Pharm RR Flashcards
what is phosphoribosylamine
needed for synthesis of purines; mercaptopurine inhibits the enzymes needed to synthesize phosphoribosylamine
form a ternary complex with topoisomerase II and DNA
Doxorubicin + Daunorubicin
produce free radicals
Doxorubicin + Daunorubicin
Bleomycin
Binds DNA and chelates iron
Bleomycin
degraded by a specific hydrolase low in skin and lungs–
Bleomycin
highly reactive alkyl groups that forms covalent bonds between guanines
Cyclophosphamide
cross-linking between two DNA strands
Cyclophosphamide
Acrolein is a metabolite
Cyclophosphamide
mesna
conjugates acrolein
prodrug that is converted in the liver to MTIC
Dacarbazine
Interrupts DNA replication by causing methylation of guanine
Dacarbazine
methylation of guanin
Dacarbazine
potent inhibitor of DNA polymerase
Cytarabine
cytidine analog
Cytarabine
Resistance: Occurs due to increased drug inactivation or decrease formation of monophosphate.
Cytarabine
severe leukopenia, thrombocytopenia, and anemia.
Cytarabine
Inhibits DNA polymerase, DNA primase, DNA ligase, and ribonucleotide reductase
Fludarabine
Purine analog; biotransformed into false purine nucleotide
Mercaptuopurine
false nucleotide also causes DNA damage upon intercalation.
Mercaptuopurine
Degraded by xanthine oxidase and thiopurine methyltransferase
Mercaptuopurine
biotransformed to polyglutamate
Methotrexate
inhibits dihydrofolate reductase
Methotrexate
Drug Interactions:aspirin or piperacillin delay drug excretion and lead to severe myelosuppression.
Methotrexate
Drug Interactions: nonsteroidal antiinflammatory agents delay drug excretion and lead to severe myelosuppression.
Methotrexate
Binds to the CD20 antigen
Rituximab
chimeric (mouse-human) monoclonal antibody
Rituximab
reduction in FAS-mediated apoptosis
Imatinib
Competitively binds to the ATP binding site on the bcr-abl
Imatinib
inhibits phosphorylation of proteins involved in CML clone proliferation
Imatinib
Resistance results from mutations in the kinase domain
Imatinib
normal tissues are able to synthesize 1) for protein synthesis
1) L-asparagine
depriving malignant cells of the asparagine necessary for 1) –> leads to cell death
1) protein synthesis
suppress mitosis in the lymphocytes
Glucocorticoids
Prednisone, Dexamethasone
displaces the repressor and promotes degradation of the PML-RAR-fusion gene.
Tretinoin
Induces lipocortins
Glucocorticoids
↓PLA2→ ↓AA
Glucocorticoids
Down-regulates expression of cytokines (IL-1,
IL-4 and TNF-α which leads to immunosuppression
Glucocorticoids
prevents activation of calcineurin phosphatase activity by Ca2+/calmodulin
Cyclosporine (Cs) and Tacrolimus
↓IL-3; IL-4, IFN-γ
Tacrolimus
immunosuppressant for transplantation
Tacrolimus
hypertension, hyperlipidemia
Cyclosporine
hepato-, nephro-,
and neuro—toxicity
Cyclosporine
↓Calcineurin phosphatase activity by
Ca2+/Calmodulin
Cyclosporine and Tacrolimus
Tacrolimus inhibits
↓IL-3; IL-4, IFN-γ
binds to FKBP → S-FKBP complex
→ ↓mTOR → ↓Protein synthesis
Sirolimus
↓mTOR–> Arrest of T-cell division in G1 phase
Sirolimus
use: coronary artery
disease
Sirolimus-eluting stents
binds to cyclophilin
CYCLOsporin
Prevention of graft versus host
disease
Methotrexate
inosine monophosphate
dehydrogenase (IMPDH) inhibitor
Mycophenolic Acid & Mycophenolate Mofetil
rate-limiting enzyme in the
synthesis of guanosine in the PURINE syntheis
IMPDH
↓NO production by immune cells
Mycophenolic Acid & Mycophenolate Mofetil
↓Hydrobiopterin [BH4] levels, which
regulates iNOS in neutrophils
Mycophenolic Acid & Mycophenolate Mofetil
autoimmune hemolytic anemia
Mycophenolate Mofetil
inhibits dihydroorotate dehydrogenase
Leflunomide
inhibition of pyrimidine synthesis
Leflunomide
inhibits purine synthesis and proliferation of B cells by inhiting IMPDH
Mycophenolic Acid & Mycophenolate Mofetil
Depletion of pyrimidine pool → ↓Lymphocyte expansion
Leflunomide
Lymphocytes depend on de novo 1) synthesis for cell replication &
clonal expansion after immune cell activation
1) pyrimidine
Leukopenia, cardiotoxicity, & ↑Risk of cancer,
Cyclophosphamide
Promotes transition from G1 to S phase
mTOR
non-specific (binds TNF-α and TNF-β)
Etanercept
TNF-α-specific
Infliximab and Adalimumab
stimulates IL-6
production → ↑Expression of adhesion molecules → ↑Cell
proliferation
IL-1
↓IL-1 activity
Anakinra
IL-1 Receptor antagonist
Anakinra
Blocks IL-1-induced metalloproteinase release from synovial fluid; use for RA
Anakinra
Blocks IL-2 receptor aka CD25
Basiliximab
Daclizumab
inhibits purine synthesis
MMF (Mycofenolate mofetil)
Azathioprine
Induction therapy for renal transplantation
Basiliximab
Daclizumab
targets all T cells → Broad
immuno-suppression
Anti-thymocyte globulin (ATG)
do not compete with nucleoside triphosphates nor
require phosphorylation to be active
Nonnucleoside: Efavirenz
bind directly to reverse transcriptase resulting in allosteric
inhibition of RNA- and DNA-dependent DNA polymerase.
Nonnucleoside: Efavirenz
Rash which could progress to Stevens-Johnson syndrome
Nonnucleoside: Efavirenz
Fetal abnormalities (neural tube defects
Nonnucleoside: Efavirenz
boost levels of protease inhibitors
Ritonavir
use in pregnant women with HIV
Zidovudine (NRTI)
competitive inhibitors of
dihydrofolate reductase
Trimethoprim and pyrimethamine
structural
analogs of para-aminobenzoic acid
(PABA)
Sulfonamides (sulfamethoxazole; sulfadiazine)
inhibit incorporation
of PABA into dihydropteroic acid
interfering with folate metabolism
Sulfonamides (sulfamethoxazole; sulfadiazine)
inhibits squalene epoxidase; squalene not converted to lanosterol
Terbinafine
Inhibits lanosterol demethylase (LD); ___ to ___
azoles; lanosterol to ergosterol
converted to 5-fluorouracil, an
antimetabolite, by fungi
Flucytosine
Inhibits GS = β-(1,3)-glucan
synthase;
echinocandins e.g Capsofungin
NOTE: selectively toxic because human cells do not contain β-(1,3)-D-glucan
inhibits fungal mitosis by interacting with polymerized microtubules
Griseofulvin
Binds to ergosterol in fungal cell membranes forming pores or
channels
Polyene such as Amphotericin B
remains the therapy of choice for many systemic fungal
infections despite its significant side effects
Polyenes: Amphotericin B
not absorbed form the GI tract so it must be
administered intravenously
Amphotericin B
insoluble in water so it is available as a
complex with the bile salt deoxycholate or as a lipid preparation
Amphotericin B
Amphotericin B Antifungal activity
(a) Aspergillus spp.
(b) Candida spp.
(c) Cryptococcus neoformans
adverse affects less with 1) of
amphotericin B than with the deoxycholate salt
1) lipid preparations
Amphotericin B:
Infusion reactions (fever, chills); can be prevented with
1)
1) antiinflammatory drugs or meperidine
Mutation in ERG11
gene encoding for 14-α-demethylase; fungi becomes resistant to AZOLES
Mechanism of fungal resistance
Occurs rapidly if used alone!
flucytosine