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Pharmacology II > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q
  • Thyroid Gland Function?
  • need sufficient ________ to produce thyroid hormones
A
  • regulates BMR
    —>person must obtain a sufficient amount of iodine to produce thyroid hormones
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2
Q

TRH comes from what part of the brain

A

hypothalamus

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3
Q

TSH comes from what part of the brain

A

pituitary

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4
Q

T3 and T4 com from what part of the brain

A

thyroid gland

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5
Q

T4 (storage) is converted to __ (active) at target tissues

A

T3

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6
Q

thyroid hormones affect what 5 things

A
  • Heat production and body temperature
  • oxygen consumption and CO
  • BV
  • Enzyme system activity
  • Metabolism of carbs, fats, and proteins
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7
Q

what hormone is important for regulator of growth and development, especially with reproductive and nervous systems

A

Thyroid gland

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8
Q

Targert cells absorb thyroid hormone which sends a message to the ___________ to stop sending out more ___, which stops production of ___, then stops T_ and T_

A

Hypothalamus; TRH; TSH; 3; 4

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9
Q

What is the clinical definition of Hypothyroidism
(__ is converted to __)

A

Elevated TSH due to insufficient amount of thyroid hormone (T4 is converted to T3)

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10
Q

5 Causes of Hypothyroidism

A
  • low iodine
  • low function of thyroid tissue due to tumor or autoimmune disorder (Hashimoto)
  • Thyroidectomy
    -Aggressive Tx with antithyroid drugs

(Low mineral, No function, autoimmune/tumor, or antithyroid drugs)

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11
Q

Symptoms of Hypothyroidism

A
  • Chills
  • low body temp
  • Lethargy, slowed speech
  • bradycardia, hypotension
  • decreased appetite
  • weight gain
  • skin pale, dry

(LOW AND SLOW)

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12
Q

What are the 2 types of Hypothyroidism

A

Cretinism (children)
- dwarfism/severe mental retardation

Myxedema (adults)
- Symptoms of normal Hypothyroidism

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13
Q

Hypothyroidism is related to what disease

A

Graves Disease

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14
Q

What are the symptoms of Hyperthyroidism

A
  • Inc. BMR
  • Tachycardia
  • Weight loss
  • Inc. Body temp
  • Anxiety
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15
Q

name of hyperthyroidism symptom of bulge of the eyes

A

Exophthalmos

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16
Q

What is the drug of use for someone with hypothyroid conditions?

A

Levothyroxine

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17
Q

What is the drug of use for someone with hyperthyroid conditions?

A

Thiomides (class)
- Propylthiouracil (PTU)***
- Methimazole (Tapazole)
- Radioactive Iodine

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18
Q

replacement therapy increases the levels of thyroid hormone and this suppresses what hormone?

A

TSH

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19
Q

How to teach a patient on how to take levothyroxine

A

used for hypothyroidism
- take with an empty stomach, 30min before breakfast, with full glass of water

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20
Q

why should you be caustious to give levothyroxine to a patient with a cardiac hx

A

the drug increases HR and BP and can cause complications

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21
Q

Adverse effects of Levothyroxine

ALL SYMPTOMS OF TAKING TOO MUCH

A
  • HTN
  • Tachycardia
  • Arrhythmia
  • Anxiety, nervousness, jittery, inability to sleep
  • Heat intolerance
  • Sweating
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22
Q

Warfarin interacting with levothyroxine causes what effect

A

Increased anticoagulant effect

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23
Q

Digoxin interacting with levothyroxine causes what effect

A

Decreased effect of levothyroxine

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24
Q

Antiseizue and antidepressants interacting with levothyroxine causes what effect

A

Increase levothyroxine metabolism

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25
Q

Binding Agents interacting with levothyroxine causes what effect

A

Decrease levothyroxine absorption

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26
Q

Pharmacokinetics of PTU

A

inhibits synthesis of thyroid hormones; inhibits peripheral conversion of T4 to T3
- well absorbed in GI tract

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27
Q

PTU adverse effects
(4ish effects)

A
  • thyroid suppression; drowsiness, lethargy
  • Watch for increase in liver issues/jaundice (HEPATITIS)
    -use with anticoagulants causes INCREASED BLEEDING
  • GI distress, N/V
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28
Q

Mthimazole(tapazole) have similar effects what drug but is associated with what suppression?

A

PTU
- Bone marrow suppression

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29
Q

Sodium iodide is sued to treat what type of thyroid issue?

A

Hyperthyroidism
- it is radioactive so it gets absorbed and then destroys thyroid cells

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30
Q

radiation such as soidum iodide is not safe for???

A

Pregnant or children

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31
Q

Adrenal Medulla is located on the inside or outside?

Adrenal cortex is located on the outside or inside? and what does it produce?

A

Medulla: Inner core; part of the SNS

Adrenal Cortex: Outer shell; produces hormones called corticosteroids

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32
Q

What includes androgens, glucocorticoids, and mineralcorticoids (this is mainly what)?

A

Corticosteroids

Mainly aldosterone

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33
Q

Corticotropin (ACTH) stimulates what to produce what

A

stimulates the adrenal cortex to produce corticosteroids

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34
Q

Incrasing levels of corticosteroids inhibit the release of what and what to start a negative feedback mechanism

A

increasing levels of corticosteroids inhibits the release of CRH and ACTH - negative feedback loop

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35
Q

sudden stops of steroids results in a crisis of adrenal ___________ until hypothalamic-pituitary axis controls stimulate the ______ _____ again

A

sudden stops of steroids results in a crisis of adrenal cortex until hypothalamic-pituitary axis controls stimulate the adrenal gland again

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36
Q

a common cause of adrenal insufficiency is prolonged use of what?

A

corticosteroid hormones

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37
Q

an exogenous use of this product acts to negate the regular feedback loop, what is it?

A

Corticosteroids

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38
Q

what causes the adrenal glands to no longer be stimulated and produce or secrete hormones?

A

The use of exogenous corticosteroids

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39
Q

when exogenous corticopsteroids are used, how long does it take fo the adrnal gland to recover from the atrophy of the lack of stimulation

A

several weeks

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40
Q

Because exogenous corticosteroids can cause atrophy of ACTH hormone release, what is recomennded with the use of steroid therapy

A

only use for short-term steroid therapy and should be weaned slowly
- this gives the adrenal glands time to recover and start producing hormones again

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41
Q

What steroid is a male and female sex hormone and effect electrolytes, stimulate protein production, and decrease protein breakdown

A

Androgens

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42
Q

What steroid stimulated an increase in glucose levels for energy
- glucocorticoids have anti-inflammatory properties, help to control metabolism of muscle, fat liver and bone, they effect vascular ton influence mood, behavior, sleep/wake cycle
- primary corticoid is cortisol

A

glucocorticoids

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43
Q

What steroid affects electrolyte levels and homeostasis
- regulate Na, H2O balance
- primary version of it is aldosterone

A

Mineralocorticoids

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44
Q

What steroid promotes homeostasis of CV, nervous, and musculoskeletal systems - to a certain extent

A

Glucocorticoids

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45
Q

What would be the INDICATIONs OF USE for
Adrenal Glands and warnings?

A
  • suppress immune system **
    (used mostly for short-term)
  • short term use: Releace acute inflammation AND for replacement therapy when release of hromone arent adequate

-DOES NOT CURE ANY INFLAMMATORY DISORDERS

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46
Q

What are the TOP 3 glucocorticoid medication names?

A

Cortisone (generic)
Dexamthasone (generic)
Prednisone (Rayos)

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47
Q

Which glucocorticoid is short acting and what activity does it produce?

A

Short acting: Cortison: Both glucocorticoid and mineralocorticoid activity

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48
Q

Which glucocorticoid medication is intermediate acting?

A

Prednisone

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49
Q

Which glucocorticoid medication is long acting?

A

Dexamethasone

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50
Q

Why are glucocorticoiuds so important (what is their function and use)

A

they are anti-inflammatory
(anti-inflammatory helps with allergies, rhinitis, asthma, dermatitis, etc.)
- Helps with Maignant disorders (Hodgkin’s disease, leukemias)
- Immunosuppression (Post-transplant surgery)

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51
Q

What is the action of Glucocorticoids/ what does it cause the body to do?

A

Cause lipogenesis (formation of fat)
- decreases WBC, inhibits tisue granulation and repair
- may cause NA and H2O retention (leading to edema and HTN)
- Opposite of androgens (inc. protein breakdown and dec. rate of protein formation)

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52
Q

Contraindications of glucocorticoids

A
  • allergic
  • acute infection
  • lactation
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53
Q

Caution with the use of glucocorticoids

A
  • pregnancy
  • diabetes
  • Acute peptic ulcer
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54
Q

Drug-drug interaction with glucocorticoids
(what drugs increase/decrease it)

A
  • Increase in glucocorticoid function when given erythromycin, ktoconazole or troleandomycin
  • Decrease in drug when given with salicylates barbiturates, pehnytoin or rifampin
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55
Q

What is the top adverse effect for the use of glucocorticoids?

A

Growth retardation in children

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56
Q

What causes Adrenal insufficiency?

A

Decrease in ACTH from pituitary or decreased output from adrenal cortex

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57
Q

What can Addisons disease or long term treatment with glucocorticoids cause?

A

Adrenal insufficiency

58
Q

What are symptoms of Adrenal insufficiency?

A
  • Fatigue
  • Low BP
  • Hypoglycemia
  • GI disturbances
59
Q

What syndrome is caused from long term use of glucocorticoids and what are the characteristics?

A

Cushings syndrome
- adrenal atrophy
- lots of fat around shoulder and neck
- increased risk of infection related to delayed wound healing.

60
Q

Top nursing process protocols for GLUCOCORTICOIDS

A
  • Do not stop abruptly – can cause adrenal crisis
  • Drugs are not curative but do suppress the inflammatory process
  • Effects of the drug last for several days, sometimes months depending on route
  • Medication may increase appetite
    Take medication with food as it can upset stomach
  • Do not use concurrently with NSAIDs – GI effects
  • Must assess fluid retention and weight gain at follow up appts
  • Long term uses is associated with increased risk for infection
  • Increased risk for hyperglycemia
61
Q

What is secreted by ovarian follicles and responsible for maturation of sex organs and secondary sex characteristics of women

A

Estrogen

62
Q

Estrogen affects the release of ___ and __ (fertility hormone)

A

FSH and LH

63
Q

what hormone is responsible for proliferatiion of the endometrial lining

A

estrogen

64
Q

What are the 6 uses of Estrogen

A
  • Contraception (combined with progestin)
  • Hormone replacment
  • palliation for discomforts of menopause
  • treat female hypogonadism and ovarian failure
  • prevent post partum breast engorgment (as part of combo pill)
  • slow bone loss in osteoporosis
65
Q

What are the therapeutic actions of estrogens

A
  • Affects release of FSH and LH
  • Maintaining the secondary female sex characteristics
  • PROTECTING THE HEART FROM ATHEROSCLEROSIS
  • retaining calcium and phosphorus in the bones
  • complete with androgens for recepto sites
66
Q

Adverse effects of Estrogen

A

break thru bleeding, menstrual irregularities, dis/amenorrhea, changes in libido
- GI tract: nausea, cramps, bloating, colitis
- Systemic effects: BLOOD CLOTS
- Ocular changes:

67
Q

what is the most important thing to do to prevent blood clots

A

DONT SMOKE

68
Q

Estrogen is not indicated in…

A

prepubesant children

69
Q

When someone is taking estrogen, what can hapen to the eyes

A

Ocular changes - corneal changes —- may need new contact lenses

70
Q

estrogen can decrease effectiveness of _______ and some _________ drugs

A

warfarin; hypoglycemic

71
Q

Progestins are secreted by the…

A

corpus luteum (progesterone most abundant)

72
Q

progestins prepare endometrium for what?

A

implantation

73
Q

In the third final cycle of the uterine cycle, there is ____ progesterone and estrogen levels

A

HIGH

74
Q

Progestins provide a ______ feedback to shut off ____, ___, and LH secretions

A

negative; GNRH; FSH

75
Q

Progestins is the class of medication

A

just to know

76
Q

How can progestins be used

A
  • used to maintain a pregnancy
  • contraception
    (most effective with combo with estrogens)
  • treat primary and secondary amenorrhea
  • trear dysfunctional uterine bleeding
77
Q

pharmacokinetics of progestins

A

well absorbed
- undergo hepatic metabolism and are excreted in the urine

78
Q

Actions of progesterone

A

Transform proliferative endometrium into a secondary endometrium
- inhibit the secretion of FSH and LH

79
Q

What are the contraindications of progestins

A
  • allergy
  • if pregnant
  • undiagnosed vaginal bleeding
  • breast/genital cancer
  • Hx of clots (DVT/PE)
80
Q

Adverse effects of progestins

A

First tier:
- Weight gain
- depression
- HTN
Second tier:
- NV, dysmenorrhea, and vaginal candidiasis

81
Q

What drugs have drug-drug interactions with progestins

A

Barbiturates
- carbamazepine
- phenytoin
- rifampin

82
Q

If a pt has Hx of blood clots or cancer, they will not be put on what hormone?

A

Estrogen

83
Q

Inc in estrogen are not good in pregnant women because…

A

it will decrease breast milk amount

84
Q

apply estrogen patches to the trunk not on waistline
- may be discontinued prior to surgeries because of potential clot formation
- take estrogen at bedtime
- notify PCP of swelling, SOB, or chest pain

A
85
Q

What are oral contraceptives

A

Hormones used to prevent pregnancy

86
Q

Are ortal contraceptives used in combo with estro and progestins?

A

YES

87
Q

How to OC help prevent pregnancies

A

Small doses prevent conception by blocking ovulation

88
Q

How many -phasic and what are the names

A
  • Monophasic
  • Biphasic
  • Triphasic
  • progestin only
89
Q

What type of estrogen-progestin contraceptive is the only one used that is approved to treat heavy menstrual bleeding

A

Quadriphasic (Natazia)

90
Q

progestin-only oral contraceptive produce what?

A

Produce thick, viscous mucus at entrance to uterus
- mucus discourages penetration by sperm
- inhibit implantation of fertilized egg

91
Q

With progestin-only oral contraceptives, there is a higher rate of what?

A

Higher rate of menstrual irregularities
- they don’t create thromboembolic or breast cancer risk

92
Q

what is the function (action) of OC combinations with progestin and estrogen?

A

Inhibit release of FSH and LH thus preventing ovulation

93
Q

OC combo primary use is…

A

Contraceptive, improvement in cycle regularity, dec. incidence of dysmenorrhea

94
Q

What are the adverse effects of OC combo?

A

edema
- nausea
- abdominal cramps

95
Q

What is the difference between monophasic, biphasic, and triphasic?

A

Monophasic - same level of hormone throughout pack

Biphasic- change level of hormone about half way through

Triphasic - 3 different doses of hormones

96
Q

again smoking increases the risk of…

A

blood clots

97
Q

Side effects of OC includes

A
  • appetite changes
  • weight gain
  • mood swings
  • edema
  • bloating
  • breast tenderness
98
Q

Use caution giving OC to patients with those with …..

A

migraine headaches

99
Q

OC may increase the risk of what type of cancer

A

breast cancer

100
Q

before taking OC, the doctor needs to ask client if they plan to do what…. (about breasts) and why

A

Breastfeeding
- estrogen will decrease milk supply
- should give progesterone only pill if plans to breast feed
- can give combo if client plans to stop breastfeeding

101
Q

What is the name of the long-term exteended-duration formulations equally effective contraception

A

Depot injection (depo-provera)

102
Q

What is the BLACK BOX for depot injections (Depo-Provera)

A

Bone loss and need break every 5 years

103
Q

Depo-Provera therapeutic class

A

hormone; drug for dysfunctional uterine bleeding

104
Q

Depo-Provera: pharmacologic class?

A

Progestin

105
Q

what are the indications for the use of Depo-Provera?

A
  • Endometriosis
  • amenorrhea
  • uterine bleeding
  • contraception
106
Q

Contraindication of Depo-Provera

A
  • Pregnant
  • known or suspected carcinoma of breast
  • caution in pat with Hx of:
  • depression and discontinued immediately at first signs
107
Q

What emergency OTC is available

A

plan B

108
Q

Function of Emergency Contraception

A
  • Prevents ovulation and implantation of fertilized egg; does not induce abortion
109
Q

is Menopause the natural process of aging?

A

yes

110
Q

What does Menopause do to the body?

A
  • Progressive decrease in estrogen secretion by the ovaries
  • permanent cessation of menses
  • can be accompanied by hot flashes, night sweats, irregular menstrual cycles, bone mass loss
111
Q

For hormone replacement rherapy for menopause, what ius the caution for combo vs estrogen alone?

A

Estrogen-progestin combination
- Increased risk of MI, stroke, breast cancer, dementia, and venous thromboembolism
- Decreased risk of hip fracture and colorectal cancer

Estrogen alone
- Increased risk of stroke and thromboembolism
- No increased breast cancer or MI

112
Q

Pros and cons of HRT

A
  • Cardiac problems
  • Stroke
  • Breast Cancer
  • Dementia
  • HRT may dec. risk of hip fractures and colorectal cancer
113
Q

conjugated equine estrogen (Premarin) is given when ovarian activity is…

A

blocked/absent or menopause

114
Q

conjugated equine estrogen (Premarin) is given when relief is needed from s/s of

A

menopause who STILL HAVE UTERUS

115
Q

Benefits of HRT

A

Reduced Hot flashes
- prevents osteoporosis
- reduced vaginal dryness

116
Q

Side effects of HRT

A

breakthrough bleeding
- inc risk of CV events

117
Q

Fertility drugs do what and what are the indications to use it?

A

Stimulate release of FSH and/or LH
- Infertility

118
Q

Clomiphene (Clomid) do what

A

treat female/male infertility
- Stimulates OVULATION

119
Q

Chorionic gonadotropin (Pregnyl)

A

Stimulation of Ovulation!!!

120
Q

When are fertility drugs contraindicated? What are some cautions?

A
  • need the ability to ovulate
  • thyroid or adrenal dysfunction
  • ovarian cyst
  • Pregnancy
  • allergic

Caution:
- breastfeeding
- thromboembolic disease
- resp. disease

121
Q

Adverse effects of fertility drugs

A

-inc. risk of multiple births and birth defects
- Ovarian overstimulation
- Headache, fluid retention, nausea, bloating
- uterine bleeding
- gynecomastia (males)

122
Q

Clomiphene
- indications
- action

A

Indication: Tx of ovarian failure in pts with normal liver function and normal endogenous estrogens; off-label use, tx of male sterility
Actions: Binds to estrogen receptors and give hypothalamus false signal to increase FSH and LH secretion causing ovarian stimulation

123
Q

What are Oxytocic

A

Natural hormones secreted by posterior pituitary
- Stimulates uterine contractions to induce labor
- Suckling stimulates release of oxytocin
- Causes more milk ejection

124
Q

Oxytocin induces what?

A

Labor: by inc. frequency and force of uterine contractions

125
Q

Adverse effects of Oxytocin

A

Complications in fetus include dysrhythmias or intracranial hemorrhage

126
Q

serious complications using Oxytocin can cause what?

A

Uterine rupture, seizures, or coma

127
Q

contraindications for Oxytocin (Pitocin)

A
  • allergy
  • Cephalopelvic Disproportion ( if pelvis not structured to accommodate the fetus during birth)
128
Q

Adverse effects of Pitocin (oxytocin)

A
  • excessive effects: Uterine hypertonicity
  • Uterine rupture
  • GI upset
  • Headache
  • BP changes
  • Water intoxication
129
Q

Oxytocin
indication:
Actions:

A

Indications: To start or improve uterine contractions for early vaginal delivery; stimulate labor; manage abortion; control postpartum bleeding hemorrhage
Actions:
- Synthetic form stimulates the uterus, especially the gravid uterus; causes myoepithelium of the lacteal glands to contract, results in milk ejection

130
Q

Tocolytics

A
  • Slow uterine contractions to delay labor
  • Used in patients with premature labor
  • Delays labor by 24-72 hrs, often enough time for fetus to develop normal lung function
  • adverse effects include tachycardia in both mother and fetus
131
Q

What are the uses of tocolytics

A
  • Relax the uterine smooth muscle and prevent contractions
  • Usually reserved for use after 20 weeks of gestation
132
Q

What is the name of the tocolytics prototype name?

A

Terbutaline (Brethine)

133
Q

What drug is a great choice for a patient with both preterm labor and asthma and works in both the lungs and the uterus

A

Terbutaline (Brethine)
[Tocolytics]

134
Q

What drug is widely used agent to relax gravid uterus

A

Tocolytics (Terbutaline)

135
Q

Tocolytics are the opposite of what drug

A

Oxytocic

136
Q

Abortifacients do what?

A

Terminate pregnancy at 12-20 weeks
- Dislodge any implanted trophoblast and preventing implantation of fertilized egg

137
Q

What is the name of the drug for Abortifacients

A

Dinoprostone (Cervidil)

138
Q

What are the contraindications of Abortifacients

A
  • Allergies
  • After 20 weeks gestation
  • Previous C-sections - risk for uterine rupture
139
Q

Adverse effects of abortifacients

A
  • amniotic fluid embolism
  • Perforated uterus or uterine rupture***, heavy bleeding
140
Q

can dinoprostone (Cervidil) induce labor or help getting pregnant

A

NO, it helps to induce labor but helps to terminate pregnancy

141
Q

What drug promotes ripening (softening), shortening, and dilating of cervix before inducing labor

A

Dinoprostone (Cervidil)

142
Q

Pitocin is given in what type of pump

A

infusion pump

Pharmacology II (2 decks)

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