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This IV form of calcium is associated with a metallic taste, mild local irritation, and is more irritating than other IV calciums.
When using IV calcium to treat severe hypocalcemia, what adverse events might you experience?
- AV block
- Cardiac arrhythmias
- Cardiac arrest
Calcium chloride should not be administered ___ or ___ (routes of administration) because of tissue necrosis and sloughing.
Calcium chloride can be slowly infused through IV, but leakage into the perivascular tissues can cause _____.
What are 2 factors that increase risk of adverse events in patients receiving IV calcium supplementation?
- Rapid infusion
- Patient is already receiving digitalis (raises calcium levels)
_____ (aka Tums) contains ____% Ca2+ is best absorbed with meals because it requires gastric acidity for absorption.
_____ is best absorbed in achlorhydric patients and contains ____% Ca2+.
Oral calcium supplementation blocks the absorption of iron, norfloxacin, and _____.
IV phosphate (PO4) supplementation can cause _____ & _____; oral phosphates can also cause these problems but less commonly.
- ectopic calcification
- kidney failure
What is the overall annual percentage of bone loss in the elderly?
In phase 1 of postmenopausal bone mineral density depletion, what is the result of estrogen deficiency?
An increase in the number & activation of bone resorption sites.
What causes the slow, continuous loss of BMD in Phase II of postmenopausal BMD depletion?
A permanent imbalance between rates of bone formation and resorption.
In terms of bone stuff, estrogen has 2 major functions, they are _____ & _____, which is basically what bisphosphonates do.
- Block osteoclast proliferation
- Slow bone resorption
Loss of estrogen at menopause increases what?
Rate of bone resorption
Is estradiol better at preventing or restoring bone loss?
The Women's Health Initiative asserts that estrogen and/or progestin promote 2 main adverse effects, which are.....
- Cardiovascular consequences
- Breast cancer
When should estrogen be used?
To treat short-term vasomotor symptoms or to treat osteoporosis and the patient is not able to take other drugs.
Tell me something interesting about Denosumab (Prolia).
- Human monoclonal antibody
- Binds to RANKL
- Reduces fractures by 20-60%
- Used to treat osteoporosis
- Used in men, women, patients with tumors, nonmetastatic prostate cancer, women receiving aromatase inhibitor therapy for breast cancer
- Administer SQ every 6 months
Evista is a SERM. What the heck is a SERM?
Selective Estrogen Receptor Modulator
Why is Evista better than hormone replacement therapy?
Reduces risk of breast cancer and cardiovascular events instead of increasing them
What are the 2 black box warnings on Evista?
Name 2 of the 3 other adverse events related to Evista.
- BBW: May increase risk of DVT
- BBW: May increase risk of stroke
- Leg cramps
- MAJOR DRAWBACK: MAY WORSEN VASOMOTOR SYMPTOMS
What are the 3 estrogenic effects of Evista?
- Stabilizes bone
- Decreases LDL cholesterol
- Increases thromboembolism risk (up to 3x)
Evista blocks estrogen receptors in which two areas?
Vitamin-D is converted in the liver to what?
Calcifediol is converted in the kidney to what?
Calcitriol's net effect is increasing _____.
Concentrations of phosphate and calcium in the body.
How is calcifediol different from calcitriol in terms of calcium movement?
Calcitriol increases absorption of caclium from the gut, while calcifediol does not
What are 2 important AEs associated with sirolimus?
What enzyme metabolizes sirolimus and could therefore result in drug interactions?
Name a purine synthesis inhibitor.
Azathioprine inhibits proliferation of cells, particularly _____.
_____ _____ is often used in place of azathioprine in organ transplant because of fewer side effects, such as less bone marrow suppression, opportunistic infections, and lower incidence of acute rejection.
_____ is an inhibitor of inosine monophosphate dehydrogenase and de novo pathway of guanine nucleotide synthesis. _____ are highly dependent on this pathway.
- B & T cells
What population should not use mycophenolate and why?
- Pregnant women
- High risk of miscarriage and birth defects
What is a common AE associated with mycophenolate seen in >1% of all patients?
High blood sugars
________ comes from
and contains cytotoxic antibodies that T-lymphocytes, thereby depleting circulating lymphocytes.
How do you treat a cytokine storm?
Daclizumab and basiliximab are _____.
Anti IL-2 Receptor Antibodies
Anti IL-2 receptor antibodies do not cause a cytokine storm, but can possibly result in _____.
IL-2 is specific to what type of immune cell?
Which medication is an inhibitor of CD3?
OKT3 (Muromonab-CD3) (comes from
What is a particularly dangerous side effect seen with anti-CD3 monoclonal antibodies?
What is the main disadvantage of using calcineurin inhibitors?
What is the main disadvantage of glucocorticoid therapy?
Changes in metabolism
Which type of cell releases histamine?
What types of foods contain histidine?
Histidine is _____ to form _____
Where is histamine stored?
- Gastric mucosa
- Mast cells & basophils
What is exocytotic release?
- Inflammatory or allergenic reactions
- Antigen-IgE complex
Antigen-induced histamine release can be inhibited by agents that ______ such as Beta2 AR agonists or adrenaline.
Increase mast cell cAMP
What is non-exocytotic histamine release?
- Mechanical or chemical release
- Displacement due to basic amine drugs such as morphine or tubocurarine
What does C5a do?
What causes post-surgical rash?
What effects are seen by activating H1?
- Vasodilation (NO release)
- Vessel leakage (enterochromaffin)
- Pain & itching
What is the primary effect of H2 activation?
Gastric acid secretion
What is the "triple response" brought about by injection of histamine into the skin?
How is histamine action terminated?
- Cellular uptake
What are the 2 ways you can inhibit histamine?
- Functional or physiological antagonism
- Histamine receptor antagonists (competitive antagonists)
Why are second generation H1-antagonists less sedating?
Less lipid soluble - don't cross the blood brain barrier
What is the metabolite of hydroxyzine?
What is the mechanism of action for H1 antagonists in treating motion sickness/vertigo?
Unknown? Most likely something to do with anti-muscarinic activity.
2nd generation H1 antagonists are shorter/longer acting than 1st generation.
T/F: Currently available antihistamines are AWESOME at relieving chronic nasal congestion.
2nd generation H1 antagonists are good at:
I. Symptomatic relief of chronic urticaria
II. Treating asthma
IV. I and II
V. All of the above
I. Symptomatic relief of chronic urticaria
Name a piperidine
Which 2nd generation antihistamine has minimal anti-cholinergic activity?
Which 2nd generation antihistamine has anti-inflammatory activity and is indicated for nasal congestion?
What adverse effect did fexofenadine show in animal trials?
When would you use immunostimulants?
- To treat infection
- To treat immunodeficiency
- To treat cancer
What does CSF stand for?
Colony Stimulating Factor
What is interferon alpha used for?
Anticancer and hepatitis
What is interferon beta used for?
Relapsing type multiple sclerosis
What is interferon gamma used for?
Chronic granulomatous disease
What is the interleukin IL-2 used for?
Enhance antitumor actions of cytotoxic T cells and NK cells
What adverse events would you expect from interferons?