Drugs Flashcards
(207 cards)
1
Q
What is the active metabolite of azathioprine?
A
6-mercaptopurine (6MP), and endpoint active metabolite is thioguanine if it goes through the HPRT pathway (the bad one)
2
Q
Generic name for Imuran
A
Azathioprine
3
Q
Purine analogue, blocks purine biosynthesis
A
Imuran (Azathioprine)
And also Cellcept is one as well
4
Q
Which phase of the cell cycle is blocked by azathioprine?
A
S phase
5
Q
Why do you check a TMPT on a patient you are about to start on Imuran?
A
Before you start someone on Imuran (Azathioprine), you should check a TMPT level because if they have a hereditary deficiency in the enzyme then the drug will be metabolized down the HPRT pathway which gives the person bone marrow suppression= bad
6
Q
What drug do you not want someone to be on while they are on imuran?
A
Allopurinol (inhibits the TMPT and XO pathway)
7
Q
Which enzyme does Cellcept inhibit?
A
Inosine monophosphate dehydrogenase (IMPDH)
8
Q
How does Cellcept treat things?
A
Inhibits purine synthesis of T and B cells in particular, because these cells do NOT HAVE A PURINE SALVAGE PATHWAY!!!
9
Q
Nitrogen mustard derivative which blocks DNA cell cycle synthesis
A
Cyclophosphamide
10
Q
Name a few side effects of Cyclophosphamide
A
HEMORRHAGIC CYSTITIS
Azoospermia
Pulmonary fibrosis
Alopecia
11
Q
What is cyclophosphamide (Cytoxan) the treatment of choice for?
A
Wegeners granulomatosis
12
Q
What is the drug of choice to treat Wegeners?
A
Cyclophosphamide
13
Q
What dose Cyclosporine inhibit?
A
T cell synthesis
14
Q
How does cyclosporine work?
A
Inhibits cyclophilin - which blocks calcineurin - which decreases NFAT - which decreases IL-2
15
Q
Gingival hyperplasia
A
Cyclosporine
16
Q
Which organ do you watch out for when prescribing cyclosporine?
A
Kidneys! (Nephrotoxic)
17
Q
Which drug is metabolized by Cytochrome P450 3A4
A
Cyclosporine
18
Q
What cytochrome is Cyclosporine metabolized by?
A
Cytochrome P450 3A4
19
Q
Name 4 drugs that will increase renal toxicity risk of Cyclosporine
A
NSAIDS
Aminoglycosides
Vancomycin
Amphotericin B
20
Q
Name 4 Cytochrome p450 inducers?
A
Carbamazepine
Phenytoin
Phenobarbital
Rifampin
21
Q
What HTN med do you give if you get Cyclosporine induced HTN?
A
Israpidine
22
Q
What is the maximum amt of time you can be on Cyclosporine?
A
One year
23
Q
Max Cyclosporine dose per day
A
5mg/kg
24
Q
What do you use Thalidomine to treat?
A
Erythema nodosum leprosum
25
What does Imiquimod bind?
TLR-7
26
Thymidyline Kinase
The enzyme that acyclovir uses to work
27
What enzyme does acyclovir use to work?
Thymidyline kinase
28
What drug do you use to treat scabies in pregnant women
Precipitated sulfur
29
How does permethrin work?
Blocks sodium channels, paralyzing the mite
30
How does ivermectin work?
Blocks chloride channels, paralyzing the parasite
31
What enzyme level should you check on a person you are about to start on Imuran?
TMPT (because if they are deficient, then too much drug will be shuttled down the main pathway-HPRT)
32
What is the active metabolite of azathioprine?
6-MP
33
What enzyme converts 6-MP to 6-Thioguanine?
HPRT
*TPMT is the one that you check because if its too low the pathway goes too much down the HPRT
34
What is the endpoint of the azathioprine pathway (the end product?)
6-Thioguanine
35
What two things should you check for before starting someone on imuran?
Imuran(azathioprine) - you should check TMPT levels, and also make sure they are not on allopurinol
36
Name two purine synthesis inhibitors
Cellcept and Imuran
37
Which drug performs which action? (Cellcept vs Imuran)
1. Inhibits de novo purine synthesis
2. Inhibits S-phase specific purine synthesis
1. Inhibits de novo purine synthesis = Cellcept
| 2. Inhibits S phase specific purine synthesis = Imuran
38
Why do you get nausea in Cellcept?
Because the drug is reacted by the epidermis and also the GI tract
39
Name the two most severe side effects of Cellcept
Progressive multifocal leukoencephalopathy &
| Pure red cell aplasia
40
What is the active metabolite of cellcept
Mycophenolic acid
41
How is Cellcept excreted?
Kidneys
42
Which is cellcept: nephrotoxic or hepatotoxic?
Neither!
43
Name the enzyme MTX inhibits
Dihydrofolate reductase (DHFR)
44
Treat liver toxicity from MTX with?
Leucovorin
45
Name the molecule Cyclosporine inhibits
Cyclophillin. (Cyclophillin activates calcineurin in the presence of calcium and calmodulin)
46
Name some side effects of Cyclosporine
Gingival hyperplasia
Uric acid
Nephrotoxicity
Reversible hypertension
47
What vital sign should you check regularly in a patient on cyclosporine?
BP (bc cyclosporine can cause reversible HTN)
48
Side effect of hydroxyurea
Leg ulcers
49
Stelara inhibits which molecules?
IL-12/IL-23
50
Which subunit of the IL12/23 molecules does Stelara inhibit?
P40 subunit
51
What drug is a PDE4 small molecule inhibitor?
Otezla
52
Name Otezla's mechanism of action
PDE4 inhibitor
53
Name Xeljanz mechanism of action
JAK inhibitor
54
Side effect of cosyntyx
Nasopharyngitis
55
Which medication used to treat SLE,DM ect can cause blue-grey nail dispigmentation
Hydroxychlororquine (Plaquenil)
56
Name Plaquenil's mechanism of action
Intercalates into DNA
57
What lab do you need to test before starting Plaquenil?
G6PD deficiency (And also should get a baseline eye exam)
58
Which eye findings in Plaquenil are reversible and which are not?
Visual field changes are reversible (premaculopathy)
Bull's eye pigment retinopathy is not
59
Which antimalarial has no risk of retinopathy?
Quinacrine
60
What is a side effect of Quinacrine?
Yellow pigmentation of the skin
61
Which anti-malarial has the highest risk of G6PD hemolysis?
Primaquine
62
Mechanism of action of Rituxan
Monoclonal Ab, anti-CD20 (destroys B cells)
63
Common side effect of intralesional Bleomycin
Raynauds
64
Most common general cause of Fixed Drug Eruption
Tetracycline
65
Most common cause of non-pigmented fixed drug eruption
Psuedophed
66
Most common cause of fixed drug eruption in children
Bactrim
67
Which drug causes a sun exposed blue-grey dispigmentation
Amiodarone
68
Where does minocycline cause a blue grey dispigmentation?
On the legs
69
Which drug causes a blue-grey dispigmentation in the sclera, teeth, nailbeds and tibia?
Quinacrine
70
Cyclosporine metabolized by what enzyme
CYP3A (so don't give itraconazole or erythromycin, or fluconazole or ketoconazole)
71
Half life of isotretinoin
20 hours
72
Side effect of foscarnet
Penile erosions
73
What drugs create gynecomastia?
*Some drugs cause awesome knockers
```
Spironolactone
Digitalis
Cimetidine
Alcohol
Ketoconazole
```
74
Are the inhibitors of 14-alpha-demethylase fungistatic or fungicidal?
Fungistatic
75
What two drugs cause inhibition of 14-alpha-demethylase?
Ketoconazole
| Itraconazole
76
Which antifungal causes visual disturbances
Voriconazole
77
Which antifungals are CYT-p450 inhibitors?
Fluconazole
Voriconazole
&also ketoconazole btw
78
What antifungal is fungicidal?
Terbinafine (Lamisil)
79
Which two -azoles require an acidic environment for absorption?
Itraconazole and ketoconazole
80
Bad side effect of oral ketoconazole?
Fulminant hepititis
81
Which oral anti-fungal can cause fulminant hepatitis?
Ketoconazole *why they dont use it any longer orally
82
What enzyme does terbinafine inhibit?
Squalene epoxidase (first step of ergosterol synthesis)
83
Which common antifungal DOES NOT inhibit cyp p450?
Terbinafine
84
What pregnancy category is terbinafine?
Category B
85
What side effect/autoimmune disease does terbinafine sometimes cause?
Drug induced LE
86
Which antifungal is at risk for causing drug induced LE?
Terbinafine
& griseofulvin
87
Which antifungal inhibits the first step of egrosterol synthesis?
Terbinafine! (Inhibits squalene epoxidase)
88
What enzyme mediates the first step of ergosterol synthesis?
Squalene epoxidase
89
Which antifungal disrupts microtubule formation?
Griseofulvin
90
Which antifungal is a cytochrome p450 INDUCER?
Griseofulvin
91
Which antiviral can cause TTP/HUS in HIV and transplant patients?
Valacyclovir
92
What is a bad side effect of using high doses of Valacyclovir in HIV or transplant patients?
TTP/HUS
93
What is the prodrug of acyclovir
Valacyclovir
94
Side effect of foscarnet
Penile erosions
95
Side effect:penile erosions
Foscarnet
96
Treatment for resistant HSV if failed acyclovir
Foscarnet
97
Why does foscarnet work when acyclovir doesnt?
Foscarnet does not require phosphorylation by viral thymidylate kinase like acyclovir does
98
What do you use if HSV is resistant to gancyclovir AND Foscarnet?
IV Cidofidir
99
Why does IV Cidofovir work when gancyclovir and foscarnet wont?
It acts completely INDEPENDANT of thymidylate kinase
100
Which antiviral works completely independant of thymidylate kinase?
Cidofivir
101
Which HIV medication causes melanonychia?
Zidovudine
102
Side effect of zidovudine?
Melanonychia
103
Which HIV medication can give a fatal hypersensitivity reaction?
Abacivir
104
Side effect of the protease inhibitor HIV meds
Periungal pyogenic granulomas
105
Which HIV med causes periungal pyogenic granulomas
The protease inhibitors (Indinavir, Ritonavir, Lopinavir)
106
Lice medication which is contraindicated if you are allergic to crysanthemums
Pyrethrin
107
How does Permethrin kill lice and scabies?
Disables the nerve cell Na transport channels
108
Which drug disables parasites sodium transport channels
Permethrin
109
Which antiparasitic disables:
Sodium channels?
Chloride channels?
Sodium channels - Permethrin
| Chloride channels - Ivermectin
110
Name three diseases you use Ivermectin to treat?
Strongyloides
Onchocerciasis
Norwegian Scabies
111
Flammable anti-parasite drug
Malathion
112
Which anti-parasite medication blocks neural transmission by interfering wtih GABA
Lindane (used for scabies)
113
Which anti-parasitic carries an increased risk for seizures
Lindane (used for scabies, blocks GABA)
114
What do you use to treat cutaneous larva migrans?
Thiabendazole/Albendazole
115
What enzyme does Thiabendazole/Albendazole inhibit?
Fumarate reductase
116
Which antparasitic inhibits fumarate reductase
Thiabendazole,
| *used to treat cutaneous larva migrans
117
Side effects of thiabendazole/albendazole
Dizziness, drowsiness, jaundice
118
Side effect of pentavalent antimonial (sodium stibogluconate, meglumine, antimoniate)
Prolonged QT interval
119
What do you use Pentamidine to treat?
Trypanosomiasis and leishmaniasis
120
What do you use DEC to treat?
Filariasis, onchocerciasis
121
Which cholesterol med reduces triglycerides the best?
Gemfibrozil
122
Hydrochlorothiazides known to cause what kind of reaction
Lichenoid eruption
123
Serum sickness is a side effect of which cephalosporin antibiotic?
Cefaclor
124
Can you use doxycycline in renal failure patient?
Yes, because it is excreted in the GI tract
125
Which part of the mouth does each medication stain?
-tetracycline
Vs
-minocycline
Tetracycline - stains the gingival 1/3
| Minocycline - stains the mid-portion on the teeth
126
Which ribosomal subunit do the tetracyclines bind?
30s subunit
127
Which type of antibiotics bind the 30s subunit?
Tetracyclines
128
Which tetracycline is the most phototoxic?
Demeclocycline
129
Which antibiotic inhibits DNA-dependent RNA polymerase?
Rifampin
130
Which antibiotic is proven to decrease OCP efficacy?
Rifampin
131
Name two types of antibiotics which inhibit the 30s subunit
Tetracyclines
| Aminoglycosides
132
Sulfonamides inhibit what enzyme?
Dihydropteroate synthetase
133
Name some antibiotics that bind the 50s ribosomal subunit?
Macrolides (Erythromycin)
Clindamycin
(*Tetracyclines and amminoglycosides bind the 30s subunit)
134
Treatment for CARP
Minocycline
135
Which antibiotic inhibits DNA gyrase
Fluoroquinolones
136
Side effect: acral erythema (erythrodysesthesia)
Doxyrubicin
5-FU
Cytarabine
MTX
*Vs bleomycin which causes acral sclerosis
137
Acral sclerosis
Bleomycin
*Bleomycin also causes Raynauds
138
Which antifungal can cause AGEP?
Terbinafine
139
Name some drugs that can cause AGEP
```
Beta lactam antibiotics (pinicillin)
Macrolides (erythromycin)
Terbinafine
Calcium channel blocks (diltiazim)
Chloriquine
```
140
Side effect: autoimmune hepatitis
Minocycline
141
What serious systemic side effect can minocycline cause?
Autoimmune hepatitis
142
Side effect: dermatomyositis-like eruption
Hydroxyurea
143
Eccrine squamous syringometaplasia
Cytarabine
| Paclitaxel
144
A patient being treated with cytaribine and paclitaxel develops erythematous macules and papules in the axilla and on the hands. What side effect could this most likely be?
Eccrine squamous syringometaplasia
145
Drugs that cause Erythema Nodosum
OCPs
NSAIDS
Antibiotics (sulfonamides and tetracyclines)
146
Side effect: Extravasation reaction
Doxyrubicin
147
Side effect: flag sign
MTX
148
Side effect: gingival hyperplasia
Phenytoin
Cyclosporine
CCBs
149
Side effect: violetbrown/blue pigmentation of skin
Clofazimine
150
In which minocycline dyspigmentation reaction is iron not deposited into the skin?
Type III
Type I - pigment within scars (with iron deposition)
Type II - pigment on shins (with iron deposition)
Type III- pigment in sunexposed areas
151
Side effect: hypertrichosis
Cyclosporine
Phenytoin
Minoxidil
152
Side effect: inflamed SCCs
Fludaribine
153
Side effect: Inflamed SKs
Cytarabine
154
Which medication will cause a flare-up of inflamed seborrheic keratosis
Cytaribine
155
Side effect: leg ulcers
Hydroxyurea
156
Side effects of Hydroxyurea
Dermatomyositis-like eruption
| Leg ulcers
157
Hydroxyurea inhibits what enzyme
Ribonucleotide reductase (inhibits DNA synthesis, S phase specific)
158
Side effect: leukocytoclastic vasculitis
Beta-lactam antibiotics (Penicillin)
159
Side effect: Lichenoid eruption
HCTZ
Beta-blockers
Quinidine
160
Which antimalarial causes a lichenoid-like eruption?
Quinidine
161
What is the most common cause of Linear IgA bullous dermatosis
Vancomycin
162
Side effect: flagellate hyperpigmentation
Bleomycin
163
Side effect: supravenous serpentine hyperpigmentation
5-FU
164
Side effect: sun exposed hyperpigmentation
MTX
5-FU
Daunorubicin
165
Side effect: hyperpigmentation of occluded areas
Thiotepa
166
Drugs causing:
SLE
Vs
SCLE
SLE: Hydralizine, procainimide, isoniazid, minocycline, phytanic, penicillamine
SCLE: Hydrochlorothiazide *most common), griseofulvin, terbinafine, CCBs
167
Most common cause of drug-induced SCLE
HCTZ
168
Name some causes of SCLE
HCTZ, Terbinafine, Griseofulvin
CCBs
169
Anticonvulsant hypersensitivity syndrome results from a defect in what enzyme
Epoxide hydroxylase
170
Antiparasitic which is an organophosphate cholinesterase inhibitor
Malathion
171
Side effect: melanonychia
Zidovudine (HIV med)
172
Side effect: mucositis
```
Daunorubicin
Cyclophosphamide
Doxorubicin
MTX
5-FU
```
173
Neutrophilic eccrine hiddradentitis
Cytarabine
174
Side effect: onycholysis (non-photo)
Captopril
Retinoids
Chemo drugs: Paclitaxel, etopiside
175
Side effect: photo-onycholysis
Tetracyclines: doxycycline
OCPs
Flouroquinolones: Cipro
Psoralen
176
Side effect: pemphigus vulgaris
Captopril
| Penacillamine
177
Side effect: pseudoporphyria
```
NSAIDS
Furosemide
HCTZ
TCNs (doxycycline)
Sulfonamides
Isotretinoin
Nalidixic acid
```
178
Side effect: induction or worsening of psoriasis
```
Terbinafine
NSAIDS
Captopril (ACE-I)
Beta-blockers
Lithium
Antimalarials
```
179
Side effect: pulmonary fibrosis
```
MTX
Bleomycin
Amiodarone
Penicillamine
Gold
Busulfan
```
180
Side effect: radiation recall
MTX
Actinomycetes-D
Doxorubicin, a ton of cancer drugs
181
Side effect: Raynaud's phenomenon
Combo of bleomycin and vinblastine
182
Side effect: sweets
GCSF*
TMP-SMZ
Carbamazepine
183
Side effect: TEN
```
Allopurinol
PCNs
Anticonvulsants (carbamazepine, lamotigene, pheytoin)
Sulfa drugs
NSAIDS
```
184
Cytochrome P450 INDUCERS
Pretty Please Can I Rent Real Props for St Johns Only Gathering
```
Phenobarbital
Phenytoin
Carbamazepine
Isoniazid
Rifampin
Ritonavir
Propranolol
St Johns Wart
Omeprazole
Griseofulvin
```
185
Which cell cycle specific phase does Bleomycin affect?
M and G2 phase specific - damages DNA by direct binding
186
Which chemotherapy drug damages DNA at M and G2 specific cell cycle phase?
Bleomycin
187
What is the Wolff-Chaikoff effect?
The inhibition of thyroid hormone synthesis when a patient is given Potassium Iodide
188
What side effect do you need to watch out for when giving Potassium Iodide?
Wolff-Chaikoff effect: inhibits thyroid hormone synthesis
189
What do you use to treat Sporotrichosis?
Potassium Iodide
190
What lab do you need to check one month after giving someone potassium iodide?
TSH
191
What is a contraindication of alendronate or other bisphosphonates?
Pregnancy
192
Which two antifungals should you not give to someone who is taking an antiacid and why?
Itraconazole and Ketoconazole
*because they both require an acidic environment to work, and they are both metabolized by the same enzyme (14-alpha-demethylase)
193
What enzyme do sulfonamide antibiotics inhibit?
Dihydopterase synthetase
194
Which retinoid has a risk of drug induced hypothyroidism
Bexarotene
195
Allopurinol blocks which enzyme in the azathioprine metabolic pathway?
XO (xanthene oxidase). *different from the genetically inherited TMPT deficiency
196
Most common drug to cause linear IgA
Vancomycin
197
Drug causing bullous pemphigoid
Furosemide
198
Name two drugs commonly causing pemphigus
Captopril
| Penacillamine
199
Drug causing pseudoporphyria
Naproxen
200
Most common drug causing AGEP
B-lactams
201
Most common drug causing FDE on the penis
Sulfonamides
202
Name three common drugs causing phototoxic reactions
Tetracyclines
Quinolones
Psoralen
203
Drug causing palmoplantar erythrodysesthesia (Acral variant of toxic erythema of chemotherapy)
Cytaribine
204
Drug causing cicatricial pemphigoid
Clonidine
205
Most common class of medications to cause drug eruptions
Aminopenicillines > anticonvulsants >TMP/SMX > NSAIDS
206
Most common drug to cause drug reaction in HIV patients
Bactrim (TMP/SMX) - drug rash occurs in 40% of patients!
*vs the regular population, penicillins are the most common cause of drug reactions over bactrim
207
Time lag for ACE-I to develop lichenoid drug
How about quinacrine?
ACE-I - 6 months
| Quinacrine - 6 weeks
