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J's ClinMed Deck > PharmFinal2 > Flashcards

PharmFinal2 Flashcards

1
Q

What hormones are secreted by the posterior pituitary?

A

Oxytocin and Vassopressin (ADH)

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2
Q

What disorder is it easy to confuse hyperthyroidism with?

A

anxiety

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3
Q

Corticotropin can be used to diagnose what?

A

adrenal insufficiency- increases cortisol levels in healthy people and will have no effect on people with adrenal issues

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4
Q

What do you need to make sure you check when doing this corticotropin test?

A

timing of your blood draws

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5
Q

What test can be done if you are unsure someone was properly tapered from their steroids?

A

dexamethasone

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6
Q

Growth hormone used in HIV associated lipodystrophy

A

sermorelin

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7
Q

T or F- Somatostatin is a more potent inhibitor of growth hormone that Octreotide?

A

FALSE!!- Octreotide is more potent

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8
Q

Somatostatin analogue used to treat excessive diarrhea associated with tumors that secrete vasoactive intestinal polypeptide, and off label for esophageal varices?

A

octreotide

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9
Q

What class of drug can be given continuously to suppress FSH and LH? Who is this used in?

A

continuous rather than pustule GnRH analogue suppresses FSH/LH- used for prostate, breast and uterine cancers

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10
Q

What do we need to know about the GnRH agonists that we use in cancer patients?

A

estrogen receptor status of the drug

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11
Q

GnRH agonist used to suppress menses in cancer patients

A

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

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12
Q

Drug that blocks receptors for GnRH in persons with advanced prostate cancer?

A

abarelix

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13
Q

What is prolactin inhibited by?

A

dopamine

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14
Q

How does bromocriptine treat excessive prolactin secretion? What other disease can it be used for?

A

it helps milk dry up

also used in parkinsons

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15
Q

Why is oxytocin given after labor?

A

to stimulate contractions to expel the placenta

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16
Q

Type of vassopressin analogue used in end of life, diabetes insipid us, von willibrands and nocturnal diaphoresis?

A

desmopressin

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17
Q

You see an alcoholic in the ICU on vassopressin. Why is he on it? What needs to be monitored?

A

esophageal varices

monitor bp

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18
Q

You have a patient with a large goiter. What are they deficient in?

A

iodine

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19
Q

Does thyroid hormone have a small or large therapeutic index?

A

very narrow~

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20
Q

Hypothyroidism in kids can result in what?

A

retardation and impaired growth and development

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21
Q

T or F: Hypothyroidism can occur from drugs

A

True! (lithium, amiodarone, TKI, corticosteroids, sulfonylureas)

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22
Q

What treatment modalities are curative for hyperthyroidism?

A

RAI and surgery (though you might need replacement therapy after)

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23
Q

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?

A

Take at the same time everyday and with meals because food effects absorption

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24
Q

What is a way that we a practitioners can limit the cardiovascular effects of levothyroxin when giving it to our patients?

A

start dose low and of up monthly to help limit CV system stress

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25
Q

How often do we have to get levels on levothyroxin?

A

every month- get levels after 3 half lives and the half live is 7 days

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26
Q

When giving levothyroxine IV, give ___%__ of the oral dose. What do you monitor?

A

50% ! Monitor bp

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27
Q

Which thioamide drug is better in pregnancy and why?

A

PTU because Methimazole is 3x more likely to cause birth defects

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28
Q

Which thiamin drug is highly PPB?

A

PTU (propylthiouracil)

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29
Q

Which anti-thyroid agent is used to block RAI reuptake by the thyroid gland after nuclear exposure?

A

Lugol’s solution- potassium iodide

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30
Q

Which antithyroid agent gives you a metallic taste and sore gums?

A

Lugol’s solution

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31
Q

Thyroid hormone may ____ insulin requirements in diabetics

A

increase

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32
Q

What does thyroid hormone do to warfarin requirements?

A

Lowers them since it degrades Vit K clotting factors

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33
Q

In what instances would thyroid hormone be administered IV?

A

myxedema coma and if can’t take PO

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34
Q

Serious adverse effects of thioamide drugs

A

leukopenia and agranulocytosis

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35
Q

Two tests that can be done to evaluate cortisol function?

A

dexamethasone and cosynotropin

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36
Q

Mineralcorticoid used for primary adrenal insufficiency and orthostatic intolerance?

A
  • Fludrocortisone used in primary adrenal insufficiency and orthostasis
  • Midadrene - orthostatisis
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37
Q

What do you monitor in patients on steroids?

A

bp, bs, K, weight, screen for osteoporosis, eyes, symptoms of disease

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38
Q

What glucocorticoid is low potency and short acting? How about medium potency and intermediate acting? How about high potency and long acting?

A

low potency- hydrocortisone(OTC)
medium potency- prednisone
high potency- Bethamethasone and dexamethasone

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39
Q

You have a patient who is on hydrocortisone oral tablets. WHy would this be?

A

replacement therapy

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40
Q

What is the only steroid that has use as an antiemetic?

A

dexamethason

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41
Q

T or F: steroids can suppress a person’s immunity significantly

A

true

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42
Q

What steroid can be used to prevent respiratory distress syndrome in premies?

A

Bethamethasone

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43
Q

Little old person on steroids. What do you want to screen for?

A

osteoporosis!

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44
Q

T or F: topical steroids can cause systemic absorption and adrenal suppression

A

True

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45
Q

A patient is on dexamethasone for greater than 2 weeks. What do we screen for?

A

(in addition to everything we normally screen for) consider cushings like reaction (buffalo hump, moon face, fate redistribution, thinning of skin,easy bruising)

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46
Q

DHEA, an adrenal androgen is contraindicated in what patient?

A

one with prostate cancer

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47
Q

What type of drug would be an issue if administered while someone was on steroids?

A

antifungal (fluconazole + ketoconazole) because they inhibit steroid synthesis by inhibiting CYTP450 (which is how steroids metabolize)

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48
Q

Give me an example of a aldosterone (mineralocorticoid) receptor antagonist. What do you have to monitor?

A

spironolactone- monitor K and bp

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49
Q

What is a more potent mineral corticoid, fludrocortisone or cortisol?

A

Fludrocortisone is approx. 100x more potent!

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50
Q

Is aldosterone suppressed by glucocorticoid administration?

A

no!

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51
Q

Give me a low potency topical corticosteroid that can treat a contact dermatitis on the face

A

desonide

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52
Q

What converts androgens to estrogens and why?

A

aromatase- gives more affinity for estrogen receptors

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53
Q

Estrogens___ LDL and ____ HDL

A

decrease LDL and increase HDL

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54
Q

Progestins ___ LDL and ___ HDL

A

increase LDL and decrease HDL

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55
Q

How does progesterone effect body temperature?

A

increases body temp by .5-.8 degrees Celcius during ovulation

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56
Q

How often are transdermal estrogen patches dosed?

A

either weekly of twice weekly. Need to know which one they are on!

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57
Q

What will liver failure do to estrogen level?

A

decrease estrogen because it undergoes enterohepatic cycling

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58
Q

which hormone has the ADR of stroke?

A

estrogen

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59
Q

What are ADRs of estrogen?

A

breast tenderness, HA, edema, anorexia, change in libido, htn, thromboembolic disorder, gallbladder disease

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60
Q

Who is estrogen contraindicated in and why?

A

pregnant people and people with clotting disorders because increases synthesis of vitamin K

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61
Q

What therapy is believed to prevent heart disease and lower cardiac effects in post menopausal women?

A

HRT

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62
Q

You have a patient who is a smoker and would like BCP. WHat do you recommend?

A

nuva ring because it is not systemically absorbed

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63
Q

Patients with what types of cancers should not receive oral contraceptive?

A

hormone sensitive cancers such as uterine and ovarian and breast

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64
Q

Will the murena ring help with acne?

A

no because it is not systemically absorbed

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65
Q

What type of drugs will interact with BCP? Give examples

A

Drugs that increase hepatic enzyme activity - carbamazepine and phenytoin

66
Q

You are a pharmacist and a young girl comes up asking you for Plan B. How do you tell her to take this pill?

A

take a single dose within 72 hours of intercourse and a second dose 12 hours later

67
Q

How effective are spermaticides as a contraceptive?

A

moderately effective but can cause irritation

68
Q

What anti estrogen causes multiple births as a side effect?

A

Clomiphene

69
Q

Which anti estrogen can be use in post menopausal women?

A

Tamoxifen

70
Q

What anti estrogen helps with osteoporosis?

A

raloxifene

71
Q

What antiprogestin has an ADR of heavy uterine bleeding?

A

mifepristone

72
Q

What is “the abortion pill” and what is it used with?

A

Mifepristone is the abortion pill and it is used with misoprostil to stimulate uterine contractions

73
Q

ADR of androgens that cause them to not be used that frequently?

A

liver failure and hepatic damage

74
Q

What androgen is used to treat endometriosis and ADRs include mild hair growth, oily skin and acne?

A

Danazol

75
Q

What antiandrogenstreat male pattern baldness but can cause impotence and decreased libido?

A

Finasteride and dutasteride

76
Q

What is the rate at which insulin is released during a meal and when does it peak?

A

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

77
Q

What is the basal rate of insulin?

A

.5-1 unit per hour- you want it to work quickly and last for a couple hours

78
Q

Which type of diabetes is more likely to have ketoacidosis?

A

Type 1

79
Q

You have a patient who was just diagnosed with gestational diabetes how will you instruct her to take her insulin?

A

Take by IV - oral meds are teratogenic (HPPB)

80
Q

Your patient with gestational diabetes ask you what her risk is of having diabetes later in life. What is your answer?

A

50% risk of DM II

81
Q

What is the first step in treating a patient in DM II?

A

lifestyle modifications! Helps decrease long term effects

82
Q

Where should a patient using SC insulin inject their dose?

A

bbest area is in the abdomen- try to alternate locations to avoid fatty deposits

83
Q

Which insulin is ideal for pre-meal administration? Do you need a snack with this insulin?

A

rapid acting insulin- DOA is 3 hours so you don’t need a snack- low risk of hypoglycemia

84
Q

What is the only type of insulin that you can give IV? Will this one require a snack

A

short acting regular insulin- this one will need a snack because DOA is 5-8 hours

85
Q

Which insulin needs to be rolled between the hands before administering? Is this one more prone to erratic absorption?

A

Intermediate acting-NPH

Yes this is more prone to erratic absorption

86
Q

Which insulin has an extremely low risk of hypoglycemia?

A

long acting insulin (ex. glargine, detemir)- these don’t have a peak effect

87
Q

What two insulins are in phase 3 of clinical trials?

A
  1. ultra long acting (degludec insulin)- dosed 3 times a week
  2. inhaled insulin
88
Q

With what form of insulin administration do we have to inform our patients about signs of DKA?

A

SC injection

89
Q

Your patient tells you they store their insulin in the freezer. How do you educate them?

A

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

90
Q

vWhat effect does insulin have on K

A

causes hypokalemia because forces K back into the cell

91
Q

WHat does insulin have drug interactions with?

A

steroids

92
Q

What does beta-adrenergic blocking agents mask signs of?

A

hypoglycemia

93
Q

Should a pregnant woman be on sulfonylurea?

A

NO- highly plasma protein bound

94
Q

ADRs of sulfonylurea

A

hypoglycemia,skin rash, weight gain, can cause disulfiram rxn

95
Q

6

What is the only anti diabetic drug that can be used with Meglitinide drugs (repaglinide, nateglinide)?

A

Metformin

96
Q

Does metformin cause weight gain or weight loss?

A

Weight loss! (SWEET!)

97
Q

ADRs of metformin? What do you monitor?

A

diarrhea, lactic acidosis

Monitor Serum Cr (no go if 1.4 or more in women, 1.5 or more in men)

98
Q

What patient should not be on Thiazolidinediones for their diabetes?

A

People with heart failure because ADR is edema

99
Q

ADR of acarbose and miglitol (Alpha glucosidase inhibitors)?

A

gas and abdominal bloating because prevents starch digestion to lower post prandial glucose levels

100
Q

If a patient is in hypoglycemia what should you give them?

A

dextrose (not glucose)

101
Q

What is the first once daily injectible incretin mimetic?

A

Liraglutide

102
Q

What is the only synthetic analogue of amylin approved for type I and II diabetes?

A

Pramlitinide

103
Q

Goals of therapy for Type I diabetics

A
  • maintain fasting bg below 140
  • maintain 2 hour post prandial bg below 175
  • maintain A1c below 7%
104
Q

First thing we do if a type I diabetic is in DKA?

A

IV fluid with NaHCO3 to replace fluids from osmotic diuresis and alkalinize - consider dextrose and potassium as well!

105
Q

Number 1 environmental factor in cancer?

A

Smoking

cancer is 90-95% environmental and a small portion genetic

106
Q

What is the slowest growing cancer?

A

prostate

107
Q

What is important to remember about alkylating agents for chemo? What types of cancers are treated with this?

A
  • red in color and cardiotoxic

- Txs - Breast cancer and leukemia

108
Q

NUmber 1 reason to withhold chemo?

A

GI problems- people get really sick

109
Q

If you are giving methotrexate IT for a cancer patient what do you have to make sure of?

A

make sure it is preservative free- give in this form to prevent CNS relapse

110
Q

What color is methotrexate?

A

yellow

111
Q

What vitamin supplementation do patients taking pemetrexed need?

A

folic acid and B12

112
Q

What cancer med has the ADR of mucositis?

A

Methotrexate, flourouracil, daunorubacin

Rub flour and meth together

113
Q

What do you have to check when patient is on methotrexate?

A

LFTs

114
Q

Antidote for methotrexate?

A

Calcium leukovorin

115
Q

You have a patient on mercaptopurine. How do you educate them on taking this drug?

A

PO without food because food will decrease absorption

116
Q

ADRs of mercaptopurine

A

myelosuppresion and hepatotoxicity

117
Q

You have a cancer patient taking mercaptopurine and allopurinol. What is important to remember about these drugs interactions?

A

dose of mercaptopurine will be reduced 50% if taking allopurinol- lowers uric acid level

118
Q

Cytarabine when given in high doses can cause what? How do we treat this?

A

can cause allergic conjunctivitis. Decadron eye drops are required prior to beginning therapy

119
Q

What can be given to minimize the toxicity of fluorouracil?

A

calcium leucovorin (same as methotrexate)

120
Q

What treats blast crisis in cancer patients? What do you monitor?

A

Hydroxyurea- can also be used to treat sickle cell

Monitor LFTs

121
Q

What is a potent immunosuppressant used in RA and SLE?

A

cyclophosphamide

122
Q

What cancer meds cause hemorrhagic cystitis? (there are two)

A
  • cyclophorphamide

- ifosfamide

123
Q

What cancer med has long term use associated with secondary acute leukemia?

A

Chlorambucil

124
Q

List some platinum compounds. Which is the most potent?

A

Cisplatin, carboplatin, oxaliplatin

- Cisplatin is the most potent

125
Q

What cancer meds cause profound N/V? What do you monitor?

A

the platinum compounds. Monitor electrolytes!

126
Q

What cancer drugs are nephrotoxic? What do you give for treatment?

A

Platinum compounds

Give mannitol to rapidly eliminate the drug

127
Q

What cancer med causes pulmonary fibrosis and requires baseline PFTs? At what point does this side effect occur?

A

Busulfan- usual onset is 3 years after initiation of treatment

128
Q

What is the average survival in a patient with pulmonary fibrosis?

A

5 months

129
Q

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?

A

Nope- it can be made into a suspension by a speciality pharmacist

130
Q

Big ADR of anthracycline drugs? Treatment?

A

Cardiotoxicity

- treated with Dexrazoxane

131
Q

What ADR do these three drugs have in common?- Methotrexate, flourouracil, daunorubacin

A

mucositis

132
Q

Antidote for daunorubacin?

A

dexrazoxane

133
Q

134

ADRs of bleomycin?

A

pulmonary toxicities, very little myelosuppression, mucocutaneous reactions

134
Q

You have a patient on dactinomycin. What can they not receive while on this treatment?

A

Radiation- it will potentiate effects

135
Q

6

ADR of vincristine

A

causes dose limiting neurotoxicity

136
Q

ADR of paclitaxel and docetaxel (taxanes)

A

infusion reactions

can cause extreme neuropathies

137
Q

Irinotecan can produce significant _____?

A

diarrhea

138
Q

What reaction do we worry about with monoclonal antibodies?

A

infusion reaction

139
Q

ADR of trastuxumab

A

cardiotoxic

140
Q

Can all cancer patients succeed with any of the monoclonal antibodies?

A

NO- they aren’t one size fits all. All specific for genotypes and phenotypes

141
Q

What reaction can cetuximab have on the skin?

A

cause acne like skin rash

- can also have hypersensitivity during drug infusion

142
Q

What monoclonal antibody cause hemorrhage?

A

Bevacizumab

143
Q

You have a patient on mercaptopurine. How do you educate them on taking this drug?

A

taken orally without food because food will decrease absorption

144
Q

What type of interferon is used for kaposi sarcoma?

A

Interferon alpha 2B

145
Q

What is the only steroid that can treat delayed N/V?

A

Dexamethasone!

146
Q

Cancer patient on leuprolide for advanced prostate cancer. What else do you have to co-treat with for the first 2 weeks and why?

A

an androgen receptor blocker because causes transient flare initially

147
Q

What women can use tamoxifen as a selective estrogen receptor modulator?

A

pre or post menopausal woman! (only one for pre meno.)

148
Q

estrogen receptor modulator in post menopausal woman with breast cancer?

A

Toremifene

149
Q

Antibody to RSV?

A

Palvizumab

150
Q

ADR of cyclosporine and what does it interact with?

A

causes nephrotoxicity, hirsituism and gingival hyperplasia

metabolized by CYTP450 so interacts with erythromycin, azole antifungals, CCBs, grapefruit juice, macrolides

151
Q

You have a patient taking a H2 blocker who needs calcium supplementation. What do you recommend?

A

Ca citrate because it does not require stomach acid for absorption like CaCO3 does

152
Q

Before starting a bisphosphonate what do you have to make sure your body has enough of?

A

Ca

153
Q

What will calcium decrease the absorption of?

A

cipro, phenytoin, tetracyclines and others (dose apart by 2 hours)

154
Q

You are about to give a patient a bisphosphonate. What do you have to tell them about taking this pill?

A

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

155
Q

Half life of bisphosphonates?

A

10 years

156
Q

ADRs of bisphosphonates?

A

necrosis of the jaw

atypical femur fractures if on this for greater than 5 years

157
Q

Which bisphosphonate only take 3 months to work instead of the usual 6?

A

Tiludronate

158
Q

What do you have to monitor when on bisphosphonates?

A

Ca, vit. D, bone densité, sérum Cr (renally eliminated)

159
Q

What bisphosphonate was the first and can be used for steroid induced osteoporosis?

A

Alendronate

160
Q

Drug that has the off label use of speeding fracture healing?

A

Teriparatide

161
Q

What can stopping teriparatide do? What do you do about it?

A

can cause a period of rapid bone loss- follow up with a bisphosphonate

162
Q

which drug causes premature closure of growth plates?

A

anabolic steroids

J's ClinMed Deck (12 decks)

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