Thorny Lecture Buzz Words Flashcards
Type C ADRs
associated with long term use involves dose accumulation
Drugs for Type 4
b-lactam antiB’s sulfonamides *also latex gloves and poison ivy are examples of these
Why is alcohol (elixir) contraindicated with metronidazole
Metronidazole blocks the bodies ability to metabolize alcohol resulting in high levels of acetaldehyde… leading the headache and facial flushing (asian flush)
What types of changes in DNA are the main focus to determine genetic variability and their corresponding changes in drug response?
SNPs
What foods should be avoided when taking warfarin?
those high in vitamin K
Isoniazid is a drug for TB… idiosyncratic differences in response to this drug makes 3 populations particularly slow metabolizers of isoniazid, potentially making it toxic… what is the enzyme responsible and what are the 3 groups?
enzyme = N-acetyltransferase 1) 80% egyptians are slow 2) 50% caucasians 3) 50% africans
Drugs causing Type 3
b-lactams sulfonamides NSAIDs hydralazine* procainamide* *implies causes a lupus-like reaction
cyp2D6 polymorphisms can have very different effects on metabolism… thus inhibitors of this enzyme can MIMIC a genetic polymorphism… what are examples of inhibitors?
cyp2D6 is inhibited by… fluoxetine, paroxetine, haloperidol, quinidine, ritonavir aka any drug that also requires cyp2D6 metabolism can decrease enzyme available to metabolize drug…
Type 1 Hypersensitivity MOA
Requires initial exposure to result in clonal expansion of B & T cells 2nd exposure results in rapid response.. T-cells activate B-cells which results in high [] of IgE causing mast cell degranulation and bronchospasm. Anaphylaxis is a sever type 1 response Re-challenge is OK after de-sensitization
Type A Adverse Drug Reactions
account for 2/3 of ADRs PREDICTABLE & Dose Dependent (include anaphylactoids) Preventable (propranolol & heart block)
Type D ADRs
delayed effects (dose INdependent) carcinogenicity teratogenicity
Difference between anaphylaxis vs anaphylactoid
Anaphylaxis is IgE-mediated histamine release (due to a severe type 1 hypersensitivity) Anaphylactoid is NON-IgE mediated histamine release
Antibiotics you gotta know frequently cause allergic reactions
b-lactams! (cephalosporins & penicillins) Sulfonamides Vancomycin
What foods should be avoided when taking diuretics?
foods high in salt
*sneaky important to know* Gotta remember these drugs are anaphylactoid… thus are DOSE-related, and have NO cross-reactivity within class (therefore using a different drug within the same class is okay)
1) codeine/morphine 2) Vancomycin 3) sulfites 4) Radiocontrast (also if you can member it… caspofungin)
Name 7 inducers of cyp450
1) EtOH 2) smoking cigarrettes 3) chewing tobacco 4) phenobarbital 5) phenytoin 6) rifampin 7) carbamazepine
Type B ADRs
idiosyncratic rare and not predictable
What is an example of an idiosyncratic response to general anesthesia?
Malignant hyperthermia
Type 1 HyperS MOA
Target organ = RBCs or platelets onset = immediate if 2nd exposure, otherwise 5-8 days for first time exposure Rechallenge NOT recommended Drug binds cell membrane (of RBCs or platelets) and antibodies are formed against the drug and attach resulting in toxicity… sometimes the anitbodies activate complement and cause cell lysis
Hypersensitivity vs Anaphylactoid
HyperS = immune-mediated, not dose related, cross-reactivity within class occurs, re-challenge only in type 1 & 4 Anaphylactoid = pharmacologically induced, IS dose related, NO cross-reactivity, and re-challenge is okay if pre-treated with antihistamine
Name a few drugs that can cause Type 1 HS
mAbs NMJ blockers quinolone antibiotics b-lactam antib’s Toluene diisocyanate (chemical factories) Apamin (evil Bee’s)
Big summary table of the 4 hypersensitivities
type 1 = IgE, onset in minutes, can desensitize drugs: b-lactams, quinolones (lone wolf = number 1), NMJ blockers type 2 = IgG, IgM, onset 5-8 days, No desensitization drugs: b-lactams and quinidine type3 = IgG, IgM, onset 10-14 days No desensitzation, drugs: b-lactams, hydralazine, procainamide, NSAIDs type 4 = *T-cell lymphocyte mediated*, usually 7-20 days for onset, can desensitize, b-lactams and *sulfa drugs*
Very low activity of thiopurine methyltransferase (TPMT) results in what?
Bone marrow toxicity (due to accumulation of thioguanine)
term for: study of relationship between individual gene variants and variable drug outcomes
Pharmacogenetics
