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Herpes virus type 1 (HSV-1) primarily causes
oropharyngeal disease (including intraoral and eye).
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Herpes virus type 2 (HSV-2) primarily causes
genital disease, which is considered a sexually transmitted disease
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Herpes Simplex Virus can occur as a __________ or _________ infection
primary or recurrent
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Primary Herpes Infection is aka as _________ and occurs in ________ and characterized by ________
- primary herpetic gingivostomatitis
- infants and during childhood
- fever, malaise, nausea, and vomiting
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Primary herpetic gingivostamitits are characterized as ___________ and lesions appear ___________ and resolve within _________
- Painful intraoral vesicles on the oral mucosa rapidly rupture to form small ulcers with erythematous (red) haloes
- Lesions appear 12 to 36 hours after the first symptoms. Lesions are self-limiting and will resolve within 10 to 14 days
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Treatment of Primary Herpes infection is ________
palliative- fluids and analgesics such as acetaminophen (Tylenol).
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After primary occurrence the virus retreats to the _________ . Secondary infection is seen in periods of ___________
- trigeminal ganglion
- systemic weakness (infections, fevers, stress) when the virus travels down the sensory nerve and herpetic ulcers break out along course of nerve
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Recurrent Herpes Simplex Virus Infection is caused by the _________ and referred to as _________ . Recurrent outbreaks preceded by ___________ stage when patient feels _________
- HSV-1
- herpes labialis, cold sores, fever blisters
- “prodromal”
- tingling or unusual sensation
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Clinically, small vesicles or ulcers appear on ___________ oral mucosa
heavily keratinized
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What drugs should not be used in Recurrent Herpes Simplex Virus Infection
Antibiotics should not be used, nor should corticosteroids such as hydrocortisone or triamcinolone, which will further suppress the immune system and prolong the infection
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What are the two drug therapies for HSV Type 1 during initial infections and when must they be taken
- acyclovir (Zovirax) - interferes with viral DNA replication in host cell
- valacyclovir (Valtrex) - Prodrug that is converted into acyclovir in the body
- Must take at first signs of recurrent infection (prodromal symptoms).
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Recurrent herpes labialis: topical creams
–Acyclovir (Zovirax) 5% cream
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What are additional Antivirals for HSV Type I
- Penciclovir (Denavir) - Shortens duration and severity of recurrent outbreaks. Available as topical and recommended to ease cold sore pain. Best used from time of prodromal symptoms
- Famciclovir (Famvir) - Prodrug of penciclovir. Used to treat VZV lesions
- Docosanol cream (Abreva) – Only approved antiviral OTC
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What is the only available OTC antiviral
Docosanol cream (Abreva) – Only approved antiviral OTC
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HIV is a ________ that invades ___________ or ___________
- retrovirus
- T-lymphocytes or T-helpers (CD4-cells).
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A retrovirus is
any of a group of RNA viruses that insert a DNA copy of their genome into the host cell in order to replicate
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What is the function of T-helper cells
signal other components of the immune system to a problem area in the body for the other parts of the immune system to deal with those foreign cells
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Drug therapy should be started if the patient is symptomatic or if the asymptomatic patient has a CD4+ count of _______ or a viral load of ________
- <500 per mm3 (of blood)
- >30,000 copies per mL
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Four classes of drugs are currently available for the treatment of HIV infection
- 1.Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
- 2.Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- 3.Protease inhibitors (PIs)
- 4.Fusion (entry) inhibitors
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For HIV patients Using _____ drug combinations for initial therapy is termed ___________ and is the preferred initial regimen
- three
- highly active antiretroviral therapy (HAART)
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Typical combinations include _______ as a "backbone" along with _____, _____, or _______ as a "base."
- 2 NRTIs
- 1 NNRTI, PI or INSTI
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Many antiretroviral drugs have adverse side effects related to the mouth such as
- –Indinavir causes a metallic taste
- –Ritonavir causes taste impairment
- –Amprenavir causes oral paresthesias
- –Atazanvir causes dental pain, taste changes
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For HIV patients place patients on a topical fluoride supplement, such as ________, to prevent dental caries
PreviDent 1.1% neutral sodium fluoride toothpaste
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Chlorhexidine gluconate as an oral rinse is effective as an _______ and ________ preventitive by reducing _________ counts
- antiplaque and anticaries
- Lactobacillus
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_______, _______ and ________ are systemic drugs used for herpes infections
Acyclovir, famciclovir, and valacyclovir
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________ and _______ are indicated for the management of herpes labialis
Topical acyclovir and penciclovir
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Fungal infections - are caused by either _____ or ______
molds or yeasts
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Candida species is part of the normal flora in the
mouth, gastrointestinal and vaginal tracts
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What are the three Mucocutaneous Mycoses of the Mouth by Candida albicans
- –Thrush (acute pseudomembranous candidiasis)
- –Chronic atrophic candidiasis (denture-sore mouth)
- Esophageal candidiasis
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Systemic antifungal agents are used primarily for fungal infections NOT involving the _________ but can be used for severe mucocutaneous candidiasis infections
oropharyngeal area
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antifungal drugs should continue to be used about ________ after oral lesions disappear
two days
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What drug Formulations are there for treating Oral Candidiasis
- Oral suspension
- aginal cream or ointment
- Troches/pastilles (oral lozenges:very sweet) or vaginal suppositories
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Nystatin (Mycostatin)
- –Functions to cause fungal cell lysis (cells break apart)
- –Oral suspension that is swished around in the mouth, then swallowed
- –Lozenges that slowly dissolves in the mouth
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Chronic Atrophic Candidiasis occurs ________ and described as _________ and treatment is ___________
- under a maxillary denture
- Palatal tissue appears as small, asymptomatic (not painful) red spots
- Nystatin suspension and an antifungal cream
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Topical antifungal agents that can be used for Chronic Atrophic Candidiasis
- –Nystatin (Mycostatin) pastilles/oral suspension/ointment
- –Miconazole (Monistat) cream 2%
- –Ketoconazole cream 2%
- –Clotrimazole (Mycelex) cream and 2%/troches
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Acute Pseudomembranous Candidiasis aka as __________ can be described as _________ and caused by _________
- (Thrush)
- Oral mucous membranes present with a creamy, white plaque that easily wipes off with gauze, leaving a raw, red, bleeding connective tissue surface
- Candida albicans
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In patients taking broad-spectrum antibiotics that affect a broad range of bacteria, allowing fungi to grow taking _________may help to reduce the incidence of overgrowth of fungi while taking antibiotics
acidophilus or yogurt
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What patients are at risk of Thrush
- –Elderly, children, pregnant women
- –In patients taking inhaled steroids for asthma or allergic rhinitis
- –Patients with poorly fitting dentures
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What is the treatment for Thrush
- –Depends on the age of the patient Nystatin oral suspension- Good in infants
- For adults, treatment is with topical and/or systemic antifungal agents such as fluconazole (Diflucan).
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Severe and extensive oropharyngeal candidiasis can be treated with _________ taken how many times a day
- fluconazole (Diflucan)
- 100 to 200 mg orally twice a day
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Prophylactic fluconazole is good for candida
suppression in HIV disease
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Clotrimazole (Mycelex)
- –Comes in a troche (slowly dissolved in the mouth), and a cream
- Patients with a high caries index should not be given troches because they contain sugar. Use a cream instead
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Since systemic antifungal drugs are metabolized by the _________ enzymes, many other drugs that also are involved in this system will interfere
P450 cytochrome liver
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What are the causes of angular cheilosis and what is the treatment
- –Fungal infection caused by Candida albicans
- –B complex deficiency
- –Drooling/overclosure (moisture)
- –Topical antifungals
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Name some broad spectrum antibiotics
tetracycline, doxycycline, minocycline, amoxicillin
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Patient using a corticosteroid inhalant should be instructed to
rinse his mouth with water after each use to prevent development of oral candidiasis
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