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what are the uses and SE of aspirin?
- use: RA, Reiter's (urethritis, arthritis, conjunctivitis)
- SE: GI bleeding/ulcer, Reye's(encephalopathy)
What is indomethacin?
- COX: ankylosing spondylitis and OA
- SE: GI, leukopenia, aplastic anemia
What is etodolac?
- mech weak COX
- use: acute pain (RA OA)
What does acetaminophen do?
inhibits PG synth
What is piroxicam(Feldende)?
use: Long term RA OA
What is meloxicam(mobic)?
What is nabumetone(felafen)?
- COX2 weak
- RA & OA w/ less GI toxicity
- treat short term soft tissue injurys
Describe the propionic acid derivatives?
- use: symptomatic RA, OA, AS, acute gouty arthrits
- naproxen: long half life
- ketoprofen: (PG synth inhibitor, antibradykinin)
- oxaprozin: 1 a day?
What is oxaprozin?
1/day proprionic acid(ibuprofen class)
What is diclofenac?
- phenyl acid derivative: weak COX-2 (RA, OA, AS)
- short term MSkel inj (sports)
- SE: GI, uterine contraction
What is ketorolac (toradol)?
- non-selective COX
- pyrrole derivative alalgesic, moderate AI
- SE: similar GI
What are the coxibs?
- selective COX2
- rofecoxib(vioxx): off market, OA,
- celecoxib(celebrex): OA, RA
- valdecoxib(bextra): withdrawn
- SE: KIDNEYS, BP, CHF
What are the NSAIDs implication in dentistery?
- relieve pain from pathological process
- TMJ disorder
What are MARDs?
- disease modifying antirhematic drugs
- slow RA
- paquenil: anti-malaria, ocular toxic
- cyclosporin A: systemic imunnosuppressant
- arava(leflunomide): pyrimidine synth inhibitor (cell cycle) TERATOGENIC
- methotrexate: antimetabolite/folate cell growth inhibitor
- gold: inhibit PG, suppress immune rxn, mucosal stomatitis
What are the biological MARDs?
- enbrel: TNFa inhibtor (RA, AS,)
- humira: recombinant IgG TNFa
Which TNFa receptor downstream signal leads to apoptosis and anti-inflammation like Fas?
- TRADD, FADD, Capsase 8
- TRAF1/2 are anti-apoptotic->inflammation
What is an gout arthritis?
- acute gout from inflammation rxn to Na-urate crystals in joints
- Haegman factor->bradykinin
- crystals phagocytized by neutrophiles
- uric stones, tophi
- tx: colchine: depolymerize mitotic spindles-> no granulocyte phagocytosis (GI, vascular toxic)
- allopurinol: xanthine oxidase inhibitor (uric acid synth)
What is the treatment of gout?
- colchine: graulocyte microtuble depolymerizer
- allopurinol: xanthine oxidase inhibitor (uric acid synth)
What are the ucosuric drugs?
- block tubular reabsorption of urate
- probenecid (many drug interactions)
What is the physiological effects of corticosteroids?
- carbohydrate & protein metabolism: anti-insulin
- redist body fat and lipolysis
- immunosuppressive/antiinflammatory (cytokine/Ab inhib)
what are the mechanisms of corticosteroids AI effects?
- lipocortin: inhibit PLA
- COX synth suppressor
- granulocyte inhibit
- inhibit cytokine synth, histamine, adhesion
What are steroids used for in dentistry?
- immunosuppressive & poor healing, exogenous suppress adrenal
- GUIDLINE: 30mg HC(hydrocort) 4+ weeks or 80mg 2+ weeks-> 2x or 3x dose routine
- major: 8 hrs before 100mg cort IM, during 300mg HC, taper over 2-3days
- oral ulceration (NOT HERPETIC GINGIVOSTOMATITIS)
- pulpal sensitivity
What are roids contraindications?
DM, PUD, HBP, infection
what are some classes of roids?
- short: cortisone
- intermediate: prednisone
- long: beta, dexa, paramethasone
What are the weak COX2 inhibitors?
- relafen: soft tissues
- diclofenac: sports
Never use corticosteroids for what?
Which systems are of allergy concern?
- respiratory, CVS
- not so much: skin, GI
What kind of pts are prone to allergies?
atopic, watch class
When is a virus treatable?
What is HERV?
- 8% of human genome of inherited retroviral DNA
How does HIV attach?
- gp120: surface glycoprotein->CD4 receptor of T -cells
- CCR5 or CXCR4 co-receptor also needed
- HTLV: gp120->GLUT1 and NRP1
How does HTLV attach?
gp120->GLUT1 and NRP1 of CD4
Who is naturally HIV resistant?
What does nef of HIV do?
downreg MHC class I
What are the accessory proteins of HIV/HLTV?
- tat/tax: transcription activator
- rev/rex: viral RNA export
- nef(HIV): downreg MHC I
What is the last step of HIV life cycle?
RNA-Gag budd then mature via viral protease to become infectious
How is HTLV spread?
- virions cannot effectivly infect another cell
- cell-cell contact then proliferation (tax)
What do Tcells target in HTLV?
How is HTLV dx and tx?
- dx: ELISA (anti-HTLV)
- tx: no specific
How is HIV dx?
- anti-HIV ELISA then confirmed with Western blot
- p24: ELISA (low sensitivity)
- viral RNA: expensive
How is HIV tx?
- inhibit: RT, protease, integrase CCR5 (CXCR4)
- future: CCR5 stem cell
What is HAART?
- highly active anti-retroviral therapy
- at least 2 drug combo for HIV
what is the main diff between HIV and Herpes?
Herpes isn't integrated, not as productive
What is EBNA1?
- Epstein Barr
- maintains viral circular DNA in proliferating cells
- only protein express in resting latenly-infected B-cells
How does acyclovir work?
- 400mg 5/day 7-14 days
- open ring guanosine analogue via viral(herpes) thymidine kinase
- HSV, VZV, EBV
- NOT CMV (altered TK)
- gertrude elion
What is Docosanol?
22C fatty acid inhibits intracellular HSV penetration
How does penciclovir (or famciclovir) work?
- topical (herpes labialis drug of choice) converts MP by HSV or VZV TK to TP(triphospate) which inhibits DNA POLYMERASE
- famciclovir: oral pro drug(liver->penciclovir)
How does valacyclovir work?
What is ganciclovir?
- anti-hsv anti CMV
- similar to ACV
What is Cidofovir?
- acyclic necleoside phosphate inhibits CMV polymerase
- effective against ACV and Ganciclovir-resistant CMV in AIDS pts
What is the anti RSV drug?
ribavirin, purine analogue
What is the significance of a blood titer with HBsAg and/or HBeAg?
Cancer risk (liver)
Which hepatitis has no vaccine?
What are some Hep B tx?
- entecavir(DNA poly)
- telbivudine(HBV DNA poly)
How do anti flu drugs work?
- typically neuraminidase inhibitors
- tamiflu, relenza
What is atripla?
- efivirenz (NN RT inhib)
- emtricitabine (N RT inhib)
- Tenofovir (N RT inhib)
What is tenofovir?
- N RT inhibitor(part of atripla)
- known to prevent HIV infection in women
How does HPV induce cancer?
How does gardasil work?
- recombinant HPV-like, activate macrophages-> induce B cell prolif-> Ab
- 6,11, 16, 18
- 3x over 6 months
What does interferon do?
- chr 9
- inhibits transcription, translation, protein processing, virus maturation
What is sequinavir?
HIV protease inhibitor, binds and inactivates blocks HIV replication
Are HIV drugs effective against HBV?
yes, hep B uses RT
what is lamivudine?
nucleoside analog inhibitor of RT, HIV, HBV