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.
