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tsomkapQ > uworld/USMLE Rx drugs and pharm Immunology > Flashcards

uworld/USMLE Rx drugs and pharm Immunology Flashcards

1
Q

Adal Inflicts Thursday Night Football on Me

A

Infliximab and adalimumab target TNF-alpha in autoimmune disorders (IBD, rheumatoid arthritis, ankylosing spondylitis, psoriasis)

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2
Q

Natali has MS

A

Nataluzimab - targets α4-integrin to impair leukocyte adhesion

used to treat MS

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3
Q

bevin eat your veggies

A

bevacizumab - hits VEGF, treats RCC, CRC, non-SCC

also used for “wet” conditions like diabetic retinopathy, macular edema, and macular degeneration

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4
Q

“ri2Ximab” to target

A

rituximab to target CD20

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5
Q

“alymtuzumab”

A

Alemtuzumab: treats CLL and MS

CLL (“alymtuzumab” for chronic lymphocytic leukemia), multiple sclerosis (MS)

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6
Q

what drug types should be avoided in the elderly when treating insomnia? what is a good drug to begin them on?

A
  1. benzos, antihistamines, sedating antidepressants.
  2. melatonin agonist- Ramelteon
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7
Q

what adverse effect do erythropoeisis stimulating agents pose?

A

hypertension and thromboembolic events

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8
Q

Alemtuzumab

A

Alemtuzumab

CD52

CLL, MS

“Alymtuzumab”—chronic lymphocytic leukemia

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9
Q

Bevacizumab

A

Bevacizumab

targets VEGF

against these cancers: Colorectal cancer, renal cell carcinoma, non-small cell lung cancer

CRC, RCC, NON-SCC

against these benign conditions: Macular edema, neovascular (“wet”) age-related macular degeneration, and proliferative diabetic retinopathy

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10
Q

Cetuximab

A

Cetuximab

targets EGFR

treats Stage IV colorectal cancer, head and neck cancer

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11
Q

Rituximab

A

Rituximab

targets CD20

treats B-cell non-Hodgkin lymphoma, CLL, rheumatoid arthritis, ITP

autoimmune disorders: ITP, multiple sclerosis, and rheumatoid arthritis

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12
Q

targets soluble TNF-α

used for….

A

Adalimumab, certolizumab, golimumab, infliximab

Soluble TNF-α

IBD, rheumatoid arthritis, ankylosing spondylitis, psoriasis

Etanercept is a decoy TNF-αreceptor and not a monoclonal antibody

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13
Q

Daclizumab

A

Daclizumab

targets CD25 (part of IL-2 receptor)

used for relapsing multiple sclerosis

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14
Q

Eculizumab

A

Eculizumab:

targets complement protein C5

use: Paroxysmal nocturnal hemoglobinuria

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15
Q

Natalizumab

A

Natalizumab

targets α4-integrin

used in Multiple sclerosis, Crohn disease

α4-integrin used by WBC in adhesion therefore runs risk of PML in patients with JC virus

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16
Q

Ustekinumab

A

targets IL-12/IL-23

used for Psoriasis, psoriatic arthritis

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17
Q

calcineurin inhibitors

A

tacrolimus and cyclosporin

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18
Q

mTOR inhibitors and indirect mtor inhitiors

A

sirolimus (rapamycin) directly inhibits, daclizumab inhibits IL-2R (receptor) which prevents mTOR signaling

mtor causes cell proliferation

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19
Q

Which immunosuppressant is often found in drug-eluting stents?

A

Sirolimus (rapamycin)

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20
Q

Apart from transplant rejection prophylaxis, what are the 3 main clinical indications for azathioprine?

A

Rheumatoid arthritis, glomerulonephritis, Crohn disease (and other autoimmune conditions)

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21
Q

Which 2 recombinant cytokines could be used to treat chemotherapy-induced leukopenia?

A
  1. FilGrastim (G-CSF)
  2. SarGraMostim (GM-CSF)

both aid in the recovery of granulocyte and monocyte counts

22
Q

Aldesleukin

A

recombinant cytokines and clinical uses

Aldesleukin (IL-2)

against Renal cell carcinoma, metastatic melanoma

23
Q

Epoetin alfa

A

Epoetin alfa (erythropoietin)

Anemias (especially in renal failure)

24
Q

Filgrastim

A

Recombinant cytokines and clinical uses

Filgrastim (G-CSF)

Recovery of bone marrow and WBC counts by granulocyte stimulation

25
Q

IFN-α

A

IFN-α

Chronic hepatitis B and C, Kaposi sarcoma, malignant melanoma, hairy cell leukemia, condyloma acuminata, renal cell carcinoma

26
Q

IFN-ß

A

IFN-ß

Multiple sclerosis

27
Q

IFN-γ

A

Recombinant cytokines and clinical uses

IFN-γ

Chronic granulomatous disease

28
Q

Romiplostim

A

Romiplostim (thrombopoietin analog)

eltrombopag (thrombopoietin receptor agonist)

Thrombocytopenia

29
Q

eltrombopag

A

eltrombopag (thrombopoietin receptor agonist)

Thrombocytopenia

30
Q

Oprelvekin

A

Oprelvekin (IL-11)

Thrombocytopenia

Oprelvekin is recombinant interleukin eleven, a thrombopoietic growth factor that directly stimulates the proliferation of hematopoietic stem cells and megakaryocyte progenitor cells and induces megakaryocyte maturation resulting in increased platelet production. It is marketed under the trade name Neumega.

31
Q

Heb B/Heb C/Renal C: treat with what cytokine?

A

IFN-alpha

32
Q

CD52

A

CD52 (targeted by alemtuzumab); think “alymtuzumab” for chronic lymphocytic leukemia

33
Q

RSV F protein

A

RSV F protein: targeted by palivizumab (paliVIzumab—VIrus) for RSV prophylaxis in high-risk infants

34
Q

Cyclosporin

A

Calcineurin inhibitor; binds cyclophilin. Blocks T-cell activation by preventing IL-2 transcription.

Psoriasis, rheumatoid arthritis.

AE:Nephrotoxicity, hypertension, hyperlipidemia, neurotoxicity, gingival hyperplasia, hirsutism.

Both calcineurin inhibitors are highly nephrotoxic.

35
Q

Tacrolimus (FK506)

A

Tacrolimus (FK506)

Calcineurin inhibitor; binds FK506binding protein (FKBP).

Blocks T-cell activation by preventing IL-2 transcription.

Similar to cyclosporine, risk of diabetes and neurotoxicity; no gingival hyperplasia or hirsutism.

36
Q

Sirolimus (Rapamycin)

A

Sirolimus (Rapamycin)

  1. mTOR inhibitor; binds FKBP.
  2. Blocks T-cell activation and B-cell differentiation by preventing response to IL-2.
  3. Kidney transplant rejection prophylaxis specifically.
  4. “PanSirtopenia” (pancytopenia), insulin resistance, hyperlipidemia; not nephrotoxic.
  5. Kidney “sir-vives.”
  6. Synergistic with cyclosporine.
  7. Also used in drug-eluting stents.
37
Q

Basiliximab

A

Basiliximab

  1. Monoclonal antibody; blocks IL-2R.
  2. Edema, hypertension, tremor.
38
Q

Azathioprine

A

Azathioprine

  1. Antimetabolite precursor of 6-mercaptopurine.
  2. Inhibits lymphocyte proliferation by blocking nucleotide synthesis.
  3. Rheumatoid arthritis, Crohn disease, glomerulonephritis, other autoimmune conditions.
  4. Pancytopenia.
  5. 6-MP degraded by xanthine oxidase; toxicity by allopurinol.
  6. Pronounce “azathio-purine.”
39
Q

Mycophenolate mofetil

A

Mycophenolate mofetil

  1. Reversibly inhibits IMP dehydrogenase, preventing purine synthesis of B and T cells.
  2. Lupus nephritis.
  3. GI upset, pancytopenia, hypertension, hyperglycemia. Less nephrotoxic and neurotoxic.
  4. Associated with invasive CMV infection.
40
Q

Corticosteroids

A

Corticosteroids

  1. Inhibit NF-κB.
  2. Suppress both B- and T-cell function by transcription of many cytokines.
  3. Induce T cell apoptosis.
  4. Many autoimmune and inflammatory disorders, adrenal insufficiency, asthma, CLL, non-Hodgkin lymphoma.
  5. Cushing syndrome, osteoporosis, hyperglycemia, diabetes, amenorrhea, adrenocortical atrophy, peptic ulcers,psychosis, cataracts, avascular necrosis (femoral head).
  6. Demargination of WBCs causes artificial leukocytosis. Adrenal insufficiency may develop if drug is stopped abruptly after chronic use
41
Q
A
42
Q

Sirolimus

A

Toxicic effect: PanSirtopenia” (pancytopenia), insulin resistance, hyperlipidemia; not nephrotoxic.

Nothes: Kidney “sir-vives.” (Kidney transplant rejection prophylaxis). Synergistic with cyclosporine. Also used in drug-eluting stents.

Sirolimus (rapamycin): mToR inhibitor- binds FKBP

43
Q

Azathio prine

A

6-mercaptopurine
azathio-purine

44
Q

Cyclosporine

A

Calcineurin inhibitor; binds cyclophilin

45
Q

de novo purine sythensis inhibitors

A
  1. mycophenolate, which inhibits IMP dehydrogenase
  2. azathioprine (6-MP) inhibits PRPP amidotransferase

both lead to inhibition of purine synthesis

46
Q
A
47
Q

Imatinib, Dasatinib

A

Imatinib, Dasatinib (bcr-abl tyrosine kinase inhibitors)

for Chronic Myelogenous Leukemia (CML) (because it has the t(BCR; ABL), philadelphia translocation)

48
Q

rivaroXaban and apiXaban

A

rivaroXaban and apiXaban ban Xa

49
Q

This patient presents with left flank pain and a left flank mass. His urinalysis demonstrates hematuria. Chest CT is obtained as a part of the staging process, and it reveals multiple foci. What is a good drug to use for this case?

A

This patient presents with left flank pain and a left flank mass. His urinalysis demonstrates hematuria. This clinical picture is classic for renal cell carcinoma (RCC). A chest CT is obtained as a part of the staging process, and it reveals multiple foci, indicating that his cancer has potentially metastasized to his lungs.

Management of metastatic renal cell carcinoma may include the use of chemotherapy drugs following surgical tumor debulking. Recombinant interleukin-2 (IL-2), also known as aldesleukin: a T lymphocyte growth factor. It stimulates T lymphocytes proliferation and increases the production of natural killer (NK) cells. NK cells help target cancerous cells for immunological attack.

Recombinant IL-2 activates the innate immune-mediated antitumor activity to help destroy cells affected by the metastatic RCC cells.

Patients with RCC have benefitted from recombinant IL-2 treatments.

50
Q

original combination chemotherapy regimen for Hodgkin lymphoma

A

MOPP regimen: Mechlorethamine, Oncovin (vincristine), Procarbazine, and Prednisone.

This regimen proved capable of curing more than 70% of patients. However, due to the development of significant, debilitating side effects from this regimen, a newer combination chemotherapy regimen was created. The current first-line combination chemotherapy regimen for Hodgkin lymphoma in the United States is the ABVD regimen: Adriamycin (doxorubicin), Bleomycin, Vinblastine, and Dacarbazine. MOPP is still used, however, for patients who relapse or have allergies that prevent them from taking the ABVD regimen.

Prednisone is a prodrug of prednisolone. Prednisone is an inactive compound that must be reduced to its active form, prednisolone, which has anti-inflammatory effects. The enzyme that catalyzes this reaction is 11-β-hydroxysteroid dehydrogenase.

The other drugs listed—betamethasone, hydrocortisone, dexamethasone, and budesonide—are active compounds and do not require bioactivitation to exert their effects, nor are they used in older cancer chemotherapy regimens.

51
Q

TB is ___ (mnemonic)

A

RIPE

rifampin, isoniazide, ethambutol, pyrazinamide (isoniazid is prophylaxis)

52
Q

dihydrofolate reducase inhibitors

A

tsomkapQ (117 decks)

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