Exam 4 Flashcards

Question

Hydrocortisone Usage

Answer 1

Hormone Replacement

Answer 2

Orally and IV Effective 8 to 12 hour duration

Answer 3

Partially selective for glucocorticoid receptors Orally and IV effective 18 to 36 hour duration

Answer 4

STRONG anti inflammatory effects VERY POTENT LONG duration of action 36 to 54 hours

Answer 5

Hormone replacement therapy for adrenal failure and 21 hydroxylase deficiency

Answer 6

Mineralocorticoid ANTAGONIST

Answer 7

K+ sparing diuretic Uses for aldosterone secreting tumors

Answer 8

Gynecomastia

Answer 9

Glucocorticoid receptor

Answer 10

More glucocorticoid receptor selectivity reduces these

Answer 11

Short term high dose therapy is safe Long term low does therapy is safe

Answer 12

2/3 in the AM and 1/3 in the PM

Answer 13

Levothyroxine Liothyronine Methimazole Propylthiouracil Potassium Iodide Radioactive Iodine

Answer 14

Follicular cells of thyroid gland Stores about a 3 month supply

Answer 15

More Potent Triiodothyronine T3 Thyroxine T4 converted in the body to active T3

Answer 16

Conversion of I- into I2 by thyroid peroxidase

Answer 17

Identical to endogenous T4

Answer 18

Nuclear transcription factor receptor Similar to glucocorticoid receptor

Answer 19

Orally available Converted to T3 in the body Full agonist Slow onset but long duration

Answer 20

Oral IV in myxedema coma Feedback suppression of TSH in thyroid cancers Hormone replacement after thyroid surgery

Answer 21

Orally available Already T3 Full agonist More potent and rapid acting 4 times more potent than levothyroxine

Answer 22

Rapid onset for replacement after surgery Rapid onset for replacement after radioiodine treatment

Answer 23

Start low go slow

Answer 24

Safe in pregnancy Treat patients until slightly hyperthyroid

Answer 25

Anything that depletes thyroid hormone Warfarin because levothyroxine accelerates degredation of vitamin K dependent clotting factors Increased cardiac response to catecholamines

Answer 26

Methimazole Propylthiouracil

Answer 27

Inhibit thyroid peroxidase DO NOT Inhibit release of preformed thyroid hormone

Answer 28

Orally absorbed Rapidly cleared from circulation Concentrated in thyroid so longer duration of action than plasma half life Metabolism through conjugation and urine excretion

Answer 29

Agranulocytosis Rash Muscle and joint aches Hypothyroidism if dose too high

Answer 30

Longer half life and duration of action Higher potency

Answer 31

Fetal side effects DO NOT USE IN 1st TRIMESTER

Answer 32

Inhibits conversion of T4 to T3 Use to treat thyroid storm Preferred drug in 1st trimester of pregnancy

Answer 33

Shorter half life

Answer 34

Protects thyroid from damage by radioactive iodine

Answer 35

Acute inhibition of synthesis and release of thyroid hormone Decreases vascularity of gland

Answer 36

Sort term suppression Thyroid storm Pre op about 10 days before surgery

Answer 37

Rash Diarrhea Brassy taste Oral irritation

Answer 38

85% beta radiation for localized therapeutic tissue destruction 15% gamma radiation for imaging and cancer diagnosis

Answer 39

Hyperthyroidism diagnosis Localization of metastatic thyroid cancers General assessment of thyroid anatomy

Answer 40

Localized destruction of thyroid gland

Answer 41

Pregnancy Breastfeeding Young children

Answer 42

Iodides Propylthiouracil Glucocorticoids Propranolol

Answer 43

Glimepiride Pioglitazone Rosiglitazone Exenatide Canagliflozin Metformin Pramlintide Acarbose Sitagliptin

Answer 44

Hypoglycemia

Answer 45

Use insulin

Answer 46

Glimepiride

Answer 47

Cause more insulin release

Answer 48

Glucose flows into beta cell through GLUT 2 Glucose is used to make ATP ATP closes K+ channels Cell depolarizes and opens voltage gated Ca2+ channels Ca2+ causes exocytosis of insulin containing vesicles

Answer 49

Block ATP sensitive K+ channels so cell stays depolarized for longer More insulin gets released

Answer 50

Well absorbed Slowed by food Protein bound

Answer 51

Metabolized by liver and excreted by kidney Excreted by BOTH urine and bile

Answer 52

Hypoglycemia Weight Gain Occasional GI, skin, liver, and blood issues

Answer 53

Liver or kidney disease Some may cause balance issues in the elderly

Answer 54

Biguanide Only drug in class

Answer 55

Works in the liver to decrease glucose production and increase glucose uptake No action on insulin so NO RISK OF HYPOGLYCEMIA

Answer 56

Oral Taken 2 to 4 times per day after meals Well absorbed and not protein bound Excreted UNCHANGED IN URINE

Answer 57

May build up to dangerous levels in patients with kidney disease Patients must be well hydrated due to renal excretion

Answer 58

Does not cause hypoglycemia or weight gain

Answer 59

Lactic acidosis especially in kidney disease and alcohol intake GI irritation

Answer 60

Alpha glucosidase inhibitor

Answer 61

Inhibit enzymes that break down sugars in the gut

Answer 62

Take 30 minutes before each meal Usually used in combination with other drugs

Answer 63

Can cause hypoglycemia ONLY when combined with other drugs Only glucose will treat hypoglycemia with this drug, OTHER SUGARS WILL NOT WORK GI effects AVOID WITH METFORMIN DUE TO GI ISSUES

Answer 64

Pioglitazone Rosiglitazone

Answer 65

“glitazone”

Answer 66

Binds and activates PPAR gamma nuclear transcription factor receptor Enhances transcription of insulin responsive genes Helps endogenous insulin work better

Answer 67

Decrease gluconeogenesis, glucose output, and triglyceride synthesis in liver Increase glucose uptake in muscle Increase glucose uptake and decreases fatty acid production in adipocytes OVERALL EFFECTS LIVER, MUSCLE, AND FAT

Answer 68

Oral Taken with food once per day Metabolized by liver and excreted in bile Subject to enterohepatic recirculation

Answer 69

Liver toxicity Edema which can lead to heart problems Bone fractures Weight gain

Answer 70

GLP 1 analogs that increase insulin secretion and decrease glucagon Slow gastric emptying to promote satiety

Answer 71

Alone or in combination with insulin or other drugs Injected subQ

Answer 72

Nausea Hypoglycemia Pancreatitis

Answer 73

Alters absorption of antibiotics and contraceptives

Answer 74

Sitagliptin

Answer 75

Inhibit the breakdown of endogenous GLP 1

Answer 76

No effect on weight Respiratory infections

Answer 77

Canagliflozin

Answer 78

Blocks glucose resorption in the kidneys to increase excretion

Answer 79

Hypotension so good for treating hypotension but can become dangerous UTIs Fractures

Answer 80

Tyrosine kinase receptor

Answer 81

Phosphorylation cascade leads to translocation of glucose transporters into the cell membrane

Answer 82

Onset Peak Duration

Answer 83

Rapid or short acting Onset 30 min to 1 hr Peak 2 to 4 hrs Duration 5 to 6 hours

Answer 84

Complexed with protamine at neutral pH Suspension and not solution

Answer 85

Onset 1 to 2 hrs Peak 6 to 12 hrs Duration 18 to 24 hrs

Answer 86

CANNOT be given IV

Answer 87

Sustained insulin effect between meals

Answer 88

Clear before cloudy

Answer 89

Lispro Aspart Glulisine

Answer 90

Glargine Detemir Degludec

Answer 91

Injected right before a meal Less risk of hypoglycemia from missed meals Less risk of hypoglycemia after a meal

Answer 92

Peak 30 min Duration 3 to 4 hrs

Answer 93

Similar onset to lispro Longer duration than lispro

Answer 94

For use before or immediately after a meal

Answer 95

Long, low, constant activity over 24 hrs Peakless or flat activity

Answer 96

Soluble at pH 4 so precipitates in blood

Answer 97

Fatty acid chain myristic acid allows it to bind to plasma albumin for a controlled release

Answer 98

More consistent absorption than glargine Shorter action than glargine

Answer 99

Fatty acid chain promote aggregation of insulins and slows release

Answer 100

Long acting over 42 hrs

Answer 101

Short acting insulin before meals Long acting insulin before bed

Answer 102

Hypoglycemia with missed meals, exertion, or if insulin dose is too high

Answer 103

Juice, candy, honey for mild Glucose preparations for more severe Glucagon injection if unconscious

Answer 104

Masks the sympathetic symptoms of hypoglycemia

Answer 105

Helps insulin work better Slows gastric emptying

Answer 106

Decreases postprandial glucose Only used with insulin Decreases need for insulin

Answer 107

Estradiol Conjugated Estrogens Ethinyl Estradiol

Answer 108

Progesterone Medroxyprogesterone Acetate Norethindrone

Answer 109

Tamoxifen Raloxifene

Answer 110

Poor oral bioavailability Metabolized by the liver

Answer 111

PROmote GESTation

Answer 112

Only safe in hypogonadism before and right at puberty

Answer 113

Hormone replacement therapy Hypogonadism

Answer 114

Identical to endogenous estrogen

Answer 115

Hormone replacement therapy

Answer 116

Estrogen conjugated with sulfate

Answer 117

Oral combined contraceptives

Answer 118

Ethinyl group increases oral bioavailability, slows clearance, and increases potency

Answer 119

Nausea Edema Cholestatis Insulin resistance Increased blood clotting

Answer 120

Increased risk of endometrial cancer which is reduced by progestins

Answer 121

Replacement therapy with estrogen in menopause Birth control Uterine bleeding Endometriosis

Answer 122

Menstrual changes Nausea Bloating

Answer 123

Masculinization Worsened lipid profile

Answer 124

Conjugated estrogens with medroxyprogesterone

Answer 125

Ethinyl estradiol with norethindrone

Answer 126

Reduction of osteoporosis Reduction in colorectal cancer May protect against Alzheimers

Answer 127

Increased breast cancer risk Increased risks of hear disease and stroke

Answer 128

Norethindrone

Answer 129

Orally effective

Answer 130

Can act as an estrogen agonist or antagonist depending on the tissue

Answer 131

Treatment of postmenopausal osteoporosis Prevention of breast cancer

Answer 132

Hot flashes due to antagonist effects Thromboembolism due to agonist effects

Answer 133

Treatment of ER+ advanced and metastatic breast cancer Breast cancer prevention

Answer 134

Uterine cancer due to agonists effects Thromboembolism due to agonist effects

Answer 135

Ethinyl Estradiol Norethindrone Norethynodrel Levonorgestrel Norgestimate Drosperinone Etonogestrel DMPA Ulipristal

Answer 136

Suppresses GnRH from hypothalamus which prevents FSH and LH release which stops the luteal surge

Answer 137

Suppresses FSH release thus blocks folliculogenesis

Answer 138

Progestin thickens cervical mucous

Answer 139

Sometimes androgenic

Answer 140

Estrogenic and not androgenic

Answer 141

Not androgenic or estrogenic A pure progestin

Answer 142

Anti androgenic Anti mineralocorticoid receptor actions Can cause hyper K+

Answer 143

Newer progestin

Answer 144

Higher progestin

Answer 145

Lower estrogen

Answer 146

Norethynodrel Norgestimate Drosperinone

Answer 147

Ethinyl Estradiol with Levonorgestrel

Answer 148

Take the pill ASAP

Answer 149

Resume taking pills as normal with backup contraception for at least 7 days

Answer 150

Normal menstruation and fertility should return to normal in 30 days If does not return to normal after 90 days evaluate for other medical issues

Answer 151

Pregnancy Estrogen Responsive Tumors Tobacco smoking in 35 or older

Answer 152

Thromboembolic disease Heart disease Diabetes Hypertension Liver disease

Answer 153

MANY due to lipid solubility Anti seizure medications Phenytoin and Carbamazepine Rifampin

Answer 154

Less effective than combined drugs

Answer 155

Taken continuously

Answer 156

Thicker cervical mucous

Answer 157

Taken 24/4 May be more effective than norethindrone

Answer 158

Subdermal implant

Answer 159

Loss of bone density Takes a year after discontinuation for fertility to return

Answer 160

Use as emergency contraceptive up to 72 hours after unprotected sex Available OTC

Answer 161

Nitroglycerin Nifedipine Verapamil Metoprolol

Answer 162

Sildenafil

Answer 163

Oxygen demand exceeds oxygen supply

Answer 164

Angina with a given amount of exercise

Answer 165

Angina at rest with increased frequency and duration

Answer 166

Most common angina Asymptomatic

Answer 167

Rare spasms of coronary arteries More common in young people and smokers

Answer 168

Immediate relief AND prophylaxis Increased exercise tolerance

Answer 169

Reduction of myocardial oxygen demands

Answer 170

Organic nitrates Ca2+ Channel Blockers Beta Blockers

Answer 171

Coronary arteries profuse during diastole Prolonging diastole increases coronary blood flow

Answer 172

Prodrug releases NO when metabolized by ALDH 2 Overall supplements endothelial production of NO Dilates veins to reduce preload and myocardial oxygen demand

Answer 173

MINIMAL because they are already maximally dilated DOES directly dilate vasospastic coronary arteries

Answer 174

Reflex tachycardia Dilation of arterioles in the face, neck, and meninges

Answer 175

Low activity of ALDH 2 which reduces the efficacy of nitroglycerin More common in Asian people

Answer 176

Achieves therapeutic levels in under a minute for rapid relief 1 hour duration of action Contact EMS if no relief 5 minutes after first dose

Answer 177

Can happen within 24 hours Nitroglycerin permanently inhibits ALDH 2 Common with oral and transdermal routes Avoid with nitrate free intervals of 10 to 12 hours

Answer 178

Headache Orthostatic hypotension Reflex tachycardia

Answer 179

Vasodilators like PDE 5 inhibitors and alpha blockers Alcohol

Answer 180

Dihydropyridines such as Nifedipine Heart rate lowering Verapamil

Answer 181

Blocks L type Ca2+ channels in vascular smooth muscle, cardiac myocytes, and pacemaker cells Overall dilates arteries to reduce afterload Useful in vasospastic angina

Answer 182

Prophylaxis to reduce need for nitroglycerin Equally efficacious as beta blockers but no increase of survival

Answer 183

More active in vascular smooth muscles than in myocardium Metabolized by CYP 3A4 so AVOID GRAPEFRUIT JUICE

Answer 184

More active in myocardial and pacemaker cells Less potent than dihydropyradines Short half life

Answer 185

Sick sinus syndrome AV Nodal Block

Answer 186

First line for hypertension Pulmonary arterial hypertension Cardiac arrhythmias

Answer 187

Bradycardia in heart rate lowering drugs Reflex tachycardia in dihydropyradines Headache, flushing, dizziness in dihydropyradines GERD Constipation in heart rate lowering drugs

Answer 188

Metoprolol

Answer 189

Decrease heart rate, contractile force, and afterload to decrease myocardial oxygen demand Increased profusion in diastole No effect on resting heart rate

Answer 190

DO NOT USE IN VASOSPASTIC ANGINA Increased airway resistance ACUTE MI ON SUDDEN WITHDRAWAL Exercise intolerance

Answer 191

Avoid with partial beta 1 agonist drugs Avoid with heart rate lowering Ca2+ channel blockers

Answer 192

Sildenafil

Answer 193

Selective PDE 5 inhibition Prolongs action of cGPM in penile erectile tissue and lungs Only works with sexual stimulation Only works with intact innervation

Answer 194

Taken 1 hour before sexual activity 1 hour onset 2 to 4 hour duration Metabolized by CYP 3A4

Answer 195

Pulmonary hypertension

Answer 196

Headache and flushing Abnormal vision Dyspepsia Sudden hearing loss Priapism

Answer 197

Organic Nitrates Alpha Blockers

Answer 198

Chlorthalidone Captopril Losartan Nitroprusside Hydralazine Minoxidil

Answer 199

Inactivates the vasodilator bradykinin

Answer 200

Under 120/80

Answer 201

120 to 129/<80

Answer 202

130 to 139/80 to 89

Answer 203

Thiazide Diuretics ACE Inhibitors or Angiotensin Receptor Blockers BUT NOT BOTH Calcium Channel Blockers

Answer 204

Higher doses or different combos of first line therapies

Answer 205

Vasodilators Beta Blockers Other drugs

Answer 206

Chlorthalidone

Answer 207

Rids Na+ from the body thus decreases blood volume Short term compensatory increase in total peripheral resistance Drop in total peripheral resistance 6 to 8 weeks later

Answer 208

Best in mild to moderate hypertension

Answer 209

ACE inhibitors or ARBs can prevent the initial increase in blood pressure

Answer 210

Hypokalemia corrected with low Na+ diet Hyponatremia and Hypercalcemia Gout, hyperglycemia, and hyperlipidemia Erectile Dysfunction

Answer 211

ACE inhibition lowers concentration of angiotensin II Inhibits degradation of endogenous vasodilator bradykinin

Answer 212

Increases renin Increases angiotensin I Decreases release of aldosterone through inhibition of AT 1 receptors in adrenal cortex Prevents and reversed vascular remodeling in the heart

Answer 213

Taken orally once or twice per day Cleared by kidneys

Answer 214

First line therapy in hypertension Improves survival overall

Answer 215

Hypotension Dry Cough Angioedema Hyperkalemia Reduced GFR in bilateral renal stenosis patients Unsafe in pregnancy

Answer 216

Losartan Other Sartans

Answer 217

Blocks Ang II AT I receptor but not AT 2 receptor Decreases TPR and secretion of aldosterone

Answer 218

Hyperkalemia Decreased GFR Unsafe in pregnancy

Answer 219

Decomposes to NO in circulation Dilated BOTH veins and arteries Tolerance DOES NOT DEVELOP

Answer 220

IV infusion to control high blood pressure in hospital patients Hypertensive emergency

Answer 221

Excessive hypotension Cyanide Toxicity Methemoglobinemia

Answer 222

Arteriolar dilation of unknown mechanism

Answer 223

N acetylation by NAT 2 in liver Consider genetic fast and slow acetylators

Answer 224

Resistant Hypertension Hypertensive crisis Congestive heart failure and hypertension comorbidity

Answer 225

Reflex tachycardia Flushing and headache Lupus like syndrome

Answer 226

Opens K+ channels on vascular smooth muscle which dilates arteries

Answer 227

Seldom used due to adverse effects Add on for resistant hypertension Topical for male pattern baldness

Answer 228

Severe Edema Pericardial Effusion and Tamponade Reflex tachycardia Hypertrichosis