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Pharmacology > Pharm II - Test 3 > Flashcards

Pharm II - Test 3 Flashcards

1
Q

Class: Levothyroxine (Synthroid)

A

Thyroid hormone replacement (synthetic T4)

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2
Q

Indication: Levothyroxine (Synthroid)

A

Hypothyroidism, TSH suppression in select cases of thyroid nodules and thyroid cancer

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3
Q

Side effects: Levothyroxine (Synthroid) and Thyroid USP (Armour) and Liothyronine (Cytomel)

A

Palpitations, tachycardia, intolerance to heat, anxiety

Long-term elevation of serum T4 may accelerate cardiac disease and osteoporosis

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4
Q

What is an important contraindication for patients with Addison’s disease and hypothyroidism take Synthroid or Armour thyroid?

A

Replacing thyroid hormone before replacing cortisol can be fatal.

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5
Q

Equivalent dosing: Armour vs. Synthroid vs. Cytomel

A

60 mg (1 grain) Armour = 100 mcg of T4 (Levothyroixine/Synthroid) = 25 mcg of T3 (Triiodothyronine/Cytomel)

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6
Q

Indication: Thyroid USP (Armour)

A

Hypothyroidism

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7
Q

MOA: Thyroid USP (Armour)

A

Replaces both T4 and T3

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8
Q

Thyroid USP (Armour) is standardized to ___

A

iodine content (0.2% iodine)

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9
Q

With what population should you use more cautious dosing of thyroid replacement?

A

Patients over 65 with a history of cardiac disease

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10
Q

Class: Liothyronine (Cytomel)

A

Thyroid hormone replacement (synthetic T3) dosed in mcg

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11
Q

Indication: Liothyronine (Cytomel)

A

Hypothyroidism with intolerance to T4 replacement therapy or no improvement on T4 replacement therapy

Myxedema coma

“Wilson’s syndrome”

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12
Q

Condition caused by excess administration of thyroid hormone

A

Thyroiditis factitia

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13
Q

Thyroid conditions can place patients at greater risk for ___(2).

A

Osteoporosis

Cardiac disease

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14
Q

What type of drugs are often used to block the signs and symptoms of hyperthyroidism?

A

Beta blockers

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15
Q

Class: Methimazole (Tapazole)

A

Thionamide

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16
Q

Indication: Methimazole (Tapazole)

A

Hyperthyroidism

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17
Q

MOA: Methimazole (Tapazole)

A

Inhibits transformation of inorganic iodine to organic iodine -> blocks production of thyroxine

Inhibits coupling of iodotyrosine to form T3/T4

Minimal effect blocking peripheral conversion of T4 to T3

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18
Q

Contraindications: Methimazole (Tapazole), Propylthiouracil (PTU)

A

Pregnancy - Propylthiouracil (PTU) is considered safer (category D)

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19
Q

Class: Propylthiouracil (PTU)

A

Thionamide

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20
Q

Indication: Propylthiouracil (PTU)

A

Hyperthyroidism

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21
Q

MOA: Propylthiouracil (PTU)

A

Inhibits transformation of inorganic iodine to organic iodine -> blocks production of thyroxine

Inhibits coupling of iodotyrosine to form T3/T4

Blocks peripheral conversion of T4 to T3

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22
Q

MOA: Methimazole (Tapazole) vs Propylthiouracil (PTU)

A

Propylthiouracil (PTU) has a greater effect on blocking peripheral conversion of T4 to T3

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23
Q

Indication: Iodine (SSKI)

A

Hyperthyroidism, thyroid storm

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24
Q

MOA: Iodine (SSKI)

A

Large doses of iodine inhibit release of thyroxine from thyroid gland

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25
Q

Beneficial effects of Iodine (SSKI) generally last no more than ___.

A

2-3 weeks

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26
Q

Indication: Radioactive iodine (131I)

A

Hyperthyroidism, Selected cases of thyroid cancer, thyroid nodules

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27
Q

Side effects: Radioactive iodine (131I)

A

Tenderness, swelling during initial week, N/V

transient BM depression and acute leukemia w/ extremely high doses

M - dec sperm, temp. infertility (~2 years)

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28
Q

Preparation for treatment with Radioactive iodine (131I)

A

Euthyroid state achieved by anti-thyroid drugs or SSKI

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29
Q

Contraindications: Radioactive iodine (131I)

A

Category X (delay 6-12 mos after tx)

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30
Q

SSx: Thyroid storm

A

High fever, irritability, delirium, V/D, dehydration, hypotension, vascular collapse

Coma, death

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31
Q

Which population is at risk for thyroid storm unless anti-thyroid medication has been administered?

A

Patients undergoing surgery for hyperthyroidism

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32
Q

Tx: Thyroid storm

A

Beta blockade + IV Iodine

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33
Q

Dx: DM

A

Confirmed fasting blood glucose level of >/= 126 mg/dl

Non-fasting blood glucose of >/= 200 mg/dl in pt presenting w/ sxs or exam findings consistent with DM

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34
Q

Concordance for development in identical twins: Type I vs II diabetes

A

Type I: 50%

Type II: 90-100%

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35
Q

What antibody testing should be considered in all non-obese adults who present with sxs of type II diabetes (type 1.5)?

A

Islet cell, insulin, and glutamic acid decarboxylase antibodies

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36
Q

MOA: Metformin vs. Sulfonylureas/Meglitinides vs. Alpha-glucosidase inhibitors vs. Thiazolidinediones (Glitazones) vs. DPP-4 inhibitors

A

Metformin = inhibits hepatogluconeogenesis, dec insulin resistance

Sulfonylureas/Meglitinides = inc secretion of insulin (secretagogues)

Alpha-glucosidase inhibitors = delay absorption of glucose by intestines

Thiazolidinediones (Glitazones) = dec insulin resistance (via PPAR-gamma)

DPP-4 inhibitors = promote release of insulin from pancreas after eating a meal (via GLP-1)

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37
Q

Class: Metformin (Glucophage)

A

Biguanides

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38
Q

MOA: Metformin (Glucophage)

A

Dec hepatic glucose production, inc insulin sensitivity in skeletal muscle

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39
Q

Pregnancy and Metformin (Glucophage)

A

Category B

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40
Q

Side effects: Metformin (Glucophage)

A

Abdominal cramping, N, metallic taste, inc risk for B12 deficiency

Lactic acidosis (rare)

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41
Q

Contraindications: Metformin (Glucophage)

A

Do not use in pts w/ impaired renal fxn (serum creatinine >1.5 mg/dl in M or >1.4 in F)

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42
Q

MOA: Sulfonylureas

A

Interaction w/ ATP-sensitive K channel in the beta cell membrane -> inc. insulin production from intact beta cells (secretagogues)

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43
Q

What is the MC side effect of sulfonylureas?

A

Weight gain

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44
Q

In general, sulfonylureas become ineffective within ___.

A

5-10 years

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45
Q

Contraindications: Sulfonylureas

A

Patients w/ sulfa allergy

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46
Q

2nd-generation sulfonylureas (3)

A

Glipizide (Glucotrol)
Glyburide (Micronase, Diabeta)
Glimepiride (Amaryl)

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47
Q

MOA: Meglitinides

A

Interaction w/ ATP-sensitive K channel in the beta cell membrane -> Inc. insulin release from beta cells (secretagogues)

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48
Q

Meglitinides (2)

A

Nateglinide (Starlix)

Repaglinide (Prandin)

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49
Q

Which meglitinide has been shown to be equally effective to the sulfonylureas?

A

Repaglinide (Prandin)

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50
Q

Side effects: Sulfonylureas, Meglitinides

A

Hypoglycemia, weight gain

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51
Q

Contraindication: Meglitinides

A

Do not combine with sulfonylurea drugs due to increased risk for hypoglycemia

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52
Q

MOA: Thiazolidinediones / Glitazone

A

Affect gene expression of PPAR gamma -> dec. peripheral insulin resistance, dec. hepatic glucose production

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53
Q

What is the only glitazone approved for concurrent use with insulin?

A

Pioglitazone (ACTOS)

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54
Q

TZDs/Glitazones (2)

A

Rosiglitazone (Avandia)

Pioglitazone (ACTOS)

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55
Q

Side effects: TZDs/Glitazones

A

Increased risk of CHF, MI(?), bone fractures, weight gain, ALT elevation

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56
Q

Alpha-glucosidase inhibitors (2)

A

Acarbose (Precose)

Miglitol (Glyset)

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57
Q

MOA: Alpha-glucosidase inhibitors

A

Inhibit alpha-glucosidase -> delays absorption of glucose and other monosaccharides

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58
Q

Alpha-glucosidase inhibitors can increase the risk for hypoglycemia when combined with ___.

A

Sulfonylureas

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59
Q

Contraindications: Alpha-glucosidase inhibitors

A

Pts w/ chronic intestinal dz, IBD, colonic ulceration, intestinal obstruction

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60
Q

Pregnancy: Alpha-glucosidase inhibitors

A

Category B

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61
Q

MOA: Sitagliptin (Januvia)

A

Dipeptidyl peptidase 4 (DPP-4) inhibitor -> prevent breakdown of GLP-1 and GIP -> potentiate secretion of insulin, suppress glucagon release -> normalize blood glucose

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62
Q

Side effects: Sitagliptin (Januvia)

A

Hypoglycemia

Inc. risk of acute/chronic pancreatitis

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63
Q

Indication: Pramlintide (Symlin)

A

Type 1 or 2 diabetes pts who are not achieving their A1c goal levels

First drug for type I since 1920s

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64
Q

Contraindication: Pramlintide (Symlin)

A

Cannot be combined with insulin

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65
Q

Side effect: Pramlintide (Symlin)

A

NAUSEA, modest weight loss

No hypoglycemia or weight gain

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66
Q

Rapid-acting insulin

A

Lispro (Aspart)

Humulog (Novalog)

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67
Q

Short-acting insulin

A

Regular Insulin (Humulin R)

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68
Q

Intermediate-acting insulin

A

NPH (Humulin N)

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69
Q

Long-acting insulin

A

Glargine (Lantus)

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70
Q

Insulin type for sleeping hours

A

Glargine (Lantus)

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71
Q

Insulin type before meals

A

Lispro (Aspart)

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72
Q

Side effects: Insulin

A

Weight gain, hypoglycemia (seizures, coma, death), hypokalemia, fibrotic/atrophic injection sites

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73
Q

Indication: Glucagon

A

Severe hypoglycemia

74
Q

MOA: Glucagon

A

Stimulation of glucagon receptor sites -> increased glucose levels from hepatic breakdown

75
Q

When prescribing Metformin to a pre-diabetic/diabetic women of child-bearing age who have been unable to become pregnant, be conscious that ___.

A

Prescription of OCs may be needed to prevent pregnancy

76
Q

A person with a Dexa scan T-score of -1 has __ the risk of a normal 40 year old. -2? -3?

A
  • 1 has 2x the risk
  • 2 has 4x the risk
  • 3 has 8x the risk
77
Q

T -1 or higher = ___

A

Normal

78
Q

T -2.5 to -1 = ___

A

Osteopenia

79
Q

T below -2.5 = ___

A

Osteoporosis

80
Q

T below -2.5 plus bone fragility = ___

A

Severe osteoporosis

81
Q

Risk factors: Osteoporosis

A

F, Small/thin body stature, increased age, Caucasian/Asian, FHx, diet low in Ca/Vit D, Low E(F), Low T(M), inactive lifestyle, smoking, excess EtOH, glucocorticoids, anticonvulsants

82
Q

Side effects: Calcitriol (Rocaltrol)

A

Inc. serum calcium levels

83
Q

Indication: Calcitonin (Mialcin)

A

Treatment of osteoporosis

84
Q

Indication: Raloxifene (Evista)

A

Treatment and prevention of osteoporosis

Reduce risk of breast cancer

85
Q

Class: Raloxifene (Evista)

A

Selective estrogen receptor modulator (SERM)

86
Q

MOA: Bisphosphanates

A

Inhibit osteoclast activity - inc. bone mass

87
Q

Indication: Bisphosphanates

A

Treatment and/or Prevention of osteoporosis

88
Q

Side effect: Alendronate (Fosamax)

A

Heartburn, N, ESOPHAGITIS, OSTEONECROSIS OF THE JAW, ATYPICAL FEMUR FRACTURES, myalgia

89
Q

Class: Alendronate (Fosamax)

A

Bisphosphanate

90
Q

Indication: Alendronate (Fosamax)

A

Prevention and Treatment of osteoporosis

91
Q

MOA: Alendronate (Fosamax)

A

Inhibition of osteoclast activity

92
Q

MOA: Raloxifene (Evista)

A

Binding to select estrogen receptor sites

93
Q

Contraindications: Raloxifene (Evista)

A

Pregnancy, lactating women, women with active/hx of DVT/PE/renal vein thrombosis

94
Q

Class: Calcitonin (Miacalcin)

A

Synthetic hormone from parathyroid gland

95
Q

MOA: Calcitonin (Miacalcin)

A

Inhibition of osteoclast activity

96
Q

Class: Teriparatide (Forteo)

A

Synthetic PTH analogue

97
Q

Indication: Teriparatide (Forteo)

A

Treatment of osteoporosis

98
Q

MOA: Teriparatide (Forteo)

A

Activates bone turnover, stimulates new bone formation in spine/hip

99
Q

Teriparatide (Forteo) can be used for how long?

A

Up to 2 years

100
Q

When estrogen is taken alone, it can increase a woman’s risk of ___.

A

endometrial cancer

101
Q

What is usually combined with estrogen in HRT to mitigate the risk for cancer?

A

progestin hormone

102
Q

What is Prempro?

A

HRT (mix of estrogen and progestin)

103
Q

Prempro has been linked to increased risk for ___.

A

MI, stroke, DVT/PE, breast cancer

104
Q

Indication: Denosumab (Prolia)

A

Osteoporosis (tx), bone metastases, RA, MM, giant cell tumor

105
Q

MOA: Denosumab (Prolia)

A

inhibits RANKL -> RANK not activated on pre-osteoclasts -> osteoclasts not formed

106
Q

Route: Denosumab (Prolia)

A

SQ, every 6 mos

107
Q

Indication: Estrogen in postmenopausal women

A

Symptoms of menopause (hot flashes, night sweats, tissue atrophy (vulva, vagina, urethra), insomnia, osteoporosis)

108
Q

BiEst is a combination of ___

A

estriol, estradiol (80:20)

109
Q

TriEst is a combination of ___

A

estriol, estradiol, estrone (80:10:10)

110
Q

Bio-identical estrogen has been shown to decease risk of ___ compared to synthetic estrogen.

A

blood clots

111
Q

Indications: Conjugated estrogens (Premarin)

A

Prevention/Tx of osteoporosis, post-menopausal sxs (hot flashes, vaginal dryness, itching)

112
Q

Premarin is a combination of ___

A

conjugated estrogens (estrone, equillin)

113
Q

MOA: Conjugated estrogens (Premarin)

A

Alters gene transcription

114
Q

___ should be added to estrogen HRT in ____.

A

Progesterone

Women who have NOT undergone a hysterectomy

115
Q

Side effects: Conjugated estrogens (Premarin)

A

vaginal bleeding, breast tenderness/pain, inc. risk of DVT, inc. risk of atherosclerosis and CAD, inc. risk of uterine and breast CA, inc. breast size,

116
Q

Contraindications: Conjugated estrogens (Premarin)

A

Hx of DVT, breast CA, ovarian CA, uterine CA

Category X

117
Q

Class: Medroxyprogesterone (Provera)

A

Synthetic progresterone

118
Q

Indications: Medroxyprogesterone (Provera)

A

Contraceptive, HRT, DUB, endometriosis

119
Q

MOA: Medroxyprogesterone (Provera)

A

Alters gene transcription

120
Q

Contraindications: Medroxyprogesterone (Provera)

A

Hx of DVT, breast CA, ovarian CA, uterine CA

Category X

121
Q

Class: Pramlintide (Symlin)

A

Amylin agonist analogs

122
Q

MOA: Pramlintide (Symlin)

A

Slows gastric emptying, suppresses glucagon production and release

123
Q

Class: Exenatide (Byetta)

A

Incretin (GLP-1) mimetics

124
Q

MOA: Exenatide (Byetta)

A

Enhance glucose-dependent insulin secretion, suppress glucagon secretion, slow gastric emptying

125
Q

MOA: Estrogen vs. Progestin in OCs

A

Estrogen suppresses ovulation

Progestin prevents implantation in the endometrium via inhibition of gonadotropin secretion

126
Q

Dosages of E vs. P in OCs

A

Constant dose of E over 21 days

Increasing, triphasic dose of P over 21 days

127
Q

OCs may lower the risk for what type of cancer?

A

Colorectal, Ovarian, Endometrial

128
Q

What is a “mini-pill”?

A

Progestin-only OC

129
Q

Drugs that can reduce the efficacy of OCs when used concurrently?

A

Penicillin, Amoxil, Tetracycline, Cephalosporins, Sulfa drugs, seizure drugs, St. John’s wort

130
Q

The use of OCs for 5 years or more dec. risk of ovarian cancer later in life by __.

A

50%

131
Q

The use of OCs for 10 years or more dec. risk of ovarian cancer and endometrial cancer later in life by __.

A

80%

132
Q

Class: Drospirenone (Yaz, Yasmin)

A

Anti-androgenic synthetic progestin

133
Q

Depo-Provera is a injectable contraceptive given ___

A

4 times per year

134
Q

Class: Depo-Provera

A

Progestin-only injectable contraceptive

135
Q

MOA: Depo-Provera

A

Dec. GnRH release -> Dec FSH and LH - inhibition of follicular development and ovulation

136
Q

Depo-Provera has been shown to reduce the risk of endometrial cancer by up to ___.

A

80%

137
Q

Side effects: Depo-Provera

A

Menstrual irregularities, abd. discomfort, weight changes, HA, hair loss, fatigue, depression, nervousness, DELAYED RETURN OF FERTILITY

BONE LOSS, INC RISK FOR OSTEOPOROSIS

138
Q

How long does it take for fertility to return after discontinuation with Depo-Provera?

A

9-10 months

139
Q

What does the black box warning for Depo-Provera say?

A

Do not use for > 2 years dt concerns over bone loss

140
Q

Class: Implanon

A

Implantable progestin contraceptive

141
Q

Implanon is inserted (location) and must be removed within ___.

A

Inner arm

3 years

142
Q

Class: Ortho Evra

A

Transdermal patch contraceptive

143
Q

Contraindications: Nuva ring

A

Risk of blood clots

144
Q

MOA: Paragard

A

Impairs mobility of sperm

Irritates endometrial lining -> inhibits implantation

145
Q

MOA: Mirena, Liletta, Skyla

A

Release of long-acting synthetic progestin (Levonorgestrel) -> diminish frequency of ovulation and changes in cervical mucosa -> dec. implantation

146
Q

Ingredients: Plan B, Next Choice

A

Progestin-only (Levonorgestrel)

147
Q

Class: Ulipristal acetate (Ella)

A

Selective progesterone receptor modulator (SPRM)

148
Q

Indication: Ulipristal acetate (Ella)

A

Emergency contraception

149
Q

MOA: Ulipristal acetate (Ella)

A

Delay/inhibition of ovulation and inhibition of follicle rupture

150
Q

Which form has been shown to be more effective as a morning after pill: combination or progestin-only?

A

Progestin-only

151
Q

Class: Mifepristone (Mifeprex)

A

Synthetic steroid abortifacient

152
Q

MOA: Mifepristone (Mifeprex)

A

Progesterone receptor antagonist w/ partial agonist activity, dec. human chorionic gonadotropin levels -> dec. progesterone production by corpus luteum

153
Q

Contraindications: Mifepristone (Mifeprex)

A

Presence of IUD, ectopic pregnancy, known hemorrhagic d/o, on anticoagulant therapy, on long-term prednisone therapy

154
Q

Class: Clomiphene (Clomid)

A

Estrogen receptor agonist

155
Q

Indications: Clomiphene (Clomid)

A

Infertility, amenorrhea

156
Q

MOA: Clomiphene (Clomid)

A

Binds to E receptor sites in brain -> interferes w/ normal negative feedback of E on GnRH -> inc secretion of GnRH -> inc release of LH and FSH -> ovulation

157
Q

Side effects: Clomiphene (Clomid)

A

Vaginal dryness, vaginal bleeding, breast tenderness, anxiety, hot flashes

MULTIPLE BIRTHS

158
Q

Contraindications: Clomiphene (Clomid)

A

Prior hx of LV dz, breast cancer, or uterine cancer

159
Q

How long can Paragard be used?

A

10 years

160
Q

Dosage of Levonorgesetrel: Mirena vs. Liletta vs. Skyla

A

Mirena = 52 mg (20 mcg/d)

Liletta = 52 mg (20 mcg/d)

Skyla = 13.5 mg (14 mcg/d)

161
Q

How long can Mirena/Liletta be used?

A

5 years

162
Q

How long can Skyla be used?

A

3 years

163
Q

Indications: Exogenous T

A

Anemia, severe osteoporosis, hormone therapy for transsexual men

164
Q

Side effects: Testosterone (M)

A

Acne, baldness, gynecomastia, priapism, inc. risk of prostatic hyperplasia and PrCa, worsening of sleep apnea, dec. sperm count/infertility, fluid retention/edema

165
Q

Side effects: Testosterone (F)

A

Virilization (excess body/facial hair), acne, deepening of voice, clitoral enlargement, menstrual irregularities

166
Q

Effect on Labs: Testosterone

A

Inc. LDL, dec. HDL, Inc. RBC

167
Q

MOA: Testosterone

A

Alters gene transcription

168
Q

MC indication of anti-androgen treatment?

A

Prostate cancer

169
Q

Normal growth of prostate tissue is regulated by ___(2).

A

T, DHT

170
Q

Class: Leuprolide (Lupron)

A

Anti-androgenic hormone, anti-estrogenic hormone

171
Q

Indications: Leuprolide (Lupron)

A

Prostate cancer, precocious puberty, endometriosis, uterine fibroids, IVF

172
Q

MOA: Leuprolide (Lupron)

A

GnRH agonist -> downregulation of FSH and LH -> dec. T/E

173
Q

Indication: Finasteride (Proscar)

A

BPH, male-pattern baldness, PrCa

174
Q

MOA: Finasteride (Proscar)

A

Limits conversion of T to DHT via inhibition of type II 5-alpha reductase

175
Q

Side effects: Finasteride (Proscar)

A

Dec. libido, ED, impotency, depression, breast swelling, breast tenderness

176
Q

Class: Sildenafil citrate (Viagra)

A

PDE5 inhibitor

177
Q

Indications: Sildenafil citrate (Viagra)

A

ED, pulmonary HTN

178
Q

MOA: Sildenafil citrate (Viagra)

A

Inhibition of PDE5 enzyme that degrades cGMP in the SM cells lining the blood vessels of the penis -> blood remains in penis -> erection maintained

179
Q

Contraindications: Sildenafil citrate (Viagra)

A

Concurrent use w/ NO donors, organic nitrites/nitrates (nitroglycerin)

CV risk factors (recent stroke, heart attack)

Severe impairment of LV or KD fxn

Hypotension

Hereditary degenerative retinal d/o

180
Q

Side effects: Sildenafil citrate (Viagra)

A

HA, flushing, nasal congestion, dyspepsia, impaired vision, cyanopsia

Acute angle closure glaucoma, ventricular arrhythmias, severe hypotension, MI, stroke, priapism

181
Q

Contraindications: T replacement therapy

A

PrCa, BrCa, erythrocytosis, unstable CHF, severe untreated sleep apnea

182
Q

Testosterone -> ? -> Estrogen

A

Aromatase

Pharmacology (4 decks)

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