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Pharm 2 Jack > Test 3 > Flashcards

Test 3 Flashcards

1
Q

class of Levothyroxine/ Synthroid

A

Thyroid hormone replacement (synthetic T4) dosed in mcg.

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2
Q

ind. of Levothyroxine/ Synthroid

A

Hypothyroidism. Also TSH suppression in select cases of thyroid nodules and thyroid cancer.

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3
Q

MOA of Levothyroxine/ Synthroid

A

Replaces normal levels of T4 and T3 (T4 is converted into T3 in the periphery.)

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4
Q

side effects of Levothyroxine/ Synthroid

A

Toxicity directly related to thyroxine level and manifests as palpitations, tachycardia, intolerance to heat, and anxiety. Long term elevation of serum T4 may accelerate cardiac disease and osteoporosis.

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5
Q

drug where long term elevation of serum T4 may accelerate cardiac disease and osteoporosis.

A

Levothyroxine/ Synthroid

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6
Q

Normal ratio of T4:T3

A

4:1

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7
Q

thyroid med always dosed in micrograms (mcg)

A

Levothyroxine/ Synthroid

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8
Q

In patients that have Addison’s disease and hypothyroidism, what treatment can lead to death.

A

Thyroid replacement without first replacing cortisol can be fatal.

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9
Q

class of Thyroid USP/ Armour

A

Thyroid hormone (T4 and T3 as well as T2 and T1) obtained from desiccated animal thyroid gland

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10
Q

ind. of Thyroid USP/ Armour

A

hypothyroidism

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11
Q

MOA of Thyroid USP/ Armour

A

Replaces both T4 and T3

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12
Q

side effects of Thyroid USP/ Armour

A

Similar to those of Thyroxine/ Synthroid. Follow patient’s clinical response and serum TSH. Hold or reduce dose if any complaints of angina. Begin at low dose and advance dosage slowly in patients over age 65 or in any patients with history of coronary artery disease.

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13
Q

60 mg dose of Thyroid USP/ Armour is equal to how many grains

A

1 grain

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14
Q

60 mg dose of Thyroid USP/ Armour is equal to how many mcg of Synthroid

A

100 mcg Synthroid

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15
Q

drug that is standardized to iodine content

A

Thyroid USP/ Armour

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16
Q

class of Liothyronine/ Cytomel

A

Thyroid hormone replacement (synthetic T3) dosed in mcg.

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17
Q

ind. of Liothyronine/ Cytomel

A

Patients with hypothyroidism that have demonstrated intolerance to T4 replacement therapy or no improvement on T4 replacement therapy. Myxedema coma. Also used for “Wilson’s syndrome”.

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18
Q

MOA of Liothyronine/ Cytomel

A

Replaces T3

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19
Q

side effects of Liothyronine/ Cytomel

A

Similar to T4. Higher peaks and troughs of T3 may increase risk of coronary artery disease and osteoporosis.

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20
Q

60 mg Thyroid USP (Armour) ~ = how many mcg of T3

A

25 mcg of T3 (Cytomel)

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21
Q

25 mcg of T3 (Cytomel) is equal to how many mcg of T4 (Synthroid)

A

100 mcg of T4 (Synthroid)

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22
Q

class of Methimazole/ Tapazole

A

Thionamide

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23
Q

ind. of Methimazole/ Tapazole

A

Hyperthyroidism (Grave’s dis.) Can control hyperthyroidism until more definitive therapy (surgery or 131I therapy) is used. Patients may achieve a euthyroid state after treatment is discontinued. Treatment failure or recurrence of hyperthyroid state suggests that definitive treatment is necessary.

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24
Q

MOA of Methimazole/ Tapazole

A

Inhibits transformation of inorganic iodine to organic iodine, therefore blocking the production of thyroxine. Also inhibits the coupling of iodotyrosine to form T3 and T4. Minimal effect of blocking the peripheral conversion of T4 to T3

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25
Q

side effects of Methimazole/ Tapazole

A

May cause hypothyroidism. Rash, edema, arthralgias may occur. Agranulocytosis is the most feared side effect. Drug is usually not given beyond a 6-12 month period. Not given during pregnancy as it can cross the placenta.

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26
Q

Most feared side effects of Methimazole/ Tapazole

A

agranulocytosis

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27
Q

drug with minimal effect of blocking the peripheral conversion of T4 to T3

A

Methimazole/ Tapazole

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28
Q

class of Propylthiouracil (PTU)

A

thionamide

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29
Q

ind. of Propylthiouracil (PTU)

A

Hyperthyroidism (Grave’s disease) Can control hyperthyroidism until more definitive therapy (surgery or 131I therapy) is used. Patients may occasionally achieve a euthyroid state after treatment is discontinued.

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30
Q

MOA of Propylthiouracil (PTU)

A

Inhibits transformation of inorganic iodine to organic iodine, blocking the production of thyroxine and inhibits the coupling of iodotyrosine to form T3 and T4. Notable effect of blocking the peripheral conversion of T4 to T3.

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31
Q

side effects of Propylthiouracil (PTU)

A

May cause hypothyroidism. Rash, edema, arthralgias may occur. Agranulocytosis is the most feared side effect. Drug usually not given beyond a 6-12 month period. Category D but PTU is considered safer then Methimazole and is used in pregnancy when benefit outweighs potential risks.

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32
Q

drug with notable effect of blocking the peripheral conversion of T4 to T3.

A

Propylthiouracil (PTU)

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33
Q

class of Propranolol/ Inderal

A

Non selective beta blocker

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34
Q

ind. of Propranolol/ Inderal

A

Blockade of adrenergic symptoms of hyperthyroidism (i.e. tachycardia, anxiety). Emergent treatment of thyroid storm.

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35
Q

MOA of Propranolol/ Inderal

A

Beta-1 and Beta-2 receptor blockade

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36
Q

side effects of Propranolol/ Inderal

A

Fatigue, sedation, impotency or depression may be noted.

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37
Q

class of Iodine/ S.S.K.I.

A

elemental iodine

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38
Q

ind. of Iodine/ S.S.K.I.

A

hyperthyroidism, thyroid storm

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39
Q

MOA of Iodine/ S.S.K.I.

A

large doses of iodine inhibit the release of thyroxine from the thyroid gland.

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40
Q

side effects of Iodine/ S.S.K.I.

A

Rash, fever. Beneficial effects generally last no more then 2-3 weeks as thyroid gland appears to adapt and resumes secretion of thyroxine.

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41
Q

class of Radioactive iodine (131I)

A

Radioactive isotope

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42
Q

ind. of Radioactive iodine (131I)

A

Thyroid gland ablation in cases of Grave’s disease, thyroid nodules and in some cases of thyroid cancer.

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43
Q

MOA of Radioactive iodine (131I)

A

Radioactive emission of beta particles results in destruction of thyroid tissue.

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44
Q

side effects of Radioactive iodine (131I)

A

As previously noted. Most patients who have undergone radioactive iodine treatment for Grave’s disease will result in hypothyroid state requiring life long administration of thyroid hormone replacement. Men who receive RAI treatment for thyroid cancer may have decreased sperm counts and temporary infertility for periods of roughly two years. A physician may discuss sperm banking with a male patient who is expected to need several doses of RAI for thyroid cancer.

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45
Q

Radioiodine should never be used in a patient who is

A

Radioiodine should never be used in a patient who is pregnant. I-131 given during pregnancy can irreversibly damage the fetal thyroid tissue. When given to a nursing mother, radioactive iodine can reach a baby through the breast milk. Pregnancy should be delayed until at least six to 12 months after I-131 treatment, since the treatment exposes the ovaries to radiation.

Category X

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46
Q

signs of a thyroid storm

A

high fever, irritability, delirium, vomiting, diarrhea, dehydration, hypotension and vascular collapse

Coma and death may occur.

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47
Q

Treatment for thyroid storm

A

beta blockade as well as I.V. iodine to “stun” the thyroid gland’s ability to utilize iodine to synthesize thyroid hormone

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48
Q

level of fasting blood glucose to be DM

A

> 126

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49
Q

class of Metformin

A

biguanides

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50
Q

MOA of Metformin

A

decreases hepatic glucose production and to a lesser extent, enhances insulin sensitivity in skeletal muscles

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51
Q

drug that may cause weight loss

A

Metformin

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52
Q

common side effects of Metformin (know this)

A

Most common are abdominal cramping and nausea. Others include metallic taste and increased risk for development of B12 deficiency.

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53
Q

Most serious side effect of Metformin

A

lactic acidosis which is rare but can prove fatal. Risk is diminished by not using drug in patients with impaired renal function.

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54
Q

MOA of sulfonylureas

A

stimulate intact beta cells of the pancreas to release more insulin

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55
Q

1st generation Sulfonylureas

A

Chlorpropamide (Diabinese) and Tolbutamide (Orinase)

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56
Q

2nd generation Sulfonylureas

A

Glipizide (Glucotrol), Glyburide (Micronase, Diabeta), Glimerpiride (Amaryl)

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57
Q

most common adverse effects of sulfonylurea

A

hypoglycemia, particularly in patients with impaired renal or hepatic function. Weight gain as well.

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58
Q

As a general rule, all of the agents in the sulfonylurea class generally become ineffective in achieving glucose control after

A

5 to 10 years of use

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59
Q

sulfonylurea drug that appears to have a greater incidence of hypoglycemic events

A

Glyburide (Micronase)

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60
Q

MOA of Meglitinides

A

stimulate the beta cells to release insulin

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61
Q

Meglitinide drugs

A

Nateglinide (Starlix) and Repaglinide (Prandin).

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62
Q

side effects of Meglitinides

A

hypoglycemia and weight gain similar to Sulfonylureas

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63
Q

MOA of Thiazolidinediones/ Glitazones

A

The TZDs aka Glitazones improve insulin sensitivity in skeletal muscle cells, fat cells and liver cells and also decreases hepatic glucose production.

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64
Q

drug associated with CHF side effect

A

The cardiovascular safety of the TZDs particularly Avandia, is controversial.

Both Avandia and Actos increase the risk of congestive heart failure.

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65
Q

what tests should be performed with use of Glitazones

A

LFTs

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66
Q

Side effects of glitazones

A

reduced bone density, weight gain

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67
Q

Alpha-glucosidase inhibitors

A

Two alpha glucosidase inhibitors are available in the US, Acarbose (Precose) and Miglitol (Glyset).

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68
Q

What drugs classes do not cause blood glucose levels to fall below 60

A

Ubiquinides and alpha glucosidase inhibitors

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69
Q

MOA of Alpha-glucosidase inhibitors

A

These agents inhibit the alpha-glucosidase enzymes that line the brush border of the small intestine, interfering with hydrolysis of carbohydrates and delaying absorption of glucose and other monosaccharides.

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70
Q

side effects of Alpha-glucosidase inhibitors

A

Unabsorbed carbohydrates can cause abdominal pain, diarrhea and flatulence due to both osmotic effects and bacterial fermentation

Acarbose in high doses has been associated rarely with moderate transaminase elevations and although considered to be a rare event fatal hepatic failure has been reported with Acarbose.

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71
Q

In the event of hypoglycemia, oral treatment of patients taking Alpha-glucosidase inhibitor drugs must be

A

dosed with glucose rather than sucrose because alpha-glucosidase inhibitors interfere with the breakdown of sucrose

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72
Q

MOA of Sitagliptin/ Januvia

A

works to competitively inhibit the enzyme dipeptidyl peptidase 4 (DPP-4).

This enzyme breaks down the incretins GLP-1 and GIP, gastrointestinal hormones that are released in response to a meal.

By preventing GLP-1 and GIP inactivation, GLP-1 and GIP are able to potentiate the secretion of insulin and suppress the release of glucagon by the pancreas.

GLP-1 and GIP preservation drives blood glucose levels towards normal.

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73
Q

Key side effect of Sitagliptin/ Januvia

A

pancretitis

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74
Q

Two relatively new injectable drugs have recently been approved by the FDA for the treatment of type 1 and type 2 diabetes

A

Pramlintide/Symlin and Exenatide

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75
Q

Drug that is a synthetic form of the hormone amylin, which is produced along with insulin by the beta cells.

A

Pramlintide/Symlin

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76
Q

Drug that is a synthetic version of exendin-4, a naturally occurring hormone that was first isolated from the saliva of the Gila monster.

A

Exenatide

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77
Q

MOA of Pramlintide/Symlin

A

allows patients to use less insulin while lowering average blood sugar levels and also acts to substantially reduce the rise in blood sugar that usually occurs in diabetics immediately after meals.

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78
Q

class of Exenatide/ Byetta

A

incretin mimetics

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79
Q

MOA of Exenatide/ Byetta

A

acts to lower blood glucose levels primarily by increasing insulin secretion

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80
Q

Way that insulin cannot be taken

A

PO

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81
Q

Rapid acting insulin onset and duration

A 
Rapid acting insulins:
Humolog/ Lispro, Novolog/ Aspart
Onset: ≤0.25h
Peak: 0.5-1.5h
Duration 3-5h
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82
Q

short acting insulin onset and duration

A 
Short acting insulins:
Regular/ Humulin R
Onset: 0.5-1h
Peak: 2-4h
Duration: 5-8h
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83
Q

intermediate acting insulin onset and duration

A 
Intermediate acting insulin:
NPH/ Humulin N:
Onset: 1-3h
Peak: 7-9h
Duration: 12-18h
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84
Q

long acting insulin onset and duration

A 
Long acting insulins
Glargine/ Lantus
Onset: 1h
Peak: “flat”
Duration: 18-24h
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85
Q

Rapid acting insulin

A

Lispro/Aspart (Humulog/Novalog)

86
Q

Short acting insulin

A

Regular (Humulin R)

87
Q

Intermediate acting insulin

A

NPH (Humulin N)

88
Q

Long acting insulin

A

Glargine (Lantus)

89
Q

Common side effect and most feared side effect

A

Weight gain is common. Hypoglycemia is most feared.

Hypokalemia can also occur.

90
Q

Treatment for severe hypoglycemia

A

Glucagon is a potent hyperglycemic agent that is indicated for the treatment of severe hypoglycemia.

Glucose is always given first though.

91
Q

what is required for survival of all type 1 diabetics

A

insulin replacement

92
Q

while there is no consensus, studies show that this type of calcium may be best absorbed

A

calcium citrate

93
Q

what type of calcium has lead in it?

A

calcium obtained from oyster shell source

94
Q

recommended daily calcium for people less than 50

A

1000 mg/day

95
Q

recommended daily calcium for people over 50

A

1200-1500 mg/day

96
Q

recommended daily calcium for breast feeding women

A

2000 mg/day

97
Q

vit D recommendation for people age 1-70

A

600 IU (15 mcg)

98
Q

vit D recommendation for people age 70+

A

800 IU (20 mcg)

99
Q

prescription form of vit D

A

Calcitriol (Rocaltrol)

100
Q

average daily dose of magnesium

A

300-1000 mg

101
Q

dose of strontium to prevent osteoporosis

A

500 mg to 1 gram daily

102
Q

dose of strontium to treat osteoporosis

A

2 grams/day

103
Q

what happens if you take >2 grams/day strontium

A

may actually weaken bone by replacing too much calcium with strontium

104
Q

drug approved by FDA for both prevention and treatment of postmenopausal osteoporosis

A

Bisphosphonates such as Alendronate

105
Q

drug approved for prevention and treatment of osteoporosis

A

Raloxifene (Evista) is a selective estrogen receptor modulator which has been approved for both the prevention and treatment of osteoporosis.

106
Q

drug approved for treatment of osteoporosis but not for prevention

A

Calcitonin (Mialcin) has been approved for the treatment of osteoporosis but is not yet approved for osteoporosis prevention.

107
Q

Drug approved for the treatment of the disease in postmenopausal women and in men who are at high risk for fracture

A

Teriparatide, a synthetic PTH analogue is approved for the treatment of the disease in postmenopausal women and in men who are at high risk for fracture.

108
Q

Drug approved for prevention of postmenopausal osteoporosis

A

Estrogen/hormone replacement therapy (ET/HRT)

109
Q

What is Denosumab?

A

Denosumab is a human monoclonal antibody that was approved by the FDA at the end of 2010 for the treatment of osteoporosis.

110
Q

requirement for people taking bisphosphonates

A

they have to be able to stand for a period of time

111
Q

class of Alendronate/ Fosamax

A

Bisphosphonates

112
Q

ind. of Alendronate/ Fosamax

A

Prevention and treatment of osteoporosis

113
Q

MOA of Alendronate/ Fosamax

A

Inhibition of osteoclast activity

114
Q

side effects of Alendronate/ Fosamax

A

GI – especially stomach ache, heartburn, nausea and possible erosive esophagitis. It is generally recommended that bisphosphonates be taken on an empty stomach in the morning with 6 to 8 ounces of water (not juice or carbonated or mineral water). The patient should remain upright and not eat for 30 minutes after each dose. Osteonecrosis of the jaw (rare) has been reported. Atypical femur fractures (sub-trochanteric and shaft). Myalgias.

115
Q

key side effects of Alendronate/ Fosamax

A

Esophagitis. Osteonecrosis of the jaw. Atypical femur fractures.

116
Q

class of Raloxifene/ Evista

A

SERM (selective estrogen-receptor modulators)

117
Q

ind. of Raloxifene/ Evista

A

Increases bone mass and reduces the risk of vertebral fracture. Raloxifene has been shown to significantly reduce the incidence of breast cancer.

118
Q

MOA of Raloxifene/ Evista

A

Binding to select estrogen receptor sites. This drug developed to maintain beneficial estrogenic activity on bone and lipids and “anti-estrogenic” activity on endometrial and breast tissue

119
Q

side effects of Raloxifene/ Evista

A

Hot flashes, arthralgias, myalgias, edema, pruritis, small but definite increased risk for development of deep venous thrombosis (DVT). Evista is contraindicated in pregnant and lactating women and women with active or past history of venous thromboembolic events, including DVT, PE and retinal vein thrombosis

120
Q

class of Calcitonin/ Miacalcin

A

Synthetic hormone to ↑serum Ca2

121
Q

ind. of Calcitonin/ Miacalcin

A

treatment of osteoporosis

122
Q

MOA of Calcitonin/ Miacalcin

A

Inhibits osteoclastic activity

123
Q

side effects of Calcitonin/ Miacalcin

A

Nose bleeds and sinusitis noted with nasal spray. Both nasal spray and IV routes may cause headache, dizziness, edema, anorexia, diarrhea and skin rashes.

124
Q

drug for osteoporosis that is available in a nasal spray

A

Calcitonin/ Miacalcin

125
Q

class of Teriparatide/ Forteo

A

Synthetic PTH analogue that has been altered to have opposite effect of native PTH model.

126
Q

ind. of Teriparatide/ Forteo

A

Approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Shown to reduce the risk of vertebral and non-vertebral fractures in postmenopausal women. In men, Teriparatide reduces the risk of vertebral fractures but the effect on nonvertebral fractures is still being investigated.

127
Q

MOA of Teriparatide/ Forteo

A

Activates bone turnover with osteoblasts being activated to a much greater extant than osteoclasts. Stimulates new bone formation in both spine and hip.

128
Q

side effects of Teriparatide/ Forteo

A

The most commonly reported side effects are nausea, leg cramps and dizziness.

129
Q

what is given alongside Estrogen/HRT in order to potentially eliminate the increased risk for development of endometrial cancer

A

progestin

130
Q

MOA of Denosumab/ Prolia

A

Denosumab targets RANKL (the RANK ligand), a protein that acts as the primary signal to promote bone removal.

131
Q

drug class that randomly may lower risk of hip and other fractures

A

statin drugs

132
Q

most potent form of endogenous estrogen in women

A

estradiol…other major estrogen have 1/10 the potency

133
Q

if given orally, what limitation do naturally occurring estrogens have

A

first pass clearance by liver

134
Q

risks of exogenous hormone replacement

A

increased risk of stroke, blood clots, ovarian cancer, endometrial cancer, and breast cacner

135
Q

what is premarin?

A

conjugated estrogen…from urine of pregnant mares

136
Q

ind. of premarin

A

Prevention and treatment of osteoporosis and of post-menopausal symptoms such as hot flashes, vaginal dryness and itching.

137
Q

MOA Conjugated estrogens/ Premarin

A

alters gene transcription

138
Q

side effects of Conjugated estrogens/ Premarin

A

Vaginal bleeding, breast tenderness, increased risk of DVT, increased risk of atherosclerosis and coronary artery disease, increased risk for uterine and breast cancer.

Side effects that may occur with Premarin include breast pain, increased breast size, palpitations, fever, hives, hoarseness, joint pain, stiffness or swelling, rash, redness of skin, shortness of breath, wheezing, edema and weight gain.

139
Q

Premarin contraindications

A

Pregnancy, prior history of DVT, breast/ovarian/uterine cancer

140
Q

two most common uses of progestins

A

prevent endometrial hyperplasia and for hormonal contraception

141
Q

class of Medroxyprogesterone/Provera

A

Medroxyprogesterone acetate is a synthetic variant of progesterone.

142
Q

ind. of Medroxyprogesterone/Provera

A

Contraceptive, hormone replacement therapy, dysfunctional uterine bleeding and treatment of endometriosis.

143
Q

MOA of Medroxyprogesterone/Provera

A

Alters gene transcription.

144
Q

side effects of Medroxyprogesterone/Provera

A

Acne, weight gain, edema, breast tenderness, increased facial hair, insomnia, anxiety, weight loss or gain. Increases the ratio of LDL to HDL cholesterol and increases risk for DVT, Contraindicated if prior history of DVT or history of breast, ovarian or uterine cancer. Can cause birth defects if taken by pregnant women.

145
Q

side effects of oral contraceptives

A

Multiple potential side effects including increased risk for cardiovascular disease, DVT, hypertension and stroke (especially in women who smoke or who are over 35 years of age. Other side effects include acne, depression, headache, edema, nausea and breast fullness.

146
Q

The use of oral contraceptives for five years or more appears to decreases the risk of

A

ovarian cancer in later life by 50%

The risk reduction increases with duration of use, with an 80% reduction in risk for both ovarian and endometrial cancer with use for more than 10 years.

147
Q

Combined oral contraceptive use appears to reduce the risk of

A

ovarian cancer by 40% and the risk of endometrial cancer by 50% compared to non-users

The risk reduction increases with duration of use, with an 80% reduction in risk for both ovarian and endometrial cancer with use for more than 10 years.

148
Q

Several studies have shown that women who take contraceptive pills containing this drug have a 6- to 7-risk of developing thromboembolism compared to women who do not take any contraceptive pill, and twice the risk of women who take a contraceptive pill containing Levonorgestrel.

A

Drospirenone

149
Q

Depo-Provera has been shown to reduce the risk of

A

endometrial cancer by up to 80%.This reduced risk is thought to be due to both the direct anti-proliferative effect of a progestogen on the endometrium as well as the protective effects of reduction of estrogen levels by suppression of ovarian follicular development.

150
Q

side effects of Medroxyprogesterone acetate/ Depo-Provera I.M.

A

Side effects include possible menstrual irregularities (bleeding or amenorrhea or alterations between the two), abdominal discomfort, weight changes, headache, hair loss, fatigue, depression and nervousness.

Delayed return of fertility. The average return to fertility is 9 to 10 months after the last injection.

Depo-Provera has been shown to increase bone loss and increase the risk for the development of osteoporosis.

151
Q

why does Medroxyprogesterone acetate/ Depo-Provera I.M. have a black box warning

A

Due to concerns over bone loss, a black box warning was added to the package insert for Depo-Provera in 2004 stating the FDA recommendation that the drug not be used for longer than 2 years, unless there is no viable alternative method of contraception.

152
Q

MOA of Medroxyprogesterone acetate/ Depo-Provera I.M.

A

Depo-Provera and other high dose forms of progestin only contraceptives inhibit follicular development and prevent ovulation as their primary mechanism of action. High dose progestogens decrease the gonadotropin-releasing hormone (GnRH) release by the hypothalamus, which decreases the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by the anterior pituitary.

153
Q

progestin implant

A

Implanon

154
Q

transdermal patch for contraception

A

Ortho Evra

155
Q

the transdermal patch contains higher levels of

A

estrogen compared to most oral hormonal pills

156
Q

what reduces the efficacy of NuvaRing

A

accidentally expelled of left outside vagina for more than three hours

157
Q

most commonly reported adverse events with NuvaRing

A

vaginitis, headache, leucorrhea, nausea, weight gain

158
Q

Beyond the risks associated with combined oral contraceptives, NuvaRing is contraindicated for a risk of ____ that is specific to 3rd generation class of contraceptives.

A

blood clots

159
Q

IUD containing copper

A

ParaGard

160
Q

Three hormone containing IUDs

A

Mirena, Liletta, Skyla…each contains progestin and levonorgestrel in differing concentrations

161
Q

The non-copper IUD utilize what

A

long-acting synthetic progestin, levonorgestrel

162
Q

Mirena and Liletta have how much levonorgestral at initial placement and are marketed for having release rates of?

A

52 mg levonorgestral and release rate of 20 mcg/day

163
Q

Skyla has how much levonorgestral at initial placement and is marketed for having release rates of?

A

13.5 mg levonorgestral and release rate of 14 mcg/day

164
Q

class of Ulipristal acetate/Ella

A

Selective Progesterone Receptor Modulator (SPRM)

165
Q

what does Ulipristal acetate/Ella do and when is it given

A

Ulipristal acetate prevents pregnancy by delaying or inhibiting ovulation and inhibiting follicle rupture.

It is to be given within 120 hrs (5 days) after unprotected intercourse or contraceptive failure.

166
Q

Progestin-only emergency contraceptive is available as a contraceptive product under many names worldwide, including

A

Plan B and Next Choice…more effective than combo drugs

167
Q

what is Mifepristone/ Mifeprex

A

Mifepristone is a synthetic steroid compound used as an abortifacient in the first two months of pregnancy, and in smaller doses as an emergency contraceptive.

168
Q

MOA of Mifepristone/ Mifeprex

A

Mifepristone acts a progestin antagonist with partial agonist activity.

MOA is blockade of progesterone receptors (which when stimulated, normally sustain the endometrium) as well as causing a decline in human chorionic gonadotropin levels which in turn causes decreased production of progesterone by the corpus luteum.

169
Q

Risk with Mifepristone/ Mifeprex

A

Administration of Mifepristone during the 1st trimester of pregnancy results in abortion in ~85% of cases.

170
Q

Mifepristone is often used in conjunction with

A

Misoprostol (Cytotec), a prostaglandin E1 analog.

171
Q

Mifepristone use is contraindicated in

A

the presence of an intrauterine device (IUD), in cases of ectopic pregnancy, in patients with known hemorrhagic disorders or on anticoagulant therapy and patients on long term prednisone therapy.

172
Q

A characteristic that distinguishes selective estrogen receptor modulators from pure receptor agonists and antagonists is that

A

their action is different in various tissues, thereby granting the possibility of selectively inhibiting or stimulating estrogen-like action in various tissues.

173
Q

class of Clomiphene/ Clomid

A

Selective estrogen receptor modulator

174
Q

ind. of Clomiphene/ Clomid

A

infertility, amenorrhea

175
Q

MOA of Clomiphene/ Clomid

A

Binding to estrogen receptor sites in the brain interferes with the normal negative feedback of estrogen on gonadotropin releasing hormone (GnRH), which results in the increased secretion of GnRH. This causes an increased release of LH and FSH and stimulation of ovulation.

176
Q

side effects of Clomiphene/ Clomid

A

vaginal dryness, vaginal bleeding, breast tenderness, anxiety, hot flashes. Potentially contraindicated if prior history of liver disease, breast cancer or uterine cancer.

Multiple births is a known potential risk when using this drug.

177
Q

The mechanism of action of testosterone and all biologic and synthetic analogues of testosterone is

A

the alteration of gene transcription.

178
Q

interesting thing testosterone increases

A

RBC production

179
Q

ratio of androgenic to anabolic activity in exogenous testosterone preparations

A

1:1

180
Q

Older testosterone preparations which were formulated to be taken orally were found to increase the risk of

A

liver disease such as hepatitis and hepatic carcinoma.

181
Q

adverse effects of androgens in males

A

In males, excess androgens can cause acne, baldness, gynecomastia, priapism, increased risk of prostatic hyperplasia and prostatic cancer*, exacerbation of sleep apnea and result in reduced sperm count and infertility (due to negative feedback).

182
Q

adverse effects of androgens in females

A

In females, excess androgens can result in virilization such as excess body and facial hair, acne, deepening of voice, clitoral enlargement and menstrual irregularities.

183
Q

adverse effects of androgens in children

A

In children, excess androgens can cause abnormal rate of sexual maturation and can result in diminished height due to premature closing of growth plates.

184
Q

The unauthorized use high dose anabolic steroids by athletes has been documented to result in

A

different liver abnormalities, gynecomastia and breast cysts, cystic acne, premature epiphyseal plate closure and increased aggression (“roid rage”).

185
Q

Effect of androgens on cholesterol

A

Androgens increase serum LDL and lower serum HDL, therefore increasing the risk of atherosclerosis and coronary artery disease.

They are cause fluid retention and edema

186
Q

class of Testosterone

A

androgenic hormone

187
Q

ind. of Testosterone

A

Testosterone replacement for both androgenic and/or anabolic effects. See prior slides

188
Q

MOA of Testosterone

A

alters gene transcription

189
Q

The approved use of anabolic steroids include

A

refractory anemia, severe osteoporosis and severe wasting conditions such as AIDS and cancer.

190
Q

Anti-androgen treatment is most often utilized for the treatment of

A

advanced prostatic cancer.

191
Q

class of Leuprolide/ Lupron

A

Anti-androgenic hormone and anti-estrogenic hormone.

192
Q

ind. of

Leuprolide/ Lupron

A

Prostatic cancer, precocious puberty, endometriosis and uterine fibroids, as well as being part of some protocols of I.V.F.

193
Q

MOA of Leuprolide/ Lupron

A

Synthetic analog of gonadotropin releasing hormone (GnRH). Leuprolide interrupts production of both testosterone and estrogen.

194
Q

side effects of

Leuprolide/ Lupron

A

Decreased libido, impotence nausea, vomiting, hot flashes, night sweats, arthralgias, myalgias, osteoporosis.

195
Q

class of Finasteride/ Proscar

A

Anti-androgen

196
Q

ind. of Finasteride/ Proscar

A

Benign prostatic hyperplasia. In lower doses it is used to treat male-pattern baldness. In higher doses it is used to treat prostate cancer.

197
Q

MOA of Finasteride/ Proscar

A

Limits conversion of testosterone to dihydrotestosterone (DHT) by inhibiting type II 5-alpha reductase.

198
Q

side effects of Finasteride/ Proscar

A

Decreased libido, erectile dysfunction, impotency, depression, breast swelling and breast tenderness.

No blood donation is allowed while a patient is taking Proscar.

199
Q

drug where women who are or may potentially be pregnant must not use and should be instructed not to handle crushed or broken tablets because of the risk of birth defects.

A

Finasteride/ Proscar

200
Q

The two main medications for management of BPH are

A

5α-reductase inhibitors and the alpha blockers.

201
Q

Example of an alpha blocker

A

Tamsulosin (Flomax and Urimax)

202
Q

Common side effects of alpha blockers include

A

weakness, orthostatic HYPOTENSION and nasal congestion.

203
Q

class of Sildenafil citrate/ Viagra

A

PDE5 inhibitor

204
Q

ind. of Sildenafil citrate/ Viagra

A

ED, pulmonary hypertension

205
Q

MOA of Sildenafil citrate/ Viagra

A

Sildenafil is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5), which is responsible for the degradation of cGMP stores in the corpus cavernosum. When this occurs in the smooth muscle cells lining the blood vessels supplying the corpus cavernosum of the penis, blood remains in the cavernosum and thereby an erection is maintained.

Sildenafil does not generally cause an erection without sexual stimulation because there is lack of activation of the nitric oxide/cGMP system.

206
Q

Drug used for pulmonary hypertension

A

Sildenafil citrate/ Viagra

207
Q

when to take Sildenafil citrate/ Viagra

A

taken between 30 minutes and 4 hours prior to sexual intercourse.

208
Q

Contraindications to Sildenafil citrate/ Viagra

A

Not to be used by patients on nitric oxide donors, organic nitrites and nitrates, such as nitroglycerin and Isosorbide dinitrate.

In men for whom sexual intercourse is inadvisable due to cardiovascular risk factors such as recent stroke or heart attack

Severe impairment of liver or renal function

Hypotension

Hereditary degenerative retinal disorders

209
Q

adverse effects of Sildenafil citrate/ Viagra

A

The most common adverse effects of Sildenafil include headache, flushing, dyspepsia and nasal congestion.

Impaired vision, including photophobia and blurred vision, is also commonly reported.

Some Sildenafil users have complained of seeing everything in the visual field as being tinted blue (cyanopsia).

210
Q

Rare but serious adverse effects of Sildenafil citrate/ Viagra

A

Rare but serious adverse effects include increased intraocular pressure and acute angle closure glaucoma, ventricular arrhythmias, severe hypotension, myocardial infarction and stroke, as well as priapism.

Pharm 2 Jack (7 decks)

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