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100 Cards in this Set
- Front
- Back
Vitamin A can exist in diifferent forms, give the names for the:
Vitamin A alcohol Vitamin A aldehyde Vitamin A acid |
Vit A alcohol = retinol
Vit A aldehyde = retinal Vit A acid = retinoic acid |
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What are the precursors of Vitamin A from plants?
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Carotenoids
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What transports retinol in the serum?
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Retinol Binding Proteins
Transthyretin |
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What transports retinol in the cell for translocation to the nucleus?
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cytosolic retinol binding protein
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What are the 1st generation synthetic retinoids?
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Tretinoin (all-trans RA) = Retin-A
Isotretinoin (13-cis-RA) = Accutane = water soluble |
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What are the 2nd generation synthetic retinoinds?
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Etretinate = Tigason = removed from market and replaced by acitretin
Acitretin = Soriatane = metabolite of etretinate = water soluble |
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What are the 3rd generation synthetic retinoids?
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aka polyaromatic retinoids:
tazarotene = tazorac adapalene = differin baxarotene = Targretin = used to treat MF = water soluble |
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Which retinoids are water soluble?
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Isotretinoin
Acitretin bexarotene Levels are gone after 1 month of stopping therapy |
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Which retinoids are more lipophilic?
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Etretinate & Acitretin
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Which proliferative keratins are downregulated by retinoids?
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K6 & K16
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Retinoids enhance keratinocyte differentiation -- in which ways?
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1. increased filaggrin production
2. increased keratohyalin granules 3. increased keratin filaments 4. increased odland body secretion of lipids |
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What does Accutane do to sebaceous glands?
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reduces the size and decreases differentiation to mature sebocytes
(also inhibits ornithine decarboxylase which lessens inflammatory hyperplasia) |
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What are some common Sfx of systemic retinoids?
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reduced night vision, diffuse interstitial skeletal hyperostosis (DISH), premature epiphyseal closure, elevated serum lipids and transaminases, pseudotumor cerebri (with TCNs), depression & myopathy
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What endocrine abnormality has been seen with bexarotene?
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reversible hypothyroidism
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What are some birth defects from retinoids?
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microtia, hearing loss, michrophthalmia, optic nerve atrophy, acral and axial skeletal abnormalities, cardiovascular defects, hydrocephalus, microcephaly, meningomyelocele, thymic aplasia, and anal&vaginal atresia
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Which retinoids target RXR receptors?
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Alitretinoin (9-cis-RA)
Bexarotene Both hit RXR alpha, beta, & gamma |
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Which Abx inhibits bacterial cell wall synthesis by blocking the transpeptidation step?
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Penicillins
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This abx blocks bacterial cell wall synthesis through inhibition of penicillin-binding proteins that catalyze transpeptidation
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Cephalosporins
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Which cephalosporin has been associated with increased incidence of serum sickness in children?
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Cefaclor
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This abx inhibits protein synthesis by binding the 30S ribosomal subunit
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Tetracyclines
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This Abx inhibits the 50S ribosomal subunit
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Macrolides
& Clindamycin |
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This Abx inhibits DNA gyrase
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Fluoroquinolones
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This Abx inhibits RNA synthesis by inhibiting DNA-dependent RNA polymerase
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Rifampin (a rifamycin)
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What drug is most common cause of fixed drug eruption?
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Tetracycline
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What is drug has been assoc with cholestatic hepatitis?
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Erythromycin
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Where is the teeth discoloration in minocycline vs. tetracycline?
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TCN = Tots (in childhood) = in Top third of teeth (top gingival third)
Minocycline = Mid-portion of teeth |
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Imiqumod induces which cytokines?
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TNF-alpha
IFN-gamma IFN-alpha IL-12 (leads to cell mediated immune response) |
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Podophyllin works how?
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[extract of the May apple plant]
Is antimitotic, arresting cells in metaphase by binding protein tubulin |
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What is a serious side effect of Protease Inhibitors? and, which one is most commonly associated with this sfx?
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Lipodystrophy - manifests as abnormal fatty deposits aka 'buffalo hump' and 'protease pouch'
Most notably = indinavir (also causes gynecomastia) |
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Which HIV medications have been reported to cause periungual/paronychial eruptions (PG-like lesions)?
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Indinavir
Zidovudine Lamivudine |
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What sfx is uniquely seen in Foscarnet?
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Penile erosions are known to occur
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What drug has been assoc with reversible obstructive nephropathy?
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Acyclovir (rapid IV infusion)
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What fatal/severe sfx is seen with valacyclovir when used in AIDS or transplant patients in high doses?
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TTP/HUS syndrome
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Mechanism of Terbinafine
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blocks the biosynthesis of ergosterol, a sterol essential to the integrity of the fungal cell membrane; inhibits squalene epoxidase (fungal inhibited 4X more than mammalian)
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What is the advantage of using Terbinafine (vs. the azoles)
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No cytochrome p450 inhibition!! however, transformed in the liver, therefore slow elimination by 30% in liver pts
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This drug blocks synthesis of ergosterol
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Terbinafine
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An allylamine
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Terbinafine
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A Triazole
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Itraconazole
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Pregnancy Category:
Acitretin |
X
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Pregnancy Category:
Etretinate |
X
|
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Pregnancy Category:
Estrogens |
X
|
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Pregnancy Category:
Finasteride |
X
|
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Pregnancy Category:
5-FU |
X
|
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Pregnancy Category:
Flutamide |
X
|
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Pregnancy Category:
MTX |
X
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Pregnancy Category:
Stanozolol |
X
|
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Pregnancy Category:
Tazarotene |
X
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Pregnancy Category:
Aspirin |
D
|
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Pregnancy Category:
Azathioprine |
D
|
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Pregnancy Category:
Bleomycin |
D
|
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Pregnancy Category:
Colchicine |
D
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Pregnancy Category: Cyclophosphamide
|
D
|
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Pregnancy Category:
Hydroxyurea |
D
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Pregnancy Category:
Mechlorethamine |
D
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Pregnancy Category:
Penicillamine |
D
|
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Pregnancy Category:
Potassium iodide |
D
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Pregnancy Category:
Tetracycline |
D
|
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Pregnancy Category:
Griseofulvin |
unrated, but probably D
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Pregnancy Category:
Spironolactone |
unrated, but probably D
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Pregnancy Category:
Quinolones/ciprofloxacin |
C
|
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Pregnancy Category:
TMP/SMX |
C
|
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Pregnancy Category:
Cyclosporine |
C (but believed to be safe in pregnancy)
|
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Pregnancy Category:
Acyclovir |
C
|
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Pregnancy Category:
fluconazole, ketoconazole, itraconazole |
C
|
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Pregnancy Category:
Benzoyl peroxide |
C
|
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Pregnancy Category:
topical retin-A |
C
|
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Pregnancy Category:
topical and oral steroids |
C
|
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Pregnancy Category:
Efalizumab |
C
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Pregnancy Category:
Penicillin |
B
|
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Pregnancy Category:
Emycin |
B (not estolate form due to hepatotoxicity in mother)
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Pregnancy Category:
Dimenhydrinate |
B
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Pregnancy Category: Cyproheptadine
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B
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Pregnancy Category: azeleic acid
|
B
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Pregnancy Category: Permethrin
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B
|
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Pregnancy Category: cephalosporins
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B
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Pregnancy Category: Lidocaine
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B
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Pregnancy Category:
etanercept, alefacept, infliximab |
B
|
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Pregnancy Category:
Folic Acid |
A
|
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Pregnancy Category:
Levothyroxine |
A
|
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What drugs have been assoc with IUD failure?
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Azathioprine, NSAIDs
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What drugs have been assoc with OCP failure?
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griseofulvin, rifampin
~ by incr estrogen metabolism by hepatic enzyme induction |
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Nitrogen mustard derivative that is cell-cycle non-specific
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Cyclophosphamide
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What is the toxicity assoc with cyclophosphamide -- which metabolite causes it? And, what is used to reduce the effect?
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Hemorrhagic cystitis (in 40%) of pts, can lead to transitional cell carcinoma.
Bladder toxicity is due to the acrolein metabolite Mesna (aka sodium 2-mercaptoethanesulfonate) has been used to reduce this toxic effect |
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Which pt's are at higher risk for pancytopenia when using MTX?
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renal patients
NSAIDS Bactrim |
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What is used to rescue pts from MTX induced myelosuppression?
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Leukovorin (folinic acid) -- can bypass dihydrofolate reductase in the cell division pathway
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What is a unique side effect of MTX?
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radiation recall (aka sunburn recall)
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Purine analog that acts only during the S-phase of the cell cycle in the formation of adenine and guanine nucleotides
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Azathioprine
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There are three enzyme pathways for Azathioprine -- name them
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1. Hypoxanthine guanine phosphoribosyl transferase (HGPRT)
2. Xanthine oxidase 3. Thiopurine methyltransferase (TPMT) activity If pathway #1 becomes the primary pathway, toxic purine analogs can accumulate --> BM suppression! This can happen in the setting of concurrent use of allopurinol (inhibits xanthine oxidase) or low TPMT allele activity |
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Rituximab is what type of drug?
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Anti-CD20 antibody
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Methotrexate blocks what?
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Folic Acid Analog, inhibits dihydrofolate reductase
|
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Mycophenolate Mofetil
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Inhibits Inosine Monophosphate in de novo purine synthesis
|
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Azathioprine
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6-mercaptopurine analog that inhibits purine synthesis; check thiopurine methyl transferase levels prior to giving
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Interferon Gamma
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Inhibits TH2 cells
|
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Cyclosporine
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calcineurin inhibitor, blocks T-lymphocytes; reduces transcription of cytokines (IL-2); monitor BP, CBC, LFTs, Mg and Uric Acid
|
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Efalizumab mechanism?
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Recombinant monoclonal antibody that binds to CD11a, subunit of Leukocyte function antigen-1 to block ICAM-1;
|
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Sfx of Raptiva?
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Efalizumab
Thrombocytopenia, anemia, 5% of pts have anti-raptiva antibodies Loading dose 0.7 mg/kg x 1 week, then 1mg/kg sc weekly. |
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Rituximab is approved for what use?
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1997 FDA approved for B-cell lymphomas and treatment resistant RA
"off-label" use for pemphigus vulgaris, paraneoplastic pemphigus, all pemphigus - Atopic dermatitis - EBA - ANCA-mediated vasculitis - cryoglobulinemia - dermatomysositis (unknown mechanism) - Chronic GvHD - Lupus |
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Target of Rituximab
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CD20 receptor (B-cell specific antigen)
CD20 not found on plasma or stem cells (so they are spared!) B-cells recover in appx 6 months |
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What type of antibody is rituximab?
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Monoclonal IgG1 (chimeric murine-human antibody):
Fc fragment is human -- recruits immune cells to lyse CD20 cells Fab fragment is mouse -- binds CD20 Ag |
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Side Effects of Rituximab?
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IV infusion reactions are most common
RARE: PML |