PHARM BLESSINGS Flashcards
endocrine?
more like endocrying
deep breath
here we go
GET PUMPED
what 3 drugs have been shown to decrease mortality?
metformin
insulin
sulfonylureas
what drug should all DM patients be on because it is cardioprotective and renoprotective?
ACE-I
what is the maximum A1C @ diagnosis that you can treat someone on oral meds?
9 or 10
what is the DOC for T2DM to decrease A1C?
metformin
can you rx a diuretic and metformin together?
looks like nah
drug-drug interaction
when do you give a diabetic aspirin?
when they have evidence of CVD
at what GFR do you decrease the dose for metformin?
30-60
at what GFR can you no longer prescribe metformin?
30
what non-pharm treatment can you use to reduce A1C by a half point?
diet and exercise
when a person is diagnosed with T2DM, should you start therapy immediately or try lifestyle changes first?
treat immediately
(people usually present when they’ve had DM for 10y and already have some “-opathies”)
what chemical (that I drink excessively every single morning in order to be a pleasant human being) decreases bone mineralization and shouldn’t be consumed if a patient has osteoporosis?
caffeine
(fuck osteoporosis, coffee is bae)
what happens if you drink alcohol on metformin?
increases risk of lactic acidosis
how often do we check A1C levels?
every 3 months at first
then every 6 months
there’s a lot going on in case 4
i’m not doing it
yes i know-ow-ow that i let you down
is it too late now to say sorry now
this kid with T1DM had a boat load of insulin but he lost it and now he wants more
whatcha gonna do
DON’T PRESCRIBE HIM MORE, IT CAN BE USED AS AN INGREDIENT FOR METH
just kidding just give him 100U or 300U insulin glargine [lantus or toujeo solostar]
and short-acting insulin for before meals
what can ETOH cause with insulin?
hypoglycemia
can you mix different types of insulin?
sodium bromate
(“NaBro”)
what if your pt is on metformin and isn’t showing A1C improvement after 3 months?
put on a sulfonylurea like glipizide [glucotrol]
so you WANT to put your patient on a sulfonylurea but she’s allergic to sulfa
now what
tell her to suck it up
lol jk you could potentially kill her so give her repaglinide [prandin]
what drug class is repaglinide [prandin]?
meglitinide: non-sulfa secretagogue
does rapaglinide [prandin] make the B cells work harder or less hard?
harder harder harder
so will prob need insulin sooner
your T2DM patient has an A1C of 12. does he need insulin?
yup
oral meds won’t cut it
what’s important when you educate your patient on subQ insulin?
change the injection sites to prevent muscle atrophy
which drug is most likely to cause hypoglycemia?
a) metformin
b) glipizide [glucotrol]
c) acarbose [preclose]
b
how much insulin should a person be taking per day?
0.2-0.5units/kg total for the whole day
they just really wanna make sure you know this
what drug has a s/e of hypoglycemia
glipizide [glucotrol]
if you got this wrong then please take a break to work on your short-term memory
(just kidding you’re still a beautiful human, keep doing you!)
DID YOU KNOW that glipizide [glycotrol] can give a patient hypoglycemia? (omg no way!)
well what do you do if glipizide [glycotrol] is giving a patient hypoglycemia?
just reduce the dose!
name 3 drugs that have been shown to reduce the risk of hip fx
alendronate [fosamax]
ibandronate
risidronate
…i don’t even know what those last 2 drugs are so if you got all 3 correct on the 1st try then congrats you are officially superhuman
hey
happy valentine’s day <3
what are the instructions for taking alendronate [fosomax]?
take 30min before breakfast
sit up for 30 mins
to prevent esophagitis
pt has hypothyroidism
oh no
what do you do
levothyroxine [synthroid]
what is the average supplementation of levothryroxine [synthroid]
120mcg
what is the MC regimen that we are going to START someone on levothyroxine [synthroid] on?
12.5-25mcg
what can a too-high dose of levothyroxine [synthroid] cause as s/e?
things like tachy and anxiety and angina
if a patient has hypothyroidism
(oh no)
what supplement should you make sure they’re getting?
iodine
(PS hypothyroidism is not a big deal, I don’t know why I keep putting “oh no”)
(it just felt right)
(don’t mind me)
when do you recheck thyroid levels
6 weeks
if you have a pt with hypothyroidism (oh no) and his TSH only decreases to 12 after 3 months, what lab levels should you check?
FT3 and FT4
what if a pt has hypothyroidism (oh no) and it’s due to low T3 levels
give triiodo somethin somethin
you ain’t gonna be giving this drug
(oh yes)
dude’s 80 with orthostatic hypotension
DOC?
the mineralcorticoid fludricortisone [florinef]
what’s the MOA of fludrocortisone [florinef]?
increases absorption of Na at renal tubule
increases intravascular volume
what drug do you need to double if your patient is on it, and begins fludrocortisone [flsomethingef]?
glipizide [glucotrol]
WHAT IS THE DIABETES HIERARCHY OF DRUGS FOR T2DM
[know this, it was literally said so many times by Big B (AKA Blessington)]
- metformin
- sulfonylureas
(if allergic to sulfa then repaglinide [prandin])
- insulin and “other” drugs on the table
which drugs on the $4 list treat A1C and just diabetes things like dyslipidemia and heart/kidney issues etc.?
metformin
ACE-Is (lisinopril)
statins (lovastatin)
tru or nah:
metformin can induce renal disease
truuuuuuu
why do we discontinue metformin before giving CT scans with dye?
could hurt the kidz
(kidneys)
for real what is the eGFR cutoff with metformin
because we mentioned it like 18 times today
30
which 3 supplements can you not take at the same time as levothyroxine [synthroid]?
Ca
Mg
Fe
take 4 hours apart
so like what happens when you mix Ca, Fe, and Mg with levothyroxine at the same time?
YOU GET MAN BOOBS.
just kidding.
YOU DIE
just kidding again.
decreased absorption of levothyroxine
(see this answer is so much more boring)
15% of the population has a hard time converting T4 to T3 so what do we treat them with?
triiodo somethin somethin (T3 rather than T4)
depression occurs with:
a) hypothyroidism (oh no)
b) hyperthyroidism
c) both
d) neither
c) both
when you start someone on metformin, what is the A1C goal?
7
patient has hyperthyroidism
how do you treat?
Beta blocker like propanolol to treat sx!
PTU or methimazole
(^^^endo will rx that^^^)
if you’re starting someone on any thyroid hormone what should you be monitoring?
thyroid levels hellloooooo
What is the most significant cause of death in elderly diabetics taking oral agents?
fatal hula hoop accidents
but actually
*hypoglycemic death due to sulfonylureas*
can you go on canaglafoxin [invokana] for T2DM if you have kidney disease?
yahh. well nahhh. i mean kind of.
if you eGFR is above 50
if a patient is going on insulin, what are the 2 insulins you’re prob gonna put them on?
insulin glargine
regular [humilin-r]
which insulin is rapid acting
lisipro [humalog]
which insulin is short acting
regular [humulin-r]
which insulin is intermediate acting
neutral protamine [humulin-N]
which insulin(s) is/are long acting
insulin glargine [lantus]
insulin glargine [toujeo solostar]
who the eff comes up with these names… toujeo solostar? really?
which insulin is a rapid-acting inhalation?
human rDNA insulin [afrezza]
which insulins can be given IV?
correct me if I’m wrong
but I/Google THINK it’s the rapid ones and regular
hey
smile
Patient
Hx of fx
Osteoporosis that has not responded to bisphosphonate therapy.
DOC?
demosumab [prolia]
how do you administer denosumab [prolia] and how often?
subQ
every 6 months
does/can denosumab [prolia] cause:
a) hypo or hyper tension?
b) hypo or hyper calcemia?
a) hyper
b) hypo
(^^^give Ca + Vit D while on this^^^)
what do osteoblasts do?
bone remodeling
what do osteoclasts do?
bone reabsorption
what is the ratio of osteoclastic activity to osteoblastic activity?
2 weeks clast : 12 weeks blast
bone remodeling takes way longer than reaborption
how long should a low risk person be on bisphosphonates?
5y
how long should a high risk pt be on bisphosphonates?
up to 10y
what T score defines osteoporosis?
greater than 2.5 SD
what can happen to patients who have been on bisphosphonates for a long time?
they turn lime green
lol throwback joke
no they make cortical bone, but can’t make trabecular bone, so pts can get unusual fractures
does alendronate [fosomax] protect against:
a) hip fx
b) vertebral fx
c) both
d) neither
c) both
what if you want to put a patient on calcium and they are taking a PPI… what’s the best doc?
calcium citrate
how many times per day can long acting insulin be given?
2x
what is the Somoygi effect?
alternating phases of hyper and hypo and hyper and hypoglycemia
what is the Dawn effect?
a surge of hormones that they body produces around 4-5am
if you don’t have insulin, you will show a high fasting glucose level
for an elderly patient with comorbid conditions, where do you want the A1C?
7.5
what can you add for a T2DM patient who wants a 3rd oral agent to control his diabetes?
a TZD like pioglitizone [actos]
true or false:
insulin does not cause weight gain
falsetto
true or false:
metformin does not cause weight gain
das true!
what do alpha cells produce?
glucagon
what do beta cells produce?
insulin
amylin
c-protein
what do delta cells produce?
somatostatin
what cells are in the ileum and what do they produce?
GLP
incretin
when PTH is high, calcitonin is _____
low
when PTH is high, Ca is _____
naked
jk it’s high too
PTH and Ca smoked together
PTH stimulates osteo_____
osteoclasts
calcitonin inhibits osteo_____
osteoclasts
what cells produce calcitonin?
parafollicular cells in the thyroid
yay we’re done!
just remember…
what does a spoonful of sugar do?
