B7 Pharm exam 1 high yield stuff (1-3)

Alcoholism

Most common acquired cause of sideroblastic anemia?

↑ Iron, ↑ Ferritin, ↓ TIBC

Iron studies in sideroblastic anemia?

Pyridoxine (Vitamin B6)

Treatment for sideroblastic anemia?

↓ Iron, ↓ Ferritin, ↑ TIBC

Lab findings in iron deficiency anemia?

PO iron

First-line treatment for iron deficiency anemia?

Ferrous sulfate

Most commonly used oral iron formulation?

Duodenum

Where is iron absorbed?

Antacids, PPIs, H2 blockers

What decreases oral iron absorption?

Accidental iron overdose

Leading cause of fatal poisoning in children <6 years?

Deferoxamine

Antidote for iron toxicity?

Iron dextran

Which IV iron requires a test dose due to anaphylaxis risk?

Ferumoxytol

Which IV iron interferes with MRI?

dTMP cycle (DNA synthesis)

What pathway do folate and B12 support?

Megaloblastic anemia

What type of anemia results from folate or B12 deficiency?

Pernicious anemia

Most common cause of B12 deficiency?

Paresthesias, gait difficulty, dementia

Neurologic symptoms specific to B12 deficiency?

Methotrexate, trimethoprim, pyrimethamine

Which drugs reduce folate levels (DHFR inhibitors)?

Leucovorin (folinic acid)

Rescue agent for methotrexate toxicity?

Inflammation → ↑ Hepcidin → ↓ iron release & absorption

Mechanism of anemia of chronic disease?

↓ Iron, ↓ TIBC, ↑ Ferritin

Lab findings in anemia of chronic disease?

pancytopenia

Key lab finding in aplastic anemia?

↑ Risk of death, MI, stroke

Major cardiovascular risk of ESAs?

11 g/dL

Hemoglobin level above which CKD patients have increased CV risk on ESAs?

Methoxy-polyethylene glycol-epoetin beta

Longest-acting ESA?

bone pain

Most common adverse effect of filgrastim?

hepatotoxicity

Serious risk of eltrombopag?

↑ HbF → ↓ HbS polymerization

Mechanism of hydroxyurea in sickle cell disease?

P-selectin blocker

Mechanism of crizanlizumab?

Inhibits HbS polymerization → ↓ sickling

Mechanism of voxelotor?

P. falciparum

Most common and most severe Plasmodium species?

P. falciparum

Severe malaria is most associated with which species?

drug resistance

Major issue in malaria treatment worldwide?

HbS carrier

What hemoglobin variant protects against malaria?

G6PD deficiency (A-form)

What enzyme deficiency protects against malaria?

Duffy-negative phenotype

What blood group phenotype protects against P. vivax?

NO

Do any drugs act on sporozoites?

Primaquine, Tafenoquine, Atovaquone/Proguanil

Drugs active against primary/developing tissue schizonts?

Primaquine, Tafenoquine

Drugs active against latent hypnozoites?

Chloroquine, Artemisinin derivatives, Quinine/Quinidine, Mefloquine, Tetracyclines, Clindamycin, Atovaquone/Proguanil

Drugs active against blood schizonts?

Primaquine, Tafenoquine, Artemisinin, Chloroquine, Quinine

Drugs with gametocidal activity?

Prevents heme → hemozoin conversion → toxic heme buildup

Mechanism of chloroquine?

Retinal toxicity

Key toxicity with chloroquine (long-term/high dose)?

G6PD deficiency

What genetic deficiency increases hemolysis risk with chloroquine?

QT prolongation

Important cardiac risk with chloroquine?

pfCRT mutation → ↑ drug efflux

Mechanism of chloroquine resistance in P. falciparum?

Artemisinin derivatives

First-line for chloroquine-resistant P. falciparum?

Endoperoxide cleavage → free radical damage

Mechanism of artemisinins?

NO — must use in combination

Should artemisinin be used alone?

Neutropenia, hemolysis, ↑ LFTs

Serious lab abnormalities with artemisinin?

Cinchonism (tinnitus, HA, GI upset, vision changes)

Classic toxicity of quinine?

Blackwater fever (intravascular hemolysis)

Life-threatening complication of quinine?

resistance risk

Why is quinine not used for prophylaxis?

Depression, psychosis, seizure disorders

Major psychiatric contraindication for mefloquine?

QT prolongation

Major cardiac risk of mefloquine?

G6PD level

What MUST be tested before starting primaquine or tafenoquine?

Hemolytic anemia

Major serious complication if given in G6PD deficiency?

Radical cure of P. vivax/ovale

What is primaquine used for?

DHFR inhibition → ↓ DNA synthesis

Mechanism of proguanil?

Rifamycins ↓ efficacy

Major interaction with atovaquone?

Chemo kills a constant FRACTION of tumor cells

What does the Log-Cell Kill Hypothesis state?

Ability to target cancer cells over normal cells

What is selective toxicity?

P-glycoprotein (MDR1)

What protein mediates multi-drug resistance?

Energy-dependent drug efflux pump

Mechanism of P-glycoprotein?

Myelosuppression

Common chemo dose-limiting toxicity?

Specific phase (e.g., S or M)

Cell cycle-specific agents act during which phase?

Cycling cells AND G0

Cell cycle–non-specific agents affect which cells?

DHFR inhibition → ↓ purines & thymidylate

Mechanism of methotrexate?

Myelosuppression, hepatotoxicity, pneumonitis

Major toxicities of methotrexate?

Inhibits thymidylate synthase

Mechanism of 5-FU?

Prodrug of 5-FU

Capecitabine is what type of drug?

Prevent microtubule disassembly

Mechanism of paclitaxel/docetaxel?

Neutropenia

Dose-limiting toxicity of paclitaxel?

Prevent microtubule assembly

Mechanism of vincristine/vinblastine?

Peripheral neuropathy

Dose-limiting toxicity of vincristine?

Myelosuppression

Dose-limiting toxicity of vinblastine?

DNA crosslinking

Mechanism of cisplatin?

Nephrotoxicity

Major toxicity of cisplatin?

Bone marrow suppression

Major toxicity of carboplatin?

Intercalates DNA + free radicals + Topo II inhibition

Mechanism of doxorubicin?

cardiotoxicity

Major dose-limiting toxicity of anthracyclines?

Dexrazoxane

Drug used to reduce anthracycline cardiotoxicity?

Hemorrhagic cystitis

Major bladder toxicity of cyclophosphamide?

Mesna

Prevent hemorrhagic cystitis with?

HER2/neu

What does trastuzumab target?

Cardiomyopathy

Major risk of trastuzumab?

CD20

What does rituximab target?

Progressive multifocal leukoencephalopathy (PML)

Serious infection risk with rituximab?

PD-1

What does pembrolizumab inhibit?

CTLA-4

What does ipilimumab inhibit?

calcineurin

What do cyclosporine and tacrolimus inhibit?

↓ IL-2 transcription

Effect of calcineurin inhibition?

Nephrotoxicity

Major toxicity of calcineurin inhibitors?

neurotoxicity and tremor

Tacrolimus common adverse effect?

mTOR

What does sirolimus inhibit?

myelosuppression

Sirolimus major toxicity?

Inhibits IMP dehydrogenase

Mechanism of mycophenolate?

GI upset + bone marrow suppression

Major toxicity of mycophenolate?

allopurinol

Azathioprine interaction with?

↓ Cytokine production

Mechanism of steroids in transplant?

osteoporosis

Major long-term steroid complication?