EXAM #4: REVIEW Flashcards
1
Q
What is Peptidoglycan?
A
A macromolecule of peptides and sugars
2
Q
What is Lipopolysaccharide?
A
A macromolecule of phospholipids and polysaccharides
3
Q
Outline the ESKAPE mnemonic of nosocomial superbugs.
A
Enterococcus faecium Staphylococcus aureus Klebsiella pneumoniae Acinetobacter bumanni Pseudomonas aeruginosa Enterobacter species
4
Q
What is the function of Penicillin-Binding Proteins (PBPs) or Transpeptidases?
A
Cross-linking peptidoglycan in the formation of the bacteria cell wall
5
Q
How can you group the PCN-type drugs?
A
- Penicillinase-sensitive PCNs
- Penicillinase-resistant PCNs
- Antipseudomonals
*****Penicillinase= Beta-Lactamase
6
Q
List the Beta-Lactamase sensitive PCNs.
A
PCN G and V
Ampicillin
Amoxicillin
7
Q
List the Beta-Lactamase resistant PCNs.
A
Oxacillin
Nafcillin
Methicillin
8
Q
Which of the PCNs are “antipseudomonal?”
A
Ticracillin
Piperacillin
9
Q
What are the narrow spectrum PCNs?
A
PCN G and V
Methicillin
Nafcillin
Oxacillin
10
Q
What are the broad spectrum PCNs?
A
Ampicillin Amoxacillin Azlocillin Piperacillin Ticracillin
Remember aminopenecillins are amped up PCNs i.e. ampicillin and broader spectrum
11
Q
What is the hallmark 1st generation Cephalosporin?
A
Cephazolin
12
Q
What is the hallmark 2nd generation Cephalosporin? List the other 2nd generation Cephalosporins.
A
Cefoxitin
- Cefotetan
- Cefaclor
- Cefuroxime
13
Q
List the 3rd generation Cephalosporins.
A
Ceftriaxone
- Cefotaxime
- Cefdnir
- Cefixime
14
Q
What is the only drug in the Monobactam family?
A
Aztreonam
15
Q
What type of bacteria can be treated with Aztreonam?
A
Gram negative (rods) only
16
Q
What are the two important clinical considerations regarding Aztreonam?
A
1) Penetrates the BBB
2) Beta-Lactamase resistant
17
Q
Are the Carbapenams resistant to Beta-Lactamase?
A
Yes
18
Q
What enzyme are the Carbapenams susceptible to?
A
Carbapenemase
19
Q
What adverse effects are associated with the Carbapenems?
A
1) GI disturbances (Dr. Henry)
2) CNS toxicity
Note that it is toxicity that limits their use to life-threatening infections and/or after other drugs have failed
20
Q
What is the MOA of Vancomycin?
A
Inhibits peptidyglycan formation by binding D-ala portion of cell wall precursors
21
Q
What is Vancomycin generally used to treat?
A
Serious, multi-drug resistant organisms including:
- MRSA
- C. diff
22
Q
What is the MOA of Bacitracin?
A
Blocks incorporation of amino acids and nucleic acids into the cell wall of bacteria
Remember that Bacitracin is Broad spectrum
23
Q
What type of antibiotic is Fosfomycin? What is the MOA?
A
Cell wall synthesis inhibitor that prevents the synthesis of UDP-NAM (component of peptidoglycan)
24
Q
What is Fosfomycin commonly used to treat?
A
UTIs
25
What antibiotic class are the Aminoglycosides? What is the MOA?
30S Protein Synthesis Inhibitors
- Prevent charged tRNA from entering the A site
Remember, "Buy AT 30, CELL at 50" (Aminoglycosides and Tetracyclines= 30S inhibitors)
26
How are the Aminoglycosides commonly administered in the clinical setting?
With Beta-Lactam antibiotics
27
When are Aminoglycosides commonly used clinically?
Serious gram negative infections
28
What is the mnemonic to remember many important features of the Aminoglycosides?
"Mean" (i.e. A-mean-oglycodies) GNATS caNNOT kill anaerobes
```
G= Gentamicin
N= Neomycin
A= Amikacin
T= Tobramycin
S= Streptomycin
```
```
N= NEPHROTOXICITY
N= neuromuscular blockade
O= OTOTOXICITY
T= teratogen
```
(CAPITLAL= Dr. Henry)
29
What is the MOA of the Macrolides?
Blocks translocation of the growing amino acid chain from the A-site to the P-site
(50S inhibitors)
30
What side effect is associated with Macrolides? Use a mnemonic to remember.
Macrolides cause Motility issue i.e. GI disturbances
31
What is the specific MOA of the Tetracyclines?
Blocks charged tRNAs from entering the A-site
| 30S inhibitors
32
What should not be taken with a Tetracycline?
1) Milk
2) Antacids
3) Iron supplements
*Bind divalent cations, which will inhibit absorption from the gut*
33
In what patient populations are Tetracyclines contraindicated?
1) Kids
2) Pregnant women
*Will prevent/induce bone growth--check ppt*
34
What type of antibiotic in Clindamycin?
50S Protein Inhibitor
35
Clinically, what is Clindamycin commonly prescribed for?
Streptococcus and Staphylococcus soft tissue infections
*Thus, it is a NARROW SPECTRUM antibiotic*
36
What is the MOA of Clindamycin?
Blocks growing amino acid chain transfer from A-site to P-site
(50S)
37
What key adverse effect is Clindamycin associated with?
Pseudomembraous colitis i.e. C.diff
38
What is the MOA of Chloramphenicol?
Blocks peptidyltransferase at 50S subunit i.e. prevents peptide bond formation
39
What are the adverse effects seen with Chloramphenicol?
1) Anemia
2) Aplastic anemia
3) Gray Baby Syndrome
40
What is Chloramphenicol commonly prescribed for?
Rocky Mountain Spotted Fever
| Typhus
41
What type of bacteria is Linezolid effective against?
Gram positive
42
What is the MOA of Linezolid?
50S inhibitor that blocks the A-site
43
What adverse effect is associated with Linezolid?
Myelosuppression
44
What is the general pattern of bacterial specificity of the protein synthesis inhibitors? Which antibiotic does NOT follow the pattern?
Generally broad spectrum, except for Clindamycin, which is used to treat Streoptoccus and Staphylococcus soft tissue infections
45
List the Sulfonamides.
Sulfamethoxazole (SMX)
Sulfamethizole
Sulfadiazine
46
What are the key adverse reactions associated with the Sulfonamides? Use a mnemonic to recall these reactions
Sulfonamides= Skin
1) Hypersensitivity
2) Photosensitivity
3) Steven-Johnson Syndrome
47
What is the bacterial specificity of the Sulfonamides?
Broad-spectrum
48
What are the two Trimethoprims?
Trimethoprim
| Pyrimethamine
49
What is the bacterial specificity of the Trimethoprims?
Gram negative bacteria
50
What is the mnemonic to remember the adverse effects associated with the Trimethoprims?
Trimethoprim= TMP
Treats Marrow Poorly i.e. megaloblastic anemia
51
List the adverse effects associated with the Fluoroquinolones.
1) GI disturbances
2) Bind divalent cations
3) QT prolongation
4) FluoroquinoLONES hurt attachment to your BONES
- Tendonitis
- Tendon rupture
52
What is the Group 1 Fluoroquinolone?
Norfloaxacin
53
What are the Group 2 Fluoroquinolones? What type of bacteria are these drugs most specific for?
Ciprfloaxcin
Levofloaxcin
Ofloaxcin
*Gram negatives*
54
What are the Group 3 Fluoroquinolones? What type of bacteria are these drugs most specific for?
Gatifloxcin
Gemifloxcin
Moxifloaxacin
*Gram positives*
55
What types of microorgansism can be treated with Metronidazole?
Bacteria AND protozoa
56
What type of bacteria can be treated with Metronidazole?
Anaerobics ONLY (below the diaphragm)
57
What is the bacterial specificity of Daptomycin?
Gram positives
58
What is the bacterial specificity of Polymyxin B?
Gram negatives/LPS i.e. it specifically is a detergent that punches in LPS
59
How is Polymxyin B administered?
Topically
60
What is a good first choice drug for an uncomplicated skin infection?
1st generation Cephalosporin i.e. Cefazolin
| Treats S. aureus and S. pyogenes that cause uncomplicated skin infections
61
What is a good alternative for an uncomplicated skin infection with hypersensitivity to a 1st generation cephalosporin?
Clindamycin
| or Vancomycin
62
What is a good first choice drug for a complicated skin infection?
Ticracillin and clavulanate
| Has anti-pseudomonal activity
63
What are good drugs to treat MRSA skin infection?
Vancomycin
Daptomycin
Linezolid
64
What two bacteria cause complicated skin infections?
1) P. aeruginosa (Ticracillin has anti-pseudomonal activity)
2) E. coli
65
What are good first line agents for bone and joint infections?
Vancomycin or Ceftriaxone (3rd/4th generation cephalosporin)
66
What is the antibiotic of choice for post-op bone/joint infections?
Ticracillin and clavulanate
67
What is a good antibiotic choice for septic arthritis?
Ceftriaxone
68
What is the first line antibiotic for acute sinusitis and chronic bronchitis?
Augmentin i.e. Amoxacillin and clavulanate
69
What is the first line antibiotic for pharyngitis? What organism commonly causes pharyngitis?
PCN
*S. pneumoniae*
70
What bacteria cause URIs (3)?
1) H. influenza
2) S. pneumonia
3) Moraxella catarrhalis
71
What is the first line antibiotic for ambulatory pneumonia?
Macrolides
72
How are patients with pneumonia that have to be hospitalized treated?
Add Beta-Lactam to the Macrolide
73
How is nosocomial pneumonia treated?
Ceftriaxone
74
How is pyelonephritis treated vs. a simple UTI?
```
UTI= TMP-SMX
Pyelo= add Fluoroquinolone
```
75
What is the first line antibiotic for intra-abdominal infections? What bacteria cause intra-abdominal infections?
Ticracillin and clavulanate
*Gram negative*
76
What is community acquired meningitis treated (older than 2 y/o)?
Ceftriaxone and Vancomycin
77
How is neonatal meningitis treated?
1) Ampicillin
2) Cephalosporin
3) +/- Gentamicin (L. monocytogenes)
78
What are the first line antibiotics for Endocarditis?
1) Ceftriaxone
| 2) Vancomycin
79
What are the first line antibiotics for neutropenic fever?
Ciprofloxacin and Augmentin
80
How are enterococci infections treated?
Deptomycin + Tigacycline
81
How are gram negative ANTIBIOTIC RESISTANT infections treated?
Carbapenam + Carbapenemase
82
What toxicities are associated with INH?
1) Hepatitis
| 2) Peripheral neuropathy
83
What factors increase the risk of peripheral neuropathy with INH therapy?
1) Malnutrition
2) Alcoholism
3) DM
4) AIDS
84
What is the MOA of Rifampin?
Inhibition of RNA synthesis
| Inhibits bacterial DNA dependent RNA polymerase
85
What is the mechanism of Pyrazinamide resistance?
- Pyrazinamide requires Pyrazinamidase to be active (prodrug)
- Mutation in Pyrazinamidase
86
What adverse effect is associated with Pyrazinamide?
Gout/ Hyperuricemia
87
What is the MOA of Ethambutol?
Inhibits arabinosyl transferase needed for mycolic acid synthesis
88
What adverse effects are seen with Ethambutol?
1) Retrobulbar neuritis
| 2) Hyperuricemia
89
What is a good first line drug to treat disseminated MAC infections in the immunocompromised?
Rifabutin
90
What four drugs are used for MAC combination therapy?
1) Macrolide
2) Rifabutin
3) Ethambutol
4) Streptamycin
91
What is the standard drug regimine for Leprosy?
1) Dapsone
2) Clofazamine
3) Rifampin
Note that these drugs are taken for YEARS****
92
What is the MOA of Dapsone?
PABA analog that inhibits folate synthesis
93
What adverse effect is associated with Dapsone?
Non-hemotylic anemia
94
What is Clofazamine?
Bactericidal dye
*Associated with skin pigmentation changes
95
What drugs are used to follow-up Metronidazole treatment for Amebiasis?
Iodoquinol or Paromomycin
96
What are halogenated Hydroxyquinolone and Paromomycin good drugs for?
BOTH forms of Entameba histolytica
97
What are the three parasites cause major opportunistic infections of AIDS patients/immunocompromised?
1) Cryptosporidium parvum
2) Pneumocystis jiroveci
3) Toxoplasma gondii
98
How is Cryptosporidosis treated?
Nitazoxanide
99
What is the MOA of NItazoxanide?
Inhibits PFOR to disrupt the energy metabolism of the parasite
100
How are pneumocystis jiroveci and toxoplasma gondii treated? What adverse reaction is common with these drugs?
Inhibitors of folate synthesis i.e.
1) TMP-SMX
2) Pyrimethamine-Sulfadiazine
101
What enzyme is specifically inhibited by the Sulfonamides?
Dihydropteroate Synthase
102
What enzyme is inhibited by the diaminopyrimidines?
DHFR
103
What is the adverse effect of TMP-SMX treatment?
Rash
104
What is the adverse effect of Pyrimethamine-Sulfadiazine?
Folic acid deficiency leading to megaloblastic anemia
105
What adverse effect is highly associated with Mefloquine?
Recall, malaria prophylaxis that causes SEVERE NEUROPSYCHIATRIC symptoms
*So bad it can lead to suicide
106
What is the MOA of Primaquine?
Prodrug that gets activated to interfere with electron transport
107
What species of malaria is Malarone specific to treating?
P. falciparum
108
What is Malarone?
Atoaquone and Proguanil
109
What is the MOA of Proguanil?
Inhibits DHFR
110
What drugs fall into the Benzimidazole class?
Albendazole
Mebendazole
Thiabendazole
111
What side effects are associated with Thabendazole?
CNS disturbances i.e. delirium and hallucinations
112
What infections are Albendazole and Mebendazole prescribed for?
1) Ascariasis
2) Pinworm
3) Hookworm
4) Whipworm
113
What is Thiabendazole prescribed for?
1) Cutaneous larval migrans
| 2) Strongyloidiasis (2nd line)
114
What infections is Ivermectin the drug of choice for?
1) First line for Strongloidiasis
2) Tissue dwelling nematodes
- O. volvulus
- Loa loa
- W. bancrofti
115
What infection is Pyrantal Pamoate used to treat?
Pinworm infections
116
What is the MOA of Praziquantel?
- Increased Ca++ permeability of cuticle covering Flukes and Tapeworms
- Leads to depolarizing NM blockade
117
List the three major opportunistic fungal infections.
1) Candida
2) Aspergillus
3) Cryptococcus neoformans
118
List the drugs that inhibit ergosterol synthesis.
Azoles
Naftidine
Terbnafine
119
What major anti-fungal works by inhibiting fungal membrane function?
Amphotericin B
120
What drug inhibits fungal cell wall function?
Capsofungin
121
List the four drugs or drug classes that can be used to treat systemic fungal infections.
1) Polyenes i.e. Amphotericin B
2) Azoles
3) Flucytosine
4) Enchinocandins
122
What is the mechanism of resistance to Amphotericin B?
Decreased membrane ergosterol
123
What are the adverse reactions seen with Amphotericin B administration?
1) Infusion site reaction
| 2) Nephrotoxicity
124
What is the packaging of Amphotericin B in a lipid micelle called?
Liposomal packaging
125
List the imidazoles.
Ketoconazole
Miconazole
Clotrimazole
126
List the triazoles.
Fluconazole
Itraconazole
Voriconazole
Posaconazle
127
What is the MOA of the azoles?
Inhibit the enzyme that produces ergosterol
128
Name three mechanisms of resistance to the azoles.
1) Decreased membrane ergosterol
2) Efflux pumps
3) Mutations in the target enzyme
129
List three reasons that Fluconazole is the first line agent for systemic fungal infections.
1) Safe--highest TI
2) Well distributed to the CNS
3) Few drug-drug interactions
130
List the infections that Fluconazole is the first line agent for.
1) Systemic Candidiasis
2) Cryptococcosis
3) Coccidiomycosis
131
What is Itraconazole the drug of choice for?
```
Histoplasmosis
Coccidiomucosis
Blastomycosis
Sporotrichosis
Oncychomycosis
```
132
What is Voriconazole the drug of choice for?
Aspergillosis
133
What adverse effect is associated with Voriconazole?
Visual disturbances
*Think Voriconazole= Visual*
134
What is Posconazole used to treat?
Mucromycoses
| Aspergillosis
135
How is Flucytosine used clinically?
Part of combination therapy for severe Cryptococcal infections
136
List the Echinocandins.
Capsofungin
Micafungin
Andidulafungin
137
What infections are the Echinocandins commonly used to treat?
Aspergillosis
| Candidiasis
138
What is Griseofulvin? What is it used to treat?
This is an ORAL antifungal used to treat the Dermatophyte infections
*Note that it concentrates in Keratin precursors*
139
What class of drug are the Allylamines? What is the MOA?
- Antifungals that inhibit ergosterol synthesis
| - Specifically inhibit SQUALENE EPOXIDASE
140
What is Terbinafine a first line agent for?
Onychomycosis
141
List the topical antifungals and their drug class.
```
Nystatin- polyene
Clotrimazole- azole
Miconazole- azole
Terbinafine- allylamine
Naftifine- allylamine
```
142
What is Nystatin used to treat?
This is a topical agent used to treat Candida infections i.e.
- Oral candidiasis
- Vaginal candidiasis
143
What are Clotrimazole and Miconazole used to treat?
Topical agents for:
1) Candida
- Vulvovaginal candidiasis
- Oral thrush
2) Dermatophyte infections
144
What are the topical Allylamines used to treat?
Topical agents for:
1) Tinea curis (jock-itch)
2) Tinea corporis (ringworm)
145
What is the MOA of Acyclovir?
This is a nucleoside analog that:
1) Competitive inhibitor of viral DNA polymerase
2) Causes chain termination via incorporation into the viral genome
146
What are the indications for oral Acyclovir?
1) Genital herpes (HSV-2)
| 2) VZV
147
List four indications for IV Acyclovir.
1) Severe/ disseminated HSV
2) Neonate infections
3) HSV encephalitis
4) VZV in the immunocompromised
148
What major toxicity is associated with Acyclovir?
Nephrotoxicity
149
What are the clinical indications for Valacyclovir?
1) Genital Herpes (HSV-2)
2) Oral Herpes (HSV-1)
3) VZV
150
How does Foscarnet compared to Acyclovir?
Does NOT require thymidine kinase activation
151
What are the clinical indications for Foscarnet?
1) HSV/VZV infections resistant to Acyclovir
2) CMV
- Retinitis
- Colitis
- Esophagitis
152
What are the adverse effects associated with Foscarnet?
1) Nephrotoxicity
| 2) Changes in blood chemistry
153
What activates Ganciclovir?
Viral CMV kinase
154
What are three adverse effects associated with Ganciclovir?
1) Myelosuppression
2) CNS toxicity
3) Injection site reaction
155
What are the two indications for Valganciclovir?
1) CMV Retinitis
| 2) Prophylaxis against CMV in transplant patients
156
What is the MOA of Trifluridine?
1) Prodrug that gets activated by phosphorylation
| 2) Competitive inhibition of thymidine incorporation into DNA
157
What are the indications for Trifluridine?
HSV-1 and 2 associated:
1) Keratoconjunctivitis
2) Keratitis
158
What is the difference between Oseltamivir, Zanamivir, and Peramivir?
```
Oseltamivir= Oral and 1+ y/o
Zanamivir= inhaled and 7+ y/o
Peramivir= IV, think "Parenteral"
```
159
What are the adverse effects associated with Peramivir?
1) Neuropsychiatric sx.
- Neurominidase inhibitors cause Neuropsychiatric symptoms
2) Steven Johnson's Syndrome
160
What is the MOA of Ribavirin?
Remember, RSV= Ribavirin
1) Phosphorylated by ADENOSINE KINASE
2) Interferes with GTP/ mRNA capping
161
What can Ribavirin be used to treat aside from RSV?
Hepatitis C
162
What adverse effect is associated with Ribarivin?
Hemolytic anemia
163
When is Ribavirin contraindicated?
1) Pregnancy
2) Anemia
3) Ischemic vascular disease
4) Severe renal disease
164
What are the two HCV DAA Protease Inhibitors?
1) Partaprevir
| 2) Simeprevir
165
What are the two HCV DAA RNA Polymerase inhibitors?
1) Sofosbuvir- nucleoside
| 2) Desabuvir- non-nucleoside
166
What are the two HCV DAA NS5A inhibitors?
1) Lepipasvir
| 2) Ombitasvir
167
What should you avoid giving Sofosbuvir with?
Rifampin
168
List the NRTIs.
```
Zidovudine
Lamivudine
Abacavir
Tenofovir disoproxil
Emtricitabine
```
169
Aside from HIV, what can the NRTIs be used to treat?
HBV
170
What adverse effects are seen with the NRTIs?
1) Lactic acidosis
2) Lipodystrophy
3) Fatty Liver Disease
171
What specific adverse reaction is associated with Abacavir?
Abacavir= NRTI
*Think "A" for allergic reaction/ hypersensitivity
172
What polymorphism is associated with hypersensitvity to Abacavir? Why is this important?
HLA-B5707
*Need to test for this prior to administration*
173
What is unique about the toxicity profile of Lamivudine?
Least toxic of the antiretrovirals
174
What unique adverse effect is seen with Emtricitabine?
Hyperpigmentation of the palms and soles
175
Name three contraindications for Emtricitabine.
1) Pregnancy
2) Young children
3) Hepatic or renal failure
176
What unique adverse effects are seen with Tenofivir?
1) Bone marrow--> "Faconi anemia"
| 2) Decreased bone density/ fetal growth
177
What unique adverse effect is seen with Zidovudine?
Myelosuppression
178
List the adverse effects common to the NNRTIs.
1) Rash
2) Steven Johnson Syndrome
3) Hepatotoxicity
4) Drug-drug interaction
179
List the two most clinically important NNRTIs.
Nevirapine
| Efavirenz
180
What unique toxicities are associated with Efavirenz?
1) Teratogenic
2) CNS toxicity
3) CYP p450 inducer
181
What unique toxicity is associated with Nevirapine?
Hepatitis
182
What is the unique clinical utility of Nevirapine?
Can prevent VERTICAL TRANSMISSION
183
List the adverse effects common to the protease inhibitors.
1) Hyperlipidemia
2) Lipodystrophy
3) GI intolerance
4) Hepatotoxicity
5) Increased bleeding risk
6) Drug-drug interactions
184
What drugs are contraindicated with Atazanavir? Why?
PPIs b/c they require acidic GI pH for proper absorption
*Think Ataznavir needs Acid*
185
What specific adverse effects are associated with Ataznavir?
1) Peripheral neuropathy
2) Hyperbilirubinemia
3) Adverse cardiac effects
186
What effect does Ataznavir have on the CYP p450 system?
Inhibition
187
What is the clinical utility of Darunavir?
Pharmacologic booster like Ritonavir
188
What specific adverse effects are associated with Darunavir?
1) Increased liver enzymes
| 2) Increased serum amylase
189
What is the specific indication for Darunavir?
Drug resistant HIV-1
190
What is the CCR5 antagonist?
Maraviroc
191
What specific adverse effect is associated with Maraviroc?
Cardiac events in those with underlying cardiac disease
192
What is the fusion inhibitor? What is unique about the administration of this drug?
Enfuvritide -- given SubQ!
193
What specific adverse effects are associated with Enfuvritide?
1) Injection site reaction
2) Allergy to drug
3) Increased risk of bacterial pneumonia
194
What suffix is associated with the Integrase Inhibitors.
"Tegravir"
- Raltegravir
- Elvitegravir
- Dolutegravir
195
What specific adverse effects are associated with Raltegravir?
1) Rhabdomyolysis
| 2) Myopathy
196
What specific adverse effects are associated with Elvitegravir?
Elevated lipase
Note that this is given orally with Ritonavir
197
What specific adverse effects are associated with Dolutegravir?
1) Hypersensitivity
| 2) Elevation of liver enzymes
198
List the non-selective COX inhibitors.
```
ASA
Ibuprofen
Idomethacin
Ketorolac
Naproxen
Oxaprozin
Piroxicam
Sulindac
```
199
List the selective COX inhibitors.
Celecoxib
Etoricoxib
Meloxicam
200
What is the MOA of Colchicine?
Inhibition of leukocyte migration and phagocytosis
201
What is the MOA of Probenecid and Sulfinpyrazone?
- Inhibit tubular absorption of uric acid
| - Increase renal clearance of uric acid
202
What is the MOA of Methotrexate in the treatment of RA?
1) Inhibits AICAR transformylase
2) Increases extracellular adenosine
3) Inhibits T-cell activation
4) Cytotoxic to lymphocytes
203
List the synthetic DMARDs.
Methotrexate
Leflunomide
Chloroquine
Hydroxycholorquine
204
What is the MOA of Leflunomide?
Inhibits ribonucleotide synthesis
205
What are the biologic DMARDs?
Etanercept
Infliximab
Anakinra
206
List the drugs used to PREVENT migraines.
1) Propanolol
2) Metoprolol
3) Amitriptyline
4) Valproate
5) Topiramate
207
What are the antiemetics used to treat migraines?
1) Metoclopramide
2) Chlopromazine
3) Prochlorperazine
208
List the antimetabolite immunosuppressants.
Azathioprine
Mycophenolate mofetil
Sirolimus
209
List the biological immunosuppressants.
1) Antithymocyte globulin
2) Muromonab-CD3
3) Anti-TNF-a
210
What are the non-genomic effects of the glucocorticoids?
1) Alternation of signaling pathways
| 2) Insertion into cell membrane to alter ion transport
211
Name four effects of glucocorticoid administration.
1) Decreased peripheral lymphocytes
2) Decreased pro-inflammatory cytokines
3) Inhibition of IL-2
4) Reduced neutrophil chemotaxis
212
List the pro-inflammatory cytokines.
IL-1
IL-6
TNF-a
IFN-y
213
List four clinical indications for the glucocorticoids.
1) Prevent transplant rejection
2) GVHD
3) Autoimmune disease
4) Prevention of cytokine storm with biological immunosuppressants
214
What adverse effects are associated with the glucocorticoids?
1) Growth retardation
2) Poor wound healing
3) HTN
4) AVN
5) Cataracts
6) Hyperglycemia
7) Adrenal crisis with d/c
215
Outline the MOA of Cyclosporine.
- Complexes with Cyclophillin in the cytosol
- That complex binds Calcineurin
- Calcineurin complex prevents dephosphorylation of NAFT
- NAFT cannot translocate to the nucleus
No NAFT= NO IL-2
216
What is the grapefruit juice/ cyclosporine interaction?
- Grapefruit juice inhibits CYP p450
| - Increased concentrations of cyclosporine-->toxicity
217
What does Azathioprine ultimately block?
De novo purine synthesis
218
List three indications for Azathioprine.
1) Prevent transplant rejection
2) Severe RA
3) Glucocorticoid resistant autoimmune disease
219
What adverse effects are associated with Azathioprine?
- Myelosuppression
| - Hepatotoxicity
220
What the MOA of Mycophenolate Mofetil?
1) Prodrug metabolized to MPA
| 2) MPA blocks IMP in de novo purine synthesis
221
What are the clinical indications for Mycophenolate Mofetil?
1) Prophylaxis for transplant rejection
| 2) SLE
222
What adverse effects are associated with Mycophenolate Mofetil?
1) Myelosuppression
2) GI upset
3) CMV infections
4) TERATOGENIC
223
What is the MOA of Sirolimus?
mTOR inhibitor
224
What is the specific utility of Sirolimus?
Renal transplant that cannot tolerate nephrotoxocity of Cyclosporine
225
What are the indications for antithymocyte globulin?
1) Induction immunosuppression
| 2) Treatment of ACUTE transplant rejection
226
What adverse reactions are associated with Antithymocyte Globulin?
1) Cytokine storm
| 2) Serum sickness
227
What are the indications for antithymocyte globulin?
Glucocorticoid resistant transplant rejection
228
What drawback is associated with Muromonab-CD3?
Mouse antibody that can only be used once
229
What are the three anti-TNF-a biologicals? What are the used to treat?
1) Infliximab
2) Adalimumab
3) Etanercept
*Autoimmune disease*
230
How does Echinacea reduce the duration and intensity of a cold?
1) Increased cytokine production
2) Anti-inflammatory/ COX inhibitor
3) Increased immunological blood cells
231
What two major side effects are associated with Gingko Biloba?
1) Bleeding
| 2) Seizure induction
232
How does garlic lower blood pressure?
1) ACE inhibitor
2) Increased NO bioavalibility
3) Increased H2S production
*Decrease vasoconstriction and increase vasodilation
233
What drug-drug interaction is associated with Glucosamine and Chondroitin?
Enhanced anticoagulant effects of Warfarin
234
List the intended uses of CoQ10.
1) Reduction of statin-induced myopathy
2) HTN
3) CAD
4) Neurodegenerative Disease
5) Migraine
235
List all the supplements that cause increased bleeding.
- Ginkgo Biloba
- Garlic
- Ginseng
- Glucosamine and Chondrioitin
- Feverfew
- CoQ10
