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Flashcards in Sem 1 Final Deck (94):
1

Ferrous sulfate, ferrous gluconate, ferrous fumarate: SE's?

N/V, *melena

2

Ferrous sulfate, ferrous gluconate, ferrous fumarate: indications?

Inadequate absorption of Fe; blood loss; (increased Fe requirements for pregnant, children, premies)

3

Ferous sulfate, ferrous gluconate, ferrous fumarate: how long does it take to work?

Quick response- anemia reversed in 1-3 months

4

Ferrous sulfate, ferrous gluconate, ferrous fumarate: MoA?
Route?

Fe supplementation
PO

5

Iron dextran, iron sucrose, iron gluconate: MoA?
Route?

Fe supplementation
IV or IM

6

Iron dextran, iron sucrose, iron gluconate: indications?

When the oral form (ferrous __) isn't tollerated, such as post-GI resection; malabsoprtive syndromes

7

Iron dextran, iron sucrose, iron gluconate: SE's?

Pain, tissue staining (IM), HA, fever, N/V, back/joint pain, allergic rxns, anaphylaxis (more than oral ferrous forms)

8

What can acute Fe toxicity cause?
What can chronic Fe toxicity cause?

- Acute Fe toxicity (usually from over-ingestion of tabs) can cause necrotizing gastroenteritis; death in children.
- Chronic toxicity (hemochromatosis, multiple transfusions) can cause organ failure.

9

What are some techniques drugs for treating acute Fe toxicity? (3)

- Gastric aspiration
- Gastric lavage (phosphate or carbonate solns)
- Deferoxamine

10

What are some techniques drugs for treating chronic Fe toxicity? (3)

- Deferoxamine
- Deferasirox
- Intermittent phlebotomy

11

What can be given for B12 supplementation? Folate supplementation?

- B12: Cyanocobalamine, hydroxycobalamine
- Folate: folic acid

12

What route can Cyanocobalamine and hydroxycobalamine be given besides PO?
What is the response time?

IM
- Quick response (1-2 months). PO might be even better!

13

If someone is experiencing B12 or folic acid def., if they are given supplemental folic acid, will the CNS sx be reversed?

No

14

EPO: routes?

IV, SubQ

15

EPO: indications?

CKD, aplastic anemia, leukemia, HIV/AIDS-associated anemias, cancers, anemia of prematuraty, post-phlebotomy

16

EPO: toxicity?

HTN, thrombotic complications, allergic rxns, tumor recurrence and progression

17

Sargamostrim: MoA?

Recombinant GM-CSF. Stimulates proliferation and differentiation of erythroid and megakaryocytic cells (less specific than below).

18

Sargamostrim, filgastrim, pegfilgastrim: indications?

(they have different MoA's and SE's)

S/p intesive chemo (particularly for AML), congenital neutropenia, cyclic neutropenia, neutropenia a/w myelodysplasia and aplastic anemia, high-dose chemo w/autologous stem cell rescue, autologous transplant (mobilization of peripheral blood cells)

19

Sargamostrim: SE's?

Fever, arthralgia, myalgia, peripheral edema, pleural/pericardial effusion, allergic rxns

20

Filgastrim, pegfilgastrim: MoA?

Recombinant G-CSF. Promotes the release of hematopoietic stem cells from the marrow into the peripheral circulation. Increases PMN count.

21

Filgastrim, pegfilgastrim: SE's?

Bone pain, rarely splenic rupture, allergic rxns.

22

Which drug is better: sarmostrim or filgastrim?

Filgastrim

23

How does pegfilgastrim differ in T1/2 from filgastrim?

Pegfilgastrim (conjugated to polyethylene glycol) has a longer T1/2

24

Oprelvekin: MoA?

Recombinant IL-11. Promotes proliferation of megakaryocyte progenitors. Increases peripheral platelet counts.

25

Oprelvekin: indications?

Chemo pts who become thrombocytopenic

(Platelet transfusions can produce adverse rxns and pts can be refractory to platelet transfusions as well, so use this drug instead to increase platelet counts)

26

Oprelvekin: SE's?

Fatigue, HA, dizziness, dyspnea, arrhythmia, hypokalemia

27

Romiplostim: MoA?

A novel protein known as a “peptibody” with two domains; a peptide domain that binds the TPO (thrombopoietin) receptor (Mpl), and an antibody Fc domain that increases half-life.

(TPO receptors are also on stem cells, so all stages of hematopoiesis are increased, including RBCs, WBCs, and platelets, making this a promising drug to treat aplastic anemia.)

28

Romiplostim, eltrombopag: indications?

(they have different MoA's)

Thrombocytopenia, idiopathic thrombocytopenic purpura (ITP), asplastic anemia, post-chemo

29

Romiplostim, eltrombopag: SE's?

(They have different MoA's)

HA, myalgia, bone marrow fibrosis (reversible)

30

Eltrombopag: MoA?

A thrombopoietin-receptor agonist (small molecule)

31

Prednisone, prednesilone: MoA?

A glucocorticoid; activates the glucocorticoid receptor TS factor; modifies expression of cytokines and other immunomodulatory genes; suppresses active immune response

32

Prednisone, prednesilone: indications?

Immunosuppression; to prevent graft rejection; to prevent GvHD; tx of cytokine release syndrome; tx of a wide variety of autoimmune and inflammatory dz's (SLE, RA, asthma, etc)

33

Prednisone, prednesilone: toxicity?

Hyperglycemia, HTN, HLD, obesity, diabetes, poor wound healing, increased infection risk, mania & psychosis

*Dose should be gradually reduced and not withdrawn abruptly.

34

Azathioprine: MoA?

Prodrug that's converted to active 6-mercaptopurine (6-MP) by HGPRT. Inhibits de novo purine synthesis. Incorporated into DNA and causes SSB mispairing --> apoptosis (inhibits lymphocyte proliferation). Inhibits CD28 co-stimulation.

35

Azathioprine: indications?

Immunosuppression; to prevent graft rejection; to prevent GvHD; tx of autoimmune dz's

36

Azathioprine: toxicity?

Leukopenia/thrombocytopenia, hepatotoxicity, ^ risk infections, ^ risk malignancy

37

Azathioprine: contraindications?

*Interacts w/anti-gout drugs allopurinol and febuxostat --> ^ [azathioprine] --> ^ toxicity.

38

Mycophenolate mofetil: MoA?

Prodrug that's converted to mycophenolic acid, inhibits IMPDH2 (which is selectively expressed in lymphocytes) --> inhibition of purine NT synthesis (no salvage pw in lymphocytes --> selectively inhibits lymphocyte proliferation)

39

Mycophenolate mofetil: indications?

Immunosuppression; to prevent graft rejection; to prevent GvHD; tx of autoimmune dz's

40

Mycophenolate mofetil: toxicity?

Leukopenia/anemia, teratogenic (male + female), ^ risk infections, ^ risk malignancy, *RARE- risk of progressive multifocal leukoencephalopathy (PML) (Fatal dz caused by reactivation of JC virus)

41

Mycophenolate mofetil: contraindications?

Pregnancy, women who wish to become pregnant, and men who wish to become fathers

42

Cyclosporin, tacrolimus: MoA?

Cyclosporin and tacrolimus bind cyclophilin and FKBP respectively to form inhibitory complexes, which inhibit calcineurin, a Ca-regulated phosphatase, thus inhibiting the NFAT ts factor, which is involved in regulating the expression of IL-2 and multiple other immunoregulatory genes. Potently inhibits the T cell immune response by inhibiting signal 1.

43

Cyclosporin, tacrolimus: indications?

Immunosuppression; to prevent graft rejection; to prevent GvHD; tx of autoimmune dz's

44

Cyclosporin, tacrolimus: toxicity?

Nephrotoxicity******, hypertension***, neurotoxicity, tremor, glc intolerance (T>C), HLD (C>T), hypertrochosis (C), alopecia (T), ^ risk infections, ^ risk malignancy

45

Cyclosporin, tacrolimus: contraindications?

*Metabolized by CYP3A4, many drug interactions. CYP3A4 inhibitors --> ^ drug level --> ^ toxicity. CYP3A4 inducers --> v drug level --> ^ risk graft rejection.

46

Sirolimus, everolimus: MoA?

Drugs form complex w/FKBP, which inhibits IL-2-mediated activation of mTOR kinase (T cell signal 2). Inhibits IL-2-mediated ptn synthesis, cell proliferation and survival.

47

Sirolimus, everolimus: indications?

Immunosuppression; to prevent graft rejection (NOT liver, NOT lung); to prevent GvHD; included in arterial stents to inhibit restenosis

48

Sirolimus, everolimus: toxicity?

Hypertriglyceridemia, hypercholesterolemia, ^ lung dz, ^ risk diabetes, anemia/cytopenia/leukopenia, v wound healing, teratogenic, ^ risk infections, ^ risk malignancy

49

Sirolimus, everolimus: contraindications?
Why aren't they recommended for lung xplant?
Why aren't they recommended for liver xplant?

Pregnancy. Metabolized by CYP3A4, many drug interactions.

NOT RECOMMENDED IN: lung xplant (risk anastomatic dehiscence), liver xplant (risk hepatic a. thrombosis)

50

Rabbit anti-thymocyte globulin: MoA?

Rabbit polyclonal AB's specific for human lymphocytes (depletes lymphocytes from the blood).

51

Rabbit anti-thymocyte globulin: indications?

Induction immunotherapy

52

Rabbit anti-thymocyte globulin: toxicity?

*Cytokine release syndrome, leukopenia.

53

Alemtuzumab: MoA?

Binds to CD52 expressed on T cells, B cells, macrophages, NK cells, & granulocytes. Depletes cells from the blood by AB-mediated lysis.

54

Alemtuzumab: indications?

Induction immunotherapy

55

Alemtuzumab: toxicity?

How long can it take to recover from this?

*Cytokine release syndrome, leukopenia.

Can take > 1 year for immune system to recover from the toxicity.

56

Basaliximab: MoA?

Antagonist of the IL-2R (blocks T cell proliferation).

57

Basaliximab: indications?

Induction immunotherapy

58

IV IG: MoA?

Pooled Ig from healthy individuals; provides pt w/Ig from healthy immunized donors to provide immunity from common pathogens

59

IV IG: indications?

Provides short-lived humoral immunity to pts w/deficiency in humoral immune system (e.g. hypogammaglobulinemia)

60

Rho (D): MoA?
When is it given to mothers?

Purified AB to Rh(D) ag. Given to Rh- mother at 28 weeks and 72 hrs post-partum to deplete any fetal RBC in maternal blood to prevent the mother from generating an immune response to RBC

61

Rho (D): indications?

Prevention of hemolytic disease of the newbown in newborns born to Rh- mothers

62

Hyperimmune Ig: MoA?

Purified Ig to specific Ag's purified from healthy volunteers. Given IV in order to promote clearance of virus/toxin

63

Hyperimmune Ig: indications?

To provide rapid, specific AB immunity to specific viruses and/or toxins

64

Ipilimumab: MoA?

AB specific for CTLA-4; antagonizes the negative regulatory CTLA-4 ptn responsible for down-regulating activated T cells, thus enhancing T cell response.

65

Ipilimumab: indications?

Tx of late stage melanoma and non-small cell lung cancers.

66

Ipilimumab: toxicity?

Potential for RARE autoimmune response (can be fatal)

67

Ipilimumab: contraindications?

Not recommended in pregnancy

68

Pembrolizumab, nivolumab: MoA?

AB specific for PD1 ptn, which is a negative regulatory receptor expressed on activated T cells that is responsible for down-regulating T cell responses. The PD1 ligand PD-L1 is expressed on tumor cells- this is a mech for tumors to avoid the immune response; AB drugs block PD1/PD-L1 interactions, blocking the inhibitory signal and leading to enhanced tumor immune responses.

69

Pembrolizumab, nivolumab: indications?

Tx of late stage melanoma and non-small cell lung cancers.

70

Pembrolizumab, nivolumab: toxicity?

Potential for RARE autoimmune response (can be fatal)

71

Pembrolizumab, nivolumab: contraindications?

Not recommended in pregnancy

72

Name 3 anti-proliferative agents that are less commonly used in transplants (that we skipped over in class but could come up as other options for answer)

Methotrexate
Cyclophosphamide
Chlorambucil

73

Toxicity of rifampin?
(the rest is on sketchy)

Hepatotoxicity, red discoloration of body fluids, AKI, influenza syndrome (more common w/intermittent dosing), thrombocytopenia, cholestatic jaundice. [activates CYP450]

74

What defines multi-drug resistance TB?

Resistance to both INH and rifampin

More common in HIV infected patients

75

What does acquiring rifampin resistance mean, in terms of duration of TB therapy?

Rifampin resistance eliminates short-course (6 month) TB therapy- requires therapy for at least 18-24 months.

76

What defines extensively-drug resistance TB?

Resistance to all of the following:
- INH and Rifampin
- A fluoroquinolone antibiotic
- 1 of 3 injectable abx (amikacin, kanamycin, capreomycin)

77

What 3 factors indicate that 6-month TB tx will be effective?

- Adherence is high
- Sputum cultures convert by 2 months
- There is no major cavitary lung disease

78

What 2 drugs are effective vs TB only?
What 2 drugs are effective vs NTM only?
What 4 drugs are effective vs TB and NTM organisms?

Active vs. TB: INH, PZA

Active vs. NTM: Clarithro, azithro (macrolides)

Active vs. Both: Rif, emb, FQ, AG

79

What organisms does amphotericin B cover?
What 2 does it not cover?
What is it TOC for?

Broad spectrum: all life-threatening mycotic infections
- Candida, cryptoccous, histoplasma, blastomyces, coccidiodes, aspergilus, fusarium, mucor
*not C. lusitaniae, not p. boydii.
- TOC: Mucormycosis

80

What specific organism does nystatin cover?
What related organisms does it not cover?

- Mucocutaneous candidiasis
* Not dermatophytes

81

What organisms does flucytosine cover?

C's
- Cryptococcus neoformans (esp. cryptoccocal meningitis), candida, chromoblastomycosis

82

What organisms do echinocandins (caspofungin, micafungin, anidulafungin) cover?
What do they not cover?

- Incasive candida (including glabrata and kruseii), invasive aspergillus
* Not cryptococcus or dimorphic fungi

83

What organisms does griseofulvin cover?

Mycotic infection of stain/hair/nails due to dermatophytes

84

What organisms does terbinafine cover?

- Tx of oncomycosis and superficial skin infections
- Candida albicans, dermatophytes
- Tx of tinea's

85

What anti-fungals have good CSF penetration?

Flucytosine
Fluconazole
Voriconazole

86

What anti-fungal can be used in pregnancy?

Amphotericin B

87

What organisms does ketoconazole cover?

Dermatophytes
Candida sp.
Cryptococcus
Coccidiodes
Histoplasma
Blastomyces

(Denise can cram cocks, historically black)

88

What organisms does fluconazole cover?

Dermatophytes
Candida sp.
C. glabrata (+/-), C. krusei (-)
Cryptococcus
Coccidiodes
Histoplasma (+/-)
Blastomyces (+/-)


Lowest SOA, but great bioavailability and effective in CNS, bladder)

(Denise can cram cocks, historically black)

89

What organisms does itraconazole cover?

Dermatophytes
Candida
C. glabrata (+/-), C. krusei (+/-)
Cryptococcus
Coccidioides
Histoplasma
Blastomyces
Pseudoallerischeri
Boydii/Scedosporium (+/-)
Aspergillus (+)

(Denise can cram cocks, historically black + some randoms and a little aspergillus)

90

What organisms does voriconazole cover?

Dermatophytes
Candida (all)
Cryptococcus
Coccidioides
Histoplasma
Blastomyces
Pseudoallerischeri
Boydii/Scedosporium
Aspergillus (+++)
Fusarium

(Denise can cram cocks, historically black, but now great aspergillus and new fusarium)

91

What organisms does posaconazole cover?

Dermatophytes
Candida (all)
Cryptococcus
Coccidioides
Histoplasma
Blastomycoses
Pseudoallerischeri
Boydii/Scedosporium
Aspergillus (+++)
Fusarium
Mucor

(Denise can cram cock, historically black. Basically covers all, but also salvage therapy for mucor)

92

Which azole requires a renal dose adjustment?

Fluconazole

93

Side effects for itraconazole?

HTN, hypokalemia, peripheral edema

94

Side effects for voriconazole?

Photosensitivity, rash, periostitis, visual changes, hallucinations, seizures