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Pharmacology > Pharm Quiz 5 > Flashcards

Pharm Quiz 5 Flashcards

1
Q

Normal serum level for Calcium

A

10 mg/dL

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2
Q

What interferes with Calcium absorption?

A

Glucocorticoids and foods with insoluble fiber

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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.

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4
Q

Calcitonin

A

Secreted by the thyroid gland and works in opposition to PTH and Ca.

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5
Q

What does hypercalcemia cause?

A

Kidney nephrolithiasis
Coma
Cardiac Dysrhythmias

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6
Q

What causes hypercalcemia?

A

Cancer
Hyperparathyroidism
*Thiazide Diuretics

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7
Q

What drugs are used for hypercalcemia?

A

IV Saline
Loop Diuretic
Edatate Disodium (Binds Ca)
Bisphosphonates

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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

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9
Q

What is osteomalacia caused by?

A

Lack of Vitamin D

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10
Q

Paget Disease

A

Pelvis, spine, femur, and tibia are replaced with abnormal bone.

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11
Q

What is the treatment for Paget Disease?

A

For severe cases bisphosphonate suppresses bone resorption

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12
Q

How much vitamin D should be supplemented?

A

10,000 IU/day

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13
Q

What is the most bioavailable Vit D?

A

D3 (Cholecalciferol)

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14
Q

Patient education for Vit D:

A

Do not chew tablets.
Take with Ca to increase response.

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15
Q

Cinacalcet

A

Decrease PTH for patients unable to have a parathyroidectomy or who have CKD.

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16
Q

Alendronate (Bisphosphonate)

A

Absorbed into bone for years and decreases the number and activity of osteoclasts to prevent resorption.

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17
Q

Zoledronic Acid

A

Bisphospenate that lasts for years

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18
Q

Estrogen

A

Reduces postmenopausal or hysterectomy bone fractures by 24%

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19
Q

Estrogen BB

A

Endometrial cancer and DVTs

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20
Q

Raloxifene/Tamoxifen

A

Selective Estrogen Receptor Modulators reduce chances of cancer in breast and endometrium as well as preventing bone resorption.

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21
Q

Raloxifene BB

A

DVT

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22
Q

Patient Education Raloxifene

A

Take with Ca and Vit D
Stop use before long periods of immobilization due to risk of DVT.

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23
Q

Teriparatide and Abaloparatide BB

A

Osteosarcoma so life time use must not exceed 2 hours

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24
Q

Teriparatide and Abaloparatide Patient Education

A

Weakness and lethargy can indicate hypercalcemia.
Dizziness or faintness is normal with first few doses.

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25
Q

Denosumab

A

Decreases amount and activity of osteoclasts.

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26
Q

Denosumab Patient Education

A

Decreases immune system
Causes osteonecrosis of the jaw

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27
Q

Where are the most common locations for osteoporosis fractures?

A

Hip, wrist, and spine

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28
Q

Osteopenia Diagnosis

A

-1-2.5 SD

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29
Q

Osteoporosis Diagnosis

A

-2.5 SD

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30
Q

What criteria does FRAX include?

A

H/W
Age
Previous fracture
Hip fracture in parent
Glucocorticoid use
Rheumatoid Arthritis
ETOH/Smoking
Hip BMD

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31
Q

Who should be treated for osteoporosis?

A

> 50 with:
Hip/vertebral fracture
-2.5 BMD
-1 BMD with a 10 year risk of a fracture

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32
Q

Drugs that prevent resorption

A

Estrogen
Raloxifene
Bisphosphenate
Calcitonin
Denosumab
(Work best if given at the start of osteoporosis)

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33
Q

Drug that promotes bone formation

A

Teriparatide

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34
Q

Drugs approved for osteoporosis in men:

A

Denosumab
Alendronate
Risedronate
Teriparatide
Zoledronic Acid

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35
Q

What type of diabetes causes DKA?

A

Type 1

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36
Q

What drugs for diabetes should be given to pregnant women?

A

Insulin or Metformin

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37
Q

What is required for the diagnosis of Diabetes?

A

Fasting glucose >126
Random glucose >200
A1C >6.5

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38
Q

What are people with prediabetes at risk for?

A

CVD

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39
Q

What medication should be given for managing dyslipidemia and HTN associated with diabetes?

A

ACE or ARB
Lisinopril or Losartan

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40
Q

Four Step approach to treating Diabetes:

A

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

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41
Q

How should the treatment regiment change for an A1C of >9%?

A

Dual therapy immediately

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42
Q

How should the treatment regiment change for an A1C of >10%?

A

Start injectable therapy immediately

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43
Q

Peak postmeal plasma glucose for healthy adults

A

<180

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44
Q

Basal Control

A

Long-acting combined with short-acting insulin

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45
Q

SNS control of insulin release

A

B: promotes secretion
A: inhibits secretion

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46
Q

Rapid-Acting insulins:

A

Insulin lispro
Insulin aspart
Insulin glulisine
Inhaled regular insulin

Onset 15 min
Peak 1 hour
Duration 3-5 hours

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47
Q

Short-Acting insulins:

A

Regular insulin
Onset 30 min
Peak 1-5 hour
Duration 10 hours

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48
Q

NPH (Humulin R, Novolin N)

A

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)

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49
Q

NPH Allergic Reaction

A

Because insulin is combined with a protein to increase absorption time, allergic reaction is possible.

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50
Q

Insulin Glargine

A

Lasts for up to 24 hours

51
Q

Insulin Detemir

A

Used as a basal insulin with control for 12-24 hours.

52
Q

When are insulin needs increased?

A

Obesity, infection, stress, growth spurt, and pregnancy after the first trimester.

53
Q

When are insulin needs decreased?

A

Exercise and first trimester pregnancy

54
Q

Who is most likely to experience hypoglycemia unawareness?

A

Patients with tight control. Loosen control to regain awareness.

55
Q

What drugs raise hyperglycemia?

A

Thiazide, SNS, Glucocorticoids

56
Q

Metformin MOA:

A

Inhibits liver glucose production
Inhibits absorption of glucose in the gut
Sensitizes glucose receptor in fat and muscle

57
Q

Metformin for PCOS effects?

A

Increases sensitivity
Decreases insulin levels
Lowers androgen levels

58
Q

Side effects of Metformin:

A

Decreases folic acid and Vit B
Contraindicated in patients with HF d/t lactic acidosis

59
Q

Metformin BB:

A

Lactic Acidosis

60
Q

Sulfonylurea MOA:

A

Stimulates release of insulin from pancreatic islets

61
Q

Sulfonylurea side effects:

A

Hypoglycemia
Weight gain

62
Q

Meglitinides (glinides)

A

Same as sulfonylureas but shorter duration and taken with each meal. They are much stronger.

63
Q

Pioglitazone

A

Reduces insulin resistance and glucose production in the liver

64
Q

Pioglitazone ADE:

A

URI, sinusitis, myalgia

65
Q

Pioglitazone BB

A

HF secondary to renal retention of water

66
Q

Acarbose

A

Delays absorption of dietary carbohydrates

67
Q

DPP-4 Inhibitors (Gliptins)

A

Enhance actions of incretin hormones and decrease A1C by .5%

68
Q

SGLT-2 Inhibitor

A

Block reabsorption of filtered glucose

69
Q

GLP-1 Agonists MOA

A

Slow gastric emptying, stimulate glucose-dependent release of insulin, inhibit postprandial release of glucagon, and suppress appetite.

70
Q

Amylin Mimetic

A

Pramlintide: Reduce postprandial levels of glucagon and slow gastric emptying

71
Q

Pramlintide BB

A

Hypoglycemia when combined with insulin.

72
Q

T3 Name

A

Liothyronine

73
Q

T4 Name

A

Levothyroxine

74
Q

What do thyroid hormones do?

A

Stimulate metabolism, stimulate growth, stimulate heart

75
Q

What is the active Thyroid hormone?

A

T4 converts to T3 which has the highest affinity.

76
Q

Thyroid Control

A

Hypothalamus (TRH) –>
Pituitary (TSH) –>
Thyroid (T3 and T4)

77
Q

Why is TSH measured?

A

Small changes in T3 and T4 levels will profoundly affect TSH levels.

78
Q

What causes hypothyroidism?

A

Hashimoto’s
Insufficient Iodine
Insufficient secretion of TSH and TRH

79
Q

Treatment for hypothyroidism:

A

Levothyroxine

80
Q

What does hypothyroidism during pregnancy cause?

A

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
Q

Hypothyroidism Tx in Infants

A

It must be initiated within in a few days or neurological and physical development will be delayed.

82
Q

Grave’s Disease S&S

A

Atrophied muscles
Increased appetite
Weight loss
Warm and moist skin
Exophthalmus

83
Q

Treatment for Grave’s disease in adults

A

Radiation is preferred but surgical removal is an option.

84
Q

Treatment for Grave’s disease in children:

A

Methimazole or Propylthiouracil

85
Q

Toxic Nodular Goiter

A

Results from a thyroid adenoma but does not cause exophthalmus

86
Q

How is thyrotoxic crisis initiated?

A

With major surgery or illness

87
Q

What are the S&S of a thyrotoxic crisis?

A

Temp >105
Tachycardia
Restlessness
Agitation
Tremor
Coma
Hypotension
HF

88
Q

What drugs decrease Levo absorption?

A

Histamine blockers
PPIs
Sucralfate
Fe
Mag

89
Q

How does Levo impact Warfarin?

A

Levo enhances Warfarin effects

90
Q

What drugs need to be increased with Levo?

A

Insulin and Digoxin

91
Q

Switching from different types of insulin:

A

Retest TSH after 6 weeks

92
Q

What is IV Levo used for?

A

Myxedema coma and for patients who cannot orally take Levo

93
Q

Thionamides

A

Methimazole and Propylthiouracil

94
Q

What thionamide is preferred?

A

Methimazole except for pregnant patients and those in thyrotoxic crisis.

95
Q

Thionamide MOA

A

Block synthesis of thyroid hormones

96
Q

What is Methimazole used for?

A

Graves disease
Adjunct until radiation therapy produces effects
Suppresses thyroid synthesis before surgery
Thyrotoxic crisis

97
Q

Radiation Iodine 131

A

Used to destroy thyroid tissue in patients without completely destroying thyroid gland.

98
Q

Advantages of radiation iodine?

A

Low cost
Spared risk of surgery
Death is extremely rare
No other tissue is damaged

99
Q

Problem with radiation iodine?

A

Hypothyroidism results in 90% of cases

100
Q

Nonradioactive iodine: Lugol Solution

A

Iodide decreases iodine uptake
Inhibit thyroid synthesis
Inhibit release of thyroid hormone
These effects do not last indefinitely.

101
Q

Administration of of Lugol Solution

A

Mix with juice to disguise taste. Give 10 drops every 8 hours for thyrotoxic crisis.

102
Q

OGTT Diabetes

A

> 200 after 2 hours

103
Q

How to diagnose Diabetes?

A

2 positive tests on different days

104
Q

What problems can change A1C?

A

Pregnancy
Liver/Kidney disease
Recent severe bleeding
Blood transfusion

105
Q

Hypoparathyroidism

A

Cause: Inadvertent removal during thyroid surgery
Tx: Ca and Vit D supplements

106
Q

Hyperparathyroidism

A

Cause: adenoma —>increased PTH and Ca
Tx: surgical resection

107
Q

DPP-4 Suffix

A

Gliptin

108
Q

SGLT-1 Suffix

A

Gliflozin

109
Q

GLP-1 Suffix

A

Glutide

110
Q

What medication should be avoided in patients with CKD?

A

Metformin

111
Q

Amylin Mimetic Suffix

A

Tide

112
Q

Sulfonylurea Suffix

A

Ide

113
Q

What insulin is usually used for basal coverage?

A

Glargine

114
Q

What insulin needs to be shaked to ensure uniform suspension of insulin crystals?

A

NPH

115
Q

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?

A

Dronates

116
Q

What medication does Gliflozin interfere with?

A

Phenobarbital

117
Q

What medication does Acarbose interfere with?

A

Acarbose and insulin or sulfonylurea can cause hypoglycemia

118
Q

When should Metformin be taken?

A

At night

119
Q

When should sulfonylureas be taken?

A

At breakfast

120
Q

What should be assessed upon diagnosis of DM?

A

Weight loss
CVD
Renal Failure

121
Q

Total T4
Free T4

A

4.5-12.5
.9-2

122
Q

Total T3
Free T3

A

80-220
230-620

123
Q

TSH Level

A

.3-6

Pharmacology (7 decks)

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