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Pharmacology > EXAM #4: REVIEW > Flashcards

EXAM #4: REVIEW Flashcards

1
Q

What is Peptidoglycan?

A

A macromolecule of peptides and sugars

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2
Q

What is Lipopolysaccharide?

A

A macromolecule of phospholipids and polysaccharides

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3
Q

Outline the ESKAPE mnemonic of nosocomial superbugs.

A 
Enterococcus faecium 
Staphylococcus aureus 
Klebsiella pneumoniae 
Acinetobacter bumanni 
Pseudomonas aeruginosa 
Enterobacter species
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4
Q

What is the function of Penicillin-Binding Proteins (PBPs) or Transpeptidases?

A

Cross-linking peptidoglycan in the formation of the bacteria cell wall

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5
Q

How can you group the PCN-type drugs?

A
  • Penicillinase-sensitive PCNs
  • Penicillinase-resistant PCNs
  • Antipseudomonals

*****Penicillinase= Beta-Lactamase

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6
Q

List the Beta-Lactamase sensitive PCNs.

A

PCN G and V
Ampicillin
Amoxicillin

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7
Q

List the Beta-Lactamase resistant PCNs.

A

Oxacillin
Nafcillin
Methicillin

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8
Q

Which of the PCNs are “antipseudomonal?”

A

Ticracillin

Piperacillin

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9
Q

What are the narrow spectrum PCNs?

A

PCN G and V
Methicillin
Nafcillin
Oxacillin

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10
Q

What are the broad spectrum PCNs?

A 
Ampicillin 
Amoxacillin
Azlocillin 
Piperacillin
Ticracillin

Remember aminopenecillins are amped up PCNs i.e. ampicillin and broader spectrum

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11
Q

What is the hallmark 1st generation Cephalosporin?

A

Cephazolin

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12
Q

What is the hallmark 2nd generation Cephalosporin? List the other 2nd generation Cephalosporins.

A

Cefoxitin

  • Cefotetan
  • Cefaclor
  • Cefuroxime
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13
Q

List the 3rd generation Cephalosporins.

A

Ceftriaxone

  • Cefotaxime
  • Cefdnir
  • Cefixime
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14
Q

What is the only drug in the Monobactam family?

A

Aztreonam

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15
Q

What type of bacteria can be treated with Aztreonam?

A

Gram negative (rods) only

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16
Q

What are the two important clinical considerations regarding Aztreonam?

A

1) Penetrates the BBB

2) Beta-Lactamase resistant

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17
Q

Are the Carbapenams resistant to Beta-Lactamase?

A

Yes

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18
Q

What enzyme are the Carbapenams susceptible to?

A

Carbapenemase

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19
Q

What adverse effects are associated with the Carbapenems?

A

1) GI disturbances (Dr. Henry)
2) CNS toxicity

Note that it is toxicity that limits their use to life-threatening infections and/or after other drugs have failed

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20
Q

What is the MOA of Vancomycin?

A

Inhibits peptidyglycan formation by binding D-ala portion of cell wall precursors

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21
Q

What is Vancomycin generally used to treat?

A

Serious, multi-drug resistant organisms including:

  • MRSA
  • C. diff
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22
Q

What is the MOA of Bacitracin?

A

Blocks incorporation of amino acids and nucleic acids into the cell wall of bacteria

Remember that Bacitracin is Broad spectrum

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23
Q

What type of antibiotic is Fosfomycin? What is the MOA?

A

Cell wall synthesis inhibitor that prevents the synthesis of UDP-NAM (component of peptidoglycan)

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24
Q

What is Fosfomycin commonly used to treat?

A

UTIs

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25
Q

What antibiotic class are the Aminoglycosides? What is the MOA?

A

30S Protein Synthesis Inhibitors
- Prevent charged tRNA from entering the A site

Remember, “Buy AT 30, CELL at 50” (Aminoglycosides and Tetracyclines= 30S inhibitors)

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26
Q

How are the Aminoglycosides commonly administered in the clinical setting?

A

With Beta-Lactam antibiotics

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27
Q

When are Aminoglycosides commonly used clinically?

A

Serious gram negative infections

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28
Q

What is the mnemonic to remember many important features of the Aminoglycosides?

A

“Mean” (i.e. A-mean-oglycodies) GNATS caNNOT kill anaerobes

G= Gentamicin 
N= Neomycin 
A= Amikacin 
T= Tobramycin 
S= Streptomycin 
N= NEPHROTOXICITY 
N= neuromuscular blockade 
O= OTOTOXICITY 
T= teratogen

(CAPITLAL= Dr. Henry)

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29
Q

What is the MOA of the Macrolides?

A

Blocks translocation of the growing amino acid chain from the A-site to the P-site

(50S inhibitors)

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30
Q

What side effect is associated with Macrolides? Use a mnemonic to remember.

A

Macrolides cause Motility issue i.e. GI disturbances

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31
Q

What is the specific MOA of the Tetracyclines?

A

Blocks charged tRNAs from entering the A-site

30S inhibitors

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32
Q

What should not be taken with a Tetracycline?

A

1) Milk
2) Antacids
3) Iron supplements

Bind divalent cations, which will inhibit absorption from the gut

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33
Q

In what patient populations are Tetracyclines contraindicated?

A

1) Kids
2) Pregnant women

Will prevent/induce bone growth–check ppt

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34
Q

What type of antibiotic in Clindamycin?

A

50S Protein Inhibitor

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35
Q

Clinically, what is Clindamycin commonly prescribed for?

A

Streptococcus and Staphylococcus soft tissue infections

Thus, it is a NARROW SPECTRUM antibiotic

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36
Q

What is the MOA of Clindamycin?

A

Blocks growing amino acid chain transfer from A-site to P-site

(50S)

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37
Q

What key adverse effect is Clindamycin associated with?

A

Pseudomembraous colitis i.e. C.diff

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38
Q

What is the MOA of Chloramphenicol?

A

Blocks peptidyltransferase at 50S subunit i.e. prevents peptide bond formation

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39
Q

What are the adverse effects seen with Chloramphenicol?

A

1) Anemia
2) Aplastic anemia
3) Gray Baby Syndrome

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40
Q

What is Chloramphenicol commonly prescribed for?

A

Rocky Mountain Spotted Fever

Typhus

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41
Q

What type of bacteria is Linezolid effective against?

A

Gram positive

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42
Q

What is the MOA of Linezolid?

A

50S inhibitor that blocks the A-site

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43
Q

What adverse effect is associated with Linezolid?

A

Myelosuppression

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44
Q

What is the general pattern of bacterial specificity of the protein synthesis inhibitors? Which antibiotic does NOT follow the pattern?

A

Generally broad spectrum, except for Clindamycin, which is used to treat Streoptoccus and Staphylococcus soft tissue infections

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45
Q

List the Sulfonamides.

A

Sulfamethoxazole (SMX)
Sulfamethizole
Sulfadiazine

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46
Q

What are the key adverse reactions associated with the Sulfonamides? Use a mnemonic to recall these reactions

A

Sulfonamides= Skin

1) Hypersensitivity
2) Photosensitivity
3) Steven-Johnson Syndrome

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47
Q

What is the bacterial specificity of the Sulfonamides?

A

Broad-spectrum

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48
Q

What are the two Trimethoprims?

A

Trimethoprim

Pyrimethamine

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49
Q

What is the bacterial specificity of the Trimethoprims?

A

Gram negative bacteria

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50
Q

What is the mnemonic to remember the adverse effects associated with the Trimethoprims?

A

Trimethoprim= TMP

Treats Marrow Poorly i.e. megaloblastic anemia

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51
Q

List the adverse effects associated with the Fluoroquinolones.

A

1) GI disturbances
2) Bind divalent cations
3) QT prolongation
4) FluoroquinoLONES hurt attachment to your BONES
- Tendonitis
- Tendon rupture

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52
Q

What is the Group 1 Fluoroquinolone?

A

Norfloaxacin

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53
Q

What are the Group 2 Fluoroquinolones? What type of bacteria are these drugs most specific for?

A

Ciprfloaxcin
Levofloaxcin
Ofloaxcin

Gram negatives

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54
Q

What are the Group 3 Fluoroquinolones? What type of bacteria are these drugs most specific for?

A

Gatifloxcin
Gemifloxcin
Moxifloaxacin

Gram positives

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55
Q

What types of microorgansism can be treated with Metronidazole?

A

Bacteria AND protozoa

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56
Q

What type of bacteria can be treated with Metronidazole?

A

Anaerobics ONLY (below the diaphragm)

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57
Q

What is the bacterial specificity of Daptomycin?

A

Gram positives

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58
Q

What is the bacterial specificity of Polymyxin B?

A

Gram negatives/LPS i.e. it specifically is a detergent that punches in LPS

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59
Q

How is Polymxyin B administered?

A

Topically

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60
Q

What is a good first choice drug for an uncomplicated skin infection?

A

1st generation Cephalosporin i.e. Cefazolin

Treats S. aureus and S. pyogenes that cause uncomplicated skin infections

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61
Q

What is a good alternative for an uncomplicated skin infection with hypersensitivity to a 1st generation cephalosporin?

A

Clindamycin

or Vancomycin

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62
Q

What is a good first choice drug for a complicated skin infection?

A

Ticracillin and clavulanate

Has anti-pseudomonal activity

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63
Q

What are good drugs to treat MRSA skin infection?

A

Vancomycin
Daptomycin
Linezolid

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64
Q

What two bacteria cause complicated skin infections?

A

1) P. aeruginosa (Ticracillin has anti-pseudomonal activity)
2) E. coli

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65
Q

What are good first line agents for bone and joint infections?

A

Vancomycin or Ceftriaxone (3rd/4th generation cephalosporin)

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66
Q

What is the antibiotic of choice for post-op bone/joint infections?

A

Ticracillin and clavulanate

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67
Q

What is a good antibiotic choice for septic arthritis?

A

Ceftriaxone

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68
Q

What is the first line antibiotic for acute sinusitis and chronic bronchitis?

A

Augmentin i.e. Amoxacillin and clavulanate

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69
Q

What is the first line antibiotic for pharyngitis? What organism commonly causes pharyngitis?

A

PCN

S. pneumoniae

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70
Q

What bacteria cause URIs (3)?

A

1) H. influenza
2) S. pneumonia
3) Moraxella catarrhalis

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71
Q

What is the first line antibiotic for ambulatory pneumonia?

A

Macrolides

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72
Q

How are patients with pneumonia that have to be hospitalized treated?

A

Add Beta-Lactam to the Macrolide

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73
Q

How is nosocomial pneumonia treated?

A

Ceftriaxone

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74
Q

How is pyelonephritis treated vs. a simple UTI?

A 
UTI= TMP-SMX 
Pyelo= add Fluoroquinolone
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75
Q

What is the first line antibiotic for intra-abdominal infections? What bacteria cause intra-abdominal infections?

A

Ticracillin and clavulanate

Gram negative

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76
Q

What is community acquired meningitis treated (older than 2 y/o)?

A

Ceftriaxone and Vancomycin

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77
Q

How is neonatal meningitis treated?

A

1) Ampicillin
2) Cephalosporin
3) +/- Gentamicin (L. monocytogenes)

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78
Q

What are the first line antibiotics for Endocarditis?

A

1) Ceftriaxone

2) Vancomycin

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79
Q

What are the first line antibiotics for neutropenic fever?

A

Ciprofloxacin and Augmentin

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80
Q

How are enterococci infections treated?

A

Deptomycin + Tigacycline

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81
Q

How are gram negative ANTIBIOTIC RESISTANT infections treated?

A

Carbapenam + Carbapenemase

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82
Q

What toxicities are associated with INH?

A

1) Hepatitis

2) Peripheral neuropathy

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83
Q

What factors increase the risk of peripheral neuropathy with INH therapy?

A

1) Malnutrition
2) Alcoholism
3) DM
4) AIDS

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84
Q

What is the MOA of Rifampin?

A

Inhibition of RNA synthesis

Inhibits bacterial DNA dependent RNA polymerase

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85
Q

What is the mechanism of Pyrazinamide resistance?

A
  • Pyrazinamide requires Pyrazinamidase to be active (prodrug)
  • Mutation in Pyrazinamidase
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86
Q

What adverse effect is associated with Pyrazinamide?

A

Gout/ Hyperuricemia

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87
Q

What is the MOA of Ethambutol?

A

Inhibits arabinosyl transferase needed for mycolic acid synthesis

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88
Q

What adverse effects are seen with Ethambutol?

A

1) Retrobulbar neuritis

2) Hyperuricemia

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89
Q

What is a good first line drug to treat disseminated MAC infections in the immunocompromised?

A

Rifabutin

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90
Q

What four drugs are used for MAC combination therapy?

A

1) Macrolide
2) Rifabutin
3) Ethambutol
4) Streptamycin

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91
Q

What is the standard drug regimine for Leprosy?

A

1) Dapsone
2) Clofazamine
3) Rifampin

Note that these drugs are taken for YEARS**

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92
Q

What is the MOA of Dapsone?

A

PABA analog that inhibits folate synthesis

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93
Q

What adverse effect is associated with Dapsone?

A

Non-hemotylic anemia

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94
Q

What is Clofazamine?

A

Bactericidal dye

*Associated with skin pigmentation changes

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95
Q

What drugs are used to follow-up Metronidazole treatment for Amebiasis?

A

Iodoquinol or Paromomycin

96
Q

What are halogenated Hydroxyquinolone and Paromomycin good drugs for?

A

BOTH forms of Entameba histolytica

97
Q

What are the three parasites cause major opportunistic infections of AIDS patients/immunocompromised?

A

1) Cryptosporidium parvum
2) Pneumocystis jiroveci
3) Toxoplasma gondii

98
Q

How is Cryptosporidosis treated?

A

Nitazoxanide

99
Q

What is the MOA of NItazoxanide?

A

Inhibits PFOR to disrupt the energy metabolism of the parasite

100
Q

How are pneumocystis jiroveci and toxoplasma gondii treated? What adverse reaction is common with these drugs?

A

Inhibitors of folate synthesis i.e.

1) TMP-SMX
2) Pyrimethamine-Sulfadiazine

101
Q

What enzyme is specifically inhibited by the Sulfonamides?

A

Dihydropteroate Synthase

102
Q

What enzyme is inhibited by the diaminopyrimidines?

A

DHFR

103
Q

What is the adverse effect of TMP-SMX treatment?

A

Rash

104
Q

What is the adverse effect of Pyrimethamine-Sulfadiazine?

A

Folic acid deficiency leading to megaloblastic anemia

105
Q

What adverse effect is highly associated with Mefloquine?

A

Recall, malaria prophylaxis that causes SEVERE NEUROPSYCHIATRIC symptoms

*So bad it can lead to suicide

106
Q

What is the MOA of Primaquine?

A

Prodrug that gets activated to interfere with electron transport

107
Q

What species of malaria is Malarone specific to treating?

A

P. falciparum

108
Q

What is Malarone?

A

Atoaquone and Proguanil

109
Q

What is the MOA of Proguanil?

A

Inhibits DHFR

110
Q

What drugs fall into the Benzimidazole class?

A

Albendazole
Mebendazole
Thiabendazole

111
Q

What side effects are associated with Thabendazole?

A

CNS disturbances i.e. delirium and hallucinations

112
Q

What infections are Albendazole and Mebendazole prescribed for?

A

1) Ascariasis
2) Pinworm
3) Hookworm
4) Whipworm

113
Q

What is Thiabendazole prescribed for?

A

1) Cutaneous larval migrans

2) Strongyloidiasis (2nd line)

114
Q

What infections is Ivermectin the drug of choice for?

A

1) First line for Strongloidiasis
2) Tissue dwelling nematodes
- O. volvulus
- Loa loa
- W. bancrofti

115
Q

What infection is Pyrantal Pamoate used to treat?

A

Pinworm infections

116
Q

What is the MOA of Praziquantel?

A
  • Increased Ca++ permeability of cuticle covering Flukes and Tapeworms
  • Leads to depolarizing NM blockade
117
Q

List the three major opportunistic fungal infections.

A

1) Candida
2) Aspergillus
3) Cryptococcus neoformans

118
Q

List the drugs that inhibit ergosterol synthesis.

A

Azoles
Naftidine
Terbnafine

119
Q

What major anti-fungal works by inhibiting fungal membrane function?

A

Amphotericin B

120
Q

What drug inhibits fungal cell wall function?

A

Capsofungin

121
Q

List the four drugs or drug classes that can be used to treat systemic fungal infections.

A

1) Polyenes i.e. Amphotericin B
2) Azoles
3) Flucytosine
4) Enchinocandins

122
Q

What is the mechanism of resistance to Amphotericin B?

A

Decreased membrane ergosterol

123
Q

What are the adverse reactions seen with Amphotericin B administration?

A

1) Infusion site reaction

2) Nephrotoxicity

124
Q

What is the packaging of Amphotericin B in a lipid micelle called?

A

Liposomal packaging

125
Q

List the imidazoles.

A

Ketoconazole
Miconazole
Clotrimazole

126
Q

List the triazoles.

A

Fluconazole
Itraconazole
Voriconazole
Posaconazle

127
Q

What is the MOA of the azoles?

A

Inhibit the enzyme that produces ergosterol

128
Q

Name three mechanisms of resistance to the azoles.

A

1) Decreased membrane ergosterol
2) Efflux pumps
3) Mutations in the target enzyme

129
Q

List three reasons that Fluconazole is the first line agent for systemic fungal infections.

A

1) Safe–highest TI
2) Well distributed to the CNS
3) Few drug-drug interactions

130
Q

List the infections that Fluconazole is the first line agent for.

A

1) Systemic Candidiasis
2) Cryptococcosis
3) Coccidiomycosis

131
Q

What is Itraconazole the drug of choice for?

A 
Histoplasmosis 
Coccidiomucosis 
Blastomycosis 
Sporotrichosis 
Oncychomycosis
132
Q

What is Voriconazole the drug of choice for?

A

Aspergillosis

133
Q

What adverse effect is associated with Voriconazole?

A

Visual disturbances

Think Voriconazole= Visual

134
Q

What is Posconazole used to treat?

A

Mucromycoses

Aspergillosis

135
Q

How is Flucytosine used clinically?

A

Part of combination therapy for severe Cryptococcal infections

136
Q

List the Echinocandins.

A

Capsofungin
Micafungin
Andidulafungin

137
Q

What infections are the Echinocandins commonly used to treat?

A

Aspergillosis

Candidiasis

138
Q

What is Griseofulvin? What is it used to treat?

A

This is an ORAL antifungal used to treat the Dermatophyte infections

Note that it concentrates in Keratin precursors

139
Q

What class of drug are the Allylamines? What is the MOA?

A
  • Antifungals that inhibit ergosterol synthesis

- Specifically inhibit SQUALENE EPOXIDASE

140
Q

What is Terbinafine a first line agent for?

A

Onychomycosis

141
Q

List the topical antifungals and their drug class.

A 
Nystatin- polyene 
Clotrimazole- azole 
Miconazole- azole 
Terbinafine- allylamine 
Naftifine- allylamine
142
Q

What is Nystatin used to treat?

A

This is a topical agent used to treat Candida infections i.e.

  • Oral candidiasis
  • Vaginal candidiasis
143
Q

What are Clotrimazole and Miconazole used to treat?

A

Topical agents for:

1) Candida
- Vulvovaginal candidiasis
- Oral thrush
2) Dermatophyte infections

144
Q

What are the topical Allylamines used to treat?

A

Topical agents for:

1) Tinea curis (jock-itch)
2) Tinea corporis (ringworm)

145
Q

What is the MOA of Acyclovir?

A

This is a nucleoside analog that:

1) Competitive inhibitor of viral DNA polymerase
2) Causes chain termination via incorporation into the viral genome

146
Q

What are the indications for oral Acyclovir?

A

1) Genital herpes (HSV-2)

2) VZV

147
Q

List four indications for IV Acyclovir.

A

1) Severe/ disseminated HSV
2) Neonate infections
3) HSV encephalitis
4) VZV in the immunocompromised

148
Q

What major toxicity is associated with Acyclovir?

A

Nephrotoxicity

149
Q

What are the clinical indications for Valacyclovir?

A

1) Genital Herpes (HSV-2)
2) Oral Herpes (HSV-1)
3) VZV

150
Q

How does Foscarnet compared to Acyclovir?

A

Does NOT require thymidine kinase activation

151
Q

What are the clinical indications for Foscarnet?

A

1) HSV/VZV infections resistant to Acyclovir
2) CMV
- Retinitis
- Colitis
- Esophagitis

152
Q

What are the adverse effects associated with Foscarnet?

A

1) Nephrotoxicity

2) Changes in blood chemistry

153
Q

What activates Ganciclovir?

A

Viral CMV kinase

154
Q

What are three adverse effects associated with Ganciclovir?

A

1) Myelosuppression
2) CNS toxicity
3) Injection site reaction

155
Q

What are the two indications for Valganciclovir?

A

1) CMV Retinitis

2) Prophylaxis against CMV in transplant patients

156
Q

What is the MOA of Trifluridine?

A

1) Prodrug that gets activated by phosphorylation

2) Competitive inhibition of thymidine incorporation into DNA

157
Q

What are the indications for Trifluridine?

A

HSV-1 and 2 associated:

1) Keratoconjunctivitis
2) Keratitis

158
Q

What is the difference between Oseltamivir, Zanamivir, and Peramivir?

A 
Oseltamivir= Oral and 1+ y/o 
Zanamivir= inhaled and 7+ y/o
Peramivir= IV, think "Parenteral"
159
Q

What are the adverse effects associated with Peramivir?

A

1) Neuropsychiatric sx.
- Neurominidase inhibitors cause Neuropsychiatric symptoms
2) Steven Johnson’s Syndrome

160
Q

What is the MOA of Ribavirin?

A

Remember, RSV= Ribavirin

1) Phosphorylated by ADENOSINE KINASE
2) Interferes with GTP/ mRNA capping

161
Q

What can Ribavirin be used to treat aside from RSV?

A

Hepatitis C

162
Q

What adverse effect is associated with Ribarivin?

A

Hemolytic anemia

163
Q

When is Ribavirin contraindicated?

A

1) Pregnancy
2) Anemia
3) Ischemic vascular disease
4) Severe renal disease

164
Q

What are the two HCV DAA Protease Inhibitors?

A

1) Partaprevir

2) Simeprevir

165
Q

What are the two HCV DAA RNA Polymerase inhibitors?

A

1) Sofosbuvir- nucleoside

2) Desabuvir- non-nucleoside

166
Q

What are the two HCV DAA NS5A inhibitors?

A

1) Lepipasvir

2) Ombitasvir

167
Q

What should you avoid giving Sofosbuvir with?

A

Rifampin

168
Q

List the NRTIs.

A 
Zidovudine 
Lamivudine
Abacavir 
Tenofovir disoproxil 
Emtricitabine
169
Q

Aside from HIV, what can the NRTIs be used to treat?

A

HBV

170
Q

What adverse effects are seen with the NRTIs?

A

1) Lactic acidosis
2) Lipodystrophy
3) Fatty Liver Disease

171
Q

What specific adverse reaction is associated with Abacavir?

A

Abacavir= NRTI

*Think “A” for allergic reaction/ hypersensitivity

172
Q

What polymorphism is associated with hypersensitvity to Abacavir? Why is this important?

A

HLA-B5707

Need to test for this prior to administration

173
Q

What is unique about the toxicity profile of Lamivudine?

A

Least toxic of the antiretrovirals

174
Q

What unique adverse effect is seen with Emtricitabine?

A

Hyperpigmentation of the palms and soles

175
Q

Name three contraindications for Emtricitabine.

A

1) Pregnancy
2) Young children
3) Hepatic or renal failure

176
Q

What unique adverse effects are seen with Tenofivir?

A

1) Bone marrow–> “Faconi anemia”

2) Decreased bone density/ fetal growth

177
Q

What unique adverse effect is seen with Zidovudine?

A

Myelosuppression

178
Q

List the adverse effects common to the NNRTIs.

A

1) Rash
2) Steven Johnson Syndrome
3) Hepatotoxicity
4) Drug-drug interaction

179
Q

List the two most clinically important NNRTIs.

A

Nevirapine

Efavirenz

180
Q

What unique toxicities are associated with Efavirenz?

A

1) Teratogenic
2) CNS toxicity
3) CYP p450 inducer

181
Q

What unique toxicity is associated with Nevirapine?

A

Hepatitis

182
Q

What is the unique clinical utility of Nevirapine?

A

Can prevent VERTICAL TRANSMISSION

183
Q

List the adverse effects common to the protease inhibitors.

A

1) Hyperlipidemia
2) Lipodystrophy
3) GI intolerance
4) Hepatotoxicity
5) Increased bleeding risk
6) Drug-drug interactions

184
Q

What drugs are contraindicated with Atazanavir? Why?

A

PPIs b/c they require acidic GI pH for proper absorption

Think Ataznavir needs Acid

185
Q

What specific adverse effects are associated with Ataznavir?

A

1) Peripheral neuropathy
2) Hyperbilirubinemia
3) Adverse cardiac effects

186
Q

What effect does Ataznavir have on the CYP p450 system?

A

Inhibition

187
Q

What is the clinical utility of Darunavir?

A

Pharmacologic booster like Ritonavir

188
Q

What specific adverse effects are associated with Darunavir?

A

1) Increased liver enzymes

2) Increased serum amylase

189
Q

What is the specific indication for Darunavir?

A

Drug resistant HIV-1

190
Q

What is the CCR5 antagonist?

A

Maraviroc

191
Q

What specific adverse effect is associated with Maraviroc?

A

Cardiac events in those with underlying cardiac disease

192
Q

What is the fusion inhibitor? What is unique about the administration of this drug?

A

Enfuvritide – given SubQ!

193
Q

What specific adverse effects are associated with Enfuvritide?

A

1) Injection site reaction
2) Allergy to drug
3) Increased risk of bacterial pneumonia

194
Q

What suffix is associated with the Integrase Inhibitors.

A

“Tegravir”

  • Raltegravir
  • Elvitegravir
  • Dolutegravir
195
Q

What specific adverse effects are associated with Raltegravir?

A

1) Rhabdomyolysis

2) Myopathy

196
Q

What specific adverse effects are associated with Elvitegravir?

A

Elevated lipase

Note that this is given orally with Ritonavir

197
Q

What specific adverse effects are associated with Dolutegravir?

A

1) Hypersensitivity

2) Elevation of liver enzymes

198
Q

List the non-selective COX inhibitors.

A 
ASA 
Ibuprofen
Idomethacin 
Ketorolac 
Naproxen
Oxaprozin
Piroxicam
Sulindac
199
Q

List the selective COX inhibitors.

A

Celecoxib
Etoricoxib
Meloxicam

200
Q

What is the MOA of Colchicine?

A

Inhibition of leukocyte migration and phagocytosis

201
Q

What is the MOA of Probenecid and Sulfinpyrazone?

A
  • Inhibit tubular absorption of uric acid

- Increase renal clearance of uric acid

202
Q

What is the MOA of Methotrexate in the treatment of RA?

A

1) Inhibits AICAR transformylase
2) Increases extracellular adenosine
3) Inhibits T-cell activation
4) Cytotoxic to lymphocytes

203
Q

List the synthetic DMARDs.

A

Methotrexate
Leflunomide
Chloroquine
Hydroxycholorquine

204
Q

What is the MOA of Leflunomide?

A

Inhibits ribonucleotide synthesis

205
Q

What are the biologic DMARDs?

A

Etanercept
Infliximab
Anakinra

206
Q

List the drugs used to PREVENT migraines.

A

1) Propanolol
2) Metoprolol
3) Amitriptyline
4) Valproate
5) Topiramate

207
Q

What are the antiemetics used to treat migraines?

A

1) Metoclopramide
2) Chlopromazine
3) Prochlorperazine

208
Q

List the antimetabolite immunosuppressants.

A

Azathioprine
Mycophenolate mofetil
Sirolimus

209
Q

List the biological immunosuppressants.

A

1) Antithymocyte globulin
2) Muromonab-CD3
3) Anti-TNF-a

210
Q

What are the non-genomic effects of the glucocorticoids?

A

1) Alternation of signaling pathways

2) Insertion into cell membrane to alter ion transport

211
Q

Name four effects of glucocorticoid administration.

A

1) Decreased peripheral lymphocytes
2) Decreased pro-inflammatory cytokines
3) Inhibition of IL-2
4) Reduced neutrophil chemotaxis

212
Q

List the pro-inflammatory cytokines.

A

IL-1
IL-6
TNF-a
IFN-y

213
Q

List four clinical indications for the glucocorticoids.

A

1) Prevent transplant rejection
2) GVHD
3) Autoimmune disease
4) Prevention of cytokine storm with biological immunosuppressants

214
Q

What adverse effects are associated with the glucocorticoids?

A

1) Growth retardation
2) Poor wound healing
3) HTN
4) AVN
5) Cataracts
6) Hyperglycemia
7) Adrenal crisis with d/c

215
Q

Outline the MOA of Cyclosporine.

A
  • Complexes with Cyclophillin in the cytosol
  • That complex binds Calcineurin
  • Calcineurin complex prevents dephosphorylation of NAFT
  • NAFT cannot translocate to the nucleus

No NAFT= NO IL-2

216
Q

What is the grapefruit juice/ cyclosporine interaction?

A
  • Grapefruit juice inhibits CYP p450

- Increased concentrations of cyclosporine–>toxicity

217
Q

What does Azathioprine ultimately block?

A

De novo purine synthesis

218
Q

List three indications for Azathioprine.

A

1) Prevent transplant rejection
2) Severe RA
3) Glucocorticoid resistant autoimmune disease

219
Q

What adverse effects are associated with Azathioprine?

A
  • Myelosuppression

- Hepatotoxicity

220
Q

What the MOA of Mycophenolate Mofetil?

A

1) Prodrug metabolized to MPA

2) MPA blocks IMP in de novo purine synthesis

221
Q

What are the clinical indications for Mycophenolate Mofetil?

A

1) Prophylaxis for transplant rejection

2) SLE

222
Q

What adverse effects are associated with Mycophenolate Mofetil?

A

1) Myelosuppression
2) GI upset
3) CMV infections
4) TERATOGENIC

223
Q

What is the MOA of Sirolimus?

A

mTOR inhibitor

224
Q

What is the specific utility of Sirolimus?

A

Renal transplant that cannot tolerate nephrotoxocity of Cyclosporine

225
Q

What are the indications for antithymocyte globulin?

A

1) Induction immunosuppression

2) Treatment of ACUTE transplant rejection

226
Q

What adverse reactions are associated with Antithymocyte Globulin?

A

1) Cytokine storm

2) Serum sickness

227
Q

What are the indications for antithymocyte globulin?

A

Glucocorticoid resistant transplant rejection

228
Q

What drawback is associated with Muromonab-CD3?

A

Mouse antibody that can only be used once

229
Q

What are the three anti-TNF-a biologicals? What are the used to treat?

A

1) Infliximab
2) Adalimumab
3) Etanercept

Autoimmune disease

230
Q

How does Echinacea reduce the duration and intensity of a cold?

A

1) Increased cytokine production
2) Anti-inflammatory/ COX inhibitor
3) Increased immunological blood cells

231
Q

What two major side effects are associated with Gingko Biloba?

A

1) Bleeding

2) Seizure induction

232
Q

How does garlic lower blood pressure?

A

1) ACE inhibitor
2) Increased NO bioavalibility
3) Increased H2S production

*Decrease vasoconstriction and increase vasodilation

233
Q

What drug-drug interaction is associated with Glucosamine and Chondroitin?

A

Enhanced anticoagulant effects of Warfarin

234
Q

List the intended uses of CoQ10.

A

1) Reduction of statin-induced myopathy
2) HTN
3) CAD
4) Neurodegenerative Disease
5) Migraine

235
Q

List all the supplements that cause increased bleeding.

A
  • Ginkgo Biloba
  • Garlic
  • Ginseng
  • Glucosamine and Chondrioitin
  • Feverfew
  • CoQ10

Pharmacology (64 decks)

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