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Pharmacology > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Most common manifestation of drug induced kidney disease?

A

Decline in GFR
Rise in serum creatinine and blood urea nitrogen (BUN)
GFR/blood volume are opposite to BUN

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2
Q

MC lab abnormalities of drug induced kidney disease

A 
Increase in Scr of >0.3mg/dL in 48 hours
OR
Increase in Scr of 1.5x baseline
OR
Reduced urine output (<0.5mL/kg/h for more than 6 hours
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3
Q

Drugs involved in acute tubular necrosis

A

Aminoglycosides, contrast dye, chemo drugs (cisplatin), amphotericin, cyclosporin

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4
Q

Drug classes involved in hemodynamically mediated kidney injury

A

NSAIDs, ACEs, ARB, cyclosporine

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5
Q

What kind of kidney injury do sulfonamides and NSAIDs cause?

A

Prerenal, vasculitis, nephrotic syndromes, obstructions, acute interstitial nephritis

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6
Q

What classes of meds cause acute allergic interstitial nephritis?

A

Penicillins, cipro, NSAID/Cox2s, Proton pump inhibitors, loop diuretics (furosemide)

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7
Q

What type of kidney injury does hydralazine/methamphetamines cause?

A

Vasculitis and thrombosis

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8
Q

What type of kidney injury does warfarin cause?

A

Cholesterol emboli

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9
Q

Risk Factors of Contrast Induced Nephrotoxicity

A

GFR <60, decreased renal blood flow, concurrent nephrotoxins (NSAIDs/ACE)

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10
Q

Prevention/Monitoring of CIN

A

Alternate imaging, hydration and antioxidants

Monitor renal function (LFTs), electrolytes and volume status

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11
Q

Amphotericin Nephrotoxicity

A

Reduced renal blood flow exacerbating ischemia, may be irreversible
Decreased GFR, ^Scr/BUN
Wasting of potassium, sodium and magnesium

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12
Q

Prevention of Amphotericin B Nephrotoxicity

A

Switch from liposomal form in high risk, increase infusion time, alternate antifungals (azaleas, caspofungin)
Monitor LFTs and electrolytes

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13
Q

ACE/ARB Nephrotoxicity

A

Reduced renal blood flow (>efferent and small afferent)

Decreased urine output, Scr rise of >30% in 3-5 days, stabilizes in 1-2 week (reversible)

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14
Q

Prevention/Management of ACE/ARB Nephrotoxicity

A

Choose shorter acting drugs (prils)
Low doses/titration
Discontinue if Scr increases >30%, can attempt to restart after correcting volume depletion

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15
Q

NSAID/Cox-2 Nephrotoxicity

A

Renal ischemia/reduced GFR from inhibited vasodilation (constricted afferent)
Diminished urine output, weight gain/edema, Scr/BUN/potassium/BP all elevated

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16
Q

Prevention of NSAID/Cox2 Nephrotoxicity

A

Avoid potent compounds (indomethacin for gout), use analgesics witless PGE inhibition (acetaminophen), use shorter half-lives

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17
Q

Crystal Nephropathy Causes

A

Precipitation of drug crystals in tubular lumen from hyperuricemia (treat w/ hydration and allopurinol), Rhabdomyolysis (treat with statins; increased risk with CYP3A4 drugs)

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18
Q

What is the leading cause of CKD?

A

Diabetes

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19
Q

Diabetes Treatment in CKD

A

ACE or ARB if urine albumin >30mg/24h

dose is increased until a drop in GFR, hyperkalemia or albuminuria reduced by 30-50%

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20
Q

Hypertension Treatment in CKD

A 
ACE or ARB, if albuminuria is down butBP is still high, increase dose or dd thiazide or dihydropyridine
Second lines (for pregnant): nondihydros (diltiazem, verapamil) or alosdterones (spironolactone)
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21
Q

Anemia Treatment in CKD

A

ESAs and iron supplementation

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22
Q

Anemia Monitoring

A

Reticulocytes

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23
Q

Erythropoetin Stimulating Agents Mechanism of Action

A

Stimulates division of differentiation of committed erythroid progenitor cells, induces release of reticulocytes from bone marrow into blood
Short (epoetin) and long (darbepoetin) acting version

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24
Q

Erythropoetin Stimulating Agents AEs

A

Box warning: increased CV and CKD events with Hg>11

Cancer (shortened survival when Hg >12), increased risk of DVT

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25
Q

What is the treatment goal in anemia?

A

Hb change of 1-2g/dL in 4 weeks

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26
Q

PTH, vitamin D and FGF23 effects on serum calcium/phosphate levels

A

PTH: increased calcium, decreased phosphate
Vit D: Increased calcium and phosphate
FGF23: decreased phosphate

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27
Q

Mineral/bone Disorder management

A

Dietary phosphorus restriction (pumpkin seeds, edamame, bacon, bakers yeast), phosphate binding agents, vit D supplementation and calcimimetic therapy

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28
Q

Calcium based phosphate binders MOA

A

forms insoluble calcium phosphate to be excreted in feces

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29
Q

Calcium based phosphate binders Indications and AEs

A

CKD hyperphosphatemia

AEs: milk-alkali syndrome (HA, nausea, irritability, weakness, hypercalciumia)

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30
Q

Types of Calcium based phosphate binders

A

Calciumacetate, calcium carbonate (tums)

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31
Q

Types of Resin Binders

A

Sevelamer carbone, sevelamer hydrochloride

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32
Q

Sevelamer Hydrochloride MOA

A

Binds phosphate within intestinal lumen limiting absorption and decreased serum phosphate concentrations

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33
Q

Sevelamer Hydrochloride Indications/AEs

A

Indications: Risk of extraskeletal calcification, hyperphosphatemia, high LDL

AEs: metabolic acidosis, N/V/D and dyspepsia

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34
Q

Lanthanum Carbonate MOA

A

Binds dietary phosphate>insoluble lanthanum phosphate complexes with decreases in phosphate and calcium levels

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35
Q

Lanthanum Carbonate Indications/AEs

A

Hyperphosphatemia

AEs: bowel obstruction, constipation, dyspepsia, fecal impaction, ileus

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36
Q

Aluminum Hydroxide MOA

A

Binds phosphate in GI tract preventing phosphate absorption

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37
Q

Aluminum Hydroxide Indications/AEs

A

NOT FIRST LINE; short term use for hyperphosphatemia with no response to other binders

AEs: aluminum toxicity, constiption, fecal impaction, hypomagnesemia, hypophosphatemia

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38
Q

Ergocalciferol and Cholecalciferol D2 MOA

A

Stimulates calcium and phosphate absorption in small intestine, promotes secretion of calcium from bone to blood, promotes renal tubule phosphate reabsorption

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39
Q

Ergocalciferol and cholecalciferol Indications and AEs

A

Hypophosphatemi, hypoparathyroidism

AE: hypercalcemia

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40
Q

Calcitrol

A

Used for hypocalcemia in pts on chronic renal dialysis

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41
Q

Types of ESAs

A 
Epoetin alpha (short half life), darbepoetin alpha (long half-life), methoxy PEG-epoetin beta (really long half life)
all available IV or subQ
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42
Q

ESA Initiation in CKD Anemia

A

Do not start if Hb>10 (best between 9-10)

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43
Q

Hb Levels in CKD Anemia

A

Do not use ESAs to intentionally increase >13 or to maintain >11.5

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44
Q

Iron Initiation in CKD Anemia

A

Start when Transferrin saturation <30% and ferritin is <500

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45
Q

Goals of UTI Treatment

A

Eradicate invading organism, prevent/treat consequences of infection, prevent recurrence of infection, decrease potential for collateral damage with too broad therapy

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46
Q

Microbes Associated with UTIs

A

E. coli #1

Staph saprophytic, klebsiella, proteus spp, pseudomonas, enterococcus

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47
Q

Recommended Treatment for Uncomplicated UTI

A

3 days of bactrim, 1 dose of fosftomycin or 5 days nitrofurantoin

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48
Q

Recommended Treatment of Pyelonephritis/Complicated UTIs

A

3 days of Cipro, levofloxacin

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49
Q

Bactrim MOA/Comments

A

Inhibits Folate Synthesis

Effective against aerobes except P. aeruginosa, effective prophylaxis

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50
Q

Nitrofurantoin MOA/Comments

A

Advantage is a lack of resistance

Can be used in pregnancy but can cause hemolytic anemia when close to delivery

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51
Q

Cipro/levofloxacin MOA/Comments

A

Inhibits DNA Gyrase
Cover P aeruginosa, Avoid in kids/pregnancy
Cipro>levo

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52
Q

Fosfomycin MOA

A

Inhibits cell wall synthesis

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53
Q

Beta-lactam MOA

A

Penicillins/cephalosporins (augmenten is preferred)

Inhibits cell wall synthesis

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54
Q

Bactrim AEs/Monitoring

A

AEs: rash, stevns-johnson, renal failure, photosensitivity

Monitor Scr, BUN, electrolytes, CBC

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55
Q

Nitro AEs/monitoring

A

GI intolerance, neuropathies, pulmonary reactions

Monitor Scr and BUN

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56
Q

Fluoroquinolone (Cipro/levo) AEs/Monitoring

A

Hypersensitivity, photosensitivity, GI symptoms, dizziness, confusion, tendonitis
Monitor CBC, Scr, BUN

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57
Q

Penicillin AE/Monitoring

A

Hypersensitivity (rash, anaphylaxis), diarrhea, seizure

Monitor CBC, signs of rash/hypersensitivity

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58
Q

Treatment of uncomplicated cystitis

A 
1: nitro x5days
bactrim x3 days
fosfomycin x1 dose
fluoroquinolone x3 days
blactams x3-7 days
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59
Q

Treatment of Cystitis in Pregnancy

A

Augmentin x7 days
cephalosporin x7 days
bactrim x7 days

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60
Q

Treatment of Uncomplicated pyelonephritis

A

Quinolone x7 days
bactrim x14 days
augmenter x 14 days if gram positive

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61
Q

Treatment of Complicated Pyelonephritis

A

Quinolone x14 days

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62
Q

Prostatitis Treatment

A

Bactrim x4-6 weeks

Quinolone x 4-6 weeks

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63
Q

Cranberry Juice in UTI

A

Decreases adherence of bacteria to bladder epithelial cells

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64
Q

Phenazopyridine HCl

A

Azo-dye
Can mask a worsening UTI
Colors body fluids red-orange/can’t wear contacts bc of this
Dose restricted max 200 mg TID for 1-2 days

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65
Q

UTI in Pregnancy

A

Treat whether symptomatic or not

Cephalexin, amoxicillin or augmente for 5-7 days

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66
Q

Principles of Topical Term Therapy

A

Efficacy of a topical drug depends on its inherent potency and its ability to penetrate the skin
Factors that affect this are: concentration, thickness/integrity of corneal, frequency of application, occlusiveness of vehicle and compliance

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67
Q

Regional Penetration Levels

A

Mucus membrane>scrotum>eyelids>face>chest/back>

upper arms/legs>lower arms/legs>doors of hands/feet>palmar and plantar skin>nails

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68
Q

Goals of Derm Treatment

A

Counteract disease, reduce inflammation, relieve symptoms, promote epithelial healing, restore cutaneous integrity, prevent complications

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69
Q

Types of Term Treatments

A

Cleansing agents, absorbent dressings/powders, anti-inflammatory, anti-infective, astringents, drying agents, moisturizing agents, keratolytics, antipruritics

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70
Q

Types of Term Vehicles

A

Liquid/oil combos (ointment or cream), liquids (lotion, foam, gel, solution, soaks/baths), spray, powder

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71
Q

How to determine quantity of topical treatments

A

Rule of 9’s
1 palm area =1% body surface (2 palms BID requires 30 g for 1 month)

Fingertip Units for steroids (2 fingertips=1g=4 palms)-apply sparingly!

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72
Q

How can you enhance absorption of topical treatment?

A

Occlusion!-plastic wrap, cotton socks, nylon suit, waterproof dressing

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73
Q

Types of dressings

A

Nonocclusive (gauze)
Wet-to-dry (wetted in saline, allowed to evaporate)
Occlusive (increases absorption and effectiveness; hydrocolloid can just use gauze)

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74
Q

Corticosteroids in Derm MOA and Absorption

A

Inhibits cell division
Minimally absorbed normally, increases x10 with plastic wrap occlusion, also increases in inflamed skin/extensor surfaces

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75
Q

Downfall to Occluding Steroid Treatment?

A

Can increase potency which increases systemic side effects

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76
Q

Where/how long can you use Class 1 (super high potency) steroids?

A

Scalp, palms, soles, thick plaques in severe dermatoses for <3 weeks

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77
Q

Where/how long can you use class 2-5 (med-high potency) steroids?

A

Flexor surfaces for <6-8 weeks

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78
Q

When/how long should you use class 6/7 (low potency) steroids?

A

Large areas/thin skin-face, eyelids, genital and intertriginous areas
Can do 1-2 week intervals

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79
Q

Class 1 Topical Steroids

A

Clobetasol Propionate cream or ointment

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80
Q

Class 2 Topical Steroids

A

Betamethasone cream or ointment

Fluocinonide cream, gel, ointment or solution

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81
Q

Class 3 Topical Steroids

A

Betamethasone cream/lotion (0.05%), ointment (0.1%)

Triamcinolone acetonide ointment

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82
Q

Class 4 Topical Steroids

A

Fluocinolone acetonide ointment, triamcinolone acetonide cream or ointment

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83
Q

Class 5 Topical Steroids

A

Fluocinolone acetonide cream, desonide ointment

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84
Q

Class 6 Topical Steroids

A

Triamcinolone acetonide cream, desonide cream

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85
Q

Class 7 Topical Steroids

A

Hydrocortisone cream, lotion, ointment; available OTV

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86
Q

Systemic Side Effects of Topical Steroids

A

Cushing’s syndrome, pseudotumor cerebri, growth retardation, Na retention/edema, suppression of hypothalamic-pituitary-adrenal axis

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87
Q

Ocular Side Effects of Topical Steroids

A

Catarct, glaucoma, slowed corneal abrasion healing, extension of herpetic infection, increased susceptibility to bacterial or fungal infection

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88
Q

Cutaneous Side Effects of Topical Steroids

A

Atrophy, stretch marks, telangiectasis, purport, hypo pigmentation, slow wound healing, allergic dermatitis

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89
Q

Types of Topical Antibiotics

A

Bacitracin, mupirocin, polymyxin B, neomycin, gentamicin

90
Q

Topical Bacitracin

A

Works against gram positives (streps, staphs, pneumococci)

Poorly absorbed so systemic toxicity is rare, but allergic dermatitis is common

91
Q

Topical Mupirocin

A

Used for gram positive infection including MRSA, insect bites, impetigo
Can cause stinging, burning, itching or HA
Comes in cream or ointment

92
Q

Triple Antibiotic (polymyxin, neomycin, bacitracin)

A

Polymyxin works on gram negatives (P aeruginosa, enterobacter, E coli)
Neomycin works on gram positive and negative bacilli (s aureus, e coli) but can cause ototoxicity/nephrotoxicity and allergic dermatitis

93
Q

4 Factors Involved in Acne Vulgaris

A

1-Increased sebum production influenced by androgens
2-Keratin and sebum plug hair follicles and accumulate>hyperkeratosis w/ comedones
3- P acnes bacteria proliferates in sebaceous follicle releasing enzymes and inflammatory cytokines
4-inflammatory response

94
Q

Treatment of mild acne

A

Topical retinoid alone
OR
Topical peroxide and/or topical antibiotic

95
Q

Treatment of Moderate Acne

A

Topical retinoid + peroxide +/- antibiotic (topical or oral)

consider referral and hormonal therapy

96
Q

Treatment of Severe Acne

A

Topical retinoid + peroxide +/- topical and oral antibiotic
Consider isoretinoin and hormonal therapy
Derm referal

97
Q

Treatment of Cystic Acne

A

Intralesional triamcinolone

98
Q

What is the preferred antibiotic for acne according to AAFP?

A

Doxycycline and minocycline>tetracycline
Should not do antibiotics as monotherapy
Can also use erythromycin or clindamycin

99
Q

Pediatric Acne (mild) Treatment

A

Peroxide (probably preferred) or retinoid

OR combo therapy of peroxide+antibiotic, retinoid+peroxide, or all 3

100
Q

Topical Antibiotics in Acne

A

Erythromycin causes burning, drying and irritation of skin; decreased drying with water-based gel
Can use clindamycin cream lotion or gel

Both are combined with peroxide

101
Q

What do we do to prevent antibiotic resistance in topical antibiotics?

A

Pair them all with peroxide

102
Q

What is Sarecycline?

A

Newest acne treatment for 9+-tetracycline with narrow spectrum for less resistance
Given as a once daily tablet but very expensive

103
Q

Retinoid Acid

A

Acid form of vitamin A, effective topical acne treatment
Decreases cohesion between epidermal cells and increased epidermal cell turnover to open and expel comedones
Start with low strength in small test area
Causes erythema and peeling

104
Q

Types of acne preparations

A

Tretinoin (best efficacy), adapalene, tazarotene

Applied every night

105
Q

How long does it take acne preps to work?

A

Use for 4-6 weeks, will get worse before peter and will Clea in 8-12 weeks

106
Q

What are topical retinoids used for and what precautions should you take?

A

photo-damaged skin, thickened skin (psoriasis) and atrophic area
Avoid sun exposure/wear sunscreen

107
Q

What retinoids should you avoid in pregnancy?

A

All of them if possible! but tazarotene is category X

108
Q

Benzoyl Peroxide Acne Preparation

A

Works against P acnes, causes peeling and comedolytic effects, will bleach cloth
Avoid contact with eyes/mucus membranes

109
Q

Tetracycline in Acne AEs

A

Doxy/minocycline: Slate gray hyper pigmentation of skin, drug-induced lupus
Cannot be used in pregnancy
Minocycline also causes dizziness

110
Q

Erythromycin in Acne AEs

A

GI upset

111
Q

Clindamycin in Acne AEs

A

clostridium difficile

112
Q

Isoretinoin Pregnancy Precautions Acne

A

Used for cystic acne
Huge risk of teratogenicity-women MUST use 2 forms of contraception, starting 1 month prior to therapy, and MUST have negative pregnancy test within 2 weeks of initiation

113
Q

Isoretinoin in Acne AEs

A

Dry mucus membranes, joint pain, thinning hair, HA, nausea, mood swings, ^ LFTs, ^ triglycerides

114
Q

Topical Antibiotics in Rosacea

A

Metronidazole, sulfacetamide

115
Q

Metronidazole in Acne/Rosacea AEs/Warnings

A

Not recommended during pregnancy/for kids
Gel causes dryness, burning, stinging
Available in cream, gel or lotion; Can cause N/V when taken orally

116
Q

Sodium Sulfacetamide MOA/Contraindications in Acne

A

Inhibition of aminobenzoic acid utilization of bacteria
Contraindicted in pts with sulfa allergy
Used in acne, rosacea and seborrheic dermatitis

117
Q

Rosacea Treatment

A

Reduction of aggravating product, daily sunscreen
Clindamycin cream/lotion/gel and erythromycin solution
Topical azoles
Tetracyclines
Isoretinoin

118
Q

How long do topical antifungal treatments require?

A

4-6 weeks, they don’t work for subQ, hair or nails

119
Q

Azoles MOA

A

Interfere with cytochrome P450 activity decreasing ergosterol synthesis and inhibiting cell membrane formation

120
Q

Types of Azoles

A

Triazoles: fluconazole, itraconazole

Imidazoles (available OTC): clotrimazole, ketoconazole, miconazole

121
Q

Nystatin MOA

A

Binds to steroid in fungal cell membrane, changing cell wall permeability allowing cellular content leakage

122
Q

What are topical imidazoles used for?

A

Stratum corneal, mucosa, cornea by dermatophytes and candida, seborhhic dermatitis
NOT subQ hair or nails

123
Q

How do you use topical imidazoles?

A

1-2 times daily clears infection in 2-3 weeks

Paronychial and intertriginous applied 3-4 times/day

124
Q

Nystatin Uses

A

Cutaneous and mucosal candida (oral or vaginal)

125
Q

How to take nystatin

A

Oral suspension or troches 4x/day for 7-10 days

Vaginal tablet BID x14 days then QHS for 14-21 more days

126
Q

Atopic Dermatitis Treatments

A

Tacrolimus and pimecrollimus

Inhibits/prevents immune response

127
Q

Tacrolimus/pimecrolimus Black Box Warning

A 
Rare malignancy (should not use occlusive dressings!)
long term use should be avoided
Not indicated for kids <2
128
Q

Treatment of Pruritis

A

Emollient cream/ointment (aquaphor, cera-ve; can be refrigerated for ^ efficacy) within 3 minutes of bathing
Topical steroids for inflammation, topical capsaicin (causes burning), topical doxepin

129
Q

Topical Doxepin Cream

A

H1 and H2 receptor antagonist properties
Can cause drowsiness, anticholinergic effects
Contraindicated in urinary retention or narrow angle glaucoma

130
Q

Head Lice Treatment

A

OTC: permethrin (1st line!) or pyrethrins w/ piperonyl but oxide
Prescription: Lindane, malathion, benzyl, spinosad, ivermectin

131
Q

AEs with Sklice lotion (ivermectin)

A

Conjunctivitis, ocular hyperemia, eye irritation, dandruff, dry skin and burning

132
Q

Which lice meds are not safe in young kids?

A

Malathion (>6 years) and spinosad (>4 years)

133
Q

Which lice med is only used once?

A

Lindane

134
Q

Permethrin

A

1st line for lice-kills humans, pubis and scabies
1% Cream rinse for head like, 5% cream for scabies
Treatment repeated one week after initial

135
Q

Lindane

A

Available as shampoo or lotion

Can cause CNS effects (seizures, neurotoxicity) bc its concentrated in fatty tissues including the brain

136
Q

Crotamiton

A

Available as cream or lotion

2 applications from chin down in 24 hour intervals with bath 48 hours after last application

137
Q

Sulfur

A

Lice drug thats safe for infants ad pregos

138
Q

Drugs for Hyperpigmentation

A

Hydroquinone, mequinol (these provide temporary lightening)
MBEH (monobenzone-irreversible depigmentation)

These inhibit tyrosinase, interfering with biosynthesis of melanin

139
Q

Drugs for Hypopigmentation

A

Trioxsalen and methoxypsoralen (topical or oral); these can cause cataracts and skin cancer, activated by UVA light

140
Q

Sunscreen

A

Chemical compounds absorb UV light

3 classes: PABA (most effective absorber in B region), benzophenones and dibenzoylmethanes

141
Q

Sunblock

A

Opaque materials like titanium dioxide or zinc oxide reflect light

142
Q

Broad Spectrum Sunscreens

A

Oxybenzone
Avobenzone (parsol 1789-complete UVA coverage)
Mexoryl (better UVA/UVB coverage than parsol 1789)

143
Q

Sunblock Pros/Cons

A

No chemical reaction, so you can go out immediately after application
Not good UVA coverage, need reapplication every 2 hours

144
Q

Keratolytic and Destructive Agents

A

Salicylic acid, urea
“special conditions”: podophyllum resin/podophyllotoxin, flurouracil
Soften the stratum corneal of epidermis promoting peeling

145
Q

Salicylic Acid

A

Used for acne, psoriasis and warts
Greater than 6% is destructive to tissue
Caution with diabetics and peripheral vascular disease

146
Q

Topical Urea

A

Makes creams and lotions less greasy from humectant
Used for hyperkeratosis of palms and soles
Concentrations of 30-50% useful in softening nil for avulsion

147
Q

Podphyllum Resin

A

Main use is condyloma acuminatum, application restricted to wart tissue only, wash off 2-3 hours after application
CONTRAINDICATED in pregnancy

148
Q

Fluorouracil

A

Used for actinic keratosis, healing continues for 1-2 months after therapy is stopped
Can cause erythema, gesticulation, erosion, ulceration, necrosis and reepithelialization
Sunlight can increase intensity of reaction

149
Q

Drugs for warts

A

Salicylic acid, topical retinoids, podophyllum resin, imiquimods, trichloroacetic acid

150
Q

Imiquimod

A

Favored by dermatologists but very expensive, can be put on by patient to secrete cytokines, IL-6 and tumor necrosis factor

151
Q

Trichloroacetic Acid

A

Used for condylomata

Caution: serious injuries (skin damage, burns, swelling and pain) can hap`pen with improper application

152
Q

Topical Minoxidil

A

Stimulates hair growth through vasodilation, increased cutaneous blood flow and stimulation of hair follicles
NOT permanent, hair loss will come back 4-6 months after stopping

153
Q

Finasteride

A

Blocks production of dihydrotestosterone to promote hair growth and prevent further hair loss
Need 3-6 months of treatment, not for women of childbearing age
Causes decreased libido, ejaculation disorders and ED

154
Q

Bimatoprost

A

Prostaglandin analogue for eyelash growth

Causes red/itchy eyes, skin pigmentation, brown iris

155
Q

Elfornithine

A

Irreversible inhibitor of orntithine decarboxylase that catalyzes biosynthesis of polyamides which are required for cell division
Reduces facial hair growth after 6 months

156
Q

Psoriasis Treatment

A

High potency topical steroid or phototherapy

157
Q

Dovonex

A

Vit D3 analog for psoriasis
Comes in cream, ointment or scalp solution
Can cause hypercalcemia
Can be used in combo with steroids

158
Q

Tazarotene

A

Topical synthetic retinoid prescribed with steroids for psoriasis
Can cause skin irritation or photosensitivity

159
Q

Tars

A

Treatment for dandruff and psoriasis

160
Q

Aciretin

A

Systemic psoriasis drug
MUST not be used in pregnancy or within 3 years
Alcohol MUST be avoided for up to 2 months after
MUST NOT donate blood for 3 years after

161
Q

Apremilast

A

Systemic psoriasis drug

Can cause diarrhea, nausea, URI

162
Q

Methotrexate

A

Tablets or injection
Cat X for pregnancy and fathers
Avoid in anemia, leukopenia, thrombocytopenia or severe liver disease

163
Q

Tumor Necrosis Factor Blockers

A

Biologic agent that blocks cytokines that cause inflammation in psoriasis
Can cause flu like symptoms

164
Q

Contraindications of Psoriasis Biologic Agents

A

Immunocompromised
Active infection
Screen for TB

Cause injection site reactions, flu like symptoms and respiratory infections

165
Q

Rare side effects of Psoriasis Biologic Agents

A

Nervous system disorders (MS, seizures, optic neuritis), hemolytic anemia, lymphoma

166
Q

What are the two most common drugs for TB?

A

Isoniazid and rifampin

167
Q

What is Multi-drug resistant TB?

A

Its resistant to both isoniazid and rifampin

168
Q

When can you use mono therapy in TB?

A

Only in latent disease

169
Q

First Line TB Drugs

A

Isoniazid, rifampin, pyrazinamide and ethambutol

170
Q

How long is a normal TB treatment?

A

8 weeks of 4 drugs for intensive phase followed by 18 weeks of isoniazid/rifampin for continuation phase
TOTAL of 6-9 months

171
Q

Treatment of Latent TB

A

Monotherapy os isoniazid (or rifampin) daily for 9 months

172
Q

Isoniazid/Ethambutol MOA

A

Inhibition of cell wall synthesis

isoniazid-mycolic acids, ethambutol-mycobacterial arabinosyl transferases

173
Q

Pyrazinamide MOA

A

Disrupts plasma membrane and energy metabolism

174
Q

Rifampin MOA

A

Inhibits RNA synthesis

175
Q

Isoniazid AEs/Monitoring

A

Hepatic toxicity, peripheral neuropathy, vitamin B6 depletion (give pyridoxine prophylactically)
Monitor: LFTs and monofilament testing

176
Q

Rifampin AEs/Monitoring

A

Turns body fluids orange, cholestasis/hepatitis, flu-like syndrome with intermittent doses, nephritis
Monitor: ALT/AST

177
Q

Pyrazinamide AEs/Monitoring

A

hepatotoxicity, hyperuricemia, rash, arthralgias
Monitor LFTs and uric acid
Use no more than 6 months

178
Q

Ethambutol AEs/Monitoring

A

EYE PROBS! retrobulbar neuritis (reversible loss of vision)

Eye exam prior to initiation

179
Q

Bedaquiline MOA/Box warning

A

Inhibits proton transfer chain of mycobacterial ATP synthase

Warning: increased mortality and QT prolongation

180
Q

Bedaquiline Monitoring

A

Once weekly for symptoms

ECG, LFTs

181
Q

First line for Systemic Fungal

A 
Amphotericin B (unless aspergillus-voriconazole)
But will usually use Azoles
182
Q

First line for Mucocutaneous Fungal

A

Terbinafine

183
Q

First line for Malaria

A

Chloroquine

184
Q

Amphotericin MOA and AEs

A

Binds to ergosterol in cell membranes forming leaky pores

Nephrotoxicity, infusion reactions (chills, fever, muscle spasms, hypotension)

185
Q

Flucytosine MOA and AEs

A

Interferes with DNA/RNA synthesis

Renal excretions and myelosuppression

186
Q

Azoles MOA and AEs

A

Blocks ergosterol synthesis

Ketoconazole-inhibits hepatic/adrenal P450s
Voriconazole-visual disturbances, class D for pregnancy

Others: GI upset and rash

187
Q

Terbinafine Uses and AEs

A

Mucocutaneous infection (toenails)

GI upset and headache

188
Q

Chloroquine MOA and Use

A

Kills/inhibits growth of protozoa by affecting different stage of life cycle

Used to treat and prevent Malaria

189
Q

Chloroquine Side Effects

A

Convulsions, depigmentation, hair loss, GI disturbance, HA

Vivid dreams in mefloquine

190
Q

Which Malaria drug should not be given in pregnancy?

A

Proguanil

Also high incidence of depression

191
Q

Hepatitis A Treatment

A

Treat with immune globulin, educate on hand washing

NO antivirals

192
Q

Hep A Immune Globulin

A

Passive coverage, used when vaccine is not an option, can be combined with all hep A vaccines
Used for post-exposure and for <3 month pre-exposure

193
Q

Hep A Vaccines

A

Provide 95% reduction in disease, active coverage
Havrix and VAQTA >1 year old at 0 and 6-12 months
TWINRIX adults only! can do 0, 1 and 6 months OR 0, 7, 21-30 days +12 months

194
Q

Hepatitis B Vaccine Doses/Schedule in Healthy

A

1mL/dose with one dose at: 0m, 1m and 6m

195
Q

Hepatitis B Treatment for Acute exposure

A

IVIG (immune globulin)

196
Q

Hepatitis B Vaccine Doses/Schedule in Newborns

A

0.5mL/dose with one dose at 0, 1 and 6 months
If mother is negative, first dose before discharge
If mother positive/unknown, first dose within 12 hours with immune globulin at different site

197
Q

Chronic Hep B Treatment

A

Detectable HBsAg >6 months
interferons (PEG-INF) and antivirals (lamivudine and -virs)
Long term treatment, never cured

198
Q

Contraindications/AEs of Hep B meds

A

hypersensitivity, syncope, angioedema

Immunosuppressants may diminish the effect

199
Q

How long are Hep C treatments?

A

6-24 weeks

200
Q

Hep C Drug Types

A

NS3/4A protease inhibitors (pr’s)
NS5A inhibitors (asvirs)
NS5B Polymerase Inhibitors (buvirs)

201
Q

NS3/4A Protease Inhibitor MOA

A

Prevents polyprotein processing

202
Q

NS5A Inhibitor MOA

A

Prevent viral assembly and formation of RNA complex

203
Q

NS5B Polymerase Inhibitor MOA

A

Responsible for RNA-dependent RNA polymerase activity

204
Q

First Line Hep C Drug

A

Sofosbuvir (NS5B), covers all genotypes

205
Q

Ribavirin Box warning

A

Must not be taken in pregnancy/male partner during treatment and 6 months later

206
Q

Simprevir Box Warning

A

interferes with hormonal birth control

Use 2 forms of non-hormonal birth control

207
Q

Common side effects of combo Hep C drugs

A

headache, fatigue, nausea, diarrhea

208
Q

HCV Genotype 1 Treatment

A

Viekira Pak or Vieira XR (ombitasvir/paritaprevir/ritonavir and dasabuvir tabs) given with ribavirin; 12 or 24 weeks
Zepatier (elbasvir/grazoprevir) for 12 or 16 weeks

209
Q

HCV Genotype 2 Treatment

A

Sovaldi (sofosbuvir) plus ribavirin for 12 or 16 weeks

210
Q

HCV Genotype 3 Treatment

A

Daklinza (daclatasvir) with Sovaldi sometimes with ribavirin for 12 weeks
Or Sovaldi plus ribavirin for 24 weeks

211
Q

HCV Genotype 4 Treatment

A

Harvoni (ledipasvir/sofosbuvir) or Technivie (ombitasvir/paritaprevir/ritonavir) with ribavirin for 12 weeks

Sovaldi plus ribavirin for 24 weeks

Zepatier (elbasvir/grazoprevir) for 12 or 16 weeks

212
Q

Classes/prototypes of HIV drugs

A

Nucleoside Reverse Transcriptase Inhibitors (NRTIs): abacavir

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): doravirine

CCRA Antagonists (CA): Maraviroc

Fusion Inhibitor (FI): enfuvirtide

Integrase Inhibitor (INSTI): dolutegravir

Pharmacokinetic Enhancer (PE): cobicistat

Protease Inhibitor (PI): atazanavir

Post Attachment Inhibitor (PAI): ibalizumab-uiyk

213
Q

Goal of Combination HIV Treatment

A

Suppression of HIV replication and increase in CD4 lymphocytes

214
Q

What is the hallmark of untreated HIV?

A

Profound CD4 lymphocyte depletion and sever immunosuppression

215
Q

Initial Treatment of HIV

A

Minimum of 3 antiretroviral agents from at least 2 drug classes
2 NRTIs plus INSTI, NNRTI or PI boosted with cobicistat or ritonavir

216
Q

Short term HIV Drug AEs

A

N/V/D, fatigue, HA, fever, insomnia, dizziness

217
Q

Long term HIV Drug AEs

A

Hyperlipidemia, osteoporosis

hepato/nephrotoxicity, diabetes, peripheral neuropathy, lipodystrophy, depression

218
Q

PrEP

A

Combination of 2 HIV meds (tenofovir and emtricitabine)

Reduces risk by >90%

219
Q

Post-exposure Prophylaxis (needle-sticks)

A

Truvada or PLUS for 28 days

220
Q

What vaccines are contraindicated in HIV?

A

MMR and VAR if CD4<200

Live attenuated flu shot (inactivated or recombinant okay)

Pharmacology (7 decks)

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