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Buzzwords 3 Flashcards

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1
Q

What are three indications of IV regular insulin?

A
  1. DKA
  2. Hyperkalemia (with glucose)
  3. Stress hyperglycemia
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2
Q

List the 4 categories of insulin, tie to peak, and their names.

A
  1. Rapid (1 hour) - Lispro, Aspart, Glulisine (LAG)
  2. Short (2-3 hours) - regular insulin
  3. Intermediate (4-10 hours) - NPH
  4. Long (no peak) - detemir, glargine
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3
Q

Name the 2 categories of non-insulin injectables and the drugs in each category.

A
  1. Amylin analogs (Pramlintide)

2. GLP-1 analogs (Exenatide, Liraglutide)

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4
Q

MOA of Pramlintide?

A

Decrease glucagon release, decrease gastric emptying, increase satiety

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5
Q

MOA of Exenatide and Liraglutide?

A

Decrease glucagon release, decrease gastric emptying, increase satiety, increase glucose-dependent insulin release

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6
Q

Drugs used to treat diabetes that may lead to weight LOSS

A
  1. GLP-1 analogs
  2. Metformin
  3. SGLT-2 inhibitors
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7
Q

Diabetes drug - AE - lactic acidosis

A

Metformin

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8
Q

Diabetes drug - AE - B12 deficiency

A

Metformin

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9
Q

MOA - metformin

A

Inhibit hepatic gluconeogenesis and the action of glucagon via inhibition of mGPD

Increase glycolysis, peripheral glucose uptake

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10
Q

Diabetes drugs that increase insulin sensitivity

A
  1. Metformin

2. Glitazones

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11
Q

Compare the MOA of sulfonylureas and meglitinides.

A

Both close the K+ channel in the beta cell membrane -> cell depolarization -> increased calcium influx -> insulin release

Binding sites differ

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12
Q

Drugs used to treat diabetes that may lead to weight GAIN.

A
  1. Sulfonylureas
  2. Meglitinides
  3. Glitazones
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13
Q

Name the first generation sulfonylureas.

A

Chlorpropamide

Tolbutamide

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14
Q

Name the second generation sulfonylureas.

A

Glimepiride, Glipizide, Glyburide

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15
Q

Diabetes drug - AE - disulfiram-like effects

A

1st generation sulfonylureas (Chlorpropamide, tolbutamide)

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16
Q

List the 2 meglitinides.

A

Nateglinide

Repaglinide

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17
Q

MOA - DDP-4 inhibitors?

A

Inhibit DDP-4 enzyme, which deactivates GLP-1

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18
Q

List the common suffix of DDP-4 inhibitors.

A

–agliptin

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19
Q

MOA - glitazones

A

Bind to PPAR-gamma nuclear transcription regulator -> increase insulin sensitivity and levels of adiponectin

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20
Q

Diabetes drug - AE - edema and Heart Failure

A

Glitazones (also increased risk of fractures)

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21
Q

Which diabetes drug has a delayed onset of action (several weeks)?

A

Glitazones

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22
Q

Common suffix for SGLT2 inhibitors

A

–Agliflozin

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23
Q

Diabetes drug - AE - vaginal yeast infections and UTIs

A

SGLT2 inhibitors

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24
Q

List the 2 alpha-glucosidase inhibitors.

A

Acarbose, miglitol

inhibit intestinal brush border enzyme, delay glucose absorption

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25
List the 2 thioamides.
Propylthiouracil and methimazole
26
MOA - block TPO, which inhibits oxidation of iodide and organification of iodine -> inhibition of TH synthesis
Thioamides (propylthiouracil and methimazole); PTU also inhibits 5'deiodinase -> decreased peripheral conversion of T4 to T3
27
Discuss how to safely treat hyperthyroidism in pregnancy.
1st trimester - PTU (methimazole is teratogenic) 2nd and 3rd trimesters - Methimazole (risk of PTU-induced hepatoxicity)
28
Rx - hypothyroidism and myxedema
Levothyroxine (T4) and liothyronine (T3)
29
Rx - SIADH
1. ADH antagonists at the V2 receptor -> conivaptan and tolvaptan 2. Demeclocyline (ADH antagonist in the tetracycline family)
30
Desmopressin indications
Central DI (not nephrogenic) VW disease Sleep eneuresis Hemophilia A
31
MOA - cinacalcet
Sensitizes the calcium sensing receptor (CaSR) in the parathyroid gland to circulating calcium -> decreased PTH
32
MOA - sevelamer
Prevents phosphate absorption in the GI tract by binding phosphate (non-absorbable)
33
MOA - activates antithrombin -> decreases action of 2a (thrombin) and 10a
Heparin
34
List the LMW heparins.
Enoxaparin | Dalteparin
35
How do LMW heparins and fondaparinux differ from heparin?
These act predominantly on or only on (fondaparinux) factor 10a. Pro - better bioavailability, longer half-life, no lab monitoring Con - NOT EASILY REVERSIBLE
36
In HIT, IgG antibodies develop against what?
Heparin-bound platelet factor 4 (PF4)
37
List the 3 direct thrombin inhibitors.
Bivalirudin, Argatroban, Dabigatran (D - oral) "BAD"
38
MOA - interferes with gamma-carboxylation of vitamin K dependent clotting factors 2, 7, 9, 10 and proteins C and S
Warfarin
39
AE - heparin vs. warfarin - skin and tissue necrosis
Warfarin
40
Heparin vs. warfarin - route of administration
H - parenteral (IV, SC) | W - oral
41
Heparin vs. warfarin - site of action
H - blood | W - liver
42
Heparin vs. warfarin - onset and duration of action
H - rapid onset (seconds), hours (duration) | W - Slow onset (limited by the half-lives of normal clotting factors), days (duration)
43
Heparin vs. warfarin - reversal?
H - protamine sulfate | W - vitamin K, FFP, PCC
44
Heparin vs. warfarin -- monitoring?
H - PTT (intrinsic) | W - PT/INR (extrinsic)
45
Heparin vs. warfarin - crosses placenta?
H - no | W - yes (teratogenic)
46
Heparin vs. warfarin - indications?
H - immediate anticoagulation for PE, ACS, MI, DVT + in pregnancy W - chronic anticoagulation for prophylaxis of venous thromboembolism and a stroke due A-Fib
47
List the two 10a inhibitor.
Apixaban, rivaroxaban
48
Indications for thrombolytic therapy.
Early MI Early ischemic stroke Severe PE
49
List the 4 ADP receptor inhibitors. Which one is reversible?
Clopidogrel Prasugrel Ticagrelor (reversible) Ticlodipine
50
MOA - inhibit platelet aggregation by irreversibly blocking ___ receptor. This prevents expression of GP 2b3a.
ADP receptor inhibitor
51
Cilostazol and dipyridamole are phosphodiesterase inhibitors. How do they function in platelets?
Increase cAMP -> inhibition of platelet aggregation (in addition to vasodilation)
52
List the GP2b3a inhibitors.
Abciximab, eptifibatide, tirofiban
53
Rx - hairy cell leukemia
Cladribine
54
Enhances effects of 5-FU?
Leucovorin
55
Cancer drug - AE - hand-foot syndrome
5-FU
56
Leucovorin rescue
Used in MTX treatment to reverse myelosuppression
57
Cardiotoxic cancer drug + prevention?
Doxorubicin; prevent with dexrazoxane (iron chelating agent)
58
Prevent hemorrhagic cystitis caused by cyclophosphamide
Mesna
59
Prevent cisplatin/carboplatin nephrotoxicity?
Amifostine (free radical scavenger) and chloride (saline) diuresis
60
MOA - TK inhibitor of BCR-ABL (CML) and c-Kit (GI stromal tumors)
Imatinib
61
MOA - proteasome inhibitors that induce arrest at G2-M phase -> apoptosis
Bortezomib, carfilzomib
62
MOA - SERMs
Estrogen receptor antagonists in the breast and agonists in bone
63
Indications for SERMS?
Both - breast cancer prevention Tamoxifen - breast cancer treatment Raloxifene - osteoporosis
64
Compare AE of tamoxifen and ralofixfene
Tamoxifen - partial agonist in endometrium -> increases risk of cancer Raloxifene - antagonist in endometrial tissue, no increase Both increase risk fo thromboembolism
65
AE - trastuzumab?
Cardiotoxicity
66
MOA - small molecule inhibitor of BRAF oncogene + melanom
VemuRAFenib for V600E-mutated BRAF inhibition
67
Prevention and treatment of tumor lysis syndrome - use ___
Rasburicase
68
Chemotoxicity - ototoxicity
Cisplatin/Carboplatin
69
Chemotoxicity - peripheral neuropathy
Vincristine
70
Chemotoxicity - pulmonary fibrosis
Bleomysin, Busulfan
71
Redirection of emotions or impulses to a neutral person or object vs. Attributing an unacceptable internal impulse to an external source
Displacement vs. Projection
72
Partially remaining at a more childish level of development vs. Involuntarily turning back the maturational clock and going back to earlier modes of dealing with the world
Fixation vs. Regression
73
Replacing a warded-off idea or feeling with an unconsciously derived emphasis on its opposite vs. Replacing an unacceptable wish with a course of action that is similar to the wish but socially acceptable
Reaction formation vs. sublimation
74
1. Neuromuscular hyperactivity (clonus, hyperreflexia, hypertonia, tremor, seizure 2. Increased autonomic stimulation (hyeprthermia, diaphoresis, diarrhea) 3. Agitation
Serotonin syndrome
75
Treat serotonin syndrome
Cyproheptadine (5-HT2 receptor antagonist)
76
Rx - carcinoid syndrome
Octreotide
77
Rx - hypertensive crisis
Phentolamine
78
Cause of neuroleptic malignant syndrome?
Antipsychotics + genetic predisposition
79
Symptoms of neuroleptic malignant syndrome?
``` Mygolobinuria Fever Encephalopathy Vitals unstable Increased enzymes (CK, etc.) Rigidity of muscles (lead pipe) ```
80
Rx - neuroleptic malignant syndrome
Dontrolene, dopamine agonist (eg. bromocriptine)
81
Rx - acute dystonia
Benztropine or diphenhydramine
82
Serum Gamma-glutamyltransferase?
Sensitive indicator of alcohol use
83
List the low-potency typical antipsychotics.
Chlorpromazine, Thioridazine | Cheating Thieves are LOW
84
List the high-potency typical antipsychotics.
Trifluoperazine, Fluphenazine, Haloperidol | Try to Fly High

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