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Flashcards in Exam 2 Deck (78):
1

First line treatment for hyperthyroidism

Radioactive iodine (recommended for patients > 40)

2

Second line treatment for hyperthyroidism

Antithyroid Drugs (PTU & methimazole)

3

Third line treatment for hyperthyroidism

Surgery

4

First line treatment for hypothyroidism

Only treatment is replacement of thyroid hormone -- levothyroxine (Synthroid)

5

Lab values for hyperthyroidism

TSH - decreased
Free T4 - increased

6

Lab values for hypothyroidism

TSH - increased
Free T4 - decreased

7

Treatment for hyperthyroidism in pregnancy

Radioactive iodine contraindicated and in lactation.

8

What is the blood test to check vitamin D level?

25-hydroxyvitamin D (25OHD)

9

What level indicates vitamin D deficiency?

< 30

10

What level indicates vitamin D toxicity?

< 150

11

Signs of vitamin D toxicity

anorexia, weight loss, polyuria, arrhythmias, increased calcium level

12

People at risk for inadequate vitamin D absoprtion

gastric bypass, IBD, liver disease, cystic fibrosis, celiac, Crohn's, ulcerative colitis

13

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

14

What S&S should a patient taking PTU report?

Sore throat and fever
Obtain CBC and stop drug if WBC is low

15

Treatment for hypothryoidism

Synthroid

16

What does the parathyroid do?

Regulates calcium and phosphate metabolism

17

What causes pernicious anemia?

Vitamin B12 deficiency due to lack of intrinsic factor

18

Treatment of pernicious anemia

Vitamin B12 (cyanocobalamin) IM

19

What condition increases the risk of pernicious anemia?

Gastric bypass surgery

20

What do you check and when after start of treatment for iron deficiency anemia

CBC, HGB, HCT
2 weeks after start of therapy

21

VTE prophylaxis in pregnancy

LMWH

22

Lab test to monitor Heparin

PTT

23

Lab to monitor coumadin

PT

24

What thrombolytic agent would you use for someone with renal failure?

Coumadin

25

Antidote for heparin

Protamine sulfate

26

What is OLDCART

Onset
Location
Duration
Characteristics
Aggravating factors
Alleviating factors
Treatment

27

Two biggest side effects from narcotics

Respiratory depression & constipation

28

Treatment of choice for neuropathic pain?

gabapentin/neurontin

29

What vital sign should you monitor with use of narcotics

Respiratory rate & BP

30

What is the use for marijuana?

Nausea and vomiting in patients receiving chemo

31

Which form of marijuana has no CNS side effects?

CBD

32

What is safest pain reliever?

Tylenol (but it is not an anti-inflammatory)

33

What is a burst of steroids?

Steroid use for 5 days (greater than that, taper off)

34

First line tx for RA

Methotrexate and folic acid

35

What are drug/drug interactions for NSAIDs and what would you monitor?

ACE/ARB
Monitor for bleeding, GI, decreased kidney fx -- GI bleed and renal failure

36

What effects do steroids have on bone health?

Can cause osteoporosis
Give calcium & vit d

37

Teaching for biophosphates?

Take medicine while sitting up and drink a full glass of water

38

First line treatment of OA

Tylenol

39

MOA of tylenol

Inhibits COX which results in decreased prostaglandin synthesis

40

Recommended dose of tylenol

4 grams/day
Chronic alcohol 1800-2000 mg/day

41

When is celebrex contraindicated?

allergy to sulfonamides

42

When is tramadol contraindicated?

Hx of seizures -- lowers seizure threshold

43

How should you stop tramadol?

Taper medication dose d/t potential to induce serotonin syndrome

44

MOA of capsaicin

depletion of substance P

45

When is maximum effect seen with capsaicin

2-4 weeks

46

When are intra-articular steroids useful?

When an effusion is present and there are clear signs of local inflammation

47

What is safest for OA patients with renal failure?

Capsaicin (no absolute contraindications with this med)

48

Most common AE of corticosteroids?

cataracts, glaucoma, glucose intolerance, osteoporosis (effect calcium absorption)

49

Contraindications to methotrexate

Pregnancy, breastfeeding, leukopenia

50

Labs to be monitored during methotrexate therapy

CBC q4weeks
BUN, creatinine, LFTs q3 months

51

TNFI (tumor necrosis factor inhibitors)

End in -mab

52

When is golimumab (Simponi) indicated?

Only in combination with methotrexate

53

When will patient see response to TNFI?

Within days to weeks

54

What test should you do before started TNFI?

tuberculin skin test or interferon gamma release assay

55

Labs to monitor with TNFI

CBC and LFTs

56

With what medication should you avoid live vaccines

TNFIs

57

What do steroids put patient at risk for?

Obesity and infection

58

First line treatment for chronic gout

Xanthin oxidase inhibitors (allopurinol)

59

When will serum urate levels begin to drop with allopurinol

2 weeks

60

How often should serum urate levels be checked

q2-5 weeks

61

Common AE of allopurinol

GI (take with food), rash, arthralgias

62

MOA of allopurinol

Decrease uric acid levels by selectively inhibiting xanthine oxidase

63

First line treatment for acute gout

Short courses of NSAIDs, corticosteroids, or colchicine

64

MOA of colchicine

Inhibits activation, degranulation, and migration of neutrophils to the area of a gout attack

65

SE of colchicine

GI (diarrhea most commonly)

66

Ditropan SE

QT prolongation and risk for torsades de pointes

67

Alpha-adrenergic blockers (flomax) MOA

relax smooth muscle of prostate and bladder neck without interfering with bladder contractility, decreasing bladder resistance to urinary outflow

68

5-a-reductase inhibitors MOA

specifically blocking 5-a-reductase (enzyme that activates testosterone in prostate) and impairs growth of prostate

69

What med to give prosthetic valve

Warfarin

70

What med to give for biological valve

aspirin

71

What is the difference in OA vs RA

RA-inflammatory markers, symmetric
OA-non-inflammatory, asymmetric

72

Serum urate to dx gout

> 6.8

73

What other med should be taken with longterm use of NSAIDs?

PPI or H2 blocker

74

Adjuvant pain meds

Gabapentin and tramadol

75

What med affects PSA?

5-AR (should reduce up to 50%)

76

BBW for NSAIDs

Potential for CV events and GI bleeding

77

First line tx UTI in pregnancy

Nitrofurantoin (1st and 2nd trimesters)

78

MOA opioids

Bind to opioid receptors in CNS (mu, kappa, delta) with analgesic effect primarily with mu