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Drugs Flashcards

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1
Q

What is the active metabolite of azathioprine?

A

6-mercaptopurine (6MP), and endpoint active metabolite is thioguanine if it goes through the HPRT pathway (the bad one)

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2
Q

Generic name for Imuran

A

Azathioprine

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3
Q

Purine analogue, blocks purine biosynthesis

A

Imuran (Azathioprine)

And also Cellcept is one as well

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4
Q

Which phase of the cell cycle is blocked by azathioprine?

A

S phase

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5
Q

Why do you check a TMPT on a patient you are about to start on Imuran?

A

Before you start someone on Imuran (Azathioprine), you should check a TMPT level because if they have a hereditary deficiency in the enzyme then the drug will be metabolized down the HPRT pathway which gives the person bone marrow suppression= bad

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6
Q

What drug do you not want someone to be on while they are on imuran?

A

Allopurinol (inhibits the TMPT and XO pathway)

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7
Q

Which enzyme does Cellcept inhibit?

A

Inosine monophosphate dehydrogenase (IMPDH)

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8
Q

How does Cellcept treat things?

A

Inhibits purine synthesis of T and B cells in particular, because these cells do NOT HAVE A PURINE SALVAGE PATHWAY!!!

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9
Q

Nitrogen mustard derivative which blocks DNA cell cycle synthesis

A

Cyclophosphamide

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10
Q

Name a few side effects of Cyclophosphamide

A

HEMORRHAGIC CYSTITIS
Azoospermia
Pulmonary fibrosis
Alopecia

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11
Q

What is cyclophosphamide (Cytoxan) the treatment of choice for?

A

Wegeners granulomatosis

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12
Q

What is the drug of choice to treat Wegeners?

A

Cyclophosphamide

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13
Q

What dose Cyclosporine inhibit?

A

T cell synthesis

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14
Q

How does cyclosporine work?

A

Inhibits cyclophilin - which blocks calcineurin - which decreases NFAT - which decreases IL-2

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15
Q

Gingival hyperplasia

A

Cyclosporine

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16
Q

Which organ do you watch out for when prescribing cyclosporine?

A

Kidneys! (Nephrotoxic)

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17
Q

Which drug is metabolized by Cytochrome P450 3A4

A

Cyclosporine

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18
Q

What cytochrome is Cyclosporine metabolized by?

A

Cytochrome P450 3A4

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19
Q

Name 4 drugs that will increase renal toxicity risk of Cyclosporine

A

NSAIDS
Aminoglycosides
Vancomycin
Amphotericin B

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20
Q

Name 4 Cytochrome p450 inducers?

A

Carbamazepine
Phenytoin
Phenobarbital
Rifampin

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21
Q

What HTN med do you give if you get Cyclosporine induced HTN?

A

Israpidine

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22
Q

What is the maximum amt of time you can be on Cyclosporine?

A

One year

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23
Q

Max Cyclosporine dose per day

A

5mg/kg

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24
Q

What do you use Thalidomine to treat?

A

Erythema nodosum leprosum

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25
Q

What does Imiquimod bind?

A

TLR-7

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26
Q

Thymidyline Kinase

A

The enzyme that acyclovir uses to work

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27
Q

What enzyme does acyclovir use to work?

A

Thymidyline kinase

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28
Q

What drug do you use to treat scabies in pregnant women

A

Precipitated sulfur

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29
Q

How does permethrin work?

A

Blocks sodium channels, paralyzing the mite

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30
Q

How does ivermectin work?

A

Blocks chloride channels, paralyzing the parasite

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31
Q

What enzyme level should you check on a person you are about to start on Imuran?

A

TMPT (because if they are deficient, then too much drug will be shuttled down the main pathway-HPRT)

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32
Q

What is the active metabolite of azathioprine?

A

6-MP

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33
Q

What enzyme converts 6-MP to 6-Thioguanine?

A

HPRT

*TPMT is the one that you check because if its too low the pathway goes too much down the HPRT

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34
Q

What is the endpoint of the azathioprine pathway (the end product?)

A

6-Thioguanine

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35
Q

What two things should you check for before starting someone on imuran?

A

Imuran(azathioprine) - you should check TMPT levels, and also make sure they are not on allopurinol

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36
Q

Name two purine synthesis inhibitors

A

Cellcept and Imuran

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37
Q

Which drug performs which action? (Cellcept vs Imuran)

  1. Inhibits de novo purine synthesis
  2. Inhibits S-phase specific purine synthesis
A
  1. Inhibits de novo purine synthesis = Cellcept

2. Inhibits S phase specific purine synthesis = Imuran

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38
Q

Why do you get nausea in Cellcept?

A

Because the drug is reacted by the epidermis and also the GI tract

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39
Q

Name the two most severe side effects of Cellcept

A

Progressive multifocal leukoencephalopathy &

Pure red cell aplasia

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40
Q

What is the active metabolite of cellcept

A

Mycophenolic acid

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41
Q

How is Cellcept excreted?

A

Kidneys

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42
Q

Which is cellcept: nephrotoxic or hepatotoxic?

A

Neither!

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43
Q

Name the enzyme MTX inhibits

A

Dihydrofolate reductase (DHFR)

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44
Q

Treat liver toxicity from MTX with?

A

Leucovorin

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45
Q

Name the molecule Cyclosporine inhibits

A

Cyclophillin. (Cyclophillin activates calcineurin in the presence of calcium and calmodulin)

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46
Q

Name some side effects of Cyclosporine

A

Gingival hyperplasia
Uric acid
Nephrotoxicity
Reversible hypertension

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47
Q

What vital sign should you check regularly in a patient on cyclosporine?

A

BP (bc cyclosporine can cause reversible HTN)

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48
Q

Side effect of hydroxyurea

A

Leg ulcers

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49
Q

Stelara inhibits which molecules?

A

IL-12/IL-23

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50
Q

Which subunit of the IL12/23 molecules does Stelara inhibit?

A

P40 subunit

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51
Q

What drug is a PDE4 small molecule inhibitor?

A

Otezla

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52
Q

Name Otezla’s mechanism of action

A

PDE4 inhibitor

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53
Q

Name Xeljanz mechanism of action

A

JAK inhibitor

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54
Q

Side effect of cosyntyx

A

Nasopharyngitis

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55
Q

Which medication used to treat SLE,DM ect can cause blue-grey nail dispigmentation

A

Hydroxychlororquine (Plaquenil)

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56
Q

Name Plaquenil’s mechanism of action

A

Intercalates into DNA

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57
Q

What lab do you need to test before starting Plaquenil?

A

G6PD deficiency (And also should get a baseline eye exam)

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58
Q

Which eye findings in Plaquenil are reversible and which are not?

A

Visual field changes are reversible (premaculopathy)

Bull’s eye pigment retinopathy is not

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59
Q

Which antimalarial has no risk of retinopathy?

A

Quinacrine

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60
Q

What is a side effect of Quinacrine?

A

Yellow pigmentation of the skin

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61
Q

Which anti-malarial has the highest risk of G6PD hemolysis?

A

Primaquine

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62
Q

Mechanism of action of Rituxan

A

Monoclonal Ab, anti-CD20 (destroys B cells)

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63
Q

Common side effect of intralesional Bleomycin

A

Raynauds

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64
Q

Most common general cause of Fixed Drug Eruption

A

Tetracycline

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65
Q

Most common cause of non-pigmented fixed drug eruption

A

Psuedophed

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66
Q

Most common cause of fixed drug eruption in children

A

Bactrim

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67
Q

Which drug causes a sun exposed blue-grey dispigmentation

A

Amiodarone

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68
Q

Where does minocycline cause a blue grey dispigmentation?

A

On the legs

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69
Q

Which drug causes a blue-grey dispigmentation in the sclera, teeth, nailbeds and tibia?

A

Quinacrine

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70
Q

Cyclosporine metabolized by what enzyme

A

CYP3A (so don’t give itraconazole or erythromycin, or fluconazole or ketoconazole)

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71
Q

Half life of isotretinoin

A

20 hours

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72
Q

Side effect of foscarnet

A

Penile erosions

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73
Q

What drugs create gynecomastia?

A

*Some drugs cause awesome knockers

Spironolactone
Digitalis
Cimetidine
Alcohol
Ketoconazole
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74
Q

Are the inhibitors of 14-alpha-demethylase fungistatic or fungicidal?

A

Fungistatic

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75
Q

What two drugs cause inhibition of 14-alpha-demethylase?

A

Ketoconazole

Itraconazole

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76
Q

Which antifungal causes visual disturbances

A

Voriconazole

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77
Q

Which antifungals are CYT-p450 inhibitors?

A

Fluconazole
Voriconazole

&also ketoconazole btw

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78
Q

What antifungal is fungicidal?

A

Terbinafine (Lamisil)

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79
Q

Which two -azoles require an acidic environment for absorption?

A

Itraconazole and ketoconazole

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80
Q

Bad side effect of oral ketoconazole?

A

Fulminant hepititis

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81
Q

Which oral anti-fungal can cause fulminant hepatitis?

A

Ketoconazole *why they dont use it any longer orally

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82
Q

What enzyme does terbinafine inhibit?

A

Squalene epoxidase (first step of ergosterol synthesis)

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83
Q

Which common antifungal DOES NOT inhibit cyp p450?

A

Terbinafine

84
Q

What pregnancy category is terbinafine?

A

Category B

85
Q

What side effect/autoimmune disease does terbinafine sometimes cause?

A

Drug induced LE

86
Q

Which antifungal is at risk for causing drug induced LE?

A

Terbinafine

& griseofulvin

87
Q

Which antifungal inhibits the first step of egrosterol synthesis?

A

Terbinafine! (Inhibits squalene epoxidase)

88
Q

What enzyme mediates the first step of ergosterol synthesis?

A

Squalene epoxidase

89
Q

Which antifungal disrupts microtubule formation?

A

Griseofulvin

90
Q

Which antifungal is a cytochrome p450 INDUCER?

A

Griseofulvin

91
Q

Which antiviral can cause TTP/HUS in HIV and transplant patients?

A

Valacyclovir

92
Q

What is a bad side effect of using high doses of Valacyclovir in HIV or transplant patients?

A

TTP/HUS

93
Q

What is the prodrug of acyclovir

A

Valacyclovir

94
Q

Side effect of foscarnet

A

Penile erosions

95
Q

Side effect:penile erosions

A

Foscarnet

96
Q

Treatment for resistant HSV if failed acyclovir

A

Foscarnet

97
Q

Why does foscarnet work when acyclovir doesnt?

A

Foscarnet does not require phosphorylation by viral thymidylate kinase like acyclovir does

98
Q

What do you use if HSV is resistant to gancyclovir AND Foscarnet?

A

IV Cidofidir

99
Q

Why does IV Cidofovir work when gancyclovir and foscarnet wont?

A

It acts completely INDEPENDANT of thymidylate kinase

100
Q

Which antiviral works completely independant of thymidylate kinase?

A

Cidofivir

101
Q

Which HIV medication causes melanonychia?

A

Zidovudine

102
Q

Side effect of zidovudine?

A

Melanonychia

103
Q

Which HIV medication can give a fatal hypersensitivity reaction?

A

Abacivir

104
Q

Side effect of the protease inhibitor HIV meds

A

Periungal pyogenic granulomas

105
Q

Which HIV med causes periungal pyogenic granulomas

A

The protease inhibitors (Indinavir, Ritonavir, Lopinavir)

106
Q

Lice medication which is contraindicated if you are allergic to crysanthemums

A

Pyrethrin

107
Q

How does Permethrin kill lice and scabies?

A

Disables the nerve cell Na transport channels

108
Q

Which drug disables parasites sodium transport channels

A

Permethrin

109
Q

Which antiparasitic disables:
Sodium channels?
Chloride channels?

A

Sodium channels - Permethrin

Chloride channels - Ivermectin

110
Q

Name three diseases you use Ivermectin to treat?

A

Strongyloides
Onchocerciasis
Norwegian Scabies

111
Q

Flammable anti-parasite drug

A

Malathion

112
Q

Which anti-parasite medication blocks neural transmission by interfering wtih GABA

A

Lindane (used for scabies)

113
Q

Which anti-parasitic carries an increased risk for seizures

A

Lindane (used for scabies, blocks GABA)

114
Q

What do you use to treat cutaneous larva migrans?

A

Thiabendazole/Albendazole

115
Q

What enzyme does Thiabendazole/Albendazole inhibit?

A

Fumarate reductase

116
Q

Which antparasitic inhibits fumarate reductase

A

Thiabendazole,

*used to treat cutaneous larva migrans

117
Q

Side effects of thiabendazole/albendazole

A

Dizziness, drowsiness, jaundice

118
Q

Side effect of pentavalent antimonial (sodium stibogluconate, meglumine, antimoniate)

A

Prolonged QT interval

119
Q

What do you use Pentamidine to treat?

A

Trypanosomiasis and leishmaniasis

120
Q

What do you use DEC to treat?

A

Filariasis, onchocerciasis

121
Q

Which cholesterol med reduces triglycerides the best?

A

Gemfibrozil

122
Q

Hydrochlorothiazides known to cause what kind of reaction

A

Lichenoid eruption

123
Q

Serum sickness is a side effect of which cephalosporin antibiotic?

A

Cefaclor

124
Q

Can you use doxycycline in renal failure patient?

A

Yes, because it is excreted in the GI tract

125
Q

Which part of the mouth does each medication stain?
-tetracycline
Vs
-minocycline

A

Tetracycline - stains the gingival 1/3

Minocycline - stains the mid-portion on the teeth

126
Q

Which ribosomal subunit do the tetracyclines bind?

A

30s subunit

127
Q

Which type of antibiotics bind the 30s subunit?

A

Tetracyclines

128
Q

Which tetracycline is the most phototoxic?

A

Demeclocycline

129
Q

Which antibiotic inhibits DNA-dependent RNA polymerase?

A

Rifampin

130
Q

Which antibiotic is proven to decrease OCP efficacy?

A

Rifampin

131
Q

Name two types of antibiotics which inhibit the 30s subunit

A

Tetracyclines

Aminoglycosides

132
Q

Sulfonamides inhibit what enzyme?

A

Dihydropteroate synthetase

133
Q

Name some antibiotics that bind the 50s ribosomal subunit?

A

Macrolides (Erythromycin)
Clindamycin

(*Tetracyclines and amminoglycosides bind the 30s subunit)

134
Q

Treatment for CARP

A

Minocycline

135
Q

Which antibiotic inhibits DNA gyrase

A

Fluoroquinolones

136
Q

Side effect: acral erythema (erythrodysesthesia)

A

Doxyrubicin
5-FU
Cytarabine
MTX

*Vs bleomycin which causes acral sclerosis

137
Q

Acral sclerosis

A

Bleomycin

*Bleomycin also causes Raynauds

138
Q

Which antifungal can cause AGEP?

A

Terbinafine

139
Q

Name some drugs that can cause AGEP

A 
Beta lactam antibiotics (pinicillin)
Macrolides (erythromycin)
Terbinafine
Calcium channel blocks (diltiazim)
Chloriquine
140
Q

Side effect: autoimmune hepatitis

A

Minocycline

141
Q

What serious systemic side effect can minocycline cause?

A

Autoimmune hepatitis

142
Q

Side effect: dermatomyositis-like eruption

A

Hydroxyurea

143
Q

Eccrine squamous syringometaplasia

A

Cytarabine

Paclitaxel

144
Q

A patient being treated with cytaribine and paclitaxel develops erythematous macules and papules in the axilla and on the hands. What side effect could this most likely be?

A

Eccrine squamous syringometaplasia

145
Q

Drugs that cause Erythema Nodosum

A

OCPs
NSAIDS
Antibiotics (sulfonamides and tetracyclines)

146
Q

Side effect: Extravasation reaction

A

Doxyrubicin

147
Q

Side effect: flag sign

A

MTX

148
Q

Side effect: gingival hyperplasia

A

Phenytoin
Cyclosporine
CCBs

149
Q

Side effect: violetbrown/blue pigmentation of skin

A

Clofazimine

150
Q

In which minocycline dyspigmentation reaction is iron not deposited into the skin?

A

Type III

Type I - pigment within scars (with iron deposition)
Type II - pigment on shins (with iron deposition)
Type III- pigment in sunexposed areas

151
Q

Side effect: hypertrichosis

A

Cyclosporine
Phenytoin
Minoxidil

152
Q

Side effect: inflamed SCCs

A

Fludaribine

153
Q

Side effect: Inflamed SKs

A

Cytarabine

154
Q

Which medication will cause a flare-up of inflamed seborrheic keratosis

A

Cytaribine

155
Q

Side effect: leg ulcers

A

Hydroxyurea

156
Q

Side effects of Hydroxyurea

A

Dermatomyositis-like eruption

Leg ulcers

157
Q

Hydroxyurea inhibits what enzyme

A

Ribonucleotide reductase (inhibits DNA synthesis, S phase specific)

158
Q

Side effect: leukocytoclastic vasculitis

A

Beta-lactam antibiotics (Penicillin)

159
Q

Side effect: Lichenoid eruption

A

HCTZ
Beta-blockers
Quinidine

160
Q

Which antimalarial causes a lichenoid-like eruption?

A

Quinidine

161
Q

What is the most common cause of Linear IgA bullous dermatosis

A

Vancomycin

162
Q

Side effect: flagellate hyperpigmentation

A

Bleomycin

163
Q

Side effect: supravenous serpentine hyperpigmentation

A

5-FU

164
Q

Side effect: sun exposed hyperpigmentation

A

MTX
5-FU
Daunorubicin

165
Q

Side effect: hyperpigmentation of occluded areas

A

Thiotepa

166
Q

Drugs causing:
SLE
Vs
SCLE

A

SLE: Hydralizine, procainimide, isoniazid, minocycline, phytanic, penicillamine

SCLE: Hydrochlorothiazide *most common), griseofulvin, terbinafine, CCBs

167
Q

Most common cause of drug-induced SCLE

A

HCTZ

168
Q

Name some causes of SCLE

A

HCTZ, Terbinafine, Griseofulvin

CCBs

169
Q

Anticonvulsant hypersensitivity syndrome results from a defect in what enzyme

A

Epoxide hydroxylase

170
Q

Antiparasitic which is an organophosphate cholinesterase inhibitor

A

Malathion

171
Q

Side effect: melanonychia

A

Zidovudine (HIV med)

172
Q

Side effect: mucositis

A 
Daunorubicin
Cyclophosphamide
Doxorubicin
MTX
5-FU
173
Q

Neutrophilic eccrine hiddradentitis

A

Cytarabine

174
Q

Side effect: onycholysis (non-photo)

A

Captopril
Retinoids
Chemo drugs: Paclitaxel, etopiside

175
Q

Side effect: photo-onycholysis

A

Tetracyclines: doxycycline
OCPs
Flouroquinolones: Cipro
Psoralen

176
Q

Side effect: pemphigus vulgaris

A

Captopril

Penacillamine

177
Q

Side effect: pseudoporphyria

A 
NSAIDS
Furosemide
HCTZ
TCNs (doxycycline)
Sulfonamides
Isotretinoin
Nalidixic acid
178
Q

Side effect: induction or worsening of psoriasis

A 
Terbinafine
NSAIDS
Captopril (ACE-I)
Beta-blockers
Lithium 
Antimalarials
179
Q

Side effect: pulmonary fibrosis

A 
MTX
Bleomycin
Amiodarone
Penicillamine
Gold
Busulfan
180
Q

Side effect: radiation recall

A

MTX
Actinomycetes-D
Doxorubicin, a ton of cancer drugs

181
Q

Side effect: Raynaud’s phenomenon

A

Combo of bleomycin and vinblastine

182
Q

Side effect: sweets

A

GCSF*
TMP-SMZ
Carbamazepine

183
Q

Side effect: TEN

A 
Allopurinol 
PCNs
Anticonvulsants (carbamazepine, lamotigene, pheytoin)
Sulfa drugs
NSAIDS
184
Q

Cytochrome P450 INDUCERS

A

Pretty Please Can I Rent Real Props for St Johns Only Gathering

Phenobarbital
Phenytoin
Carbamazepine
Isoniazid
Rifampin
Ritonavir
Propranolol
St Johns Wart 
Omeprazole
Griseofulvin
185
Q

Which cell cycle specific phase does Bleomycin affect?

A

M and G2 phase specific - damages DNA by direct binding

186
Q

Which chemotherapy drug damages DNA at M and G2 specific cell cycle phase?

A

Bleomycin

187
Q

What is the Wolff-Chaikoff effect?

A

The inhibition of thyroid hormone synthesis when a patient is given Potassium Iodide

188
Q

What side effect do you need to watch out for when giving Potassium Iodide?

A

Wolff-Chaikoff effect: inhibits thyroid hormone synthesis

189
Q

What do you use to treat Sporotrichosis?

A

Potassium Iodide

190
Q

What lab do you need to check one month after giving someone potassium iodide?

A

TSH

191
Q

What is a contraindication of alendronate or other bisphosphonates?

A

Pregnancy

192
Q

Which two antifungals should you not give to someone who is taking an antiacid and why?

A

Itraconazole and Ketoconazole

*because they both require an acidic environment to work, and they are both metabolized by the same enzyme (14-alpha-demethylase)

193
Q

What enzyme do sulfonamide antibiotics inhibit?

A

Dihydopterase synthetase

194
Q

Which retinoid has a risk of drug induced hypothyroidism

A

Bexarotene

195
Q

Allopurinol blocks which enzyme in the azathioprine metabolic pathway?

A

XO (xanthene oxidase). *different from the genetically inherited TMPT deficiency

196
Q

Most common drug to cause linear IgA

A

Vancomycin

197
Q

Drug causing bullous pemphigoid

A

Furosemide

198
Q

Name two drugs commonly causing pemphigus

A

Captopril

Penacillamine

199
Q

Drug causing pseudoporphyria

A

Naproxen

200
Q

Most common drug causing AGEP

A

B-lactams

201
Q

Most common drug causing FDE on the penis

A

Sulfonamides

202
Q

Name three common drugs causing phototoxic reactions

A

Tetracyclines
Quinolones
Psoralen

203
Q

Drug causing palmoplantar erythrodysesthesia (Acral variant of toxic erythema of chemotherapy)

A

Cytaribine

204
Q

Drug causing cicatricial pemphigoid

A

Clonidine

205
Q

Most common class of medications to cause drug eruptions

A

Aminopenicillines > anticonvulsants >TMP/SMX > NSAIDS

206
Q

Most common drug to cause drug reaction in HIV patients

A

Bactrim (TMP/SMX) - drug rash occurs in 40% of patients!

*vs the regular population, penicillins are the most common cause of drug reactions over bactrim

207
Q

Time lag for ACE-I to develop lichenoid drug

How about quinacrine?

A

ACE-I - 6 months

Quinacrine - 6 weeks

DERMATOLOGY Premade cards (15 decks)

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