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consider the characteristics of drug effects, how does one differentiate between therapeutic effects and adverse effects?
- Therapeutic effects are desired effects
- Adverse effects are undesired effects
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Identify an example in which a side effect is used for a therapeutic effect
antihistamine used for insomnia
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Identify an example of an off-label use
antihypertensive drug propranolol to prevent or treat migraines
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List 4 characteristics to consider before selecting a drug for a therapeutic effect
- diagnosis
- physiologic status
- variations in disease
- pharmacodynamic and pharmacokinetic variables
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Define tachyphylaxis
an uncommon condition where tolerance to a drug develops rapidly
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list factors that can alter drug effects and explain the cause for the alteration.
- pt non-compliance
- psychologic factors - placebo
- tolerance to the medication - when a drug is taken for a long period of time, and greater doses are necessary for the same effect
- time of administration - agents likely to disturb taste need to be taken after meals
- sex of client - women may be more sensitive to men
- age and weight - children or geriatric pts require lower doses
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What 2 groups age groups are more likely to experience ADE's?
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Give 2 examples of how the registered dental hygienist can monitor for ADE's and how the dental hygiene treatment plan can be affected.
- follow-up questioning - may nee to monitor for potential side effects
- oral examination for ADEs - for example xerostomia leading to recommendation of home fluoride
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Explain the mechanisms involved in each component of Type A and Type B ADE's. Make a list of each inorder to organized the information and avoid confusion. What is the most common type?
- Type A: cytotoxic and toxic reactions from overdose, drug-drug interactions, drug-food interactions, drug-disease interactions
- Type B: hypersensitivity related reactions, allergy-related reactions, idiosyncratic reactions, age-related variables
- Type A are most common
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Which ADEs are related to a genetic determination?
Type - B idiosyncratic
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Which type of ADEs are usually more serious?
type B
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Which type of ADEs are predictable?
Type A
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Which type of ADE usually manifests after long periods of drug ingestion?
type B
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List examples of cytotoxic reations and describe associated etiologic factors for each.
- overdose of barbiturates - results in oversuppression of respiration leading to death
- oxidative pathway - produce compounds that vind covalently with cellular macromolecules
- reductive pathway - gives rise to the formation of free radicals
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List examples of drug-drug reactions and describe associated etiologic factors for each.
- Pharmacologic interaction - drugs compete for same receptor site
- physiologic - drugs interact with different receptor sites and enhance or oppose
- chemical - drug a competes with drug b interacting with its receptor
- receptor alterations - drgs increase or decrease the number of its own receptors
- absorption -
- distribution
- metabolism
- renal excretion
- biliary excretion
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list examples of drug-food reactions and describe etiologic factors
- tetracycline vs. mile - avoid milk
- absorption - meals with high fatty acid component will increase absorption of liquid drugs
- metabolism - grapefruit inhibits enzyme in liver
- excretion - vitamin C lowers pH in kidney delaying excretion
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list examples of drug-disease interactions and describe etiologic factors
- propranolol vs. asthma - blocks receptors that aid in bronchodilation
- beta 1-adrenergic antagonists vs. diabetes - adversely affects glycogen metabolism
- aspirin vs. peptic ulcers - cause GI bleeding
- APAP and amoxilcillin vs. renal dysfunction - renal toxicity
- opioids vs. hyperthyroidism - hypertension cardiac arrhythmias
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What patient instructions regarding diet should be given when tetracycline is prescribed?
to avoid milk and dairy products
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Why are some drugs to be taken on an empty stomach?
because certain nutrients can act as a mechanical barrier that prevents drug access to mucosal surfaces, reducing or slowing the absorption of some drugs
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give an example of a chelating drug-food interaction.
tetracylcine with calcium in milk and other dairy products
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Which liver enzymes are responsible for drug-grapefruit interactions?
CYP450 3A4 isoenzyme
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How would an acidic agent affect excretion of other acidic drugs used simultaneously?
It could prolong the duration of drug action by inhibiting renal tubular excretion of the drug
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differentiate between hyporeactive and hyperreactive reactions.
- hyporeactive - high dose creates response
- hypperreactive - low dose creates response
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Which groups are most likely to have idiosyncratic reactions?
those on the extreme of the age spectrum (children and elderly)
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Outline the process of the allergic drug reaction from sensitization to production of hives. What is the role of an antigen, a hapten, and plasma cell?
- antigen - drug enters the body and is recognized as 'foreign' to antibodies
- hapten - a substance (drug) that is lower weight than an antigen; such as penicillin, it attaches to another molucule (protein)
- plasma cell - plasma cells recognize penicillin attached to albumin as an antigen and create antibodies to destroy it
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What age groups and sexes are more likely to develop drug allergies?
- younger or older populations
- women
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which type of hypersensitivity reaction is immediate?
type I
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Which type of hypersensitivity reaction is delayed?
Type IV
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Anaphylaxis is an example of what type of hypersensitivity reaction?
type I
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Which immunoglobins are associated with each type of hypersensitivity reaction?
- type I - IgE
- type II and III - IgG
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Which hypersensitivity reaction involves T-cell activation?
type IV
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which hypersensitivity reaction is most dangerous?
type IV
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Which type of hypersensitivity reaction results fom the TB skin test?
type IV
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differentiate between hypersensitive and pseudoallergic reactions.
pseudoallergic reactions cannot be explained on an immunologic basis like hypersensitivity reactions
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What is a teratogenic reaction?
a reaction that causes physical or functional disorders in the fetus in the absence of toxic effects on the mother
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Differentiate between a primary oncogenic effect and a secondary oncogenic effect.
- primary - are produced by procarcinogenic drugs; covalent binding oxidized metabolites to DNA leads to carcinogenic effects
- secondary - associated with therapeutic immunosuppression; drug induced immunosuppression to prevent rejection of an organ; leads to reactivation of latent infection with oncogenic viruses
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List and describe the various clinical manifestations of type A ADEs.
- cytotoxic effects - liver injury; mucositis
- GI disturbances
- urinary incontinence
- mood alterations
- cardiovascular dysfunction
- equilibrium problems
- xerostomia
- bleeding diatheses
- bacterial infections
- fungal infections
- viral infections
- gingival hyperplasia
- neurologic complications
- inadequate nutrition
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List signs of hepatotoxicity
- nausea
- vomitting
- anorexia
- abdominal pain
- jaundice a few days later
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What is a possible ADE associated with benzocaine and prilocaine that can affect blood components?
- interferes with hemoglobin oxygen carrying capacity
- cyanosis
- nausea
- sedation
- seizures
- coma
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What is mucositis, and how can it lead to systemic infection?
- ulceration of oral mucous membranes occurs during cancer chemotherapy
- it provides an entry mechanism leading to systemic infection by the wide variety of oral microorganisms
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What area of the brain induces vomiting?
chemoreceptor trigger zine found in the medullary area of brain
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describe the effects of chronic xerostomia and the dental hygiene implications
- reduced lubrication, reduced antibacterial, antiviral, antifungal activity; loss of mucosal integrity; loss of buffering capacity; reduced lavage and cleansing of oral tissues, interference with normal remineralization of teeth, and altered digestion, taste, and speech
- place pt on maintenance schedule of 3-4 months
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anticoagulant drugs increase the risk for what ADE?
increase bleeding time and increase intraoperative bleeding
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Describe the mechanisms by which an infection occurs as a result of an ADE
Therapeutic immunosuppression can exacerbate latent viral activity
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What is dysgeusia?
taste disurbance
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List the clinical manifestations of type-B ADEs
- idiosyncratic reactions
- allergic/immunologic reactions:
- Type I, II, III, and IV hypersensitivity
- pseudoallergic reactions
- lichenoid stomatitis
- erythema multiforme and steven-johnson syndrome
- teratogenic effects
- oncogenic effects
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describe the various clinical appearances of hypersensitivity reactions.
- allergic - erythematous, cramping, vomiting, diarrhea, hives and rash, itching, vasodilation, bronchoconstriction, jaundice, redness, edema, fever, malaise
- pseudoallergic - asthma, hives
- lichenoid stomatits - reticular, erythematous, or atrophic around buccal mucosa, gingivae, and lateral borders of tongue
- erythema multiforme and stevens-johnson syndrome - crusting of lips, painful lesions, ulcerations and erosions on oral mucosa
- teratogenic - altered growth, retardation, developmental impairments
- oncogenic - lip cancer, oropharyngeal kaposi sarcoma
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Describe clinical signs associated with the four types of hypersensitivity reactions.
- Type I - anaphylaxis
- Type II - fever, urticaria, swelling of face and feet, lymphadenopathy, and arthralgia, sometimes jaundice
- Type III - redness, edema, hemorrhage, ischemic necrosis of tissue
- Type IV - inflammatory response, erythema, tiny vesicular lesions, and edema in target tissues
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Which hypersensitivity reaction leads to shock?
Type I
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Which hypersensitivity reaction includes high fever?
Type II
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Which type of hypersensitivity reaction includes diarrhea and vomiting?
Type I
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Which type of ADE includes lichenoid stomatits?
pseudoallergic
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Differentiate between the pathology of erythema multiforme and the ADEs that are similar.
- EM major and minor are related to an infectious agent (HSV)
- SJS is related to pharmacologic agents (sulfonamides, anticonvulsive drugs, and COX-1 inhibitors)
- similar ADEs, they both affect eyes/iris
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Describe pathognominic signs associated with EM ans SJS. What is the management for photophobia
- hemorrhagic crusting of lips
- management of photophobia is to direct overhead dental light away from the pts eyes
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