Term
| Why should you never biopsy an adrenal mass suspected to be a pheochromocytoma? |
|
Definition
| It could send the patient into a hypertensive crisis. |
|
|
Term
| In what ways can a pheochromocytoma be diagnosed? |
|
Definition
| 24 hour urine catecholamines, plasma catecholamines, MRI, nuclear imaging and PET scan. |
|
|
Term
| What is the pharmacological management of a pheochromocytoma before it can be surgically resected? |
|
Definition
| Alpha blockade with phenoxybenzamine or prazosin for 7-10 days pre-op, volume expansion with isotonic NaCl, beta blockade after adequate alpha blockade, and IV phentolamine (alpha blocker) and antiarrhythmics on call. |
|
|
Term
| What drug can be used for a chemical adrenalectomy for the treatment of Cushing's syndrome if it is ACTH independent (low ACTH, high cortisol - due to adrenal tumor)? |
|
Definition
|
|
Term
| What are some pharmacological treatment options for treatment of ACTH independent Cushing's Syndrome (low ACTH, high cortisol - due to adrenal tumor) if the patient is not a surgical candidate? |
|
Definition
Nizoral (ketoconazole) - blocks adrenal steroid synthesis.
Metyrapone - blocks steroid synthesis.
Aminoglutethimide - blocks steroid synthesis.
Mifepristone (RU 486) - glucocorticoid receptor antagonist (only recommended in inoperable patients that have failed other treatment). |
|
|
Term
| What is the treatment for Primary Adrenal Insufficiency (Addison's)? Secondary? What about an acute exacerbation of Adrenal Insufficiency? |
|
Definition
Primary Tx = glucocorticoid replacement (hydrocortisone) and mineralocorticoid replacement (fludrocortisone) because the problem is in the adrenal gland.
Secondary Tx = just glucocorticoid replacement (hydrocortisone) bc the problem is in the pituitary and it is not secreting enough ACTH.
Acute exacerbation = IV hydrocortisone that is gradually lowered to a maintenance dose over 5 days. |
|
|
Term
| What is Cortisol synthesized from? Describe the hypothalamic-pituitary axis in respect to cortisol secretion. |
|
Definition
It is synthesized from cholesterol.
CRH is released from the hypothalamus which stimulates the anterior pituitary to release ACTH which tells the adrenal medulla to release Cortisol. High Cortisol levels will negative feedback inhibit ACTH and CRH. |
|
|
Term
| What are the 5 main functions of Cortisol in the body? |
|
Definition
| Gluconeogenesis , inhibits insulin release, regulation of BP, inflammatory response and immunity. |
|
|
Term
| What is the average daily Cortisol production and when is the majority of it produced? |
|
Definition
| Daily cortisol production is 10-20 mg (majority between 5 and 9 am and after meals). |
|
|
Term
| How does stress affect free Cortisol levels? Where is it metabolized? |
|
Definition
Stress levels exceed 20-30 mcg/dl so once CBG is saturated, free cortisol rises rapidly.
It is metabolized in the liver. |
|
|
Term
| What are the indications for Prednisone use? What is the peak, duration of action and half life of PO Prednisone? Where is it metabolized and excreted? Is it considered a short-to-medium, intermediate or long acting glucocorticoid? |
|
Definition
Indications = Replacement therapy in adrenal cortical insufficiency, inflammatory and allergic disorders, hypercalcemia associated with cancer, hematological disorders, ulcerative colitis, exacerbations of multiple sclerosis, and palliation in some leukemias.
Peak = 1-2 hours.
Duration = 1-1.5 days.
HL = 3.5 hours.
It is metabolized in the liver and excreted in urine.
It is considered a short-to-medium acting glucocorticoid. |
|
|
Term
| What is the major use of glucocorticoids? How might they be helpful in premature babies? Someone that needs a new liver? |
|
Definition
Major use = Short-term treatment of many inflammatory disorders.
They are helpful in the development of fetal lungs by helping to produce surfactant. They also help prevent rejection of organ transplantation. |
|
|
Term
| What are the immune effects of glucocorticoids? |
|
Definition
Up regulate expression of anti-inflammatory proteins and down regulate expression of pro-inflammatory proteins.
They also prevent the migration of neutrophils through the capillary membranes (peripheral demargination) and deplete peripheral stores of lymphocytes, monocytes and eosinophils, redistributing them to the spleen, lymph nodes, thoracic duct and bone marrow. |
|
|
Term
| What are the metabolic effects of glucocorticoids? |
|
Definition
| They stimulate hepatic enzymes for gluconeogenesis, suppress the secretion of insulin, stimulate fat breakdown in adipose and increase amino acid availability for substrates in gluconeogenesis. |
|
|
Term
| What are the hemodynamic effects of Glucocorticoids? |
|
Definition
| Maintains cardiac output. |
|
|
Term
| What are the SEs of glucocorticoids? (behavioral, anterior pituitary, electrolytes, and others). |
|
Definition
Behavioral Sx (depression, mania, insomnia & euphoria).
Suppression of anterior pituitary release of ACTH, GH, SH (somatotropic hormone) and LH.
Can also lead to peptic ulcers, fat redistribution, osteoporosis, pancytosis (increase in WBCs, RBCs and platelets), Cushing's syndrome, impaired wound healing, myopathy, cataracts, fluid retention, hypokalemia, hypochloremia, alkalosis, HTN, heart failure, and adrenal suppression with long term therapy. |
|
|
Term
| What are the contraindications/precautions to glucocorticoid use as a class? |
|
Definition
Peptic ulcer disease
Heart disease
HTN with heart failure
Infectious diseases
Psychoses
Diabetes
Osteoporosis
Glaucoma |
|
|
Term
Are betamethasone (Celestone) and
dexamethasone (Decadron) are short-to-medium, intermediate or long acting glucocorticoids? |
|
Definition
|
|
Term
| Are triamcinolone (Kenacort, Kenalog) and paramethasone short-to-medium, intermediate or long acting glucocorticoids? |
|
Definition
|
|
Term
Are hydrocortisone (Cortef),
cortisone (Cortone), prednisone (Deltasone), prednisolone (Prelone), and methylprednisolone (Medrol) short-to-medium, intermediate or long acting glucocorticoids? |
|
Definition
|
|
Term
| What are some special dosage forms for glucocorticoids other than IV and PO? |
|
Definition
| Topical (skin diseases), ophthalmic forms, nasal sprays (allergic rhinitis), intra-articular injections (joint disease), inhaled forms (asthma) and hydrocortisone enemas (UC). |
|
|
Term
| What are the instructions for a female that misses her oral contraceptive pill for less than 24 hours but is not in the first week of the cycle? What if she is in the first week of her cycle? When should she consider using an emergency contraceptive if she missed a pill? |
|
Definition
Take the pill ASAP and continue as usual if not in the first week.
If in the first week take the pill ASAP and use back-up contraception for 7 days.
Consider using an EC if unprotected intercourse occured within 5 days prior to missing the pill in the first week. |
|
|
Term
| What should a female on oral contraceptives do if she misses less than 3 pills during week 2 or 3 of her cycle? |
|
Definition
| Take 1 active pill ASAP and continue the active pills as usual but when it comes time to start the placebo, discard them and start a new pack. |
|
|
Term
| What should a female on oral contraceptives do if she misses 3 or more pills during week 2 or 3 of her cycle? |
|
Definition
| Take 1 active pill ASAP and continue the active pills as usual but when it comes time to start the placebo, discard them and start a new pack. Must also use back up contraception for 7 days. |
|
|
Term
| What should a female on the Minipill oral contraceptive do if she is more than 3 hours late or has missed one of more of her pills and has has unprotected intercourse within the previous 5 days? What is she has not had unprotected intercourse within the previous 5 days? |
|
Definition
If intercourse then consider emergency contraceptive and continue pills the next day and use backup contraception for 48 hours.
If no unprotected sex then take 1 pill ASAP and continue to take 1 pill per day and use backup contraception for 48 hours.
*Minipill must be taken at the same time every day. |
|
|
Term
| What are the 3 types of corticosteroids? |
|
Definition
| Androgens, glucocorticoids and mineralocorticoids. |
|
|
Term
| What is the major electrolyte that must be monitored when using corticosteroids? |
|
Definition
| Potassium, consider using potassium supplements. |
|
|
Term
| What is the treatment for the acute, life-threatening emergency of Adrenal Crisis? |
|
Definition
| Tx = massive infusion of replacement steroids, constant monitoring and life support procedures. |
|
|
Term
| What is Fludrocortisone (Florinef)? Is it short, intermediate or long acting? What are some adverse effects of the class? |
|
Definition
It is the prototype mineralocorticoid drug. It is short-acting.
AEs = fluid retention, edema, hypokalemia and headache. |
|
|
Term
| What are the treatments for Hyperaldosteronism? |
|
Definition
Florinef (fludrocortisone) PO,(provides negative feedback inhibition)
DOCA (deoxycorticosterone acetate)
K sparing diuretics (Spirinolactone, Inspra (eplerenone), Midamor (amiloride)).
Nifedipine (CCB) and
ACE inhibitors. |
|
|
Term
| What are the 4 main indications for estrogen? |
|
Definition
| Primary hypogonadism, HRT, contraception and osteoporosis. |
|
|
Term
| What are the minor and major AEs of estrogen/progesterone combo use? |
|
Definition
Minor = breast tenderness, headache, edema, nausea, vomiting, anorexia and libido changes.
Major = HTN, thromboembolism, gallbladder disease, dementia, stroke, hypercalcemia, and endometrial carcinoma if just estrogen. |
|
|
Term
| What is the indication for the non-steroidal estrogen (DES, diethylstilbestrol)? SEs? |
|
Definition
Limited to treatment of inoperable breast or prostate cancer.
In the past, was used to treat threatened miscarriage in pregnant women
but it was later found to cause vaginal and cervical cancer in the offspring of those women. |
|
|
Term
| What are the indications for progesterone therapy? |
|
Definition
| Suppress ovarian function (dysmenorrhea, endometriosis and uterine bleeding), HRT (in combo with estrogen in those with a uterus) and contraception. |
|
|
Term
| In what formulations are progesterone and medroxyprogesterone offered? |
|
Definition
| Progesterone is only oral and medroxyprogesterone is offered oral (Provera) and IM (Depo-Provera). |
|
|
Term
| What are the contraceptive methods offered for estrogen/progesterone combined and progesterone only forms of contraception. |
|
Definition
Combo = Oral, patch or vaginal ring.
Progesterone only = Oral, injection or implant. |
|
|
Term
| What are the main mechanisms of action for oral contraceptives? |
|
Definition
| Inhibit ovulation by suppressing FSH, thicken cervical mucus (progesterone) and thin the endometrium so the egg cannot implant. |
|
|
Term
| Describe the effects of progesterone and estrogen on the ovary/pituitary, cervical mucus and endometrium. |
|
Definition
Progesterone = inhibits pituitary and ovary so no ovulation(but less effective than estrogen/progesterone combo), thickens the cervical mucus and atrophies the endometrium.
Estrogen = inhibits pituitary and ovary so no ovulation, thinning of the cervical mucus and endometrial proliferation. |
|
|
Term
| Describe the differences in combination oral contraceptives that are monophasic, biphasic or triphasic. |
|
Definition
Classified based on progestin content
Monophasic has the same amount of progestin in each week.
Biphasic has an increased amount of progestin after first one-third of cycle.
Triphasic has increased amount of progestin after first and second phase of cycle.
Biphasic and triphasic were developed to mimic natural cycle but the efficacy is comparable for all. |
|
|
Term
| What are the known complications of oral contraceptive use? |
|
Definition
| Complications = stroke, HTN, CHO metabolism, dyslipidemia, breast cancer, venous thromboembolism, and seizure risk. |
|
|
Term
| What are the serious warning signs to oral contraceptive use? |
|
Definition
ACHES -
Abdominal pain
Chest pain/SOB
Headache
Eye problems
Severe leg pain |
|
|
Term
| Which drugs have been shown to decrease the effectiveness of oral contraceptives? |
|
Definition
| Anticonvulsants (barbituates, phenytoin, carbamazepine, toprimate, vigabatin) and antimicrobials (rifampin, griseofulvin, sulfonamides?, tetracycline?) |
|
|
Term
| When should a women start combined oral contraception use? What about Minipill? |
|
Definition
COC = first sunday after menses.
Minipill = first day of menses. |
|
|
Term
| What is Plan B (levonorgestrel)? How should it be taken? |
|
Definition
It is a progesterone-only emergency contraceptive. The first dose should be taken within 72 hours of unprotected intercourse and the second dose should be taken 12 hours after the first dose.
*Data indicate a single dose of 1.5 mg levonorgestrel is as effective and causes similar side effects as traditional two-dose levonorgestrel. |
|
|
Term
| How old must a women be to get emergency contraceptives without a prescription? |
|
Definition
|
|
Term
| What are the effects of estrogen HRT on LDL and HDL? Progesterone HRT? |
|
Definition
Estrogen = ↓ LDL and ↑ HDL.
Progestin = ↑ LDL and ↓ HDL. |
|
|
Term
| What are some of the downsides to using oral HRT vs transdermal HRT? |
|
Definition
| Oral has an extensive first-pass metabolism so they need larger doses, which increase drug interactions, venous thromboembolism risk and gall bladder disease. Transdermal avoids the first-pass effect. |
|
|
Term
| Describe the regimen of estrogen and progesterone in cyclic HRT and continuous HRT. |
|
Definition
Cyclic = estrogen for 25 days, progesterone for the last 10-13 days of estrogen use and no therapy for 5-6 days.
Continuous = estrogen daily and progesterone for the first 10-13 days of each month. |
|
|
Term
| What were the 3 negative outcomes of the WHI study on HRT? 2 positive outcomes? |
|
Definition
Negative = increased risk of heart attacks, strokes and breast cancer.
Positive = decreased risk of colorectal cancer and fractures. |
|
|
Term
| What are the 2 pharmacologic forms of estrogen? |
|
Definition
| Ethinyl estradiol (EE) and Mestranol (Methyl ester of EE so must be converted at a rate of 50 mcg to 35 mcg of EE). |
|
|
Term
| What are the SEs of estrogen excess in oral contraceptive use? |
|
Definition
| Nausea, weight gain, edema, uterine cramps, irritability, depression, headache, HTN, lactation suppression, cystic breast changes, breast tenderness, increase risk of stroke and cyclic weight gain. |
|
|
Term
| What are the SEs of progesterone excess in oral contraceptive use? |
|
Definition
| Increased appetite, weight gain, fatigue, depression, decreased libido, acne, dilated leg veins, cholestatic jaundice, HTN, headache between packs, swollen breast and decreased carbohydrate tolerance. |
|
|
Term
| What are the SEs of androgen excess resulting from oral contraceptive use? |
|
Definition
| hepatic dysfunction, increased appetite, weight gain, hirsutism, acne, oily skin, increased libido, cholestatic jaundice and pruritis. |
|
|
Term
| What are the SEs of estrogen deficiency? |
|
Definition
| Irritability, hot flashes, vasomotor symptoms, uterine prolapse, midcycle spotting, decreased menstrual flow, no withdrawal bleeding to PCT, dry vagina, vagintitis, headache and depression. |
|
|
Term
| What are the SEs of progesterone deficiency? |
|
Definition
| Late breakthrough bleeding, heavy menstrual flow, delayed onset of menses, dysmenorrhea and weight loss. |
|
|
Term
| What is the indication and MOA for the antiestrogen: Clomid (clomiphene)? What is the major adverse effect? |
|
Definition
Indication = anovulatory infertility (including PCOS).
MOA = Estrogen agonist and antagonist that antagonizes the the negative feedback of estrogen so FSH and LH secretion is increased, leading to ovulation.
Major AE = multiple births. |
|
|
Term
| What is the indication and MOA for the antiestrogen: tamoxifen (Soltamox)? What are the adverse effects? |
|
Definition
Indication = Used to treat breast cancer in estrogen receptor-positive patients.
MOA = Acts as an estrogen receptor antagonist in the breast tissue.
AEs = nausea, vomiting, hot flashes, vaginal bleeding, menstrual irregularities and increased risk of endometrial cancers. |
|
|
Term
| What are the forms that testosterone is given? What form can be given PO? |
|
Definition
Testosterone = IV, IM or transdermal.
Methytestosterone is resistant to hepatic metabolism so it can be given PO. |
|
|
Term
| What are the indications for testosterone/methytestosterone use? What is it given with in the case of hypopituitarism? |
|
Definition
| Hypogonadism, in the case of hypopituitarism it is given with GH. |
|
|
Term
| What is the indication and MOA for the antiestrogen: danazol (Danocrine)? |
|
Definition
Indication = used primarily to treat endometriosis.
MOA = weak androgen and antiestrogen, suppressing LH and FSH. |
|
|
Term
| What is the indication and MOA for the antiandrogen: leuprolide (Lupron)? |
|
Definition
Indication = endometriosis and uterine fibroids.
MOA = gondotropin-releasing hormone analog given continuously and reduces LH/FSH secretion (negative feedback), reducing testosterone production. |
|
|
Term
| Describe the indication and MOA for flutamide (Eulexin). |
|
Definition
Indication = Inoperable prostate cancer.
MOA = competes with testosterone for the androgen receptor. |
|
|
Term
| Describe the indications and MOA for finasteride (Propecia, Proscar). |
|
Definition
Indications = BPH and male pattern alopecia.
MOA = antiandrogen, 5-alpha-reductase inhibitor, decreasing synthesis of DHT (dihydrotestosterone) in the prostate, skin and other target tissues. |
|
|
Term
| Describe whether Ortho-Tricyclen, -Novum and -Cyclen and mono-, bi- or triphasic oral contraceptives. |
|
Definition
Tricyclen = triphasic.
Novum = monophasic, biphasic or triphasic.
Cyclen = monophasic. |
|
|
Term
| What are the common estrogen/progesterone HRTs? |
|
Definition
Prempro
Femhrt
Combipatch
Activella
Prefest |
|
|
Term
| Which form of testosterone is used to treat hypogonadism, is given IM and is slowly absorbed, providing effective levels for weeks? |
|
Definition
|
|
Term
| How do the androgens (Androxy and Oxandrin) affect the secretion of LH and FSL? |
|
Definition
| They inhibit the secretion of LH and FSH by negative feedback. |
|
|
Term
| What are the uses and MOA for Unfractionated Heparin? |
|
Definition
Uses = acute coronary syndrome, STEMI, DIC, and venous thromboembolism prophylaxis against PE.
MOA = binds to antithrombin enhancing the inactivation of clotting factors (intrinsic pathway). |
|
|
Term
| Which pathway does heparin and coumadin work on? How are they each monitored? How is an OD of each reversed? |
|
Definition
Heparin is monitored by aPTT, works on the intrinsic pathway and is reversed by protamine sulfate.
Coumadin is monitored by PT (INR), works on the extrinsic pathway and is reversed by vitamin K. |
|
|
Term
| How is Unfractionated Heparin titrated to proper dose? |
|
Definition
| It is titrated until the aPTT is 2-2.5 times the normal value. |
|
|
Term
| Describe the SEs/toxicity of Unfractionated Heparin. |
|
Definition
| Allergic rxn (derived from bovine or porcine source), hemorrhage, and heparin-induced thrombocytopenia (increases risk of venous thrombosis due to antibodies that active platelets even though platelet levels are low). |
|
|
Term
| What are the contraindications to Unfractionared Heparin/LMWH use? |
|
Definition
| Contraindications = spinal anesthesia/epidural, Heparin-Induced Thrombocytopenia (HIT), active bleeding, hemophilia, thrombocytopenia, severe HTN, infective endocarditis, active TB, visceral carcinoma and advanced hepatic/renal disease. |
|
|
Term
| How much protamine sulfate do you give per 100 units of heparin for adequate reversal? |
|
Definition
| 1mg protamine sulfate per 100 units of heparin. |
|
|
Term
| What are the 3 forms of Low Molecular Weight Heparin? What are the uses of LMWH? |
|
Definition
Enoxaparin (Lovenox)
Dalteparin (Fragmin)
Tinazaparin (Innohep)
Uses = venous thromboembolism treatment/prophylaxis, heparin use in pregnancy and acute coronary syndrome. |
|
|
Term
| What are the advantages and disadvantages of LMWH vs. UFH? |
|
Definition
Advantages = Predictable pharmacokinetics, as effective as UFH, increased bioavailability due to subcutaneous administration, once or twice daily dosing and can be easily used in outpatient setting.
Disadvantages = expensive, requires renal adjustment, may be less effective in the obese and it only has incomplete reversal by protamine sulfate. |
|
|
Term
| How is LMWH dosed and administered? What are the SEs? Block box warning for all? |
|
Definition
Dosing is based on weight and it is administered subcutaneously.
SEs = hemorrhage and HIT (less commonly than UFH though).
Black box warning = do not use in patients undergoing spinal/epidural anesthesia or puncture. |
|
|
Term
| What is the only medication that is FDA approved for outpatient DVT treatment? |
|
Definition
|
|
Term
| What is the MOA and use for fondaparinux (Arixtra)? |
|
Definition
MOA = Factor Xa inhibitor thrombin formation inhibitor (anticoagulant).
Use = Outpatient DVT treatment and DVT prophylaxis. |
|
|
Term
| What are the uses and MOA for the Direct Thrombin Inhibitor: bivalirudin (Angiomax)? |
|
Definition
It is used as an IV anticoagulant used in adjunct with percutaneous coronary intervention (PCI).
MOA = Reversibly inhibits thrombin and has anti-platelet effects. |
|
|
Term
| What is the MOA and uses of warfarin (Coumadin)? |
|
Definition
MOA = inhibits vitamin K oxide reductase enzyme and thus preventing the formation of prothrombin from prothrombin precursors.
Uses = long term venous thromboembolism treatment, Afib, pulmonary HTN and in heart valve replacements. |
|
|
Term
| What are the SEs/Toxicity for Warfarin? What condition do you want to avoid warfarin use? |
|
Definition
hemorrhage, tissue necrosis and purple toe syndrome.
*Avoid in pregnancy |
|
|
Term
| What is the plan of action for Warfarin OD (with method of delivery)? |
|
Definition
| D/C warfarin, administer vitamin K (only PO or IV) and give FFP. |
|
|
Term
| What are the MOA and uses for fibrinolytics (t-PA, TNK-tPA and r-PA)? How are they administered? |
|
Definition
MOA = converts plasminogen to plasmin and plasmin degrades fibrin.
Uses = PE w/ hemodynamic instability, severe DVT, superior vena cava syndrome, ascending thrombophlebitis and acute MI.
They are only administered IV. |
|
|
Term
| What is the MOA and major uses of Aspirin? SEs? |
|
Definition
MOA = inhibits the synthesis of thromboxane A2 prostaglandin, which prevents platelet aggregation (antiplatelet agent).
Uses = MI and stroke prophylaxis.
SEs = hemorrhage, GI ulcer and bronchospasm. |
|
|
Term
| What is the MOA and uses of clopidogrel (Plavix)? |
|
Definition
MOA = inhibits ADP induced platelet aggregation.
Uses = TIA, stroke, unstable angina and thrombosis prophylaxis following stent placement. |
|
|
Term
| What are the 3 main glycoprotein IIB/IIIA blockers? MOA of the class? Uses of the class? How is the class administered? |
|
Definition
3 main = Abciximab (ReoPro), Eptifibatide (Integrilin) and Tirofiban (Aggrastat).
MOA = Inhibits glycoprotein IIB/IIIA platelet receptors preventing platelet aggregation (antiplatelet).
Uses = Acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI).
The class is only given IV. |
|
|
Term
| What is the use of the Phosphodiesterase Inhibitor: dipyridamole/ASA (Aggrenox)? |
|
Definition
| Thrombotic stroke prophylaxis in those with a history of TIA or thrombotic stroke |
|
|
Term
| What is the function of phytonadione/vitamin K (Mephyton)? What are the AEs? What are the routes of administration? Why is it given to newborns? |
|
Definition
It aids in the synthesis of prothrombin and mainly extrinsic factor production.
AEs = dyspnea, chest pain, back pain and death.
Given IV, PO, SubQ or IM.
Given to newborns to prevent hemorrhagic disease of vitamin K deficiency, especially in premature babies. |
|
|
Term
| What is in cryoprecipitate and what can it be used in the treatment of? |
|
Definition
It contains factor VIII, XIII, fibrinogen and vWF.
It can be used in the treatment of fibrinogen abnormalities (DIC, liver disease), Hemophilia A and Von WIllebrand disease. |
|
|
Term
| What is the MOA and uses of DDAVP (Desmopressin Acetate)? |
|
Definition
MOA = synthetic ADH and it also increases factor VIII and vWF activity.
Uses = hemophilia A, Von Willebrand and in disease central DI. |
|
|
Term
| What is in fresh frozen plasma (FFP) and what are the indications? |
|
Definition
FFP is the liquid portion of human blood that contains coagulation factors and proteins.
Indications = replacement of isolated factor deficiencies and in massive blood transfusion. |
|
|
Term
A 54 year old man with a prosthetic aortic valve replacement complains of black and tarry stools. Pysical exam showed bleeding gums and hemorrhaging. The pt has been receiving Coumadin for 1 year. Which would provide the fastest recovery of bleeding?
A. IV vit k
B. Transfusion of fresh frozen plasma
C. IV protamine
D. Immediate withdrawal of warfarin |
|
Definition
| B. Whole blood is most rapid. |
|
|
Term
A 60 year old man is diagnosed with DVT and heparin was started. One hour later, pt was bleeding profusely from IV site. The heparin was stopped but bleeding continued. Protamine was given IV and bleeding stopped. The protamine:
A. Degraded the heparin
B. Inactivates antithrombin
C. Inonically binds with heparin |
|
Definition
| C. Infused slowly, protamine combines ionically with heparin to form a stable, inactive complex |
|
|
Term
A 22 year old woman experienced pain and swelling in her right leg at the ER. She was diagnosed with DVT. Pt is in her 2nd trimester and was treated with heparin. When pt is D/C, what treatment is best if she lives far from a hospital?
A. Warfarin
B. Aspirin
C. Unfractionated heparin
D. Low molecular weight heparin (LMWH) |
|
Definition
| D. Can be given SC by home injection taught to pt once D/Ced. LMWH does not cross the placenta and shows no teratogenic effects. |
|
|
Term
Which of the following is not a sex steroid?
Estradiol
Progesterone
Cortisol
Testosterone |
|
Definition
|
|
Term
Which of the following is an indication for tamoxifen (Nolvadex) therapy?
Menopausal symptoms (hot flashes, night sweats, vaginal dryness)
Osteoporosis prevention
Treatment of estrogen receptor positive breast cancer
To induce abortion up to 49 days post-conception |
|
Definition
| Treatment of estrogen receptor positive breast cancer |
|
|
Term
Estrogen plus progestin is used in post-menopausal women with a uterus to decrease the risk of breast cancer.
True
False |
|
Definition
| False; they are used together because progestin reduces risk of endometrial cancer |
|
|
Term
Which of the following is used for HRT?
Ortho-cyclen
Lo-Ovral
Prempro
Plan B |
|
Definition
|
|
Term
Which of the following is an effect of excess estrogen?
Acne
Hirsutism
Nausea
Increased libido |
|
Definition
|
|
Term
Which of the following is a serious warning sign for a patient taking OCs that require immediate evaluation?
Irritability
Bloating
Severe leg pains
HA relieved by Tylenol |
|
Definition
|
|
Term
The “minipill” is a estrogen only product that is often prescribed to breastfeeding moms.
True
False |
|
Definition
|
|
Term
RW calls your clinic because she has missed 2 doses of her OC while on vacation. It was during week 2 of the pack, you instruct her to:
Toss the old pack & start a new one today
Take her missed doses ASAP and then continue with one tablet daily
Take 1 extra pill ASAP, continue as usual and then skip placebo before next pack
Does RW need to use a backup method of contraception and, if so, for how long?
None needed is missed during weeks 2 & 3
Needs a backup x 48 hours
Needs a backup x 7 days
Needs a backup until next pack is started |
|
Definition
Take 1 extra pill ASAP, continue as usual and then skip placebo before next pack
None needed is missed during weeks 2 & 3 |
|
|
Term
Which of the following is not true about emergency contraception:
Should be given within 72 hrs of intercourse
Rx is required for women <18 years old
Causes the uterine lining to expel an implanted embryo
Requires two doses taken 12 hours apart |
|
Definition
| Causes the uterine lining to expel an implanted embryo |
|
|
Term
| What are HMG-CoA reductase Inhibitors better known as? |
|
Definition
|
|
Term
| What are the effects of HMG-CoA reductase Inhibitors on lipids? |
|
Definition
| Decrease LDL, Increase HDL and decrease TGs. |
|
|
Term
What are the AEs to the HMG-CoA reductase Inhibitors (Statins)?
Contraindications? |
|
Definition
elevation in LFTs, myalgia, myopathy and rhabdomyolysis, which can damage the kidneys.
Contraindications = active liver disease and pregnancy/lactation. |
|
|
Term
| What is the effect of Niacin (Nicotinic Acid) on lipids? SEs? Absolute and Relative Contraindications? |
|
Definition
Decreases LDL, increases HDL and decreases TGs.
SEs = flushing, headache, upper GI distress, hepatotoxicity, hyperglycemia, gout, tachycardia and palpitations.
Absolute C/I = chronic liver disease and severe gout.
Relative C/I = DM, hyperuricemia and PUD. |
|
|
Term
| What are the effects of Fibrates (Lopid and Tricor) on lipids? SEs? Contraindications? Major drug interaction? |
|
Definition
Decrease LDL, increase HDL and decrease TGs.
SEs = dyspepsia, gallstones, myopathy, rashes, increased LFTs and rhabdomyolysis.
C/I = severe renal or hepatic disease.
Interaction = increases action of anticoagulants. |
|
|
Term
| What is the MOA and effect on lipids for the Bile Acid Sequestrants (Questran, Colestid and Welchol)? SEs? Absolute and relative Contraindications? |
|
Definition
MOA = Bind to bile acids increasing excretion which results in enhanced conversion of cholesterol to bile acids.
Effects = decrease LDL, increase HDL and no change/possible increase in TGs.
SEs = GI distress, constipation, diarrhea, decreased absorption of other drugs.
Absolute C/I = TGs over 400.
Relative C/I = TGs over 200 or diverticulitis. |
|
|
Term
| What is the MOA and effect on lipids for ezetimibe (Zetia)? What is it usually prescribed with? |
|
Definition
MOA = Selectively inhibits the intestinal absorption of cholesterol.
Effect = decrease LDL and increase HDL.
Usually given with a statin. |
|
|
Term
| What are some examples of HMG-CoA reductase Inhibitors (Statins)? |
|
Definition
Lovastatin (Mevacor)
Fluvastatin (Lescol)
Pravastatin (Pravachol)
Simvastatin (Zocor)
Atorvastatin (Lipitor)
Rosuvastatin (Crestor) |
|
|
Term
Which one of the following is the most common side effect of antihyperlipidemic drug therapy?
A. Elevated blood sugar
B. Gastrointestinal disturbance
C. Neurological disturbances
D. Heart palpitations
E. Migraine headaches |
|
Definition
|
|
Term
Which one of the following drugs decreases de novo cholesterl synthesis by inhibiting the enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase?
A. Fenofibrate
B. Niacin
C. Cholestyramine
D. Lovastatin
E. Gemfibrozil |
|
Definition
|
|
Term
Which of the following drugs causes a decrease in triglycerides by limiting availability of free fatty acids as needed as building blocks for this pathway?
A. Niacin
B. Fenofibrate
C. Cholestyramine
D. Gemfibrozil
E. Lovastatin |
|
Definition
| A. Niacin strongly inhibits lipolysis in adipose tissue, which is the primary producer of circulating free fatty acids. The liver noramlly uses the free fatty acids as a major precursor of triglyceride synthesis. Thus, niacin causes a decrease in liver triglyceride synthesis, which is required for VLDL production |
|
|
Term
Which one of the following drugs binds bile acids in the intestine, preventing their return to the enterohepatic circulation?
A. Niacin
B. Fenofibrate
C. Cholestyramine
D. Fluvastatin
E. Lovastatin |
|
Definition
| C. It binds to bile acids/bile salts in small intestine. The complex is excreted into feces, preventing bile acids from returning to the liver by enterohepatic circulation |
|
|
Term
| What antihyperlipidemia agent has the greatest effect on LDL levels? |
|
Definition
| HMG-CoA reductase Inhibitors (Statins) - ↓18-55% |
|
|
Term
| What antihyperlipidemia agent has the greatest effect on HDL levels? |
|
Definition
| Niacin - Increases HDL (15-35%) |
|
|
Term
| What antihyperlipidemia agent has the greatest effect on TG levels? |
|
Definition
| Niacin and Fibrates (Lopid & Tricor) both decrease TGs by 20-50%. |
|
|
Term
| What are the 2 main Fibrate drugs? |
|
Definition
Gemfibrozil (Lopid)
Fenofibrate (Tricor) |
|
|
Term
| What are the optimal and high levels for LDL, HDL, Trigs and Total Cholesterol? |
|
Definition
LDL:
optimal = less than 100
high = over 160
HDL:
optimal = over 40 for men and 50 for women
Trigs:
optimal = less than 150
high = over 200
Total Cholesterol:
optimal = less than 200
high = over 240 |
|
|
Term
| What is the major difference between COX1 and COX2 inhibition? |
|
Definition
| COX1 inhibitors inhibit the formation of Thromboxane A2 which leads to a prolonged bleeding time. |
|
|
Term
| What are some common examples of NSAIDs? |
|
Definition
| Ibuprofen (Advil, Motrin), Aspirin, and Indomethacin, among many others. |
|
|
Term
| What are the therapeutic actions of NSAIDs? |
|
Definition
| Anti-inflammatory (except APAP - Acetominophen(Tylenol)), analgesic and antipyretic. |
|
|
Term
| What is the MOA and uses of the NSAID: Aspirin? SEs? Toxicity? |
|
Definition
MOA = irreversible non-selective inhibition of COX 1 & 2.
Uses = anti-inflammatory, analgesic, anti-pyretic and anti-platelet.
SEs = bleeding, rash, bronchospasm, Reye's syndrome and GERD.
Toxicity = Tinnitus, vertigo, respiratory alkalosis followed by metabolic acidosis. |
|
|
Term
| What is the MOA and uses for the NSAID: Celecoxib (Celebrex)? Contraindication? |
|
Definition
MOA = Reversible inhibition of COX 2 at sites of inflammation.
Uses = Osteoarthritis and Rheumatoid arthritis.
Contraindication = patients with sulfa allergies. |
|
|
Term
| What is the MOA and use for the NSAID: meloxicam (Mobic)? |
|
Definition
MOA = Preferentially inhibits COX-2 over COX-1.
Uses = approved for osteoarthritis. |
|
|
Term
| Describe the effects of the NSAID: diclofenac (Voltaren, Cataflam). AEs? Contraindications? |
|
Definition
It it a potent anti-inflammatory, antipyretic, and analgesic agent.
AEs = GI bleeding, ulceration or perforation and elevated LFTs.
C/I = children, nursing mothers or pregnancy. |
|
|
Term
| What is the MOA and effects of the NSAID: etodolac (Lodine)? |
|
Definition
MOA = inhibits prostaglandin synthesis.
Effects = good anti-inflammatory but weak antipyretic. |
|
|
Term
| What is the MOA, effects and uses of the NSAID: indomethacin (Indocin)? |
|
Definition
MOA = inhibits prostaglandin synthesis.
Effects = good anti-inflammatory and weak antipyretic effects.
Uses = osteoarthritis, rheumatoid arthritis, gout, bursitis, and tendonitis. |
|
|
Term
| What are the 3 main Acetic Acid derivative NSAIDs? What is their primary MOA? What are their effects? |
|
Definition
Agents = Indomethacin, Sulindac and Etodolac.
MOA = inhibit prostaglandin synthesis.
Effects = good anti-inflammatory and weak antipyretic. |
|
|
Term
| What is the use of the NSAID: Ketorlac (Toradol)? How can it be administered? AEs? |
|
Definition
Use = As effective as morphine or meperidine for the short- term relief of moderate to severe pain.
Can be administered PO, IM or IV.
AEs = drowsiness, dyspepsia, GI pain and nausea. |
|
|
Term
| What is the maximum number of days that Ketorlac (Toradol) can be used consecutively? Why? |
|
Definition
| 5 days bc use after will increase the risk of GI bleeding and potentially fatal cardiovascular thrombotic events. |
|
|
Term
| What is the max daily dose for Acetaminophen (Tylenol)? |
|
Definition
|
|
Term
| Which common NSAIDs are propionic acid derivatives? MOA? What are they better tolerated than ASA and indomethacin for? |
|
Definition
Agents = Ibuprofen (Motrin, Advil), naproxen and ketoprofen.
MOA = inhibits prostaglandin synthesis but they do not inhibit leukotrienes.
Better tolerated at anti-inflammatory doses than ASA & indomethacin. |
|
|
Term
| What is the main MOA behind the anti-inflammatory and analgesic action of the NSAID class? What are the 3 main organs that have AEs with the NSAID class? |
|
Definition
MOA = anti-inflammatory and analgesic action via inhibition of prostaglandin (PG) biosynthesis.
AEs = GI, kidney and liver. |
|
|
Term
| If a patient with rheumatoid arthritis is not responding to NSAIDs, they typically switch them to DMARDS (Disease-Modifying AntiRheumatic Drugs). What is involved with the patient education with this switch? |
|
Definition
| They have a 3-4 month onset of action |
|
|
Term
| What is the MOA and use for Methotrexate as a DMARD? AEs? C/I? What drug can be given 24 hours after each daily dose to help minimize the SEs? |
|
Definition
MOA = Immunosuppressant agent, which slows erosion within involved joints in rheumatoid arthritis.
Use = many but with DMARD it is used to treat rheumatoid arthritis.
AEs = ulcer, nausea, decreased WBCs and elevated LFTs.
C/I = pregnancy.
Leucovorin administration 24 hrs after each weekly dose can help minimize SEs. |
|
|
Term
| What is the class, use and AEs for Hydroxychloroquine (Plaquenil)? |
|
Definition
Class = DMARD.
Use = Rheumatic diseases.
AEs = ocular toxicity, dyspepsia, nausea, vomiting, rash and nightmares. |
|
|
Term
| What is the MOA and use for Infliximab (Remicade)? |
|
Definition
MOA = binds and inhibits tumor necrosis factor alpha, reducing inflammation.
Use = It is a DMARD so rheumatic diseases, among others. |
|
|
Term
What is the MOA of:
Adalimumab (Humira)
Infliximab (Remicade)
Etanercept (Enbrel)
Abatacept (Orencia)
Rituximab (Rituxan) |
|
Definition
| They are all TNF-alpha blocking agents that can be used as DMARDs |
|
|
Term
| What is the use and AEs of Colchicine? |
|
Definition
Use = acute gouty attack prophylaxis and it relieves gout pain and inflammation within 12-24 hours of administration.
AEs = diarrhea, nausea, vomiting, CNS suppression and bone marrow depression. |
|
|
Term
| What is the MOA, use and AEs for Probenecid? |
|
Definition
MOA = increase urate excretion from the body.
Use = used 2-3 weeks after an acute gouty attack when allopurinol is contraindicated.
AEs = GI irritation, rash and rarely aplastic anemia. |
|
|
Term
| What is the MOA, use and AEs for Allopurinol? |
|
Definition
MOA = inhibits xanthine oxidase (enzyme responsible for the formation of uric acid).
Use = used to treat gout and in gout prophylaxis in hyperuricemia patients.
AEs = GI upset, peripheral neuritis and hepatic toxicity. |
|
|
Term
In which of the following conditions would aspirin be contraindicated?
A. Myalgia
B. Fever
C. Peptic ulcer
D. Rheumatoid arthritis
E. Unstable angina |
|
Definition
| C. The worst among all the NSAIDS for causing gastric irritation. ASA can be used to treat fever, since it has antipyretic actions and can be used for headaches since it is an analgesic. |
|
|
Term
Which of the following statements concerning COX-2 inhibitors is correct?
A. Show greater analgesic activity rather than traditional NSAIDS
B. Decrease platelet function
C. Do not affect the kindeys
D. Show anti-inflammatory activity similar to that of the traditional NSAIDS
E. Cardioprotective |
|
Definition
| D. They do not effect the platelets |
|
|
Term
An 8 year old girl has a fever and muscle aches from a viral infection. Which one of the following drugs would be the most appropriate to treat her symptoms?
A. Acetaminophen
B. Aspirin
C. Celecoxib
D. Codeine
E. Indomethacin |
|
Definition
| A. Asprin should be avoided in children because of association of Reye’s syndrome |
|
|
Term
A 70 year old man has a history of ulcer disease. He has recently experienced swelling and pain in the joints of his hands. His physician wants to begin therapy with an NSAID. Which one of the following drugs might also be prescribed along with the NSAID to reduce the risk of activating this patient’s ulcer disease?
A. Allopurinol
B. Colchicine
C. Misoprostol
D. Sulindac |
|
Definition
| C. It is a prostaglandin analog that can reduce gastric acid and pepsin secretion and promote the formation of mucus in the stomach. |
|
|
Term
|
Definition
| growth hormone-inhibiting hormone (GHIH) |
|
|
Term
| How are the effects of Growth Hormone mediated throughout the body? |
|
Definition
|
|
Term
| What are the 2 types of recominant GH drugs approved for use? Which one is long acting and can be dosed monthly or twice a week? |
|
Definition
Somatropin and Somatrem.
Somatropin is long acting and can be dosed monthly or twice weekly. |
|
|
Term
| What are some other conditions that recombinant GH has been approved for treating? |
|
Definition
| Treatment of wasting in AIDS, short bowel syndrome and in anti-aging programs. |
|
|
Term
| What are some possible SEs of recombinant GH use in children? |
|
Definition
| intracranial HTN, scoliosis, otitis media, hypothyroidism, pancreatitis, gynecomastia and nevus growth. |
|
|
Term
| What are some possible SEs of recombinant GH use in adults? |
|
Definition
| Peripheral edema, myalgias, arthalgias, carpal tunnel syndrome, increases activity of P450 enzymes and increases the incidence of malignancies. |
|
|
Term
| What drugs can reduce GH production in the event of pituitary Gigantism? |
|
Definition
| Octreotide (somatostatin ) and bromocriptine (dopamine receptor agonist) both reduce GH production. |
|
|
Term
| What is the MOA, use and AEs for Octreotide? |
|
Definition
MOA = somatostatin analogue (inhibits GH).
Use = GH secreting tumors (somatotrophs).
AEs = nausea, vomiting, abdominal cramps, flatulence, steatorrhea, gallstones, bradycardia, heart conduction disturbances and B12 deficiency with long term use. |
|
|
Term
| Which gonadotropin is hCG nearly identical to? Which gonadotropin is responsible for testosterone production? |
|
Definition
hCG placental protein is nearly identical to LH.
LH is responsible for production of testosterone by Leydig cells. |
|
|
Term
| What is the gonadotropin treatment for male infertility? |
|
Definition
| Both FSH (uFSH or rFSH) and LH (rLH) |
|
|
Term
| What are the common pregnancy complications to using recombinant FSH, LH or hCG? Most common complication in men? |
|
Definition
Preg = OHSS (Ovarian hyperstimulation syndrome) and multiple pregnancies.
Men = gynecomastia. |
|
|
Term
| Which gonadotropin is favored with higher and lower GnRH pulsatile frequencies? |
|
Definition
Lower pulse frequencies favor FSH release
Higher pulse frequencies favor LH release |
|
|
Term
| What are the 3 main GnRH analogs and what conditions can they be used to treat? Contraindications? |
|
Definition
Leuprolide (Lupron), Goserelin (Zoladex) and Nafarelin (Synarel).
Can be used to suppress or stimulate gonadotropin release, female/male infertility, infertility in PCOS women, endometriosis, uterine fibroids, and prostate cancer.
C/I = pregnancy and breast feeding. |
|
|
Term
| What are the medical uses for oxytocin? |
|
Definition
| Administered IV for initiation and augmentation of labor (increases frequency and force of contractions) or administered IM for postpartum bleeding. |
|
|
Term
| Which thyroid hormone is more potent and which is more prevalent? |
|
Definition
| T3 is more potent but T4 is more prevalent |
|
|
Term
| What are the effects of high and low thyroid hormone levels on the skin, eyes, CV system, respiratory system, appetite, CNS, musculoskeletal system, renal system, hematopoietic system and metabolic rate? |
|
Definition
Skin:
High = warm and moist.
Low = cold and dry.
Eyes:
High = exophalmos.
Low = drooping eyelids.
CV system:
High = decreased MAP and increased inotropic/chronotropic effects.
Low = increased MAP and decreased inotropic/chronotropic effects.
Respiratory system:
High = dyspnea.
Low = hypoventilation.
Appetite:
High = increased appetite.
Low = decreased appetite.
CNS:
High = nervousness.
Low = lethargy.
Musculoskeletal System:
High = weakness, fatigue and increased DTRs.
Low = stiffness, fatigue and decreased DTRs.
Renal System:
High = increased GFR.
Low = decreased GFR.
Hematopoietic system:
High = increased erythropoiesis.
Low = decreased erythropoiesis.
Metabolic rate:
High = increased BMR.
Low = decreased BMR. |
|
|
Term
| What is the DOC for hypothyroidism? |
|
Definition
| Levothyroxine (synthetic T4) |
|
|
Term
| What class of drug is methimazole and propylthiouracil? Uses? Which is more potent? |
|
Definition
They are both Thioamides (antithyroid agents).
Uses = hyperthyroidism or thyrotoxicosis.
Methimazole is 10-times more potent than propylthiouracil. |
|
|
Term
| Describe the how often Propylthiouracil and Methimazole are dosed. |
|
Definition
| Propylthiouracil is dosed every 6-8 hours and Methimazole is dosed once daily. |
|
|
Term
| What are the common and severe adverse reactions seen with Propylthiouracil? |
|
Definition
AEs:
Common = GI distress and pruritic rash.
Severe = Hepatitis. |
|
|
Term
| What are the common and severe adverse reactions seen with Methimazole? |
|
Definition
Common = GI distress, altered sense of smell/taste and pruritic rash.
Severe = Cholestatic jaundice and agranulocytosis. |
|
|
Term
| What are the pharmacologic use of potassium iodide? Disadvantages to use? |
|
Definition
Use = in pharmacologic doses it inhibits thyroid hormone release so it can be used in hyperthyroidism and in the treatment of thyroid storm.
Disadvantages = increases stores of iodine so thioamide therapy (PTU and methimazole) is less effective, withdrawal may produce severe thyrotoxicosis, can cross placenta so cannot use in pregnancy and it can protect the thyroid from radiation in the case of a radiation emergency (cancer). |
|
|
Term
| How does radioactive iodine (131-I) treat hyperthyroidism? |
|
Definition
| It is taken up by the thyroid and within weeks it will destroy the thyroid parenchyma. |
|
|
Term
| What are some complications to chonic overtreatment of hypothyroidism in elderly patients? |
|
Definition
|
|
Term
| What is the major concern in elderly patients with longstanding untreated hypothyroidism? What is the major concern with treating these patients now? |
|
Definition
Myxedema and eventually myxedema coma.
It is often associated with underlying coronary artery disease and low levels of thyroid hormones are protective against heart disease due to the negative inotropic/chronotropic effects of hypothyroidism so a sudden increase in thyroid hormones could spark this person into an MI. If these patients have heart conditions they should be fixed before starting them on levothyroxine. |
|
|
Term
| Why is it extremely important that the daily dose of thyroxine is adequate in a pregnant mother with hypothyroidism? |
|
Definition
| Development of fetal brain depends on maternal thyroxine, (Many patients require 30-50% increase in dose). |
|
|
Term
| What is the most common drug to cause drug-induced hypothyroidism? Tx? |
|
Definition
Amiodarone.
Tx = discontinue use or if that is not possible, take Levothyroxine (may have to take it regardless due to the long HL of Amiodarone). |
|
|
Term
| What are the treatment options of choice for Graves Disease? Which is the preferred option out of the Thioamides? What about in pregnancy? What is the preferred treatment in those over 21 without any heart disease? |
|
Definition
Thioamides (Methimazole or propylthiouracil) administered until remission and radioactive iodine (131-I). (They are the only therapies that will leave an intact thyroid).
Preferred DOC is Methimazole except PTU is better in pregnancy bc it doesn't cross the placenta as readily.
Radioactive iodine is the preferred treatment in those over 21 without heart disease. |
|
|
Term
| What are some adjunct drugs to antithyroid therapy in Graves disease? |
|
Definition
BBs = help during acute phase of thyrotoxicosis.
CCBs = same reason as BBs but can be used in the person has asthma.
Barbiturates = accelerate T4 breakdown. |
|
|
Term
| How can Amiodarone use effect the thyroid? |
|
Definition
| It can cause hypo- or hyper- thyroidism |
|
|
Term
| What is secreted by the alpha, beta and delta cells of the pancreas? |
|
Definition
Alpha = glucagon.
Beta = insulin.
Delta = somatostatin (GHIH). |
|
|
Term
| What is the effect of Somatostatin (GHIH) on insulin and glucagon? |
|
Definition
| It inhibits the release of them both. |
|
|
Term
| What are the typical Sx of hyperglycemia? |
|
Definition
Polydipsia
Polyuria
Polyphagia
Weight loss
Slow wound healing
Dry itchy skin
Numbness and tingling in the feet
Blurry eyesight
Fatigue |
|
|
Term
|
Definition
Nausea and vomiting
Abdominal pain
Polyuria/Polydipsia
Visual disturbance
Shortness of breath
Weakness
Anorexia
Fruity breath
Decreased reflexes
Uncoordinated ocular movements, dilated pupils |
|
|
Term
| Which type of Diabetes is DKA more common in? Which type always needs insulin treatment? |
|
Definition
|
|
Term
| What is the MOA for the drug class: Sulfonylureas? Indication? SEs? Precautions? Contraindications? Examples? |
|
Definition
MOA = stimulates insulin secretion, reduces glucose production and increases tissue sensitivity to insulin.
Indication = Type II DM.
SEs = hypoglycemia, weight gain, nausea, vomiting, headache, dizziness, rash, photosensitivity reaction and cardiac mortality.
Precautions = Disulfiram like reaction with alcohol, and hepatic/renal impairment.
C/I = Sulfa allergy and pregnancy.
Examples = Micronase, Amaryl, Glucotrol and Glynase) |
|
|
Term
| What is the MOA and use for Meglitinides? Contraindications? Example? |
|
Definition
MOA = Stimulates pancreatic insulin secretion from functioning beta cells.
Use = DM Type II.
Example = repaglinide (Prandin)
C/I = DKA. |
|
|
Term
| What class of drug is Metformin (glucophage)? MOA? Indications? SEs? Contraindications? |
|
Definition
It is a Biguanide.
MOA = reduces intestinal glucose absorption, reduces hepatic glucose production and increases tissue sensitization to insulin.
Indications = DM Type II in monotherapy or with Sulfonylureas or insulin.
SEs = nausea, vomiting, diarrhea, metallic taste and lactic acidosis (rare).
C/I = renal dysfunction and iodinated contrast dye. |
|
|
Term
| What is the MOA, indication, SEs and contraindications to Alpha glucosidase inhibitors (Precose, Glyset) use? |
|
Definition
MOA = delays absorption of dietary CHO.
Indication = DM Type II.
SEs = GI disturbances.
C/I = chronic intestinal disease, patients prone to intestinal obstruction and cirrhosis. |
|
|
Term
| What is the MOA, indication, SEs and contraindications to the Thiazolidinediones (Actos, Avandia)? |
|
Definition
MOA = increases tissue sensitivity and decreases hepatic glucose production.
Indication = DM Type II in monotherapy or combo with sulfonylureas, metformin or insulin.
SEs = weight gain, fluid retention and liver damage.
C/I = NYHA Class III and above heart failure. |
|
|
Term
| What are the rapid acting insulins? |
|
Definition
| lispro, aspart and glulisine |
|
|
Term
| What is the short acting insulin? |
|
Definition
|
|
Term
| What are the intermediate acting insulins? |
|
Definition
|
|
Term
| What are the long acting insulins? |
|
Definition
| ultralente, glargine and detemir |
|
|
Term
| Describe when the dose is typically taken for rapid and long acting insulin. |
|
Definition
Rapid = ac (before meals) or pc (after meals).
Long = QHS (before bed) |
|
|
Term
| One unit of insulin will typically cover how many grams of CHO and lower blood glucose by how much? |
|
Definition
| 10-15 grams and lower blood glucose by 30-50 mg/dL |
|
|
Term
| What is the MOA, Indication and SEs/considerations of the Incretin Mimetic (GLP-1 agonist): Exenatide (Byetta)? |
|
Definition
MOA = increases insulin secretion, decreases glucagon secretion and delays gastric emptying.
Indication = DM Type II patients that cannot maintain glycemic control with sulfonylureas and/or metformin.
SEs = weight loss!, nausea, vomiting, diarrhea and it may reduce absorption of oral drugs so take them 1 hour before or 2 hours after. |
|
|
Term
What is the MOA and Indication for the DPP-IV Inhibitor:
Sitagliptin (Januvia)? |
|
Definition
MOA = inhibits the DPP-IV enzyme resulting in increased plasma insulin levels and increased GLP-1 levels (glucagon-like peptide 1 - which actually acts to lower glucagon and glucose levels).
Indication = DM Type II as monotherapy or with metformin or Thiazolidinediones (TZDs). |
|
|
Term
| What are the Sx for hypoglycemia? |
|
Definition
Nervousness
Sweating
Shakiness
Confusion
Difficulty speaking
Hunger
Dizziness
Lightheadedness |
|
|
Term
| What is the typical treatment for DM Type II at diagnosis? If still not controlled? If still not controlled? What should be discontinued when initiating insulin? |
|
Definition
At diagnosis = Metformin.
Step 2: Metformin + basal insulin OR metformin + sulfonylurea.
Step 3: Metformin + intensive insulin.
*When initiating insulin, discontinue sulfonylureas or Meglitinides. |
|
|
Term
| In what circumstances would insulin therapy be started initially upon diagnosis of a Type II DM patient? |
|
Definition
| Fasting blood glucose over 250 mg/dl, random blood glucose over 300 mg/dl, A1C over 10% and/or the presence of ketonuria. |
|
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Term
Which of the following is not an affect of diabetes (DM)?
a. Heart disease
b. Blindness
c. Ketone production
d. All of the above are effects of DM |
|
Definition
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Term
Which of the following is not a symptom of hypoglycemia?
a. Shakiness
b. Dizziness
c. Slow wound healing
d. Confusion |
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Definition
|
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Term
Which of the following is NOT considered an endocrine hormone?
a. Renin
b. Insulin
c. Glucagon
d. Somatostatin |
|
Definition
|
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Term
What type of cell secretes glucagon?
a. Beta cells
b. Alpha cells
c. Plasma cells
d. Acinar cells |
|
Definition
|
|
Term
What type of cells secrete insulin?
a. Beta cells
b. Alpha cells
c. Plasma cells
d. Acinar cells |
|
Definition
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Term
Which of the following would NOT be considered a symptom of hyperglycemia?
a. Polyuria
b. Weight gain
c. Polyphagia
d. Polydipsia |
|
Definition
|
|
Term
Which of the following is NOT related to chronic diabetes?
a. Atherosclerosis
b. Neuropathy
c. Glaucoma
d. Hypotension |
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Definition
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Term
| What are the DMARD indications for the TNF-alpha Blocking agent: Infliximab (Remicade)? |
|
Definition
| Indications = Rheumatic/Psoriatic arthritis. |
|
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Term
| What are the effects on the serum calcium and phosphate for PTH, Vitamin D and Calcitonin? |
|
Definition
PTH = increases calcium and reduces phosphate.
Vitamin D = increases both of them.
Calcitonin = lowers both of them. |
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Term
| What bone mineral density levels are considered normal, osteopenia and osteoporosis? |
|
Definition
Normal = -1.0 and above.
Osteopenia = -1.0 to -2.5.
Osteoporosis = -2.5 and below. |
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Term
| Every standard deviation below normal in the bone mineral density scan does what to the risk of fracture? |
|
Definition
Doubles it.
-1 standard deviation equals 2 times the risk of fracture
-2 standard deviation equals 4 times the risk of fracture
-3 standard deviation equals 8 times the risk of fracture |
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|
Term
| What is the recommended daily calcium intake in those 19-49? Over 50? Postmenopausal? |
|
Definition
19-49 = 1000mg.
Over 50 = 1200 mg.
Postmenopausal = 1200-1500mg. |
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Term
| What is the MOA, drug interactions and considerations for the Bisphosphonate class of drugs? Examples? |
|
Definition
MOA = They coat the bone and are taken up by osteoclasts (which are then inhibited) and whatever is remaining on the bone is incorporated into the matrix.
Interactions = NSAIDs.
Considerations = must be taken with water at least 30 minutes before food and they should not lie down for at least 30 minutes.
Examples = Boniva, Fosamax, Actonel and Reclast. |
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|
Term
| What is the class and indication for alendronate (Fosamax)? |
|
Definition
| Bisphosphonate used to treat osteoporosis. |
|
|
Term
| What is the class and indication for ibandronate (Boniva)? |
|
Definition
| Bisphosphonate used to treat osteoporosis in postmenopausal women. |
|
|
Term
| What is the class and indication for risedronate (Actonel)? |
|
Definition
| Bisphosphonate used to treat osteoporosis in postmenopausal women, men and glucocorticoid associated osteoporosis. |
|
|
Term
| What is the class and indication for zoledronic acid (Reclast)? |
|
Definition
| Bisphosphonate used to treat osteoporosis in postmenopausal women, men and in glucocorticoid associated osteoporosis. |
|
|
Term
| What is the MOA and Indications for raloxifene (Evista)? Contraindications? |
|
Definition
MOA = SERM (selective estrogen receptor modulator).
Indication = spine fractures (not hip) and prevention/treatment of osteoporosis in postmenopausal women.
C/I = **Should not be given to women with increased risk of stroke, TIAs, Afib, or uncontrolled HTN. |
|
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Term
| What did the WHI study indicate that HRT therapy in women led to an increased risk of? |
|
Definition
| Increased risk of breast cancer, stroke, blood clots, heart attack |
|
|
Term
| What is the MOA and indication for Miacalcin & Fortical? |
|
Definition
MOA = active ingredient is calcitonin.
Indication = 3rd line for treatment of osteoporosis. |
|
|
Term
| What is the MOA, Indication and Black box warning for teriparatide (Forteo)? |
|
Definition
MOA = the active ingredient is PTH.
Indication = treatment of osteoporosis in postmenopausal women with hx of fractures or several risk factors and have failed other therapy.
Black Box warning = increases risk for osteosarcoma. |
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