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Paige: Endocrine! > PHARM BLESSINGS > Flashcards

PHARM BLESSINGS Flashcards

1
Q

endocrine?

A

more like endocrying

deep breath

here we go

GET PUMPED

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2
Q

what 3 drugs have been shown to decrease mortality?

A

metformin

insulin

sulfonylureas

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3
Q

what drug should all DM patients be on because it is cardioprotective and renoprotective?

A

ACE-I

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4
Q

what is the maximum A1C @ diagnosis that you can treat someone on oral meds?

A

9 or 10

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5
Q

what is the DOC for T2DM to decrease A1C?

A

metformin

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6
Q

can you rx a diuretic and metformin together?

A

looks like nah

drug-drug interaction

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7
Q

when do you give a diabetic aspirin?

A

when they have evidence of CVD

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8
Q

at what GFR do you decrease the dose for metformin?

A

30-60

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9
Q

at what GFR can you no longer prescribe metformin?

A

30

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10
Q

what non-pharm treatment can you use to reduce A1C by a half point?

A

diet and exercise

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11
Q

when a person is diagnosed with T2DM, should you start therapy immediately or try lifestyle changes first?

A

treat immediately

(people usually present when they’ve had DM for 10y and already have some “-opathies”)

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12
Q

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?

A

caffeine

(fuck osteoporosis, coffee is bae)

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13
Q

what happens if you drink alcohol on metformin?

A

increases risk of lactic acidosis

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14
Q

how often do we check A1C levels?

A

every 3 months at first

then every 6 months

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15
Q

there’s a lot going on in case 4

i’m not doing it

A

yes i know-ow-ow that i let you down

is it too late now to say sorry now

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16
Q

this kid with T1DM had a boat load of insulin but he lost it and now he wants more

whatcha gonna do

A

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

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17
Q

what can ETOH cause with insulin?

A

hypoglycemia

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18
Q

can you mix different types of insulin?

A

sodium bromate

(“NaBro”)

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19
Q

what if your pt is on metformin and isn’t showing A1C improvement after 3 months?

A

put on a sulfonylurea like glipizide [glucotrol]

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20
Q

so you WANT to put your patient on a sulfonylurea but she’s allergic to sulfa

now what

A

tell her to suck it up

lol jk you could potentially kill her so give her repaglinide [prandin]

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21
Q

what drug class is repaglinide [prandin]?

A

meglitinide: non-sulfa secretagogue

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22
Q

does rapaglinide [prandin] make the B cells work harder or less hard?

A

harder harder harder

so will prob need insulin sooner

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23
Q

your T2DM patient has an A1C of 12. does he need insulin?

A

yup

oral meds won’t cut it

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24
Q

what’s important when you educate your patient on subQ insulin?

A

change the injection sites to prevent muscle atrophy

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25
Q

which drug is most likely to cause hypoglycemia?

a) metformin
b) glipizide [glucotrol]
c) acarbose [preclose]

A

b

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26
Q

how much insulin should a person be taking per day?

A

0.2-0.5units/kg total for the whole day

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27
Q

they just really wanna make sure you know this

what drug has a s/e of hypoglycemia

A

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!)

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28
Q

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?

A

just reduce the dose!

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29
Q

name 3 drugs that have been shown to reduce the risk of hip fx

A

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

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30
Q

hey

A

happy valentine’s day <3

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31
Q

what are the instructions for taking alendronate [fosomax]?

A

take 30min before breakfast

sit up for 30 mins

to prevent esophagitis

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32
Q

pt has hypothyroidism

oh no

what do you do

A

levothyroxine [synthroid]

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33
Q

what is the average supplementation of levothryroxine [synthroid]

A

120mcg

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34
Q

what is the MC regimen that we are going to START someone on levothyroxine [synthroid] on?

A

12.5-25mcg

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35
Q

what can a too-high dose of levothyroxine [synthroid] cause as s/e?

A

things like tachy and anxiety and angina

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36
Q

if a patient has hypothyroidism

(oh no)

what supplement should you make sure they’re getting?

A

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)

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37
Q

when do you recheck thyroid levels

A

6 weeks

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38
Q

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?

A

FT3 and FT4

39
Q

what if a pt has hypothyroidism (oh no) and it’s due to low T3 levels

A

give triiodo somethin somethin

you ain’t gonna be giving this drug

(oh yes)

40
Q

dude’s 80 with orthostatic hypotension

DOC?

A

the mineralcorticoid fludricortisone [florinef]

41
Q

what’s the MOA of fludrocortisone [florinef]?

A

increases absorption of Na at renal tubule

increases intravascular volume

42
Q

what drug do you need to double if your patient is on it, and begins fludrocortisone [flsomethingef]?

A

glipizide [glucotrol]

43
Q

WHAT IS THE DIABETES HIERARCHY OF DRUGS FOR T2DM

[know this, it was literally said so many times by Big B (AKA Blessington)]

A
  1. metformin
  2. sulfonylureas

(if allergic to sulfa then repaglinide [prandin])

  1. insulin and “other” drugs on the table
44
Q

which drugs on the $4 list treat A1C and just diabetes things like dyslipidemia and heart/kidney issues etc.?

A

metformin

ACE-Is (lisinopril)

statins (lovastatin)

45
Q

tru or nah:

metformin can induce renal disease

A

truuuuuuu

46
Q

why do we discontinue metformin before giving CT scans with dye?

A

could hurt the kidz

(kidneys)

47
Q

for real what is the eGFR cutoff with metformin

because we mentioned it like 18 times today

A

30

48
Q

which 3 supplements can you not take at the same time as levothyroxine [synthroid]?

A

Ca

Mg

Fe

take 4 hours apart

49
Q

so like what happens when you mix Ca, Fe, and Mg with levothyroxine at the same time?

A

YOU GET MAN BOOBS.

just kidding.

YOU DIE

just kidding again.

decreased absorption of levothyroxine

(see this answer is so much more boring)

50
Q

15% of the population has a hard time converting T4 to T3 so what do we treat them with?

A

triiodo somethin somethin (T3 rather than T4)

51
Q

depression occurs with:

a) hypothyroidism (oh no)
b) hyperthyroidism
c) both
d) neither

A

c) both

52
Q

when you start someone on metformin, what is the A1C goal?

A

7

53
Q

patient has hyperthyroidism

how do you treat?

A

Beta blocker like propanolol to treat sx!

PTU or methimazole

(^^^endo will rx that^^^)

54
Q

if you’re starting someone on any thyroid hormone what should you be monitoring?

A

thyroid levels hellloooooo

55
Q

What is the most significant cause of death in elderly diabetics taking oral agents?

A

fatal hula hoop accidents

but actually

*hypoglycemic death due to sulfonylureas*

56
Q

can you go on canaglafoxin [invokana] for T2DM if you have kidney disease?

A

yahh. well nahhh. i mean kind of.

if you eGFR is above 50

57
Q

if a patient is going on insulin, what are the 2 insulins you’re prob gonna put them on?

A

insulin glargine

regular [humilin-r]

58
Q

which insulin is rapid acting

A

lisipro [humalog]

59
Q

which insulin is short acting

A

regular [humulin-r]

60
Q

which insulin is intermediate acting

A

neutral protamine [humulin-N]

61
Q

which insulin(s) is/are long acting

A

insulin glargine [lantus]

insulin glargine [toujeo solostar]

who the eff comes up with these names… toujeo solostar? really?

62
Q

which insulin is a rapid-acting inhalation?

A

human rDNA insulin [afrezza]

63
Q

which insulins can be given IV?

A

correct me if I’m wrong

but I/Google THINK it’s the rapid ones and regular

64
Q

hey

A

smile

65
Q

Patient

Hx of fx

Osteoporosis that has not responded to bisphosphonate therapy.

DOC?

A

demosumab [prolia]

66
Q

how do you administer denosumab [prolia] and how often?

A

subQ

every 6 months

67
Q

does/can denosumab [prolia] cause:

a) hypo or hyper tension?
b) hypo or hyper calcemia?

A

a) hyper
b) hypo

(^^^give Ca + Vit D while on this^^^)

68
Q

what do osteoblasts do?

A

bone remodeling

69
Q

what do osteoclasts do?

A

bone reabsorption

70
Q

what is the ratio of osteoclastic activity to osteoblastic activity?

A

2 weeks clast : 12 weeks blast

bone remodeling takes way longer than reaborption

71
Q

how long should a low risk person be on bisphosphonates?

A

5y

72
Q

how long should a high risk pt be on bisphosphonates?

A

up to 10y

73
Q

what T score defines osteoporosis?

A

greater than 2.5 SD

74
Q

what can happen to patients who have been on bisphosphonates for a long time?

A

they turn lime green

lol throwback joke

no they make cortical bone, but can’t make trabecular bone, so pts can get unusual fractures

75
Q

does alendronate [fosomax] protect against:

a) hip fx
b) vertebral fx
c) both
d) neither

A

c) both

76
Q

what if you want to put a patient on calcium and they are taking a PPI… what’s the best doc?

A

calcium citrate

77
Q

how many times per day can long acting insulin be given?

A

2x

78
Q

what is the Somoygi effect?

A

alternating phases of hyper and hypo and hyper and hypoglycemia

79
Q

what is the Dawn effect?

A

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

80
Q

for an elderly patient with comorbid conditions, where do you want the A1C?

A

7.5

81
Q

what can you add for a T2DM patient who wants a 3rd oral agent to control his diabetes?

A

a TZD like pioglitizone [actos]

82
Q

true or false:

insulin does not cause weight gain

A

falsetto

83
Q

true or false:

metformin does not cause weight gain

A

das true!

84
Q

what do alpha cells produce?

A

glucagon

85
Q

what do beta cells produce?

A

insulin

amylin

c-protein

86
Q

what do delta cells produce?

A

somatostatin

87
Q

what cells are in the ileum and what do they produce?

A

GLP

incretin

88
Q

when PTH is high, calcitonin is _____

A

low

89
Q

when PTH is high, Ca is _____

A

naked

jk it’s high too

PTH and Ca smoked together

90
Q

PTH stimulates osteo_____

A

osteoclasts

91
Q

calcitonin inhibits osteo_____

A

osteoclasts

92
Q

what cells produce calcitonin?

A

parafollicular cells in the thyroid

93
Q

yay we’re done!

just remember…

what does a spoonful of sugar do?

A

Paige: Endocrine! (3 decks)

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