Term
| False! Oral infections are broad spectrum and often mixed... therefore aminopenicillins (extended spectrum) are better than penicillin VK because it is narrow. |
|
Definition
| T/F: Oral infections are narrow spectrum therefore Penicillin VK is the best choice for treatment. |
|
|
Term
|
Definition
| ___'s absorption is not affected by food and is administered orally every 8 hours. |
|
|
Term
|
Definition
| ___ is uric acid in the joints. |
|
|
Term
|
Definition
| Ampicillin and amoxicillin are examples of ____ which are effective against g(+) and g(-). They have extended spectrum and can be taken with food without a decrease in effectiveness. |
|
|
Term
| probenecid... used to treat gout |
|
Definition
| Penicillin + ___ leads to decreased renal tubular secretion of penicillin. |
|
|
Term
|
Definition
| T/F: If you are allergic to one penicillin you are allergic to them all and may even be allergic to cephalosporins. |
|
|
Term
|
Definition
| Allergies, candidiasis, GI reactions and clostridium difficile colitis are all adverse reactions of which group of antibiotics? |
|
|
Term
|
Definition
| Penicillin __ is narrow spectrum, bactericidal and more stable to effects of GI enzymes. It can be administered orally every 6 hours, but is effected by food. It is excreted via the kidney (90% active tubular, 10% filtration) |
|
|
Term
|
Definition
| Penicillin ___ is used intravenously to treat Ludwig's Angina. |
|
|
Term
|
Definition
| Penicillin ___ is narrow spectrum, bactericidal which is susceptible to penicillinase. It can be administered IM and IV, but not orally because it is destroyed by stomach enzymes. It is not routinely used in dentistry. |
|
|
Term
|
Definition
| ___ of penicillins depend on the amount of peptidoglycan, number of penicillin receptors (PBP) and amount of autolytic enzymes. |
|
|
Term
|
Definition
| T/F: Penicillins have the most effect against growing and dividing cells. |
|
|
Term
| 1. transpeptidases are inhibited which inhibits cross-linkages between peptidoglycan polymer strands; 2. autolysins are promoted which breaks section of cell wall to permit bacterial cell growth. |
|
Definition
| When penicillins bind to penicillin binding proteins, what two things happen? |
|
|
Term
|
Definition
| ___ bind to PBPs which inhibit transpeptidases and promote autolysins. |
|
|
Term
|
Definition
| T/F: The bacterial cell wall is rigid, permeable and mesh-like. |
|
|
Term
| They are good for drug-resistant bacteria that produce beta-lactamase to destroy the antibiotics. |
|
Definition
| What makes cloxacillin, methicillin and amoxicillin/clavulanate different from other penicillins? |
|
|
Term
| penicillin VK and amoxicillin |
|
Definition
| What are the top two penicillins used in dentistry? |
|
|
Term
| penicillins and cephalosporins |
|
Definition
| ___ and ___ are beta-lactams which contain a beta-lactam ring which is the most important part of their structure. |
|
|
Term
| sulfonamides and trimethoprim |
|
Definition
| ___ and ____ are antimetabolites. |
|
|
Term
|
Definition
| ____ is a nucleic acid synthesis inhibitor. |
|
|
Term
| aminoglycosides (bactericidal), clindamycin, erythromycin and tetracyclines (bacteriostatic) |
|
Definition
| ___ is a bactericidal protein synthesis inhibitor, while ___, ___ and ___ are bacteriostatic protein synthesis inhibitors. |
|
|
Term
| penicillins, cephalosporins and vancomycin |
|
Definition
| ___ , ___ and ___ are cell wall synthesis inhibitors. |
|
|
Term
| False! It should be given only after incision and drainage. |
|
Definition
| T/F: Antibiotics should be give to treat periodontal abscesses/osteomyelitis/etc prior to incision and drainage. |
|
|
Term
| post surgery, to prevent endocarditis and neutropenia (low WBCs) |
|
Definition
| What are the three conditions that antibiotic prophylaxis are used? |
|
|
Term
|
Definition
| tetracyclines have a ___ spectrum. |
|
|
Term
|
Definition
| ____ spectrum agents are active against a wide range of pathogens. |
|
|
Term
|
Definition
| Amoxicillin is an ____ spectrum antibiotic. |
|
|
Term
|
Definition
| Pen VK, erythromycin and clindamycin are (narrow/broad) spectrum antibiotics. |
|
|
Term
| narrow, Pen VK, erythromycin and clindamycin |
|
Definition
| ___ spectrum agents are active against a single species or limited group of pathogens. |
|
|
Term
|
Definition
| ___ is the range of a drug. |
|
|
Term
|
Definition
| ___ antibiotic therapy is when you begin treatment immediately usually with a severe infection. |
|
|
Term
|
Definition
| A ___ is a new infection while a patient is being treated for a primary infection. It is more likely with a broad spectrum antibiotic and is often difficult to treat. |
|
|
Term
|
Definition
| Bacteria are said to be ___ if their growth is not halted by the maximum level of antibiotic that is tolerated by the host. |
|
|
Term
|
Definition
| T/F: Erythromycin, clarithromycin, azithromycin, clindamycin, tetracycline and doycycline are bacteristatic. |
|
|
Term
|
Definition
| T/F: Pen VK, amox, cephalexin, cefadroxil, metronidazole and ciprofloxacin are bacteriostatic. |
|
|
Term
| Bacteriocidal because it relies less on the immune system to overtake bacteria |
|
Definition
| Btwn bacteriostatic and bacteriocidal, which is better for immunocompromised patients? |
|
|
Term
| By disrupting bacterial protein synthesis/ribosomes |
|
Definition
| clindamycine, tetracyclin, erythromycin, clarithromycin and azithromycin all inhibit invading organisms how? |
|
|
Term
| Folic acid is a building block for DNA/RNA. Bacteria must synthesize folic acid from PABA and humans obtain it from diet. Therefore, if the synthesis of folic acid is inhibited (by sulfonamides, for example), bacteria die. |
|
Definition
| What is folic acid's significance in selective toxicity? |
|
|
Term
| 1. disrupt bacterial cell wall, 2. inhibit enzyme unique to bacteria (folic acid), 3. disrupt bacterial protein synthesis |
|
Definition
| What are the 3 ways that a substance can be selectively toxic to invading organisms? |
|
|
Term
| inhibiting folic acid synthesis |
|
Definition
| Sulfonamides inhibit invading organisms by doing what? |
|
|
Term
| By disrupting bacterial cell wall |
|
Definition
| Penicillins, cephalosporins and vancomycin affect invading organisms how? |
|
|
Term
|
Definition
| The principle of ___ ___ is where drugs inhibit functions of invading organisms or neoplastic cells that differ from normal cells. |
|
|
Term
|
Definition
| ___ is the use of drugs to eradicate pathogens or neoplastic cells. It is based on selective toxicity. |
|
|
Term
|
Definition
| ___ infection is an infection caused by normal flora. |
|
|
Term
|
Definition
| ___ is the invasion or multiplication of microorganisms in the body tissues resulting in local cellular injury due to competitive metabolism, toxin production or immune-mediated reactions. |
|
|
Term
|
Definition
| ___ substances destroy/suppress growth/multiplication of viruses. |
|
|
Term
|
Definition
| ___ substances destroy/suppress growth/multiplication of fingi. |
|
|
Term
| antibiotics/antibacterial |
|
Definition
| ____/____ agents are substances that destroy or suppress the growth or multiplication of bacteria. |
|
|
Term
|
Definition
| ____ agents are substances that destroy/suppress growth or multiplication of microorganisms. |
|
|
Term
|
Definition
| ____ agents are substances that act against or destroy infections. |
|
|
Term
| Betalactamase/Penicillinase |
|
Definition
| ___ is an enzyme produced by some bacteria that destroys penicillin V and amoxicillin. |
|
|
Term
| penicillin V and amoxicillin |
|
Definition
| Bacteria that produce penicillinase are said to be resistant to ____ and ____. |
|
|
Term
| 1. use penicillins (Cloxacillin and methicillin) that are resistant to the enzyme ; 2. use amoxicillin and clavulanic acid combination to destroy the enzyme |
|
Definition
| What are two ways to overcome bacteria that contain betalactamase? |
|
|
Term
| Cloxacillin and methicillin |
|
Definition
| ___ and ___ are penicillins not affected by penicillinase. |
|
|
Term
| amoxicillin and clavulanate (clavulanic acid) |
|
Definition
| Augmentin is the choice antibiotic for penicillin resistant bacteria. It contains ___ and ___. |
|
|
Term
|
Definition
| ___ inhibits beta-lactamase and when paired with amoxicillin, is the choice antibiotic for penicillin resistant strains. |
|
|
Term
| Because the interaction that occurs in the GI tract activates thems |
|
Definition
| Why aren't oral contraceptives injected? |
|
|
Term
|
Definition
| ___ generation cephalosporins are destroyed by lactamases. |
|
|
Term
|
Definition
| ___ generation cephalosporins are more resistant to lactamases and work with mainly g(+) bacteria. |
|
|
Term
|
Definition
| ___/___ generation cephalosporins are highly resistant to lactamases and are more effective against g(-) bacteria. |
|
|
Term
|
Definition
| ___ have adverse reactions similar to penicillins (allergic reactions, GI and cross-sensitivity w/penicillin) |
|
|
Term
|
Definition
| ___ acts as precursors to cell wall synthesis and is effective against MRSA. |
|
|
Term
|
Definition
| ___ is not absorbed from GI and is excreted unchanged by the kidneys. It is used orally for serious GI infections, via slow-infusion for serious infections and should never be given via bolus injection due to histamine reaction. |
|
|
Term
|
Definition
| ___ is used orally to treat pseudomembranous collitis along with metronidazole. |
|
|
Term
| erythromycin, azithromycin and clarithromycin (--romycin) |
|
Definition
| ___, ___ and ___ are macrolides. |
|
|
Term
| erythromycin, azithromycin and clarithromycin (--romycin = macrolides) |
|
Definition
| ___, ___ and ___ are antibiotics that inhibit protein synthesis. The have a greater affinity for microbial robosomes because protein synthesis occurs at a much faster rate here than in host cells. |
|
|
Term
|
Definition
| Tetracyclines, macrolides and clindamycin are bacteri(ostatic/cidal). |
|
|
Term
| tetracycline (along with tetracycline) |
|
Definition
|
|
Term
|
Definition
| Erythromycin, azithromycin and clarithromycin are ____. |
|
|
Term
|
Definition
| ___ is used in refractory pockets or ANUG. It blocks protein synthesis by binding to ribosomes. |
|
|
Term
| Tetracycline, it is used clinically to treat acne, peptic ulcer and periodontal diseases |
|
Definition
| Bacteria can be resistant against ___ by reducing drug accumulation, increasing drug inactivation and decreasing binding to ribosomes by changing binding sites. |
|
|
Term
|
Definition
| Discoloration of bone/teeth, photosensitivity, GI disturbances and hypertrophy of papilla are all adverse reactions of ____. |
|
|
Term
|
Definition
| ___ interact with cations (Ca, Al, Mg, etc), protein synthesis inhibiting antibiotics and oral contraceptives. |
|
|
Term
|
Definition
| ___ is a narrow spectrum alternative for patients with allergies to penicillins. It binds to ribosomes and blocks addition of new amino acids to the growing peptide (blocks protein synthesis). |
|
|
Term
|
Definition
| ___ frequently has GI disturbances, but rarely QT prolongation leading to cardiotoxicity. |
|
|
Term
|
Definition
| ___ interacts with antihistamines by increasing cardiotoxicity, cyclosporins by causing gingival overgrowth, warfarin by increasing clotting time (leading to increased bleeding), and triazolam/midazolam by increasing sedation. |
|
|
Term
| antihistamine (cardiotoxicity), cyclosporin (gingival overgrowth), warfarin (bleeding), triazolam/midazolam (increase sedation) |
|
Definition
| Erythromycin interacts with ___ (increase cardiotoxicity), ___ (gingival overgrowth), ___ (increase bleeding), ___/___ (increase sedation). |
|
|
Term
|
Definition
| Clindamycin, cephalosporins, ampicillin and erythromycin often cause ___ ___ in elderly and women with GU diseases. |
|
|
Term
| PC has a delayed onset whereas diarrhea is immediate. |
|
Definition
| What is the main difference between pseudomembranous colitis and diarrhea? |
|
|
Term
| metronidazole and vancomycin |
|
Definition
| Which antibiotics are used to treat pseudomembranous colitis and do not cause it? |
|
|
Term
| sulfonamides (aka sulfa-drugs) |
|
Definition
| ___ are bacteriostatic antibiotics that competitively inhibit folic acid synthesis. |
|
|
Term
| sulfonamides such as sulfamethoxazole |
|
Definition
| ___ are used to treat UTIs, conjunctivitis and corneal ulcers. |
|
|
Term
|
Definition
| If someone is allergic to sulfonamides, they are most likely also allergic to ___ local anesthetics. |
|
|
Term
|
Definition
| ___ is used with sulfamethoxazole to block folic acid sysnthesis at a different site. |
|
|
Term
| fluoroquinolones and metronidazole |
|
Definition
| ___ and ___ are nucleic acid synthesis inhibitors. |
|
|
Term
| metronidazole = bactericidal |
|
Definition
| ___ is a prodrug (chemically reduced to a toxic metabolite) which interacts with DNA resulting in loss of helical structure, strand breakage, inhibition of nucleic acid synthesis and cell death. |
|
|
Term
|
Definition
| ___ is administered after amoxicillin for periodontal abscesses caused by g(-) bacteria. |
|
|
Term
|
Definition
| ___ + alcohol --> disulfram reaction = confusion, psychotic reactions, convulsions. |
|
|
Term
| ciprofloxacin = fluoroquinolones |
|
Definition
| Ciprofloxacin is a ____ which is bactericidal and may cause cartilage damage in children <18 yrs old. |
|
|
Term
|
Definition
| ____ like cipro inhibit bacterial DNA gyrase preventing the conversion of closed circular DNA into a supercoiled configuration. This stops DNA replication. |
|
|
Term
|
Definition
| ____'s latent infection can be treated with isoniazid or rifampin alone. The active infection should be treated with a combination of isoniazid, rifampin, pyrasinamine and streptomycin/ethambutol to arrest the infection. |
|
|
Term
|
Definition
| ___ has lots of drug interactions and colors saliva and body fluids orange! |
|
|
Term
|
Definition
| ___ and __ are topical antibiotics that effect cell membranes. |
|
|
Term
|
Definition
| ___ is the presence of viable bacteria in the circulating blood. |
|
|
Term
|
Definition
| ___ ___ is the administration of antibiotics in the ABSENCE of infection. Its aim is to prevent microbial colonization and reduce potential post-op complications. |
|
|
Term
|
Definition
| T/F: IE is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by dental/GI tract/GU tract procedure. |
|
|
Term
|
Definition
| Amoxicillin administered orally to an adult = ___g and ___ mg/kg for a child. |
|
|
Term
| 600mg for adult, 20mg/kg for child |
|
Definition
| If someone is allergic to penicillin or ampicillin, clindamycin administered orally to an adult = ___mg and ___mg/kg to a child. |
|
|
Term
| 500mg to adult, 15mg/kg to child |
|
Definition
| If a patient is allergic to penicillin, ampicillin and clindamycin, azithromycin or clarithromycin administered orally to an adult = ___mg and ___mg/kg to a child. |
|
|
Term
|
Definition
| T/F: A child >/= 70 kg is given an adult dose of antibiotics. |
|
|
Term
| 1st false, 2nd true... It is NOT required for pins, plates or screws. |
|
Definition
| T/F: Antibiotic prophylaxis is required for pins, plates and screws in total joint prosthesis. It is not routinely indicated for total joint replacement unless a patient is at increased risk. |
|
|
Term
|
Definition
| T/F: Patients during the first two years following total joint replacement, on anticancer drugs, corticosteroids or antirejection drugs should be given antibiotic prophylaxis. |
|
|
Term
|
Definition
| Fungal infection diseases are called ____. Histoplasmosis, candidiasis and aspergillosis are examples seen in dentistry. |
|
|
Term
| Nystatin = polyene; ketoconazole, clotrimazole and fluconazole |
|
Definition
| ____ is a polyene antifingual agent. ____, ____ and ____ are azole antifungal agents. |
|
|
Term
|
Definition
| T/F: Metronidazole is an antifungal. |
|
|
Term
|
Definition
| ____ and ____ are antifungals that alter cell membrane permeability. |
|
|
Term
| ergosterol, nystatin binds to ergosterol |
|
Definition
| ___ is the primary sterol in the cell membrane of sensitive fungi. ___ binds to this causing the formation of pores resulting in cellular constituents leaking and cell death. |
|
|
Term
|
Definition
| ___ is selective against Candida species. It is administered topically for candida infections. It is not absorbed via GI or following topical application to intact skin or mucous membranes. |
|
|
Term
|
Definition
| ____ is a broad spectrum antifungal that can be administered systemically and topically. It inhibits ergesterol synthesis. |
|
|
Term
|
Definition
| ___ may cause hepatotoxicity, inhibit hormone synthesis causing gynecomastia in males and menstrual irregularities in females. |
|
|
Term
|
Definition
| ____ inhibits ergosterol synthesis and is the drug of choice for patients with AIDS. It also tastes better than nystatin. |
|
|
Term
|
Definition
| ___ is a triazole also known as Diflucan. It is water soluble and available in creams and lozenges. |
|
|
Term
|
Definition
| ___ acts as an antimetabolite and competes with uracil for incorporation into fungal DNA. It is active against Candida and Crytococcus species. |
|
|
Term
|
Definition
| Resistance to ___ occurs readily due to mutation of the enzyme and overproduction of uracil. It is well absorbed orally and eliminated unchanged in the urine. |
|
|
Term
|
Definition
| ____ inhibits mitosis of fungal cells by impairing microtubule protein. This mechanism only effects growing fungal cells. It is selectively concentrated in skin and nail beds to act against dermatophytes. |
|
|
Term
|
Definition
| ___ is active against dermatophytes. |
|
|
Term
| AZOLES (ketoconazole, clotrimazole, fluconazole) and POLYENES (nyastatin) alter fungal cell membrane permeability. FLUCOCYTOSINE blocks nucleic acid synthesis. GRISEOFULVIN disrupts microtubule function. |
|
Definition
| ____ and ____ alter fungal cell membrane permeability. ____ blocks nucleic acid synthesis. ____ disrupts microtubule function. |
|
|
Term
|
Definition
| HSV __ causes herpes labialis. HSV ___ causes herpes genitalis. |
|
|
Term
|
Definition
| ___ is a systemic and topical anti-viral for herpes virus. |
|
|
Term
|
Definition
| ___ is a nucleoside analogue prodrug that is phosphorylated by herpes infected cell to form an active triphosphate metabolites. |
|
|
Term
|
Definition
| ___ stops viral DNA synthesis in herpes infected cells. |
|
|
Term
|
Definition
| ____ is a prodrug rapidly converted to acyclovir in the liver (a pro-prodrug). |
|
|
Term
|
Definition
| ____ is an nucleoside reverse transcriptase inhibitor used to treat HIV. |
|
|
Term
|
Definition
| ____ is a non-nucleoside reverse transcriptase inhibitor used to treat HIV. |
|
|
Term
|
Definition
| ___ is a protease inhibitor used to treat HIV. |
|
|
Term
|
Definition
| NRTIs like ___ are active against RNA viruses such as HIV by preventing RNA being transcribed as viral DNA. |
|
|
Term
|
Definition
| NNRTIs like ____ treat HIV by binding to viral RNA reverse transcriptase enzyme and preventing chain elongation. |
|
|
Term
|
Definition
| Protease inhibitors like ___ treat HIV by blocking infectivity of viruses. It then decreases the serum viral load. |
|
|
Term
|
Definition
| Inferon alpha, ribavirin and interferon alpha-2b are antiviral agents to treat ____ ___/___. |
|
|
Term
|
Definition
| ___ is a first generation drug used to treat influenza. ___ is a second generation drug. |
|
|
Term
|
Definition
| ___ is an influenza prophylaxis, also used to treat parkinson's disease and drug-induced extrapyramidal reactions. |
|
|
Term
|
Definition
| ___ is an antiviral used to treat influenza which inhibits/delays uncoating process that precedes transcription. |
|
|
Term
| oseltamivir and zanamivir |
|
Definition
| ____ and ___ are used to treat influenza A/B by inhibiting neuraminidase, therefore inhibiting viral replication by alteration in viral particle aggregating and release. |
|
|
Term
|
Definition
| ___ are local hormones such as histamine. They are synthesized by cells, released locally and affect local cells. |
|
|
Term
| Histamine (blocked by antihistamines) |
|
Definition
| ___ mediates allergies, inflammatory reactions, pain, gastric acid secretion and neurotransmission in CNS. It has no clinical application except in blocking them. |
|
|
Term
|
Definition
| There are high amounts of ___ is the lungs, skin and GI tract. |
|
|
Term
| red spot due to vasodilation, wheal due to fluid leakage causing edema and flare is diffuse edema |
|
Definition
| The red spot caused by ___, ___ caused by fluid leakage --> edema and ___ which is diffuse edema are the three parts of the classic triple response to histamine. |
|
|
Term
|
Definition
| Decarboxylation of histidine to histamine occurs mainly in ___ ___ and ____. |
|
|
Term
|
Definition
| Once released, free histamine is rapidly metabolized/inactivated by ___ ___. |
|
|
Term
|
Definition
| Ig___ interacts with an antigen causing degranulation of mast cells. This causes the release of histamine. |
|
|
Term
|
Definition
| Complement components C__ __ and C__ __ interact with specific receptors on cell surface leading to the release of histamine. |
|
|
Term
|
Definition
| Histamine release can be blocked by ___ ___. |
|
|
Term
|
Definition
| ___ ___ inhibits sensitized mast cell degranulation by indirectly blocking calcium ions from entering the cells. |
|
|
Term
|
Definition
| ___ ___ blocks immediate/non-immediate bronchoconstrictive reaction to inhaled antigens. It has no instrinsic bronchodilator/antihistamine activity. |
|
|
Term
|
Definition
| T/F: Cromolyn sodium has intrinsic bronchodilating and antihistamine activity. |
|
|
Term
| morphine and tubocurarine |
|
Definition
| LPS and drugs such as ___ and ___ chemically stimulate the release of histamine from mast cells. |
|
|
Term
|
Definition
| H__ receptors deal with allergic reactions. When stimulated it increases vascular permeability, vasodilation, bronchoconstriction, edema, redness, hives and inflammation. |
|
|
Term
|
Definition
| H__ receptors deal with gastric mucosa by increasing gastric secretion. |
|
|
Term
| 1st true, 2nd false, antihistamines are classic H1 receptor blockers |
|
Definition
| T/F: Antihistamines block receptors before histamine release occurs. They interact with/block H2 receptors. |
|
|
Term
|
Definition
| Diphenylhyramine, hydroxyzine and promethazine are ___ generation H1 receptor antagonists. |
|
|
Term
|
Definition
| T/F: 1st generation is non-drowsy and 2nd generation is drowsy. |
|
|
Term
|
Definition
| Cetirizine, fexofenadine and loratadine are ___ generation H1 receptor antagonists and do not cross the BBB. |
|
|
Term
| 1st generation such as Diphenylhydramine, promethazine and hyroxyzine |
|
Definition
| ___ generation H1 antagonists have rapid oral absorption, can cross BBB, and are extensively metabolized by CYP450. |
|
|
Term
|
Definition
| ___, a 1st generation H1 antagonist, has active metabolites. |
|
|
Term
|
Definition
| ___ generation cause sedation by blocking central H1 receptors. |
|
|
Term
|
Definition
| ___ generation have anticholinergic effects (dry mouth, stops vomiting) and also used in local anesthetics. |
|
|
Term
|
Definition
| ___ generation H1 antagonists are used for motion sickness, drug-induced extrapyramidal symptoms, antitussive (anticough), and can cause paradoxical reactions as well as dry mouth. |
|
|
Term
| 2nd generation such as Cetirizine, fexofenadine and loratadine |
|
Definition
| ___ generation H1 antagonists have rapid oral absorption and are then widely distributed. They do not penetrate the BBB, however. |
|
|
Term
|
Definition
| T/F: 2nd generation H1 antagonist have local anesthetic activity. |
|
|
Term
|
Definition
| ___ generation H1 antagonist causes prolonged QT interval and interacts with drugs that increase serum concenration of antihistamine. |
|
|
Term
| macrolide antibiotics like erythromycin interact with 2nd generation |
|
Definition
| Macrolide antibiotics such as ____ and ketoconazole azole antifungals interact with ___ generation H1 antagonists. |
|
|
Term
|
Definition
| ____ interact with alcohol, macrolide antibiotics, and grapefruit juice. |
|
|
Term
|
Definition
| Cimetidine, ranitidine and famotidine are all H___ receptor antagonists. |
|
|
Term
|
Definition
| H__ receptor antagonists are used to treat duodenal ulcers, GERD and gastric ulcers. |
|
|
Term
| hypothalamus and pituitary gland |
|
Definition
| ___ and ___ gland function cooperatively as regulators of endocrine system. |
|
|
Term
| thyroxine (T4) and triiodothyronine (T3) |
|
Definition
| The follicular thyroid cells secrete ___ and ___ that regulate metabolism and growth. |
|
|
Term
|
Definition
| The parafollicular C cells secrete ___ that regulates bone mineral homeostasis. |
|
|
Term
| calcitonin, thyroxine (T4), triiodothyronine (T3) |
|
Definition
| ___ regulates bone mineral homeostasis. ___ and ___ regulate metabolism and growth. |
|
|
Term
|
Definition
| Graves disease is due to ___thyroidism. |
|
|
Term
| thyrotoxicosis (excessive circulating thyroid hormones) |
|
Definition
| Excessive heat, increase sympathetic activity, increase pain sensitivity, protruding eyes, anxiety and avoiding epinephrine describe ____. |
|
|
Term
| methimazole and propylthiouracin (PTU) |
|
Definition
| Thioamides such as ___ and ___ are used to manage hyperthyroidism. |
|
|
Term
| thioamides (methimazole, propylthiouracil), iodine, beta-blockers |
|
Definition
| ___, ___ and ___-___ are used to manage hyperthyroidism. |
|
|
Term
| methimazole and propylthiouracil |
|
Definition
| ___ and ___ are thioamides and decrease T4/T3 production/synthesis to manage hyperthyroidism. |
|
|
Term
|
Definition
| Non radioactive __ ___ inhibits hormone release and decreases the size of the hyperplastic gland. Side effects include salivary gland swelling and tenderness. |
|
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Term
|
Definition
| Radioactive ___ destroys thyroid parenchyme cells. |
|
|
Term
|
Definition
| Beta-blockers such as ___ reduce hyperthyroid symptoms and nonselectively decreases circulating T3 levels. They do not effect T4. |
|
|
Term
| False! It only nonselectively decreases circulating T3 levels |
|
Definition
| T/F: Beta blockers affect both T4 and T3 levels. |
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Term
|
Definition
| ___ ___ is a rare medical emergency characterized by thyrotoxicosis with fever and tachycardia. Patient is given epinephrine, otherwise may suffer from pneumonia. |
|
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Term
|
Definition
| ___ is characterized by low circulating levels of T4/T3 and may cause permanent mental retardation in infants/children. |
|
|
Term
| primary = thyroid, secondary = pituitary, tertiary = hypothalamus |
|
Definition
| Primary hypothyroidism = ____. Secondary hyperthyroidism = ____. Tertiary hypothyroidism = ____. Hypothyroidism may also be caused by generalized resistance to thyroid hormone in peripheral tissues caused by a defect in beta receptors for T3/T4. |
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Term
|
Definition
|
|
Term
|
Definition
| ___ is the active component which controls DNA transcription, protein synthesis, gluconeogenesis, increases BMR and metabolism of glycogen stores. |
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Term
|
Definition
| ____ is the most widely used drug used to manage hypothyroidism. It is a synthetic T4 hormone. |
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|
Term
|
Definition
| Adverse effects of ___ include coronary heart disease and exacerbation of angina while it is used to manage hypothyroidism. |
|
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Term
|
Definition
| ___ is an extract of thyroid glands from animals. T__ is the major component with the same adverse effects as levothyroxine. |
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Term
|
Definition
| ____ hormone regulates plasma calcium levels. |
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Term
|
Definition
| ___ is a recombinant DNA human parathyroid hormone that stimulates bone formation. |
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Term
|
Definition
| Raloxifene, calcium nitrate, and premarin are used to treat ___. |
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Term
|
Definition
| ___ increases bone mass and has analgesic properties. |
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Term
|
Definition
| ___ such as alendronate prevent bone reabsorption by inhibiting osteoclast activity. |
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Term
|
Definition
| __ are used to treat glucocorticoid-induced isteoporosis. |
|
|
Term
| alendronate sodium, a bisphosphonate |
|
Definition
| ___ ___ may cause GI mucosa irritation, interact with aspirin and NSAIDs, and prevent extraction sites from healing. |
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Term
|
Definition
| ___ are associated with osteonecrosis of the jaw. |
|
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Term
|
Definition
| Osteonecrosis of the jaw associated with ___ are usually seen in patients with a history of cancer, immunosuppressed, anemia and osteoporosis. |
|
|
Term
| gastroesophageal reflux disease |
|
Definition
| GERD stands for ______ ___ ___. |
|
|
Term
| 1. H2 antagonists; 2. proton pump inhibitors; 3. sucralfate; 4. Cisapride |
|
Definition
| Name the four classes of drugs used to treat GERD. |
|
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Term
|
Definition
| Gastric ___ release from entrochrom-like cells in the gastric fundus is stimulated by gastrin leading to H+ receptor activation on parietal cells. |
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Term
|
Definition
| Anticholinergic stimulation will also affect ___ secretion. |
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|
Term
|
Definition
| Cimetidine, Ranitidine, Famotidine and Nizatidine are all ___ ___ ___. |
|
|
Term
|
Definition
| H2 receptor antagonists compete for H2 receptors on gastric ___ cells. It inhibits H+/K+-ATPase proton pump to reduce concentration of gastric acid production. |
|
|
Term
| It increases it from 5.5-6.5 |
|
Definition
| How do H2 receptor antagonists affect gastric pH? |
|
|
Term
|
Definition
| ___ ___ are used to treat conditions associated with excessive acid production such as dyspepsia, peptic ulcer disease and gastroesophageal reflux disease. |
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|
Term
|
Definition
| __ ___ ___ may cause confusion in elderly patients with renal impairment and gynecomastia in males. |
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|
Term
| benzodiazepines, macrolide antibiotics and codeine |
|
Definition
| H2 receptor antagonists inhibit CYP450 isoenzymes involved in the metabolism of ___, ___ ___ and ___. |
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|
Term
|
Definition
| ___ is used in the treatment of zollinger-ellison syndrome. |
|
|
Term
|
Definition
| Impotence and gynecomastia caused by cimetidine is due to its ___ effects. |
|
|
Term
|
Definition
| ___ is a proton pump inhibitor. |
|
|
Term
|
Definition
| Proton pump inhibitors (reversibly/irreversibly) bind proton pumps causing cells to synthesize new ATPase. They have a long duration of action and decrease acidity of the stomach. |
|
|
Term
| peptic ulcers, GERD and zollinger-ellison syndrome |
|
Definition
| Proton pump inhibitors treat ___ ___, ___ and __-___ ___. |
|
|
Term
|
Definition
| ___ is a polysaccharide with antipeptic activity that acts as a cytoprotective agent. |
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|
Term
|
Definition
| ___ forms a protective, non-absorbable barrier over an ulcer in the presence of gastric acid. |
|
|
Term
|
Definition
| Sucralfae, bismuth salts and bismuth salicylic acid are all ___ agents. |
|
|
Term
|
Definition
| Helicobacter pylori and long term use of NSAIDs may cause ___ ___. |
|
|
Term
|
Definition
| ____ is a PGE1 analog that inhibits gastric acid secretion by inhibiting histamine-stimulated cAMP production. |
|
|
Term
|
Definition
| ___ ___ is a g(-) microorganism that is directly linked to peptic ulcers and gastritis. |
|
|
Term
| 1. tetracycline, 2. amoxicillin, 3. clarithromycin, 4. metronidazole |
|
Definition
| Which four antibiotics are used to treat peptic ulcers? |
|
|
Term
|
Definition
| ___ are weak bases that neutralize acids and increase pH. They reduce gastric acid and activity of pepsin, stimulate prostaglandin release and provides protective barrier for ulcer sites. |
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|
Term
|
Definition
| Aluminum hydroxide and magnesium hydroxide are ___. They may interact with tetracycline antibiotics (doxicycline and aminocycline). |
|
|
Term
|
Definition
| ___ promote bowel movements and treat constipation. They hasten elimination of toxic substances and assist in radioimaging of GI tract. |
|
|
Term
|
Definition
| ___ laxatives are inorganic salts such as magnesium sulfate. They are poorly absorbed and act in the intestines by attracting/holding water in intestinal lumen. |
|
|
Term
|
Definition
| __ ___ is the most potent saline laxative. It may alter fluid and electrolyte balance. |
|
|
Term
| psyillium and methylcellulose |
|
Definition
| Organic hydrophilic colloids such as ___ and ___ are bulk-forming agents that mimic normal physiology. |
|
|
Term
|
Definition
| Irritant laxatives such as ___ ___ increase peristaltic movement. Misuse may lead to hypokalemia, dehydration and severe diarrhea. |
|
|
Term
|
Definition
| ___ ___ is an irritant laxative and is hydrolyzed in the intestine to its active form, ricinoleic acid. |
|
|
Term
|
Definition
| ___ is a lubricant laxative that holds water within the fecal mass, softening the stool. |
|
|
Term
|
Definition
| ___ laxatives may decrease absorption of fat-soluble vitamins (A, D, K, E). |
|
|
Term
|
Definition
| ___ diarrhea is usually caused by laxative abuse, lactose intolerance or endocrine disorders. ___ diarrhea is usually caused by infection, toxins or drugs (antibiotics). |
|
|
Term
| viral / bacterial-induced |
|
Definition
| Diphenoxylate with atropine is used to treat ___/__-___ diarrhea. |
|
|
Term
| pseudomembranous collitis |
|
Definition
| Clindamycin, penicillins, macrolides, tetracyclines and cephalosporins are all used to treat ___ ___. |
|
|
Term
| corticosteroids (endocrine drugs) |
|
Definition
| ____ may cause inflammatory bowel disease. |
|
|
Term
|
Definition
| Diphenoxylate is a ___-derivative used to treat irritable bowel syndrome. |
|
|
Term
|
Definition
| ___ is induced by activation of the vomiting center, chemoreceptor trigger zone or vestibular apparatus. |
|
|
Term
|
Definition
| ____ is also an antihistamine that is used to control anesthesia-induced emesis. It may cause head-neck movements, however. |
|
|
Term
|
Definition
| ____ blocks dopamine-2 and 5-HTN receptors. It is employed in cisplatin (an anticancer drug)-induced emesis. |
|
|
Term
|
Definition
| ____ is a synthetic cannabinoid employed in emesis associated with anti-cancer drugs, increases appetite, has analgesic properties and can produce euphoria. |
|
|
Term
|
Definition
| ___ (benadryl) is 1st generation H1 antagonist antihistamine along with hydroxacin and promethazine. |
|
|
Term
| scopolamine and propantheline |
|
Definition
| ____ (a rinse) and ____ (a transdermal patch) are anticholinergics that cause drowsiness and dry mouth. |
|
|
Term
| tolterodine and oxybutynin |
|
Definition
| ____ and ___ are anticholinergics used to treat urinary incontinence. |
|
|
Term
| Adrenal glands = kidneys; Cortex secretes gluco / cortisol and mineral / aldosterone |
|
Definition
| The adrenal glands are located on the ____. The cortex secretes glucocorticoids (such as ____) and mineralcorticoids (such as ____). |
|
|
Term
|
Definition
| Adrenocorticotrophic hormone is secreted from the ___ ____. |
|
|
Term
| Corticotropic Releasing Factor (CRF) |
|
Definition
| ____ ____ ____ is a peptide in papaventricular nucleus of hypothalamus. Its secretion is stimulated by parasympathetic pathways and stress. |
|
|
Term
| negative feedback, as one gets too high, the other inhibits its secretion |
|
Definition
| Glucocorticoids act by a (negative/positive) feedback mechanism with CRF and ACTH. |
|
|
Term
| Adrenocorticotrophic hormone --> adrenal cortex synthesizes cortisol |
|
Definition
| _____ _____ is secreted from the anterior pituitary gland. It stimulates the adrenal cortex which synthesizes ___ and other glucocorticoids. |
|
|
Term
|
Definition
| ___ also known as hydrocortisone occurs naturally at low levels and is synthesized as needed by the adrenal cortex. |
|
|
Term
| cortisol (a glucocorticoid) |
|
Definition
| ___ stimulates peripheral fat and protein break down to become substrates for glucose production. |
|
|
Term
| cortisol (a glucocorticoid) |
|
Definition
| ___ stimulates protein break down increasing the amino acid supply needed for sugar production. |
|
|
Term
| cortisol (a glucocorticoid) |
|
Definition
| Thinning of the skin, muscle wasting, negative nitrogen balance, Cushing's syndrome, fat redistribution and diabetic-like symptoms are adverse reactions of ____. |
|
|
Term
| cortisol (a glucocorticoid) |
|
Definition
| ___ stimulates fat breakdown while inhibiting glucose uptake by adipose tissue. |
|
|
Term
| cortisol (a glucocorticoid) |
|
Definition
| ___ ensure the supply of glucose to the brain during stress or survival situations by stimulating gluconeogenesis and reducing peripheral glucose utilization. |
|
|
Term
| Increase! By stimulating gluconeogenesis and reducing peripheral glucose utilization. |
|
Definition
| Cortisol causes blood glucose to (increase/decrease). |
|
|
Term
| cortisol (a glucocorticoid) |
|
Definition
| ___ induces formation of glucose from amino acids. This may cause diabetic-like symptoms. |
|
|
Term
| cortisol (a glucocorticoid) |
|
Definition
| ___ prevents leukocyte migration into extravascular spaces, suppresses activation of T lymphocytes, suppresses the production of cytokines and inhibits production of arachidonic acid metabolites (prostaglandins). This induces a profound anti-inflammatory and immunomodulatory effect. |
|
|
Term
| cortisol (a glucocorticoid) |
|
Definition
| ___ stabilizes lysosomal membranes and prevents mast cells from releasing inflammatory mediators. |
|
|
Term
| cortisol (a glucocorticoid) |
|
Definition
| ___ may cause increased bone catabolism leading to osteoporosis. It may also exacerbate peptic ulcers by stimulating gastric acid and pepsin production. |
|
|
Term
|
Definition
| Prednisone, methylprednisone and triamcinolone are all ____ along with cortisol and cortisone. |
|
|
Term
| hydrocortisone and cortisone / prednisone |
|
Definition
| ___ is a short-acting corticosteroid. ___ is an intermediate-acting corticosteroid. |
|
|
Term
| Betamethasone / beclomethasone |
|
Definition
| ___ is a long-acting corticosteroid. ___ is an inhaled corticosteroid. |
|
|
Term
|
Definition
| Glucocorticoids are used as replacement therapy in ____ disease to counteract adrenal corticol deficiency. It is also used as a supplement in lupus and arthritis. |
|
|
Term
|
Definition
| Topical ___ are used to treat oral lesions such as apthous stomatitis, vesiculo-bullous diseases, burning mouth/tongue and drug-induced cancer [stomatitis]. It is often called Magic Mouthwash. |
|
|
Term
| False! Usually only occurs at supra-physiological doses |
|
Definition
| T/F: Cushing's syndrome occurs with glucocorticoid replacement therapy. |
|
|
Term
|
Definition
| Osteoporosis, hyperglycemia, muscle wasting, weakness, growth-retardation and delayed wound healing may be adverse reactions due to ____ use. |
|
|
Term
|
Definition
| Ecchymoses (bleeding), mood changes and oral candidiasis are possible adverse reactions of ____. |
|
|
Term
|
Definition
| Recovery of full adrenal function due to long-term use of glucocorticoids can take up to ____ years. |
|
|
Term
| prednisone / adrenal suppressed |
|
Definition
| Patients who have received high doses of ___ for 7-10 days in past year or patients receiving typical maintenance dose are considered ___ ___. |
|
|
Term
|
Definition
| Cataracts/glaucoma, Tb history, ocular herpes simplex, infections and osteoporosis are all contraindications of ____. |
|
|
Term
|
Definition
| The pancreas secretes ___ and ___. |
|
|
Term
| alpha = glucagon / beta = insulin |
|
Definition
| __ cells in the islets of Langerhans produce glucagon. ___ cells produce insulin. |
|
|
Term
|
Definition
| ___ and ___ play a primary role in regulation of glucose metabolism. |
|
|
Term
|
Definition
| ___ increases hepatic glucose output and blood glucose concentration. |
|
|
Term
|
Definition
| ___ promotes the uptake, utilization and storage of glucose. It thereby lowers plasma glucose concentration. |
|
|
Term
|
Definition
| ___ is insulin linked to a C peptide. |
|
|
Term
|
Definition
| High blood glucose is the main trigger for the release of ___. |
|
|
Term
| sulfonylureas, meglitinides and beta-2 agonists |
|
Definition
| Drugs such as ___, ___ and ___ can stimulate insulin stimulation. |
|
|
Term
|
Definition
| Glucose is taken up by ___ cells and insulin is released due to the influx of Ca2+. |
|
|
Term
|
Definition
| ___ mediates glucose uptake, increases glucose --> glycogen storage in hepatocytes, promotes protein and glycogen synthesis in muscle cells and forms triglyceride deposits in adipose tissue. |
|
|
Term
| hepatocytes, muscle cells, adipose tissue ... all of these are actions of insulin |
|
Definition
| Glucose is stored as glycogen in ____. Protein and glycogen synthesis occurs in ____ cells. Triglycerides are deposited in ____ ___. |
|
|
Term
| fasting glucose = <120 mg/dL and HbA1c = <6% |
|
Definition
| The goal of diabetes mellitus medical management is to reduce fasting glucose to levels ____ and HbA1c levels to ____. |
|
|
Term
| fasting glucose = <120 mg/dL |
|
Definition
| Management of diabetes is judged most importantly based on the (fasting glucose/HbA1c levels). |
|
|
Term
|
Definition
| ____ shows how much glucose is bound in RBCs. |
|
|
Term
|
Definition
| Patients with type __ diabetes have no circulating insulin due to destruction of pancreatic beta cells. It occurs mainly in juveniles. |
|
|
Term
|
Definition
| Patients with Type ___ diabetes have sufficient insulin to prevent ketoacidosis, but the overall insulin activity is reduced due to tissue insensitivity. Obesity is a major factor and generally occurs in adults. |
|
|
Term
|
Definition
| Type ___ diabetes patients are treated with injected human insulin which is less immunogenic. |
|
|
Term
| (1) Rapid-acting (2) short-acting / regular and (3) long-acting |
|
Definition
| Name the three different insulin preparations. |
|
|
Term
|
Definition
| ___ is very common is a diabetic patient misses a meal or undergoes an unusual amount of exercise or stress. |
|
|
Term
| the injection site, if not rotated |
|
Definition
| Localized fat hypertrophy is found where in Type I diabetic patients? |
|
|
Term
| False! Patients with any form of diabetes may require insulin. |
|
Definition
| T/F: Only patients with Type I diabetes require insulin. |
|
|
Term
| Tissue insensitivity / insulin resistance |
|
Definition
| ___ ___ is when insulin binds to receptor and target cell, but tissue does not respond. |
|
|
Term
|
Definition
| Glyburide, tobutamide, metformin, repaglinide, acarbose, rosigliazone and sitagliptin are all ___ antidiabetic drugs. |
|
|
Term
|
Definition
| Exenatide and pramlinitide are ___ antidiabetic drugs. |
|
|
Term
|
Definition
| Glyburide, tobutamide, metformin, repaglinide, acarbose, rosigliazone sitagliptin, Exenatide and pramlinitide are drugs used to treat _____. |
|
|
Term
|
Definition
| ___ is a 1st generation Sulfonylureas while ___ is a 2nd generation. |
|
|
Term
| Sulfonylureas (Tolbutamide / Glyburide) |
|
Definition
| ____ increase release of insulin from the pancreas and may lead to hypoglycemia, skin rash and allergies. |
|
|
Term
|
Definition
| Sulfonylureas may interact with ___ antifungals such as ketoconazole (not nistatin). |
|
|
Term
|
Definition
| ____ is a Meglitinide also known as Prandin. |
|
|
Term
| It increases insulin release |
|
Definition
| How do Meglitinides affect diabetes? |
|
|
Term
|
Definition
| ____, a biguanide, is the most common antidiabetic drug. It decreases liver glucose production and glucose absorption. It also increases cells' ability to uptake insulin and tissue sensitivity to insulin. |
|
|
Term
|
Definition
| ___ increases tissue sensitivity to insulin. |
|
|
Term
| midozolam (antianxiety / benzodiazepine / sedation in dentistry) |
|
Definition
| Rosiglitazone may decrease blood levels of ___ and interact with oral contraceptives. |
|
|
Term
|
Definition
| ___-____ is an enzyme present in the small intestine that aids in the absorption of starch / carbohydrates. Acarbose inhibits this. |
|
|
Term
|
Definition
| ___ is an alpha-glucosidase inhibitor. This inhibition causes a decrease in glucose levels due to the decreased absorption of starches. |
|
|
Term
|
Definition
| ____ is a new (oral) antidiabetic drug. It is also known as Januvia. |
|
|
Term
| non-selective beta blockers |
|
Definition
| Which drug group tends to worsen hypoglycemia in diabetic patients? |
|
|
Term
|
Definition
| ___ is used for contraception and postemenopausal therapy. May cause patient to be prone to osteoporosis. |
|
|
Term
|
Definition
| ___ and ___ are antiestrogens. |
|
|
Term
|
Definition
| ___ is an antiestrogen that is used to stimulate ovulation in infertility. May lead to multiple births. |
|
|
Term
|
Definition
| ____ is an antiestrogen that blocks estrogen receptors and is used to prevent further cancer in estrogen sensitive breast cancer. |
|
|
Term
|
Definition
| ____/____ are contraceptives with estrogens. |
|
|
Term
|
Definition
| ____ is a progestin antagonist used to induce abortion early in a pregnancy. |
|
|
Term
|
Definition
| Anabolic steroids and testosterone are ____. |
|
|
Term
|
Definition
| ___ is an androgen used as a supplement therapy in hypogonadism, to assist growth in boys with pituitary dwarfism, in patients with endometriosis and increases lean body mass, muscle strength and aggressiveness. |
|
|
Term
|
Definition
| ___ is a reversible airway obstruction caused by bronchial constriction that is episodic. Secretions and swelling in bronchioles increase. |
|
|
Term
|
Definition
| ___ has an acute phase and a late phase response. |
|
|
Term
|
Definition
| ___ is a corticosteroid used to treat asthma. |
|
|
Term
|
Definition
| ___ have anti-inflammatory, immunosupressive and immunomodulatory actions that are beneficial in the treatment of asthma. They are the first line in moderate-severe asthma and appropriate for children. |
|
|
Term
|
Definition
| Which antifungal is used to treat oral candidiasis caused by corticosteroid use? |
|
|
Term
| Terbutaline, albuterol and salmeterol |
|
Definition
| ____, ____ and ____ are beta-2 selective agonists that cause bronchodilation and are beneficial in treating asthma. |
|
|
Term
|
Definition
| Drugs such as terbutaline, albuterol and salmeterol (stimulate/inhibit) beta-2 receptors causing relaxation of bronchi smooth muscle. |
|
|
Term
| Terbutaline / albuterol / salmeterol |
|
Definition
| ___ and ___ are short acting agents and are used for acute episodes. ___ is a long acting agent and is used for prophylaxis. |
|
|
Term
| Mathylxanthines (caffiene-like) |
|
Definition
| Theophylline and aminophylline are ____ that are used to treat asthma by inhibiting phosphodiestrases, causing relaxation of broncho smooth muscle. They also increase strength of contraction of the diaphragm. |
|
|
Term
|
Definition
| ___ is a methylxanthine used to treat asthma and COPD with a low therapeutic window which is why it is associated with high toxicity. |
|
|
Term
| ipratropium and tiotropium |
|
Definition
| ___ and ___ are muscarininc antagonists that competitively block muscarinic receptors in the airways preventing bronchoconstriction. |
|
|
Term
|
Definition
| Zafirlukast and montelukast are ___ antagonists. |
|
|
Term
|
Definition
| ___ is a lipoxygenase enzyme inhibitor. It inhibits LTB4 which inhibits chemotaxis. |
|
|
Term
|
Definition
| T/F: Zileuton, montelukast and zafirlukast are useful during acute attack and status asthmaticus. |
|
|
Term
| Omalizumab (remember that -mab = monoclonal antibody which targets specific site) |
|
Definition
| ___ binds to IgE on surface of mast cells. |
|
|
Term
|
Definition
| ___ ___ is a mast cell stabilizer used in asthma therapy. |
|
|
Term
| Metabisulfite in lidocaine with epinephrine |
|
Definition
| Asthmatics may have a reaction with sulfites in what? |
|
|
Term
|
Definition
| ___ is used to treat status asthmaticus. |
|
|
Term
| True! Also, removing environmental causes |
|
Definition
| T/F: COPD may be treated with antibiotics and a bronchodilator. |
|
|
Term
|
Definition
| ____ is a mucolytic agent used to treat COPD. |
|
|
Term
|
Definition
| Codeine, benzonotate and dextromethophan have ___ activity. |
|
|
