Week 6_7 reverse cards Flashcards by Amalia Gedney-Lose

Prednisone binds to glucocorticoid receptors, influencing gene transcription to increase anti-inflammatory proteins and suppress pro-inflammatory mediators.

Prednisone - Mechanism of Action

How well did you know this?

Not at all

Perfectly

Dexamethasone binds to glucocorticoid receptors, modifying gene transcription and exerting potent anti-inflammatory and immunosuppressive effects.

Dexamethasone - Mechanism of Action

How well did you know this?

Not at all

Perfectly

Hydrocortisone binds to glucocorticoid receptors, altering gene transcription to suppress inflammation and immune responses.

Hydrocortisone - Mechanism of Action

How well did you know this?

Not at all

Perfectly

Prednisone is a prodrug, converted to active prednisolone in the liver; it has a moderate mineralocorticoid effect and a biological half-life of 18-36 hours.

Prednisone - Pharmacokinetics

How well did you know this?

Not at all

Perfectly

Dexamethasone has a long half-life of 36-54 hours with high glucocorticoid and negligible mineralocorticoid activity; cleared primarily by hepatic metabolism.

Dexamethasone - Pharmacokinetics

How well did you know this?

Not at all

Perfectly

Hydrocortisone has a biological half-life of 8-12 hours, significant mineralocorticoid activity, and moderate glucocorticoid potency; cleared hepatically.

Hydrocortisone - Pharmacokinetics

How well did you know this?

Not at all

Perfectly

Prednisone can cause hypokalemia, especially with potassium-depleting diuretics and digoxin. It increases hyperglycemia risk and interacts with NSAIDs and vaccines.

Prednisone - Drug Interactions

How well did you know this?

Not at all

Perfectly

Dexamethasone interacts with potassium-depleting drugs, NSAIDs (GI bleeding), hypoglycemics (hyperglycemia), and vaccines (reduced response).

Dexamethasone - Drug Interactions

How well did you know this?

Not at all

Perfectly

Hydrocortisone interacts similarly with NSAIDs, diuretics, and digoxin; risk for adrenal suppression with abrupt discontinuation.

Hydrocortisone - Drug Interactions

How well did you know this?

Not at all

Perfectly

Prednisone’s adverse effects include osteoporosis, hyperglycemia, infection susceptibility, delayed wound healing, and adrenal suppression with prolonged use.

Prednisone - Adverse Effects

How well did you know this?

Not at all

Perfectly

Dexamethasone can cause muscle weakness, hyperglycemia, mood changes, immune suppression, cataracts, and peptic ulcers with prolonged use.

Dexamethasone - Adverse Effects

How well did you know this?

Not at all

Perfectly

Hydrocortisone’s adverse effects include significant sodium retention, potassium loss, hypertension, and GI disturbances.

Hydrocortisone - Adverse Effects

How well did you know this?

Not at all

Perfectly

Prednisone is used for inflammatory, autoimmune, and allergic conditions; also in transplant rejection prevention and as part of cancer therapy.

Prednisone - Therapeutic Use

How well did you know this?

Not at all

Perfectly

Dexamethasone is used for severe inflammation, cerebral edema, respiratory distress syndrome, and diagnostic testing for Cushing syndrome.

Dexamethasone - Therapeutic Use

How well did you know this?

Not at all

Perfectly

Hydrocortisone is used for adrenal insufficiency, allergic reactions, and inflammatory conditions with balanced glucocorticoid and mineralocorticoid effects.

Hydrocortisone - Therapeutic Use

How well did you know this?

Not at all

Perfectly

Prednisone is contraindicated in systemic fungal infections and live virus vaccination; caution in diabetes, osteoporosis, and infections.

Prednisone - Contraindications

How well did you know this?

Not at all

Perfectly

Dexamethasone is contraindicated in systemic fungal infections and live vaccines; use caution in hypertension, diabetes, and pediatric patients.

Dexamethasone - Contraindications

How well did you know this?

Not at all

Perfectly

Hydrocortisone is contraindicated in systemic fungal infections; caution in patients with renal or cardiac impairments.

Hydrocortisone - Contraindications

How well did you know this?

Not at all

Perfectly

Monitor blood glucose, bone density, potassium levels, and signs of infection during long-term prednisone use.

Prednisone - Monitoring

How well did you know this?

Not at all

Perfectly

Monitor glucose levels, signs of adrenal suppression, infection, and psychologic disturbances with dexamethasone.

Dexamethasone - Monitoring

How well did you know this?

Not at all

Perfectly

Monitor electrolyte balance, fluid retention, glucose levels, and adrenal function during hydrocortisone therapy.

Hydrocortisone - Monitoring

How well did you know this?

Not at all

Perfectly

Prednisone carries no black box warning but risks adrenal insufficiency, especially if discontinued abruptly after long-term use.

Prednisone - Black Box Warning

How well did you know this?

Not at all

Perfectly

Dexamethasone carries no black box warning but requires tapering after prolonged use to prevent adrenal crisis.

Dexamethasone - Black Box Warning

How well did you know this?

Not at all

Perfectly

Hydrocortisone carries no black box warning but long-term use can cause adrenal insufficiency and significant fluid retention.

Hydrocortisone - Black Box Warning

How well did you know this?

Not at all

Perfectly

Mimics natural insulin release, rapidly lowering blood glucose by promoting glucose uptake in muscle and fat tissues.

Rapid-Acting Insulin - Mechanism of Action

Promotes glucose uptake into tissues; regular insulin is used for mealtime glucose control and emergencies.

Short-Acting Insulin - Mechanism of Action

NPH insulin provides prolonged basal glucose control by delaying absorption.

Intermediate-Acting Insulin - Mechanism of Action

Degludec, detemir, and glargine provide steady, long-term glucose regulation with minimal peaks.

Long-Acting Insulin - Mechanism of Action

Reduces hepatic gluconeogenesis, improves peripheral insulin sensitivity, and slows intestinal glucose absorption.

Metformin - Mechanism of Action

Enhances insulin secretion, slows gastric emptying, increases satiety, and suppresses glucagon secretion.

GLP-1 Receptor Agonists - Mechanism of Action

Inhibits renal glucose reabsorption, increasing urinary glucose excretion to lower blood glucose.

SGLT-2 Inhibitors - Mechanism of Action

Inhibits DPP-4 enzyme, prolonging incretin hormone activity, enhancing insulin release, and suppressing glucagon.

DPP-4 Inhibitors - Mechanism of Action

Stimulates pancreatic beta cells to release insulin by blocking ATP-sensitive K+ channels, reducing glucose levels.

Sulfonylureas - Mechanism of Action

Activates PPAR-y receptors, improving insulin sensitivity in adipose tissue, liver, and skeletal muscle.

Thiazolidinediones (TZDs) - Mechanism of Action

Onset: 10-30 min; peak: 1-3 hr; duration: 3-5 hr. Examples: insulin lispro, aspart, glulisine.

Rapid-Acting Insulin - Pharmacokinetics

Long duration (up to 24-42 hours), no pronounced peak, providing steady glucose control.

Long-Acting Insulin - Pharmacokinetics

Well absorbed orally, not metabolized, excreted via kidneys as unchanged drug.

Metformin - Pharmacokinetics

Subcutaneous injection; long-acting forms (dulaglutide, semaglutide) dosed weekly; short-acting daily.

GLP-1 Receptor Agonists - Pharmacokinetics

Metabolized via glucuronidation; contraindicated in severe renal dysfunction.

SGLT-2 Inhibitors - Pharmacokinetics

Well absorbed; saxagliptin metabolized via CYP3A4; linagliptin excreted via enterohepatic system.

DPP-4 Inhibitors - Pharmacokinetics

Oral absorption, metabolized in liver, excreted in urine/feces. Duration: 12-24 hours.

Sulfonylureas - Pharmacokinetics

Extensive metabolism via CYP2C8; pioglitazone excreted via bile; rosiglitazone excreted renally.

TZDs - Pharmacokinetics

GI issues (nausea, diarrhea); risk of lactic acidosis in renal impairment. Monitor renal function.

Metformin - Adverse Effects

GI effects (nausea, vomiting); risk of pancreatitis; contraindicated in medullary thyroid cancer.

GLP-1 Receptor Agonists - Adverse Effects

UTIs, genital mycotic infections, hypotension due to osmotic diuresis; rare: ketoacidosis, fractures.

SGLT-2 Inhibitors - Adverse Effects

Hypoglycemia, weight gain, increased risk in renal/hepatic impairment.

Sulfonylureas - Adverse Effects

Weight gain, fluid retention, risk of fractures; contraindicated in symptomatic heart failure.

TZDs - Adverse Effects

Type 2 diabetes management; cardiovascular benefits; some forms approved for obesity.

GLP-1 Receptor Agonists - Therapeutic Use

Severe renal impairment; therapy depends on adequate kidney function.

SGLT-2 Inhibitors - Contraindications

Contraindicated in severe renal dysfunction (eGFR <30 mL/min); risk of lactic acidosis.

Metformin - Contraindications

Estrogen inhibits FSH release, preventing follicular development. Progestin suppresses LH, preventing ovulation, and thickens cervical mucus to hinder sperm movement.

Combination Oral Contraceptives (COCs) - Mechanism of Action

Progestin thickens cervical mucus to prevent sperm penetration and suppresses LH secretion, inhibiting ovulation.

Progestin-Only Pills - Mechanism of Action

Progestin suppresses ovulation, thickens cervical mucus, and alters the endometrium to prevent implantation.

Medroxyprogesterone Injection - Mechanism of Action

A subdermal progestin implant prevents ovulation and thickens cervical mucus, providing contraception for up to 3 years.

Etonogestrel Implant - Mechanism of Action

Releases progestin locally, thickening cervical mucus, thinning the endometrium, and inhibiting sperm mobility.

Levonorgestrel IUD - Mechanism of Action

Ethinyl estradiol and progestin undergo hepatic metabolism; synthetic forms resist first-pass metabolism for prolonged action.

Combination Oral Contraceptives - Pharmacokinetics

Rapidly metabolized in the liver, requiring daily administration for effectiveness.

Progestin-Only Pills - Pharmacokinetics

Provides high sustained progestin levels with a long half-life (40-50 days), ensuring efficacy for 3 months per injection.

Medroxyprogesterone Injection - Pharmacokinetics

CYP3A4 inducers like rifampin and carbamazepine reduce efficacy. Antibiotics may interfere with enterohepatic recycling of estrogen.

Combination Oral Contraceptives - Drug Interactions

Common effects include nausea, breast fullness, headache, fluid retention, and increased blood pressure. Severe risks: thromboembolism, MI, and stroke.

Combination Oral Contraceptives - Adverse Effects

Irregular bleeding, headache, and reduced efficacy compared to combination oral contraceptives.

Progestin-Only Pills - Adverse Effects

Weight gain, bone loss (osteoporosis risk), delayed return to fertility post-discontinuation.

Medroxyprogesterone Injection - Adverse Effects

Irregular bleeding and headaches; efficacy may decrease in women >130% ideal body weight.

Levonorgestrel IUD - Adverse Effects

Contraindicated in thromboembolic disease, estrogen-dependent cancers, liver disease, and pregnancy.

Combination Oral Contraceptives - Contraindications

Not recommended in women with BMI â‰¥ 30 kg/mÂ² due to increased venous thromboembolism risk.

Transdermal Patch - Contraindications

Avoid in patients with pelvic inflammatory disease or a history of ectopic pregnancy.

Levonorgestrel IUD - Contraindications

Monitor for adverse effects like thromboembolism, breakthrough bleeding, and blood pressure elevation.

Combination Oral Contraceptives - Monitoring

Monitor bone mineral density for long-term users due to osteoporosis risk.

Medroxyprogesterone Injection - Monitoring

Long-term contraception and treatment for heavy menstrual bleeding.

Levonorgestrel IUD - Therapeutic Use

Postcoital contraception: single high dose of levonorgestrel within 72 hours or ulipristal within 5 days. Copper IUD effective within 5 days.

Emergency Contraception - Therapeutic Use

Increased risk of thromboembolism, especially in women over 35 who smoke.

Combination Oral Contraceptives - Black Box Warning

Black box warning for significant bone loss with prolonged use beyond 2 years.

Medroxyprogesterone Injection - Black Box Warning

Levothyroxine (T4) is converted into active T3 in tissues, which binds to nuclear receptors, modulating gene expression and restoring normal metabolism.

Levothyroxine - Mechanism of Action

Liothyronine (T3) directly binds nuclear receptors, stimulating gene transcription and rapidly improving hypothyroid symptoms.

Liothyronine - Mechanism of Action

Inhibits thyroid peroxidase, blocking iodination and coupling of tyrosines, preventing T3/T4 synthesis.

Methimazole - Mechanism of Action

Blocks thyroid peroxidase and inhibits peripheral conversion of T4 to T3, reducing thyroid hormone levels.

Propylthiouracil (PTU) - Mechanism of Action

Absorbed orally but reduced by food, calcium, and iron. Metabolized via deiodination; long half-life (7-10 days), allowing once-daily dosing.

Levothyroxine - Pharmacokinetics

Longer half-life than PTU (6-13 hours), enabling once-daily dosing; metabolized hepatically.

Methimazole - Pharmacokinetics

Shorter half-life than methimazole; metabolized in the liver, requires multiple daily doses.

Propylthiouracil (PTU) - Pharmacokinetics

CYP450 inducers (e.g., rifampin, phenytoin) increase metabolism of levothyroxine, reducing efficacy.

Levothyroxine - Drug Interactions

Minimal drug interactions compared to PTU; fewer effects on CYP450 enzymes.

Methimazole - Drug Interactions

Overdose mimics hyperthyroidism, causing tachycardia, heat intolerance, weight loss, and nervousness.

Levothyroxine - Adverse Effects

Common: rash, pruritus. Severe: agranulocytosis and hepatotoxicity. Methimazole has a lower risk of hepatotoxicity than PTU.

Methimazole - Adverse Effects

Severe risk of hepatotoxicity and agranulocytosis; black box warning for liver failure.

Propylthiouracil (PTU) - Adverse Effects

First-line for hypothyroidism; preferred due to its stability, once-daily dosing, and predictable effects.

Levothyroxine - Therapeutic Use

First-line for hyperthyroidism except in pregnancy (first trimester); normalizes thyroid function within weeks.

Methimazole - Therapeutic Use

Used in hyperthyroidism during the first trimester of pregnancy due to lower teratogenic risk than methimazole.

Propylthiouracil (PTU) - Therapeutic Use

Contraindicated in untreated adrenal insufficiency and thyrotoxicosis; caution with cardiac disease.

Levothyroxine - Contraindications

Contraindicated in severe liver dysfunction; caution in pregnancy (except for second/third trimesters).

Methimazole - Contraindications

Monitor TSH levels 6-8 weeks after initiation or dose changes; assess symptom improvement.

Levothyroxine - Monitoring

Monitor for agranulocytosis (sore throat, fever) and liver function during treatment.

Methimazole - Monitoring

Treat with beta-blockers (e.g., propranolol) for sympathetic symptoms, thioamides (high-dose methimazole/PTU), and supportive care.

Thyroid Storm - Management