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DERMPHARM > Pharm 101 - 150 > Flashcards

Pharm 101 - 150 Flashcards

1
Q

At standard dosages, which of the following is fungicidal?
1 Terbinafine
2 Fluconazole
3 Ketoconazole
4 Itraconazole
5 Griseofulvin

A

Terbinafine block ergosterol synthesis early in the synthetic pathway by inhibitins squalene epoxidase. Squalene then accumulates within fungal cells and discupts cell membranes. At standard dosaging, it is believed to be fungicidal. The other choices are fungistatic.
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2
Q

The mechanism action of this cytotoxic agent is via inhibition of IMP dehydrogenase.
1 Azathioprine
2 Methotrexate
3 Hydroxyurea
4 5-fluorouracil
5 Mycophenolate mofetil

A 
Mycophenolate mofetil (cellcept), a purine analog, blocks de novo purine synthesis by inhibiting the enzyme inosine monophosphate dehydrogenase.
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3
Q

Which of the following antifungal agent works by way of inhibiting ergosterol synthesis by blocking squalene epoxidation:
1 Itraconazole
2 Terbinifine
3 Naftifine
4 Itraconazole and Terbinifine
5 Terbinifine and Naftifine

A

Terbinafine and Naftifine work by way of inhibiting ergosterol synthesis by blocking squalene epoxidation (B&C). Itraconazole works by inhibiting ergosterol synthesis by blocking Lanosterol 14-alpha demthylase.
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4
Q

Which of the following medicines reduces the formation of methemoglobin?
1 Dapsone
2 Cimetidine
3 Azathioprine
4 Cyclosporine
5 Rifampin

A

Cimetidine and vitamin E can reduces the formation of methemoglobin, thereby increasing tolerance to dapsone which can lead to methemoglobinemia. Azathioprine can cause hepatitis, lymphoproliferative malignancy, infections, and hypersensitivity syndrome. Cyclosporine can lead to renal dysfunction, hypertension, and ginvigal hyperplasia. Rifampin can cause decreased effectiveness of oral contraceptives.
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5
Q

A patient is taking 15 mg of methotrexate each week for psoriasis. Which of the following medications would be safe for use in this patient?
1 Tetracyclines
2 Phenytoin
3 Ibuprofen
4 Aspirin
5 Acetaminophen

A

Methotrexate is a S-phase specific antimetabolite which competitively and irreversibly blocks dihydrofolate reductase from catalyzing the formation of tetrahydrofolate, an important cofactor in thymidylate and purine synthesis. Tetracyclines, phenytoin, phenothiazines, chloramphenicol, NSAIDs, salicylates, and sulfonamides can all increase methotrexate levels by displacement of plasma proteins. Acetaminophen is safe for concurrent use with methotrexate.
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6
Q

Concomitant administration of retinoid or ketoconazole with doxorubicin may lead to which side effect?
1 Dermatomyositis-like reaction
2 Papulopustular eruption
3 Capillary leak syndrome
4 Sticky skin
5 Leg ulcers

A

Doxorubicin when given with retinoids or ketoconazole may lead to sticky skin. A dermatomyositis-like reaction and leg ulcers may be seen with hydroxyurea. Epidermal growth factor receptors such as erlotinib and cetuximab can produce papulopustular eruptions. Capillary leak syndrome is seen with interleukins.
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7
Q

Which one of the following sunscreens has an absorption spectrum primarily in the UVA range?

1 Padimate O
2 Octyl Salicylate
3 Parsol 1789 (butyl dibenzoylmethane)
4 PABA (para-aminobenzoic acid)
5 Cinnamates

A

Avobenzone (Parsol 1789) is primarily a UVA blocker. Photostability of avobenzone may be a problem if it is combined with octyl methoxycinnamate. Salicylates, PABA, Padimate O, and cinnamates are primarily UVB blockers.
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8
Q

What is the most common cause of nonpigmented fixed drug eruption?
1 Naproxen
2 Tetracycline
3 Sulfonamides
4 Phenolphthalein
5 Pseudoephedrine

A

Pigmented incontinence is usually prominent in a fixed drug eruption; yet occasionally, fixed drug reactions do not result in long-lasting hyperpigmentation. The so-called nonpigmented fixed drug eruption is distictive. Pseudoephedrine hydrochloride is by far the most common cause.
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9
Q

Which of the following inhibits bacterial cell wall synthesis by complexing with the carrier protein C55-prenol pyrophosphatase.
1 Bacitracin
2 Polymyxin
3 Neomycin
4 Mupirocin
5 Silver sulfadiazine

A

Bacitracin is a polypeptide antibiotic produced by the Tracey I stain of Bacillus subtilis. It inhibits bacterial cell wall synthesis by complexing with the carrier protein C55-prenol pyrophosphatase, which is involved in the transfer of polysaccharides, liposaccharides, and peptidoglycans to a growing cell wall.
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10
Q

In addition to minocycline, which of the following drugs has been associated with drug-induced lupus erythematosus-like syndrome?
1 Amiodarone
2 Itraconazole
3 Rifampin
4 Doxycycline
5 Hydralazine

A

Drugs associated with drug-induced SLE include minocycline, hydralazine, procainamide, isonaizid, penicillamine, and anti-convulsants.
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11
Q

What drug can potentiate bone marrow suppression when used concomitantly with azathioprine?
1 NSAIDS
2 Salicylates
3 Sulfonamides
4 Phenytoin
5 Allopurinol

A

Concomitant allopurinol use, which inhibits xanthine oxidase, can lead to excess toxic purine analogs via increased metabolism of azaithioprine via the HGPRT pathway, causing bone marrow suppression.
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12
Q

What is the treatment of choice for methemoglobinemia?
1 Methylene blue
2 Aspirin
3 Iron
4 Hydration
5 Observation

A

Methylene blue is reduced in the presence of NADPH and diaphorase II to leukomethylene blue, which then reduces methemoglobin (Fe3+) to hemoglobin (Fe2+)
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13
Q

Onycholysis is a potential side effect of treatment with which therapy?
1 Dapsone
2 Ketaconazole
3 Chloroquine
4 Tetracycline
5 Retinoids

A

Tetracycline has been associated with onycholysis and photo-onycholysis. Chloroquine may cause a blue-brown discoloration of the nail bed and retinoids are associated with paronychia.
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14
Q

Peak vulnerability to thalidomide occurs between which days of gestation?
1 Days 1-14
2 Days 15-20
3 Days 21-36
4 Days 37-56
5 Days 57-70

A

Peak vulnerability to thalidomide occurs between days 21 to 36 of gestation, during which only a single dose will cause birth defects to occur. Birth defects associated with thalidomide include phocomelia (underdevelopment of arms and legs, the most common birth defect), ear malformation, and gastrointestinal and urogenital defects.
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15
Q

A patient presents with a likely fixed drug eruption. Her medications include glyburide, lisinopril, hydrochlorthiazide, and aspirin, as well as an over-the-counter laxative. Which is the most likely culprit?
1 Glyburide
2 Lisinopril
3 Hydrochlorthiazide
4 Aspirin
5 Laxative

A

Phenopthalein, found in laxatives, is a known cause of fixed drug eruptions.
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16
Q

Which of the following medications used in dermatology is known to increase the risk for bone fractures?
1 Dapsone
2 Isotretinoin
3 Acitretin
4 Prednisone
5 Doxycycline

A

Long term use of oral corticosteroids has been shown to decrease bone mineral density (BMD). This decrease in BMD leads to an increased risk for fractures. It was originally thought that Vitamin A analogues such as isotretinoin and acitretin may also increase the risk of fracture but in a large case-controlled study published in the May 2010 Archives illustrates that risk of fracture is not associated with Vitamin A analogues. Vitamin A analogues have been associated with hyperostosis.
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17
Q

Which of the following is an adverse effect of oral retinoid therapy?
1 Mania
2 Fibroydysplasia ossicficans progressiva
3 Vascular calcification
4 Hypertension
5 Hypertrichosis

A

Adverse effects of oral retinoid therapy: Cutaneous: Xerosis, palmoplantar digital desquamation, retinoid dermatitis, photosensitivity, pyogenic granulomas, stickiness sensation, Staph aureus infxns Hair: Teolgen effluvian, abnormal hair texture, dryness Nails: Fragility with nail softening, paronychia, onycholysis Occular: Dry eyes w/visual blurriness, Blepharoconjunctivitis, Photophobia Oral: Cheilitis, dry mouth, sore mouth and tongue Nasal: Nasal mucosal dryness, decreased mucous secretion, epistaxis Musculoskeletal: Arthralgias, myalgias, fatigue and muscle weakness, tendinitis Neurological: Headache, mild depression Gatrointestinal: N/V/D, adb pain
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18
Q

Which of the following statements regarding antifungal medications is TRUE?
1 Griseofulvin is safe for patients with variegate porphyria
2 Ketoconazole has been associated with gynecomastia
3 Griseofulvin is a cytochrome P450 3A4 inhibitor
4 Terbinafine is fungistatic
5 Ketoconazole is fungicidal

A

Medications that can precipitate acute attacks in variegate porphyria include barbiturates, estrogen, griseofulvin, sulfonamides and ethanol. Ketoconazole can produce impotence and gynecomastia by interfering with androgen synthesis. Ketoconazole inhibits cytochrome (CYP) P450 and most concerning, can rarely cause fulminant hepatitis. Griseofulvin induces CYP P450, not inhibits it. Terbinafine is fungicidal along with amphotericin B. Ketoconazole is fungistatic.
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19
Q

Which of the following is NOT known to increase methotrexate levels?
1 Salicylates
2 Tetracyclines
3 Phenothiazines
4 NSAIDs
5 None of these answers are correct(all are known to increase methotrexate levels)

A

Tetracyclines, phenytoin, phenothiazines, chloramphenicol, NSAIDs, salicylates, and sulfonamides, among other drugs, can all increase methotrexate levels by displacement of plasma proteins.
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20
Q

Which of the following medications is most likely to result in increased carbamazepine levels?
1 Minocycline
2 Rifampin
3 Erythromycin
4 Azithromycin
5 TMP-SMX

A

Eythromycin inhibits the hepatic cytochrome P450 system and can increase serum levels and potential toxicities of carbamazapene, theophylline, warfarin, digoxin, methylprednisolone.
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21
Q

Which of the following agents is NOT a UVB blocker?
1 Sulisobenzone
2 PABA
3 Cinnamates
4 Salicylates
5 Padimate A

A

Sulisobenzone is a benzophenone, a UVA blocker. The others are UVB blockers. Padimate A is a PABA derivative.
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22
Q

Which drug is known to cause an SCLE-like eruption?
1 Captopril
2 Minocycline
3 Barbituates
4 Furosemide
5 Terbinafine

A

SCLE-like reaction are known to occur most likely from glyburide, griseofulvin, hydrochlorothiazide, penicillamine, piroxicam, and terbinafine.
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23
Q

The treatment of choice for scabies in pregnant women is:
1 Malathion
2 1% permethrin
3 Thiabendazole
4 Precipitated sulfur 6%
5 Ivermectin

A

Many authors consider precipitated sulfur to be the drug of choice for the treament of scabies in pregnant women, although there are no published studies for this indication (see Wolverton). Permethrin of note is category B in pregnancy.
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24
Q

Which of the following drugs has been known to cause penile erosions?
1 Gancyclovir
2 Cidofovir
3 Foscarnet
4 Penciclovir
5 Abacavir

A

Foscarnet has been reported to cause penile erosions.
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25
Q

Which of the following antifungal agents is contraindicated in patients with a history of porphyria?
1 Griseofulvin
2 Ketoconazole
3 Fluconazole
4 Itraconazole
5 Terfinafine

A

Griseofulvin has been reported as a potential exacerbator of acute intermittent porphyria, and thus is contraindicated in patients with a history of porphyria.
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26
Q

The laboratory abnormality most associated with cyclosporine is:
1 Hypermagnesemia
2 Hyponatremia
3 Hyperkalemia
4 Hypouricemia
5 Increased LDH

A

The laboratory abnormalities associated with cyclosporine are decreased magnesium, increased potassium, and increased uric acid. Renal function and blood pressure must also be monitored closely in patients using cyclosporine.
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27
Q

Which of the following medications is associated with painful symmetrical erythema and paresthesias of the palms and soles?
1 sorafenib
2 cetuximab
3 bortezomib
4 erlotinib
5 gefitinib

A

Sorafenib is a small-molecule multi-kinase inhibitor used in the treatment of renal cell cancer and hepatocellular cancer. Notably it inhibits Raf kinase, which functions in the Ras signaling pathway, in addition to blocking VEGFR-2, VEGFR-3, FLT3, and PDGFRb signaling. Reports of hand and foot syndrome have been noted, characterized by acral erythema and paresthesias. This side effect seems to resolve rapidly after discontinuation of treatment.
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28
Q

A patient being treated for aspergillosis develops altered vision. What is the most likely medication he is taking?
1 Caspofungin
2 Voriconazole
3 Amphotericin B
4 Itraconazole
5 Griseofulvin

A

Voriconazole blocks ergosterol synthesis by inhibiting 14-alpha-demethylase. Side effects include visual disturbances in 30%, headaches, nausea, vomiting, fever, and peripheral edema.
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29
Q

Which antifungal medication has a black box warning for CHF?
1 Terbinafine
2 Griseofulvin
3 Itraconazole
4 Ketoconazole
5 Caspofungin

A

Itraconazole should be avoided in heart patients due to its black box warning against CHF. Other reported adverse effects from itraconazole include photosensitivity and COPD.
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30
Q

Which drug has recently been shown to be of use in chemoprevention of squamous cell carcinoma in recessive dystrophic epidermolysis bullosa:
1 Isotretinoin
2 Cyclosporine
3 Mycophenolate mofetil
4 Methotrexate
5 Topical tar

A

Despite low therapeutic responses of advanced cancers to retinoids, these drugs appear to have a promising role in chemoprevention. Patients with oral leukoplakia, actinic keratoses, arsenic keratoses, and Bowen’s disease can benefit from retinoid therapy.
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31
Q

Which one of the following sites has the highest percutaneous absorption of topical drugs?
1 Scrotum
2 Eyelid
3 Chest
4 Acral area
5 Mucous membrane

A

Mucous membranes have the highest absorption of topical medicines. Percutaneous absorption, from highest to lowest, is as follows: mucous membrane > scrotum > eyelids > face > chest and back > upper extremity > lower extremity > acral.
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32
Q

A 40 year old man with acute promyelocytic leukemia develops scrotal ulcers 1 month after starting therapy. All tests for STD causes of ulcers as well as CMV and EBV are negative. What is the most likely cause?
1 All-trans retinoic acid
2 Daunorubicin
3 Methotrexate
4 6-mercaptopurine
5 Cytarabine

A

All-trans-retinoic acid (ATRA) has been shown to improve the outcome of patients with acute promyelocytic leukemia (APL). However, various adverse effects of ATRA treatment have been noted, such as scrotal and genital ulcers.
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33
Q

Tazarotene is what category for safety in pregnancy?
1 Category A
2 Category B
3 Category C
4 Category D
5 Category X

A

Category X drugs include: acitretin, etretinate, estrogens, finasteride, 5-fluorouracil, flutamide, isotretinoin, methotrexate, stanozolol, thalidomide, and tazarotene.
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34
Q

Which site of the body has the highest penetration ability when topical medications applied
1 Face
2 Eyelids
3 Scrotum
4 Mucous membrane
5 Upper arms and legs

A

Drug penetration varies depending on body site and thickness of stratum corneum. An important consideration in topical therapy is that abnormal skin may have an altered (increased, decreased, or absent) stratum corneum, thus changing the body site’s barrier function. Regional penetration of topical therapy is ranked from highest penetration to less penetration as following: Mucous membrane > scrotum > eyelids > face > chest and back > upper arms and legs > dorsal hands and feet > palms and soles > nails
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35
Q

Bone marrow suppression can occur more often in individuals taking azathioprine with genetically low allele activity of what enzyme?
1 Inosine monophosphate dehydrogenase
2 Thiopurine methyltransferase
3 Glucose-6-phosphatase
4 Dihydrofolate reductase
5 Epoxide hydroxylase

A

Thiopurine methyltransferase is one of three enzymes that metabolize azathioprine along with xanthine oxidase and HGPRT. Decreased activity of TPMT leads to heightened metabolism by HGPRT into the active 6-thioguanine. This may lead to increased toxicity including bone marrow suppression.
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36
Q

What family of medications is associated with xerosis?
1 Sulfonylureas
2 Beta blockers
3 Calcium channel blockers
4 Loop diuretics
5 Cholesterol lowering agents

A

Medications that alter the lipid composition of the epidermis and stratum corneum may impair the normal barrier function of the skin. Cholesterol lowering medications like HMG-CoA reductase inhibitors and niacin may cause xerosis through this mechanism.
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37
Q

Which of the following supplements is most likely to decrease hemolysis associated in patients taking dapsone?
1 Vitamin A
2 Vitamin B6
3 Folic acid
4 Vitamin D
5 Vitamin E

A

Adverse effects from dapsone are both pharmacologic and idiosyncratic and include hemolytic anemia, methemoglobinemia, agranulocytosis, hypersensitivity syndrome and neuropathy. Of these, the first two are pharmacologic and anticipated, to some degree, in most patients treated with dapsone. However, the magnitude of toxicity varies greatly among individuals on the drug. Methemoglobinemia is the formation of methemoglobin in the blood, which has a decreased oxygen-carrying capacity compared with hemoglobin and can result in cyanosis. The reaction is related to the N-hydroxy metabolites of dapsone, which are potent oxidants. G6PD-deficient individuals are more susceptible to oxidative stresses, including those from dapsone metabolites, and a baseline G6PD level is recommended prior to initiation of dapsone therapy. Vitamin E (800 IU/day) has been shown to provide a small amount of protection against methemoglobinemia and hemolysis, however, the clinical benefit of this strategy is unclear.
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38
Q

Side effects of PUVA include all of the following except:
1 Headache
2 Pruritus
3 Neutropenia
4 Insomnia
5 Nausea

A

Side effects of psoralen with ultraviolet A light (PUVA) include side effects which are due to phototoxic effects including pruritus, photoonycholysis, friction blisters, ankle edema and hypertrichosis. In addition, there are adverse effects from methoxypsoralen including gastrointestinal and neurologic effects, hepatotoxicity and exanthems. Neutropenia is not a described side effect of PUVA.
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39
Q

The combination of doxorubicin and which medications has been reported to cause sticky skin?
1 Vancomycin
2 Amphotercin
3 Ketoconazole
4 G-CSF
5 Cisplatin

A

Polsen et. al. reported a 29% incidence of sticky skin in patients treated with high dose ketoconazole and doxorubicin for prostate cancer. Other medications reported to cause this include etretinate and tretinoin. Polsen JA, Cohen PR, Sella: Acquired cutaneous adherence in patients with androgen-independent prostate cancer receiving ketoconazole and doxorubicin: medication-induced sticky skin. J Am Acad Dermatol: 32 (4):571-5 1995
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40
Q

What antihistamine can cause gynecomastia, impotence, and loss of libido?
1 Cyproheptadine
2 Chlorpheniramine
3 Cimetidine
4 Doxepin
5 Fexofendine

A

Cimetidine competitively inhibits dihydrotestosterone at the androgen receptor site and can exhibit anti-androgen effects.
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41
Q

Which of the following medications would be safe for use in pregnancy?
1 Tazarotene
2 Finasteride
3 Etretinate
4 Azeleic acid
5 5-fluorouracil topically

A

All of the listed medications except azeleic acid are pregnancy category X. Azeleic acid is a pregnancy category B medication, meaning that there are controlled human studies that show no risk to fetus but may show risk to animals, or no risk in animals with no human studies conducted.
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42
Q

Fomivirsen is a single-stranded antisense oligonucleotide FDA-approved for the treatment of:
1 HSV infection
2 HIV infection
3 EBV infection
4 CMV infection
5 HPV infection

A 
Fomiversen (Vitraene) represents a new class of therapeutic agents known as antisense drugs. It is indicated for the treatment of CMV retinitis in patients with AIDS. The most common adverse effects are ocular inflammation and increases in intraocular pressure.
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43
Q

What drug is known to cause scotomas?
1 Dapsone
2 Isotretinoin
3 Quinacrine
4 Chloroquine
5 Gold

A

True retinopathy is associated with “bull’s eye” pigment deposition, central scotoma, and diminished visual acuity. Chloroquine is at greatest risk of causing retinopathy. Quinacrine is not associated with the risk of retinopathy.
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44
Q

Combination oral contraceptives decrease free testosterone levels by:
1 Directly binding free testosterone
2 Increasing SHBG (sex hormone binding globulin) production
3 Acting as competitive inhibitors of the androgen receptor
4 Acting as a GnRH agonist
5 Acting as a GnRH antagonist

A

Oral contraceptives decrease free testosterone levels by increasing the production of sex hormone binding globulin (SHBG).
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45
Q

Which of the following chemotherapeutic agents has been linked to acneiform eruptions?
1 Bleomycin
2 Cytarabine
3 Cisplatin
4 Doxorubicin
5 Cetuximab

A

Cetuximab is a chimeric anti-epidermal growth factor receptor antibody that is FDA approved to treat advanced colorectal cancer. Acneiform eruptions have been reported to occur in up to 1/3 of patients.
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46
Q

Which biologic agent blocks T-cells from egressing the vasculature and entering the skin?
1 Alefacept
2 Etanercept
3 Efalizumab
4 Infliximab
5 None of the above

A

Efalizumab blocks LFA-1 on T-cells from interacting with ICAM-1 on antigen presenting cells, endothelial cells, and cells in the dermis and epidermis. It thus blocks T-cells from egressing the vasculature and entering the skin.
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47
Q

Which of the following chemotherapeutic agents is not cell cycle specific?
1 Methotrexate
2 5-fluorouracil
3 Cyclophosphamide
4 Azathioprine
5 Hydroxyurea

A

Cyclophosphamide is an alkylating agent that cross links DNA at any point during the cell cycle. Methotrexate, 5-fluorouracil, azathioprine, and hydroxyurea are S-phase specific cytotoxic agents. Methotrexate is a folic acid analog that blocks dihydrofolate reductase. 5-FU is a pyrimidine analog that prevents the conversion of deoxyuridine monophosphate to deoxythymidine monophosphate in DNA synthesis. Azathioprine is a purine analog that is converted into the active metabolite 6-thioguanine bit hypoxanthine guanine phosphoribosyltransferase. Hydroxyurea inhibits ribonucleotide reductase which normally converts ribonucleotides to deoxyribonucleotides in DNA synthesis.
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48
Q

Which of the following is not a side effect of bleomycin?
1 Erythromelalgia
2 Pulmonary fibrosis
3 Flagellate hyperpigmentation
4 Serpentine supravenous hyperpigmentation
5 Acrosclerosis

A

All of the above are side effects of bleomycin except serpentine supravenous hyperpigmentation. This is a side-effect of 5-fluorouracil.
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49
Q

Which antiparasitic agent acts by inhibiting fumarate reductase?
1 Ivermectin
2 Lindane
3 Permethrin
4 Thiabendazole
5 Cidofovir

A

Thiabendazole inhibits fumarate reductase, a helminth-specific enzyme. It is used to treat creeping eruption or cutaneous larva migrans and larva currens. Ivermectin blocks glutamate-gated chloride ion channels, and is used to treat strongyloidiasis, onchocerciasis, and Norwegian scabies. Lindane is an organochloride which blocks neural transmission, and is effective against scabies, pubic lice, head lice, and body lice. Permethrin disables sodium transport channels in the nerve cell membrane of the parasite. Cidofovir is an antiviral nucleotide analogue.
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50
Q

You see a patient with dark streaking in the nails, diffuse and oral hyperpigmented macules and trichomegaly. Which of the following medication are they taking?
1 Imatinib
2 Zidovudine
3 Hydroxyurea
4 Cyclophosphamide
5 Bleomycin

A

All of the listed medications have been reported to cause nail hyperpigmentation, but the addition of oral hyperpigmented macules and trichomegaly (lengthened anagen phase of the eyelashes). AZT can also cause bone marrow suppression with subsequent anemia and granulocytopenia.
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