201 HI - Disease & Pharmacology Flashcards by Ina Vong

Immuno- suppressors, immuno-modulators and antibody treatments

Induction therapy for transplantation

Lymphocyte-depleting agents - Antithymocyte globulin
Interleukin 2 receptor antagonists - Basiliximab

Glucocorticoids (corticosteroids)

Antiproliferative immunosuppressants - Azathioprine

Calcineurin inhibitors - Ciclosporin

mTOR inhibitors - Sirolimus

TNF-α inhibitors - Infliximab

Antibodies against CD20 - Rituximab

Interleukin inhibitors - Tocilizumab

Janus kinase (JAK) Inhibitors - Tofacitinib
Immunomodulation therapy	- Interferons, interleukins, IVIG

How well did you know this?

Not at all

Perfectly

AE of Glucocorticoids (corticosteroids)

Immuno- suppressors, immuno-modulators and antibody treatments

Iatrogenic Cushing syndrome

How well did you know this?

Not at all

Perfectly

Antiproliferative immunosuppressants

Immuno- suppressors, immuno-modulators and antibody treatments

Azathioprine

Activated to 6-mercaptopurine (6-MP)

AE: Bone marrow suppression

How well did you know this?

Not at all

Perfectly

Calcineurin inhibitors

Immuno- suppressors, immuno-modulators and antibody treatments

Ciclosporin

Inhibit calcineurin, which normally activates the transcription of interleukin-2

AE: Hyperlipidaemia, hypertension, gingival hyperplasia, renal dysfunction

How well did you know this?

Not at all

Perfectly

mTOR inhibitors

Immuno- suppressors, immuno-modulators and antibody treatments

Sirolimus

AE: Myelosuppression

How well did you know this?

Not at all

Perfectly

TNF-α inhibitors

Immuno- suppressors, immuno-modulators and antibody treatments

Infliximab

AE: Latent TB and other serious infections may recur

How well did you know this?

Not at all

Perfectly

Antithrombotic drugs

Thrombolytics/fibrinolytics - Alteplase

Heparin - Enoxaparin

Low-molecular-weight heparin - Fondaparinux

Direct thrombin inhibitor - Bivalirudin

Vitamin K antagonist - Warfarin

Direct Oral Anticoagulants (DOACs) - Dabigatran

Antiplatelet drugs:

Aspirin
P2Y12 antagonists - Clopidogrel (CYP2C19)
GPIIb/IIIa Receptor Antagonists - Abciximab

How well did you know this?

Not at all

Perfectly

Thrombolytics/fibrinolytics

Antithrombotic drugs

Alteplase

Enzymically activate plasminogen to give plasmin which digests fibrin and fibrinogen, lysing the clot.

AE: Bleeding

How well did you know this?

Not at all

Perfectly

Heparin, low-molecular-weight heparin

Antithrombotic drugs

Enoxaparin

Binds to AT III → inhibits factor Xa

How well did you know this?

Not at all

Perfectly

Vitamin K antagonist

Antithrombotic drugs

Warfarin

Inhibits the reduction of vitamin K and thus prevents the γ-carboxylation of the glutamate residues in factors II, VII, IX, and X

How well did you know this?

Not at all

Perfectly

AE of Direct Oral Anticoagulants (DOACs)

Antithrombotic drugs

Bleeding

How well did you know this?

Not at all

Perfectly

Haem iron vs non-haem iron

Haem:

binds to haemoglobin & myoglobin
can be found in animal products
in ferrous state (Fe2+)

Non-Haem:

free iron molecules
can be found in plant-based foods
in ferric state (Fe3+)

How well did you know this?

Not at all

Perfectly

Mechanisms of iron absorption

Duodenal cytochrome B reduces Fe3+ → Fe2+ (meat product not needed to be converted)
DMT1 transport Fe2+ into duodenal enterocyte
Ferroportin export iron from enterocyte when needed - Fe2+ released from ferritin stores into blood
Hephaestin converts Fe2+ → Fe3+ - binds to transferrin and transported to target tissues
Fe3+ stored in ferritin

How well did you know this?

Not at all

Perfectly

Where does iron absorption mainly occur?

Duodenum

How well did you know this?

Not at all

Perfectly

How is iron absorption regulated?

Hepcidin

produced in the liver in response to increased iron load & inflammation
binds to ferroportin and causes degradation

High hepcidin levels block intestinal iron absorption

How well did you know this?

Not at all

Perfectly

4 main causes of iron deficiency anemia

↓ iron intake
↓ iron absorption
↑ demand
↑ loss

How well did you know this?

Not at all

Perfectly

Hepcidin levels ______ in iron deficiency

decrease

How well did you know this?

Not at all

Perfectly

Primary & secondary causes of iron overload

Primary:

hereditary hemochromatosis
iron poisoning

Secondary:

blood transfusions
iron loading anemias

How well did you know this?

Not at all

Perfectly

What causes megaloblastic macrocytic anaemia?

Vitamin B12 & B9 (folate) deficiency

What is the most common type of anemia?

Iron deficiency

Iron deficiency can cause _____ anemia

hypochromic microcytic

How can iron status be assessed?

Functional iron
Transported iron
Serum iron

Treatment of iron overload

Iron chelation

Cytotoxic drugs target mechanisms by which?

Cells divide & grow and prevents cell from dividing

3 main approaches to delivering dose-intense chemotherapy

Dose escalation: increasing dosage Reduction of interval: reduce the time between cycles Sequential dosing: single or combination drugs given sequentially

What are the 3 phases of chemotherapy?

Induction Consolidation Maintenance

Hematological malignancies (3)

Leukaemia - cancer which starts usually in bone marrow 白血病 Lymphoma - cancer that begins in lymphocytes 淋巴瘤 Myeloma - cancer that forms in plasma cells 骨髓瘤

MOA of Vincristine (for Acute Lymphoblastic Leukemia)

Inhibits microtubule assembly - disrupts M-phase

Chronic leukaemia

Lots of partially developed WBC over a long period of time

Chronic Myeloid Leukaemia (CML) vs Chronic Lymphoblastic Leukaemia (CLL)

CML affects granulocytes - neutrophil, basophil, eosinophil - cells divide too quickly CLL affects lymphocytes - cells don't die as they should

Why are chemotherapy drugs often used in combination?

To provide maximum cell kill within the range of toxicity To broaden the range of interaction between drugs & tumor cells To prevent or slow the development of cellular drug resistance

Sepsis

A life-threatening condition that arises when the body's response to an infection injures its own tissues & organs

Septicaemia

Septicaemia is when bacteria enter the bloodstream, and cause blood poisoning which triggers sepsis

What is SIRS (Systemic inflammatory response syndrome)?

A non-specific clinical response with 2 or more objective signs of systemic inflammation 全身炎症反應綜合症

What is sepsis in the setting of SIRS?

SIRS w a presumed or confirmed infectious process Infection associated w organ injury distant from the site of infection

Is it required to have a confirmed infection to confirm sepsis?

No | - only ~60% of confirmed cases are w confirmed infections

Role of endothelium

Maintains homeostasis between coagulation & fibrinolysis

How does septic shock occur?

Sepsis increases nitric oxide levels | → leading to excessive vasodilation & refractory hypotension

When to prescribe antibiotic for sepsis pt?

ASAP - don't wait for culture, use broad spectrum antibiotic - re-evaluate choice of antibiotics after culture data available

The "sepsis six" bundle

1. Give high flow oxygen 2. Start intravenous fluid resuscitation 3. Take blood cultures 4. Give intravenous antibiotics 5. Measure lactate and FBC 6. Monitor accurate hourly urine output

What is the target of HIV?

CD4+ lymphocytes | - cluster of differentiation protein 4

How many copies of RNA does each HIV virion contain?

Opportunistic infections

An infection caused by a pathogen that does not normally produce disease in a healthy individual

Threshold of CD4+ to worry about opportunistic infections

<200 cells/mm3

Causative agent of Kaposi's sarcoma

Human herpes virus 8

Causative agent of non-Hodgkin's lymphoma

Epstein-Barr virus