PharmFinal2 Flashcards
What hormones are secreted by the posterior pituitary?
Oxytocin and Vassopressin (ADH)
What disorder is it easy to confuse hyperthyroidism with?
anxiety
Corticotropin can be used to diagnose what?
adrenal insufficiency- increases cortisol levels in healthy people and will have no effect on people with adrenal issues
What do you need to make sure you check when doing this corticotropin test?
timing of your blood draws
What test can be done if you are unsure someone was properly tapered from their steroids?
dexamethasone
Growth hormone used in HIV associated lipodystrophy
sermorelin
T or F- Somatostatin is a more potent inhibitor of growth hormone that Octreotide?
FALSE!!- Octreotide is more potent
Somatostatin analogue used to treat excessive diarrhea associated with tumors that secrete vasoactive intestinal polypeptide, and off label for esophageal varices?
octreotide
What class of drug can be given continuously to suppress FSH and LH? Who is this used in?
continuous rather than pustule GnRH analogue suppresses FSH/LH- used for prostate, breast and uterine cancers
What do we need to know about the GnRH agonists that we use in cancer patients?
estrogen receptor status of the drug
GnRH agonist used to suppress menses in cancer patients
Leuprolide- if we don’t give them their dose they can get pregnant, bleed out because no platelets and kill the fetus because taking intense chemo drugs
Drug that blocks receptors for GnRH in persons with advanced prostate cancer?
abarelix
What is prolactin inhibited by?
dopamine
How does bromocriptine treat excessive prolactin secretion? What other disease can it be used for?
it helps milk dry up
also used in parkinsons
Why is oxytocin given after labor?
to stimulate contractions to expel the placenta
Type of vassopressin analogue used in end of life, diabetes insipid us, von willibrands and nocturnal diaphoresis?
desmopressin
You see an alcoholic in the ICU on vassopressin. Why is he on it? What needs to be monitored?
esophageal varices
monitor bp
You have a patient with a large goiter. What are they deficient in?
iodine
Does thyroid hormone have a small or large therapeutic index?
very narrow~
Hypothyroidism in kids can result in what?
retardation and impaired growth and development
T or F: Hypothyroidism can occur from drugs
True! (lithium, amiodarone, TKI, corticosteroids, sulfonylureas)
What treatment modalities are curative for hyperthyroidism?
RAI and surgery (though you might need replacement therapy after)
You have a patient that you are about to put on levothyroxin, what do you have to tell them in regards to taking this medication?
Take at the same time everyday and with meals because food effects absorption
What is a way that we a practitioners can limit the cardiovascular effects of levothyroxin when giving it to our patients?
start dose low and of up monthly to help limit CV system stress
How often do we have to get levels on levothyroxin?
every month- get levels after 3 half lives and the half live is 7 days
When giving levothyroxine IV, give ___%__ of the oral dose. What do you monitor?
50% ! Monitor bp
Which thioamide drug is better in pregnancy and why?
PTU because Methimazole is 3x more likely to cause birth defects
Which thiamin drug is highly PPB?
PTU (propylthiouracil)
Which anti-thyroid agent is used to block RAI reuptake by the thyroid gland after nuclear exposure?
Lugol’s solution- potassium iodide
Which antithyroid agent gives you a metallic taste and sore gums?
Lugol’s solution
Thyroid hormone may ____ insulin requirements in diabetics
increase
What does thyroid hormone do to warfarin requirements?
Lowers them since it degrades Vit K clotting factors
In what instances would thyroid hormone be administered IV?
myxedema coma and if can’t take PO
Serious adverse effects of thioamide drugs
leukopenia and agranulocytosis
Two tests that can be done to evaluate cortisol function?
dexamethasone and cosynotropin
Mineralcorticoid used for primary adrenal insufficiency and orthostatic intolerance?
- Fludrocortisone used in primary adrenal insufficiency and orthostasis
- Midadrene - orthostatisis
What do you monitor in patients on steroids?
bp, bs, K, weight, screen for osteoporosis, eyes, symptoms of disease
What glucocorticoid is low potency and short acting? How about medium potency and intermediate acting? How about high potency and long acting?
low potency- hydrocortisone(OTC)
medium potency- prednisone
high potency- Bethamethasone and dexamethasone
You have a patient who is on hydrocortisone oral tablets. WHy would this be?
replacement therapy
What is the only steroid that has use as an antiemetic?
dexamethason
T or F: steroids can suppress a person’s immunity significantly
true
What steroid can be used to prevent respiratory distress syndrome in premies?
Bethamethasone
Little old person on steroids. What do you want to screen for?
osteoporosis!
T or F: topical steroids can cause systemic absorption and adrenal suppression
True
A patient is on dexamethasone for greater than 2 weeks. What do we screen for?
(in addition to everything we normally screen for) consider cushings like reaction (buffalo hump, moon face, fate redistribution, thinning of skin,easy bruising)
DHEA, an adrenal androgen is contraindicated in what patient?
one with prostate cancer
What type of drug would be an issue if administered while someone was on steroids?
antifungal (fluconazole + ketoconazole) because they inhibit steroid synthesis by inhibiting CYTP450 (which is how steroids metabolize)
Give me an example of a aldosterone (mineralocorticoid) receptor antagonist. What do you have to monitor?
spironolactone- monitor K and bp
What is a more potent mineral corticoid, fludrocortisone or cortisol?
Fludrocortisone is approx. 100x more potent!
Is aldosterone suppressed by glucocorticoid administration?
no!
Give me a low potency topical corticosteroid that can treat a contact dermatitis on the face
desonide
What converts androgens to estrogens and why?
aromatase- gives more affinity for estrogen receptors
Estrogens___ LDL and ____ HDL
decrease LDL and increase HDL
Progestins ___ LDL and ___ HDL
increase LDL and decrease HDL
How does progesterone effect body temperature?
increases body temp by .5-.8 degrees Celcius during ovulation
How often are transdermal estrogen patches dosed?
either weekly of twice weekly. Need to know which one they are on!
What will liver failure do to estrogen level?
decrease estrogen because it undergoes enterohepatic cycling
which hormone has the ADR of stroke?
estrogen
What are ADRs of estrogen?
breast tenderness, HA, edema, anorexia, change in libido, htn, thromboembolic disorder, gallbladder disease
Who is estrogen contraindicated in and why?
pregnant people and people with clotting disorders because increases synthesis of vitamin K
What therapy is believed to prevent heart disease and lower cardiac effects in post menopausal women?
HRT
You have a patient who is a smoker and would like BCP. WHat do you recommend?
nuva ring because it is not systemically absorbed
Patients with what types of cancers should not receive oral contraceptive?
hormone sensitive cancers such as uterine and ovarian and breast
Will the murena ring help with acne?
no because it is not systemically absorbed
What type of drugs will interact with BCP? Give examples
Drugs that increase hepatic enzyme activity - carbamazepine and phenytoin
You are a pharmacist and a young girl comes up asking you for Plan B. How do you tell her to take this pill?
take a single dose within 72 hours of intercourse and a second dose 12 hours later
How effective are spermaticides as a contraceptive?
moderately effective but can cause irritation
What anti estrogen causes multiple births as a side effect?
Clomiphene
Which anti estrogen can be use in post menopausal women?
Tamoxifen
What anti estrogen helps with osteoporosis?
raloxifene
What antiprogestin has an ADR of heavy uterine bleeding?
mifepristone
What is “the abortion pill” and what is it used with?
Mifepristone is the abortion pill and it is used with misoprostil to stimulate uterine contractions
ADR of androgens that cause them to not be used that frequently?
liver failure and hepatic damage
What androgen is used to treat endometriosis and ADRs include mild hair growth, oily skin and acne?
Danazol
What antiandrogenstreat male pattern baldness but can cause impotence and decreased libido?
Finasteride and dutasteride
What is the rate at which insulin is released during a meal and when does it peak?
released at a rate of 1 unit per 10gm of carb. eaten and peaks in 1 hr
pre-prandial glucose levels return within 2 hrs
What is the basal rate of insulin?
.5-1 unit per hour- you want it to work quickly and last for a couple hours
Which type of diabetes is more likely to have ketoacidosis?
Type 1
You have a patient who was just diagnosed with gestational diabetes how will you instruct her to take her insulin?
Take by IV - oral meds are teratogenic (HPPB)
Your patient with gestational diabetes ask you what her risk is of having diabetes later in life. What is your answer?
50% risk of DM II
What is the first step in treating a patient in DM II?
lifestyle modifications! Helps decrease long term effects
Where should a patient using SC insulin inject their dose?
bbest area is in the abdomen- try to alternate locations to avoid fatty deposits
Which insulin is ideal for pre-meal administration? Do you need a snack with this insulin?
rapid acting insulin- DOA is 3 hours so you don’t need a snack- low risk of hypoglycemia
What is the only type of insulin that you can give IV? Will this one require a snack
short acting regular insulin- this one will need a snack because DOA is 5-8 hours
Which insulin needs to be rolled between the hands before administering? Is this one more prone to erratic absorption?
Intermediate acting-NPH
Yes this is more prone to erratic absorption
Which insulin has an extremely low risk of hypoglycemia?
long acting insulin (ex. glargine, detemir)- these don’t have a peak effect
What two insulins are in phase 3 of clinical trials?
- ultra long acting (degludec insulin)- dosed 3 times a week
- inhaled insulin
With what form of insulin administration do we have to inform our patients about signs of DKA?
SC injection
Your patient tells you they store their insulin in the freezer. How do you educate them?
YOu should not keep your insulin in the freezer or in a really sunny or warm area. You can keep it in the fridge. After you open the insulin, the medication lasts about a month before expiration
vWhat effect does insulin have on K
causes hypokalemia because forces K back into the cell
WHat does insulin have drug interactions with?
steroids
What does beta-adrenergic blocking agents mask signs of?
hypoglycemia
Should a pregnant woman be on sulfonylurea?
NO- highly plasma protein bound
ADRs of sulfonylurea
hypoglycemia,skin rash, weight gain, can cause disulfiram rxn
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What is the only anti diabetic drug that can be used with Meglitinide drugs (repaglinide, nateglinide)?
Metformin
Does metformin cause weight gain or weight loss?
Weight loss! (SWEET!)
ADRs of metformin? What do you monitor?
diarrhea, lactic acidosis
Monitor Serum Cr (no go if 1.4 or more in women, 1.5 or more in men)
What patient should not be on Thiazolidinediones for their diabetes?
People with heart failure because ADR is edema
ADR of acarbose and miglitol (Alpha glucosidase inhibitors)?
gas and abdominal bloating because prevents starch digestion to lower post prandial glucose levels
If a patient is in hypoglycemia what should you give them?
dextrose (not glucose)
What is the first once daily injectible incretin mimetic?
Liraglutide
What is the only synthetic analogue of amylin approved for type I and II diabetes?
Pramlitinide
Goals of therapy for Type I diabetics
- maintain fasting bg below 140
- maintain 2 hour post prandial bg below 175
- maintain A1c below 7%
First thing we do if a type I diabetic is in DKA?
IV fluid with NaHCO3 to replace fluids from osmotic diuresis and alkalinize - consider dextrose and potassium as well!
Number 1 environmental factor in cancer?
Smoking
cancer is 90-95% environmental and a small portion genetic
What is the slowest growing cancer?
prostate
What is important to remember about alkylating agents for chemo? What types of cancers are treated with this?
- red in color and cardiotoxic
- Txs - Breast cancer and leukemia
NUmber 1 reason to withhold chemo?
GI problems- people get really sick
If you are giving methotrexate IT for a cancer patient what do you have to make sure of?
make sure it is preservative free- give in this form to prevent CNS relapse
What color is methotrexate?
yellow
What vitamin supplementation do patients taking pemetrexed need?
folic acid and B12
What cancer med has the ADR of mucositis?
Methotrexate, flourouracil, daunorubacin
Rub flour and meth together
What do you have to check when patient is on methotrexate?
LFTs
Antidote for methotrexate?
Calcium leukovorin
You have a patient on mercaptopurine. How do you educate them on taking this drug?
PO without food because food will decrease absorption
ADRs of mercaptopurine
myelosuppresion and hepatotoxicity
You have a cancer patient taking mercaptopurine and allopurinol. What is important to remember about these drugs interactions?
dose of mercaptopurine will be reduced 50% if taking allopurinol- lowers uric acid level
Cytarabine when given in high doses can cause what? How do we treat this?
can cause allergic conjunctivitis. Decadron eye drops are required prior to beginning therapy
What can be given to minimize the toxicity of fluorouracil?
calcium leucovorin (same as methotrexate)
What treats blast crisis in cancer patients? What do you monitor?
Hydroxyurea- can also be used to treat sickle cell
Monitor LFTs
What is a potent immunosuppressant used in RA and SLE?
cyclophosphamide
What cancer meds cause hemorrhagic cystitis? (there are two)
- cyclophorphamide
- ifosfamide
What cancer med has long term use associated with secondary acute leukemia?
Chlorambucil
List some platinum compounds. Which is the most potent?
Cisplatin, carboplatin, oxaliplatin
- Cisplatin is the most potent
What cancer meds cause profound N/V? What do you monitor?
the platinum compounds. Monitor electrolytes!
What cancer drugs are nephrotoxic? What do you give for treatment?
Platinum compounds
Give mannitol to rapidly eliminate the drug
What cancer med causes pulmonary fibrosis and requires baseline PFTs? At what point does this side effect occur?
Busulfan- usual onset is 3 years after initiation of treatment
What is the average survival in a patient with pulmonary fibrosis?
5 months
You have a patient that you want to treat with Temozolamide but they tell you they can’t swallow pills. Is this a deal breaker?
Nope- it can be made into a suspension by a speciality pharmacist
Big ADR of anthracycline drugs? Treatment?
Cardiotoxicity
- treated with Dexrazoxane
What ADR do these three drugs have in common?- Methotrexate, flourouracil, daunorubacin
mucositis
Antidote for daunorubacin?
dexrazoxane
134
ADRs of bleomycin?
pulmonary toxicities, very little myelosuppression, mucocutaneous reactions
You have a patient on dactinomycin. What can they not receive while on this treatment?
Radiation- it will potentiate effects
6
ADR of vincristine
causes dose limiting neurotoxicity
ADR of paclitaxel and docetaxel (taxanes)
infusion reactions
can cause extreme neuropathies
Irinotecan can produce significant _____?
diarrhea
What reaction do we worry about with monoclonal antibodies?
infusion reaction
ADR of trastuxumab
cardiotoxic
Can all cancer patients succeed with any of the monoclonal antibodies?
NO- they aren’t one size fits all. All specific for genotypes and phenotypes
What reaction can cetuximab have on the skin?
cause acne like skin rash
- can also have hypersensitivity during drug infusion
What monoclonal antibody cause hemorrhage?
Bevacizumab
You have a patient on mercaptopurine. How do you educate them on taking this drug?
taken orally without food because food will decrease absorption
What type of interferon is used for kaposi sarcoma?
Interferon alpha 2B
What is the only steroid that can treat delayed N/V?
Dexamethasone!
Cancer patient on leuprolide for advanced prostate cancer. What else do you have to co-treat with for the first 2 weeks and why?
an androgen receptor blocker because causes transient flare initially
What women can use tamoxifen as a selective estrogen receptor modulator?
pre or post menopausal woman! (only one for pre meno.)
estrogen receptor modulator in post menopausal woman with breast cancer?
Toremifene
Antibody to RSV?
Palvizumab
ADR of cyclosporine and what does it interact with?
causes nephrotoxicity, hirsituism and gingival hyperplasia
metabolized by CYTP450 so interacts with erythromycin, azole antifungals, CCBs, grapefruit juice, macrolides
You have a patient taking a H2 blocker who needs calcium supplementation. What do you recommend?
Ca citrate because it does not require stomach acid for absorption like CaCO3 does
Before starting a bisphosphonate what do you have to make sure your body has enough of?
Ca
What will calcium decrease the absorption of?
cipro, phenytoin, tetracyclines and others (dose apart by 2 hours)
You are about to give a patient a bisphosphonate. What do you have to tell them about taking this pill?
take on an empty stomach because food retards absorption. Take it sitting up and with a whole glass of water because it can perforate your esophagus
Half life of bisphosphonates?
10 years
ADRs of bisphosphonates?
necrosis of the jaw
atypical femur fractures if on this for greater than 5 years
Which bisphosphonate only take 3 months to work instead of the usual 6?
Tiludronate
What do you have to monitor when on bisphosphonates?
Ca, vit. D, bone densité, sérum Cr (renally eliminated)
What bisphosphonate was the first and can be used for steroid induced osteoporosis?
Alendronate
Drug that has the off label use of speeding fracture healing?
Teriparatide
What can stopping teriparatide do? What do you do about it?
can cause a period of rapid bone loss- follow up with a bisphosphonate
which drug causes premature closure of growth plates?
anabolic steroids
