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REM II > Pharm > Flashcards

Pharm Flashcards

1
Q

What drug do we use for hypothyroidism

A

Levothyroxine

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2
Q

What do you use to guide dose adjustments for levothyroxine and how often do you check it

A

Use TSH

4-8 wks

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3
Q

What is the weight-based dose for levothyroxine

A

1.6 mcg/kg/day

Use ibw if obese

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4
Q

What is the levothyroxine dose for older pts with no cvd

A

50 mcg/kg/day

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5
Q

What is the dose for levothyroxine in a patient with CVD

A

12.5-25 mcg/kg/day

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6
Q

What test do you use for central hypothyroidism to monitor levothyroxine

A

Free T4

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7
Q

What drug is preferred for graves disease

A

Methimazole

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8
Q

MOA of Methimazole

A

Blocks iodide incorporation onto TG
Block coupling of t3/t4
Inhibits peroxidase

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9
Q

ADRs of Methimazole

A

Poly arthritis
Fetal abnormalities
Cholestasis

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10
Q

What medication do you give for thyroid storm

A

Propylthiouracil PTU

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11
Q

Moa of PTU

A

Blocks iodide incorporation onto TG
Block coupling of t3/t4
Inhibits peroxidase
Inhibits peripheral t4 conversion

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12
Q

What medication is used in pregnancy

A

PTU

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13
Q

ADRs of PTU

A

Polyarhyritis
ANCA + vasculitis
Hepatitis
Agranulocytosis

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14
Q

MOA of iodide solution

A

Inhibits production of thyroid hormones, inhibits release of thyroid hormone, decreased vascularity of thyroid gland

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15
Q

When do you want to use an iodide solution

A

Perioperatively

Don’t start until one hr after antithyroid

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16
Q

What is the mechanism of action on the thyroid gland for beta blockers propranolol

A

It blocks peripheral conversion of t4

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17
Q

What is the mechanism of action on the thyroid gland for corticosteroids

A

Inhibits peripheral conversion of t4

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18
Q

Which hyperthyroidism medication has a black box warning

A

PTU

Liver damage and failure

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19
Q

What medication do you use for acromegaly

A

Octreotide

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20
Q

What is the mechanism of action for octreotide

A

Inhibits release of GH TSH GLUCAGON INSULIN GASTRIN

21
Q

ADRs for octreotide

A

GI complaints
Cardiac effects
Treatment > 6 mo: biliary sludge and gallstones
Treatment >12 mo: vit b 12 def

22
Q

What medications do you use for hyperprolactinemia

A

Bromocriptine

Cabergoline

23
Q

Moa of bromicriptine/ cabergoline

A

D2 receptor agonist

24
Q

What is the contraindication for dopamine agonist

A

Small adenomas during pregnancy

25
Q

What are the adverse reactions for dopamine agonist

A

Nausea
Headache
Orthostatic hypotension
Fatigue

26
Q

What do you use to treat addison’s dz?

A

hydrocortisone + fludrocortisone (15-30 mg/day)
acute- 100-400mg/day
salt intake

27
Q

What do you use to treat cushings dz?

A

stop use of glucocorticoids

dexamethasone test

28
Q

strategies to limit corticosteroids ADRs

A

i. Use other drugs for chronic immunosuppression/immunomodulation/anti-inflammation
ii. Limit duration of use
iii. Local; topical administration
iv. Chronic system use:
1. Minimally effective dose
2. Once in AM
3. Every-other-day therapy (use intermediate duration drugs, e.g. prednisone)
4. Use with other anti-inflammatory and/or immunosuppressant drugs “steroid-sparing”
c. Tapering Corticosteroid Dose
i. Disease activity drops…steroid need drops…can decrease dose, maintain effectiveness and decrease potential ADRs.
ii. If chronic adrenal axis suppression and adrenal atrophy: adrenal axis cannot release physiologic and stress amounts of corticosteroids…slowly decrease dose…deliver physiologic corticosteroid levels and allow adrenal axis to recover (still need stress dose)…final tapering stages involve testing axis for adequate stress response. (after long time Tx, see suppression of HPA axis.)
d. Exogenous source of glucocorticoids used in system, thus inhibiting CRH and ACTH release (negative feedback) – must taper them off b/c have suppressed this axis.
e. Recovering from suppression may take 6-9 months.
i. CRH secretion return to normal and w/in few weeks, ACTH levels begin to increase, rising above normal values until adrenal steroidogenesis recovers.
ii. In interim, need replacement therapy (just a little bit). W/o replacement therapy, pts may experience symptoms of glucocorticoid deficiency, e.g. anorexia, nausea, weight loss, arthralgia, lethargy, skin desquamation, postural dizziness, etc.
iii. Make plan: get off exogenous glucocorticoids and taper off; test to make sure ok before take them off fully.
f. After stopping Tx, cortisol plasma conc. doesn’t start up until after 6 months.
g. ACTH is a trophic hormone (=helps support dev’t of tissue), so takes time to nourish the tissue and get it to recover before able to stimulate Cortisol release again.

29
Q

What is adrenal suppression/acquired secondary adrenal insufficiency

A

caused by sudden cessation of exogenous glucocorticoid use

glucocorticoids affected; mineralcorticoid ok

30
Q

What is a main indication for glucocorticoid use outside of autoimmune?

A

respiratory distress syndrome

inject betamethasone to stimulate cortisol in baby

31
Q

what is the rapid effect of corticosteroids

A

vasoconstriction reversing inflammatory hyperperfusion

32
Q

Prednisone is:

A

potent anti-inflammatory and less Na retaining

33
Q

corticosteroid ADRs

A 
osteoporosis
hyperlipidemia
depression
headaches
glaucoma
cataracts
gastric ulcer
DM
impaired wound healing
34
Q

how does glucocorticoid inhibit inflammation

A

stimulate annexin A1 (lipocortin)

thus inhibiting prostaglandins, phospholipase A2, cyclooxygenases

35
Q

fludrocortisone is:

A

high anti inflamm and salt retaining

36
Q

What is the standard glucocorticoid?

A

hydrocortisone

37
Q

what are lispro, aspart, and glulisine insulins

A

rapid acting

38
Q

what is the onset, peak, and duration of rapid acting insulin?

A

onset:

39
Q

What is the peak, onset, and duration of short acting insulin?

A

onset: 30-60 min
peak: 2-4 hrs
duration: 5-8 hrs

40
Q

what type of insulin is regular U-100

A

short acting

41
Q

what type of insulin is NPH?

A

intermediate acting

42
Q

what is the onset, peak, and duration of intermediate insulin?

A

onset: 1-3 hrs
peak: 6-12 hrs
duration: 14-24 hrs

43
Q

what is the onset, peak, and duration for long acting insulin

A

onset: 1-2 hrs
peak: flat
duration: 24 hr

44
Q

what type of insulin are detemir and glargine

A

long acting insulin

45
Q

when do you decrease dosage requirements for insulin

A

wt loss
exercise
renal/hepatic failure
hypoglycemic episodes

46
Q

what is the best insulin therapy?

A

long acting + rapid acting with meals

47
Q

what do you use for correction doses of insulin?

A

insulin sensitivity factor

1:50 (insulin: glucose)

48
Q

what do you use to determine mealtime doses?

A

carb counting
1:10
1 insulin to 10 g of carbs

49
Q

what are the rescue medications for hypoglycemia?

A

oral glucose
glucagon, IM
for severe cases: D50

REM II (11 decks)

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