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DT4 Exam 1 > Pharm > Flashcards

Pharm Flashcards

1
Q

administration of testosterone

A

IM or transdermal

cannot be administered oral

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2
Q

reason testosterone not oral

A

metabolized by small intestine and undergoes extensive first pass
low bioavailability

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3
Q

topical gel

A

acts as 24 h depot

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4
Q

no patch on scrotum

A

can absorb too much testosterone

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5
Q

caution with MRI and testosterone patch

A

aluminum can cause burns

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6
Q

adverse reactions in female partner of patch

A

acne and abnormal hair growth

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7
Q

children coming in contact with gels and topical solutions

A

virilization can occur

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8
Q

testosterone esters

A

testosterone cypionate and enanthate

more lipophilic

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9
Q

administration of testosterone esters

A

IM longer duration (administer every 2-4 weeks)

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10
Q

use of testosterone esters

A

hypogonadism

metastatic breast cancer in women

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11
Q

17 alpha alkylated testosterone

A

methyltestosterone, fluoxymesterone

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12
Q

use of 17 alpha testosterone

A

hypogonadism

metastatic breast cancer in women

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13
Q

contraindications 17 alpha testosterone

A

male breast cancer
prostate cancer
pregnancy

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14
Q

adverse reactions 17 alpha testosterone

A

cholestatic hepatitis and jaundice
edema
liver cancer
bleeding (decline in II, V, VII, and X)

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15
Q

adverse reactions all testosterone analogs

A

salt and water retention leading to HTN
jaundice (greatest risk with 17 alpha)
hepatic carcinomas from high dose or prolonged use

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16
Q

MOA danazol

A

depreses preovulatory surge in FSH and LH which results in reduction of estrogen and progesterone
anovulation

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17
Q

uses danazol

A

endometriosis
hereditary angioedema
fibrocytic breast disease

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18
Q

adverse effects danazol

A 
weight gain
acne
thrombosis 
mood swings
hepatic dysfunction
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19
Q

contraindications danazol

A

pregnancy

breast feeding

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20
Q

MOA stanazolol

A

derivative 17alpha

increases C1 inh and C4

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21
Q

use stanazolol

A

hereditary angioedema

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22
Q

drug contraindicated for hereditary angioedema

A

ACEi

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23
Q

adverse effects stanazolol

A 
increased bleeding times (decrease II, VII, IX, X)
edema
acne
virilization in women, baldness
hepatic toxicity
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24
Q

contraindications stanazolol

A

pregnancy
male breast cancer or prostate cancer
female breast cancer with hypercalcemia

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25
Q

MOA oxandrolone

A

derivative of testosterone

high anabolic to androgenic ratio

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26
Q

use oxandrolone

A

weight gain

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27
Q

side effects oxandrolone

A

edema, water retention
HTN
irritability, aggression, excitation

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28
Q

contraindications oxandrolone

A 
breast cancer (men or women)
prostatic cancer
pregnancy
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29
Q

MOA finasteride and dutasteride

A

reduce DHT
finasteride type 2 competitive inhibitor
dutasteride type 1 and 2 competitive inhibitor

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30
Q

use finasteride and dutasteride

A

BPH (may take 6 weeks to reduce)

male baldness

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31
Q

MOA tamsulosin and alfuzosin

A

alpha 1 adrenergic receptor inhibitors

decrease smooth muscle tone in prostate and bladder neck

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32
Q

adverse effects finasteride and dutasteride

A

gynecomastia
decrease PSA
elevated T but decreased DHT
hepatic dysfunction-finasteride

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33
Q

contraindications finasteride and dutasteride

A

contraindicated in women and children

should not handle tablets if pregnant

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34
Q

MOA leuprolide

A

GnRH agonist

continuous GnRH leads to down regulation of LH and FSH and decreased T

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35
Q

use leuprolide

A

prostatic cancer

endometriosis

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36
Q

adverse effects leuprolide

A

hot flashes/night sweats
gynecomastia
bone pain, higher risk of osteoporosis
greater risk of thrombosis

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37
Q

MOA flutamide

A

interferes with binding of DHT and T

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38
Q

use flutamide

A 
prostatic cancer (oral)
acne (topical
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39
Q

side effects flutamide

A

gynecomastia

elevated liver function tests

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40
Q

estrogen synthesis premenopausal

A

granulosa cells of ovary

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41
Q

estrogen synthesis pregnancy

A

fetoplacental unit

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42
Q

conversion of androstenedione and testosterone to estrone

A

hepatic tissue and adpisoe

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43
Q

most potent endogenous estrogen

A

17B estradiol

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44
Q

starting point of estrogen

A

cholesterol

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45
Q

excretion of estrogen

A

conjugated with glucuronide and sulfate conjugates

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46
Q

estrogen in ovary

A

follicular growth

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47
Q

estrogen in uterus

A

endometrial growth

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48
Q

estrogen in vagina

A

cornification of epithelial cells with thickening and stratification of epithelium

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49
Q

estrogen in cervix

A

lowers viscosity

helps the swimmers

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50
Q

estrogen on external and internal genitalia

A

development and maintenance

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51
Q

estrogen on bone

A

osteoblastic

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52
Q

estrogen on cholesterol

A

hypocholesterolemic effect

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53
Q

estrogen on electrolytes

A

retention of NaCl and water by kidney

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54
Q

sites of synthesis progesterone

A

ovary (corpus luteum)
placenta
adrenal cortex
testis

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55
Q

physiological action of progesterone

A

secretory endometrium
increases viscosity
decline initiates mensturation

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56
Q

hormones in follicular phase

A

pulsatile GnRH leading to pulsatile FSH and LH
ovary leading to E and P
E inhibits release of FSH and LH from pituitary

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57
Q

hormones midcycle

A

E positive feedback on pituitary

preovulatory surge of LH and FSH

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58
Q

hormones in luteal phase

A

E and P from corpus luteum
P controls LH, important for implantation
drop in P leads to menses
if pregnancy occurs, hCG maintains elevated E and P

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59
Q

therapeutic use of E and P

A

contraception and postmenopausal hormone therapy

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60
Q

therapeutic use of P only

A

dysmenorrhea
endometriosis
dysfunctional uterine bleeding

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61
Q

monophasic OCP

A

constant level of estrogen and progesterone

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62
Q

biphasic OCP

A

2 levels of progesterone and constant estrogen

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63
Q

triphasic OCP

A

3 levels of progesterone with estradiol

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64
Q

Mircette

A

2 days placebo
only 5 days of unopposed estrogen-prevents early folliculogenesis during placebo period
fewer estrogen-withdrawal HA

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65
Q

Yaz

A

4 days of placebo
24 days of EE and diospirenone
used for premenopausal dysphoric disorder

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66
Q

Seasonale

A

84 days with 7 days of placebo

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67
Q

Seasonique

A

10 EE instead of placebo

better follicular suppression and less unscheduled bleeding

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68
Q

Lybrel

A

365 days without placebo or pill free days

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69
Q

Xulane

A

patch with norelgestromin
3 weeks on, 1 week off
localized rash

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70
Q

NuvaRing

A

EE and etonogestrel

inserted for 3 weeks, 1 break week

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71
Q

synthetic estrogens

A

mestranol and EE

mestranol metabolized to EE to be active

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72
Q

less weight gain progesterone component

A

drospirenone

also less acne

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73
Q

monitor while on drospirenone

A

monitor K

antimineralocorticoid component

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74
Q

highest androgenic activity progestins

A

levonorgestrel and norgestrel

leads to acne and hirsutism

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75
Q

timing for effectiveness tricyclics

A

7 days

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76
Q

timing for effectiveness monophasics

A

21 days

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77
Q

starting of pack

A

first or fifth day of menses

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78
Q

timing of pills

A

same time of day to minimize adverse effects

better therapeutic success

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79
Q

general adverse OCP effects

A

nausea, headache, breast tenderness, weight gain, bleeding, migraines, depression, lethargy

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80
Q

metabolic adverse OCP effects

A

decreased HDL, worsens abnormal glucose tolerance, increased gall stones

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81
Q

cardiovascular adverse OCP effects

A

increased coag factors II, VII, VIII, IX, X
greater platelet aggregation
higher incidence of thrmbophlebitis and thromboembolism
higher incidence of HTN and MI
higher incidence thrombotic strokes

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82
Q

contraindications OCP

A

pregnancy
thrombophlebitis or thromboembolic disease
breast or estrogen dependnet carcinoma
cerebrovascular or CAD
liver disease
cholestatic jaundice during pregnancy or with OC
estrogen associated benign or malignant hepatic tumors
diabetes with vascular disease
cigarette smoker (>15/day) over 35

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83
Q

non-contraceptive benefits OCP

A 
cycle regulation
decreased flow
increased bone mineral density
decreased dysmenorrhea
decreased peri-menopausal symptoms
decreased acne
decreased hirsutism
decreased endometrial cancer
decreased epithelial ovarian cancer
decreased fibroids, fewer ovarian cysts 
lower ectopic pregnancy
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84
Q

PID patient with past ectopic pregnancy put them on

A

OCP

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85
Q

side effects due to excess estrogen

A 
nausea, bloating
HA
cyclic weight gain
irritability 
chloasma, hyperpigmentation
hypermenorrhea
hypertension
breast fullness
leg cramps, edema
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86
Q

side effects due to too little estrogen

A 
spotting and bleeding early 
hypomenorrhea
nervousness
vasomotor symptoms
atrophic vaginitis
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87
Q

side effects due to progestin excess

A

depression, fatigue
breast regression
hirsutism
libido change

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88
Q

side effects due to too little progestin

A

late cycle bleeding

hypermenorrhea

89
Q

missed 1 pill

A

take immediately

90
Q

missed 2 pills

A

take extra pill for 2 days

91
Q

missed 2 pills in week 3

A

stop current pills and start new cycle

92
Q

cigarette smoking and OCP

A

increase failure

increase clearance

93
Q

anticonvulsants and OCP

A

carbamazepine, phenytoin, phenobarbital, primidone

enhance clearance

94
Q

antibiotics and OCP

A

increase failure-estrogens undergo enterohepatic recirculation following conjugation
tetracycline, penicillin V, erythromycin, ampicillin

95
Q

timing in non-nursing mother for OCP

A

4 weeks after delivery

if breast feeding-progestrone only

96
Q

minipill use

A

women who cannot take estrogen
CVD, migraines
nursing mothers

97
Q

progesterone in minipill

A

norethindrone

norgestrel

98
Q

DMPA-medroxyprogesterone acetate

A

depot prep

inject every 3 months

99
Q

adverse effects DMPA

A

delay in fertility after withdrawal of drug
weight gain, insomnia, menstrual irregularities
increased risk of bone mineral density loss

100
Q

nexplanon

A

progestin based rod

101
Q

Mirena

A

replace in 5 years
high incidence of irregular bleeding in first 6 months
insert 7 days after onset of menstruation or first trimester abortion

102
Q

ParaGard

A

copper containing-spermicidal

insert for 10 years

103
Q

Skyla

A

smallest IUD

3 years

104
Q

Liletta

A

similar to Mirena

3 years

105
Q

side effects plan B

A

headache, abdominal pain

106
Q

decrease plan B efficacy

A

increasing BMI

107
Q

effectiveness emergency contraceptive

A

within 72 hrs

108
Q

combined ECP

A

2 doses 12 hrs apart

109
Q

antiprogestin ECP

A

selective progesterone receptor modulator
prescription
approved for 5 days after unprotected sex

110
Q

active ingredient vaginal spermicides

A

octoxynol-9 or nonoxynol-9

111
Q

use vaginal spermicides

A

before intercourse
most effective when combined with diaphragm, condom, or cervical cap
perfumes and additives may be irritating

112
Q

goal menopausal replacement therapy

A

delay or prevent osteoporosis
reduce CVD
reduce vasomotor disturbances

113
Q

combined estrogen and progesterone in replacement therapy

A

unopposed estrogen associated with increased risk of endometrial cancer

114
Q

adverse effects hormone replacement

A

blood clots

HTN (dose dependent)

115
Q

contraindications hormone replacement

A

estrogen dependent neoplasia
breast cancer
thrombophlebitis

116
Q

conjugated estrogens/selective estrogen receptor modulator

A

prevent osteoporosis with combination of bazedoxifene

117
Q

biosynthesis of insulin

A

prepro to pro in RER
granules proinsulin and Ca dependent endopeptidases
insulin, C peptide and amylin released from beta cell

118
Q

biologically active form of insulin

A

monomer

119
Q

stored form of insulin

A

hexamer

120
Q

cellular mechanism insulin

A

glucose alters ATP/ADP
ATP sensitive K channels results in depolarization of beta cell
activation Ca channels, phosphatidyl inositol turnover
insulin secretion requires rise in intracellular calcium

121
Q

agents that stimulate insulin release

A 
glucose
glucagon
gastrin
secretin
ketones
amino acids
isopreterenol (beta 2)
vagal stimulation
fatty acids
sulfonylureas
122
Q

agents that inhibit insulin release

A

beta-2 antagonists
alpha-2 agonists
somatostatin
diazoxide

123
Q

advantages of rapid acting insulin

A

greater flexibility in dosing compared to regular
more effective at decreasing postprandial hyperglycemia
can be mixed with NPH insulin

124
Q

aspart

A

aspartic acid

inject prior to meal

125
Q

lispro

A

lysine and proline

inject 15 min prior to meal or after a meal

126
Q

glulisin

A

glutamic acid and lysine

inject 15 min after a meal or within 20 min of starting meal

127
Q

neutral protamine hagedorn insulin

A

crystallized insulin complexed with protamine and zinc

128
Q

detemir

A

constant level, no peak

cannot mix with other insulins or use pump

129
Q

degludec

A

duration 42 hrs

depot prep

130
Q

glargine

A

onset in 1 hr but constant response
for 24 hrs
precipitates at pH 7

131
Q

factors influencing insulin action

A

abdomen>arm>thigh>buttocks
blood flow
insulin prep
physical activity

132
Q

increased insulin requirements

A

fever, hyperthyroidism, surgery, trauma, infection

133
Q

decreased insulin requirements

A

nausea/vomiting, hypothyroidism, renal impairment, liver impairment

134
Q

symptoms hypoglycemia

A

sweating, dizziness, nervousness, tremor, hunger, progression to confusion, disorientation, unconsciousness

135
Q

local signs of insulin allergy

A

redness, itching, swelling at injection site

usually stops after a week

136
Q

lipohypertrophy

A

accumulation of fat at injection site

avoid by rotating injection sites

137
Q

lipoatrophy

A

atrophy of subcutaneous fat at site of injection

138
Q

MOA pramlintide

A

amylin analog
slows gastric emptying, suppresses glucagon secretion following a meal, leads to suppression of glucose output from the liver, satiety lowers calorie intake

139
Q

use of pramlintide

A

type 1 and type 2 diabetics

140
Q

adverse reactions pramlintide

A

hypoglycemia

never mix with insulin in same syringe

141
Q

contraindication pramlintide

A

diabetic with gastroparesis

142
Q

MOA sulphonylureas

A

stimulate insulin release

extrahepatic-increase receptors, stimulate glucose transporters, decrease hepatic gluconeogenesis

143
Q

advantages of second gen

A

more potent
less binding displacement drug interactions
second generation has less water retention

144
Q

uses sulphonylureas

A

T2DM ketosis resistant

combined with insulin in evening to lower FBG

145
Q

special uses chlorpropamide

A

diabetes insipidus

used when patient cannot tolerate desmopressin

146
Q

adverse reactions sulphonylureas

A

hypoglycemia

contraindication in ketoacidosis

147
Q

contraindications sulphonylureas

A

sulfonamide allergy

DKA

148
Q

drug interactions sulphonylureas

A

miconazole, erythromycin, ketoconazole inhibit p450 and have higher incidence of h ypoglycemia
beta blockers, salicylates, NSAIDS cause binding displacement

149
Q

MOA meglitinides

A

stimulates pancreatic insulin release

150
Q

use meglitinides

A

T2DM ketoacidosis resistant

151
Q

drug interactions meglitinides

A

miconazole, eryhtromycin, and ketoconazole (inhibit p450)

metabolism increased by inducers of cyp3A4 (rifampicin and carbamazepine)

152
Q

phenoformin

A

increase glucose transport into skeletal muscle

153
Q

meformin MOA

A

decrease hepatic glucose production
decreases intestinal glucose absorption
increases peripheral glucose uptake
does not affect insulin secretion

154
Q

drugs that can be combined with metformin

A

sulphonylureas, metaglinides, thiazolinediones

155
Q

contraindications metformin

A

renal or hepatic disease
CHF
ketoacidosis
history of lactic acidosis

156
Q

adverse reactions to metformin

A

diarrhea, nasuea, vomiting, flatulence
decreased B12
lactic acidosis worsened by alcohol

157
Q

other uses for metformin

A

PCOD

prior to conception

158
Q

MOA acarbose and miglitol

A

competitive reversible inhibitor intestinal amylase and alpha glucosidease
reduces absorption of starches, disaccharides, and dextrin

159
Q

uses alpha glucosidase inhibitors

A

T2DM

160
Q

adverse effects alpha glucosidase inhibitors

A

flatulence, abdominal pain, diarrhea

acarbose-elevated transaminase levels, higher incidence of GI pain

161
Q

contraindications alpha glucosidase inhibitors

A

DKA

acarbose liver cirrhosis

162
Q

mechanism thiazolinediones

A

increase insulin sensitivity
enhances insulin dependent glucose uptake into skeletal muscles
agonist for PPAR-stimulates transcription of insulin responsive genes

163
Q

adverse effects thiazolinediones

A

hepatic dysfunction, elevated transaminase levels (monitor liver enzymes)
edema
may worsen liver enzymes

164
Q

GLP-1 agonist MOA

A

stimulates glucose dependent insulin release and suppresses glucagon secretion

165
Q

frequency doses GLP1 agonists

A

exenatide 2x/day with meal
liraglutide 1x/day
dulaglutide 1x/week

166
Q

adverse effects GLP-1 agonists

A

hypoglycemia

acute pancreatitis

167
Q

contraindication GLP-1 agonists

A

family history of thyroid cancer (liraglutide)

168
Q

DPP4 inhibitors MOA

A

inhibit degradation of GLP-1 increasing half life

169
Q

adverse effects DPP4 inhibitors

A

hypoglycemia
pancreatitis
elevated liver enzymes
worsen renal impairment

170
Q

dose of DPP4 with cyp3A4 inhibitors

A

reduce dose

171
Q

MOA SGLT2 inhibitors

A

enhance urinary glucose excretion by inhibiting Na-glucose cotransporter

172
Q

adverse effects SGLT2 inhibitors

A

increased GU infections
hyperkalemia
hypotension

173
Q

precautions SGLT2 inhibitors

A

severe renal dysfunction

174
Q

uses of glucagon

A

hypoglycemia or insulin shock

radiograph (relaxes stomach, duodenum, small bowel)

175
Q

diazoxide use

A

orally to induce hyperglycemia
used in insulin secreting tumors
can lead to sodium and water retention

176
Q

sermorelin

A

synthetic GHRH

177
Q

uses GH

A

Turner, Prader Willi, chronic renal insufficiency, children with short stature, AIDS wasting

178
Q

side effects GH therapy

A

early-increase in ICP

diabetogenic-decreased glucose utilization

179
Q

Mecasermin

A

recombinant IGF-1

used for Laron Dwarfism (defect in GH receptor)

180
Q

adverse effects mecasermin

A

hypoglycemia and lipohypertrophy

181
Q

somatostatin anaglogs

A

octreotide and lanreotide (longer acting)

182
Q

side effects somatostatin analogs

A

GI (diarrhea, nausea, abdominal pain)
gallstones
reduce thyrotropin secretion

183
Q

off label use somatostatin analogs

A

thyrotrope adenomas

184
Q

pegvisomant

A

competitive GH receptor antagonist

used for acromegaly

185
Q

adverse effects pegvisomant

A

lipohypertrophy

monitor liver function

186
Q

advantage of cabergoline over bromocriptine

A

longer half life and greater selectivity for D2 receptors than bromocriptine

187
Q

adverse effects bromocriptine and cabergoline

A

B>C nausea
cabergoline-valvular disease (ergot activity)
hypotension and dizziness

188
Q

prob off label could use cabergoline to treat neuro

A

migraines due to ergot activity

189
Q

protirelin

A

synthetic TRH

190
Q

diagnostic use protirelin

A

normal levels-hypothalamic
increased-thyroid
not increased-pituitary failure

191
Q

cosyntropin

A

ACTH analog to diagnose primary vs secondary adrenal insufficiency

192
Q

use of hCG

A

mimics LH

used for stimualtion of ovulation and to treat male infertility and cryptorchidism

193
Q

menotropins

A

equal parts FSH and LH

used for infertility and spermatogenesis

194
Q

urofollitropin

A

only FSH component

used for infertility

195
Q

follitropin beta and alpha

A

FSH, similar to urofollitropin

196
Q

choriogonadotropin alpha

A

similar to LH and hCG

197
Q

clomiphene MOA

A

estrogen antagonist

increases gonadotropin secretion and stimulates ovulation

198
Q

use clomiphene

A

female infertility due to PCOS

199
Q

side effects clomiphene

A

multiple births, antiestrogenic effects on the developing follicle, ovarian cysts endometrium and cervical mucosa

200
Q

gonadorelin

A

synthetic GnRH

administered via a pump

201
Q

longer half life of synthetic GnRH agonists

A

substitution at position 6 confers resistance to proteolysis

202
Q

use synthetic GnRH agonists (leuprolide, goserelin, naferlin, histrelin)

A

endometriosis, uterine fibroids, advanced prostate cancer, breast cancer, precocious puberty

203
Q

adverse effects GnRH agonists

A

hot flashes, decreased bone density, vaginal dryness

atrophy of vagina, erectile dysfunction

204
Q

use and mechanism flutamide and bicalutamide

A

androgen antagonists given with GnRH analog for treatment of metastatic prostate therapy

205
Q

black box warning flutamide and bicalutamide

A

reversible liver damage

206
Q

finasteride MOA

A

5 alpha reductase inhibitor blocks conversion of testosterone to DHT

207
Q

use finasteride

A

male pattern baldness

BPH

208
Q

diagnosis DI

A

increase urine osmolality by vasopressin-central DI

no change-nephrogenic

209
Q

desmopressin

A

enhanced anti-diuretic activity

210
Q

other uses desmopressin

A

vWF deficiency and factor 8 (hemophilia A)

211
Q

adverse effects desmopressin

A

facial pallor, increase GI activity, muscle cramps, vasoconstriction of coronary arteries due to V1

212
Q

overstimulation V2

A

water intoxication

213
Q

drug interactions desmopressin

A

chlorpropamide and carbamazepine increase sensitivity

lithium and demeclocycline inhibit actions

214
Q

treatment nephrogenic DI

A

adequate water intake-thiazide diuretics reduce polyuria

amiloride blocks Li uptake

215
Q

treatment SIADH

A

fluid restriction
demeclocyclin
vaptans
IV hypertonic saline and loop diuretics

216
Q

conivaptan and tolvaptan selectivity

A

V1 and V2 antagonists for conivaptan

V2 for tolvaptan

217
Q

use oxytocin

A

abortion, induction of labor, postpartum hemorrhage, induction of lactation

218
Q

adverse effects oxytocin

A

overstimulation=trauma to mother or fetus, uterine rupture, water intoxication, allergic reactions

DT4 Exam 1 (5 decks)

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