Endo - Conrad Fischer Medquest Pharm

Question 1

SE of PTU and methimazole

Answer 1

neutropenia (agranulocytosis, aplastic anemia)

Question 2

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

Answer 2

Propranolol

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

Question 3

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

Answer 3

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

Question 4

PTU and methimazole has what MoA

Answer 4

(-) production and deiodination of T3

Question 5

How is thyroid hormone stored in gland and transported?

Answer 5

Thyroglobulin storage in gland
Thryoid binding globulin transport in body

Question 6

What proportion of T4 and T3 is made?

Answer 6

20 T4 : 1 T3

Question 7

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

Answer 7

period - hyperthyroidism leads to amenorrhea

Question 8

What Rx works fastest in thyroid storm?

Answer 8

Propranolol

Question 9

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?

Answer 9

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

Question 10

Why does a volume deficit occur with Inc Ca2+

Answer 10

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

Question 11

4 things that lead to nephrogenic DBI

Answer 11

hypercalcemia
hypOkalemia
Li
demeclocycline

Question 12

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

Answer 12

Bisphosphonates/Calcitonin

Calcitonin works faster but also wears off faster

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

Question 13

List 5 Bisphosphonates

Answer 13

Pamidronate
Alendronate
Ibandronate
Risedronate
Zoledronic acid

Question 14

Bisphosphonates are also used as osteoporosis when T score is?

Answer 14

2.5 std dev < N

Question 15

MoA of Bisphosphonates

Answer 15

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

Question 16

Major SE of Bisphosphonates

Answer 16

pill induced esophagitis
osteonecrosis of jaw

Question 17

What else causes pill induced esophagitis

Answer 17

bisphosphonates
ferrous sulfate
potassium chloride
NSAIDs
tetracyclins

Question 18

Endogenous calcitonin made where?

Answer 18

parafollicular C cells

Question 19

When is calcitonin used?

Answer 19

acute Inc Ca2+
paget’s disease of bone

Question 20

Calcitonin MoA

Answer 20

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

Question 21

SE of calcitonin

Answer 21

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

Question 22

Denosumab MoA and use

Answer 22

vs RANK-L

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

used in osteoporosis, prostate cancer

Question 23

SE/ of Denosumab

Answer 23

Inc urinary and resp tract infections

Question 24

DPP4(-)’rs - ex/

Answer 24

Linagliptin, Saxagliptin, Sitagliptin

Question 25

Fxn of DPP4

Answer 25

dipeptidyl peptidase - breaks down integrins like GLP1, GIP (-) DPP-4 leads to inc insulin from pancreas and dec glucagon

Question 26

GLP1 analogs - ex/ MoA

Answer 26

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

Question 27

How are GLP1 analogues \> than endogenous incretins

Answer 27

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

Question 28

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

Answer 28

Thyroid C cell cancer

Question 29

Pramlintide - MoA

Answer 29

amylin analog dec glucagon release, dec gastric emptying, inc satiety by supressing glucagon release, delay gastric emptying (+) weight loss.

Question 30

SE of both Pramlintide, and GLP1 analogs

Answer 30

bloating, constipation, hypoglycemia

Question 31

List and MoA of Sulfonylureas

Answer 31

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

Question 32

SE/ of sulfonylureas

Answer 32

1st - disulfiram like effects 2nd - hypoglycemia

Question 33

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

Answer 33

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

Question 34

Octreotide and Pegvisomant - major use and MoA

Answer 34

Acromegaly Octreotide - somatostatin analogue Pegvisomant - GH-R (-)'r

Question 35

Other uses of Octreotide

Answer 35

Portal hypertension - esophageal varices carcinoid syndrome VIPoma, glucagonoma

Question 36

Highest mortality of GI bleeds

Answer 36

esophageal varices

Question 37

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

Answer 37

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

Question 38

List a long acting octreotide

Answer 38

Lanreotide

Question 39

Most common cause of death in acromegaly?

Answer 39

cardiomyopathy

Question 40

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

Answer 40

metformin

Question 41

MoA of Metformin

Answer 41

(-) hepatic gluconeogenesis

Question 42

Metformin is CI in?

Answer 42

patients with renal insufficiency - lactic acid accumulates

Question 43

Metformin causes a def in which vitamin?

Answer 43

B12

Question 44

MoA of Fludrocortisone

Answer 44

synthetic analog of aldosterone, with a little glucocorticoid effect

Question 45

Fxn of Aldosterone

Answer 45

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

Question 46

How to treat an aldosterone def? (Addison)

Answer 46

Uncommon to have def of just one hormone of adrenals , usually all of them. Give Fludrocortisone, and Cortisone, (glucocorticoids like effect)

Question 47

Other use of fludrocortisone

Answer 47

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

Question 48

SE of Fludrocortisone

Answer 48

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

Question 49

Ex of α-glucosidase inhibitors mech?

Answer 49

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

Question 50

SE of α-glucosidase inhibitors

Answer 50

basically like lactose intolerance flatulence, GI upset

Question 51

Ex and MoA of thiazolidinediones

Answer 51

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

Question 52

CI of glitazones

Answer 52

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

Question 53

SE of glitazones

Answer 53

edema, weight gain, cardiac issues

Question 54

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?

Answer 54

insulin - permanently

Question 55

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

Answer 55

\>6.5% is diagnostic \<7% is the goal

Question 56

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

Answer 56

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.

Question 57

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

Answer 57

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