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NAPLEX STUDY > Endocrine disorders > Flashcards

Endocrine disorders Flashcards

(44 cards)

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1
Q

Drugs that cause hypothyroidism: ITALC

A

interferon
TKi’s
Amiodarone
Lithium
Carbamazepine

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2
Q

T4

A

-thyroxine
-short half-life

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3
Q

T3

A

-triiodothyronine
-potent

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4
Q

hypothyroidism

A

deficiency in T4 and incr TSH
-commonly caused by Hashimoto’s
-Sx/S: cold intolerance, dry skin, fatigue, muscle cramps, voice changes, constipation, weight gain, goiter, myalgias, weakness, depression, bradycardia, coarse hair/loss of hair, menorrhagia, memory and mental impairment

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5
Q

hypothyroidism treatment

A

-levothyroxine (T4 -Synthroid, Levoxyl, Unithrold) > full replacement dose is 1.6 mcg/kg/day; different dose for those with known CAD
-Thyroid, dessicated USP (T3, T4 -Armour Thyroid)
-Liothyronine (T3) (Cytomel)
-levothyroxine > take with water, at least 60 min before breakfast or at bedtime (3 hours after last meal)
-levothyroxine IV: 0.75:1

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6
Q

Orangutans Will Vomit On You Right Before They Become Large Proud Giants

A

25 mcg = orange
50 mcg = white
75 mcg = violet
88 mcg = olive
100 mcg = yellow
112 mcg = rose
125 mcg = brown
137 mcg = turquoise
150 mcg = blue
175 mcg = lilac
200 mcg = pink
300 mcg = green

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7
Q

drugs that decrease the effect of thyroid replacement: decrease levothyroxine absorption

A

-antacids and polyvalent cations that contain iron, Ca, Al, or magnesium multivitamins
-cholestyramine, sevelamer, sucraflate

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8
Q

hyperthyroidism

A

-FT4 is high and TSH is low
-Sx/S: heat intolerance or increased sweating, weight loss, agitation, nervousness, irritability, anxiety, palpitations, tachycardia, fatigue, and muscle weakness, diarrhea, insomnia, tremor, thinning hair, goiter, light or absent periods
-common causes: graves disease, iodine, amiodarone, and interferons

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9
Q

hyperthyroidism treatment

A

-BB for symptom control
-surgery
-Propylthiouracil (PTU) or methimazole

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10
Q

PTU and Methimazole

A

-takes 1-3 months for symptom control once symptoms are controlled reduce dose to prevent hypothyroidism
-PTU box warning: severe liver injury and acute liver injury, preferred in 1st trimester
-methimazole is the DOC
-PTU is preferred in thyroid storm
-methimazole can be used in 2nd and 3rd trimester

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11
Q

S/Sx of thyroid storm

A

fever, tachycardia, tachypnea, dehydration, profuse sweating, agitation, delirium, psychosis, coma

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12
Q

tx of thyroid storm

A

PTU + inorganic iodide therapy + BB + systemic steroid

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13
Q

cortisol

A

replaced by giving any of the steroids

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14
Q

aldosterone

A

replaced by giving fludrocortisone - has mineralcorticoid activity and is used for addisons disease and orthostatic hypotension

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15
Q

glucocorticoids

A

cause adrenal glands to stop producing cortisol due to suppression of HPA

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16
Q

cushings syndrome

A

-making too much cortisol or high dose steroids that are higher than the normal amount of endogenous cortisol
-moonface, buffalo hump, acne, pink/purple stretch marks, poor wound healing, poor bone health, diabetes, muscle wasting

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17
Q

Steroids least potent to most potent: Cute Hot Pharmacists and Physicians Marry Together and Deliver Babies

A

cortisone > hydrocortisone > prednisone > prednisolone > methyprednisolone > triamcinolone > dexamethasone > betamethasone

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18
Q

short-acting steroid

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A

cortisone and hydrocortisone (Solu-cortef)

19
Q

intermediate-acting steroid

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A

prednisone (Deltasone), prednisolone (millipred, orapred), methylprednisolone (medrol, solu-medrol), triamcinolone (kenalog)

20
Q

long-acting steroid

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A

dexamethasone (dexpak, decadron) and betamethasone

21
Q

steroid side effects

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A

-adrenal suppression
-increased appetite, weight gain, emotional instability

22
Q

prednisone

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A

prodrug of prednisolone

23
Q

steroid immunosuppression

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A

-using >2 mg/kg/day or > 20 mg/day of prednisone or prednisone equivalent for > 2 weeks
-immunosuppressed patients cannot receive live vaccines
-they must be tapered off steroids - typically 10-20%

24
Q

RA

Study These Flashcards
A

-bilateral, symmetrical disease
-joint swelling, pain, stiffness, bone deformity
-stiffness and pain worse after rest (OA does not cause prolonged stiffness)
-ACAP and RF

25
RA tx
-patients w/symptomatic RA should be started on DMARD -MTX is the preferred initial tx for most patients -low-dose steroids can be added in patients with moderate-high disease activity when starting DMARD as a bridging option
26
DMARD: methotrexate (Trexall)
-inhibits dihydrofolate reductase, inhibiting folate -oral tablet, injection, oral solution -once weekly dosing (no daily dosing for MTX) -hepatotoxicity, myelosuppression, mucositis/stomatitis, pregnancy -folate can be given to dcr hematological, GI, and hepatic side effects
27
DMARD: hydroxychloriquine (plaquenill)
-immune modulator -irreversible retinopathy
28
Other DMARDs
-sulfasalazine (immune modulator); caution in sulfa allergy -leflunomide (inhibits pyrimidine synthesis); do not use in pregnancy, hepatotoxicity
29
Janus Kinase Inhibitors (non-biologic DMARD)
Tofacitinib, Baricitinib, Upadacitinib -boxed warning: infections, malignancy, thrombosis -do not use with biologic DMARDs
30
Anti-Tumor necrosis factors
-Enteracept (Enbrel); +/- MTX; weekly -Adalimumab (Humira); +/- MTX; every other week -Infliximab (Remicade); + MTX; requires filter and can be used in only -Certolizumab pegol (Cimzia); +/- MTX -Golimumab (Simponi); + MTX; SC/IV *serious infections, malignancies *can cause demyelinating disease, hep B reactivation, HF, hepatotoxicity, lupus-like-syndrome *do not use with other biologic DMARDs or live vaccines
31
Other biologic DMARDs (non-TNF inhibitors)
Rituximab (Rituxan) + MTX -depletes CD20 B cells -premedicate with a steroid, acetaminophen and an antihistamine -infusion related reactions, HBV reactivation -do not use with other biologic DMARDs or live vaccines
32
systemic lupus erythematosus (SLE)
-fatigue, depression, anorexia, weight loss, muscle pain, malar rash (butterfly rash), joint pain and stiffness -arthritis and cutaneous symptoms most common -renal, hematologic, and neurologic manifestations contribute to morbidity and mortality - positive ANAs, anti-ssDNA, anti-dsDNA, anti-Sm, apa, low complements, and elevated acute phase reactants
33
drugs that can cause DILE: My Pretty Malar Marking Probably Has A TransIent Quality
Methimazole, Propythiouracil, Methyldopa, Minocycline, Procainamide, Hydralazine, Anti-TNF agents, Terbinafine, Isoniazid, Quinidine
34
SLE Tx
-Hydroxychloroquine -Cyclophosphamide -Azathioprine -Mycophenolate mofetil -cyclosporine
35
Belimumab (Benlysta)
-IgG1 -lamda mAb -serious infections -do not give with other biologic DMARD or live vaccines
36
MS
-chronic progressive autoimmine disease - where immune cells attacks the myelin sheath -early symptoms: fatigue, numbness, and blurred vision -deterioration of cognitive function, muscle spasms, pain, incontinence
37
Relapsing MS Tx
-interferon beta formulations (Betaseron, AVonex, Rebif, Extavia, Plegridy) -glatiramer acetate (Copaxone) -Fingolimod (Gilenya) and Teriflunomide (Aubagio); oral -mitoxantrone (second-third line)
38
Glatiramer acetate (Copaxone)
-immune modulator -SC injection -flushing, diaphoresis, dyspnea
39
Siponimod
-S1P receptor modulator -CYP2C9*3/*3 genotype testing required
40
Ozanimod
-S1P receptor modulator -severe untreated sleep apnea, use of MAOi
41
Natalizumab (Tysabri)
-mAb that binds to a subunit of integrins expressed on the surface of leukocytes -Risk of PML - only available through REMs
42
Raynuds
nifedipine
43
drug-induced raynuds
- dcr blood flow to fingers causes incr cyanosis and pain -beta blockers, bleomycin, cisplatin, sympathomimetics: amphetamines, pseudoephedrine and illicit drugs; drugs that worsen raynuds
44
drugs that worsen myasthenia gravis
AMG, quinolones, magnesium salts, select antiarrhythmics, BB, CCB, select antipsychotics, muscle relaxants, local anesthetics -treatment: pyridostigmine (cholinergic)

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