Flashcards in Exam 2 Deck (78):
First line treatment for hyperthyroidism
Radioactive iodine (recommended for patients > 40)
Second line treatment for hyperthyroidism
Antithyroid Drugs (PTU & methimazole)
Third line treatment for hyperthyroidism
First line treatment for hypothyroidism
Only treatment is replacement of thyroid hormone -- levothyroxine (Synthroid)
Lab values for hyperthyroidism
TSH - decreased
Free T4 - increased
Lab values for hypothyroidism
TSH - increased
Free T4 - decreased
Treatment for hyperthyroidism in pregnancy
Radioactive iodine contraindicated and in lactation.
What is the blood test to check vitamin D level?
25-hydroxyvitamin D (25OHD)
What level indicates vitamin D deficiency?
What level indicates vitamin D toxicity?
Signs of vitamin D toxicity
anorexia, weight loss, polyuria, arrhythmias, increased calcium level
People at risk for inadequate vitamin D absoprtion
gastric bypass, IBD, liver disease, cystic fibrosis, celiac, Crohn's, ulcerative colitis
What do you need to monitor when treating a hyperthyroid patient with PTU?
Monitor CBC during first 3 months of therapy to avoid fatal agranulocytosis
What S&S should a patient taking PTU report?
Sore throat and fever
Obtain CBC and stop drug if WBC is low
Treatment for hypothryoidism
What does the parathyroid do?
Regulates calcium and phosphate metabolism
What causes pernicious anemia?
Vitamin B12 deficiency due to lack of intrinsic factor
Treatment of pernicious anemia
Vitamin B12 (cyanocobalamin) IM
What condition increases the risk of pernicious anemia?
Gastric bypass surgery
What do you check and when after start of treatment for iron deficiency anemia
CBC, HGB, HCT
2 weeks after start of therapy
VTE prophylaxis in pregnancy
Lab test to monitor Heparin
Lab to monitor coumadin
What thrombolytic agent would you use for someone with renal failure?
Antidote for heparin
What is OLDCART
Two biggest side effects from narcotics
Respiratory depression & constipation
Treatment of choice for neuropathic pain?
What vital sign should you monitor with use of narcotics
Respiratory rate & BP
What is the use for marijuana?
Nausea and vomiting in patients receiving chemo
Which form of marijuana has no CNS side effects?
What is safest pain reliever?
Tylenol (but it is not an anti-inflammatory)
What is a burst of steroids?
Steroid use for 5 days (greater than that, taper off)
First line tx for RA
Methotrexate and folic acid
What are drug/drug interactions for NSAIDs and what would you monitor?
Monitor for bleeding, GI, decreased kidney fx -- GI bleed and renal failure
What effects do steroids have on bone health?
Can cause osteoporosis
Give calcium & vit d
Teaching for biophosphates?
Take medicine while sitting up and drink a full glass of water
First line treatment of OA
MOA of tylenol
Inhibits COX which results in decreased prostaglandin synthesis
Recommended dose of tylenol
Chronic alcohol 1800-2000 mg/day
When is celebrex contraindicated?
allergy to sulfonamides
When is tramadol contraindicated?
Hx of seizures -- lowers seizure threshold
How should you stop tramadol?
Taper medication dose d/t potential to induce serotonin syndrome
MOA of capsaicin
depletion of substance P
When is maximum effect seen with capsaicin
When are intra-articular steroids useful?
When an effusion is present and there are clear signs of local inflammation
What is safest for OA patients with renal failure?
Capsaicin (no absolute contraindications with this med)
Most common AE of corticosteroids?
cataracts, glaucoma, glucose intolerance, osteoporosis (effect calcium absorption)
Contraindications to methotrexate
Pregnancy, breastfeeding, leukopenia
Labs to be monitored during methotrexate therapy
BUN, creatinine, LFTs q3 months
TNFI (tumor necrosis factor inhibitors)
End in -mab
When is golimumab (Simponi) indicated?
Only in combination with methotrexate
When will patient see response to TNFI?
Within days to weeks
What test should you do before started TNFI?
tuberculin skin test or interferon gamma release assay
Labs to monitor with TNFI
CBC and LFTs
With what medication should you avoid live vaccines
What do steroids put patient at risk for?
Obesity and infection
First line treatment for chronic gout
Xanthin oxidase inhibitors (allopurinol)
When will serum urate levels begin to drop with allopurinol
How often should serum urate levels be checked
Common AE of allopurinol
GI (take with food), rash, arthralgias
MOA of allopurinol
Decrease uric acid levels by selectively inhibiting xanthine oxidase
First line treatment for acute gout
Short courses of NSAIDs, corticosteroids, or colchicine
MOA of colchicine
Inhibits activation, degranulation, and migration of neutrophils to the area of a gout attack
SE of colchicine
GI (diarrhea most commonly)
QT prolongation and risk for torsades de pointes
Alpha-adrenergic blockers (flomax) MOA
relax smooth muscle of prostate and bladder neck without interfering with bladder contractility, decreasing bladder resistance to urinary outflow
5-a-reductase inhibitors MOA
specifically blocking 5-a-reductase (enzyme that activates testosterone in prostate) and impairs growth of prostate
What med to give prosthetic valve
What med to give for biological valve
What is the difference in OA vs RA
RA-inflammatory markers, symmetric
Serum urate to dx gout
What other med should be taken with longterm use of NSAIDs?
PPI or H2 blocker
Adjuvant pain meds
Gabapentin and tramadol
What med affects PSA?
5-AR (should reduce up to 50%)
BBW for NSAIDs
Potential for CV events and GI bleeding
First line tx UTI in pregnancy
Nitrofurantoin (1st and 2nd trimesters)