Pharm cards 1 Flashcards
cladribine
mech:
pruine analog -> multiple mechs (eg inhbition of dna polymerase, dna strand breaks)
hairy cell leukemia
myelosupression
nephrotxic
neurotoxcity
dactinomycin (actinomycin d)
antitumor
intercalates dna
inhibits rna polymerase
wilms tumor, ewing sarcoma, rhabdomyosarcoma, used for childhood tumors.
myelosupression
bevacizumab
mab agaisnt vegf, inhbiting angiogenesis.
solid tumors (colon renal cell carcinoma)
hemmorhage, blood clots, and impaired wood healing
rituximab
monoclonal antibody against cd20. found on most b cell neoplasms
non hodgkin lymphoma, cll, itp, RA
increased risk of PML
Vemurafenib
small molecule inhbitor of BRAF oncogene in + melanomas. for v600e mutation.
metastatic melanoma
tumor lysis syndrome
emergency, most often in treatment of leukemias/lymphomas.
hyperkalemia and hyperphosphatemia, increased phosphate causes decreased calcium. increased nucelec acid breakdown -> hyperuricemia -> AKI
treat with agressive hydration, allopurinol, rasburicase.
rasburicase
recombinant uricase -> uric acid to allantoid
use in prevention and treatment of tumor lysis syndrome
idarucizumab
mab against dabigatran
tranexamic acid
inhibits fibrin breakdown
alemtuzumab
mab to cd52
cll and ms
daclizumab
cd25 (part of il2 receptor)
relapsing MS
natalizumab
a4 integrin (involved in WBC adhesion)
MS and chron disease
Risk of PML in patients with JC virus
ustekinumab
il-12/il-23
psorisasis, psoriatic arthritis
ranibizumab, bevacizumab
vegf
neovascular age related macular degeneration, proliferative diabetic retinopathy, and macular edema
alirocumab
pcsk9 inhibitor
decrease decrease decrease / increase / decrease
inactivated ldl receptor degradation, increased ldl removed from blood
myalagias, delirium, dementia, other neurocognitive defects
evolucumab
pcsk9 inhibitor
decrease decrease decrease / increase / decrease
inactivated ldl receptor degradation, increased ldl removed from blood
myalagias, delirium, dementia, other neurocognitive defects
ivabradine
antiarrythymic
selective inhibition of funny na channels. prolongs phase 4. decreases sa node firing. negative chronotrope without inotrope. reduces o2 requirement.
chronic stable angina in people who cant take b blockers. chronic HF with reduced ejection fraction.
luminous phenomana/visual brightness, hypertension, bradycardia
cefazolin
1st cephalo
cephalexin
1st cephalo
cefaclor
2nd cepha
cefoxitin
2nd cepha
cefuroxime
2nd cepha
ceftriaxone
3rd cepha
cefotaxime
3rd cepha
cefpodoxime
3rd cepha
ceftazidime
3rd cepha
cefepime
4th cepha
ceftaroline
5th cepha
aminoglycoside resistance and mech
irreversible inhibition of inititation complex by binding 30s. mrna misreading. block translocation.
bacterial transferases inactivtion drug by acetylation, phosphorylation, or adenylation.
methylation of ribosomes.
modification of 30s genes makes resistant
tetracycline mech and resistance
bind to 30s and prevent attachement of aminoacyl trna.
decreasd uptake or increased efflux by plasmid encoded transport pumps
chloramphenicol
blocks peptidyl transferase at 50s
plasmid encoded acetyltransferase inactivated the drug
clindamycin
blocks peptide transfer (translocation) at 50s
linezolid
inhibition of protein synthesis by binding to the 23s of the 50s subunits and preventing formation of the initiation complex
point mutation of the ribosomal RNA
macrolide
inhibits protein synthesis bly blocking translocation by binding to the 23s rrna of the 50s.
methylation of the 23s rrna
von hippel lindau
3
renal cell carcinoma
3
pkd2
4
achondroplasia
4
hemochromatosis
6
willams syndrome
7
cystic fibrosis
7
fridierich ataxia
9
wilson disease
13
rb1
13
brca2
13
prader willi
15
angelman syndrome
15
marfan syndrome
15
brca1
17
p53
17
hairy cell leukemia
adult males. mature b cell tumor. cells have filamentous hair like projections. “fuzzy”
marrow fibrosis. dry tap. pancytopenia and splenomegaly.
trap
treat with cladribine and pentostatin (purine antimetabolite)
no lymphadenoapthy. accumulate in red pulp.
adult t cell leukemia/lymphoma
adults
mature cd4 t cells
caused by htlv-1 which is associated with IV drug abuse
rash (infiltration) generalized lymphadenopathy. hepatosplenomegaly, lytic lesions (punched out) with hypercalcemia.
most common in the japan west africa and carribbean
mycosis fungiodes
adults
mature cd4 cells
infiltrate the skin producing rash, plagues, and nodules. aggreates of neoplastic cells called pautrier microabscesses.
can spread to blood producing sezary syndrome (t cell leukemia)
- lymphocytes with cerebriform nuclei are seen on blood smear.
langerhans cell histocytosis
langerhans cells are dendritic cells found in the skin
derived from bone marrow monocytes
present to naive t cells
birbeck granules (tennis racke) granules. cd1a+ and s100+ (mesodermal origin).
letterer-siwe disease
- malignant
- skin rash and cystic skeletal defects in infant less than 2
- multiple organs involved and rapidly fatal
eosinophilic granuloma
- benign proliferation in the bone
- adolescent with patholgic fracture
- biopsy shows langerhans cells with mixed inflammation including eosinophils
hand-schuller-christian disease
- malignant
- scalp rash, lytic skull lesions, diabetes insipidus, and exopthalmos in a child
FA
presents in child as lytic bone lestions and skin rash or reccurent otitis media with a mass involing the mastoid process. cells are fxnnly immature and do not present antigens
MAC prophylaxis and treatment
azithromycin, rifabutin for prophylaxis
hiv prophylaxis < 50 azithromycin or clarithromycin
Treatment
azithromycin or clarithromycin + ethambutol
can add rifabutin or ciprofloxacin
M laprea treatment
long term treatment with dapson and rifampin for tuberculoid form. Add clofazimine for lepromatous form
haloperidol
high potency typical
pimozide
typical not specified
trifluoperazine
high potency typical
fluphenazine
high potency typical
thioridazine
low potency antipsychotic
chlorpromazine
low potency antipsychotic
aripiprazole
atypical
asenapine
atypical
clozapine
atypical
olanzapine
atypical
quetiapine
atypical
iloperidone
atypical
paliperidone
atypical
risperidone
atypical
lurasidone
atypical
ziprazidone
atypical
fluoxetine
ssri
fluvoxamine
ssri
paroxetine
ssri
sertraline
ssri
escitalopram
ssri
citalopram
ssri
venlafaxine
snri
desvelafaxine
snri
duloxetine
snri
levomilnacipram
snri
milnacipram
snri
amitriptyline
tca
nortriptyline
2nd tca
imipramine
tca
desipramine
tca 2nd
clomipramine
tca
doxepin
tca
amoxapine
tca
truncus arteriosus
ascending aorta and pulmonary trunk
bulbus cordis
smooth parts (outflow track) of the left and right ventricles
endocardial cushions
atrial septum, membranous interventricular septum, av and semilunar valves
primitive atrium
trabeculated (left and right atria)
primitive ventricle
trabeculated part of the left and right ventricle
primitive pulmonary vein
smooth part of the left atrium
left horn of the senous venosis
coronary sinus
right horn of the sinus venosus
smooth part of right atrium
right common cardinal vein and right anterior cardinal vein
svc
endocarditis dental prevention high risk
amoxicillin
gonorrhea exposure
cetriaxone
reccurent utis
tmp smx
meningicoccal exposure
ceftriaxone, ciprofloxacin, rifampin
pregnant women with strep b
intrapartum penniciln g or ampicillin
prevention of gonogoccal conjuncitivits in newborn
erythromycin ointment on eyes
prevention of postsurgical infection due to s aureus
cefazolin
prophylaxis of strep pharyngitis in child with prior rhematic fever
penicillin g or oral penicillin v
exposure to syphhils
benzathine penicillin g
cd4 less than 200 prophylaxis
use tmp smx for pneumocystis
cd4 less than 100 prohylaxis
tmp and smx for pneumocystis and toxoplasmosis
cd4 less than 50 prophylaxis
use azithromycin or clarithromycin for MAC
mrsa treatment
vancomycin, daptomycin, linezolid, tigecycline, cefaroline, doxycycline
vre treatment
linezolid, streptogamins (quinupristin, dalfopristin) - bind to 50s, i added (daptomycin, linezolid, tigecycline)
multidrug resistant p aeruginosa
polymixins B and E(colistin)
multidrug resistant acinetobacter baumannii
polymixins B and E(colistin)
azole for histoplasma, coccidioides, blastomyces
itraconazole
topical azole for fungal infections of skin
coltrimazole and miconazole
asperigillus infection
voriconazole (also works agaisnt some candida)
serious aspergillus use isavuconazole
mucorales infection
amphoterricin
isavuconazole
terbinafine side effects
gi upset, headaches, hepatotoxicity, tast disturbance
-fungins
echinodins
echinodins side effects
gi upset, flushing (by histamine release)
griseofulvin
teratogenic, carcinogenic, confusion, headaches, disulfarim like reaction, increase cyp and warfarin metabolism
toxoplasmosis treatment
pyrimethamine + sulfadiazine
t cruzi
benznidazole or nifurtimox; crusing in my benz with a fur coat on
leshminiasis
amphotericin b (localized cutaneous) or sodium stibogluconate (sever diffuse cutaneous and visceral)
antimite/louse therapy
permethrin (neuronal membrane deplorization via na channels)
malathion (acetylcholinesterase inhibitor)
lindane (blocks gaba channels -> neurotoxicity)
used to treat scabies (sarco scabiei) and live (pediculus and pthirus)
treat Pesky Mites and Lice with PML because they NAG you
scabies: permethin cream, washing/drying all clothing/bedding, treat close contacts
lice: pyrethoids, malathion, or ivermectin lotion, and nit combing. children can attend school and treated at home
malaria treatments
use choloroquine for sensitive species (dont use for falciparum, resistance too common)
if resistant use:
mefloquine, atovaquone/proguanil
Treat falciparum with:
artemether/lumefantrine or atovaquone/proguanil
for life threatening use:
use IV quinidine in US (quinine elsewhere) or artesunate
for p vivax/ovale
add primaquine for hypnozoite
chloroquine (hydrozychloroquine)
blocks plasmodium heme polymerase which turns heme into hemozoin. heme accumulates and is toxic.
resistance due to membrane pump that reduces intracellular concentrations
retinopathy; pruitis (especially in dark skinned people)
adenoma
benign of the epithelium
adenocarcinoma
malignant of epithelium
leiomyoma
benign smooth muscle
leiomyosarcoma
malignant smooth muscle
rhabdomyoma
benign striated
rhabdomyosarcoma
malignant striated
three most common cancers
basal > squamos > > melanoma (skin)
men cancer incidence
prostate, lung, colon/rectum
men cancer mortality
lung, prostate, colon/rectum
women cancer incidence
breast, lung, colon/rectum
women cancer mortality
lung, breast, colon/rectum
children cancer incidence/mortality (0 to 14)
leukemia. brain and CNS, neuroblastoma
four carcinomas with hematogenous spread
renal, hepatocellular, follicular of thyroid, choriocarcinoma
cytokeratin/keratin
epithelial
vimentin
mesenchymal tissue (eg fibroblasts, endothelial cells, macrophages)
mesenchymal tumors and others (eg endometrial carcinoma, renal cell carcinoma, meningioma)
desmin
muscle tumors (eg rhabdomyosarcoma)
gfap
neuroglia (astrocytes, schwann cells, oligodendrocytes)
eg astrocytoma, glioblastoma
neurofilaments
neurons
empiric meningitis treatment
ceftriaxone and vancomycin (add ampicillin if listeria suspected)
viral causes of meningitis
enterviruses (especiialy coxsackie), hsv-2 (hsv-1 = encephalitis), hiv, wnv (also causes encephalitis), vzv
infections causing brain abscess
most commonly viridans group or s aureus. if dental extraction or infection, oral anerobes commonly involved.
multiple abscesses are usually from bactermia, single lesions from contigous sites: otitis media and mastoiditis -> temporal lobe. sinusitis or dental infection -> frontal lobe
distal renal tubular acidosis causes (type 1)
amphoterricin b, ibuprofen, congenital abnormalities (obstruction), autoimmune like sjorgrens and rheuematoid, ifosfamide, hypercalcuria for any reason, genetic
proximal renal tubular acidosis (type 2)
fanconi or carbonic anhydrase inhibitor
hyperkalemic renal tubular acidosis (type 4)
decreased aldosterone production (diabetic hyporenism, ace in, arbs, nsaids, heparin, cyclosporine, adrenal insufficiency) or aldosterone resistance (k sparing dieuretics, nephropathy due to obstruction, tmp smx)
fanconi syndrome causes
heriditary causes - wilson disease, tyrsinemia, glycogen storage disorder, cystinosis
acquired - iscehmia, multiple myleoma, nephrotoxins/drugs (eg ifosfamide, cisplatin, tenofovir, expired tetracyclines), lead poisoning
septic arthritis
s aureus, strep, and n gonorrhea are common causes. affected joint is swollen red and painful. synovial fluid purulent (greater than 50000 wbcs)
gonococcal ahtirtis - sti that presents as either purulent arthritis (eg knee) or triad of polyarthalgia, tenosynovitis (hand), dermatitis (eg pustules)
molecules working on the parietal cells
ach, gastrin, histamine, somatostatin, prostaglandins
parietal cell ach
m3 gq
gastrin parietal cell
cckb gq
histamine on parietal cell
h2 recep gs
somatostain on parietal
gi
prostaglandin on parietal
gi
abacavir (ABC)
nrti hlab 5701
didanosine (ddl)
nrti pancreatitis
emtricitabine (ftc)
nrti macular rash on palms
lamivudine
nrti
stavudine (d4t)
nrti
tenofovir (tdf)
nrti nucleotide
zidovudine (zdv, formely azt)
nrti general prophylaxis and pregnancy, anemia
delavirdine
nnrti ci in pregnancy
efavirenz
nnrti cns symptoms and vivide dreams
nevirapine
nnrti ci in pregnancy
rilpivirine
nnrti
indinavir
protease inhbitor. nephopathy and hematuria from stones of drug. thrombocytopenia
autoclave
pressurized steam at greater than 120. may be sporicidal
alcohols
denature proteins and disrupt cell membranes. not sporicidal
chlorhexidine
denatures proteins and disrupts cell membranes. not sporicidal
hydrogen peroxide
free radical oxidation. sporicidal.
iodine and iodophors
halogenation of dna, rna, and proteins. may be sporicidal.
c tetani treatment
prevent with vaccine. treat with antitoxin plus minus vaccine booster., diazepem (for muscle spasms), wound debridement.
c diff treatment
often caused by clindamycin, ampicillin, associated with ppi use.
metronidazole or oral vancomycine. reccurent cases consider fidaxomicin, or fecal microbiota transplant.
listeria monocytogenes treatment
ampicillin
nocardia treatment
tmp smx
actinomyces treatment
penicillin
gonocci treatment
cetriaxone + (azithromycin or doxycyline) for chlamydia
erythromycin oitment prevents neonatal blindness
menigocci treatment
rifampin, ciprofloxacin, ceftriaxone for prophylaxis of close contacts.
treat with ceftriaxone or penicillin g
haemophilus influenza treatment
amoxicillin +/- claculanate for mucosal infections. ceftriaxone for meningitis. rifampin prophylaxis for close ocntacts.
legionella treatment
macrolide or quinolone
pseudomonas treatment treatment
“campfire”
carbapenems
aminoglycosides
monobactams
polymyxins (polymixn b, colistin)
fluroquinolones (ciprofloxacin, levofluroquinolone)
thIRd and fourth gen cepahlospoins (eg ceftazidime, cefepime)
extended spectrum peniciilins (eg ticarcillin, piperacillin)
salmonella typhi
ceftriaxone or fluroquinolones
h pylori
amoxicillin (metronidazole if allergic) + clarythromycin + ppi (antibiotics cure pylori)
lyme disease
doxycyline (1st line); amoxicillin and cefuroxime in pregnant women and children
utd says all work for early stage
g vaginalis
metro or clindamycin
chlamydiae
treatment: azithromycin (prefered because one time treatment) or doxycyline (+ceftriaxone)
lacks classic peptidoglycan due to reducde muramic acid so b lactams dont work
m pneumonia
macrolides, doxycyline, or fluroquinionlens.
penicillin infeective since no cell wall
candida
oral fluconazole/topical azole for vaginal.
nystatin, fluconazole, or capsofungin for oral/esophageal.
fluconazole, caspofungin, or amphoterricin b for systemic
c neoformans
amphoterricin b + flucytosine followed by fluconzaole for meningitis
mucor and rhizopus
surgical debridement and amphoterricin b
PCP
tmp-smx, pentamidine (if sulfa allergy), dapsone (prophylaxis only), atovaquone. Start prophylaxis when cd4 less than 200
sporothrix
itraconazole or k iodide
giardia
metro
e histolytica
metronidazole; paromomycin or iodoquinol for asymptomatic stool passers
cryptosporidium
prevention by filtering city water supplies; nitazoxanide in immunocmopetent hosts
toxoplasmosis
tmp smx prophylaxis
sulfadiazine + pyrimethamine
n fowleri
amphoterrin b has been effective in a few
t brucei
suramin for blood
melarsoprol for CNS
babesia
atovaquone + azithromycin
t cruzi
benznidazole or nifurtomox
curising in my benz with my fur coat
l donovani
amphoterricn b (localized cutaneous)
sodium stibogluconate (severe diffuse cutaneous or visceral)
t vaginalis
metronidazole for patient and partner (prophylaxis)
enterobius vermiculuari (pin worm)
bendazoles (1st line)
pyrantel pamoate (pregnant)
ascaris (giant roundworm)
bendazoles
strongyloides (threadworm)
ivermectin or bendazoles
ancyclostome/necator (hookworms)
bendazoles or pyrantel pamoate
t spiralis
bendazoles
trichuris trichiura (whipworm)
bendazoles
toxocara canis
bendazoles
onchocerca volvulus
ivermectin
loa loa
diethylcarbamazine
wuchereria bancrofti
diethylcarbamazine
t solium
intestinal tapeworm - paziquantel
cystercercosis - praziquantel
neurocystercerci - albendazole
d latum
praziquantel
e granulosis
albendazole
schistoma
praziquantel
clonorchis
praziquantel
rsv prophylaxis in premies
palivizumab
postexposure prohylazin rabies
wound cleaning plus immunization with killed vaccine and rabies immunoglobin
