Pharm III Final Exam Flashcards

Question

prostatis treatment

Answer 1

fluoroquinolone or TMP-SMX

Answer 2

ceftriaxone

Answer 3

ceftriaxone, doxycycline and metronidazole

Answer 4

penicillin, amoxicillin, cephalexin or cefadroxil

Answer 5

vancomycin plus efepime

Answer 6

dicloxaacillin, cephalexin or cefadroxil

Answer 7

TMP-SMX, amoxicillin and doxycycline or linezolid

Answer 8

B complex and C

Answer 9

beriberi: neuropathy, muscle weakness, cardiomegaly, edema, ophthalmoplegia, confabulation

Answer 10

magenta tongue, stomatitis, seborrhea, cheilosis, ocular symptoms

Answer 11

pellagra: dermatitis, red tongue, diarrhea, apathy, dementia, disorientation

Answer 12

seborrhea, glossitis, convulsions, neuropathy, depression, confusion, microcytic anemia

Answer 13

megaloblastic anemia, glossitis, depression, elevated homocysteine

Answer 14

megaloblastic anemia, loss of vibration and proprioception, abnormal gait, demential, impotence, loss of bladder and bowel control, increased homocysteine and MMA

Answer 15

scurvy: petechiae, ecchymosis, coiled hair, inflamed gums, join pain, poor wound healing

Answer 16

MCC of blindness in developing countries xerophthalmia, night blindness, bitot spots, follicular hyperkeratosis, impaired embryonic development, immune dysfunction

Answer 17

rickets: skeletal deformity, rachitic rosary, bow legs, osteomalacia

Answer 18

peripheral neuropathy, spinocerebellar ataxia, muscle atrophy, retinopathy

Answer 19

elevated PTT, bleeding

Answer 20

vision and skin

Answer 21

bone health

Answer 22

hypercalcemia, renal failure, kidney stones, hyperphosphatemia

Answer 23

cholecalciferol, sun

Answer 24

ergocalciferol, food

Answer 25

antioxidant

Answer 26

synthesis of coagulation factors VII, IX, X, II

Answer 27

K1: phytonadione K2: menaquinone K3: menadione

Answer 28

osteoporosis

Answer 29

anemia, growth retardation, defective keratinization and pigmentation of hair, hypothermia, degemnative changes in aortic elastin, mental deterioration

Answer 30

dental caries

Answer 31

thyroid enlargement, low T4, cretinism

Answer 32

pica, anemia, impaired cognitive development, muscle abnormalities, premature labor, increased perinatal maternal death

Answer 33

rickets, proximal muscle weakness, rhabdo, paresthesia, ataxia, seizures, confusion, HF, acidosis

Answer 34

growth retardation, decreased taste and smell alopecia, diarrhea, FTT, gonadal atrophy, congenital malformation

Answer 35

folic acid, prevents neural tube defects

Answer 36

B12, ADEK, calcium, iron

Answer 37

dry skin, hyperpigmentation, alopecia, night sweats, anorexia, hepatomegaly, hyperlipidemia, polyuria, albuminuria, arthralgia, growth retardation, hypomenorrhea, increased ICP, ataxia, headache

Answer 38

HTN, dysrhythmia, metallic taste, dry mouth, anorexia, bone pain, fatigue, headache

Answer 39

n/v, flatulence, BUN elevation, weakness, increased bleeding, blurry vision, dizziness

Answer 40

urticaria, hyperbilirubinemia, hemolytic anemia, headache, brain damage

Answer 41

angioedema, pruritus, cyanosis, CV collapse

Answer 42

urine discoloration

Answer 43

hypotension, anxiety, dysrhythmia, peptic ulcer, hepatitis, hyperuricemia, hyperglycemia, flushing

Answer 44

paresthesia, flushing, lethargy

Answer 45

itching, diarrhea, fever, vascular thrombosis, optic nerve atrophy, flushing

Answer 46

abdominal cramping, renal stones

Answer 47

renal insufficiency, nephrolithasis, impaired iron absorption

Answer 48

dental and skeletal fluorosis, osteosclerosis

Answer 49

GI, organ damage

Answer 50

n/v/d, hepatic failure, hemolytic anemia, mental deterioration

Answer 51

gastritis, sweating, respiratory distress, pulmonary fibrosis

Answer 52

small amount of research, misses and harm can result due to increasing public use and inadequate communication

Answer 53

immune modulation: increased phagocytosis, monocytes, neutrophils and NK cells anti-inflammatory: inhibits COX, 5-lipoxygenease and hyaluronidase, eczema benefit antibacterial, fungal and antioxidant effects

Answer 54

unpleasant taste, GI upset, allergy

Answer 55

CV and metabolic: inhibits HMG-CoA reductase, reduces cholesterol and LDL antimicrobial antineoplastic: inhibits precarcinogens for colon, esophagus, lung, breast and stomach possible systolic and diastolic reduction

Answer 56

nausea, hypotension, allergy, odor, bleeding

Answer 57

warfarin, aspirin, ibuprofen

Answer 58

compromised immune system, AI disorders, immunosuppresants

Answer 59

CV: increased blood flow, reduces blood viscosity, vasodilation CNS: cognition and ADL improvement with dementia and negative affects in schizophrenia

Answer 60

nausea, headache, stomach upset, diarrhea, allergy, anxiety, insomnia

Answer 61

antiplatelets, anticoagulants, seizure disroders

Answer 62

cold prevention, lower postprandial glucose, cancer related fatigue

Answer 63

psych patiens, estrogen or hypoglycemic medication, warfarin

Answer 64

antidepressant

Answer 65

photosensitivity

Answer 66

stimulants, decreases effective of: digoxin, OC, cyclosporine, HIV meds, warfarin, anticonvulsants

Answer 67

BPH: blocks conversion of testosterone to dihydrotestosteeon by 5 alpha reductase

Answer 68

abdominal pain, n/d, headache, fatigue, decreased libido, rhinitis

Answer 69

HTN, CAD, chronic stable angina, prevention of statin induced myopathy, HF

Answer 70

knee osteoarthritis used to produce glycosaminoglycans and proteoglycans in articular cartilage

Answer 71

mild diarrhea, abdominal cramping, nausea

Answer 72

shellfish allergy, increases INR in warfarin

Answer 73

insomnia, sleep induction, jet lag, can reduce anxiety

Answer 74

drowsiness, fatigue, headache, irritability, depression, dysphoria, BP changes

Answer 75

NSAIDs, antidepressants, BB

Answer 76

ephedra or Ma huang

Answer 77

statin activity

Answer 78

symptoms are treated with a very dilute substance that would cause the same symptoms if given at a high dose, little to no active ingredient

Answer 79

any method of feeding that uses GI tract

Answer 80

delivery of calories and nutrients through vein

Answer 81

Maintains normal metabolic pathways Allows delivery of a full range of nutrients Triggers the release of cholecystokinin Preserves hepatic lipid metabolism Maintain normal intestinal pH and flora Supports GI tract as an organ of the immune system Promotes wound healing Lowers cost Reduces infectious complications

Answer 82

Poor oral intake: will not eat Anorexia, depression, disability, eating disorder, early satiety, nausea, painful swallowing Unsafe oral intake: can’t eat Altered LOC, dysphagia, ET intubation, gastroparesis, impaired sucking swallowing, proximal intestinal obstruction Elevated needs: can’t eat enough Burns, open wounds, pressure ulcers, sepsis, trauma

Answer 83

Anyone who cannot and will not eat or cannot maintain their fluid and/or nutritional status by oral eating or by tube feeding may be appropriate for IV nutrition Conditions that impair nutrient absorption: Short bowel syndrome, enterocutaneous fistula, infectious colitis, radiation, chemotherapy effects, small bowel obstruction Need for bowel rest: IBD, ischemic bowel, severe pancreatitis, chylous fistula, preoperative status, NPO Motility disorders: Prolonged ileus, scleroderma, pseudo-obstruction visceral organ myopathy Inability to achieve or maintain enteral access: Unstable clinical condition, hyperemesis gravidarum, eating disorder

Answer 84

mild to moderately stressed patient who is expected to have adequate GI function in 10-14 days, requires no fluid restriction, cannot require nutrients in large amounts

Answer 85

preferred, for those who need nutrition 14+ days

Answer 86

unstable patients with unstable fluid balance or glucose homeostasis

Answer 87

Generally given over 12-18 hours per day Useful for hospitalized patients with limited venous access and infusion in interrupted by administration of other medications May minimize incidence or reverse liver injury that can occur with continuous infusion If patient receiving PN at home, allows a more “normal” lifestyle

Answer 88

25.0-26.9: diet, exercise, behavioral therapy 27.0-29.9: diet, exercise, behavioral therapy and pharmacotherapy with comorbidities 30.0-34.9 (class 1): diet, exercise, behavioral therapy, pharmacotherapy and lap band surgery with comorbidities 35.0-39.9 (class 2): diet, exercise, behavioral therapy, pharmacotherapy, surgery with comorbidities >40 (class 3): diet, exercise, behavioral therapy, pharmacotherapy, surgery

Answer 89

Correlates with high levels of intra-abdominal or visceral fat Can be approximated by measuring waist circumference: Measured at narrowest point between last rib and top of iliac crest High risk >40 inches in men >35 inches in women

Answer 90

selective glucagon-like peptide-1 receptor agonist that increases glucose dependent insulin secretion, decreases inappropriate glucagon secretion, slows gastric emptying, also acts in the areas of the brain involved in regulation of appetite and caloric intake

Answer 91

Nausea, hypoglycemia, diarrhea, constipation, vomiting, headache, decreased appetite, dyspepsia, fatigue, dizziness, abdominal pain, increased lipase Black box: causes dose-dependent and treatment duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice, human effect is unknown Serious Hypoglycemia Heart Rate Increase SI Renal impairment

Answer 92

Personal or family history of medullary thyroid carcinoma or MEN 2 Pregnancy

Answer 93

Abdominal pain, nausea, diarrhea, constipation, vomiting, decreased appetite Black box: causes dose-dependent and treatment duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice, human effect is unknown Cardiovascular effects: Increased resting heart rate has been observed in placebo-controlled trials. Gallbladder disease: Use of GLP-1 agonists may increase risk of gallbladder and bile duct disease. Cholelithiasis has been reported in patients treated with semaglutide; substantial or rapid weight loss may increase risk. pancreatitis, psychiatric, renal

Answer 94

Personal or family history of medullary thyroid carcinoma or MEN 2

Answer 95

reversibly inhibits gastric and pancreatic lipases, inhibits absorption of dietary fats by 30%

Answer 96

Most common: Oily rectal leakage Flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, increased defecation, and fecal incontinence

Answer 97

Chronic malabsorption syndrome Cholestasis Pregnancy

Answer 98

nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth and diarrhea. HTN, tachycardia, hepatotoxicity, acute angle closure glaucoma

Answer 99

Uncontrolled hypertension. Seizure disorders, anorexia nervosa or bulimia, or undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Use of other bupropion-containing products. Chronic opioid use. During or within 14 days of taking monoamine oxidase inhibitors (MAOI). Pregnancy

Answer 100

educes appetite most likely due to CNS effect

Answer 101

Insomnia, increased heart rate, dry mouth, taste alteration, dizziness, tremors, headache, diarrhea, constipation, vomiting, gastrointestinal distress, anxiety, and restlessness Primary pulmonary hypertension has been reported in use of phentermine with fenfluramine, development of tolerance, effects ability to engage in hazardous tasks, safety with serotonergic agents such as SSRIs has not been established Indicated as short-term monotherapy

Answer 102

Pregnancy History of cardiovascular disease or stroke Use of MAO inhibitors Hyperthyroidism Glaucoma Agitated states Uncontrolled hypertension History of drug abuse Seizures

Answer 103

long term use Option for males and post-menopausal females without uncontrolled HTN or CAD Use in caution in females with childbearing potential due to risk of fetal malformations

Answer 104

paresthesia, dizziness, dysgeusia, insomnia, constipation, and dry mouth. Fetal Toxicity: Females of reproductive potential must obtain a negative pregnancy test before treatment and monthly thereafter; use effective contraception. (REMS program). Increase in Heart Rate: Monitor heart rate in all patients, especially in cardiac or cerebrovascular disease. Suicidal Behavior and Ideation: Monitor for depression or suicidal thoughts. Discontinue if develop. Mood and Sleep Disorders: Consider dose reduction or d/c for clinically significant or persistent symptoms. Cognitive Impairment: May cause disturbances in attention or memory. Caution patients about operating automobiles or hazardous machinery when starting treatment. Metabolic Acidosis: Measure electrolytes before/during treatment. Elevated Creatinine

Answer 105

Glaucoma Hyperthyroidism During or within 14 days of taking monoamine oxidase inhibitors Pregnancy

Answer 106

In non-diabetic patients: headache, dizziness, fatigue, nausea, dry mouth, and constipation. In diabetic patients, most common adverse reactions are hypoglycemia, headache, back pain, cough, and fatigue. Removed from market due to increased risk of cancer

Answer 107

Every 6 weeks for all patients Weight: if patient does not lose 4-5% of body weight after 12 weeks of therapy and max tolerated dose → taper and discontinue BP and HR Electrolytes with phentermine/topiramate Ask about adverse effects

Answer 108

Garcinia cambogia Widely marketed for weight loss Cases of acute hepatitis and acute liver failure resulting in need for liver transplant have been reported (thought to be associated with active ingredient, hydroxycitric acid) Supplements can also be contaminated with a hepatotoxic substance (sibutramine) Green Tea and Coffee Extract Activity is due to caffeine Chromium picolinate Side effects mostly CNS (headache, mood changes) Use with caution in renal and hepatic impairment, diabetes

Answer 109

Dronabinol Antiemetic, appetite stimulant, cannabinoid Side effects of CNS effects, euphoria, tachycardia Risk of substance abuse Megestrol Progestin hormone Similar side effects to corticosteroids Adrenal suppression, cushing syndrome, diabetes, thromboembolism Cyproheptadine Used off label for decreased appetite secondary to chronic disease First generation H1 antagonist MOA: potent antihistamine and serotonin antagonist with anticholinergic effects, competes with histamine for H1 receptor sites on effector cells in the GI tract, blood vessels and respiratory tract Contraindicated in: newborns and infants, breastfeeding mothers, elderly, concurrent MAOI use, angle closure glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, bladder neck obstruction pyloroduodenal obstruction

Answer 110

Megestrol Dronabinol: well studies but has significant CNS side effects Mirtazapine: antidepressant Ghrelin mimetics: growth hormone secretagogues: new, not well studied Treat depression if present Treat and manage dementia if present

Answer 111

MOA: incorporated into viral DNA causing chain termination Entecavir, tenofovir disoproxil, tenofovir alafenamide Drugs with a high barrier to resistance are preferred to ones with low barrier Also have some activity against HIV Generally, well tolerated with some fatigue, elevated CPK and GI disturbances Limitations Lamivudine: HBV resistance to drug is high Adefovir: less effective Entecavir Effective against HBV strains that are resistant to other drugs Once daily dosing Dose adjustment with renal dysfunction Should not be used with other renal toxic medications Tenofovir Tenofovir alafenamide → only indicated for HBV Tenofovir disoproxil fumarate → indicated for HBV and HIV

Answer 112

IFN-alfa and pegylated-IFN-alfa Flu like symptoms, fatigue, depression Dose limiting toxicity Bone marrow suppression, severe fatigue, weight loss, neurotoxicity (somnolence and behavioral disturbances), AI disorders, cardiovascular problems 48 week treatment duration

Answer 113

Direct acting anti-HCV agents (DAAs) NS3/4A protease inhibitors: -previr NS5A inhibitors: -asvir NS5B polymerase inhibitors: -buvir

Answer 114

Resolution of acute complications Tamponade of bleeding and resolution of hemodynamic instability for an episode of acute variceal hemorrhage Prevention of complications through lowering of portal pressure with medical therapy and/or supporting abstinence from alcohol

Answer 115

Primary prophylaxis is to prevent first bleeding episode Screen for varices upon diagnosis Use nonselective beta adrenergic blocker therapy: propranolol, nadolol or carvedilol MOA: decrease portal pressure by decreasing cardiac output and decreasing splanchnic blood flow Continue indefinitely Monitor for contraindications that may develop → renal impairment or hypotension Carvedilol is believed to be better tolerate than the pure nonselective beta adrenergic blockers Beta adrenergic blocker therapy is not indicated if varices are not present Endoscopic vein ligation is an alternative

Answer 116

Specific interventions to control the acute hemorrhage and prevent complications Initial treatment goals Adequate resuscitate blood volume Protect the airway from blood aspiration Prophylaxis against spontaneous bacterial peritonitis (SBP) and other infections Control bleeding Prevent rebleeding Preservation of liver function of HE Acute kidney injury prevention Start octreotide (antidiarrheal, somatostatin analog) Start early to control bleeding and facilitate endoscopy Initiate prophylactic antibiotics to prevent spontaneous bacterial peritonitis (SBP) in ALL patients upon admission For patients with cirrhosis + acute variceal bleeding, Ceftriaxone IV recommended and preferred due to high quinolone resistance Other option: ciprofloxacin (oral) Can also administer erythromycin IV before endoscopy Accelerates gastric emptying of clots and improves visibility during endoscopy Patients with advanced disease are more likely to fail octreotide and endoscopic variceal ligation (EVL) and need a transjugular intrahepatic portosystemic shunt (TIPS)

Answer 117

Alcohol abstinence Sodium restriction Diuretics Spironolactone and furosemide or spironolactone alone Stop diuretics if Uncontrolled or recurrent encephalopathy Severe hyponatremia despite fluid restriction Renal insufficiency If tense ascites is present, perform paracentesis before diuretics and salt restriction Consider liver transplant with refractory ascites

Answer 118

If documented or suspected SBP, Abx need to cover Escherichia coli, Klebsiella pneumoniae, and pneumococci. Drug of choice- Cefotaxime, IV (or similar 3rd generation cephalosporin) x 5 days Alternatives for community-acquired SBP: ceftriaxone or piperacillin/tazobactam After recovery, patients should be on long-term, daily, oral antibiotic prophylaxis with ciprofloxacin

Answer 119

Lactulose (lactitol)- can be administered orally or by retention enema Encourages passage of ammonia in the stool Polyethylene glycol- also effective for acute HE Antibiotics Rifaximin- when added to lactulose, is superior for recurrent HE Zinc Patients with HE are frequently deficient in zinc Supplementation not recommended in absence of deficiency Zinc can inhibit copper absorption which can lead to anemia Flumazenil- used for short-term therapy in refractory HE with suspected or confirmed benzodiazepine intake

Answer 120

simethicone, alpha-galactosidase, lactase replacement

Answer 121

Indicated for flatulence MOA: defoaming agent: reduces surface tension of gas bubbled embedded in mucus in GI tract, as surface tension changes, gas bubbles are broken No systemic absorption Is often combined with antacids

Answer 122

Indicated for flatulence MOA: hydrolyzes oligosaccharides into smaller parts to be metabolized by intestinal bacteria Enzyme is derived from aspergillus fungus Used for treatment of intestinal gas produced by high fiber diets or foods containing oligosaccharides such as legumes and cruciferous vegetables Must be taken before or within initial bite of food Caution in DM patients Avoid with mold allergy

Answer 123

MOA: lactase enzymes break down lactose, a disaccharide, into monosaccharides glucose and galactose Aids in dairy digestion

Answer 124

Intestinal gas symptoms that persist for more than several months or occur more often than occasionally (several times a month) Severe, debilitating symptoms Sudden change in location of abdominal pain, increase in the frequency of symptoms, or onset of symptoms in patients >40 years of age Symptoms + significant abdominal discomfort or sudden change in bowel function Symptoms + severe persistent diarrhea or constipation, GI bleeding, fatigue, unintentional weight loss, or frequent nocturnal symptoms

Answer 125

Have metabolic activity Bind to specific intracellular cytoplasmic receptors in target tissues which are widely distributed throughout the body Dexamethasone, prednisone, fluticasone, betamethasone, methylprednisolone, prednisolone, triamcinolone

Answer 126

Have electrolyte regulating activity Receptors are confined mainly to excretory organs, such as kidney, colon, salivary glands and sweat glands Fludrocortisone, aldosterone

Answer 127

Bind to receptor Receptors dimerize or pair up Receptor-hormone complex recruits coactivator (or corepressor) proteins Until translocates into nucleus Attaches to gene promoter elements Can serve as a transcription factor to turn genes on (when complexed with coactivators) or off (when complexes with corepressors) depending on tissue Because of this mechanism, some effects of corticosteroids take hours to days to occur

Answer 128

Principle human glucocorticoid Peaks in AM then declines → secondary smaller peak in late afternoon (diurnal production) Stress and levels of circulating steroid influence secretion

Answer 129

Receptors are spread throughout the body Adverse effects can occur throughout the body Stimulate gluconeogenesis and catabolism of proteins Facilitate glucose production and breakdown of proteins into amino acids Physiologic effect Increase in liver glycogen levels Increase in fasting blood glucose levels Increase in urinary nitrogen output

Answer 130

Promote normal intermediary metabolism Increase resistance to stress Alter blood cell levels in plasma Possess anti-inflammatory action Affect other systems

Answer 131

Relief of inflammatory symptoms Treatment of asthma and allergies Acceleration of lung maturation Replacement therapy for primary adrenal insufficiency Replacement therapy for secondary or tertiary adrenal insufficiency Diagnosis of cushing syndrome Replacement therapy for congenital adrenal hyperplasia

Answer 132

Minimally absorbed when applied to normal skin Long term occlusion with an impermeable film → enhances penetration Penetration caries based on region of the body Penetration increased several fold in inflame skin and in severe exfoliative diseases Comes in various different preparations which can alter potency Grade 1-7: super high potency to least potent Least potent: hydrocortisone base and hydrocortisone acetate Triamcinolone is commonly prescribe in the primary care setting Lowest potency hydrocortisone is available OTC

Answer 133

All absorbable formulation have a risk of suppressing the HPA axis Can lead to a severely impaired stress response Prolonged use in large quantities → iatrogenic cushing syndrome Local effects Atrophy of skin Hypopigmentation Corticoid rosacea Perioral dermatitis Steroid acne Hypertrichosis Increased intraocular pressure Allergic contact dermatitis

Answer 134

Triamcinolone acetonide or kenalog IM or intra-articular use Indications Acute gout flare Inflammatory ot allergic condition Acute MS exacerbation Rheumatic condition Can also be used for intralesional injections into dermatoses

Answer 135

Beneficial in treatment of allergic rhinitis, drug, serum or transfusion reactions Fluticason is inhaled into the respiratory tract from an MDI for treatment of allergic rhinitis and asthma

Answer 136

ICS are recommended for daily use in all patients with asthma except those with intermittent asthma ICS are indicates for group E COPD patients on GOLD criteria Should be combined with LAMA and LABA Oral glucocorticoid therapy has shown benefit in treating COPD exacerbations

Answer 137

Fetal cortisol is a regulator of lung maturation Betamethasone or dexamethasone IM to mother within 48 hours prior to premature delivery → accelerate lung maturation in fetus to prevent respiratory distress syndrome

Answer 138

Significantly reduces inflammation associated with RA Inflammatory skin conditions including redness, swelling, heat and tenderness Agents that are important for symptom control in Persistent asthma Exacerbation of asthma Exacerbations in IBD Intra Articular corticosteroids may be used for treatment of an osteoarthritis flare Corticosteroids are not curative in these disorders

Answer 139

Short term of oral glucocorticoids lasting <2 weeks Used for asthma or COPD exacerbations, inflammatory pain

Answer 140

Help control fluid status and concentration of electrolytes, especially with sodium and potassium Increase rate of sodium, bicarbonate and water resorption Increase rate of potassium excretion Can help maintain normal sodium and potassium concentration in serum Aldosterone acts on mineralocorticoid receptors in the distal tubules and collecting ducts in the kidney, causing reabsorption of Na+, HCO3- and H2O. Aldosterone decreases reabsorption of K+, which, with H+, is lost in the urine. Enhancement of Na+ reabsorption by aldosterone also occurs in gastrointestinal mucosa and in sweat and salivary glands. Elevated aldosterone levels may cause alkalosis and hypokalemia, retention of sodium and water, and increased blood volume and blood pressure. Hyperaldosteronism is treated with spironolactone

Answer 141

Fetal liver cannot convert it to active compound → prednisolone, any prednisolone made by mother is converted back to prednisone by placenta enzyme

Answer 142

Osteoporosis is the MC adverse effect with long term use Glucocorticoids suppress intestinal calcium absorption, inhibit bone formation and decrease synthesis of sex hormones Patients should take vitamin D and calcium Bisphosphonates can be used to treat Can increase appetite → use in cancer patients (prednisone0 Hyperglycemia → DM Monitor blood glucose and adjust medication as needed Cushing like signs: Body fat redistribution, moon facies, hirsutism, increased appetite Cataract with long term use Topical therapy: Skin atrophy, Ecchymosis, Purple striae

Answer 143

If the HPA axis is suppressed, sudden discontinuation can have serious consequences including death. Abrupt discontinuation of the corticosteroids àacute adrenal insufficiency that can be fatal Risk of acute adrenal insufficiency + possibility that corticosteroid withdrawal could exacerbate the disease à dose must be tapered SLOWLY according to individual tolerance. Patient must be monitored carefully.

Answer 144

used for <3 weeks