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🄼 Histo/Rx(TB/anemia/immuno)/Mycology > Pharm (TB / Anemia / Immunomodulation) > Flashcards

Pharm (TB / Anemia / Immunomodulation) Flashcards

1
Q

3 Principles of [TB / NTM] tx

A

MID

  1. MultiDrug Therapy should be used: Enhances response rate and [DEC Resistance]
  2. INC Tx Adherence: [use short therapy course] & [DOT: Direct Observed therapy]
  3. Duration of tx: needs to be adequate to ensure INC cure and [DEC relapse]
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2
Q

Isoniazid

A: Clinical Use

B: MOA

C: Static or Cidal?

A

A: [1st Line Tx for ACTIVE Pulmonary TB used in combination with 2 other active drugs]

B: Prodrug; activated by [TB katG-catalase peroxidase] and targets [inhA gene product] –> [DEC Cell Wall Mycolic Acid]

(mutations in any of these genes –> TB Resistance to tx)

C: [Cidal for replicating organisms] / [Static for resting organisms]

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3
Q

Rifampin

A1: Disclaimer for this drug

A2: 2 exceptions to the Disclaimer

B: MOA

C: Contraindications (4)

A

A: Can NOT be used alone as an abx b/c of rapid resistance development

A2: LTBI (Latent TB infection) or [meningitis px]

B: Inhibits [rpoB gene] –> Inhibits [DNA-dependent RNA polymerase]

C: Interacts with >100 drugs but specifically [Accelerates clearance and DEC effectiveness of CAAE:

  • Coumadin
  • Estrogen
  • Anticonvulsants
  • AntiRetroviral drgus
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4
Q

Ethambutol

A: Toxicity

B: Clinical use

A

A:

  1. Optic Neuritis
  2. Peripheral Neuropathy (less common)

B: [1st Line “helper” TB therapy] - helps other drugs

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5
Q

PyraZinAmide

A1: Clinical Use

A2: single or combination tx

B: MOA

C: Toxicity

D: Good or Poor Distribution?

A

A1: [TB Drug for 1st two months of therapy only]

A2: Combination

B: Prodrug; activated by [TB pyrazinamidase tht’s encoded by [pncA]

C: Hepatitis

D: Good Distribution; especially in CSF

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6
Q

A: Describe [1° Resistance] vs. [2° Resistance]

B: What is the “pattern” for Resistance development for 2 drugs?

A

A:

[1° resistance is acquired at infection (drug resistant TB)]

vs.

[2° resistance - which develops during (SubOptimal TB tx)]

B: Risk of resistance development to 2 drugs= Risk of resistance development to each drug separately (their product)

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7
Q

A: Define [MDR-TB] MultiDrugResistance TB

B: Resistance to which of those eliminates ability to use [short 6 month course for TB]

A

A: Resistance to both Isoniazid and Rifampin

B: Rifampin

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8
Q

A: 4 Drug Regimen for TB Tx

B: Which drugs make up the Initial Phase

C: Which drugs make up the Continuation Phase

A

A: RIPE- Rifampin/ Isoniazid/ PyraZinAmide/ Ethambutol

B: Initial Phase = RIPE

C: Continuation Phase= ( R I )Ethambutol not needed if pt is not resistant to anything

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9
Q

A: Tx Course (Time) for TB

B: What 3 factors make this tx course successful

A

A: [2-3 times /week with DOT(Direct Observed Therapy)]

for 6 months —>

B: Success if:

1) STRONG adherence
2) Sputum cultures convert in 2 mos.
3) No major cavitary lung dz

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10
Q

A: Define [XDR-TB] (eXtensively Drug Resistant TB)

B: What is the fundamental strategy to TB tx (2)

A

A: [XDR-TB] (eXtensively Drug Resistant TB) = Resistance to

  • Isoniazid
  • Rifampin
  • Fluoroquinolone
  • 1 injectable (-kacin)

B: Only use drugs never used in that pt before and use [2 drugs that are effective against pt’s particular TB strain]

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11
Q

LTBI (Latent TB Infection) [Treatment Regimens] (3)

A
  1. [9 mo. Isoniazid Monotherapy] = HIGHLY EFFECTIVE
  2. [4 mo. Rifampin daily therapy]= just as effective as #1
  3. [3 mo / 12 dose / once weekly / DOT: Isoniazid + Rifapentene]= just as effective as #1
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12
Q

[T or F]

[Leprosy Tx] is Similar to [TB Tx]

A

FALSE!!

Leprosytx is DIFFERENT THANTB Tx

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13
Q

Oral Iron Therapy

  • A: Examples (3)*
  • B: Route of Administration*
A
  1. Ferrous Sulfate
  2. Ferrous Gluconate
  3. Ferrous Fumarate

B: PO

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14
Q

Parenteral Iron Therapy

  • A: Examples (3)*
  • B: Route of Administration (2)*
A
  1. iron dextran
  2. iron sucrose
  3. iron gluconate

B: IM / IV

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15
Q

Vitamin B 12 Supplement

  • A: Examples (3)*
  • B: Route of Administration (3)*
A
  1. CyanoCobalamin = IM
  2. HydroxyCobalamin = IM
  3. [Oral Supplement (Oral only)]
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16
Q

EPO (Erythropoietin)

A: Route of Administration (2)

A

IV / [SubQ injection]

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17
Q

[Recombinant Human IL 11]

  • A: Examples (1)*
  • B: MOA*
A
  1. Oprelvekin

B: Promotes proliferation of [megakaryocytic progenitors] to INC [peripheral platelet count]

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18
Q

Oral Iron Therapy

A: MOA

B: Indication

A

A: INC Iron levels QUICKLY–>[Anemia reversal in 1-3 months]

B: Iron Deficiency Anemia

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19
Q

Oral Iron Therapy

Side Effects (2)

A
  1. N/V
  2. Black Stools
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20
Q

Parenteral Iron Therapy

A: MOA

B: Indication (3)

A

A: INC Serum iron

B:

1) When Oral Iron is NOT tolerated
2) POST GI Resection
3) MalAbsorption syndromes

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21
Q

Parenteral Iron Therapy

Side Effects (4)

A
  1. Pain
  2. [Tissue Staining when IM]
  3. Anaphylaxis
  4. N/V
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22
Q

Deferoxamine / DeferaSirox

A: MOA

B: Indication

A

A: Iron Chelation (removal)

B: REVERSES Iron Toxicity

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23
Q

Vitamin B 12 Supplement

Indications (2)

A
  • B 12 Deficiency
  • Folic Acid Deficiency (also requires oral folic acid)
24
Q

EPO (Erythropoietin)

Indications (7)

A

Use EPO for CLACHAP

  1. Chronic Renal Failure
  2. [Aplastic Anemia]
  3. Leukemia
  4. HIV/AIDS
  5. Cancer
  6. Phlebotomy-post
  7. [Anemia of Prematurity]
25
**EPO** (*Erythropoietin*) * A: Prognosis after usage (2)* * B: Side Effects (3)*
[Retics seen in 10 days] [HgB INC in 2-6 weeks] B: 1) Many Tumors have EPO Receptors = EPO may INC Tumor Progression! 2) HTN 3) Thrombosis
26
**G(M)CSF** MOA (2)
1. Stimulates proliferation/differentiation of **myeloid** cells 2. **GMCSF** specifically stimulates proliferation of erythroid and megakaryocytic cells
27
**G(M)CSF** Indications (3)
1. Post Chemo 2. Neutro**penia** tx 3. Mobilizes peripheral blood stem cells for autologous transplant (*GCSF*)
28
A: **GCSF** Side Effects (2) B: **G*M*CSF** Side Effects (3) C: Which is clinically preferred?
A: Bone pain / Splenic Rupture B: [Joint & Muscle _pain_] / [Peripheral _Edema_] / [Pleural & Pericardial _Effusion_] --------"*M for Many problems"* B: **GCSF**
29
**[Recombinant Human IL 11]** * A: Indication* * B: Side Effects (4)*
A: Post Surgical Thrombocyto**penia** B: - Fatigue - Dyspnea - Arrhythmias - hypOkalemia
30
**[Romiplastin and EltromBopag]** A: MOA B: Indication (2)
A: Thrombopoeitin-Receptor **AGONIST** B: Thrombocyto**penia** / [Aplastic Anemia]
31
**[Romiplastin and EltromBopag]** Side Effects (3)
- [**MILD** Bone marrow Fibrosis tht looks worse than actually is] - Myalgia - HA
32
**Diphenhydramine** A: MOA (2) B: Indications (3) C: route of administration (2)
A: [Histamine H1] and [Muscarinic receptor] Blocker B: [Allergic Rhinitis] / Urticaria / [Anaphylactic rxn] C: PO / IV
33
**Diphenhydramine** A: Side Effects B: Classification
A: [Sedation or Agitation] due to [Muscarinic receptor blockade] B: [1st generation H1 Blocker]
34
**Chlorphenlramine** A: MOA (2) B: Indications (2)
A: [Histamine H1] and [Muscarinic receptor] Blocker B: [Allergic Rhinitis] / [Common ingredient for OTC meds]
35
**Chlorphenlramine** A: Side Effects B: Classification
A: [*Slight* Sedation or Agitation] due to [Muscarinic receptor blockade] B: [1st generation H1 Blocker]
36
**Fexofenadine** A: MOA B: Indications (2) C: Classification
A: [Histamine H1] Blocker B: [Idiopathic Chronic Urticaria] / [Allergic Rhinitis] C: [2nd generation H1 Blocker]
37
**Loratadine** A: MOA B: Indications (3)
A: [Histamine H1] Blocker B: [Blood Allergic Rxns]/ [Allergic Rhinitis] / [Anaphylactic rxn adjunct]
38
**Loratadine** A: Side Effects (3) B: Classification
A: Nausea / Fatigue / HA B: [2nd generation H1 Blocker]
39
**Cetirizine** A: MOA (2) B: Indications (2)
A: [Histamine H1 Blocker] + [Histamine Release Blocker] B: [Idiopathic Chronic Urticaria] / [Allergic Rhinitis]
40
**Cetirizine** A: Side Effects (3) B: Classification
A: Sedation / Fatigue / [Dry Mouth] B: [2nd generation H1 Blocker]
41
**Doxepin** A: MOA B: Indication C: Side Effects D: Classification
A: [Histamine H1] Blocker B: Chronic Urticaria that does **not** respond to other [H1 Blockers] C: Disorientation (*confusion*) D: [2nd generation H1 Blocker]
42
[**B2 Agonist** (*short vs. long acting*) are \_\_\_\_\_\_\_] A: Indications (2) B: Side Effects (3)
[**B2 Agonist** (*short vs. long acting*) are BRONCHODILATORS] ## Footnote A: 1) Bronchospasm in acute asthma attacks 2) Adjunct for [Inhaled Corticosteroids] B: x: [Sk. Muscle Tremors] x: Tachycardia x: Anxiety
43
[**B2 Agonist** (*short vs. long acting*) are \_\_\_\_\_\_\_] A: MOA (2) B: Route of Administration (3)
[**B2 Agonist** (*short vs. long acting*) are BRONCHODILATORS] ## Footnote A: 1) Stimulates Adenylate Cyclase--\> INC cAMP--\> Bronchodilation 2) Blocks mast cell degranulation B: Inhale / PO / SubQ (*Terbutaline only*)
44
[**Theophylline** is a \_\_\_\_\_\_\_] A: MOA (2) B: Route of Administration (2)
[**Theophylline** is a BRONCHODILATOR] ## Footnote A: 1) Inhibits [cAMP Phosphodiesterase] 2) [Adenosine Receptor _competitive_ Blocker] B: PO / [Slow IV over 40 min]
45
[**Theophylline** is a \_\_\_\_\_\_\_] A: Indication (2) B: Side Effects (4)
[**Theophylline** is a BRONCHODILATOR] ## Footnote A: 1) Chronic Asthma Maintenance (*3rd Line*) 2) Sustained release oral therapy B: x: [Narrow Therapeutic Window] x: Convulsions x: Tachycarida x: [Circulatory Collapse]
46
[**Ipratropium** is a \_\_\_\_\_\_\_] A: MOA B: Route of Administration
[**Ipratropium** is a BRONCHODILATOR] ## Footnote A: [Airway Muscarinic Receptor **Competitive** Blocker] B: Inhale
47
[**Ipratropium** is a \_\_\_\_\_\_\_] A: Indication (2) B: Side Effect
[**Ipratropium** is a BRONCHODILATOR] ## Footnote A: 1) Acute Asthma (alone or with [B2 agonist] ) 2) Asthmatic pt w/ [chronic bronchitis or cough] B: [High Dose --\> Atropine like effects]
48
[**Corticosteroids** is an \_\_\_\_\_\_\_] A: MOA B: Route of Administration (3)
[**Corticosteroids** is an Anti-Inflammatory] ## Footnote A: DEC [Arachidonic acid synthesis] --\> Inhibits release of PGE2 and Leukotrienes B: Inhale / PO / IV
49
[**Corticosteroids** is an \_\_\_\_\_\_\_] Indication
[**Corticosteroids** is an Anti-Inflammatory] ## Footnote Chronic Asthma Maintenance (*Reduces frequency/severity of asthma attacks by treating underlying inflammation*)
50
[**Corticosteroids** is an \_\_\_\_\_\_\_] *Side Effects* A: Short term (4) B: Long term (5)
[**Corticosteroids** is an Anti-Inflammatory] ## Footnote A: INC energy / insomnia / hunger / mood changes B: Osteoporosis / Cataracts / Myopathy / [Pituitary adrenal axis suppresion] / Depression
51
[**MonteLUKAST / ZafirLUKAST** are \_\_\_\_\_\_\_] A: MOA B: Route of Administration
[**MonteLUKAST / ZafirLUKAST** are [Leukotriene Inhibitors] ] ## Footnote A: [LT**D**4 and LT**E**4 Receptor _Blockers_] B: PO
52
[**Cromolyn** is an \_\_\_\_\_\_\_] A: Indication (3) B: Side Effect
[**Cromolyn** is an Anti-Inflammatory] ## Footnote A: 1) Bronchospasm **Px** 2) Exercise Pre-Tx 3) Cold Air Pre-Tx B: Cough-*occasional*
53
[**MonteLUKAST / ZafirLUKAST** are \_\_\_\_\_\_\_] A: Indication (3) B: Side Effect (2)
[**MonteLUKAST / ZafirLUKAST** are [Leukotriene Inhibitors] ] ## Footnote A: 1) Bronchospasm **Px** 2) [ASA induced asthma] 3) [Cold Air Pre-Tx] B:HA / Nausea
54
[**Zileuton** is a \_\_\_\_\_\_\_] A: MOA B: Route of Administration
[**Zileuton** is a [Leukotriene Inhibitor] ] ## Footnote A: Inhibits [5-LipoOxygenase] --\> DEC Leukotriene production B:PO
55
[**Zileuton** is a \_\_\_\_\_\_\_] A: Indication (2) B: Contraindication
[**Zileuton** is a [Leukotriene Inhibitor] ] ## Footnote A: 1) Bronchospasm **Px** 2) [ASA / Exercise / Antigen induced asthma] B:pts with _Hepatic dz_
56
A: Most effective single agent for **allergic rhinitis** B: What should you add if this isn't effective by itself?
A: **Glucocorticoid Nasal Sprays** B: [Antihistamine nasal spray]
57
If a pt is refractory to [Glucocorticoid nasal spray] but has asthma (or nasal polyposis), which medication may be helpful for them?
**MonteLUKAST**

🄼 Histo/Rx(TB/anemia/immuno)/Mycology (3 decks)

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