Block 2 Pharm Review

Question 1

What corticosteroids have high potency against inflammation?

Answer 1

betamethasone
dexamethasone

Question 2

what corticosteroid has the weakest potency against inflammation

Answer 2

hydrocortisone

Question 3

what are examples of high potency topical corticosteroids?

Answer 3

clobetasol
halobetasol

Question 4

what are the 2 most common steroid preparations for rectal use

Answer 4

cortenema
proctocort

Question 5

T or F: most corticosteroids in circulation are extensively bound to albumin.

Answer 5

False
corticosteroids have much higher affinity for globulin compared to albumin

Question 6

which glucocorticoid is long-acting?

Answer 6

Dexamenthasone

Question 7

What glucocorticoid is short-acting?

Answer 7

hydrocortisone

Question 8

what 2 glucocorticoids are the most commonly used intermediate-acting agents?

Answer 8

prednisone
methylprednisolone

Question 9

T or F: supraphysiologic doses of glucocorticoids for less than 2 weeks may be discontinued without tapering.

Answer 9

True
tapering should be considered if pt. is on the steroid for over 2 weeks

Question 10

What does the most common protocol for steroid tapering state

Answer 10

reduce steroid dose by 2.5-5 mg of prednisone equivalent weekly

Question 11

what hormone has been shown to decrease corticosteroid clearance when co-administered exogenously

Answer 11

estrogen

Question 12

T or F: CYP Inhibitors may necessitate an increase in glucocorticoid dose

Answer 12

False
CYP inducers decrease bioavailability of corticosteroids

Question 13

What are relative contraindications for glucocorticoid administration

Answer 13

Miliary TB; h/o osteoporosis, PUD, HTN

Question 14

what is the average amount of cortisol secreted by the adrenal gland

Answer 14

5 mg equivalent of prednisone

Question 15

Glucocorticoids induce osteoporosis via what 3 mechanism?

Answer 15

suppressing intestinal calcium absorption

decreassing sexc hormone production

inhibiting bone formation

Question 16

what type of corticosteroid formulations are most assoc. w/ myopahties?

Answer 16

fluorinated agents

Question 17

What MSK complication are pts. w/ long-term corticosteroid use at high risk for?

Answer 17

avascular necrosis

most common site: femoral head

Pt. may present w/ bone or groin pain

Question 18

what are risk factors for ophthalmic complications of corticosteroids

Answer 18

diabetes, myopia, h/o glaucoma (IOP must be monitored every 6 ms.)

Question 19

If there is a concern for potential GI complications of corticosteroid administration what should the pt. be advised to do?

Answer 19

take oral glucocorticoids with food to minimize adverse GI effects

Question 20

the are the most common allergic rxns. assoc. w/ topical steroid use?

Answer 20

maculopapular eruptions
urticaria

Question 21

T of F: dermatological complications of corticosteroids is most assoc. w/ potent steroid formulations.

Answer 21

true
Rash: striae distensae

Question 22

why are pt. on oral corticosteroid therapy at increased risk for cutaneous fungal infections?

Answer 22

impaired wound healing

Question 23

What is steroid withdrawal syndrome?

Answer 23

some pt. can present with nausea, anxiety, and sleep disturbances upon abrupt discontinuation or decreased dose

Question 24

what is the MOA of aminoglutethimide?

Answer 24

inhibits aromatase required for production of estrogen and testosterone

blocks conversion of cholesterol to pregnenolone by inhibiting P450scc

Question 25

what anti-fungal agent is commonly used to treat primary adrenal disorders of hypersecretion due to its effects of androgen production

Answer 25

ketoconazole

Question 26

T or F: digoxin toxicity may be potentiated by ketoconazole

Answer 26

True

Question 27

what is the MOA of pasireotide?

Answer 27

somatostatin analogue: inhibits ACTH secretion by activating hsst receptors

Question 28

what are AEs of pasireotide?

Answer 28

QT prolongation, bradycardia, cholelithiasis,

Question 29

what drugs may need an altered does when co-administered w/ pasireotide?

Answer 29

cyclosporine: decreased BA bromocriptine: increased BA

Question 30

what is the MOA of spironolactone?

Answer 30

aldosterone antagonist: competes for the mineralocorticoid receptor to inhibit sodium reabsorption

Question 31

what are AEs of spironolactone?

Answer 31

hyperkalemia, acidosis, gynecomastia

Question 32

what OTC drug can decrease efficacy of spironolactone?

Answer 32

NSAIDS

Question 33

T or F: eplerenone is more selective for mineralocorticoid receptors than spironolactone?

Answer 33

true

Question 34

This drug causes cytotoxic atrophy of the adrenal cells and therefore indicated for the treatment of adrenocortical carcinoma and Cushing's Syndrome.

Answer 34

Mitotane

Question 35

why is metyrapone useful for diagnosing adrenal insufficiency in adult & pediatric pts.

Answer 35

inhibits endogenous production of corticosteroids by inhibiting 11beta-hydroxylase which stimulates ACTH secretion and subsequently increases plasma levels of 11-deoxycortisol levels

Question 36

what is the MOA of Mifepristone?

Answer 36

competitive inhibitor of progesterone receptors

Question 37

what are AEs of mifepristone?

Answer 37

endometrial hyperplasia, irregular uterine bleeding, abortion, QT prolongation

Question 38

T or F: osilodrostat is an 11beta-hydroxylase inhibitor

Answer 38

true

Question 39

what are the negative physiological consequences of prolonged testosterone therapy in pediatric pts.?

Answer 39

Genital hypertrophy, advanced bone age, aggressive behaviour

Question 40

what complication assoc. w/ gel and transdermal admin. of testosterones is not assoc. w/ buccal admin.

Answer 40

transference to female partners and children

Question 41

T or F: buccal formulations of exogenous testosterone can be swallowed but never chewed

Answer 41

false should never be chewed Or SWALLOWED

Question 42

Should pt. taking buccal testosterone be advised to not chew gum or alcoholic beverages?

Answer 42

no; this delivery system is not affected by these conditions

Question 43

exogenous testosterone admin. can increase the toxicity of what drugs?

Answer 43

warfarin levothyroxine cyclosporin antidiabetics

Question 44

What should baseline testing include for testosterone replacement therapy monitoring?

Answer 44

hemoglobin, hematocrit (to detect polycythemia); liver function, PSA, digital rectal exam, lipid panel, testosterones levels should be repeated every 3 to 6 months

Question 45

the use of what supplements should you caution pt. against if they take exogenous testosterone therapy?

Answer 45

HGH, DHEA, melatonin, St. John's wort, garlic, Vit. E.

Question 46

what are anabolic steroids?

Answer 46

synthetic versions of natural testosterone

Question 47

Oxymetholone, an anabolic steroid, is used to treat what conditions?

Answer 47

acquired aplastic anemia hereditary angioedema fanconi syndrome familial anti-thrombin III deficiency

Question 48

what is the most common AE assoc. w/ oxymetholone?

Answer 48

virilization

Question 49

what anabolic steroid is specifically used for anemia of CKD?

Answer 49

nandrolone

Question 50

What side effects of nandrolone are exclusively found in males?

Answer 50

breast tenderness and enlargement frequent erections urine incontinence groin and scrotum pain

Question 51

what side effects of nandrolone are exclusively found in females

Answer 51

irregular vaginal bleeding decreased breast size enlarged clitoris hair loss facial hair growth voice changes

Question 52

what anabolic steroid is exclusively used for prophylaxis and treatment of hereditary angioedema?

Answer 52

stanozolol

Question 53

what anabolic steroid has been approved for promoting weight gain

Answer 53

oxandrolone

Question 54

what anabolic steroid is commonly used for wasting syndrome in HIV pts.

Answer 54

oxandrolone

Question 55

what anabolic steroid is used as an adjunctive to growth hormone in girls w/ Turner's syndrome?

Answer 55

oxandrolone

Question 56

list the OTC ASs you need to know

Answer 56

DHEA androstenedione

Question 57

what is a very serious AE of too much testosterone

Answer 57

palpitations and arrhythmias

Question 58

what are signs and symptoms of anabolic steroid abuse in pediatric pts.?

Answer 58

irregular heart beat, hepatic and hematologic irregularities such as jaundice and aplastic anemia, hypogonadism, aggressive and impulsive behavior, hair loss/hair gain, gynecomastia, striae in axilla, abnormal lipid panel, inappropriate body size for pt's age

Question 59

why might calcitriol be used instead of calcifediol in some cases?

Answer 59

treats hypocalcemia in dialysis-dependent renal failure patients calcifediol must be activated by healthy kidneys to be effective

Question 60

calcitriol is used for what?

Answer 60

secondary hyperparathyroidism

Question 61

What Vit. D isomer is used to treat hypocalemia-induced tetany?

Answer 61

DHT: Dihydrotachysterol

Question 62

Composite a list of drugs known to deplete Vit. D.

Answer 62

isoniazid, cholestyramine, antacids, CCBs, anticonvulsants, thiazides

Question 63

what precautions should be taken when administering IV calcium to pts. on digitalis?

Answer 63

rapid admin. could result in arrhythmias since digitalis increases sensitivity to IV calcium

Question 64

T or F: PTH is the 1st line for treating hypoparathyroidism

Answer 64

FALSE 1st line would be calcium and Vit. D. supplementation PTH can be used as an adjunct to the above but typically reserved for pts. intolerant of the above

Question 65

Exogenous PTH increases the risk for what malignancy

Answer 65

osteosarcoma

Question 66

what malignancies are commonly assoc. w/ hypercalcemia?

Answer 66

lung and breast

Question 67

describe the pathogenesis of hypercalcemia of malignancy

Answer 67

cancer cells stimulate osteoclasts which accelerates bone breakdown

Question 68

T or F: the first step in management of hypercalcemia is hydration.

Answer 68

True

Question 69

how does hydration promote excretion of calcium

Answer 69

expands ICV which increases renal calcium excretion

Question 70

T or F: if the pt. is not adequately hydrated, the efficacy of loop diuretics will be reduced. Explain your reasoning.

Answer 70

True volume expansion must precede admin. of furosemide b/c the drug's effects depends on delivery of Ca to the ascending limb

Question 71

what can happen if furosemide is admin. w/o adequate volume expansion

Answer 71

reduced GFR and Ca clearance

Question 72

furosemide is implicated in what situations

Answer 72

acute hypercalcemia

Question 73

List the bisphosphonates you need to know.

Answer 73

Etidronate pamidronate zoledronic acid risedronate alendronate ibandronate

Question 74

T of F: glucocorticoids have the exact opposite effects as Vit. D for calcium metabolism

Answer 74

True

Question 75

what is the MOA of mithramycin?

Answer 75

selective RNA synthesis inhibitor in osteoclasts

Question 76

what are the AEs of mithramycin?

Answer 76

proteinuria, thrombocytopenia, increased serum creatinine

Question 77

what is the MOA of denosumab?

Answer 77

humanized monoclonal antibody inhibits binding of RANKL with its RANK receptor

Question 78

what facet of denosumab Pk-PD profile is desirable?

Answer 78

NOT EXCRETED BY KIDNEYS

Question 79

What is the MOA of calcimimetrics

Answer 79

as the name suggests: body treats it as calcium effect: reduced PTH secretion with a 0 net concentration of calcium and phosphorus levels

Question 80

what calcimimetrics are used for hyperparathyroidism in pt. w/ CKD on dialysis?

Answer 80

cinacalcet etelcalcetide

Question 81

What drugs can potentially cause osteoporosis

Answer 81

antiepileptics like phenytoin thyroxine anticoagulants: heparin, warfarin glucocorticoids

Question 82

T or F: unlike calcium citrate, calcium carbonate does not require an acidic environment.

Answer 82

FALSE It's the other way around

Question 83

HRT increases the risk for what malignacies?

Answer 83

breast cancer and heart disease

Question 84

what are the clinical indications for both alendronate and risedronate?

Answer 84

postmenopausal osteoporosis male osteoporosis management of glucocorticoid induced osteoporosis

Question 85

how should alendronate and risedronate be taken?

Answer 85

on an empty stomach w/o laying down 30 min. after admin.

Question 86

what bisphosponate is an alternative for pts. who canno sit upright for 30 to 60 minutes and/or cannot swallow a pill

Answer 86

Ibandronate IV injection every 3 months

Question 87

what are CIs for zoledronic acid?

Answer 87

Arrythmias (AE is A fib), creatinine clearance < 35 mL/min

Question 88

T or F: bisphosphonates are safe for pregies?

Answer 88

false

Question 89

What AE should you inform a pt. of who is about to take a high dose bisphosphonate via IV?

Answer 89

acute phase reaction presents as flu-like symptoms mild discomfort should disappear after 3 days

Question 90

what are additional AEs that have been reported by pts. taking bisphosphonates

Answer 90

osteonecrosis of the jaw atypical femoral fractures

Question 91

calcitonin should be taken in conjunction w/ what supplements to avoid AEs?

Answer 91

calcium & Vit. D

Question 92

what are the benefits of raloxifene?

Answer 92

no endometrial stimulation decreased incidence of breast cancer improved lipid profile increases BMD assoc. w/ reduced fracture risk

Question 93

what are the AEs of raloxifene?

Answer 93

hot flashes leg cramps increased risk of VTD

Question 94

how often do pts. receive their denosumab shots

Answer 94

once every six months

Question 95

what is the name of the PTH synthetics that shows promising potential for replacement of depleted bone storage

Answer 95

teriparatide abaloparatide

Question 96

what is the MOA of romosozymab

Answer 96

inhibits sclerostin: modulator of the Wnt/Beta-catenin signaling pathway implicated for osteoporosis

Question 97

what are AEs of romosozymab?

Answer 97

MI, stroke, CVD