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Chelsea: Endocrine Pharm > Because Blessington said this pharm test sucks ass. > Flashcards

Because Blessington said this pharm test sucks ass. Flashcards

1
Q

What are the three available treatment styles for osteoporosis?

A
  1. Lifestyle modifications (tobacco, exercise, nutrition, caffeine avoidance)
  2. Supplements (Calcium and Vitamin D)
  3. Pharm (Catabolic Inhibitors and Anabolic stimulants)
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2
Q

How much oral calcium is absorbed?

A

30-40%

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3
Q

What is the ceiling dose of calcium?

A

3 times per day

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4
Q

At what age does the daily dose of calcium change from 1,000 mg to 1,200 mg in women?

A

50

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5
Q

Tell me about the three types of calcium supplements…

A
  1. Calcium carbonate (cheap - cannot take with food)
  2. Calcium citrate (better absorbed)
  3. Calcium Gluconate (Expensive)
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6
Q

What calcium supplement should you take with a PPI?

A

Calcium Citrate

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7
Q

What is the dosing range for OTC Vitamin D supplement?

A

700-800IU (controversial)

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8
Q

When is estrogen therapy helpful in osteoporosis?

A

In peri-menopausal causes – prevents further break down

Not therapeutic so calcium and vitamin D also need to be given

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9
Q

How does estrogen work?

A

Reduces levels of cytokines, TNF-alpha, IL-1, and IL-6, which stimulate osteoclasts and directly modulate osteoclast activation

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10
Q

Why isn’t estrogen help in senile osteoporosis?

A

Because in senile, there is decreased osteoblast activity, NOT increased osteoclast activity

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11
Q

When is estrogen therapy cautioned?

A

Past history/family history of BC, endometrial cancer or history of thromboembolic disorder

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12
Q

Adverse effects of estrogen therapy?

A

Breakthrough bleeding, breast tenderness, increase risk of cancer - because of this, it is no longer recommended

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13
Q

What is Raloxifene [Evista]?

A

Selective Estrogen Receptor Modulators (SERM’s)

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14
Q

What does Raloxifene [Evista] do?

A

Estrogen-like effect on bone and lipids - decreasing bone resorption

Thought not to stimulate endometrium and breast tissue

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15
Q

When is Raloxifene [Evista] used?

A

Prevention and treatment of osteoporosis

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16
Q

What are the side effects of Raloxifene?

A

Flu-like syndrome, hot flashes, arthralgias, peripheral edema, headache, weight gain, vaginal bleeding

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17
Q

Who should not take Raloxifene?

A

History of venous thrombosis and caution when on thyroid medications - may decrease its absorption.

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18
Q

Do you cycle progesterone with Raloxifene?

A

Negatory.

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19
Q

What do bisphosphates do?

A

Suppress osteoclast activity with no negative effect on mineralization (except Etidronate)

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20
Q

When should you take bisphosphonates?

A

On an empty stomach with 8oz of fluids in the AM - sit upright for 30 minutes after to avoid esophagitis.

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21
Q

Who should avoid taking bisphosphonates?

A

Renal failure patients

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22
Q

What is a side effect of bisphosphonates?

A

Osteonecrosis of the jaw

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23
Q

Tell me about the 4 formulations of bisphosphonates and what do they do?

A
  1. Risedronate - reduces vertebral fractures (not hip)
  2. Etidronate - used in Paget’s disease only - inhibits mineralization
  3. Alendronate - most common -reduces both hip and vertebral fractures
  4. Zolendronic Acid - used in post-hip fractures (IV only - every 12 months)
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24
Q

What is Aldendronate’s MOA?

A

Decreases rate of bone resorption

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25
Q

What are the side effects of Alendronate?

A

Esophagitis, hypophosphatemia, myalgia

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26
Q

Who should not take Alendronate?

A

Esophageal abnormalities

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27
Q

What drugs interact with Alendronate?

A

Antacids

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28
Q

How often is Alendronate taken?

A

Daily/weekly

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29
Q

What is Calcitonin?

A

Hormone - administered in osteoporosis, Paget’s disease and hypercalcemia

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30
Q

What does Calcitonin do?

A

Decreases osteoclast activity (binds to osteoclast receptors) by antagonizing impact of PTH and possible analgesic effect

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31
Q

Side effects of Calcitonin?

A

Rhinitis, epistaxis, nasal mucosal ulcerations…

Because inhaled in the nose

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32
Q

How is Calcitonin administered?

A

IM or nasal spray (hence the SE’s we just talked about)

Alternate nostrils daily

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33
Q

What does Calcitonin reduce the risk of?

A

Vertebral fractures

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34
Q

Anabolic therapies for osteoporosis?

A

Testosterone, fluoride, Teriparatide [Forteo]

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35
Q

Does testosterone supplementation help men with osteoporosis?

A

No

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36
Q

Why is fluoride not a good treatment?

A

Increases bone mass but the new bone is poorly mineralized and brittle

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37
Q

When is Teriparatide used?

A

Moderate to severe cases with previous hip/vertebrae fractures not responding to bisphosphonates

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38
Q

How does Teriparatide work?

A

Injection of low dose recombinant form of PTH - stimulates osteoblast activity causing new bone formation

Must give as low dose injections in order for it to stimulate osteoblasts

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39
Q

Max time frame to take Teriparatide?

A

2 years

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40
Q

Can you take Teriparatide in combination with bisphosphonates?

A

No - but bisphosphonates may be started after 2 years of discontinuing Teriparatide

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41
Q

What is Levothyroxine?

A

T4 replacement

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42
Q

When is Levothyroxine given?

A

Hypothyroidism

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43
Q

How does Levothyroxine work?

A

Replacement T4 converted to T3 in peripheral tissues, travels to nuclear receptors, causes protein synthesis, metabolic rate, promotes gluconeogenesis

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44
Q

When should we take Levothyroxine?

A

In AM 30 minutes before eating

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45
Q

What is a major drug to drug interaction with Levothyroxine?

A

Iodide

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46
Q

How should hypothyroidism be monitored once on drug?

A

TSH - 6 to 8 weeks until normalized, 8-12 weeks after dose change

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47
Q

What drugs decrease TSH level?

A

Corticosteroids and dopamine

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48
Q

What drug increases TSH?

A

Metoclopramide - no one knows why… well, at least I don’t.

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49
Q

If patient pharmacy swtiches brands of Levo, what should be done?

A

Curb stomp a bitch.

And then check TSH in 6-8 weeks

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50
Q

As patients age, does their dose change?

A

It may - typically decreases with age

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51
Q

What is Liothyronine?

A

T3 replacement (rarely needed)

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52
Q

When is Liothyronine indicated?

A

Hypothyroidism unresponsive to Levo or treatment for myxedema coma

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53
Q

What percent of hypothyroid patients need Liothyronine?

A

Roughly 15% - genetic deaminase deficiency so they cannot convert T4 to T3

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54
Q

How does Liothyronine work?

A

T3 in peripheral tissues to nuclear receptors to cause protein synthesis, metabolic rate, promote gluconeogenesis

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55
Q

How often should Liothyronine be dosed?

A

BID or TID because short half life

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56
Q

Why is thyroid USP not used anymore?

A

Don’t even know what this is but it has unpredictable hormone amounts, causing potential T3 toxicity

This probably isn’t important.

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57
Q

What is Liotrix?

A

Synthetic T4 and T3 in a 4:1 ratio - seldom use

58
Q

What is Sasha eating right now?

A

Mac and cheese

59
Q

Does depression happen with hypothyroidism or hyperthyroidism?

A

Both!

60
Q

Starting dosing regimen for Levo?

A

12.5 to 25 micrograms

61
Q

What drugs reduce thyroid hormone synthesis?

A

Anti-thyroid drugs - duh.

Propylthiouracil, methimazole and radioactive iodine

62
Q

What does radioactive iodine do?

A

Thyroid ablation - concentrates in thyroid gland and kills off gland cells over 6-8 weeks

63
Q

Can pregnant women take radioactive iodine?

A

No

64
Q

How does methimazole work?

A

Oxidation of iodine in thyroid gland preventing iodine combining with tyrosine to for T3 and T4

65
Q

Does Methimazole inactivate circulation T3 and T4?

A

Nope.

66
Q

How does Prednisone work?

A

Suppresses adrenal function at high dose - decreases leukocyte migration - enters cell nucleus to alter synthesis of proteins

67
Q

Half life of prednisone?

A

12-26 hours

68
Q

Side effects of long term use of Prednisone?

A

HPA-axis suppression

Decreased Ca++ absorption

Hypercorticolism

69
Q

Can someone on prednisone get live vaccines?

A

No way Jose

70
Q

Where is prednisone metabolized to active form?

A

Liver

Active form = Prenisilone

71
Q

After how long does a person need to be down titrated when coming off prednisone?

A

2 weeks of therapy or more

72
Q

What makes Dexamethasone different from Prednisone?

A

Longer half life of 48+ hours

8-10 times more potent

Less dose required

73
Q

What is Fludrocortisone?

A

Mineralocorticoid - used for Addion’s disease and resistant orthostatic hypotension

74
Q

What is Fludrocortisone’s MOA?

A

Promotes increased distal renal tubule absorption of Na+ and loss of K+

75
Q

What drug interacts with Fludrocortisone?

A

Diuretics - increase levels of loops

76
Q

What is Glipizide?

A

Sulfonylurea - used in type 2 DM

77
Q

MOA of Glipizide?

A

Stimulates pancreatic B cells to release insulin

78
Q

Why is there controversy on using sulfonylureas as first line?

A

May increase rate of B cell burn out

Weight gain

79
Q

Side effects of Glipizide?

A

HYPOGLYCEMIA

Weight gain

80
Q

Contraindications of Glipizides?

A

Sulfa allergy

Type 1 DM

81
Q

Drug-drug interactions with Glipizide?

A

Beta blockers - decrease hypoglycemic effect/symptoms

82
Q

What is Repaglinide?

A

Non-sulfonylurea secreatgogue

83
Q

When do we use Repaglinide?

A

To reduce post-prandial glucose levels - used in patients with sulfa allergies that cannot take Glipizide

84
Q

How does Repaglinide work?

A

Binds to adjacent receptor on sulfonylurea receptor on beta cell to stimulate insulin release

85
Q

How much does Repaglidine decrease post prandial glucose levels?

A

65-70 mg/dL

86
Q

When should Repaglidine be taken?

A

15 minutes prior to meals TID

87
Q

Can Repaglidine be used as monotherapy?

A

Yes - but also in combo with Metformin and TZD

88
Q

What is the amylin mimetic?

A

Pramlintide

89
Q

Is Pramlintide used in type 1 or type 2 DM?

A

Both - used to lower post prandial glucose levels

90
Q

What else does Pramlintide do?

A

Decreases gastric emptying, glucagon secretion and appetite

91
Q

How is Pramlintide administered?

A

Subcutaneously 15 minutes pre-meal - DO NOT MIX WITH INSULIN

92
Q

What is Exantide [Byetta]?

A

Incretin-synthetic analog of GLP-1

93
Q

When do we use Exantide?

A

Type 2 DM with Metformin +/- Sulfonylurea to lower post prandial glucose levels

94
Q

Side effects of GLP-1?

A

Necrotizing, hemorrhagic pancreatitis

Can cause hypoglycemia if used with insulin secretagogue

95
Q

How is Exantide administered?

A

SubQ BID up to 60 minutes pre meal

96
Q

When should someone stop Exantide therapy?

A

If they develop antibodies to the drug

97
Q

What is Liraglutide?

A

Incretin-synthetic analog of GLP-1 used to Type 2 DM with Metformin +/- Sulfonylurea to lower post prandial glucose levels

98
Q

How does Liraglutide work?

A

Increases insulin release, decreases glucagon release, slows gastric emptying, decreases appetite, *increases beta cell growth/replication

99
Q

What is Sitagliptin?

A

DPP-4 inhibitor used in type 2 DM

100
Q

How does Sitagliptin work?

A

Inhibits DPP-4 to reduce degradation of GLP-1 - increases levels of GLP-1

101
Q

What is Metformin?

A

Biguanide

102
Q

Is Metformin the first line drug for Type 2 DM?

A

Yes!

103
Q

How does Metformin work?

A

Unknown - decreases hepatic glucose production, decreases renal gluconeogenesis, slows intestinal absorption glucose, increase glucose conversion to lactate by enterocytes, etc.

104
Q

Side effects of Metformin?

A

N, V, D, farting

105
Q

What drugs interact with Metformin?

A

Iodinated IV contrast

106
Q

What should you watch for on patients taking Metformin that have renal failure?

A

Lactic acidosis

107
Q

Is hypoglycemia seen in patients with Metformin?

A

No, not typically

108
Q

Metformin should be started at low doses and titrated up to avoid what side effect?

A

Diarrhea

109
Q

If someone needs IV contrast, what should they do with taking their Metformin?

A

Hold 48 hours

110
Q

What is Pioglitazone?

A

TZD (Thiazolidinedione)

111
Q

Is Pioglitazone used in Type 1 or Type 2 DM?

A

Type 2

112
Q

How does Pioglitazone work?

A

Decreases insulin resistance - it is the most potent insulin sensitizer

113
Q

Contraindications of Pioglitazone?

A

Macular edema, diabetic retinopathy

114
Q

What is Rosiglitazone?

A

TZD - no longer used due to severe CV side effects (CHF and AMI)

115
Q

What hormone does Pioglitazone require for activity?

A

Insulin - because it sensitizes insulin! Duh!

116
Q

What should be monitored while on Pioglitazone?

A

Regular eye exams

117
Q

What is acarbose?

A

Alpha-glucosidase inhibitor

118
Q

Is Acarbose used in type 1, type 2 DM, or both?

A

Both!

119
Q

How does Acarbose work?

A

Reduces post prandial glucose levels by inhibition of intestinal alpha-glucosidase conversion polysaccharides to monosaccarides

120
Q

Side effects of Acarbose?

A

Farting, diarrhea, abdominal pain - people hate these

121
Q

When should Acarbose be taken?

A

Before each meal

122
Q

What is Colesevelam?

A

Bile Acid Sequesterant

123
Q

What is Colesevelam used for?

A

Hypercholesteremia

Type 2 DM in adjunct with Metformin/Sulfonylurea/Insulin

124
Q

MOA of Colesevelam?

A

Decreases intestinal glucose absorption

125
Q

What does Colsevelam do to triglycerides?

A

Elevates them
Caution if >200mg/dL
Discontinue if >500mg/dL

126
Q

How should Colsevelam be taken?

A

3 tabs prior to meal BID

127
Q

What is desmopressin?

A

Vasopressin receptor agonist

128
Q

What is desmopressin used to treat?

A

Diabetes insipidus

129
Q

How does desmopressin work?

A

Increases permeability of renal tubular cells to water reabsorption causing decreased urine volume

130
Q

What is the rapid-acting insulin?

A

Insulin lispro

131
Q

What is the short acting insulin?

A

Regular insulin

132
Q

Intermediate acting insulin?

A

Neutral Protamine

133
Q

Long acting?

A

Insulin Glargine

134
Q

Which type of insulin is inhaled?

A

Exubra

135
Q

What drug interacts with insulin?

A

Alcohol - increases hypoglycemia risk

136
Q

Onset, peak, duration for Lispro?

A 
Onset = 5-15 minutes
Peak = 1-1.5 hours
Duration = 3-5 hours
137
Q

Onset, peak, duration of Regular?

A 
Onset = 0.5-1 hour
Peak = 2-4 hours
Duration = 5-8 hours
138
Q

Onset, peak, duration of Neutral Protamine?

A 
Onset = 2-4 hours
Peak = 4-10 hours
Duration = 10-24 hours
139
Q

Onset, peak, duration of Glargine?

A

Onset = 2-4 hours
Does not peak
Duration = 20-24 hours

Do not mix with other insulins in the same syringe

140
Q

What kind of doing is used in type 1 DM?

A

Short acting (with meals) and intermediate/long acting (basal levels)

141
Q

What kind of dosing of insulin in used in type 2 DM?

A

Long acting (basal) +/- short acting

142
Q

At what A1C level is therapy initiated?

A

8.5% - single drug therapy may suffice - Metformin or Sulfonylurea

Over 9% - typically needs multiple drugs to work on different mechanisms

Chelsea: Endocrine Pharm (1 decks)

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