Pharm 2 - Exam 3 Flashcards
1
Q
Which thyroid hormone(s) does Levothyroxine/Synthroid replace?
A
T4
2
Q
Which thyroid hormone(s) does Thyroid USP/Armour thyroid replace?
A
T4 and T3
3
Q
Which thyroid hormone(s) does Liothyronine/Cytomel replace?
A
T3
4
Q
Which form of thyroid hormone is active?
A
T3
5
Q
What is the normal T4:T3 ratio?
A
4:1
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.
7
Q
In what unit doses are Armour and Synthroid given?
A
Armour: mg
Synthroid: mcg
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
9
Q
Long term elevation of T4 (such as from Levothyroxine/Synthroid use) increases the risk of what two pathologies?
A
Osteoporosis
CVD
10
Q
This hypothyroid med is also indicated for Wilson’s Syndrome.
A
Liothyronine/Cytomel (T3)
11
Q
In what class of drugs are Methimazole/Tapazole and PTU?
A
Thionamide
12
Q
What is the MOA of Methimazole/Tapazole and PTU?
A
Blocks conversion of T4 to T3
13
Q
What is the most feared side effect of Methimazole/Tapazole and PTU?
A
agranulocytosis
14
Q
What is the result of super physiologic doses of iodine?
A
stuns the thyroid into inactivity for days to weeks
15
Q
Name the two thionamide drugs.
A
Methimazole/Tapazole
Propylthiouricil (PTU)
16
Q
Of the two thionamide drugs, which is most effective in preventing the conversion of T4 to T3 in peripheral tissues?
A
PTU
17
Q
What is the MOA of the thionamide drugs?
A
- inhibits conversion of inorganic iodine to organic iodine which prevents the formation of thyroxine.
- blocks the coupling of iodotyrosine, therefore stopping the production of T3 and T4
18
Q
Which of the thionamide drugs is more appropriate for pregnancy?
A
PTU. Both are category D though.
19
Q
Which drugs would be most appropriate for the treatment of thyroid storm?
A
Propanolol/Inderal
IV Iodine/SSKI
20
Q
How long do the beneficial side effects of iodine/SSKI last?
A
2-3 weeks
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
22
Q
How long is radioactive iodine typically in the body after a dose is taken?
A
3-5 days.
23
Q
What is the drug classification of radioactive iodine?
A
category x
24
Q
How long should pregnancy be delayed following radioactive iodine treatment?
A
6-12 months
25
What are the s/sx of a thyroid storm?
high fever, irritability, delerium, vomiting, diarrhea, hypotension, dehydration, vascular collapse
26
Diabetes diagnoses all rely on what form of testing?
Serum glucose
27
What might be the problem with calcium derived from oyster or bone?
Lead and other heavy metal contamination
28
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?
bisphosphonates
29
In what class of drugs is Alendronate/Fosamax?
Bisphosphonates
30
What are the two major SE of Alendronate/Fosamax?
Osteonecrosis of the jaw
| Atypical femur fractures (ex. in the shaft)
31
In what class is Raloxifene/Evista?
SERM
32
What is the MOA of the SERM class of drugs?
Binds to select estrogen receptor sites to beneficial estrogen activity
33
What is the MOA of bisphosphonates?
inhibits osteoclastic activity
34
This drug is a synthetic hormone that inhibits osteoclastic activity.
Calcitonin/Miacalcin
35
This osteoporosis drug is available in a nasal spray.
Calcitonin/Miacalcin
36
Name the synthetic PTH analogue.
Teriparatide/Forteo
37
This drug activates bone turnover with osteoblasts being activate to a much greater extent than osteoclasts
Teriparatide/Forteo
38
Which to drugs have been shown to reduce the spinal fracture risk in individuals with osteoporosis.
Calcitonin/Miacalcin
Teriparatide/Forteo
Estrogen/HRT
39
What is Estrogen/HRT combined with to reduce the risk of endometrial CA?
Progestin
40
Name the human monoclonal Ab approved for the treatment of osteoporosis.
Denosumab/Prolia
41
How is Denosumab/Prolia administered?
SQ injection once every 6 months
42
MOA of Metformin
inhibits glucose production by the liver and decreases insulin resistance
43
MOA of Sulfonylureas and Meglitinides
increases secretion of insulin by interaction with ATP sensitive K+ channels in beta cell membrane
44
MOA of alpha-glucosidase inhibitors
delays absorption of glucose by inhibiting alpha-glucosidase enzyme at brush border
45
MOA of Thiazolidinediones/Glitazones
improves insulin sensitivity in skeletal muscle cells, fat cells, liver cells and decreases hepatic glucose production
46
MOA of DPP-4 inhibitors
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/
47
In what two instances may patients on oral diabetic medications be switched to insulin?
acute infections
| in-patient surgery
48
What medication is used for women with gestational diabetes?
insulin
49
In what class of drugs is Metformin/Glycophage?
Biguanides
50
T/F. Metformin is likely to cause weight gain
False. Metformin can cause modest weight loss (unlike sulfonylureas)
51
If you put a patient on Metformin, what side effects might you want to tell them to expect?
```
abdominal cramping
nausea
metallic taste in mouth
increased risk for B12 deficiency
lactic acidosis (fatal)
```
52
To prevent lactic acidosis, what population of people should not use Metformin/Glycophage.
those with impaired renal function
53
What is the most concerning side effect of Sulfonylureas?
hypoglycemia (esp. in patients with impaired renal or liver function)
54
What is the most common SE of Sulfonylureas?
weight gain
55
In general, how long are sulfonylureas effective?
5-10 years
56
Name the 1st generation Sulfonylureas.
Chlorpropamide/Diabinese
| Tolbutamide/Orinase
57
Name the 2nd generation sulfanylurea drugs.
Glipizide/Glucotrol
Glyburide/Micronase/Diabeta
Glimepiride/Amaryl
58
How is Metformin/Glucophage dosed?
BID
| QD if extended release
59
Name the two Meglitinides
Nateglinide/Starlix
| Repaglinide/Prandin
60
Which Meglitinide is more effective?
Repaglinide/Prandin
61
What classes of DM drugs cause weight gain?
Sulfonylureas
Meglintinides
Glitazones
62
Which class of drugs should Meglitinides not be combined with?
Sulfonylureas
63
Name the TZD/Glitazones
Rosiglitazone/Avandia
| Pioglitazone/ACTOS
64
Of the Glitazones, which is approved for concurrent use with insulin?
Pioglitazone/ACTOS
65
Can both Glitazones be combined with Metformin or Sulfonylurea?
yes
66
What do the Glitazones increase the risk for?
CHF
inc. liver enzymes
dec. bone density, inc. fracture
weight gain
67
Name the alpha-glucosidase inhibitors.
Acarbose/Precose
| Miglitol/Glyset
68
How is Alpha-glucosidase inhibitors dosed?
with each meal
69
When might Alpha-glucosidase inhibitors cause hypoglycemia?
when combined with Sulfonylurea or insulin
70
To correct hypoglycemia when taking Alpha-glucosidase inhibitors, what form of sugar should be used?
glucose
71
What population of people should not take Alpha-glucosidase inhibitors?
IBD, chx intestinal dz, any intestinal obstruction
72
Name the DPP-4 inhibitor
Sitagliptin/Januvia
73
Which other drug should Sitagliptin/Januvia not be combined with?
insulin
74
This injectable drug is a synthetic form of amylin, which is produced along with insulin by the beta cells.
Pramlintide/Symlin
75
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.
Exenatide
76
When is Pramlintide/Symlin used?
In DM Type 1 or 2 when insulin is being used but goal levels of HGbA1c are still not being reached.
77
What are the only two drugs approved by the FDA for lowering blood sugar in type 1 diabetics?
Insulin
| Pramlintide/Symlin
78
Which DM drugs promote weight loss?
Metformin
Pramlintide/Symlin
Exenatide/Byetta
79
T/F. Insulin and Pramlintide/Symlin can be combined and injected from the same vial.
False.
80
In what class of drugs is Exenatide/Byetta? What is the MOA?
incretin mimetics
| lowers blood glucose by increasing insulin secretion
81
Insulin is never given ______(SQ/IM/IV/Orally).
orally
82
What is the onset speed and duration of action of Lispro/Aspart and Humulog/Novalog.
Rapid acting
| 3-5 hours
83
What is the action time and duration of action of Regular Insulin/Humulin R?
Short acting
| 4-12 hours
84
What is the action time and duration of action of NPH/Humulin N?
Intermediate acting
| 10-18 hours
85
What is the action time and duration of action of Glargine/Lantus?
Long acting
| 24 hours
86
What are some SE of insulin therapy?
```
weight gain
hypoglycemia
hypokalemia
fibrosis of injection site
muscle/fat atrophy at injection site
```
87
What agent is used for treatment of severe hypoglycemia?
Glucagon
88
In what class of drugs is Leuprolide/Lupron?
Anti-androgenic hormone and anti-estrogenic hormone
89
T/F Leuprolide/Lupron is given PO, SQ, IM.
False. It is only given SQ and IM
90
Name the anti-androgen med
Finasteride/Proscar
91
MOA of Finasteride/Proscar
limits conversion of testosterone to DHT by inhibiting type II 5-alphareductase
92
What must the PARQ of Finasteride/Proscar include?
That pregnant women should not handle crushed or broken tablets because of risk of birth defects
93
What is the name of the low dose versions of Finasteride/Proscar?
Propecia
94
What two drug categories are used to treat BPH?
5 alpha reductase inhibitors and alpha blockers
95
Which alpha blocker should not be used by those who are allergic to sulfa drugs?
Tamulosin/Urimax/Flomax
96
What drug is indicated for ED and pulmonary hypertension?
Sildenafil citrate/Viagra
97
What is the MOA of Sildenafil citrate/Viagra?
inhibits cGMP specific phosphodiesterase type 5 which keeps blood in the in the corpus cavernosum
98
Who should not use Sildenafil citrate/Viagra?
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
Which drug may cause cyanopsia?
Sildenafil citrate/Viagra
100
Which form of estrogen is the most potent?
Estradiol
101
Regarding potency, how do the other major forms of estrogen compare to estradiol?
They are 1/10th as strong
102
Is endogenous estrogen or synthetic estrogen more subject to first pass metabolism and thus less effective when given orally?
endogenous/naturally produced estrogen
103
What are the risks for women taking estrogen only?
Inc. risk of stroke, blood clots, fracture. No difference in risk of MI or colorectal CA.
104
What are the risks for women taking estrogen plus progestin?
Inc. risk of MI, stroke, DVT, PE, breast CA. Decreased risk of colorectal CA and fractures
105
What kind of CA may occur in unopposed estrogen therapy?
endometrial CA
106
What is the hormone ratio of BiEst?
80:20 estriol to estradiol
107
What is the hormone ration of TriEst?
80:10:10 estriol, estradiol, estrone
108
What is the MOA of the progesterone drugs?
alters gene transcription
109
What is the source of conjugated estrogens/Premarin and how is it delivered?
mare urine
| oral or topical
110
What are the contraindications for the use of progesterone drugs?
hx of DVT or breast, ovarian or uterine CA
111
What is the FDA drug classification for conjugated estrogens/Premarin?
Category X
112
How is Medroxyprogesterone/Provera administered?
PO
| Depp-Form is IM
113
What are the roles of estrogen and progestin in COCPs?
Estrogen: suppresses ovulation
Progestin: prevents implantation and makes cervical mucus impenetrable to sperm
114
What is the time frame regarding when missed COCPs lead to reduced contraceptive protection?
If one or more tablets are forgotten for more than 12 hours
115
What is the most commonly used estrogen in COCPs?
ethinyl estradiol
116
Describe how triphasic COCPs work.
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
T/F. Other medications rarely decrease the efficacy of OCPs.
False. So many drugs/herbs interact with OCPs. Especially antibiotics, seizure meds, St. John's Wort
118
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.
50%, 40%, 50%
119
The use of OCPs for 10 yrs or more decreases the risk of ovarian and endometrial CA by a combined _____%
80%
120
Which synthetic progestin is more similar to natural progesterone?
Drospirenone/Yaz
121
What is the degree of increased risk of DVT with the use of Drospirenone/Yaz compared to women who don't take the pill?
6 to 7 fold increased risk
122
How often is Medroxyprogesterone acetate/Depo-Provera administered?
4x a year
123
How soon after a Medroxyprogesterone acetate/Depo-Provera is the woman protected from becoming pregnant?
immediately
124
What is the MOA of Medroxyprogesterone acetate/Depo-Provera?
Prevents ovulation by decreasing release of GnRH by the hypothalamus which decreases the release of FSH and LH by the ant. pituitary.
125
Does Medroxyprogesterone acetate/Depo-Provera reduce the risk of endometrial CA?
yes. By 80%
126
How long after the last injection of Medroxyprogesterone acetate/Depo-Provera can a woman expect to achieve pregnancy?
9-10 months
127
Name the implant contraceptive and how long it remains effective.
Implanon
| 3 years
128
Name the contraceptive patch and how often it is replaced
Ortha Evra
| weekly for 3 weeks, one week off
129
Which contraceptive option contains the hormone etonogestrel, the active metabolite of the pro-drug desogestrel?
NuvaRing
130
What in what class of drugs is Ulipristal acetate/Ella?
SPRM: selective progesterone receptor modulator
131
What is the timeline for the use of Ulipristal acetate/Ella?
should be given within 120 hours (5 days) after unprotected intercourse/contraceptive failure.
132
What is the MOA for Ulipristal acetate/Ella?
delays ovulation and inhibits follicle rupture.
133
Name the abortifacient pills and the timeline for use.
Mifepristone/Mifeprex
| Within the first two months of pregnancy
134
What is the efficacy of Mifepristone during the first trimester of pregnancy?
85%
135
What is the MOA of Mifepristone/Mifeprex?
blocks progesterone receptors and decreases HCG levels, which leads to decreased progesterone production by the corpus luteum
136
What are the likely side effects of Mifepristone/Mifeprex?
```
abdominal pain
cramping
vaginal bleeding (9-16 days on average)
```
137
What are the contraindications of Mifepristone/Mifeprex?
IUD, ectopic pregnancy, pts with hemorrhagic disorders, anticoagulant therapy, long-term prednisone use
138
Class and MOA of Clomiphene/Clomid
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
What is the side effect profile of Clomiphene/Clomid?
Looks like menopause
| vag dryness, bleeding, breast tenderness, anxiety, hot flashes
140
Of the second generation Sulfonylureas, which is most likely to cause hypoglycemia?
Glyburide/Micronause/Diabeta
141
Of the Meglitinides, which drug is more effective?
Repaglinide/Prandin
