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)
2
Q
which allergen extracts are standardized? (5)
A
Grass
Ragweed
Cat
DM
venom
3
Q
what is the probable effective dose range in biologic allergy units (BAU) for cat IT?
A
1000-4000 BAU
4
Q
what does the blue allergen vial indicate (vol/vol)?
A
1:100 vol/vol (Green-Blue-Yellow-Red)
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)
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)
7
Q
how long does cat allergen remain in homes after cat removal?
A
4-6 months
8
Q
which allergen extracts contain proteolytic enzyme which degrade pollen?
A
mold and cockroach
9
Q
which venom extracts can be mixed together? (2)
A
Vespid venoms (hornets and yellow jacket)
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
11
Q
what is the probable effective dose range in biologic allergy units (BAU) for DM immunotherapy?
A
500-2000 BAU
12
Q
what percent of allergen IT injections lead to systemic reactions?
A
0.2% of injections lead to SR
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
14
Q
what type of COX inhibition is generally tolerated in patients with AERD?
A
Selective inhibition of COX-2
15
Q
what is the function of H4 receptor? (3)
A
pro-inflammatory
eosinophil
mast cell chemotaxis
16
Q
LTB4 can lead to chemotaxis of which cell types? (2)
A
neutrophils and eosinophils
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
18
Q
in pts with AERD, COX inhibitor decreases the production of what prostaglandin product, leading to increased cys-LT production?
A
PGE2
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
20
Q
what enzyme does theophylline inhibit, leading to increase in cAMP?
A
phosphodiesterase
21
Q
which antibiotics result in increased serum levels of theophylline? (2)
A
Macrolides and ciprofloxacin
22
Q
which medications decrease glucocorticoid metabolism? (3)
A
Ketoconazole, oral contraceptives, macrolides
23
Q
what type of intranasal spray is recommended for treatment of intermittent seasonal allergic rhinitis/ non allergic rhinitis?
A
intranasal antihistamine
24
Q
which antihistamine has potential side effect of increased appetite and weight gain?
A
Cyproheptadine
25
what are some examples of ultra long activating beta agonists? (3)
carmoterol, indacaterol, vilanterol
26
which mediators are inhibited with the use of zileuton? (2)
LTB4 and cyst-LT
27
which phase (early vs late) to antigen challenge is prevented with use of mast cell stabilizers?
both early and late
28
which muscurinic receptor is responsible for bronchodilatory effect?
M2 receptor
29
what are the adverse effects of steroid? (7)
STEROID
- Stunted growth
- Thrush
- Eyes/Endocrine (inc IOP, cataract, glaucoma)
- Rage (psychiatric)
- Osteopenia/osteoporosis/Obesity
- Immunosuppression
- Dysphonia/ Diabetes/ Derm effects
30
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?
Cushing's syndrome/ adrenal suppression
31
cyclosporine (CsA) and tacrolimus function by binding to which type of proteins?
immunophilins
- CsA binds to cyclophilin
- tacro binds to FK-binding protein
32
what is a potential cause of renal insufficiency when treating patients with IVIG?
hyperosmolar renal damage induced by breakdown of sucrose (used as a stabilizer in IVIG preparations)
33
which constant heavy chain domain does omalizumab bind to on IgE
CH3 domain (Fc portion)
34
how does omalizumab affect total/bound IgE vs free IgE?
increases total/bound IgE (complexes are eliminated slowly)
decreases free IgE
35
which of the biologics approved for asthma has shown no improvement in lung function?
omalizumab
36
of the biologics approved for allergic diseases, which have a black box warning for anaphylaxis? (2)
omalizumab and benralizumab
37
which biologic is associated with increased herpes zoster infections?
mepolizumab
38
which immunosuppressant binds to FKBP-12 and ultimately inhibits mTOR?
Rapamycin/sirolimus
39
removal of this molecule reduced the thrombotic effect of immunoglobulin replacement
Factor XIa
40
monoclonal Ab that is well-known to most commonly cause secondary hypogammaglobulinemia
rituximab
41
only monoclonal Ab that is approved for chronic rhinosinusitis with nasal polyposis
dupilumab
42
eculizumab inhibits a complement protein leading to increased susceptibility to which microbe?
Neisseria
43
how many grams of ointment are needed to cover the body of an average adult?
30g
44
drug fever is an example of which type of hypersensitivity reaction?
type 3
45
contact dermatitis is an example of which type of hypersensitivity reaction?
type 4a
46
what is the conjugated pneumococcal vaccine? what is the unconjugated pneumococcal vaccine?
PCV-13 is conjugated
PSV-23 is unconjugated
47
what are three contraindications to receiving another dose of the same vaccine?
anaphylaxis
encephalopathy
Gullian-Barre syndrome
48
what is the name and mechanism of a monoclonal Ab used to treat moderate to severe eczema?
Dupilumab, anti-IL-4 alpha
49
what is the name of the major determinant in PCN allergy?
Benzylpenicilloyl polylysine (Pre-Pen)
50
what percent of patients with EBV develop a rash and given an aminopenicillin (amox, amp)?
80%
51
what is the name of the blistering disease due to vancomycin hypersensitivity?
linear IgA bullous dermatitis
52
what mechanism of reactions are contraindications to desensitization?
exfoliative or blistering skin reactions and immune complex-mediated reactions.
53
What is one mechanism for the therapeutic benefit of IVIG therapy in autoimmune disorders?
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
54
list of TNF alpha blockers (5)
- infliximab
- adalimumba
- certolizumab
- golimumab
- etanercept
55
what is Tocilizumab
anti IL-6R mAb
56
what is Sarilumab
anti IL-6R mAb
57
Abatacept MOA
- CTLA4-Ig.
- binds and inhibits to the costimulatory molecules CD80 and CD86 on APCs
58
what is rituximab
anti-CD20 mAb
59
effective maintenance dose for most aeroallergens
- 5-20 mcg per 0.5mL
- 1000-4000 BAU or AU
60
effective maintenance dose for cat
1000 - 4000 BAU
61
effective maintenance dose for dog
15 mcg Can f 1
62
effective maintenance dose for DM
500-2000 AU
63
effective maintenance dose for Bermuda
300-1500 BAU
64
effective maintenance dose for grass
1000 - 4000 BAU
65
effective maintenance dose for short ragweed (2)
6-12 mcg Amb a 1 OR 1000-4000 BAU
66
Pregnancy Class B antihistamines (3)
- loratadine
- cetirizine
- levocetirizine
67
antihistamines that can be used in renal failure (2)
loratadine and first gen antihistamines
68
antihistamines that can be used in hepatic failure (1)
fexofenadine
69
adverse effects of beta-agonists (7)
- tremor
- tachycardia
- prolonged QT/ arrhythmias
- myocardial ischemia
- transient increased hypoxia
- high glc
- low potassium, magnesium
70
adverse effects of montelukast (2)
- suicidal thinking
- behavioral/mood changes
71
adverse effects of zafirlukast (2)
- dose-dependent liver toxicity
- interacts with warfarin (need to dec warfarin dose)
72
(5)adverse effects of zileuton
- 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
M2 (muscarinic) receptor function
inhibitory receptor on parasympathetic nerves. decreases acetylcholine release
74
M3 (muscarinic) receptor function (3)
- primary mediator of smooth mm contraction in human airways
- increases intracellular Ca, causing bronchoconstriction
- antihistamines can bind to M3 receptor
75
sequence of events after steroid binds to its receptor in the cytoplasm (3)
- heat shock proteins dissociate from the receptor
- the receptor is phosphorylated
- steroid-receptor complex translocates into the nucleus
76
which drugs can increase serum steroid (like budesonide, fluticasone) levels? (4)
- CYP450 3A4 inhibitors (ritonavir, itraconazole)
- barbiturates
- barbiturates
77
relative binding affinity for GC receptor
- fluticasone
- triamcinolone
- mometasone
- budesonide
mometasone > fluticasone > budesonide > triamcinolone
78
steroid resistance is mediated by?
- 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
mometasone inhaler brand name and dosage (3)
- Asthmanex: 100/200 mcg 2 puffs BID
- Asthmanex Twisthaler 110/220 mcg 2 puffs BID
80
fluticasone inhaler brand name and dosage (43
- 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
beclomethasone inhaler brand name and dosage (1)
- Qvar; 40/80 mcg 1 puff BID
82
budesonide inhaler brand name and dosage (1)
- Pulmicort Flexhaler: 90/180 mcg 2 puffs BID
83
fluticasone-salmeterol inhaler brand name (3)
- Advair
-Advair Diskus
- Airduo
84
fluticasone-vilanterol inhaler brand name (1)
- Breo Ellipta
85
mometasone-formoterol inhaler brand name (1)
Dulera
86
budesonide-formoterol inhaler brand name (1)
Symbicort
87
tiotropium bromide brand name
Spiriva
88
~omab biologic
murine Ig
89
~ximab
variable region are murine, but rest is human
90
~zumab
humanized (CDRs are murine)
91
~umab
all human
92
omalizumab MOA (2)
- binds to Fc region (CH3 domain) of free IgE
- decreases expression of high-affinity IgE receptors on mast cells
93
indications of omalizumab (3)
- mod/severe asthma > 6yo
- CSU >12yo
- CRSwNP > 18yo
94
something that does not improve with omalizumab use
no improvement in pulmonary function
95
mepolizumab indications (3)
- severe persistent asthma (eosinophilic phenotype) > 6yo
- HES > 18yo
- EGPA > 18yo
96
precaution with mepolizumab
herpes zoster infections -- Singles vaccine recommended for > 50yo
97
reslizumab MOA
IL-5 antagonist
98
reslizumab indication
eosinophilic severe asthma > 18yo (via IV!)
99
precautions with reslizumab (2)
- oropharyngeal pain
- black box warning for anaphylaxis
100
benralizumab MOA
- binds to IL-5 receptor alpha --> death of eos and basophils via Ab dependent cellular cytotoxicity
101
benralizumab indication
severe eosinophilic asthma >12yo
102
benralizumab does not affect..?
FEV1
103
precautions for benralizumab (3)
HA, pharyngitis, fever
104
dupilumab MOA
binds to IL-4 receptor alpha -- blocks IL 4 and 13
105
dupilumab indications (3)
- mod/severe eosinophilic asthma > 6yo
- mod/severe AD > 6yo
- CRSwNP > 18yo
106
precautions with dupilumab (3)
- conjunctivitis (more with AD)
- transient eosinophilia
- dz does recur after discontinuation
107
Immune effects, molecular target and indication (3) for Alemtuzumab
- profound T and B cell depletion
- targets Cd52 (cell surface glycoprotein)
- indicated for B-CLL, leukemia and MS
108
Immune effects, molecular target and indication (2) for Cetuximab
- binds and inhibits epidermal growth factor receptor
- targets epidermal growth factor receptor
- indicated for metastatic colorectal cancer, and head and neck cancer
109
Immune effects, molecular target and indication (2) for Vedolizumab
- blocks migration of gut homing lymphocytes
- a4b7 antagoinst
- indicated for Crohn and UC
110
Immune effects, molecular target and indication (2) for Natalizumab
- block migration of leukocytes into CNS
- a4 integrin antagonist
- indicated for MS and Crohn
111
Immune effects, molecular target and indication (2) for Eculizumab
- binds C5, inhibits terminal complement activation
- targets C5
- indicated for PNH and atypical HUS
112
Immune effects, molecular target and indication (2) for Ustekinumab
- blocks IL-12 and IL-23
- targets p40 subunit (IL-12/23)
- indicated for psoriasis and Crohn's
113
Immune effects, molecular target and indication (2) for secukinumab
- blocks IL-17 pathway
- targets IL-17A
- indicated for psoriasis and ankylosing spondylitis
114
list of TNF-alpha blockers (4)
- adalimumab
- infliximab
- certolizumab
- golimumab
115
list of IL-1b neutralizers (2)
canakinumab and rilonacept
116
IL-1 receptor antagonist
anakinra
117
Immune effects, molecular target and indication (2) for tocilizumab
- affects B cells and Tregs
- targets IL6 receptor
- indicated for RA and JIA
118
target for rituximab
CD20
119
Immune effects, molecular target and indication (2) for emapalumab
- blocks IFN- gamma
- targets IFN g
- indicated for primary HLH
120
Immune effects, molecular target and indication (2) for Abatacept
- disrupts CD28 co-stimuation
- targets B7-1,2
- indicated for RA and JRA
121
Immune effects, molecular target and indication (2) for Belatacept
- disrupts Cd28 costimulation
- targets CD80/86
- indicated in kidney and lung transplantation
122
Immune effects, molecular target and indication (3) for ruxolitinib
- 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
Immune effects, molecular target and indication (3) for tofacitinib
- 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
Immune effects, molecular target and indication (3) for baricitinib
- 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
Immune effects, molecular target and indication (3) for ibrutinib
- inhibits B cell maturation/production
- targets BTK
- indicated in lymphoma, chronic GVHD, Waldensstorm macroglobulinemia
126
pharmacology and immune effects of methotrexate (4)
- structural analog to folic acid
- competitively inhibits binding of dihydrofolic acid to dihydrofolate reductase
- eliminated via renal clearance
- inhibits cell replication
127
pharmacology and immune effects of azathioprine (4)
- 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
pharmacology and immune effects of mycophenolate mofetil (3)
- affects purine nucleotide synthesis and metabolism via reversible inhibition of IMP dehydrogenase
- decrease T and B cell proliferation
- dec Ab production
129
pharmacology and immune effects of cyclosporine (2)
- inhibit T helper cell function as a calcineurin inhibitor
- result in inhibition of transcription factors like NFAT
130
pharmacology and immune effects of tacrolimus/pemicrolimus (2)
- inhibits calcineurin phosphatase activity
- result in inhibition of transcription factors like NFAT
131
pharmacology and immune effects of rapamycin/ sirolimus (2)
- inhibits mTOR
- leads to inhibition of T cell activation and proliferation
132
how does Alum work?
it works as an adjuvant through the NLRP3 pathway involving the inflammasome
133
immunomodulating effects of IGRT (5)
- 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
conjugated polysaccharide vaccines - mechanism and examples (4)
- T cell dependent
- Hib
- Prevnar
- meningococcal (Menactra and Menveo) -- Menomune is purely polysacch.
135
gelatin containing vaccines (4)
- MMR
- varicella
- rabies
- yellow fever
136
vaccine to avoid if egg allergic
yellow fever
137
vaccine precaution in latex allergic pts
- do not administer vaccines supplied in vials containing natural rubber products, unless benefits > risks
138
yeast containing vaccines (2)
- hep b
- HPV
139
contraindications for vaccine administration (4)
- anaphylaxis to prior dose
- encephalopathy < 7d after pertussis-containing vaccine
- history of Guillain Barre syndrome
- pregnancy and immunosuppression for live vaccines
140
very low potency topical steroids (2)
- hydrocortisone acetate 0.5-1%
- hydrocortisone hydrochloride 0.25-2.5%
141
low potency topical steroids (3)
- alclometasone 0.05
- desonide 0.05
- hydrocortisone butyrate 0.1
142
medium potency topical steroids (4)
- fluocinolone acetonide 0.025
- hydrocortisone valerate 0.2
- mometasone furoate 0.1
- triamcinolone acetonide 0.1
143
med-high potency topical steroids (3)
- betamethasone valerate
- fluticasone pripionate 0.005
- triamcinolone acetonide 0.5
144
high potency topical steroids (5)
amcinonide
- betamethasone dipropionate
- desoximetasone
- fluocinonide
- halcinonide
145
very high potency topical steroids (3)
- clobetasol
- diflorasone
- halobetasol
146
topical phosphodiesterase 4 inhibitor
crisaborole
147
MHC associated with reaction to Abacavir in Whites
HLA-B*5701
148
MHC associated with carbamazepine reactions in Han Chinese
HLA-B*1502
149
what is the major determinant for penicillin?
benzylpenicilloyl polylysine (PrePen)
150
medications that share the same R1 side chain as amoxicillin (2)
cefadroxil, cefprozil
151
medications that share the same R1 side chain as ampicillin (2)
- cefaclor
- cephalexin
152
medications that share the same R1 side chain as ceftriaxone (2)
- cefotaxime
- cefpodoxime
153
medications that share the same R1 side chain as cefoxitin (2)
- cephaloridine
- cephalothin
154
medications that share the same R1 side chain as ceftazidime (1)
aztreonam
155
beta lactams that share the same amino R1 group (5)
ampicillin
amoxicillin
cefaclor
cephalexin
cefadroxil
156
beta lactams that share the same methoxyimino R1 group (6)
ceftriaxone
cefotaxime
cefuroxime
cefepime
ceftazidime
cefpodoxime
157
cephalosporin that has a unique R group side chain and does not require testing in patient with PCN allergy
cefazolin
158
major determinant for type I reactions to sulfa
N4-sulfonamoidoyl hapten
159
medications that can cause linear IgA bullous dermatitis (3)
vancomycin
furosemide
Bactrim
160
most common agent to cause perioperative drug reactions
quaternary ammonium mm relaxants
161
which immunosuppressive medication is known to cause capillary leak syndrome?
Sirolimus/rapamycin
162
what kind of reaction do taxanes (ie paclitaxel, docetaxel) cause?
anaphylactoid
163
what kind of reactions do platinum compounds (cisplatin, carboplatin, oxaliplatin) cause?
IgE mediated reactions
164
non antihistamine meds that interfere with skin testing (3)
TCAs, phenothiazines (1st gen typical antipsychotics), omalizumab
165
What type of receptor is the glucocorticoid receptor?
Nuclear receptor
166
Minor determinants of penicillin are most commonly associated with what type of reactions?
Anaphylaxis
167
Inhibitors targeted at which enzyme have been able to restore glucocorticoid sensitivity in patients with steroid-refractory asthma?
P38 MAPK (MAPK14)
168
Which interleukin, associated with neutrophilic asthma, is elevated in sputum and serum samples from patients with severe asthma?
IL-17
169
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?
Vitamin D3 (calcitriol)
170
5-lipoxygenase inhibitor zileuton blocks __
blocks the production of LTB4 and LTC4
171
After allergen challenge, leukotriene receptor antagonists prevent immediate or late response?
both
172
The primary toxicity associated with zafirlukast and zileuton affect which organ
Liver (not in montelukast)
173
Tralokinumab MOA
binds to IL-13 -- prevents binding to IL-13R
174
Tralokinumab indication
mod/severe AD
