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Endocrine Exam 2 > Medication > Flashcards

Medication Flashcards

1
Q

Calcium recommendations in young adults

A

1000mg/day

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2
Q

calcium recommendation in adolescents/teens, postmenopausal women, men>70

A

1200-1300mg

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3
Q

when do you need calcium supplementation?

A

when dietary intake is inadequate

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4
Q

what is calcium carbonate primarily composed of

A

40% elemental calcium

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5
Q

what supplement is citracal? how many pills necessary to achieve 500-600mg dose of calcium

A

calcium citrate

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6
Q

what is the daily dose recommendation for Vitamin D

A

600iU per day

Pts with osteooporosis may need more

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7
Q

MOA: CaSR agonist. It can be used to suppress abnormal/unwanted PTH secretion

A

cinacalcet

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8
Q

cinacelot is approved for?

A
  • suppressing PTH in the setting of parathyroid carcinoma
  • suppressing PTH in the setting of secondary hyperparathyroidsim due to ESRD/HD
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9
Q

what can be used to treat sever hypercalcemia?

A

furosemide

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10
Q

which medication can be useful in the treatment of hypercalciuria (increased risk of kidney stones)

A

thiazide diuretics
(e.g hydrochlorothiazide)

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11
Q

what form of vitamin D is found in most supplements?

A

Cholecalciferol (D3)

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12
Q

form of Vitamin D that is produced by irridating plant sterols, and is found in some vitamin D supplements

A

Vitamin D2

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13
Q

which forms of vitamin D are readily activated and are equally effective at binding and activating the Vitamin D receptor

A

Vitamin D synthesis/ Activation

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14
Q

1,25-dihydroxy vitamin D(1,25-D) is the active form. Pharmacologically, this is called?

A

calcitriol

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15
Q

what medications can be used to treat vitamin D deficiency?

A

cholecalciferol (D3) and ergocalciferol (D2)

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16
Q

What medication is used to treat secondary hyperparathyroidism (due to impaired renal 1alpha-hydroxylase activity)

A

calcitriol or other active vitamin D analogues

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17
Q

what medications can be used to treat hypoparathyroidsm?

A

calcium and calcitriol (as lacking PTH needed to activate)

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18
Q

although estrogen is effective, what is something to note?

A

it is not first line therapy for prevention or treatment of osteoporosis

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19
Q

MOA:binds to the estrogen receptor, but has differential effects depending on the tissue

A

raloxifene

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20
Q

what is Raloxifene effect on bone

A

Estrogen like- at bone: small improvement in bone density, prevents further loss

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21
Q

what is raloxifene effect at the breast?

A

anti-estrogen like at breast: (decreases breast cancer risk)
* neutral at endometrium (no endometrial hyperplasia
* increased hot flashes and risk of thromboembolic diseae

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22
Q

what does raloxifene decrease the risk of?

A

vertebral fracture by 30-50%, no proven effect on hip or hop fractures

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23
Q

what medications are biphosphonates?

A

alendronate
risedronate
ibandronate
zoledronic acid

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24
Q

MOA: reabsorbed by osteoclasts, they impair their function and induce apoptosis; prevent further bone loss

A

biphosphonates

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25
side effects of biphosphonates?
**Upper GI symptoms/heartburn ** * Osteonecrosisis of the Jaw(very rare) * atypical femoral fractures (very rare) | take on empty stomach, 8oz H2O, upright 39 min
26
oral dosed weekly decreases risk of fractures by about 50%- all types
alendornate
27
Dosed weekly or monthly side effect profile and antifracture efficacy similar to alendronate
Risedronate
28
Dosed orally, monthly or IV every **3 months ** Side effect profile similar to other bisphosphonates antifracture efficacy demonstrated for vertebral fractures only *Second line for this reason*
Ibandronate
29
IV, dosed yearly for osteoporosis (every 2 years for prevention of osteoporosis)
Zoledronic acid
30
side effects of zoledronic acid?
No GI side Effects Up to 1/3 of pts will have an acute phase reaction to the 1st infusion (fever, myalgias)
30
side effects of zoledronic acid?
No GI side Effects Up to 1/3 of pts will have an acute phase reaction to the 1st infusion (fever, myalgias)
31
the most potent bisphosphonate antifracture efficacy at ALL sites- vertebral fracture rates decreased by 70%
Zoledronic Acid
32
what is produced by the thyroid parafollicular cells and has no significant role in calcium balance in humans
calcitonin
33
* can be used to decrease calcium levels acutely in the treatment of severe hypercalcemia, but effect is short-lived * has some minimal vertebral fracture prevention data * has some data supporting effectiveness in pain control
Calcitonin
34
MOA: Is monoclonal antibody to RANK-L (functions similarly OPG) Decreases activation of osteoclasts
Denosumab
35
subcutaneous injection dosed every 6 months antifracture efficacy at all sites, vertebral fractures decreased 70%
denosumab
36
which medications or anabolics
teriparatide abaloparatide
37
short-acting recombinant PTH pulsatile PTH induces osteoblastic activity much more than osteoclastic activity leading to net gains in bone density
teriparatide abaloparatide
38
given as a daily injection approved use for 2 years shown to decrease vertebral fractures by 65% and nonvertebral fractures by 50%
teriparatide abaloparatide
39
side effects of anabolics?
*often mild nausea dizziness weakness
40
what needs to be given after treatment of teriparatide? why?
antiresorptive medications bone gains are quickly lost when the drug is stopped
41
First line medication for hypothyroidism?
levothyroxine
42
medication that can be used in rare T4-T3 coversion disorders
liothyronine
43
"natural derived from bovine or pocrine thryoid glands" contiaines T4 an T3 but not in phsyiolgoic ratios
Dessicated thyroid
44
short acting, low potency glucocorticoids | Exogenous cortisol, weakest of the steroids
hydrocortisone
45
intermediate acting, medium potency glucocorticoids
Prednisone, prednisolone, methylprednisolone, triamcinolone
46
long acting, high potency glucocorticoids
dexmethasone, betamethasone
47
preferred glucocorticoid for replacement therapy in adrenal insufficiency and crisis? why?
hydrocortisone- it has both mineral corticoid and glucocorticoid affects
48
steroid used to treat cancer, inflammation, allergy and autoimmune conditons most commonly used steroid for chronic therapy
prednisone/prednisolone
49
water soluable form of prednisone which allows for injectable formulation used to treat cancer, inflammation, allergy and autoimmune conditions preferred over IV HC when greater inflammatory effect is needed
methylprednisolone
50
used in diagnostic suppresion tests and variety of neoplastic infectious and inflammatory conditions high glucocorticoid, and zero mineralcorticoid
dexmethasone
51
immediate side effects of steroids?
gastritis mood changes (euphoria) insomnia weight gain and increased appetite fluid retention/ edema blurry vision
52
gradual side effect of steroid use?
* hyperglycemia---> diabetes (recommend dividing daily dose into BID for better glycemic control) * osteopenia---> osteoporosis (recommend calcium/vitamin D therapy) * dyslipidemia (increased LDL/TG, decreased HDL) * increased blood pressure * gastritis---> peptic ulcers * physical changes * adrenal suppresion
53
what are idosyncratic side effects of steroids?
avascular necrosis ocular changes (Cataract formation, open angle glaucoma) psychosis * can be mild or severe
54
when do you have to taper steroid use? what should it include?
when steroid use is greater than 2 weeks taper should include small, graduated dose decreases over increments of 1-2 weeks until daily dose of predinsone
55
in adrenal crisis (triggering events such as surgery, infection, trauma) how do you treat patients? why is it important?
inability to secrete extra cortisol during stress can lead to hypotension, hypoglycemia, seizues, shock and death treatment requires IV glucocorticoid theryapy -**Hydrocortisone** is the drug of choice
56
treating Addison's disease?
hydrocortisone and fludrocortisone
57
pituitary lesions, metastatic breast, prostate, lung cancer symptoms:**no hyperpigmentation, no hyperkalemia, no vitiligo, isolated (glucocorticoid insufficiency) **
secondary adrenal insufficiency
57
pituitary lesions, metastatic breast, prostate, lung cancer symptoms:** no hyperpigmentation, no hyperkalemia, no vitiligo, isolated (glucocorticoid insufficiency) **
secondary adrenal insufficiency
58
inhibit intrathyroidal peroxidase, do not effect iodine trapping or release of thyroid hormone. oral therapy
Thiocarbamides: PTU, Methimazole
59
Inhibits conversion of T4 to T3 drug of choice for Grave's disease in the 1st trimester of pregnancy Dosage 100-150 TID(50mg tablets)
PTU
60
preferred agent due to less incidence of hepatotoxicity dosage 10-30mg 1-2 times daily (5-10mg tablets)
methimazole
61
side effects of anti-thyroid drugs like PTU and methimazole
Rash agrunulocytosis toxic hepatitis lupus like syndrome fever **aplasia cutis with methimazole** used in 1st trimester of pregnancy (absence of skin +/- underlying structures- commonly the scalp)
62
MOA: taken up and stores the same as iodide- incorporated in to TG emits beta and gamma rays may be used in diagnostic thyroid uptake and scan usually results in permanent hypothyroidism
radioactive iodione
63
contraindications of radioactive iodine
children and pregnant women women should not conceive for 6 months discontinue anti-thyroid drugs for atleast 3 days low iodine diet recommended 1-2 weeks
64
* requires pretreatment with antithyroid drugs and beta blockers * effective 90%, may see late recurrence * can be employed during 2nd trimester of pregnancy
total thyroidectomy or lobectomy
65
treatment of myexedma coma?
Hydrocortisone IV q 8hrs Levothyroxine IV loading dose supportive care: Intubation/ ventilatory support,

Endocrine Exam 2 (4 decks)

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