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Step 1 > Rapid Review > Flashcards

Rapid Review Flashcards

1
Q

Abdominal pain, diarrhea, leukocytosis, recent abx (clindamycin)

A

Clostridium difficile infection

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2
Q

Achilles’ tendon xanthoma; accelerated atherosclerosis (MI before age 20)

A

Familial hypercholesterolemia IIa - absent/defective LDL receptors; increased cholesterol levels

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3
Q

Increased chylomicrons and triglycerides in blood; pancreatitis; NO increased risk for atherosclerosis; “creamy” layer in supernatant

A

Hyperchylomicronemia (I) - lipoprotein lipase deficiency or ApoC2 deficiency (cofactor for LPL)

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4
Q

hypertriglyceridemia >1000 mg/dL; acute pancreatitis

A

Hypertriglyceridemia (IV) - hepatic overproduction of VLDL

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5
Q

adrenal hemorrhage, hypotension, DIC

A

Waterhouse-Friderichsen syndrome (meningococcemia)

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6
Q

Anaphylaxis following blood transfusion

A

IgA deficiency

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7
Q

arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints

A

Marfan syndrome (fibrillin defect)

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8
Q

Athlete w/ polycythemia (inc EPO and inc RBC mass)

A

secondary to erythropoietin injection

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9
Q

bilateral acoustic schwannomas; juvenile cataracts; meningiomas; ependymomas

A

neurofibromatosis type 2 - NF2 gene on chromosome 22

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10
Q

cafe-au-lait spots, cutaneous neurofibromas, optic gliomas, pheochromocytomas, Lisch nodules (pigmented iris hamartomas)

A

Neurofibromatosis type 1 - Von Recklinghausen disease (NF1 gene on chromosome 17)

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11
Q

bilateral hilar adenopathy, uveitis

A

Sarcoidosis

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12
Q

black eschar on face of pt w/ DKA

A

Mucor or Rhizopus fungal infection

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13
Q

Blue line on gingiva

A

Burton line - lead poisoning

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14
Q

bone pain, bone enlargement, arthritis

A

Paget disease of bone (increased osteoblastic & osteoclastic activity)

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15
Q

bounding pulses, diastolic heart murmur, head bobbing

A

aortic regurg

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16
Q

cafe-au-lait spots (unilateral), polyostic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities

A

McCune-Albright syndrome (mosaic G-protein signaling mutation)

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17
Q

cervical LAD, desquamating rash, coronary aneurysms, red conjunctiva, strawberry tongue

A

Kawasaki disease - treat w/ IVIG and aspirin

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18
Q

Cherry-red spot on macula

A

Tay-Sachs (ganglioside accumulation)
Niemann - Pick (sphingomyelin accumulation)

Central retinal artery occulusion

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19
Q

chest pain, pericardial effusion/friction rub, persistent fever post-MI

A

Dressler syndrome - autoimmune mediated post-MI fibrinous pericarditis

2-12 wks after acute MI

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20
Q

child with fever later develops red rash (slapped cheeks) on face that then spreads to body

A

parvovirus B19

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21
Q

chorea, dementia, caudate degeneration

A

Huntington disease (AD “CAG” repeat expansion)

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22
Q

chorioretinitis, hydrocephalus, intracranial calcifications

A

Congenital toxoplasmosis (ToRCHES)

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23
Q

Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria

A

McArdle disease - skeletal muscle glycogen phosphorylase deficiency

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24
Q

conjugate horizontal gaze palsy, horizontal diplopia

A

Internuclear ophthalmoplegia (damage to MLF)

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25
Q

continuous machine-like murmur

A

PDA - close w/ indomethacin; keep open w/PGE analog

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26
Q

cutaneous/dermal edema due to connective tissue deposition

A

Myxedema due to hypothyroidism, Graves disease (pre-tibial)

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27
Q

cutaneous flushing, diarrhea, brochspasm

A

carcinoid syndrome (right sided cardiac valve lesions, inc 5-HIAA)

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28
Q

dermatitis, dementia, diarrhea

A

Pellagra (niacin/B3 deficiency)

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29
Q

dilated cardiomyopathy, edema, alcoholism/malnutrition

A

Wet BeriBeri (thiamine/B1 deficiency)

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30
Q

dry eyes, dry mouth, arthritis

A

Sjogren - autoimmune destruction of exocrine glands

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31
Q

dysphagia (esophogeal web), glossitis, iron deficiency anemia

A

Plummer Vinson syndrome - may progress to esophageal squamous cell carcinoma

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32
Q

elastic skin, hypermobile joints, increased bleeding tendency

A

Ehlers-Danlos syndrome - type IV collagen defect

Type III collagen defect in vascular subtype

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33
Q

episodic vertigo, tinnitus, sensorineural hearing loss

A

Meniere disease (increased endolymph leading to distention of endolymphatic system and damage to vestibular and cochlear components)

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34
Q

erythroderma, LAD, HSM, atypical CD4+ T-cells (skin and/or blood)

A

mycosis fungoides or Sezary syndrome

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35
Q

facial muscle spasm upon tapping

A

Chvostek sign - hypocalcemia

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36
Q

fat, female, fertile, forty

A

Cholelithiasis (gallstones)

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37
Q

fever, cough, conjunctivitis, coryza, Koplik spots followed by maculopapular rash that starts at head and spreads downward

A

Measles

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38
Q

golden-brown rings around peripheral cornea

A

Kayser-Fleischer rings - accumulation of Copper - Wilson Disease

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39
Q

Gout, intellectual disability, self mutilating behavior in a boy

A

Lesch-Nyhan syndrome - HGPRT deficiency (XR)

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40
Q

hamaratomatous GI polyps, hyper-pigmentation of mouth/feet/hands/genitals

A

Peutz-Jeghars syndrome - inherited, benign polyposis that can cause bowel obstruction; inc. GI cancer risk

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41
Q

HSM, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises

A

Gaucher disease (glucocerebrosidase deficiency)

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42
Q

hereditary nephritis, sensorineural hearing loss, cataracts

A

Alport syndrome (mutation in collagen IV)

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43
Q

hyperphagia, hypersexuality, hyperorality, hyperdocility

A

Kluver-Bucy syndrome (bilateral amygala lesion)

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44
Q

posthepatic venous thrombosis

Abdominal pain, ascites, hepatomegaly

A

Budd - Chiari Syndrome

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45
Q

hypoxemia, polycythemia, hypercapnia, “blue bloater”

A

chronic bronchitis: hyperplasia of mucous cells

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46
Q

indurated, ulcerated genital lesion

A

Painless -> chancre due to primary syphilis

Painful w/ exudate -> chancroid due to H ducreyi

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47
Q

infant w/ cherry-red spot on macula, HSM, neurodegeneration

A

Neimann-Pick (sphingomyelinase deficiency)

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48
Q

infant with cleft-lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia

A

Trisomy 13 (Patau)

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49
Q

Infant with hypoglycemia and hepatomegaly

A

Cori disease - debranching enzyme deficiency

Von Gierke disease - glucose -6-phosphatase deficiency

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50
Q

infant with microcephaly, rocker-bottom feet, clenched hands, structural heart defect

A

Edwards syndrome (Trisomy 18)

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51
Q

jaundice, palpable distended non-tender gallbladder

A

Courvoisier sign - distal obstruction of biliary tree

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52
Q

male child, recurrent infections (bacterial, enteroviral, giardia), no mature B-cells

A

Bruton disease - X-linked agammaglobinemia (defective BTK tyrosine kinase)

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53
Q

mucosal bleeding and prolonged bleeding time

A

defective platelet aggregation due to lack of GpIIb/IIIa - Glanzmann thrombasthenia

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54
Q

multiple colon polyps, osteomas/soft-tissue tumors, impacted/supernumerary teeth

A

Gardner syndrome (FAP)

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55
Q

muffled heart sounds, distended neck veins, hypotension

A

cardiac tamponade

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56
Q

myopathy (infantile hypertrophic cardiomyopathy) and exercise intolerance

A

Pompe disease due to lysosomal alpha-1,4-glucosidase deficiency

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57
Q

neonate w/ arm paralysis following difficult birth

A

Erb-palsy (waiter’s tip) - traction/tear of upper roots (C5-C6)

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58
Q

no lactation postpartum, absent menstruation, cold intolerance

A

Sheehan syndrome - pituitary infaction

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59
Q

nystagmus, intention tremor, scanning speech, bilateral INO

A

multiple sclerosis

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60
Q

painful raised red lesions on pads of fingers/toes

A

Osler nodes - infectious endocarditis or immune complex deposition

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61
Q

painless erythematous lesions on palms and soles

A

Janeway lesions - infectious endocarditis, septic emboli/microabcesses

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62
Q

Palpable purpura on butt/legs, joint pain, abdominal pain (child) hematuria

A

Henoch-Schonlein purpura - IgA vasculitis affecting skin and kidneys

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63
Q

Pancreatic, pituitary, parathyroid tumors

A

MEN1 (AD)

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64
Q

Dyspnea, hyperventilation, “pink puffer”

A

Emphysema: centriacinar - smoking; panacinar - alpha1-antitrypsin deficiency

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65
Q

Polyuria, renal tubular acidosis, growth failure, electrolyte imbalance, hypophosphatemic rickets

A

Fanconi syndrome - multiple combined dysfunctions of the proximal convoluted tubule

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66
Q

Pruritic, purple, polygnal, planar papules and plaques

A

Lichen Planus

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67
Q

Ptosis, miosis, anhidrosis

A

Horner (sympathetic chain lesion)

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68
Q

Pupil accommodates but does not react

A

Neurosyphilis - Argyll Robertson pupil

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69
Q

rapidly progressing limb weakness that ascends following GI/UR infection

A

Guillain-Barre - acute inflammatory demyelinating polyradiculopathy

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70
Q

rash on palms and soles

A

Coxsackie A, secondary syphilis, Rocky Mountain spotted fever

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71
Q

Recurrent cold (non-inflamed) abscesses, unusual eczema, high serum IgE

A

Hyper IgE syndrome

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72
Q

red “current jelly” stools

A

Acute mesenteric ischemia (adults)

Intussusception (children)

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73
Q

red, itchy, swollen rash of nipple/areola

A

Paget disease of the breast - underlying malignancy

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74
Q

red urine in the morning and fragile RBCs

A

paroxysmal nocturnal hemoglobinuria (absent DAF/GPI) - RBC destruction by complement

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75
Q

renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma

A

von Hippel-Lindau (tumor suppressor gene mutation)

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76
Q

retinal hemorrhages with pale centers

A

Roth spots - bacterial endocarditis

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77
Q

short stature, cafe-au-lait spots, thumb/radial defects, increased tumors/leukemias, aplastic anemia

A

Fanconi anemia - genetic loss of DNA crosslink repair; often progresses to AML

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78
Q

Situs inversus, chronic sinusitis, bronchiectasis, infertility (male)

A

Kartagener syndrome (dynein arm defect affecting cilia)

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79
Q

skin hyperpigmentation, hypotension, fatigue

A

Primary adrenocortical insufficiency (Addison disease) - increase ACTH and increase alpha-MSH production

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80
Q

streak ovaries, congenital heart disease, horseshoe kidney, cyctic hygroma at birth, short stature, webbed neck, lymphedema

A

Turner syndrome - 45XO

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81
Q

Swollen gums, mucosal bleeding, poor wound healing, petechia

A

Scurvy - Vitamin C deficiency - can’t hydroxylate proline/lysine for collagen synthesis

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82
Q

telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria

A

Osler-Weber-Rendu syndrome

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83
Q

thyroid tumors, parathyroid tumors, pheochromocytoma

A

MEN2A (AD Ret mutation)

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84
Q

thyroid tumors, pheochromocytoma, ganglioneuromatosis

A

MEN2B - AD Ret mutation

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85
Q

Unilateral facial drooping involving the forehead

A

LMN CNVII palsy (UMN spares forehead)

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86
Q

urethritis, conjunctivitis, arthritis in male

A

reactive arthritis (HLA-B27)

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87
Q

Vascular birthmark - “port wine stain” on face

A

nevus flammeus (benign but assoc w/ Sturge-Weber syndrome)

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88
Q

Sporatic port-wine stain, tram-track calcifications, ipsilateral leptomenigeal angioma, intellectual disability, early onset glaucoma, epilepsy

A

Sturge-Weber Syndrome - GNAQ activating mutation affecting small blood vessels

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89
Q

anticentromere antibodies

A

Scleroderma (CREST)

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90
Q

Anti-GBM antibodies

A

Goodpasture syndrome (glomerulonephritis and hemoptysis)

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91
Q

Antihistone antibodies

A

Drug induced SLE (hydralazine, isoniazid, phenytoin, procainamide)

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92
Q

Anti IgG antibodies

A

Rheumatoid arthritis

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93
Q

Antimitochondrial antibodies

A

Primary biliary cirrhosis

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94
Q

P-ANCA

A

microscopic polyangiitis and Churg-Strauss

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95
Q

C-ANCA

A

Wegener

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96
Q

Antinuclear antibodies (Anti-smith and anti-dsDNA)

A

SLE (type III hypersensitivity)

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97
Q

anti-platelet antibodies

A

Idiopathic thrombocytopenic purpura

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98
Q

anti-topoisomerase antibodies

A

diffuse systemic scleroderma

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99
Q

Basophilic stippling on RBCs

A

sideroblastic anemia or Lead poisoning

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100
Q

hypertension, hypokalemia, metabolic alkalosis

A

Conn syndrome - primary hyperaldosteronism

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101
Q

Arnold-Chiari malformation

A

herniation of cerebellar tonsils and vermis through foramen magnum w/ aqueductal stenosis and hydrocephalus

posterior fossa malformation

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102
Q

Dandy-Walker malformation

A

agenesis of cerebellar vermis with cystic enlargement of the 4th ventricle (fills the enlarged posterior fossa)

associated w/ spina bifida and hydrocephalus

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103
Q

syringomyelia

A

cystic cavity w/in spinal cord
anterior commissure white fibers damaged first - “cape-like” bilateral loss of pain and temperature sensation in upper extremities (ususally C8-T1)

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104
Q

Taste sensation - tongue

A 
CN VII (facial) - anterior 2/3
CN IX (glossopharyngeal) - posterior 1/3
CN X (vagus) - epiglottis
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105
Q

Pain Sensation - tongue

A 
CN V3 (trigeminal) - anterior 2/3
CN IX (glossopharyngeal) - posterior 1/3
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106
Q

Motor innervation - tongue

A

CN X (vagus) - palatoglossus - elevates posterior tongue during swallowing

CN XII (hypoglossal) - hyoglossus (retracts/depresses), genioglossus (protrudes), styloglossus (trough for swallowing)

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107
Q

norepinephrine - change in disease

A

increased in anxiety, decreased in depression

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108
Q

norepinephrine - location of synthesis

A

locus ceruleus (pons)

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109
Q

dopamine - tuberoinfundibular pathway

A

connects hypothalamus and pituitary; dopamine dependent tonic inhibition of prolactin

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110
Q

Dopamine - change in disease

A

increased in Huntington

Decreased in Parkinson and depression

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111
Q

5-HT - change in disease

A

serotonin

decreased in anxiety, decreased in depression

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112
Q

5-HT - location of synthesis

A

Raphe nuclei - pons, medulla, midbrain

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113
Q

Acetylcholine - change in disease

A

increased in Parkinson

decreased in Alzheimer, Huntington

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114
Q

Acetylcholine - location of synthesis

A

basal nucleus of Meynert

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115
Q

GABA - change in disease

A

decreased in anxiety

decreased in Huntington

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116
Q

GABA - location of synthesis

A

nucleus accumbens

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117
Q

Mesolimbic-Mesocortical dopaminergic pathway

A

regulates behavior; hyperactive in schizophrenia

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118
Q

nigrostriatal domaminergic pathway

A

coordination of voluntary movement; decreased in Parkinson

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119
Q

Hypothalamus - roles

A

“TAN HATS”

Thirst and water balance, adenohypophysis control, neurohypophysis releases hypothalamic hormones, hunger, autonomic regulation, temperature regulation, sexual urges

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120
Q

hypothalamic inputs

A

OVLT - senses change in osmolarity

Area postrema -responds to emetics

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121
Q

Site of ADH production

A

supraoptic nucleus (hypothalamus)

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122
Q

site of oxytocin production

A

paraventricular nucleus (hypothalamus)

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123
Q

Lateral area of hypothalamus

A

hunger

destruction leads to anorexia, failure to thrive

inhibited by leptin

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124
Q

ventromedial area of hypothalamus

A

satiety - stimulated by leptin

destruction (via craniopharyngioma) leads to hyperphagia

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125
Q

anterior hypothalamus

A

cooling (parasympathetic)

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126
Q

posterior hypothalamus

A

heating (sympathetic)

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127
Q

suprachiasmatic nucleus of hypothalamus

A

circadian rhythm - releases norepinephrine which acts on pineal gland - releases melatonin

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128
Q

Awake/eyes open - EEG waveform

A

Beta (highest frequency, lowest amplitude)

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129
Q

Awake/eyes closed - EEG waveform

A

Alpha

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130
Q

Non-REM - stage N1 EEG wave form

A

Theta

Light sleep

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131
Q

Non-REM N2 sleep stage - EEG waveform

A 
deeper sleep (bruxism)
Sleep spindles and K complexes
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132
Q

Non-REM N3 sleep stage - EEG waveform

A

deepest non-REM sleep - sleepwalking, night terrors, bedwetting

Delta (lowest frequency, highest amplitude)

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133
Q

REM sleep - EEG waveform

A

loss of motor tone, increased brain O2 use, increased/variable pulse/BP; dreaming and penile/clitoral tumescence; memory processing function

Beta

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134
Q

VPL nucleus of thalamus

A

pain, temp, pressure, touch, vibration, proprioception

input - spinothalamic tract and DC/ML
output - primary somatosensory cortex

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135
Q

VPM nucleus of thalamus

A

face sensation, taste

input: trigeminal and gustatory pathway
output: primary somatosensory cortex

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136
Q

LGN nucleus of thalamus

A

Vision

input: CN II
output: calcarine sulcus

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137
Q

MGN nucleus of thalamus

A

Hearing

input: superior olive and inferior colliculus of tectum
output: auditory cortex (temporal lobe)

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138
Q

VL nucleus of thalamus

A

motor

input: basal ganglia, cerebellum
output: Motor cortex

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139
Q

Limbic system

A

hippocampus, amygdala, fornix, mammillary bodies, cingulate gyrus

“Feeding, fleeing, fighting, feeling, sex”

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140
Q

MCA stroke

A

motor cortex - contralateral paralysis of upper limb and face

sensory cortex - contralateral loss of sensation in upper limb and face

temporal lobe (Wernicke) - aphasia if dominant; hemineglect if non-dominant

frontal lobe (Broca) - aphasia if dominant; hemineglect if non-dominant

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141
Q

ACA stroke

A

Motor cortex - contralateral lower limb paralysis

Sensory cortex - contralateral lower limb loss of sensation

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142
Q

Lenticulostriate artery stroke

A

striatum/internal capsule - contralateral hemiparesis/hemiplegia

*Lacunar infarct secondary to HTN

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143
Q

ASA stroke

A

lateral corticospinal tract - contralateral hemiparesis in upper & lower limbs

medial lemniscus - decreased contralateral proprioception

caudal medulla - ipsilateral hypoglossal dysfunction (deviates ipsilaterally)

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144
Q

PICA stroke

A

Lateral medulla

vomiting, nystagmus (vestibular nuclei)
decreased pain and temp sensation from ipsilateral face (spinal trigem nucl) and contralateral body (lateral spinothalamic tracts)
dysphagia and hoarseness and decreased gag reflex (nucl ambiguus)
ipsilateral Horner (sympathetics)
ataxia and dysmetria (inferior cerebellar peduncle)

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145
Q

AICA stroke

A

Lateral pons (vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetics); Middle and inferior cerebellar peduncles

Vomiting, vertigo, nystagmus, paralysis of face, decreased lacrimation/salivation, decreased taste from anterior 2/3 of tongue, decreased pain and temperature of ipsilateral face and contralateral body, ataxia, dysmetria

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146
Q

PCA stroke

A

occipital cortex and visual cortex - contralateral hemianopia with macular sparing

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147
Q

Basilar artery

A

Locked in syndrome

preserved consciousness and blinking w/ quadraplegia, loss of voluntary facial, mouth, and tongue movements

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148
Q

AComm stroke

A

more commonly aneurysm - visual field defects due to impingement of cranial nerves

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149
Q

PComm aneurysm

A

CN III palsy - eye is “down and out” with ptosis and mydriasis

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150
Q

urinary incontinence, ataxia, cognitive dysfunction in elderly person

A

“wet, wobbly, wacky” = normal pressure hydrocephalus

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151
Q

Amyotrophic lateral sclerosis - lesion sites

A

anterior motor horn (LMN)

lateral corticospinal tract (UMN)

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152
Q

Amyotrophic lateral sclerosis - symptoms

A

combined UMN and LMN with no sensory or oculomotor deficit; onset in middle age

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153
Q

Amyotrophic lateral sclerosis - familial mutation

A

Superoxide dismutase 1 mutation - free radical injury in neurons

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154
Q

Tabes dorsalis

A

tertiary syphilis - degeneration of dorsal columns and roots

impaired sensation and proprioception, progressive sensory ataxia

absence of DTRs and +Romberg sign

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155
Q

Vitamin B12 deficiency (cobalamin)

A

subacute combined degeneration - demyelination of DC, lateral corticospinal tracts and spinocerebellar tracts

ataxic gait, paresthesia, impaired position and vibration sense

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156
Q

Poliomyelitis - causes

A

poliovirus (fecal-oral) - replicates in oropharynx and small intestine. spreads to CNS via bloodstream. infection destroys anterior motor horn (LMN death)

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157
Q

Poliomyelitis - symptoms

A

LMN lesions + infection (fever, malaise, headache, etc)

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158
Q

poliomyelitis - clinical findings

A

CFS with increased WBCs and slight increase in protein (no increase in glucose)

virus can be recovered from stool or throat

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159
Q

spinal muscular atrophy (Werdnig-Hoffman disease)

A

congenital degeneration of anterior horns of spinal cord - LMN lesions

“floppy baby” w/ hypotonia and tongue fasciculations (median death ~7 mo)

Autosomal recessive

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160
Q

frataxin

A

regulates mitochondrial iron - mutation leads to loss of regulation and increased iron with free radical damage

GAA repeat - Friedreich Ataxia

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161
Q

staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, diabetes mellitus, hypertrophic cardiomyopathy, kyphoscoliosis

A

Friedriech Ataxia - GAA repeat in frataxin gene on chromosome 9

degeneration of spinocerebellar tracts (ataxia)
degeneration of DC and DRG (loss of position sense and vibration)

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162
Q

Biceps reflex

A

C5,C6

“pick up sticks”

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163
Q

Achilles reflex

A

S1, S2

“buckle my shoe”

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164
Q

Patellar reflex

A

L3, L4

“kick the door”

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165
Q

triceps reflex

A

C7, C8

“lay them straight”

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166
Q

cremaster reflex

A

L1, L2

“testicles move”

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167
Q

anal wink reflex

A

S3, S4

“winks galore”

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168
Q

structures through the optic canal

A

CN II (optic), ophthalmic artery, central retinal vein

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169
Q

structures through superior orbital fissure

A 
CN III (oculomotor)
CN IV (trochlear)
CN V1 (trigeminal - ophthalmic nerve)
CN VI (abducens)
ophthalmic vein
sympathetic fibers
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170
Q

Structures through foramen rotundum

A

CN V2 - maxillary nerve

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171
Q

structures through foramen ovale

A

CN V3 - mandibular nerve

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172
Q

structures through the foramen spinosum

A

middle meningeal artery (branch of maxillary artery)

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173
Q

Structures through the jugular foramen

A 
CN IX (glossopharyngeal)
CN X (vagus)
CN XI (accessory)
jugular vein
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174
Q

structures through foramen magnum

A

spinal roots of CN XI (accessory)
brain stem
vertebral arteries

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175
Q

low frequency hearing

A

at the apex of the basilar membrane near helicotrema (wide and flexible)

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176
Q

high frequency hearing

A

at the base of cochlea (thin and rigid)

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177
Q

noise-induced hearing loss

A

damage to stereociliated cells in organ of Corti - loss of high frequency hearing first

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178
Q

Hyperacusis

A

due to CNVII injury leading to paralysis of stapedius

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179
Q

Hyperopia

A

eye too short for refractive power of cornea and lens - light focused behind the retina
(farsightedness)

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180
Q

Myopia

A

eye too long for refractive power of lens and cornea - light focused in front of retina

(nearsightedness)

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181
Q

presbyopia

A

age-related impaired accommodation (focusing on near objects)
necessitates reading glasses

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182
Q

deposition of yellowish extracellular material (drusen) with gradual decrease in vision and scotomas

A

Dry macular degeneration due to chronic oxidative damage

prevent progression with multivitamin and antioxidant supplements

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183
Q

rapid loss of vision (scotomas), grey-green subretinal discoloration with adjacent fluid/hemorrage

A

Wet macular degeneration - secondary to choroidal neovascularization
treat with anti-VEGF

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184
Q

decreased bilateral pupillary constriction when flashlight is shone in affected eye relative to unaffected eye (swinging flashlight test)

A

afferent pupillary defect - Marcus Gunn pupil due to optic nerve damage or severe retinal injury

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185
Q

one sided anopia

A

optic nerve lesion

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186
Q

homonymous hemianopia

A

optic tract lesion

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187
Q

upper quadrant anopia

A

Meyer loop lesion (temporal lobe)

MCA (temporal lobe)

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188
Q

lower quadrant anopia

A 
dorsal optic radiation lesion (parietal lobe)
MCA stroke (parietal lobe)
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189
Q

hemianopia with macular sparing

A

PCA infarct

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190
Q

conjugate gaze palsy with nystagmus

A

INO (MLF lesion)

nystagmus in “good eye”

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191
Q

opioid analgesics - MoA

A

agonists at opioid receptors

decrease synaptic transmission - open potassium channels, close calcium channels

inhibit release of ACh, NE, 5-HT, glutamate, substance P

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192
Q

Butorphanol - MoA

A

kappa-opioid receptor agonist and mu-opioid receptor partial agonist - produces analgesia

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193
Q

Butorphanol - clinical use

A

pain (migraine, labor)

less respiratory depression than full opioid agonists

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194
Q

Butorphanol - toxicity

A

opioid withdrawal symptoms if pt is taking full opioid agonist b/c competition for opioid receptors

not easily reversed w/ naloxone

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195
Q

tramadol - MoA

A

very weak opioid agonist, inhibits 5-HT and NE reuptake

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196
Q

Tramadol - clinical use

A

chronic pain

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197
Q

tramadol - toxicity

A

similar to opioids
decreases seizure threshold
serotonin syndrome

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198
Q

ethosuximide - MoA

A

blocks thalamic T-type calcium channels

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199
Q

ethosuximide - clinical use

A

absence seizures

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200
Q

ethosuximide - toxicity

A

GI, fatigue, headache, urticaria, Stevens-Johnson syndrome

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201
Q

Benzodiazepines (seizure) - MoA

A

diazepam/lorazepam

increase GABAa action (potentiate)

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202
Q

Benzodiazepines (seizure) - clinical use

A

first line for acute status epilepticus

also use for eclampsia seizures

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203
Q

Benzodiazepines (seizure) - toxicity

A

sedation, tolerance, dependance, respiratory depression

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204
Q

Phenytoin - MoA

A

increases sodium channel inactivation (zero order kinetics)

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205
Q

Phenytoin - clinical use

A

Simple, Complex, Tonic-clonic

prophylaxis for status epilepticus

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206
Q

Phenytoin - toxicity

A

**CYP450 inducer; SLE-like syndrome; Stevens-Johnson syndrome; teratogenic

nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megaloblastic anemia, LAD, osteopenia

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207
Q

carbamazepine - MoA

A

increases sodium channel inactivation

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208
Q

carbamazepine - clinical use

A

simple, complex, tonic-clonic seizures

trigeminal neuralgia

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209
Q

carbamazepine - toxicity

A 
Blood dyscrasia (agranulocytosis, aplastic anemia)
liver toxicity
Stevens-Johnson
Inducer of CYP450
teratogenic
SIADH
diplopia
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210
Q

Valproic acid - MoA

A

increases sodium channel inactivation

increases GABA concentration by inhibiting GABA transaminase

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211
Q

sonic hedgehog gene

A

patterning along anterior-posterior axis; CNS development (mutation - holoprosencephaly)

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212
Q

wnt-7 gene

A

organization along dorsal-ventral axis

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213
Q

FGF gene

A

stimulates mitosis of mesoderm - lengthening of limbs

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214
Q

Hox (homeobox) genes

A

segmental organization in craniocaudal direction
codes for transcription factors
Hox mutations - appendages in wrong locations

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215
Q

1st aortic arch

A

maxillary artery

216
Q

2nd aortic arch

A

stapedial artery and hyoid artery

217
Q

3rd aortic arch

A

common carotid and proximal internal carotid artery

218
Q

4th aortic arch

A

on the left - aortic arch
on the right - proximal part of right subclavian

(4th arch = 4 limbs = systemic circulation)

219
Q

6th aortic arch

A

proximal part of pulmonary arteries and ductus arteriosus

220
Q

IL-1

A

osteoclast activating factor
secreted by macrophages
Fever, acute inflammation
Activates endothelium expression of adhesion molecules
Induces chemokine secretion to recruit WBCs

221
Q

IL-6

A

secreted by macrophages

caused fever and stimulated production of acute phase protein

222
Q

IL-8

A

secreted by macrophages

major chemotactic factor for neutrophils

223
Q

IL-12

A

secreted by macrophages
induces differentiation of T cells into Th1 cells
activates NK cells

224
Q

TNF-alpha

A

secreted by macrophages
mediates septic shock
activates endothelium - causing WBC recruitment and vascular leak

225
Q

IL-2

A

secreted by all T cells

stimulates growth of helper, cytotoxic, and regulatory T cells and NK cells

226
Q

IL-3

A

secreted by all T Cells

supports growth and differentiation of bone marrow stem cells (like GM-CSF)

227
Q

Interferon-gamma

A

secreted from Th1 cells
secreted by NK cells in response to IL-12 from macrophages - stimulates macrophages to kill phagocytosed pathogens
activates NK cells to kill virus infected cells
increases MHC expression and antigen presentation by all cells

228
Q

IL-4

A

secreted by Th2 cells
induces differentiation into Th2 cells
promotes growth of B cells
enhances class switching to IgE and IgG

229
Q

IL-5

A

secreted by Th2 cells
promotes differentiation of B cells
enhances class switching to IgA
stimulates growth and differentiation of eosinophils

230
Q

IL-10

A

secreted by Th2 cells
modulates inflammatory response
decreases expression of MHC-II and Th1 cytokines
inhibits activated macrophages and dendritic cells

231
Q

anti-inflammatory cytokines

A

TGF-beta and IL-10 - attenuate immune response

232
Q

widespread thrombosis of graft vessels leading to ischemia/necrosis within minutes of transplant

A

hyperacute transplant rejection - pre-existing recipient antibodies react to donor antigen

T2HSR
activates complement

233
Q

vasculitis of graft vessels with dense interstitial lymphocytic infiltrate

A

acute transplant rejection (w/in weeks to months)
cellular rejection - CD8+ T cells activated against donor MHCs
humoral rejection - recipient antibodies against donor antigen develop after transplant

Prevent/reverse with immunosuppressants

234
Q

proliferation of vascular smooth muscle and parenchymal fibrosis in transplanted organ - arterioscelerosis

A

chronic transplant rejection - months to years after transplant
CD4+ T cells respond to recipient APCs presenting donor peptides, including allogenic MHC, and secrete cytokines
cellular and humoral components

235
Q

maculopapular rash, jaundice, diarrhea, HSM following bone marrow or liver transplant

A

Graft vs host disease
grafted immunocompetent T cells proliferate in immunocompromised host and reject host cells with “foreign” proteins - leads to severe organ dysfuntion

236
Q

endocrine hormones that use cAMP signaling pathway

A

FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH, calcitonin, GHRH, glucagon

“FLAT ChAMP” + calcitonin, GHRH, glucagon

237
Q

endocrine hormones that use cGMP signaling pathway

A

ANP, BNP, NO (EDRF)

  • vasodilators
238
Q

endocrine hormones that use IP3 signaling pathway

A

GnRH, Oxytocin, ADH (V1), TRH, Histamine (H1), Angiotensin II, Gastrin

“GOAT HAG”

239
Q

endocrine hormones that use intracellular receptor for signaling

A

Vitamin D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone

“VETTT CAP”

240
Q

Intrinsic tyrosine kinase signalling

A

MAP kinase pathway - growth factors

Insulin, IGF-1, FGF, PDGF, EGF

241
Q

receptor associate tyrosine kinase singaling

A

JAK-STAT pathway - PIGGLET

Prolactin, Immunomodulators (cytokines), GH, G-CSF, Erythropoietin, Thrombopoietin

242
Q

Penicillin and cephalosporin - resistance mechanism

A

Production of beta-lactamases, which cleave the beta-lactam ring structure; change in penicillin-binding proteins; change in porins

243
Q

aminoglycoside - mechanism of resistance

A

Formation of enzymes that inactivate drugs via conjugation reactions that transfer acetyl, phosphoryl, or adenylyl groups

(Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin)

244
Q

macrolides and clindamycin - mechanism of resistance

A

Formation of methyltransferases that alter drug binding sites on the SOS ribosomal subunit

Active transport out of cells

Macrolides - erythromycin, azithromycin, clarithromycin

245
Q

tetracyclines - mechanism of resistance

A

Increased activity of transport systems that “pump” drugs out of the cell (plasmid encoded transport pumps)

tetracycline, doxycycline, minocycline

246
Q

sulfonamides - mechanism of resistance

A

Change in sensitivity to inhibition of target enzyme; increased formation of PABA; use of exogenous folic acid

sulfamethaxazole, sulfisoxazole, sulfadiazine

247
Q

fluoroquinolones - mechanism of resistance

A

Change in sensitivity to inhibition oftarget enzymes; increased activity of transport systems that promote drug efflux

ciprofloxacine, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin

248
Q

chloramphenicol - mechanism of resistance

A

Formation of inactivating acetyltransferases

249
Q

Inhibition of bacterial cell-wall synthesis

A

Penicillins, cephalosporins, imipenem/meropenem, aztreonam, vancomycin

250
Q

Inhibition of bacterial protein synthesis

A

Aminoglycosides, chloramphenicol, macrolides, tetracyclines, streptogramins, linezolid

251
Q

Inhibition of folic acid synthesis

A

sulfonamides, trimethoprim, pyrimethamine

252
Q

Penicillin - MoA

A

Bacterial cell wall is cross-linked polymer of polysaccharides and penta­peptides - Penicillins interact with cytoplasmic membrane-binding proteins (PBPs) to inhibit transpeptidation reactions involved in cross-link­ing, the final steps in cell-wall synthesis

253
Q

Penicillin (narrow spectrum, beta-lactamase sensitive: penicillin G and V) - clinical use

A

streptococci, pneumococci, meningococci, Treponema
pallidum

254
Q

penicillin - toxicity

A

hypersensitivity reactions, hemolytic anemia

255
Q

Very narrow spectrum, beta-lactamase resistant: nafcillin, methicillin, oxacillin - clinical use

A

known or suspected staphylococci (not MRSA)

256
Q

Broad spectrum, aminopenicillins, beta-lactamase sensitive: ampi­cillin and amoxicillin - clinical use

A

gram-positive cocci (not staph), E. coli, H. influenzae, Listeria monocytogenes (ampicillin), Borrelia burgdorferi (amoxicil­lin), H. pylori (amoxicillin)

257
Q

Extended spectrum, antipseudomonal, beta-lactamase sensitive: ticarcillin, piperacillin - clinical use

A

increased activity against gram-negative rods, including Pseudomonas aeruginosa

258
Q

cephlosporins - MoA

A

beta-lactam drugs that inhibit cell wall synthesis - same as penicillins
less susceptible to penicillinases

bactericidal

259
Q

First generation cephalosporins: cefazolin, cephalexin - clinical use

A

Spectrum: gram-positive cocci (not MRSA), E. coli, Klebsiella pneumoniae, and some Proteus species (PEcK)

Common use in surgical prophylaxis

Pharmacokinetics: none enter CNS

260
Q

Second generation cephalosporins: cefotetan, cefaclor, cefuroxime - clinical use

A

Spectrum: gram positive cocci and increased gram-negative coverage, including some anaerobes
Pharmacokinetics: no drugs enter the CNS, except cefuroxime

HEN PEcKS : H.flu, Enterobacter, Neisseria, Proteus mirabilis, E.coli, Klebsiella, Serratia

261
Q

Third generation cephalosporins: ceftriaxone (IM) and cefotaxime (parenteral), cef­tazidime - clinical use

A

Spectrum: gram-positive and gram-negative cocci (Neisseria gonorrhea), plus many gram-negative rods

Ceftriaxone - meningitis, gonorrhea, Lyme disease
Ceftazidime - pseudomonas

Pharmacokinetics: most enter CNS; important in empiric manage­ment of meningitis and sepsis

262
Q

Fourth generation cephalosporins: cefepime (IV) - clinical use

A

Even wider spectrum - increased activity against pseudomonas
Resistant to most beta-lactamases
Enters CNS

263
Q

fifth generation cephalosporins - ceftaroline - clinical use

A

broad gram positive and gram negative - including MRSA

does NOT cover pseudomonas

264
Q

cephalosporins - toxicity

A

hypersensitivity (cross-react w/ penicillin)
autoimmune hemolytic anemia
disulfiram-like reaction
vitamin K deficiency

increase nephrotoxicity of aminoglycosides

265
Q

carbapenems - MoA

A

same as penicillin - beta-lactamase resistant

Imipenen, meropenem, ertapenem, doripenem

266
Q

carbapenems - clinical use

A

Imipenen, meropenem, ertapenem, doripenem

  • Gram-positive cocci, gram-negative rods (e.g., Enterobacter,
    Pseudomonas spp.), and anaerobes

Important in-hospital agents for empiric use in severe life-threatening infections

267
Q

Imipenem - pharmokinetics

A

Imipenem is given with cilastatin, a renal dehydropeptidase inhibitor,
which inhibits imipenem’s metabolism to a nephrotoxic metabolite
Both drugs undergo renal elimination- decrease dose in renal dysfunction

268
Q

carbapenems - toxicity

A

imipenem, meropenem, ertapenem, doripenem

GI distress
Drug fever (partial cross-allergenicity with penicillins)
CNS effects, including seizures with imipenem in overdose or renal dysfunction

269
Q

monobactam (aztreonam) - MoA

A
  • Same as for penicillins and cephalosporins
  • Resistant to beta-lactamases
270
Q

monobactam (aztreonam) - clinical use

A

• Uses:
IV drug mainly active versus gram-negative rods
No cross-allergenicity with penicillins or cephalosporins
synergistic with aminoglycosides

271
Q

vancomycin - MoA

A

Binding at the D-ala-D-ala muramyl pentapeptide to sterically hin­der the transglycosylation reactions (and indirectly preventing transpeptidation) involved in elongation of peptidoglycan chains

Does not interfere with PBPs

272
Q

vancomycin - clinical use

A

Gram positive only -

MRSA
Enterococci
Clostridium difficile (backup drug)

273
Q

vancomycin - resistance

A

Vancomycin-resistant staphylococcal (VRSA) and enterococcal (VRE) strains emerging

Enterococcal resistance involves change in the muramyl pentapeptide “target” such that the terminal D-ala is replaced by D-lactate

274
Q

vancomycin - toxicity

A
  • “Red man syndrome” (histamine release)
  • Ototoxicity (usually permanent, additive with other drugs)
  • Nephrotoxicity (mild, but additive with other drugs)
  • Thrombophlebitis
275
Q

aminoglycosides - MoA

A

Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin

Bind 30S ribosomal subunit - inhibit initiation complex, cause misreading of mRNA, block translocation

Bactericidal, accumulated intracellularly in microorganisms via an
02-dependent uptake (anaerobes are innately resistant)

276
Q

Aminoglycosides - clinical use

A

Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin

Useful spectrum includes gram-negative rods; gentamicin, tobramycin,
and amikacin often used in combinations

Synergistic actions occur for infections caused by enterococci (with penicillin G or ampicillin) and P. aeruginosa (with an extended-spectrum penicillin or third-generation cephalosporin)

Neomycin for bowel surgery

Streptomycin used in tuberculosis; is the DOC for bubonic plague and tularemia

277
Q

aminoglycosides - toxicity

A

Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin

Nephrotoxicity (6 to 7% incidence) includes proteinuria, hypokalemia, acidosis, and acute tubular necrosis-usually reversible, but enhanced by vancomycin, amphotericin B, cisplatin, and cyclosporine

Ototoxicity (2% incidence) from hair cell damage; includes deafness (irreversible) and vestibular dysfunction (reversible); toxicity may be enhanced by loop diuretics

Neuromuscular blockade with decreased release of ACh-may enhance effects of skeletal muscle relaxants

278
Q

tetracyclines - MoA

A

tetracycline, doxycycline, minocycline

Bacteriostatic - bind to 30S subunit of ribosomes and prevent attachment of aminoacyl-tRNA
limited CNS penetration

279
Q

tetracycline - clinical use

A

tetracycline, doxycycline, minocycline

Broad-spectrum antibiotics, with good activity versus chlamydia and mycoplasmal species, H. pylori (GI ulcers), Rickettsia, Borrelia burgdorferi

also used to treat acne

280
Q

tetracycline - toxicity

A

tetracycline, doxycycline, minocycline

GI distress, discoloration of teeth and inhibition of bone growth in children, photosensitivity

contraindicated in pregnancy

do not take with calcium, magnesium, iron - divalent cations decrease intestinal absorption

281
Q

chloramphenicol - MoA

A

blocks peptidyltransferase at 50S ribosomal subunit

bacteriostatic

282
Q

chloramphenicol - clinical use

A

meningitis (H.flu, neisseria, s. pneumo)

Rocky Mountain spotted fever

283
Q

chloramphenicol - toxicity

A 
anemia (dose dependent)
aplastic anemia (dose independent)
grey baby syndrome (lack liver UDP-glucuronyl transferase)
284
Q

clindamycin - MoA

A

blocks peptide transfer at 50S ribosomal subunit

bacteriostatic

285
Q

clindamycin - clinical use

A

anerobic infections - baceriodes, c. perfringens - in aspiration pneumonia, lung abscesses, oral infections (above the diaphragm)

invasive group A strep

286
Q

clindamycin - toxicity

A

C. difficile overgrowth
fever
diarrhea

287
Q

Linezolid - MoA

A

inhibits protein synthesis by binding 50S subunit and preventing formation of initiation complex

288
Q

Linezolid - clinical use

A

gram positive including MRSA and VRE

289
Q

Linezolid - toxicity

A

bone marrow suppression, peripheral neuropathy, serotonin syndrome

290
Q

Macrolides - MoA

A

azithromycin, clarithromycin, erythromycin

inhibit protein synthesis by blocking translocation
binds to the 23S rRNA of the 50S subunit

bacteriostatic

291
Q

macrolides - clinical use

A

azithromycin, clarithromycin, erythromycin

atypical pneumonia, STIs (chlamydia), gram positive cocci (strep), B. pertussis

292
Q

macrolides - toxicity

A

azithromycin, clarithromycin, erythromycin

MACRO:
GI Motility, Arrhythmia (prolonged QT), acute Cholestatic hepatitis, Rash, eOsinophilia

increase serum concentration of theophyllines and oral anti-coags

Clarithromycin and erythromycin - inhibit CYP450

293
Q

trimethoprim - MoA

A

inhibits bacterial dihydrofolate reductase

bacteriostatic

294
Q

trimethoprim - clinical use

A

in combo w/ sulfonamides
TMP-SMX - sequential block of folate synthesis

UTIs, shigella, salmonella, pneumocystis jirovecii, toxoplasmosis prophylaxis

295
Q

trimethoprim - toxicity

A

megaloblastic anemia, leukpenia, granulocytopenia

“Treats Marrow Poorly”

296
Q

Sulfonamides - MoA

A

inhibit folate synthesis
PABA antimetabolites inhibit dyhydropteroate synthase
bacteriostatic (-cidal w/ TMP)

297
Q

sulfonamides - clinical use

A

gram positives, gram negatives, Nocardia, Chlamydia

triple sulfas or sulfamethoxazole (SMX) for UTI

298
Q

sulfonamides - toxicity

A

hypersensitivity reactions
hemolysis if G6PD deficient
nephrotoxicity (tublointerstitial nephritis)
photosensitivity
kernicterus (infants)
displaces other drugs from albumin (warfarin)

299
Q

fluoroquinolones - MoA

A

ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin

inhibit prokaryotic enzymes - topoisomerase II (DNA gyrase) and topoisomerase IV

bactericidal

CANNOT TAKE W/ ANTACIDS

300
Q

fluoroquinolones - clinical use

A

ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin

gram-neg rods - urinary and GI tracts
pseudomonas, neisseria
some gram-positives

301
Q

fluoroquinolones - toxicity

A

ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin

Tendonitis, tendon rupture
Phototoxicity, rashes
CNS effects (insomnia, dizziness, headache)
Contraindicated in pregnancy and in children (inhibition of chondrogenesis)

302
Q

daptomycin - MoA

A

lipopeptide that disrupts cell membrane of gram+ cocci

303
Q

daptomycin - clinical use

A

S.aureus skin infections (MRSA)
bacteremia, endocarditis, VRE

**NOT for pneumonia - inactivated by surfactant

304
Q

daptomycin - toxicity

A

myopathy, rhabdomyolysis

305
Q

Metronidazole - MoA

A

forms toxic free radical metabolites in the bacterial cell that damage DNA

bactericidal, antiprotozoal

306
Q

metronidazole - clinical use

A

GET GAP on the Metro

Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes. H.Pylori (part of triple therapy)

anaerobic below the diaphragm

307
Q

metronidazole - toxicity

A

disulfram-like rxn w/ alcohol

headache, metallic taste

308
Q

M. tuberculosis - treatment/prophylaxis

A

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

Isoniazid - prophylaxis

309
Q

M. avium-intracellulare - treatment/prophylaxis

A

more drug resistant than TB - azithromycin or clarithromycin + ethambutol (can add rifabutin or ciprofloxacin)

azithromycin, rifabutin - prophylaxis

310
Q

M. leprae - treatment

A

long-term - dapsone and rifampin for tuberculoid form

add clofazimine for lepromatous form

311
Q

rifamycins (rifampin/rifabutin) - MoA

A

inhibit DNA dependent RNA polymerase

312
Q

rifamycins (rifampin/rifabutin) - clinical use

A

TB
delay resistance to dapsone in leprosy
meningococcal prophylaxis in contacts of children w/ H. influenzae B

313
Q

rifamycins (rifampin/rifabutin) - toxicity

A

minor hepatotoxicity and drug interactions (rifampin increases CYP450)
orange body fluids

rifabutin preferred in pts w/ HIV - less CYP450 stimulation

314
Q

rifamycins (rifampin/rifabutin) - resistance

A

mutations reduce drug binding to RNA polymerase

monotherapy = rapid resistance

315
Q

isoniazid - MoA

A

decreases synthesis of mycolic acids
bacterial catalase-peroxidase needed to convert into active metabolite (mutations leading to underexp. of KatG -> resistance)

316
Q

isoniazid - clinical use

A

solo prophylaxis against TB

317
Q

isoniazid - toxicity

A

neurotoxicity, hepatotoxicity (10-20%)

prevent neurotoxicity w/ pyridoxine (B6)

318
Q

pyrazinamide - MoA

A

uncertain - prodrug that is converted to active drug

intracellular activity

319
Q

pyrazinamide - clinical use

A

TB

320
Q

pyrazinamide - toxicity

A

hyperuricemia, hepatotoxicity

321
Q

ethambutol - MoA

A

decreases carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase

322
Q

ethambutol - clinical use

A

TB

323
Q

ethambutol - toxicity

A

red-green colorblindness

324
Q

amphotericin B - MoA

A

binds ergosterol (unique to fungi) - forms membrane pores that allow leakage of electrolytes

325
Q

amphotericin B - clinical use

A

serious, systemic mycoses
intrathecally for fungal meningitis

supplement K and Mg b/c altered renal tube permeability

326
Q

amphotericin B - toxicity

A

fever/chills, hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis

hydration will decrease nephrotoxicity

327
Q

Nystatin - MoA

A

binds ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes

topical use only

328
Q

Nystatin - clinical use

A

oral candidiasis
diaper rash
vaginal candidiasis

329
Q

Flucytosine - MoA

A

inhibits DNA and RNA biosynthesis by conversion to 5-fluorouracil by cytosine deaminase

330
Q

Flucytosine - clinical use

A

systemic fungal infections in combo w/ amphotericin B

meningitis - cryptococcus

331
Q

Flucytosine - toxicity

A

bone marrow suppression

332
Q

Azoles - MoA

A

inhibit fungal sterol (ergosterol) synthesis by inhibiting the CYP450 complex that converts lanosterol to ergosterol

333
Q

azoles - clinical use

A

local and less serious systemic fungal infections

fluconazole - chronic suppression of cryptococcal meningitis in AIDS pts and candidal infections of all types

Itraconazole - blastomyces, coccidioides,

clotrimazole and miconazole - topical

334
Q

azole - toxicity

A

testosterone synthesis inhibition (ketoconazole - gynecomastia)
liver dysfunction - inhibits CYP450

335
Q

terbinafine - MoA

A

inhibits fungal enzyme squalene epoxidase

336
Q

terbinafine - clinical use

A

dermatophytoses

337
Q

terbinafine - toxicity

A

GI upset, headaches, hepatotoxicity, taste disturbance

338
Q

echinocandins - MoA

A

caspofungin, micafungin

inhibit cell wall synthesis by inhibiting synthesis of Beta-glucan

339
Q

echinocandins - clinical use

A

caspofungin, micafungin

invasive aspergillosis, Candida

340
Q

echinocandins - toxicity

A

GI upset, flushing (histamine release)

341
Q

griseofulvin - MoA

A

interferes with microtubule function
disrupts mitosis
deposits in keratin containing tissue

342
Q

griseofulvin - clinical use

A

oral treatment of superinfections, inhibits growth of dermatophytes

343
Q

griseofulvin - toxicity

A

teratogenic, carcinogenic, confusion, headaches, induces CYP450 and warfarin metabolism

344
Q

chloroquine

A

blocks detoxification of heme into hemozoin
heme accumulates and is toxic to plasmodia

DOES NOT TREAT p.falciparum due to resistance

345
Q

oseltamivir/zanamivir - MoA

A

inhibit influenza neuraminidase - prevent release of viral progeny

346
Q

oseltamivir/zanamivir - clinical use

A

treatment/prevention of influenza A and B

347
Q

acyclovir, famciclovir, valacyclovir - MoA

A

guanosine analogs. monophosphorylated by HSV/VZV thymidine kinase (not phosphorylated in uninfected cells)
preferentially inhibit viral DNA polymerase by chain termination

348
Q

acyclovir, famciclovir, valacyclovir - clinical use

A

HSV and VZV
weak activity agains EBV

for herpes zoster - used famciclovir

349
Q

acyclovir, famciclovir, valacyclovir - toxicity

A

obstructive crystalline nephropathy and acute renal failure w/o proper hydration

350
Q

acyclovir, famciclovir, valacyclovir - resistance

A

mutated viral thymidine kinase

351
Q

ganciclovir - MoA

A

5’-monophosphate formed by a CMV viral kinase
guanosine analog
preferentially inhibits viral DNA polymerase by chain termination

352
Q

ganciclovir - clinical use

A

CMV - esp. in immunocompromised

353
Q

ganciclovir - toxicity

A

leukopenia, neutropenia, thrombocytopenia, renal toxicity

more toxic than acyclovir

354
Q

ganciclovir - resistance

A

mutate viral kinase

355
Q

Foscarnet - MoA

A

viral DNA/RNA polymerase inhibitor and HIV reverse transcriptase inhibitor

binds to pyrophosphate binding site of enzyme

does NOT require activation

356
Q

foscarnet - clinical use

A

CMV retinitis when ganciclovir fails

acyclovir resistant HSV

357
Q

foscarnet - toxicity

A

nephrotoxic, electrolyte abnormalities - seizures

358
Q

foscarnet - resistance

A

mutated DNA polymerase

359
Q

cidofovir - MoA

A

preferentially inhibits viral DNA polymerase

does NOT require phosphorylation by viral kinase

360
Q

Cidofovir - clinical use

A

CMV retinitis

acyclovir resistant HSV

361
Q

cidofovir - toxicity

A

nephrotoxic - coadminister with probenecid and IV saline to decrease toxicity

362
Q

interferons - MoA

A

glycoproteins normally synthesized by virus-infected cells - antiviral and antitumoral properties

363
Q

interferons - clinical use

A

IFN-alpha: chronic HepB and HepC, Kaposi sarcoma, hairy cell leukemia, condyloma acuminatum, renal cell carcinoma, malignant melanoma
IFN-beta: multiple sclerosis
IFN - gamma: chronic granulomatous disease

364
Q

interferons - toxicity

A

neutropenia, myopathy

365
Q

ribavirin - MoA

A

inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase

366
Q

ribavirin - clinical use

A

Chronic HepC

RSV

367
Q

ribavirin - toxicity

A

hemolytic anemia; severe teratogen

368
Q

simeprevir - MoA

A

HCV protease inhibitor, prevents viral replication

369
Q

simeprevir - clinical use

A

Chronic HepC in combo with ribavirin and peginterferon alfa

370
Q

sofosbuvir - MoA

A

inhibits HCV RNA dependent RNA polymerase

acts as chain terminator

371
Q

sofosbuvir - clinical use

A

chronic HepC w/ ribavirin +/- peginerferon alfa

372
Q

afferent arteriole constriction

A

dec GFR
dec RPF
no change in FF

373
Q

efferent arteriole constriction

A

inc GFR
dec RPF
inc FF

374
Q

increase plasma protein concentration (effect of GFR, RPF)

A

dec GFR
no change in RPF
dec RPF

375
Q

decrease plasma protein concentration (effect of GFR, RPF)

A

inc GFR
no change in RPF
increase FF

376
Q

constriction of ureter

A

dec GFR
no change in RFP
decrease FF

377
Q

effect of prostaglandins on glomerulus

A

prostglandins preferentially dilate the afferent arteriole - increased RPF, increased GFR (no change in FF)

378
Q

effect of NSAIDS on glomeruli

A

NSAIDS inhibit prostglandins (which preferentially dilate the afferent arteriole) so they cause unopposed constriction of the afferent arteriole - decreased RPF, decreased GFR

379
Q

effects of ACE-inhibitors on glomeruli

A

ACE-I decrease AT-II (normally constricts efferent arteriole) - vasodilation of efferent arteriole - decreases GFR

380
Q

reabsorptive defect in thick ascending loop of Henle resulting in hypokalemia and metabolic alkalosis with hypercalciuria

A

Bartter syndrome - affects triple transporter (Na/K/Cl)

AR

381
Q

reabsorptive defect in DCT - results in hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria

A

Gitelman syndrome - defective NaCl reabsorption

AR

382
Q

gain of function mutation leading to increased Na reabsorption in collecting tubules

A

Liddle syndrome - AD - results in hypertension, hypokalemia, metabolic alkalosis, decreased aldosterone levels

treat with amiloride

383
Q

11 beta hydroxysteroid dehydrogenase deficiency

A

syndrome of apparent mineralocorticoid excess
enzyme normally converts cortisol to cortisone in mineralocorticoid receptor-containing cells before cortisol can act on receptors

excess cortisol resulting from deficiency - increased receptor activity - hypertension, hyperkalemia, metabolic alkalosis

low serum aldosterone

can acquire from licorice

384
Q

Angiotensin II - actions on kidney

A

efferent arteriole constriction - increases GFR and FF
compensatory Na reabsorption in proximal and distal nephron

Net effect: increased FF in low-volume state w/ increased Na reabsorption to maintain circulating volume

385
Q

PTH - action on kidney

A

increased Ca reabsorption from DCT
decreased phosphate reabsorption from PCT
increased D3 production

386
Q

Atrial natriuretic peptide - action on kidney

A

increased GFR and increased Na filtration with NO compensatory Na reabsorption
Net effect: Na loss and volume loss

387
Q

Aldosterone - effect on kidney

A

increased Na reabsorption

increased K and H secretion

388
Q

ADH - effect on kidney

A

increased aquaporins and H2O reabsorption

389
Q

Potassium shift - out of cell

A

hyperkalemia

Digitalis (blocks Na/K ATPase)
hyperOsmolarity
Lysis of cells 
Acidosis
B-blockers
high blood Sugar

“DO LABS”

390
Q

potassium shift into cells

A

hypokalemia

hypo-osmolarity
alkalosis
beta-adrenergic agonists (increase Na/K ATPase)
Insulin (increase Na/K ATPase)

391
Q

RBC casts in urine

A

glomerulonephritis, malignant HTN

392
Q

WBC casts

A

tubulointerstitial inflammation, acute pyelonephritis, transplant rejection

393
Q

Fatty casts (oval fat bodies)

A

nephrotic syndrome

394
Q

granular casts (muddy brown)

A

acute tubular necrosis

395
Q

waxy casts

A

ESRD/chronic renal failure

396
Q

Hyaline casts

A

nonspecific - concentrated urine; can be normal

397
Q

mannitol - MoA

A

osmotic diuretic - increased tubular fluid osmolarity causing increased urine flow, decreased intracranial/intraocular pressure

398
Q

mannitol - clinical use

A

drug OD

elevated ICP/intraocular pressure

399
Q

mannitol - toxicity

A

pulmonary edema, dehydration,

contraindicated in anuria, heart failure

400
Q

acetazolamide - MoA

A

carbonic anhydrase inhibitor

causes NaHCO3 diuresis and decreases total body HCO3 stores

401
Q

acetazolamide - clinical use

A

glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri

402
Q

loop diuretics - MoA

A

furosemide, bumetanide, torsemide

inhibit triple transporter in thick ascending limp of loop of Henle
stimulate PGE release (vasodilatory effect on afferent arterioles) - inhibited by NSAIDS
increase calcium excretion

403
Q

loop diuretics - clinical use

A

furosemide, bumetanide, torsemide

edematous states
HTN
hypercalcemia

404
Q

loop diuretics - toxicity

A

furosemide, bumetanide, torsemide

Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout

“OH DANG”

405
Q

ethacrynic acid - MoA

A

loop diuretic - nonsulfa

inhibits triple transporter in thick ascending limp of the loop of HENLE

406
Q

ethacrynic acid - clinical use

A

diuresis in people with sulfa allergies

407
Q

ethacrynic acid - toxicity

A

can cause hyperuricemia - never use to treat gout

408
Q

thiazide diuretics - MoA

A

chlorthalidone, hydrochlorothiazide

inhibit Na/Cl reabsorption in early DCT
decreases diluting capacity of nephron
decreases Ca excretion

409
Q

thiazide diuretics - clinical use

A

chlorthalidone, hydrochlorothiazide

HTN, HF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis

410
Q

thiazide diuretics - toxicity

A

chlorthalidone, hydrochlorothiazide

hypokalemic metabolic alkalosis (muscle weakness and paralysis), hyponatremia
hyperGlycemia, -Lipidemia, -Uricemia, -Calcemia (hyperGLUC)
sufla allergy

411
Q

potassium sparing diuretics

A

Spironolactone, eplerenone, triamterene, amiloride

412
Q

Spironolactone, eplerenone - MoA

A

potassium sparing diuretics

competitive aldosterone receptor antagonists in cortical collecting tubule

413
Q

triamterene, amiloride - MoA

A

potassium sparing diuretics - block Na channels in cortical collecting tubule

414
Q

potassium sparing diuretics - clinical use

A

Spironolactone, eplerenone, triamterene, amiloride

hyperaldosteronism, K depletion, HF

415
Q

potassium sparing diuretics - toxicity

A

Spironolactone, eplerenone, triamterene, amiloride

hyperkalemia (arrhythmias)
spironolactone - gynecomastia, anti-androgen effects

416
Q

ACE inhibitors - MoA

A

captopril, enalapril, lisinopril, ramipril

inhibit ACE - decreases ATII - decreases GFR by preventing constriction of efferent arterioles

increased renin due to loss of negative feedback

prevents inactivation of bradykinin - vasodilator

417
Q

ACE-I - clinical use

A

captopril, enalapril, lisinopril, ramipril

HTN, HF, proteinuria, diabetic nephropathy (dec intraglomerular pressure - slows GBM thickening)
prevent unfavorable heart remodeling as a result of chronic HTN

418
Q

ACE-Inhibitor - toxicity

A

captopril, enalapril, lisinopril, ramipril

cough
angioedema
teratogen
increased creatinine (dec GFR)
hyperkalemia, hypotension

“CATCH”

avoid in bilateral RAS - further inhibit GFR leading to renal failure

419
Q

angiotensin II receptor blockers - MoA

A

losartan, candesartan, valsartan

selectively block binding of AT II to AT1 receptor - similar effect to ACE-inhibitor w/o effect on bradykinin

420
Q

ARB - clinical use

A

losartan, candesartan, valsartan

HTN, Heart failure, proteinuria, diabetic nephropathy (intol. to ACE-I)

421
Q

ARB - toxicity

A

hyperkalemia, dec renal function, hypotension, teratogen

422
Q

Aliskiren - MoA

A

direct renin inhibitor

423
Q

aliskiren - clinical use

A

HTN

424
Q

aliskiren - toxicity

A

hyperkalemia, decreased renal function, hypotension

contraindicated in diabetics taking ACE-I or ARBs

425
Q

follicular lymphoma - translocation

A

t(14;18) - BCL-2

426
Q

mantle cell lymphoma - translocation

A

t(11;14) - cyclin D1

427
Q

Acute lymphoblastic leukemia/lymphoma - translocation

A

t(12;21) - kids

t(9;22) - adults

428
Q

zileuton - MoA

A

5-lipoxygenase pathway inhibitor

blocks conversion of arachidonic acid to leukotrienes

429
Q

zilueton - clinical use

A

asthma

430
Q

zileuton - toxicity

A

hepatotoxic

431
Q

fluricasone/budesonide - MoA

A

corticosteroids - inhibit synthesis of cytokines

inactivate NF-kB - transcription factor that induces production of TNF-alpha and other inflammatory agents

432
Q

fluricasone/budesonide - clinical use

A

first line, chronic asthma (inhaled)

433
Q

montelukast/zafirlukast - MoA

A

block leukotriene receptors

inhibit bronchoconstriction

434
Q

montelukast/zafirlukast - clinical use

A

aspirin induced asthma

prophylactic, slow onset

435
Q

omalizumab - MoA

A

monoclonal anti-IgE antibody

binds unbound IgE in serum and blocks binding to FceRI

436
Q

omalizumab - clinical use

A

allergic asthma resistant to beta agonists and corticosteroids

437
Q

theophylline - MoA

A

bronchodilator via inhibition of phosphodiesterase - increases cAMP by decreasing cAMP hydrolysis

438
Q

theophylline - clinical use

A

asthma - limited by narrow therapeutic index due to nephro- and cardiotoxicity

439
Q

theophylline - toxicity

A

blocks action of adenosine

cardio- and nephrotoxic (increased HR; arrhythmias)

440
Q

cromolyn - MoA

A

prevents degranulation of mast cells

441
Q

cromolyn - clinical use

A

asthma - prophylaxis

442
Q

guaifenesin

A

expectorant, does not suppress cough; thins secretions

443
Q

N-acetylcysteine

A

expectorant - mucolytic
loosens mucous plugs in CF pts by disrupting disulfide bonds

antidote for acetaminophen OD

444
Q

dextromethorphan

A

antitussive - antagonizes NMDA glutamate receptors

synthetic codeine analog

445
Q

Bosetan

A

endothelin receptor antagonist - decreases pulmonary vascular resistance in pulmonary HTN

hepatotoxic

446
Q

epoprostenol, iloprost

A

prostacyclin analogs - treat pulmonary HTN

PGI2 w/ direct vasodilatory effects on pulmonary and systemic vascular beds
inhibit platelet aggregation
side effects: flushing, jaw pain

447
Q

acetaminophen - MoA

A

reversibly inhibit COX

mostly in CNS (inactivated peripherally)

448
Q

acetaminophen - cliicla use

A

anti-pyretic and analgesic (not anti-inflammatory)

449
Q

acetaminophen toxicity

A

OD - hepatic necrosis
metabolite depletes glutathione and forms toxic tissue byproducts

antidote = N acetylcysteine - regenerates glutathione

450
Q

celecoxib - MoA

A

reversibly inhibits COX2 - spares gastric mucosa and platelet function

451
Q

celecoxib - clinical use

A

RA, osteroarthritis

452
Q

celecoxib - toxicity

A

increased risk of thrombosis,, sulfa allergy

453
Q

bisphosphonates - MoA

A

pyrophosphate analogs - bind hydroxyapatite in bone, inhibit osteoclast activity

454
Q

bisphosphonates - clinical use

A

osteoporosis, hypercalcemia, Paget disease of bone

455
Q

bisphosphonates - toxicity

A

corrosive esophagitis

osteonecrosis of jaw

456
Q

teriparatide - MoA

A

recombinant PTH - increases osteoblastic activity

457
Q

teriparatide - clinical use

A

osteoporosis - causes increased bone growth

458
Q

teriparatide - toxicity

A

transient hypercalcemia, possible inc risk of osteosarcoma

459
Q

allopurinol - MoA

A

inhibits XO - decreases conversion of xanthine to uric acid (chronic gout)

460
Q

febuxostat

A

inhibits XO (chronic gout)

461
Q

pegloticase

A

recombinant uricase - catalyzes metabolism of uric acid to allantoin (chronic gout)

462
Q

probenecid

A

inhibits reabsorption of uric acid in PCT ( chronic gout)
can precipitate uric acid stones

inhibits secretion of penicillin

463
Q

acute gout treatment

A

NSAIDS, glucocorticoids, colchicine

464
Q

colchicine - MoA

A

acute gout

binds and stabilize tubulin to inhibit microtubule polymerization - impairs neutrophil chemotaxis and degranulation

465
Q

entanercept

A

TNF alpha decoy receptor

RA, psoriasis, ankylosis spondylitis

466
Q

infliximab, adalimumab

A

anti-TNF-alpha monoclonal antibody

IBD, RA, ankylosing spondylitis, psoriasis

467
Q

azathioprine, 6-MP, 6-TG - MoA

A

purine (thiol) analogs that decrease de novo purine synthesis
activated by HGPRT
azathioprine metabolized in 6-MP

468
Q

azathioprine, 6-MP, 6-TG - clinical use

A

preventing organ rejection
RA, IBD, SLE

used to wean pts off steroids and treat steroid refractory chronic disease

469
Q

azathioprine, 6-MP, 6-TG - toxicity

A

myelosuppression, GI, liver

azathioprine, 6-MP - metabolized by XO - increased toxicity with allopurinol or febuxostat use

470
Q

cladribine (2-CDA) - mechanism

A

purine analog - multiple mechanisms including inhibition of DNA poly and DNA strand breaks

471
Q

cladribine - clinical use

A

hairy cell leukemia

472
Q

cladribine - toxicity

A

myelosuppression, nephrotoxicity, neurotoxicity

473
Q

cytarabine (arabinofuranosyl cytidine) - MoA

A

pyrimidine analog - inhibits DNA synthesis

474
Q

cytarabine (arabinofuranosyl cytidine) - clinical use

A

leukemias (AML), lymphomas

475
Q

cytarabine (arabinofuranosyl cytidine) - toxicity

A

leukopenia, thrombocytopenia, megaloblastic anemia

476
Q

5-FU - MoA

A

pyrimidine analog bioactivated to 5F-dUMP - covalently complexes folic acid

inhibits thymidylate synthase - decreases dTMP - decreases DNA synthesis

477
Q

5-FU clinical use

A

colon cancer, pancreatic cancer, BCC (topical)

478
Q

5-FU toxicity

A

myelosuppression, not reversible with leuovorin (folinic acid)

479
Q

methotrexate - MoA

A

folic acid analog that competitively inhibits dihydrofolate reductase - decreases dTMP - decreases DNA synthesis

480
Q

methotrexate - clinical use

A

leukemia (ALL), lymphomas, choriocarcinoma, sarcomas

ectopic preg, medical abortion, RA, psoriasis, IBD, vasculitis

481
Q

methotrexate - toxicity

A

myelosuppression, reversible w/ leuvocorin rescue

hepatotoxic, mucositis, pulmonary fibrosis

482
Q

bleomycin - MoA

A

induces free radical formation - breaks in DNA strands

483
Q

bleomycin - clinical use

A

testicular cancer, Hodgkin lymphoma

484
Q

bleomycin - toxicity

A

pulmonary fibrosis, skin hyperpigmentation, mucositis

485
Q

dactinomycin (Actinomycin D) - MoA

A

intercalates in DNA

486
Q

dactinomycin - clinical use

A

Wilms tumor, Ewing sarcoma, rhabdomyosarcoma

childhood tumors

487
Q

doxorubicin, daunoribicin - MoA

A

generates free radicals

intercalates DNA - breaks in DNA - decreases replication

488
Q

doxorubicin, daunorubicin - clinical use

A

solid tumors, leukemias, lymphomas

489
Q

doxorubicin, daunorubicin - toxicity

A

cardiotoxicity (dilated cardiomyopathy) - prevent with dexrazoxane
myelosupp. alopecia,
toxic to tissues

490
Q

busulfan - MoA

A

cross-links DNA

491
Q

busulfan - clinical use

A

CML

bone marrow ablation

492
Q

busulfan - toxicity

A

severe myelosupp. pulmonary fibrosis, hyperpigmentation

493
Q

cyclophosphamide - MoA

A

cross links DNA at guanine N-7

req’s bioactivation in liver

494
Q

cyclophosphamide - clinical use

A

solid tumors, leukemia, lymphoma

495
Q

cyclophosphamide - toxicity

A 
myelosupp.
hemorrhagic cystitis (give mensa)
496
Q

nitrosoureas - MoA

A

req bioactivation
cross BBB - CNS
cross link DNA

497
Q

nitrosoureas - clinical use

A

CNS tumors

498
Q

nitrosoureas - toxicity

A

CNS toxicity

499
Q

Taxols (paclitaxel) - MoA

A

hyperstabilize polymerized microtubules in M phase

mitotic spindle cannot break down

500
Q

taxols (paclitaxel) - clinical use

A

breast and ovarian cancer

501
Q

Taxols (paclitaxel) - toxicity

A

myelosupp. alopecia, hypersensitivity

502
Q

Vinca alkaloids - MoA

A

Vincristine, Vinblastine - bind beta-tubulin and inhibit it’s polymerization into microtubules - prevent mitotic spindle formation (arrested in M phase)

503
Q

vinca alkaloids - clinical use

A

Vincristine, Vinblastine

solid tumors, leukemias, Hodgkin and non-Hodgkin lymphomas

504
Q

vinca alkaloids - toxicity

A

Vincristine - neurotoxic, paralytic ileus

Vinblastine - marrow suppression

505
Q

cisplatin/carboplatin - MoA

A

crosslink DNA

506
Q

cisplatin/carboplatin - clinical use

A

testicular, bladder, ovary, lung CA

507
Q

cisplatin/carboplatin - toxicity

A

nephrotoxic (prevent with amifostine - free rad scavenger; chloride diuresis), ototoxic

508
Q

etoposide, teniposide - MoA

A

inhibits topoisomerase II - increased DNA degredation

509
Q

etoposide, teniposide - clinical use

A

solid tumors, leukemia, lymphoma

510
Q

etoposide, teniposide - toxicity

A

myelosupp.
GI upset
alopecia

511
Q

irinotecan, topotecan - MoA

A

inhibits DNA topoisomerase I - prevents DNA unwinding and replication

512
Q

irinotecan, topotecan - clinical use

A

colon cancer, ovarian and small cell lung cancers

513
Q

irinotecan, topotecan - toxicity

A

severe myelosupp, diarrhea

514
Q

hydroxyurea - MoA

A

inhibits ribonucleoside reductase - decreases DNA synthesis (S Phase)

515
Q

hydroxyurea - clinical use

A

melanoma, CML, sickle cell (inc HbF)

516
Q

hydroxyurea - toxicity

A

severe myelosupp, GI upset

517
Q

bevacizumab - MoA

A

monocolonal antibody against VEGF

inhibits angiogenesis

518
Q

bevacizumab - clinical use

A

solid tumors

519
Q

bevacizumab - toxicity

A

hemorrhage, clotting, impaired wound healing

520
Q

erlotinib - MoA

A

EGRF tyrosine kinase inhibitor

521
Q

erlotinib - clinical use

A

non small cell lung cancer

522
Q

erlotinib - toxicity

A

rash

523
Q

imantinib - MoA

A

BCR-ABL and c-kit tyrosine kinase inhibitor

524
Q

imantinib - clinical use

A

CML - BCR-ABLE

stromal GI tumors - c-kit

525
Q

imantinib - toxicity

A

fluid retention

526
Q

rituximab - MoA

A

monoclonal antibody against CD20 (B-cell neoplasms)

527
Q

rituximab - clinical use

A

non-Hodgkin lymphomas, CLL, IBD, RA

528
Q

rituximab - toxicity

A

increased risk of progressive multifocal leukoencephalopathy

529
Q

tamoxifen, raloxifene - MoA

A

selective estrogen receptor modulators
antagonist in breast, agonist in bone

blocks binding of estrogen to ER+ cells

530
Q

tamoxifen, raloxifene - clinical use

A

tamoxifen - breast cancer treatment and prevention

raloxifene - prevents osteoporosis

531
Q

tamoxifen and raloxifene - toxicity

A

tamoxifen - partial agonist in endometrium - increases risk of endometrial CA; hot flashes

532
Q

trastuzumab (Herceptin) - MoA

A

monoclonal antibody against HER-2 tyrosine kinase receptor

533
Q

trastuzumab (Herceptin) - clinical use

A

Her-2+ breast cancer and gastric cancer

534
Q

trastuzumab (Herceptin) - toxicity

A

cardiotoxic

535
Q

vemurafenib - MoA

A

small molecule inhibitor of BRAF oncogene + melanoma

use to treat metastatic melanoma

536
Q

death cap mushroom

A

alpha amantinin in amanita phalloides inhibits RNA pol II causing severe hepatotoxicity - causing mRNA synthesis to stop

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