Pharm test 2

Question 1

somatostatin analogs

Answer 1

inhibit release of GH, glucagon, insulin and gastrin

Question 2

Octreotide (Sandostatin)

Answer 2

a long acting somatostatin analog- inhibits release of GH, glucagon, insulin, and gastrin

Question 3

Bromocriptine (Parlodel)

Answer 3

dompamine D2 receptor agonists- effective at inhibiting prolactin release (more than GH) but high does have some efficacy in small GH secreting Tumors
(use: agromegaly, hypeprolactinemia)

Question 4

Dopamine

Answer 4

physiologic inhibitor of prolactin release

Question 5

thyroid hypofunction

Answer 5

(trh HIGH) tsh HIGH, t3-t4 LOW

Question 6

pituitary hypofunction

Answer 6

(trh HIGH) tsh LOW

T3-T4 LOW

Question 7

Thyroid hyperfunction

Answer 7

(trh low) TSH low, t3-t4 HIGH

Question 8

Pituitary hyperfunction

Answer 8

(trh low) tsh HIGH

t3-t4 HIGH

Question 9

Levothyroxine

and adverse effects

Answer 9

synthetic T4 thyroid replacement

AE: nervousness, heat intolerance, palpitation/ tachycardia, weight loss

Question 10

131 I (radio active iodine)

Answer 10

treat thyrotoxicosis
rapidly absorbed, concentrated in the thyroid, and incorporated into storage follicles
crosses the placenta and excreted in breat milk (contraindicated)

Question 11

Methimazole (Tapazole)

Answer 11

thioamide- antithyroid agent

Question 12

Propylthiouracil

• mechanism
• adverse effects

Answer 12

Thioamide- also inhibits conversion of T4–>T3 so brings level down faster
Mechanism: inhibit thyroid peroxidase- catalyzed reactions and blocking iodine organification (prevents binding of iodine to tyrosine)
AE: rash, SEVER HEPATITIS (PTU), Agranulocytosis (infrequent but potentially fatal)

Question 13

Potassium Iodine

SSKI- super saturated KI

Answer 13

mechanism: block release of t4/t3 and inhibit Iodine from being used in new hormone synthesis
- given a week after RAI, normalizes thyroid function earlier than RAI alone
- given to protect thyroid from radioactive iodine fallout (uptake of RAI is inversely proportional to serum concentration of stable iodine

cross placenta—fetal goiter

Question 14

Beta Blockers

Answer 14

useful in controlling tachycardia and other cardiac abnormalities of severe thyrotoxicosis

Question 15

Propranolo

Answer 15

beta blocker- inhibits peripheral conversion of t4 to t3

Question 16

Aspirin & NSAIDs

Answer 16

decrease protein binding (ass. with displacement of thyroid hormone from TBG)

cause increase in free thyroid hormone

Question 17

old people’s heart is very sensitive to levels of circulating ______?

Answer 17

thyroxine- becareful when treating long standing hypothyroidism with cardiac issues

Question 18

Hypothyroid in pregnancy

Answer 18

early fetal brain development depends on maternal thyroxine

-May have to increase in dose to normalize TSH levels

Question 19

most patients with primary hyperparathyroidism also have _______________?

Answer 19

hypercalcemia

Question 20

estrogen replacement

risk

Answer 20

breast cancer, stroke, and heart attack

Question 21

BisphosphoNATES

Answer 21

use is osteoporosis, hypercalcemia, hyper-parathyroidism

inhibits bone reabsorption by suppressing osteoclast activity

Question 22

Calciminetic (cinacalcet)

Answer 22

treat hypercalcemia

allosterically increase the sensitivity of the Ca sensing receptor (CaSR) in the parathyroid gland to calcium

Question 23

calciminetic side effects

Answer 23

nausea vomiting

Question 24

secondary hyper-parathyroidism

Answer 24

usually caused by chronic renal failure
-PTH and decreased GFR increase proximal tubular reabsorption of phosphate

• formation of insoluble calcium phosphate
• reduces circulating free calcium, rather as insoluble calcium phosphate

Question 25

Treatment of Secondary hyper- parathyroidism

Answer 25

phosphate binders-
- non calcium containing
SEVELAMER CARBONATE

Question 26

phosphate binders actions and side effects

Answer 26

actions: bind to dietary phosphate, form insoluble complex, carry through bowel unabsorbed
SE: hypercalcemia (ca load plus unbinding of circulating Ca-Phoshate complexes)

Question 27

non calcium containing phosphate binders

Answer 27

sevelamer carbonate
seelamer hydrocholride
lanthanum carbonate

Question 28

Vit. D active

Answer 28

Calcitriol (d3)
most potent agent

-also can be a treatment for hypoparathyroidism

Question 29

vit D inactive

Answer 29

Cholecalciferol (vit d3)

ergocalciferol (vit d2)

Question 30

Calcium Carbonate (Caltrate)

Answer 30

40% ca

better absorption in acidic environment

Question 31

calcium citrate (Citracal)

Answer 31

21% calcium

better for patients taking acid reducing medications

Question 32

Sodium Fluoride

Answer 32

deposits in bone and teeth

makes bones hard but “brittle” fewer breaks but more shattering

Question 33

HMG CoA Reductase Inhibitors (statins)

• Atorvastatin
• Fluvastatin
• Lovastatin

Answer 33

ATP pReference: statins block early step in cholesterol synthesis

-improves endothelial function (non-lipid effect)

Question 34

do not drink what when taking statins

Answer 34

grapefruit juice! contains furanocoumarin (inhibit cyp 450)

Question 35

Bile acid sequestrants (aka Bile acid resins) 
"COLES" 
-cholestyramine
-colestipol
-colesevelam

Answer 35

reduce gastric reabsorption of cholesterol

-inhibit enterohepatic recirculation of bile acids leading and increased expression of LDL receptors

Question 36

what vitamin may be deficient with bile acid sequestrants

Answer 36

K

Question 37

nicotinic acid

• niacor
• niaspan
• nicobid
• nicolar
• slo-niacin

SE?

Answer 37

SE: high dose/ fast release promote flushing!
- sustained release preparations minimize flushing episodes, but have higher incidence of hepatic toxicities (monitor liver functions)

• trigger gout attacks
• now questionable if niacin really does much

Question 38

fibric acid derivatives (fibrates)

“FIBR”

Answer 38

increase LDL receptor expression
markedly reduce triglycerides
- drive uptake utilization, and catabolism of fatty acids

Question 39

Fibrates - side effects

Answer 39

Rhabdomyolysis

Question 40

Ezatimibe (Zetia) component of Vytorin

Answer 40

reduces LDL-C, but there is limited evidence on improvement in clinical outcomes
- not evidence it improves long term outcomes. has been combined with statins

Question 41

Fish Oil- omega 3

Answer 41

triglycerides exceed 500mg.dl