Unit 8 Endocrine pt. 3 ppt. slides

Question 0

Osteoporosis treatment :

Answer 0

Bisohosphonates
Hormones
Selective estrogen receptor modulators (SERMs)

Question 1

Alendronate sodium (Fosamax)
Risedronate (Actonel)
Ibandronate sodium (Boniva)
Zoledronic acid (Reclast 
are all examples of :

Answer 1

Bisphosponates

Osteoporosis tx.

Question 2

Mechanism of action of Bisposphonates:

Fosamax, Actonel, Boniva, Reclast

Answer 2

Inhibit activity of osteoclasts –> normalize rate of bone turnover –> indirectly increased BMD

Question 3

Mechanism of action of SERMs

Raloxifene (Evista)

Answer 3

Decrease reabsorption of bone

Decrease overall bone turnover

Question 4

Mechanism of action of hormones:

Calcitonin & Terioaratide

Answer 4

Calcitonin: naturally occuring in thyroid, blocks bone reabsorption via potent inhibition of osteoclasts

Teriparatide: synthetic human PTH, stimulates new bone formation via stimulation of osteoblastic activity

Question 5

Treatment principles of osteoporosis :

Answer 5

1. Reduce fracture risk (non pharmacological tx first if possible)
2. Bisposphonates (1st line tx)
3. Teriparatide (2nd line tx)
4. Calcitonin (reserved for unstable pts in tolerating other tx.s)
5. PTH ( severe osteoporosis and unresponsive)

Question 6

Nonpharmacological treatment of osteoporosis:

Answer 6

Calcium and Vitamin D supplementation
Weight baring exercises
Avoid tobacco and alcohol
Bone density testing

Question 7

How much calcium supplementation daily in osteoporosis pt?

Answer 7

> 1200 mg/day

Question 8

Mechanism of action Thyroid supplementation:

Levothyroxine sodium

Answer 8

Replacement of inadequate levels of endogenous T3 and T4. Supplementation increases basal metabolic rate and metabolism of carbohydrates, proteins and fats.

Question 9

Treatment of choice for hypothyroidism :

Answer 9

Levothyroxine

Titration q4-6 wk until normal TSH

Question 10

T/F Administration of thyroid hormone may exacerbate cardiovascular disease

Answer 10

True

Question 11

Patient education for hypothyroidism :

Answer 11

Response takes about 2 weeks
Lifelong therapy
Don’t abruptly stop med
Don’t change the brand name !

Question 12

Treatment principles for hyperthyroidism:

Answer 12

1. Radioactive iodine (first line)
2. Surgical intervention
3. Antithyroid drugs

Question 13

Preferred drug tx. for hyperthyroidism :

Answer 13

Methimazole

-longer acting and requires less frequent dosing schedule

Question 14

Preferred drug for hyperthyroidism in pregnancy ?

Answer 14

PTU

Watch for PTU hepatotoxicity in pediatrics

Question 15

Thyroid cancer recurrence, metastasis, or post surgical evaluation follow up may require the drug :

Answer 15

Thyrotropin (Thyrogen)

MOA: enhances sensitivity of thyroglobulin testing in patients maintained on thyroid hormone therapy

Question 16

Thyroid hormones can induce P-glycoprotein in the intestine resulting in diminished absorption of which drugs subject to P-gp efflux?

Answer 16

Immunosuppressants used with transplant patients
-the only drugs believed to be effected by the thyroid hormones.
Class 2 recommendation.
Monitor levels of substrate to assure adequate immunosuppression.

Question 17

What is the most accurate measure of vitamin D in humans ?

Answer 17

Calcidiol

Due to its long half life

Question 18

What is the primary function of vitamin D?

Answer 18

To facilitate absorption of calcium and phosphate from the bowel

Question 19

Drugs that can inactivate calcitriol (vitamin D supplement) and result in vitamin D deficiency are :

Answer 19

Antiepileptics: carbamazepine, clonazepam, phenobarbital, phenytoin, valproic acid
Glucocorticoids
Antiestrogens: SERMs

Question 20

Patients taking Bisposphonates with NSAIDs should be cautioned about the risk of :

Answer 20

G.I. Bleeding

Question 21

Bisposphonates, including denosumab won’t work without adequate amounts of :

Answer 21

Calcium and Vitamin D stores prior to use