EXAM #4: REVIEW Flashcards Preview

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Flashcards in EXAM #4: REVIEW Deck (235):
1

What is Peptidoglycan?

A macromolecule of peptides and sugars

2

What is Lipopolysaccharide?

A macromolecule of phospholipids and polysaccharides

3

Outline the ESKAPE mnemonic of nosocomial superbugs.

Enterococcus faecium
Staphylococcus aureus
Klebsiella pneumoniae
Acinetobacter bumanni
Pseudomonas aeruginosa
Enterobacter species

4

What is the function of Penicillin-Binding Proteins (PBPs) or Transpeptidases?

Cross-linking peptidoglycan in the formation of the bacteria cell wall

5

How can you group the PCN-type drugs?

- Penicillinase-sensitive PCNs
- Penicillinase-resistant PCNs
- Antipseudomonals

*****Penicillinase= Beta-Lactamase

6

List the Beta-Lactamase sensitive PCNs.

PCN G and V
Ampicillin
Amoxicillin

7

List the Beta-Lactamase resistant PCNs.

Oxacillin
Nafcillin
Methicillin

8

Which of the PCNs are "antipseudomonal?"

Ticracillin
Piperacillin

9

What are the narrow spectrum PCNs?

PCN G and V
Methicillin
Nafcillin
Oxacillin

10

What are the broad spectrum PCNs?

Ampicillin
Amoxacillin
Azlocillin
Piperacillin
Ticracillin

*Remember aminopenecillins are amped up PCNs i.e. ampicillin and broader spectrum*

11

What is the hallmark 1st generation Cephalosporin?

Cephazolin

12

What is the hallmark 2nd generation Cephalosporin? List the other 2nd generation Cephalosporins.

Cefoxitin

- Cefotetan
- Cefaclor
- Cefuroxime

13

List the 3rd generation Cephalosporins.

Ceftriaxone

- Cefotaxime
- Cefdnir
- Cefixime

14

What is the only drug in the Monobactam family?

Aztreonam

15

What type of bacteria can be treated with Aztreonam?

Gram negative (rods) only

16

What are the two important clinical considerations regarding Aztreonam?

1) Penetrates the BBB
2) Beta-Lactamase resistant

17

Are the Carbapenams resistant to Beta-Lactamase?

Yes

18

What enzyme are the Carbapenams susceptible to?

Carbapenemase

19

What adverse effects are associated with the Carbapenems?

1) GI disturbances (Dr. Henry)
2) CNS toxicity

*Note that it is toxicity that limits their use to life-threatening infections and/or after other drugs have failed*

20

What is the MOA of Vancomycin?

Inhibits peptidyglycan formation by binding D-ala portion of cell wall precursors

21

What is Vancomycin generally used to treat?

Serious, multi-drug resistant organisms including:
- MRSA
- C. diff

22

What is the MOA of Bacitracin?

Blocks incorporation of amino acids and nucleic acids into the cell wall of bacteria

*Remember that Bacitracin is Broad spectrum*

23

What type of antibiotic is Fosfomycin? What is the MOA?

Cell wall synthesis inhibitor that prevents the synthesis of UDP-NAM (component of peptidoglycan)

24

What is Fosfomycin commonly used to treat?

UTIs

25

What antibiotic class are the Aminoglycosides? What is the MOA?

30S Protein Synthesis Inhibitors
- Prevent charged tRNA from entering the A site

Remember, "Buy AT 30, CELL at 50" (Aminoglycosides and Tetracyclines= 30S inhibitors)

26

How are the Aminoglycosides commonly administered in the clinical setting?

With Beta-Lactam antibiotics

27

When are Aminoglycosides commonly used clinically?

Serious gram negative infections

28

What is the mnemonic to remember many important features of the Aminoglycosides?

"Mean" (i.e. A-mean-oglycodies) GNATS caNNOT kill anaerobes

G= Gentamicin
N= Neomycin
A= Amikacin
T= Tobramycin
S= Streptomycin

N= NEPHROTOXICITY
N= neuromuscular blockade
O= OTOTOXICITY
T= teratogen

(CAPITLAL= Dr. Henry)

29

What is the MOA of the Macrolides?

Blocks translocation of the growing amino acid chain from the A-site to the P-site

(50S inhibitors)

30

What side effect is associated with Macrolides? Use a mnemonic to remember.

Macrolides cause Motility issue i.e. GI disturbances

31

What is the specific MOA of the Tetracyclines?

Blocks charged tRNAs from entering the A-site

(30S inhibitors)

32

What should not be taken with a Tetracycline?

1) Milk
2) Antacids
3) Iron supplements

*Bind divalent cations, which will inhibit absorption from the gut*

33

In what patient populations are Tetracyclines contraindicated?

1) Kids
2) Pregnant women

*Will prevent/induce bone growth--check ppt*

34

What type of antibiotic in Clindamycin?

50S Protein Inhibitor

35

Clinically, what is Clindamycin commonly prescribed for?

Streptococcus and Staphylococcus soft tissue infections

*Thus, it is a NARROW SPECTRUM antibiotic*

36

What is the MOA of Clindamycin?

Blocks growing amino acid chain transfer from A-site to P-site

(50S)

37

What key adverse effect is Clindamycin associated with?

Pseudomembraous colitis i.e. C.diff

38

What is the MOA of Chloramphenicol?

Blocks peptidyltransferase at 50S subunit i.e. prevents peptide bond formation

39

What are the adverse effects seen with Chloramphenicol?

1) Anemia
2) Aplastic anemia
3) Gray Baby Syndrome

40

What is Chloramphenicol commonly prescribed for?

Rocky Mountain Spotted Fever
Typhus

41

What type of bacteria is Linezolid effective against?

Gram positive

42

What is the MOA of Linezolid?

50S inhibitor that blocks the A-site

43

What adverse effect is associated with Linezolid?

Myelosuppression

44

What is the general pattern of bacterial specificity of the protein synthesis inhibitors? Which antibiotic does NOT follow the pattern?

Generally broad spectrum, except for Clindamycin, which is used to treat Streoptoccus and Staphylococcus soft tissue infections

45

List the Sulfonamides.

Sulfamethoxazole (SMX)
Sulfamethizole
Sulfadiazine

46

What are the key adverse reactions associated with the Sulfonamides? Use a mnemonic to recall these reactions

Sulfonamides= Skin

1) Hypersensitivity
2) Photosensitivity
3) Steven-Johnson Syndrome

47

What is the bacterial specificity of the Sulfonamides?

Broad-spectrum

48

What are the two Trimethoprims?

Trimethoprim
Pyrimethamine

49

What is the bacterial specificity of the Trimethoprims?

Gram negative bacteria

50

What is the mnemonic to remember the adverse effects associated with the Trimethoprims?

Trimethoprim= TMP

Treats Marrow Poorly i.e. megaloblastic anemia

51

List the adverse effects associated with the Fluoroquinolones.

1) GI disturbances
2) Bind divalent cations
3) QT prolongation
4) FluoroquinoLONES hurt attachment to your BONES
- Tendonitis
- Tendon rupture

52

What is the Group 1 Fluoroquinolone?

Norfloaxacin

53

What are the Group 2 Fluoroquinolones? What type of bacteria are these drugs most specific for?

Ciprfloaxcin
Levofloaxcin
Ofloaxcin

*Gram negatives*

54

What are the Group 3 Fluoroquinolones? What type of bacteria are these drugs most specific for?

Gatifloxcin
Gemifloxcin
Moxifloaxacin

*Gram positives*

55

What types of microorgansism can be treated with Metronidazole?

Bacteria AND protozoa

56

What type of bacteria can be treated with Metronidazole?

Anaerobics ONLY (below the diaphragm)

57

What is the bacterial specificity of Daptomycin?

Gram positives

58

What is the bacterial specificity of Polymyxin B?

Gram negatives/LPS i.e. it specifically is a detergent that punches in LPS

59

How is Polymxyin B administered?

Topically

60

What is a good first choice drug for an uncomplicated skin infection?

1st generation Cephalosporin i.e. Cefazolin

(Treats S. aureus and S. pyogenes that cause uncomplicated skin infections)

61

What is a good alternative for an uncomplicated skin infection with hypersensitivity to a 1st generation cephalosporin?

Clindamycin

(or Vancomycin)

62

What is a good first choice drug for a complicated skin infection?

Ticracillin and clavulanate

(Has anti-pseudomonal activity)

63

What are good drugs to treat MRSA skin infection?

Vancomycin
Daptomycin
Linezolid

64

What two bacteria cause complicated skin infections?

1) P. aeruginosa (Ticracillin has anti-pseudomonal activity)
2) E. coli

65

What are good first line agents for bone and joint infections?

Vancomycin or Ceftriaxone (3rd/4th generation cephalosporin)

66

What is the antibiotic of choice for post-op bone/joint infections?

Ticracillin and clavulanate

67

What is a good antibiotic choice for septic arthritis?

Ceftriaxone

68

What is the first line antibiotic for acute sinusitis and chronic bronchitis?

Augmentin i.e. Amoxacillin and clavulanate

69

What is the first line antibiotic for pharyngitis? What organism commonly causes pharyngitis?

PCN

*S. pneumoniae*

70

What bacteria cause URIs (3)?

1) H. influenza
2) S. pneumonia
3) Moraxella catarrhalis

71

What is the first line antibiotic for ambulatory pneumonia?

Macrolides

72

How are patients with pneumonia that have to be hospitalized treated?

Add Beta-Lactam to the Macrolide

73

How is nosocomial pneumonia treated?

Ceftriaxone

74

How is pyelonephritis treated vs. a simple UTI?

UTI= TMP-SMX
Pyelo= add Fluoroquinolone

75

What is the first line antibiotic for intra-abdominal infections? What bacteria cause intra-abdominal infections?

Ticracillin and clavulanate

*Gram negative*

76

What is community acquired meningitis treated (older than 2 y/o)?

Ceftriaxone and Vancomycin

77

How is neonatal meningitis treated?

1) Ampicillin
2) Cephalosporin
3) +/- Gentamicin (L. monocytogenes)

78

What are the first line antibiotics for Endocarditis?

1) Ceftriaxone
2) Vancomycin

79

What are the first line antibiotics for neutropenic fever?

Ciprofloxacin and Augmentin

80

How are enterococci infections treated?

Deptomycin + Tigacycline

81

How are gram negative ANTIBIOTIC RESISTANT infections treated?

Carbapenam + Carbapenemase

82

What toxicities are associated with INH?

1) Hepatitis
2) Peripheral neuropathy

83

What factors increase the risk of peripheral neuropathy with INH therapy?

1) Malnutrition
2) Alcoholism
3) DM
4) AIDS

84

What is the MOA of Rifampin?

Inhibition of RNA synthesis

(Inhibits bacterial DNA dependent RNA polymerase)

85

What is the mechanism of Pyrazinamide resistance?

- Pyrazinamide requires Pyrazinamidase to be active (prodrug)
- Mutation in Pyrazinamidase

86

What adverse effect is associated with Pyrazinamide?

Gout/ Hyperuricemia

87

What is the MOA of Ethambutol?

Inhibits arabinosyl transferase needed for mycolic acid synthesis

88

What adverse effects are seen with Ethambutol?

1) Retrobulbar neuritis
2) Hyperuricemia

89

What is a good first line drug to treat disseminated MAC infections in the immunocompromised?

Rifabutin

90

What four drugs are used for MAC combination therapy?

1) Macrolide
2) Rifabutin
3) Ethambutol
4) Streptamycin

91

What is the standard drug regimine for Leprosy?

1) Dapsone
2) Clofazamine
3) Rifampin

Note that these drugs are taken for YEARS****

92

What is the MOA of Dapsone?

PABA analog that inhibits folate synthesis

93

What adverse effect is associated with Dapsone?

Non-hemotylic anemia

94

What is Clofazamine?

Bactericidal dye

*Associated with skin pigmentation changes

95

What drugs are used to follow-up Metronidazole treatment for Amebiasis?

Iodoquinol or Paromomycin

96

What are halogenated Hydroxyquinolone and Paromomycin good drugs for?

BOTH forms of Entameba histolytica

97

What are the three parasites cause major opportunistic infections of AIDS patients/immunocompromised?

1) Cryptosporidium parvum
2) Pneumocystis jiroveci
3) Toxoplasma gondii

98

How is Cryptosporidosis treated?

Nitazoxanide

99

What is the MOA of NItazoxanide?

Inhibits PFOR to disrupt the energy metabolism of the parasite

100

How are pneumocystis jiroveci and toxoplasma gondii treated? What adverse reaction is common with these drugs?

Inhibitors of folate synthesis i.e.
1) TMP-SMX
2) Pyrimethamine-Sulfadiazine

101

What enzyme is specifically inhibited by the Sulfonamides?

Dihydropteroate Synthase

102

What enzyme is inhibited by the diaminopyrimidines?

DHFR

103

What is the adverse effect of TMP-SMX treatment?

Rash

104

What is the adverse effect of Pyrimethamine-Sulfadiazine?

Folic acid deficiency leading to megaloblastic anemia

105

What adverse effect is highly associated with Mefloquine?

Recall, malaria prophylaxis that causes SEVERE NEUROPSYCHIATRIC symptoms

*So bad it can lead to suicide

106

What is the MOA of Primaquine?

Prodrug that gets activated to interfere with electron transport

107

What species of malaria is Malarone specific to treating?

P. falciparum

108

What is Malarone?

Atoaquone and Proguanil

109

What is the MOA of Proguanil?

Inhibits DHFR

110

What drugs fall into the Benzimidazole class?

Albendazole
Mebendazole
Thiabendazole

111

What side effects are associated with Thabendazole?

CNS disturbances i.e. delirium and hallucinations

112

What infections are Albendazole and Mebendazole prescribed for?

1) Ascariasis
2) Pinworm
3) Hookworm
4) Whipworm

113

What is Thiabendazole prescribed for?

1) Cutaneous larval migrans
2) Strongyloidiasis (2nd line)

114

What infections is Ivermectin the drug of choice for?

1) First line for Strongloidiasis
2) Tissue dwelling nematodes
- O. volvulus
- Loa loa
- W. bancrofti

115

What infection is Pyrantal Pamoate used to treat?

Pinworm infections

116

What is the MOA of Praziquantel?

- Increased Ca++ permeability of cuticle covering Flukes and Tapeworms
- Leads to depolarizing NM blockade

117

List the three major opportunistic fungal infections.

1) Candida
2) Aspergillus
3) Cryptococcus neoformans

118

List the drugs that inhibit ergosterol synthesis.

Azoles
Naftidine
Terbnafine

119

What major anti-fungal works by inhibiting fungal membrane function?

Amphotericin B

120

What drug inhibits fungal cell wall function?

Capsofungin

121

List the four drugs or drug classes that can be used to treat systemic fungal infections.

1) Polyenes i.e. Amphotericin B
2) Azoles
3) Flucytosine
4) Enchinocandins

122

What is the mechanism of resistance to Amphotericin B?

Decreased membrane ergosterol

123

What are the adverse reactions seen with Amphotericin B administration?

1) Infusion site reaction
2) Nephrotoxicity

124

What is the packaging of Amphotericin B in a lipid micelle called?

Liposomal packaging

125

List the imidazoles.

Ketoconazole
Miconazole
Clotrimazole

126

List the triazoles.

Fluconazole
Itraconazole
Voriconazole
Posaconazle

127

What is the MOA of the azoles?

Inhibit the enzyme that produces ergosterol

128

Name three mechanisms of resistance to the azoles.

1) Decreased membrane ergosterol
2) Efflux pumps
3) Mutations in the target enzyme

129

List three reasons that Fluconazole is the first line agent for systemic fungal infections.

1) Safe--highest TI
2) Well distributed to the CNS
3) Few drug-drug interactions

130

List the infections that Fluconazole is the first line agent for.

1) Systemic Candidiasis
2) Cryptococcosis
3) Coccidiomycosis

131

What is Itraconazole the drug of choice for?

Histoplasmosis
Coccidiomucosis
Blastomycosis
Sporotrichosis
Oncychomycosis

132

What is Voriconazole the drug of choice for?

Aspergillosis

133

What adverse effect is associated with Voriconazole?

Visual disturbances

*Think Voriconazole= Visual*

134

What is Posconazole used to treat?

Mucromycoses
Aspergillosis

135

How is Flucytosine used clinically?

Part of combination therapy for severe Cryptococcal infections

136

List the Echinocandins.

Capsofungin
Micafungin
Andidulafungin

137

What infections are the Echinocandins commonly used to treat?

Aspergillosis
Candidiasis

138

What is Griseofulvin? What is it used to treat?

This is an ORAL antifungal used to treat the Dermatophyte infections

*Note that it concentrates in Keratin precursors*

139

What class of drug are the Allylamines? What is the MOA?

- Antifungals that inhibit ergosterol synthesis
- Specifically inhibit SQUALENE EPOXIDASE

140

What is Terbinafine a first line agent for?

Onychomycosis

141

List the topical antifungals and their drug class.

Nystatin- polyene
Clotrimazole- azole
Miconazole- azole
Terbinafine- allylamine
Naftifine- allylamine

142

What is Nystatin used to treat?

This is a topical agent used to treat Candida infections i.e.
- Oral candidiasis
- Vaginal candidiasis

143

What are Clotrimazole and Miconazole used to treat?

Topical agents for:
1) Candida
- Vulvovaginal candidiasis
- Oral thrush
2) Dermatophyte infections

144

What are the topical Allylamines used to treat?

Topical agents for:
1) Tinea curis (jock-itch)
2) Tinea corporis (ringworm)

145

What is the MOA of Acyclovir?

This is a nucleoside analog that:
1) Competitive inhibitor of viral DNA polymerase
2) Causes chain termination via incorporation into the viral genome

146

What are the indications for oral Acyclovir?

1) Genital herpes (HSV-2)
2) VZV

147

List four indications for IV Acyclovir.

1) Severe/ disseminated HSV
2) Neonate infections
3) HSV encephalitis
4) VZV in the immunocompromised

148

What major toxicity is associated with Acyclovir?

Nephrotoxicity

149

What are the clinical indications for Valacyclovir?

1) Genital Herpes (HSV-2)
2) Oral Herpes (HSV-1)
3) VZV

150

How does Foscarnet compared to Acyclovir?

Does NOT require thymidine kinase activation

151

What are the clinical indications for Foscarnet?

1) HSV/VZV infections resistant to Acyclovir
2) CMV
- Retinitis
- Colitis
- Esophagitis

152

What are the adverse effects associated with Foscarnet?

1) Nephrotoxicity
2) Changes in blood chemistry

153

What activates Ganciclovir?

Viral CMV kinase

154

What are three adverse effects associated with Ganciclovir?

1) Myelosuppression
2) CNS toxicity
3) Injection site reaction

155

What are the two indications for Valganciclovir?

1) CMV Retinitis
2) Prophylaxis against CMV in transplant patients

156

What is the MOA of Trifluridine?

1) Prodrug that gets activated by phosphorylation
2) Competitive inhibition of thymidine incorporation into DNA

157

What are the indications for Trifluridine?

HSV-1 and 2 associated:
1) Keratoconjunctivitis
2) Keratitis

158

What is the difference between Oseltamivir, Zanamivir, and Peramivir?

Oseltamivir= Oral and 1+ y/o
Zanamivir= inhaled and 7+ y/o
Peramivir= IV, think "Parenteral"

159

What are the adverse effects associated with Peramivir?

1) Neuropsychiatric sx.
- Neurominidase inhibitors cause Neuropsychiatric symptoms
2) Steven Johnson's Syndrome

160

What is the MOA of Ribavirin?

Remember, RSV= Ribavirin

1) Phosphorylated by ADENOSINE KINASE
2) Interferes with GTP/ mRNA capping

161

What can Ribavirin be used to treat aside from RSV?

Hepatitis C

162

What adverse effect is associated with Ribarivin?

Hemolytic anemia

163

When is Ribavirin contraindicated?

1) Pregnancy
2) Anemia
3) Ischemic vascular disease
4) Severe renal disease

164

What are the two HCV DAA Protease Inhibitors?

1) Partaprevir
2) Simeprevir

165

What are the two HCV DAA RNA Polymerase inhibitors?

1) Sofosbuvir- nucleoside
2) Desabuvir- non-nucleoside

166

What are the two HCV DAA NS5A inhibitors?

1) Lepipasvir
2) Ombitasvir

167

What should you avoid giving Sofosbuvir with?

Rifampin

168

List the NRTIs.

Zidovudine
Lamivudine
Abacavir
Tenofovir disoproxil
Emtricitabine

169

Aside from HIV, what can the NRTIs be used to treat?

HBV

170

What adverse effects are seen with the NRTIs?

1) Lactic acidosis
2) Lipodystrophy
3) Fatty Liver Disease

171

What specific adverse reaction is associated with Abacavir?

Abacavir= NRTI

*Think "A" for allergic reaction/ hypersensitivity

172

What polymorphism is associated with hypersensitvity to Abacavir? Why is this important?

HLA-B5707

*Need to test for this prior to administration*

173

What is unique about the toxicity profile of Lamivudine?

Least toxic of the antiretrovirals

174

What unique adverse effect is seen with Emtricitabine?

Hyperpigmentation of the palms and soles

175

Name three contraindications for Emtricitabine.

1) Pregnancy
2) Young children
3) Hepatic or renal failure

176

What unique adverse effects are seen with Tenofivir?

1) Bone marrow--> "Faconi anemia"
2) Decreased bone density/ fetal growth

177

What unique adverse effect is seen with Zidovudine?

Myelosuppression

178

List the adverse effects common to the NNRTIs.

1) Rash
2) Steven Johnson Syndrome
3) Hepatotoxicity
4) Drug-drug interaction

179

List the two most clinically important NNRTIs.

Nevirapine
Efavirenz

180

What unique toxicities are associated with Efavirenz?

1) Teratogenic
2) CNS toxicity
3) CYP p450 inducer

181

What unique toxicity is associated with Nevirapine?

Hepatitis

182

What is the unique clinical utility of Nevirapine?

Can prevent VERTICAL TRANSMISSION

183

List the adverse effects common to the protease inhibitors.

1) Hyperlipidemia
2) Lipodystrophy
3) GI intolerance
4) Hepatotoxicity
5) Increased bleeding risk
6) Drug-drug interactions

184

What drugs are contraindicated with Atazanavir? Why?

PPIs b/c they require acidic GI pH for proper absorption

*Think Ataznavir needs Acid*

185

What specific adverse effects are associated with Ataznavir?

1) Peripheral neuropathy
2) Hyperbilirubinemia
3) Adverse cardiac effects

186

What effect does Ataznavir have on the CYP p450 system?

Inhibition

187

What is the clinical utility of Darunavir?

Pharmacologic booster like Ritonavir

188

What specific adverse effects are associated with Darunavir?

1) Increased liver enzymes
2) Increased serum amylase

189

What is the specific indication for Darunavir?

Drug resistant HIV-1

190

What is the CCR5 antagonist?

Maraviroc

191

What specific adverse effect is associated with Maraviroc?

Cardiac events in those with underlying cardiac disease

192

What is the fusion inhibitor? What is unique about the administration of this drug?

Enfuvritide -- given SubQ!

193

What specific adverse effects are associated with Enfuvritide?

1) Injection site reaction
2) Allergy to drug
3) Increased risk of bacterial pneumonia

194

What suffix is associated with the Integrase Inhibitors.

"Tegravir"

- Raltegravir
- Elvitegravir
- Dolutegravir

195

What specific adverse effects are associated with Raltegravir?

1) Rhabdomyolysis
2) Myopathy

196

What specific adverse effects are associated with Elvitegravir?

Elevated lipase

Note that this is given orally with Ritonavir

197

What specific adverse effects are associated with Dolutegravir?

1) Hypersensitivity
2) Elevation of liver enzymes

198

List the non-selective COX inhibitors.

ASA
Ibuprofen
Idomethacin
Ketorolac
Naproxen
Oxaprozin
Piroxicam
Sulindac

199

List the selective COX inhibitors.

Celecoxib
Etoricoxib
Meloxicam

200

What is the MOA of Colchicine?

Inhibition of leukocyte migration and phagocytosis

201

What is the MOA of Probenecid and Sulfinpyrazone?

- Inhibit tubular absorption of uric acid
- Increase renal clearance of uric acid

202

What is the MOA of Methotrexate in the treatment of RA?

1) Inhibits AICAR transformylase
2) Increases extracellular adenosine
3) Inhibits T-cell activation
4) Cytotoxic to lymphocytes

203

List the synthetic DMARDs.

Methotrexate
Leflunomide
Chloroquine
Hydroxycholorquine

204

What is the MOA of Leflunomide?

Inhibits ribonucleotide synthesis

205

What are the biologic DMARDs?

Etanercept
Infliximab
Anakinra

206

List the drugs used to PREVENT migraines.

1) Propanolol
2) Metoprolol
3) Amitriptyline
4) Valproate
5) Topiramate

207

What are the antiemetics used to treat migraines?

1) Metoclopramide
2) Chlopromazine
3) Prochlorperazine

208

List the antimetabolite immunosuppressants.

Azathioprine
Mycophenolate mofetil
Sirolimus

209

List the biological immunosuppressants.

1) Antithymocyte globulin
2) Muromonab-CD3
3) Anti-TNF-a

210

What are the non-genomic effects of the glucocorticoids?

1) Alternation of signaling pathways
2) Insertion into cell membrane to alter ion transport

211

Name four effects of glucocorticoid administration.

1) Decreased peripheral lymphocytes
2) Decreased pro-inflammatory cytokines
3) Inhibition of IL-2
4) Reduced neutrophil chemotaxis

212

List the pro-inflammatory cytokines.

IL-1
IL-6
TNF-a
IFN-y

213

List four clinical indications for the glucocorticoids.

1) Prevent transplant rejection
2) GVHD
3) Autoimmune disease
4) Prevention of cytokine storm with biological immunosuppressants

214

What adverse effects are associated with the glucocorticoids?

1) Growth retardation
2) Poor wound healing
3) HTN
4) AVN
5) Cataracts
6) Hyperglycemia
7) Adrenal crisis with d/c

215

Outline the MOA of Cyclosporine.

- Complexes with Cyclophillin in the cytosol
- That complex binds Calcineurin
- Calcineurin complex prevents dephosphorylation of NAFT
- NAFT cannot translocate to the nucleus

No NAFT= NO IL-2

216

What is the grapefruit juice/ cyclosporine interaction?

- Grapefruit juice inhibits CYP p450
- Increased concentrations of cyclosporine-->toxicity

217

What does Azathioprine ultimately block?

De novo purine synthesis

218

List three indications for Azathioprine.

1) Prevent transplant rejection
2) Severe RA
3) Glucocorticoid resistant autoimmune disease

219

What adverse effects are associated with Azathioprine?

- Myelosuppression
- Hepatotoxicity

220

What the MOA of Mycophenolate Mofetil?

1) Prodrug metabolized to MPA
2) MPA blocks IMP in de novo purine synthesis

221

What are the clinical indications for Mycophenolate Mofetil?

1) Prophylaxis for transplant rejection
2) SLE

222

What adverse effects are associated with Mycophenolate Mofetil?

1) Myelosuppression
2) GI upset
3) CMV infections
4) TERATOGENIC

223

What is the MOA of Sirolimus?

mTOR inhibitor

224

What is the specific utility of Sirolimus?

Renal transplant that cannot tolerate nephrotoxocity of Cyclosporine

225

What are the indications for antithymocyte globulin?

1) Induction immunosuppression
2) Treatment of ACUTE transplant rejection

226

What adverse reactions are associated with Antithymocyte Globulin?

1) Cytokine storm
2) Serum sickness

227

What are the indications for antithymocyte globulin?

Glucocorticoid resistant transplant rejection

228

What drawback is associated with Muromonab-CD3?

Mouse antibody that can only be used once

229

What are the three anti-TNF-a biologicals? What are the used to treat?

1) Infliximab
2) Adalimumab
3) Etanercept

*Autoimmune disease*

230

How does Echinacea reduce the duration and intensity of a cold?

1) Increased cytokine production
2) Anti-inflammatory/ COX inhibitor
3) Increased immunological blood cells

231

What two major side effects are associated with Gingko Biloba?

1) Bleeding
2) Seizure induction

232

How does garlic lower blood pressure?

1) ACE inhibitor
2) Increased NO bioavalibility
3) Increased H2S production

*Decrease vasoconstriction and increase vasodilation

233

What drug-drug interaction is associated with Glucosamine and Chondroitin?

Enhanced anticoagulant effects of Warfarin

234

List the intended uses of CoQ10.

1) Reduction of statin-induced myopathy
2) HTN
3) CAD
4) Neurodegenerative Disease
5) Migraine

235

List all the supplements that cause increased bleeding.

- Ginkgo Biloba
- Garlic
- Ginseng
- Glucosamine and Chondrioitin
- Feverfew
- CoQ10

Decks in Pharmacology Class (64):