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NMSK-A II > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Drugs which treat chronic inflammations such as rheumatoid arthritis target this cytokine

A

TNF-alpha (tumor necrosis factor-alpha)

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2
Q

What are DMARDS and what are they used for?

A

Disease-Modifying Anti-Rhemuatic Drugs; slow down progression of rheumatoid arthritis

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3
Q

What is the goal of therapy for Rheumatoid Arthritis?

A

remission

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4
Q

Are NSAIDs disease modifying for RA?

A

No; used for pain and inflammation

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5
Q

What are the 2 branches of DMARDs?

A

1) Biologic DMARDs 2) Conventional DMARDs

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6
Q

What is the main side effect of using corticosteroids to treat RA?

A

Cushing’s Syndrome (and growth retardation in children)

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7
Q

What are the 3 goals of therapy with DMARDs?

A

1) preventing/controlling joint damage 2) preventing loss of function 3) decreasing pain

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8
Q

What is the stem for naming monoclonal antibodies?

A

-mab

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9
Q

What is the biggest concern with using monoclonal antibodies?

A

Allergic reaction to mouse protein

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10
Q

What do fusion proteins target during treatment?

A

TNF-alpha

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11
Q

How do fusion proteins work in drugs?

A

Fuse the receptor to the Fc portion of IgG and picks off the TNF-alpha to serve as a decoy receptor (adds stability and leads to longer action time)

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12
Q

Which action is blocked by fusion proteins?

A

CD80/86 on APC blocked from binding to CD28 on T-cell

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13
Q

What is the stem for the name of kinase inhibitors?

A

-nib

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14
Q

What is a commercially available kinase inhibitor used to treat RA?

A

Xeljanz (tofacitinib citrate) oral JAK inhibitor

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15
Q

What is the stem for the name of fusion proteins?

A

-cept

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16
Q

What are the most significant side effects of biologica DMARDs

A

1) increased risk of tuberculosis 2) fungal infections

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17
Q

What are 2 conventional oral DMARDs?

A

1) Methotrexate (MTX) 2) Leflunomide

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18
Q

How is folic acid important to the administration of methotrexate?

A

MTX antagonist to folic acid, but low dose of MTX does not have same MOA as folic acid. Give with folic acid supplement so the folic acid does not affect the MOA of MTX i.e., folic acid fights the side effects of MTX

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19
Q

What is the active intracellular form of folic acid?

A

tetrahydrofolate

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20
Q

What is the role of Dihydrofolate Reductase?

A

modifies folate we ingest to its active form

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21
Q

What is the role of methotrexate in relation to intracellular folate?

A

MTX inhibits DHFR, preventing formation of tetrahydrolate and ultimately inhibiting DNA/RNA synthesis

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22
Q

How does methotrexate affect adenosine?

A

Promotes the release of adenosine, an endogenous anti-inflammatory mediator

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23
Q

How does methotrexate affect AICAR?

A

Inhibits AICAR transformylase and leads to increase in AICAR which ultimately leads to increase in adenosine

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24
Q

What are the main adverse reactions to methotrexate?

A

1) GI intolerance 2) Bone marrow suppression 3) liver cirrhosis

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25
Q

What is leflunomide?

A

Prodrug which rapidly converts to its active metabolite A77 1726; **suppresses pyrimidine synthesis which cannot be made by T-cells otherwise!

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26
Q

When A77 1726 (teriflunomide) is isolated, what is it’s MOA?

A

non-competitive inhibitor of DHODH (dihydroorotate dehydrogenase)

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27
Q

What is the drug elimination procedure for leflunomide?

A

1) administer cholestyramine 2) verify plasma levels are below 0.02 mg/L

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28
Q

How is septic arthritis treated?

A

1) adequate drainage of purulent joint fluid 2) appropriate antimicrobial therapy

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29
Q

Which 4 drugs are used to treat septic arthritis?

A

1) daptomycin 2) linezolid 3) clindomycin 4) ceftaroline

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30
Q

What is bacteremia used for and what is its treatment course?

A

endocarditis; 2-6 weeks (long)

31
Q

What is special about the structure of cephalosporins?

A

beta-lactam antibiotics which inhibit cell wall synthesis

32
Q

Which drug(s) are used for inhibition of protein metabolism?

A

1) clindomycin 2) linezoid (tedizolid)

33
Q

Which drug(s) alter cell membrane permeability?

A

daptomycin

34
Q

What is the spectrum coverage of cephalosporins?

A

broad spectrum

35
Q

What is ceftaroline used to treat?

A

1) MRSA, CA-MRSA 2) S. epidermidis

36
Q

What is ceftriaxone used for?

A

1) N. gonorrhea 2) N. meningitidis

37
Q

What is cefepime used for?

A

P. aeruginosa

38
Q

What is ceftazidime used for?

A

P. aeruginosa

39
Q

What is cefoxitin used for?

A

1) B. fragilis 2) B. thetaiotaomicron

40
Q

What is cefazolin used for?

A

MSSA **Not MRSA**

41
Q

Which drug do you have to worry about a reaction with the MTT side chain leading to cleeding and alcohol reactions?

A

cefotetan

42
Q

When can a cephalosporin still be given due to an allergic reaction to penicillin?

A

Hives; immediate hypersensitivity

43
Q

Which cepahlosporin has best activity against MSSA?

A

cefazolin (1st generation)

44
Q

Which cephalosporin is used in treating menegitis, Lyme disease, and Gonorrhea?

A

ceftriaxone

45
Q

Which cephalosporin has Pseudomonas aeruginosa activity?

A

ceftazidime, cefepime

46
Q

Which cephalosporin has anaerobic Bacteroides fragilis activity?

A

cefoxitin

47
Q

Which cephalosporin has MRSA activity?

A

ceftaroline

48
Q

What are the stem names for cephalosporins?

A

-cef -ceph

49
Q

What is the MOA for daptomycin?

A

binds to bacterial membranes and causes rapid depolarization, resulting in inhibition of protein/DNA/RNA synthesis; causes rapid cell death

50
Q

What is the antibacterial spectrum of daptomycin?

A

gram + only

51
Q

Is daptomycin effective for lung infections?

A

No; lipid tail binds to cerfactin in the lung

52
Q

When administering daptomycin what should be monitored?

A

CPK levels; creatine phosphokinase

53
Q

When administering daptomycin what should be avoided?

A

Statins (HMG-CoA Reductase Inhibitors)

54
Q

What is the MOA of linezolid?

A

inhibits bacterial protein synthesis by binding to bacterial ribosome

55
Q

What is the MOA of tedizolid?

A

same as linezolid; inhibits bacterial protein synthesis by binding to bacterial ribosome

56
Q

What is the antibacterial spectrum for linezolid?

A

Gram +

57
Q

What is Serotonin Syndrome?

A

drug interaction where 2 drugs hit the CNS in separate places and lead to toxic levels of serotonin in the body; i.e., linezolid + antidepressentants (SSRI)

58
Q

Mechanistically, what causes Serotonin Syndrome?

A

inhibition of monoamine oxidase which normally inhibits NE inactivation; ultimately leads to increase of serotonin

59
Q

What is another name for serotonin?

A

5-Hydroxytriptamine (5-HT)

60
Q

What is an SSRI?

A

Selective Serotonin Reuptake Inhibitor; i.e., prozac; blocks serotonin from being taken back into presynaptic terminal and allows it to bind to serotonin receptor on postsynaptic terminal

61
Q

What is the MOA of clindamycin?

A

inhibits protein synthesis by binding to ribosome

62
Q

What is the anibacterial spectrum of clindamycin?

A

Gram +, Gram - anaerobes

63
Q

Which infection is commonly treated with clindamycin?

A

necrotizing fasciitis

64
Q

What is an adverse drug reaction to clindomycin?

A

diarrhea which may lead to C. difficile colitis

65
Q

Is clindamycin a good drug for MRSA and MSSA infections?

A

No; 70-80% sensitivity to drug

66
Q

Is clindamycin a good drug to treat B. frag or B. thetaiotaomicron?

A

No; use metronidazole instead

67
Q

What are the 3 stages in which gout is managed?

A

1) treating acute attack 2) provide prophylasix to prevent acute flares (while lowering uric acid levels) 3) lowering excess stores of urate to prevent flares of gouty arthritis and to prevent tissue deposition of urate crsytals

68
Q

Which drugs can be used to lower uric acid levels in chronic gout?

A

1) allopurinol (Xanthine Oxidase inhibitor) 2) febuxostat (Xantine Oxidase inhibitor) 3) probenecid (uricosuric) 4) pegloticase (uricase)

69
Q

Which drugs are used to treat acute gout?

A

1) NSAIDs 2) Colchicine 3) Glucocorticoids (corticosteroid)

70
Q

When comorbidities limit the use of NSAIDs or colchicine to treat acute gout, what is used instead?

A

intra-articular steroid injection

71
Q

What is the MOA of colchicine?

A

inhibits or halts cell division by interferring with microtubules

72
Q

Acute gout flare is the most common adverse event of which treatment?

A

initiation of serum urate-lowering therapy

73
Q

What is the role of uricase in the treatment of gout?

A

converts uric acid to highly soluble allatonin and allows for its excretion

74
Q

What is Tumor Lysis Syndrome?

A

elevation of plasma uric acid after cancer treatment and it is treated by Elitek (uricase)

NMSK-A II (10 decks)

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