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Flashcards in Quiz 5 Deck (100):
1

What is osteoarthritis?

a. Loss of articular cartilage with secondary changes in bone

b. Presents in some degree in most persons >65 years of age. Symptoms worsen with excessive use.

c. Due to wear and tear

d. No inflammatory changes

2

What are the types of breast carcinoma?

• Invasive carcinoma: 75-85%

• Most are ductal and the incidence increases with age and have invasive and non-invasive types

• Can do lumpectomies to remove smaller masses.

3

What is endometrial hyperplasia and what are the treatments?

• Exaggerated responses due to excessive estrogen (e.g., excessive ovarian activity), that can progress to cancer.

• Treatment: Progesterone, Hysterectomy

4

What does mammography help with?

1. It detects density

2. Can show architectural distortions

3. Identifies calcification

4. Changes over time and these changes can indication pathologies such as cancers

5. Can use imaging to help guide biopsy needle in order to sample a growth.

5

What is osteogenesis imperfecta?

1. Osteogenesis imperfecta

a. Deficient or defective type 1 collagen—too little bone

b. Generalized osteopenia

• Multiple fractures and bone deformities

• Malformed teeth (dentin deficiency)

6

What are the three main causes of polyps in the endometrium?

1. Hypertension

2. Obesity

3. Late menopause

7

What are the three expressions of acne?

• Opened comodones (blackheads)

• Closed comodones (white heads)

• Cysts, pustules and abscesses

8

Dantrolene

-An anti-spasmotic that is used as a muscle relaxant. is a postsynaptic muscle relaxant that lessen excitation-contraction coupling in muscle cells by inhibiting Ca2+ ions release from sarcoplasmic reticulum stores by antagonizing ryanodine receptors.

-It is the primary drug used for the treatment and prevention of malignant hyperthermia, a rare, life-threatening disorder triggered by general anesthesia.

-Its direct effect is peripheral only.

9

What types of diseases or conditions can chronic inflammation lead to?

• Cancers

• Pulmonary diseases

• Cardiovascular diseases

• Diabetes

• Alzheimer’s disease

• Oral diseases (periodontal tissues)

• Neurological disease

• Arthritis

10

What are the different types of delivery forms for contraceptives?

• Combinations:

  • • Monophasics- constant doses of both estrogen and progesterone
  • • Biphasic- dosage of one or both change one time during cycle
  • • Triphasic-dosages change 2 times

• Progestin only—referred to as the “minipill” (no estrogen); fewer side effects, but less effective

• Implantable

• Injections (i.m., sustained effects)

• Intravaginal rings

• IUDs with and without estrogen/progestin

• Transdermal combinations

11

Tetracyclines

Antibiotics for Acne Vulgaris. Minocycline is more lipophilic (may accumulate in sebaceous gland).

• Chelated by dairy products, calcium, and magnesium so passes though gut without absorbtion with wrong foods/drinks.

• has higher incidence of inner ear disturbances with associated dizziness, ataxia, vertigo and Tinnitus (especially in women), and is more expensive than doxycycline.

• Doxycycline may be associated with more GI upset than minocycline.

– Harder to chelate thus beNer absorbed with food.

– All tetracycline antibiotics are associated with increased risk of irritable bowel syndrome.

– If tetracyclines aren’t tolerated or effective, then 3rd line opDon is trimethaprim or trimethaprim-sulfamethoxazole (TMP-SMZ). - Category D pregnancy Risk

12

What are the risks and treatment associated with endometrial cancer (adenocarcinoma)?

1. Risks • Obesity • Diabetes • Hypertension

2. Treatment • Hysterectomy-treatment of choice • Radiation/chemotherapy adjunctive

13

What are the four main physiologic effects of progestins?

1. Increase fat deposition

2. Decrease CNS excitability (e.g., antiseizure—opposite of estrogen)

3. Increase aldosterone---increase Na+ retention—increase BP—increase water retention and blood volume

4. Increase body temperature

14

What are the three types of therapeutic groups for muscle relaxants?

1. Spasmolytics (reduce spasticity by modifying the stretch reflex arc and/ or interfering directly with excitation-contraction coupling of the skeletal muscles. (Diazepam, Baclofen, Tizanidine, Dantrolene)

2. Non-depolarizing blocking (produce muscle paralysis by either nondepolarizing blockade (d-tubocurarine))

3. Depolarizing blocking (paradoxical depolarizing blockade (desensitization) (succinylcholine) of the ganglionic nicotinic ACh receptor)

15

What are the characteristics of perioral dermatitis?

• Young women

• Long-term steroid use or cosmetic use

• Follicular papules, vesicles and pustules

16

What is osteomyelitis and what are the five things that can cause it?

Osteomyelitis (inflammation of bone/marrow)

a. blood-born or direct

b. trauma from compound fractures

c. pyogenic infections (e.g., staph aureus or salmonella)

d. granulomatous (TB or fungal)- called “Pott disease” when associated with TB

e. Diabetes—due to poor circulation in the extremities-if chronic can form a drainage site and can even become osteosarcoma

17

What is the main type of cervical cancer and what are the risk factors?

• HPV (human papillomavirus)- associated squamous cell neoplasm represents most cervical cancers -use pap smear to detect early

• Risk factors -multiple sex partners -Immunosuppression -early age of first sexual contact -oral contraception for >5 years -nicotine use

18

How are non-depolarizing blockers reversed?

Non-depolarizing blockers are reversed by acetylcholinesterase (AChE) inhibitors, since they are competitive antagonists at the ACh receptor.

19

D-tubocurarine

Is a non-depolarizing neuromuscular blocker. Blocks ganglionic nicotinic receptor.

20

What are progestins made from, other characteristics, hal-life, etc?

• Made from cholesterol

• Present in males, but less than females

a. Progesterone (natural)—most important progestin in human • Precursor to estrogen, androgen and adrenalcortical steroids (e.g., cortisol)

• Also precursor to testosterone and estradiol c. Half life= 5 min. (very short acting)

21

What is the main cause of endometritis?

IUDs

22

Clomiphene

Clomifene or clomiphene is a selective estrogen receptor modulator that has become the most widely prescribed drug for ovulation induction to reverse anovulation or oligoovulation. Ovulation-inducing; for promoting fertilization and pregnancy (increased risk of multiple births—e.g., twins). Clomed.

23

What is fat necrosis of the breast usually associated with?

• Usually associated with trauma (from a seat belt during an accident)

24

What are the characteristics of NSAIDS?

• Decrease pain and inflammation

• Cox I (GI, bleeding and kidney side effects) and Cox II (MI and stroke and hypertension side effects) inhibitors

• Aspirin, ibuprofen, naproxen are non-selective COX I and II inhibitors

• Celecoxib is COX II inhibiton

Side Effects

  • (a) CNS-tinnitis
  • (b) CVS-hypertension
  • (c) GI-nausea, ulcers or bleeding
  • (d) Hepatic-altered liver functions
  • (e) Pulmonary-asthma
  • (f) Skin-rashes
  • (g) Renal- insufficiency, in extreme can have failure

25

What are the various skin definitions? (macule, papule, etc)

• Macule- flat, circumscribed (5 mm)

• Plaque-elevated flat-topped lesion (> 5mm)

• Lichenfication-thickened skin due to repeated rubbing

• Pustule-discrete, pus-filled raised lesion

• Scale-dry, plate-like excrescence, imperfect cornification

• Vesicle-fluid filled raised area, 5 mm

• Dyskeratosis—abnormal keratization, deeper in epidermis

• Hyperkeratosis—hyperplasia of stratum cornum

• Spongiosis-intercellular edema of epidermis

26

What are the characteristics to bone?

• 99% Calcium stored in bones

• In adult, the bones are the primary site of hematopoeises

• Constantly remodeling

• Medullary bone resists compression forces, Cortical bone is thick and resists bending forces

• Periosteum is tough fibrous membrane—covers bone surfaces except at joints—well innervated

27

Dapsone

Antibiotic used for acne. 5% gel, sulfone antibiotic for Acne vulgaris, antibacterial mechanism unclear, anti-inflammatory effects.

– Should not be used orally in patients with glucose-6-phosohatedehydrogenase(G6PD) deficiency due to risk of hemolysis, but risk is minimal with topical preparaDons.

– Adverse effects include Dryness, redness, skin peeling.

– Dapsone + benzoyl peroxide may temporarily discolor skin and hair yellow.

28

What is scoliosis?

Abnormal lateral curvature of spine

29

What are the names of the three stages of the menstrual cycle?

The menstrual cycle:

• Menstrual stage—menses

• Follicular stage—proliferative

• Luteal stage—secretory

30

What are the three scenarios in which estrogens are contraindicated?

• Liver disease (slows metabolism)

• Breast/endometrial cancers

• Thrombolytic disorders

31

What are the genetic and behavioral causes of osteoporosis?

Genetic: age, low estrogen, fair hair and skin, tall and thin

Behavior: inactivity, smoking/alcohol, malnutrition, medication (chronic corticosteroids)

32

What are the characteristics of acute mastitis?

• Can cause breast abscesses and necrosis

• Typically associated with women who are breast feeding.

• Can be caused by plugged ducts

• Can be infectious or non-infectious

33

Succinylcholine

Depolarizing neuromuscular blocker. Blocks ganglionic nicotinic receptors by desensitizing (overstimulating?)

- fast acting, get initial twitching before paralysis

-rapid onset (30sec) but very short duration of action (5–10 min); agonist at nicotinic ACh receptors, depolarizes the muscle fiber (similar to ACh), but in a biphasic manner:

– Phase I (depolarizing phase) muscle twitches occur while depolarizing the muscle fibers.

– Phase II (desensitizing phase) aqer sufficient depolarization has occurred the muscle is no longer responsive to ACh released by the motor neurons. At this point, full neuromuscular block (paralysis) has been achieved.

• Effects are sustained under the influence of AChE inhibitor.(not reverse by administering the AChE inhibitor)

• Adverse effects: Postoperative myalgia and fatigue, arrhythmia, hyperkalemia (burn patients), increased ocular pressure, increased risk of regurgitation/aspiration (obese patients, diabetic patients).

– Rare, inheritable risk for interaction with volatile anesthetics causing malignant hyperthermia (abnormal release of Ca2+ from skeletal muscle stores.)

– Treated with dantrolene.

34

Danazol

Danazol is a derivative of the synthetic steroid ethisterone that suppresses the production of gonadotrophins and has some weak androgenic effects. Suppresses ovarian function (has a masculinizing effect). Treats endometriosis, fibrocystic breast disease, and hereditary angioedema.

35

What are the characteristics of the three main malignant skin diseases?

Malignant (most are UV-induced especially in fair skinned persons)-most common cancers

• Basal cell-most common, least aggressive/ most common malignancy worldwide. Slow growing. -remove with local incision—does not metastasize

• Squamous cell- next most common, intermediate aggression, no metastasis -red scaling plaques—locally aggressive

• Melanoma- least likely, typically aggressive and metastasizes -warnings: rapid enlargement of nevus; new pigmented lesion-not from pre-existing nevi; irregular borders; irregular surface and colors -caused by UV exposure and genetics -prognosis: poor if metastasized (common sites are lungs, liver and brain)

• High mitotic rate, lack of immune response to slow spread especially once it hits lymph nodes

36

Isotretinoin

Retinoid (Vitamin A) used for acne. Isotretinoin (Accutane) – oral retinoid used for severe cystic acne and acne that has not responded to other treatments.

• Considered the only true “cure” for acne. It also reduces the amount of oil secreted by glands in the skin.

• Isotretinoin has been associated with bowel diseases (Crohn’s disease), liver damage, depression, teratogenicity and miscarriage.

• contraindicated during pregnancy as they have been shown to cause CNS, craniofacial, cardiovascular and other birth defects.

– At least two negative pregnancy tests are required and either signed statement of abstinence (iPledge contract) or confirmation of 2 forms of contraception is required to obtain a prescription.

37

How do estrogens and progestins work as hormone replacement therapy options?

Estrogens and Progestins

1. Natural estrogens are steroid hormones—synthesized estrogens may be non-steroidal

2. They cross cell membranes and activate estrogen receptors inside cell—modulate expression of genes

38

What are the symptoms of breast carcinoma?

• Pain

• Masses (assessed by palpitation, mammography, ultrasound, MRI, or tissue biopsied)

39

Foscarnet

Used for shingles and herpes. selectively inhibits viral DNA polymerase enzymes (not kinases).

-Unlike acyclovir and ganciclovir, foscarnet is not activated by viral protein kinases, making it useful in acyclovir- or ganciclovir-resistant HSV and CMV infections.

-Do not require activation by viral thymidine kinase and thus have preserved activity against acyclovir-resistant strains of HSV and VZV.

40

What are the characteristics of herpes simplex, varicella zoster?

• Oral expression: HSV 1 (cold sores) Genital: HSV 2

• Expressions: -group vesicles—epidermal acantholysis—vesicles—sloughing

• Zoster: -dermatomal distribution (can get trigeminal nerve involvement and can be very dangerous spreading to surrounding tissue such as eye or brain) - Varicella Zoster Virus (VZV) can cause shingles usually later in life in those who experienced chicken pox (i.e., exposed to the VZV when young)

• Unilateral, dermatomal distribution

• Expresses as a band of rash that often itches, burns or throbs. It may persist for weeks to months. Usually is relieved by anti-inflammatories or opioid analgesics

• In extreme cases it becomes like an intense neuralgia and does not respond to traditional analgesics

• Not contagious, typically does not repeat, but can in some cases.

41

What are the main appendages of skin?

• Appendages include: apocrine (sweat milky with odors-located near hair follicles), eccrine (found widely distributed, and sweat is watery for thermo control), sebaceous (also located near hair follicles—secrets oily sebum for lubrication and to prevent water loss).

42

Tretinoin

Retinoid (vitamin A) used for acne. Tretinoin (Retin-A) topical retinoid cream available at 0.025%, 0.05% and 0.1% concentrations.

• promotes epithelial cell turnover, causing the extrusion of the plugged material from the follicle and preventing the formation of new comedones

• may cause dryness and increased sensitivity to sunlight, redness, scaling, itching, and burning.

43

What are the four types of bone fracture?

• Complete

• Closed (overlying tissue intact)

• Commuted—bone splintered

• Displaced

44

What category drug is lidocaine?

Lidocaine (FDA Category B): most commonly used drug for dental work.  Since it crosses the placenta after administration, the amount of anesthesia administered should be minimal dose sufficient to make patient comfortable.

45

What are the characteristics of breast cysts?

• Fibrolytic changes

• Higher risk of breast cancer

• Occurs 20-40 years old

• Doesn’t typically occur after menopause

• Can calcify

• Can look like cancer on mammogram

46

What percent of breast cancers can't be detected through mammography?

~10% of breast cancers that are not detected by mammography, can be detected by palpitation

47

What does the progesterone and estrogen contraceptive combination do?

• Decreases ovulation (approaching 100%)

• Decreases conception and implantation

48

What are the symptoms of ovarian masses? When is the screening recommended for ovarian cancer?

• Pelvic pain

• Pelvic mass

• Abdominal bleeding

Unlike cervical cancer, there is no effective screening for ovarian cancer

49

What is the main neoplastic benign skin disease?

• Seborrhea keratosis (elderly, middle age-coin-like plaques;stuck-on appearance, tan to dark brown-granular surface)

50

Tamoxifen

Estrogen receptor antagonist. Blocks actions of estrogen in breast-used to treat breast cancers.

51

Benzoyl Peroxide

Is a keratolytic used for acne vulgaris. Topical keratolytics-removes keratin layer and opens sebaceous glands (also used as wart removers). containing preparations also work as peeling agents to increases skin turnover, clearing pores (comedolytic) and reducing the bacterial count (P. acnes) as well as acting directly as an antimicrobial.

52

What are the two main clinical uses for estrogens?

• Primary hypogonadism

• Postmenopausal

(1) Guidelines for use

• Always use the smallest dose for the shortest period of time possible

• Sometimes local creams are preferred to minimize exposure

53

What are the names of the three natural estrogens? And at what stage of life are these predominant?

• Estrone (predominant during menopause)- E1

• Estradiol (predominant during productive years)—E2

• Estratriol (predominant during pregnancy)—E3

54

What is testosterone?

It is an androgen, causes male puberty.

• Converts to estradiol

• Replacement therapy for males

• Gynecological disorders—reduces breast size (gynecomastia)

• Has protein anabolic effects—helps replace muscle loss

• Growth stimulation—can prematurely close growth plates in growing adolescents

• Counter some age-related loss of muscle mass

• Adverse effects in women especially—masculinization

• Testosterone analogs abused for muscle and strength building—can cause acne, aggressiveness and “roid rage”, although this is controversial.

55

What is kyphosis?

Abnormal forward curvature of spine

56

What do muscle relaxants do and when are they primarily used?

They enhance levels of inhibition, usually via CNS (GABA-mediated). Uses include Surgical relaxation – esp., intra-abdominal & intrathoracic surgery

• Endotracheal intubation – relaxes pharyngeal and laryngeal muscles

• Control of Ventilation – reduce chest wall resistance during intubation

• Anticonvulsant – relax the motor manifestations of status epilepticus or motor seizures due to local anesthetic toxicity.

57

Metronidazole

Antibiotic used for acne. nitroimidazole antibiotic for anaerobic bacterial & parasitic infections and the inhibition of Demadex brevis (parasitic mites)

– Demodex mites are ~3x more prevalent in acne vulgaris paDents than in healthy controls.

– Anti-inflammatory effect (inhibits neutrophils)

– Common adverse effects include local dryness, burning and stinging.

– Contraindicated during pregnancy, in nursing mothers, or in children due to risk of carcinogenesis.

58

What are the breast carcinoma statistics?

  • Rarely occurs <25 years of age
  • ~30% incidence by 70 yrs of age
  • No racial influence, but there is environmental influences
  • Inherited=5-10% (BRCA 1 and 2 the most common inherited genes)

~250,000 new breast cancers in U.S./yr.

59

As populations age, they spend less time in menopause (females) or andropause (males). True or False?

False, they spend more time.

60

What are the non-drug treatments of Acne?

Diet therapy: avoidance of fatty “junk foods”.

• UV Phototherapy- P. acnes bacteria produce a natural byproduct of metabolism called porphyrins. Porphyrins are light sensitive and thus vulnerable to UV and narrow band visible blue light.

61

What are three common symptoms of breast diseases?

1. Pain

2. Palpable Masses

3. Nipple Discharge

62

What are the characteristics of gout?

a. Primary cause by reduced renal excretion of purine

b. A primary treatment is with allopurinol—decreases the synthesis of purines

c. Symptoms:

• Hot, swollen, pain in joints---progressive joint destruction—gouty tophi (crystalized aggregates of uric acid)

d. Pseudo-gout—crystal deposits of calcium pyrophosphate

63

What are the characteristics of benign neoplasms of the breast?

• Fibroadenomas are the most common

• Mostly connective tissue

• Well circumscribed

• Don’t typically remove unless uncomfortable.

64

What are ganglion cysts?

Ganglion cysts—a cyst resulting from connective tissue around joints—often painful

65

Famciclovir

-Effective against VZV virus and shingles and herpes viruses. Longer acting than acyclovir

-Requires activation by the HSV thymidine kinase enzyme.

66

Clindamycin

Antibiotic used for acne. antiribosomal antibiotic useful against gram positive and anaerobic bacteria; only ~10% absorbed topically.

– Common side effects include GI upset and diarrhea. Rarely bloody diarrhea and colitis have been reported, even with topical application.

67

Why don't we screen women for breast cancer until age 40?

• Start screening at ~40 yrs because younger women have denser breast tissue making it difficult to identify a mass

68

Carisoprodol

Muscle relaxant/sedative; may have some dependence problems, works by blocking pain sensations.

69

What are the six physiologic functions of estrogens?

1. Sexual maturity

2. Increased CNS excitability (seizure inducing?)

3. Increased endometrial and uterine growth

4. Maintain skin elasticity

5. Reduce bone adsorption

6. Increase blood coagulability

70

What is rheumatoid arthritis?

a. Autoimmune- 1% prevalence

b. Most common in Caucasians/ uncommon in Asians

c. Onset age: 25-50 yrs.-75% female/ can have juvenile RA

d. Joint swelling, pain and tenderness—often cause extreme distortions of joints and surrounding bone—deforming and debilitating

e. Other areas also affected: • Ulcers • Pulmonary nodules and fibrosis • Carditis and pericarditis • Vasculitis

71

What are the nutritional, endocrine, and systemic deficiency bone diseases?

1. Vitamin deficiencies : scurvy (vit. C), rickets (vit. D)

2. Endocrine factors—hyperparathyroidism

3. Osteoporosis—common in elderly women, after menopause

4. Osteomalacia—vitamin D deficiency

72

What are the characteristics of DMARDS?

DMARDS (Disease modifying anti-rheumatic drugs) and other Immunosuppressants

• E.g., methotrexate, sulfasalazine

• Decrease inflammation and slow bone damage in rheumatoid arthritis

• Potentially more toxic than other options -severe hepatotoxicity -stomatitis -immunosuppression

73

What does the progestin only contraceptive do?

Progestin only (less effective, ~80-90%)

• Decreases ovulation 50-80%

• Thickens mucus and reduces sperm penetration

• Impairs implantation

74

Tizanidine

An anti-spasmotic used as a muscle relaxant.

-Alpha2 adrenoreceptor agonist (spinal cord) ; central acting

-Pre- and post- synaptic inhibition of reflex motor output

-Spasms related to ALS, stroke, MS

-Renal and hepatic elimination; 3-6h duration; weakness, sedation, hypotension

75

What are the characteristics behind the four main acute inflammatory skin diseases?

• urticaria (hives), hypersensitivity mediated by antigens (e.g., pollen, food, drugs; mediated by IgE)

• eczematous dermatitis (e.g, contact dermatitis most common, delayed hypersensitivity reaction, can be pruritic, edematous or oozing plaques/vesicles),

• Allergic contact dermatitis—cellular memory of the reaction so that future contacts cause an increased dermatitis reaction

• Erythema multiforma (hypersensitivity to infections and drugs-dermal edema-can have blisters and necrosis)-wide range of expressions and severity -can be severe life-threatening reaction known as Stevens-Johnson Syndrome—generalized all over the body—reaction to medicines (e.g., sulfonamides, salicylates)—can also be a reaction to infections such as herpes virus or fungal infections

76

What are the main cell types of skin?

• Cell types include: squamous cells, basal cells, melanocytes

77

What is usually stronger, an ointment or a cream?

Potency is effected by the topical formulation selected, since ointments are absorbed more effectively than creams. Thus, at the same dosage, most topical preparations will be considered “stronger” (more potent) when packaged as an ointment than as a cream although patients prefer creams as they spread more easily due to higher water/oil ratio.

78

What are the characteristics behind bacterial, viral, and fungal infections dermatosis?

- bacterial (e.g., impetigo: staph and strep infections superficial) on face and extremities, contagious through contact, --primarily kids; honey color crust-pustules

-fungal (tinea [ring worm] or candida); often infections in immunocompromised patients

-viral (wart pathology-human papillomavirus-HPV; verrucae); contagious by direct contact; can auto-innoculate and spread/epidermal hyperplasia, papillo mitosis

• Bulbous blistering prominent feature: pemphigus (painful flaccid blister like-deep erosions and crust after rupture-hypersensitivity reaction), dermatitis herpetiformis-use immunosuppressive treatment -tend to be auto-immune responses

79

Mifepristone

Mifepristone is a synthetic, steroidal anti-progestogen and anti-glucocorticoid pharmaceutical drug. Morning after contraceptive: blocks progesterone and glucocorticoid receptors. Ends a pregnancy that is less than 7 weeks along (49 days or less since the start of your last menstrual period). Also used to control high blood sugar in patients with Cushing syndrome who also have type 2 diabetes and have failed surgery or are not candidates for surgery.

80

What are the three main uses of contraceptives?

• Oral contraception

• Menstrual disorders, irregularity, heavy discharge

• Acne

81

What are the characteristics behind the two main chronic inflammatory skin diseases?

• psoriasis, inciting antigen—auto-rejection or environmentally induced -1-2% in US -can be accompanied by increased heart attacks and arthritis -treatment includes NSAIDS and immunosuppressant drugs -well-marked by pink to salmon colored plaques -regular acanthosis in epidermis

• lichen planus; -middle age -extremities and oral cavity -lace-like white markings. -resolve after 1-2 years although often persists in oral cavity Hyperkerotosis, and epidermal hyperplasia -Unknown inciting mechanisms

82

What are the two main types of ovarian masses?

• Non-neoplastic cysts (e.g., follicular)

• Neoplastic: e.g., endometroioid

• Most are sporadic

• Contraceptives can decrease risk

• Treatment: -total hysterectomy + removal of surrounding tissue + chemotherapy

83

What are the side effects of combination contraceptives?

• Reduced ovarian functions and size

• Increased breast size and tenderness

• Increased thromboembolytic events (clotting)

• Increased heart rate and BP

• Hyperpigmentation, especially around the eye

• Mild nausea, breakthrough bleeding, headaches

• May interact with antibiotics that disrupt G.I. normal flora (e.g., wide spectrum antibiotics such as amoxicillin)—normal absorption of contraceptives from GI system is dependent on these flora

84

What are the statistics of osteoporosis?

• 10 million have osteoporosis in US, mostly women

• 1/3 women >50 years old have at least one osteoporitic fracture

85

What are the main adverse effects of estrogens?

• Postmenopausal bleeding

• Nausea, breast tenderness

• Migraines

• Hypertension

• Hyperpigmentation (especially around eyes)

• Increases some cancers (e.g.. breast and endometrial)

86

What is the prognosis of breast carcinoma?

• Based on size, axillary node status, and distant metastasis

• 5 year Survival rate of stage 0 (early stage)=92%, stage IV (late)= 13%

• If tumor expresses estrogen/progesterone receptors, it often responds to hormonal treatment

87

What are the four main clinical uses of progestins?

• Replacement therapy

• Oral contraception

• Long-term ovarian suppression (e.g., dysmenorrhea or endometriosis)—in contrast to estrogens, no problem with bleeding or clotting

• Contraindications:

• Breast cancer is a risk

• Severe hypertension or heart disease is risk

88

What are the "other" inflammatory arthritides?

a. Psoriatic (psorias) arthritis

b. Other autoimmune diseases (e.g., lupus [erythematosus], scleroderma)

c. Postinfections (e.g., rheumatic fever)

d. Infectious—staph/strep, TB

e. Gout (crystallized uric acid)

f. Lyme disease, if not treated—arthritis and neurological consequences

89

What are the characteristics of acne vulgaris?

• Hormone changes (i.e., sex hormones)-increases testosterone influence

• Blocks hair follicle and sebaceous gland

• Hair follicle have proliferation of lining cells and cellular sloughing—forms a cellular plug and traps bacteria, cellular debris and sebum

• Gland ruptures and contents spreads to form cysts, abscesses and scarring—area is inflamed and swollen

• Treatments: -antibiotics -keratolytics -drying agents -vitamin A (topical and systemic-Accutane)

90

What are the characteristics of glucocorticoids?

• Rapidly acting

• Dramatic effect on inflammation and slowing bone erosions in rheumatoid arthritis

• Side effect: loss of muscle mass, osteoporosis, diabetogenesis, peptic ulcers, round face, buffalo hump

• Drugs: -dexamethasone: long-acting -cortisone, prednisone: short- to medium-acting

91

What are the two main chronic inflammatory skin diseases?

1. Psoriasis

2. Lichen Planus

92

Salicylic Acid

Is a keratolytic used for acne vulgaris. Topical keratolytics-removes keratin layer and opens sebaceous glands (also used as wart removers). has been extensively used in dermatologic therapy . Salicylic acid works as a keratolytic, comedolytic, and bacteriostatic agent, causing the cells of the epidermis to shed more readily, opening clogged pores and neutralizing bacteria within, preventing pores from clogging up again by constricting pore diameter, and allowing room for new cell growth.

93

Balcofen

An anti-spasmotic used as a muscle relaxant. GABA B agonist. -GABAB agonist; central acting -Pre- and post- synaptic inhibition of motor output -Severe spasticity due to CP, MS, stroke -p.o., i.t.; sedation, weakness

94

Acyclovir

-(Zovirax, Denavir ointments): most effective for herpes simples virsus (HSV-1 and HSV-2)

-cold sores on mouth and nose; less potent on Varicella-zoster virus (VZV-chickenpox--shingles).

-Requires activation by the HSV thymidine kinase enzyme.

95

What are the two main synthetic estrogens?

• Steroidal: ethinyl estradiol

• Non-steroidal: diethylstilbesterol

96

What are the four main acute inflammatory diseases?

1. Urticaria (hives)

2. Eczematous dermatitis

3. Allergic contact dermatitis

4. Erythema multiforma

97

Erythromycin

Antibiotic used for acne. macrolide antibiotic used to treat P. acnes.; antibiotic resistant strains are an ongoing complication of macrolides, especially when exposed to staphylococci.

– Broad spectrum, generally well-tolerated

– Local adverse effects include burning sensation, drying, & irritation.

98

Diazepam

An anti-spasmotic used as a muscle relaxant. Diazepam -Facilitates (Increases frequency of opening) GABAA receptor; central acting -Increased interneuron inhibition; central sedation -Spasms related to CP, stroke, spinal cord injury, acute muscle injury =Hepatic metabolism; 12-24h duraDon; sedaDon, depression, suppression of REM sleep

99

Which trimester is best for dental work during pregnancy?

2nd

100

What are benign epithelial lesions?

Benign epithelial lesions

-typically fibrocytic changes (e.g.,60% of women have microscopic cysts associated with epithelial tissue.