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Pharmacology NPLEX2 > Pharm 2 - Exam 3 > Flashcards

Pharm 2 - Exam 3 Flashcards

1
Q

Which thyroid hormone(s) does Levothyroxine/Synthroid replace?

A

T4

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2
Q

Which thyroid hormone(s) does Thyroid USP/Armour thyroid replace?

A

T4 and T3

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3
Q

Which thyroid hormone(s) does Liothyronine/Cytomel replace?

A

T3

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4
Q

Which form of thyroid hormone is active?

A

T3

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5
Q

What is the normal T4:T3 ratio?

A

4:1

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6
Q

If a patient has Addison’s Disease and hypothyroidism, which disease must be addressed first in terms of treatment with medication?

A

Addison’s. Replace cortisol before replacing thyroid hormone.

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7
Q

In what unit doses are Armour and Synthroid given?

A

Armour: mg
Synthroid: mcg

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8
Q

60mg of Thyroid USP/Armour is equivalent to how much Levothyroxine/Synthroid and how much Liothyronine/Cytomel?

A

100mcg Levothyroxine/Synthroid

25mcg Liothyronine/Cytomel

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9
Q

Long term elevation of T4 (such as from Levothyroxine/Synthroid use) increases the risk of what two pathologies?

A

Osteoporosis

CVD

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10
Q

This hypothyroid med is also indicated for Wilson’s Syndrome.

A

Liothyronine/Cytomel (T3)

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11
Q

In what class of drugs are Methimazole/Tapazole and PTU?

A

Thionamide

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12
Q

What is the MOA of Methimazole/Tapazole and PTU?

A

Blocks conversion of T4 to T3

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13
Q

What is the most feared side effect of Methimazole/Tapazole and PTU?

A

agranulocytosis

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14
Q

What is the result of super physiologic doses of iodine?

A

stuns the thyroid into inactivity for days to weeks

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15
Q

Name the two thionamide drugs.

A

Methimazole/Tapazole

Propylthiouricil (PTU)

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16
Q

Of the two thionamide drugs, which is most effective in preventing the conversion of T4 to T3 in peripheral tissues?

A

PTU

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17
Q

What is the MOA of the thionamide drugs?

A
  1. inhibits conversion of inorganic iodine to organic iodine which prevents the formation of thyroxine.
  2. blocks the coupling of iodotyrosine, therefore stopping the production of T3 and T4
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18
Q

Which of the thionamide drugs is more appropriate for pregnancy?

A

PTU. Both are category D though.

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19
Q

Which drugs would be most appropriate for the treatment of thyroid storm?

A

Propanolol/Inderal

IV Iodine/SSKI

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20
Q

How long do the beneficial side effects of iodine/SSKI last?

A

2-3 weeks

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21
Q

Compare the onset of action and half-life of Levothyroxine/Synthroid to Liothyronine/Cytomel?

A

L/S: slow onset, half-life of ~1 week

L/C: rapid onset, half-life of several hours

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22
Q

How long is radioactive iodine typically in the body after a dose is taken?

A

3-5 days.

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23
Q

What is the drug classification of radioactive iodine?

A

category x

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24
Q

How long should pregnancy be delayed following radioactive iodine treatment?

A

6-12 months

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25
Q

What are the s/sx of a thyroid storm?

A

high fever, irritability, delerium, vomiting, diarrhea, hypotension, dehydration, vascular collapse

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26
Q

Diabetes diagnoses all rely on what form of testing?

A

Serum glucose

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27
Q

What might be the problem with calcium derived from oyster or bone?

A

Lead and other heavy metal contamination

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28
Q

What drug class requires that a patient is able to stand or sit upright for 30-60 minutes due to its propensity to cause inflammations and erosion of the esophagus?

A

bisphosphonates

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29
Q

In what class of drugs is Alendronate/Fosamax?

A

Bisphosphonates

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30
Q

What are the two major SE of Alendronate/Fosamax?

A

Osteonecrosis of the jaw

Atypical femur fractures (ex. in the shaft)

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31
Q

In what class is Raloxifene/Evista?

A

SERM

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32
Q

What is the MOA of the SERM class of drugs?

A

Binds to select estrogen receptor sites to beneficial estrogen activity

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33
Q

What is the MOA of bisphosphonates?

A

inhibits osteoclastic activity

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34
Q

This drug is a synthetic hormone that inhibits osteoclastic activity.

A

Calcitonin/Miacalcin

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35
Q

This osteoporosis drug is available in a nasal spray.

A

Calcitonin/Miacalcin

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36
Q

Name the synthetic PTH analogue.

A

Teriparatide/Forteo

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37
Q

This drug activates bone turnover with osteoblasts being activate to a much greater extent than osteoclasts

A

Teriparatide/Forteo

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38
Q

Which to drugs have been shown to reduce the spinal fracture risk in individuals with osteoporosis.

A

Calcitonin/Miacalcin
Teriparatide/Forteo
Estrogen/HRT

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39
Q

What is Estrogen/HRT combined with to reduce the risk of endometrial CA?

A

Progestin

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40
Q

Name the human monoclonal Ab approved for the treatment of osteoporosis.

A

Denosumab/Prolia

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41
Q

How is Denosumab/Prolia administered?

A

SQ injection once every 6 months

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42
Q

MOA of Metformin

A

inhibits glucose production by the liver and decreases insulin resistance

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43
Q

MOA of Sulfonylureas and Meglitinides

A

increases secretion of insulin by interaction with ATP sensitive K+ channels in beta cell membrane

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44
Q

MOA of alpha-glucosidase inhibitors

A

delays absorption of glucose by inhibiting alpha-glucosidase enzyme at brush border

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45
Q

MOA of Thiazolidinediones/Glitazones

A

improves insulin sensitivity in skeletal muscle cells, fat cells, liver cells and decreases hepatic glucose production

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46
Q

MOA of DPP-4 inhibitors

A

promote release of insulin by inhibiting the enzyme that breaks down GI hormones released in response to meal. Also suppresses release of glucagon by the pancreas/

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47
Q

In what two instances may patients on oral diabetic medications be switched to insulin?

A

acute infections

in-patient surgery

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48
Q

What medication is used for women with gestational diabetes?

A

insulin

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49
Q

In what class of drugs is Metformin/Glycophage?

A

Biguanides

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50
Q

T/F. Metformin is likely to cause weight gain

A

False. Metformin can cause modest weight loss (unlike sulfonylureas)

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51
Q

If you put a patient on Metformin, what side effects might you want to tell them to expect?

A 
abdominal cramping
nausea
metallic taste in mouth
increased risk for B12 deficiency
lactic acidosis (fatal)
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52
Q

To prevent lactic acidosis, what population of people should not use Metformin/Glycophage.

A

those with impaired renal function

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53
Q

What is the most concerning side effect of Sulfonylureas?

A

hypoglycemia (esp. in patients with impaired renal or liver function)

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54
Q

What is the most common SE of Sulfonylureas?

A

weight gain

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55
Q

In general, how long are sulfonylureas effective?

A

5-10 years

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56
Q

Name the 1st generation Sulfonylureas.

A

Chlorpropamide/Diabinese

Tolbutamide/Orinase

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57
Q

Name the 2nd generation sulfanylurea drugs.

A

Glipizide/Glucotrol
Glyburide/Micronase/Diabeta
Glimepiride/Amaryl

58
Q

How is Metformin/Glucophage dosed?

A

BID

QD if extended release

59
Q

Name the two Meglitinides

A

Nateglinide/Starlix

Repaglinide/Prandin

60
Q

Which Meglitinide is more effective?

A

Repaglinide/Prandin

61
Q

What classes of DM drugs cause weight gain?

A

Sulfonylureas
Meglintinides
Glitazones

62
Q

Which class of drugs should Meglitinides not be combined with?

A

Sulfonylureas

63
Q

Name the TZD/Glitazones

A

Rosiglitazone/Avandia

Pioglitazone/ACTOS

64
Q

Of the Glitazones, which is approved for concurrent use with insulin?

A

Pioglitazone/ACTOS

65
Q

Can both Glitazones be combined with Metformin or Sulfonylurea?

A

yes

66
Q

What do the Glitazones increase the risk for?

A

CHF
inc. liver enzymes
dec. bone density, inc. fracture
weight gain

67
Q

Name the alpha-glucosidase inhibitors.

A

Acarbose/Precose

Miglitol/Glyset

68
Q

How is Alpha-glucosidase inhibitors dosed?

A

with each meal

69
Q

When might Alpha-glucosidase inhibitors cause hypoglycemia?

A

when combined with Sulfonylurea or insulin

70
Q

To correct hypoglycemia when taking Alpha-glucosidase inhibitors, what form of sugar should be used?

A

glucose

71
Q

What population of people should not take Alpha-glucosidase inhibitors?

A

IBD, chx intestinal dz, any intestinal obstruction

72
Q

Name the DPP-4 inhibitor

A

Sitagliptin/Januvia

73
Q

Which other drug should Sitagliptin/Januvia not be combined with?

A

insulin

74
Q

This injectable drug is a synthetic form of amylin, which is produced along with insulin by the beta cells.

A

Pramlintide/Symlin

75
Q

This injectable drug is a synthetic form of exendin-4, a naturally occurring hormone that was first isolated from the saliva of the Gila monster.

A

Exenatide

76
Q

When is Pramlintide/Symlin used?

A

In DM Type 1 or 2 when insulin is being used but goal levels of HGbA1c are still not being reached.

77
Q

What are the only two drugs approved by the FDA for lowering blood sugar in type 1 diabetics?

A

Insulin

Pramlintide/Symlin

78
Q

Which DM drugs promote weight loss?

A

Metformin
Pramlintide/Symlin
Exenatide/Byetta

79
Q

T/F. Insulin and Pramlintide/Symlin can be combined and injected from the same vial.

A

False.

80
Q

In what class of drugs is Exenatide/Byetta? What is the MOA?

A

incretin mimetics

lowers blood glucose by increasing insulin secretion

81
Q

Insulin is never given ______(SQ/IM/IV/Orally).

A

orally

82
Q

What is the onset speed and duration of action of Lispro/Aspart and Humulog/Novalog.

A

Rapid acting

3-5 hours

83
Q

What is the action time and duration of action of Regular Insulin/Humulin R?

A

Short acting

4-12 hours

84
Q

What is the action time and duration of action of NPH/Humulin N?

A

Intermediate acting

10-18 hours

85
Q

What is the action time and duration of action of Glargine/Lantus?

A

Long acting

24 hours

86
Q

What are some SE of insulin therapy?

A 
weight gain
hypoglycemia
hypokalemia
fibrosis of injection site
muscle/fat atrophy at injection site
87
Q

What agent is used for treatment of severe hypoglycemia?

A

Glucagon

88
Q

In what class of drugs is Leuprolide/Lupron?

A

Anti-androgenic hormone and anti-estrogenic hormone

89
Q

T/F Leuprolide/Lupron is given PO, SQ, IM.

A

False. It is only given SQ and IM

90
Q

Name the anti-androgen med

A

Finasteride/Proscar

91
Q

MOA of Finasteride/Proscar

A

limits conversion of testosterone to DHT by inhibiting type II 5-alphareductase

92
Q

What must the PARQ of Finasteride/Proscar include?

A

That pregnant women should not handle crushed or broken tablets because of risk of birth defects

93
Q

What is the name of the low dose versions of Finasteride/Proscar?

A

Propecia

94
Q

What two drug categories are used to treat BPH?

A

5 alpha reductase inhibitors and alpha blockers

95
Q

Which alpha blocker should not be used by those who are allergic to sulfa drugs?

A

Tamulosin/Urimax/Flomax

96
Q

What drug is indicated for ED and pulmonary hypertension?

A

Sildenafil citrate/Viagra

97
Q

What is the MOA of Sildenafil citrate/Viagra?

A

inhibits cGMP specific phosphodiesterase type 5 which keeps blood in the in the corpus cavernosum

98
Q

Who should not use Sildenafil citrate/Viagra?

A

those on NO donors, organic nitrites and nitrates (nitroglycerin and isosorbide dinitrate)
those with CV risk factors
severe liver or renal impairment
hypotension
Hereditary degenerative retinal disorders

99
Q

Which drug may cause cyanopsia?

A

Sildenafil citrate/Viagra

100
Q

Which form of estrogen is the most potent?

A

Estradiol

101
Q

Regarding potency, how do the other major forms of estrogen compare to estradiol?

A

They are 1/10th as strong

102
Q

Is endogenous estrogen or synthetic estrogen more subject to first pass metabolism and thus less effective when given orally?

A

endogenous/naturally produced estrogen

103
Q

What are the risks for women taking estrogen only?

A

Inc. risk of stroke, blood clots, fracture. No difference in risk of MI or colorectal CA.

104
Q

What are the risks for women taking estrogen plus progestin?

A

Inc. risk of MI, stroke, DVT, PE, breast CA. Decreased risk of colorectal CA and fractures

105
Q

What kind of CA may occur in unopposed estrogen therapy?

A

endometrial CA

106
Q

What is the hormone ratio of BiEst?

A

80:20 estriol to estradiol

107
Q

What is the hormone ration of TriEst?

A

80:10:10 estriol, estradiol, estrone

108
Q

What is the MOA of the progesterone drugs?

A

alters gene transcription

109
Q

What is the source of conjugated estrogens/Premarin and how is it delivered?

A

mare urine

oral or topical

110
Q

What are the contraindications for the use of progesterone drugs?

A

hx of DVT or breast, ovarian or uterine CA

111
Q

What is the FDA drug classification for conjugated estrogens/Premarin?

A

Category X

112
Q

How is Medroxyprogesterone/Provera administered?

A

PO

Depp-Form is IM

113
Q

What are the roles of estrogen and progestin in COCPs?

A

Estrogen: suppresses ovulation
Progestin: prevents implantation and makes cervical mucus impenetrable to sperm

114
Q

What is the time frame regarding when missed COCPs lead to reduced contraceptive protection?

A

If one or more tablets are forgotten for more than 12 hours

115
Q

What is the most commonly used estrogen in COCPs?

A

ethinyl estradiol

116
Q

Describe how triphasic COCPs work.

A

Constant estrogen for 21 days plus a concurrent but increasing dose of progestin given over 3 successive 7 day periods. Iron or placebo pills are given during the last week of the pack.

117
Q

T/F. Other medications rarely decrease the efficacy of OCPs.

A

False. So many drugs/herbs interact with OCPs. Especially antibiotics, seizure meds, St. John’s Wort

118
Q

The use of OCPs for five yrs or more decreases the risk of: ovarian CA in later life by ____%
ovarian CA overall by ___40%
endometrial CA overall by ___% compared to non-users.

A

50%, 40%, 50%

119
Q

The use of OCPs for 10 yrs or more decreases the risk of ovarian and endometrial CA by a combined _____%

A

80%

120
Q

Which synthetic progestin is more similar to natural progesterone?

A

Drospirenone/Yaz

121
Q

What is the degree of increased risk of DVT with the use of Drospirenone/Yaz compared to women who don’t take the pill?

A

6 to 7 fold increased risk

122
Q

How often is Medroxyprogesterone acetate/Depo-Provera administered?

A

4x a year

123
Q

How soon after a Medroxyprogesterone acetate/Depo-Provera is the woman protected from becoming pregnant?

A

immediately

124
Q

What is the MOA of Medroxyprogesterone acetate/Depo-Provera?

A

Prevents ovulation by decreasing release of GnRH by the hypothalamus which decreases the release of FSH and LH by the ant. pituitary.

125
Q

Does Medroxyprogesterone acetate/Depo-Provera reduce the risk of endometrial CA?

A

yes. By 80%

126
Q

How long after the last injection of Medroxyprogesterone acetate/Depo-Provera can a woman expect to achieve pregnancy?

A

9-10 months

127
Q

Name the implant contraceptive and how long it remains effective.

A

Implanon

3 years

128
Q

Name the contraceptive patch and how often it is replaced

A

Ortha Evra

weekly for 3 weeks, one week off

129
Q

Which contraceptive option contains the hormone etonogestrel, the active metabolite of the pro-drug desogestrel?

A

NuvaRing

130
Q

What in what class of drugs is Ulipristal acetate/Ella?

A

SPRM: selective progesterone receptor modulator

131
Q

What is the timeline for the use of Ulipristal acetate/Ella?

A

should be given within 120 hours (5 days) after unprotected intercourse/contraceptive failure.

132
Q

What is the MOA for Ulipristal acetate/Ella?

A

delays ovulation and inhibits follicle rupture.

133
Q

Name the abortifacient pills and the timeline for use.

A

Mifepristone/Mifeprex

Within the first two months of pregnancy

134
Q

What is the efficacy of Mifepristone during the first trimester of pregnancy?

A

85%

135
Q

What is the MOA of Mifepristone/Mifeprex?

A

blocks progesterone receptors and decreases HCG levels, which leads to decreased progesterone production by the corpus luteum

136
Q

What are the likely side effects of Mifepristone/Mifeprex?

A 
abdominal pain
cramping
vaginal bleeding (9-16 days on average)
137
Q

What are the contraindications of Mifepristone/Mifeprex?

A

IUD, ectopic pregnancy, pts with hemorrhagic disorders, anticoagulant therapy, long-term prednisone use

138
Q

Class and MOA of Clomiphene/Clomid

A

Estrogen receptor agonist
Binds estrogen receptors in the brain»alters negative feedback of estrogen on GnRH»>increased GnRH secretion»>increased LH and FSH»>ovulation

139
Q

What is the side effect profile of Clomiphene/Clomid?

A

Looks like menopause

vag dryness, bleeding, breast tenderness, anxiety, hot flashes

140
Q

Of the second generation Sulfonylureas, which is most likely to cause hypoglycemia?

A

Glyburide/Micronause/Diabeta

141
Q

Of the Meglitinides, which drug is more effective?

A

Repaglinide/Prandin

Pharmacology NPLEX2 (8 decks)

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