Ch. 7 Pharmacology & Therapeutics Flashcards
(112 cards)
1
Q
How long does cat allergen remain in the home after cat removal?
A
4-6 months
2
Q
Indications for AIT?
A
allergic rhinitis/conjunctivitis, allergic asthma, atopic dermatitis with aeroallergen sensitization, venom hypersensitivity
3
Q
With regard to asthma, AIT improves what?
A
bronchial hyper responsiveness only, there is NO effect on pulmonary functions tests
4
Q
With regard to AR, AIT improves what?
A
symptom scores, quality of life, and medication reduction
5
Q
What happens to allergen-specific IgE in the first few months of AIT?
A
allergen-specific IgE increases (decreases later).
6
Q
What immunologic changes are expected with completion of AIT?
A
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
Q
What are the standardized extracts?
A
cat, dust mite, grass (northern grasses and Bermuda), ragweed
8
Q
What color vial is 1:10,000 vol/vol (1:1,000,000 w/v)
A
silver
9
Q
What color vial is 1:1000 vol/vol (1:100,000 w/v)
A
green
10
Q
What color vial is 1:100 vol/vol (1:10,000 w/v)
A
blue
11
Q
What color vial is 1:10 vol/vol (1:1000 w/v)
A
yellow
12
Q
What color vial is 1:1 vol/vol (1:100 w/v)
A
red (maintenance)
13
Q
Name the 7 northern grasses
A
timothy, orchard, kentucky blue, perennial rye, sweet vernal, red top, meadow fescue
14
Q
Which two southern grasses cross-react?
A
bahia and johnson
15
Q
What does glycerin in allergen extracts do?
A
inhibitor of proteolytic activity that can be irritating/painful (NOT associated with local reactions)
16
Q
What does phenol in allergen extracts do?
A
antibacterial
17
Q
Which allergen extracts contains proteolytic enzymes that degrade pollen?
A
mold and cockroach
Note: can mix mold and cockroach together
18
Q
T or F, can you mix dust mite (in >10% glycerin) with cockroach and mold?
A
T
Note: Can also mix dust mite with pollen, dog/cat
19
Q
Which venoms can be mixed together?
A
Mixed vespid (yellow jacket, white hornet, yellow hornet)
20
Q
What is the maintenance dose for a single venom?
A
100ug
21
Q
What is the maintenance dose for mixed vespid
A
300ug
22
Q
What is the effective BAU for cat allergen?
A
1000-4000 BAU
23
Q
What is the effective dose for dog allergen Can f 1?
A
15ug Can F 1
24
Q
What is the effective AU for dust mites (Der f1, Der p1)?
A
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
