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99 Cards in this Set
- Front
- Back
DOC for cryptococcal infx
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amphotericin B + flucytosine
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DOCfungal meningitis
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amphotericin B
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Amphotericin B limiting toxicity
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nephrotoxic
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Flucytosine
most prominent SE |
protdrug metabolized to 5fu interacts with nucleic acid synth;
myelodepression |
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azoles
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all strong CYP3A$ inhibitors except fluconazole
fluconazole good CNS penetration not much interaction with p450 |
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Echinocandins
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mostly used for refractory aspergilosis
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Griseofulvin
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inhibits MT assembly
given orally concentrated by keratin disulfram lik eeffect |
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nystatin
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just like amphotericin B but not absorbed no systemic effect because not absorbed (not nephrotoxic)
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terbinafine
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inhibits ergosterol synthesis
topical OTC perscription needed for systemic:hepatotoxicity |
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Alkylating Agents Toxicity
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myelosuppression
CTZ vomitting Nausea form dead gut cells allopeeia sterility teratogenesis |
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Mechlorethamine
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[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) |
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Cyclophosphamide
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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] |
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Ifosfamide
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An alkylating anti-cancer drug
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Thiotepa
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alkylating agent used for bladder cancer
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Busulfan (Myleran)
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alkylating agent used for CML
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Streptozocin (Zanosar)
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alkylating nitrosurea used for pancreatic cancer
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Pancreatic Cancer
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Streptozocin (Zanosar) (alkylating nitrosurea)
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CML
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Busulfan (Myleran)
Imatinib |
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Rx for bladder cancer
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Thiotepa
alkylating agent |
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Cisplatin
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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
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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 |
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Rx's which cause pulmonary fibrosis
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Bleomycin (DNA fragmentation in Testicular and Ovarian Cancers)
Busulfan (alkylating agent for CML) Methotrexate (DHF reductase inhibitor in many cancers) |
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mercaptopurine
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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 |
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5FU
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inhibits thymidilate synthase, augmented by leukovorin
esp cholorectal cancer basal cell carcinoma bone marrow supppression |
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leukovorin
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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
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AML
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Cytarabine
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Cancer Rx: Cholestatic Jaundice
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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 |
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acoustic nerve toxicity
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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
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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) |
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Daunorubicin
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intercolate into DNA
dose limiting cardiotoxicity-- ↓ with dexrazoxane iron chelator substrate of P glycoprotein --mechanism of resistance |
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Bleomycin
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testicular Cancer esp
molecular scissors just chops up DNA Pulmonary Fibrosis |
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Dactinomycin
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suppresses RNA synthesis used in lab tests
radiation recall: appearance of burns during chemotherapy in areas which were previously treated with radiation |
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MT affecting drugs
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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
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topoisomerase
used for testicular cancers |
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CA Rx resistance via P glycoprotein
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Doxorubicin and Daunorubicin
intercolate into DNA dose limiting cardiotoxicity |
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CA Rx: RNA suppression
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Dactinomycin
suppresses RNA synthesis used in lab tests radiation recall: appearance of burns during chemotherapy in areas which were previously treated with radiation |
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CA Rx: Advanced lung cancer
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taxol used for advanced cancers: advanced breast, advanced ovarian, advance dlungs
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CA Rx: radiation recall
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Dactinomycin
suppresses RNA synthesis used in lab tests radiation recall: appearance of burns during chemotherapy in areas which were previously treated with radiation |
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asperaginiase
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hydrolyzes asperagine
used for leukkemias |
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hairy cell leukemia
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IFNα2a Roferon : hairy cell leukemia and kaposi's sarcoma
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kaposi's sarcoma
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IFNα2a Roferon : hairy cell leukemia and kaposi's sarcoma
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IL2
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malignant melanoma
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Trastuzumab (Herceptin)
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Her2 protein
increases cardiotoxicity of Doxorubicin |
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Flutamide (Eulexin)
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testosterone receptor antagonist to suppress flare of prostate cancer when you satr leuprolide
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Tamoxofen
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SERM: estrogen positive tumors, prophylactic in hx or high risk of breast CA
agonist in endometrium |
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testosterone receptor antagonist to suppress flare of prostate cancer when you satr leuprolide
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Flutamide (Eulexin)
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Prophylaxis vs Breast CA
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Tamoxofen: SERM: estrogen positive tumors, prophylactic in hx or high risk of breast CA
agonist in endometrium |
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DOC:malignant melanoma
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IL2
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Imatinib
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Bcr-Abl fusion protein, product of the t(9:29) Philadelphia chromosome
drives CML in 90% of pts |
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Malaria from mexico
Malaria from Malaysia |
Mexico is chloraquine sensitive
SE Asia is chloroquine resistant: malarone or doxycycline |
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Chloroquine
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very long λ: 1/week dosing
toxicities: not at theraputic doses: same as quinidie: dizziness, ringing ears |
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DOC: severe malaria
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Quinine + Doxycycline
Quinine Side effects: arhythmogenic Artemisinin and derivatives: new drugs with unknown side effects |
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Mefloquine
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prophylaxis in chloroquine resistant areas
should not be given to pt with hx seizures mental disorders |
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Good drug to carry around for presumptive treatment of malaria
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pyrimethamine plus sulfadoxine (Fansidar)
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Malaria prophylaxis with 1/week dosing
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Chloroquine
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DOC: non complicated, fully conscious malaria
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Atovaquone + proguanil (Malarone)
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Acyclovir
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activated by Thymidine Kinase
competes with guanosine valacyclovir more orally active sleepiness if taken with zidovudine safe in pregnancy |
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Topical for HSV eye infx
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Trifluridine (Viroptic)
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Topical for cold sores
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Docosanol (Abreva)
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Ganciclovir
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activated by thymidine kinase if herpes
by protein kinase phosphotransferase if CMV good for CMV prophylaxis/coverage NEUTROPENIA esp combined with zidovudine |
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Ramantidine/Amanditine Mech of Action
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prevents uncoating
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Ribovirin (Virazole)
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HepC and RSV (RNA viruses)
inhlation for RSV: chest soreness, need asmea inhaler oral for HepC Anemia Teratogenic |
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Palivizumab (Synagis)
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Antibody vs RSV
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Lamivudine (Epivir)
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HepB and HIV
low toxicity extremely effective |
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Rx's which inhibit HepB DNA polymerase
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Hepsera
Baraclude Tyzeka |
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DOC: HepC
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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 |
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Zidovudine/Lamivudine
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Nucleotide RTI's
well tolerated safe in pregnancy anemia and neutropenia Gancyclovir /acetaminophen + Zidovudine = neutropnia Zidovudine inhibits phosphorylation of stavudine |
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Tenofovir/ Emtricitabine
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Extremely well toelrated very few effects
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RTI's with peripheral neuropathy
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Didanosine; ddI (Videx)
Stavudine (Zerit) Zalcitabine (ddC; Hivid) |
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Efavirenz (Sustiva)
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DOC nnRTI
teratogenic not teratogenic substitude: Nevirapine (Viramune) |
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Pregnant Lady on HAART
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Efavirenz (Sustiva): DOC nnRTI
teratogenic not teratogenic substitude: Nevirapine (Viramune) |
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Increasing Protease Inhibitor uptake
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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 |
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Drugs which cause anemia
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Ribavirin (Virazole) for HepB and RSV
IFNα2a & IFNα2b for HepC HepC: Victrelis/Incivik: NS3/4 inhibitors: strong inhibition of CYP3A4 & anemia |
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Neutropenia worst combo
AIDS |
Zidovudine + Gancyclovir or Acetaminophen
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Mycophenolate Mofetil (CellCept)
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suppresses monophosphate dehydrogenase
selective for T and B goal is to prevent rejection |
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Azathioprine (Imuran)
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converted to 6MP
prevent rejection |
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Thalodimide
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multiple myeloma
graft vs host AML category X teratogen |
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Leflunomide (Arava)
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for RA by inhibiting de novo purine synth
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Muromonab CD3 (OKT3)
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cytokine release sro (flu like)
rejection rescue |
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Dicluzimab (Zenepax)
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anti-IL2R-ab
no cytokine release sro long duration of action immunosuppression in kidney transplant beforehand -identical to Basiliximab (Simulect) |
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Basiliximab (Simulect)
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anti-IL2R-ab
no cytokine release sro long duration of action immunosuppression in kidney transplant beforehand identical to Dicluzimab (Zenepax) |
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preparing for a renal transplant
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Basiliximab (Simulect) or Dicluzimab (Zenepax)
anti-IL2R-ab no cytokine release sro long duration of action immunosuppression in kidney transplant beforehand |
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calcineurin inhibitors
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↓ 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 |
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mTOR
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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) |
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Immunosuppressants do not cause myelosuppression
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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 |
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Insomnia from an immune suppressant
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Tacrolimus
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Gingival hyperplasia from an immune suppressent
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Cyclosporin
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Oprelvekin (Neumega)
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recombinant IL11 for Thrombocytopenia
causes fluid retention |
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treated for bleeding
fluid retention |
Oprelvekin (Neumega): recombinant IL11 for Thrombocytopenia
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GCSF
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vs neutropenia
causes bone pain |
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treated for recurrent infections
has bone pain |
GCSF
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treated for anemia
now has hypertension adn blood clots |
EPO
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EPO
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vs anemia
htn & blood clots |
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Interferon beta 1-B (Betaseron)
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for multiple sclerosis
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Multiple sclerosis treatment
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Interferon beta 1-B
Betaseron |
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Categories A, B, C, D, and X
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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 |
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Category X drugs we know about
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Leflunomide
Methotrexate Thalidomide IFN α2b |
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Mycophenolate Mofetil (CellCept)
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suppresses monophosphate dehydrogenase, de novo purine synth in T and B
used to prevent rejection |