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13 Cards in this Set
- Front
- Back
Medrol Dose Pak
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Class: Corticosteroid
MOA: Alter gene expression to achieve effects; Enter cells and bind to cytosolic receptors, Receptor migrates to nucleus (GR), Binds to response elements (GREs) Steroid action in inflammation; 2 Mechanisms 1. AP-1and NF-κB; Bind and ↓ actions directly through protein-protein interactions, ↑ expression of glucocorticoid induced leucine zipper proteins (GILZ), High concentrations 2. Chromatin Remodeling; Anti-inflammatory genes - Acetylation of H4 portion of the histone by steroid co-activator molecules, Anti-inflammatory protein expression Pro-inflammatory genes - GR binds to pro-inflammatory molecules and inhibits HAT activity, GR recruits histone deacetylases to transcriptional complex Low concentrations used clinically Effects: Anti-Inflammatory Inhibition of; accumulation of macrophages and leukocytes, phagocytosis, lysosomal enzyme release, release of chemical mediators of inflammation Uses: Preoperative antimicrobial prophylaxis Suppression of signs of inflammation Medrol Dose pack is given in a step down method. “…6 the first day, 5 the second day, 4, 3, you know the rest. That way they’re not going to get into that acute adrenal crisis. This is for something like poison ivy. Or if the pt has an accident with inflammation. If you need to treat someone’s TMJ or trigeminal neuralgia. You might try Medrol dose pack to get rid of the inflammation if other drugs aren’t working.” -KG Replacement Therapy - most common Prednisone Indications: Chronic Inflammatory and Immune Diseases, RA, Lupus, Psoriasis, Crohn’s Disease, Chronic Hepatitis, Asthma, Organ Transplants, TMD, COPD Do not have any curative properties, decrease signs and symptoms of disease, like inflammation and pain Adverse: Withdrawal from Corticosteroids: Even for short duration therapy (3 days) doses should be tapered Withdrawal symptoms; Joint pain, Muscle pain, Fatigue, Fever, Nausea and vomiting, Acute Adrenal Crisis Caused by insufficient levels of cortisol; Low BP, Dehydration , Confusion, Tachypnea, Sweating of face and hands, Shock, Coma, Seizures Fluid and Electrolyte; Sodium and fluid retention, CHF, HTN and potassium loss Musculoskeletal: Loss of muscle mass, Osteoporosis, Compression fractures GI; Peptic ulcer, Pancreatitis, Ulcerative esophagitis Dermatologic; impaired and delayed wound healing, Thin fragile skin, Neurologic; Convulsions, Vertigo, Headache Endocrine; Development of Cushing's state, Secondary adrenocortical and pituitary unresponsiveness, Diabetes |
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Prednisone
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Class: Corticosteroid
MOA: Alter gene expression to achieve effects; Enter cells and bind to cytosolic receptors, Receptor migrates to nucleus (GR), Binds to response elements (GREs) Steroid action in inflammation; 2 Mechanisms 1. AP-1and NF-κB; Bind and ↓ actions directly through protein-protein interactions, ↑ expression of glucocorticoid induced leucine zipper proteins (GILZ), High concentrations 2. Chromatin Remodeling; Anti-inflammatory genes - Acetylation of H4 portion of the histone by steroid co-activator molecules, Anti-inflammatory protein expression Pro-inflammatory genes - GR binds to pro-inflammatory molecules and inhibits HAT activity, GR recruits histone deacetylases to transcriptional complex Low concentrations used clinically Effects: Anti-Inflammatory Inhibition of; accumulation of macrophages and leukocytes, phagocytosis, lysosomal enzyme release, release of chemical mediators of inflammation Uses: Preoperative antimicrobial prophylaxis Suppression of signs of inflammation Replacement Therapy - most common Prednisone Anti-inflammatory effects only produced by supra-physiologic doses of steroids 7.5 mg Prednisone q Day or more is supra-physiologic dose Synthetic steroids are less protein-bound = increases active form increased anti-inflammatory effects Increased side-effects Dental Treatment may require a stress dose(pt undergoing siginificant surgical stress and adrenal glands are suppressed so you double daily steroid dose before procedure) of corticosteroid to prevent Acute Adrenal Insufficiency Indications: Chronic Inflammatory and Immune Diseases, RA, Lupus, Psoriasis, Crohn’s Disease, Chronic Hepatitis, Asthma, Organ Transplants, TMD, COPD Do not have any curative properties, decrease signs and symptoms of disease, like inflammation and pain Adverse: Withdrawal from Corticosteroids: Even for short duration therapy (3 days) doses should be tapered Withdrawal symptoms; Joint pain, Muscle pain, Fatigue, Fever, Nausea and vomiting, Acute Adrenal Crisis Caused by insufficient levels of cortisol; Low BP, Dehydration , Confusion, Tachypnea, Sweating of face and hands, Shock, Coma, Seizures (treatment – 100mg Hydrocortisone IM Trendelenberg, O2) Fluid and Electrolyte; Sodium and fluid retention, CHF, HTN and potassium loss Musculoskeletal: Loss of muscle mass, Osteoporosis, Compression fractures GI; Peptic ulcer, Pancreatitis, Ulcerative esophagitis Dermatologic; impaired and delayed wound healing, Thin fragile skin, Neurologic; Convulsions, Vertigo, Headache Endocrine; Development of Cushing's state, Secondary adrenocortical and pituitary unresponsiveness, Diabetes |
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Methotrexate
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Class: Cytotoxic agent, inhibitor of gene expression
MOA: Folate analog Anti-inflammatory effects Apoptosis of CD4 and CD8 T cells Indications: Rheumatoid arthritis Psoriasis Graft vs host disease Severe asthma Effects: Once a week dosing |
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Mycophenolic Acid (CellCept)
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Class: Cytotoxic agent, Inhibitor of gene expression
MOA: Inhibitor of inosine monophosphate dehydrogenase Rate limiting enzyme in the biosynthesis of guanosine Effects: Decreases lymphocyte activation and activity Induces apoptosis of activated T cells Decreased expression of adhesion molecules Decreased production of NO by neutrophils Oral Adverse Effects: Mouth ulceration, gum hyperplasia, gingivitis, dry mouth, dysphagia |
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Cyclosporine
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Class: Specific lymphocyte signaling inhibitor
MOA: Inhibits synthesis of IL-2 in activated T-cells Interleukin-2 Cytokine Activation and proliferation of T-cells Nuclear factor of activated T-cells (NFAT) Has to be dephosphorylated to translocate to nucleus Dephosphorylated by calcineurin Form a complex with cyclophilin Complex binds to calcineurin and inactivates it Indications: Immunosuppressive for graft survival, Topical for oral lichen planus, Psoriases, RA Adverse Rxns: Renal toxicity, HTN, Hyperlipidemia, Neurotoxicity, Gingival hyperplasia |
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Tacrolimus (Prograf)
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Class: Specific lymphocyte signaling inhibitor
MOA: Inhibits synthesis of IL-2 in activated T-cells Interleukin-2 Cytokine Activation and proliferation of T-cells Nuclear factor of activated T-cells (NFAT) Has to be dephosphorylated to translocate to nucleus Dephosphorylated by calcineurin Form a complex with cyclophilin Complex binds to calcineurin and inactivates it Indications: Immunosuppressive for graft survival, Topical for oral lichen planus, Psoriases, RA Adverse Rxns: Renal toxicity, HTN, Hyperlipidemia, Neurotoxicity, Gingival hyperplasia |
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Diphenhydramine (Benadryl)
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Class: Anti-histamine (1st Gen, OTC)
MOA: Inverse agonists at histamine receptor sites - bind to and stabilize the inactive conformation of the H1 receptor, two state model of H1 receptor Therapeutic Uses: Nasal Allergies, Allergic Dermatoses, Symptomatic relief of the common cold, Sedation Therapeutic Uses in Dentistry: Allergic lesions of the oral mucosa Adverse: CNS depression - drowsiness, lethargy, decreased motor coordination (less than others in same class) Anti-muscarinic effects - dry mouth, constipation, blurred vision |
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Meclizine (Antivert)
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Class: Anti-histamine (1st Gen, Rx only)
MOA: Inverse agonists at histamine receptor sites - bind to and stabilize the inactive conformation of the H1 receptor, two state model of H1 receptor Therapeutic Use: Vertigo Adverse: CNS depression - drowsiness, lethargy, decreased motor coordination Anti-muscarinic effects - dry mouth, constipation, blurred vision |
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Promethazine (Phenergan)
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Class: Anti-histamine (1st Gen, Rx only)
MOA: Inverse agonists at histamine receptor sites - bind to and stabilize the inactive conformation of the H1 receptor, two state model of H1 receptor Therapeutic Use: Nausea Therapeutic Uses in Dentistry: Reduction of post-operative nausea Adverse: CNS depression - drowsiness, lethargy, decreased motor coordination Anti-muscarinic effects - dry mouth, constipation, blurred vision |
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Fexofenadine (Allegra)
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Class: Anti-histamine (2nd Gen)
MOA: Inverse agonists at histamine receptor sites - bind to and stabilize the inactive conformation of the H1 receptor, two state model of H1 receptorDoes not cross BBB Therapeutic Uses: Nasal Allergies, Allergic Dermatoses, Symptomatic relief of the common cold, Motion sickness, Sedation Therapeutic Uses in Dentistry: Conscious sedation, Pre-medication for general anesthesia, Reduction of post-operative nausea, Allergic lesions of the oral mucosa Adverse: CNS depression - drowsiness, lethargy, decreased motor coordination Anti-muscarinic effects - dry mouth, constipation, blurred vision |
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Loratadine (Claritin)
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Class: Anti-histamine (2nd Gen)
MOA: Inverse agonists at histamine receptor sites - bind to and stabilize the inactive conformation of the H1 receptor, two state model of H1 receptorDoes not cross BBB Therapeutic Uses: Nasal Allergies, Allergic Dermatoses, Symptomatic relief of the common cold Therapeutic Uses in Dentistry: Allergic lesions of the oral mucosa Adverse: CNS depression - drowsiness, lethargy, decreased motor coordination Anti-muscarinic effects - dry mouth, constipation, blurred vision |
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Adalimumab (Humira)
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Class: Antibody
MOA: Binds to and inactivates tumor necrosis factor α (TNFα) TNFα: Cytokine, Normal inflammatory and immune responses Uses: These things are used for psoriasis, Crohn’s disease, rheumatoid arthritis. Adverse: Headache, rash, nausea |
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Basiliximab (Simulect)
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Class: Antibody
MOA: IL-2 receptor antagonist IL-2Rα receptor on activated T-lymphocytes Inhibits IL-2 activation of lymphocytes Pathway in the cellular immune response Uses: These things are used for psoriasis, Crohn’s disease, rheumatoid arthritis. Adverse: Headache, rash, nausea |