Term
|
Definition
RIPES
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
First line: Start 4 drugs (INH, RIF, PZA, EMB) for 2 months followed by 2 drugs from 4-6 months |
|
|
Term
| Which anti-TB drug inhibits the synthesis of mycolic acid of the cell wall? |
|
Definition
|
|
Term
| What anti-TB drug requires catalase peroxidase? |
|
Definition
| Isoniazid ---prodrug is activated by catalase peroxidase (katG gene) |
|
|
Term
| Where is INH metabolized? How can this vary among the population? |
|
Definition
| N-acetylated in the liver (reduce dosage by half in liver toxicity). Some are rapid, some slow acetylators. |
|
|
Term
| Which anti-TB must be adminisitered with B6/pyridoxine? |
|
Definition
|
|
Term
|
Definition
| inhibits DNA-dependent RNA polymerase |
|
|
Term
|
Definition
| Mutations in rpoB gene which produces RNA polymerase B subunit |
|
|
Term
| A patient complains of red body fluids and and flu-like symptoms. What drug have they recently taken? |
|
Definition
|
|
Term
| Drug interactions with Rifampin? |
|
Definition
| reacts with 100+ drugs metabolized by liver microsomal enzymes; impairs OCPs; HIV drug interactions |
|
|
Term
| What TB drug kills ONLY mycobacteria by inhibiting the synthesis of arabinosyl transferase (cell wall synthesis enzyme)? |
|
Definition
|
|
Term
| How could a mycobacterium make itself resistant to Ethambutol? |
|
Definition
| Point mutation in embB gene encoding arabinosyl transferase |
|
|
Term
| Pharmacokinetics of Ethambutol? |
|
Definition
| reduce dose in renal failure, do NOT use in CSF infections |
|
|
Term
| Which drug can cause ocular-retrobulbar neuritis? What are the symptoms? |
|
Definition
Ethambutol --
manifests as red-green colorblindness, blurred vision, central scotomata. Cannot be used in kids who cannot take a visual acuity test. |
|
|
Term
| What anti-TB drug works intracellularly and ONLY works against M. tuberculosis? |
|
Definition
|
|
Term
|
Definition
| mutuation in pncA gene encoding pyrazinamidase which converts the drug to the active form (pyrazinoic acid) |
|
|
Term
| Which anti-TB drug causes athralgia (due to inc uric acid levels)? |
|
Definition
|
|
Term
| Which anti-TB drugs cause hepatotoxicity? |
|
Definition
| INH (10-20% of pts), Rifampin, Pyrazinamide |
|
|
Term
| Which anti-TB drug can cause Lupus-like syndrome? |
|
Definition
|
|
Term
| Which drugs are good for TB meningitis? Which anti-TB should NOT be given? |
|
Definition
Pyrazinamide**, Rifampin
do NOT give Ethambutol |
|
|
Term
| What combo of drugs should be given in a pt with hepatitis and tuberculosis? |
|
Definition
| Streptomycin and Ethambutol |
|
|
Term
|
Definition
| bactericidal by inhibiting protein synthesis by binding to ribosome |
|
|
Term
| What aminoglycosides is streptomycin cross resistant to TB with? |
|
Definition
|
|
Term
| What are the two major SE of streptomycin? |
|
Definition
| ototoxicity, nephrotoxicity |
|
|
Term
| What drugs are used to treat M Leprae? |
|
Definition
|
|
Term
| What drug is used for prophylaxis against PJP? |
|
Definition
|
|
Term
| What drug can cause hemolysis in G6PD deficient patients? |
|
Definition
|
|
Term
| What anti-mycobacterial can cause erythema nodosum? |
|
Definition
|
|
Term
| What drugs are used to treat M avium intracellulare (MAI)? |
|
Definition
| Clofazamine, RIF, EMB, Clarithromycin |
|
|
Term
| What drugs are used to treat M. kansasii? |
|
Definition
| RIF, EMB, INH for 18 months |
|
|
Term
| Which anti-mycobacterial causes skin pigmentation (look tan)? |
|
Definition
|
|
Term
| What 3 drugs are used are used for ORAL iron therapy in anemia? |
|
Definition
FERROUS SALTS = Ferrous sulfate, ferrous gluconate, ferrous fumarate
*Ferrous form (Fe2+) is absorbed in the duodenum and jejunum and is used to make heme. Ferric iron (Fe3+) is storage iron. |
|
|
Term
| What 3 drugs could you give an iron deficient pt with a GI resection/malabsorption syndromes? |
|
Definition
Iron dextran (most common)
also - iron sucrose and iron gluconate |
|
|
Term
| What molecule in the plasma can be used to measure total body stores of iron? |
|
Definition
ferritin
Note: ferritin goes down in iron deficiency and transferrin goes up |
|
|
Term
|
Definition
| Iron chelating substance given for acute iron toxicity (overdose of iron tablets or necrotizing gastroenteritis) |
|
|
Term
|
Definition
"Iron overload"
usually a term reserved for a genetic cause |
|
|
Term
| How is Vit B12 absorbed? Transported? Stored? |
|
Definition
| B12 complexes with Intrinsic Factor and is absorbed in the distal ileum. Absorbed B12 is bound to plasma Transcobalamin II for distribution. B12 is stored mainly in the liver. |
|
|
Term
| What are cyanocobalamin and hydroxycobalamin? |
|
Definition
| Prodrugs of Vit B12 given IM. They take 1-2 months to treat anemia. |
|
|
Term
| A pt has megaloblastic anemia, atrophic glossitis (smooth tongue), "subacute combined degeneration" (degeneration of the posterior and lateral columns of the spinal cord) as well as lower limb parathesias. What is your diagnosis? How do you treat it? |
|
Definition
Vitamin B12 deficiency/pernicious anemia
Treat with Vit B12.
*DO NOT GIVE FOLIC ACID AS TREATMENT TO THIS PT. It will not reverse CNS damage. |
|
|
Term
| Who needs recombinant human EPO therapy (eg. Epoetin alfa, Epogen)? |
|
Definition
Chronic renal failure
aplastic anemia
leukemia
HIV/AIDS
Cancer
Anemia of prematurity
post-phlebotomy |
|
|
Term
|
Definition
|
|
Term
| There is usually an inverse relationship between EPO and Hgb, except for in what condition? |
|
Definition
Chronic Renal Failure
both EPO and Hgb are low |
|
|
Term
| What are the two endogenous myeloid growth factors? which one stimulates proliferation of erythroid and megakaryocytic cells too? which one promotes release of hematopoietic stem cells from bone marrow? |
|
Definition
G-CSF and GM-CSF both stimulate growth/differentiation of myeloid cells.
GM-CSF - erythroid and megakaryocytes
G-CSF - release of HSCs |
|
|
Term
| What are filgastrim and pegfilgastrim? what cell lines do they stimulate? |
|
Definition
recombinant G-CSF
FIL and PEG release babies (HSCs) and stimulate growth/differentiation of myeloid |
|
|
Term
| What is sargramostim? what cell lines does it stimulate? |
|
Definition
recombinant GM-CSF
SARah GRAM stimulates MY MEGA ERection (myeloid, megakaryocytes, erythroid) |
|
|
Term
| Which has more toxicities between G-CSF and GM-CSF? |
|
Definition
GM-CSF, thus G-CSF is more preferred.
GM-CSF causes fever, arthralgia, myalgia, peripheral edema, pleural/pericardial effusion |
|
|
Term
| What therapy would you give a pt after intense myelosuppressive chemo to help replenish neutrophil supplies? |
|
Definition
|
|
Term
| What is an autologous transplant? What therapy is administered to a pt beforehand? |
|
Definition
| An autologous transplant is when a patient receives his or her own bone marrow or stem cells that were collected and frozen before admission for high-dose chemotherapy or radiation. G-CSF is used for the mobilization of peripheral blood stem cells for collection. |
|
|
Term
| What is Oprelvekin? What stem cell line does it promote proliferation of? |
|
Definition
recombinant IL-11
megakaryocytes (inc platelets) |
|
|
Term
| What therapy is used to treat thrombocytopenia after chemo? |
|
Definition
| IL-11 (oprelvekin) given for 2-3 weeks or until platelet count >50,000/uL |
|
|
Term
| What "peptibody" treats thrombocytopenia by binding to the thombopoietin receptor (Mp1)? |
|
Definition
|
|
Term
|
Definition
| thrombopoietin agonist - literally says it in the name "the thrombop ag" |
|
|
Term
| Can you name the five solo albums Beyonce has produced? |
|
Definition
Dangerously in Love (2003)
B'Day (2006)
I Am... Sasha Fierce (2008)
4 (2011)
Beyoncé (2013) |
|
|
Term
| What drug class is a nonspecific competitor of NF-kB at the promoter? |
|
Definition
|
|
Term
| What are the four ways that corticosteroids cause "blanket immunosuppression"? |
|
Definition
1. Dec pro-inflammatory cytokine production by MACs (esp IL-1, 6 and TNF-a)
2. (partial) suppression of antigen presentation
3. Alteration in PMN/lymphocyte cell traffic that reduces their availability at inflammatory sites
4. Impaired chemotaxis of PMNs |
|
|
Term
| At what hour of the day would it theoretically be most effective to give corticosteroids? |
|
Definition
| 2 am (circadian rhythm dictates cytokine peaks in the early morning) |
|
|
Term
| What are the 6 side effects of corticosteroids?* |
|
Definition
1. High risk of infection due to impaired T cell response and poor neutrophil function.
2. Osteoporosis (dec Ca++ uptake, altered bone cytokine balance)
3. DM (due to inc insulin resistance)
4. CNS - insomnia, depression, emotional lability
5. Obesity and stria
6. HTN (interference with RAAS) |
|
|
Term
| Which immunosuppressant is an "alkylating agent"? |
|
Definition
|
|
Term
| Which immunomodulator is used to treat Granulomatous Polyangiitis (Wegener's)? |
|
Definition
|
|
Term
| Which immunomodulator is used to treat vasculitis? |
|
Definition
|
|
Term
| What is the name of Beyonce's current tour? |
|
Definition
| The Mrs. Carter Show World Tour |
|
|
Term
| Which immunomodulator can cause hemorrhagic cystitis, bladder fibrosis and cancer? |
|
Definition
|
|
Term
| Which immunomodulator can cause infertility? |
|
Definition
|
|
Term
| Which immunomodulator is a prodrug metabolized to 6-mercaptopurine? What genetic polymorphism prolongs its activation? |
|
Definition
Azathioprine
TPMT genetic polymorphism decreases deactivation of active 6-mercaptopurine |
|
|
Term
| What drug should not be given with Azathioprine? |
|
Definition
| Allopurinol - causes bone marrow suppression |
|
|
Term
| How is Methotrexate used differently for immunosuppression than oncology? |
|
Definition
Used at high doses in oncology to inhibit DNA synthesis.
Used a low doses as an anti-inflammatory |
|
|
Term
| What immunosuppression drug is used to treat RA? |
|
Definition
|
|
Term
| Which immunosuppressive drug has a SE of oral ulcers and hypersensitivity pneumonitis? What should be coadministered to reduce this SE? |
|
Definition
Methotrexate
Folic acid PO may reduce SE |
|
|
Term
| Which immunosuppressive drug inhibits T&B cell proliferation by blocking de novo nucleotide synthesis? |
|
Definition
|
|
Term
| What immunosuppressive is the DOC for SLE? |
|
Definition
|
|
Term
| Which immunosuppressive is "steroid sparing", aka helps us to use less corticosteroids? |
|
Definition
|
|
Term
| Which immunosuppressive is the most teratogenic? |
|
Definition
Leflunomide
(washout with cholestyramine if the pt gets pregnant) |
|
|
Term
| Which immunosuppressive has a very long half life and extensive entero-hepatic recirculation? |
|
Definition
|
|
Term
| Which immunosuppressive inhibits de novo pyrimidine synthesis? |
|
Definition
|
|
Term
What are the two calcineurin inhibitors? what is calcineurin? wtf is Signal #1 blocking?
LONG ANSWER, GET READY |
|
Definition
Cyclosporine and Tacrolimus
Calcineurin = Ca-dependent protein phosphatase that dephosphorylates a cystopasmic TF in T cells that then translocates to the nucleus and stimulates growth/differentiation of T cells
Signal #1 = normal calcineurin activation after antigen binding to T cell receptor.
Cylcosporine binds to cyclophilin A and then together they bind calcineurin and kill its signal pathway.
Tacrolimus does the same shiz with FKBP.
No Calcineurin activation = no progression to G1. |
|
|
Term
| How many days til Christmas? |
|
Definition
|
|
Term
| Which 2 immunosuppressive drugs are given synergistically after transplants to prevent rejection? |
|
Definition
CNIs (Cyclosporine, Tacrolimus)
and RAP (mTOR/rapamycin/sirolimus) |
|
|
Term
| Which immunosuppressive drug is given for diseases that are primarily T-cell mediated? (eg. ulcerative colitis, uveiitis) |
|
Definition
| CNIs (Cyclosporine, Tacrolimus) |
|
|
Term
| Which immunosuppressive drug has a narrow therapeutic window and wide intra/interindividual metabolism? |
|
Definition
| CNIs (Cyclosporine, Tacrolimus) |
|
|
Term
| Which immunosuppressive drug is metabolized by P450 enzymes? What happens when given with drugs that activate or suppress this system? |
|
Definition
CNIs (Cyclosporine, Tacrolimus)
This is super important in allograft transplants. Don't be a dipshit and give drugs that ACTIVATE P450 system like phenytoin, dilantin, barbiturates, rifampin because the patient will lose an organ.
ALSO be careful when giving with drugs that INHIBIT P450 like macrolides (erthyromycin, clarithromycin) and the antifungal conazoles. IT CAUSES TOXIC LEVELS of CNIs leading to HTN, HYPERCHOLESTOROLEMIA and NEPHROTOXICITY (cyclo) and NEUROTOXICITY AND DIABETES (tacro). BUT IF YOU'RE SMART, you can actually use this principle to the pts benefit to reduce daily dose of CNI saving them money. |
|
|
Term
| Which immunosuppressive drug needs to be monitored through checking serum blood levels? |
|
Definition
| CNIs (Cyclosporine, Tacrolimus) |
|
|
Term
| What does mTOR stand for? What is this drug also called? |
|
Definition
mammalian target of rapamycin
aka sirolimus |
|
|
Term
| How does mTOR/rapamycin/sirolimus work? |
|
Definition
RAP blocks signal #2 (co-stimulation) which prevents cytokine receptor signalling pathways (signal #3). This is mainly IL2/ILR mediated.
Recall: CNIs block signal #1 - TCR activation by Ag. |
|
|
Term
| Which immunosuppressant is anti-fibrinogenic and can also be used on coronary artery stents to prevent re-stenosis?* |
|
Definition
|
|
Term
| Which immunosuppressant inhibits expression of bcl and is therefore pro-apoptotic? |
|
Definition
|
|
Term
| Which immunosuppressant can cause hypertriglyceridemia (by decreasing LPL and IGF)? |
|
Definition
|
|
Term
| Why are monoclonal antibodies that are CD28 blockers "beautiful drugs to use in transplant"? |
|
Definition
| T cells are activated when TCR binds to MHCII AND costimulatory CD28 binds to CD80/86. A monoclonal ab called Abatacept (not important to know name) is a CTLA IgG that binds to the CD 80/86 on APC and inhibits CD28 activation. T cells cannot be activated to attack graft. Additionally, you "tolerize" the cell, making the T cell tolerant to the graft. |
|
|
Term
| Which monoclonal antibody works "beautifully" against B cell lymphomas? What is its MOA? |
|
Definition
| Rituximab depletes B cells by binding CD20 which makes cells disappear into spleen where they are destroyed. Relatively few side effects. Dr. Robinson's "favorite drug". |
|
|
Term
| What is a "good, transient way" to block an immune response if you don't know what type of immune dz the person has when they come into the hospital? |
|
Definition
|
|
Term
| What is a side effect of IVIG due to its anti-TNF properties? |
|
Definition
| Fungal infections, especially histoplasmosis , and progressive multifocal leukencephalopathy |
|
|
Term
| What cytokine would you want to block with a mab in hyper-eosinophilic syndromes? |
|
Definition
|
|
Term
| What mab is used to treat osteoporosis? |
|
Definition
anti-rankL
rankL activates osteoclasts and is overproduced in osteoporosis |
|
|
Term
| What is the generic name for Benadryl? |
|
Definition
|
|
Term
| What are the 2 first generation H1 Receptor Antagonists? |
|
Definition
Diphenhydramine
Chlorpheniramine |
|
|
Term
| H1 antagonists with strong anti-cholingergic activity (eg. diphenhydramine) are contraindicated in what type of patient? |
|
Definition
| COPD, esp during acute attacks, because its anticholinergic activity thickens secretions and decreases expectoration. |
|
|
Term
| Which H1 Receptor Antagonist has anti-motion sickness activity? |
|
Definition
|
|
Term
| Which H1 Receptor Antagonist treats allergic rhinitis? |
|
Definition
| all of first and second generations |
|
|
Term
| All of the H1 receptor antagonists are slight sedatives except for which one? |
|
Definition
|
|
Term
| Which H1 receptor antagonist is not to be used in cold medicines for children under 4yrs? |
|
Definition
|
|
Term
| Which H1 receptor antagonists are cxdx in glaucoma? |
|
Definition
| Diphenhydramine and Fexofenadine |
|
|
Term
| What are the second generation H1 receptor antagonists? |
|
Definition
Fexofenadine
Loratidine
Cetirizine |
|
|
Term
| What is the generic name for Allegra? |
|
Definition
|
|
Term
| What is the generic name for Claritin? |
|
Definition
|
|
Term
| What is the generic name for Zyrtec? |
|
Definition
|
|
Term
| Which H1 receptor antagonist should not be given with hydroxyzine (a 1G H1 antagonist)? |
|
Definition
|
|
Term
| Where are H1 receptors found? |
|
Definition
| smooth muscle, endothelium |
|
|
Term
| Where are H2 receptors found? |
|
Definition
| gastric mucosa (parietal cells), cardiac muscle, vascular smooth muscle |
|
|
Term
| Where are H3 receptors found? |
|
Definition
|
|
Term
| Where are H4 receptors found? |
|
Definition
| blood cells in bone marrow and circulation - mediate chemotaxis of eosinophils and mast cells |
|
|
Term
| Which two histamine receptors affect the heart? What are the pathways? |
|
Definition
H1 (endothelium) -- Ca --> NO --> sGC --> cGMP --> vasodilation of arterioles
H2 (smooth muscle) -- AC --> cAMP --> relaxation of precapillary sphincters |
|
|
Term
| Which histamine receptor is responsible for gastric secretion? which is responsible for contraction of GI smooth muscle? |
|
Definition
H2 - secretions
H1 - contractions |
|
|
Term
| Which histamine receptor can cause bronchoconstriction? |
|
Definition
|
|
Term
| What is the triple response to histamine in the skin? |
|
Definition
1. Reddening (dilation of small vessels)
2. Red irregular flare with itching, stimulation of nerve endings.
3. Edematous wheal |
|
|
Term
| Which H1 receptor antagonist is cxdx during pregnancy and lactation? |
|
Definition
|
|
Term
| Which H1 receptor antagonist is cxdx with MAO inhibitors? |
|
Definition
|
|
Term
| What is the most potent anti-histamine available? 800x more potent than diphenhydramine |
|
Definition
| tricyclic anti-depressant Doxepin |
|
|
Term
| Which H1 receptor antagonist has reduced bioavailability if taken with antacids and fruit juices? |
|
Definition
|
|
Term
| Which H1 receptor antagonist is cxdx in a pt with urinary retention? |
|
Definition
|
|
Term
| Which H1 receptor antagonist also inhibits histamine release by reducing degranulation of mast cells? |
|
Definition
|
|
Term
| What percentage of asthma is due to allergy? |
|
Definition
|
|
Term
| What immediate phase spasmogens are released in asthma? |
|
Definition
| histamine, platelet-activating factor (PAF) and leukotrienes C4 and D4 |
|
|
Term
| What late phase spasmogens are released in asthma? |
|
Definition
|
|
Term
| What are the two main categories of anti-asthmatic drugs? |
|
Definition
| bronchodilator drugs and anti-inflammatory drugs |
|
|
Term
What is normal FEV1?
mild obstruction?
severe obstruction? |
|
Definition
normal = 3.9 L
mild obstruction = 3.0 L
severe = 0.9L |
|
|
Term
| What is Beyonce's net worth? |
|
Definition
|
|
Term
| Which B2-agonist is the standard inhaled B-2 agonist for bronchospasm in asthma? |
|
Definition
|
|
Term
| Which B2-agonist can be administered subQ? |
|
Definition
|
|
Term
| Which B2-agonist has the quickest onset? |
|
Definition
|
|
Term
| Which B2-agonist has a unique metabolism? |
|
Definition
Bitolterol is a PRODRUG. Lung esterases hydrolyze hitolterol to terbutylnorepinephrine which is the active form of the drug.
Esterases that hydrolyze the drug are present in higher concentrations in the lung compared to the heart. |
|
|
Term
| Which B2-agonist has the longest duration of action, but should only be used for maintenance treatment of asthma? |
|
Definition
|
|
Term
| What are the side effects of b2-agonists? |
|
Definition
| skeletal muscle tremor (most common), anxiety, restlessness, tachycardia |
|
|
Term
| What is the MOA for B2-agonists? |
|
Definition
| bind to B2 G protein. Activate AC--> cAMP --> PKA --> dec intracellular Ca (decreases contractility) |
|
|
Term
| What 3 ways does theophylline treat asthma? |
|
Definition
1. Inhibition of smooth muscle cAMP phosphodiesterase to maintain high levels of cAMP (smooth muscle relaxant)
2. Antagonism of smooth muscle cell surface receptors for adenosine (bronchoconstrictor in asthmatics)
3. Interference with uptake and sequestration of Ca2+ by the SR in striated muscle to inc cytoplasmic conc - increase cardiac/skeletal muscle contraction |
|
|
Term
| Which methylxanthine is given IV for acute, severe asthma? |
|
Definition
|
|
Term
| How does smoking affect the half-life of theophylline? |
|
Definition
decreases t1/2
Smoking induces hepatic enzymes that degrade theophylline.
Smoking adults half life = 5 hours.
Non-smoking adults = 9 hours. |
|
|
Term
| How does hepatic dysfunction (as in cirrhosis or decreased blood flow to liver in CHF) affect the half-life of theophylline? |
|
Definition
| increases t1/2 (theophylline is hydroxylated and demethylated in the liver) |
|
|
Term
| How does obesity affect the half-life of theophylline? |
|
Definition
|
|
Term
| How do OCPs affect the half-life of theophylline? |
|
Definition
|
|
Term
| How does a viral upper resp tract infection affect the half-life of theophylline? |
|
Definition
|
|
Term
| Why do serum conc of theophylline need to be monitored? |
|
Definition
NARROW therapeutic window = 5-15 micrograms/ml
Interindividual variability of clearance
Dose-related toxicities above 35ug/ml-- CNS: fasciculations, convulsions that are refractory to standard anticonvulsant therapy; Cardiac: tachycardia, arrhythmias, circulatory collapse; elevation in body temp in kids; relaxation of bladder muscle |
|
|
Term
| How is theophylline administered? |
|
Definition
| short-acting oral, prolonged oral or iv ...but it CANNOT BE INHALED |
|
|
Term
| Which asthma treatment is a muscarinic antagonist? Why do anticholinergics work for asthma? |
|
Definition
Ipratropium bromide
Asthma can be assoc with vagal-mediated stimulation of bronchial smooth muscle causing bronchospasm and mucus hypersecretion. |
|
|
Term
| What is the MOA of ipratropium bromide? |
|
Definition
| inhibits the effect of Ach released from airway vagal nerves by antagonizing muscarinic receptors in bronchial smooth muscles --> dec IP3 --> dec Ca2+ --> relaxation of bronchial sm |
|
|
Term
| What drug should be given with b2-agonists if additional bronchodilitation is needed? |
|
Definition
|
|
Term
| What drug do you give when B2-agonists and/or theophylline is not well tolerated in asthmatic pts? |
|
Definition
|
|
Term
| What is the DOC for chronic bronchitis or emphysema in non-asthmatic pts? |
|
Definition
| Tiotropium (24 hr anticholinergic bronchodilator) |
|
|
Term
| What minor side effects are assoc with ipratropium bromide? |
|
Definition
| dry mouth and pupil dilation (just need to close eyes when inhaling) |
|
|
Term
| How to adrenal corticosteroids help treat asthma? What is the pathway? |
|
Definition
Treats the underlying inflammation which inc airway diameter.
Inc synthesis of lipomodulin --> inhibits phospholipase A2 --> suppresses release of arachidonic acid --> inhibits release of leukotrienes and prostaglandins = bronchodilation |
|
|
Term
| What drug is used to treat Scaptia beyonceae? |
|
Definition
| Scaptia beyonceae is not an infectious entity. It is the species of horse fly named after Beyonce in 2011. |
|
|
Term
| What asthma treatment can cause oropharyngeal candidiasis? |
|
Definition
|
|
Term
| What is the only asthma adrenal corticosteroid treatment available orally? |
|
Definition
|
|
Term
| What adrenal corticosteroid is used iv as emergency treatment in status asthmaticus? |
|
Definition
|
|
Term
| What adrenal corticosteroids for asthma are inhaled? |
|
Definition
| beclomethasone, flunisolide, triamcinolone |
|
|
Term
| Should adrenal corticosteroids be considered as a first line prophylactic therapy in all cases of asthma? |
|
Definition
|
|
Term
| SE of short-term oral adrenal corticosteroids? |
|
Definition
| hyperglycemia, edema, rounding of facial contour |
|
|
Term
| SE of long-term oral adrenal corticosteroids? |
|
Definition
| osteoporosis, cataracts, myopathy, HPA axis suppression, psychological depression |
|
|
Term
| SE of inhaled adrenal corticosteroids? |
|
Definition
| oropharyngeal candidiasis, dysphonia, dryness of mouth and throat, coughing |
|
|
Term
|
Definition
| Long acting B-agonist + glucocorticoid combination therapy |
|
|
Term
| What NSAID is used to prevent asthma attacks, including exercise or cold-induced asthma? |
|
Definition
|
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Term
| What asthma therapy inhibits degranulation of mast cells? |
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Definition
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Term
| What 3 ways does cromolyn sodium prevent asthma? |
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Definition
| inhibits degranulation of mast cells, inhibits recruitment of PMNs and eosinophils to pulmonary epithelium, attenuates the ability of PAF to cause airway hyperreactivity |
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Term
| What is Zafirlukast?* How must it be taken? |
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Definition
| leukotriene inhibitor used in the treatment of asthma by competing with LTD4 (most potent leukotriene) at its cysteinyl LT1 receptor site on airway target cells. Must be taken on empty stomach. 12 years or older. |
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Term
| What drugs are used to treat aspirin-induced asthma? |
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Definition
| any of the Leukotriene inhibitors-- Zafirlukast, Montelukast sodium, Zilueton |
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Term
| Which asthma drug increases PT time when taken with Warfarin? |
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Definition
| Zafirlukast because it inhibits cytP450 degradation of Warfarin |
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Term
| Which leukotriene inhibitor should not be used in breast feeding women? |
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Definition
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Term
| What drug inhibits leukotriene synthesis by blocking 5' lipooxygenase?* |
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Definition
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Term
| What asthma treatment has a side effect of increasing alanine transaminase (ALT)? What is the treatment for that? |
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Definition
| Zileuton; discontinue drug and ALT levels return to normal |
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Term
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Definition
| anti-IgE mab which lowers serum free IgE preventing release of histamine and leukotrienes from mast cells. Given subQ. Prophylactic for chronic asthma. |
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Term
| What is the most broad spectrum anti-fungal? |
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Definition
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Term
| What is the MOA of Ampho B? |
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Definition
| binds ergosterol in cell wall, forms pores for osmotic fragility |
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Term
| What 2 fungi does Ampho B not treat? |
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Definition
| Candida lusitiniae and Pseudallerischeri boydii |
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Term
| What is the DOC for zygomycosis/mucormycosis? |
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Definition
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Term
| Which antifungal should be given in a pregnant/breastfeeding woman? |
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Definition
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Term
| What drug should be used to treat fungal infections in immunosuppressed pts? |
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Definition
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Term
| What the side effects related to iv infusion of Ampho B? |
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Definition
| fever, chills, muscle spasms, vomiting, HA, hypotension |
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Term
| What antifungal enters the cell via a cytosine-specific permease not found in mammalian cells? |
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Definition
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Term
| What happens to 5-Flucytosine once inside the cell? |
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Definition
| It is converted to 5-fluorouracil by cytosine deaminase (not expressed in mammalian cells) and then to 5-FdUMP (inhibits thymidylate synthase - a key enzyme in nucleotide/DNA synthesis) and 5-FUTP (inhibits RNA synthesis) |
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Term
| What drug given with Flucytosine increases its cell permeability? |
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Definition
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Term
| What 3 drugs are used to treat Candidal, Cryptococcal or Coccidioidal meningitis? |
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Definition
Ampho B + Flucytosine (induction)
Fluconazole (consolidation/maintenance) |
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Term
| How many number 1 singles has Beyonce had? |
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Definition
"Bills, Bills, Bills" (1999)
"Independent Women Part I" (2000)
"Say My Name" (2000)
"Bootylicious" (2001)
"Crazy in Love" feat. Jay-Z (2003)
"Baby Boy" feat. Sean Paul (2003)
"Check On It" feat. Slim Thug (2005)
"Irreplaceable" (2006)
"Single Ladies" (2008) |
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Term
| What is the MOA for azoles? |
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Definition
inhibit 14a-sterol demethylase, a fungal CYP450 enzyme involved in the conversion of lanesterol into ergosterol
FUNGISTATIC |
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Term
| What is the order of SOA for the azole antifungals? |
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Definition
Posaconazole (broadest)
Voriconazole
Itraconazole
Fluconazole (narrowest) |
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Term
| What is the prototype for azole antifungals? What are its side effects? |
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Definition
Ketoconazole (rarely used, replaced by itraconazole)
SE: dec cortisol and testosterone (due to inhibition of CYP450 enzymes involved in adrenal and gonadal steroid synthesis) leads to gynecomastia, dec libido, impotence, menstrual irregularities, hypotension, fatigue |
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Term
| Which azole can be used in pregnancy? |
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Definition
| NONE, they can cause fetal abnormalities |
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Term
| What antifungals should you not use statins with due to the risk of rhabdomyolysis? |
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Definition
| Itraconazole and Voriconazole |
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Term
| What antifungal drugs act on the plasma membrane? |
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Definition
| Polyenes -- Ampho B and Nystatin |
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Term
| What antifungal drug inhibits DNA/RNA synthesis? |
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Definition
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Term
| What antifungal drugs act on the ER, inhibiting ergosterol synthesis? |
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Definition
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Term
| What antifungal drug acts on the microtubules of the mitotic spindle? |
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Definition
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Term
| What antifungal drugs act on the cell wall? |
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Definition
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Term
| What are the 3 side effects of all azole drugs? |
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Definition
| GI distress, hepatotoxicity, teratogenic |
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Term
| What is the only azole that needs renal dose adjustment in renal insufficiency? |
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Definition
Fluconazole
It is eliminated 80% unchanged by the kidney |
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Term
| What antifungal has a minor side effect of alopecia that is reversible? |
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Definition
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Term
| What is the DOC for non-meningeal endemic dimorphic fungal infections (blastomyces, histoplasmosis, sporothrix, coccidioidomycosis, oral dermatophytes) |
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Definition
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Term
| What is the triad of SE seen with Itraconazole use? |
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Definition
| HTN, hypokalemia, peripheral edema |
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Term
| When is Itraconazole Cxdx? |
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Definition
CHF and ventricular dysfunction
also with statins |
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Term
| What is the TOC for invasive aspergillus? |
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Definition
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Term
| Which antifungal can cause periostitis? |
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Definition
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Term
| Which antifungal can cause changes in color vision (in 30% of pts)? |
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Definition
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Term
| Which antifungal can cause visual/auditory hallucinations, seizures, and phososensitivity/rash? |
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Definition
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Term
| Which antifungal has non-linear metabolism? |
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Definition
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Term
| Which antifungal is an inhibitor of CYP34A AND CYP2C9, CYP2C19? |
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Definition
Voriconazole
(other azoles inhibit just CYP3A4, voriconazole has the most potential for drug interaction) |
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Term
| What is the only azole active against zygomycosis/mucormycosis? |
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Definition
| Posaconazole (this would be given if Ampho B didn't work/couldn't be given) |
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Term
| What is Posaconazole primarily used to treat? |
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Definition
| invasive fungal infections |
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Term
| What are the 3 echinocandins? |
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Definition
| Caspofungin, Micafungin, Anidulafungin |
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Term
| What antifungal targets B(1,3)-D-glucan synthase complex in the cell wall? |
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Definition
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Term
| What are the echinocandins two major uses? |
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Definition
1. treatment of severe disease candidiasis (NOT in meningitis).
2. given for Aspergillus if Ampho B/Voriconazole don't work |
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Term
| SOA for Griseofulvin? what is its clinical use? |
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Definition
only dermatophytes (epidermophyton, microsporum, trichophyton)
Used to treat superficial skin/nail infection with dermatophytes. 6 month treatment. |
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Term
| Which antifungal inhibits squalene epoxidase, increasing the levels of squalene (toxic to fungus)? |
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Definition
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Term
| What is the most effective treatment for tinea capitis, corpis, cruris, pedis and onchomycosis? |
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Definition
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Term
| Which antifungal has extensive first pass metabolism? |
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Definition
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Term
| What is the MOA for Nystatin? |
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Definition
| Nystatin is a polyene like Ampho B but is used topically. It binds ergosterol and forms pores. |
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Term
| What drug is used in a "swish and swallow" way to treat oral candidiasis? |
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Definition
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Term
| What is used to treat oral and vulvovaginal candidiasis? |
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Definition
| Topical azoles - clotrimazole, miconazole, terconazole |
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Term
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Definition
| a topical benzylamine used to treat mild cases of tinea cruris, corporis, pedis |
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