Mechanism of Action
Adverse Events
High Yield (Bold Alikhan)
Eruptions as AE
100
IL-[number] is decreased when treating with cyclosporine
IL-2 is decreased when treating with cyclosporine. This leads to a decrease in CD4 and CD8 T-cell activation.
100
The two common SE of dupilumab are:
The two common SE of dupilumab are conjunctivitis and keratitis.
IL-13 inhibitors appear to have lower conjunctivitis risk than dupilumab.
100
-------- may be added to hydroxychloroquine or chloroquine for increased therapeutic effect
Quinacrine
CQ and HCQ should not be given together
100
this eruption [name eruption] is an adverse effect of this -------- cytotoxic agent
Dermatomyositis-like eruption in the setting of hydroxyurea therapy
200
Mycophenolate mofetil inhibits ----------- [name enzyme] which is a key enzyme for the de novo synthesis of ------ [purines vs pyrimidines]; essential in activated lymphocytes which cannot use purine salvage
Mycophenolate mofetil inhibits inosine monophosphate dehydrogenase which is a key enzyme for the de novo synthesis of purines; essential in activated lymphocytes which cannot use purine salvage
200
What type of neuropathy is associated with dapsone?
Bonus: is this damage reversible or irreversible?
peripheral neuropathy (predominantly distal motor) + some degree of sensory involvement; may present as wasting of hand muscles
reversible if detected early
200
Most patients treated with dapsone for dermatitis herpetiformis rapidly respond within [time frame].
Most patients treated with dapsone for dermatitis herpetiformis rapidly respond within 24 to 36 hours.
Bonus: dapsone inhibits myeloperoxidase leading to decreased oxidative damage in various neutrophilic dermatoses
200
This cutaneous eruption [name eruption] risk is much greater in ----------- [dermatomyositis vs lupus] patients on anti-malarial agents
Risk is much greater of morbilliform hypersensitivity eruptions in dermatomyositis (31%) than lupus (3%)
300
What is the MOA of crisaborole and roflumilast?
Name the four inflammatory mediators affected?
Inhibit PDE-4 --> increased cAMP --> decreased IFN-gamma, TNF-alpha, IL-23 and increased IL-10
300
Name at least four cutaneous adverse events associated with TNF-alpha inhibitors?
Psoriasis
Palmoplantar pustulosis
connective tissue disease (+ANA, lupus, DM)
cutaneous vasculitis
Bonus: highest risk of drug-induced lupus with infliximab. treatment is withdrawal of the drug.
300
Reduction in activity of these two enzymes [name enzymes] leads to increased azathioprine levels and increased risk of myelosuppression
decreased activity of thiopurine methyltransferase (TPMT) or xanthine oxidase leads to increased azathioprine levels and increased risk of myelosuppression
300
this adverse event is due to ---------- [name medication]
Cyclosporine can precipitate gout because it can cause hyperuricemia
Bonus: some attendings check urine acid, Mg, and K at baseline for cyclosporine
400
Ustekinumab inhibits ------- [which p-subunit] of IL- and IL (name interleukins)
Ustekinumab inhibits p40 of IL-12 and IL23.
400
Name at least three carcinomas of increased risk in the setting of cyclophosphamide treatment?
Transitional cell carcinoma of the bladder (thus monitoring periodic urine analysis with cytologic examination)
Non-hodgkin's lymphoma
leukemia
SCC (in transplant and oncology patients)
400
While monitoring kidney function on cyclosporine, this [% increase in Cre] should prompt decreasing dose by at least ------- mg/kg for 4 weeks.
While monitoring kidney function on cyclosporine, 30% increase in Cre should prompt decreasing dose by at least 1 mg/kg for 4 weeks
400
This adverse event [name AE] is seen in patients with RA on ------------ [name therapy]
MTX can cause accelerated nodule development in patients with rheumatoid arthritis. these are similar to RA nodules but are smaller and classically occur on fingers.
500
True or false
Rituximab binds both B cells and plasma cells, targeting the CD20
False
Rituximab binds CD20 surface antigen on B cells but not plasma cells (do not express CD20)
500
When prescribing anakinra or other IL-1 inhibitors, monitor ----------- [name lab] as ----------- [name adverse outcome] can occur
Important to monitor absolute neutrophil count as neutropenia can occur.
500
-------- and --------- [two most notable adverse events due to cyclosporine] are both dose and duration dependent. they can be managed by medication rather than by dose reduction. prescription of choice are ---------- [name of class medication] because ----------- [reasoning].
HTN and nephrotoxicity are the two most notable AE due to cyclosporine. They are both dose and duration dependent. HTN can be managed by medication rather than by dose reduction. Prescription of choice = calcium channel blockers. CCB vasodilate renal arterioles and do not alter cyclosporine level.
500
------------- [name medical emergency] is due to ------- [name drug] and can be reversed using --------- [name treatment]
This is methemoglobinemia emergency due to dapsone. it can be treated with methylene blue.