Pharmacology and Therapeutics Flashcards
What allergen is most likely to be found in undisturbed air in homes?
cat, dog
What happens to serum specific IgE after starting immunotherapy?
initial increase (months), then steady decrease
During immunotherapy, what happens to IL-10 levels, TGFβ levels, and the ration of IFNγ to IL-4?
all increase
Which antigens should not be mixed with pollens to avoid proteolytic degradation?
molds, cockroach
Which allergen extracts are standardized?
cat, ragweed, grass, dust mite
How often do systemic reactions to immunotherapy occur?
1/2000 injections
How often do fatal reactions to immunotherapy occur?
1/2.5 million
Which second generation antihistamines have the fastest onset of action?
cetirizine and levocetirizine
Which antihistamine has the longest half-life?
hydroxyzine or chlorpheniramine
Which 2nd generation antihistamine is safest to use in pregnancy?
cetirizine or loratidine
What is the MOA of theophylline?
inhibits phosphodiesterase -> increased cAMP; adenosine receptor antagonist
At what level do you start to see toxic effects of theophylline?
> 20 mg/L
What is the MOA of albuterol?
binds to G-protein coupled receptors and activates adenylyl cyclase -> increases cAMP leading to muscle relaxation
What can cause resistance to the muscle relaxing effects of albuterol?
polymorphisms in the β2-adrenergic receptor
What is the function of 15-lypoxygenase?
converts arachidonic acid to lipoxins
What is the function of 5-lypoxygenase?
converts arachidonic acid to LTA4
Leukotriene B4 is a chemoattractant for what cell type?
neutrophils - upregulates CD11b/CD18
What is the MOA of montelukast?
blocks the CysLT1 receptor
What phase of the bronchoconstrictor response (early or late) do leukotriene antagonists affect?
both early and late
What lab value can be elevated as an adverse effect of leukotriene antagonists?
elevated transaminases
What is the MOA of cromolyn?
Inhibits IgE mediated Ca channel activation - maintains elevated intracellular Ca necessary for degranulation of mast cells
Smooth muscle contraction and bronchoconstriction are primarily mediated through which muscarinic receptor?
M3
What is the function of the M2 muscarinic receptor?
inhibitory receptor on parasympathetic nerves, decreasing acetylcholine release
How can ipratropium cause paradoxical bronchoconstriction?
Blocks M2 as well as M3. Blocking M2 causes increased acetylcholine release which can lead to bronchoconstriction
What is the advantage of tiotropium over ipratropium?
blocks both M2 and M3, but dissociates from M2 10 x faster
What happens to serum IgE levels on omalizumab?
increased total IgE, decreased free IgE
What part of the FcεRI binds to IgE?
alpha portion - receptor has one alpha, one beta and 2 gamma
What supplement must be given if treating with methotrexate?
folic acid
Cyclosporine and tacrolimus function by binding wo which type of proteins?
immunophilins
What is the MOA of azathioprine?
inhibits purine nucleotide synthesis and metabolism
What is the most common method used to isolate Ig from plasma for IVIG?
modified Cohn-Oncley cold ethanol fractionation
What is the starting dose for IVIG or for sub-q IG?
400-600 mg/kg q 4 weeks; 100 mg/kg weekly
What is a potential cause of renal insufficiency when treating with IVIG?
Hyperosmolar renal damage due to sucrose (used as stabilizer)
What are type I interferons and type II interferons used to treat, respectively?
chronic viral infections; CGD
Which TNF antagonist binds both TNF alpha and Beta?
Etanercept
What source (bone marrow, peripheral blood, or cord) for stem cell transplant has the fastest and slowest engraftment?
peripheral blood, cord blood
What source (bone marrow, peripheral blood, or cord) for stem cell transplant has the highest T cell content?
peripheral blood
What source (bone marrow, peripheral blood, or cord) for stem cell transplant has the greatest risk of GVHD?
peripheral blood
What 2 SCID types cannot undergo myeloablative conditioning in preparation for HSCT?
Artemis and DNA ligase 4 - lack DNA repair capability
Which mitogen assesses both T and B cell function?
pokeweed
What mitogen bypasses the T cell receptor?
PMA
How long after giving a live vaccine should you wait to give a patient IVIG?
2 weeks
What 2 vaccines should be given during pregnancy if the patient is not up to date?
Tdap and inactivated influenza
Elevated levels of C4 synthase and increase expression of cysLT1 receptor are seen with what disease?
NSAID hypersensitivity
Why are COX-2 inhibitors tolerated in NSAID allergic patients while COX-1 inhibitors are not?
levels of PGE2 are decreased by COX-1 inhibition but not COX-2; PGE2 inhibits 5-lipoxygenase
What medication should be given prior to starting ASA desensitization?
Montelukast - ASA sensitivity is NOT IgE mediated
