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Step 1 2019 First Aid Flashcards > Endo - Conrad Fischer Medquest Pharm > Flashcards

Endo - Conrad Fischer Medquest Pharm Flashcards

1
Q

SE of PTU and methimazole

A

neutropenia (agranulocytosis, aplastic anemia)

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2
Q

What rx is used as a adjunct to PTU/methimazole for a symptomatic hyperthyroid pt? and why?

A

Propranolol

used to (-) cardio tox (Afib Vtach) and HTN of the increased SNS activity

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3
Q

What is PTU effect on TSH, iodine avail, and target organ action by T3?

A

No effect on TSH, iodine avail, or target organ action by T3

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4
Q

PTU and methimazole has what MoA

A

(-) production and deiodination of T3

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5
Q

How is thyroid hormone stored in gland and transported?

A

Thyroglobulin storage in gland
Thryoid binding globulin transport in body

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6
Q

What proportion of T4 and T3 is made?

A

20 T4 : 1 T3

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7
Q

Inc T3 increases HR, BMR, etc, but what does it decrease?

A

period - hyperthyroidism leads to amenorrhea

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8
Q

What Rx works fastest in thyroid storm?

A

Propranolol

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9
Q

59 yr old man w/ prostate cancer @ ED w/ lethargy, constipation, and gen weakness for 4 days. Ca2+ = 14.5

What is the first step to Tx?

A

Hydration w. saline should fix the high Ca levels on its own, If they aren’t producing enough urine, add loop diuretic

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10
Q

Why does a volume deficit occur with Inc Ca2+

A

Inc Ca2+ (-) ADH effect @ V2 collecting duct = nephrogenic DBI

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11
Q

4 things that lead to nephrogenic DBI

A

hypercalcemia
hypOkalemia
Li
demeclocycline

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12
Q

What is the next best step in the hypercalcemic pt (after hydration/loops)? Which works fastest? Which works longer?

A

Bisphosphonates/Calcitonin

Calcitonin works faster but also wears off faster

Bisphosphonates take a few days to work, but effect will last longer.

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13
Q

List 5 Bisphosphonates

A

Pamidronate
Alendronate
Ibandronate
Risedronate
Zoledronic acid

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14
Q

Bisphosphonates are also used as osteoporosis when T score is?

A

2.5 std dev < N

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15
Q

MoA of Bisphosphonates

A

pyrophosphate analogs - bind hydroxyapetite inbone, (-) osteoclasts activity

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16
Q

Major SE of Bisphosphonates

A

pill induced esophagitis
osteonecrosis of jaw

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17
Q

What else causes pill induced esophagitis

A

bisphosphonates
ferrous sulfate
potassium chloride
NSAIDs
tetracyclins

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18
Q

Endogenous calcitonin made where?

A

parafollicular C cells

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19
Q

When is calcitonin used?

A

acute Inc Ca2+
paget’s disease of bone

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20
Q

Calcitonin MoA

A

(-)osteoclasts
also dec Ca absorption in GI
(+) renal excretion of Ca2+

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21
Q

SE of calcitonin

A 
#1 rhinitis, flu-like symptoms
flushing, rash, constipation
rest - depression, bronchospasm
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22
Q

Denosumab MoA and use

A

vs RANK-L

RANK-L - is the primary signal that (+) bone removal will (+) osteoclasts

used in osteoporosis, prostate cancer

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23
Q

SE/ of Denosumab

A

Inc urinary and resp tract infections

24
Q

DPP4(-)’rs - ex/

A

Linagliptin, Saxagliptin, Sitagliptin

25
Q

Fxn of DPP4

A

dipeptidyl peptidase - breaks down integrins like GLP1, GIP

(-) DPP-4 leads to inc insulin from pancreas and dec glucagon

26
Q

GLP1 analogs - ex/

MoA

A

Exenatide,
liraglutide
dec glucagon relsease, gastric emptying, inc glucose dep insulin release

27
Q

How are GLP1 analogues > than endogenous incretins

A

Analogues will imitate the fxn of endogenous incretins, but last longer. Endogenous last a few min, but analogues last 10-12 hours

28
Q

Liraglutide is also used for what other disease aside from DB?

A

Thyroid C cell cancer

29
Q

Pramlintide - MoA

A

amylin analog
dec glucagon release, dec gastric emptying, inc satiety

by supressing glucagon release, delay gastric emptying (+) weight loss.

30
Q

SE of both Pramlintide, and GLP1 analogs

A

bloating, constipation, hypoglycemia

31
Q

List and MoA of Sulfonylureas

A

1st gen - chlorpropamide, tolbutamide
2nd gen - glimepiride, glipizide, glyburide
closes K+ channel in pancreatic B cell mem –> depol –> insulin release via Inc Ca2+ influx

32
Q

SE/ of sulfonylureas

A

1st - disulfiram like effects

2nd - hypoglycemia

33
Q

Only DB rx that doesn’t cause hypoglycemia and why?

A

metformin, bc it doesn’t (+) insulin release

34
Q

Octreotide and Pegvisomant - major use and MoA

A

Acromegaly

Octreotide - somatostatin analogue
Pegvisomant - GH-R (-)’r

35
Q

Other uses of Octreotide

A

Portal hypertension - esophageal varices
carcinoid syndrome
VIPoma, glucagonoma

36
Q

Highest mortality of GI bleeds

A

esophageal varices

37
Q

How to treat acromegaly - 1st, and 2nd?

A

Surgery 1st - remove adenoma
2nd - rx like somatostatin, or dopamine agonist (cabergoline, bromocriptine)

38
Q

List a long acting octreotide

A

Lanreotide

39
Q

Most common cause of death in acromegaly?

A

cardiomyopathy

40
Q

1st choice of tx in DB after diet/exercise?

A

metformin

41
Q

MoA of Metformin

A

(-) hepatic gluconeogenesis

42
Q

Metformin is CI in?

A

patients with renal insufficiency - lactic acid accumulates

43
Q

Metformin causes a def in which vitamin?

A

B12

44
Q

MoA of Fludrocortisone

A

synthetic analog of aldosterone, with a little glucocorticoid effect

45
Q

Fxn of Aldosterone

A

retain Na+, release K+. and H+ @ late collecting duct, salivary glands, sweat glands, and GI glands

46
Q

How to treat an aldosterone def? (Addison)

A

Uncommon to have def of just one hormone of adrenals , usually all of them.

Give Fludrocortisone, and Cortisone, (glucocorticoids like effect)

47
Q

Other use of fludrocortisone

A

Orthostatic hypotension
septic shock Tx (adjunct to hydrocortisone)
type IV renal acidosis

48
Q

SE of Fludrocortisone

A

edema, inc pigmentation, dec K+, HTN –> alkalosis
bc of glucocorticoid effect
osteoporosis, impaired wound healing, easy bruising

49
Q

Ex of α-glucosidase inhibitors

mech?

A

acarbose
miglitol
(-) intestinal brush border α-glucosidases –> delayed carb hydrolysis and glucose absorpion

50
Q

SE of α-glucosidase inhibitors

A

basically like lactose intolerance
flatulence, GI upset

51
Q

Ex and MoA of thiazolidinediones

A

Pioglitazone, Rosiglitazone
(+) PPAR-γ (a nuclear receptor) –> inc insulin sensitivity in musc, adipose, liver cells.

52
Q

CI of glitazones

A

can lead to heart issues bc of fluid overload - CI in CHF

53
Q

SE of glitazones

A

edema, weight gain, cardiac issues

54
Q

Man with DB, glucose levels > 200 mg/dl despite max dose of several oral hypoglycemic agents

A1C >9%

Best rx for pt? how long should they be on it?

A

insulin - permanently

55
Q

What A1C level is diagnostic?
What is the goal A1C for a DB under treatment

A

>6.5% is diagnostic

<7% is the goal

56
Q

What combination of insulin do you prescribe? With or without oral hypoglycemics

A

Insulin is in addition to the oral hypoglycemics
Give one long acting insulin - like glargine 1x/d

and one short acting acting (lispro, aspart, glulisine) to be given with every meal.

57
Q

Diff in onset, peak, and duration of long acting and rapid acting insulin

A

Glargine reaches peak level and stays constant for 24 hours
LAG (Lispro, aspart, glulisine) - is effective in minutes and lasts for 3-4 hours, peaks in 1 hr

Step 1 2019 First Aid Flashcards (63 decks)

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