Exam 2 Flashcards
1
Q
Type I hypersensitivity rxn (3)
A
Allergic rhinitis, asthma, systemic anaphylaxis
2
Q
Type II hypersensitivity rxn (2)
A
Hemolytic anemia, thrombocytopenia
3
Q
Type III hypersensitivity rxn (2)
A
Serum sickness, Arthus reaction
4
Q
Type IVa hypersensitivity rxn (2)
A
Tuberculin rxn, eczema
5
Q
Type IVb hypersensitivity rxn (3)
A
Chronic asthma, chronic allergic rhinitis, DRESS
6
Q
Type IVc hypersensitivity rxn (2)
A
SJS/TEN, pustular exanthema
7
Q
Type IVd hypersensitivity rxn (2)
A
AGEP, Behcet’s disease
8
Q
OA Risk factors
A
- Older age
- Women
- Bone deformities
- Joint injuries
- Sports- repetitive motion
- Obesity
- Gout, RA, Paget’s disease, septic arthritis
9
Q
OA Nonpharmacologic treatment (2)
A
- Exercise
- Self efficacy & self management programs
10
Q
OA Pharmacologic treatment: what to use
A
- NSAIDs = first line
- APAP - if fails NSAIDs
- Glucocorticoid injections - later line; short-term
11
Q
OA Pharmacologic treatment: what to AVOID
A
Opioids, glucosamine, chondroitin
12
Q
OA NSAIDs GI bleed
A
Celecoxib > APAP
13
Q
OA NSAIDs CV risk high to low order
A
Celecoxib > IBU > NAP
14
Q
RA tx: low activity, naive pt
A
Hydroxychloroquine
15
Q
RA tx: moderate or high activity, naive pt
A
Methotrexate
16
Q
RA tx: moderate or high activity, NOT naive pt
A
Hydroxychloroquine + MTX
17
Q
RA tx conventional DMARD agents
A
Hydroxychloroquine, MTX
18
Q
RA tx TNFi agents
A
Etanercept, Infliximab + MTX
19
Q
RA tx when to use TNFi agents
A
If the pts fail MTX –> 60% will respond to etanercept
20
Q
RA NSAIDs limitation
A
Does not prevent damage, must be used in combination to DMARDs/TNFi
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
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)
23
Q
Gouty attack treatment
A
Colchicine, NSAIDs, corticosteroids - high dose, short-term
24
Q
Intercritical gout = hyperuricemia treatment
A
Allopurinol (low dose),feboxustat
25
Gouty attack prophylaxis
Colchicine low dose, NSAID + peptic ulcer disease suppressive
26
Colchicine toxicity that limits the use
Diarrhea
27
Choice of NSAIDs used in gout tx
Indomethacin, naproxen, sulindac
28
Allopurinol - reduce dose with
Azathioprine, mercaptopurine, theophylline, cyclophosphamide
29
Febuxostat C/I drugs
Azathioprine, mercaptopurine
30
Probenecid place in therapy
Hyperuricemia alternative; **underexcreters only**
31
Lesinurad place in therapy
Hyperuricemia alternative; **add on to XOI only**
32
Glaucoma risk factors
FH, HTN, diabetes, high IOP, Male, older age, Caucasian
33
Glaucoma clinical s/s (3)
Halo vision, vision loss, scotoma (black dots)
34
Open angle glaucoma (OAG) tx that decrease aqueous humor secretion
BB, CAI
35
OAG tx that increase outflow of aqueous humor
A2-adrenergic agonists (sympathomimetics), docosanoid, NO PA, prostaglandin analogues, Rho Kinase inhibitors
36
OAG tx with lowest IOP decrease
Docosanoid - Unoprostone
37
OAG tx with highest IOP decrease
NO PA - Latanoprostene bunod (Vyzulta)
38
OAG 1st line tx
BB ('-olol'), prostaglandin analogues ('-prost')
39
OAG tx: alpha2-adrenergic agonists agents
Brimonidine
40
OAG tx: CAI agents
**'-zolamide'**
Acetazolamide, dichlorphenamide, methazolamide, dorzolamide, brinzolamide
41
OAG tx: Rho Kinase inhibitor agents
Netarsudil
42
OAG tx: PA ADRs
Eye pigment, eye lash changes (irreversible)
43
Ocular HTN when to treat
IOP >25 mmHg, cup:disk ratio ~0.5, thin central corneal thickness
44
Closed angle glaucoma (CAG) IOP level
40 - 90 mmHg
45
CAG definitive tx option
Iridectomy (surgery)
46
CAG tx secondary to pupillary block or plateau iris syndrome
Pilocarpine
- Start when IOP <40 mmHg
47
How to instill eye drops
- 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
Early & Dry AMD tx vitamins in non-smokers vs current/former smokers
- AREDS: beta-carotene
- AREDS2: Lutein, Zeaxanthin (X beta-carotene bc increase risk of lung cancer)
49
Dry AMD is AKA
Geographic atrophy
50
Dry AMD tx, concerning SE
C3, C5 complement inhibitors
- Pegcetacoplan (Syfovre), Avacincaptad pegol (Izervay)
- Wet AMD
51
Wet AMD is AKA
Neovascular
52
Wet AMD tx: anti-VEGF
Aflibercept, Ranibizumab (injection, implant), Bevacizumab, Brolucizumab-dbll
53
Which anti-VEGF tx can cause dry AMD?
Bevacizumab
54
Wet AMD tx: anti-VEGF + anti-angiopoietin-2 inhibitors
Faricimab-svoa (Vabysmo)
55
What drug causes dry eye/ocular surface disease (DE/OSD)
Benzalkonium chloride (BAK)
56
DE/OSD OTC tx (2)
Artificial tears, omega-3 fatty acids
57
DE/OSD Rx tx (5)
1. Cyclosporine ophthalmic
2. Lifitegrast
3. Loteprednol etabonate ophthalmic suspension
4. Varenicline nasal spray
5. Perfluorohexyloctane
58
DE/OSD Rx tx: QID administration
Loteprednol etabonate, Perfluorohexyloctane
59
Optic neuropathy associated meds (4)
1. Amiodarone
2. Ethambutol
3. Linezolid
4. PDE-5i
60
Retinopathy associated meds (2)
1. Aminoquinolones (hydroxychloroquine)
2. Phenothiazide
61
"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?
Warfarin
62
Warfarin skin necrosis management
1. D/c warfarin
2. Reverse w/ vitamin K
3. Start parenteral anticoagulant: heparin, enoxaparin
4. Fresh frozen plasma, protein C
63
"Butterfly rash" are caused by ... (3)
1. Procainamide
2. Hydralazine
3. Isoniazid
64
"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?
DRESS
65
Erythema multiforme vs SJS/TEN
Erythema multiforme is **localized**
66
Erythema multiforme is caused by ... (4)
PCN, sulfa drugs, NSAIDs, anticonvulsants
67
SJS vs TEN
TBSA: SJS = <10%, TEN = >30%
68
SJS/TEN: HLA-B*1502 is related to ...
CBZ/OXC
69
SJS/TEN: HLA-B*5701 is related to ...
Abacavir
70
SJS/TEN core therapeutic strategy (3)
Supportive care, analgesia, infection prevention
71
SJS/TEN adjunctive therapies (2)
1. High dose systemic corticosteroids = methylprednisolone, prednisone
2. IVIG
72
Psoriasis mild-to-moderate tx
1. Topical
2. Topical + phototherapy
3. Topical + systemic
73
Psoriasis moderate-to-severe tx
1. Systemic +/- topical/phototherapy or biologics
2. More potent systemic or biologics +/- topical
3. Biologic if not already used +/- other agents
74
Psoriasis nonpharm tx
1. Stress reduction
2. Nonmedicated moisturizers
3. Oatmeal baths
4. Sunscreens
5. Minimize skin irritation
6. X nicotine & alcohol, diet, exercise
75
Psoriasis topical tx options
**Corticosteroids (mainstay)**, Vitamin D3 analogs, retinoids, Calcineurin inhibitors
76
Psoriasis TCS ADRs
Telangiectasias (spider web veins), topical steroid w/drawal syndrome (rebound)
77
Superpotent TCS
Betamethasone dipropionate ointment
78
Least potent TCS
Hydrocortisone
79
Psoriasis Vitamin D3 topical agents
Calcitriol, calcipotriol/Calcipotriene
80
Calcipotriol can be inactivated by ... (2)
1. UVA light - apply after exposure
2. Acidic substance - avoid salicylic acid
81
Psoriasis retinoids topical agent & caution
- Tazarotene
- **C/I in pregnancy**
82
Psoriasis Calcineurin inhibitors (CI) agents & place in therapy
- Pimecrolimus cream, tacrolimus ointment
- Alternative for intertriginous areas (skin folds) or on the face
83
Psoriasis phototherapy options
1. UVB broadband or narrowband
2. UVA: **PUVA** = UVA + methoxypsoralen (photosensitizer; oral)
84
Psoriasis phototherapy ADR
Hyperpigmentation - **lentigines** (Freckles)
85
Psoriasis systemic agents
Acitretin, cyclosporine, MTX, biologics
86
Psoriasis systemic: Acitretin caution
**C/I in pregnancy**
87
Psoriasis systemic: Cyclosporine caution
Gradual taper as opposed to abrupt d/c to reduce the risk of **rebound of psoriasis**
88
Psoriasis systemic: MTX caution
**C/I in pregnancy**
89
Psoriasis biologics first line options based on Canadian & British guidelines
Ustekinumab (Stelara), Adalimumab (Humira)
- British: +Secukinumab (Cosentyx)
90
Psoriasis: Adalimumab (Humira) class, safety
TNFai, TAILS, **C/I in CHF**
91
Psoriasis: Ustekinumab (Stelara) class
IL-12/-23 inhibitors
92
Psoriasis: Secukinumab (Cosentyx) class, safety
IL-17 inhibitors, **avoid in IBD**
93
Psoriasis: which IL-17i is in REMS?
Brodalumab (Siliq) - suicidal ideation & behavior
94
Psoriasis: Bimekizumab (Bimzelx) class, safety
IL-17A/F inhibitor, **avoid in IBD**
95
Psoriasis: Tildrakizumab-asmn (Ilumya), Guselkumab (Tremfya), Risankizumab-rzaa (Skyrizi) class
IL-23 inhibitor
96
Psoriasis: Abatacept (Orencia) class
T-cell activation inhibitor
97
Psoriasis: Tofacitinib class, administration, caution
JAKi, **oral, DDI with CYP3A4/2C19 substrates**
98
Psoriasis: Deucravacitinib (Sotyktu) class, administration
TYK2i, **oral**
99
Psoriasis: Apremilast (Otezla) class, administration
PDE4i, **oral**
100
Psoriasis: Crisaborole (Eucrisa) class, administration
PDE4i, **ointment**
