Pharm 51-100 Flashcards
A 58-year old female receives thio-TEPA (trietheylenethiophosphoramide) for adenocarcinoma of the breast. Which of the following cutaneous side effects might she expect?
- Generalized hyperpigmentation sparing the palmar creases and mucous membranes
- Hyperpigmentation of the teeth with permanent pigmentation of the gingival margin
- Intense flushing of the skin
- Hyper pigmentation of the axillae
- Alternating colors of hair
Hyperpigmentation of the axillae
Thio-TEPA is an alkylating agent used in a variety of cancers. It can cause pruritus, urticaria, angioedema, and hyperpigmentation localized to occluded areas. Generalized Addisonian-hyperpigmentation may be caused by busulfan. Hyperpigmentation of the teeth with discoloration of the gingival margins is associated with cyclophosphamide. Intense flushing of the skin is usually seen with dacarbazine and carmustine. Alternating colors of hair, representing the “flag sign,” can be seen with methotrexate.
A 21-year old male presents with a sudden onset of fever, rash, facial edema, leukocytosis and hepatitis four weeks after starting phenytoin for seizures. This patient most likely had which risk factor for developing this skin condition: 1 Slow acetylator 2 Deficiency of epoxide hydroxylase 3 Renal failure 4 Recent vaccination 5 Thyroid disease
Deficiency of epoxide hydroxylase
This patient has anticonvulsant hypersensitivity syndrome most likely resulting from a deficiency of epoxide hydroxylase. Slow acetylators are also predisposed to this condition after being given sulfonamides. Renal failure is a risk factor with allopurinol administration. Recent vaccination and thyroid disease are not known risk factors.
What medication's mechanism of action is via suppression of the halide-myeloperoxidase system? 1 Cyclophosphamide 2 Quinicrine 3 Dapsone 4 Melphalan 5 Hydroxyurea Dapsone inhibits
Dapsone inhibits the neutrophil halide-myeloperoxidase system which results in an impaired respiratory burst and subsequent tissue damage.
A 56 year-old man presents with blue-gray discoloration on his face, ears, and dorsal hands. What is the most likely offending agent? 1 Minocycline 2 Amiodarone 3 Chloroquine 4 Quinacrine 5 Clofazimine
Amiodarone
The patient presents with blue-gray discoloration in sun-exposed areas. The most likely offending agent is amiodarone. Blue-gray discoloration from minocycline usually occurs on legs. Chloroquine usually causes blue-gray discoloration in the sclerae, teeth, buccal mucosa, nail beds, and pretibial areas. Quinacrine causes yellow discoloration of skin and conjunctiva. CLofazimine usualy causes a red-brown discoloration
The most common side effect of treatment with interferon-alpha is: 1 Weight loss 2 Nausea 3 Liver toxicity 4 Flu-like symptoms 5 Spastic diplegia
Flu-like symptoms
The most common side effect of treatment with interferon-alpha is flu-like symptoms of fever, chills, myalgias, headache and arthralgias. Prophylactic administration of non steroidal anti-inflammatory medications may alleviate some of these symptoms.
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Keratinocyte differentiation is enhanced by retinoids with all of the following EXCEPT:
1 Increased filaggrin production
2 Increased keratohyalin granules
3 Stimulation of ornithine decarboxylase
4 Odland body secretion of lipids
5 Increased keratin filaments
Stimulation of ornithine decarboxylase
Keratinocyte differentiation is enhanced by retinoids with increased filaggrin production, increased keratohyalin granules, keratin filaments, and Odland body secretion of lipids. Retinoids directly inhibit ornithine decarboxylase and therefore lessen inflammatory hyperplasia.
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A patient presents with tingling and burning of their lateral upper lip. They report that blisters will form which then crust and heal. She gets these episodes once or twice each year. You prescribe acyclovir. What is the mechanism of action of acyclovir when treating this type of infection?
1 Acts on viral thymidine kinase
2 Inhibits viral DNA polymerase
3 Inhibits viral RNA polymerase
4 Enhances CD8+ T-cell function leading to immune destruction of the virally infected cells
5 Is a non-competitive inhibitor of viral DNA polymerase at the pyrophosphate binding site
Inhibits viral DNA polymerase
Acyclovir relies upon the fact that thymidine kinase is produced at a higher rate in herpes infected cells than in noninfected cells. It is a guanosine analog that is preferentially phosphorylated by viral thymidine kinase which then inhibits viral DNA polymerase, thus halting viral DNA synthesis by chain termination. Acyclovir does not inhibit viral RNA polymerase or boost immune destruction of infected cells. It is not a non-competitive inhibitor of viral DNA polymerase at the pyrophosphate binding site – this mechanism of action is that of Foscarnet, also an antiviral active against HSV.
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What is the half-life of isotretinoin? 1 7 hours 2 20 hours 3 50 hours 4 30 days 5 120 days
20 hours
The half-life of isotretinoin is 20 hours. The half lives of bexarotene, acitretin, etretinate are 7 hours, 50 hours, 120 days respectively.
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What is the difference between podophyllin and podophyllotoxin?
1 Essentially the same; they are interchangable in terms of treatment and side effects
2 Podophyllotoxin contains quercetin which is a potent mutagens
3 Podophyllin contains kaempherol which is a potent mutagens
4 Podophyllotoxin is a phosphodiesterase inhibitor
5 Podophyllin reversibly binds tubulin inhibiting cells in metaphase
Podophyllin contains kaempherol which is a potent mutagens
Podophyllotoxin, also known as podofilox or Condolox, is a anti-mitotic agent that reversibly binds tubulin, arresting cells in metaphase. It is used topically to treat genital warts. Podophyllin, which has the same mechanism of action, contains kaempero and quercetin which are potent mutagens. Both are derived from the May Apple plant. Cantharin, an antiviral agent derived from the Blister beetle, is a phosphodiesterase inhibitior.
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All of the following agents exert their function in a cell-cycle specific manner except: 1 Cyclophosphamide 2 Methotrexate 3 Azathioprine 4 Hydroxyurea 5 5-fluorouracil
Cyclophosphamide is a cell-cycle nonspecific agent, which produces DNA cross-linkages at any point in the cell cycle. Methotrexate, azaithioprine, and hydroxyurea are S-phase specific cytotoxic agents. 5-fluorouracil is a cell-cycle specific pyrimidine antagonist.
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Side effects from this antihistamine include gynecomastia, impotence, and loss of libido: 1 Doxepin 2 Cyproheptadine 3 Promethazine 4 Fexofenadine 5 Cimetidine
Cimetidine, an H2 antihistamine, also competitively inhibits dihydrotestosterone at the androgen receptor site, with resultant antiandrogen side effects including gynecomastia, impotence, and loss of libido.
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Which of the following is known to induce lichen planus-like eruptions? 1 Dapsone 2 Doxepin 3 Minocycline 4 Gold 5 Mercury
Mucocutaneous side effects of gold include stomatitis, cheilitis, lichen planus- like eruptions, and pityriasis rosea-like eruptions.
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Which of the following is not an ingredient of Castellani's paint? 1 Resorcinol 2 Industrial methylated spirit 3 Phenol 4 Boric Acid 5 Ethyl acetate
Castellani’s paint was named after Sir Aldo Castellani and contains resorcinol, acetone, magenta, phenol, boric acid, industrial methylated spirit, and water. It is fungicidal and bactericidal with local anesthetic effects. It has been used to treat inflammatory tinea cruris, leg ulcers, and acute paronychia.
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The mechanism of action of podophyllin most closely resembles that of what other drug listed below? 1 Chlorambucil 2 Dactinomycin 3 Colchicine 4 5-fluorouracil 5 Permethrin
Both podophyllin and colchicine have antimitotic activity. They bind to tubulin dimers, interfering with mitotic spindle and microtubule assembly.
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For which of the following medications is sedation a very common side effect that may limit treatment? 1 Colchicine 2 Gold 3 Potassium iodide 4 Thalidomide 5 Chlorambucil
Sedation is a very common side effect of treatment with thalidomide. It is additive with other sedatives, such as alcohol and barbiturates.
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The risk of pseudotumor cerebri in patients taking isotretinoin is increased by: 1 Dehydration 2 Concomitant use of tetracycline 3 Concomitant use of TMP-SMX 4 Doses higher than 1.0 mg/kg/day 5 Comorbid affective disorder
The risk of pseudotumor cerebri is increased in patients on isotretinoin and a tetracycline.
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Which of the following statements is true regarding the absorption of antibiotics?
1 Fluoroquinolone absorption is not altered by antacids
2 Tetracycline absorption is impaired by the ingestion of calcium products but not iron
3 Minocycline absorption is not significantly impaired by the ingestion of calcium products but it should be taken on an empty stomach
4 Doxycycline absorption is impaired by the ingestion of dairy products and calcium
5 None of the above (all of the above statements are false)
Antacids decrease the absorption of fluoroquinolones and should be taken at least 2 hours after the drug. Tetracycline absorption is impaired by the ingestion of dairy products, calcium, and iron or zinc salts. Minocycline and doxycycline absorption is not impaired by the ingestion of those products; they may be taken on an empty stomach or with food. Thus, all of the statements are false.
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68 Need Photo
Which of the following events is most important in the pathogenesis of this painful eruption?
1 Increased expression of FasL
2 Reduction in circulating tumor necrosis factor
3 Reduction in circulating IL-6
4 Overexpression of keratins 6 and 16
5 Cleavage of desmoglein 1
Toxic epidermal necrolysis is a life threatening drug eruption characterized by widespread epidermal necrosis. The exact etiology of the keratinocyte necrosis has not been fully elucidated. However, FasL (FasL and Fas are able to trigger apoptosis) has been shown to be upregulated in TEN.
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Approximately what percentage of patients with drug hypersensitivity syndrome will have liver function test abnormalities? 1 Less than 10% 2 25% 3 50% 4 75% 5 Close to 100%
Drug hypersensitivity syndrome is characterized by fever, skin eruption and internal organ involvement. Drugs associated with drug hypersensitivity syndrome include sulfonamindes, dapsone, anticonvulsants (carbamezapine, phenobarbitol, lamotrigine), anti-retrovirals (ritonovir, nevirapine) and minocycline. Approximately 50% of patients will have abnormal liver enzymes.
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Which of the following drugs binds iron and thereby significantly prevents absorption? 1 Methotrexate 2 Azathioprine 3 Cyclosporine 4 Mycophenolate mofetil 5 Tacrolimus
Mycophenolate mofetil binds with Fe preparations preventing its absorption. Oral iron supplements markedly reduce absorption of mycophenolate mofetil (CellCept�). It is recommended that iron be taken four to six hours before, or two hours after mycophenolate mofetil.
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