26 April wk7-B Flashcards
What drug can be used to control bleeding in mild hemophilia A? How does it work? What other functions does it have?
Desmopressin
ADH analog that binds to V2 receptor in renal tubule and can be used for diabetes insipidus and nocturnal enuresis
Treats hemophilia by increasing factor VIII levels and can also increase release of vWF from endothelial cells
Name some TNF-alpha inhibiting drugs and explain their MOA and use.
Inhibition of TNF-alpha is done to reduce inflammation, commonly used to treat patients with RA who have failed therapy with Methotrexate
Etanercept: fushion protein that acts as a decoy for TNF-alpha
Infliximab: monoclonal antibody against TNF-alpha
Adalimumab: monoclonal antibody against TNF-alpha
What should be considered before administering a TNF-alpha inhibitor?
Inhibition of TNF-alpha inhibits the function of cell-mediated immunity which is especially important in fighting off mycobacterium.
Therefore a TB skin test should be done to screen for latent TB, and drug should not be given to anyone with an underlying infection.
Methotrexate
Inhibits dihydrofolate reductase to inhibit DNA, RNA, protein synthesis in cancer. Also used as an immune suppressant in RA, organ transplants, psoriasis, severe asthma
Reversed by Leucovorin
Hepatotoxic, teratogenic, renal precipitation, myelosuppression
What baseline test should be performed before admin. of doxorubicin?
Echocardiogram or radionucleotide ventriculography to assess function of the LV
What drugs can cause pulmonary fibrosis?
Bleomycin, Amiodarone, Procainamide, Penicillamine, Nitrofurantoin, Cyclophosphamide
Hydroxychloroquine can cause permanent damage to what?
Retinal damage with long term use
How is methacholine used in asthma?
Methacholine is a cholinergic agonist that causes bronchoconstriction and increased mucus production. Used as a challenge test to see if it produces asthma-like Sx to help the diagnosis of asthma.
Patient has periodic nocturnal dyspnea, episodic cough, and family Hx of atopy and normal spirometry values. What might be the Dx?
Consider asthma
Patients with a family Hx of allergy-like conditions “allergic triad” (allergic rhinitis, atopic dermatitis, allergic asthma) should raise suspicion of allergy leading to asthma even if normal spirometry levels
What is a classic treatment for partial seizures, and tonic-clonic seizures? MOA? SE?
Carbamazepine
Blocks Na channels in the inactive state–helpful to reduce conduction of impulses throughout the brain during a seizure
SE: Bone marrow suppression, hepatotoxicity, SIADH
What drug is used for absence seizures? MOA?
Ethosuximide
Blocks T-type Ca channels in thalamic neurons
Not associated with marrow suppression like Carbamazepine
NMDA receptor
Glutamate receptor that is a channel for cations–non-selective
Associated with neural plasticity and learning/memory
Binding of glutamate and either D-serine or glycine opens the channel in the neuron causing depolarization
Phencyclidine (PCP), Ethanol, Dextromethorphan act at this receptor
What is neuroleptic malignant syndrome?
Idiosyncratic reaction that can occur after initiation of antipsychotic drugs
Acute onset of hyperthermia, extreme generalized rigidity, autonomic instability, altered mental status
What are the SE’s likely to accompany antipsychotic medications?
Extrapyramidal Sx’s: acute dystonic reaction, akathisia, drug induced parkinsonism
Tardive dyskinesia: involuntary movements that may be permanent even after discontinuing the drug, involves lip smacking, biting, grimacing, tongue protrusions, choreoathetoid movements of head limbs and trunk
Neuroleptic malignant syndrome
Patient recently started taking a new antipsychotic drug and develops involuntary movements including lip smacking, grimacing, biting, tongue protrusions. What is this called?
Tardive dyskinesia
