Pharm Spring Test 2 Supplement

Front 1

DOC for cryptococcal infx

Back 1

amphotericin B + flucytosine

Front 2

DOCfungal meningitis

Back 2

amphotericin B

Front 3

Amphotericin B limiting toxicity

Back 3

nephrotoxic

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Flucytosine

most prominent SE

Back 4

protdrug metabolized to 5fu interacts with nucleic acid synth;

myelodepression

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azoles

Back 5

all strong CYP3A$ inhibitors except fluconazole

fluconazole good CNS penetration not much interaction with p450

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Echinocandins

Back 6

mostly used for refractory aspergilosis

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Griseofulvin

Back 7

inhibits MT assembly
given orally
concentrated by keratin
disulfram lik eeffect

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nystatin

Back 8

just like amphotericin B but not absorbed no systemic effect because not absorbed (not nephrotoxic)

Front 9

terbinafine

Back 9

inhibits ergosterol synthesis
topical OTC
perscription needed for systemic:hepatotoxicity

Front 10

Alkylating Agents Toxicity

Back 10

myelosuppression
CTZ vomitting
Nausea form dead gut cells
allopeeia
sterility teratogenesis

Front 11

Mechlorethamine

Back 11

[Alkylating Agent: myelosuppression, CTZ vomitting, Nausea form dead gut cells, allopeeia, sterility teratogenesis]

hodgkins: hyperuricemia

tx with adequate hydration and allopurinol (to inhibit xanthine oxidase)

Front 12

Cyclophosphamide

Back 12

Prodrug activated in liver

hemorrhagic systitis from accumulation of acrolein in bladder
Tx with MESNA
also SIADH

[Alkylating Agent: myelosuppression, CTZ vomitting, Nausea form dead gut cells, allopeeia, sterility teratogenesis]

Front 13

Ifosfamide

Back 13

An alkylating anti-cancer drug

Front 14

Thiotepa

Back 14

alkylating agent used for bladder cancer

Front 15

Busulfan (Myleran)

Back 15

alkylating agent used for CML

Front 16

Streptozocin (Zanosar)

Back 16

alkylating nitrosurea used for pancreatic cancer

Front 17

Pancreatic Cancer

Back 17

Streptozocin (Zanosar) (alkylating nitrosurea)

Front 18

CML

Back 18

Busulfan (Myleran)
Imatinib

Front 19

Rx for bladder cancer

Back 19

Thiotepa

alkylating agent

Front 20

Cisplatin

Back 20

cross links proteins causes DNA damage

DOES NOT CAUSE MYELOSUPPRESSION

solid tumors: breast ,testicular, lung

usual toxicities: renal, acoustic nerve, anaphylaxis

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Methotrexate

Back 21

DHF reductase inhibitor

can use leukovorin to rescue from toxicity

many cancers and also immunsuppressent

kidney, liver toxiciteis
pulmonary fibrosis
big dog for pulmonary fibrosis is bleomycin

Front 22

Rx's which cause pulmonary fibrosis

Back 22

Bleomycin (DNA fragmentation in Testicular and Ovarian Cancers)

Busulfan (alkylating agent for CML)

Methotrexate (DHF reductase inhibitor in many cancers)

Front 23

mercaptopurine

Back 23

activated by HGPT (underexpression = resistance)

metabolized by xanthine oxidase, so if you treat with allopurinol to reduce hyperuricemia, you have to cut the dose of 6mp

unusual side effect: cholestatic jaundice

Front 24

5FU

Back 24

inhibits thymidilate synthase, augmented by leukovorin

esp cholorectal cancer
basal cell carcinoma

bone marrow supppression

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leukovorin

Back 25

used to reduce side effects of methotrexate

used to increase potency of 5fu

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Cytarabine

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used for AML

Front 27

AML

Back 27

Cytarabine

Front 28

Cancer Rx: Cholestatic Jaundice

Back 28

activated by HGPT (underexpression = resistance)

metabolized by xanthine oxidase, so if you treat with allopurinol to reduce hyperuricemia, you have to cut the dose of 6mp

unusual side effect: cholestatic jaundice

Front 29

acoustic nerve toxicity

Back 29

Cisplatin

cross links proteins causes DNA damage

DOES NOT CAUSE MYELOSUPPRESSION

solid tumors: breast ,testicular, lung

usual toxicities: renal, acoustic nerve, anaphylaxis

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Doxorubicin

Back 30

intercolate into DNA
dose limiting cardiotoxicity-- ↓ with dexrazoxane iron chelator
substrate of P glycoprotein --mechanism of resistance

Doxorubicin esp for breast and ovarian cancers

increased cardiotoxicity with Trastuzumab (Herceptin)

Front 31

Daunorubicin

Back 31

intercolate into DNA
dose limiting cardiotoxicity-- ↓ with dexrazoxane iron chelator
substrate of P glycoprotein --mechanism of resistance

Front 32

Bleomycin

Back 32

testicular Cancer esp
molecular scissors just chops up DNA
Pulmonary Fibrosis

Front 33

Dactinomycin

Back 33

suppresses RNA synthesis used in lab tests

radiation recall: appearance of burns during chemotherapy in areas which were previously treated with radiation

Front 34

MT affecting drugs

Back 34

Vinchristine, Vinblastine, Taxol

Vinchristine "crips" the nerves, esp used for hodgkins

vinblastine much more myelosuppressive

taxol used for advanced cancers: advanced breast, advanced ovarian, advance dlungs; really really toxic: muscle pain, GI, myelosuppressive

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Etoposide

Back 35

topoisomerase
used for testicular cancers

Front 36

CA Rx resistance via P glycoprotein

Back 36

Doxorubicin and Daunorubicin

intercolate into DNA
dose limiting cardiotoxicity

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CA Rx: RNA suppression

Back 37

Dactinomycin

suppresses RNA synthesis used in lab tests

radiation recall: appearance of burns during chemotherapy in areas which were previously treated with radiation

Front 38

CA Rx: Advanced lung cancer

Back 38

taxol used for advanced cancers: advanced breast, advanced ovarian, advance dlungs

Front 39

CA Rx: radiation recall

Back 39

Dactinomycin

suppresses RNA synthesis used in lab tests

radiation recall: appearance of burns during chemotherapy in areas which were previously treated with radiation

Front 40

asperaginiase

Back 40

hydrolyzes asperagine

used for leukkemias

Front 41

hairy cell leukemia

Back 41

IFNα2a Roferon : hairy cell leukemia and kaposi's sarcoma

Front 42

kaposi's sarcoma

Back 42

IFNα2a Roferon : hairy cell leukemia and kaposi's sarcoma

Front 43

IL2

Back 43

malignant melanoma

Front 44

Trastuzumab (Herceptin)

Back 44

Her2 protein

increases cardiotoxicity of Doxorubicin

Front 45

Flutamide (Eulexin)

Back 45

testosterone receptor antagonist to suppress flare of prostate cancer when you satr leuprolide

Front 46

Tamoxofen

Back 46

SERM: estrogen positive tumors, prophylactic in hx or high risk of breast CA

agonist in endometrium

Front 47

testosterone receptor antagonist to suppress flare of prostate cancer when you satr leuprolide

Back 47

Flutamide (Eulexin)

Front 48

Prophylaxis vs Breast CA

Back 48

Tamoxofen: SERM: estrogen positive tumors, prophylactic in hx or high risk of breast CA

agonist in endometrium

Front 49

DOC:malignant melanoma

Back 49

IL2

Front 50

Imatinib

Back 50

Bcr-Abl fusion protein, product of the t(9:29) Philadelphia chromosome

drives CML in 90% of pts

Front 51

Malaria from mexico
Malaria from Malaysia

Back 51

Mexico is chloraquine sensitive
SE Asia is chloroquine resistant: malarone or doxycycline

Front 52

Chloroquine

Back 52

very long λ: 1/week dosing

toxicities: not at theraputic doses: same as quinidie: dizziness, ringing ears

Front 53

DOC: severe malaria

Back 53

Quinine + Doxycycline

Quinine Side effects: arhythmogenic


Artemisinin and derivatives: new drugs with unknown side effects

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Mefloquine

Back 54

prophylaxis in chloroquine resistant areas

should not be given to pt with hx seizures mental disorders

Front 55

Good drug to carry around for presumptive treatment of malaria

Back 55

pyrimethamine plus sulfadoxine (Fansidar)

Front 56

Malaria prophylaxis with 1/week dosing

Back 56

Chloroquine

Front 57

DOC: non complicated, fully conscious malaria

Back 57

Atovaquone + proguanil (Malarone)

Front 58

Acyclovir

Back 58

activated by Thymidine Kinase
competes with guanosine

valacyclovir more orally active

sleepiness if taken with zidovudine
safe in pregnancy

Front 59

Topical for HSV eye infx

Back 59

Trifluridine (Viroptic)

Front 60

Topical for cold sores

Back 60

Docosanol (Abreva)

Front 61

Ganciclovir

Back 61

activated by thymidine kinase if herpes
by protein kinase phosphotransferase if CMV

good for CMV prophylaxis/coverage

NEUTROPENIA esp combined with zidovudine

Front 62

Ramantidine/Amanditine Mech of Action

Back 62

prevents uncoating

Front 63

Ribovirin (Virazole)

Back 63

HepC and RSV (RNA viruses)

inhlation for RSV: chest soreness, need asmea inhaler
oral for HepC

Anemia
Teratogenic

Front 64

Palivizumab (Synagis)

Back 64

Antibody vs RSV

Front 65

Lamivudine (Epivir)

Back 65

HepB and HIV

low toxicity extremely effective

Front 66

Rx's which inhibit HepB DNA polymerase

Back 66

Hepsera
Baraclude
Tyzeka

Front 67

DOC: HepC

Back 67

Locepravir
Genomes 2 and 3: IFNα2b
IFNα2a if refractory

polyethylene glycol slow release depot
flu like malaise, depression, neutropenia, anemia, edematoous hypotension, not throbocytopenia

Victrelis/Incivik: NS3/4 inhibitors: strong inhibition of CYP3A4 & anemia

Front 68

Zidovudine/Lamivudine

Back 68

Nucleotide RTI's

well tolerated
safe in pregnancy

anemia and neutropenia

Gancyclovir /acetaminophen + Zidovudine = neutropnia

Zidovudine inhibits phosphorylation of stavudine

Front 69

Tenofovir/ Emtricitabine

Back 69

Extremely well toelrated very few effects

Front 70

RTI's with peripheral neuropathy

Back 70

Didanosine; ddI (Videx)
Stavudine (Zerit)
Zalcitabine (ddC; Hivid)

Front 71

Efavirenz (Sustiva)

Back 71

DOC nnRTI

teratogenic

not teratogenic substitude: Nevirapine (Viramune)

Front 72

Pregnant Lady on HAART

Back 72

Efavirenz (Sustiva): DOC nnRTI

teratogenic

not teratogenic substitude: Nevirapine (Viramune)

Front 73

Increasing Protease Inhibitor uptake

Back 73

grape juice
ritonavir inhiibts CYP3A4, used at subtheraputic concenrtations
st john's wort decreases effectivness

looks like corticosteroid sbut face gets thin
atazanavir best toelrated

Front 74

Drugs which cause anemia

Back 74

Ribavirin (Virazole) for HepB and RSV

IFNα2a & IFNα2b for HepC

HepC: Victrelis/Incivik: NS3/4 inhibitors: strong inhibition of CYP3A4 & anemia

Front 75

Neutropenia worst combo

AIDS

Back 75

Zidovudine + Gancyclovir or Acetaminophen

Front 76

Mycophenolate Mofetil (CellCept)

Back 76

suppresses monophosphate dehydrogenase

selective for T and B

goal is to prevent rejection

Front 77

Azathioprine (Imuran)

Back 77

converted to 6MP
prevent rejection

Front 78

Thalodimide

Back 78

multiple myeloma
graft vs host
AML

category X teratogen

Front 79

Leflunomide (Arava)

Back 79

for RA by inhibiting de novo purine synth

Front 80

Muromonab CD3 (OKT3)

Back 80

cytokine release sro (flu like)
rejection rescue

Front 81

Dicluzimab (Zenepax)

Back 81

anti-IL2R-ab
no cytokine release sro
long duration of action
immunosuppression in kidney transplant beforehand

-identical to Basiliximab (Simulect)

Front 82

Basiliximab (Simulect)

Back 82

anti-IL2R-ab
no cytokine release sro
long duration of action
immunosuppression in kidney transplant beforehand

identical to Dicluzimab (Zenepax)

Front 83

preparing for a renal transplant

Back 83

Basiliximab (Simulect) or Dicluzimab (Zenepax)

anti-IL2R-ab
no cytokine release sro
long duration of action
immunosuppression in kidney transplant beforehand

Front 84

calcineurin inhibitors

Back 84

↓ IL2 release, very selective for Tcells do not cause bone marrow suppression
SE's: HTN, Hyperglycemia, Kidney Toxicity

cyclosporin has gingival hyperplasia
tacrolimus likely to cause insomnia, less toxic
pimecrolimus: topical

Front 85

mTOR

Back 85

mammalian target of Rapamycin m-TOR

this is what Rapammune interacts with to ↓ T cell response to IL2

does cause bone marrow suppression
(contrast to calcinurin inhibitors: cyclosporin, tacrolimus)

Front 86

Immunosuppressants do not cause myelosuppression

Back 86

calcineurin inhibitors
↓ IL2 release, very selective for Tcells do not cause bone marrow suppression
SE's: HTN, Hyperglycemia, Kidney Toxicity

cyclosporin has gingival hyperplasia
tacrolimus likely to cause insomnia, less toxic
pimecrolimus: topical

Front 87

Insomnia from an immune suppressant

Back 87

Tacrolimus

Front 88

Gingival hyperplasia from an immune suppressent

Back 88

Cyclosporin

Front 89

Oprelvekin (Neumega)

Back 89

recombinant IL11 for Thrombocytopenia

causes fluid retention

Front 90

treated for bleeding
fluid retention

Back 90

Oprelvekin (Neumega): recombinant IL11 for Thrombocytopenia

Front 91

GCSF

Back 91

vs neutropenia
causes bone pain

Front 92

treated for recurrent infections
has bone pain

Back 92

GCSF

Front 93

treated for anemia
now has hypertension adn blood clots

Back 93

EPO

Front 94

EPO

Back 94

vs anemia
htn & blood clots

Front 95

Interferon beta 1-B (Betaseron)

Back 95

for multiple sclerosis

Front 96

Multiple sclerosis treatment

Back 96

Interferon beta 1-B
Betaseron

Front 97

Categories A, B, C, D, and X

Back 97

A: no risks in controlled studies
B: no evidence, not control studied
C: Risk cannot be ruled Out
D: evidence for Risk
X: contraindicated in pregnancy requires two forms of birth control

Front 98

Category X drugs we know about

Back 98

Leflunomide
Methotrexate
Thalidomide
IFN α2b

Front 99

Mycophenolate Mofetil (CellCept)

Back 99

suppresses monophosphate dehydrogenase, de novo purine synth in T and B
used to prevent rejection