Pharmacology Test 3 Flashcards
Cause of hypopituitarism
deficiency in any hormones
Anterior Pituitary hypopituitarism
deficiency in GH = dwarfism
Tx for dwarfism
replace GH with synthetic form somatropin
MOA of somatropin
increase bone, skeletal and organ growth, RBC mass, transport of water, electrolytes and fluid
AE of somatropin
- fluid retention/edema 2. muscle and joint pain
Posterior pituitary hypopituitarism
decreased ADH = Diabetes Insipidus
what is ADH also called?
Vasopressin
What does ADH normally do?
decrease water excretion by increasing urine concentration
Tx of Diabetes Insipidus
Desmopressin (DDAVP)
what is desmopressin?
synthetic form of Vasopressin (ADH)
administration route for Desmopressin?
1). subcut. 2). PO 3). intranasal
MOA of desmopressin
increase water reabsorption @ kidney by increasing aquaporin 2 channel permeability
other indications for Desmopressin?
nocturia
Desmopressin AE
1). dry mouth 2). hyponatremia
What hormones does the Anterior Pituitary normally secrete?
1). GH 2). LH and FSH 3). TSH 4). ACTH 5). Pr
What hormones do the posterior pituitary normally secrete?
1). oxytocin 2). ADH
Hyperpituitarism
excessive production of hormones from pituitary (typically anterior)
Hyperpituitarism results in which disease(s)?
1). Gigantism 2). Acromegaly
T/F: Gigantism occurs in children not adults
TRUE
what is gigantism in adults called?
Acromegaly
What causes acromegaly?
excessive GH
physiologic effects of acromegaly
1). affects bone and soft tissue growth 2). hyperglycemia 3). cardiomeglia (increase risk for HTN and arrhythmias)
T/F: individuals with acromegaly have an increased risk for HTN and arrhythmias?
TRUE
TX for acromegaly
1). surgery is 1st line - typically remove a tumor that is the cause 2). medications follow surgery
Medications used in Tx of acromegaly
1). somatostatin analogue 2). GH receptor anatagonist
Therapeutic Concerns with Hypopituitarism Tx
1). easy to over treat 2). watch for AE of increased hormone levels 3). communicate with endocrinologist any changes 4). decreased GH = decreased BMD
T/F: there is an increased risk of bone fractures in individuals with dwarfism?
TRUE
what is slipped capital femoral epiphyses and who is at greater risk for it?
essentially a hip condition that causes hip dislocations. Hypopituitarism has increased risk for it
Suffix for synthetic GHs
-trope/tropin
Various brand names for synthetic GHs
1). Humatrope 2). Genotropin 3). Norditropin
Hyperthyroidism disease
Graves disease
S/sx of Graves disease
goiter, expothalmos, increased metabolism, nervousness, weight loss despite increased appetite
T/F: graves disease can result in thyroid storm
TRUE
what is thyroid storm
fatal symptoms of dehydration, tachycardia, delirium and fever
TX for graves disease
1). anti-thyroid meds 2). Radioactive Iodine 3). Thyroidectomy
Antithyroid meds
1). Methimazole 2). Propylthirouracil (PTU)
Which antithryoid med is the preferred option?
Methimazole - smaller dose needed and no black box warning
PTU black box warning
heptatoxicity
MOA of antithyroid meds
blocks formation of T4 to T3 by inhibiting iodine oxidation
When are antithyroid meds used?
1). mild cases 2). older 3). avoid radioactive iodine
AE of antithyroid meds
1). rash 2). GI upset 3). arthralgia
how often is methimazole dosed?
one or 2x daily
how often is propylthirouracil dosed?
initially dosed 4x/day
T/F: methimazole can cause birth defects in 1st trimester of pregnancy?
TRUE
When is PTU preferred over methimazole
1). during 1st trimester of pregnancy 2). while breastfeeding
Rare AE of antithyroid meds
1). agrunulocytosis 2). heptotoxicity
s/sxs of agrunlocytosis
1). fever 2). sore throat 3). mouth ulcers
what is radioactive iodine?
radioactive destruction of thyroid
AE for radioactive iodine?
hypothyroidism (will require life long treatment)
What other med can be used in trx of hyperthyroidism?
Propanolol >> used to trx symptoms
Types of Hypothyroidism
1). primary 2). secondary
What is primary hypothryoidism?
autoimmune destruction of thyroid gland
What is secondary hypothryoidism?
1). reduced secretion of TRH (hypothalamus) 2). reduced secretion of TSH (pituitary)
S/Sxs of hypothyroidism (8)
1). bradycardia 2). anemia 3). lethargy 4). wt gain 5). cold intolerance 6). menstrual irregularities 7). general muscle weakness 8). Goiter is possible
Tx for hypothyroidism
Levothyroxine (Synthroid)
What is levothyroxine
synthetic T4 > it is the DOC for hypothyroidism b/c it is cheap
MOA of Levothyroxine
synthetic T4 is converted to T3
T/F: Levothyroxine is an NTI drug?
TRUE >> requires monitoring and dose adjustments
AE of Levothyroxine (Synthroid)?
overall well tolerated unless overtreated: 1). sweating 2). heat intolerance 3). tachycardia 4). diarrhea 5). nervousness 6). menstrual irregularities 7). increased BMR
Special considerations for Levothyroxine (2)
1). take on empty stomach 2). don’t take along with Fe, Ca, Mg, Al containing products
T/F: chronic hypothyroidism can increase your risk of CV disease?
TRUE
Types of hyperparathyroidism
1). primary 2). seconday
Cause of primary hyperparathyroidism
1). parathyroid adenoma 2). hyperplasia or carcinoma
Causes of secondary hyperparathyroidism
underlying conditions such as chronic kidney disease > Ca lvls become low triggering release of PTH
TX options of primary hyperparathyroidism
1). surgery 2). medications
Medications used to trx hyperparathyroidism
1). Calcimimetics 2). Bisphosphonates
MOA of calcimimetics
competitive antagonist of Ca receptors >> decreases PTH secretion
AE of calcimimetics
1). most common: N/V 2). monitor for hypocalcemia
TX options for secondary hyperparathyroidism
treat underlying condition
Causes of Hypoparathyroidism
All result in hypocalcemia1). injury during surgery 2). autoimmune disease 3). congenital defect
TX for hypoparathyoidism
1). Calcium 1-3 grams/day 2). Vitamin D
Over treatment of hypoparathyroidism can cause _________
1). hypercalcemia 2). hypercalciuria >> leading to nephrolithiasis
The adrenal glands secrete from what regions?
1). Cortex 2). medulla
What is secreted from the medulla of the adrenal glands?
1). NE 2). epinephrine
What is secreted from the cortex of the adrenal glands?
1). mineralocorticoids 2). glucorticooids 3). some sex steroid
What is an example of a mineralocorticoid?
Aldosterone
What do mineralocorticoids do?
effects electrolyte/water balance
What do glucocorticoids do?
effect carb/fat metabolism
What are some examples of glucocorticoids?
1). hydrocortisone 2). cortisol
A deficiency of mineralocorticoids is called _____
Hypoaldosteronism
What disease is primarily associated with hypoaldosteronism?
Addison’s Disease
What causes Addison’s disease?
1). general adrenocoticoid insufficiency >> autoimmune system destroys adrenal cortex (main cause)2). defective aldosterone producing enzyme (rare)
TX for Addison’s disease
Fludrocortisone (synthetic aldosterone)
What is excessive production of aldosterone called?
hyperaldosteronism
causes of Hyperaldosteronism?
1). Adrenal tumor (Conn’s syndrome) 2). Adrenal hyperplasia
Tx for Conn’s syndrome
Surgery
Tx for adrenal hyperplasia
1). Spironolactone 2). Eplerenone
why are diuretics used to treat hyperaldosteronism
they are aldosterone receptor antagonists
which diuretic tx for hyperaldosteronism have less AE?
Eplerenon (selective for aldosterone receptors, Spironolactone is nonselective)
S/Sxs of Hyperaldosteronism (7)
1). muscle weakness 2). fatigue 3). paresthesias 4). headache 5). polydipsia 6). nocturnal polyuria 7). HTN
What is excessive production of glucocorticoids called?
1). Cushing’s syndrome
What is Cushing’s syndrome due to?
Hypercortisolism
what can lead to hypercortisolism?
1). take too much 2). make too much 3). tumor on pancreas/thyroid telling adrenal gland to make too much
TX options for Cushing’s syndrome?
1). surgery (1st line)2). meds surrounding surgery
Medications used as adjunct TX in Cushing’s syndrome?
1). Steroidogenesis inhibitors 2). Glucocorticoid-antagonist
Glucocortioid deficiency types
1). primary adrenal insufficiency 2). secondary adrenal insufficiency
What is primary adrenal insufficiency?
Addison’s Disease >> autoimmune destruction of adrenal cortex
Primary adrenal insufficiency results in what ______?
deficiency of both mineralcorticoids and glucocorticoids
What causes secondary adrenal insufficiency?
Too much exogenous corticosteroid admin >> suppresses hypothalamic-pituitary-adrenal axis >> decreased ACTH release
What does secondary adrenal insufficiency tell us about steroid dosages?
It is important to taper off of steroids
TX for primary and secondary adrenal insufficiency
1). Both = replace glucocorticoids (hydrocortisone, prednisone, cortisone) 2). primary = fludrocortisone as well (replace aldosterone)
Short term AE of primary/secondary adrenal insufficiency TX
1). increased blood glucose 2). mood changes 3). fluid retention
Long term AE of primary/secondary adrenal insufficiency TX
1). osteoporosis (increased fracture risk) 2). thin skin 3). muscle wasting 4). poor wound healing 5). Adrenal suppresion 6). Cushing’s syndrome 7). increased risk of infection
T/F: exercise and increased stress will require higher med dosing for glucocortioid deficiencies?
TRUE
Therapeutic Concerns of Adrenal Steroids
1). lots of pts w/dif disorder use them (RA, lupus, bursitis, etc.)2). catabolic effect on supporting tissue >> fall risk ! do not overload 3). can cause HTN 4). immunosupressive = increase infection risk 5). drug toxicity >> mood changes, psychoses
Stimulation cascade for sex hormones
Hypothalamus releases GnRH –> Ant. pituitary gland releases LH and FSH –> stimulates gonads to release sex hormones
Effects of testosterone (6)
1). masculinizing effects 2). development of male genitals in embryo 3). increase muscle/bone size 4). stimulates synthesis of clotting factors in liver 5). stimulates production of erythropietin in kidneys 6). regulates LH production from ant pituitary
Types of testosterone deficiency
1). primary 2). secondary
what causes primary testosterone deficiency?
testicular failure
what cause secondary testosterone deficiency?
decreased GnRh
S/Sxs of testosterone deficiency? (8)
1). delay in puberty 2). low energy 3). decreased libido 4). ED 5). decreased pubic hair6). anemia 7). osteoporosis 8). muscle atrophy
TX for testosterone deficiency
exogenous admin of testosterone (IM or topical)
T/F: perfectly safe to administer testosterone PO?
FALSE >> risk of heptatoxicity
IM admin of testosterone considerations
1). variable symptom relief (cycle between high to low)2). mood changes 3). can cause hepatic adenomas
topical admin of testosterone considerations
keep it covered so no contact
Risks/AE with testosterone administration
1). increased risk of MI, stroke, CV death 2). hepatotoxicity (long-term) 3). large doses may cause infertility
AE of testosterone in Athletic populations (11)
1). acne 2). MI, CV death, VTE3). PE 4). Cancer (testicular or prostate) 5). injection site infections 6). feminization 7). menstrual irregularities (in women) 8). tendon/ligament rupture 9). insomnia 10) mood disorder 11). aggressiveness
Therapeutic concerns with testosterone TX
1). monitor BP 2). athletic use of androgens
Role of estrogen (4)
1). develops female genitals in embryo 2). causes puberty and female specific changes 3). deposition of subcutaneous fat stores 4). widens pelvic girdle
What is the menstrual cycle?
28 day cycle. regulated by interaction between pituitary and ovarian hormones
Positive feedback loop in Menstrual cycle
1). low estrogen levels increase LH release 2). LH release further increases estrogen
Negative feedback loop in Menstrual cycle
LH and FSH are inhibited during second half of cycle from high estrogen and progesterone levels
What does the altering normal control between pituitary and ovarian hormones provide?
contraceptive control
Estrogen and Progesterone Medical uses
1). Contraceptives 2). Post-menopausal hormone replacement therapy (HRT)
Types of Contraceptives
1). Combination Oral contraceptive (COC)2). Long-acting intrauterine device (IUD)
common COC AEs (6)
1). increased BO2). N/V 3). weight gain 4). acne 5). depression 6). topical rxn
Rare COC AEs (3)
1). DVT/PE 2). Stroke 3). MI
T/F: the risk for MI from contraceptive use increases after 35 years of age?
TRUE, also if uncontrolled smoker and diabetic
T/F: AE of N/V from COC generally improve after 2-3 cycles?
TRUE
Complications from IUDs?
pelvic inflammatory disease
Goals of HRT?
1). decrease menopausal symptoms 2). increase BMD 3). decrease fracture risk
TX for HRT
1). estrogen only (if no uterus) 2). estrogen + progestogens
Route of admin for estrogen (4)
1). PO 2). transdermal patch/spray 3). topical gel/solution 4). vaginal ring/cream
Estrogen AE (4)
1). nausea 2). HA 3). breast tenderness 4). vaginal bleeding
Progestogens admin
1). PO 2). patch
Progestogens AE (4)
1). bloating 2). headache 3). weight gain 4). irritability
Known risks with HRT TXs
1). DVT 2). PE 3). gallbladder disease 4). breast cancer (with combo) 5). endometrial cancer (with estrogen alone)
General Men’s health disorder
Benign prostatic hypertrophy (BPH)
TX options for BPH
1). Alpha-adrenergic antagonists 2). 5a-reductase inhibitors 3). anticholinergic agents 4). B3-adrenergic agonsit
Alpha-adrenergic antagonist used for BPH
Tamsulosin
MOA of tamsulosin
relax smooth muscle in prostate and bladder neck
5a-reductase inhibitor used for BPH
finasteride
MOA of finasteride
interfere with stimulatory effects of testosterone
AE of tamsulosin and finasteride
Hypotension
Anticholinergic agents used to treat BPH
oxybutynin
MOA of oxybutynin
antispasmodic effect on smooth muscle >> blocks acetylcholine on smooth muscle
AE of oxybutynin
ABCDs
B3-adrenergic agonist used to treat BPH
mirabegron (Myrbetriq)
MOA of mirabegron (Myrbetriq)
relaxes detrusor muscle to decrease voiding symptoms
AE of mirabegron (Myrbetriq)
may increase BP
Other indication for mirabegron (Myrbetriq)
OAB
Male to Female gender transition meds
1). Estrogen and Progesterone 2). Spironolactone (testosterone blocker) 3). Finasteride (testosterone blocker)
Female to Male gender transition meds
testosterone
T/F: sex at birth still defines some risks for individuals undergoing gender transition?
TRUE
What causes Osteoporosis?
decreased osteoblast function
T/F: osteoporosis is more common in post-menopausal women?
TRUE
Types of Osteoporosis
1). primary 2). seconday
What causes primary osteoporosis?
1). idiopathic (unknown 2). increased age
what causes secondary osteoporosis?
1). underlying diseases2). medications
Clinical manifestations for osteoporosis
1). sudden back pain (compression fx of vertebral body) 2). increased kyphosis of T spine 3). decreased height
Risk factors for developing osteoporosis (9)
1). decreased bone mass after 35 years old 2). female hormone changes 3). genetics 4). Caucasian 5). low physical activity 6). tobacco/alcohol use 7). medications 8). depression 9). diet/nutrition deficits
TX for osteoporosis?
1). calcium and Vitamin D2). Bisphosphonates (most common tx) 3). Denosumab 4). Sclerostin Inhibitor 5). Teriparatide
AEs of calcium?
Consitipation
suffix for Bisphosphonates
-dronate
MOA of Bisphosphonates
binds key enzyme to inhibit natural bone turnover pathway >> increases osteoclast apoptosis which decreases bone turnover
Bisphosphoantes considerations
1). stay upright 2). take w/water 30-60 minutes before food
Bisphosphonates common AE
GI issues (increased if not upright)
Rare Bisphosphoantes AE
1). atypical femur fx 2). osteonecrosis of jaw (ONJ) - from IV use or long-term trx
Bisphosphonates contraindications
1). hypocalcemia 2). esophageal abnormalities 3). inability to remain upright
what type of drug is denosumab (Prolia)
Anti-RANKL
denosumab (Prolia) AEs
same as bisphospnates
denosumab (Prolia) considerations
administered in provider’s office
Sclerostin inhibitors MOA
increase bone formation
Sclerostin inhibitors common AE
arthraligia
Sclerostin inhibitors rare AEs
1). hypocalcemia (atypical) 2). femur fx3). ONJ 4). increased risk of MI, stroke, or CV death
Synthetic PTH MOA
1). stimulate osteoblast function 2). increases GI calcium absorption 3). increase renal calcium absorption all this increases BMD
Synthetic PTH AEs
transient OH within 4 hours of dose
Drug name for Synthetic PTH
Teriparatide (Forteo)
Osteoporosis medication considerations
also given to pts with longterm steroid use and men receiving androgen deprivation therapy
Osteoporosis meds Therapeutic Concerns
1). excessive doses of Ca supplements can cause arrhythmias 2). utilize weight bearing activities to promote bone growth 3). avoid high impact activities for pts with osteroporosis
Types of Diabetes
Type 1Type 2
Pathophysiology T1DM
selective beta cell destruction in the pancreas >> can’t produce insulin
what causes T1DM?
Autoimmune dysfunction, genetic, viral infections
What is T2DM?
1). moderate beta cell destruction that can become more severe 2). Insulin resistance
Which type of diabetes is more prevalent in youth?
T1DM
what is LADA?
latent autoimmune diabetes in adults (Type 1.5 >> requires insulin)
What type of diabetes can only be treated with insulin?
T1DM
Pathophysiology of T2DM?
Egregious Eleven
what is the overall result of the egregious eleven?
Hyperglycemia
TX options for T2DM?
1). diet 2). exercise 3). non-insulin meds 4). insulin
what are non-insulin meds that treat T2DM also called?
Antihyperglycemic Drug
List the classes of Antihyperglycemic Drugs (6)
1). Biguanide 2). Sulfonylureas 3). Thiazolidinedione (TZDs) 4). DPP-4 inhibitor 5). SGLT2 Inhibitor 6). GLP1 Receptor agonist
MOA for Biguanide
unclear, but it stops: 1). production of glucose 2). intestinal absorption of glucose also 3). increases insulin sensitivity in muscle and fat
AE of Biguanide
1). GI (N/V/cramps) 2). Vitamin B12 deficiency
how is vitamin B12 deficiency from Biguanide important?
it can be misdiagnosed as peripheral neuropathy
Biguanide boxed warnings
lactic acidosis
Sulfonylureas MOA
increase insulin release
Sulfonylureas AE
1). hypoglycemia 2). weight gain
AE from Sulfonylureas are increased in which populations?
1). elderly 2). individuals with renal dysfunction
T/F: some Sulfonylureas are on the Beer’s List?
TRUE
