Extra Stuff

Question 1

What Drugs belong to the 1st generation of Cephalosporins and what are they used for?

Answer 1

1. Cephalexin - commonly prescribed for outpatient use

2. Cefazolin - Surgical Prophlylaxsis

Question 2

What are second gernerations Cephalosporins used for?

Answer 2

Mild Gram (-) and Intraabdominal Infections

Question 3

What drugs belong to the 3rd generation of Cephalosporins?

- what are they used for?

Answer 3

1. Ceftriaxone - treatment of STDs, Pediatric Meningitis

2. Cefepime - pseudomonal Infections

Question 4

What are 4th generation Cephalosporins used for?

Answer 4

Nosocomial Infections

Question 5

T or F: Cephalosporins are acid stable so you can take them without food.

Answer 5

True

Question 6

What are Monobactams used for?

Answer 6

Treatment of Gram (-) rods

Question 7

T or F: Ampicillin works better on gram (-) bacteria because its amino groups allow it to pass through the LPS layer

Answer 7

True

Question 8

T or F: Mitronidazole is given as a pro-drug

Answer 8

True

Question 9

What does binding to CD3 prevent?

- what drug does this?

Answer 9

• Prevents T cell activation

- Muranomab-OKT3 does this

Question 10

What does Ab binding to CD80/86 prevent?

- what drug does this?

Answer 10

• Prevents T cell co-stimulation so T cell never becomes completely active - apoptosis follows
• Balatacept does this

Question 11

What does Ab binding to CD25 do?

- what drug does this?

Answer 11

• Prevents clonal expansion

- Basiliximab does this

Question 12

T or F: since both sirolimus and tacrolimus work on FKBP12, they both act to some extent on calcineurin

Answer 12

False, they both act on FKBP12 but only tacrolimus works on calcineurin, sirolimus only works on mTOR

Question 13

Which of the cell-cycle inhibitors is specific to B and T cells?
- explain.

Answer 13

Mycophenolate mofetil is specific to B and T cells because it interrupts the synthesis of Guanosine from IMP. B and T cells lack a GMP salvage pathway so depleting GMP synthesis is particularly toxic to these cells.

Question 14

Which of the cell cycle drugs might be contraindicated with patients that have gout. why?

Answer 14

• Contraindicated if they are taking Allopurinol
• Allopurinol blocks the salvage pathways of Purines, this inhibits the side metabolic route of AZATHIOPRINE which shifts the dose response curve to the left because more 6-MP (mercaptopurine) is being produced

Question 15

Which immunosuppressive drugs may vary in their bioavailability from patient to patient? why?

Answer 15

• Sirolimus, Cyclosporine, Tacrolimus

- They are metabolized by CYP3A4

Question 16

Why are so many drugs given during the maintenance phase of immunosuppressive therapy?

Answer 16

To prevent dose related toxicity (some drugs like sirolimus and cyclosporine are even synergistic)

Question 17

What are the 2 general effects of Ab treatment?

Answer 17

• Block T Cell activation/Proliferation

- Activate complement and produced ADCC

Question 18

Azoles prevent conversion of what to what by what?

Answer 18

Lanosterol to Ergosterol via blockage of p450 (extensive side affects from azoles related to their ability to affect human p450 isoforms e.g. CYP3A4)

Question 19

What biochemical process causes the symptoms seen in an infusion reaction?

Answer 19

-Increases in PG synthesis

Question 20

Which of the Anti fungals is uniquely eliminated in the urine?

Answer 20

Fluconazole

Question 21

Which of the Anti-fungal drugs should you not use in the patients that a immunosuppressed? why?

Answer 21

Terbinafine because it causes transient lymphopenia and neutropenia (patients receiving this drug should have CBCs performed regularly)

Question 22

Why does treatment with azole drugs have to last so long?

Answer 22

• its fungistatic, so ending treatment early would leave original cells in tact to reproduce when therapy was terminated
• This is associated with high Relapse Rate