Pharmacology Flashcards
Which medications are most likely to be implicated in medication-induced SCLE? What is the most likely antibody to be positive?
"THe D-BAG causes scle" Terbinafine HCTZ Diltiazem Beta-blockers ACEIs Griseofulvin
Also, 5-FU and capecitabine can induce as well as antihistamines, PUVA, IFN, TNF-inhibitors, PPIs
Most likely antibody: Anti-Ro (SSA)
38% of SCLE is drug-induced within 2 w - 6 months after drug started
Which medications can cause gingival hyperplasia?
Cyclosporine, phenytoin, calcium channel blockers
Which electrolyte abnormalities can cyclosporine cause?
Increased potassium, uric acid; decreased magnesium
Which medications are recommended for blood pressure management for patients on cyclosporine?
CCBs, specifically isradipine and nifedipine
What is the difference between how the following work: etanercept, adalimumab and infliximab?
- Etanercept: fusion protein of TNF-alpha receptor linked to Fc portion of human IgG1; binds free (soluble) TNF-alpha.
- Adalimbumab: fully human monoclonal Ab against TNF-alpha; binds soluble and membrane-bound TNF
- Infliximab: chimeric monoclonal Ab against TNF-alpha (mouse Fv/human IgG1); binds soluble and membrane-bound TNF
The two biologics for psoriasis that are off the market and should never be asked about on a board exam are: _______. Their functions are ______. Why were they removed from market?
Efalizumab: humanized murine Ab against CD11a (blocks LFA1 interaction with CAM1); given sq. Removed from market due to risk of progressive multifocal leukoencephalopathy.
Alefacept: human fusion protein of LFA3 and Fc portion of IgG1 (inhibits CD2/LFA3 interaction, blocking T-cell activation); given IM; must monitor CD4 counts weekly.
Name some EGFR inhibitors (6 or so)…
Cetuximab, Panitumumab, Erlotinib, Gefitinib, Lapatinib, Vandetanib.
Treat: colorectal, head/neck SCC, non-small cell lung, pancreatic cancers
What are common skin manifestations of EGFR inhibitors?
"PRIDe" Syndrome: Papulopustular eruption Paronychia Regulatory changes of Hair Itching Dryness
What distinguishes bexarotene from the other retinoids (5 things)?
- RXR-specific
- Used to treat CTCL
- Eliminated by hepatobiliary system (others excreted in urine and bile)
- Can cause central hypothyroidism (check TSH and free T4)
- DEET is contraindicated when taking bexarotene; gemfibrozil is also contraindicated because it increases bexarotene levels (and therefore TG levels) via CYP.
Name four low-androgenic progestins.
Norethindrone, levonorgestrel, desogestrel, norgestimate
Which medications can lead to drug-induced bullous pemphigoid (7)?
Furosemide, Penicillin, Captopril, beta-blockers, sulfonamides, terbinafine, penicillamine
What are the three types of minocycline dyspigmentation and which stains distinguish them?
Type 1: blue/black in scars; iron (hemosiderin) stains with Perls
Type 2: blue-grey on shins; melanin stains with Fontana-Masson, iron stains with Perls
Type 3: generalized muddy brown in sun-exposed areas; increased melanin in epidermis but NO iron deposition.
What medications are frequently implicated in lichenoid drug eruptions?
HCTZ, beta-blockers, antimalarials, quinidine, penicillamine, gold, furosemide, ACEI
Which medications are implicated in causing pseudoporphyria?
NSAIDs (naproxen, piroxicam), nalidixic acid, furosemide, HCTZ, isotretinoin, TCNs, sulfonamides
Which anticonvulsants are safe for a patient who developed DRESS syndrome after taking carbamazepine?
Levetiracetam, valproic acid = safe
Phenytoin, carbamazepine and phenobarbital cross-react and are not safe options.
Which medications that can cause SJS/TEN have specific HLA-alleles that increase an individual’s risk of developing SJS/TEN (3)?
Carbamazepine (#1) = HLA-B1502 (especially in Asians)
Allopurinol = HLA-B5801
Abacavir = HLA-B5701
How are amide anesthetics metabolized? Esters?
Amides: metabolized by cytochrome p450 3A4; excreted by kidneys
Esters: hydrolyzed by plasma pseudocholinesterase; excreted by kidneys
– Esters are “especially allergic” and cross-react with PABA
What is the maximum recommended lidocaine dose for a 70 kg person…with epi? without epi? if he is a child?
With Epi: 7.0 mg/kg
Without Epi: 4.5 mg/kg
Child: 3-4 mg/kg WITH epi
1% lidocaine is 10 mg lidocaine/ml, so 70 kg person can have 49 ml.
What is the ratio of sodium bicarbonate to 1% lidocaine in a buffered solution? What is the purpose?
1:10
Buffering raises the pH to a more physiologic level so that injection is less painful. Makes lidocaine’s T1/2 shorter.
Mechanism of action of hydroxyurea
S-phase specific cytotoxic agent that inhibits ribonucleotide reductase
Side effects: Anemia, hepatitis, and renal toxicity
Which drugs are penicillinase resistant penicillins?
Oxacillin, Cloxacillin, Dicloxacillin, Nafcillin
Name 1st generation cephalosporins (3) and their antimicrobial coverage.
Cephalexin, Cefazolin, Cefadroxil
– Primarily gram positives (MSSA, group A strep); some gram negative (E.coli, Klebsialla, Proteus mirabilis), no anaerobic coverage
Name 2nd generation cephalosporins (5) and antimicrobial coverage.
Cefaclor, Cefotetan, Cefoxitin, Cefprozil, Cefuroxime
– Gram positive coverage similar to 1st gen, improved gram negative coverage (H.flu, M.catarrhalis, Neisseria), some anaerobic (B.fragilis)
Name 3rd generation cephalosporins (7) and antimicrobial coverage.
Cefdinir, Cefditoren, Cefixime, Cefotaxime, Ceftazidime, Ceftibuten, Ceftriaxone
– Some degree of gram positive coverage except for ceftazidime; improved gram negative coverage compared with 1/2 generations; some anaerobic coverage
