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** Basic & Applied Science ENT Topics > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What % of patients with penicillin allergy will have a cephalosporin allergy

A

0.1

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2
Q

How do the general antimicrobial spectra differ between 1 sc, 2”d, 3rd, and 4th generation quinolones

A
  • 1st generation {nalidixic acid): only gram negative, no Pseudomonas coverage.
  • 2nd generation ( ciprofloxacin, ofloxacin): Staph aureus but not pneumococcus; some gram negative, including atypicals. Pseudomonas
  • 3rd generation (levofloxacin): gram negative, including Pseudomonas; gram positive,including Staph aureus and pneumococcus; expanded atypical coverage.
  • 4th generation (gatifloxacin, moxifloxacin): same as 3rd generation with enhanced coverage of pneumococcus decreased activity against Pseudomonas.
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3
Q

What is the best time to begin prophylactic antibiotic therapy for elective surgery

A

1 hour prior to the operation.

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4
Q

What % of cases of antibiotic-associated diarrhea are due to Clostridium difficile

A

10- 20°/o.

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5
Q

What is the incidence of C. diff in cases of antibiotic-associated diarrhea?

A

10-20%.

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6
Q

What is the treatment for otosyphilis?

A

2-4 million U of benzathine penicillin IM every week for at least 3 weeks (up to 1 year) or 10 million U of penicillin G IV every day for 10 days followed by 2-4 million U of IM benzathine penicillin every week for 2 weeks plus prednisone 40-60 mg every day for 2-4 weeks followed by a taper.

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7
Q

What percent of all adverse drug reactions among hospitalized patients can be attributed to antibiotics?

A

25%.

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8
Q

After aminoglycoside treatments for Meniere’s disease, when is the usual onset of disequilibrium?

A

4 days after treatment.

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9
Q

What is the incidence of rash after taking penicillin

A

5%.

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10
Q

What percent of patients with mononucleosis will develop a rash after taking amoxicillin?

A

50%.

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11
Q

What % of these patients will develop a rash the next time they take penicillin

A

50%.

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12
Q

What % of patients with mononucleosis will develop a rash after taking amoxicillin

A

50%.

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13
Q

Approximately what percent of C. difficile cases occur after taking quinolones?

A

55%.

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14
Q

How long may the onset of pseudomembranous enterocolitis begin after initiation of antibiotics?

A

6 weeks.

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15
Q

How long may the onset of pseudomembranous enterocolitis begin after initiation of antibiotics

A

6 weeks.

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16
Q

What can happen if a quinolone is given to a patient dependent on benzodiazepines?

A

Acute withdrawal symptoms from the benzodiazepines.

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17
Q

Aminoglycosides are effective against what bacteria

A

Aerobic gram negative bacilli (including Pseudomonas aeruginosa), enterococci, staphylococci and streptococci.

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18
Q

Aminoglycosides are effective against what bacteria?

A

Aerobic gram-negative bacilli (including Pseudomonas aeruginosa), enterococci, staphylococci, and streptococci.

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19
Q

Mitochondrial mutations have been found to produce enhanced sensitivity to the ototoxic effects of which medications?

A

Aminoglycosides.

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20
Q

Which antibiotics potentiate muscle blockade induced by curare

A

Aminoglycosides.

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21
Q

Which penicillin analogue can be given to patients with a history of anaphylaxis after taking penicillin?

A

Aztreonam.

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22
Q

Which penicillin analogue can be given to patients with a history of anaphylaxis after taking penicillin

A

Aztreonam.

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23
Q

What region of the inner ear is most susceptible to permanent loss of hair cells?

A

Basal turn of the cochlea.

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24
Q

How do aminoglycosides exert their toxic effects on the outer hair cells of the inner ear?

A

Bind to the plasma membrane and displace calcium and magnesium; once transported into the cell, bind with phosphatidylinositol, causing disruption of the plasma membrane and inhibition of inositol triphosphate, resulting in cell death.

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25
Q

Which 1st generation cephalosporin has the longest half-life

A

Cefazolin (Ancef or Kefzol).

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26
Q

Which first-generation cephalosporin has the longest half-life?

A

Cefazolin.

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27
Q

Which 3rd generation cephalosporin is associated with possible clotting impairment

A

Cefoperazone (Cefobid).

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28
Q

Which antibiotic agents are bacteriostatic

A

Chloramphenicol, clindamycin, erythromycin, sulfonamides, tetracyclines and trimethoprim.

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29
Q

Why are iodine solutions superior to chlorhexidine as a surgical antiseptic

A

Chlorhexidine is not effective against viruses and fungi.

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30
Q

Which antibiotics are most commonly associated with development of Clostridium difftcile

A

Clindamycin, cephalosporins, and penicillins.

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31
Q

Which medications, when given concurrently with a quinolone, significantly increase the risk of quinolone-associated tendon rupture?

A

Corticosteroids.

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32
Q

What is the alternate therapy and when should it be initiated?

A

Dapsone should be used when severe reactions (e.g., skin blistering, mucosal involvement, or anaphylaxis) to TMP-SMX occur.

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33
Q

Which method is responsible for the resistance of S. pneumoniae to penicillins?

A

Decreased penicillin-binding protein affinity.

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34
Q

What problem has arisen with the increase use of vancomycin

A

Development of vancomycin resistant enterococci (VRE).

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35
Q

Which of these attains the highest blood levels

A

Dicloxacillin.

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36
Q

Which of these attains the highest blood levels?

A

Didoxacillin.

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37
Q

What is the most important factor determining risk of ototoxicity with use of aminoglycosides?

A

Duration of therapy > 10 days.

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38
Q

What is the most important factor determining risk of ototoxicity with use of aminoglycosides

A

Duration of therapy >I Odays.

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39
Q

Which macrolide does not cover H.injluenzae?

A

Erythromycin.

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40
Q

Which macrolide does not cover Haemophilus injluenzae

A

Erythromycin.

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41
Q

What is the primary problem of 1M penicillin therapy for otosyphilis?

A

Fails to achieve treponemicidal levels in the cerebrospinal fluid (CSF).

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42
Q

T /F: Closed suction drainage decreases the incidence of wound infection in clean cases.

A

False.

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43
Q

What is the Jarisch-Herxheimer reaction?

A

Fever and flulike symptoms beginning within 4 hours of commencing treatment for secondary syphilis.

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44
Q

What drug has shown equal efficacy as vancomycin for the treatment of C. diff infections with a lower rate of recurrence (15% vs. 25% for vancomycin)?

A

Fidaxomicin.

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45
Q

Which class of antibiotic is most commonly associated with the development of C. diff?

A

Fluoroquinolones.

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46
Q

What is Red Man’s Syndrome

A

Flushing of the face and neck, pruritus and hypotension associated with rapid infusion of vancomycin and subsequent release of histamine.

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47
Q

What is Red Man’s Syndrome?

A

Flushing of the face and neck, pruritus and hypotension associated with rapid infusion of vancomycin, and subsequent release of histamine.

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48
Q

In patients with postoperative pneumonia, empiric monotherapy should cover which organisms

A

Gram negative organisms.

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49
Q

In emergency surgery following trauma, which organisms are most likely to cause serious sepsis

A

Gram-negative bacteria.

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50
Q

In patients with postoperative pneumonia, empiric monotherapy should cover which organisms?

A

Gram-negative organisms.

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51
Q

Vancomycin is effective against which bacteria

A

Gram-positive cocci, including methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, enterococci, diphtheroids and Clostridium difficile.

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52
Q

Vancomycin is effective against which bacteria?

A

Gram-positive cocci, including methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, enterococci, diphtheroids, and C. difficile.

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53
Q

What is the incidence of bone marrow suppression with chloramphenicol

A

I :24,000.

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54
Q

What are the four processes of bacterial resistance to antibiotics?

A

Inability of the antibiotics to penetrate the bacterial cell, -lactamase production, altered penicillin-binding protein affinity, and methicillin-resistance pattern.

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55
Q

What can be done to overcome this method of resistance?

A

Increase the concentration of the drug.

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56
Q

Why is the mg/kg dosage of gentamicin given to infants higher than that given to older children?

A

Infants have a higher extracellular fluid volume per weight.

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57
Q

Why is the mg/kg dosage of gentamicin given to infants higher than that given to older children

A

Infants have a higher extracellular fluid volume per weight.

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58
Q

What is the mechanism of action of quinolones?

A

Inhibition of DNA gyrase, which is needed to package DNA into dividing bacteria.

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59
Q

What other therapy has been shown to decrease the risk of recurrence of C. diff?

A

Intravenous infusion of neutralizing monoclonal antibodies to C. difficile toxins A and B.

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60
Q

Why is ciprofloxacin contraindicated in children?

A

It has been shown to cause arthropathy of the weight-bearing joints in immature animals.

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61
Q

What are the features of the epidemic strain of C. diff (Bt/NAPt/027) that set it apart from other strains?

A

It produces 16-23 x the amount of toxins A and B; produces a third toxin (binary toxin CDT); and has high levels of fluoroquinolone resistance.

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62
Q

What is the incidence of wound infections in clean, clean-contaminated, contaminated and dirty cases

A

Less than 2%, 1 O%, 20% and 40%, respectively.

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63
Q

What perioperative factors are associated with an increased risk of postoperative wound infection

A

Long preoperative hospitalization; no preoperative shower; early shaving of the operative site; hair removal; and prior antibiotic therapy.

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64
Q

Which penicillins are most active against S. aureus?

A

Methicillin, oxacillin, dicloxacillin, and nafcillin.

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65
Q

Which penicillins are most active against Staphylococcus aureus

A

Methicillin, oxacillin, dicloxacillin, nafcillin.

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66
Q

Which of these is not active against Streptococcus pneumoniae?

A

Methicillin.

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67
Q

Which of these is not active against Streptococcus pneumoniae

A

Methicillin.

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68
Q

What is the initial drug of choice for treating C.diJJicile?

A

Metronidazole.

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69
Q

Which quinolone carries the highest risk for QTc prolongation and CNS toxicity?

A

Moxifloxacin.

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70
Q

What is the best medication to eradicate nasal colonization with methicillin-resistantS. aureus?

A

Mupirocin.

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71
Q

What is the best medication to eradicate nasal colonization with methicillin-resistant Staphylococcus aureus

A

Mupirocin.

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72
Q

Which of these is best for patients with renal failure?

A

Nafcillin.

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73
Q

Which of these is best for patients with renal failure

A

Nafcillin.

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74
Q

What is the mechanism of action of aminoglycoside ototoxicity

A

Primarily damage to the outer hair cells, first to the basal tum of the cochlea.

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75
Q

What medication extends the half-life and facilitates CSF penetration of penicillin?

A

Probenecid.

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76
Q

How do organisms inactivate penicillin

A

Produce beta-lactamase.

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77
Q

How do organisms inactivate penicillin?

A

Produce-lactamase.

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78
Q

What risks are associated with the use of aminoglycosides

A

Prolonged neuromuscular blockade, ototoxicity and nephrotoxicity.

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79
Q

What risks are associated with the use of aminoglycosides?

A

Prolonged neuromuscular blockade, ototoxicity, and nephrotoxicity.

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80
Q

What organisms are covered by amoxicillin and ampicillin that are not covered by penicillin

A

Proteus, E. Coli, Haemophilus influenzae.

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81
Q

What organisms are covered by amoxicillin and ampicillin that are not covered by penicillin?

A

Proteus, Escherichia coli} Haemophilus in.fluenzae.

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82
Q

Which medications can be used to treat people exposed to meningococcus?

A

Rifampin, ciprofloxacin, or ceftriaxone.

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83
Q

Which medications can be used to treat people exposed to meningococcus

A

Rifampin, ciprofloxacin, or ceftriaxone.

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84
Q

Which organisms can produce fl-lactamase?

A

S. aureus, H. infiuenzae, Moraxella catarrhalis, and oral anaerobes.

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85
Q

What is the sensitivity and specificity of testing for C. diff toxins A and B with ELISA?

A

Sensitivity 63-99%; specificity 93-100%.

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86
Q

Wound infections that occur in clean operations are most commonly caused by what organisms

A

Staphylococci.

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87
Q

Which organisms can produce beta-lactamase

A

Staphylococcus aureus, Haemophilus in.fluenzae, Moraxella catarrhalis, oral anaerobes.

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88
Q

What organisms do penicillin G and V cover

A

Streptococcal pyogenes, Streptococcal pneumococcus, Actinomyces, oral anaerobes.

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89
Q

What organisms do penicillin G and V cover?

A

Streptococcal pyogenes} Streptococcal pneumoniae} Actinomyces, oral anaerobes.

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90
Q

What characteristic is common to clavulanate, sulbactam and tazobactam

A

They are all beta-lactamase inhibitors.

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91
Q

What characteristic is common to clavulanate, sulbactam, and tazobactam?

A

They are all P-lactamase inhibitors.

92
Q

What is the mechanism of action of quinolones

A

They inhibit DNA gyrase, which is needed to package DNA into dividing bacteria.

93
Q

Why do hematomas increase the risk of infection

A

They prevent fibroblast migration and capillary formation.

94
Q

Which penicillin derivatives are active against Pseudomonas

A

Ticarcillin-clavulanate (Timentin), piperacillin-tazobactam (Zosyn).

95
Q

Which penicillin derivatives are active against Pseudomonas?

A

Ticarcillin-clavulanate and piperacillin-tazobactam.

96
Q

What is the drug of choice for the prophylaxis of Pneumocystis carinii infections in patients with HIV?

A

TMP-SMX.

97
Q

What antibiotic is effective for treatment of Wegener’s granulomatosis?

A

Trimethoprim/sulfamethoxazole (TMP jSMX).

98
Q

True/False: The rate of colonization of hospitalized patients with Clostridium diJJicile increases in proportion to the patient’s length of stay.

A

True.

99
Q

True/False: The incidence of community-acquired C. diJJicile is higher in patients taking H 2 blockers and proton pump inhibitors.

A

True.

100
Q

T/F: The dose of metronidazole must be modified for patients with significant liver disease

A

True.

101
Q

What is an alloantigen?

A

A human antigen from a different individual.

102
Q

What is an alloantigen?

A

A human antigen from a different individual.

103
Q

What is a proto-oncogene and what is an oncogene?

A

A proto-oncogene participates in normal cellular signaling, transduction, and transcription; an oncogene is a mutant allele of a proto-oncogene.

104
Q

What is an antisense drug?

A

A small, single-stranded nucleotide complementary to a target mRNA molecule that binds to mRNA and halts transcription.

105
Q

What is the most common toxicity of methotrexate?

A

Abnormal liver function.

106
Q

What are the advantages of using adenovirus?

A

Adenovirus is highly infective of both quiescent and actively dividing cells, has a known tropism for cells of the upper aerodigestive tract, and can carry large genes.

107
Q

What viruses are employed in head and neck gene therapy?

A

Adenovirus, adena-associated virus, herpes virus, retroviruses, and vaccinia virus.

108
Q

What is allovectin-7?

A

An alloantigen that encodes for class I MHC HLA-B7. It is plasmid DNA with a liposome vector that is injected directly into the tumor. Partial response without toxicity has been demonstrated in Phase III trials for stages 3 and 4 melanoma.

109
Q

What is allovectin-7?

A

An alloantigen that encodes for class I MHC HLA-B7. It is plasmid DNA with a liposome vector that is injected directly into the tumor. Partial response without toxicity has been demonstrated in Phase III trials for stages 3 and 4 melanoma.

110
Q

Where does the adeno-associated virus vector insert its DNA in the host cell?

A

At the 19q13-4 location.

111
Q

What are the problems with using retroviruses?

A

Can only infect actively dividing cells, are permanently integrated into the host cell’s genome, and randomly insert into the host genome.

112
Q

What are some physical methods of gene transfer?

A

Cationic liposomes, plasmid DNA, ballistic particle, calcium-phosphate-induced uptake, and electroporation.

113
Q

What is the most effective chemotherapeutic therapy for anaplastic thyroid cancer?

A

Doxorubicin with valproic acid.

114
Q

What is the most effective chemotherapeutic therapy for anaplastic thyroid cancer?

A

Doxorubicin with valproic acid.

115
Q

What is immunologic gene therapy?

A

Enhancement of an immune response specifically against tumor-associated antigens using viral vectors.

116
Q

What is immunologic gene therapy?

A

Enhancement of an immune response specifically against tumor-associated antigens using viral vectors.

117
Q

What is adoptive T-cell immunotherapy?

A

Ex vivo enhancement of tumor immunogenicity; lymphocytes are removed from the patient then reinfused after in vitro activation against the patient’s own tumor cells.

118
Q

What is adoptive T-cell immunotherapy?

A

Ex vivo enhancement of tumor immunogenicity; lymphocytes are removed from the patient then reinfused after in vitro activation against the patient’s own tumor cells.

119
Q

How does the herpes simplex virus-thymidine kinase gene (HSV-tk) work?

A

Expresses a viral thymidine kinase that is foreign to mammalian cells but phosphorylates the drug ganciclovir into a compound that terminates DNA synthesis in tumor cells.

120
Q

What are the potential side effects of interferon a-2b?

A

Fever, weight loss, liver enzyme elevation, and DIC.

121
Q

What does the adenovirus vector do once it enters the host cell?

A

Forms a nonreplicating, extrachromosomal entity called an episome that persists for 7-42 days.

122
Q

What are the potential side effects of cyclophosphamide?

A

Hemorrhagic cystitis, leukopenia, sterility, and malignancies of the urinary tract.

123
Q

What are the mechanisms of action of interferon a-2b?

A

Inhibit epithelial cell migration and proliferation and inhibit growth factor.

124
Q

What is the mechanism of action of methotrexate?

A

Inhibits dihydrofolate reductase, interfering with DNA synthesis, repair, and replication.

125
Q

Other than corticosteroids, what medications can be used to treat hemangiomas?

A

Interferon a-2a or -2b.

126
Q

What are the problems with physical methods of gene transfer?

A

Lack of specificity and extremely low efficiency.

127
Q

What are the two most common tumor suppressor genes under investigation for treatment of head and neck cancers?

A

P53 and p16.

128
Q

How is isotretinoin effective in the treatment of SCCA of the head and neck?

A

Reduces the incidence of second primary tumors.

129
Q

How is isotretinoin effective in the treatment of SCCA of the head and neck?

A

Reduces the incidence of second primary tumors.

130
Q

What are the five major approaches of gene transfer, and which is most common?

A

Replacement of mutated tumor suppressor genes, introduction of toxic/suicide genes, immunomodulation (most common), delivery of antisense nucleotides, and cytolytic viral therapy.

131
Q

What are the characteristics of an ideal oncolytic virus?

A

Selective for infection and lysis of cancer cells; stimulates a potent antitumor response with limited local/systemic toxicity.

132
Q

What problems may result from insertion at this location?

A

This location is associated with chronic B-cell leukemias and integration into both copies of chromosome 19 may lead to cell death.

133
Q

What drug targets the BRAF V6ooE mutation in melanoma and has shown significantly improved survival compared with dacarbazine?

A

Vemurafenib.

134
Q

What drug targets the BRAF V6ooE mutation in melanoma and has shown significantly improved survival compared with dacarbazine?

A

Vemurafenib.

135
Q

What are the two main categories of gene delivery agents?

A

Viral and nonviraljphysical.

136
Q

What is the appropriate tetanus prophylaxis for a patient with a tetanus-prone wound, who has not been previously immunized?

A

0.5 mL absorbed toxoid and 250 units of human tetanus immune globulin.

137
Q

What is the proper tetanus prophylaxis for a patient with a tetanus-prone wound, who last received a booster 7 years ago?

A

0.5 mL absorbed toxoid.

138
Q

In a nonacute setting, what is the maximum useful amount of calcium supplementation?

A

2 g of calcium per day.

139
Q

Dr. Mark Beers found that hospitals made mistakes when recording the medications of elderly patients being admitted to the hospital what percent of the time?

A

60%.

140
Q

What are the Beers criteria?

A

A list of medications that tend to cause increased side effects in the elderly.

141
Q

What is the appropriate calcium supplementation if the maximum amount of calcium has already been given and the patient is still hypocalcemic?

A

Calcitriol or other vitamin D preparations should be added.

142
Q

What effect does zinc have on viral upper respiratory tract infections?

A

Decreases the duration of symptoms.

143
Q

What are the most widely used agents for treatment of acute migraine?

A

Ergotamine tartrate and sumatriptan.

144
Q

Which comorbid conditions are contraindications to use of sumatriptan?

A

Hypertension and coronary artery disease.

145
Q

What is the effect of adrenergic blockers on the lower esophageal sphincter pressure?

A

Increases it.

146
Q

Tricyclic antidepressants are most likely to benefit patients with tinnitus who have what other problem?

A

Insomnia.

147
Q

What is the best agent for rapid surgical preparation of thyrotoxic patients?

A

Long-acting-blocker.

148
Q

In a patient with chronic obstructive pulmonary disease (COPD), which beta-blocker would be preferred: propranolol or metoprolol?

A

Metoprolol.

149
Q

What is an absolute contraindication to treatment of lymphatic malformations with OK-432?

A

Penicillin allergy.

150
Q

When is exogenous T4 used in patients with thyroid carcinoma?

A

Postoperatively in patients with TSH-dependent carcinomas (follicular, papillary, and Hiirthle cell).

151
Q

What medication is most commonly used to treat hyperthyroidism during pregnancy?

A

Propylthiouracil (PTU).

152
Q

A 26-year-old man with frequent migraines is requesting medication for migraine prevention. He is otherwise healthy but reports difficulty exercising secondary to cough. He has had an allergic reaction to a tricyclic antidepressant in the past. What test should be ordered prior to starting him on migraine prophylaxis?

A

Pulmonary function test.

153
Q

What medication can be given as an alternate to thyroid hormone withdrawal prior to radioiodine therapy?

A

Recombinant human TSH.

154
Q

What is the medical treatment for otosclerosis?

A

Sodium fluoride, vitamin D.

155
Q

Prior to radioiodine therapy, which medications should be discontinued and at what time?

A

T3, 1week before; T4, 4-6 weeks before; Propylthiouracil, 2 weeks before.

156
Q

What are the most widely used agents for prophylaxis of migraine?

A

Tricyclic antidepressants,-blockers, anticonvulsants, and calcium antagonists.

157
Q

What are the indications for migraine prophylaxis?

A

Two or more migraines a week and/ or abortive treatment inadequate.

158
Q

What is the prevalence of CYP2D6 poor metabolizers?

A

7-10% Caucasians; less commonly found in African Americans (3%) and Asians (1%).

159
Q

Which nonsteroidal anti-inflammatory drug (NSAID) has the lowest risk of gastrointestinal side effects?

A

Ibuprofen.

160
Q

When should proton pump inhibitors be used in conjunction with NSAIDs?

A

In patients with a previous history of a gastrointestinal event and/ or patients taking aspirin, steroids, or warfarin.

161
Q

What effect can the maximum daily dose of acetaminophen have on the international normalized ratio (INR) in patients taking warfarin?

A

INR may increase.

162
Q

Ultra-rapid CYP2D6 metabolizers are more commonly found in which areas of the world?

A

Middle East and North Mrica.

163
Q

Tramadol is particularly effective for which type of pain?

A

Neuropathic.

164
Q

What drugs are the strongest inhibitors to the CYP2D6 enzyme, rendering opioids less effective?

A

Selective serotonin reuptake inhibitors (SSRis), bupropion, quinidine, cinacalcet, and ritonavir.

165
Q

What is the most reliable method of pain assessment in children 4 years and older?

A

Self-report (faces pain scale in children younger than 7 and numerical rating scale in children 7 and older).

166
Q

Why should codeine and hydrocodone be avoided in neonates and veryyoung children?

A

Their metabolism to morphinejhydromorphone depends on the cytochrome P450 2D6 (CYP2D6) enzyme, which is inactive at birth and only 25% active by age 5.

167
Q

Which patients should avoid taking NSAIDs?

A

Those with a history of ischemic cardiac disease, stroke, congestive heart failure, and recent coronary artery bypass grafting.

168
Q

True/False: Unless contraindicated, all surgery patients should routinely be given acetaminophen and an NSAID in scheduled doses throughout the early postoperative course.

A

True.

169
Q

True/False: CYP2D6 has the largest phenotypic variability among the CYPs.

A

True.

170
Q

What are the four levels of trichloroacetic acid (TCA) peels?

A
  • Level o-No frost, skin appears slick and shiny representing removal of the stratum corneum.
  • Level1-Irregular light frost with some erythema; 2-4 days of light peeling.
  • Level 2-Pink white frost, full-thickness epidermal peel, 5 days of peeling.
  • Level 3-Solid white frost, papillary dermis.
171
Q

What skin preparations have been shown to significantly improve the overall severity of photodamaging but have not been shown to affect wrinkles?

A

8-10% a-hydroxy acids.

172
Q

What is ochronosis?

A

A potential adverse reaction to hydroquinone characterized by a reticulated, sooty pigmentation of the cheeks, forehead, and periorbital regions.

173
Q

What is an antisense drug?

A

A small, single-stranded nucleotide complementary to a target mRNA molecule that binds to mRNA and halts transcription.

174
Q

Which drugs potentiate the effect of botulinum toxin?

A

Aminoglycoside antibiotics.

175
Q

Which bleaching agent is also an effective treatment for acne?

A

Azelaic acid.

176
Q

What is the mechanism of action of hydroquinone?

A

Blocks the conversion of dopa to melanin.

177
Q

What is the mechanism of action of retinoids?

A

Cause a 70% inhibition of AP-1 transcription factor binding to DNA, which decreases the activation of metalloproteases such as collagenase, gelatinase, and stromatolysis.

178
Q

What are lathyrogenic agents?

A

Compounds that inhibit collagen cross-linking, such as penicillamine and N-acetyl-L-cysteine.

179
Q

What are the clinical effects of tretinoin?

A

Decrease in fine wrinkling, roughness, and mottled hyperpigmentation after 6 months of use.

180
Q

How deep can a 20% trichloroacetic acid (TCA) solution penetrate?

A

Down to the papillary dermis.

181
Q

How many serotypes of botulinum toxin exist? Which is the most useful clinically?

A

Eight serotypes (A through G) with type A being the most useful.

182
Q

True/False: Large doses of vitamin E enhance wound healing.

A

False.

183
Q

What medication used to treat androgenetic alopecia can reduce libido?

A

Finasteride.

184
Q

What factors are thought to account for diminished responses to botulinum toxin?

A

Formation of antibodies, high cumulative dose, and drug interactions.

185
Q

Which drugs limit the effect of botulinum toxin?

A

Guanidine and aminopyridines.

186
Q

What are the initial manifestations of systemic phenol toxicity from a chemical facial peel?

A

Hyperreflexia and hypertension.

187
Q

What effects do a-hydroxy acids have on the dermis?

A

Increase collagen and glycosaminoglycan production.

188
Q

What would be the histologic findings on muscle biopsies at the site of botulinum toxin injections?

A

Increased unmyelinated axonal sprouts; no change in muscle fibers histologically.

189
Q

What is the mechanism of action of botulinum toxin?

A

Inhibition of acetylcholine release from cholinergic nerve endings.

190
Q

Which bleaching agent is produced by Aspergillus and Penicillium?

A

Kojic acid.

191
Q

What medication used to treat androgenetic alopecia is also used to treat hypertension?

A

Minoxidil.

192
Q

What are the onset, peak, and duration of effects of botulinum toxin?

A

Onset 24-72 hours, peak effect at 10-14 days, duration 3-6 months.

193
Q

Which patients are better served by 15-20% a-hydroxy acids?

A

Patients with sebaceous, Fitzpatrick type III and IV skin.

194
Q

How deep does Jessner’s solution penetrate?

A

Remains intraepidermal.

195
Q

What are the components of Jessner’s solution?

A

Resorcinol, salicylic acid, lactic acid, and ethanol.

196
Q

What is mitomycin C?

A

Substance produced by Streptomyces caespitosus that inhibits DNA synthesis and fibroblast proliferation.

197
Q

What are the histologic effects of tretinoin?

A

Thinner stratum corneum, thickened epidermis, increased collagen, angiogenesis, and more uniform dispersion of melanin granules.

198
Q

What is the purpose of application of topical vitamin C after skin resurfacing?

A

To decrease the inflammation associated with prolonged erythema (must wait until reepithelization is complete before applying).

199
Q

True/False: Exogenous use of TGF-P appears to improve healing in tissues injured by radiation therapy.

A

True.

200
Q

How is recovery of function accomplished?

A

Via sprouting of new nerve terminals and an increase in the number of postjunctional receptors.

201
Q

When are cardiac arrhythmias that develop during a phenol peel most likely to occur?

A

Within 30 minutes of the start of the procedure.

202
Q

‘What are the criteria for bone densitometry in patients on long-term corticosteroids?

A

> 5 mg/day for 3 or more months.

203
Q

What is the treatment for Familial Ataxia Syndrome (Episodic Ataxia)?

A

Acetazolamide.

204
Q

What is montelukast?

A

An antileukotriene, believed to stabilize rhinosinusitis in patients with Samter’s triad.

205
Q

What is the mechanism of action of steroids in the treatment of hemangiomas?

A

Block the estradiol-17 receptor.

206
Q

In the United States, how are topical corticosteroids classified?

A

By their ability to constrict capillaries: Class I agents are the strongest and Class VII agents are the weakest.

207
Q

What is the only nonsedating antihistamine that is eliminated primarily through the kidneys?

A

Cetirizine.

208
Q

What effect does daily use of fluticasone have on nasal mucous?

A

Decreases the number of eosinophils in the mucous.

209
Q

How do corticosteroids diminish lgE hypersensitivity reactions?

A

Diminish capillary permeability, block migratory inhibiting factor, stabilize lysosomal membranes, and inhibit edema formation.

210
Q

True/False: Prolonged use of high-dose nasal steroids has been found to cause ocular hypertension.

A

False: This association was found with high-dose orally inhaled steroids only.

211
Q

What is the recommended treatment for autoimmune inner ear disease?

A

First-line treatment is high-dose prednisone, then methotrexate, then cyclophosphamide.

212
Q

What is the mechanism of action of meclizine?

A

H1-receptor antagonist.

213
Q

What is the drug class of choice for mild esophagitis?

A

H2-receptor antagonists.

214
Q

Why should patients on long-term PPI therapy be tested for Helicobacter pylori?

A

Hagiwara et al. found that long-term PPI administration promotes gastric adenocarcinoma in gerbils infected with H. pylori.

215
Q

What is the mechanism of action of nasal cromolyn sodium?

A

Inhibits degranulation of mast cells.

216
Q

‘What is the most effective monotherapy for allergic rhinitis?

A

Intranasal corticosteroids.

217
Q

Which causes less dry mouth: meclizine or scopolamine?

A

Meclizine.

218
Q

What are the metabolic effects of prolonged thiazide diuretic therapy?

A

Metabolic alkalosis with hypokalemia and hypochloremia, hyperglycemia.

219
Q

What drug used for gastroesophageal reflux disease (GERD) may cause irreversible tardive dyskinesia and is associated with dystonic reactions in 25% of young adults (18-30 years) who take it?

A

Metoclopramide.

220
Q

What effect does oxymetazoline have on the nasal cilia?

A

Paralyzes them.

221
Q

Which drug class used for the treatment of GERD is associated with an increased risk of hip fracture in postmenopausal women?

A

Proton pump inhibitors (PPis).

222
Q

What symptom do intranasal anticholinergics treat?

A

Rhinorrhea.

223
Q

Why is ticlid only warranted in patients unable to tolerate aspirin?

A

Risk of life-threatening neutropenia.

224
Q

What is the mechanism of action of ondansetron and dolasetron?

A

Selective antagonists of serotonins-HT3 receptors with no effect on dopamine receptors.

225
Q

What is the primary reason periodic breaks should be taken when using topical corticosteroids for chronic conditions?

A

To prevent tachyphylaxis.

** Basic & Applied Science ENT Topics (6 decks)

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