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DERMPHARM > Pharm 1-50 > Flashcards

Pharm 1-50 Flashcards

0
Q

Which of the following antiviral agents is NOT phosphorylated by viral thymidine kinase?

A

Cidofovir

Cidofovir is a nucleotide analogue antiviral agent. It does not require phosphorylation by virus, but is converted by host cell kinases to a diphosphate.
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1
Q

The most common side effect of azathioprine is:

A

The most common side effect of azathioprine is:

1 Bone marrow suppression
The most common side effect of azathioprine (Imuran) is bone marrow suppresion (Pancytopenia). It is a rare adverse event resulting from excessive immunosuppression by azathioprine. To prevent catastrophic bone marrow failure, regular complete blood counts should be checked.
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2
Q 
Which cell type is increased by glucocorticoids?
1		Neutrophils
2		Monocytes
3		T-cells
4		B-cells
5		Eosinophils
A

1 Neutrophils
Glucocorticoids alter the balance of circulating leukocytes, causing an increase in the number of polymorphonuclear leukocytes and diminishing the numbers of lymphocytes, eosinophils, and monocytes.

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3
Q

A non-pigmenting fixed drug eruption is known to be caused by what agent?

1		Tetracycline
2		Barbiturates
3		Phenopthalein
4		Naproxen
5		Pseudoephedrine
A

Pseudoephedrine

All agents listed are associated with fixed drug eruptions, however, pseudoephedrine hydrochloride is the one most commonly associated with non-pigmenting fixed drug eruptions.
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4
Q 
A patient is being treated by a dermatologist. Yellowish changes of his sclera and yellowish discoloration of his dorsal hands and feet is noted. Which medication is most likely responsible?
1		Quinacrine
2		Minocycline
3		Hydroxychloroquine
4		Terbinafine
5		Prednisone
A

1 Quinacrine

Quinacrine frequently produces a yellow discoloration of the sclera and skin, especially over the dorsal hands and feet.

Minocycline and hydroxychloroquine can cause bluish-gray hyperpigmentation.

Terbinafine and prednisone are not associated with alteration of cutaneous pigmentation.
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5
Q 
All of the following are true regarding water-soluble retinoids EXCEPT:
1		They are undetectable in the serum after 1 month of stopping therapy
2		They include isotretinoin
3		They include etretinate
4		They include bexarotene
5		They have very little lipid   
                 deposition
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A

3 They include etretinate

Isotretinoin, acitretin, and bexarotene are water-soluble, with very little lipid deposition. Etretinate is 50 times more lipophilic than acitretin, with increased storage in adipose tissue.

IBAqua Tretinoin

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6
Q 
Which of the following antiparasitic agents is an organophosphate cholinesterase inhibitor?
1		Precipitated sulfur
2		Thiabendazole
3		Ivermectin
4		Lindane
5		Malathion
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A

5 Malathion

Malathion is an organophosphate cholinesterase inhibitor.
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7
Q

Which of the following statements regarding retinoids is true?
1 Tretinoin and isotretinoin are second-generation synthetic retinoids
2 Etretinate is a first-generation retinoid
3 Second-generation retinoids are polyaromatic retinoids
4 Tazarotene is a fourth-generation selective retinoid
5 Bexarotene is a third-generation retinoid
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A

5 Bexarotene is a third-generation retinoid
First-generation retinoids are tretinoin (all-trans RA) and isotretinoin (13-cis RA). Second-generation synthetic retinoids are etretinate, which was replaced by its metabolite acitretin. Third-generation (polyaromatic retinoids) include the arotinoids, tazarotene, adapalene, and bexarotene.

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8
Q 
The anti-CD 20 antibody rituximab is FDA-approved for treatment of which of the following?
1		Mycosis fungoids
2		Metastatic melanoma
3		Psoriasis
4		Paraneoplastic 
                pemphigus
5		Non-Hodgkin�s 
                lymphoma
A

5 Non-Hodgkin�s lymphoma
Rituximab (brand name Rituxan) is a monoclonal antibody is approved for the treatment of CD20 non-Hodgkin�s lymphoma. Rituximab is a monoclonal antibody directed against B lymphocytes which are CD20.

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9
Q 
This retinoid targets RXR receptors:
1		Tretinoin
2		Isotretinoin
3		Acitretin
4		Bexarotene
5		Etretinate
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A

4 Bexarotene
Bexarotene targets RXR receptors. It is used in the treatment of mycosis fungoides refractory to conventional therapy. Side effects include central hypothyroidism and hyperlipidemia. These should be treated with synthroid, lipitor, and fenofibrate.
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10
Q 
One of the main concerns for prescribing azathioprine to a gout patient with a normal level of thiopurine methyltransferase on chronic allopurinol is:
1		Azathioprine does not 
                work
2		Allopurinol does not work
3		Patient may develp 
                photosensitivity
4		Patient may become 
                pancytopenic
5		No concerns
A

Patient may become pancytopenic
Allopurinol inhibits xanthine oxidase, an enzyme that catabolizes azathioprine. In patients concurrently taking bothe medications, the allopurinol shunts more 6-MP from the xanthine oxidase catabolic pathway to the hypoxanthine-guanine phosphoribosyltransferase(HGPRT)anabolic pathway, creating an excess of purine analogs. This in turn may lead to to excessive immunosuppression and risk of pancytopenia.

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11
Q 
Which of the following may cause an acneiform eruption?
1		Fluoxetine
2		Valproic acid
3		ACTH
4		Finasteride
5		Methotrexate
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A

3 ACTH
Many medications are associated with acneiform eruptions, including halogens (bromide and iodide), androgenic hormones such as testosterone, ACTH, corticosteroids, isoniazid (INH), lithium, phenytoin, and vitamins B2, B6 and B12.
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12
Q 
The steroid with the least minerocorticoid activity is:
1		Hydrocortisone
2		Cortisone
3		Prednisone
4		Methylprednisolone
5		Prednisolone
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A

4 Methylprednisolone
Of the corticosteroids listed, the steroid with the lowest mineralcorticoid activity is methylprednisolone. Minerocorticoids act on the kidney to decrease the rate of sodium excretion (with accompanying retention of water). Triamcinolone, dexamethasone, and betamethasone also have low mineralcorticoid activity.
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13
Q 
The treatment of choice for Wegner's granulomatosis is:
1		Chlorambucil
2		Systemic 
                 glucocorticosteroids
3		Cyclophosphamide
4		Methotrexate
5		Azaithioprine
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A

3 Cyclophosphamide
Wegener granulomatosis is an idiopathic disorder characterized by necrotizing granulomatous vasculitis of the upper and lower respiratory tract, glomerulonephritis, and a variable degree of small-vessel vasculitis. Testing for c-ANCA is 90% sensitive for the diagnosis when the presentation is classic. Cyclophosphamide has been used very effectively and now is the usual drug of choice for induction of remission.

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14
Q 
PREVIOUS NEXT FINISH SHOW ANSWER
All of the following are reported cutaneous side effects of zidovudine EXCEPT:
1		Trichomegaly
2		Diffuse and oral 
                hyperpigmented macules
3		Hyperpigmented streaks 
                in nails
4		Periungual pyogenic 
                granulomas
5		None of the above (all are 
                reported side effects)
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View Detail

A

None of the above (all are reported side effects)
All of the following are cutaneous side effects reported with zidovudine, a nucleoside HIV reverse transcriptase inhibitor. Periungal/paronychial eruptions resulting in pyogenic granuloma-like lesions have also been reported with other HIV medications, including indinavir and lamivudine.

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15
Q 
The form of erythromycin most likely to cause jaundice is:
1		Ethylsuccinate
2		Estolate
3		Stearate
4		Gluceptate
5		Lactobionate
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A

2 Estolate
The form of erythromycin that most likely causes jaundice is estolate.
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16
Q 
The combination of ethanol and acitretin is potentially problematic because:
1		Ethanol exacerbates the 
                cheilitis caused by 
                acitretin
2		Acitretin increases the 
                toxicity of ethanol
3		Ethanol inhibits the 
                cytochrome p450 system
4		Ethanol promotes the 
               conversion of acitretin to 
               etretinate
5		Ethanol promotes the metabolism of acitretin
A

4 Ethanol promotes the conversion of acitretin to etretinate
Acitretin is an synthetic retinoid with affinity to the retinoic acid receptor (RAR). It can modulate the proliferation and differentiation of epidermal keratinocytes. The concurrent injestion of ethanol and alcohol increases the formation of etretinate. Unlike acitretin, etretinate is more lipophilic and accumulates in the fat. It therefore has a much longer elimination half-life, estiimated at 120 days.

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17
Q 
Which of the following biologic therapies is pregnancy category C?
1		Etanercept
2		Alefacept
3		Infliximab
4		Efalizumab
5		Adalimumab
A

4 Efalizumab
All of the above drugs are pregnancy category B except efalizumab which is category C.
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18
Q 
A 10 year old child with a seizure disorder develops a morbiliform eruption and elevated LFT's two weeks after starting Dilantin therapy. As his physician you:
1		Continue Dilantin and 
                treat rash with topical 
                corticosteroids
2		Discontinue Dilantin and 
                begin Phenobarbital
3		Discontinue Dilantin and 
                begin carbamazepine
4		Restart Dilantin once the 
                rash resolves
5		Discontinue Dilantin and 
                begin valproic acid
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A

Discontinue Dilantin and begin valproic acid
Anticonvulsant hypersensitivity syndrome (also drug rash with eosinophilia and systemic symptoms (DRESS0 and dilantin hypersensitivity syndrome) presents with cutaneous eruption accompanied by fever, facial edema, lymphadenopathy, leukocytosis and hepatitis. Cross reactivity is present in all aromatic anticonvulsants including phenytoin, carbamazepine and phenobarbitol. There is no cross reaction with valprioc acid.

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19
Q 
Which of the following class of medications has been associated with acquired brachial dyschromatosis?
1		Non-Steroidal Anti-
                inflammatory medications
2		ACE-inhibitors
3		Anti-virals
4		HMG-CoA Reductase 
                inhibitors
5		Protease inhibitors
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A

2 ACE-inhibitors
Acquired brachial dyschromatosis is a condition described as asymptomatic, gray-brown patches with geographic borders, occasionally interspersed with hypopigmented macules, on the dorsum of the forearms, mostly bilaterally and seen in middle aged women. Epidermal atrophy, basal layer hyperpigmentation, elastosis and angiectases were histopathologic features. An association with Civatte’s poikiloderma as well as hypertension and/or antihypertensive drugs, especially ACE-inhibitors, is suggested.

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20
Q 
Which drug has been associated with cholestatic hepatitis?
1		Clindamycin
2		Erythromycin
3		Rifampin
4		Doxycycline
5		Ampicillin
A

2 Erythromycin
The estolate form of erythromycin has been associated with cholestatic hepatitis.
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21
Q 
Concomitant use of methotrexate and what other drug is contraindicated because of the potential increased risk of pancytopenia?
1		Folic acid
2		NSAIDs
3		Tetracycline
4		Acetaminophen
5		Systemic retinoids
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A

2 NSAIDs
Drugs that simultaneously inhibit the folate metabolic pathway, such as NSAIDS, dapsone, or trimethoprim-sulfamethoxazole, can increase hematologic toxicity when combined with methotrexate.
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22
Q 
If a patient develops a dilantin hypersensitivity reaction, which anticonvulsant is the better alternative therapy?
1		Carbamezapine
2		Phenytoin
3		Phenobarbital
4		Valproic acid
5		None of these answers 
                are correct
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A

4 Valproic acid
Carbamezapine, phenytoin, and phenobarbital are known to cross-react with one another.
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23
Q 
What is the target antigen for rituximab?
1		CD4
2		CD7
3		CD8
4		CD20
5		CD22
A

4 CD20
Rituximab is an anti-CD20 monoclonal antibody. CD20 is a B-cell marker and is used to treat Non-Hodgkins B-cell lymphoma. It is also approved for the treatment of rheumatoid arthritis.
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24
Q 
Methotrexate toxicity with myelosuppression is treated with what agent?
1		Folinic acid
2		Folic acid
3		Oral methylene blue
4		Cimetidine
5		Vitamin E
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A

1 Folinic acid
Leukovorin, or folinic acid, is able to bypass dihydrofolate reductase in the cell division pathway. It is administered under conditions of methotrexate-induced myelosuppression. Leukovorin is also available as an oral form, and may be administered as a continual part of methotrexate therapy, instead of folic acid. It is now believed that neither folic acid nor folinic acid inhibit the efficacy of methotrexate�s antipsoriatic actions.
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25
Q 
Of the medications listed below, the safest to use during pregnancy is:
1		Penicillin
2		Erythromycin estolate
3		Doxycycline
4		Estrogens
5		NSAIDS
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A

1 Penicillin
Erythromycin estolate is contraindicated in pregnancy because of the risk of cholestatic hepatitis. Other forms of erythromycin are safer for use in pregnancy. Tetracyclines are category D and estrogens are category X. NSAIDS may promote persistent fetal circulation or oligohydramnios.
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26
Q 
For which of the following medications is abdominal cramping and watery diarrhea a very common side effect that may limit treatment?
1		Colchicine
2		Gold
3		Potassium iodide
4		Thalidomide
5		Chlorambucil
A

1 Colchicine
Colchicine is an alkaloid with antimitotic activity that is used in dermatology for its effects on neutrophils. The most common side effect from colchicine use is gastrointestinal distress with abdominal cramping and watery diarrhea.

27
Q 
Which one of the following agents when used prophylactically has demonstrated efficacy in reducing skin cancer in organ transplant patients?
1		Tacrolimus
2		Acitretin
3		Imiquimod
4		Interleukin-2
5		Cyclosporine
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A

2 Acitretin
Systemic retinoids like acitretin have been used in the chemoprophylaxis of skin cancers. Several studies have suggested a beneficial effect of retinoids with lowered incidences of skin cancer. However, following cessation of the retinoids, the incidence normalizes.
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28
Q 
Which of the following medications is most likely to have caused this reaction?
1		Pseudoephedrine hydrochloride
2		Vancomycin
3		Lithium
4		ACE inhibitor
5		Diclofenac
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A

Pseudoephedrine hydrochloride
Fixed drug eruptions occur 30 mintues to 8 hours after ingestion of offending agent. After rechallenge with the same agent, the fixed drug eruption will recur. Potential causes of a fixed drug eruption include analgesics, sulfonamides, barbituates, pseudoephedrine and anticonvulsants.

29
Q 
Which of the following is considered most safe in pregnancy?
1		Benzoyl peroxide
2		Epinephrine
3		Methotrexate
4		Azelaic Acid
5		Isotretinoin
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A

4 Azelaic Acid
Azelaic Acid is pregnancy category B. The other choices are in less safe pregnancy categories. Epinephrine is category C, Benzoyl peroxide is category C, and Methotrexate and Isotretinoin are category X.
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30
Q 
Which of the following is a potentially irreversible ocular side effects of antimalarial agents?
1		Corneal deposition - 
                causing halos, blurred 
                vision, photophobia
2		Neuromuscular eye 
                toxicity
3		Retinopathy
4		Cataracts
5		Pterygium
A

3 Retinopathy
Three types of ocular adverse effects may develop from antimalarials: corneal deposits, neuromuscular eye toxicity and retinopathy. Only retinopathy is potentially irreversible. It is recommended that a patient be evaluated for retinopathy at baseline, then every 6 months by an ophthamologist. Testing visual acuity, visual fields and performing a funduscopic examination are considered acceptable for screening purposes.
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31
Q 
The anti-viral agent used most often for acyclovir-resistent HSV and VZV infections is:
1		Valacyclovir
2		Gancyclovir
3		Foscarnet
4		Famcyclovir
5		Pencyclovir
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A

3 Foscarnet
Foscarnet does not require phosphorylaton for antiviral activity. Thereofre, it is achieve against viruses resistant to acyclovir, famcyclovir, or gancyclovir on the basis of altered-kinase activities.
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32
Q 
What is used to reduce bladder toxicity from cyclophosphamide?
1		Mesna
2		Leukovorin
3		Cimetidine
4		Vitamin E
5		Folic acid
A

1 Mesna
Mesna or sodium 2-mercptoethanesulfonate, has been used to reduce bladder toxicity from cyclophosphamide.
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33
Q 
Hemorrhagic cystitis is a risk of what chemotherapy?
1		Chlorambucil
2		Cyclophosphamide
3		Vinca alkaloids
4		Hydroxyurea
5		Azaithioprine
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A

2 Cyclophosphamide
Bladder toxicity is due to the acrolein metabolite of cyclophosphamide. Hemorrhagic cystitis is associated with the increased risk of transitional cell carcinoma of the bladder. Mesna has been used to reduce the toxic effect. The risk of cystitis is avoided by adequate fluid intake, frequent voiding, and careful screening for hematuria.

34
Q 
Treatment with isotretinoin has been shown to cause increased colonization of the skin with which of the following organisms?
1		Streptococcus pyogenes
2		Pseudomonas aeruginosa
3		Staphylococcus aureus
4		Pityrosporum orbiculare
5		Demodex folliculorum
A

3 Staphylococcus aureus
Staphylococcus aureus colonization tends to correlate with isotretinoin-induced reduction in sebum production and may lead to infections. This complication may possibly be prevented with pulsed intranasal mupirocen therapy. There has been a report of staphylococcus endocarditis in a patient with underlying aortic insufficiency.
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35
Q 
Which drug has mucocutaneous side effects which can include stomatitis, chelitis, lichen planus-like eruptions, and pityriasis rosea-like eruptions?
1		Colchicine
2		Gold
3		Potassium iodide
4		Thalidomide
5		None of the above
A

2 Gold
Mucocutaneous side effects, which are more common with injectable gold, include stomatitis, cheilitis, lichen planus-like eruptions, and pityriasis rosea-like eruptions.
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36
Q 
Which cutaneous side effect is a common complication of nitrogen mustard therapy?
1		Bullous drug eruption
2		Telangiectasia
3		Hyperpigmentation
4		Allergic contact dermatitis
5		Fixed drug eruption
  Q/Q(M)-477136  Report a Problem
A

4 Allergic contact dermatitis
Topical nitrogen mustard, or mechlorethamine, is an antineoplastic agent which works via alkylation thereby inhibiting DNA synthesis. Allergic contact dermatitis occurs in two-thirds of patients who are treated with topical nitrogen mustard in aqueous solution, but occurs in less than 5% of patients treated with the ointment based preparation.

37
Q 
Which of the following is the most common adverse effect of Thalidomide therapy?
1		Diarrhea
2		Sedation
3		Skin discoloration
4		Photosensitivity
5		Hypertension
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A

2 Sedation
Thalidomide was introduced in the late 1950’s as a “safe” sleeping aide. It readily penetrates the CNS, where it exerts a hyposedative effect comparable with barbiturates. By far, the most common adverse effect from thalidomide is sedation, which in many patients may require that primarily night-time doses be utilized.
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38
Q 
Which biologic agent is infused intravenously?
1		Alefacept
2		Etanercept
3		Efalizumab
4		Infliximab
5		None of these answers are correct
A

4 Infliximab
Infliximab is infused intravenously.
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39
Q 
Extension of this blister by application of perpendicular pressure is an example of what?
1		Fitzpatrick sign
2		Nikolsky sign
3		Asboe-Hansen's sign
4		Hutchinson's sign
5		Gorlin's sign

Add photo
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A

3 Asboe-Hansen’s sign
Toxic epidermal necrolysis is a serious and potentially life threatening reaction to medications. The most commonly implicated medications include penicillins, NSAIDS, and anti-convulsants. Asboe-Hansen’s sign results in extension of a blister with perpendicular pressure. Nikolsky sign is the separation of epidermis from the dermis by application of tangential mechanical pressure.

40
Q 
Which biologic agent is administered intramuscularly?
1		Alefacept
2		Efalizumab
3		Etanercept
4		Infliximab
5		None of the above
A

1 Alefacept
Alefacept is given intramuscularly.
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41
Q 
What is the best medication to lower isotretinoin induced hypertriglyceridemia?
1		Simvastatin
2		Gemfibrozil
3		Niacin
4		Cholestyramine
5		All are equally effective
  Q/Q(M)-476701  Report a Problem
A

2 Gemfibrozil
Gemfibrozil generally reduces trygliceride levels to a greater extent than niacin, cholestyramine, and the HMG-CoA reductase inhibitors.
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42
Q 
Which chemical sunscreen has UVB and UVA II absorption capability?
1		Methyl anthranilate
2		Oxybenzone
3		Octyl salicylate
4		Titanium dioxide
5		Padimate O
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A

2 Oxybenzone
The benzophenones, oxybenzone and dioxybenzone, have the broadest absorption spectrum of the chemical sunscreens, with UVB and UVA II range. Methyl anthranilate absorbs UVA II, and octyl salicylate, and padimate O are UVB-absorbing chemicals. Titanium dioxide is not a chemical absorber, it is a physical blocker.
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43
Q 
Which of the following medications can lead to hematologic toxicity when combined with methotrexate?
1		Trimethoprim
2		Sulfonamides
3		Dapsone
4		All of these answers are 
                correct
5		None of these answers 
                are correct
  Q/Q(M)-475208  Report a Problem
A

4 All of these answers are correct
All of the above inhibit the folic acid metabolic pathway, and can lead to hematologic toxicity when combined with methotrexate.
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44
Q 
Which of the following drugs may cause acute generalized exanthematous pustulosis?
1		Ampicillin
2		Azithromycin
3		Cefazolin
4		Mercury
5		All of these answers are 
                correct
  Q/Q(M)-475924  Report a Problem
A

5 All of these answers are correct
Acute generalized exanthematous pustulosis (AGEP) has been associated with beta-lactam antibiotics, macrolide antibiotics, cephalosporins, and mercury.

45
Q 
Over use of of which medication may lead to this clinical image?
1		Topical steroid
2		Topical antibiotic
3		Calcipotriene
4		Imiquimod
5		Hydroquinone

Add photo
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A

5 Hydroquinone
Exogenous ochronosis has been reported with prolonged use of high concentration hydroquinone. On pathology, a characteristic ochre colored deposit is noted between the collagen bundles.

46
Q 
Which of the following chemotherapeutic agents causes increased growth of eyelashes?
1		Interleukin 2
2		Interferon alpha
3		Mitomycin
4		Cytarabine
5		Methotrexate
  Q/Q(M)-476709  Report a Problem
A

2 Interferon alpha
Interferons can cause increased growth of eyelashes. Trichomegaly has been reported after treatment with interferon-alpha in patients with chronic hepatitis, B-cell lymphoma, chronic granulocytic leukemia, and cutaneous melanoma. Trichomegaly has also been reported in associatoin with latanoprost, minoxidil, cyclosporine, phenytoin, psoralen, and penicillamine.
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47
Q 
Which one of the following antifungals requires an acidic environment for its absorption?
1		amphotericin B
2		fluconazole
3		griseofulvin
4		terbinafine
5		itraconazole
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A

5 itraconazole
Itraconazole is a triazole whose mechanism, like the other azoles, is inhibition of cytochrome P-450 enzyme lanosterol 14-alpha demethylase, with resultant inhibition of lanosterol conversion to ergosterol. Ergosterol is an essential component of fungal cell membranes. Itraconazole is a weak base, which is highly lipophilic and virtually insoluble in water. It is ionized only at a low pH. Griseofulvin is administered in divided doses for the treatment of tinea capitus. Its absorption is optimized when given with a fatty food. Oral fluconazole is very well absorbed when given orally with over 90% bioavailability. Terbinafine, though highly lipophilic, has 70 to 80% absorption, when administered orally, with a bioavailability not significantly impacted by food intake.
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48
Q 
Which of the following cytotoxic agents has been associated with poikiloderma of the dorsal hands with a band-like distribution of the fingers and toes?
1		Intralesional bleomycin
2		Doxorubicin
3		Flurouracil
4		Azathioprine
5		Hydroxyurea
A

5 Hydroxyurea
Hydroxyurea has been associated with poikiloderma of the dorsal hands with a band-like distribution of the fingers and toes. It has also been associated with diffuse hyperpigmentation, and with leg ulcers upon withdrawal.

49
Q 
Penile erosions are a reported side effect associated with which medication?
1		Trimethoprim-sulfamethoxazole
2		Acyclovir
3		Foscarnet
4		Azaithioprine
5		Bleomycin
A

3 Foscarnet
Genital ulcers have been reported as a complication of foscarnet therapy.
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