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Pharm Flashcards

1
Q

What is the DOC for Primary Syphilis: Treponema palladium infections?

A

Benzathine Pen G

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2
Q

DOC for Chlamydia infection?

A

Azithromycin

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3
Q

DOC for Gonococcal infection?

A

Ceftriaxone

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4
Q

What is the DOC for Trichomniasis?

A

Metronidazole

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5
Q

What is the DOC for Bacterial vaginosis?

A

Metronidazole

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6
Q

Bioavailability of Acyclovir is dependent on?

A

DOSE
Higher dose= lower BA
Lower dose= Higher BA

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7
Q

MOA: competitively inhibits viral DNA poly by competing with Deoxyguanosine triphosphate for incorporation into viral DNA?

A

Acyclovir
Famciclovir
Valacyclovir

Do NOT cause chain termination

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8
Q

What drug is de-acetylated into penicyclovir its active metabolite?

A

Famciclovir

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9
Q

What are the AE for Acyclovir?

A

Neurotoxic= Seizures
Renal failure= insoluble @ high doses
Pt must HYDRATE

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10
Q

What is the function of “Benzathine” preparation of Pen G for Syphilis tx?

A

IM to all for Drug depot and slow release

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11
Q

Poor CSF penetration
Rapid renal elimination via tubular excretion
Hypersensitivity?

A

Pen G

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12
Q

DOC and preparation for Congenital syphilis?

A

Aqueous crystalline Pen G

Procaine Pen G

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13
Q

What is a Jarisch- Herxheimer rxn?

A

Chills, fever, headache, myalgias, arthralgias and more prominent Syphilitic lesions following Penicillin G administration
Caused by Release of Spirochete antigens and host rxn
DO NOT discontinue Pen G

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14
Q

What drug is given for symptomatic relief of Jarisch Herxheimer rxn?

A

Aspirin

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15
Q

MOA of Azithromycin?

A

Binds 50s ribosomal subunit: bacteriostatic

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16
Q

MOA of Doxycycline?

A

Binds 30s subunit: Bacteriostatic

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17
Q

MOA of Levofloxacin?

A

Inhibit DNA gyrase (topo II) in G-; CIDAL

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18
Q

MOA of Ofloxacin?

A

Inhibits topo IV in G+: CIDAL

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19
Q

AE of Azithromycin?

A

GI

Vaginitis

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20
Q

AE of Doxycycline?

A

GI
Hepatic damage
Photosensitivity
Teratogen (D)

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21
Q

AE of Erythromycin?

A

GI
Inhibits CYP3A4
Cholestatic jaundice

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22
Q

AE of Floxacins?

A

Taste disturbance
BBW: tendonitis/ rupture + muscle weakness
Avoid with Myasthenia gravis

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23
Q

Ceprofloxacin is CI in?

A

Pregnancy and lactation

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24
Q

MOA of Ciprofloxacin?

A

Bacteriocida beta lactam: binds PBPs causing cell lysis

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25
What Antibiotic inhibits CYP1A2?
Cipro
26
Antibiotics with LONG t1/2, extensive tissue uptake & slow release, Mostly eliminated in Stool?
Azithromycin | Doxy
27
Antibiotics with SHORT t1/2, Base form readily inactivated by gastric acid. Estolate preps are stable and are liberated into base upon absorption from upper Intestine, Mostly eliminated in stool?
Erythromycin
28
Antibiotics with Medium t1/2 that is Prolonged in RENAL dysfunction?
FLoxacins
29
Associated with hypertrophic pyloric stenosis in neonatal exposure?
Erythromycin
30
What antibiotic is distributed to tissues, bodily fluids, secretions, Renal elimination, does NOT cross placenta, but may get into Breast milk causing infant diarrhea, candidiasis, skin Rash>
Amoxicillin
31
MOA of Ceftraixone?
Bacteriocidal Beta lactam: binds PBP causing cell lysis
32
MOA of cipro?
Bactiocidal G-= inhibits TOPO II G+= Inhibits TOPO IV Widely distributed Esp Genital fluids
33
Elimination route for Ceftriaxone?
Urine by GF
34
Elimination of Cipro?
Hepatic metabolism to active metabolite Renal elimination 2/3 Stool 1/3
35
AE of cetixime?
Diarrhea + GI Increase Clotting Time False + urine Glucose in Diabetic pts
36
MOA of Metronidazole and Tinidazole?
Amebicidal, Bactericidal, Trichomonocidal Unionize drug taken up by anaerobes= reduced to its active metabolite= Disrupts DNA Helical Structure, INHIBITS nucleic acid synthesis Equally effective agains dividing vs non dividing
37
Widely distributed, Extensive hepatic metabolism, Renal Elimination (Discolors urine) Inhibits CYP2C9?
Metronidazole
38
Widely distributed, Extensive CYP3A4 metabolism with renal Elimination (discoloring urine)?
Tinidazole
39
AE of Metronidazole and Tinidazole?
Avoid pregnancy and breastfeeding Candidiasis DISULFIRAM like effect 2nd malignancies
40
AE of Clindamycin?
Intravaginal use only in 1st trimester Can cause: low birth weight, premies, neonatal infection, Excreted in breast milk GI: diarrhea
41
Conazoles MOA?
Block ergosterol synthesis through 14-alpha demethylase (CYP that converts Lanosterol-> ergosterol)
42
Azole that is widely distributed and has RENAl elimination, inhibits CYP2C9?
Fluconazole
43
AE of Azoles?
Teratogen: high doses= abdominal wall defects, cleft palate Avoid in 1st trimester Weaken Latex condoms or diaphragms
44
What are Gardasil and Cervarix made from?
Recombinant L1 proteins= HPV capsid antigen
45
What is the HPV quadrivalent vaccine?
Gardasil (6, 11, 16, 18)
46
What is the Bivalent HPV vaccine?
Cervarix (16, 18)
47
MOA of Podofilox?
plant derived mitotic spindle inhibitor blocking microtubular activity in Keratinocytes
48
MOA of imiquimod?
Modifies immune response | Activates immune cells through Toll-like Receptor 7 = increases cytokines and immune cells
49
MOA of SInecatechins?
Green tea extract antioxidant | pain and discomfort at application site
50
What are the aromatase inhibitors?
Anastrozole Exemestane Letrozole
51
What are the SERDs & SERMs?
Rolaxifene Tamoxifene Toremifene Fulvestrant
52
What is Goserelin?
GnRH agonist
53
What are the HER-2/neu Antibodies?
Pertuzumab Trastuzumab Ado-Trastuzumab Emtasine
54
What is the TKI indicated for Tx of breast cancer?
Lapatinib
55
What is the mTOR inhibitor indicated for Breast/endometrial cancer?
Everolimus
56
What are the clinical features that warrant genetic testing for BRCA 1/2 mutations?
Early-onset breast cancer (<50) Ovarian, fallopian tube, primary peritoneal cancer Individuals with two or more primary breast cancers or breast and ovarian cancer Male breast cancer Two or more individuals in family with breast/ovarian cancer Ashkenazi Jewish ancestry
57
What Tx are recommended for premenopausal women with breast Cancer?
GnRH agonists/antagonists | Surgical excision
58
Tx for postmenopausal women with breast cancer?
SERM SERD Aromatase inhibitors
59
What is the reason that estrogen sensitivity in Tumors decreases?
Estrogen receptors can activate nuclear gene expression or act with Growth factor receptors *tumors tend to direct ER towards anther route of actions
60
MOA: selective estrogen receptor downregulator?
Fulvestrant
61
ER+ metastatic BC in postmenopausal women with progression. Pure antagonist, no Estrogenic actions?
Fulvestrant
62
What is the precise MOA of Fulvestant?
Impairs DImerization increased turnover Disrupted nuclear localization degradation--> decreases ER levels
63
What are the AE for Fulvestrant?
``` PM symptoms Nausea Asthenia Pain Vasodilation (hot flashes) Headache ```
64
ER agonist/antagonist depending on location of ER subtypes. + on bone and - on mammary glands?
Tamoxifene | Rolaxifene
65
Causes decreased bone metabolism Decreased serum LDL, cholesterol, increases Apolipoprotein-A1 Retinal Degeneration Teratogen
Tamoxifene | Rolaxifene
66
What drug has BBW for endometrial hypertrophy, vaginal bleeding, endometrial cancer?
Tamoxifene
67
What drugs have BBW for Thromboembolic disease, (DVT or PE). stroke?
Tamoxifene | Rolaxifene
68
This drug is CYP3A4 metabolized Teratogenic Prolongs QT Avoid w/ Hx of Endometrial hyperplasia + Thromboembolic disease?
Toremifene
69
AE of Torimemfene that is different from Tamoxifene?
Prolongs QT
70
Which drug is CYP2D6 metabolized?
Tamoxifene= into 4(OH) tamoxifene + Enoxifene both more active that parent drug
71
What is CYP19A1?
Aromatase
72
What is the steroidal Aromatase inhibitor?
Exemestane
73
What is the difference btwn steroidal and Nonsteroidal Aromatase inhibitors?
``` Non-steroidal= Reversible Steroidal = Non-reversible ```
74
AE of Aromatase inhibitors?
``` Arthralgia Cataracts Diarrhea Hot flashes Nausea Hair thinning ```
75
ASCO recommends that all PM women with hormone receptor + early breast cancer receive adjuvant therapy with what?
Aromatase inhibitors with Tamoxifene
76
MOA of Pertuzumab?
Binds EC domain and PREVENTS lignad dependent Dimerization
77
MOA of Trastuzumab?
Bonds the Juxtaglomerular Region of EC domain of HER-2
78
What is the Extra MOA for Ado-Trastuzumab?
Interferes with Microtubules
79
AE of Pertuzumab?
Decreased LVEF Neutropenia Leukopenia Teratogenic
80
AE of Trastuzumab?
Cardiomyopathy/ HF Renal Failure Hepatotoxic Pneumonia and respiratory failure
81
What are the BBW for Pertuzumab?
Pregnancy
82
BBW for Trastuzumab?
``` Cardiomyopathy Infusion Rxn Pregnancy respiratory distress syndrome Respiratory insufficiency ```
83
BBW for Ado-Trastuzumab?
Heart failure Hepatic disease Pregnancy Ventricular Dysfunction
84
What is the Metabolism of Lipatinib?
Extensive CYP3A 4&5 | *Liver disease= increased Drug concentrations
85
Drug causes Elevated LFTs so routine Liver monitoring is required?
Lapatinib
86
AE of Lapatinib?
``` GI toxic Aneaia Thrombocytopenia Hand- Foot syndrome Rash pain Headache/backache INterstial lung disease/ pneumonitis QT prolongation ```
87
Which drugs prolong QT interval?
Lapatinib | Toremifene
88
What drug is associated with initial Transient disease flare (bone pain, hypercalcemia, Breast enlargement or tenderness)?
Goserelin
89
AE of Goserelin?
``` Hypo-estrognic actions: Amenorrhea Hot flashes decreased libido Vaginal dryness Emotional liability Depression Gynecomastia Osteopenia/osteoporosis ```
90
What is the function of mTOR?
Central regulator of cell proliferation Angiogenesis Cell Metabolism
91
MOA of Everolimus?
mTOR inhibitor
92
AE of Everolimus?
``` Opportunistic infections Neoplasia Lymphoma SCC non-infectious Pneumonitis (can be fatal) HYPER everything ```
93
Drugs used in Endometrial cancer?
Medroxyprogesterone | Megestrol
94
MOA for Medroxyprogesterone?
Progestin contraceptive | bonds progestin receptor and blocks GnRH release
95
AE of Medroxyprogesterone?
Amenorrhea Edema Anorexia Weakness
96
MOA of Megestrol?
Synthetic oral Progestin -- Suppresses pituitary LH release and enhances estrogen degradation Promotes diff/maintenance of Endometrial tissue
97
AE of Megestrol?
``` Wght gain (increased appetite) Hot flashes sweating lethargy Tumor Flare + Hypercalcemia + Thromboembolisms ```

Reproductive (6 decks)

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