Ch. 7 Pharmacology & Therapeutics Flashcards Preview

ACAAI Review 3rd Edition > Ch. 7 Pharmacology & Therapeutics > Flashcards

Flashcards in Ch. 7 Pharmacology & Therapeutics Deck (112):
1

How long does cat allergen remain in the home after cat removal?

4-6 months

2

Indications for AIT?

allergic rhinitis/conjunctivitis, allergic asthma, atopic dermatitis with aeroallergen sensitization, venom hypersensitivity

3

With regard to asthma, AIT improves what?

bronchial hyper responsiveness only, there is NO effect on pulmonary functions tests

4

With regard to AR, AIT improves what?

symptom scores, quality of life, and medication reduction

5

What happens to allergen-specific IgE in the first few months of AIT?

allergen-specific IgE increases (decreases later).

6

What immunologic changes are expected with completion of AIT?

Increase: IgG4, IgA in respiratory secretions, Tregs, CD8+ T cells, Th1 cytokines (IFNgamma, IL-12), Th1/Th2 ratio, IFNg/IL-4 ratio

Decrease: allergen-specific IgE (initially increases), early-late response to allergen, FcERII (CD23 - low affinity receptor), basophil hyperactivity, recruitment of eos/baso/mast cells, allergen-specific lymphocyte proliferation

7

What are the standardized extracts?

cat, dust mite, grass (northern grasses and Bermuda), ragweed

8

What color vial is 1:10,000 vol/vol (1:1,000,000 w/v)

silver

9

What color vial is 1:1000 vol/vol (1:100,000 w/v)

green

10

What color vial is 1:100 vol/vol (1:10,000 w/v)

blue

11

What color vial is 1:10 vol/vol (1:1000 w/v)

yellow

12

What color vial is 1:1 vol/vol (1:100 w/v)

red (maintenance)

13

Name the 7 northern grasses

timothy, orchard, kentucky blue, perennial rye, sweet vernal, red top, meadow fescue

14

Which two southern grasses cross-react?

bahia and johnson

15

What does glycerin in allergen extracts do?

inhibitor of proteolytic activity that can be irritating/painful (NOT associated with local reactions)

16

What does phenol in allergen extracts do?

antibacterial

17

Which allergen extracts contains proteolytic enzymes that degrade pollen?

mold and cockroach

Note: can mix mold and cockroach together

18

T or F, can you mix dust mite (in >10% glycerin) with cockroach and mold?

T
Note: Can also mix dust mite with pollen, dog/cat

19

Which venoms can be mixed together?

Mixed vespid (yellow jacket, white hornet, yellow hornet)

20

What is the maintenance dose for a single venom?

100ug

21

What is the maintenance dose for mixed vespid

300ug

22

What is the effective BAU for cat allergen?

1000-4000 BAU

23

What is the effective dose for dog allergen Can f 1?

15ug Can F 1

24

What is the effective AU for dust mites (Der f1, Der p1)?

500-2000 AU

25

What is the effective BAU for Bermuda?

300-1500 BAU

26

What is the effective BAU for grass

1000-4000 BAU

27

What is the effective dose of Amb a1 and AU?

6-12 ug Amb a 1; 1000-4000 AU

28

In general, what is the range of the effective maintenance dose for most inhalant allergens?

5-20 ug per 0.5mL maintenance dose

29

What are the 5 grasses in the SLIT tablet and when do you start?

timothy, orchard, kentucky blue, perennial rye, sweet vernal; 16 weeks before grass season
(age 10-65)

30

What is the grass pollen in the single SLIT tablet and when do you start?

timothy grass; start 12 weeks before grass season
(age 5-65)

31

What allergen is in the ragweed tablet and when do you start?

Amb a 1; 12 weeks before ragweed season
(age 18-65)

32

Which anti-histamines need dose adjustment if there is hepatic impairment, i.e. exclusively cleared by the liver?

1st generation: diphenhydramine, doxepin, hydroxyzine
2nd generation: loratadine

33

Which anti-histamines need dose adjustment for renal impairment, i.e. exclusively cleared by the kidney?

fexofenadine

34

Which anti-histamines are both cleared by the kidney and liver and need adjustment for renal and hepatic impairment?

cetirizine, desloratadine, levocetirizine

35

Which anti-histamines are pregnancy class B?

1st gen: chlorpheniramine, diphehydramine
2nd gen: cetirizine, levocetirizine, loratadine
topical: emedastine

36

Adverse effect of dry mouth and urinary retention are due to H1 antihistamine effects on which receptor?

muscarinic / cholinergic receptors

37

Cyproheptadine can cause increased appetite due to its effect on which receptor?

serotonin receptor

38

What is the mechanism of action of albuterol?

binds to B2 receptor (GPCR), activates adenylate cyclase, increases cAMP, activating PKA, leading to phosphorylation and muscle relaxation (bronchodilation)

39

What accounts for salmeterols longer/slower onset of action compared to formoterol?

greater lipophilicity

40

Increasing the bulk of the B agonist side chain results in what pharmacologic property?

increased selectivity for B2 receptor, prolonged duration of action, and protects from catceholamine-O-methyltransferase (COMT) degradation

41

Increasing the size of the terminal amino group of B agonists results in?

protection from degradation by monamine oxidase

42

What genetic polymorphism has been shown to result in B2 agonist receptor down regulation resulting in resistance to smooth-muscle relaxing effect of B2 agonists?

B16 Arg/Arg homozygosity

43

Name the 5 non-selective B blockers

propanolol, timolol, pindolol, nadolol, labetalol (also blocks alpha 1)
Note: associated with blunted response to B2 agonists

44

Name the 2 cardioselective B blockers

metoprolol and atenolol
Note: >20 times more affinity for B1 receptors

45

What are the effects of leukotriene antagonists in AERD?

1. Improves FEV1
2. Less need for rescue B agonist
3. decrease in asthma exacerbations

46

Which leukotriene antagonist can have liver toxicity and can interact with warfarin leading to increased PT time?

zafirlukast
Note: Pregnancy class B

47

Which leukotriene antagonist can increase ALT (liver transaminases), inhibits CYP1A2, and affects the levels of theophylline, warfarin, and propranolol?

Zileuton (5-LO inhibitor)
Note: Pregnancy class C

48

Antileukotriene therapy has been associated with what disease due to unmasking with corticosteroid taper?

eosinophilic granulomatosis with polyangiitis (EGPA aka Churg-Strauss)

49

What is the function of the M2 (muscarinic) receptor?

inhibitory receptor on parasympathetic nerves, decreases Ach release

50

Which muscarinic receptor is the primary mediator of smooth muscle contraction in human airways?

M3 receptor - increases intracellular Ca, causing bronchoconstriction

51

Ipratropium is recommended in the 2007 EPR3 to be used in combination with B agonists in mod-severe asthma exacerbations because it has been shown to decrease...?

hospitalization rates

52

Ipratropium blocks M2 and M3 receptors with equal affinity, blocking of M2 receptors can lead to?

bronchoconstriction (blocking M2 receptors leads to increase Ach release, thus why you can see paradoxical bronchoconstriction with ipratropium)

53

Theophylline is metabolized by cytochrome P450, what medications can INCREASE its serum levels?

macrolide antibiotics, cimetidine, cipro, verapamil, zileuton, allopurinol

54

Theophylline is metabolized by cytochrome P450, what medications can DECREASE its serum levels?

carbamazepine, phenobarbital, phenytoin, rifampin, ethanol

55

Adverse effects of theophylline are seen at plasma levels greater than...?

>20 mg/L

56

Steroids cause what type of cataracts?

sub capsular posterior cataracts

57

Which phase of antigen challenge do steroids inhibit?

late phase only

58

Relative anti-inflammatory potency of ICS

mometasone > fluticasone > budesonide = beclomethasone

59

Where does omalizumab bind?

CH3 domain (Fc portion) of IgE

60

What happens to total and free IgE with omalizumab?

free IgE decreases, total IgE increases

61

What is the difference between the FcERI receptors on mast cells and basophils compared to other cells?

FcERI on mast cells & basophils has 4 chains (one alpha, one beta, two gamma chains)

FcERI on other cells has 3 chains: NO BETA CHAIN (one alpha, two gamma chains)
Note: IgE binds to alpha chain

62

What infection has been reported in patients taking mepolizumab?

herpes zoster (shingles)

63

What is the dose for omalizumab in asthma?

based on weight and total IgE (between 30 - 700 IU/ml)

64

What is the dose for omalizumab in CIU?

150mg or 300mg subq every 4 weeks

65

What is the dose for mepolizumab in asthma?

100mg subq every 4 weeks
(blood eos>150 cells/uL, or 300 in last 12 months)

66

What is the dose for reslizumab in asthma?

3mg/kg IV every 4 weeks
(blood eos >400)

67

What is the most common adverse event with reslizumab?

oropharyngeal pain

68

Medications that decrease glucocorticoid metabolism

OCPs, macrolide antibiotics, ketoconazole

69

What is the incidence of anaphylaxis with omalizumab?

0.20%

70

Cyclosporine binds to...?

cyclophilin (immunophilin)

71

Tacrolimus binds to...?

FK-binding protein (immunophilin)

72

Which interferon is approved for clinical use for CGD and malignant osteopetrosis?

IFNgamma-1b

73

Which TNF inhibitor binds both TNFa and TNFb?

etanercept (enbrel)

all others bind TNFa only (infliximab, adalimumab, certolizumab pegol, golimumab)

74

A screen for which infectious organism is needed prior to starting TNF inhibitors and annually while on therapy?

mycobacterium tuberculosis (PPD test)

75

COX-2 inhibitors

celecoxib, etoricoxib, lumiracoxib, parecoxib, rofecoxib, valdecoxib

76

AERD patients typically tolerate acetaminophen at what dose?

<1000 mg

77

COX-1 inhibition results in decreased production of?

PGE2 - inhibitor of 5-LO

78

When should leukotriene inhibitors be started prior to aspiring challenge/desensitization for AERD?

1 week prior

79

At what dose do reactions to aspirin desensitization typically occur?

40mg

80

In children or infant CPR, if there are 2 rescuers, what is the compression: breath ratio?

15:2
Note: 30:2 for adults or child with 1 rescuer

81

Patient is on b-blocker, first drug given for anaphylaxis?

Epinephrine
(0.01 mg/kg SC/IM of 1:1000 dilution; 0.01 mg/kg IV of 1:10,000 dilution)

82

Name the live vaccines

MMR, Nasal flu, Oral polio, Rotavirus, Smallpox (Vaccinia), Varicella, Zoster

83

Live vaccines must be separated by how many days if not given the same day?

28 days

84

If a patient does not have a functioning spleen, how should you administer PCV13 and Menactra?

administration should be separated by 4 weeks

85

After IVIG or packed RBCs, how long to wait before giving live vaccine?

>3 months for live vaccine

86

After packed RBCs, how long to wait before giving non-live vaccine? After IVIG?

6 months after RBC, 8 months after IVIG

87

If a live vaccine is given, how long to wait to give IVIG?

2 weeks
exception: no issue with pavlizumab and live vaccine

88

Which vaccines contain egg?

Influenza, Yellow fever

89

What are the gelatin containing vaccines?

MMR. Varicella-zoster, rabies, and yellow fever

90

Which vaccine causes a delayed urticaria and angioedema?

Japanese encephalitis virus (JEV) vaccine

91

Which vaccine can cause eczema vaccinatum?

smallpox vaccine

92

If not given the same day, TB skin test and MMR should be spaced by?

4 weeks

93

Contraindications to live vaccines

pregnancy, immunosuppression

94

Contraindication to vaccination

severe allergic reaction (anaphylaxis) to vaccine, encephalopathy <7 days after pertussis vaccine, hx of Guillain-Barre

95

Indications for tympanostomy tubes

OME with structural damage
Recurrent OME (3 or more in 6 months, 4 or more in 1 year)
Persistent OME (3 months bilateral, 6 months unilateral)
Hearing loss

96

Type IVa - cytokines, cells involved, skin findings

Th1 (IFNg), monocyte, eczema

97

Type IVb - cytokines, cells involved, skin findings

Th2 (IL-4, IL-5), eosinophil, maculopapular or bullous

98

Type IVc - cytokines, cells involved, skin findings

CTL (perforin, granzyme), CD4 and CD8, maculopapular/bullous/pustular

99

Type IVd -cytokines, cells involved, skin findings

T lymphocytes (IL-8), PMNs, pustular

100

Which MHC marker is associated with abacavir reaction?

HLA-B*5701

101

MHC marker associated with carbamazepine reaction?

HLA-B*1502

102

What is the major determinant for Penicillin?

benzylpenicilloyl polylysine (Prepen)

103

What is the NPV of PCN skin testing?

97%

104

Aztreonam cross reacts with what B-lactam?

ceftazidime

105

IgE mediated reactions to sulfa antibiotics are due to which determinant?

N4-sulfonamidoyl

106

Risks for radio contrast adverse reactions?

female, asthma/atopy, CV disease, prior hx of reaction

107

Treatment for SJS/TEN?

supportive, IVIG may be helpful.
Note that steroids are contraindicated in TEN

108

Vancomycin is associated with what skin condition?

linear IgA bullous dermatitis

109

Mechanism of HIT (heparin induced thrombocytopenia)?

IgG to heparin platelet factor 4 immune complexes

110

Most common drug causing serum sickness in kids?

cefaclor

111

autoAb in drug induced CUTANEOUS lupus? Most common drugs to cause?

anti-Ro (SSA) or anti-La (SSB);
HCTZ, CCB, ACE-I, antifungals

112

AutoAb in drug induced lupus (systemic)? Common offending agents?

antihistone;
procainamide, hydralazine, phenytoin, isoniazid