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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
Q

EPO (Erythropoietin)

  • A: Prognosis after usage (2)*
  • B: Side Effects (3)*
A

[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
Q

G(M)CSF

MOA (2)

A
  1. Stimulates proliferation/differentiation of myeloid cells
  2. GMCSF specifically stimulates proliferation of erythroid and megakaryocytic cells
27
Q

G(M)CSF

Indications (3)

A
  1. Post Chemo
  2. Neutropenia tx
  3. Mobilizes peripheral blood stem cells for autologous transplant (GCSF)
28
Q

A: GCSF Side Effects (2)

B: GMCSF Side Effects (3)

C: Which is clinically preferred?

A

A: Bone pain / Splenic Rupture

B: [Joint & Muscle pain] / [Peripheral Edema] / [Pleural & Pericardial Effusion] ——–“M for Many problems”

B: GCSF

29
Q

[Recombinant Human IL 11]

  • A: Indication*
  • B: Side Effects (4)*
A

A: Post Surgical Thrombocytopenia

B:

  • Fatigue
  • Dyspnea
  • Arrhythmias
  • hypOkalemia
30
Q

[Romiplastin and EltromBopag]

A: MOA

B: Indication (2)

A

A: Thrombopoeitin-Receptor AGONIST

B: Thrombocytopenia / [Aplastic Anemia]

31
Q

[Romiplastin and EltromBopag]

Side Effects (3)

A
  • [MILD Bone marrow Fibrosis tht looks worse than actually is]
  • Myalgia
  • HA
32
Q

Diphenhydramine

A: MOA (2)

B: Indications (3)

C: route of administration (2)

A

A: [Histamine H1] and [Muscarinic receptor] Blocker

B: [Allergic Rhinitis] / Urticaria / [Anaphylactic rxn]

C: PO / IV

33
Q

Diphenhydramine

A: Side Effects

B: Classification

A

A: [Sedation or Agitation] due to [Muscarinic receptor blockade]

B: [1st generation H1 Blocker]

34
Q

Chlorphenlramine

A: MOA (2)

B: Indications (2)

A

A: [Histamine H1] and [Muscarinic receptor] Blocker

B: [Allergic Rhinitis] / [Common ingredient for OTC meds]

35
Q

Chlorphenlramine

A: Side Effects

B: Classification

A

A: [Slight Sedation or Agitation] due to [Muscarinic receptor blockade]

B: [1st generation H1 Blocker]

36
Q

Fexofenadine

A: MOA

B: Indications (2)

C: Classification

A

A: [Histamine H1] Blocker

B: [Idiopathic Chronic Urticaria] / [Allergic Rhinitis]

C: [2nd generation H1 Blocker]

37
Q

Loratadine

A: MOA

B: Indications (3)

A

A: [Histamine H1] Blocker

B: [Blood Allergic Rxns]/ [Allergic Rhinitis] / [Anaphylactic rxn adjunct]

38
Q

Loratadine

A: Side Effects (3)

B: Classification

A

A: Nausea / Fatigue / HA

B: [2nd generation H1 Blocker]

39
Q

Cetirizine

A: MOA (2)

B: Indications (2)

A

A: [Histamine H1 Blocker] + [Histamine Release Blocker]

B: [Idiopathic Chronic Urticaria] / [Allergic Rhinitis]

40
Q

Cetirizine

A: Side Effects (3)

B: Classification

A

A: Sedation / Fatigue / [Dry Mouth]

B: [2nd generation H1 Blocker]

41
Q

Doxepin

A: MOA

B: Indication

C: Side Effects

D: Classification

A

A: [Histamine H1] Blocker

B: Chronic Urticaria that does not respond to other [H1 Blockers]

C: Disorientation (confusion)

D: [2nd generation H1 Blocker]

42
Q

[B2 Agonist (short vs. long acting) are _______]

A: Indications (2)

B: Side Effects (3)

A

[B2 Agonist (short vs. long acting) are BRONCHODILATORS]

A:

1) Bronchospasm in acute asthma attacks
2) Adjunct for [Inhaled Corticosteroids]

B:

x: [Sk. Muscle Tremors]
x: Tachycardia
x: Anxiety

43
Q

[B2 Agonist (short vs. long acting) are _______]

A: MOA (2)

B: Route of Administration (3)

A

[B2 Agonist (short vs. long acting) are BRONCHODILATORS]

A:

1) Stimulates Adenylate Cyclase–> INC cAMP–> Bronchodilation
2) Blocks mast cell degranulation

B: Inhale / PO / SubQ (Terbutaline only)

44
Q

[Theophylline is a _______]

A: MOA (2)

B: Route of Administration (2)

A

[Theophylline is a BRONCHODILATOR]

A:

1) Inhibits [cAMP Phosphodiesterase]
2) [Adenosine Receptor competitive Blocker]

B: PO / [Slow IV over 40 min]

45
Q

[Theophylline is a _______]

A: Indication (2)

B: Side Effects (4)

A

[Theophylline is a BRONCHODILATOR]

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
Q

[Ipratropium is a _______]

A: MOA

B: Route of Administration

A

[Ipratropium is a BRONCHODILATOR]

A: [Airway Muscarinic Receptor Competitive Blocker]

B: Inhale

47
Q

[Ipratropium is a _______]

A: Indication (2)

B: Side Effect

A

[Ipratropium is a BRONCHODILATOR]

A:

1) Acute Asthma (alone or with [B2 agonist] )
2) Asthmatic pt w/ [chronic bronchitis or cough]

B: [High Dose –> Atropine like effects]

48
Q

[Corticosteroids is an _______]

A: MOA

B: Route of Administration (3)

A

[Corticosteroids is an Anti-Inflammatory]

A: DEC [Arachidonic acid synthesis] –> Inhibits release of PGE2 and Leukotrienes

B: Inhale / PO / IV

49
Q

[Corticosteroids is an _______]

Indication

A

[Corticosteroids is an Anti-Inflammatory]

Chronic Asthma Maintenance (Reduces frequency/severity of asthma attacks by treating underlying inflammation)

50
Q

[Corticosteroids is an _______]

Side Effects

A: Short term (4)

B: Long term (5)

A

[Corticosteroids is an Anti-Inflammatory]

A: INC energy / insomnia / hunger / mood changes

B: Osteoporosis / Cataracts / Myopathy / [Pituitary adrenal axis suppresion] / Depression

51
Q

[MonteLUKAST / ZafirLUKAST are _______]

A: MOA

B: Route of Administration

A

[MonteLUKAST / ZafirLUKAST are [Leukotriene Inhibitors] ]

A: [LTD4 and LTE4 Receptor Blockers]

B: PO

52
Q

[Cromolyn is an _______]

A: Indication (3)

B: Side Effect

A

[Cromolyn is an Anti-Inflammatory]

A:

1) Bronchospasm Px
2) Exercise Pre-Tx
3) Cold Air Pre-Tx

B: Cough-occasional

53
Q

[MonteLUKAST / ZafirLUKAST are _______]

A: Indication (3)

B: Side Effect (2)

A

[MonteLUKAST / ZafirLUKAST are [Leukotriene Inhibitors] ]

A:

1) Bronchospasm Px
2) [ASA induced asthma]
3) [Cold Air Pre-Tx]

B:HA / Nausea

54
Q

[Zileuton is a _______]

A: MOA

B: Route of Administration

A

[Zileuton is a [Leukotriene Inhibitor] ]

A: Inhibits [5-LipoOxygenase] –> DEC Leukotriene production

B:PO

55
Q

[Zileuton is a _______]

A: Indication (2)

B: Contraindication

A

[Zileuton is a [Leukotriene Inhibitor] ]

A:

1) Bronchospasm Px
2) [ASA / Exercise / Antigen induced asthma]

B:pts with Hepatic dz

56
Q

A: Most effective single agent for allergic rhinitis

B: What should you add if this isn’t effective by itself?

A

A: Glucocorticoid Nasal Sprays

B: [Antihistamine nasal spray]

57
Q

If a pt is refractory to [Glucocorticoid nasal spray] but has asthma (or nasal polyposis), which medication may be helpful for them?

A

MonteLUKAST

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

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