High yield Drugs/Side effects

Question 1

Anti-Cholinergic Side effects and Drugs that Cause Anti-cholinergic toxicity

Answer 1

Hot as hare (no sweat), Dry as a bone (no lacrimation, very thirsty), red as a beet ( flushing), Blind as a bat (blurry), AMS (psychosis, Hallucinations, agitation, delirium)

Drugs:
Anticholinergics- atropine, scopolamine (motion sickness), oxybutynin (overactive bladder tx)

Antihistamines- Diphenhydramine, hydroxyzine
Antipsychotics - chlorpromazine, olanzapine
Antispasmodics- Hyocyamine, dicyclomine
Cyclic Anti Depressants- Amitryptyline, desipramine

Question 2

Cyclosporine

Answer 2

Calcineurin Inhibitor
-binds cyclophilin
Blocks T-cell activation and Prevent IL2 transcription

use: Transplant rejection and Rheumatoid

HIGH YIELD:
NEPHROTOXIC- use Sirolimus (prevents IL2 response)
can also cause gingival hyperplasia

Question 3

Tacrolimus

Answer 3

Calcineurin inhibitor
-binds FK506 binding protein, blocking T-cell activation and PREVENTING IL2 TRANSCRIPTION

use: Transplant rejection

toxicity- NEPHROTOXIC (use sirolimus) same as cyclosporine but increased risk for neurotoxicity and diabetes.

Question 4

Sirolimus (rapamycin)

Answer 4

mTOR inhibitor, binds FKBP.
- Blocks T-cell activation and B-cell differentiation via
DECREASING T- CELL RESPONSE IL2

use: Kidney Transplant rejection (dont use tacrolimus or cyclosporine)

Toxicity- Pancytopenia, insulin resistance

synergistic with cyclosporine

Question 5

Daclizumab + Basiliximab

Answer 5

monoclonal antibodies BLOCKS IL2 RECEPTOR (CD-25)

use: kidney transplant rejection

Side effects: edema and HTN, tremor

Question 6

Azathioprine

Answer 6

• anti-metabolite
• precursor of 6-Mercaptopurine
• PURINE analog

Both block de-novo purine synthesis, activated by HGPRT.

• Inhibits lymphocyte proliferation by blocking nucleotide synthesis.

Uses: Transplant rejection, Crohns, RA,

effects: Leukopenia, anemia, thrombocytopenia

6MP is degraded by xanthine oxidase
- Pts taking Allopurinol or Febuxostat (XO inhibitor) are at increased risk for toxicity.

Question 7

Mycophenolate

Answer 7

• reversibly inhibits IMP dehydrogenase preventing B and T cell PURINE synthesis.
  use: Transplant rejection and lupus nephritis.

less nephrotoxic and neurotoxic, can cause pancytopenia.

ASSOCIATED WITH INVASIVE CMV INFECTION

Question 8

FILGRASTIM

Answer 8

G-CSF
Recombinant cytokine
recovery of bone marrow

Question 9

SARGRAMOSTIM

Answer 9

GM-CSF
Recombinant cytokine
recovery of bone marrow

Question 10

IFN-alpha

Answer 10

used recombinant for Hep B and C, kaposi and malignant melanoma

Also part of innate host defense
released by multiple cells (monocytes, B-cells, NK cells)
-synthesized from virally infected cells and act locally on uninfected cells – priming for viral defense
- halting protein synthesis in cells
- RNAase degrades all RNA in the cell
- Protein Kinase R -inactivates EIF-2 blocking translation

Question 11

IFN- Beta

Answer 11

used recombinant for MS

Also same innate host defense as IFN Alpha

Question 12

Corticosteroids

Answer 12

Phospholipase A2 inhibitor

Inhibit NF-kB supress B and T cell function by decreasing transcription of cytokines.
Induces apoptosis of T-Lymphocytes

Used for rapid relief of RA patiens and for Proptosis in Hyperthyroid patients.

Cataracts
Ulcers
Striae
Hirsutis
Infection
Necrosis of Femoral head
Glucose Increase
Osteoporosis
Immune supression
Depression/Delerium

Question 13

Rituximab

Answer 13

Anti-CD20 - 
used for B-cells
- Non-hodgkin lymphoma
- CLL
- RA
- ITP

Increases risk for PML (progressive multifocal leukoencephalopathy)

Question 14

Alemtuzumab

Answer 14

Anti- CD52

CLL and MS

aLYMtuzumab= LYMphocytic leukemia

Question 15

Bevacizumab

Answer 15

Anti-VEGF

Colorectal cancer, RCC
can also be used for Wet age related macular degeneration

Question 16

Ranibizumab

Answer 16

Anti -VEGF

used for age related macular degeneration

Question 17

Cetuximab

Answer 17

anti-EGFR
monoclonal antibody
Stage IV colorectal cancer also Lung adenocarcinoma

Question 18

Trastuzumab

Answer 18

Anti- HER2/Neu tyrosine kinase receptor

used for breast cancer

Question 19

Adalimumab

Infliximab

Answer 19

Soluble TNF- alpha inhibitor
monoclonal antibody

Crohns, RA, psoriasis, Ankylosing spondylitis

Check for TB first

Question 20

Etanercept

Answer 20

Fusion protein for TNF-alpha and IgG1
Acts as a decoy receptor

RA, psoriasis

Check for TB first

Question 21

Teriparitide

Answer 21

Recombinant PTH increases osteoblastic activity

Question 22

VermurRAFenib

Answer 22

BRAF + oncogene in metastatic melanoma

used for V600E mutated BRAF

Question 23

Imatinib

Answer 23

Tyrosine Kinase inhibitor of BCR-ABL (t 9;22 - CML or B-ALL) and C-KIT inhibitor in GI tumors

Question 24

Erlotinib + Gefitinib

Answer 24

EGFR tyrosine kinase inhibitor

NON-SMALL cell lung cancer.

Question 25

Eculizumab

Answer 25

Complement protein C5 monoclon antibody - used in paroxysmal nocturnal hemoglobinuria ( no DAF to protect)

Question 26

Omalizumab

Answer 26

IgE inhibitor for severe asthma, prevents IGE binding

Question 27

Palivisumab

Answer 27

RSV prophylaxis

Question 28

Abciximab

Answer 28

antibody agains platelet glycoproteins IIB/IIIA anti-platelet agent to prevent complications in patients undergoing PCI

Question 29

Natalizumab

Answer 29

alpha- 4 integrin inhibitor preventing WBC adhesion.

Question 30

Cisplatin/Carboplatin

Answer 30

cross link DNA Testicular Bladder and lung carcinoma Nephrotoxic and Ototoxic Prevent nephrotoxicity with AMIFOSTINE (free radical scavenger)

Question 31

Etoposide and Teniposide

Answer 31

inhibitor of Topoisomerase II -- Increase DNA degradation | - blocks the sealing of strand breaks.

Question 32

Irinotecan and Topotecan

Answer 32

Inhibits Topoisomerase I - preventing DNA unwinding Colon Cancer- Irinotecan Small Cell - Topotecan

Question 33

Hydroxyurea

Answer 33

inhibits ribonucleotide reductase- Decreases DNA synthesis (S specific phase) Blocks Purine AND Pyrimidine synthesis Melanoma CML, Sickle Cell (increases HbF)

Question 34

Cladribine

Answer 34

Purine Analog- dna polymerase inhibitor and dna breaks Used for Hairy cell leukemia Myelosupression, nephrotoxic, neurotoxic

Question 35

Cytarabine

Answer 35

Pyrimidine analog- inhibits DNA polymerase. use for Leukemias Can cause PanCYTopenia

Question 36

5- Fluorouracil

Answer 36

- Pyrimidine analog activated to 5-FdUMP - Covalently complexes folic acid, - Inhibits THYMIDYLATE SYNTHASE (decreases DNA synthesis) Effects enhanced by Leucovorin (folinic acid) can worsen myelosupression

Question 37

Methotrexate

Answer 37

folic acid analog, that competitively inhibits dihydrofolate reductase (decreases DNA synthesis) INHIBITS PYRIMIDINE SYNTHESIS Uses: Cancer: leukemias (ALL), lymphomas, choriocarcinoma Non-cancer: 1st line for RA, IBD, ectopic preg, medical abortion (with misoprostol) Myelosupression reversed by Leucovorin (folinic acid) Mucositis, hepatotoxic, pulmonary fibrosis.

Question 38

Bleomycin

Answer 38

Anti-tumor Free radical formation- DNA Strand Breaks. Pulmonary fibrosis - skin hyperpigmentation

Question 39

Dactinomycin

Answer 39

intercalates DNA Used for WIlms, Ewing sarcoma, rhabdomyosarcoma, (childhood tumors)

Question 40

Demeclocyclin

Answer 40

Used to treat SIADH, by inducing nephrogenic DI

Question 41

Doxorubicin/Danorubicin

Answer 41

Generates free radicals intercalates DNA Cardiotoxic- dilated cardiomyopthy Dexrazoxane - iron chelator to prevent cardiotoxicity - prevents Fe2+ free radical damage

Question 42

Ribavirin

Answer 42

inhibits inosine monophosphate dehydrogenase used for Hepatitis C and RSV in adults (palivisumab prophylaxis in high risk babies)

Question 43

Leflunomide

Answer 43

Inhibits Dihydroorotate dehydrogenase- inhibits pyrimidine synthesis