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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
Q

side effects of biphosphonates?

A

**Upper GI symptoms/heartburn **
* Osteonecrosisis of the Jaw(very rare)
* atypical femoral fractures (very rare)

take on empty stomach, 8oz H2O, upright 39 min

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26
Q

oral
dosed weekly
decreases risk of fractures by about 50%- all types

A

alendornate

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27
Q

Dosed weekly or monthly
side effect profile and antifracture efficacy similar to alendronate

A

Risedronate

28
Q

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

A

Ibandronate

29
Q

IV, dosed yearly for osteoporosis (every 2 years for prevention of osteoporosis)

A

Zoledronic acid

30
Q

side effects of zoledronic acid?

A

No GI side Effects
Up to 1/3 of pts will have an acute phase reaction to the 1st infusion (fever, myalgias)

30
Q

side effects of zoledronic acid?

A

No GI side Effects
Up to 1/3 of pts will have an acute phase reaction to the 1st infusion (fever, myalgias)

31
Q

the most potent bisphosphonate
antifracture efficacy at ALL sites- vertebral fracture rates decreased by 70%

A

Zoledronic Acid

32
Q

what is produced by the thyroid parafollicular cells
and has no significant role in calcium balance in humans

A

calcitonin

33
Q
  • 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
A

Calcitonin

34
Q

MOA: Is monoclonal antibody to RANK-L (functions similarly OPG)
Decreases activation of osteoclasts

A

Denosumab

35
Q

subcutaneous injection
dosed every 6 months
antifracture efficacy at all sites, vertebral fractures decreased 70%

A

denosumab

36
Q

which medications or anabolics

A

teriparatide
abaloparatide

37
Q

short-acting recombinant PTH
pulsatile PTH induces osteoblastic activity much more than osteoclastic activity leading to net gains in bone density

A

teriparatide
abaloparatide

38
Q

given as a daily injection
approved use for 2 years
shown to decrease vertebral fractures by 65% and nonvertebral fractures by 50%

A

teriparatide
abaloparatide

39
Q

side effects of anabolics?

A

*often mild

nausea
dizziness
weakness

40
Q

what needs to be given after treatment of teriparatide? why?

A

antiresorptive medications
bone gains are quickly lost when the drug is stopped

41
Q

First line medication for hypothyroidism?

A

levothyroxine

42
Q

medication that can be used in rare T4-T3 coversion disorders

A

liothyronine

43
Q

“natural derived from bovine or pocrine thryoid glands”
contiaines T4 an T3 but not in phsyiolgoic ratios

A

Dessicated thyroid

44
Q

short acting, low potency glucocorticoids

Exogenous cortisol, weakest of the steroids

A

hydrocortisone

45
Q

intermediate acting, medium potency glucocorticoids

A

Prednisone, prednisolone, methylprednisolone, triamcinolone

46
Q

long acting, high potency glucocorticoids

A

dexmethasone, betamethasone

47
Q

preferred glucocorticoid for replacement therapy in adrenal insufficiency and crisis? why?

A

hydrocortisone- it has both mineral corticoid and glucocorticoid affects

48
Q

steroid used to treat cancer, inflammation, allergy and autoimmune conditons
most commonly used steroid for chronic therapy

A

prednisone/prednisolone

49
Q

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

A

methylprednisolone

50
Q

used in diagnostic suppresion tests and variety of neoplastic infectious and inflammatory conditions
high glucocorticoid, and zero mineralcorticoid

A

dexmethasone

51
Q

immediate side effects of steroids?

A

gastritis
mood changes (euphoria)
insomnia
weight gain and increased appetite
fluid retention/ edema
blurry vision

52
Q

gradual side effect of steroid use?

A
  • 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
Q

what are idosyncratic side effects of steroids?

A

avascular necrosis
ocular changes (Cataract formation, open angle glaucoma)
psychosis
* can be mild or severe

54
Q

when do you have to taper steroid use? what should it include?

A

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
Q

in adrenal crisis (triggering events such as surgery, infection, trauma) how do you treat patients? why is it important?

A

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
Q

treating Addison’s disease?

A

hydrocortisone and fludrocortisone

57
Q

pituitary lesions, metastatic breast, prostate, lung cancer
symptoms:**no hyperpigmentation, no hyperkalemia, no vitiligo, isolated (glucocorticoid insufficiency) **

A

secondary adrenal insufficiency

57
Q

pituitary lesions, metastatic breast, prostate, lung cancer
symptoms:** no hyperpigmentation, no hyperkalemia, no vitiligo, isolated (glucocorticoid insufficiency) **

A

secondary adrenal insufficiency

58
Q

inhibit intrathyroidal peroxidase, do not effect iodine trapping or release of thyroid hormone.
oral therapy

A

Thiocarbamides: PTU, Methimazole

59
Q

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)

A

PTU

60
Q

preferred agent due to less incidence of hepatotoxicity
dosage 10-30mg 1-2 times daily (5-10mg tablets)

A

methimazole

61
Q

side effects of anti-thyroid drugs like PTU and methimazole

A

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
Q

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

A

radioactive iodione

63
Q

contraindications of radioactive iodine

A

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
Q
  • requires pretreatment with antithyroid drugs and beta blockers
  • effective 90%, may see late recurrence
  • can be employed during 2nd trimester of pregnancy
A

total thyroidectomy or lobectomy

65
Q

treatment of myexedma coma?

A

Hydrocortisone IV q 8hrs
Levothyroxine IV loading dose
supportive care: Intubation/ ventilatory support,

Endocrine Exam 2 (4 decks)

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