea?

  • Theory-it has a defensive function
  • Drying agents are for convenience, but may prolong infection by diminishing cleansing action of secretions

98

What is the treatment regimen for mercury toxicity, particularly the recommended chelators?

Dimercaprol, succimer

99

t.i.d.

three times daily

100

What is biomagnification?

  • Increases in the relative amount of a contaminant in a biological system as it passes up the food chain
  • Mercury – increases up the food chain

101

What are Unithiol's routes of administration?

ORALLY or IV

102

What are the symptoms of mercury?

  • Cause gingivostomatitis
  • Neurological
  • Psychiatric
    • “MAD HATTER” – hat makes used Hg
    • Memory loss, depression, confusion

103

What is lead's symptoms?

Headaches, neurocognitive deficits, kidney damage, etc.

104

aq (aque)

water

105

What is the defintion of a schedule V drug?

  • Low potential for abuse
  • Limited quantities
  • Cough preparations - robitussin

106

Dimercaprol is water soluble.  True or False?

False, it is not water soluble

107

Unithiol:

  • Used to treate Hg, As, and Pb poisoning
  • Water soluble derivative of Dimercaprol—succimer is usually preferred
  • Route of administration = ORALLY or IV
  • T1/2 – 20 hours
    • Much longer than other chelating agents
  • Not FDA approved for any heavy metal poisonings

108

What is lead's half-life?

1-2 months

109

p.c.

(post cibum) after meals

110

Dimercaprol is FDA-approved for which heavy metal poisonings as a monotherapy?

Used for arsenic and Hg, but not for Pb by itself because it resdistributes larger doses to the CNS and brain

111

What twelve items are found on a prescription slip?

  1. DEA No.
  2. Name
  3. Age
  4. Address
  5. Date
  6. Drug name
  7. Brand name of drug
  8. Form (tabs, pills, etc)
  9. Dosage (200mg, 100mg, etc)
  10. Disp: (how many tablets, 20 tabs, etc)
  11. Sig: (1 tab qrh prn pain)
  12. Signature

112

St. John's Wort

Herbal.  Promoted to treat DEPRESSION.

113

What are the physiological effects of marijuana?

  • Activates cannabinoid receptors
  • Bronchodilator
  • Vasodilator
  • Tolerance and dependence
  • Many cannabinoid agonists developed for street drugs; e.g., ‘Spice”
  • Cannabidiol receptors
  • -Heavy concentration in cerebellum - impaired motor control
  • -Cortex - impaired executive decision making
  • -Mesolimbic system - pleasure is given through dopamine release
  • -Hypothalamus - the munchies

114

What steps can be taken to prevent pulpitis caused by unpolymerized monomers in resin composites used in deep fillings?

To prevent pulpitis – use twice the recommended curing time and cure in increments for composite restorations

115

What is Zero order kinetics?

  • Plasma levels become very high – protein binding and normal metabolism can both become saturated and the rate of elimination can become fixed
  • Not dependent on plasma concentration (fixed rate)
  • More drug is delivered into circulation in unbound fraction – easier to become toxic

116

Aloe Vera

Herbal.  

  • Promoted for SKIN CARE – helps with wound healing
  • Dietary supplement to treat constipation (very effective!)

117

bis

twice

118

What is the definition of a schedule IV drug?

  • Low potential for abuse
  • Alprazolam (Xanax), diazepam (Valium), Triazolam, Tramadol

119

Miconazole

  • Antifungal
  • Thrush
  • Vaginal infections

120

What is the endogenous ligand of marijuana?

Anandamide (natural neurotransmitter)

121

What does the IRB stand for?

Institutional Review Board

122

What does an expectorant do?

  • Increases productive cough
  • Increases mucus formation
  • Thin the mucus

123

What are the pros and cons of Aspirin?

  • Pros:
    • Good analgesic
    • Anti-pyretic
    • Anti-inflammatroy
  • Cons:
    • Reyes Syndrome – DO NOT GIVE TO CHILDREN
    • GI irritation
    • Acetylsalicyclic
    • Anti-clotting (do not take before surgery)

124

Docosanol

Antiviral, have some benefit for colds (shortens infection for 1-2 days if taken early.  Not OTC.  This is for cold sores (herpes)

125

What are the characteristics of Arsenic? Sources? Toxicokinetics? Arsenic Toxicity? Symptoms? Treatment?

Sources:

  • Industrial contamination
  • Groundwater contamination
  • Arsenite

 

Toxicokinetics:

  • Absorbed via respiratory and GI
  • POOR ABSORPTION THROUGH SKIN
    • Binds to keratin
  • Excreted though kidney’s

 

Arsenic toxicity:

  • Interferes with ezyme function
  • Interfere with signal transduction
  • Hemolytic effects on RBCs

 

Symptoms:

  • Fatigue
  • Anemia
  • Renal Failure
  • Hyperpigmentation
  • Carcinogenic in lungs, skin, and bladder
  • Hemolytic on RBC

 

Treatment:

  • Acute Arsenic Intoxication:
    • Decontamination
    • Unithiol (IV)
    • Dimercaprol (IM)
  • Chronic Arsenic Intoxication
    • Folate dietary supplement
    • NO CHELATORS – no therapeutic benefit
    • Irreversible damage has already occurred
  • Acute Arsine Gas Intoxication
    • Hemodialysis and transfusions
    • Aggressive hydration
    • NO CHELATORS – no benefit

126

Codeine

Antitussive

127

What is the only route of administration of Dimercaprol?

IM

128

Capsacin

  • Pain relief
  • Topical ointment
  • Targets TRPV channels
  • Decreases substance P

129

What does water/humidification do to colds, etc.?

Decreases viscosity of respiratory secretions

130

How does the apparent volume of distribution for a drug or toxin determine the effectiveness of hemodialysis at purifying them from the blood?

  • Volume of distribution  = apparent volume into which a substance is distributed in the body
    • Large Vd – implies a substance will not be easily accessible to purification attempts [Antidepressants, antipsychotics, antimalarials, opiods]
    • Small Vd – easier to extract [salicylates, ethanol, phenobarbital]

131

Dimenhydrinate

Anti-cholinergic

Treats motion sickness

Side effects:

  • Dry mouth,
  • constipation,
  • blurred vision,
  • reduced urinating

132

What are demulcents?

Cough drops/syrupy products; coat the throat to reduce irritation

133

What is the definition of toxicity?

  • The ability of a material to damage a biological system, cause injury, or impair function
  • Dose, Route of exposure, and chemical species, age, gender, genetics, and nutritional status of exposed individuals all affect the degree of toxicity

134

Echinacea

Herbal.  Promoted to treat COLDS.

135

The longer the half life, the more effective is the use of chelators to remove the heavy material.  True or False?

False.  The shorter the half-life the more effective.  

136

Zanamivir

Antiviral, have some benefit for colds (shortens infection for 1-2 days if taken early.  Not OTC.  

137

Phenylephrine

Decongestant, vasoconstrictor, sympathomimetics, alpha-1 agonist

138

How do chelators work on heavy metals?

They render heavy metal ions unavailable for covalent interactions

139

bid

twice daily

140

q

(quaque)every

141

Zinc

Little benefit – if any in killing cold viruses

Ma have permanent damage to sense of smell

142

Docosanol

Cold Sores

Ant-viral

143

What type of person heads up the ONDCP (Office of National Drug Control Policy), and what do they do?

Drug Czar

  • As part of the Executive branch, the Drug Czar (and ONDCP) evaluates, coordinates and oversees both international and domestic anti-drug efforts. Oversees DEA, NIDA & NIAAA (from NIH) activities and budget

 

144

Chlorpheniramine

Antihistamine, not effective for colds. Chlor-Trimeton.

145

What are the characteristics of Lead?

No physiological value

 

Sources:

  • Building materials
  • Batteries
  • Lead pipes
  • Paint

 

Lead toxicity:

  • Interferes with Ca
  • Causes anemia
  • Cause immunosuppression

 

Detrimental to young children:

  • Absorbed because it competes with Ca
  • Growing bodies require Ca
  • Absorbed > 50%, adults absorb only 10-15%
  • Eat or suck on things containing Pb

 

SUBSTITUTES CA IN BONE

 

T1/2 = 1-2 months in soft tissues, years in bone

 

Symptoms:

  • Headaches
  • Neurocognitive deficits
  • Kidney damage
  • Burtonian Lines:
    • Lead lines causing a darkening of the gingiva

 

Treatment:

  • Remove exposure
  • EDTA (edetate calcium disodium) chelator
    • Removes Pb from bone slowly and requires multiple chelating treatments

146

What is the positive aspect of Naproxen?

Long-acting!

147

What is the Orphan Drug Act?

  • for rare disease to encourage drug development
  • Illnesses involving less than 200,000 individual
  • -Tax incentives
  • -Extend patent

148

Dextromethorphan

Antitussive (robotussin)

149

What are the common allergic reaction observed in dental practices and the steps that can be taken to prevent or minimalize them?

  • Allergic contact dermatitis
    • Common on distal fingers and finger tips
    • Avoid direct contact (wear gloves)
  • Latex allergies
  • Allergies to denture base materials
    • Methyl methacrylate monomer

150

What is amotivational syndrome?

Loss of sense of ambition, thinking dulled

151

What are the main four sources of lead?

Sources:

  • Building materials
  • Batteries
  • Lead pipes
  • Paint

152

What is the definition of a schedule I drug?

  • No current acceptable medical use in US
  • Lack accepted safety for use under medical supervision
  • HIGH potential for abuse
  • [Heroin, LSD, Cannabis, meth]

153

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—contraindicated to use for lead poisoning alone

154

What does IND stand for?

Investigational New Drug

155

What is the difference between bioaccumulation and biomagnification?

  • Bioaccumulation accumulation of a toxic agent when the uptake of the agent exceeds the organism’s ability to metabolize excrete it
    • 1st metabolism can be overwhelmed – increased levels in blood and kidney

Biomagnification – increase in the relative amount of a contaminant in a biological system as it passes up the food chain

156

What is the mission of the DEA?

  • Mission: enforce the controlled substances laws and regulations of the USA
  • Address issues of illegal growing, manufacturing or distribution both domestically and internationally

157

What is bioaccumulation?

  • Accumulation of toxic agent when the uptake of the agent exceeds the organism’s ability to metabolize/excrete it

158

How is EDTA excreted?

100% by the kidneys

159

q.i.d.

(quates in die) 4 times a day

160

What are the four biocompatibility criteria for the ideal dental material?

  • Sould not be harmful to pulp or soft tissue
  • Should not contain toxic diffusible substances that may be released and absorbed into the circulatory system to cause systemic toxicity
  • Free of potentially sensitizing agents that may cuase allergic reactions
  • NO carcinogenic potential

161

Oxymetazoline

Decongestant, vasoconstrictor, sympathomimetics.  

162

What is the on and off label use of prescriptions?

Not FDA approved, but confirmed by research and clinical experience

163

What are the differences betwen a systemic and topical decongestant?

1. systemic

         * increase BP and HR

         * longer acting

2. topical

         * NASAL SPRAYS

         * less systemic problems

 

-Sprays have a much faster effect, but you can get rebound congestion because it doesn’t last 6-8 hours sometimes and they use it too much, even though the cold is gone, they should be feeling better, but they still feel congested because they are dependent.
-If you take these drugs orally, you could get an increase in blood pressure because of the vasoconstriction
-The sprays have less peripheral effects and are less likely to increase blood pressure
-The sprays are actually probably more effective.

         * dependence-tolerance

                  * Short acting – but MORE EFFECTIVE

164

What are the characteristics of CBD (Cannabidiol)?

  • Ø One of more than 80 active cannabinoid chemicals in the marijuana plant
  • Ø Unlike THC, CBD does not produce euphoria or intoxication
  • Ø CBD has a very low affinity for cannabinoid receptors (100-fold less) Ø CBD may acts on other brain signaling systems (serotonin??)
  • Ø CBD may have anti-seizure, antioxidant, neuroprotective, anti- inflammatory, analgesic, anti-tumor, anti-psychotic, anti-anxiety properties.
  • Ø NIH is currently supporting a number of studies effects as well as the health risks of cannabinoids.

165

Scopolamine

Anti-cholinergic

Treats Motion sickness

Side effects:

  • Drowsiness,
  • disorientation,
  • dry mouth,
  • blurred vision,
  • dilated pupils,
  • constipation

166

What is a dietary supplement?

  • Congress defined the term "dietary supplement" as a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites.

167

What is the process of DOPL and UCSD?

  • Outpatient pharmacies report dispensing of scheduled drugs within 7 days and the data are posted within 24 hours after receipt.

168

What was the cause and effect of the Kefauver-Harris Amendment?

The phocomelia caused by thalidomide (morning sickness) tragedy.  Required testing for safety and efficacy.

169

Succimer is FDA-approved for which heavy metal poisonings?

Used to treat Pb, As, and Hg poisoning

170

Hydrocortisone

  • Anti-inflammatory
  • Anti-itching
  • Dermal lesions
  • Eczema
  • Insect bites

171

What is the DEA?

Drug Enforcement Administration

172

What are Burtonian lines?

Lead lines causing a darkening of the gingiva

173

What is the definition of toxicology?

Study of the adverse effects of a chemical, physical, or biological agent on living organisms and the ecosystem.

Includes prevention of such adverse effects in

  • Occupational
  • Environmental
  • Ecological

174

EDTA has been FDA-approved for which heavy metal poisonings?

Pb poisoning

175

stat

immediately

176

What do we know about Arsenic's toxicokinetics?

 

  • Absorbed via respiratory and GI
  • POOR ABSORPTION THROUGH SKIN
    • Binds to keratin
  • Excreted though kidney’s

177

Pseudoephedrine

Decongestant, vasoconstrictor, sympathomimetics, restricted sales

178

q.h.

every hour

179

What are the three primary exposure sources of arsenic?

  • Industrial contamination
  • Groundwater contamination
  • Arsenite

180

Ginko

Herbal.  Promoted to IMPROVE MEMORY.  Uncooked ginko seeds contain ginkotoxin and can cause seizures.

181

Based on their comparative adverse effects, why has succimer largely replaced dimercaprol use?

Succimer has less side effects (GI and mild rashes) as compared to hypertension, tachycardia, nausea, vomiting, salivation, pain

182

ad.lib.

(ad libitum) use freely

183

What is the water soluble form of Dimercaprol?

Succimer

184

Minoxidil

  • Hair Growth (Rogaine)
  • Vasodilator – Causes rapid HR

185

What were the CDC’s conclusions regarding mercury exposure related to (a) thimerosal in influenza vaccines and (b) dental amalgam?

  • No evidene of harm from vaccines
  • No health hazard from dental amalgams

186

What regulates the herbal products?

  • DSHEA, -Dietary Supplement Health and Education Act.
  • Regulates herbal dietary supplements: defined as taken by mouth and contains a ‘dietary’ ingredient to supplement diet. May include vitamins, minerls, herbs or other botanical and nutrients.

187

What was the cause and effect of the Dietay Supplement Health and Education Act?

Little regulation lead to regulating herbal products like food, servign size, structure, functions, claims, with the big statement = These statements have not been evaluated by the FDA.  Not intended to diagnose, treat, cure, or prevent any disease.

188

Succimer is the water soluble derivative of what other chelator?

Dimercaprol

189

What are the pros and cons of Ibuprofen?

  • Pros:
    • Good analgesic
    • Antipyretic
    • Anti-inflammatory
    • No reyes syndrome
  • Cons:
    • GI irritation
    • Anti-clotting

190

What are the pros and cons of Acetaminophen?

  • Pros:
    • Anti-pyretic
    • Analgesic
    • Not irritating to stomach
    • Give to children
  • Cons:
    • NOT an anti-inflammatory
    • LIVER toxic

191

What is Succimer's main mechanism for removing heavy metals?

Urinary excretion

192

Ginseng

Herbal.  Boosts immune system, may lower blood sugar.

193

What is EDTA's only route of administration?

IV