1
Q
s
A
(sina) without
2
Q
What is fast tracking?
A
-Shorten FDA approval time for urgent situations
3
Q
What is the DOPL and the UCSD, and their purpose?
A
- Division of Occupational and Professional Licensing, and Utah Controlled Substance Database
- This is a legislatively created database to track and collect data on dispensing of Schedule II-V drugs by retail, institutional and outpatient hospital pharmacies
- Purpose: identify over-utilization, misuse and over-prescribing of controlled substances throughout the state.
4
Q
Succimer:
A
Succimer (water-soluble form of Dimercaprol):
- Used to treat Pb, As, and Hg poisoning
- Urinary excretion (main mechanism for removal)
- Water soluble derivative of dimercaprol
- T1/2 – 2-4 hours
- Route of administration -> ORAL USE ONLY
- Succimer has less side effects (GI and mild rashes) as compared to hypertension, tachycardia, nausea, vomiting, salivation, pain
5
Q
Doxylamine
A
Antihistamine
OTC sleep aide
6
Q
What three groups are not required to report to the UCSD?
A
- Prescriptions at federal facitilies (e.g. VA, military)
- Out-of-state pharmacies
- Pharmacies servicing in-patient populations (i.e. hospital)
7
Q
What was the case and effect of the Modified Food, Drug, and Cosmetic Act?
A
Caused by the diethyleneglycol tragedy. Requires drug safety.
8
Q
Unithiol is effective for what types of heavy metal poisoning?
A
Hg, As, and Pb poisoning
9
Q
In which patient population is EDTA contraindicated and why?
A
Contraindicated in Anuric patients
10
Q
What is Succimer’s only route of administration?
A
Oral use only
11
Q
What is the mechanism of mercury toxicity?
A
- Reacts with selenium (necessary for reducing oxidized Vitamin C and E)
- Can cause gingivostomatitis
12
Q
What are the three primary exposure sources of Mercury?
A
- Found in fish
- Amalgam (no CDC-recognized evidence that it is a problem in dentistry)
- thermometers
- Vaccines?
13
Q
How does the half-life of the heavy metal effect the ability of a chelator to remove it from a target organ?
A
The longer the t1/2 of the heavy metal, the less effective is the chelator
14
Q
Diphenhydramine
A
Antihistamine, not effective for colds. Has a lot of drowsiness. Also used as an anti-tussive. OTC sleep aide as well
15
Q
Guaifenesin
A
Expectorant, increases productive cough, mucus formation, thins mucus.
16
Q
There are no over-the-counter sedatives available. True or False?
A
True
17
Q
What is the definition of a schedule III drug?
A
- Have potential for abuse – may lead to moderate or low physical dependence or high psychological dependence
- [Codeine, buprenorphine, ketamine]
18
Q
What does the DEA oversee specifically?
A
- DEA oversees programs that deal with illicit and prescribed Scheduled drugs (Schedules 1-V) such as:
- Drug eradication
- Drug education
- Assist state and local agencies, civic groups, school systems and officials to combat drug abuse
- Help secure borders against drug trafficking
19
Q
What are the symptoms of Arsenic poisoning?
A
- Fatigue
- Anemia
- Renal Failure
- Hyperpigmentation
- Carcinogenic in lungs, skin, and bladder
- Hemolytic on RBC
20
Q
What is a productive cough?
A
Removes mucous and cellular debri, don’t need to treat
21
Q
How does Dimercaprol’s therapeutic index compare to succimer or unithiol?
A
- Narrow therapeutic index
- Can be very toxic – especially on the kidneys
- Succimer has for most replaced dimercaprol
22
Q
p.o.
A
(per os) by mouth
23
Q
What was the cause and effect for the Pure Food and Drug Act?
A
Caused by addiction to opium and cocaine; requires labeling and naming ingredients, patent medicines
24
Q
Why is lead exposure particularly detrimental to young children?
A
- Their bodies absorb because Pb competes with Ca, and growing bodies require considerable Ca. Children absorb >50% consumed whereas adults absorb ~10-15%
- They often eat or suck on things that contain Pb, such as things covered with Pb-containing paint, dirt etc.
25
Neosporin/Polysporin
* Antibiotic
* First aid – preventative on minor abrasions
26
Nicotine
Patches, lozenges, gum
Treat tobacco dependence
Side effects:
* Dizziness
* Headach
* Nausea
27
What is the mechanism of cyanide poisoning?
**Cyanide is not a heavy metal**
* Prevents cells of the body from getting oxygen and ATP causeing cell death
28
What was the cause and effect of the Durham Humphrey Amendment?
Many new drugs that needed to be regulated. Effect was Prescription vs Other the Counter (OTC)
29
What is the activite ingredient in Marijuana?
THC - Tetrohydrocannabinol
30
Unithiol is the water soluble derivative of what other chelator?
Dimercaprol---succimer is usually preferred
31
How can a dentist prevent lesions caused by zinc phosphate cement?
* (coronal pulp tissue lesion due to phosphoric acid)
* Use proper mix – don’t thin
* Alternatiely use a resin modified glass ionomer cement
32
When using amalgam in filings, what step results in the greatest release of mercury?
The greatest amount of mercury is released during dry polishing of an amalgam restoration
33
What is phenylephrine also used to treat besides being used as a decongestant?
Treats hemorrhoids. Is a good vasoconstrictor.
34
What are the phases of drug testing?
- Phases of Drug Testing (for example, preclinical; also phases I, II & III)
* Animal preclinical testing: controlled by IACUC (institutional animal care committee)
* Phase I: small group of healthy (usually) subjects to test safety, doses, administration and other kinetics
* Phase II: small group of subjects with condition to be treated to test safety (still) and efficacy
* Phase III: extended clinical phase- large group of subjects, using double blind construct, placebos and multi-sites groups to test for statistical efficacy
* Marketing (‘phase 4’): see how the product does in production
35
Is it better to treat with chelators quickly or take a wait and see approach when an exposure has occurred?
Most effective administration is ASAP after exposure
36
What is a non-productive cough?
Dry hacking, non cleansing. Need treatment.
37
What is biocompatability?
* Materials ability to perform with an appropriate host response
38
What is the definition of clearance?
* Measure of the plasma cleared per unit time
* Sum of both the **RENAL** and **HEPATIC** contributions
* 1st order vs Zero Order kinetics
39
What is the mechanism of Arsenic's toxicity?
* Interferes with ezyme function
* Interfere with signal transduction
* Hemolytic effects on RBCs
40
What is the definition of hazard?
* Ability of an agent to cause toxicity
* Depends on inherent properties of the agent and exposure liability
41
What are the therapeutic considerations and proposed uses of marijuana?
* Legal status: Schedule I Federal laws; variable according to state laws (range from illegal, medical marijuana, to legalization [e.g., Colorado])
* **Marinol (dronabinol)-**FDA Rx approved agonist
* Proposed uses:
* nausea
* appetite
* glaucoma
* chronic pain
\* **CBD** (cannabidiol)- analog promoted as **_antiseizure_**, not as addicting as THC
42
noct
(nocta) at night
43
What are the non-prescription drug categories?
(I (safe and effective), II (unsafe or ineffective), III (not sure—requires more studies) )
44
Loratidine
Antihistamine, not effective for colds. Less drowsiness. Claritin.
45
What are the three most toxic substances?
lead (#1), mercury (#2) and arsenic (#3)
46
How does Unithiol's half-life compare to other chelators?
* T1/2 – 20 hours
* Much longer than other chelating agents
47
What schedule drug is hydrocodone?
Schedule II drug
48
What are the characteristics of Mercury? Sources? Toxicity? Symptoms? CDC? Treatment?
**Liquid at room temp**
**Primarily used in methylHg form**
Sources:
* Fish
* Amalgam
* Thermometers
* Vaccines
Mercury toxicity:
* Reacts with selenium
Symptoms:
* Cause gingivostomatitis
* Neurological
* Psychiatric
* **“MAD HATTER”** – hat makers used Hg
* Memory loss, depression, confusion
CDC
* No evidene of harm from vaccines
* No health hazard from dental amalgams
Treatment:
* **Dimercaprol**
* Chronic use can cause serious renal toxicity
* **Succimer**
49
Dimercaprol:
* Used for **_arsenic and Hg, but not for Pb alone_**
* Can be administered with CaNa2-EDTA for severe, chronic poisoning for **_LEAD POISONING_**
* ***_It pulls Pb from bone and it goes to brain and causes toxicity_****_—contraindicated to use for lead poisoning alone_*
* **Not water soluble**
* Rout of administration = **IM**
* **Narrow therapeutic index**
* Can be very toxic – especially on the kidneys
* Succimer has for most replaced dimercaprol
* Half-life is 4-8 hours
50
w
with
51
Caffeine
**Xanthine** (caffeine, theobromine, theophylline)
* **Adenosine antagonist**
Stimulant
* Diminish fatigue and sleepiness
* Minor CVS effects
* Simulates gastric secretion
* Mild diuretic
* Decreases bloating with menstruation
52
Why at very high blood concentrations can normal kinetic properties of a drug or toxin change?
* Under normal concentration elimination of most drugs is proportional to their plasma concentration – **1st order kinetics**
* As plasma levels increase and become very high, protein binding and normal metabolism can become saturated and the rate of elimination becomes fixed – **zero order kinetics**
At toxic doses normal kinetics may be altered, ***_reflects a prolonged half life and increases toxicity_*** *_(high concentration of unbound free fractions)_*
53
Garlic
Herbal. Slowly LOWERS CHOLESTEROL.
54
What does ADME stand for?
* Absorption
* Distribution
* Metabolism
* Excretion
* Of toxic substances and their metabolites
55
What is the switching policy of the FDA (Rx to OTC)?
* Based on the need to reduce cost,
* New drugs are always made prescription for at least 3 years before considering their conversion to OTC status
* Good safety record
* Used frequently to demonstrate a need.
56
w/o
without
57
How can dentists reduce cytotoxicity of acrylate bonding agents?
Rinse with tap water between applications
58
Phenol
Oral anesthetic
Do not use if patient is allergic to local anesthetic
59
What is the mechanism of lead’s toxicity?
* Interferes with Ca++ use
* Causes anemia
* Causes immunosuppression
60
What are the main things that the FDA regulates?
Foods, dietary supplements, bottled water, food additives, drugs, biologics, medical devices, cosmetics, veterinary products, tobacco products, advertising of these products.
61
What is the distinction between prescription and OTC drugs?
* Addiction/abuse liability
* RX – addictive potential
* Relative safety
* RX – more toxic, serious indication
* Intent of use-does it require professional input/control (OTC)
62
Why is adequate ventilation and use of exhaust fans essential if working with metals in the laboratory?
Exposure of beryllium dust, nickel dust, and or beryllium vapors
63
prn
(pro re nata) as needed
64
What is the definition of route of exposure?
Route of entry into the body
* Inhalation **(most common)**
* Transdermal
* Oral
* Mucosal
65
What is 1st order kinetics?
* Elimination of most drugs/chemicals is proportional to their plasma concentration
66
Oseltamivir
Antiviral, have some benefit for colds (shortens infection for 1-2 days if taken early. **Not OTC.** This is Tamiflu.
67
What is the antidote for cyanide poisoning?
Hydroxycobalamin
68
What is the FDA policy regarding herbal products?
* Regulates herbal products like food
* \* Label regulations à name of mandufacturer, list of ingredients, contents, servings
* \* Manufacture is is responsible for ensuring the dietary supplement is safe
* \* FDA “approves”
* \* Full disclosure to FDA or consumer is regulated
* \* Consumers must demonstrate that the herbal supplement is safe to the FDA
* \* Labeling controlled by FTC (Federal Trade Commission). This category of products cannot be promoted to diagnose, treat or prevent disease
69
a.c.
(ante cibum) before meals
70
Cyanide is not a heavy metal. True or False?
True
71
What is the definition of volume of distribution?
* Apparent volume into which a substance is distributed in the body
* Large Vd = Substances will not be easily accessible to purification attemtps (hemodialysis)
* **Antidepressants, antipsychotics, antimalarials, opioids**
* Small Vd = better candidates
* **Salicylates, ethanol, phenobarbital**
* ***Harder to remove a substance with a larger Vd than a smaller Vd***
72
What is the definition of duration of exposure?
* May effect selection of treatment
* Acute vs Chronic
73
Dimercaprol can be administered with CaNa2-EDTA for severe, chronic poisoning with what heavy metal?
severe, chronic poisoning for LEAD POISONING
74
c.f.
with food
75
What is the definition of risk?
The expected frequency of exposure to a hazardous agent
76
q.d.
every day
77
dc
discontinue
78
Mercury is primarily solid at room temp. True or False?
False, liquid, and primarily used in methyl Hg form
79
* How does the treatment regimen, including the use of chelators, differ for each of the following conditions:
* acute arsenic intoxication
* chronic arsenic intoxication
* acute arsenic gas intoxication
* Acute Arsenic Intoxication:
* Decontamination
* **Unithiol (IV)**
* **Dimercaprol (IM)**
* Chronic Arsenic Intoxication
* Folate dietary supplement
* **NO CHELATORS** – no therapeutic benefit
* Irreversible damage has already occurred
* Acute Arsine Gas Intoxication
* Hemodialysis and transfusions
* Aggressive hydration
* **NO CHELATORS** – no benefit
80
Unithiol has been FDA-approved for which heavy metal poisonings?
None
81
What does NDA stand for?
New Drug Application
82
Once marketed, who is responsible for assuring herbal products are safe?
The FDA. Cannot be promoted to diagnose, cure, or prevent disease.
83
sig
write on the label
84
What is the main repository in the body for its lead burden?
It substitutes for Ca++ in bone
85
Does EDTA target intracellular or extracellular lead?
Only chelates EXTRACELLULAR Pb
86
What schedule drug is Tramadol?
Schedule IV drug
87
What is the treatment regimen for lead toxicity, particularly the recommended chelators?
* Remove exposure
* Administer a chelator such as EDTA (edetate calcium disodium). It removes Pb from bone slowly and requires multiple chelating treatments
88
What is EDTA's half life?
1 hour
89
What defines some metals as “heavy”?
**HEAVY METALS:**
* **High atomic weight**
* **Density is 5x greater than water ,** **\>5 g/cm3**
***Lead (1), Mercury (2), Arsenic (3), Cadmium (7)***
90
What is biocompatibility?
Biocompatibility = The ability of a material to elicit an appropriate biolgocial response in a given application in the body
91
What is the definition of a schedule II drug?
* High potential for abuse – may lead to sever psychological or physical dependence
* [Hydromorphone, methadone, meperidine, fentanyl, **hydrocodone**, codeine]
92
How do heavy meatls interfere with normal biological processes?
Heavy metals (high atomic weight), interfere with normal biological processes by competing with normal substrates
93
What is Succimer's half-life compare to dimercaprol?
T1/2 – 2-4 hours, whereas dimercaprol is 4-8 hours
94
h
(hora) hour
95
Why is dimercaprol contraindicated in chronic mercury intoxication scenarios?
Chronic use of dimercaprol can cause serious renal toxicity
96
Edetate Calcium Disodium (CaNa2-EDTA):
* Used to treat **_Pb poisoning_**
* Only chelates EXTRACELLULAR Pb
* Route of administration à **IV**
* T1/2 – 1 hour
* 100% by the kidneys
* Contraindicated in Anuric patients
* Should not be used \> 5 days due to nephrotoxicity
97
What are the characteristics of Rhinorrhea?
* Theory-it has a defensive function
* Drying agents are for convenience, but may prolong infection by diminishing cleansing action of secretions
98
What is the treatment regimen for mercury toxicity, particularly the recommended chelators?
Dimercaprol, succimer
99
t.i.d.
three times daily
100
What is biomagnification?
* Increases in the relative amount of a contaminant in a biological system **as it passes up the food chain**
* **Mercury** – increases up the food chain
101
What are Unithiol's routes of administration?
ORALLY or IV
102
What are the symptoms of mercury?
* Cause gingivostomatitis
* Neurological
* Psychiatric
* **“MAD HATTER”** – hat makes used Hg
* Memory loss, depression, confusion
103
What is lead's symptoms?
Headaches, neurocognitive deficits, kidney damage, etc.
104
aq (aque)
water
105
What is the defintion of a schedule V drug?
* Low potential for abuse
* Limited quantities
* Cough preparations - robitussin
106
Dimercaprol is water soluble. True or False?
False, it is not water soluble
107
Unithiol:
* Used to treate **_Hg, As, and Pb poisoning_**
* Water soluble derivative of Dimercaprol—succimer is usually preferred
* Route of administration = **ORALLY or IV**
* T1/2 – 20 hours
* Much longer than other chelating agents
* ***Not FDA approved for any heavy metal poisonings***
108
What is lead's half-life?
1-2 months
109
p.c.
(post cibum) after meals
110
Dimercaprol is FDA-approved for which heavy metal poisonings as a monotherapy?
Used for arsenic and Hg, but not for Pb by itself because it resdistributes larger doses to the CNS and brain
111
What twelve items are found on a prescription slip?
1. DEA No.
2. Name
3. Age
4. Address
5. Date
6. Drug name
7. Brand name of drug
8. Form (tabs, pills, etc)
9. Dosage (200mg, 100mg, etc)
10. Disp: (how many tablets, 20 tabs, etc)
11. Sig: (1 tab qrh prn pain)
12. Signature
112
St. John's Wort
Herbal. Promoted to treat DEPRESSION.
113
What are the physiological effects of marijuana?
* Activates cannabinoid receptors
* Bronchodilator
* Vasodilator
* Tolerance and dependence
* Many cannabinoid agonists developed for street drugs; e.g., ‘Spice”
* Cannabidiol receptors
* -Heavy concentration in cerebellum - impaired motor control
* -Cortex - impaired executive decision making
* -Mesolimbic system - pleasure is given through dopamine release
* -Hypothalamus - the munchies
114
What steps can be taken to prevent pulpitis caused by unpolymerized monomers in resin composites used in deep fillings?
To prevent pulpitis – use twice the recommended curing time and cure in increments for composite restorations
115
What is Zero order kinetics?
* Plasma levels become very high – protein binding and normal metabolism can both become saturated and the rate of elimination can become fixed
* **Not dependent on plasma concentration (fixed rate)**
* More drug is delivered into circulation in unbound fraction – easier to become toxic
116
Aloe Vera
Herbal.
* Promoted for **SKIN CARE –** helps with wound healing
* Dietary supplement to treat constipation (very effective!)
117
bis
twice
118
What is the definition of a schedule IV drug?
* Low potential for abuse
* Alprazolam (Xanax), diazepam (Valium), Triazolam, **Tramadol**
119
Miconazole
* Antifungal
* Thrush
* Vaginal infections
120
What is the endogenous ligand of marijuana?
Anandamide (natural neurotransmitter)
121
What does the IRB stand for?
Institutional Review Board
122
What does an expectorant do?
* Increases productive cough
* Increases mucus formation
* Thin the mucus
123
What are the pros and cons of Aspirin?
* Pros:
* Good analgesic
* Anti-pyretic
* Anti-inflammatroy
* Cons:
* Reyes Syndrome – ***DO NOT GIVE TO CHILDREN***
* GI irritation
* Acetylsalicyclic
* Anti-clotting (do not take before surgery)
124
Docosanol
Antiviral, have some benefit for colds (shortens infection for 1-2 days if taken early. Not OTC. This is for cold sores (herpes)
125
What are the characteristics of Arsenic? Sources? Toxicokinetics? Arsenic Toxicity? Symptoms? Treatment?
Sources:
* Industrial contamination
* Groundwater contamination
* Arsenite
Toxicokinetics:
* Absorbed via respiratory and GI
* POOR ABSORPTION THROUGH SKIN
* Binds to keratin
* Excreted though kidney’s
Arsenic toxicity:
* Interferes with ezyme function
* Interfere with signal transduction
* Hemolytic effects on RBCs
Symptoms:
* Fatigue
* Anemia
* Renal Failure
* Hyperpigmentation
* Carcinogenic in lungs, skin, and bladder
* Hemolytic on RBC
Treatment:
* Acute Arsenic Intoxication:
* Decontamination
* **Unithiol (IV)**
* **Dimercaprol (IM)**
* Chronic Arsenic Intoxication
* Folate dietary supplement
* **NO CHELATORS** – no therapeutic benefit
* Irreversible damage has already occurred
* Acute Arsine Gas Intoxication
* Hemodialysis and transfusions
* Aggressive hydration
* **NO CHELATORS** – no benefit
126
Codeine
Antitussive
127
What is the only route of administration of Dimercaprol?
IM
128
Capsacin
* Pain relief
* Topical ointment
* Targets **TRPV channels**
* **Decreases substance P**
129
What does water/humidification do to colds, etc.?
Decreases viscosity of respiratory secretions
130
How does the apparent volume of distribution for a drug or toxin determine the effectiveness of hemodialysis at purifying them from the blood?
* **Volume of distribution** = apparent volume into which a substance is distributed in the body
* **_Large Vd_** – implies a substance will not be easily accessible to purification attempts [Antidepressants, antipsychotics, antimalarials, opiods]
* **_Small Vd_** – easier to extract [salicylates, ethanol, phenobarbital]
131
Dimenhydrinate
Anti-cholinergic
Treats motion sickness
Side effects:
* Dry mouth,
* constipation,
* blurred vision,
* reduced urinating
132
What are demulcents?
Cough drops/syrupy products; coat the throat to reduce irritation
133
What is the definition of toxicity?
* The ability of a material to damage a biological system, cause injury, or impair function
* Dose, Route of exposure, and chemical species, age, gender, genetics, and nutritional status of exposed individuals all **affect the degree of toxicity**
134
Echinacea
Herbal. Promoted to treat COLDS.
135
The longer the half life, the more effective is the use of chelators to remove the heavy material. True or False?
False. The shorter the half-life the more effective.
136
Zanamivir
Antiviral, have some benefit for colds (shortens infection for 1-2 days if taken early. Not OTC.
137
Phenylephrine
Decongestant, vasoconstrictor, sympathomimetics, alpha-1 agonist
138
How do chelators work on heavy metals?
They render heavy metal ions unavailable for covalent interactions
139
bid
twice daily
140
q
(quaque)every
141
Zinc
Little benefit – if any in killing cold viruses
Ma have permanent damage to sense of smell
142
Docosanol
Cold Sores
Ant-viral
143
What type of person heads up the ONDCP (Office of National Drug Control Policy), and what do they do?
Drug Czar
* As part of the Executive branch, the Drug Czar (and ONDCP) evaluates, coordinates and oversees both international and domestic anti-drug efforts. Oversees DEA, NIDA & NIAAA (from NIH) activities and budget
144
Chlorpheniramine
Antihistamine, not effective for colds. Chlor-Trimeton.
145
What are the characteristics of Lead?
**No physiological value**
Sources:
* Building materials
* Batteries
* Lead pipes
* Paint
Lead toxicity:
* Interferes with Ca
* Causes anemia
* Cause immunosuppression
Detrimental to young children:
* Absorbed because it *_competes with Ca_*
* Growing bodies require Ca
* Absorbed \> 50%, adults absorb only 10-15%
* Eat or suck on things containing Pb
***SUBSTITUTES CA IN BONE***
**T1/2 = 1-2 months in soft tissues, years in bone**
Symptoms:
* Headaches
* Neurocognitive deficits
* Kidney damage
* **Burtonian Lines:**
* Lead lines causing a darkening of the gingiva
Treatment:
* Remove exposure
* **EDTA (edetate calcium disodium) chelator**
* Removes Pb from bone slowly and requires multiple chelating treatments
146
What is the positive aspect of Naproxen?
Long-acting!
147
What is the Orphan Drug Act?
* for rare disease to encourage drug development
* Illnesses involving less than 200,000 individual
* -Tax incentives
* -Extend patent
148
Dextromethorphan
Antitussive (robotussin)
149
What are the common allergic reaction observed in dental practices and the steps that can be taken to prevent or minimalize them?
* Allergic contact dermatitis
* Common on distal fingers and finger tips
* Avoid direct contact (wear gloves)
* Latex allergies
* Allergies to denture base materials
* Methyl methacrylate monomer
150
What is amotivational syndrome?
Loss of sense of ambition, thinking dulled
151
What are the main four sources of lead?
Sources:
* Building materials
* Batteries
* Lead pipes
* Paint
152
What is the definition of a schedule I drug?
* No current acceptable medical use in US
* Lack accepted safety for use under medical supervision
* HIGH potential for abuse
* [Heroin, LSD, Cannabis, meth]
153
Why should dimercaprol not be given as a monotherapy after chronic exposure to lead?
It pulls Pb from bone and it goes to brain and causes toxicity—contraindicated to use for lead poisoning alone
154
What does IND stand for?
Investigational New Drug
155
What is the difference between bioaccumulation and biomagnification?
* **Bioaccumulation** **–** accumulation of a toxic agent when the uptake of the agent exceeds the organism’s ability to metabolize excrete it
* **1st metabolism can be overwhelmed – increased levels in blood and kidney**
**Biomagnification** – increase in the relative amount of a contaminant in a biological system as it passes up the food chain
156
What is the mission of the DEA?
* Mission: enforce the controlled substances laws and regulations of the USA
* Address issues of illegal growing, manufacturing or distribution both domestically and internationally
157
What is bioaccumulation?
* Accumulation of toxic agent when the uptake of the agent exceeds the organism’s ability to metabolize/excrete it
158
How is EDTA excreted?
100% by the kidneys
159
q.i.d.
(quates in die) 4 times a day
160
What are the four biocompatibility criteria for the ideal dental material?
* Sould not be harmful to pulp or soft tissue
* Should not contain toxic diffusible substances that may be released and absorbed into the circulatory system to cause systemic toxicity
* Free of potentially sensitizing agents that may cuase allergic reactions
* NO carcinogenic potential
161
Oxymetazoline
Decongestant, vasoconstrictor, sympathomimetics.
162
What is the on and off label use of prescriptions?
Not FDA approved, but confirmed by research and clinical experience
163
What are the differences betwen a systemic and topical decongestant?
1. **_systemic_**
\* increase BP and HR
\* longer acting
2. **_topical_**
\* NASAL SPRAYS
\* less systemic problems
- Sprays have a much faster effect, but you can get rebound congestion because it doesn’t last 6-8 hours sometimes and they use it too much, even though the cold is gone, they should be feeling better, but they still feel congested because they are dependent.
- If you take these drugs orally, you could get an increase in blood pressure because of the vasoconstriction
- The sprays have less peripheral effects and are less likely to increase blood pressure
- The sprays are actually probably more effective.
\* dependence-tolerance
\* **Short acting – but MORE EFFECTIVE**
164
What are the characteristics of CBD (Cannabidiol)?
* Ø One of more than 80 active cannabinoid chemicals in the marijuana plant
* Ø Unlike THC, CBD does not produce euphoria or intoxication
* Ø CBD has a very low affinity for cannabinoid receptors (100-fold less) Ø CBD may acts on other brain signaling systems (serotonin??)
* Ø CBD may have anti-seizure, antioxidant, neuroprotective, anti- inflammatory, analgesic, anti-tumor, anti-psychotic, anti-anxiety properties.
* Ø NIH is currently supporting a number of studies effects as well as the health risks of cannabinoids.
165
Scopolamine
Anti-cholinergic
Treats Motion sickness
Side effects:
* Drowsiness,
* disorientation,
* dry mouth,
* blurred vision,
* dilated pupils,
* constipation
166
What is a dietary supplement?
* Congress defined the term "dietary supplement" as a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites.
167
What is the process of DOPL and UCSD?
* Outpatient pharmacies report dispensing of scheduled drugs within 7 days and the data are posted within 24 hours after receipt.
168
What was the cause and effect of the Kefauver-Harris Amendment?
The phocomelia caused by thalidomide (morning sickness) tragedy. Required testing for safety and efficacy.
169
Succimer is FDA-approved for which heavy metal poisonings?
Used to treat Pb, As, and Hg poisoning
170
Hydrocortisone
* Anti-inflammatory
* Anti-itching
* Dermal lesions
* Eczema
* Insect bites
171
What is the DEA?
Drug Enforcement Administration
172
What are Burtonian lines?
Lead lines causing a darkening of the gingiva
173
What is the definition of toxicology?
Study of the adverse effects of a chemical, physical, or biological agent on living organisms and the ecosystem.
Includes prevention of such adverse effects in
* Occupational
* Environmental
* Ecological
174
EDTA has been FDA-approved for which heavy metal poisonings?
Pb poisoning
175
stat
immediately
176
What do we know about Arsenic's toxicokinetics?
* Absorbed via respiratory and GI
* POOR ABSORPTION THROUGH SKIN
* Binds to keratin
* Excreted though kidney’s
177
Pseudoephedrine
Decongestant, vasoconstrictor, sympathomimetics, restricted sales
178
q.h.
every hour
179
What are the three primary exposure sources of arsenic?
* Industrial contamination
* Groundwater contamination
* Arsenite
180
Ginko
Herbal. Promoted to IMPROVE MEMORY. Uncooked ginko seeds contain ginkotoxin and can cause seizures.
181
Based on their comparative adverse effects, why has succimer largely replaced dimercaprol use?
Succimer has less side effects (GI and mild rashes) as compared to hypertension, tachycardia, nausea, vomiting, salivation, pain
182
ad.lib.
(ad libitum) use freely
183
What is the water soluble form of Dimercaprol?
Succimer
184
Minoxidil
* Hair Growth (Rogaine)
* Vasodilator – Causes rapid HR
185
What were the CDC’s conclusions regarding mercury exposure related to (a) thimerosal in influenza vaccines and (b) dental amalgam?
* No evidene of harm from vaccines
* No health hazard from dental amalgams
186
What regulates the herbal products?
* DSHEA, -Dietary Supplement Health and Education Act.
* Regulates herbal dietary supplements: defined as taken by mouth and contains a ‘dietary’ ingredient to supplement diet. May include vitamins, minerls, herbs or other botanical and nutrients.
187
What was the cause and effect of the Dietay Supplement Health and Education Act?
Little regulation lead to regulating herbal products like food, servign size, structure, functions, claims, with the big statement = **These statements have not been evaluated by the FDA.** **Not intended to diagnose, treat, cure, or prevent any disease.**
188
Succimer is the water soluble derivative of what other chelator?
Dimercaprol
189
What are the pros and cons of Ibuprofen?
* Pros:
* Good analgesic
* Antipyretic
* Anti-inflammatory
* No reyes syndrome
* Cons:
* GI irritation
* Anti-clotting
190
What are the pros and cons of Acetaminophen?
* Pros:
* Anti-pyretic
* Analgesic
* Not irritating to stomach
* Give to children
* Cons:
* NOT an anti-inflammatory
* LIVER toxic
191
What is Succimer's main mechanism for removing heavy metals?
Urinary excretion
192
Ginseng
Herbal. Boosts immune system, may lower blood sugar.
193
What is EDTA's only route of administration?
IV
Human Diseases & Therapeutics
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