Pharmacology Exam 2: Ch 15-21

Anti seizure drugs are:

CNS Depressants

Ipratropium is the first choice for _______

COPD

H1 antagonists counteract histamines effect. They competitively or antagonize histamine's effect at the following sites:

Capillaries permeability, vascular smooth muscle (vessels), nonvascular (bronchial) smooth muscle, cutaneous nerve endings

Which medication is also used for trigeminal neuralgia?

Carbamazepine

Most effective long term tx for mild, moderate, severe persistent asthma

Corticosteroids

Congenital disease caused by the absence or deficiency of normal thyroid secretion; characterized by physical deformity, dwarfism, mental retardation, and goiter.

Cretinism

Least toxic of all asthma meds, SAFE

Cromolyn

Excess steroids resulting in a "moon face and hunch back."

Cushing's syndrome

Output of large amounts of dilute urine; results from lack of antidiuretic hormone.

Diabetes insipidus

Which medication has an adverse reaction of gingival enlargement in one half of chronic users?

Dilantin (phenytoin)

Normal thyroid.

Euthyroid

Eyeballs that protrude, caused by hyperthyroidism.

Exophthalmos

first vs. second generation antihistamines

First generation- more drowsiness/sedation (CNS depression). Medication crosses blood brain barrier Second generation- less drowsiness.

Easily breakable, easy to crumble.

Friable

Abnormal growth of body or its parts.

Giantism (gigantism)

Undersized, abnormal; body parts not in proportion.

Gland that secretes hormones into the bloodstream

Adrenocorticosteroids that primarily affect carbohydrate metabolism.

Glucocorticoids

Sugar that is the main source of energy for the body.

Glucose

Hyperplasia of thyroid gland; exophthalmos common.

Graves' disease

antihistamines are ______ blockers

H1

Drugs Used to Treat GI Disease

H2 blocking agents Mech of Action=competitively block action of histamine at the H2 receptors of parietal cells OTC examples Prototype-cimetidine (Tagamet)=more side effects Newer-famotidine, ranitidine, nizatidine=fewer side effects Uses-treat ulcers and GERD Adverse effects of cimetedine CNS effects Antiadrogenic effects Hemotologic effects Inhibits P-450 (liver microsomal enzyme) effect Adverse effect of famotidine Dry mouth Taste alteration

Lymphocytes enter thyroid, diffuse goiter; hypothyroidism produced thyroiditis.

Hashimoto's disease

Side Effects of PPIs

Headaches Abdominal pain Atrophy of tongue Dry mouth Long-term use- osteoporotic fractures Example-omeprazole (Prilosec) (In rats produced tumors but unlikely in humans so ban lifted) Other-lansoprazole (Prevacid), esomeprazole (Nexium)

Use of natural or artificial hormones to treat hormone deficiencies.

Hormone replacement therapy (HRT)

Increased level of prolactin in blood; abnormal.

Hyperprolactinemia

Low blood sugar.

Hypoglycemia

Organ, tissue, or device surgically inserted and left in the body.

Implant

Hormone made in the pancreas that plays an important role in the absorption of glucose (the body's main source of energy) into muscle cells.

Insulin

Reaction that occurs when blood sugar is too low; excessive insulin is one factor.

Insulin shock

______________ corticosteroids are very effective for the treatment of moderate to severe allergic rhinitis and are considered first-line therapy

Intranasal

Adverse effects

Intranasal corticosteroids can cause mild dryness, irritation, burning, or bleeding of the nasal mucosa, sore throat, epistaxis, and headache

topical "magic mouthwash"

Kenalog in Orabase-- given for severe inflammation, a severe outbreak of aphthous ulcers.

Laxative

Laxatives- Overuse common Abuse can occur in bulimic pts Can be used short term Can be used prior to diagnostic tests Types- Bulk laxative Lubricant Stimulants Stool softeners Osmotic (saloine laxative)

Hormone produced by the pituitary gland that causes the ovaries and testicles to release sex hormones and plays a role in the development of eggs and sperm.

Luteinizing hormone

Disease of larger blood vessels.

Macroangiopathy

The period in a woman's life when menstruation stops, resulting in a reduced production of estrogen and cessation of egg production.

Menopause

Disease of small capillaries.

Microangiopathy

Adrenocorticosteroids that affect the body's sodium and water balance (fluid levels.

Mineralcorticoids

Oral contraceptive containing only progesterone (no estrogen).

Minipill

A condition characterized by thickening of the skin, blunting of the senses and intellect, and labored speech; associated with hypothyroidism.

Myxedema

Histamine

NO PHARMACOLOGICAL BENEFIT

Adverse reaction to anticonvulsants:

Narrow TI Toxicity can occur

GERD (Heartburn)

Occurs when stomach acid and contents flow backwards thru the cardiac sphincter in the esophagus and erosion occurs Pain is in chest and often mistaken for heart attack GERD set off by large meals then assuming supine position So-eat small meals, raise head of bed, don't eat 4 hrs prior to bedtime Treat by: decrease acid in stomach Constrict cardiac sphincter GERD

Which medication is a Proton Pump Inhibitor (PPI)?

Omeprazole (Prilosec) "prazoles"

Two almond-shaped glands located at the opening of the fallopian tubes on both sides of the uterus; produce eggs and the sex hormones estrogen and progesterone.

Ovaries

Development and release of the egg from the ovary, which usually occurs halfway through a woman's menstrual cycle.

Ovulation

Hormone from the pituitary gland; causes contraction of the uterus and stimulation of milk flow.

Oxytocin

Gland that produces enzymes that break down food and hormones (insulin and glucagon) that help to regulate blood glucose levels.

Pancreas

Small glands located in the neck that produce a hormone that regulates the levels of calcium in the blood.

Parathyroid glands

The most common barbiturate used in treatment of epilepsy

Phenobarbital

Master gland, a small endocrine organ located at the base of the brain.

Pituitary gland

Development occurs early; used to refer to early puberty.

Precocity

Female sex hormone; plays role in reproduction, thickens uterine lining.

Progesterone

_____________ is the most common side effect with the FIRST generation antihistamines

Sedation

Thyroid hormone.

Tetraiodothyronine (T4)

Long-acting β2 agonists improve lung function, decrease symptoms, and reduce exacerbations and rescue use of short-acting β2 agonists. They are also recommended as monotherapy for asthma.

The first statement is true; the second statement is false.

Thyroid removal.

Thyroidectomy

Produced by excessive thyroid hormone.

Thyrotoxicosis

Antiemetics

Treat vomiting Choice of drug depends on cause of vomiting 1. Ex-phenothiazines (Compazine) Side effect: Extrapyramidal effect-Tardive dyskinesia Sedation In dentistry: Phenergan (a phenothiazine w/antihistaminic effect; used to treat POST operation nausea occurring w/gen anesthesia/surgery 2. Anticholinergics To control nausea Examples Dramamine (dimenhydrinate) Bonine (meclizine) Trans Derm Scop (scopolamine transdermal patch) Side effects Blurred vision Sedation Dizziness Dry mouth 3. Anti histamines Antiemetic effect Example: Diphenhydramine (Benadryl) Hydroxyzine (Atarax)-antiemetic and antianxiety Side effect Sedation 4. Trimethobenzamide (Tigan)-avoid in pts allergic to ester LA Side effects- Sedation Dry mouth Headache agitation 5. Metoclopramide (Reglan) Dopamine antagonist and stimulates acetylcholine 6. Cannabinoids Derived from marijuana

Antacids

Treatment for acute gastritis (heartburn or upset stomach) Antacids partially neutralize hydrochloric acid in stomach Ex-sodium bicarbonate BUT alkalosis can occur and it contains sodium so contraindicated in CV pts.

Thyroid hormone.

Triiodothyronine (T3)

T/F: Smoking is associated with almost ALL cases of COPD

True

Chronic disease that is caused by a total lack of insulin production and primarily occurs in people less than 20 years of age; can only be treated with insulin.

Type I diabetes

Chronic disease that occurs mainly in people older than 40 years and in overweight persons; treated with diet changes and oral drugs that reduce glucose levels in the blood; known as type II diabetes; insulin may be needed in some patients.

Type II diabetes

Agents for IBD

Use Laxatives Colonic stimulants Osmotic agents Anti spasmodics Newest- infliximab (Remicade)- Anti-inflamitory

Disease with tendency to bleed, prolonged bleeding time; inherited.

Von Willebrand's disease

Addison's disease

a deficiency of adrenocorticosteriods

type 1 diabetes

acute and quick onset, occurs with younger people.

Emphysema is characterized by alveolar destruction with air space enlargement and ________ collapse

airway

Emphysema is characterized by __________ ___________ with air space enlargement and airway collapse.

alveolar destruction

Cushing's syndrome

an excess of adrenocorticosterioids

Glucocorticosterioid

anti-inflammation and anti-allergenic

The ________________________ are the first line agents for treating COPD, but B2-adreneric agonists are also used to produce bronchodilation in patients with this disease

anticholinergics

The FIRST GENERATION antihistamines have several pharmacologic effects, including:

antihistaminic, anticholinergic, antiserotonergic, and sedative effects

Avoid asprin or NSAIDS with patients with _______

asthma. use acetaminophen instead.

The ventilation drive for breathing in normal persons is stimulated by elevated levels of the partial pressure of oxygen, and the partial pressure of carbon dioxide can vary widely. In patients with COPD, a gradual rise in the partial pressure oxygen over time causes the ventilation drive to be triggered by an increase in carbon dioxide. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

b. Both statements are false.

Mineralcorticosterioid

balances water and electrolytes

Salmeterol

black box warning.

The non sedating H1 blockers, such as loratadine (Claritin), produce less sedation because they do not penetrate to the ______ as easily

brain

Five common antihistamines:

brompheniramine (Dimetane), chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), fexofenadine (Allegra), and loratadine (Claritin)

All of these medication groups are used in treatment of asthma except which of the following? a. β-adrenergic agonists b. Xanthines c. Cholinergic agents d. Cromolyn e. Corticosteroids f. Leukotriene-altering agents

c. cholinergic agents

"Tropine's"

cause anticholinergic effects -xerostomia

The major glucocorticoid present in the body is ___________ (hydrocortisone)

cortisol

Inhaled corticosteroids are the most effective long-term treatment for control of symptoms in all patients with which of the following conditions? a. Mild asthma b. Moderate asthma c. Severe persistent asthma d. All of the above

d. All of the above

What is the action of sympathomimetic or adrenergic agonists in treatment of respiratory diseases? a. Increased secretions b. Vasoconstriction of arterioles c. Increased blood pressure in lungs d. Bronchodilation by β receptors of lungs

d. Bronchodilation by β receptors of lungs

What is the first line of defense for an intermittent asthma attack? a. Mucolytics b. Corticosteroids c. Long-acting β2 agonists d. Short-acting β2 agonists

d. Short-acting β2 agonists

insulin

decreases blood glucose level

asthma causes constriction so we want to ______

dilate bronchials.

Which treatment considerations should the dental health care worker make for patients with asthma? a. Minimal stress is induced during the appointment. b. Patients should be asked to bring their fast-acting β2-agonist inhalers with them to the appointments. c. Observe and question the patient before the appointment to prevent an acute asthma attack. d. Advise the patient to reduce environmental pollution, such as strong perfumes. e. All of the above apply. f. Only a and c apply.

e. All of the above

corticosterioids

end in "sone" and "lone"

Gland that secretes hormones into the bloodstream.

endocrine gland

Which medications are used in the management of emphysema? a. Anticholinergics b. β-adrenergic agonists c. Corticosteroids d. Xanthines e. All of the above f. a, and b, only

f. a and b, only

Which components of asthma must be treated to control the disease? a. Inflammation b. Bronchodilation c. Bronchoconstriction d. Alveolar destruction e. All of the above f. a and c only

f. a and c only (inflammation and bronchoconstriction)

Corticosteroids that are commonly used in inhaler devices include which of the following? a. Beclomethasone b. Triamcinolone c. Fluticasone d. Prednisone e. All of the above f. a and c, only

f. a and c, only

Which is are advantages of the metered-dose inhaler (MDI)? a. Medication is delivered directly to bronchiole, reducing the total dose and systemic adverse effects. b. The bronchodilator effect is greater than the comparable dose by mouth. c. Inhaler use is easy. d. Onset of action is rapid and predictable compared with dose by mouth. e. MDIs are compact, portable, and sterile, making them ideal for the ambulatory patient. f. All of the above are advantages. g. Only a, b, d, and e are advantages.

g. Only a, b, d, and e are advantages.

COPD is associated with which factors or conditions? a. Chronic bronchitis b. Smoking c. Asthma d. Emphysema e. Decreased sputum production f. All of the above g. a, b, and d only

g. a, b, and d only

Medications that are currently delivered by MDIs include which of the following? a. Xanthines b. β-adrenergic agonists, both specific and nonspecific c. Corticosteroids d. Cromolyn e. Anticholinergic drugs f. a, b, and c only g. b, c, d, and e only Correct h. All of the above

g. b, c, d, and e only

Adverse effects of the short-acting β2 agonists include which of the following? a. Bradycardia b. Tachycardia c. Nervousness d. Insomnia e. Central nervous system depression f. a, c, and e only g. b, d, and e only

g. b, d, and e only

Intranasal anticholinergic drugs are used with caution in patients with __________

glaucoma

The adrenocorticosteroids can be divided into two major groups: the ___________________, which affect intermediate carbohydrate metabolism, and the ___________________, which affect the water and electrolyte composition of the body.

glucocorticoids; mineralocorticoids

H2

increased gastric acid

H1

increased itching

steriod inhaler is used for _______

inflammation

cromolyn

inhibits mast cell degranulation and prevents the antigen-induced release of histamine. Cormolyn is the least toxic of all asthma medications.

________ is the only drug used to manage type 1 diabetes

insulin

COPD is _______ airway obstruction

irreversible

prednisone

most commonly prescribed oral medication for corticosteriod drugs.

Valproate inhibits metabolism of _____________________, producing excessive sedation

phenobarbital

Inhalers have a ________ onset with _______ toxicity.

quick, low

Ulcers

related to H pylori or Helicobacter pylori Many ulcers cured by combo of 1 or more antibiotics and H2 blocker or PPI to decrease stomach acid

asthma is __________ airway obstruction with inflammation

reversible

The SECOND GENERATION H1 antihistamines penetrate poorly into the CNS and so are less likely to cause ___________

sedation

type 2 diabetes

slower onset, occurs with older age

Chronic bronchitis is a result of chronic inflammation of the airways and excessive __________ production

sputum

chronic bronchitis is a result of chronic inflammation of the airways and excessive _________ production

sputum

In __________, patients have persistent life-threatening bronchospasm despite drug therapy.

status asthmatics

PPIs

suffix-prazoles Potent inhibitors of gastric acid secretions Used in combo w/antibiotic for duodenal ulcer Used alone for GERD Mechanism of Action-involves inhibition of hydrogen/potassium adenosine triphosphatase enzyme system at the surface of the gastric parietal cell Parietal= stomach epithelial cells that secrete gastric acids PPIs heal ulcers faster than H2 receptor blockers or any other drug Tolerance does not occur

corticosterioids

they are not curative but help treat the pain and is pallative

The first-generation H1 antihistamines can cause anticholinergic effects such as __________

xerostomia

Chapter 19

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Chapter 20

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Chapter 18

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Inflammatory Bowel Disease (IBD)

2 categories a. Ulcerative colitis b. Crohn's disease a. Ulcerative colitis Assoc w/autoimmune response Involves mucosa Involves distal part of colon and rectum Smoking is protective (decreases problems associated with UC) Cessation can cause increase in symptoms b. Crohn's Disease Extends through all layers of intestinal wall Involves entire intestine

Enlargement of peripheral body parts such as head, face, hands, feet; secondary to metabolic disorder.

Acromegaly

Steroid deficiency.

Addison's disease

negative feedback

Adrenal cortex atrophies when we use medication that mimics the negative feedback mechanism because these patients own natural body system isn't working on its own.

Naturally occurring compounds secreted by the adrenal cortex.

Adrenocorticosteroids

Agent secreted by the pituitary that causes the release of hormones from the adrenal cortex.

Adrenocorticotropic hormone (ACTH)

Drug similar to testosterone that builds muscles and strengthens bones.

Anabolic steroids

Anti Diarrheals

Antidiarrheals- Treat diarrhea in adsorbent or opioid like action Ex- kaolin & pectine (kao-pectate) Ex- Opioid: diphenoxylate w/atropine(Lomotril); loperamide (Immodium)

"zines"

Antipsychotics

Antibodies to thyroglobulin.

Antithyroglobulin

suffix "mabs"

Anything that ends in -mabs is used to treat rheumatoid arthritis and eczema.

Which prazole suffix medication is an exception to the PPI rule?

Aripiprazole (antidepressant)

Inflamed joints with pain and stiffness; rheumatoid arthritis: autoimmune disease of joints characterized by inflammation, pain, stiffness, and redness.

Arthritis - Osteoarthritis

suffix "am" and "pam"

Benzodiazepines used paternally to treat recurrent tonic-clonic seizures or status epilepticus

Management of normal breathing function is best achieved with treatment of short-acting β2 agonists, and no danger of overuse of these medications has been found.

Both parts of the statement are false.