Week 16: Endocrine Meds Flashcards

Question

ADRs of Cholecalciferol/Ergocalciferol

Answer 1

1. Hypercalcemia *Hypercalcemia causes - anorexia, NV, weakness, constipation, lethargy, depression, amnesia, disorientation, hallucination, syncope, diarrhea, vertigo, HA, polyuria, thirst ataxia*

Answer 2

Drug for renal patients on dialysis with hypocalcemia Increase GI absorption of Ca when you have renal disease It is already activated Vitamin D since the kidneys would normally do this

Answer 3

(Fish Form) Hypocalcemic Hormone (from thyroid)

Answer 4

Direct inhibition of osteoclasts Decreases tubular resorption leading to increased excretion of Ca

Answer 5

in diseases like osteoporosis, Pagets disease, or Hypercalcemia It is going to save the bones and inhibit resorption/osteroclast breakdown

Answer 6

PH will pull Ca from bone while Calcitonin keeps it in the bone

Answer 7

1. HYPOCALCEMIA (with tetany) Other: NV, allergy, tenderness and swelling of hands, flushing

Answer 8

IM - no more than 2 cc per site SubQ - no more than 1 cc

Answer 9

Bone resorption inhibitor, Biphosphonate

Answer 10

Inhibits osteoclast activity

Answer 11

Oral FOOD GREATLY DELAYS ABSORPTION

Answer 12

class fo drugs inhibiting osteoclast activity ex: Alendronate Sodium

Answer 13

1. *MOST ARE MILD - MAY HAVE SOME MILD GI DISTRESS, ULCERS, ESOPHAGITIS/ESOPHAGUS ULCER* 2. BRONJ ? JAW NECROSIS Other: A fib concerns (may be correlation not causation

Answer 14

Biphosphonate related osteonecrosis of the jaw There is concern with a higher incidence of bone death in the jaw / jaw necrosis with dental procedures when taking alendronate sodium

Answer 15

AT LEAST 30 minutes before FIRST intake of the day Taken with a full glass of water

Answer 16

you must not lay down (prevent esophagus ulcers)

Answer 17

This drug can stay in bones for a long time so sometimes people can take breaks from taking it

Answer 18

Thyroid Hormone Synthetic T4 (which converts to T3 in the body)

Answer 19

1. Regulate growth/dev through control of PROTEIN SYN 2. Calorigenic effect - increase metabolic rate 3. Metabolic - increase metabolic rate by various modes 4. Inhibition of thyrotropin secretion by pituitary

Answer 20

Oral Food delays absorption - give on empty stomach

Answer 21

it is used as hypothyroidism hormone replacement therapy treatment for this is lifelong

Answer 22

(Look like Hyperthyroidism) 1. CNS - Nervous, insomnia 2. CV - arrhythmia, palpitation 3. GI - WEIGHT LOSS, cramp, diarrhea 4. GU - menstrual irregularities OVERDRIVE OF SNS

Answer 23

anticoagulants

Answer 24

patients with heart disease, esp. coronary insufficiency patients with diabetes patients on tricyclic antidepressants

Answer 25

calcium carbonate (TUMS and other local antacids)

Answer 26

thyroid hormone is given in mcg (tiny doses)

Answer 27

TSH (Thyroid Stimulating Hormone) will be high

Answer 28

Radioactive Thyroid Hormone

Answer 29

Destroy thyroid tissue mainly through Beta rats Goal to produce clinical remission without complete thyroid destruction - in hyperthyroidism/Graves dx

Answer 30

1. DELAYED HYPOTHYROIDISM (10% a year after) Other: Depressed hematopoietic system, anemia, thyroiditis

Answer 31

since it is uptook by the thyroid gland it can be given in miniscule non damaging amounts for diagnostic purposes

Answer 32

Pregnant Patients children lactating patients

Answer 33

drug used for management of hyperglycemia by promoting cellular uptake of glucose varies in onset peak and duration of action

Answer 34

Mostly IV, SubQ, IM - does have inhaled version but iffy rn

Answer 35

increase cellular uptake of amino acids, glucose, and other monosaccharides

Answer 36

It is inactivated by gastric enzymes so must be given subcu or IV

Answer 37

1. HYPOGLYCEMIA (most common) 2. ALLERGIC MANIFESTATIONS (if from an animal rather than synthetic source) 3. INSULIN RESISTANCE DEVELOPMENT

Answer 38

it will only occur in Type 2 diabetics probably due to development of antibodies

Answer 39

yes, it does not cross membranes

Answer 40

hypoglycemia

Answer 41

hyperglycemia

Answer 42

mealtime insulins

Answer 43

fast acting and short lasting

Answer 44

intermediate acting insulin works in 8-10 hours appears as a cloudy / milky suspension

Answer 45

Insulin Glargine/Detemir Not a real peak, a flat level in the body given once daily and never mixed with other insulins

Answer 46

Biguanide Oral Hypoglycemic

Answer 47

decreases hepatic glc production and intestinal absorption of glucose also increases peripheral glucose intake

Answer 48

Oral Route - ER form absorbed v slowly Often given in 1500-2550 mg PO in divided doses

Answer 49

1. GI EFFECTS (Metal Taste, NV, Abdominal pain, Mod Weight Loss) 2. LACTIC ACIDOSIS Other: Cognitive decline?

Answer 50

if someone has a kidney issue and getting dye studied, they can end up with renal impairment and lactic acidosis So metformin should cease 48 hours prior to dye study and resume 48 hours after

Answer 51

Lactic Acidosis in Dye Studied Renal Impairment if Metformin not discontinued 48 hours prior and 48 hours after

Answer 52

NO in most cases

Answer 53

Insulin Sensitizer, Antidiabetic Agent, Thiazolidinedione (TZD)

Answer 54

part of the TZD/Thiazolidinedione family

Answer 55

increases ability of target cells to respond to insulin (DECREASES INSULIN RESISTANCE)

Answer 56

Oral - rapidly absorbed Food may increase absorption!!!

Answer 57

Nothing to dreadful!: URI, HA, Sinusitis, Myalgia, lower TG levels, Raised LDL AND HDL IN THE BACK OF THE MIND KEEP LIVER AND HEART CONCERNS

Answer 58

Rosiglitazone was not recommended because of risk of MI and CVA The first ever glitazone was troglitazone and causes hepatic failure

Answer 59

Corticosteroid (Glucocorticoids)

Answer 60

release in the stress response role in inflammation, immune response, protein, fat and carbohydrate metabolism

Answer 61

glucocorticoid (corticosteroid)

Answer 62

1. Anti Inflammatory 2. Maintenance of normal BP 3. Carbohydrate and Protein Metabolism 4. Fat Metabolism 5. Immunosuppressive 6. Stress Effects 7. Anti-diuretic 8. CNS effects

Answer 63

stabilize lysosomal membrane to inhibit proteolytic enzyme release during inflammaation MAJOR anti inflammatory group

Answer 64

potentiate vasoconstrictor action of NEP - help keep vessels constricted MINOR EFFECT

Answer 65

Facilitate muscle and extrahepatic tissue breakdown increasing plasma AA levels Increase AA trapping by liver and deaminate them Increase enzyme activity important to gluconeogenesis and inhibit glycolytic enzymes MAJOR: BREAKDOWN MUSCLES LEADING TO AA RELEASE TO FORM GLUCOSE - THIS IS WHY GLUCOCORTICOIDS LEAD TO INCREASED GLUCOSE LEVEL WITH MUSCLE ATROPHY IN LONG TERM USE

Answer 66

Promote mobilization of FA from adipose tissue Long term therapy will redistribute fat to neck, back, face, supraclavicular area, and decrease it in extremeties

Answer 67

Thymolytic, Lymphocytic, and eosinopenia actions - as well as atrophy of thymus and decrease # of lymphocytes, plasma cells, and eosinophils in blood Decrease rate of conversion of lymphocytes into antibodies This and the anti inflammatory action make them GREAT IMMUNOSUPPRESSANTS AND ANTI ALLERGENICS

Answer 68

during stress, acute release of corticosteroids occurs leading to synergistic action of catecholamines

Answer 69

Not as strong as a mineralo-corticoid (aldosterone) Acts on distal tubules of kidney (ENHANCE REABSORPTION OF Na from TUBULAR FLUID) INCREASE URINARY EXCRETION OF BOTH K AND H IONS - not as strong as aldosterone but you retain fluid

Answer 70

AFFECTS MOOD (euphoria, excitation, depression) Potential steroid psychosis (eager, active, hungry, hyper)_

Answer 71

Oral, IM, IV Topical

Answer 72

adrenal deficiency

Answer 73

anti-inflammatory and immunosuppressant therapy

Answer 74

the most common long term corticosteroid

Answer 75

THEY ARE HUGE Common for systemic symptoms from long time use but can even occur in shorter term use where chronic issues appear

Answer 76

Delay in wound healing (Immunosuppression) GI Ulceration and Perforation (disrupts lining) Amenorrhea Disorders of calcium metabolism (long term use suppresses bone formation and boosts resorption) Cushings Syndrome/Hypercortisolism (Hump back, moon face, hirsutism, acne, water and Na retention, edema, restlessness, insomnia, euphoria, manic states) Decreased resistance to infection Masking of symptoms of inflammation and infection Weakness Striae Thin Friable Skin Lyte imbalances Increased lymphoma (cancer) changes higher cataract incident can precipitate diabetes in the susceptible Withdrawal issues Resp issues in premautre infants

Answer 77

no they cross the BBB

Answer 78

anti rejection drugs

Answer 79

adrenal gland wont be ready to go back to making cortisol leading to severe adrenal insufficiency

Answer 80

infection, dehiscence, and evisceration

Answer 81

the effect on Na retention and K excretion is much less than aldosterone

Answer 82

Androgen Hormone (Primary Male Sex Hormone)

Answer 83

fxns as a stimulator to promote and maintain male secondary sex characteristics Powerful anabolic agent- stimulates formation and maintenance of muscular and skeletal protein and nitrogen retention

Answer 84

Oral - rapid absorption - but actively inactivated by the liver - SO NOT GIVEN ORALLY Sublingual will bypass the liver

Answer 85

yes it is schedule III

Answer 86

they can have masculazation rapidly and easy

Answer 87

1. LIVER TOXICITY 2. HYPERCALCEMIA 3. CHOLESTEROL ELEVATION Other: Retention of Na and water, Nausea, Lipid disorder, HTN from water and Na

Answer 88

deepening of voice hirsutism flushing acne regression of breasts enlargement of clitoris general masculinization

Answer 89

it decreases secretion of Ca so the levels of Ca are rising

Answer 90

liver function

Answer 91

prostate cancer serious cardiorenal dysfunction pregnancy

Answer 92

Progestin Hormone "The Hormone of Pregnancy"

Answer 93

Exact mechanism not completely known but it does bind to cell receptors and causes reproductive effects

Answer 94

1. INHIBIT OVULATION (decrease LH and FSH release) 2. Induce biochem changes in endometrium in prep for fert egg implant 3. CAUSE CERVICAL MUCUS TO BECOME STICKY AND VISCOUS 4. decrease sensitivity of uterus to oxytocin 5. facilitate dev of secretory apparatus in mammary glands 6. increase body temp 7. elevate basal insulin levels and potentiate response to glc 8. promote hepatic glycogen storage and ketogenesis 9. decrease plasma levels of AA

Answer 95

it is preparing the endometrium for implantation it also is decreasing uterine contractions to maintain the endometrium and making thick sticky mucus

Answer 96

first pass

Answer 97

Parenteral - but too rapid to maintain efficiency Oral - less effective

Answer 98

Hormonal ADRs

Answer 99

drowsiness GI Symptoms HA Dizziness Allergic Response Irregular Vaginal Bleeding Photosensitivity Retinal Damage CV Complications Prolonged High Dose: Edema, Weight gain via fluid retention, vertigo, oligomenorrhea, breast congestion, hirsutism, rash, depression, migraine

Answer 100

as a part of contraception with estrogen Can also be sued for amenorrhea, threatened abortion, dysmenorrhea, endometriosis

Answer 101

to counteract the adverse estrogen effects stimulation of the uterus via estrogen replacement could cause endometrial cancer if uterus is still present so this will counteract it

Answer 102

Synthetic Progesterone Like For deficiencies, dysfunctional uterine bleeding, an amenorrhea If combined with estrogen it will help prevent endometrial cancer BUT increase breast, and ovarian cancer risk and heart disease risk

Answer 103

Estrogen Hormone Comes from urine of pregnant mare

Answer 104

estrogen replacement

Answer 105

Stimulate Female Characteristics 1. Reproductive 2. Metabolic 3. Blood coagulation

Answer 106

1. FACILITATE OVULATION (increase LH release) 2. DECREASE RELEASE OF FSH (through negative feedback) 3. Stimulate development of endometrium 4. promote growth and cornification of vaginal epithelium 5. increase sensitivity of uterus to oxytocin 6. promote development of duct system in mammary glands

Answer 107

1. DECREASE BONE RESORPTION RATE (DECREASES BREAKDOWN SO WOMEN ARE NOT AS PRONE TO OSTEOPOROSIS UNTIL AFTER MENOPAUSE) 2. Increase protein synthesis 3. accelerate closure of epiphyses 4. increase serum triglycerides, and HDL 5. decrease serum cholesterol and LDL 6. enhance sodium and water retention 7. increase blood glucose (anti insulin action)

Answer 108

1. INCREASES LEVELS OF VITAMIN K DEPENDENT CLOTTING FACTORS 2. PROBABLY INCREASES PLATELET AGGREGATION 3. PROMOTES FORMATION OF BLOOD CLOTS

Answer 109

Oral - prompt and complete Also parenteral, topical, or vaginal

Answer 110

HORMONAL ADR: (Similar to progesterone): Nausea, Anorexia (like morning sickness), Increased feminine characteristics, fluid retention, break through bleeding, changes in menstrual flow, breast tenderness, irritability, depression, HTN, HA, Cancer (ovarian and breast fed by estrogen), gallbladder disease STRONG RELATIONSHIP TO EMBOLIC DISEASE (BLOOD CLOT ISSUES LIKE STROKE OR MI)

Answer 111

menopausal symptoms or dysfunctional uterine bleeding

Answer 112

Estrogen Dependent Cancers (Breast, Ovarian, anything with estrogen receptors) Undiagnosed Vaginal Bleeding (could be endometrial cancer) Thrombus or Thromboembolic Dissorders (estrogen already promotes blood clots)

Answer 113

in post menopausal women this increases risk for uterine cancer because it will thicken the endometriumd leading to cancer

Answer 114

C. 10-15 min before a meal

Answer 115

A. 3-4 hours

Answer 116

C. Immune System Compromise