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Sh*t I don't know Flashcards

1
Q

Colchicine is only given in acute gout flares if….

A

It is within 36 hours of sx onset & NSAIDs are contraindicated

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2
Q

Colchicine MOA

A

Antiinflammatory: prevent activation, degranulation, migration of neutrophils

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3
Q

How do we approach prescribing colchicine for pt. w/ renal or hepatic impairment on a P-gp or CYP3A4 inhibitor?

A

Do not give it

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4
Q

How do we approach prescribing colchicine for pt. w/o renal or hepatic impairment on a P-gp or CYP3A4 inhibitor?

A

Decrease the dose

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5
Q

Colchicine ADRs

A
  • Diarrhea
  • BM suppression
  • Myopathy & rhabdo (do not combine w/ statins or fibrates)
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6
Q

Examples of CYP34A and P-gp inhibitors to avoid with colchicine:

A

CYP34A inhibitor: clarithromycin

P-gp inhibitor: cyclosporine

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7
Q

Clinical indication for allopurinol

A
  • Gout prevention
  • Urate urolithaisis
  • Tumor lysis syndrome
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8
Q

Allopurinol ADRs

A
  • Paradoxical gout flare
  • BM suppression
  • Drug fever & rash
  • AHS/DRESS (fever, hepatitis, eosinophilia, AKI, red rash)
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9
Q

Who gets AHS/DRESS?

A

CKD pt. w/ HLA-B*5801

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10
Q

Febuxostat ADRs

A
  • Paradoxical gout flares
  • Cardiac issues
  • LFT abnl
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11
Q

Probenecid MOA

A

Inhibit urate-anion exchanger in the proximal tubule (“urate diuretic”)

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12
Q

What is required physiologically for the use of probenecid?

A
  • CrCl >50

- Normal urate UA

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13
Q

In addition to increasing the excretion of urate, probenecid increases the excretion of…
What does this mean clinically?

A

Ca+

Avoid drug in stone formers

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14
Q

Probenecid ADRs

A
  • Acute gout attack
  • Uric acid stones
  • Rash
  • N/V/D
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15
Q

Probenecid alters anion exchange in the kidney, so there are many possible interactions.
One example: it decreases the clearance of….

A

MTX

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16
Q

Pegloticase MOA

A

Converts urate into ALLANTOIN = water soluble metabolite that is easily excreted

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17
Q

Clinical indication for pegloticase

A
  • Chronic severe gout

- Max dose of XO inhibitor

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18
Q

Severe gout attack is an ADR of pegloticase. How do we avoid this happening that is different from any other drug?

A

On board NSAIDs >1wk before initiating pegloticase therapy

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19
Q

Pegloticase ADRs

A
  • Gout flare
  • Ab to pegloticase
  • Infusion rxns
  • Anaphylaxis
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20
Q

ABX that inhibit 30S ribosome

A

AG, TTC

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21
Q

ABX that inhibit 50S ribosome

A

Macrolides, oxazolidinones, pseudomutilins, lincosamide

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22
Q

TTC ADRs

A
  • Nausea
  • Photosensitivity
  • Hyperpigmentation (mino)
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23
Q

Hepatic excretion

A

Macrolides, lincosamide, lefumalin

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24
Q

Split excretion

A

TTC (including synthetics), oxazolidinone, FQs, metronidazole

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25
Q

Renal excretion

A
  • AGs

- TMP-SMX

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26
Q

Bacteriostatic drugs

A
  • TTC
  • Macrolides
  • Oxazolidinones
  • Pseudomutilins
  • Lincosamide
  • TMP-SMX
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27
Q

Bacteriocidal drugs

A
  • Fidoxamicin against CDI
  • FQs
  • AGs
  • Metronidazole
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28
Q

Drugs that INCREASE INR

A

TTC, macrolides, FQs

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29
Q

2nd gen synthetic TTC

A

Omadacycline, ervacycline

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30
Q

What are macrolides actually used for (6)

A
  1. B-lactam allergy (last resort)
  2. Atypical CAP (<8 yo)
  3. Enteritis (campy, shigella, cholera)
  4. H. pylori
  5. Pertussis
  6. NGU
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31
Q

Fidoxamicin MOA

A

Inhibits RNA polymerase

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32
Q

Fidoxamicin ADRs

A
  • BM suppression
  • N/D
  • Abd pain
  • GI bleed
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33
Q

Clindamycin clinical indication

A

REPLACES B-LACTAM IF ALLERGY:

  • SSTI
  • Strep pharyngitis
  • Abd infectios/abscesses
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34
Q

Clindamycin microbial coverage

A
  • Anaerobes
  • S. aureus
  • S. pyo
  • Viridans strep
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35
Q

AGs clinical indication

A
  • Severe infections

- Endocarditis (w/ cell-wall agents)

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36
Q

AG microbial coverage

A

Narrow spectrum aerobic GNB

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37
Q

AG ADRs

A
  • Ototoxicity

- Nephrotoxicity

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38
Q

What ABX are CYP34A substrates?

A
  • Macrolides

- Lefumalin

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39
Q

What ABX are CYP34A inhibitors?

A

Macrolides

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40
Q

Concentration dependent drugs?

A

AGs, FQs

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41
Q

Time-dependent drugs

A

FQs

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42
Q

Pleuromutilins clinical indication

A

CAP

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43
Q

Pleuromutilins microbial coverage

A
  • Atypical & typical CAP organisms

- STI organisms (gono, chlamydia, M. gen)

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44
Q

Pleuromutilin ADRs

A
  • N/D

- QT prolongation

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45
Q

FQ clinical indications

A

C/L/M: upper & lower UTI, enteric infections/traveler’s diarrhea
L/M: URI, LRTI
D: SSTI

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46
Q

FQ ADRs

A
  • Arthropathy
  • Tendinopathy
  • Nephrotixic/liver failure
  • Dysglycemia
  • QT prolongation
  • Photosensitvity
  • AIN
  • Anaphylaxis
  • CNS toxicity
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47
Q

Nitroimidazole MOA

A

Loss of helical DNA structure and strand breakage

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48
Q

Nitroimidazole clinical indication

A
  • BV
  • Giardia, trick
  • CDI
  • Intraabd abscess
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49
Q

Nitroimidazole ADRs

A
  • Neurotox
  • Fetotoxoc
  • Metallic taste
  • Disulfram-like rxn
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50
Q

TMP-SMX microbial coverage

A
  • P. jiroveci
  • MRSA
  • E. coli, proteus, klebsiella
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51
Q

Nitrofurantoin MOA

A

Inhibits enzyme systems (acetyl CoA) which interferes w/ metabolism & cell wall synthesis

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52
Q

Nitrofurantoin is contraindicated in pts. w/….

A

CrCl <60 (<30 may be accepted)

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53
Q

Nitrofurantoin ADR

A

Pulmonary toxicity/fibrosis

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54
Q

Fosfomycin MOA

A

Inhibits pyuvyl transferse -> affects cell wall synthesis

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55
Q

Fosfomycin microbial coverage

A
  • E. coli
  • GNB
  • Staph
    (MDR EBSL CRE & VRE/MRSA, +/- pseudomonas)
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56
Q

Chloramphenicol microbial coverage

A
  • H. flu
  • S. pneumo
  • N. meningitidis
  • Anaerobes
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57
Q

Rifampin non-Tb clinical indication

A

Meningococal meningitis prophylaxis

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58
Q

Isoniazid MOA

A

Inhibits mycolic acid synthesis

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59
Q

What genetic alteration can occur in pts. on isoniazid

A

Acetylation (slow -> peripheral neuropathy)

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60
Q

Ethambutol MOA

A

Inhibits cell wall synthesis

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61
Q

Ethambutol is a…..

A

Metal chelator

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62
Q

AZA non-transplant clinical indications

A
  • Active RA
  • Corticosteroid dependent IBD
  • Hard to treat rheum dz (psoriasis, reactive arthritis, lupus, etc)
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63
Q

AZA ADRs

A
  • N/V
  • Myelosuppression (bacterial inf >)
  • Hepatitis
  • Pancreatitis
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64
Q

Mycophenolate non-transplant clinical indications

A
  • Lupus nephritis, psoriasis, myasthenia gravis

- GVHD

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65
Q

BBW of mycophenolate

A

Miscarriage & birth defects (cleft palate, ear deformity)

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66
Q

Caution using what with mycophenolate?

A

Fe, antacids, cholestyramine

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67
Q

Cyclosporine non-transplant clinical indications

A
  • Severe refractory RA, psoriatic arthirits, IBD

- Keratoconjunctivitis sicca (dry eye)

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68
Q

Tacrolimus non-transplant clinical indications

A
  • Refractory UC

- Atopic dermatitis

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69
Q

ADR I always forget of prednisone

A

Myopathy

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70
Q

Antacid MOA

A
  • Increase gastric pH (neutralize)

- Inhibits proteolytic activity of pepsin

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71
Q

Al(OH)3 ADRs

A
  • Constipation

- Aluminum toxicity (encephalopathy, coma, seizure in CKD pt.)

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72
Q

CaCO3 ADRs

A
  • Constipation
  • Milk alkali syndrome (HA, nausea, irritability, weakness, hypercalcemia, metabolic alkalosis, hypophos in CKD pt. OR on large, prolonged doses)
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73
Q

Sucralfate clinical indiactions

A
  • GERD/PUD
  • NSAID induced ulcers
  • SUP (not anymore w/ H2RA)
  • Stomatitis/mucositis in chemo pt.
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74
Q

How often is sucralfate dosed?

A

QID

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75
Q

H2RA Class ADRs

A
  • Acid rebound

- Confusion in cognitive impaired/demented elderly pt.

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76
Q

Cimetidine ADRs

A
  • Agranulocytosis
  • Drug fever
  • Anti-androgen (ED/gynecomastia)
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77
Q

PPI ADRs

A
  • Acid rebound
  • N/V/D
  • Nosocomial infections (CAP/HAP, CDI)
  • Osteoporosis (affects Ca+ absorption)
  • Hypomag
  • Anemia (B12, IDA)
  • AIN -> CKD w/ long-term use (rare, mech unknown)
78
Q

Misoprostol ADR

A
  • Diarrhea

- Abd pain

79
Q

Misoprostol MOA

A

Analog of prostaglandin E -> antisecretory

80
Q

Fe+ supplements decrease the absorption of what drugs?

A
  • TTC, FQ
  • Bisphosphonate
  • LT4
  • Levodopa
81
Q

H. pylori triple therapy

A

PPI + clarithromycin + amoxicillin

82
Q

H. pylori concomitant therapy (quad)

A

PPI + clarithromycin + amoxicillin + metronidazole/tinidazole (BID)

83
Q

H. pylori bismuth therapy (quad)

A

PPI + bismuth + TTC + metronidazole/tinidazole (QID)

84
Q

ADRs of “swish & swallow” of magic mouthwash

A
  • Systemic absorption

- Aspiration (swallowing lidocaine affects gag reflex)

85
Q

Lubiprostone MOA

A

Prostaglandin metabolite -> open Cl- channels -> stimulate Cl- rich fluid

86
Q

Why is lubiprostone contraindicated in pt. w/ gastroporesis?

A

Causes delayed gastric emptying

87
Q

Linaclotide & precanatide MOA

A

Guanylate cyclase-C receptor agonist: activate CFTR -> secretino of Cl- & HCO3

88
Q

Linaclotide & precanatide is not approved in what patients

A

Pt. <18 (BBW - death in mice)

89
Q

Prucalopride MOA

A

Serotonin agonist

90
Q

CIC drug clinical indications

A

Lubiprostone: CIC, IBS-C, OID (nonCA)
Linaclotide & precanatide: CIC, IBS-C
Prucalopride: CIC

91
Q

OIC drug clinical indications

A

Methylnaltrexone: OIC in CA & nonCA pt.
Naloxegol: OIC in nonCA pt.
Naldemedine: OIC nonCA pt.

92
Q

What anti-constipation drugs are CYP3A4 substrates?

A

Naloxegol & naldemedine

93
Q

OIC what to do and what not to do

A

DON’T: increase fluid & fiber (won’t work), give docusate
DO: docusate + stimulant OR PEG

94
Q

Drugs that cause constipation:

A
  • Opioids
  • Anticholinergic
  • TCA
  • CCB
  • Levodopa
  • APs
  • Antacids, Ca+, Fe+
  • Antidiarrheals (bismuth)
95
Q

1st line agent in constipated pregnant women

A

Bulk laxatives

96
Q

Treating constipated children

A
  1. Disimpaction (pharm (PEG) > manual)

2. Maintenance: fiber, water, decrease diary, PEG x6mo

97
Q

Bismuth/subsalicylate MOA

A

Antimicrobial, antisecretory, antiinflammatory

98
Q

Who can’t receive bismuth/subsalicylate?

A

<12yo

99
Q

Bismuth/subsalicylate ADRs

A
  • Darkening of tongue, stool
  • Constipation > impaction
  • RAASH (ASA ADRs)
100
Q

Use of loperamide & diphenoxylate/atropine is contraindicated in….

A
  • Acute IBD flare

- Inflammatory infectious diarrhea

101
Q

Steps in treating IBS

A
  1. Stress mgmt
  2. Exercisse
  3. Diet
  4. Fiber
  5. Laxatives or antidiarrheals (caution w/ mixed types)
  6. Antispasmodics - hyoscyamine, dicyclomine (used PRN for abd pain)
  7. Psychotherapy
102
Q

IBS-C drugs

A
  • Lubiprostone
  • Linaclotide & precanatide
  • Tegaserod (only in women <65 w/o h/x AMI/CVA)
  • Tenapanor
  • SSRI
  • Probiotics
  • Peppermint oil (Ca+ channels)
103
Q

IBS-D drugs

A
  • Eluxadoline (pancreatitis risk)
  • Alonsetron
  • Rifaxminin
  • TCA
  • Probiotics
  • Peppermint oil (Ca+ channels)
104
Q

Medical marijuana (dronabinol & nabilone) ADRs

A
  • Dry mouth
  • Sedation
  • Syncope/dizziness
  • Ataxia
  • Agitation, confusion
105
Q

Promethazine clinical indications

A
  • Motion sickness
  • Antiemetic
  • Pain mgmt
  • Tx of allergic conditions
106
Q

Which nausea med is contraindicated in pregnancy & why?

A

Prochloperazine - causes EPS in newborns

107
Q

Metachlopramide ADRs

A
  • Dizziness

- EPS (acute dystonia) BBW

108
Q

Serotonin antagonist clinical indications

A
  • Antiemetic (PONV)
  • CIE
  • Nausea d/t radiation
  • Kids w/ GE in the ED
  • Kids & adults @ risk for dehydration
109
Q

Steps in N/V management in pregnancy

A
  1. Lifestyle changes (smaller meals, avoid triggers, rest, ginger tea)
  2. Vitamin B6
  3. Doxylamine (if refractory -> dimenhydrinate or diphenhydramine)
  4. Ondansetron (CHD, cleft defects 1st trimester)
  5. Metochlopramide, promethazine
110
Q

Steps in gastroporesis mgmt

A
  1. Lifestyle changes (small meals, increased fiber + water)
  2. Optimize DM treatment
  3. Check for meds that induce gastroporesis (e.g. exenitide, lubiprostone, opioids etc.)
  4. Metachlopramide
  5. Erythromycin
  6. Domperidone, cisapride
111
Q

Anti-cell membrane (antifungals) MOA

A

Polyenes - binds to ergosterol
Azoles - inhibits CYPs that inhibits conversion of lanosterol -> ergosterol
Allylamine - binds to squalene epoxidase (ergosterole synthesis)

112
Q

Fluconazole is an inhibitor of what CYPs

Allylamines are inhibitors of what CYPs

A

Fluconazole: 2C9, 2C19, 3A4
Allylamines: 2D6

113
Q

NNRTI 1st gen (bolded)

A

Efavirenz

114
Q

Efavirenz ADRs

A
  • Teratogen
  • Rash
  • CNS disengagement
115
Q

CMV is among the most common causes of ________ in _____ or ______ patients

A

OI in solid organ or HCT patients

116
Q

Letermovir MOA

A

DNA terminase complex inhibitor (viral DNA processing & packaging)

117
Q

Why are amantidine & rimantidine used minimally in influenza tx?

A

Significant resistance

118
Q

Peramivir clinical indication

A

TREATMENT of critical influenza when IV version is required (hospitalized pt.)

119
Q

Neuraminidase inhibitor cellular MOA

A

No virion release -> no replication

120
Q

Chemoprophylaxis these types of influenza:

Treat these types of influenza:

A

Chemoprophylaxis: A & B
Treat: A, B, swine, avian

121
Q

Chemoprophylaxis for influenza is not recommended in what subset of pts.?

A

Healthy pt.

122
Q

When a pt. w/ influenza develops viral pneumonia, bacterial superinfection is common. What organisms are commonly present?

A

S. pneumo, S. aureus

123
Q

When a pt. w/ influenza develops viral pneumonia, bacterial superinfection is common. How do we treat the common inflicting organisms?

A

Vanco or ceftaroline (cover MRSA!)

124
Q

Baloxavir MOA

A

Inhibits cap-dependent endonuclease (CEN) -> blocks viral replication

125
Q

Baloxavir pearls

A
  • Single dose
  • Less N/V c/t oseltamivir
  • Not approved for prophylaxis
  • Don’t take with multivalent cations
126
Q

NRTIs interfere with replication of…..

A

Mitochondria

127
Q

What are the clinical manifestations of mitochondrial dysfcn:

A
  • Neuropathy
  • Myopathy
  • CMP
  • Pancreatitis
  • Lactic acidosis
128
Q

What NRTI is most implicated in mitochondrial dysfcn:

A

ddl

129
Q

Zidovudine ADRs

A
  • Anemia/neutropenia (can treat w/ EPO!)

- Hyperpigmentation (oral mucosa/nail beds)

130
Q

Which two NRTIs cause pancreatitis & PN

A

Stavudine & didanosine

131
Q

Sx of hypersensitivity reaction assoc. w/ abacavir

A

Fever, rash, fatigue, GI sx (N/V/abd pain), respiratory sx (pharyngitis, dyspnea, cough)

132
Q

Pts. w/ HLA B*5701 have hypersensitivity to what drug?

Pts. w/ HLA B*5801 have hypersensitivity to what drug?

A

HLA B*5701 - abacavir

HLA B*5801 - allopurinol

133
Q

2nd gen NNRTIs end in “_____”

A

“virine (e.g. Rilpivirine)

134
Q

Rilpivirine ADR

A

Rash

135
Q

PIs end in “_____”

A

“avir”

136
Q

1st PI based STR

A

DRV/COBI/TAF

137
Q

Cobicistat is an inhibitor of CYP____ & ____ & ____

A

3A4, 2D6, P-gp

138
Q

Since COBI is an inhibitor of 3A4, 2D6, P-gp, what meds should we be cautious with?

A
  • PDE5 inhibitors
  • Antiplts/anticoagulants
  • CCB
  • ABX
  • Steroids
  • Statins
139
Q

Asthma pt. w/ HIV on COBI should do what in regards to their therapy to avoid Iatrogenic cushing’s syndrome

A
  • Use beclomethasone as their ICS

- Change their HIV regimen (non-PI, non-COBI)

140
Q

PI ADRs

A
  • N/V/D
  • Hyperglycemia, insulin resistance, hyperlipidemia
  • Hepatotoxicity
141
Q

What drugs from this exam material are sulfas?

A
  • TMP-SMX
  • Tamsulosin
  • Darunavir
  • SSZ
142
Q

INSTIs end in “_____”

A

“gravir”

143
Q

INSTI ADRs

A
  • N/V/D

- Abd pain

144
Q

Examples of the following drug classes:

  1. Fusion inhibitor
  2. Entry inhibitor
  3. Post-attachment inhibitor
A
  1. Fusion inhibitor ENFUVIRTIDE
  2. Entry inhibitor MARAVIROC
  3. Post-attachment inhibitor IBALIZUMAB-UIYK
145
Q

What drug is indicated for MDR HIV

A

Ibalizumab-uiyk

146
Q

Overall HIV-AIDs response

A

Seek -> test -> treat -> retain -> adhere -> simplify

147
Q

SEARCHING for VERY GOOD PIZZA

A

Sofosbuvir-velpatasvir

Glecaprevir-pibrentasvir

148
Q

Mirabegron drug interactions

A

Inhibits 2D6 & digoxin excretion

149
Q

Mirabegron ADR

A

HTN

150
Q

IVS sx

OVS sx

A

IVS: nocturia, frequency, urgency (OAB)
OVS: hesitancy, incomplete emptying, dribbling, intermittent stream (BPH)

151
Q

5a reductase MOA

A

Inhibits conversion of testosterone to dihydrotestosterone -> SHRINKS PROSTATE

152
Q

Pregnant women or women trying to conceive should be cautious handling 5a rectuctase inhibitors

A

It can be absorbed through skin and cause abnl in male genitalia (category X)

153
Q

How do PDE5 inhibitors work?

A

INHIBIT the degradation of cGMP which is responsibility for smooth muscle relaxation and engorgement of corpus cavernosum with blood

154
Q

PDE5 inhibitor ADRs

A
  • HA, facial flushing, nasal congestion, & dyspepsia
  • Priapism
  • Nonarteric ischemic optic neuropathy (sudden blindness d/t blocked blood flow optic nerve)
155
Q

Sildenafil & tadalafil ADRs

A

Sildenafil: cyanopsia
Tadalafil: back pain

156
Q

General MOA of filbanserin & bremelanotide

A

Filbanserin: manipulates serotonin
Bremelanotide: melanocyte receptors & neuronal receptors

157
Q

Filbanserin ADRs

A
  • CNS depression

- Hypotension/syncope (ETOH contraindicated)

158
Q

Filbanserin precaution

A

Hepatic impairment

159
Q

Bremelanotide contraindicated

A

CVD, uncontrolled HTN

160
Q

Bremelanotide ADRs

A
  • Nausea
  • Flushing
  • Injection site rxns
  • HA
  • Hyperpigmentation
161
Q

GU drugs:
CYP3A4 substrates
CYD2D6 substrates
CYD2D6 inhibitor

A

CYP3A4 substrates: tolterodine, fesoterodine, 3rd gen M3 antagonists, alpha blockers, PDE5 inhibitors
CYD2D6 substrates: tolterodine, fesoterodine
CYD2D6 inhibitor: mirabegron

162
Q

Antiinflammatory drug that’s a….
CYP3A4 sub (1)
P-gp sub (1)

A

CYP3A4 sub: JAK inhibitors

P-gp sub: MTX

163
Q

Leflunomide MOA

A

Inhibits pyrimidine synthesis -> antiproliferative & anti-inflammatory effects

164
Q

Leflunomide ADRs

A
  • Profound diarrhea
  • Alopecia
  • BM suppression
  • LFT abnl
165
Q

HCQ MOA

A

Inhibits mvmt of neutrophils, eosinophils, complement-dependent Ag-AB rxns

166
Q

SSZ MOA

A

Inhibits prostaglandin synthesis (how it affects RA unclear)

167
Q

SSZ ADRs

A
  • Gi intolerance
  • Sulfa rash
  • Hepatitis (severe)
  • BM suppression (severe)
  • Lupus-like syndrome
  • Hemolysis in G6P
168
Q

JAK inhibitor MOA

A

JAK signaling is a critical step in hematopoiesis & immune activation [INHIBIT THIS]

169
Q

JAK inhibitor ADRs

A
  • N/D
  • URTI
  • Thromboembolic dz (BBW)
  • LFTs
170
Q

TNF inhibitor MOA

A

= proinflammatory cytokine [INHIBIT THIS]

171
Q

TNF inhibitor clinical indication

A
  • RA
  • Psoriatic arthritis
  • sJIA
  • IBD
  • Ankylosing spondylitis
172
Q

TNF inhibitor precautions/contraindications

A
  • h/o CA
  • h/o demyelinating dz (e.g. MS)
  • NYHA Class III & IV
173
Q

TNF inhibitor ADRs

A
  • Infusion rxns
  • Injection site rxns
  • URTI
  • GI intolerance
  • BM suppression
  • Lupus-like syndrome
  • Increased risk of lymphoma
  • Increased risk of serious infections (e.g. pneumonia, cellulitis - M/C, invasive/disseminated fungal infections (e.g. histo) - BBW, Tb)
174
Q

“Other” anti-inflammatory agents used for the following disorders:
sJIA (2)
Psoriatic arthritis (1)
RA pt. who don’t respond to TNF - w/ MTX (4)
Giant cell arteritis (1)

A

sJIA: Tocilizumab, Anakinera (off-label)
Psoriatic arthritis: Abatacept
RA pt. who don’t respond to TNF - w/ MTX: Abatacept, Rituximab, Tocilizumab, Sarilumab
Giant cell arteritis (1): Tocilizumab

175
Q

PML and HBV reactivation is an ADR of what anti-inflammatory agent

A

Rituximab (CD20)

176
Q

What is the SQ IL-1 drug approved for sJIA

A

Canakinumab

177
Q

Steps in treating psoriatic arthritis

A

Mild dz: NSAIDs
Mod-severe: 1. MTX or leflunomide 2. TNF inhibitors 3. “Other” -> Abatacept, Tofacitinib, Apremilast (PDE4), secukinumab, ustekinumab

178
Q

Steps in treating sJIA

A

Mild dz: NSAIDs or corticosteroids

Mod-severe: 1. MTX or TNF inhibitors 2. Tocilizumab, Anakinera, Canakinumab

179
Q

What is the name of the bladder toxic metabolite produced by cyclophosphamide?

A

Acronlein

180
Q

What can speed the resolution of MTX-induced stomatitis?

A

Folate supplementation

181
Q

ADR of MTX (chemo regimen)

A

Lymphoproliferative malignancies

182
Q 
General MOA - chemo agents:
Alkylating agents
Anti-metabolites
ABX
Plant alkaloids
A

Alkylating agents: cross linking
Anti-metabolites: pseudometabolites
ABX: intercalating
Plant alkaloids: inhibition of mitotic spindle formation

183
Q

Specific anti-metabolites in the anti-metabolite drugs

A

MTX - folate
5FU - pyrimidine
Ara-C - cytosine triphosphate

184
Q

Cytarabine syndrome sx

A
  • Fever
  • Malaise
  • Myalgia
  • Conjunctivitis
  • Bone pain,
  • CP
  • MP rash
185
Q

What component of doxorubicin MOA explains it’s cardiotoxicity?

A

It’s an iron chelator

186
Q

Bleomycin ADRs

A
  • Striae (+ other skin manifestations)
  • Acute febrile reactions
  • Pneumonitis > pulmonary fibrosis
187
Q

Paclitaxel ADRs

A
  • PN
  • Hypersensitivity rxns
  • Arthralgias/myalgias
  • Rhythm disturbances
188
Q

Substance P/NK receptor antagonist ADR

A

WELL-TOLERATED

189
Q

What CSF is most commonly used and why?

A

Pegfilgastrim - single dose

190
Q

CSF clinical indications - be specific

A

CA pt. treated w/ chemo (if regimen risk is >20% to produce neutropenia) or BMT

191
Q

CSF ADRs

A
  • Fever
  • Rash
  • Splenomegaly/spenic rupture
  • Bone pain
  • Increased risk of treatment-related myeloid leukemia in pt on chemo (e.g. doxorubicin)
192
Q

What is the most common malignancy caused by use of antimetabolite chemotherapy?

A

Secondary AML

Pharm (1 decks)

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