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Pharm II Exam 4 > Special Considerations > Flashcards

Special Considerations Flashcards

1
Q

Pharmacogenetics Test for Ethanol

A

No FDA approved test yet

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2
Q

Pharmacogenetics Test for Phenytoin

A

No FDA approved test yet.

In theory:

Inactive CYP2D6 and CYP2C19
alleles – ↓ phenytoin dose

Hyperactive MDR1 promoter allele – ↑ dose

Low affinity VGSC allele – switch to different anti-seizure medication w/ diff MOA such as topirimate

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3
Q

Pharmacogenetics Test for 5-fluorouracil (5FU)

A

Yes, FDA recommended for inactive A allele.

↓ 5FU dose for inactive ‘A’ allele

No FDA approved test yet for 2R/2G,2R/2Cor3R/3C allele of TS gene

Choose different cytotoxic drug for 3R/3G allele

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4
Q

Pharmacogenetics Test for Codeine

A

Yes, FDA recommended test for CYP2D6 allele

For poor metabolizers replace codeine with opioid analgesic not dependent on CYP2D6 conversion to active metabolite (e.g. hydrocodone)

For ultra-metabolizers: ↓ dose of codeine

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5
Q

Pharmacogenetics Test for Warfarin

A

Yes, FDA has approved the Nanosphere test for warfarin ADR

This tests looks at CYP2C9 and VKORC1 alleles

Nanosphere does not test for bleeding susceptibility alleles that are common in the African American population

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6
Q

Benzimidazole resistance

A

Switch β-tubulin isotype 1
(sensitive) to isotype 2 (resistant)

Point mutation in β-tubulin isotype 1 that changes phenylalanine (wild-type) to tyrosine (mutation) at position 200

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7
Q

Ivermectin resistance

A

P-glycoprotein ↑ regulation

Mutation in glutamate- gated Cl- channel

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8
Q

Pyrantel Pamoate resistance

A

Typically not a problem

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9
Q

Diethylcarbamazine resistance

A

Typically not a problem

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10
Q

Praziquantal resistance

A

Typically not a problem

May have mutation in VGCC

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11
Q

mech of resistance for Artemisinins

A

Counterfeit drug threat to resistance

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12
Q

mech of resistance for Chloroquine Phosphate

A

Pfcrt (efflux pump) mutations → gene amplification → pumps drug out

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13
Q

mech of resistance for Quinne Sulfate

A

Pfmdr1 (efflux pump)gene amplification → pumps drug out

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14
Q

mech of resistance for Atovaquone

A

Cyt b mutations → inhibit drug binding

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15
Q

ACT with Lumefantrine special considerations

A

Take with high fat meal to ↑ absorption

Substantial drug‐drug interactions w/ ARV/protease inhibitors (may need to ↑ ACT dose)

Can only get from the CDC by request

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16
Q

Chloroquine Phosphate special considerations

A

Loading dose requires

Must monitor doses due to potentially lethal plasma concentrations

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17
Q

Quinne Sulfate special considerations

A

Combination/adjunctive therapy to ↓ duration/toxicity → doxycycline, clindamycin and tetracyclines (inhibit protein translation)

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18
Q

Atovaquone special considerations

A

Resistance to monotherapy

Combo w/ proguanil

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19
Q

Proguanil special considerations

A

Enhances atovaquone effect

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20
Q

Isoniazid (INH) special considerations

A

Fast acetylaters of INH → don’t have enough drug won’t be effective

Slow acetylaters of INH → too much drug will become toxic

Depletes pyridoxine → give pyridoxine vitamin

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21
Q

Mech of resistance of Isoniazid (INH)

A

KatG deletion/mutation → if its compromised it won’t activate the drug and won’t work

InhA overexpression→ plenty of the protein that the drug isn’t binding to

22
Q

Mech of resistance of Pyrazinamide

A

pcnA mutations bc if not converted it won’t work

23
Q

Mech of resistance of Ethambutol

A

embB mutations → inhibits binding of drug

24
Q

Mech of resistance of Rifampin

A

rpoB mutations → mutates binding site and durg can’t bind

25
Q

Mech of resistance of Bedaquiline

A

Mutation of atpE (subunit ATP synthase) → drug can’t bind

26
Q

Mech of resistance for Acyclovir

A

Mutation in viral thymidine kinase or viral DNA polymerase (will be cross resistant to valacyclovir, famciclovir and ganciclovir) → treat with Foscarnet if resistant

Can be reversible

27
Q

Mech of resistance for Ganciclovir

A

Resistance is mostly related to mutations in viral kinase (UL97)

28
Q

Mech of resistance for Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

A

Mutations in viral RT

29
Q

Mech of resistance for Abacavir

A

Resistance is slow → requires 2-3 mutations in RT

30
Q

Mech of resistance for Efavirenz

A

Single mutation in RT can quickly cause resistance

31
Q

Mech of resistance for HIV protease Inhibitors

A

Resistance is common → use in combo therapy

32
Q

Acyclovir

A

Topical acyclovir less effective than oral administration for 1° HSV and ineffective against recurrent infection

33
Q

Anti-Influenza Agents

A

Must be given quickly after onset of sx - 48 hr for pts at high risk for complications

34
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

A

Food used to ↑ bioavailability

35
Q

Abacavir

A

Test for HLA-B*5701 and if + → DO NOT GIVE

36
Q

Lamivudine

A

Admin w/ tenofovir

37
Q

Emtricitibine

A

Admin w/ tenofovir

38
Q

Ritonavir

A

Take w/ food to ↑ bioavailability

39
Q

Darunavir

A

Superior to lopinavir/ritonavir

40
Q

Elvitegravir

A

Combo w/ cobicistat (CYP3A4 inhibitor → booster)

41
Q

Evidence for effectiveness of Garlic

A

Some (not all) human studies show modest ↓ in total cholesterol

42
Q

Evidence for effectiveness of Ginko

A

Some (modest) improvement seen only in some clinical trials w/ Alzheimer’s pts

Large double-blind trial recently completed→ no diff from placebo

43
Q

Evidence for effectiveness of St. John’s Wort

A

Results of 2 large clinical trials → no more effective than placebo in treating major depression of moderate severity

44
Q

Evidence for effectiveness of Ginseng

A

Actual data not compelling

45
Q

Evidence for effectiveness of Black Cohosh

A

Some small studies report ↓ iof sx in menopause and in PMS

Larger double-blind clinical trial showed no difference

46
Q

Evidence for effectiveness of Glucosamine

A

NEJM study showed no sig relief from OA pain with glucosamine plus chondroitin sulfate

Smaller subgroup study w/ mod-severe pain showed significant relief w/ combined glucosamine plus chondroitin sulfate

May possibly improve sx

47
Q

Evidence for effectiveness of Fish Oil (Omega 3)

A

Evidence supports significant ↓ in TG, modest ↓ in BP

Eating fish has a protective effect against CV dz → in some studies this is at least equal to the benefit of statins

Not demonstrated that taking fish oil provides any added benefit in a person who regularly (2-3 times a week) eats fatty fish

Insufficient data on effects in macular degeneration or ADD

48
Q

Alternatives to Garlic

A

Statins and bile-acid sequestering drugs both better at ↓ cholesterol

49
Q

Alternatives to Ginko

A

Donepezil(modestimprovement)

50
Q

Alternatives to St. John’s Wort

A

SSRI

TCAs

MAOIs

51
Q

Alternatives to Black Cohosh

A

Estrogen therapy

52
Q

Alternatives to Fish Oil (Omega 3)

A

3 approved omega 3-acid for hypertriglyceridemia(Lovaza, Vascepa and Epanova)

Can use w/ statin to ↑ effectiveness

Pharm II Exam 4 (7 decks)

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