Drugs Test 2 Flashcards
Live attenuated vaccine
live microbes are weakened by growing them for many generations in animals or tissue cultures.
Avoid during pregnancy.
Live stored in freezer. All others are in fridge.
oral polio, MMR, zoster
Inactivated vaccine
whole organisms that have been killed. Stimulate the immune system but do not cause disease.
polio, influenza, Hepatitis A
tetanus, diphtheria
Subunit vaccine
Use only a part of the bacteria or virus.
typhoid, hepatitis B, pertussis, meningitis
Conjugate vaccines
Link proteins from a second organism to the outer coat of the bacteria. Allows a baby’s immune system to recognize the bacteria.
Haemophilus influenzae - b (Hib), pneumococcus
Flu vaccine
Everybody. Every year.
Nursing home:
- 50-60% effective in preventing pneumonia and hospitalization.
- 60-70% effective in preventing death
- Not effective in reducing ambulatory care visits for respiratory problems
Working adults:
- 25% fewer episodes of URI
- 43% fewer sick days due to URI
- 44% fewer visits to physicians’ offices for URI
Cost savings: $46.85 per person vaccinated.
Contraindications: Anaphylaxis, Allergy to Thimerosol, history of guillain-barre syndrome
HPV vaccine
Young women and men starting at 11 or 12. Males up to 21 and females up to 26
Meningoccal vaccine
All children up to 11-12 and college freshmen/ soldiers
Pneumococcal Vaccine
Side effects: up to 50% have local erythema and soreness.
Hepatitis A Vaccine
Inactivated vaccine w/ low cost and high efficacy.
People we give to: travelers to developing world; IV drug users, chronic liver disease, military, health care providers
Hepatitis B
Given to at risk adults for travel, health care providers.
Minimal side effects.
Tdap
Kids and people 11-65 should get booster.
VZV vaccine
Adults over 60.
Bortezomib
Proteosome inhibitor that is used to treat multiple myeloma. Selectivity for abnormal B cells.
Side effects of immunosuppression –> add prophylactic Bactrim and acyclovir. Can cause reactivation of HepB or HepC (monitor and treat w/ entacavir or sobosfabir respectively)
Rutiximab
Binds CD20 on surface of B cells and improves the ability for NK cells to attack.
Entacavir
Nucleoside analog (more specifically, a deoxyguanosine analogue) that inhibits reverse transcription, DNA replication and transcription in the viral replication process
Used to treat HepB.
Melphelan
DNA alkylation inhibiting DNA and RNA synthesis.
Treats: multiple myeloma, ovarian cancer, AL amyloidosis, and occasionally malignant melanoma.
Side effects:
Thalidomide
MOA: Inhibits NF-kB and thus inhibits TNF-α, IL-6, IL-10 and IL-12. Activates more TH2 response over TH1. Also suppresses VEG-F
Adverse effects: immune suppression, sedation. Phocomelia (terrible birth defects).
Positive side effects of anti-nausea and anti-anorexia which are useful for chemotherapy pts.
Vincristine
Cell Cycle Specific -Metaphase MT inhibitor, Vincristine binds to tubulin dimers, inhibiting assembly of microtubule structures and arresting mitosis in metaphase.
IV treatment.
Non-cytotoxic
Doxorubicin
CCNS. Intercalating agent
Inhibits Topo II and causes DNA breaks.
IV treatment.
Ara-C
Pyrimidine imitator, cytosine analog, inhibits DNA polymerase.
S phase-specific.
IV treatment
Lenalidomide
Thalidomide analog
Exhibits direct antitumor effects by inducing cell cycle arrest and apoptosis in certain myeloma cell lines. Interferes with growth signaling between myeloma cells and bone marrow stromal cells by modulating expression of cell surface adhesion molecules. Oral treatment. Discontinued in 2009 after pulmonary embolism.
2-4% risk of P.E. on lenalidomide
Cyclophosphamide
Alkylating agent.
Non-cell cycle specific.
IV treatment
6-mercaptopurine
Blocks purine synthesis. “Pseudofeedback inhibition” of PNP and PRPP.
DNA synthesis inhibitor.
Oral treatment
***Methotrexate and 6-MP are highly synergistic, possibly because methotrexate blocks the de novo synthesis of purines and enhances the use of preformed purines and purine analogues such as 6-MP.
Methotrexate
Dihydrofolate reductase inhibitor, limits purine synthesis→ limits DNA synthesis, s phase specific.
Oral treatment.
***Methotrexate and 6-MP are highly synergistic, possibly because methotrexate blocks the de novo synthesis of purines and enhances the use of preformed purines and purine analogues such as 6-MP.
Erythropoeitin, Darbepoetin, Methoxy polyethylene glycol epoetin
MOA: Stimulates RBC production.
Hormone normally produced in kidney that works via Jak/Stat pathway when body senses low oxygen levels.
Inverse relationship between EPO and hemotocrit except during chronic liver failure.
EPO - short half life –> must be given 3-4x per week
Darbepoetin –> once per week
Methoxy polyethylene glycol epoetin - biweekly or monthly.
Therapeutic uses:
- Anemia of chronic disease (+/- iron/folate)
- high risk surgery
Don’t give to athletes!
Increased death when used in cancer patients
Side effects: Life threatening = thrombus
Common serious = hypertension
Rare serious = increased tumor growth, allergic rxns
Filgrastim, Pegfilgrastim
G-CSF analog –> increase neutrophils
Therapeutic uses: Cancer therapy, certain immunodeficiencies
Side effects: Common innocuous = mild/mod. bone pain
Rare serious = allergic rxn, and splenic rupture
Pefgilgrastim = long half life form
Sagramostim
GM-CSF analog –> increase all myeloid cells
Therapeutic uses: Cancer therapy, certain immunodeficiencies
Side effects:
Common serious = capillary leak syndrome, edema
Common innocuous = mod/severe bone pain, fever, malaise, arthrlagia, myalgia
Rare serious = allergic rxns
IL-11 and Romiplostim
Megakaryocyte growth factors that increase platelet production.
Pharmacokinetics: every 3-4 days
Therapeutic uses: Cancer chemo adjunct, thrombocytopenia
Side effects: Common serious = afib
Common innocuous = fatigue, headache, dz, mild edema, fluid dyspnea, anemia
Rare serious = hypokalemia
Dimercaprol (British Anti-Leweisite; BAL)
Uses: Acute arsenic poisoning, Acute mercury poisoning, lead poisoning (EDTA)
Binds most bivalent cations (monitor for hypocalcemia)
Side effect: Nephrotoxicity (give bicarb with drug to keep dimercaprol unprotonated)
Dimercaptosuccinic acid (DMSA)
Lead poisoning, arsenic poisoning, and mercury poisoning.
Dimercapto-propane sulfonate (DMPS)
Severe acute arsenic poisoning and severe acute arsenic poisoning.
Penicillamine
Mainly copper toxicity.
Ethylenediamine (EDTA)
lead poisoning (w/ Dimercaprol)
Defroxamine and Deferasirox
Acute iron poisoning and iron overload.
Rhogam
Anti-D antibody. The medicine is a solution of IgG anti-D (anti-RhD) antibodies that take out any fetal RhD-positive erythrocytes which have entered the maternal blood stream from fetal circulation, before maternal immune system can react to them, thus preventing maternal sensitization
Administered at 28 weeks and within 72 hours of delivery to Rh- mothers to prevent erythroblastosis fetalis.
Only first pregnancy.
Must quantify amt of fetomaternal hemorrhage to dose; use kleihauer-Betke test or flow cytometry.
Contraindicated if:
Mother is Rh+
Infant is known to be Rh-
Rh- but have been previously alloimmunized
Kleihauer-Betke Test
- ) Make a smear of mom’s blood
- ) Expose smear to acid bath (removes HbA)
- ) Stain smear
- ) Baby’s cells appear pink; mom’s appear ghostly
Flow cytometry test for fetal cells
- ) Use mom’s blood
- ) apply anti-Hbf antibody
- ) run flow
- ) baby cells, if present, are intensely positive
