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Immune/Ocular/Derm > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Type I hypersensitivity rxn (3)

A

Allergic rhinitis, asthma, systemic anaphylaxis

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2
Q

Type II hypersensitivity rxn (2)

A

Hemolytic anemia, thrombocytopenia

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3
Q

Type III hypersensitivity rxn (2)

A

Serum sickness, Arthus reaction

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4
Q

Type IVa hypersensitivity rxn (2)

A

Tuberculin rxn, eczema

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5
Q

Type IVb hypersensitivity rxn (3)

A

Chronic asthma, chronic allergic rhinitis, DRESS

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6
Q

Type IVc hypersensitivity rxn (2)

A

SJS/TEN, pustular exanthema

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7
Q

Type IVd hypersensitivity rxn (2)

A

AGEP, Behcet’s disease

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8
Q

OA Risk factors

A
  1. Older age
  2. Women
  3. Bone deformities
  4. Joint injuries
  5. Sports- repetitive motion
  6. Obesity
  7. Gout, RA, Paget’s disease, septic arthritis
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9
Q

OA Nonpharmacologic treatment (2)

A
  1. Exercise
  2. Self efficacy & self management programs
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10
Q

OA Pharmacologic treatment: what to use

A
  • NSAIDs = first line
  • APAP - if fails NSAIDs
  • Glucocorticoid injections - later line; short-term
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11
Q

OA Pharmacologic treatment: what to AVOID

A

Opioids, glucosamine, chondroitin

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12
Q

OA NSAIDs GI bleed

A

Celecoxib > APAP

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13
Q

OA NSAIDs CV risk high to low order

A

Celecoxib > IBU > NAP

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14
Q

RA tx: low activity, naive pt

A

Hydroxychloroquine

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15
Q

RA tx: moderate or high activity, naive pt

A

Methotrexate

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16
Q

RA tx: moderate or high activity, NOT naive pt

A

Hydroxychloroquine + MTX

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17
Q

RA tx conventional DMARD agents

A

Hydroxychloroquine, MTX

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18
Q

RA tx TNFi agents

A

Etanercept, Infliximab + MTX

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19
Q

RA tx when to use TNFi agents

A

If the pts fail MTX –> 60% will respond to etanercept

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20
Q

RA NSAIDs limitation

A

Does not prevent damage, must be used in combination to DMARDs/TNFi

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21
Q

Gout risk factors

A

Age 35-45, Male, HTN, obesity, diabetes, lipid abnormalities, excessive alcohol intake, serum Cr, BUN, trauma, surgery, infection, stress

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22
Q

Gout nonpharm

A

Limit purine rich meat/seafood, high fructose corn syrup-sweetened drinks, eat vegetables, low/nonfat dairy, reduce alcohol (worst beer)

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23
Q

Gouty attack treatment

A

Colchicine, NSAIDs, corticosteroids - high dose, short-term

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24
Q

Intercritical gout = hyperuricemia treatment

A

Allopurinol (low dose),feboxustat

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25
Q

Gouty attack prophylaxis

A

Colchicine low dose, NSAID + peptic ulcer disease suppressive

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26
Q

Colchicine toxicity that limits the use

A

Diarrhea

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27
Q

Choice of NSAIDs used in gout tx

A

Indomethacin, naproxen, sulindac

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28
Q

Allopurinol - reduce dose with

A

Azathioprine, mercaptopurine, theophylline, cyclophosphamide

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29
Q

Febuxostat C/I drugs

A

Azathioprine, mercaptopurine

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30
Q

Probenecid place in therapy

A

Hyperuricemia alternative; underexcreters only

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31
Q

Lesinurad place in therapy

A

Hyperuricemia alternative; add on to XOI only

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32
Q

Glaucoma risk factors

A

FH, HTN, diabetes, high IOP, Male, older age, Caucasian

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33
Q

Glaucoma clinical s/s (3)

A

Halo vision, vision loss, scotoma (black dots)

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34
Q

Open angle glaucoma (OAG) tx that decrease aqueous humor secretion

A

BB, CAI

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35
Q

OAG tx that increase outflow of aqueous humor

A

A2-adrenergic agonists (sympathomimetics), docosanoid, NO PA, prostaglandin analogues, Rho Kinase inhibitors

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36
Q

OAG tx with lowest IOP decrease

A

Docosanoid - Unoprostone

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37
Q

OAG tx with highest IOP decrease

A

NO PA - Latanoprostene bunod (Vyzulta)

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38
Q

OAG 1st line tx

A

BB (‘-olol’), prostaglandin analogues (‘-prost’)

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39
Q

OAG tx: alpha2-adrenergic agonists agents

A

Brimonidine

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40
Q

OAG tx: CAI agents

A

‘-zolamide’
Acetazolamide, dichlorphenamide, methazolamide, dorzolamide, brinzolamide

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41
Q

OAG tx: Rho Kinase inhibitor agents

A

Netarsudil

42
Q

OAG tx: PA ADRs

A

Eye pigment, eye lash changes (irreversible)

43
Q

Ocular HTN when to treat

A

IOP >25 mmHg, cup:disk ratio ~0.5, thin central corneal thickness

44
Q

Closed angle glaucoma (CAG) IOP level

A

40 - 90 mmHg

45
Q

CAG definitive tx option

A

Iridectomy (surgery)

46
Q

CAG tx secondary to pupillary block or plateau iris syndrome

A

Pilocarpine
- Start when IOP <40 mmHg

47
Q

How to instill eye drops

A
  • Close your eye OR press the lower lid lightly w/ your finger where the lids meet the nose for at least 1 min (Do NOT blink)
  • Before opening the eye, wipe away any tears or unabsorbed drops w/ a clean tissue, then open the eye
  • If using >1 drop, WAIT at least 5 mins
  • Dispose after 30 days
48
Q

Early & Dry AMD tx vitamins in non-smokers vs current/former smokers

A
  • AREDS: beta-carotene
  • AREDS2: Lutein, Zeaxanthin (X beta-carotene bc increase risk of lung cancer)
49
Q

Dry AMD is AKA

A

Geographic atrophy

50
Q

Dry AMD tx, concerning SE

A

C3, C5 complement inhibitors
- Pegcetacoplan (Syfovre), Avacincaptad pegol (Izervay)
- Wet AMD

51
Q

Wet AMD is AKA

A

Neovascular

52
Q

Wet AMD tx: anti-VEGF

A

Aflibercept, Ranibizumab (injection, implant), Bevacizumab, Brolucizumab-dbll

53
Q

Which anti-VEGF tx can cause dry AMD?

A

Bevacizumab

54
Q

Wet AMD tx: anti-VEGF + anti-angiopoietin-2 inhibitors

A

Faricimab-svoa (Vabysmo)

55
Q

What drug causes dry eye/ocular surface disease (DE/OSD)

A

Benzalkonium chloride (BAK)

56
Q

DE/OSD OTC tx (2)

A

Artificial tears, omega-3 fatty acids

57
Q

DE/OSD Rx tx (5)

A
  1. Cyclosporine ophthalmic
  2. Lifitegrast
  3. Loteprednol etabonate ophthalmic suspension
  4. Varenicline nasal spray
  5. Perfluorohexyloctane
58
Q

DE/OSD Rx tx: QID administration

A

Loteprednol etabonate, Perfluorohexyloctane

59
Q

Optic neuropathy associated meds (4)

A
  1. Amiodarone
  2. Ethambutol
  3. Linezolid
  4. PDE-5i
60
Q

Retinopathy associated meds (2)

A
  1. Aminoquinolones (hydroxychloroquine)
  2. Phenothiazide
61
Q

“Pain, redness, lesions w/ sharp borders then become hard & purpuric, may progress into a large/irregular/hemorrhagic bullae, necrotic” is a description of which drug-induced dermal toxicity?

A

Warfarin

62
Q

Warfarin skin necrosis management

A
  1. D/c warfarin
  2. Reverse w/ vitamin K
  3. Start parenteral anticoagulant: heparin, enoxaparin
  4. Fresh frozen plasma, protein C
63
Q

“Butterfly rash” are caused by … (3)

A
  1. Procainamide
  2. Hydralazine
  3. Isoniazid
64
Q

“Fever + rash + internal organs (hepatitis, myocarditis, nephritis, pneumonitis) with widespread papulopustular/ erythematous skin eruptions that progresses to exfoliating dermatitis” is a description of which drug-induced dermal toxicity?

A

DRESS

65
Q

Erythema multiforme vs SJS/TEN

A

Erythema multiforme is localized

66
Q

Erythema multiforme is caused by … (4)

A

PCN, sulfa drugs, NSAIDs, anticonvulsants

67
Q

SJS vs TEN

A

TBSA: SJS = <10%, TEN = >30%

68
Q

SJS/TEN: HLA-B*1502 is related to …

A

CBZ/OXC

69
Q

SJS/TEN: HLA-B*5701 is related to …

A

Abacavir

70
Q

SJS/TEN core therapeutic strategy (3)

A

Supportive care, analgesia, infection prevention

71
Q

SJS/TEN adjunctive therapies (2)

A
  1. High dose systemic corticosteroids = methylprednisolone, prednisone
  2. IVIG
72
Q

Psoriasis mild-to-moderate tx

A
  1. Topical
  2. Topical + phototherapy
  3. Topical + systemic
73
Q

Psoriasis moderate-to-severe tx

A
  1. Systemic +/- topical/phototherapy or biologics
  2. More potent systemic or biologics +/- topical
  3. Biologic if not already used +/- other agents
74
Q

Psoriasis nonpharm tx

A
  1. Stress reduction
  2. Nonmedicated moisturizers
  3. Oatmeal baths
  4. Sunscreens
  5. Minimize skin irritation
  6. X nicotine & alcohol, diet, exercise
75
Q

Psoriasis topical tx options

A

Corticosteroids (mainstay), Vitamin D3 analogs, retinoids, Calcineurin inhibitors

76
Q

Psoriasis TCS ADRs

A

Telangiectasias (spider web veins), topical steroid w/drawal syndrome (rebound)

77
Q

Superpotent TCS

A

Betamethasone dipropionate ointment

78
Q

Least potent TCS

A

Hydrocortisone

79
Q

Psoriasis Vitamin D3 topical agents

A

Calcitriol, calcipotriol/Calcipotriene

80
Q

Calcipotriol can be inactivated by … (2)

A
  1. UVA light - apply after exposure
  2. Acidic substance - avoid salicylic acid
81
Q

Psoriasis retinoids topical agent & caution

A
  • Tazarotene
  • C/I in pregnancy
82
Q

Psoriasis Calcineurin inhibitors (CI) agents & place in therapy

A
  • Pimecrolimus cream, tacrolimus ointment
  • Alternative for intertriginous areas (skin folds) or on the face
83
Q

Psoriasis phototherapy options

A
  1. UVB broadband or narrowband
  2. UVA: PUVA = UVA + methoxypsoralen (photosensitizer; oral)
84
Q

Psoriasis phototherapy ADR

A

Hyperpigmentation - lentigines (Freckles)

85
Q

Psoriasis systemic agents

A

Acitretin, cyclosporine, MTX, biologics

86
Q

Psoriasis systemic: Acitretin caution

A

C/I in pregnancy

87
Q

Psoriasis systemic: Cyclosporine caution

A

Gradual taper as opposed to abrupt d/c to reduce the risk of rebound of psoriasis

88
Q

Psoriasis systemic: MTX caution

A

C/I in pregnancy

89
Q

Psoriasis biologics first line options based on Canadian & British guidelines

A

Ustekinumab (Stelara), Adalimumab (Humira)
- British: +Secukinumab (Cosentyx)

90
Q

Psoriasis: Adalimumab (Humira) class, safety

A

TNFai, TAILS, C/I in CHF

91
Q

Psoriasis: Ustekinumab (Stelara) class

A

IL-12/-23 inhibitors

92
Q

Psoriasis: Secukinumab (Cosentyx) class, safety

A

IL-17 inhibitors, avoid in IBD

93
Q

Psoriasis: which IL-17i is in REMS?

A

Brodalumab (Siliq) - suicidal ideation & behavior

94
Q

Psoriasis: Bimekizumab (Bimzelx) class, safety

A

IL-17A/F inhibitor, avoid in IBD

95
Q

Psoriasis: Tildrakizumab-asmn (Ilumya), Guselkumab (Tremfya), Risankizumab-rzaa (Skyrizi) class

A

IL-23 inhibitor

96
Q

Psoriasis: Abatacept (Orencia) class

A

T-cell activation inhibitor

97
Q

Psoriasis: Tofacitinib class, administration, caution

A

JAKi, oral, DDI with CYP3A4/2C19 substrates

98
Q

Psoriasis: Deucravacitinib (Sotyktu) class, administration

A

TYK2i, oral

99
Q

Psoriasis: Apremilast (Otezla) class, administration

A

PDE4i, oral

100
Q

Psoriasis: Crisaborole (Eucrisa) class, administration

A

PDE4i, ointment

Immune/Ocular/Derm (1 decks)

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