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Exit Viva > pharmaco > Flashcards

pharmaco Flashcards

1
Q

acitretin dose, T1/2

VS isotret?

A

10-25(+photoRx,2w before, NBUVB 25% dose reduction,)/50mg/d;T1/2-2d preganncy +2-3y

isotret: 0.5-2mg/kg/d, t1/2 20H , preganncy +1 m

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2
Q

acitretin Monitoring

A
  1. terataogenic, lipids, transaminits, bone
  2. UPT(pregancy 3Y-etretinate-T1/2-120d/LFT/fasting lipids q 1mx3m, q3m, (pediatric-yearly skeletal Xray, adult-3y skeletal survey)
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3
Q

acitretin ADR

A 
chelitis, conjunctivitis, xerosis, periungual PG, alopecia ,
pseutdotumor cerrebri(tetracycline); 
osteoporosis, skeletal hyperostoses.interosseous ligament/tendon ossification/premature epiphyseal closure
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4
Q

acitretin MOA:

A

bind RARs normalise keratinization(reduced follicular occlusion)
inhibit ornithine decarboxylase/collagenase/AP1/IL6 K6K16
increase filagrin/kf

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5
Q

Colchicine dose

A

0.5mg bd-tds;

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6
Q

Colchicine MOA

A

inhibit microtubules mitotic metaphase arrest

neutrophil chemotaxis

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7
Q

Colchicine ADR

A

CI:severe renal/hepatic dz; ADR: GIT,ocasioal BM(prolonged), cat C

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8
Q

dapsone dose

A

50-100 mg OD(anemia, elderly )

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9
Q

dapsone monitoring +ADR

A

G6PD, FBC+retic(hemolytic anemia, agranulocytosis, methemoglobinemia->30% methylene blue lightheaded SOB, headache), LFT, UECr,UPT(C)
hypersensitivity(3-6w onset), peripheral neuropathy dose related

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10
Q

dapsone:drug toxiciity

A

: bactrim

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11
Q

dapsone: MOA

A

MOA:sulfonamide, antibacterial mycobacteria, antiinflammatory(neutrophils-inhibit myeloperoxidase)

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12
Q

Antimalarials DOSE

A

(IBW ht-100(0.9/0.85),onset 4-8w)- HCQ 6.5mg/kg/d,

CQ 4mg/kg/d

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13
Q

chronic CS: ADR

A
  1. PUD prophylaxis;+ ca/vitD supplement
  2. BP/HC/HepB/C reactivation/HPA immunosuppresion
  3. osteoporosis(BMD Z score femoral neck baseline) opthalmo-6mo cataract/glacucoma
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14
Q

chronic CS MOA

A

MOA:antiinflammatory/immunosupressive(↓lymph/eos/mono/macrophage/ab/proinfllammtory/fibroblast)

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15
Q

Antimalarials monitoring, ADR

A

G6PD,retinopathy, LFT/FBC 3monthly

baseline, after 7years or CD 1000g(HCQ) CQ 5 y, ) +/- quinacrine,(100mg OD, alternative if retinopathy N.A Sg)
Baseline opthalmo, 6monthly nurse screen, 5 y opthalmo rv, risk factors- > 60y, weight extremes, liver/renal impairment/baseline eye dz;

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16
Q

Antimalarials MOA

A

stabilize lysosomal mb, inhibit neutrophil/ eosinophil/ complements/prostaglandin/TLR 3,7,9; inh DNA intercalation

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17
Q

MTX dose, CI?

A

2.5-25mg/w+ folic acid, nausea: AM/PM/2-day;

CI; pregnancy/alcoholism/liver disease/active infection rCI:renal mpaired/obesity/DM

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18
Q

MTX monitoring

LFTx2 vs x5?

A

baseline FBC q2wq3m(TW, Plt, macrocytic Hb),q3m UECr/CrCl(ederly)LFT(transaminitis, cirrhosis), liver Bx- 3.5g/q1.5g, high risk-CLD/DM/obesity/alcoholic(baseline, q1.5g)LFT2x reduce, rpt 2w, 5x-stop rpt 4w, liver bx

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19
Q

MTX ADR

A

1.baseline FBC q2wq3m(TW, Plt, macrocytic Hb),q3m UECr/CrCl(ederly)LFT(transaminitis, cirrhosis),
2.liver Bx- 3.5g/q1.5g, high risk-CLD/DM/obesity/alcoholic(baseline, q1.5g)
3.Immunosuppresion(HepB/C); malignant lymphoma
teratogencity/male fertililty
radiation recall/mucosal/pulmonary fibrosis

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20
Q

MTX MOA:

A

antimetabolite/antifolate, inhibit S phase spec DHFR(folic acid pathway)–>DNA/RNA synthesis(purine/thymidalate synthesis)

21
Q

Cyclosporin ADR, monitoring

A

baseline: BP,UE Cr,/UA,UPT, Mg(hypo)/uric acid/lipid, FBC, LFT,
hepb/c malignancies, gingival hyperplasia
monitor: cr(dose reduction if >30% baseline,) bp q2wx2m, q 2-3m

22
Q

Cyclosporin MOA:

A

bind cyclophilin, inhibit T cell acitvity/calcineurin activation/NFAT/IL12 release

23
Q

AZA dose, response

A

1-3mg/kg/d, response 6-8w

24
Q

AZA monitoring

A

FBC, LFT( myelosuppression-TW,lymp,Plt, MCVHb-B12/folate, transamininitis), UPT(D) drug toxicity:
preRx TPMT(N.A.), allopurinol, ACE, bactrim
monitor: Hb drop 3,plt>70k 50%, rpt
Hb>3, TW>3 plt

25
Q

AZA ADR

A

opportunistic infections, malignancy(NHL/SCC), hypersensitvity, GIT

26
Q

MMF dose

A

500mg bd–>1.5g BD

27
Q

AZA MOA:

A

purine analog blocks S-phase specific purine synthesis,
6MP active metabolite→ 6 thioguianine via
TPMT, HRPT(toxic purine analog), XO pathways

28
Q

MMF monitoring ADR ,

A 
monitor FBC(myelosuppresion)/LFT/UPT(C)-
opportunistic infections, malignancy-lymphoproliferative, GIT-hemorrhage (elderly)
29
Q

MMF MOA

A

inhibit IMPDH/ purine synthesis /T/B cell

30
Q

MMF drug toxicity-

A

concomitant AZA(myelosuppresion)

31
Q

CyP MOA:

A

nitrogen mustard derivative, non-cell cycle specific DNA Xlinkage

32
Q

IvIg dose

A

(2mg/kg over 4d(or >4 if low EF) q monthly, 50ml/h–>q25ml q 15min–>150ml/h,

33
Q

IvIg monitoring, ADR

A

baseline IgA,LFT,FBC,hepB/C, BP/PR/T,

infusion/anaphylactic/ARF/VTE,MI/HepC/meningitis)

34
Q

IvIg MOA

A

immunomodulatory-

inhibit Fc receptor/complement/cytokine/circulating ab/ toxins

35
Q

CPA Dose

A

1-3mg/kg/d AM(+fluid+PU)

36
Q

CPA ADR monitoring

A

baseline FBC, UEC/UA/UPT(D), LFT
monitor: FBC/UFEME/Cr (hemorrhagic cystitis, TW, plt, Hb)
opportunistic infections, malignancy(lifelong UA 6mo-bladder CA; myeloproliferative),
teratogenic/sterility-permanent, nail/skin hyperpigmentation

37
Q

pulse iv methylpred dose

A

10-20mg/kg(100ml NS in 2h)x 3-5d

500mg methylpred=625mg pred

38
Q

ritux dose

A

375mg/m2 q w x 1m (500ml 0.9% NS), 50ml/h+50ml/h (max400ml/h)q 30min( BP, HR, SPO2 q 15minx1h, then hourly)

alt: Lubeck, 1000mg q 2w x2(same efficacy$10K); lower dose effective: BJD 2012 : 2x 500 mg q2w;

39
Q

ritux ADR monitoring

? BP 120/minute and/or SpO2 ≤ 92% on RA,

A

stop infusion When stabilize, restart infusion at previous tolerated

pretreatment CD19(mirrors CD20 exp), HIV, TB T spot
premed: paracet, iv benadryl, iv hydrocort 100mg
ADR: infusion-angioedema(stop), hypotension, bronchospasm, opportunistic infx, neutropenia

40
Q

ritux MOA:

A

bind CD20(surface mature B cell), apoptosis

41
Q

iv methylpred ADR monitoring

A

baseline +daily UECr(hypoK), ECG(sudden death, VF)+ cardiac monitoring, stop pred( restart D1 post completion)

42
Q

eczema herpeticum-Severe, immunocompromise,Mild dose?

A

(Renal adjust)IV acyclovir 15mg/kg/day >=5 days; PO 25mg/kg/d 5 divided doses
Mild – PO acyclovir 400mg tds 5-10d

43
Q

Biologics -which ones and how do they compare?

A

TNFa inhibitor(B)-etanercept, adalimumab infliximab(onset,efficacy,dosing interval but secondary failure-antibodies, admission) ,ustekinumab(C)( IL 12-23 inhibitor)

44
Q

Biologics CI

A

hypersensitivity(murine-inflix)
active/chronic infx (TB ) LE(relative CI)
malignancy(

45
Q

Biologics Invx-

A

FBC, UECR, UA, LFT, CXR
INFX:HepB(anti HbsAb/HBsAg, antiHBc(total), anti HCV,TB T spot, HIV
malignancy: age appropriate cancer screen/ANA

46
Q

Biologics monitoring:

A

fbc/lft 1month, q3m; uecr q6m, TB Tspot yearly, HepB/C/HIV/UPT periodically

47
Q

Biologics onset of action

A

: infliximab(2w)

48
Q

Biologics dosing most infrequent? comparison?:

A

SC ustekinumab q3mo

EAI( shortest–>longest) etanercept qw; adalimumab q2w, IV infliximab q2mo(admission)

49
Q

Biologics indication for *psoriasis

A

DLQI/PASI/BSA>10%;high impact site+ CI/failure(PASI 75 improvement)/ADR standard systemic Rx(MTX, CyA, Acitretin)*

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