Pharmacology

true or false. Pt instruction may be provided by the dental hygienist for application of some topical agents?
True False

If endocrine-related drugs are reported on health history, what are 2 things to consider?

What are 2 dental hygiene functions in regards to drugs of the endocrine system?

What secretes humoral substances internally into systemic circulation?

What is the primary function of the endocrine system?

Do endocrine glands act in isolation? How do they act?

These things are released into the bloodstream and are delivered indiscriminately to target and nontarget tissues, target cells contain specialized molecules or receptors that bind the thing and cause cellular activity. Is the mechanism of action for what? (thing)

What are the 9 endocrine glands?

Which adrenal hormone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes, and suppresses the immune system by reducing the activity of lymphoid cells?

What is a negative effect of blucocorticoids (steriods)?

Which endocrine gland is known as the "Master Gland"?

Which type of drugs mimic the effect of hormones produced by the pituitary?

Where is the pituitary gland located in the body?

There are 2 parts of the pituitary gland; anterior and posterior, how is each portion nourished?

List the 6 hormones secreted by the anterior pituitary and which organs they effect.

List the 2 hormones secreted by the posterior pituitary gland and the organs they effect.

What type of drugs are used therapeutically to control the function of the thyroid and adrenal glands and the ovaries and testes?

Why are anterior pituitary drugs administered by injection?

What are substances that originate in the hypothalmus and are transported to the anterior pituitary gland via portal vessels of pituitary stalk through the bloodstream?

Which gland stores and releases vasopressin and oxytocin?

Which hormone regulates reabsorption of water by the kidneys?

What is the major physiologic action of vasopressin?

The absence of ADH, a failure to concentrate the urine despite an increased solute concentration of the plasma; this endocrine deficiency state is what?

The following are clinical manifestations of what condition?
Polyuria: excessive amounts of pale diluet urine
polydipsia: excessive thirst

What drug is used as synthetic vasopressin? And what is it used to treat?

How is synthetic vasopressin, or desmopressin acetate (Octostem, DDAVP) administered?

What hormone induces contractions in the uterus and promotes lactation, and it can be supplied by injection or intranasally?

Which endocrine glands are located on the kidney and are composed of a cortex and medulla?

What endocrine hormones secrete glucocorticoids and mineralocorticoids?

Synthesis and secretion of glucocorticoids is under the control of what hormone?

What is the main glucocorticoid steroid?

What hormone does the renin-angiotensin pathway control?

What is the main mineralocorticoid hormone? And what does it do?

What hormone does the following:
regulates cell metabolism
induces anti-inflammatory and immunomodulatory effets
allows other hormones to modulate cardiac contractility, vascular tone, and blood pressure
provides negative feedback to hypothalamus and anterior pituitary: which regulates CRH and ACTH

What is often used for the treatment of oral inflammatory lesions?

true or false. corticosteroids should never be used for tx of mucocutaneous viral infections because of their anti-inflammatory and immunomodulatory effects
True False

What is an exception of a viral infection that it is ok to use corticosteroids for?

Which hormone's mechanism of action is to
decrease inflammation: by suppressing migration of polymorphonuclear leukocytes
suppress the immune system: by reducing the activity of lymphoid cells
possibly resulting in delayed wound healing and infection

Name 7 glucocorticosteroids in the Top 200.

What drugs are prescribed when endogenous cortosol hyposecretion develops, also called adrenocortical insufficiency or Addison disease?

In pt's with what condition do pts have very low to undetectable levels of aldosterone and cortisol in the blood? And cortisol levels do not increase in response to stress and ACTH?

The following are clinical manifestation's of what condition?
lethargy, anorexia, weight loss, nausea, possible brown patches on skin, buccal mucosa and tongue

What is the treatment for Addison's disease?

Are adrenal crisis's common in dentistry? (from Addison's disease)

What are 4 conditions besides Addision
s disease that indicate the use of glucocorticoids?

What is the most common corticosteroid used for oral administration?

What condition may occur when supraphysiologic dosease of corticosteroids are used for prolonged periods of time?

How are the target doses of corticosteroids generally determined?

What is the physiologic cortisol secretion per day?

3 agents used as medicine to administer cortisol to the body include:
hydrocortisone
prednisone and prednisolone
dexamethasone
What is the proper daily dose in mg for each of them?

true or false. When an oral glucocorticoid such as methyleprednisolone (Medrol) is prescreibed, the administration includes a step-down approach
True False

Describe 3 dental uses of glucocorticoids.

What type of glucocorticoids are most often used in dentistry? Why?

Name 3 topical glucocorticoids used in dentistry.

Describe how topical agents of glucocorticoids are applied.

Why are topical glucocorticoid agents often formulated with non-water-soluble products with adsorptive qualities?

Which of the following doseforms of glucocorticoids has a greater potential to produce ADEs?
tablets
elixers
sprays
pastes
creams
gels

The following Adverse drug effects may affect dental hygiene treatment and are caused by what agent?
masked symptoms of infection, candidiasis, nervousness, hyperglycemia, vision disturbances, edema, hypertension, peptic ulceration, osteoperosis, and Cushing's syndrome

The following are signs and symptoms of what condition? (caused by glucocorticoids)
round face (moon face)
fat distrubution around shoulders (buffalo hump)
truncal obesity

If a pt reports using a steroid spray for respiratory disease, what precautions should be made? (3)

true or false. Topical gels of steroids are unlikely to result in a yeast infection
True False

Why is periodontal health assessed using probing depth info with pts using steroids?

What are 3 potential drug-drug interactions in the dental setting that may occur with the use of steroids?

What are 3 potential medical emergencies to be aware of in pts taking steroids?

The following are clinical considerations for systemic cortocosteroid administration; What is the clinical procedure in which these will be identified?
chronic, high dose of steroid
masked infection
opportunistic infection
hypertension
miscellaneous

What hormone is the releasing factor that stimulates the release of lutenizing hormone (LH) and follicle-stimulating hormone (FSH)? (a hormone of reproduction)

What regulates the activities of LH and FSH?

When estrogens and progesterone drugs are taken, how are they?

true or false. Oral contraceptives contain a variety of hormones.
Which oral contraceptives are most likely to be reported on the health history?
True False

Where are estrogens mainly synthesized? (3 places)

During menopause, what is the main source of estrogen in women?

What hormone dramatically influences the growth and development of female reproductive organs by inducing the synthesis of specific proteins via intracellular receptors?

What drug is supplied as menopause approaches, to relieve hot flashes or other symptoms?

name 3 estrogen drugs used for relief of menopausal symptoms that are in the TOP 200.

Name 5 estrogen drugs used for oral contraception combination products in the TOP 200.

Which hormone's mechanism of action is to inhibit the release of gonadotropin-releasing hormone and reduce the release of FSH and LH?
What does this action permit? how?

List 6 therapeutic indications for the use of estrogen.

true or false. Oral contraceptives may use both estrogen and progesterone.
True False

What are the 3 different preparations and cycles of oral contraceptives?

true or false. A recent study found that oral contraceptive users had poorer periodontal health than nonusers.
True False

What are 5 indications for use of oral contraceptives?

Estrogens are well absorbed after ______ administration but tend to be extensively ______________ by the liver during _______________

Name 6 ADEs that may be caused by estrogens that affect dental hygiene management.

_____________________ in pts taking estrogens increases the risk for thromboembolism, stroke, and MI.

What are 2 potential medical emergencies that may happen in the dental office with pts taking estrogens?

true or false. There have been NO documented interactions between estrogen and drugs used in the dental officde
True False

What are 3 potential drug interactions that SHOULD be commnicated to the pt taking estrogens when APAP or antibiotics are prescribed by the dentist?

Is Hypertension more associated with taking estrogens for contraception or menopause?

What association recommends that dental management includes monitoring BP annually in all pts taking estrogens?

true or false. There is no pharmacokinetic data to support the contention that antibacterial agents reduce the efficay of oral contraceptives
What do the AMA and ADA council of scientific affairs recommend in regards to this?
True False

The _______ gland is located in the neck in ________ of the trachea.

Which endocrine gland secretes the hormones thyroxine and tri-iodothyronine?

What do each of the following terms mean in regards to thyroid function?
euthyroid
hypothyroid
hyperthyroid

Name 3 drugs in the TOP 200 used to treat hypothyroidism.

Of the 3 drugs in the top 200 used to treat hypothyroidism which is the drug of choice? Which is next in line? Which is used when the conversion of levothyroxine from T4-T3 is abnormal?

Which type of drugs mechanism of action is to promote oxygen consumption by tissues, increasing basal metabolic rate and metabolism of carbohydrates, lipids, and proteins?

Thyroid hormones act synergistically with epi to stimulate ______________ and enhance tissue sensitivity to catecholamines

Which type of drug is indicated in pts who have effects of hypothyroidism, and to return them to euthyroid state, or used in treatment or prevention of goiters and management of thyroid cancer?

Name 6 ADEs from thyroid drugs that might affect the DH treatment plan.

How are cardiovascular side effects from thyroid drugs determined?

true or false. epinepherine interaction with increased levels of thyroid hormones is possible so dental hygienist's should administer local anesthetics with caution.
What techniques are recommended?
True False

What is a clinical disease state produced by the effect of excessibe thyroid hormone on peripheral tissue?

Hyperthyroidism is characteristics of _______ disease

What are 2 therapeutic stragegies for managing pts with hyperthyroidism? Which of the 2 is the primary tx or cornerstone in the management of it?

Antithyroid drugs are usually stopped or tapered after ____________ of therapy

Name 4 common antithyroid drugs.

What are 3 potential medical emergencies that may occur in pts taking thyroid hormones, or in pts with uncontrolled hyperthyroidism?

What is the extreme manifestation of hyperthyroidism, and what are 3 signs and symptoms that this is occuring?

In most cases, what 2 precautions can be taken to result in little to no risk for a cardiac-related emergency in pts with controlled hyperthyroidism?

Why is it importance to balance the use of LA with low vasoconstrictor and in using profound anesthesia?

We should NOT treat pts if ther MET does not meet the demand of _____

Which type of thyroid dysfunction poses the greates risk during dental hygiene procedures, and we should not treat?

What is expressed in terms of metabolic equivalents (METs), it is a measure of an individual's ability to perform a spectrum of daily tasks?

At what measurement is a pt at an increased cardiac risk?

Which type of hormone is used to treat postmenopausal women with osteoporosis at hight risk for fracture, and also men with osteoporosis to increase bone mass?

What is the name of a parathyroid hormone that is administered subcutaneously once a day into the thigh or abdomen, is used for bone growth stimulation, and has warnings of an increased risk for osteosarcoma?

What are 2 ADEs seen in the use of teriparatide (Forteo)? What are drug interactions?

What is a clinical consideration for using the parathyroid hormone teriparatide (Forteo)? What are 3 precautions to take?

What type of parathyroid hormone derivatives can lead to osteoclast apoptosis (cell death)?

What type of parathyroid hormone is most commonly used to treat or prevent osteoporosis (Paget's disease of the bone) and in cancer chemotherapy?

What are 3 drugs that are used to prevent or treat osteoperosis; paget's disease of the bone, and cancer chemotherapy, that are Nitrogen-containing bisphosphonate oral formulations?

What are 2 drugs that are Nitrogen-containing bisphosphonate formulations administered by IV? (parathyroid hormones)

Name 2 drugs (parathyroid) that are non-Nitrogen-containing bisphosphonate formulations used in the treatment of Paget's disease of the bone.

Which type of drug's mechanism of action is to inhibit bone resorption by suppressive action on osteoclasts or osteoclasts precursors?

what is the main indication for oral doseforms of BIS? When are they indicated at higer dose forms?

IV formulations of BIS have recently been approved for the treamtne of osteoporosis and Paget disease of the bone. Name 2 BIS IV formulations.

What is the most important ADE associated with the use of BIS drugs? What doseform are these ADEs most common with?

true or false. The mechanism for ONJ from BIS is unclear but is related to the suppresion of osteoclast action and increase apoptosis.
True False

List 2 different cases where reports of ONJ and BIS have been reported.

desquamation of the mucosa revelaing exposed bone in the jaw, pain and purulent exudate being present, condition mostly affects mandible but can affect either jaw, are lesion characteristics of what condition?

What are 2 other potential ADEs with BIS besides ONJ that may affect the DH tx plan?

How does the dental hygeinist play a role in the AAOM recommendations for individuals having taken a BIS?

What are 7 topics to discuss with the pt to help prevent BIS associated ONJ prior to them taking the drug?

What is the best procedure to do in pts that report taking a BIS who also have pulpal inflammation? What about extractions?

Have their been any documented cases of medical emergencies or drug-drug interactions in the dental setting of pts taking bisphosphonate?

What are the 2 pancreatic hormones that are synthesized by pancreatic cells?

Reducing fasting blood glucose levels to less than 120 mg/dL and HbA1c (A1C) levels to less than 6% is the goal of therapy for what?

Which type of DM is described?
absolute deficiency of insulin; treated with short, intermediate, or long acting injectable insulin preparations, and inhaled insulin

Which type of DM is described?
decreased release of insulin or decreased number of insulin receptors; they are treated initially with an orally administered hypoglycemic agent, this type may progress to insulin-dependancy

The goal of what drug therapy is to provide adequate glucose control through each 24-hour period while minimizing the number of injections required?

most insulin/antidiabetic drug regimens combine ____________ insulin with an _______________ agent

What is the main ADE risk for pts taking insulin/antidiabetic drugs, in the dental office? What is the best way to prevent this from occuring?

What is the test for pts with DM that determines long-term control and is completed at quarterly medical appointments?

Name 4 first-generation sulfonylureas. (drugs used in the tx of DM/pancreatic hormones)

What are 2 drugs used for DM that are under the meglitinide classification and are used uncommonly?

Name 3 combination products that companies are providing, used in the tx of DM.

Oral antidiabetics/insulin agents have various actions according to the type of drug. List 3 different mechanisms of action for them.

Which type of antidiabetic agent is the most likely to cause hypoglycemia?

What type of antidiabetic agent is indicated for type 1 DM? which is for type 2 DM? What is one way the form of DM can be determined?

true or false. It is important to investigate each antidiabetic agent in a drug reference to determine ADEs. It is also important to question pt for ADEs with relationship to oral health care appointments

In the pain management for pts taking pancreatic hormones for DM, describe features of each of the following:
salicylates
opioid/ASA vs opioid/Ibu combos
opioid/APAP combination

What is the most common potential medical emergency that may occur in pts taking pancreatic hormones? Who does this most often effect, and is it common in the dental office?

The following drug-drug interactions in the dental setting are ones to be aware of in pts taking what?
glipizide and fluconazole - may cause hypoglycemic coma
epi - but at levels in dental setting should not raise blood glucos levels too much
ACE inhibitors and beta-adrenergic receptor antagonists

The following are clinical signs and symptoms for what condition?
dizziness
impaired consciousnes
lack of concentration
sweating

When is the best time to treat pts with DM?

Why is it important to monitor vital signs in pts with DM?

true or false. No studies support recommendation of administration of antimicrobial prophylaxis before dental therapy
True False

What are 3 important actions to take when you treat a pt with DM who presents with significant oral infection?

endocrine diseases are __________ conditions that are not ___________ with drugs, but are ___________ with drugs.

true or false. For most endocrine diseases, the drugs are taken for a lifetime.
True False