Term
| Tx for diabetic in pregnancy? |
|
Definition
|
|
Term
| Type II DM drug that suppresses glucagon and enhances insulin secretion |
|
Definition
|
|
Term
| Biguanide mode of action? |
|
Definition
| reduced gluconeogenesis and thus reduced insulin secretion |
|
|
Term
| Effects of estrogen on bone metabolism in post-menopausal women? |
|
Definition
| increased bone density and reduces fx rate |
|
|
Term
| common complication after long term inhaled glucocorticoids? |
|
Definition
|
|
Term
| Best abx for young woman hospitalized w/ pyelo? |
|
Definition
|
|
Term
| main toxicity of metformin? |
|
Definition
|
|
Term
Parasitic pathogens:
1. ___ - single celled. 5 common ones?
2. ___ - multicellular |
|
Definition
1. protozoans - entamoeba histolytica, giardia lambia, toxoplasmosis gondii, trich vaginalis, plasmodium (malaria)
2. helminths |
|
|
Term
dysentery - severe, possibly life-threatening diarrhea:
1. 2 causative protozoa?
2. 2 txs
3. possible complication? |
|
Definition
1. giardia and entamoeba histolytica
2. flagyl (metronidazole) and chloroquine
3. liver abscess |
|
|
Term
Most common GI parasite in the US
tx? |
|
Definition
|
|
Term
Toxoplasmosis gondii:
1. non-pathogenic in humans except in what 2 populations?
2. carriers?
3 tx? |
|
Definition
1. immunocompromised - encephalitis, pregnancy - fetal injury in PRIMARY infection
2. cats are carriers, rodents are hosts
3. pyrimehamine (daraprim) + clindamycin + folinic acid |
|
|
Term
Protozoa causing vaginitis with an irritating, frothy discharge
tx? |
|
Definition
trichomonas
metronidazole (flagyl) |
|
|
Term
metronidazole (flagyl)
SE?
What is a "cousin" drug to flagyl that has similar safety and side effects, a shorter treatment duration, and is more expensive? |
|
Definition
Generally safe
SE: nausea, metallic/bitter taste, dizziness, and
disulfiram (antabuse)-like reaction when mixed with alcohol
Indications: protozoal infections (trich, amoeba), anaerobic infections (abscesses, pseudomembranous colitis), bacterial vaginosis (gardnerella)
Tinidazole - fasigyn
|
|
|
Term
Malaria:
1. ___ total cases, __-__ fatalities/year
2. __ causes the most deaths
3. 3 other species?
4. preferred tx fr non-resistant organisms?
5. tx for resistant organisms? |
|
Definition
1. 1 billion, 1-3 million
2. plasmodium falciparum
3. p. vivax, p. ovale, p. malariae
4. chloroquine (quinine is active ingredient)
5. artemisinin |
|
|
Term
| Antimalarial antibiotic given to people who are going to travel to an area of malaria as prophylaxis for p. falciparum? |
|
Definition
|
|
Term
What drug?
blocks the malaria parasite enzyme and thus prevents heme digestion
Can cause EKG changes
Can cause visual disturbances (blurred vision/vision loss)
Can cause hemolysis in G6PD-deficient individuals
___ toxicity is common in chronic use. |
|
Definition
|
|
Term
enterobius vermicularis
txs:
1. pregnancy safety unknown
2. teratogenic
3. paralyzes worms so they detach and are expelled |
|
Definition
pinworms
1. albendazole
2. mebendazole
3. pyrantel pamoate |
|
|
Term
2 for each?
1. nematodes
2. trematodes?
3. cestodes? |
|
Definition
1. nematodes: mebendazole
2. trematodes: praziquantel
3. cestodes: nicolasmide or albendazole |
|
|
Term
an obligate intracellular parasite
genetic material is either DNA or RNA
Small genome
produces multiple copies
rupture/damage the host cell |
|
Definition
|
|
Term
Viral pathogenesis:
1. attachment and penetration into ___
2. uncoating of ___
3. synthesis of ___ and ___ and ___
4. assembly of ____
5. release from ___
antiviral strategies block any of these steps
They work synergistically & avoid resistanceswhen more than one step is blocked |
|
Definition
1. host cell
2. viral nucleic acids
3. nucleic acid polymerases and nucleic acids and structural proteins
4. assembly of viral particles
5. release from host cell |
|
|
Term
| 4 classifications of antiviral agents |
|
Definition
anti-HHV
anti-hepatitis
anti-influenza
anti-retrovirus |
|
|
Term
Herpes viruses:
1&2 cause?
3 causes?
4 causes?
5 causes?
6&7 cause
8 causes? |
|
Definition
1&2 - HSV
3 - VZV
4 - espstein barr
5 - CMV
6&7 - roseolovirus
8 - kaposi's sarcoma associated HV |
|
|
Term
|
Definition
acyclovir (zovirax)- oral/IV
famciclovir (famvir)- oral
Valacyclovir (Valtrex)- oral
Foscarnet (foscavir)- IV
Penciclovir (Denavir)- topical
Trifluridine (Viroptic) - tpical |
|
|
Term
very common virus with a long latent period that can infect and damage an embryo/fetus and can cause retinitis and encephalitis in immunocompromised
most commonly presents as URI
txs:
1. myelosuppression common. Additive w/ anti-HIV drugs
2. renal toxicity |
|
Definition
CMV - HHV5
tx:
1. ganciclovir (cytovene)
2. cidofovir (vistide)
Others: foscarnet (foscavir), fomivirsen (vitravene), valganciclovir (Valcyte) |
|
|
Term
2 hepatitis viruses that can cause chronic infection?
which one is "infectious" because it can be spread by fecal-oral route
anti-hep agents? |
|
Definition
B and C
A
Lamivudine (epivir), adefovir (Hepsera), entecavir (baraclude), interferon alfa-2a (Roferon), interferon alpha-2b (intron), interferon alpha-N3 (alferon), ribavirin |
|
|
Term
| Immune cell-produced cytokines with are anti-viral and anti-neoplastic because they activate key immune system components (macrophages, NK cells, antigen-presenting T cells) |
|
Definition
|
|
Term
| anti-hepatitis toxicity for interferon and ribavirin |
|
Definition
interferon: neuropsych (contraindicated in psychosis and depression!), flu-like sx, marrow suppression, hepatic tox
Ribavirin: hemolytic anemia, teratogenic in animals
adefovir: renal tox
entecavir: renal tox |
|
|
Term
HIV:
1. about how many people are HIV+ in the US?
2. how many new cases of AIDS per year in the US?
3. 4 AIDS defining illnesses
4. 5 treatment strategies?
5. When to initiate therapy? |
|
Definition
1.1 million
2. 40,000
3. Pneumocystic penumonia, toxoplasmosis, candiasis of esophagus or bronchi, Kaposi's
4. inhibit reverse transcriptase, inhibit viral protein production, prevent viral entry into cell, prevent/treat opportunistic infections, supportive therapy
5. CD4 counts <200, diagnosis of AIDS established, |
|
|
Term
class of HIV drugs with the treatment strategy of preventing HIV from inserting its DNA into human DNA
used in pts with multi-drug resistant HIV |
|
Definition
| integrase inhibitors - Raltegravir |
|
|
Term
NRTI HIV drugs
name?
toxicity? |
|
Definition
1. NRTI: zidovudine (retrovir, AZT)
2. bone marrow toxicity, drug interactions (cimetidine, indomethacin, lorazepam, acetominaphen), pancreatitis, renal impairment, peripheral neuropathy |
|
|
Term
|
Definition
nevirapine, delaviridine, efavirenz
tox: epidermal rx (toxic epidermal necrolysis, stevens-Johnson syndrome), rash, fever, HA, elevated liver enzymes |
|
|
Term
| Protease inhibitor HIV drugs |
|
Definition
saquinavir (invirase)
drug interactions: quinidine, ergots, rifampin, benzos, inhaled steroids, st. john's wort, statins, fentanyl
hyperglycemia and hyperlipidemia (metabolic syndrome)
n/v/d, fatigue, headache, lipodystrophy, elevated liver enzymes |
|
|
Term
| Fusion inhibitor HIV drugs |
|
Definition
prevent attachment of virus
enfuvirtide, maraviroc
part of multi-drug strategy
problems: rash, injection rxn, hypersensitivity, eosinophilia |
|
|
Term
HIV tx strategy:
1. ___ are more effective, provide less risk of resistance, but are expensive. ex?
2. Options for this? |
|
Definition
1. multi-drug combos - HAART
2. A - One NNRTI, two NRTIs
B - one protease inhibitor + two NRTIs |
|
|
Term
a non-narcotic analgesic that reduces prostaglandin production
___ - Converts arachidonic acid to prostaglandins
1. __ is an irreversible Cox 1&2 inhibitor
2. ___ are reversible COX 1 & 2 inhibitors
Indication for a COX 2 inhibitor |
|
Definition
NSAIDS - COX
1. aspirin
2. all other NSAIDs
indications: arthritis in pts at high risk for PUD and low risk for CVD |
|
|
Term
___ actions:
1. thermoregulary center - anti-pyretic effect
2. thalamus/hypothalamus - analgesic effect
3. tissues - analgesic and anti-inflammatory |
|
Definition
|
|
Term
what NSAID?
analgesic, anti-pyretic equal to aspirin but minimal/zero anti-inflammatory effect
generally well-tolerated but can be HEPATOTOXIC at high doses
doses > __g for 2 days can cause liver toxicity
early sx resemble flu
new recommendations: max single dose = ___, max daily dose = ___, max dose per tablet: ___ |
|
Definition
acetaminophen
6 g
650 mg
3250 mg
325 |
|
|
Term
What drug class?
Gold salts
chloroquine, hydroxychloroquine, D-penicillamine, methotrexate, cyclosporine, cyclophosphamide, azathioprine, sulfasalazine, chlorambucil, MMF, TNF-a blocking |
|
Definition
|
|
Term
Gold salts
Indications
Side effects |
|
Definition
indications: RA
1/3 of pts have side effects: dermatitis, proteinuria/nephrosis, blood dyscrasias (agranulocytosis, aplastic anemia)
tx toxicity with dimercaprol - hastens excretion |
|
|
Term
DMARD with antimalarial agent with unknown anti-inflammatory action
- immunosuppressants and stabilizes lysosomal membranes
adverse effects: GI upset, retinitis, exacerbates gold-related dermatitis |
|
Definition
|
|
Term
DMARD that is a chelating agent. used to treat RA but probably has an immunosuppressive action
Quite nephro toxic and can cause aplastic anemia
reserved for difficult cases of RA |
|
Definition
|
|
Term
DMARD: antimetabolite and antifolate - blocks use, not synthesis of folic acid
Blocks nucleic acid production, blocks reduction of folate to folinic acid, which can be used to rescue a pt after high doses
First chemotherapeutic cure for choriocarcinoma
targets rapidly diving cells
used for RA, cancer, psoriasis, early pregnancy termination
toxicities: immunosuppressive, bone marrow effects, lymphoid tissue effects, liver tox, mucosal ulceration |
|
Definition
|
|
Term
glucocorticoids in RA tx
toxicity? |
|
Definition
have to use high doses in RA tx - cannot use alternate day dosing to prevent adrenal suppression
tox: HTN, cushing's, osteoporosis, central obesity |
|
|
Term
Targeted immunosuppressives in RA tx:
1. slows lymphocyte mitosis. reduces pain, swelling. reduces disease progression. adverse effects: anorexia, allergy, teratogenic
2. TNF-a blocker that is a geneticaly engineered fusion protein. causes injection site irritation and may have some long term safety problems as it interacts w/ TNF-B receptors to some extent and thus could lead to cancer
3. 3 TNF-a blockers
4. chimeric IgG monoclonal antibody against TNF-a. also works in severe Crohns disease. can create antibodies against this drug.
5. may help slow progression of osteoarthritis. reduces inflammaiton in RA. |
|
Definition
1. leflunomide
2. etanercept (Enbrel)
3. adalimumab (humira), etanercept (enbrel), infliximab (remicade)
4. infliximab
5. doxycycline |
|
|
Term
Recurrent, mono-articular arthritis
90% male age >30
disorder of uric acid metabolism - nucleic acid breakdown
___: nodular deposit of urate monohydrate crystals
long term can cause kidney damage |
|
Definition
|
|
Term
Gout treatment strategies:
1. ___: through diet management - reduce protein and alcohol. stop/change chemotherapy. use meds.
2. ___: colchicine. NSAIDs.
3. ___: probenecid, sulfinpyrazone |
|
Definition
reduce uric acid production
reduce inflammation
enhance urinary excretion of uric acid |
|
|
Term
2 main gout drugs that block uric acid production
1. purine analog that yields more water soluble precursor to uric acid. effective in primary and secondary gout. well-tolerated (allergic rxn, may interfere w/ azathioprine and some chemo drugs)
2. better at lowering uric acid levels but not as cost-effective as #1. similar side effects as #1.
3. anti-inflammatory effect only (reduces pain quickly but no effect on uric acid). common side effect: diarrhea. largely replaced by NSAIDs. AVOID ASPIRIN - can raise uric acid levels. avoid macrolides - can raise drug levels
4. block uric acid reabsorption from proximal tubules. generally well tolerated but maybe some GI upset. blocks secretion of penicillin and some NSAIDs |
|
Definition
allopurinol (alloprim)
febuxostat (uloric)
colchicine
uricosuric agents - probenecid, sulfipyrazone |
|
|
Term
Abrupt onset "Knock me down fever"
cough, URI like sx
headache
fever, chills x 3 days
pronounced fatigue
muscle aches
fatal 0.1% of cases - mostly >65 and <2 |
|
Definition
|
|
Term
| Unexpected benefits of flu vaccines? |
|
Definition
reduced risk of recurrent MI
50% reduction in sudden death
CVA risk reduced by 50%
50-75% reduced adverse CVD endpoints |
|
|
Term
2 prophylactic flu drugs for pts allergic to vaccine due to egg allergy or when there is a new strain that
70-90% effective
Some help w/in first 24-48 h of sx onset
mode of action uncertain
adverse effects? |
|
Definition
amantadine/rimantadine
adverse effects: insomnia, dizziness, ataxia, hallucinations, seizures
caution in uncontrolled seizure disorder and renal failure |
|
|
Term
group of anti-flu drugs that prevent the release of newly developed viral particles
Can be used for prophylaxis or treatment
work best when started less than 48 h after sx onset
1. inhaled drug that can cause airway irritation and can be fatal if given to a pt with asthma or COPD
2. can cause GI upset, cramps, nausea. needs to be taken w/ food
3. in phase III clinical trials - approved for emergency use in hospitalized pts in 2009 |
|
Definition
neuramidase inhibitor
1. zanamivir
2. oseltamivir
3. peramivir |
|
|
Term
| What flu tx influences survival the most? |
|
Definition
|
|
Term
| 3 most common forms of contraception |
|
Definition
sterilization
oral contraceptives
condoms |
|
|
Term
contraceptive efficacy of each with typical use and perfect use
none
condom
OCs
IUD
Depo-Provera
Sterilizaiton |
|
Definition
(% pregnant in 1st year of use)
None - 85%, 85%
Condom - 14%, 3%
OCs - 8%, 0.1%
IUD - 0.1-0.8%, 0.1-0.6%
Depo-provera - 0.3%, 0.3%
Sterilization - 0.1-0.05% |
|
|
Term
| Forms of male contraception |
|
Definition
1. vasectomy (permanent)
2. testosterone injections to suppress FSH, q 3-6 weeks - creates temporary azospermia or severe oligospermia. 12 week "waiting period". reversible. can cause unwanted side effects (ED)
3. |
|
|
Term
Female contraceptive strategy:
Supresses gonadotropic (FSH) release
2 kinds? |
|
Definition
steroid contraceptives (most common)
GnRH analogs (Leuprolide - Lupron) |
|
|
Term
| Most common form of combination steroid contraception? |
|
Definition
| triphasic oral contraception - amount of estogen and progesterone vary from day to day |
|
|
Term
Steroid contraceptive components:
1. Estrogens: most common form? typical dose? adverse effects? in what group are they contraindicated?
2. Progestins: typical dose? adverse effects? what type of progestin is not a good choice? cautions?
How do each of these work? |
|
Definition
most common estrogen: ethyinyl estradiol (EE2)
- dose: 10-50 mcg (most commonly 30-35)
- adverse effects: increase cltting factors, activation of R-A-A system (dose-dependent HTN risk), increased cholestasis, increased risk of endometrial hyperplasia, MI, thromboembolism
CONTRAINDICATED: smokers >35 y/o
progestin: 0.15-1.0 mcg
adverse effects: lipid changes (trigs and LDL up, HDL down), androgenic (hirsutism, acne, oily skin), dysphoria
progesterone gel or IM is not a good choice
cautions: thrombosis risk, anti-mineralcorticoid effects (increased hyperkalemia, contraindicated if taking ACE-I)
Progestins are main contraceptive: blocks ovulation, renders cervical mucus inhospitable
Estrogens control uterine bleeding |
|
|
Term
|
Definition
|
|
Term
3 non-cyclic OCs
advantages of these? |
|
Definition
seasonale
seasonique
lybrel
advantages: fewer periods helps with dysmenorrhea and endometriosis. also prevents PMS and menstrual migraines |
|
|
Term
| only BCP approved specifically to treat PMS? |
|
Definition
Yaz (EES + drospirenone)
however many other BCPs work for PMS |
|
|
Term
Contraceptive patch that must be changed weekly
150 mcg/day of norgestimate metabolite and 20 mcg of ethinyl estradiol
works well
adverse effects? |
|
Definition
ortho evra
ae: possible higher risk of DVT and PE than BCP due to higher sustained estradiol levels |
|
|
Term
vaginal ring that contains EE2 and etonogestrel
insert, leave in place for 3 weeks, remove, and insert a new one a week later
use profile similar to BCP |
|
Definition
|
|
Term
|
Definition
Estrogen: breast tenderness, nausea, weight gain
Progestin: dysphoria, breast tenderness, oily skin/acne, weight gain |
|
|
Term
If pt on OC is having breast tenderness and wants to try a new pill, what do you need to change?
If pt on OC is having dysphoria ("just isn't feeling good) and wants to try a new pill, what do you need to change? |
|
Definition
Breast tenderness: could be due to estrogen or progestin. Have to experiment
Dysphoria could only be related to progestin: try estrogen-only drug |
|
|
Term
|
Definition
1. Smokers >35 y/o
2. Undiagnosed breast tumors
3. Undiagnosed vaginal bleeding
4. Active liver disease
5. Hx of DVT
6. Pregnancy |
|
|
Term
| Things that reduce OC efficacy |
|
Definition
Large body size - need higher dose
drug interactions: St. John's wort, anticonvulsants, rifampin, anti-fungals, Abx |
|
|
Term
| OC advantages (other than birth control) |
|
Definition
reduced menstrual bleeding
reduced menstrual cramps
predictable periods
possible to have no periods
50% reduced risk endometrial and ovarian cancer |
|
|
Term
| Which OC should you pick first? |
|
Definition
Estrogen: 30-35 mcg
Progestin: "gonane" group - norgestrel, norgestimate |
|
|
Term
2 ex of progestin-only pills
problems? |
|
Definition
micronor, Nor-QD, ovrette
irregular bleeding, metabolic changes |
|
|
Term
Medroxyprogesterone acetate injection 150 mg IM every 3 mos
very effective but prominent side effects:
bleeding, weight gain, dysphoria, lipid/cardiovascular concerns, probable bone loss due to low estrogen, sexual dysfunction
Thus, low continuation rate |
|
Definition
|
|
Term
GnRH agonists that down regulate receptors, resulting in suppression of FSH and LH
Very effective but also very expensive
side effects result from hypoestrogenism: including bone loss |
|
Definition
| leuprolide (lupron), nafarelin (synarel) |
|
|
Term
IUDs:
1. copper device
2. contains progestin - less bleeding, cramping, small metabolic changes. can be used for excessive menstrual bleeding and cramping. |
|
Definition
|
|
Term
Postcoital contraceptives:
1. progestin-only pill (levonorgestrel)
2. 2 high dose OC pills and then again in 12 hrs
3. IUD insertion within __ days
e |
|
Definition
1. Plan B
2. preven or Yuzpe
3. 5 |
|
|
Term
Menopause:
- Cessation of menses for __-__ mos + elevated ___ levels (>40)
- mean age?
- factors that affect onset? |
|
Definition
- 6-12 mos, FSH
- 51
- Genetics, BMI, smoking |
|
|
Term
Goals with menopausal hormonal support (4)
Goals of general health enhancement (3) |
|
Definition
1. reduce/prevent vasomotor flushes
2. improve sleep
3. prevent bone loss
4. maintain helath of GU tract
1. CV
2. breast cancer - slight increased risk
3. cognition |
|
|
Term
| Why did the women's health initiative study stop? |
|
Definition
estrogen + progesterone - slight increased risk of MI, CVA, and breast cancer
estrogen only - 2 fold increase in DVT |
|
|
Term
|
Definition
estrogen
others: clonidine patch, progestin (MPA), SSRIs, Gabapentin |
|
|
Term
| Risks of unopposed estrogen |
|
Definition
endometrial hyperplasia and carcinoma
if pt still has uterus, must add progestin |
|
|
Term
SERMs:
1. used in breast cancer prevention and tx
2. used for osteoporosis |
|
Definition
1. tamoxifen (nolvadex)
2. raloxifene (evista) |
|
|
Term
| FDA use-in-pregnancy ratings: |
|
Definition
A: controlled studies show no risk (2%)
B: no evidence of risk in humans (50%)
C: risk cannot be ruled out (38%)- ok to use if significant benefit expected
D: positive evidence of risk (5%)- benefits MAY outweigh risk
X (5%): contraindicated |
|
|
Term
| general cautions of drugs in pregnancy |
|
Definition
vit A analogs
Antifolate meds
ACE-I, ARBs
Gonadal steroids (androgens)
anti-androgens
Chemo drugs
anticonvulsants |
|
|
Term
Androgens:
Orals: methyltestosterone, fluoxymeterone, oxandrolone (all end in -one)
Percutaneous Testosterone: androgel, testoderm, androderm, testopel (IM injection)
injections; cypionate, enenthate, prioprionate
Adverse effects
when should a man use a testosterone for andropause? |
|
Definition
liver damage
increased hct
increased libido
increased aggressiveness
oily skin/acne
prostatic hypertrophy
gynecomastia
total T <200 ng/dl + sx |
|
|
Term
What class of drugs?
reduce production of estrogens
anastrozole, letrozole, eemestane
side effects are related to hypoestrogenism
indications: breast cancer tx and prevention, ovulaiton induction |
|
Definition
|
|
Term
indications for antiandrogens?
side effects? |
|
Definition
women: hirsutism, masculinization, PCO
Men: male pattern baldness, BPH, prostate cancer
side effects: diminished libido, erectile dysfunction, decreased muscle mass, diminished sense of well-being |
|
|
Term
progesterone receptor blocker used for early (<7 weeks) pregnancy termination
can have sepsis deaths from mismanaged cases and anti-glucocorticoid receptor action (Cushing's syndrome tx) |
|
Definition
|
|
Term
Fertility drugs:
1. ex are pergonal, gonal-F, follistim, repronex, HMG, metrodin, fertinex. FSH w/ or w/o LH. expensive. risky: multiple births, hyperstimulation
2. anti-estrogenic and estrogenic properties. induces FSH and LH release from pituitary. adverse effets: ovarian cysts, reduced cervical mucus, limited growth of endometrium, vasomotor flushes. If it's going to work, it will work w/in first 3-4 mos. no value continuing beyond 6 mos |
|
Definition
1. gonadotropin injections
2. clomiphene |
|
|
Term
| 4 DNA insults that can lead to cancer |
|
Definition
Copy errors
electromagnetic dmage
Cosmic rays
chemicals |
|
|
Term
| which type of tissue is most vulnerable to cancer? |
|
Definition
| epithelium - because they are exposed to the environment and are rapidly dividing |
|
|
Term
Cancer types:
1. derived from epithelial cells (ectoderm)
2. derived from endothelial cells (endoderm)
3. derived from mesoderm
4. derived from hepatopoetic cells
5. derived from germ cells
6. undetermined origin |
|
Definition
1. epithelial = carcinoma
2. endothelial = adenocarcinoma
3. mesoderm = sarcoma
4. hematopoetic = leukemia, lymphoma
5. germ cells = seminoma, dysgerminoma
6. undetermined = anaplastic |
|
|
Term
| 3 properties of malignant cell behavior |
|
Definition
1. uncontrolled prliferation (large nutrient requirements, may outgrow vascular supply)
2. loss of differentiation & apoptosis
3. reduced repair capacity --> target of chemo |
|
|
Term
|
Definition
surgery
chemo
radiation
immunotherapy |
|
|
Term
Chemo drugs:
1. first agents were derivatives of mustard gas. effective againsted damaged DNA, esp in dividing cells. work poorly as single agents. Ex: cyclophosphamide, ifosfamide, mechlorethamine, carmustin, lomustine. side effects?
2. an antimetabolite that was the first cancer cure for choriocarcinoma. tox?
3. disrupt DNA similar to alkylating agents. consist of doxorubicin, bleomycin, dactinomycin. Suppress bone marrow. tox?
4. interrupt mitotic spindles. tox: n/v/d, alopecia, bone marrow suppression, peripheral neuropathies, hypersensitivity |
|
Definition
1. alkylating agents
Side effects: n/v/d, bone marrow suppresion, germ cell destruction, neurotox
2. MTX: bone marrow suppression, ulcers, hepatotoxic
3. antibiotics - Doxorubicin = CARDIAC TOX. Bleomycin = PULMONARY FIBROSIS. side effects can be so bad that they'll cure the cancer but kill the pt
4. microtubule inhibitors |
|
|
Term
steroid hormones for cancer tx:
1. for ALL and lymphomas
2. for breast cancer
3. aromatase inhibitors to prevent breast cancer recurrence
4. prostate cancer
5. prostate cancer
6. used as anti-emetic and to block hypersensitivity
toxicity? |
|
Definition
1. prednisone
2. tamoxifen
3. letrozole, anastrozole
4. estrogen
5. leuprolide (lupron) - GnRH agonist
6. dexamethasone (decadron)
tox: nausea, nephroox, ototox, myelosuppression |
|
|
Term
Immuno drugs for cancer:
1. available via recombinant DNA. MOA - stimuates NK lymphocytes. tox: leukopenia, thrombocytopenia, mild nephrotox, neuropsych
2. MAB against HER-2. possible cardiomyopathy |
|
Definition
1. interferons
2. trastuzumab (herceptin) |
|
|
Term
| General toxicities of chemo drugs |
|
Definition
rapidly dividing tissues:
bone marrow suppression
mucosal ulceration
scalp hair loss
hepatic tox
renal tox
cardiac tox
pulm tox
fetal tox
germ cell loss - infertility, early menopause
electrolyte imbalances
surgical complications
long term survivor problems |
|
|
Term
___ use hematologic growth factors to reduce chemo toxicity
commonly used in renal failure, cancer, aids, rheumatologic diseases, autologous donation prior to surgery, chronic disease, and athletes
toxicity? |
|
Definition
biologic response modifiers, such as erythropoeitin
rHuEpo, epoetin alfa
tox: may enhance growth of some tumors, increased blood viscosity (HTN, DVT), best to keep Hgb low, allergy |
|
|
Term
ex; pegfilgastrium
used for chemo-induced neutropenia to prevent infection in cancer pt but may cause malaise and BONE PAIN |
|
Definition
| granulocyte colony stimulating factor G-CSF |
|
|
Term
| Long term problems for cancer survivors |
|
Definition
adults survivors of childhood cancers - 62% had chronic medical condition
major joint replacement
CHF
second malignancy
severe cognitive dysfunction
coronary artery disease
CVA
renal failure
hearing loss
ovarian failure |
|
|
Term
| most permeable areas of skin? |
|
Definition
face
scalp
axila
genitals |
|
|
Term
| moistening and drying agents |
|
Definition
moistening: ointment, creams, pastes, powders
drying: tinctures, lotions, gels, aerosols |
|
|
Term
| relative potencies of topical steroid preparations |
|
Definition
lowest: hydrocortisone
low: triamcinolone acetonide (kenalog)
intermediate: hydrocortisone probutate
high: desoximetasone
Highest: clobetasol |
|
|
Term
immunosuppressive fusion protein that suppresses CD4 count and is thus contraindicated in HIV+ individuals
used for psoriasis tx
main concerns: infection, neoplasms |
|
Definition
|
|
Term
| what effect do tar compounds have? |
|
Definition
| anti-pruritic - useful in psoriasis and lichenified dermitis |
|
|
Term
ciclopirox
naftifine
terbinifine (lamisil) - liver tox
butenafine
Tolnafate
Nystatin |
|
Definition
|
|
Term
topical acne cream that requires 8-12 weeks for effect
need to use sunscreen
may have some risk in pregnancy |
|
Definition
retinoic acid
alapalene, tazarotene |
|
|
Term
oral acne tx taken with meals for 4-5 mos
reduces sebceous oil secretion dramatically
may worsen acne in first 2-6 weeks
se: chapped lips, dry skin/itching, nosebleeds, dry eyes, joint/muscle pain, temporary hair thinning, photosensitivity
Category X teratogen |
|
Definition
|
|
Term
topical acne med in OTC and prescription strengths
action at skin pore openings but may also be antibacterial
combo with abx most effective |
|
Definition
|
|
Term
dicarboxylic acid derivative acne cream w/ uncertain mode of action
will result in dryness and erythema |
|
Definition
|
|
Term
salicylic acid - irritation/ulceration, salicylism
propylene glycol
urea
phodophyllum - tincture from mandrake root. avoid in pregnancy. can cause neuropathy
flurouracil - local inflammation, pruritis, pain
aminolevulinic acid = photosensitivity |
|
Definition
| keratolytic agents for destroying lesions (warts, condyloma, actinic keratosis) |
|
|
Term
3 anti-pruritis tx
1. used in atopic dermatitis (poison ivy)
2. TCA cream that seems to have antihistamine effect. significant systemic absorption with drowsiness, aggravates narrow angle glaucoma, avoid MAOIs
3. topic anesthetic. may cause transient burning |
|
Definition
topical corticosteroids
doxepin
pramoxine |
|
|
Term
psoriasis tx
1. oral vit a derivative that is highly tertogenic - cannot donate blood w/in 3 mos of stopping tx. also liver tox (no alcohol while on tx)
2. retinoid derivative. also teratogenic. photosensititivy
3. synthetic vit D analog. hypercalcemia is rare. may cause local irritation |
|
Definition
anti-inflammatories: tar compounds, topical corticosteroids
acitretin
tazarotene
calcipotriene
alefacept |
|
|
Term
2 hair growth promoters
1 hair growth inhibitor |
|
Definition
topical minoxidil (rogaine)
finasteride (propecia)
eflornithin (vaniqa) |
|
|
Term
Risks of OTC meds:
1. risk of ___ in using aspiring in kids/teens with viral illness
2. risk for pts w/ htn, T1DM, and hyperthyroidism
3. CYP450 inhibition - increased blood levels of phenytoin, warfarin, and others
4. risk of ___ using topical nasal decongestants >3 days
5. ___ with ethanol-containing liquids and first gen antihistamines
6. ____ can increase BP by 5 mm Hg
7. ___ are associated with increased risk of prostate cancer
8. first generation antihistamines have anticholinergic action which is a risk factor for ___ in older pts |
|
Definition
1. Reye's syndrome
2. sympathomimetics (pseudoephrdrine)
3. cimetidine (tagomet)-caused reactions
4. reactive hyperemia
5. sedation
6. NSAIDs
7. Vit E supplements
8. dementia |
|
|
Term
|
Definition
HTN
lowered seizure threshold
increased risk of MI and CVA |
|
|
Term
|
Definition
photosensitivity
mania
hyperactivity
redueced effectiveness of steroid contraceptives! |
|
|
Term
1. Thioamides (PTU) block ____
2. Low TSH level in a pt with hypothyroidism?
3. GnRH agonist does what to LH production?
4. prazosin has what adverse effects?
5. Pradaxa is set to overtake ___
6. alpha blockers are used to treat?
7. can use __ instead of aspirin
8. TTP alteplse can be used for ___
9. hypokalemia results from ___, hyperkalemia results from ____
10. ACE-I/ARB block ___ production |
|
Definition
1. synthesis
2. too much levothyroxine
3. no LH
4. rebound tachy + postural hypotension
5. coumadin
6. BPH
7. plavix
8. MI
9. diuretics, ACE-I
10. aldosterone |
|
|
Term
1. ___ can result in rhabdo and liver damage and should not be used in pregnancy
2. ACE/ARB contraindication?
3. HTN emergency tx?
4. vasovagal syncope can be treated with?
5. scopolamine has ___ effects
6. ___ can be used to lessen hypokalemia caused by diuretics
7. Why can't nitrates be used with sildenafil?
8. migraines, hyperthyroid, CAD, and HTN can all be treated with ?
9. if pt has asthma, must use ___ beta blocker
10. __ is an osmotic diruetic |
|
Definition
1. statins
2. pregnancy
3. nitroprusside
4. atropine
5. anticholinergic
6. spironolactone
7. hypotension
8. B-blockers
9. selective
10. mannitol |
|
|
Term
1. if you're giving oral iron, add vit __-
2. if you're giving niacin, add ___
3. what happens if a drug's CYP450 is inhibited?
4. if pt has neuro sx, check __ levels
5. iron overdose can cause ___
6. EPO causes a risk of ___
7. antithrombin III = what drug?
8. heparin can lead to ____
9. prednisone rebound = reduced ability to ___
10. ___ = HTN, weight gain, bone loss, ulcers |
|
Definition
1. C
2. aspirin
3. toxic, OD effects
4. b12
5. necrotizing enteritis
6.thrombosis
7. heparin
8. thrombocytopenia
9. fight stress
10. prednisone |
|
|
Term
1. what drug affects vit K?
2. to counter heparin effects, use ___
3. a fib tx?
4. a fib anticoagulant?
5. cox-2 inhibitor increases risk of
6. tylenol has no ___ effect
7. Li- in mab = ?
8. LMWH is good because?
9. most powerful anti emetic?
10. amoxicillin has better gram __ coverage |
|
Definition
1. warfarin
2. protamine
3. bblocker
4. warfarin
5. MI
6. anti-inflammatory
7. immune drug
8. less monitoring - outpt
9. serotonin antagonist
10. negative |
|
|
Term
1. why is an ssri better than a tca?
2. propoxyphene causes __ tox
3. anticholinergic effect?
4. best abx for gram neg infection?
5. what abx are ok in pregnancy?
6. what abx is a protein inhibitor?
7. 1st generation antipsychotic side effects?
8. Morphine is DEA class?
9. mixing an agonnist with a mixed opiate creates a ?
10. contraindication for morphine? |
|
Definition
1. less risk of OD
2. cardiac
3. dry mouth
4. aminoglycoside
5. macrolides
6. erythromycin
7. extrapyramidal
8. II
9. antagonist
10 . increased ICP |
|
|
Term
1. parkinsons tx should be target at?
2. __ is an antiinflammatory abx
3. MS tx?
4. alzheimer's tx?
5. why was rosiglitazone taken off the market?
6. most powerful gastric acid suppressor?
7. why do NSAIDs cause gastric upset?
8. contraindication for misoprostol?
9. asthma drug for acute attack?
10. Only AE of ICS? |
|
Definition
1. anticholinergic - increased dopamine
2. TCN
3. IVIG
4. acetylcholinesterase inhibitor
5. increase in MIs
6. PPI
7. anti-prostaglandin
8. pregnancy
9. saba
10. thrush |
|
|
Term
1. monteleukast is a ___
2. epinephrine contra
3. estrogen effects on bone?
4. indication for bisphosphonates
5. what abx cross reacts w/ penicillin?
6. aminoglycoside tox?
7. fluoroquinolones cause ___
8. would you continue phenytoin in pregnant pt?
9. ipratropirum indication?
10. dexamethasone/zofran indication |
|
Definition
1. leukotriene modulator for asthma
2. pregnancy
3. increases bone density and decreases fx rate
4. osteoporosis
5. cephalosporins
6. ototox
7. tendon rupture
8. yes if many seizures
9. COPD/asthma
10. n/v for chemo |
|
|
Term
1. metformin tox?
2. doxycycline side effect?
3. What happens if you eat dairy/cheese on MAOI?
4. contraindication for dopamine agonist?
5. INH tox?
6. drug wtih a beta-lactam ring
7. drug with anti-beta lactamase |
|
Definition
1. lactic acidosis, GI upset
2. discolored teeth
3. tyramine storm
4. psychosis
5. hepatic/peripheral neuropathy
6. PCN
7. clavulanic acid |
|
|
