Midterm 3 Pharmacology Flashcards
(236 cards)
1
Q
What are natural estrogens?
A
Steroid hormones
2
Q
Are all synthesized estrogens steroids?
A
No, they may be non steroidal
3
Q
How do estrogens and progestins function?
A
they cross cell membranes and activate estrogen receptors inside the cell –> modulate expression of genes
4
Q
What are the 3 stages of the menstrual cycle?
A
- Menstrual stage: menses
- Follicular stage: proliferative
- Luteal stage: secretory
5
Q
What happens with menopaus/andropause with age?
A
As populations age, they spend more time in menopause (females) or andropause (males)
6
Q
What are the 3 natural estrogens?
A
- Estrone E1
- Estradiol E2
- Estratriol E3
7
Q
What is the predominant natural estrogen during menopause?
A
Estrone E1
8
Q
What is the predominant natural estrogen during productive years?
A
Estradiol E2
9
Q
What is the predominant nautral estrogen during pregnancy?
A
Estratriol E3
10
Q
What are 2 types of synthetic estrogens?
A
- Steroidal: ethinyl estradiol
2. non-steroidal: diethylstilbesterol
11
Q
What are the physiological functions of estrogen?
A
- Sexual maturity
- Increased CNS excitability (seizure inducing?)
- increased endometrial and uterine growth
- maintain skin elasticity
- reduce bone adsorption
- increase blood coagulability
12
Q
What are the clinical uses of estrogen?
A
- Primary hypogonadism
2. Postmenopausal
13
Q
What are the guidelines for estrogen use?
A
- always use the smallest dose for the shortest period of time possible
- sometimes local creams are preferred to minimize exposure
14
Q
What are the adverse effects of estrogen use?
A
- Postmenopausal bleeding
- nausea, breast tenderness
- migraines
- hypertension
- hyperpigmentation (esp around eyes)
- increases some cancers (breast and endometrial)
15
Q
When is estrogen treatment contraindicated?
A
- liver disease (slow metabolism)
- breast/endometrial cancers
- thrombolytic disorders
16
Q
What are progestins made from?
A
Cholesterol
17
Q
Is progestins in males or females?
A
Both, but less in males
18
Q
What is the most important progestin in humans?
A
Progesterone (natural)
19
Q
What is progesterone a precursor to?
A
1 .Estrogen
- Androgen
- Adrenalcortical steroids (eg. cortisol)
- trestosterone
- estradiol
20
Q
What are synthetic progestins?
A
- Medroxyprogesterone
2. norgestimate
21
Q
Which synthetic progetsin are most like progesterone and why?
A
-Medroxyproesterone because of 21 carbon progestin
- antiestrogentic like progesterone
- unlike progesterone in that it is also androgenic
22
Q
what is a 3rd generation “19- Nor 13-ethyl” steroid progestin? and what is there about androgen activity?
A
norgestimate, has lower androgenic activity than the older synthetic progestins
23
Q
What is the half life of progestins?
A
5 min (very short acting)
24
Q
What are the physiological effects of progestins?
A
- increase fat deposition
- decrease CNS excitability (eg. antiseizure – opposite of estrogen)
- increase aldosterone –> increase Na+ retention –> Increases BP –> increases water retention and blood volume
- increase body temperature
25
What are the clinical uses of progestins?
1. replacement therapy
2. oral contraception
3. long-tern ovarian suppression (e.g. dysmenorrhea or endometriosis) -- in contrast to estrogens, no problem with bleeding or clotting
26
What are the contraindications for progestin use?
1. Breast cancer risk
| 2. sever hypertension or heart disease is risk
27
What does combination contraception include?
Progesterone + estrogen
28
What are the functions of combination contraception?
1. Decreases ovulation (approaching 100 %)
| 2. Decreases conception and implantation
29
How effective is progestin only contraception?
~80-90%
30
What are the functions of progestin ONLY contraception?
1. decreases ovulation 50-80%
2. thicken mucus and reduces sperm penetration
3. impairs implantation
31
What does monophasic refer to for combination contraception?
Constant doese of both estrogen and progesterone in delivery
32
what does biphasic refer to for combination contraception?
Dosage of one or both (estrogen and progesterone) change one time during cycle
33
What does triphasic refer to for combination contraception?
Dosage changes 2 times in delivery
34
What is referred to as the "minipill" and why?
Progestin only because there is no estrogen; has fewer side effects, but also is less effective
35
What are other forms of delivery for contraception?
1. Implantable
2. Injections (IM = sustained effects)
3. Intravaginal rings
4. IUDs with and without estrogen/progestin
5. Transdermal combinations
36
What are the side effects of combination contraception?
1. Reduces ovarian function and size
2. increases breast size and tenderness
3. increased thrombolytic events
4. increase heart rate and BP
5. hyperpigmentation, especially around the eye
6. mild nausea, breakthrough bleeding, headaches
7. May interact with antibiotics that disrupt G.I. normal flora (e.g wide spectrum abx like amoxicillin.
37
Why is the interaction between contraceptives and abx important?
Normal absorption of contraceptives from GI system is depended on these flora
38
What are the clinical uses of contraceptives?
1. oral contraception
2. menstrual disorders, irregularity, heavy discharge
3. acne
39
What does TAMOXIFEN do?
1. Antagonist
2. Blocks actions of estrogen in breast
3. used to treat breast cancers
40
What does MIFEPRISTONE do?
1. Antagonist
2. morning after contraceptive
3. blocks progesterone and glucocorticoid receptors
41
What does DANAZOL do?
1. suppresses ovarian function (has a masculinizing effect)
42
What does CLOMIPHENE (CLOMID) do?
1. Ovulation inducing
2. promotes fertilization and pregnancy
3. increase risk of multiple births eg. twins
43
What is testosterone?
androgen that causes male puberty
44
What does testosterone convert to?
estradiol
45
T/F Testosterone can be used as replacement therapy for males?
True
46
How does testosterone help with gynecological disorders?
Reduces breast size (gynecomastia)
47
How does testosterone 's protein anabolic effects help?
Helps replace muscle loss
48
How does testosterone help with growth stimulation?
can prematurely close growth plates in growing adolescents
49
How can testosterone help with increased age?
Counter some age-related loss of muscle mass
50
Where and why is there an adverse affect of testosterone?
In females because of masculinization
51
What can testosterone analogs abused for muscle and strength building cause?
1. Acne
2. aggressiveness
3. "roid rage"
*this is controversial
52
What can chronic inflammation lead to? (8)
1. Arthritis
2. Alzheimer's disease
3. Cancer
4. Cardiovascular
5. Diabetes
6. Neurological disease
7. Oral diseases (perio!)
8. pulmonary diseases
53
What are NSAIDS?
1. Anti-inflammatory drugs
| 2. decrease pain and inflammation
54
What areas can COX 1 NSAIDs affect?
1. GI (ulceration)
2. Platelet aggregation (anti-thrombotic, increase bleeding)
3. Kidney (hyperkalemia)
55
What side affects can COX 2 NSAIDS have?
1. MI
2. Stroke
3. Hypertension side effects
* DO NOT INHIBIT PLATELET AGGREGATION
* these are antipyretic, analgsice, anti-inflammatory
56
What are 3 non-selective COXI and II inhibitors?
1. Aspirin
2. Ibuprofen
3. Naproxen
57
How does Aspirin work?
1. acetylsalicyclic acid (ASA)
2. Irreversible inhibition!
3. rarely used as anti-inflammatory b/c require higher doses
4. valued for anti-platelet aggregation effects
58
How does Ibuprofen work?
1. Derivative of propionic acide
2. analgesic and antipyretic and anti-inflammatory
3. Motrin/advil
4. interferes with antiplatelet effect of low dose aspirin, rendering aspirin less effective for MI, stroke prevention when taken together
59
What is ibuprofen used for?
1. fever
2. mild to moderate pain
3. dysmennorhea
4. reduce inflammation: osteoarthritis, juvenile arthritis, dental pain, headache, migraine, RA, closing patent ducts arteriosus
60
What is nice about Naproxen?
available in slow releasing formulation "all day strong"
61
What are contraindications for Aspirin?
1. NSAID allergies
2. CHF
3. Renal insufficiency
4. gout
5. hemophilia or other blood thinners (warfarin)
6. ACE inhibitors. methotrexate
7, hypoglycemic drugs
8. patients within 10 days of surgery
9. pregnant patients
10. children with Reye syndrome (viral)
62
What is a selective COX 2 inhibitor?
Celecoxib
63
What is Celecoxib used for?
1. Osteoarthritis
2. RA
3. ankylosing spondylitis
4. acute pain
5. painful menstruation
64
Why can Celecoxib be used as a pre-emptive analgesic in dental surgery?
due to long duration and lack of antiplatelet effect (once daily dosing)
65
What are the effect os Celecoxib?
1. Analgesic
2. antipyretic
3. anti-inflammatory
4. NO EFFECT ON PLATELET AGGREGATION
5. do not inhibit cox 2 mediated prostacyclin synthesis so NO cardioprotective effect, significantly fewer GI adverse effects
66
What are adverse effects common for ALL NSAIDS?
1. CNS- tinnitis
2. CVS- hypertension
3. GI- nausea, ulcers, or bleeding
4. Hepatic- altered liver function
5. Pulmonary- asthma
6. Skin - rashes
7. Renal- insufficiency, in extreme can have failure
67
What are glucocorticoids used for?
Dramatic effect on inflammation and slowing bone erosions in RA
68
Are glucocorticoids rapid or slow acting?
Rapidly acting
69
What are the side effects of glucocorticoids?
1. Loss of muscle mass
2. osteoporosis
3. diabetogenesis (increase in fate, serum glucose and insulin)
4. peptic ulcers
5. round face
6. buffalo hump
70
What is long acting glucocroticoid?
Dexamethasone
71
What are 2 short to medium acting glucocorticoids?
1. Cortisone
| 2. Prednisone
72
What can glucocorticoids be used for?
1. Allergic reactions
- bee stings, contact dermatitis, drug rxs, allergic rhinitis
2. GI, inflammatory bowel disease
3. Systemic Inflammation
- ARDS, SLE, pleurisy
4. Infection
- ARDS, sepsis
5. Inflammatory conditions of bones and joints
- arthritis, bursitis
6. Pulmonary disease
- Aspiration pneumonia, bronchial asthma, infant RDS
7. Skin
- dermatitis
73
What are DMARDS?
Disease modifying anti-rheumatic drugs
74
What are 2 DMARDS?
1. methotrexate (also anti-cancer, not w/ aspirin, blocks enzymes needed for purine metabolism, downregulates T cells and B cells, inhibit methyltransferase, block interleukin 1-beta )
2. sulfasalazine (use when can't take other NSAIDS)
75
What do DMARDS and immunosuppressants?
decrease inflammation and slow bone damage in RA
76
What are the side effects of DMARDS?
1. potentially more toxic than other options
2. severe hepatotoxicity
3. stomatitis
4. immunosuppression
77
What causes Acne Vulgaris?
inflammation/bacterial infections of plugged sevaceous glands: white heads, cysts, abscesses
78
What are topical Keratolytics and what are they used for?
1. used for Acne Vulgaris and wart removers
| 2. removes keratin layer and opens sebaceous glands
79
What are 2 examples of Topical Keratolytics?
1. Salicyclic acid
| 2. bezoyl peroxide
80
How does Salicyclic acid work?
causes cells of epidermis to shed more readily, open clogged pores, neutralizing bacteria, prevent pores from clogging up again, and allow new cell growth
81
How does Benzoyl Peroxide work?
- increases skin turnover, clearing pores (comedolytic) and reducing bacterial count (P. acnes)
- often used with salicycle acid, abx, or retinoids
82
How do abx treat acne vulgaris?
Eliminate the bacteria that cause the infection and inflammation associated with acne. Can use either topical or systemic. Drugs concentrate in skin
83
What are 4 abx used to treat acne vulgaris?
1. erythromycin (mild-moderate)
2. tetracyline (anti-ribosomal abx)
3. clindimycin (mild-moderate)
4. Dapson (mild-moderate)
84
How does Erythromycin work?
1. macrolide abx to treat P. acnes
2. there are abx resitstant strains
3. broad spectrum
4. side effects include local irritation, burning sensation, drying
85
How does Clindamycin work?
1. antiribosomal abx useful against gram + and anaerobic bacteria
2. ~10% absorbed topically
3. side effects include GI upset and diarrhea. rarely bloody diarrhea and colitis reported
86
How does dapsone work?
1. 5% gel, sulfone abx for acne vulgaris
2. abx mechanism unclear
3. anti-inflammatory
4. NO oral use with G6PD deficiency, can cause dryness, redness, skin peeling
5. when used with benzoyl peroxide may temporarily discolor skin and hair yellow
87
What are retinoids? used for?
1. vitamin A derivatives
| 2. Acne vulgaris
88
What are 2 types of retinoids?
1. Tretinoin
| 2. Isotretinoin
89
How does Tretinoin function?
1. Retin A, topical retinoid cream
2. promote epi cell turnover
3. prevent formation of new comedones
4. can cause dryness, increased sensitivity to sunlight, redness, scaling, itching, burning
90
How does Isotretinoin work?
Accutane
1. oral retinoid used for severe cystic acne and acne not responding to other treatments
2. considered only true "cure" for acne. Reduces the amount of oil secreted by glands
3. side effecs: bowel diseases, liver damage, depression, teratogenicity, miscarriage
4. contraindicated for preganancy: cause CNS, craniofacial, CVS birth defects
91
What is a non drug tx for acne?
UV phototherapy-- acne causing bacteria are UV sensitive
92
How do muscle Relaxants function?
Enhance levels of inhibition, usually via CNS (GABA mediated)
93
How do Antispasmotic muscle relaxants function?
reduce spasticity by modifying the stretch reflex arc and/or interfering directly w/ excitation-contraction coupling of the skeletal muscles (either enhance level of inhibition or reducing levels of excitation)
94
What are 4 antispasmotic muslce relaxants?
1. Diazepam
2. Baclofen
3. Dantrolene
4. Carisoprodol
95
How does Dantrolene work?
1. Blocks ryanidine receptor Ca2+ release from SR of skeletal muscle; peripheral only (direct)
2. decreased intracellular Ca = weakens contraction
3. use for malignant hyperthermia (from general anesthesia)
96
How does Baclofen work?
1. GABA b agonist; central acting
2. pre and post synaptic inhibition of motor output
3. severe spasticity due to CP, MS, stroke
97
How does Carisoprodol (Soma) work?
Muscle relaxant/sedative; may have some dependence problems
98
How does Diazepam work as a muscle relaxant?
1. facilitates (increase frequency of opening) GABA A receptor; central acting
2. increased interneuron inhibition; central sedation
3. spasms related to CP, stroke, spinal cord injury, acute muscle injury
99
How do non-depolarizing muscle relaxants work?
closed blockade
Produce muscle
paralysis by preventing the opening of the Ach nictoinic channel when bound
- reversed by acetylcholinesterase inhibitors
100
What is a non depolarizing muscle relaxants?
1. D tubocurarine
101
How does D tubrocurarine work?
- Blocks ganglionic nicotinic receptor from opening
- rarely used
- side effects for hypotension and bronchoconstriction
102
How does Acetylcholinesterase inhibitors block d-tubrocuranine?
blocks by overwhelming the blockade with increased Ach
103
How do Depolarizing neuromuscular blocking work?
| open blockade
Paradoxical depolarizing blockade (desensitization) of ganglionic nicotinic Ach receptors. Occupy receptor binding site and block channel, preventing normal closure of the gate. desensitize by persistent depolarization
104
What is an example of depolarizing muscle relaxant?
Succinylcholine
105
How does Succinylcholine function?
1. blocks ganglionic nicotinic receptors by desensitizing (oversimulating?)
2. fast acting with short duration, get initial twitching (phase 1- depolarizing) before paralysis (phase 2- desensitizing)
3. acetylcholinesterase inhibitor does NOT reverse
4 side effects: post op myalgia/fatique, hyperkalemia, regurgitation/aspiration
-Malignant hyperthermia (tx: dantrolene)
106
When is the best time to use Antivirals for shingle and herpes?
use early in infection
107
what is the problem with viral thymidine kinase dependent type drugs?
getting some resistant viruses
108
What are 2 examples of viral thymidine kinase dependent types?
1. Acyclovir (Zorivax cream/ointment, Denavir ointments)
2. Famciclovir
* ointment = gential
* cream = cold sores
109
How does Acyclovir work?
Most effective for herpes simplex virsuses (1 and 2); cold sores on mouth and nose (10x more potent )
- less potent on Varicella zoster virus (chicken pox and shingles)
- inhibit viral DNA synthesis
110
How does Famciclovir work?
- Effective against VZV virus and shingles and herpes. Longer acting than Acyclovir
- metabolized by penciclovir which achieves higher intracellular concentrations than acyclovir
111
What is better about non thymidine kinase dependent antivirals?
Less of a resistant problem from HSV and VZV b/c don't require activation by viral thymidine kinase
112
What is an example of a non-thymidine kinase dependent antiviral?
Foscarnet
113
How does Foscarnet work?
1. selectively inhibit viral polymerase enzymes (NOT KINASE)
2. IV administration ONLY
3. for Acyclovir resistant HSV/VZV
4. nephrotoxicity, electrolyte disturbance, irritability, hallucination
114
Which 5 drugs treat Glaucoma?
1. Pilocarpine
2. Timolol
3. Epinephrine
4. Lantanoprost
5. Acetazolamide
115
How does Pilocarpine work?
1. cholinomimetic
2. contracts ciliary muscle and increases outflow of aqueous humor
3. works of OAG, presurgically for closed angle glaucoma
116
How does Timolol work?
1. beta blocker non selective
2. decreases aqueous humor secretion
3. popular for open angle glaucoma
117
How does epinephrine work for glaucoma?
1. alpha agonist- nonselective
| 2. increase ouflow and decrease AH secretion
118
How does Lantanoprost work?
1. prostaglandin
2. increase outflow of aqueous humor
3. popular for open angle glaucoma
4. topical
119
How does Acetazolamide work?
1. Carbonic anhydrase inhibitor
2. reduces aqueous humor secretion
3. works for OAG and presurgically for closed angle glaucoma
4. oral
120
What drugs can worsen glaucoma?
1. anticholinergic
| 2. stimulants (amphetamines)
121
What are the 5 drugs used to treat Meniere disease?
1. Meclizine (Antivert)
2. Diazepam
3. Promethazine
4. Hydrochlorothiazide
5. Dexamethasone
122
How does Meclizine (antivert) function?
1. H1 blocker
2. anticholinergic
3. CNS depressant
4. antimotion sickness medication
5. can cause xerostomia
123
How does Diazepam function for meniere disease?
1. Benzodiazepine with sedative and anxiolytic effect
| 2. used for motion sickness
124
How does promethzine function?
1. H1 blocker
2. anticholinergic
3. antinausea and motion sickness
4. can cause xerostomia
125
How does Hydrochlorothiazide function?
1. diuretic
| 2. regulates fluid volume and pressure in inner ear
126
How does dexamethasone work?
1. long acting steroid/injection into the ear
2. reduces fluid
3. help control vertigo attacks. performed with local anesthesia
127
What is used to treat acute Otitis media?
1. Amoxicillin (1st line)
| 2. Amoxicillin + clavulanate or cefaclor (recurrent w/ h. influenza, recent abx exposure and 2nd line)
128
How does amoxicillin work?
mainly bactericidal and inhibits third and final stage of bacterial cell wall synthesis.
129
How does amoxicillin/claculanate combo work?
1. treats bacteria resistance to B-lactam antibiotics by reestablishing amoxicillins activity against B lactamase producing bacteria
2. excellend for treating infection due to b lactamase producing H. influenza and penicillinase producing anaerobes
3. sides effects: diarrhea, head ache, GI upset, thrush, vaginal yeast infections
130
What are second level drugs used for Otitis media?
1. Trimethoprim (sulfa) -- folate antagonist
| 2. Macrolides - (erythromycin), for ppl who have allergy to penicillin
131
How many cancer patients are cured with local treatment (surgery, radiotherapy)?
1/3
132
Under what conditions is chemotherapy used for cancer tx?
1. advanced disease or as an adjuvant
| 2. administered after primary treatment (surgery, radiation) to prevent secondary tumor development or spread
133
Where do anticancer drugs usually exert their action?
on cells in cell cycle
134
Should chemotherapy and radiation be used separately?
- No, typically requires combination of drugs.
| - combine chemo and radiation tx in locally advanced disease.
135
What is the goal in cancer treatment?
Need maximal cell kill within the range o toxicity tolerated by host
136
How can you protect the patient in treatment?
adjust scheduling and overlapping toxicities
137
What type of mutation leads to drug resistance?
P53 is a mutation that occurs in up to 50% of all human tumors- leads to resistance to radiation therapy and anticancer agents
138
What are 4 new treatment strategies for cancer?
1. Imatinib (Gleevec)
2. Erlotinib
3. Hormones
4. Retinoic Acid
139
How does Imatinib work?
- Bcr-Abl Tyrosine hydroxylase (and tyrosine kinase) inhibitor
- used for multiple types of cancers such as mylogenous leukemia
140
How does Erlotinib work?
Blocks EGFR (epidermal growth factor receptor) and treats non small cell lung and pancreatic cancer
141
What types of cancers can hormones treat?
Breast and prostate cancers
142
How does retinoic acid work?
Induced differentiation of some leukemia
eg. promyelocytic leukemia
143
What are the 4 principles of drug combinations?
1. Usually single drugs at clinically tolerable doses DOES NOT cure cancer alone
2. efficiency usually better in combinations
3. avoid toxicity overlap
4. design optimal scheduling
144
What does optimal scheduling for cancer tx mean?
1. maintain constant intervals with tx fee intervals short as possilbe
2. allow most sensitive tissue adequate time to recover (bone marrow)
145
Drug resistance and Melanoma
1. exhibits primary resistance on initial exposure (lack of tumor response)
2. needs multiple exposures to treatment to get response to tumor
146
T/F tumors can acquire resistance during treatment
True
147
What is an example of a cancer tx alkylating agent?
Cyclophosphamide
148
What is cyclophosphamide used for?
1. Hodgkin's lymphoma
2. Multiple myeloma
3. Leukemia
4. Breast Cancer
149
What is the MOA for alkylating agents such as cyclophosphamide?
- transfer their alkyl groups to various cell constituents such as DNA
- Alkylation of DNA in nucleus causes miscoding and can break DNA strands
150
How do tumor cells resist alkylating agents?
Increase capacity to repair damaged DNA
151
What are the adverse affect of alkylating agents such as cyclophosphamide?
1. Nausea, vomiting
2. damage to rapidly growing tissue (bone marrow, GI tract, Reproductive tissue)
3. Carcinogenic in nature (increases risk of secondary cancer-- bladder cancer)
152
What is an example of a nitrosoureas tx for cancer?
Procarbazine
153
How does Procarbazine function and used for?
requires biotransformation and passes BBB and used to treat brain tumors
154
What is an example of platinum analog for cancer tx?
Cisplatin
155
What is Cisplatin used for?
Broad range of solid tumors
156
What is a side effect of cisplatin?
nephrotoxic
157
What is an example of antimetabolites used for cancer tx?
Methyltrexate
158
What is methyltrexate an analog of?
Folic acid
159
How to antimetabolites work?
act on intermediary metabolism of proliferating cells
160
How specifically does methyltrexate work?
inhibits tetrahydrofolate-- interferes with formation of DNA, key proteins
161
What is methyltrexate used for?
treats head and neck cancers, breast cancers
162
What is the toxicity of methyltrexate?
Mucositis
| diarrhea
163
What is 5- Fluorouracil?
- antimetabolite
- inhibits thymidine synthase, decreases DNA synthase and decreases DNA synthesis and function
- results in altered RNA processing
164
What does 5 fluorouracil treat?
1. colorectal cancer
2. anal cancer
3. breast cancer
4. head and neck
5. hepatocellular cancer
165
What are Vinca Alkaloids?
Natural product cancer chemotherapy drug
166
What are 2 types of Vinca Alkaloids?
1. Vinblastin
| 2. Vincristin
167
How do Vinblastin work?
inhibits tubulin polymerization- cytoskeleton component --> arrests in metaphase of cell division and causes cell death
168
Vinca Aklaloid toxicity?
mucositis and myelosuppression
169
What is Vinblastin used to treat?
1. breast cancer
2. kaposi's lymphoma
3. Hodgkins lymphoma
170
How does Vincristine work and for?
combined with prednisone in tx of acute lymphoblastic leukemia in children
less immunosuppresion SE than Vinblastin
171
What are anthracyclines?
anti-tumor antibiotics
| among most widely used cytotoxic anticancer drugs
172
What are 2 examples of anthracyclines?
1. Doxorubicin
| 2. Bleomycin
173
What is MOA of doxorubicin?
formation of free radicals that bind to DNA, causing breaks
174
What do anthracyclines (doxorubicin, bleomycin) treat?
1. Lymphomas
2. Breast cancer
3. Thyroid cancer
175
What toxicity is there anthracyclines (doxorubicon, bleomycin)
1. nausea
| 2. red (not blood) urine
176
What is ASPARAGINASE?
1. anticancer druge
2. hydrolyzes circulating L-asparagine to aspartic acid and ammonia
3. results in rapid inhibition of protein synthesis
4. treatment of Acute Lymphoblastic leukemia
177
What are 4 treatments for hodgkins lymphoma?
1. Anthracycline
2. doxorubicin
3. bleomycin
4. vinblastine
178
Gastroesophageal disease (GERD) is _______; "Acid Reflux" is ______
1. Chronic
| 2. acute (isolated incidents)
179
GERD Episodes referred to as heartburn occur daily in ________ population
7%
180
What are aggravating factors for GERD?
1. empty stomach
2. inclined
3. increased age
4. obesity
5. fatty foods
6. caffeine/alcohol/smoking
7. large meals
8. some drugs (anticholinergics)
181
What can bring relief for GERD problems?
1. small meals
2. reduced fat
3. reduced weight
4. elevate head of bed
5. avoid aspirin/NSAIDs
182
What are dental tips for GERD problems?
protect teeth from erosion by gastric acids with:
1. mouth guard
2. neutralize acid with basic solution --> 1 tsp baking soda in 8 ounce water
3. don't brush teeth after gastric juices are in mouth (acidic)
183
What is the MOA for antacids?
neutralize gastric HCL
184
What are 4 types of Antacids?
1. Magnesium salts (constipation and gastric acid)
2. Bicarbonate
3. calcium carbonate
4. aluminum salts (not very effective)
185
What is a side effect of magnesium salts?
Can cause diarrhea
186
What is a side effect of bicarbonate?
causes gas; can interfere with digestions b/c need SOME acid to digest
187
What is a side effect of calcium carbonate?
chalky and constipation
188
What is the MOA for H2 receptors blockers?
"antihistamine"
1. not as effective at the H1 receptors (not good antihistamines)
2. reduce GASTRIC SECRETIONS by blocking H2 receptors in gut -- parietal/chief cells releasing HCl
189
What are 3 types of H2 receptor blockers available both OTC and by Rx?
1. Climetidine (Tagamet)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
190
What are the side effects for H2 receptor blockers?
1. headaches
2. diarrhea
3. drowsiness
191
What is the MOA for Proton Pump Inhibitors?
*OTC and Rx
Disrupts hydrogen exchange for K in pareital cells, which block production and release of HCl into gut
192
What are the side effects of PPI?
1. Diarrhea -- interferes with pH
2. interferes with digestion
3. increases food allergies b/c block digestion
4. oral sores/ulcers
193
What are PPI often combined with?
H2 blockers
*PPI take awhile to take effect, subtle and take some time
194
What are 4 types of PPIs?
1. Omeprazole (Prolisec)
2. Omeprazole + sodium bicarb for fast release
3. Lansoprazole (Prevocid)
4. Esomeprazole (Nexium)
195
Peptic ulcer disease involved what 2 types of ulcers?
1. Gastric
| 2. Duodenal
196
What causes peptic ulcer disease?
1. Inflammation of epithelium
2. erosion
3. infection by H. pylori (70-80% incidence) --> contagious esp b/w family members
197
What are the symptoms of Peptic Ulcer disease?
1. Epigastric burning, alleviated by eating or antacids
2. pain worse on empty stomach and at night - high HCl concentration
3. pain often mistaken for a heart attack and vice versa
198
What are 3 ways to suppress acidity to heal sores (not cure) in peptic ulcer disease?
1. Antacids
2. PPIs
3. H2 blockers
199
Prevpac
combination of lansaprazole (PPI) and the abx amoxicillin and clarithromycin to treat H.pylori peptic ulcers
200
Milk of Magnesia
Magnesia based may also help kill bacteria in H. pylori peptic ulcer disease
201
What nutrients are absorbed in the stomach?
1. Water
| 2. Alcohol
202
What nutrients are absorbed in the duodenum?
1. Fe
2. Ca
3. Mg
4. Na
5. Fats
6. Water
7. Proteins
8. Vitamins
203
What nutrients are absorbed in the jejunum?
1. Carbohydrates
| 2. Proteins
204
What nutrients are absorbed in the Ileum?
1. Bile Salts
2. B12
3. Cl
205
What nutrients are absorbed in the Colon?
1. Water
| 2. Electrolytes
206
What happens in constipation?
GI mobility is too slow and too much water absorption
207
What is constipation treated with?
Laxatives
208
What are 2 types of laxatives?
1. Bisacodyl
| 2. Docusate (Dulcelax)
209
How does Bisacodyl work?
1. stimulant of smooth muscles
2. fast acting
3. OTC
4. suppository/oral
5. Cramps
210
How does Docusate work?
1. Water retention in stools, softens stools
| 2. OTC (dulcelax)
211
What happens in diarrhea?
GI motility is too fast result in loose, watery stools; not enough absorption and too much secretion
212
What are the consequences of diarrhea?
1. dehydration
| 2. malnutrition (worse in young and elderly)
213
What are 3 medications for diarrhea?
1. Loperamine- Imodium
2. Bismuth subsalicylate (Pepto bismol)
3. Anti-choinergics such as atropine
214
What is the MOA for Loperamine?
Mild opioid agonist: if sever, can use strong opioid agonists
215
What are side effects of diarrhea meds?
1. constipation
2. nausea
3. drowsiness - anticholinergis!
216
What are the symptoms of Irritable Bowel Syndrome?
1. No structural defect
2. no sure of exact cause
3. typically episodic pain and bloating
4. could be 5HT- dependent neuromuscular disorder
217
what percent of population have suffered from IBS?
20% -- most common GI disorder
218
In what population is IBS most common?
Young adults and ~50 yrs old. --> possible associations with stress and poor diet
219
How treat IBS symptoms?
*normally symptomatic
Deal with diarrhea or constipation with diet and anti stress changes.
Diet: avoid rich foods, eat fiber if constipated
220
What is the only FDA approved drug for IBS with constipation?
Linaclotide (Linzess)
221
What is the MOA for Linaclotide?
it is a guanylate cyclase C agonist- it increases bowel movement, fluid secretion and reduce pain
222
What are the side effects of Linaclotide?
1. Diarrhea
| 2. gas
223
What percent of population of Inflammatory Bowell Disease?
less/equal to 1%
224
What are the symptoms of Crohn's Disease?
1. Chronic diarrheal problems
2. can affect entire GI, but more intense in ILEUM and COLON and intermittent areas with stricture between --> ulcerations, swelling, scarring
4. Hypogastric pain
5. perianal fissure/fistulas
6. higher incidence of ARTHRITIS
7. fatty liver
8. posssible genetic link
9. perhaps abnormal inflammatory response to normal floral
10. has remission
11. increase incidence of colon cancer
225
What are anti-inflammatory medications for Crohn's disease?
1. Mesalamine (topical anti inflammatory)
| 2. Corticosteroids- act systemically
226
What is the MOA for mesalamine?
blocks cyclo-oxygenase: may interact with NSAIDs (note if dental patients have pain)
227
What is a possilbe antibiotic for Crohn's disease?
Metronidazole (abx MOA?)
228
What is Ulcerative colitis?
1. Similar to Crohn's disease but limited to colon and more generalized (NO STRICTURES)
2. ulcerative, diarrheal, inflammatory disease
229
What medications are used for ulcerative colitis?
Similar meds to Crohn's disease.
230
What is the most significant occupational dental hazard?
HBV infection
231
What are the vectors for HBV?
1. blood
2. saliva
3. nasopharyngeal secretions
232
Where is the highest concentration of hepatitis in the mouth?
Gingival sulcus
233
What are the oral manifestations of hepatitis?
*infections and bleeding based
1. lichen planus
2. periodontal disease
3. Candidiasis
4. increased oral bleeding
5. increased incidence of type II diabetes
6. Sjogrens syndroms
234
What are forms of chronic hepatitis?
Hep B and C due to
1. infection
2. drugs
3. autoimmune diseases
235
How do you manage an accidental exposure?
1. carefully wash wound- don't rub! (embeds viruses)
2. use antiviral disinfectant (iodine, chlorine formulations)
3. initiate HBV vaccine series
236
How do you manage HBV patients?
Don't be Judgemental!!
| oral infection management (perio disease)
