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Pharmacology 2 > Exam 3: Uterus, Thyroid, And Osteo > Flashcards

Exam 3: Uterus, Thyroid, And Osteo Flashcards

1
Q

What is the DOC for inducing labor at term?

A

Oxytocin

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2
Q

What can cause strong contractions in the second trimester?

A

Prostaglandins

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3
Q

What is the first line treatment in postpartum hemorrhage?

A

Massage

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4
Q

What is oxytocin?

A

Cyclic octapeptide stored in posterior pituitary normally released in response to suckling and cervical pressure

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5
Q

What are the indications for Oxytocin?

A
  • DOC to induce labor at term
  • prevention of hemorrhage (IM route preferred)
  • Stimulation of milk let-down reflex
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6
Q

What are the adverse effects of oxytocin?

A
  • Water intoxication with convulsions
  • Uterine rupture
  • Anaphylaxis
  • Sinus bradycardia
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7
Q

What are the contraindications fo oxytocin?

A
  • Malpresentation
  • cephalopelvic disproportion
  • complete placenta prevails
  • uterine scar from previous C section
  • unengaged head
  • cervical scarring
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8
Q

What is the MOA of Ergot Alkaloids?

A

Contraction of uterine smooth muscle through activation of serotonin and alpha-adrenergic receptors

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9
Q

What are the indications to use Ergot Alkaloids?

A

-After completion of labor and the delivery of the placenta to produce firm uterine contractions to decrease uterine bleeding (2nd line after oxytocin and massage have failed)

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10
Q

What are the adverse effects of Ergot alkaloids?

A
  • Transient hypertension

- Angina, MI

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11
Q

What are the contraindications to Ergot Alkaloids?

A
  • Should never be used to induce labor (will cause fetal hypoxia)
  • Peripheral vascular disease or CAD
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12
Q

What are the 3 prostaglandin drugs?

A

Dinoprostone, Carboprost Tromethamine, and misoprostol

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13
Q

What are the indications to use prostaglandins?

A
  • Expulsion of the uterine contents after miscarriage/abortion
  • cervical ripening prior to delivery at term
  • postpartum bleeding due to uterine atony (3rd line)
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14
Q

What are the adverse effects of prostaglandins?

A
  • GI disturbances, vomiting, DIARRHEA (BLACK BOX)
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15
Q

What are the 5 drugs known to cause significant diarrhea?

A 
Metformin
Quinidine
Dinoprostone
Erythromycin
Colchicine

“Many quality drugs expel crap”

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16
Q

When should prostaglandins not be used for cervical ripening?

A

If there is problems with the mother or fetus such as fetal distress or history of difficult deliveries or C section

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17
Q

What are the contraindications to prostaglandins?

A
  • Acute cardiac, pulmonary, renal, or hepatic diseases

- Asthma, HTN, anemia, jaundice, or epilepsy

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18
Q

What kind of drug is Tranexamic acid?

A
  • Non-uterotonic drug

- Anti-fibrinolytic, inhibits plasminogen activation

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19
Q

What are the indications of Tranexamic acid?

A
  • Reduced death due to bleeding in women with postpartum hemorrhage
  • uterine bleeding when hormonal therapy is not wanted or C/I
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20
Q

How is tranexamic acid administered?

A

IV, alongside standard uterotonic therapy

** should not be regarded as alternative therapy

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21
Q

What are the adverse effects of tranexamic acid?

A

-May cause intravascular thrombosis

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22
Q

What are tocolytics and what is their goal?

A
  • Uterine relaxants

- Prevent premature labor or delay premature labor until term or until fetus has matured sufficiently for survival

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23
Q

If delivery of a baby happens before the 37th week, what should be administered?

A

Corticosteroids to cause production of surfactant in the lungs

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24
Q

What are the 4 tocolytic drugs?

A

Magnesium sulfate, Nifedipine, indomethacin, and progesterone

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25
Q

What is the MOA of magnesium sulfate?

A

Relax the uterus probably by a direct effect, unknown mechanism

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26
Q

What are the indications for magnesium sulfate?

A
  • Considered first line (no FDA approved first line)

- can prevent convulsions in pre-eclampsia and treat eclampsia

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27
Q

How is magnesium sulfate administered?

A

Slow IV, may cause hypotension or asystole is too fast)

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28
Q

What are the adverse effects of magnesium sulfate?

A
  • Flushing, diaphoresis, hypotension
  • Depressed DTRs, muscle paralysis, weakness
  • Circulatory collapse, respirator depression
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29
Q

What is the MOA of Nifedipine?

A

-CCB

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30
Q

What is the MOA of indomethacin?

A

Inhibits COX enzyme (reduction of PG synthesis)

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31
Q

What are the adverse effects of Indomethacin?

A
  • possible partial closure of fetal ductus arteriosus, impaired fetal renal function, and persistent PAH in the neonatal period
  • Maternal GI irritation, peptic ulceration, thrombocytopenia
32
Q

What are the indications to using progesterone as a tocolytic?

A
  • More effective than placebo in maintaining length of pregnancy when given prophylactically from the 16th-37th week
  • Not effective for acute treatment
33
Q

What are the signs and symptoms of hypothyroidism (myxedema)?

A
  • Slow metabolic rate, weight gain, hypothermia
  • fatigue, depression
  • bradycardia
  • High TSH
  • Possible goiter
34
Q

What is the DOC for hypothyroidism?

A

Levothyroxine sodium

35
Q

How is Levothyroxine dosed?

A

It must be carefully titrations to the individual

36
Q

What are the 3 drugs used for hypothyroidism?

A

Levothyroxine, Liothyronine sodium , and dessicated thyroid

37
Q

When is liothyronine used?

A

Used for initial therapy of hypothyroid, not maintenance

38
Q

When would you use dessicated thyroid?

A

Patients with deficiency in peripheral deiodinase enzyme

39
Q

What are the causes of hyperthyroidism?

A
  • Graves disease
  • Toxic adenoma
  • toxic multinodular goiter
40
Q

What are the 4 options of treating hyperthyroidism?

A
  • Surgical removal of the gland
  • destroy the gland with 131I
  • decreased T3 and T4 (thioamides, iodide)
  • Block the symptoms with b blockers
41
Q

What are the 2 thioamide drugs?

A

Propylthiouracil and methimazole

42
Q

What is the MOA of Thioamides?

A

Inhibits synthesis of T4 (methimazole is more potent)

-PTU blocks conversation of T4 to T3

43
Q

What is the first line treatment for Graves’ disease?

A

Thioamides

44
Q

What is the black box warning for PTU?

A

Severe liver injury, acute liver failure

45
Q

Is Methimazole or PTU DOC in most causes of graves? What are the exceptions?

A

Methimazole is DOC, except for in cases of allergy or pregnancy

46
Q

What are the side effects common with methimazole and PTU?

A
  • Itching/rash (most common)
  • Granulocytopenia and agranulocytosis
  • Goiter
47
Q

What is the MOA of iodide?

A

-Rapidly decreases synthesis and release of T4/T3

48
Q

What are the indications for iodide?

A
  • decreases vascularity and thyroid content of gland
  • used 7-10 days before surgery to decreased likelihood of thyroid storm
  • radioactive emergencies
49
Q

What is the MOA of radioactive iodide (131I)?

A

Taken into the gland specifically

  • Small dose is diagnosis
  • Large amount destroys the gland
50
Q

What are the indications to radioactive iodide (131I)?

A
  • Used in elderly patients and those with HD
  • Definitive treatment for Graves, but thioamides preferred
  • preferred treatment for toxic nodular goiter
51
Q

What are the adverse effects of radioactive iodide (131I)?

A
  • usually causes hypothyroidism over time

- thyroid storm risk (decrease risk by use of thioamide prior to treatment)

52
Q

What is the C/I to radioactive iodide?

A

Pregnancy, nursing, or mothers who lack childcare

53
Q

How do Beta blockers treat hyperthyroid?

A

Propranolol inhibits the conversion of T4 to T3

54
Q

What are the indications of Beta blockers in hyperthyroidism?

A
  • Decreased many of the symptoms of hyperthyroid

- used to prepare for surgery while waiting for thioamides or 131I to take effect

55
Q

What are the contraindications to B blockers?

A

Asthma, but CCB instead

56
Q

What is key to osteoporosis treatment and fracture prevention?

A

Decreasing bone resorption

57
Q

What is the DOC for treatment of osteoporosis?

A

Bisphosphonates

58
Q

What are the 4 treatment options of osteoporosis?

A
  • Calcium and vitamin D
  • HRT (estrogen inhibits bone resorption)
  • Calcium regulating hormones (PTH, calcitonin)
  • Bisphosphonates (DOC)
59
Q

Can calcium and vitamin D treat osteoporosis alone?

A

NO

60
Q

What are the adverse effects of calcitonin?

A
  • nasal rhinitis/sinusitis
  • nausea and vomiting
  • allergy
61
Q

What are the indications of calcitonin?

A
  • Osteoporosis (not first line)

- pagets disease

62
Q

What is the MOA of calcitonin?

A
  • Decrease bone resorption of Ca

- antagonizes PTH

63
Q

What are the 3 PTH drugs?

A

Teriparatide, abaloparatide, and rhPTH (1-84)

64
Q

What are the adverse effects of Teriparatide and Abaloaparatide?

A
  • Hypercalcemia and hypercalciuria
  • dizziness, leg cramps
  • Abaloparatide causes hyperuricemia
65
Q

What is the black box warning for Teriparatide and abaloparatide?

A

-May cause osteosarcoma

66
Q

What kind of drug is Denosumab?

A

Antibody against receptor activator of nuclear factor kappa beta ligand (RANKL)

67
Q

What is the MOA of Denosumab?

A
  • Inhibits bone resorption

- inhibits RANKL (factor make by osteoblasts that is necessary for the formation of mature osteoclasts)

68
Q

What are the indications of Denosumab?

A
  • Osteoporosis in men and postmenopausal women at high risk for fractures
  • Increase bone mass and strength in both cortical and trabecular bone
69
Q

What are the contraindications of Denosumab?

A
  • Hypocalcemia

- pregnancy

70
Q

What are the precautions of Denosumab?

A
  • CKD

- Patients at risk for serious infections

71
Q

What are the 4 bisphosponate drugs?

A

Alendronate, Risedronate, Ibandronate, and Zoledronic acid

72
Q

What bisphosphonates are given orally? Which are IV?

A

Orally: Aledronate, risedronate, and ibandronate

IV: Ibandronate and zoledronic acid

73
Q

What is the MOA of Bisphosphonates?

A

P-C-P bond binds analogs of pyrophosphate

  • substitutes for PO4 in Ca binding (incorporates into bone)
  • inhibits osteoclast activity and bone resorption
74
Q

What are the indications of Bisphosphonates?

A
  • DOC for post-menopausal osteoporosis
  • Paget’s disease
  • osteopenia
75
Q

How are bisphosphonates administered?

A
  • Orally, absorption is poor
  • must be taken on an empty stomach and stay upright for 30 minutes after
  • other preparations are IV only
76
Q

What are the adverse effects of bisphosphonates?

A
  • Abdominal pain, esophageal ulceration, diarrhea, flatulence, N/V
  • IV may cause renal tox if given too quickly
  • osteonecrosis of the jaw
77
Q

What are the contraindications of Bisphosphonates?

A
  • oral: Inability to stand/sit upright or esophageal disease

- IV: renal disease

Pharmacology 2 (12 decks)

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