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A&I > Pharmacology and therapeutics > Flashcards

Pharmacology and therapeutics Flashcards

1
Q

what types of allergens are most likely to be found in undisturbed air in homes? (2)

A

Cat and Dog (DM and cockroach allergens settle quickly)

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2
Q

which allergen extracts are standardized? (5)

A

Grass
Ragweed
Cat
DM
venom

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3
Q

what is the probable effective dose range in biologic allergy units (BAU) for cat IT?

A

1000-4000 BAU

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4
Q

what does the blue allergen vial indicate (vol/vol)?

A

1:100 vol/vol (Green-Blue-Yellow-Red)

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5
Q

what cytokines do you expect in increase after IT? (4)

A

Th1-associated cytokines (IFN gamma, IL-12)
Treg-associated cytokines (IL-10, TGF-beta)

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6
Q

what other grass is cross-reactive to Timothy grass? (6)

A

other northern grasses (orchard, Kentucky bluegrass, perennial rye, sweet vernal, fescue, and red top)

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7
Q

how long does cat allergen remain in homes after cat removal?

A

4-6 months

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8
Q

which allergen extracts contain proteolytic enzyme which degrade pollen?

A

mold and cockroach

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9
Q

which venom extracts can be mixed together? (2)

A

Vespid venoms (hornets and yellow jacket)

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10
Q

what is the effective maintenance dose for most inhalant allergens?

A

5 - 20 ug of the major allergen per 0.5mL maintenance dose

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11
Q

what is the probable effective dose range in biologic allergy units (BAU) for DM immunotherapy?

A

500-2000 BAU

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12
Q

what percent of allergen IT injections lead to systemic reactions?

A

0.2% of injections lead to SR

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13
Q

which allergens/formulations are available with SLIT? (4)

A

Timothy grass
5 grass mix (northern grass: timothy, orchard, kentucky blue, perennial rye, sweet vernal)
Short ragweed
DM

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14
Q

what type of COX inhibition is generally tolerated in patients with AERD?

A

Selective inhibition of COX-2

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15
Q

what is the function of H4 receptor? (3)

A

pro-inflammatory
eosinophil
mast cell chemotaxis

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16
Q

LTB4 can lead to chemotaxis of which cell types? (2)

A

neutrophils and eosinophils

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17
Q

which antihistamines can be used with precaution in patients with renal failure?

A

Loratadine and 1st-gen antihistamines.
- for pt with hepatic failure, fexofenadine

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18
Q

in pts with AERD, COX inhibitor decreases the production of what prostaglandin product, leading to increased cys-LT production?

A

PGE2

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19
Q

between formoterol and salmeterol, which one has earlier onset of action?

A

Formoterol; salmeterol has a more lipophilic side chain, leading to slower onset

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20
Q

what enzyme does theophylline inhibit, leading to increase in cAMP?

A

phosphodiesterase

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21
Q

which antibiotics result in increased serum levels of theophylline? (2)

A

Macrolides and ciprofloxacin

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22
Q

which medications decrease glucocorticoid metabolism? (3)

A

Ketoconazole, oral contraceptives, macrolides

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23
Q

what type of intranasal spray is recommended for treatment of intermittent seasonal allergic rhinitis/ non allergic rhinitis?

A

intranasal antihistamine

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24
Q

which antihistamine has potential side effect of increased appetite and weight gain?

A

Cyproheptadine

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25
Q

what are some examples of ultra long activating beta agonists? (3)

A

carmoterol, indacaterol, vilanterol

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26
Q

which mediators are inhibited with the use of zileuton? (2)

A

LTB4 and cyst-LT

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27
Q

which phase (early vs late) to antigen challenge is prevented with use of mast cell stabilizers?

A

both early and late

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28
Q

which muscurinic receptor is responsible for bronchodilatory effect?

A

M2 receptor

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29
Q

what are the adverse effects of steroid? (7)

A

STEROID
- Stunted growth
- Thrush
- Eyes/Endocrine (inc IOP, cataract, glaucoma)
- Rage (psychiatric)
- Osteopenia/osteoporosis/Obesity
- Immunosuppression
- Dysphonia/ Diabetes/ Derm effects

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30
Q

Patient is being treated with a protease inhibitor for his HIV and also inhaled steroids for his asthma. what side effect should be considered due to potential drug interaction?

A

Cushing’s syndrome/ adrenal suppression

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31
Q

cyclosporine (CsA) and tacrolimus function by binding to which type of proteins?

A

immunophilins
- CsA binds to cyclophilin
- tacro binds to FK-binding protein

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32
Q

what is a potential cause of renal insufficiency when treating patients with IVIG?

A

hyperosmolar renal damage induced by breakdown of sucrose (used as a stabilizer in IVIG preparations)

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33
Q

which constant heavy chain domain does omalizumab bind to on IgE

A

CH3 domain (Fc portion)

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34
Q

how does omalizumab affect total/bound IgE vs free IgE?

A

increases total/bound IgE (complexes are eliminated slowly)
decreases free IgE

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35
Q

which of the biologics approved for asthma has shown no improvement in lung function?

A

omalizumab

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36
Q

of the biologics approved for allergic diseases, which have a black box warning for anaphylaxis? (2)

A

omalizumab and benralizumab

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37
Q

which biologic is associated with increased herpes zoster infections?

A

mepolizumab

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38
Q

which immunosuppressant binds to FKBP-12 and ultimately inhibits mTOR?

A

Rapamycin/sirolimus

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39
Q

removal of this molecule reduced the thrombotic effect of immunoglobulin replacement

A

Factor XIa

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40
Q

monoclonal Ab that is well-known to most commonly cause secondary hypogammaglobulinemia

A

rituximab

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41
Q

only monoclonal Ab that is approved for chronic rhinosinusitis with nasal polyposis

A

dupilumab

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42
Q

eculizumab inhibits a complement protein leading to increased susceptibility to which microbe?

A

Neisseria

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43
Q

how many grams of ointment are needed to cover the body of an average adult?

A

30g

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44
Q

drug fever is an example of which type of hypersensitivity reaction?

A

type 3

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45
Q

contact dermatitis is an example of which type of hypersensitivity reaction?

A

type 4a

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46
Q

what is the conjugated pneumococcal vaccine? what is the unconjugated pneumococcal vaccine?

A

PCV-13 is conjugated
PSV-23 is unconjugated

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47
Q

what are three contraindications to receiving another dose of the same vaccine?

A

anaphylaxis
encephalopathy
Gullian-Barre syndrome

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48
Q

what is the name and mechanism of a monoclonal Ab used to treat moderate to severe eczema?

A

Dupilumab, anti-IL-4 alpha

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49
Q

what is the name of the major determinant in PCN allergy?

A

Benzylpenicilloyl polylysine (Pre-Pen)

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50
Q

what percent of patients with EBV develop a rash and given an aminopenicillin (amox, amp)?

A

80%

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51
Q

what is the name of the blistering disease due to vancomycin hypersensitivity?

A

linear IgA bullous dermatitis

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52
Q

what mechanism of reactions are contraindications to desensitization?

A

exfoliative or blistering skin reactions and immune complex-mediated reactions.

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53
Q

What is one mechanism for the therapeutic benefit of IVIG therapy in autoimmune disorders?

A

IVIG increases expression of FcgRIIb expression and binds to it –> delivers inhibitory signals to B cells and myeloid cells to decrease Ab production and dampen inflammation

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54
Q

list of TNF alpha blockers (5)

A
  • infliximab
  • adalimumba
  • certolizumab
  • golimumab
  • etanercept
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55
Q

what is Tocilizumab

A

anti IL-6R mAb

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56
Q

what is Sarilumab

A

anti IL-6R mAb

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57
Q

Abatacept MOA

A
  • CTLA4-Ig.
  • binds and inhibits to the costimulatory molecules CD80 and CD86 on APCs
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58
Q

what is rituximab

A

anti-CD20 mAb

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59
Q

effective maintenance dose for most aeroallergens

A
  • 5-20 mcg per 0.5mL
  • 1000-4000 BAU or AU
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60
Q

effective maintenance dose for cat

A

1000 - 4000 BAU

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61
Q

effective maintenance dose for dog

A

15 mcg Can f 1

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62
Q

effective maintenance dose for DM

A

500-2000 AU

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63
Q

effective maintenance dose for Bermuda

A

300-1500 BAU

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64
Q

effective maintenance dose for grass

A

1000 - 4000 BAU

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65
Q

effective maintenance dose for short ragweed (2)

A

6-12 mcg Amb a 1 OR 1000-4000 BAU

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66
Q

Pregnancy Class B antihistamines (3)

A
  • loratadine
  • cetirizine
  • levocetirizine
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67
Q

antihistamines that can be used in renal failure (2)

A

loratadine and first gen antihistamines

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68
Q

antihistamines that can be used in hepatic failure (1)

A

fexofenadine

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69
Q

adverse effects of beta-agonists (7)

A
  • tremor
  • tachycardia
  • prolonged QT/ arrhythmias
  • myocardial ischemia
  • transient increased hypoxia
  • high glc
  • low potassium, magnesium
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70
Q

adverse effects of montelukast (2)

A
  • suicidal thinking
  • behavioral/mood changes
71
Q

adverse effects of zafirlukast (2)

A
  • dose-dependent liver toxicity
  • interacts with warfarin (need to dec warfarin dose)
72
Q

(5)adverse effects of zileuton

A
  • headache
  • dyspepsia
  • leukopenia
  • inc in ALT (not recommended in liver dz or alcoholics). need q3mo check
  • interacts with drugs bc it inhibits cytochrome CYP1A2 – need to decrease dose of warfarin, theophylline, and propranolol
73
Q

M2 (muscarinic) receptor function

A

inhibitory receptor on parasympathetic nerves. decreases acetylcholine release

74
Q

M3 (muscarinic) receptor function (3)

A
  • primary mediator of smooth mm contraction in human airways
  • increases intracellular Ca, causing bronchoconstriction
  • antihistamines can bind to M3 receptor
75
Q

sequence of events after steroid binds to its receptor in the cytoplasm (3)

A
  • heat shock proteins dissociate from the receptor
  • the receptor is phosphorylated
  • steroid-receptor complex translocates into the nucleus
76
Q

which drugs can increase serum steroid (like budesonide, fluticasone) levels? (4)

A
  • CYP450 3A4 inhibitors (ritonavir, itraconazole)
  • barbiturates
  • barbiturates
77
Q

relative binding affinity for GC receptor
- fluticasone
- triamcinolone
- mometasone
- budesonide

A

mometasone > fluticasone > budesonide > triamcinolone

78
Q

steroid resistance is mediated by?

A
  • overexpression of GC receptor beta.
  • this receptor does not bind to GC, but rather inhibits anti-inflammatory response
  • associated with fatal asthma and nocturnal asthma
79
Q

mometasone inhaler brand name and dosage (3)

A
  • Asthmanex: 100/200 mcg 2 puffs BID
  • Asthmanex Twisthaler 110/220 mcg 2 puffs BID
80
Q

fluticasone inhaler brand name and dosage (43

A
  • Flovent: 44/110/220 mcg 2 puffs BID
  • Flovent Diskus: 50/100/250 mcg 1 puff BID
  • Arnuity Ellipta: 100/200 mcg once daily
81
Q

beclomethasone inhaler brand name and dosage (1)

A
  • Qvar; 40/80 mcg 1 puff BID
82
Q

budesonide inhaler brand name and dosage (1)

A
  • Pulmicort Flexhaler: 90/180 mcg 2 puffs BID
83
Q

fluticasone-salmeterol inhaler brand name (3)

A
  • Advair
    -Advair Diskus
  • Airduo
84
Q

fluticasone-vilanterol inhaler brand name (1)

A
  • Breo Ellipta
85
Q

mometasone-formoterol inhaler brand name (1)

A

Dulera

86
Q

budesonide-formoterol inhaler brand name (1)

A

Symbicort

87
Q

tiotropium bromide brand name

A

Spiriva

88
Q

~omab biologic

A

murine Ig

89
Q

~ximab

A

variable region are murine, but rest is human

90
Q

~zumab

A

humanized (CDRs are murine)

91
Q

~umab

A

all human

92
Q

omalizumab MOA (2)

A
  • binds to Fc region (CH3 domain) of free IgE
  • decreases expression of high-affinity IgE receptors on mast cells
93
Q

indications of omalizumab (3)

A
  • mod/severe asthma > 6yo
  • CSU >12yo
  • CRSwNP > 18yo
94
Q

something that does not improve with omalizumab use

A

no improvement in pulmonary function

95
Q

mepolizumab indications (3)

A
  • severe persistent asthma (eosinophilic phenotype) > 6yo
  • HES > 18yo
  • EGPA > 18yo
96
Q

precaution with mepolizumab

A

herpes zoster infections – Singles vaccine recommended for > 50yo

97
Q

reslizumab MOA

A

IL-5 antagonist

98
Q

reslizumab indication

A

eosinophilic severe asthma > 18yo (via IV!)

99
Q

precautions with reslizumab (2)

A
  • oropharyngeal pain
  • black box warning for anaphylaxis
100
Q

benralizumab MOA

A
  • binds to IL-5 receptor alpha –> death of eos and basophils via Ab dependent cellular cytotoxicity
101
Q

benralizumab indication

A

severe eosinophilic asthma >12yo

102
Q

benralizumab does not affect..?

A

FEV1

103
Q

precautions for benralizumab (3)

A

HA, pharyngitis, fever

104
Q

dupilumab MOA

A

binds to IL-4 receptor alpha – blocks IL 4 and 13

105
Q

dupilumab indications (3)

A
  • mod/severe eosinophilic asthma > 6yo
  • mod/severe AD > 6yo
  • CRSwNP > 18yo
106
Q

precautions with dupilumab (3)

A
  • conjunctivitis (more with AD)
  • transient eosinophilia
  • dz does recur after discontinuation
107
Q

Immune effects, molecular target and indication (3) for Alemtuzumab

A
  • profound T and B cell depletion
  • targets Cd52 (cell surface glycoprotein)
  • indicated for B-CLL, leukemia and MS
108
Q

Immune effects, molecular target and indication (2) for Cetuximab

A
  • binds and inhibits epidermal growth factor receptor
  • targets epidermal growth factor receptor
  • indicated for metastatic colorectal cancer, and head and neck cancer
109
Q

Immune effects, molecular target and indication (2) for Vedolizumab

A
  • blocks migration of gut homing lymphocytes
  • a4b7 antagoinst
  • indicated for Crohn and UC
110
Q

Immune effects, molecular target and indication (2) for Natalizumab

A
  • block migration of leukocytes into CNS
  • a4 integrin antagonist
  • indicated for MS and Crohn
111
Q

Immune effects, molecular target and indication (2) for Eculizumab

A
  • binds C5, inhibits terminal complement activation
  • targets C5
  • indicated for PNH and atypical HUS
112
Q

Immune effects, molecular target and indication (2) for Ustekinumab

A
  • blocks IL-12 and IL-23
  • targets p40 subunit (IL-12/23)
  • indicated for psoriasis and Crohn’s
113
Q

Immune effects, molecular target and indication (2) for secukinumab

A
  • blocks IL-17 pathway
  • targets IL-17A
  • indicated for psoriasis and ankylosing spondylitis
114
Q

list of TNF-alpha blockers (4)

A
  • adalimumab
  • infliximab
  • certolizumab
  • golimumab
115
Q

list of IL-1b neutralizers (2)

A

canakinumab and rilonacept

116
Q

IL-1 receptor antagonist

A

anakinra

117
Q

Immune effects, molecular target and indication (2) for tocilizumab

A
  • affects B cells and Tregs
  • targets IL6 receptor
  • indicated for RA and JIA
118
Q

target for rituximab

A

CD20

119
Q

Immune effects, molecular target and indication (2) for emapalumab

A
  • blocks IFN- gamma
  • targets IFN g
  • indicated for primary HLH
120
Q

Immune effects, molecular target and indication (2) for Abatacept

A
  • disrupts CD28 co-stimuation
  • targets B7-1,2
  • indicated for RA and JRA
121
Q

Immune effects, molecular target and indication (2) for Belatacept

A
  • disrupts Cd28 costimulation
  • targets CD80/86
  • indicated in kidney and lung transplantation
122
Q

Immune effects, molecular target and indication (3) for ruxolitinib

A
  • inhibits signaling of cytokine and growth factors responsible for hematopoiesis and immune function
  • targets JAK1 and JAK2
  • off label use for STAT3-GOF, STAT1-GOF, CANDLE synd
123
Q

Immune effects, molecular target and indication (3) for tofacitinib

A
  • inhibits signaling of cytokine and growth factors responsible for hematopoiesis and immune function
  • targets JAK1 and JAK3
  • off label use for STAT3-GOF, STAT1-GOF, CANDLE synd
124
Q

Immune effects, molecular target and indication (3) for baricitinib

A
  • inhibits signaling of cytokine and growth factors responsible for hematopoiesis and immune function
  • targets JAK1 and JAK2
  • off label use for STAT1-GOF, CANDLE synd
125
Q

Immune effects, molecular target and indication (3) for ibrutinib

A
  • inhibits B cell maturation/production
  • targets BTK
  • indicated in lymphoma, chronic GVHD, Waldensstorm macroglobulinemia
126
Q

pharmacology and immune effects of methotrexate (4)

A
  • structural analog to folic acid
  • competitively inhibits binding of dihydrofolic acid to dihydrofolate reductase
  • eliminated via renal clearance
  • inhibits cell replication
127
Q

pharmacology and immune effects of azathioprine (4)

A
  • prodrug that inhibits purine nucleotide synthesis and metabolism
  • metabolites are incorporated into replicating DNA and halt replication
  • inhibits proliferation of T and B cells
  • causes apoptosis of T cells
128
Q

pharmacology and immune effects of mycophenolate mofetil (3)

A
  • affects purine nucleotide synthesis and metabolism via reversible inhibition of IMP dehydrogenase
  • decrease T and B cell proliferation
  • dec Ab production
129
Q

pharmacology and immune effects of cyclosporine (2)

A
  • inhibit T helper cell function as a calcineurin inhibitor
  • result in inhibition of transcription factors like NFAT
130
Q

pharmacology and immune effects of tacrolimus/pemicrolimus (2)

A
  • inhibits calcineurin phosphatase activity
  • result in inhibition of transcription factors like NFAT
131
Q

pharmacology and immune effects of rapamycin/ sirolimus (2)

A
  • inhibits mTOR
  • leads to inhibition of T cell activation and proliferation
132
Q

how does Alum work?

A

it works as an adjuvant through the NLRP3 pathway involving the inflammasome

133
Q

immunomodulating effects of IGRT (5)

A
  • ADCC inhibition by FcgRIII (Cd16) blockade on NK cells
  • inhibition of Ab production by blockade of FcgRIIb (CD32) on B cells
  • neutralization
  • inhibit cytokines, complements
134
Q

conjugated polysaccharide vaccines - mechanism and examples (4)

A
  • T cell dependent
  • Hib
  • Prevnar
  • meningococcal (Menactra and Menveo) – Menomune is purely polysacch.
135
Q

gelatin containing vaccines (4)

A
  • MMR
  • varicella
  • rabies
  • yellow fever
136
Q

vaccine to avoid if egg allergic

A

yellow fever

137
Q

vaccine precaution in latex allergic pts

A
  • do not administer vaccines supplied in vials containing natural rubber products, unless benefits > risks
138
Q

yeast containing vaccines (2)

A
  • hep b
  • HPV
139
Q

contraindications for vaccine administration (4)

A
  • anaphylaxis to prior dose
  • encephalopathy < 7d after pertussis-containing vaccine
  • history of Guillain Barre syndrome
  • pregnancy and immunosuppression for live vaccines
140
Q

very low potency topical steroids (2)

A
  • hydrocortisone acetate 0.5-1%
  • hydrocortisone hydrochloride 0.25-2.5%
141
Q

low potency topical steroids (3)

A
  • alclometasone 0.05
  • desonide 0.05
  • hydrocortisone butyrate 0.1
142
Q

medium potency topical steroids (4)

A
  • fluocinolone acetonide 0.025
  • hydrocortisone valerate 0.2
  • mometasone furoate 0.1
  • triamcinolone acetonide 0.1
143
Q

med-high potency topical steroids (3)

A
  • betamethasone valerate
  • fluticasone pripionate 0.005
  • triamcinolone acetonide 0.5
144
Q

high potency topical steroids (5)

A

amcinonide
- betamethasone dipropionate
- desoximetasone
- fluocinonide
- halcinonide

145
Q

very high potency topical steroids (3)

A
  • clobetasol
  • diflorasone
  • halobetasol
146
Q

topical phosphodiesterase 4 inhibitor

A

crisaborole

147
Q

MHC associated with reaction to Abacavir in Whites

A

HLA-B*5701

148
Q

MHC associated with carbamazepine reactions in Han Chinese

A

HLA-B*1502

149
Q

what is the major determinant for penicillin?

A

benzylpenicilloyl polylysine (PrePen)

150
Q

medications that share the same R1 side chain as amoxicillin (2)

A

cefadroxil, cefprozil

151
Q

medications that share the same R1 side chain as ampicillin (2)

A
  • cefaclor
  • cephalexin
152
Q

medications that share the same R1 side chain as ceftriaxone (2)

A
  • cefotaxime
  • cefpodoxime
153
Q

medications that share the same R1 side chain as cefoxitin (2)

A
  • cephaloridine
  • cephalothin
154
Q

medications that share the same R1 side chain as ceftazidime (1)

A

aztreonam

155
Q

beta lactams that share the same amino R1 group (5)

A

ampicillin
amoxicillin
cefaclor
cephalexin
cefadroxil

156
Q

beta lactams that share the same methoxyimino R1 group (6)

A

ceftriaxone
cefotaxime
cefuroxime
cefepime
ceftazidime
cefpodoxime

157
Q

cephalosporin that has a unique R group side chain and does not require testing in patient with PCN allergy

A

cefazolin

158
Q

major determinant for type I reactions to sulfa

A

N4-sulfonamoidoyl hapten

159
Q

medications that can cause linear IgA bullous dermatitis (3)

A

vancomycin
furosemide
Bactrim

160
Q

most common agent to cause perioperative drug reactions

A

quaternary ammonium mm relaxants

161
Q

which immunosuppressive medication is known to cause capillary leak syndrome?

A

Sirolimus/rapamycin

162
Q

what kind of reaction do taxanes (ie paclitaxel, docetaxel) cause?

A

anaphylactoid

163
Q

what kind of reactions do platinum compounds (cisplatin, carboplatin, oxaliplatin) cause?

A

IgE mediated reactions

164
Q

non antihistamine meds that interfere with skin testing (3)

A

TCAs, phenothiazines (1st gen typical antipsychotics), omalizumab

165
Q

What type of receptor is the glucocorticoid receptor?

A

Nuclear receptor

166
Q

Minor determinants of penicillin are most commonly associated with what type of reactions?

A

Anaphylaxis

167
Q

Inhibitors targeted at which enzyme have been able to restore glucocorticoid sensitivity in patients with steroid-refractory asthma?

A

P38 MAPK (MAPK14)

168
Q

Which interleukin, associated with neutrophilic asthma, is elevated in sputum and serum samples from patients with severe asthma?

A

IL-17

169
Q

Supplementation of which vitamin may augment responsiveness to glucocorticoids in patients with steroid-refractory asthma by increasing steroid-induced T cell secretion of IL-10?

A

Vitamin D3 (calcitriol)

170
Q

5-lipoxygenase inhibitor zileuton blocks __

A

blocks the production of LTB4 and LTC4

171
Q

After allergen challenge, leukotriene receptor antagonists prevent immediate or late response?

A

both

172
Q

The primary toxicity associated with zafirlukast and zileuton affect which organ

A

Liver (not in montelukast)

173
Q

Tralokinumab MOA

A

binds to IL-13 – prevents binding to IL-13R

174
Q

Tralokinumab indication

A

mod/severe AD

A&I (10 decks)

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