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92 Cards in this Set

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Weird side effect of aspirin
Tinnitus
Ticlopidine
Hypercoagulability

Anti-PLATELET

Inhibits ADP from binding to platelet receptors -> v activation of GPIIb/IIIa
Dipyridamole
Hypercoagulability

Anti-platelet

^ platelet cAMP levels -> inhibits platelet activation
Clopidogrel
Hypercoagulability

Anti-platelet

Inhibits ADP from binding to platelet receptors -> v activation of GPIIb/IIIa
Abciximab
monoclonal antibody to GP IIb/IIIa receptor
What can Vitamin E and Garlic cause in proper circumstances?
Bleeding
Warfarin MOA
Antagonize Vitamin K, which makes Factors II, VII, IX, and X nonfuctional
What rate is used to measure monitor Warfarin?

What should the range be?
INR (internal Normalized Ratio) = (partient's Prothrombin Time/mean normal PT in seconds)

2-3
What interferes with Warfarin?
Foods with Vitamin K and ginseng
Heparin MOA
potentiate antithrombin III

inactivates IIa, IXa, Xa, XIa & XIIa

act in many steps to not get crosslinked fibrin
Enoxaparin
Anticoagulant

Low Molecular Weight Heparin

Only inhibits Xa to inactivate thrombin
Major SE of Heparin (less so w/ LMWH)
Heparin-Induced Thrombocytopenia (HIT)

v amount of platelet count
Lepirudin
Direct Thrombin Inhibitor

1st line for HIT
Argatroban
Direct Thrombin Inhibitor

1st line for HIT
Streptokindase
Plasminogen Activator
Urokinase
Thrombolytic

Plasminogen Activator
Tranexamic Acid
Procoagulant

Fibrinolysis inhibitors
Essential Nutrients for RBC production (erythropoiesis)?
Folate, B12 & iron
What nutrient is key for AA and purine synthesis?
Folate
Where is folate absorbed, stored and for how long?
proximal jejunum; liver; 1-6 months
Folate deficiency leads to?
1) MACROcytic/megaloblastic Anemia

2) Slow down nuclear replication
*Methotrexate blocks what nutrient?

also oral contraceptives, Isoniazid, and Phenytoin and Trimethoprim block as well
Folate
Wernicke-Korsakoff has what deficiency?
Thiamine (B1)
Pernicious Anemia
Vitamin B12 deficiency
Difference b/w Folate and Vitamin B12 (cobalamine) Megaloblastic anemia?
Vitamin B12 = neuroloical syndrome

-paresthesias
-weakness
-ataxia

Folate: no neurologic syndromes
Iron deficiency causes?
MICROcytic anemia (too little cytoplasm
What is an adequate measure of total body iron stores?
Plasma Ferritin
Do sickle cell patients have iron deiciency?
No
Transferrin
^ during v storage iron to ^ import of more iron from GI mucosa
Weird SE of oral iron
Black stool
Acute iron toxicity causes?
Necrosis of gut
Do you give sickle cell patients iron?
No, they do not have an Iron deficiency
Erythropoietin
Main growth factor for Hematopoiesis

Produced by peritubular system of the kidney

Epo level drop = red cell production drop

Travels to BM & v apoptosis to ^ RBC
Thyroid System is directly triggered/impacted by what?
Temperature
Liothyronine
T3

Used only in acute situations (ie Myxedema coma) b/c faster acting than T4
Levothyroxine
T4

Almost always the DOC for Hypothyroidism (except for acute situations -> T3)
Iodide
Anthi-thyroid @ HIGH doses

Inhibits 1)iodide uptake & 2) release of T3 and T4

High dose useful b/f surgery
Propothiouracil (PTU)
Anti-thyroid

Inhibits iodide organification

AND

Coupling of MIT & DIT

Conversion of T4 -> T3

FASTER onset than Methimazole but take 3x daily
Methimazole
Anti-thyroid

ONLY Inhibits iodide organification (iodination of tyrosine in thyroglobulin)
SLOWER onset than Propothiouracil but only give 1x daily
B-Blockers' and Corticosteroids hormonal action
Antagonize effects of thyroid hormone
Expression of Na/K ATPase is regulated hormonally by?

Thereby important in the metabolsm of ALL cells
T3
Cretinism (short stature) is caused by?
Lack of thyroid hormone during development
Give high dose of iodide therapy 2 weeks prior to surgical storm?
YES, shrinks thyroid making surgery easier
Give high dose of iodide therapy prior to implantation of radioactive iodide?
NO, b/c it would block the uptak of the radioactive iodide
Calcitriol
1, 25-dihydroxy D3 (renal-activated form of Vitamin D)

stimulates the intestine to increase absoprtion of phosphate and calcium (esp in intestine, kidney, & bone
For Hypocalcemia w/

Hepatic Failure
Give 25-Hydroxy D3
For Hypocalcemia w/

Renal failure
Give 1,25-Dihydroxy D3
For Hypocalcemia w/

Normal Renal and Hepatic fxn
Give vitamin D3
Unlike thyroid hormone, effects of 1,25-Dihydroxy D3 not found all over the body but mostly in?
Gut
Calcitonin synthesized in?
Thyroid gland
Net affect of Vit D and Parathyroid hormone?
increasing Ca in

1)intestine
2)kidney
3)bone
Biphosphonates are a class of drugs useful for? **ALENDRONATE**

Etidronate
Pamidronate
Pyrophosphate
Treatment of Osteoporosis

**SE: Esophageal erosion**
Penicillin most useful for what bacteria?
Gram +
Main difference b/w Cycloserine and Penicillin?
Cycloserine is REVERSIBLE and Penicillin is IRREVERSIBLE
What are the 5 classes of immunosuppressnt agents?
1)T Cell blockers
2)Glucocorticoids
3)Cytotoxic drugs
4)Antibody reagents
5)Cytokine inhibitors
Cyclosporine
Immunosuppressant - T-cell Blocker

Organ transplant, Autoimmune Dz (RA), & Psoriasis



Binds cyclophilin, and the cyclosporine=cyclophilin complex inhibits calcineurin (decrease in IL-2 production which is a T cell growth factor)

Narrow TI

SE: Nephrotoxicity, HT, CYP450 ACTIVATION!
Tacrolimus
Immunosuppressant - T-cell Blocker

Organ Transplant

Binds FKBP, complex then inhibits calcineurin (decrease in IL-2 production which is a T cell growth factor)

MORE potent than cyclosporine

Narrow TI

SE: Nephrotoxicity, Neurotoxicity, Diarrhea, CYP450 ACTIVATION!
Sirolimus
Immunosuppressant - T-cell Blocker

Organ Transplant, Antifungal agent

Binds FKBP, complex but DOES NOT inhibit calcineurin It inhibits signal pathway from IL-2 recepor to the DNA transcription --> decresed IL-2 responsiveness (v T cell
AND B cells growth)

SE: CYP450 ACTIVATION!

LESS NEPHROTOXICITY than Cyclosporine and Tacrolimus
Prednisone
Immunosuppressant - Glucocorticoid

Organ trasplant & Autoimmune Disease

Converts to Prednisolone

Antiinflammatory: ^ Neutrophils & v lymphocytes (B AND T cells) & cytokines in circulation

Pharmadynamic effect is longer than its pharacokinetic effect (short 1/2 life, longer effective duration)

SE: Adrenal insufficiency
Azathioprine
Immunosuppresant - Cytotoxic Agent - PURINE

Organ Transplants, Auntoimmune DX (RA)

Adenine Analog - ANTAGONIST TO PURINE SYN which lymphocytes need for proliferation

Pharmadynamic effect is longer than its pharacokinetic effect

SE: v Renal and Hepatic fxn

** AVOID ALLOPURINOL Interaction -> inhibits xanthine oxidase which inactivates activity; THUS Allopurinol causes ^ levels of azathioprnie -> PANCYTOPENIA
Mycophenylate Mofetil
Immunosuppresant - Cytotoxic Agent - PURINE

Organ Transplants

Inibits IMP Dehydrogenase -> inhibits de novo synthesis of Purines

Undergoes enterohepatic circulation --> inactive metabolites activated in liver

SE: GI upset, BM suppression & Infection risk
Cyclophosphamide
Immunosuppresant - Cytotoxic Agent - Alkalating Agent

Interferes with DNA replication and transcription of RNA, thus disrupting nucleic acid function

SE: GI upset, cardiotoxicity BM suppression & NEOPLASIA (esp BLADDER cancer)
Leflunomide
Immunosuppressant - Cyotoxic Agent - PYRIMIDINE

Used mainly for RA

SE: alopecia, N/V, diarrhea, rash
Antithymocyte Globulin
Immunosuppresant - Antibody Reagent

Organ transplants

Purified Animal Gamma Globulin (mailinly IgG) against T lymphocytes

SE: Allergic Rxn
OKT3
Immunosuppresant - Antibody Reagent

Organ transplants (ACUTE REJECTION)

Used in conjunction with Azahioprine & Corticosteroids

Murine monoclonal T3 antibody --> blocking fxn of all T cells

SE: Flu-like symptoms, HA, seizures, aseptic meningitis and encephalopathy
Basiliximab
Immunosuppresant - Antibody Reagent

Organ transplants (ACUTE REJECTION)

Used in conjunction with Azahioprine & Corticosteroids

Monoclonal antibody from Human recombinant DNA - blocks CD 25 -> inhibits T Lymphocytes

SE: Hypersensitivity
Daclizumab
Immunosuppresant - Antibody Reagent

Organ transplants (ACUTE REJECTION)

Used in conjunction with Azahioprine & Corticosteroids

Monoclonal antibody from Human recombinant DNA - blocks CD 25 -> inhibits T Lymphocytes

SE: Gi effects, HA, dizziness, otherwiise well tolerated compared to other agents
Etanercept
Immunosuppressant: Cytokine Inhibitor

Autoimmune Dz (RA, Crohn's Dz)

Monoclonal IgG antibody from recombinant human DNA that binds specifically to TNF alpha --> Inhibition of inflammatory cascade

"EI EI LUPUUUUUUS"
"TNF-alpha now!"

SE: Infusion reactions, Upper respiratory infecions, LUPUS-llike syn
Infliximab
Immunosuppressant: Cytokine Inhibitor

Autoimmune Dz (RA, Crohn's Dz)

Monoclonal IgG antibody from recombinant human DNA that binds specifically to TNF alpha --> Inhibition of inflammatory cascade

SE: Infusion reactions, Upper respiratory infecions, LUPUS-llike syn

"EI EI LUPUUUUUUS"
"TNF-alpha now!"
IV Immunoglobulin
Immunostimulant

Used for Primary immune deficiency (ie AIDS)

Contain no IgM, variable IgA, and normal IgG

SE: allergic rxn -> anaphylaxis
INF Gamma 1B
Immunostimulant

Prevention of infection in Chronic Granulomatous Dz
INF Beta 1a/b
Immunostimulant

Used to reduce the severity of MS attacks
INF Alpha 2a/b
Immunostimulant

Used in Hepatitis, HPV, Kaposi's sarcoma
IL-2
Immunostimulant

stimulates T helper and T cytotoxic cells

HIGHLY TOXIC w/ life-threatening cardiotoxicity, pulmonary edema and renal toxicity
Levamisole
Immunostimulant

Used in Hodgkin's Dz, RA, & Colorectal cancer

Causes macrophages and T cells to secrete cytokines and other factors suppressing tumor growth
St John's Wort
Treat Depression

Can bind FXR receptor and activate CYP450 system - ^ metabolism of drugs such as cyclosporin & theophylline

DO NOT TAKE with MAO INHIBITORS
Echinacea
Common Cold

DO NOT TAKE with IMMUNOSUPPRESSANTS (ie corticosteriods)
Saw Palmetto
Treat BPH
Cranberry Exract
Treat UTI
Ginkgo Biloba
Treat Anxiety/Stress & Memory Loss
Black Cohosh
Treat Menopause

Contains isoflavones
*Grape Seed Extract
Neuroprotective

high antioxidants
Garlic
Contains *INDOLE-3-CARBINOL (found in broccili; anticancer properties) & *ALLICIN - both antioxidants

DO NOT TAKE with NSAIDs
Evening Primrose
DO NOT TAKE with Anti-convulsants
Ginseng
Energy

DO NOT TAKE with NSAIDs
Yohimbe
Depression

MAO inhibitor

TOXIC - PSYCHOSIS
Comfrey
Demulcent

TOXIC - Hepatotoxicity
Chaparral
Antibiotic

contains anti-oxidants

TOXIC - Hepatotoxicity
*Genistein
also Red Clover & Kudzu

Soy products

An isoflavone resembling 17B-estradiol binding estrogen receptor SELECTIVELY in bone, brain, and CV system

Polyphenols have ANTIOXIDANT properties; may enhance cell viablilty/logevity by enhancing certian de-acetylases
Chinese Red Rice
Treat hypercholesteremia

fungus that contains statins -> inhibition of HMG CoA Reductase
Tissue Plasminogen Activator
U: Hypercoagulability

Thrombolytic (most common)
-specific for clot-bound plasma
What kind of iron is direcly absorbed?
Meat iron

Iron from other food sources must be reduced to ferrous to form Fe2+ before it can be actively tranproted into intestinal mucosa