Immunology/Toxicology Flashcards

1
Q

What/how does the following laboratory method test: ELISA

A

measures Ig G/M/A
used in dz detection and allergen identification

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2
Q

What/how does the following laboratory method test: RAST

A

quantifies IgE

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3
Q

What/how does the following laboratory method test: IgG

A

delayed hypersensitivity rxn to antigen

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4
Q

What/how does the following laboratory method test: IgE

A

immediate hypersensitivity rxn to antigen

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5
Q

IgG is associated with what and is a measure of what?

A

long term exposure/delayed rxns (food allergy)

marker of exposure, not sucessful tx

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6
Q

IgM is associated with what and is a measure of what?

A

acute phase rxns
marker of recent infection or reexposure

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7
Q

IgA is associated with what and is a measure of what?

A

secretory Ig (serum, stool, saliva)
shows mucosal response and is a good marker of successful tx

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8
Q

IgE is associated with what and is a measure of what?

A

anaphylaxis (type 1 rxn)

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9
Q

what would the folowing ab testing results indicate:
high IgG
low IgM or IgA

A

probable past infxn/exposure that is inactive or cured

in food allergy testing, ig G is always considered active, but delayed response allergy

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10
Q
A
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11
Q

what would the folowing ab testing results indicate:
low IgG
high IgM

A

new infxn / exposure

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12
Q

what would the folowing ab testing results indicate:
high IgG
high IgM

A

reactivated infection / exposure

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13
Q

what would the folowing ab testing results indicate:
high IgG
low IgM
high IgA

A

current immune response (mucosal) that is past the initial IgM response window (ongoing problem)

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14
Q

ANA is the typical screening test for which type of disorders?

A

RA, SLE, lupus, MCTD, CREST syndrome, scleroderma, polymyositis

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15
Q

what titer level for ANA is positive?

A

> 1:160

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16
Q

what is what of the only conditions the nonspecific measure of ESR can be diagnostic in?

A

giant cell arteritis

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17
Q

what testing would you consider in someone with a RA like presentation who tested negative for RF?

A

parvo B19 viral assay

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18
Q

HLA B27 is what type of testings and gives diagnostic information about what conditions/when will it be elevated?

A

glycoproteins; seronegative arthritities; AS, reiters, MS, chronic active hepatitis, gluten sensitive enteropathy, SLE, DM, hemochromatosis

also done for tranplantation matches

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19
Q

what infection would you want to test for in a patient with reiters?

A

chlamydia

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20
Q

anti-thyroid ab (anti microsomal or TPO Ab) is a marker for which disorders?

A

hashimotos thyroiditis
atophic thyroiditis
graves disease

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21
Q

antithyroglobulin (Anti TG) ab is a marker for what disorders?

A

autoimmune thyroiditis
hashimoto thyroiditis

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22
Q

thyroid stimulating ig (TSI) (thytrophin receptor ab) is a marker for what disorder(s)? when would you order this testing?

A

graves dz
order when graves sn/sx and TPO elevation

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23
Q

what testing would you run in someone you suspect is having post streptococcal sequelae? what would be a positive result?

A

anti streptolysin O (ASO) test
pos >200 iu/ml

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24
Q

what types of testing is available for EBV?

A

monospot (sx, more sensitive in first infxn, IgM for 4-21 days)

PCR (chronic reactivating cases)

panel (early phase IgM antiVCA, acute illness IgG anti VCA and anti EA, convalescence/reactivation anti EBNA)

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25
Q

e coli testing

A

stool ag testing O157-H7

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26
Q

giardia testing

A

stool assay in sx pt

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27
Q

h pylori testing

A

nitrogen breath test
igG (PAST infxn)
igM (current, will dec regardless of tx status)
serum/salivary/stool IgA (rises with ifxn, falls with tx)

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28
Q

HAV testing

A

IgM (acute)
IgG (years after)

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29
Q

HBV testing

A

HbsAg - detected 1-4 months post infection

appearance past >6 mo exhibit chronic illness

antiHbs Ab - protected against HBV

HbcAg- IgM and IgG

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30
Q

HCV testing

A

PCR
HCV ab - 4x inc foir HCC

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31
Q

HDV testing

A

coexists with HB and makes HB more deadly; worst in pregnancy

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32
Q

HSV testing

A

IgG/M type (1 or 2) specific serology best for dx

PCR available

virus isolation (tzank smear) is OLD method, not specific to 1 or 2 and can have false pos

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33
Q

HIV testing

A

ELISA measures anti HIV titers; confirmed by western blot analysis
may take 6 months to seroconvert

decreased CD4/8 ratio
newly dx: t cell subset

earliest dx: PCR

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34
Q

types of HPV common causes for plantar and genital warts

A

6, 11

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35
Q

types of HPV common causes for cervical cancer and how to test for them

A

16, 18, 31, 33
PCR on pap smear

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36
Q

what testing would indicate a present infection of rubella

A

presence of IgM and/or four fold inc in IgG

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37
Q

syphilis testing

A

VDRL/RPR
nontreponemal tests used primarily for detection of primary syphilic infection

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38
Q

tuberculosis testing

A

intradermal skin test; read 48-72 hours for induration

BCG: post ID, check serology results

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39
Q

lyme testing

A

> 250 rxn units

skin, blood, synovial, CSF
ELISA or western blot checking for ab detection
PCR now available

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40
Q

nystatin MOA

A

disrupts fungal wall

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41
Q

nystatin uses

A

cutaneous, intestinal, vaginal, and mucocutaneous candida infxns

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42
Q

nystatin adverse effects

A

contact dermatitis
poorly absorbed/ better for topical

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43
Q

miconazole MOA

A

disrupts fungal wall

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44
Q

miconazole uses

A

tineas, cutaneous and vulvovaginal candida

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45
Q

miconazole adverse effects

A

pruritis, skin irritation, burning, contact dermatitis

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46
Q

amphotericin class, uses

A

IV only (unless compounded) antifungal; two types
high potential side effect profile

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47
Q

triazole drugs are what type of drugs and end in what suffix

A

antifungals
-conazole aside from terbinafine

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48
Q

triazole MOA

A

inhibits fungal p450, degrading fungal cell wall

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49
Q

main side effect concern with triazoles

A

liver damage; inhibits p450
dont take with other drugs with hepatotoxicity risks

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50
Q

terbinafine uses

A

topical and oral; toenail fungus

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51
Q

where can nystatin be used?

A

topical infxns (includes GI tract)

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52
Q

nystatin dosing

A

GI infxns: 500k-1 mil units po tid

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53
Q

fluconazole dosing

A

varies based on infxn and immunocompetence

150-200mg single dose
200 mg bid for 2-4 weeks
100 mg daily for months (long term may dose 5 days on/2 days off rotation)

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54
Q

terbinafine dosing

A

fingernail onychomycosis: 250 mg qd x 6 weeks
toenail: 250 mg qd x 12 weeks

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55
Q

permethrin MOA/uses

A

causes paralysis by disrupting sodium current in the parasite

scabies, pedivulosis

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56
Q

permethrin adverse effects

A

pruritis, edema, rash, burning, stinging

if a child gets a hold of permethrin and drinks it they can have seizures and die since it is a CNS irritant

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57
Q

permethrin method of dosing

A

topical

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58
Q

mebendazole class/MOA/uses

A

antihelminthic; irreversibly inhibits nutrient uptake by helminthes

pinworms, roundworks, hookworks

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59
Q

mebendazole adverse effects

A

abdominal pain
diarrhea
fever

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60
Q

mebendazole dosing

A

pinworm: 100 mg single dose, repeat 2-3 weeks

roundworm, hookwork, whipworm: 100 mg po bid x 3 days, repeat 3 weeks

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61
Q

metronidazole class/MOA/uses

A

antiprotozoal; inhibits DNA synthesis in microorganism causing cell death

amoebas, trich, giardia

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62
Q

metronidazole AEs

A

GI distress, seizures, ataxia, cramping, rash, joint pain

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63
Q

metronidazole CIs

A

do NOT take with Etoh (acts like antabuse)

potentizes p450 metabolized drugs

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64
Q

hyroxychloroquinine class/MOA/uses

A

antimalarial; unknown MOA

malaria, extraintestinal amebiasis

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65
Q

hyroxychloroquinine AEs

A

HA
dizziness
pruritis
neuropathy
seizures
retinal changes
ototoxic

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66
Q

metronidazole dosing

A

intestinal amebiasis: 750 mg bo BID 5-7 days > then iodoquinol rx

trich: 750 mg po TID 7 days OR 1 g po bid x 1 day, repeat in 4-6 weeks

BV: 500 mg po bid x 7 days

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67
Q

is the following medication/medication class safe for lactation: gentamycin

A

generally safe due to low transfer and low oral availability

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68
Q

is the following medication/medication class safe for lactation: cephalosporins

A

considered safe; low transfer into milk (third generation have greater potential to alter bowel flora)

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69
Q

is the following medication/medication class safe for lactation: ciproflaxin

A

avoid fluroquinolones due to theoretical risk of arthopathies

70
Q

is the following medication/medication class safe for lactation: macrolides

A

generally safe; may alter bowel flora

71
Q

is the following medication/medication class safe for lactation: amoxycillin

A

generally safe

72
Q

is the following medication/medication class safe for lactation: tetracyclines

A

avoid where feasible due to possible risks of dental staiing and averse effects on bone development

73
Q

is the following medication/medication class safe for lactation: acyclovir

A

safe

74
Q

is the following medication/medication class safe for lactation: fluconazole

A

potential for accumulation esp in premature infants

75
Q

is the following medication/medication class safe for lactation: metronidazole

A

controversial as exposure may be high; with high doses consider expressing and discarding milk

76
Q

is the following medication/medication class safe for lactation: nitrofurantoin

A

avoid in G6PD def infants due to risk of hemolysis

77
Q

is the following medication/medication class safe for lactation: sulfamethoxazole

A

avoid in infants with hyperbilirubinemia and G6PD def

78
Q

bactericidal antibiotics that target:

bacterial cell wall

A

penicillins
cephalosporins

79
Q

bactericidal antibiotics that target:

bacterial cell membrane

A

polymixins

80
Q

bactericidal antibiotics that interfere with essential bacterial enzymes

A

quinolones, sulfonamides usually

81
Q

bacteriostatic abx (target protein synthesis)

A

aminoglycosides
macrolides
tetracyclines

82
Q

ab for gram pos

A

penicillin G
vancomycin
bacitracin

83
Q

ab for gram neg

A

aminoglycosides
polymixins

84
Q

broad spectrum ab

A

quinolones
ampicillin
cephalosporins
tetracyclines
chloramphenicol
sulfonamides

85
Q

ab side effects

A

GI tract - kill good flora; dysbiosis
kidneys (usu injected/IV) - inc kidney excretion
liver (less common)

systemic superinfection with bacteria or fungi that are not effected by the abx given

86
Q

what are the B lactam ab

A

penicillins
cephalosporins
carbapenems
monobactams

87
Q

penicillin MOA/uses

A

break down / inhibit bacterial cell wall synthesis

gram + cocci, anaerobic bacteria, syphilis

88
Q

penicillin adverse effects

A

N/V, rash, seizures, anaphylaxis, neurotoxic, nephrotoxic

89
Q

penicillin CI/caution

A

not effective against B lactamase producing organisms or gram - anaerobes

90
Q

ampicillin class/MOA/uses

A

penicillin; inhibits cell wall synthesis;

some gram + and gam - organisms, prophylaxis for dental procedures

91
Q

ampicillin CI/caution

A

not effective against B lactamase producing organism

92
Q

amoxicillin class/MOA/uses

A

penicillin; inhibits cell wall synthesis;

some gram + and gam - organisms, prophylaxis for dental procedures

93
Q

amoxicillin CI/caution

A

not effective against B lactamase producing organism UNLESS used with clavulanate

94
Q

clavulanate MOA/uses

A

used with amoxicillin; makes it effective against B lactamese producing organisms

95
Q

what ab should you be cautious of concerning allergies?

A

penicillin, cephalosporin (cross allergy; if your pt is allergic to penicillin, dont give them cephalosporins either)

96
Q

cephalexin uses

A

URI, GI infxn, cutaneous ifxn, soft tissue ifxn

97
Q

cephalosporins AEs

A

nausea, diarrhea, maculopapular rash, anaphylaxis, serum sickness, GI distress

98
Q

cephalosporins CI/caution

A

dont give to pts with penicillin allergy

99
Q

cephalosporin MOA

A

bactericidal by inhibiting cell wall synthesis

100
Q

cefactor uses

A

UTI, URI, OM

101
Q

cefdinir/cefixime uses

A

more resistant to gram - B lactamase organisms

102
Q

cefepime uses

A

e coli, proteus, k pneumoniae, enterobacteria, b fragilis, staph/strep

103
Q

what are the common cephalosporins

A

1st gen - cephalexin
2 - cefactor
3 - cefixime, cefdinir
4 - cefepime

104
Q

what are the macrolide abx

A

erythromycin
clarithromycin
azithromycin

105
Q

macrolide MOA

A

inteferes with bacterial DNA synthesis

106
Q

erythromycin uses

A

M pneumo
pertussis
neonatal c pneumo
strep thraot
URI

107
Q

erythromycin AEs

A

abdominal pain, nausea/vomiting, diarrhea, anaphylaxis

108
Q

macrolides CI/caution

A

CI in pregnancy; caution with impaired renal function

109
Q

clarithromycin AEs

A

abdominal pain, nausea/vomiting, diarrhea, anaphylaxis

110
Q

clarithromycin uses

A

bronchitis
non gonococcal urethritis
cervicitis
chancroid

111
Q

azithromycin uses

A

bronchitis
non gonococcal urethritis
cervicitis
chancroid

112
Q

which macrolide has less GI side effects and requires less medication to achieve the same effect?

A

azithromycin

113
Q

macrolides safety in preg

A

CI in preg in general
clarithromycin Cat C (benefits > risks)
azithromycin cat B (safest)

114
Q

macrolide suffix

A

-ROmycin (be careful as other meds also end in mycin)

115
Q

tetracyclines MOA/uses

A

inteferes with bacteria protein synthesis;
susceptible gram + and gram - organisms including chlamydia and lyme disease

sebulytic (acne)

116
Q

tetracyclines AEs

A

intracranial HTN
GI distress
rash
photosensitivity
inc pigmentation

117
Q

tetracyclines CI/caution

A

avoid in pregnancy and lactation
avoid in children under 9 due to permanent discoloration/other dental effects and possible bone effects

118
Q

sulfonamides MOA/uses

A

interfere with bacterial folic acid synthesis

UTI, OM, URI, pneumocystis, travelers diarrhea

119
Q

sulfonamides AEs

A

rash, seizures, stevens johnson syndrome (SJS) / toxic epiderml necrolysis (TEN)
N/V, diarrhea, nephrotoxic, hepatic necrosis, anaphylaxis

120
Q

sulfonamides CI/caution

A

many potential side effects
interefere w OCPs (all abx can do this)

121
Q

nitrofurantoin uses

A

specific UTI indication

122
Q

nitrofurantoin CI/cautions

A

anuria, oligura, or renal impairement are CI (cleared almost exclusively through kidneys)

pregnant pts at term, during labor/delivery, neonates (hemolytic anemia risk if born with it in their system)

123
Q

clindamycin class/MOA/uses

A

lincosamide; interferes with peptide elongation in bacterial protein synthesis

gram + cocci and anaerobes; often alternative to penicillin

124
Q

suffixes
aminoglycosides
lincosamides
macrolides

A

aminoglycosides: - mycin / -micin
lincosamides: only clindamycin
macrolides: - romycin

125
Q

floroquinolones naming

A

ciprofloxacin family - “flox”’s

126
Q

fluoroquinolones MOA/uses

A

bactericidal by interfering with bacterial DNA synthesis

wide spectrum ab ; URI, UTI, cutaneous ifxn, bone/joint infxn, abdominal infxns

127
Q

fluoroquinolones AEs

A

achilles tendon rupture/other tendon pathology

rash, arthralgias, nausea, diarrhea, seizures, GI/CNS effects

128
Q

fluoroquinolones CI

A

do not use in kids under 18; can arrest growth plate in children

129
Q

aminoglycosides MOA/uses

A

bactericidal by interfering with bacterial DNA synthesis

serious infxns of enterobacter, e coli, k pneumonia, psedomonas

130
Q

aminoglycosides AEs

A

severe ototoxicity
nephrotoxic, seizures, anaphylaxis, neurotoxic

131
Q

isoniazid class/MOA/uses

A

antituberculosis drug; inhibits cell wall synthesis in mycobacterium TB

132
Q

antituberculosis AEs

A

neuropathies
hepatotoxic
GI disturbance
fever
rash
sexual side effects

133
Q

what is the CI/caution that all antituberculosis drugs share?

A

hepatotoxicity

134
Q

rifampin class/MOA/uses

A

antituberculosis drug; impairs RNA synthesis

135
Q

what should rifampin and other antituberculosis drugs be rx with?

A

B6

136
Q

neomycin class/MOA/uses

A

topical antibiotic; disrupts bacterial protein synthesis

topical bacterial infxns

137
Q

neomycin AEs

A

contact dermatitis, rash, nephrotoxic, ototoxic

138
Q

mupirocin class/MOA/uses

A

topical antibiotic; bacterial RNA inhibition

impetigo, MRSA prophylaxis

139
Q

antiviral suffixes

A

-cyclovir

140
Q

antivirals MOA

A

inhibits viral multipication by interering with DNA synthesis

141
Q

metabolism/dosing differences between the antivirals

A

valacyclovir and famcyclovir both metabolize to acyclovir in the body, but require lower dosing.

142
Q

antiviral AEs

A

nausea/vomiting, rash, headache, seizures, coma

143
Q

antivirals used for: human herpes virus 1-7 (except CMV)

A

acyclovir, valcyclovir, famcyclovir

144
Q

antivirals used for: hepatitis B and C

A

interpheron alpha, peglyated interferon

145
Q

antivirals used for: influenza

A

oseitamivir

146
Q

types of HIV pharm tx

A

Nucleoside reverse-transcriptase inhibitiors (NRTI)
Non-Nucleoside reverse-transcriptase inhibitiors (NNRTI)
protease inhibitors
triple therapy (2 NRTIs and PI or NNRTI)

147
Q

types of NRTIs

A

type A: zidovudine, stavudine

148
Q

adalimumab & etanercept class/moa/uses

A

TNFa inhibitor
RA, PA, anklylosing spondylitis, chrohns, chronic psoriasis and juvenile idiopathic arthritis

149
Q

adalimumab & etanercept CI/cautions

A

prolonged tx with adalimumab may slightly increase the risk of developing infections and cancer

150
Q

montelucast class/MOA/uses

A

leukotriene receptor antagonist

phrophylaxis and chronic tx of asthma in pts 12 mo +, seasonal allergic rhinitis 2+, exercise induced bronchoconstriction prevention

151
Q

montelucast AEs

A

LOTS in multiple systems!

152
Q

interferon alpha uses

A

hep B/C, HPV, hairy cell leukemia, kaposis sacroma

153
Q

interferon beta uses

A

MS

154
Q

interferon AEs

A

flu like sx
hypothyroidism
low blood cell counts
n/v, diarrhea

155
Q

tacrolimus class/MOA/uses

A

CMI suppressor; suppresses cell mediated immune rxns and some humoral immunity

PO and IV prophylaxis of organ rejection in pts getting allogenic liver, kidney, or heart transplants; used in conjunction with adrenal corticosteroids

topical second line therapy for short term/noncont chronic tx of atopic dermatitis

156
Q

cyclosporine class/MOA/uses

A

CNI blocker; inhibits cell mediated immune responses; inhibition of lymphocytic proliferation and function

dry eye drops, psoriasis

157
Q

cyclosporine AEs

A

nephrotoxic (dose dependent, reversible)

157
Q

anastrazole class/MOA/uses

A

aromatase inhibitor; dec estrogen formation

tx breast CA after surgery and in mets in both pre and post menopausal women

158
Q

anastrazole AEs

A

similar to SERMS; menopausal type sx

159
Q

doxorubicin class/MOA/uses

A

chemotherapeutic agent; anthracycline antiobiotic, intercalates DNA

wide range of cancers including hematological malignancies, carcinomas, and soft tissue sarcomas

160
Q

doxorubicin AEs

A

life-threatening heart damage

161
Q

paclitaxel class/MOA/uses

A

taxanes; mitotic inhibitior isolated from bark of pacific yew tree (taxus brevifolia); stabilizes microtubules and interferes with their breakdown during cell division

lung, ovarian, breast CA
head and neck CA
advanced forms of kaposis sarcoma

162
Q

paclitaxel AEs

A

N/V
loss appetite
chagne in taste
thinned/brittle hair
pain in joints
change in color of nails
tingling in hands/toes

163
Q

methotrexate class/MOA/uses

A

competitively inhibits dihydrofolate reductase; inhibits synthesis of DNA, RNA, thymidylates, and proteins

alone or in combo for chemo with breast, head and neck, leukemia, lymphoma, lung, osteosarcoma, bladder, trophoblastic neoplasms

abortions/ectopic pregnancies, AI disorders

164
Q

methotrexate AEs

A

ulcerative stomatitis
low WBC count > predisposition to infection, nausea, abdominal pain, fatigue, fever, and dizziness

165
Q

common dermatologic SE findings with chemo/radiation

A

cellulitis
mucositis > N/V
ecchymosis/thrombocytopenia
purpura/petichiae
nose/face rash
tongue lesions
radiation burns/hypopigmentation
photosensitivity
nail changes
tumor seeding to skin

166
Q

penicillamine MOA/uses

A

chelates heavy metals esp copper

wilsons dz, RA, mercury or lead poisoning

167
Q

penicillamine AEs

A

optic neuritis, GI distress, stomatitis, nephrotic syndrome, GN, leukopenia, skin rash, arthralgia

168
Q

lead poisonin medication

A

EDTA

169
Q

add purpose of immunizations, shcedules, not in fevers, other admin/hygeiene rules***

A
170
Q
A