Pharm Quiz 5 Flashcards
1
Q
Normal serum level for Calcium
A
10 mg/dL
2
Q
What interferes with Calcium absorption?
A
Glucocorticoids and foods with insoluble fiber
3
Q
How does PTH control Ca levels?
A
Bone resorption
Prevents tubular reabsorption
Promotes activation of Vitamin D which increases absorption in the gut.
4
Q
Calcitonin
A
Secreted by the thyroid gland and works in opposition to PTH and Ca.
5
Q
What does hypercalcemia cause?
A
Kidney nephrolithiasis
Coma
Cardiac Dysrhythmias
6
Q
What causes hypercalcemia?
A
Cancer
Hyperparathyroidism
*Thiazide Diuretics
7
Q
What drugs are used for hypercalcemia?
A
IV Saline
Loop Diuretic
Edatate Disodium (Binds Ca)
Bisphosphonates
8
Q
Hypocalcemia
A
Causes: *CKD, Mag, Drugs used to manage osteoporosis Deficiency of Ca, Vit D, PTH
S&S: Neuromuscular excitability
Tx: Calcium gluconate
9
Q
What is osteomalacia caused by?
A
Lack of Vitamin D
10
Q
Paget Disease
A
Pelvis, spine, femur, and tibia are replaced with abnormal bone.
11
Q
What is the treatment for Paget Disease?
A
For severe cases bisphosphonate suppresses bone resorption
12
Q
How much vitamin D should be supplemented?
A
10,000 IU/day
13
Q
What is the most bioavailable Vit D?
A
D3 (Cholecalciferol)
14
Q
Patient education for Vit D:
A
Do not chew tablets.
Take with Ca to increase response.
15
Q
Cinacalcet
A
Decrease PTH for patients unable to have a parathyroidectomy or who have CKD.
16
Q
Alendronate (Bisphosphonate)
A
Absorbed into bone for years and decreases the number and activity of osteoclasts to prevent resorption.
17
Q
Zoledronic Acid
A
Bisphospenate that lasts for years
18
Q
Estrogen
A
Reduces postmenopausal or hysterectomy bone fractures by 24%
19
Q
Estrogen BB
A
Endometrial cancer and DVTs
20
Q
Raloxifene/Tamoxifen
A
Selective Estrogen Receptor Modulators reduce chances of cancer in breast and endometrium as well as preventing bone resorption.
21
Q
Raloxifene BB
A
DVT
22
Q
Patient Education Raloxifene
A
Take with Ca and Vit D
Stop use before long periods of immobilization due to risk of DVT.
23
Q
Teriparatide and Abaloparatide BB
A
Osteosarcoma so life time use must not exceed 2 hours
24
Q
Teriparatide and Abaloparatide Patient Education
A
Weakness and lethargy can indicate hypercalcemia.
Dizziness or faintness is normal with first few doses.
25
Denosumab
Decreases amount and activity of osteoclasts.
26
Denosumab Patient Education
Decreases immune system
Causes osteonecrosis of the jaw
27
Where are the most common locations for osteoporosis fractures?
Hip, wrist, and spine
28
Osteopenia Diagnosis
-1-2.5 SD
29
Osteoporosis Diagnosis
-2.5 SD
30
What criteria does FRAX include?
H/W
Age
Previous fracture
Hip fracture in parent
Glucocorticoid use
Rheumatoid Arthritis
ETOH/Smoking
Hip BMD
31
Who should be treated for osteoporosis?
>50 with:
Hip/vertebral fracture
-2.5 BMD
-1 BMD with a 10 year risk of a fracture
32
Drugs that prevent resorption
Estrogen
Raloxifene
Bisphosphenate
Calcitonin
Denosumab
(Work best if given at the start of osteoporosis)
33
Drug that promotes bone formation
Teriparatide
34
Drugs approved for osteoporosis in men:
Denosumab
Alendronate
Risedronate
Teriparatide
Zoledronic Acid
35
What type of diabetes causes DKA?
Type 1
36
What drugs for diabetes should be given to pregnant women?
Insulin or Metformin
37
What is required for the diagnosis of Diabetes?
Fasting glucose >126
Random glucose >200
A1C >6.5
38
What are people with prediabetes at risk for?
CVD
39
What medication should be given for managing dyslipidemia and HTN associated with diabetes?
ACE or ARB
Lisinopril or Losartan
40
Four Step approach to treating Diabetes:
1: Lifestyle modifications with Metformin
2: Metformin and Thiazolidinedione or DPP-4 inhibitor, SGLT-2 inhibitor. Sulfonylurea or basal insulin should be added if the original drugs do not achieve control.
3: Three-drug combination
4: Basal insulin, insulin, GLP-1
41
How should the treatment regiment change for an A1C of >9%?
Dual therapy immediately
42
How should the treatment regiment change for an A1C of >10%?
Start injectable therapy immediately
43
Peak postmeal plasma glucose for healthy adults
<180
44
Basal Control
Long-acting combined with short-acting insulin
45
SNS control of insulin release
B: promotes secretion
A: inhibits secretion
46
Rapid-Acting insulins:
Insulin lispro
Insulin aspart
Insulin glulisine
Inhaled regular insulin
Onset 15 min
Peak 1 hour
Duration 3-5 hours
47
Short-Acting insulins:
Regular insulin
Onset 30 min
Peak 1-5 hour
Duration 10 hours
48
NPH (Humulin R, Novolin N)
Injected 2-3x/day to provide ample control through the night.
The only long-acting insulin that can be combined with short-acting insulins.
(Draw up short-acting first)
49
NPH Allergic Reaction
Because insulin is combined with a protein to increase absorption time, allergic reaction is possible.
50
Insulin Glargine
Lasts for up to 24 hours
51
Insulin Detemir
Used as a basal insulin with control for 12-24 hours.
52
When are insulin needs increased?
Obesity, infection, stress, growth spurt, and pregnancy after the first trimester.
53
When are insulin needs decreased?
Exercise and first trimester pregnancy
54
Who is most likely to experience hypoglycemia unawareness?
Patients with tight control. Loosen control to regain awareness.
55
What drugs raise hyperglycemia?
Thiazide, SNS, Glucocorticoids
56
Metformin MOA:
Inhibits liver glucose production
Inhibits absorption of glucose in the gut
Sensitizes glucose receptor in fat and muscle
57
Metformin for PCOS effects?
Increases sensitivity
Decreases insulin levels
Lowers androgen levels
58
Side effects of Metformin:
Decreases folic acid and Vit B
Contraindicated in patients with HF d/t lactic acidosis
59
Metformin BB:
Lactic Acidosis
60
Sulfonylurea MOA:
Stimulates release of insulin from pancreatic islets
61
Sulfonylurea side effects:
Hypoglycemia
Weight gain
62
Meglitinides (glinides)
Same as sulfonylureas but shorter duration and taken with each meal. They are much stronger.
63
Pioglitazone
Reduces insulin resistance and glucose production in the liver
64
Pioglitazone ADE:
URI, sinusitis, myalgia
65
Pioglitazone BB
HF secondary to renal retention of water
66
Acarbose
Delays absorption of dietary carbohydrates
67
DPP-4 Inhibitors (Gliptins)
Enhance actions of incretin hormones and decrease A1C by .5%
68
SGLT-2 Inhibitor
Block reabsorption of filtered glucose
69
GLP-1 Agonists MOA
Slow gastric emptying, stimulate glucose-dependent release of insulin, inhibit postprandial release of glucagon, and suppress appetite.
70
Amylin Mimetic
Pramlintide: Reduce postprandial levels of glucagon and slow gastric emptying
71
Pramlintide BB
Hypoglycemia when combined with insulin.
72
T3 Name
Liothyronine
73
T4 Name
Levothyroxine
74
What do thyroid hormones do?
Stimulate metabolism, stimulate growth, stimulate heart
75
What is the active Thyroid hormone?
T4 converts to T3 which has the highest affinity.
76
Thyroid Control
Hypothalamus (TRH) -->
Pituitary (TSH) -->
Thyroid (T3 and T4)
77
Why is TSH measured?
Small changes in T3 and T4 levels will profoundly affect TSH levels.
78
What causes hypothyroidism?
Hashimoto's
Insufficient Iodine
Insufficient secretion of TSH and TRH
79
Treatment for hypothyroidism:
Levothyroxine
80
What does hypothyroidism during pregnancy cause?
Decrease IQ and other neuropsychological effects
Test for hypothyroidism once pregnant.
Women with hypothyroidism who become pregnant may need to increase Levo by 50%.
81
Hypothyroidism Tx in Infants
It must be initiated within in a few days or neurological and physical development will be delayed.
82
Grave's Disease S&S
Atrophied muscles
Increased appetite
Weight loss
Warm and moist skin
Exophthalmus
83
Treatment for Grave's disease in adults
Radiation is preferred but surgical removal is an option.
84
Treatment for Grave's disease in children:
Methimazole or Propylthiouracil
85
Toxic Nodular Goiter
Results from a thyroid adenoma but does not cause exophthalmus
86
How is thyrotoxic crisis initiated?
With major surgery or illness
87
What are the S&S of a thyrotoxic crisis?
Temp >105
Tachycardia
Restlessness
Agitation
Tremor
Coma
Hypotension
HF
88
What drugs decrease Levo absorption?
Histamine blockers
PPIs
Sucralfate
Fe
Mag
89
How does Levo impact Warfarin?
Levo enhances Warfarin effects
90
What drugs need to be increased with Levo?
Insulin and Digoxin
91
Switching from different types of insulin:
Retest TSH after 6 weeks
92
What is IV Levo used for?
Myxedema coma and for patients who cannot orally take Levo
93
Thionamides
Methimazole and Propylthiouracil
94
What thionamide is preferred?
Methimazole except for pregnant patients and those in thyrotoxic crisis.
95
Thionamide MOA
Block synthesis of thyroid hormones
96
What is Methimazole used for?
Graves disease
Adjunct until radiation therapy produces effects
Suppresses thyroid synthesis before surgery
Thyrotoxic crisis
97
Radiation Iodine 131
Used to destroy thyroid tissue in patients without completely destroying thyroid gland.
98
Advantages of radiation iodine?
Low cost
Spared risk of surgery
Death is extremely rare
No other tissue is damaged
99
Problem with radiation iodine?
Hypothyroidism results in 90% of cases
100
Nonradioactive iodine: Lugol Solution
Iodide decreases iodine uptake
Inhibit thyroid synthesis
Inhibit release of thyroid hormone
These effects do not last indefinitely.
101
Administration of of Lugol Solution
Mix with juice to disguise taste. Give 10 drops every 8 hours for thyrotoxic crisis.
102
OGTT Diabetes
>200 after 2 hours
103
How to diagnose Diabetes?
2 positive tests on different days
104
What problems can change A1C?
Pregnancy
Liver/Kidney disease
Recent severe bleeding
Blood transfusion
105
Hypoparathyroidism
Cause: Inadvertent removal during thyroid surgery
Tx: Ca and Vit D supplements
106
Hyperparathyroidism
Cause: adenoma —>increased PTH and Ca
Tx: surgical resection
107
DPP-4 Suffix
Gliptin
108
SGLT-1 Suffix
Gliflozin
109
GLP-1 Suffix
Glutide
110
What medication should be avoided in patients with CKD?
Metformin
111
Amylin Mimetic Suffix
Tide
112
Sulfonylurea Suffix
Ide
113
What insulin is usually used for basal coverage?
Glargine
114
What insulin needs to be shaked to ensure uniform suspension of insulin crystals?
NPH
115
Which osteoporosis medication should be taken on an empty stomach with a full glass of water, and the patient should remain upright for at least 30 minutes after taking it?
Dronates
116
What medication does Gliflozin interfere with?
Phenobarbital
117
What medication does Acarbose interfere with?
Acarbose and insulin or sulfonylurea can cause hypoglycemia
118
When should Metformin be taken?
At night
119
When should sulfonylureas be taken?
At breakfast
120
What should be assessed upon diagnosis of DM?
Weight loss
CVD
Renal Failure
121
Total T4
Free T4
4.5-12.5
.9-2
122
Total T3
Free T3
80-220
230-620
123
TSH Level
.3-6
