Daunorubicin

(same as doxorubixin)

MOA:intercalation--> DNA breaks

Used in: hodgkin's, myelomas, sarcomas, hard tumors 

Toxicity:Cardiotoxicity (use dexrazoxane as iron chelator) , alopecia 

estrogen antagonist for estrogen sensitive tumors

Aromatase inhibitor

breast cancer in postmenupause women

non steroid competative androgen antagonist 

used in prostate cancer 

(flu w/ Leu--- floor, lights)

GnRH (pusitle = analog vs continuous= down reg GnRH receptors--> less FSH, LH) 

Use: infertility, uterine fibroids (leiomyoma in myometrium) , percocious pubert, Prostate cancer (w/ Flutamide), 

Adverse: anti- androgen, vomiting 

Class: folic acid analog

MOA: A prodrug that  blocks dihydrofolate reductase (S phase-all anti- metabolites are)

Use: L&L , choriocarcinoma, sarcoma, Abortion, ectopic preg, R. arthritis 

can be given Intrathecal

Antidote: Leucovorin (folic acid that doesnt need activation, so unaffected by methotrexate)

Toxicity: Macro-vesicular fatty liver, teratogenic, myelosupression (leucovorin rescue), mucositis

Class: Alkylating agent CCNS

Use: solid tumor, CNS, Leukemia, lymohoma, 

MOA:  cross-links DNA --> Apoptosis

PK:  liver splices to phosphoramide mustard + acrolein 

Antidote: Mesna binds toxic acrolein

Toxicity: severe BM, hemorragic cystitis 

MOA: binds DNA bases--> crosslinks

Use: ovarian , testicular , lung , bladder

Antidote: amifostine prevents nephrotoxicty (ROS scavanger)

Toxicity: Ototoxicity, nephrotoxicity,

G2

MOA:  radical formation,ntercalates in DNA

Use: solid tumors, L&L 

Antidote:  Dexrazonxane (iron chelator for cardiomyopathy) 

Toxicity: severe dilated cardiomyopathy, lowers BM  

 G2 

Uses: hodkins, testicular cancer

MOA: ROS

Toxicity: Pulmonary toxicity,No BM suppresion 

Class: Vinca alkaloids (hypersensitivity)

MOA: M phase, binds tubulin and blocks polymerization of microtubules

Use: non hodgkin, hodgkin, ALL

PD: Peripheral nephropathy neurotoxicity, NO BM SUPRESSION

Class: vinca alkaloids

Use: testicular cancer, hodgkin

MOA: M phase, binds tubulin--> no microtubules  

PD: BM supression

S, G2

MOA: -- Inhibits topoisomerase II (cuts DNA in synthesis)--> DNA destroyed 

Uses: Solid tumors, L&L 

Adverse: *yrs later AML*,  low BM, G.I irritation

M-Phase

Class: Taxol 

MOA:  stablizes microtubules (no anaphase)

Use: breast cancer, ovarian cancer 

Adverse:  low BM, severe hypersensitivity

Tamoxifen

(raloxifene identical only diff is that this one is not agonist at endometrium so cant ^ risk of endometrial cancer ) 

MOA: SERM (antagonist at estrogen receptor, agonist at bone) 

Use: breast cancer, prevent osteoporosis

Toxicity: ^ risk of endometrial carcinoma (hot flash) agonist at endometrium 

aka:

MOA: Ig against HER2 growth receptor

Use: specific breast cancers

Toxicity: cardiac failure 

MOA: 5-alpha reductase (T--> DHT)

Use: BPH, balding

Adverse: gynocomastia 

competative inhibitor of progesterone receptor

Use: abortion w/ misoprostol (PGE1- ^ contraction of myometrium) 

Adverse:  vomiting, heavy bleeding, 

Glucocorticoid

MOA: inhibits phospholipase A2 --> low leukotrienes, low prostaglandings 

Use: lower immune, Addision Disease (mimics cortisol)

Adverse: Cushing 

Estrogens

(Ethinyl Estrodiol, DES, mestranol)

MOA: binds estrogen receptor

Use: hypogonads, ovarian failure, menstrual abnormalities, HRT in post menupause, men androgen dependent cancer

Adverse: ^ risk of endometrial cancer, thrombi, clear cell adenocarcinoma--(DES) 

C/I: DVT, estrogen tumor 

Distractors in Turnbull drug sheet:

Pamidronate

Zoledronic acid, pamidronate

Oxandrolone 

P- osteoporosis

Z,P-- used in skeletal metastasis, hypercalcemia in patients with breast cancer (or osteolytic lesions in Mulitple myeloma)

O- anabolic steroid of DHT but more anabolic than androgenic--used in wasting disease in AIDS, testical atrophy

MOA: blocks androgen receptor  (many more MOA) 

Use: prevent hirsutism

Adverse: gynocomastia, amenorrhea

Abortion at 1st trimester, < 49 days

Pharm treatment?

Mifepristone (progesterone receptor antagonist, detachement of blastocyst) vs Methotrexate (anti-folate)  followed by misoprostol (PGE1 analog = ^ contraction of uterus) 

Mife vs MTX: 2 days vs 5 days wait for misoprostol 

Adverse: fever, diarrhea, bleeding 

Treatment to delay labor (before the crucial 34 wks) 

Treatment?

Fetus Treatment ? 

Mother

Tocolytics (uterine relaxants) for 48 hrs to give fetus time 

Terbutaline (Beta-2) vs Nifedipine (Ca channel block) vs Indomethacin ( low prostaglandins--> less contraction) 

Fetus

Betamethasone, Dexamethasone (long acting, less protein bound, 11-8 hydroxysteriod dehydrogenase in placenta cant barely inactivates)

Adverse: Nifedipine (vessel dilation problem: flushing, dizzy, nausea, ^ HR) Indomethacin (fetus: ductus arteriosus)

Induction and Maintenance of Labor 

Treatment?

Step1: Misoprostol (PGE1), Dinoprostone (PGE2)--- intravaginal, ^ ripening of cervix

Step 2: Oxytoxin, upper uterus contraction, lower uterus relaxes. very short T 1/2 & adverse are dose dependent (^ ADH, water intox, contraction ruptures uterus) 

Postpartum Hemorrhage

Treatment?

Sequence of use 

1) Oxytocin (IV)

2) Oxytocin + Ergonovine (IM),partial 5-HT2 agonist & alpha= sustained universal contraction)**

3) above + Misoprostol (rectal)

** C/I: HTN, sepsis, liver & kidney disease

Drugs that: ^ lactation vs lactation supression 

Estrogen is C/I immediate wks due to : milk supression, ^ risk of coagulation condition (progestin ok) 

Dopamine antagonist: Metoclopramide, Domperidone (milk)

Dopamine Agonist: Bromocriptine, cabergoline 

Endometriosis Treatment focus: pain and controlling size

Limitions: ^ recurrence, sucks at fixing endometriosis related infertility, No Contraceptives for 35 yr smoker

Size control

Mild: Combined oral contraceptives, progestins 

Severe: leuprolide,goserelin,Nafarelin** ( GnRH agonist), Anastrozole  (aromatase inhibitor, inhibits extra-ovarian estrogen production) 

Danazol discontinued, ^ adverse 

Pain- NSAIDS, above work on pain indirectly

** Adverse: bone loss (bisphosphonate, raloxifene) vasomotor symptoms 

Polycystic Ovarian Syndrome 

Symptoms treated related to androgenicity:  infertility, hirsutism, acne

Tx for hirsutism + acne

1) Combind OC: lower testosterone(T)  by lowering ovarian androgen secretion, ^ sex hormone binding globulin 

2) combined OC + Spironoactone* (weak but : androgen receptor antagonist, inhibits T synthesis, inhibits 5-alpha reductase, also antagonist at aldosterone receptor ) Hepatotoxic*

3) finasteride, flutamide (or GnRH agonist alone + estrogen replacement) 

Tx for Infertility:

Clomiphene ( inhibits estrogen receptors in hypothalamus & anterior pituitary)--> ^FSH, LH)

Metformin: corrects ^ insulin in this peeps, may promote ovulation ( ^ glycolysis,  ^ glucose uptake, lower gluconeogenis, adverse: lactic acidosis

Menopause

Symptoms are vasomotor, osteoporosis 

PK of Horomone replacement therapy:

transdermal:  if hypertriglyceridemia, liver & gall bladder disease, (17beta-estradiol + NETA- oral too) 

gel: if vaginal atrophy only problem (17beta-estradiol)

(+ progesterone if still have uterus)  

Osteoporosis:

1st line: bisphosphonates 

IV, IM Bactericidal, acid liabile

MOA: binds Penicillin binding protein (transpetidase, no cross-link), activates autolytic enzymes

Use: Neisseria Meningitis (rifampin in carriers) , Syphyllis, Actinomycosis (lumpy jaw), (probenecid given to lower kidney excretion)

Adverse: allergy, hemolytic anemia 

Resistance: B-lactamase cleaves B-lactam ring

Penicillin

syphyllis 

IV (if allergic give vancomycin) 

Penicillinase resistance (due to bulky R- group) penicillin 

Use: s. aureus , except MRSA (alters PBP-drug site) also strep

Adverse:  Interstitial nephritis

(naf w/ staph)

oral

Penicillinase resistance (due to bulky R- group) penicillin 

Use: S. aureus except MRSA (alters PBP-drug site)

Adverse:  Interstitial nephritis

 w/ clavulanic acid (time dependet conc. so more than 1), W/ Cetriaxone cover all 

USE: HELPSS enterococci

(H. influenza, E.coli, Listeria, Proteaus, Salmonella, shigella)

Adverse: Mono-Rash, pseudomembranous colitis (ampicillin is more prone to do this than amoxicillin= better oral)

Penicillin (antipseudomonas) + clavulanic acid

Use: G- rods,pseudomonas

synergistic effect with aminoglycoside

Adverse: allergy (like all penicillin), bleeding

1st genCephalosporins B-lactam drug that inhibits cell wall synthesis + resitant to penicillase, Bactericidal

Use: PEcK (proteaus, E.coli, Klebsiella pneumonia

Dont treat LAME

(listeria, atypicals, *MRSA*, enterococci)

Adverse:pseudomembranous colitis,  nephrotoxcity, allergy

2nd genCephalosporins B-lactam drug that inhibits cell wall synthesis + resitant to penicillase, Bactericidal

Use: HEN PEcK (H.influenza, enterobacter, Neisseria, proteaus, E.coli, Klebsiella pneumonia

Cefuroxime: vs Cefoxitin (B. fragilis, mixed anaerobic infections--PID, peritonitis)

Dont treat LAME

(listeria, atypicals, *MRSA*, enterococci)

Adverse: pseudomembranous colitis,  nephrotoxcity, allergy  

Ceftriaxone

vs

Ceftazidime

vs

Cefotaxime

3rd gen Cephalosporins (^ potent, ^ resistant, ^ CNS penetration)

Use: Meningitis, gonarrhea (ceftriaxone, G- resistant to other B-lactams), Pseudomonas Ceftazidime 

Cefrtiaxone : best for imperical therapy for meningitis C/I in neonates, competes w/ bilirubin binding--> kenicterus)

Dont treat LAME

(listeria, atypicals, *MRSA*, enterococci)

Adverse: pseudomembranous colitis,  nephrotoxcity, allergy

4th gen Cephalosporins B-lactam drug that inhibits cell wall synthesis + resitant to penicillase, Bactericidal

Use: Pseudomonas, G+

Dont treat LAME

(listeria, atypicals, *MRSA*, enterococci)

Adverse: lowers vit K, ^ nephrotoxcity of aminoglycosides (low cross-reactivity w/ aspirin)

Imipenem + cilastin

(inhibits enzyme in kidney = no inactivation) 

vs 

Meropenem

Broad B-lactamase resistant carbapenem (sick patient, many bugs, resistant to treatment)

Use: all except MRSA, enterobacter (imipenem drug of choice)

Adverse: cross rxn other antibiotics, rash, seizures at ^ conc (Meropenem has a lower risk of seizures)

Resistant B-lactamase Monobactam

MOA: blocks cross linking by binding PBP3

Use: G- rods (H.influenza, pseudomonas) ONLY

 penicillin allergy, kidneys cant withstand aminoglycosides 

D-D: Synergistic w/ aminoglycosides

MOA: binds D-ala D-ala of cell wall precursor (resitance: D-ala D-lac)

USE: G+ ONLY (due to aquaporin) big dogs ( MRSA, enterococci-endocarditis, C. difficile) 

poor oral so good for C.difficile enterocolitis

Adverse: nephrotoxicity, ototoxicity, RED MAN

Beta lactamase inhibitor (also clavulanic acid )

Amoxicillin + Clavulanic = oral

Ticarcillin + clavulanic = IV

Ampicillin + sulbactam = I

1)Methicillin sensitive= Nafcillin, dicloxacillin

2) resistant to 1 = Vancomycin, daptomycin, tigecycline

3) Resistant to vancomycin: Linezolid, Quinupristin, Dalfopristin

Aminoglycoside 

Bactericidal 

MOA: binds 30 subunit inhibits assembly + translocation

USE: aerobic G- rods (G+ w/ others) Most commonly used 

PK: long postantibiotic effect, synergistic w/ cell wall synthesis inhibitors, IV or oral if G.I , no CNS, excreted unchanged in urine

Resistance: transferase enzyme adds functional group

Adverse: Nephrotoxicity (Amp-B, vancomycin) , otoxicity (furosemide)

Aminoglycoside 

Bactericidal 

MOA: binds 30 subunit inhibits assembly + translocation

USE: aerobic G- rods (G+ w/ others)

PK: long postantibiotic effect, synergistic w/ cell wall synthesis inhibitors, IV or oral if G.I , no CNS, excreted unchanged in urine

Resistance: transferase enzyme adds functional group

Adverse: Nephrotoxicity (Amp-B, vancomycin) , otoxicity (furosemide)

Aminoglycoside 

Bactericidal 

MOA: binds 30 subunit inhibits assembly + translocation

USE: serious G- rod,MDR TB aerobic G- rods (G+ w/ others)

PK: long postantibiotic effect, synergistic w/ cell wall synthesis inhibitors, IV or oral if G.I , no CNS, excreted unchanged in urine

Resistance: transferase enzyme adds functional group, HIGHLY RESISTANT 

Adverse: Nephrotoxicity (Amp-B, vancomycin) , otoxicity (furosemide)

Aminoglycoside 

Bactericidal 

MOA: binds 30 subunit inhibits assembly + translocation

USE: aerobic G- rods (G+ w/ others), P.aeruginosa (w/ piperacillin + tobramycin) 

PK: long postantibiotic effect, synergistic w/ cell wall synthesis inhibitors, IV or oral if G.I , no CNS, excreted unchanged in urine

Resistance: transferase enzyme adds functional group

Adverse: Nephrotoxicity (Amp-B, vancomycin) , otoxicity (furosemide)

Aminoglycoside 

Bactericidal 

MOA: binds 30 subunit inhibits assembly + translocation

USE: aerobic G- rods (G+ w/ others) M. tuberculosis, yersinia pestis, Francisella tularemia 

PK: long postantibiotic effect, synergistic w/ cell wall synthesis inhibitors, IV or oral if G.I , no CNS, excreted unchanged in urine

Resistance: transferase enzyme adds functional group

Adverse: Nephrotoxicity (Amp-B, vancomycin) , otoxicity (furosemide)

 Tetracycline, Bacteriostatic 

Use: All, Atypicals (lyme), (ex: proteus, pseudomonas),Protozoa (malaria), Chlamydial (#1),Acne, H. pylori

MOA: 50s, no tRNA to A site 

Adverse: Superinfections, bone and teeth formation (brown)

Resistance : efflux pump 

 Tetracycline, Bacteriostatic 

Use: All, Atypicals (lyme), (ex: proteus, pseudomonas),Protozoa (malaria), Chlamydial (#1),Acne, H. pylori

Pk: only one in class can give in renal disease 

MOA: 50s, no tRNA to A site 

Adverse: Superinfections, bone and teeth formation (brown)

Resistance : efflux pump 

 Tetracycline, Bacteriostatic 

Use: All, Atypicals (lyme), (ex: proteus, pseudomonas),Protozoa (malaria), Chlamydial (#1),Acne, H. pylori

MOA: 50s, no tRNA to A site 

Pk: induces Nephrogenic diabetes insipidus 

Adverse: Superinfections, bone and teeth formation (brown)

Resistance : efflux pump 

Glycycycline-30 subunit, 30S, bacteriostatic 

Use: MRSA, vancomycin-resistant enteroccoci, MDR strep pneumoniae (no proteus, pseudo)

D-D:Warfarin lowers clearance

Adverse: Nausea vomiting

(metformin, exanatide too)

50S subunit, bacteriostatic 

Use: broad, limit use

D-D: prolongs T1/2 of phenytoin, warfarin, tolbutamide

Adverse: BM suppression, gray baby syndrome

similar to lincomycin 

Use: Bacteroides Fragilis (G- rod, anaerobic), G+ cocci (alternate to strep, staph) 

Adverse: Pseudomembranous colitis (^ Clostridium difficile) 

novel antibiotic

MOA: binds P site of 50S

Use: G+ (MSSA,MRSA, VRE, VR S.aureus) 

D-D: inhibits MAO, hypoglycemia w/ oral insulin

Adverse: BM suppression, lactic acidosis, peripheral, optic neuropathy

novel antibiotics, both 50S

Use: G+ cocci  ( VR Staph, E. faecium) 

PK: inhibits CYP, bactericidal, long postantibiotic effect 

Sulfonamide, together Bactericidal

MOA: analog of PABA (--> folic acid) 

Use: UTI (e.coli), Pneumocystis jiroveci (#1, pneumonia in HIV) 

Adverse:Hypersensitivity rxn (SJ, etc), Hemolysis if G6PD deficien, Aseptic meningitis

Sulfonamide, topical

MOA:  inhibits dihydropteroate synthetase (no PABA) 

Use:used on burns or ulcers to prevent  bac + fungi

Adverse:Hypersensitivity rxn (SJ, etc), Hemolysis if G6PD deficient  

Sulfonamide

MOA: ?

Use: ulverative colitis, R. arthritis

Adverse:Hypersensitivity rxn (SJ, etc), Hemolysis if G6PD deficient   

Use: anerobic organism  (B. fragilis , C.difficile, H. pylori)

MOA:  reduced inside --> links to cysteine bearing enzymes

Adverse: metallic taste, disulfiram-like rxn w/ alcohol, superinfections

urinary antiseptic

MOA: at low urine pH (so no proteaus) --> formaldehyde kills

Urinary antiseptic

MOA: converted to ROS--> DNA damage

Adverse: G6PD deficiency (hemolytic anemia)

Amphotericin B

(Deoxycholate formulation- drug choice)

Antifungal Polyenes

IV,IM, intrathecal (poor CNS distribution), intr-articular, topical

Use: all fungi

PD: low therapeutic index

MOA: binds ergosterol on cell membrane--> pores

Adverse: Nephrotoxicity

Resistance: modified on ^ eflux

Antifungal Polyenes

topical (cream, powder, oral--dissolves in mouth,vagina tablet)-LOCAL

Use: candida albican only

MOA: binds ergosterol on cell membrane--> pores

Resistance: modified on ^ eflux

PK: distributed into CNS % eye, T1/2: 5 hrs but 200 if bad kidneys

Use in combo: deep candida infection, cryptoccocal meningitis, chromomycosis

MOA: Fungi does 5-FC --> 5-FU --> 5-FUMP-->

1) 5-FdUMP = inhibits DNA synthesis  thymidylate synthase(U-->T)

2) 5-FUTP: incorporated in RNA = inhibits RNA synthesis

Resistance: low enzymes conc to make 5-FUMP

Antifungal Azole

Topical : oral, vagina,

Use: Candidas, tinea cruris (jock itch), tinea pedis (athlete's foot)

MOA: inhibits fungi P450 (no lanosterol--> ergosterol)

Resistance: cross-resistance in azole class, alters P450 enzyme or alters drug

Antifungal Azole

Topical : oral, vagina,

Use:  candidemia, vaginal & Esophageal candidiasis (1# choice),

MOA: inhibits fungi P450 (no lanosterol--> ergosterol)

Adverse: hepatic failure, torsades de pointes, seizures, stevenjohnson syndrome  

Resistance: cross-resistance in azole class, alters P450 enzyme or alters drug

Antifungal Azole

Topical : oral, vagina,

Use: life threatening systemic mycoses (like amp-B)

MOA: inhibits fungi P450 (no lanosterol--> ergosterol)

Adverse: CHF, hepatitis, pancreatitis  

Resistance: cross-resistance in azole class, alters P450 enzyme or alters drug

  Voriconazole

(not in flashcards, just another azole: Miconazole )

Antifungal Azole

Topical : oral, vagina,

Use: Invasive aspergillosis ( 1#)

MOA: inhibits fungi P450 (no lanosterol--> ergosterol)

Adverse:  visual changes, acute resp fail, cardio, liver

Resistance: cross-resistance in azole class, alters P450 enzyme or alters drug

Echinocandins

IV

MOA: inhibits glucan synthase (inhibits cell WALL)

Adverse: hypokalemia, inflammation of vessel, pancreatis, hepatic, renal

Resistance: mutation to drug

Micafungin

(another one in list, not on cards: Caspofungin)

Echinocandins

IV

MOA: inhibits glucan synthase (inhibits cell WALL)

Use: prophylaxis in BM transplant

Resistance: mutation to drug

oral w/ fatty meal

Bacteristatic

PK: exclusively in keratinized tissue

MOA:keratin shield, disrupts mitotic spindle 

Use: Dermatophytes of hair(wks) skin & nails (months)

Adverse: rash 

 (leukopenia, lupus etc rare)

oral

Bactericidal

PK: keratinized tissue + fat

MOA:keratin shield, inhibits squalene epoxidase (no ergosterol--> ^squalene =toxic)

Use: Dermatophytes: 90% cure of onychomycosis

Adverse: severe liver (rare)

Ciclopirox

vs

Undecylenic Acid

Both topical, use on dermatophytes especially

mild to moderate onychomycosis

vs

 especially tinea pedis, corporis

Topical- anti-infective

MOA: de-P of lipid carrier bactoprenol 

Use: Bacterial dermatosis staph in nares, wounds ect 

Topical/ Bactericidal

MOA: inhibits bacterial isoleucyl- tRNA synthetase 

Use: Imetigo, MRSA colonization 

Resistance: different tRNA-carrier, associated with nosocomial outbreaks of Staph

Topical /Bacteristatic 

MOA: inhibits 50S 

Use: Acne vulgaris (Propionibacterium acne) 

Resistance : change in ribosome 

topical/ bacteristatic

MOA: comp inhibition of PABA = no folic acid

Use: seborrheic dermatitis, acne vulgaris  

MOA: complexes with FKBP-12 --> inhibits calcineurin phosphatase activity (no T-cell activation, no IgE mediated mast cells)

Use: atopic dermatitis 

MOA: inhibition of tyrosinase ( no melanin) 

Use: reduces melanin hyperpigmentation 

Oral, topical 

PK: T 1/2 = 1 hr but 8-12 when exposed to light

MOA: photoactivated by UVA--> 1) added to pyrimidine base 2) ROS (O2-) to lymphocytes outside body and reintroduced --> ^ suppressor T cells, immune response to T cells

Use: Psoriasis, vitiligo

Topical 

MOA: ROS oxidizes proteins of bacteria in sebaceous follicles 

Use: Acne vulgaris  (P.acne) 

IM 

MOA: binds CD2 on lymphocytes = no binding to LF3A = no T cell activation

Use: severe psoriasis 

Adverse: lymphopenia 

MOA: agonist at Vit D receptor (nuclear) (like retnoid)

Use: Psoriasis 

Betamethasone 

Clobetasol

Hydrocortisone 

Triamcinolone 

Dermatology 

Absorption: ^^^ scrotal skin > vulvar> forehead> scalp

100% bioavailability 

Adverse: Cushing 

MOA: keratolytic agent, antipruritic 

Use: Psoriasis, seborrheic dermatitis 

alternative to glucocorticoids 

Aminolevulinic Acid/Methylaminolevulinate  (AM)

Fluorouracil 

Podophyllum 

Keratolytic/ Topical 

MOA: unknown, AM is converted inot protoporhyrin and light --> ^ -O, promotes apoptosis 

Use: warts, calluses, corns, seborrheic dermatitis, photorejuvention, non-melanoma cancer, kaposi

Adverse: salicylism + death = children, complete avoidance of sun for 2 days

alitretinoin

Becarotene

iuse in dermatology?

Oral

MOA: inhibits histone deacetylase ( normally it causes DNA wrapped more tighly 

Use: cutaneous T cell lymphoma, MM, mesothelioma 

Adverse: Diarrhea, thrombocytopenia 

Diphtheria toxin complexed with IL-2 receptor binding molecule

MOA: binds IL-2R on activated Tcell--> endocytosis--> ADP ribosylation of EF2

Use: advanced cutaneous or peripheral T cell lymphoma

>20%  of T cells expressing CD25 

Adverse: Hypoalbuminemia, infection, capillary leak 

MOA: comp antagonist of PABA, inhibits respiratory burst from myeloperoxidase, inhibits neutrophil migration, blocks Ig adherence to neutrophils 

Use: Leprosy, dermatitis herpetiformis 

topical

MOA: vanilloid-1 agonist --> down regulated --> less substance P 

Use: neuropathic pain in DM, HIV