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