Exam 3 Flashcards
(678 cards)
1
Q
Term? An unpleasant sensory and emotional experience associated with actual or potential damage
A
pain
2
Q
three causes of acute pain?
A
disease, injury, or inflammation
3
Q
onset of acute pain?
A
comes on suddenly
4
Q
what two things often accompany acute pain?
A
anxiety or emotional distress
5
Q
what is chronic pain believed to represent?
A
disease itself
6
Q
what two types of factors greatly worsen chronic pain?
A
environmental and psychological factors
7
Q
term? Persists over a long period of time and is resistant to most medical treatments
A
chronic pain
8
Q
examples of acute pain?
A
MVA; broken bone
9
Q
what is one of the most prevalent public health epidemics?
A
death involving prescription drug abuse
10
Q
what type of opioids are most problematic re: death?
A
synthetic opioids
11
Q
lack of knowledge among prescribers (re: opioids) involve what three topics?
A
addiction, dependence, and misuse
12
Q
current pain management guidelines, risk management practices, research in pain management- these are what?
A
contributing factors to opioid misuse/issues
13
Q
non-low back, musculoskeletal injuries- start with what?
A
topical NSAIDs with or without menthol gel
14
Q
non-low back, musculoskeletal injuries- second recommendation?
A
oral NSAIDs +/- acetaminophen
15
Q
non-low back, musculoskeletal injuries- third recommendation?
A
opioids including tramadol
16
Q
whether or not to prescribe opioids for pain- which guidelines?
A
CDC
17
Q
selecting opioids and determining dosages- which guidelines?
A
CDC
18
Q
deciding duration of initial opioid prescription and determining follow up- which guidelines?
A
CDC
19
Q
assessing risk and addressing potential harms of opioid use- which guidelines?
A
CDC
20
Q
what methodology do CDC guidelines use?
A
GRADES framework
21
Q
what is the most common source of chronic pain?
A
lower extremity pain
22
Q
what is the second most common source of chronic pain?
A
back pain
23
Q
2023 opioid guidelines- what are the four 1st line recommended classes of agents?
A
NSAIDs, anticonvulsants, acetaminophen, muscle relaxants
24
Q
what are the three 1st line opioids for mild pain?
A
tramadol, codeine, hydrocodone
25
opioids used for mild to moderate pain?
hydrocodone or oxycodone
26
three opioids used for mild pain? 1st line
tramadol, codeine, hydrocodone
27
three opioids used for severe pain?
hydrocodone, oxycodone, morphine
28
three fundamental tenets of responsible opioid prescribing?
1- patient eval and selection 2- period review and monitoring 3- treatment plans
29
1- patient eval and selection 2- periodic review and monitoring 3- treatment plans (what are these?
fundamental tenets of responsible opioid prescribing
30
what are the seven components of comprehensive pain assessment?
1- pain condition; 2-general medical history; 3-previous treatments; 4- psychosocial history and eval; 5- substance use history and addiction screening; 6-sleep patterns; 7- functional assessment
31
two examples of opioid prescribing risk stratification tools?
opioid risk tool; SOAPP Version 1.0-14Q
32
a self-report screening tool designed for adult patients in primary care settings to assess risk for opioid abuse among pts with chronic pain
opioid risk tool
33
a tool for clinicians designed to determine how much monitoring a patient on long-term opioid therapy might need
SOAPP
34
urine drug testing- component of what?
responsible opioid prescribing
35
pain management agreement- component of what?
responsible opioid prescribing
36
establishing treatment goals- component of what?
responsible opioid prescribing
37
setting realistic treatment goals- component of what?
responsible opioid prescribing
38
WHAT is needed to prescribe opioids for chronic pain?
informed consent
39
what are the three types of opioids?
natural, semisynthetic, or synthetic
40
absence of pain?
analgesia
41
what do opioid analgesics provide?
absence of pain without resulting in loss of consciousness/sleep
42
what are the two natural opioids?
morphine and codeine
43
what are the three semisynthetic opioid derivatives?
oxycodone, hydromorphone, and oxymorphone
44
what are the two categories of synthetic opioids?
phenylpiperidines and pseudopiperidine
45
what are the two phenylpiperidines?
meperidine and fentanyl
46
what is the example of the pseudopiperidine?
methadone
47
methadone- drug class?
pseudopiperidine (synthetic)
48
fentanyl- drug class?
phenylpiperidines (synthetic)
49
meperidine- drug class?
phenylpiperidines (synthetic)
50
oxycodone- type of opioid?
semisynthetic derivative
51
hydromorphone- type of opioid?
semisynthetic derivative
52
oxymorphone- type of opioid?
semisynthetic derivative
53
morphine- type of opioid?
natural
54
codeine- type of opioid?
natural
55
what are the three categories of opioid receptors?
mu, kappa, delta
56
what is the most important opioid receptor?
mu receptor
57
what receptor is responsible for most of the action of the opioids?
mu receptor
58
where is the mu 1 receptor located?
outside of the spinal cord
59
what receptor is responsible for central interpretation of pain?
mu 1
60
what is mu 1 receptor responsible for?
central interpretation of pain
61
where is the mu 2 receptor located?
throughout the CNS
62
what four things is mu 2 responsible for?
respiratory depression, spinal analgesia, physical dependence, euphoria
63
what receptor? Respiratory depression, spinal analgesia, physical dependence, euphoria
mu 2
64
what receptor is responsible for some of the side effects of opioid analgesia?
mu 2
65
which opioid receptors give modest analgesia?
kappa receptors
66
do kappa receptors affect respiratory depression? Yes/no
no
67
do kappa receptors pose risk of dependence? Yes/no
no
68
which opioid receptor causes dysphoric effects?
kappa receptors
69
term- sense of unease, anxiety
dysphoria
70
delta receptor agonists, show poor WHAT?
analgesia
71
do delta receptor agonists have addictive potential?
little addictive potential
72
delta agonists are used to minimize what?
some of the mu2 side effects
73
what drugs are used to minimize some of the mu 2 side effects?
delta agonists
74
morphine- drug class?
pure opioid agonist
75
codeine- drug class?
pure opioid agonist
76
buprenorphine- drug class?
mixed opioid agonist (mu)
77
nalaxone- drug class?
pure opioid antagonist
78
butorphanol- drug class?
mixed opioid agonist (kappa)
79
pentazocine- drug class?
mixed opioid agonist (kappa)
80
what opioid receptors decrease GI motility?
mu and kappa
81
by what three routes are opioid analgesics generally well-absorbed?
cutaneous, IM, and mucosal surfaces
82
where are the highest concentrations of opioid analgesics?
in the tissues
83
first pass effect of oral opioid analgesics?
fairly significant
84
highly lipophilic opioids concentrate where?
adipose tissue
85
what type of opioids are concentrated in adipose tissue?
highly lipophilic
86
what is a large reservoir of opioid analgesics?
skeletal muscle
87
what are two examples of highly lipophilic opioid analgesics?
fentanyl and codeine
88
what can cause prolonged analgesia in patients with compromised renal function?
morphine metabolites
89
renal excretion of opioid analgesics?
renally excreted unchanged
90
other than renal, route of excretion of opioid analgesics?
bile- minor amounts in enterohepatic circulation
91
what is another name for the descending aminergic pathways?
antinociceptive pathway
92
what class? Enhance activity in descending aminergic pathways that exert inhibitory effects on the processing of nociceptive information in the spinal cord
opioid analgesics
93
what pathway is affected with opioid analgesics?
descending aminergic pathways
94
what mechanism is closed with opioid analgesics?
close N-type voltage operated calcium channels
95
what type of channels are closed with opioid analgesics?
N-type voltage operated calcium channels
96
what type of channels are opened with opioid analgesics?
calcium dependent potassium channels
97
what is the results of changes to channels that happens with opioid analgesics?
hyperpolarization and reduction in neuronal excitability
98
what are the two components of pain?
affective and sensory
99
where does analgesia happen?
CNS
100
what component relates to pain unpleasantness?
affective
101
what component relates to pain intensity?
sensory
102
pain unpleasantness- term?
affective pain component
103
pain intensity- term?
sensory pain component
104
anxiolytic, pleasant- term?
euphoria
105
where does euphoria occur?
CNS
106
individuals not in pain may experience WHAT with opioid analgesics?
dysphoria
107
when might dysphoria occur in patients taking opioid analgesics?
if they are not in pain
108
what is a common consequence of opioid administration?
sedation
109
sedation with opioid use can result in what?
limited amnesia
110
describe sleep with opioid use?
patient can be easily awakened
111
describe sleep with opioid + sedative hypnotic?
deep sleep
112
what two opioids are likely to produce significant sleep?
synthetic morphine, oxycodone (less likely with fentanyl)
113
what is caused by inhibition of the brainstem respiratory center with opioids?
respiratory depression
114
what causes respiratory depression in opioids?
inhibition of the brainstem respiratory center
115
where is the respiratory center located?
brainstem
116
what are the two factors affecting opioid respiratory depression?
dose-related and influenced by sensory input
117
what patients can tolerate slight resp depression with opioids?
patients without prior respiratory problems
118
where is the cough center located?
medulla oblongata
119
what class of drugs suppresses cough center in medulla oblongata?
opioids
120
which specific opioid analgesic is the best at producing cough suppression?
codeine
121
class? Stimulate the brainstem chemoreceptor trigger zone
opioids
122
where is the chemoreceptor trigger zone?
brainstem
123
vestibular component may also be present with what?
opioid-related nausea and vomiting
124
effect of opioid on heart rhythm?
usually just mild bradycardia
125
what happens to PCO2 with opioid resp depression?
increased
126
what is the cerebral vascular effect of increased PCO2 with opioids?
cerebral vasodilation and increased blood flow
127
what effect do opioids have on ICP?
increased ICP
128
why do opioids have increased ICP?
respiratory depression and increased PCO2
129
increased or decreased PCO2 with opioids?
increased (resp depression)
130
what two mechanisms are involved with opioid-related constipation?
local and enteric CNS mechanisms
131
effects on stomach motility- opioids?
decreased
132
effect of opioids on stomach tone?
increased
133
effect of opioids on stomach acid production?
decreased
134
effect of opioids on tone of small intestine?
increased
135
effect of opioids on tone of large intestine?
increased
136
effect of opioids on biliary tract?
biliary smooth muscle contriction
137
effect of opioids on intestinal peristalsis?
diminished
138
effect of opioids on renal function?
depressed
139
effect of opioids on renal blood flow?
decreased
140
effect of opioids on bladder tone?
increased
141
effect of opioids on ureteral tone?
increased
142
where is the thermoregulatory center?
hypothalamus
143
what drugs alter the equilibrium point of the hypothalamic heat regulatory mechanisms?
opioids
144
what do opioids do to the hypothalamic heat regulatory mechanisms?
alter the equilibrium point
145
renal blood flow increased/decreased with opioids?
decreased
146
renal function increased/decreased with opioids?
decreased
147
bladder tone increased/decreased with opioids?
increased
148
ureteral tone increased/decreased with opioids?
increased
149
chills during opioid withdrawal likely related to what?
altered equilibrium of hypothalamus
150
effect of opioids on blood pressure?
hypotension
151
effect of opioids on ability to urinate?
urinary retention
152
cross tolerance can be seen among what?
different opioid agents
153
psychological dependence seen with what class?
opioid analgesics
154
what three situations can lead to opioid toxicity?
clinical overdosage, accidental overdosage in addicts, or suicide attempts
155
coma, pinpoint pupils, depressed respiratory status suggests what?
opioid toxicity
156
what three things suggest opioid toxicity?
coma, pinpoint pupils, respiratory depression
157
pupil appearance in opioid toxicity?
pinpoint
158
rhinorrhea and lacrimation- seen what withdrawal of what class?
opioids
159
hyper/hypoventilation seen in opioid withdrawal?
hyperventilation
160
HR changes in opioid withdrawal?
tachycardia
161
GI (3) sx seen in opioid withdrawal?
N/V/D
162
yawning- seen in what condition?
opioid withdrawal
163
skin appearance in opioid withdrawal?
piloerection
164
respiratory changes in opioid withdrawal?
hyperventilation
165
what does federal government have re: controlled substances?
dual imperative
166
what three things does a governmental system of controls prevent?
abuse, trafficking, diversion
167
abuse, trafficking, diversion are prevented by what?
government system of control
168
what are the two components of the federal government's dual imperative?
establish a system of controls; ensure medical availability
169
ensuring medical availability of controlled substances is part of the government's WHAT?
dual imperative
170
term- first enacted in 1970 to regulate the manufacture, importation, possession, use, and distribution of certain substances
Controlled Substances Act
171
when was the Controlled Substances Act enacted?
1970
172
who is responsible for interpreting and enforcing the CSA?
DEA
173
who has supporting responsibilities for CSA?
DHHS
174
DEA does what re: CSA?
interpreting and enforcing the CSA
175
what schedule- no currently acceptable medical use, high potential for abuse?
schedule 1
176
schedule 1 description?
no currently acceptable medical use, high potential for abuse
177
what schedule- high potential for abuse?
schedule 2
178
schedule 2- description?
high potential for abuse
179
what schedule- less abuse potential than schedule 2?
schedule 3
180
schedule 3- description?
less abuse potential than schedule 2
181
schedule 4 description?
less abuse potential relative to schedule 3
182
schedule 5 description?
low abuse potential relative to schedule 4
183
cocaine- schedule?
schedule 1
184
heroin- schedule?
schedule 1
185
two examples of schedule 1 drugs?
cocaine and heroin
186
when is cocaine used medically?
intractable epistaxis
187
pseudoephedrine- schedule in some states?
schedule 5
188
what label does not change medical value of medications?
"controlled substance"
189
efforts to prevent abuse must not interfere with what two things?
medical practice and patient care
190
healthcare providers must comply with what two types of regulations?
federal and state
191
which rule applies when federal and state regulations differ?
the more stringent rule applies
192
where do you find the federal regulations?
the Controlled Substances Act
193
where do you find the state regulations?
the state/licensing board/governing board
194
class? Biguanides
antidiabetic drugs
195
class? Sulfonylureas
antidiabetic drugs
196
class? Thiazolidinediones
antidiabetic drugs
197
class? Meglitinides
antidiabetic drugs
198
class? Selective sodium glucose cotransporter 2 inhibitors
antidiabetic drugs
199
class? Amylin agonists
antidiabetic drugs
200
class? Dipeptidyl peptidase-4 inhibitors
antidiabetic drugs
201
class? Glucagon-like peptide 1 receptor agonists
antidiabetic drugs
202
class? Dual-acting GLP1 and glucose-dependent insulinotropic polypeptide receptor agonists
antidiabetic drugs
203
biguanide drug?
metformin
204
specific class? Metformin
biguanide
205
other uses for metformin/biguanides?
metabolic-syndrome type disorders like PCOS
206
drugs used in PCOS?
metformin (biguanides)
207
does metformin address major patho processes of diabetes?
yes
208
effect of metformin on insulin sensitivity?
improved
209
effect of metformin on hepatic gluconeogenesis?
decreased
210
effect of metformin on absorption of glucose by intestines?
decreased
211
effect of metformin on weight?
weight-neutral or weight loss
212
effect of metformin on platelets?
inhibition of platelet aggregation
213
effect of metformin on triglycerides?
decreased
214
effect of metformin on HDL?
increased
215
effect of metformin on LDL?
decreased
216
what generally improves triglyceride levels in DM?
better glycemic control
217
when is metformin primarily used?
first line for DM
218
what are most prominent side effects with metformin?
GI
219
examples of GI side effects with Metformin?
bloating, nausea, and diarrhea
220
how should metformin be dosed?
start low and titrate slow
221
how to reduce side effects with metformin?
start low and titrate slow
222
deficiency of what can be caused by metformin?
vitamin B12
223
patients on metformin should be monitored for deficiency of what?
vitamin B12
224
rare but serious side effect with metformin?
lactic acidosis
225
what increases the risk for lactic acidosis with metformin?
comorbid conditions (renal dysfunction)
226
hypoglycemia with metformin?
rare (not an insulin secretagogue)
227
side effect of metformin re: liver?
hepatitis (Rare)
228
effect of metformin on TSH?
decreased TSH levels
229
when is thyroid function most likely to be altered with metformin?
first 6 months
230
what patients are at risk for decreased TSH with metformin?
those with abnormal thyroid function
231
possible life threatening side effect of metformin?
lactic acidosis
232
does metformin cause more insulin to be released from the pancreatic beta cells?
no
233
strategy to avoid adverse effects of metformin?
start low and titrate slow
234
why should metformin be used cautiously in older adult population?
liver and kidney dysfunction due to aging
235
why is severe renal dysfunction a contraindication for metformin?
increased risk for lactic acidosis
236
acute or chronic metabolic acidosis is a contraindication for what drug?
metformin (biguanides)
237
hypoperfusion of the kidneys increases risk of what with metformin?
lactic acidosis
238
patients with hypoxia are at increased risk for what with metformin?
lactic acidosis
239
alcoholics with severe liver dysfunction are at increased risk for what with metformin?
lactic acidosis
240
patients with liver dysfunction are at risk for what with metformin?
lactic acidosis
241
what may happen when IV contrast given with metformin?
renal dysfunction
242
can you give metformin if DKA?
no
243
two example drugs of sulfonylureas?
glyburide and glipizide
244
glyburide and glipizide drug class?
sulfonylurea
245
glyburide drug class?
sulfonylurea
246
glipizide drug class?
sulfonylurea
247
are sulfonylureas insulin secretagogues?
yes
248
can hypoglycemia occur with sulfonylureas?
yes
249
when is hypoglycemia most likely to occur with sulfonylureas?
especially with older generation drugs
250
hypoglycemia can be WHAT with sulfonylureas?
life-threatening
251
weight gain with sulfonylureas?
yes
252
how to minimize GI upset with sulfonylureas?
divide up the dose
253
what drug class may produce disulfram-like reaction with alcohol?
sulfonylureas
254
what causes disulfram like reaction with sulfonylureas?
alcohol
255
what is increased in disulfram reaction with sulfonylureas?
increased serum acetaldehyde
256
signs of disulfram reaction?
sweating, palpitations, flushing, N/V, vertigo, hypotension, tachycardia
257
signs of what? Sweating, palpitations, flusing, N/V, vertigo, hypotension, tachycardia
disulfram-like reaction (sulfonylureas + alcohol)
258
blood cell dyscrasias- what antidiabetic class?
sulfonylureas
259
what are signs of blood cell dyscrasias?
evidence of infections (WBCs), easy bruising/bleeding (platelets), fatigue/pallor (RBCs)
260
sulfonylureas- antidiuretic effects?
yes
261
why should patients report edema, weight gain, SOB with sulfonylureas?
antidiruetic effects
262
what is the exception to antidiuretic effects with sulfonylureas?
glyburide
263
glyburide does what to fluid balance?
mild diuresis
264
are sulfonylureas usually first line drugs?
no
265
what is an insulin secretagogue?
increases amount of insulin being released from the pancreas
266
why should we use newer generation sulfonylureas?
less risk of hypoglycemia
267
how should we divide doses of sulfonylureas?
divide into two doses
268
use of sulfonylureas with what may mask hypoglycemia?
alcohol
269
what type of risk is posed with long-term use of sulfonylureas?
cardiovascular risk
270
what drug should not be used in older patients as may mask hypoglycemia?
glyburide
271
what happens when sulfonylureas used in pregnancy?
risk for severe neonatal hypoglycemia
272
sulfonylureas in lactation?
no
273
sulfonylureas in pediatrics?
cautious use
274
sulfonylureas in type 1 DM?
no
275
oral drugs in DKA?
no
276
sulfonyulreas in severe hepatic dysfunction?
no
277
sulfonylureas in severe renal dysfunction?
no
278
sulfonyulreas in uncontrolled infection, burns, trauma?
no
279
sulfonylureas in patients that are unstable?
no- increased risk for hypoglycemia
280
what antidiabetic agent is preferred in pregnancy?
insulin
281
when are thiazolidinediones used?
type 2 diabetes
282
can TZDs be used alone?
yes
283
specific class? Pioglitzaone
thiazolidinediones
284
specific class? Rosiglitazone
thiazolidinediones
285
what effect do TZDs have in insulin resistance?
decreased
286
does insulin have to be present to decrease insulin resistance?
yes
287
how to TZDs decrease insulin resistance?
activation of the peroxisome proliferator-activated receptor gamma
288
peroxisome proliferator-activated receptor gamma- involved in what class?
thiazolidinediones
289
gene transcription is regulated so that proteins are produced in the cell that help insulin to act in the cell- what class?
thiazolidinediones
290
what is regulated in TZDs to help proteins be produced to allow insulin to act in the cell?
gene transcription
291
weight gain with TZDs?
yes
292
edema with TZDs?
yes (fluid volume expansion)
293
fluid volume expansion can be significant and progress to what with TZDs?
heart failure
294
why is there edema and potential HF with TZDs?
decreased urinary excretion of sodium and water
295
296
fluid volume expansion can be significant and progress to what with TZDs?
heart failure
297
why is there edema and potential HF with TZDs?
decreased urinary excretion of sodium and water
298
what causes plasma volume expansion with TZDs?
decreased urinary excretion of sodium and water
299
what happens to vascular permeability with TZDs?
increased vascular permeability
300
what does increased vascular permeability cause with TZDs?
edema
301
heart failure exacerbation- possible with what antidiabetic class?
thiazolidinediones
302
hypertension can be caused by what antidiabetic class?
thiazolidinediones
303
cholestatic hepatitis- adverse effect of what antidiabetic class?
thiazolidinediones
304
cholestatic hepatitis in TZDs- prevalence?
rare
305
hepatotoxicity in TZDs- prevalence?
rare
306
macular edema- what antidiabetic class?
thiazolidinediones
307
what causes decrease in hemoglobin with TZDs?
increase in plasma volume
308
what is a marker for increased plasma volume with TZDs?
decreased hemoglobin
309
decreased hemoglobin- what antidiabetic class?
thiazolidinediones
310
effect of TZDs on liver function?
elevated LFTs; hepatotoxicity possible but is rare
311
patients taking what antidiabetics should monitor for edema and weight gain?
thiazolidinediones
312
what antidiabetic agent should be used cautiously in HIV?
thiazolidinediones
313
what can happen if TZD taken on HAART?
increased cholesterol and triglyceride levels
314
increased cholesterol and triglyceride levels increase the risk for what? (antidiabetic context)
pancreatitis
315
macular edema is also a contraindication for what class?
thiazolidinediones
316
what antidiabetic class can cause ovulation?
thiazolidinediones
317
TZDs in pregnancy?
only if benefits clearly outweigh risks
318
TZDs in lactation?
avoid
319
NYHA class III or class IV- contraindication for what antidiabetic class?
thiazolidinediones
320
any volume overload situation- contraindication for what antidiabetic class?
thiazolidinediones
321
what antidiabetic class is contraindicated during an acute coronary event?
thiazolidinediones
322
what is the rule for ALT contraindications in TZDs?
ALT > 2.5x upper limit of normal
323
development of jaundice signals what?
hepatic injury
324
active bladder cancer or risk for bladder neoplasm- contraindication for what drug?
pioglitazone
325
class? Acarbose
alpha-glucosidase inhibitors
326
class? Miglitol
alpha-glucosidase inhibitors
327
two example drugs of alpha-glucosidase inhibitors?
acarbose and miglitol
328
acarbose and miglitol- class?
alpha-glucosidase inhibitors
329
where do alpha-glucosidase inhibitors act?
small bowel
330
what do AGIs compete with in the small bowel?
complex carbohydrates
331
class? Act in small bowel to compete with complex carbohydrates for digestion?
alpha-glucosidase inhibitors
332
where does induction of digestive enzyme occur with AGIs?
large intestine
333
what may patient experience over weeks to months when starting AGIs?
excessive flatus and abdominal bloating
334
when do AGIs lower blood glucose relative to meals?
postprandial lowering of blood glucose
335
effect of AGIs on A1c?
reduction over time
336
are AGIs insulin secretagogues?
no
337
what benefit can AGIs have if given with sulfonylureas?
mitigate the weight gain that tends to happen with sulfonylureas
338
what antidiabetic class can worsen underlying bowel disease?
alpha-glucosidase inhibitors
339
Chron disease or ulcerative colitis can be worsened by what antidiabetic class?
alpha-glucosidase inhibitors
340
why do patients often discontinue AGIs?
Gi side effects (diarrhea, abdominal pain, excessive gas, bloating)
341
what can minimize adverse effects of AGIs?
slow titration
342
when can hypoglycemia occur with AGIs?
if combined with other medications that cause hypoglycemia
343
are AGIs used for monotherapy?
no
344
when may adverse effects dissipate with AGIs?
first two weeks at same dose
345
when can adverse effects return with AGIs?
when a dose is increased
346
AGIs in pregnancy?
safety not established- avoid use
347
AGIs in lactation?
no
348
AGIs in children?
safety not established
349
AGIs in severe renal impairment?
no
350
what should be monitored with AGIs? (acarbose)
AST, ALT, renal function
351
AGIs in bowel disorders?
no
352
what antidiabetic class is contraindicated with use of any intestinal absorbents?
alpha-glucosidase inhibitors
353
what antidiabetic class is contraindicated with use of prescribed digestive enzymes?
alpha-glucosidase inhibitors
354
when should AGIs be taken?
first bite of a meal
355
what antidiabetic class should be taken with the first bite of a meal?
alpha-glucosidase inhibitors
356
what antidiabetic class is contraindicated with charcoal?
alpha-glucosidase inhibitors
357
intestinal adsorbents are contraindicated with what antidiabetic class?
alpha-glucosidase inhibitors
358
are meglitinides monotherapy?
usually not
359
indication for meglitinides?
type 2 diabetes
360
nateglinide- class?
meglitinides
361
repaglinide- class?
meglitinides
362
are meglitinides insulin secretagogues?
yes
363
can meglitinides cause hypoglycemia?
yes
364
meglitinides effect on postprandial glucose?
decrease
365
describe meglitinides effect on postprandial glucose?
proportional to the level of postprandial hyperglycemia
366
two examples of meglitinides?
nateglinide, repaglinide
367
nateglinide and repaglinide- class?
meglitinides
368
when should repaglinide be given?
30 minutes before meals
369
when should nateglinide be given?
1-30 minutes before meals
370
do insulin secretagogues work with minimal beta cell function?
no
371
severe hepatic impairment with meglitinides?
cautious use and adjustment
372
severe renal impairment with meglitinides?
cause use and adjustment
373
repaglinide should not be combined with what drug?
gemfibrozil
374
gemfibrozil should not be combined with what antidiabetic drug?
repaglinide
375
meglitinides- pregnancy?
safety not established- avoid use
376
meglitinides- lactation?
safety not established- avoid use
377
meglitinides- pediatrics?
safety not established- avoid use
378
combination of what two antidiabetic drugs has caused myocardial ischemia?
repaglinide and NPH insulin
379
SGLT2 inhibitors- stands for what?
selective sodium glucose co-transporter 2 inhibitors
380
SGLT2 inhibitors- indications?
type 2 diabetes as monotherapy or combination therapy
381
can SGLT2 inhibitors be used as monotherapy?
yes
382
canagliflozin- class?
selective sodium glucose co-transporter 2 inhibitors
383
empagliflozin- class?
selective sodium glucose co-transporter 2 inhibitors
384
dapagliflozin- class?
selective sodium glucose co-transporter 2 inhibitors
385
ertugliflozin- class?
selective sodium glucose co-transporter 2 inhibitors
386
what antidiabetic class inhibits reabsorption of glucose in kidney proximal tubule?
selective sodium glucose co-transporter 2 inhibitors
387
what antidiabetic class causes increased excretion of glucose in the urine?
selective sodium glucose co-transporter 2 inhibitors
388
where to SGLT2s work?
renal proximal tubule
389
how to SGLT2s lower blood glucose?
increased glucose excretion in the urine
390
what antidiabetic class can cause hypovolemia?
selective sodium glucose co-transporter 2 inhibitors
391
what causes hypovolemia with SGLT2 inhibitors?
osmotic diuresis
392
what antidiabetic class can cause genital fungal infections?
selective sodium glucose co-transporter 2 inhibitors
393
what antidiabetic class can cause UTI?
selective sodium glucose co-transporter 2 inhibitors
394
what antidiabetic class can cause intravascular volume depletion?
selective sodium glucose co-transporter 2 inhibitors
395
what antidiabetic class can cause increased LDL cholesterol?
selective sodium glucose co-transporter 2 inhibitors
396
what antidiabetic class can cause increased hemoglobin?
selective sodium glucose co-transporter 2 inhibitors
397
what is SGLT2 effect on hemoglobin?
increased
398
why can SLGT2 inhibitors increase hemoglobin?
intravascular volume contraction
399
what antidiabetic class poses a risk for DKA?
selective sodium glucose co-transporter 2 inhibitors
400
what two conditions may experience DKA with SGLT2 inhibitors?
type 1 and type 2 DM
401
what antidiabetic class can cause bone loss and fracture?
selective sodium glucose co-transporter 2 inhibitors
402
what antidiabetic class can cause lower extremity infection?
selective sodium glucose co-transporter 2 inhibitors
403
what antidiabetic class is associated with risk for amputation?
selective sodium glucose co-transporter 2 inhibitors
404
when can hypoglycemia happen with SGLT2 inhibitors?
when combined with insulin or insulin secretagogues
405
what class of drugs is used in HFrEF and diabetes?
selective sodium glucose co-transporter 2 inhibitors
406
what antidiabetic class should be used cautiously with osteoporosis?
selective sodium glucose co-transporter 2 inhibitors
407
what antidiabetic drug has a black box warning for risk for amputation?
canagliflozin
408
what antidiabetic drug should not be used with a history of amputation?
canagliflozin
409
SGLT2s- use in severe renal dysfunction?
contraindication
410
can SGLT2 inhibitors be used in DKA or type 1?
no
411
can SGLT2 inhibitors be used in DKA?
NO
412
can SGLT2 inhibitors be used in T1DM?
no
413
what are the risks with intravascular volume depletion in SGLT2 inhibitors?
syncope and falls
414
what should be monitored with SGLT2 inhibitors?
renal function, electrolytes, volume status
415
what antidiabetic drug is associated with increased risk for fractures?
canagliflozin
416
what electrolyte imbalance may occur with SGLT2 inhibitors?
hyperkalemia
417
what antidiabetic class may cause hyperkalemia?
selective sodium glucose co-transporter 2 inhibitors
418
antidiuretics and antihypertensives may worsen intravascular volume depletion with what drug class? (antidiabetics)
selective sodium glucose co-transporter 2 inhibitors
419
peripheral vascular disease is a contraindication for what antidiabetic drug?
canagliflozin
420
neuropathy is a contraindication for what antidiabetic drug?
canagliflozin
421
history of leg ulcers is a contraindication for what antidiabetic drug?
canagliflozin
422
history of leg infection is a contraindication for what antidiabetic drug?
canagliflozin
423
current leg ulcer or infection are contraindications for what antidiabetic drug?
canagliflozin
424
amylin agonists use in type 2 dm?
yes
425
amylin agonists use in type 1 dm?
yes
426
are amylin agonists first line therapy?
no
427
pramlintide- class?
amylin agonists
428
example drug of amylin agonists?
pramlintide
429
what effect does pramlintide have on gastric emptying?
delayed
430
how do amylin agonists affect weight?
possible weight loss
431
what does weight loss in DM accomplish?
improve insulin sensitivity
432
what is the black box warning with pramlintide?
severe hypoglycemia (esp in type 1 dm)
433
what effect do amylin agonists have on glucagon?
decreased glucagon secretion
434
what effect do amylin agonists have on appetite?
central inhibition of appetite
435
who is most at risk for severe hypoglycemia with amylin agonists?
type 1 diabetics
436
what are the GI adverse effects of amylin agonists?
nausea, vomiting, abdominal pain, decreased appetite
437
how to minimize GI adverse effects with amylin agonists?
gradually titrate to desired dosing
438
amylin synthetic analogue that acts like endogenous amylin- class?
amylin agonists
439
what antidiabetic class is contraindicated with gastroparesis?
amylin agonists
440
why are amylin agonists contraindicated with gastroparesis?
might worsen it due to delayed gastric emptying effects
441
what antidiabetic class is contraindicated in hx of severe hypoglycemia?
amylin agonists
442
what antidiabetic class should be avoided in noncompliance?
amylin agonists
443
why should amylin agonists be used cautiously in older adults?
may not be aware of hypoglycemia
444
amylin agonists- pregnancy?
safety not established- avoid use
445
amylin agonists- lactation?
safety not established- avoid use
446
what does DPP4 stand for?
dipeptidyl peptidase-4 inhibitors
447
another name for DPP4 inhibitors?
gliptins
448
when are DPP4 inhibitors used?
type 2 diabetes
449
sitagliptin- class?
dipeptidyl peptidase-4 inhibitors
450
saxagliptin- class?
dipeptidyl peptidase-4 inhibitors
451
linagliptin- class?
dipeptidyl peptidase-4 inhibitors
452
alogliptin- class?
dipeptidyl peptidase-4 inhibitors
453
what antidiabetic class slows the breakdown of GLP-1?
dipeptidyl peptidase-4 inhibitors
454
how do DPP4 inhibitors work?
slow the breakdown of GLP1
455
what is the benefit of slowing the breakdown of GLP1 with DPP4 inhibitors?
allow it to exert its effects longer
456
what does GLP1 do to gastric emptying?
slows
457
what does GLP1 do to glucagon secretion?
suppress
458
what does GLP1 do to beta cell mass?
increases
459
what does GLP1 do to insulin synthesis?
increases
460
what does GLP1 do to appetite?
decreased
461
joint pain- adverse effect of what antidiabetic class?
dipeptidyl peptidase-4 inhibitors
462
hypoglycemia with DPP4 inhibitors?
yes
463
urinary and respiratory tract infection- what antidiabetic class?
dipeptidyl peptidase-4 inhibitors
464
can you see weight loss with DPP4 inhibitors?
yes
465
can renal dysfunction occur with DPP4 inhibitors?
yes
466
what antidiabetic class can cause bulbous phemphgoid?
dipeptidyl peptidase-4 inhibitors
467
what antidiabetic class can cause SJS?
dipeptidyl peptidase-4 inhibitors
468
what antidiabetic class can cause heart failure?
dipeptidyl peptidase-4 inhibitors
469
what antidiabetic class can cause rhabdomyolysis?
dipeptidyl peptidase-4 inhibitors
470
lab monitoring with DPP4 inhibitors?
renal function, electrolytes, volume status
471
teach patients to monitor for signs of what with DPP4 inhibitors?
heart failure
472
DPP4 inhibitors- pregnancy?
safety not established- avoid use
473
DPP4 inhibitors- lactation?
safety not established- avoid use
474
DPP4 inhibitors- pediatrics?
safety not established- avoid use
475
can GLP1 agonists be used in type 1?
no
476
can GLP1 agonists be monotherapy?
yes
477
can GLP1 agonists be combination therapy?
yes
478
exenatide- class?
GLP1 receptor agonist
479
liraglutide- class?
GLP1 receptor agonist
480
lixisenatide- class?
GLP1 receptor agonist
481
dulaglutide- class?
GLP1 receptor agonist
482
semaglutide- class?
GLP1 receptor agonist
483
what class acts like endogenous GLP1?
GLP1 receptor agonist
484
effect of GLP1 agonists on insulin synthesis?
increased
485
effect of GLP1 agonists on beta cell mass?
increased
486
effect of GLP1 agonists on gastric emptying?
slowed
487
effect of GLP1 agonists on appetite?
decreased
488
effect of GLP1 agonists on triglycerides?
decreased
489
effect of GLP1 agonists on systolic blood pressure?
decreased
490
which antidiabetic class can reduce SBP?
GLP1 receptor agonist
491
effect of GLP1 agonists on glucagon secretion?
suppressed
492
GI adverse effects of GLP1 agonists?
nausea vomiting
493
GI adverse effects of GLP1 agonists? Improve or not
tend to resolve over time
494
diarrhea or constipation with GLP1 agonists?
diarrhea
495
gallbladder disease associated with which antidiabetic class?
GLP1 receptor agonist
496
biliary disease associated with which antidiabetic class?
GLP1 receptor agonist
497
pancreatic duct metaplasia associated with which antidiabetic class?
GLP1 receptor agonist
498
potential thyroid dysfunction and nodules- which antidiabetic class?
GLP1 receptor agonist
499
pancreatitis associated with which antidiabetic class?
GLP1 receptor agonist
500
elevated calcitonin levels associated with which antidiabetic class?
GLP1 receptor agonist
501
which antidiabetic class associated with acute kidney dysfunction/failure/injury?
GLP1 receptor agonist
502
immune thrombocytopenia associated with which antidiabetic drug?
exenatide
503
risk for hypoglycemia with GLP1 agonists?
small when used alone but only when combined with other drugs that cause hypoglycemia
504
exenatide has been associated with what?
immune thrombocytopenia
505
what antidiabetic class has been associated with thyroid cancer?
GLP1 receptor agonist
506
GLP1 agonist- route?
injection
507
how often to give GLP1 agonists?
once weekly
508
when might GLP1 agonists not be effective?
if not adequate GLP1 receptors in the gut (lost in DM)
509
when should GLP1 agonists be used?
in severe forms of GI disease- chrons or UC
510
history of pancreatitis is a contraindication for what antidiabetic drug class?
GLP1 receptor agonist
511
endocrine neoplasia is a contraindication for what antidiabetic drug class?
GLP1 receptor agonist
512
what antidiabetic class is associated with neuroendocrine tumor precautions?
GLP1 receptor agonist
513
lab monitoring with GLP1 agonists?
GLP1 receptor agonist
514
GLP1 agonist- pregnancy?
safety not established- avoid use
515
GLP1 agonist- lactation?
safety not established- avoid use
516
GLP1 agonists should not be used alongside what other antidiabetic drug class?
dipeptidyl peptidase-4 inhibitors
517
medullary thyroid dysfunction- contraindication for what antidiabetic drug class?
GLP1 receptor agonist
518
when should we monitor liver function with GLP1 agonists?
history of gallbladder or liver disease
519
can GLP1 agonists be used with metformin?
yes- consider clinical siguation
520
can you use GLP1 agonists with basal insulin?
yes- depending on clinical situation
521
tirzepatide- class?
dual acting GLP1 and glucose-dependent insulinotropic polypeptide receptor agonists
522
tirzepatide indications? 2
diabetes type 2 and weight management
523
tirzepatide, actions?
same as the GLP1 agonists alone
524
what must be present for GLP1 agonists and GIP dual agonists to work?
glucose
525
another name for HMG CoA reductase inhibitors?
statins
526
class- HMG CoA reductase inhibitors?
antilipidemics
527
class- cholesterol absorption inhibitors?
antilipidemics
528
class- bile acid sequestrants?
antilipidemics
529
class- fibric acid derivatives?
antilipidemics
530
class- niacin?
antilipidemics
531
class- proprotein convertase subtilisin/kexin type 9?
antilipidemics
532
class- bempedoic acid?
antilipidemics
533
what does PCSK9 stand for?
proprotein convertase subtilisin/kexin type 9
534
rosuvastatin- class?
statin
535
atorvastatin- class?
statin
536
two examples of statins?
rosuvastatin and atorvastatin
537
class? Competitively block HMG CoA reductase
statins
538
what is HMG CoA reductase?
an enzyme required in cholesterol synthesis in the liver
539
clinical uses of statins?
to decreases LDL and treat hyperlipidemia; includig hypertriglyceridemia
540
what three levels do statins lower?
total cholesterol, LDL, apo B lipoprotein
541
what other use do statins have?
prevention of atherosclerosis
542
what is the FDA warning with statins?
concerns re: statins causing DM and cognitive dysfunction (memory and concentration)
543
what are the manifestations of cognitive dysfunction caused by statins?
memory and concentration
544
GI side effects of statins?
nausea, vomiting, pain/dyspepsis, constipation/diarrhea, flatulence
545
what is the common muscular side effect of statins?
myalgia
546
what are the three muscular side effects of statins?
myalgia (common), myositis, rhabdomyolysis
547
what is the potentially life-threatening side effect of statins?
rhabdomyolysis (can injure the kidneys and be life-threatening)
548
characterize the risk of liver dysfunction with statins?
small- routine LFT testing not advised
549
fatigue and flu-like symptoms seen with which antilipidemics?
statins
550
statins in active liver disease?
contraindication
551
statins with heavy alcohol intake?
caution
552
statins with history of liver disease?
caution
553
statins in pregnancy?
most cases- absolutely contraindicated
554
statins in women planning to become pregnant?
do not prescribe
555
statins in lactation?
do not prescribe
556
ezetimibe- specific class?
cholesterol absorption inhibitor
557
can ezetimibe be used as monotherapy?
yes (for patients intolerant to statins)
558
can ezetimibe be used as an adjunct to statins?
yes
559
what cholesterol metrics does ezetimibe affect?
LDL (reduction)
560
what drug- inhibits the absorption of cholesterol at the brush border of the small intestine?
ezetimibe (cholesterol absorption inhibitor)
561
what sources of cholesterol are inhibited by ezetimibe?
dietary and biliary sources
562
where does ezetimibe inhibit cholesterol absorption?
brush border of the small intestine
563
what drug? Decreased delivery of intestinal cholesterol to the liver?
ezetimibe (cholesterol absorption inhibitor)
564
two significant adverse effects with ezetimibe?
acute liver injury; muscular- myalga, myopathy, rhabdomyolysis
565
ezetimibe in active liver disease?
contraindication
566
colestipol- specific class?
bile acid sequestrants
567
cholestyramine- specific class?
bile acid sequestrants
568
colestipol- broad class?
antilipidemics
569
cholestyramine- broad class?
antilipidemics
570
effect of bile acid sequestrants on LDL?
reduction
571
effect of bile acid sequestrants on HDL?
some increase
572
class? Chloride ions are exchanged with bile acids (negatively charged)
bile acid sequestrants
573
what effect do bile acid sequestrants have on bile acid?
more bile acid is excreted
574
class? Liver converts more cholesterol to bile acids along with an upregulation of LDL recptors on cell membranes
bile acid sequestrants
575
constipation that can lead to impaction- antilipidemic class?
bile acid sequestrants
576
folate deficiency seen in which antilipidemic class?
bile acid sequestrants
577
(rare) urine has an odor of something being burned? Antilipidemic class?
bile acid sequestrants
578
down or upregulation of LDL receptors on cell membranes with bile acid sequestrants?
upregulation
579
gemfibrozil- specific class?
fibric acid derivatives
580
fenofibrate- specific class?
fibric acid derivatives
581
gemfibrozil- general class?
antilipidemics
582
fenofibrate- general class?
antilipidemics
583
class? Act by causing an increase in lipolysis of triglycerides by using lipoprotein lipases
fibric acid derivatives
584
class? Decreases VLDL synthesis by the liver
fibric acid derivatives
585
what antilipidemic class is linked to gallstones?
fibric acid derivatives
586
what antilipidemic class is linked to decreased hemoglobin, HCT, WBC?
fibric acid derivatives
587
fibric acid derivatives- pregnancy?
avoid
588
class? Reduce hypertriglyceridemia with indirect elevation of HDL cholesterol d/t lowering of triglyceride levels
fibric acid derivatives
589
class? Assists to avoid pancreatitis in hypertriglyceridemia?
fibric acid derivatives
590
what antilipidemic drug is not longer favored?
niacin
591
what antilipidemic drug has been removed from guidelines for therapy?
niacin
592
what antilipidemic drug? No efficacy in decreasing cardiovascular endpoints and all-cause mortality
niacin
593
why has niacin been removed from guidelines?
no efficacy in decreasing cardiovascular endpoints and all-cause mortality
594
monoclonal antibodies- specific class?
PCSK9 inhibitors
595
monoclonal antibodies- broad class?
PCSK9 inhibitors
596
class? Reduction in LDL cholesterol usually in those with atherosclerotic cardiovascular disease or familial hypercholesterolemia
PCSK9 inhibitors
597
class? Alteration of an LDL transporter protein so that it transports more LDL to the liver to be used again
PCSK9 inhibitors
598
what is the overall effect of PCSK9 inhibitors?
more LDL removed from circulation
599
what do PCSK9 inhibitors do in the liver?
upregulation of LDL receptors in the liver
600
PCSK9 inhibitors- adverse effects?
usually well-tolerated
601
class? Mild injection site reactions- erythema, redness, mild swelling
PCSK9 inhibitors
602
reduction in LDL cholesterol in those with ASCVD (secondary prevention)?
bempedoic acid
603
class? Those with heterozygous familial hypercholesterolemia
bempedoic acid
604
class? An adenosine triphosphate-citrate lyase inhibitor that inhibits cholesterol production by the liver
bempedoic acid
605
adenosine triphosphate citrate lyase is involved in synthesis of what?
cholesterol
606
where does bempedoic acid work relative to statins?
before the HMG CoA reductase step that the statins inhibit
607
why does bempedoic acid lower LDL cholesterol?
because more LDL receptors are expressed
608
what antilipidemic class? Hyperuricemia and gout can occur
bempedoic acid
609
what antilipidemic class? Tendon rupture
bempedoic acid
610
is bempedoic acid first line therapy?
no
611
contraindications for bempedoic acid?
no known contraindications except precautions re: using in the setting of hyperuricemia and/or gout
612
what is preferred over natural pork-derived thyroid hormone?
synthetic levothyroxine
613
synthetic levothyroxine is preferred over what?
pork-derived thyroid hormone
614
synthetic levothyroxine acts like what?
body's endogenous thyroid hormone
615
what results in increased metabolic rate in all tissues with concomitent increased O2 consumption?
thyroid hormone
616
effect of thyroid hormone on protein metabolism?
increased
617
effect of thyroid hormone on enzyme activity?
increased
618
effect of thyroid hormone on fat metabolism?
increased
619
effect of thyroid hormone on temperature?
increased
620
effect of thyroid hormone on HR?
increased
621
effect of thyroid hormone on respiratory rate?
increased
622
effective of thyroid hormone on growth, differentiation, and tissue maturation?
promotes
623
what is the cause of adverse effects with thyroid hormone therapy?
those of hyperthyroidism
624
HR with hyperthyroidism?
increased
625
respiratory rate with hyperthyroidism?
increased
626
gastrointestinal motility with hyperthyroidism?
increased
627
weight with hyperthyroidism?
weight loss
628
heat tolerance with hyperthyroidism?
heat intolerance
629
cardiac effects with hyperthyroidism?
chest pain, acute coronary syndromes, cardiac dysrhythmias
630
menstrual effects with hyperthyroidism?
menstrual alterations
631
what are the symptoms associated with increased GI motility with hyperthyroidism?
diarrhea and vomiting
632
what should patients be cautioned about with thyroid hormone?
signs and symptoms of both hypo/hyper thyroidism
633
what should patients be taught to monitor with thyroid hormone?
heart rate
634
what thyroid dysfunction is very important to treat in pregnancy?
hypothyroidism
635
what state may require higher doses of thyroid hormone?
pregnancy
636
why might there be an increased dosage need for thyroid hormone in pregnancy?
higher metabolic demand in pregnancy
637
thyroid hormone may exacerbate symptoms of what two conditions?
diabetes insipidus and adrenal insufficiency
638
what medication may precipitate adrenal crisis? (endocrine med)
thyroid hormone
639
how is adrenal crisis treated?
adrenocorticosteroids
640
what is the TSH goal for patients with osteoporosis?
upper limits of normal
641
what may happen to bone density with thyroid hormone therapy?
may decrease
642
what usually causes the bone density decrease with thyroid hormone therapy?
use of levothyroxine that causes subclinical hyperthyroidism
643
cautious use of thyroid hormone in what disease process?
cardiovascular disease, especially older adults
644
thyroid hormone should be avoided in acute WHAT?
acute coronary syndromes if possible
645
use of levothyroxine to treat what three things is inappropriate in absence of a diagnosis?
obesity, infertility, and depression
646
what effect does lithium have on the thyroid?
antithyroid
647
what two things can lithium do re: thyroid?
may cause a goiter and hypothyroidism
648
thyroid hormone replacement alongside what med may cause a goiter?
lithium
649
concern for hypo/hyperthyroidism with lithium + thyroid hormone?
hypothyroidism
650
in what three conditions may we try to suppress TSH?
thyroid cancer, nodules, euthyroid goiter
651
dosing of thyroid hormone for thyroid suppression therapy?
2.5 mcg/kg daily for 7 to 10 days
652
start at a lower/higher dose of levothyroxine than you would for hypothyroidism replacement?
higher
653
another name for for thionamides?
antithyroid drugs
654
when are thionamides used?
hyperthyroidism
655
two examples of antithyroid drugs?
propylthiouracil (PTU) and methimazole
656
what type of drugs are propylthiouracil and methimazole?
thionamides
657
what do thionamides do?
prevent the synthesis of thyroid hormones
658
what two drugs are used to prevent the synthesis of thyroid hormone?
propylthiouracil (PTU) and methimazole
659
effect of thionamides on preexisting thyroxine or triiodothyronine stored in thyroid gland?
not affected
660
effect of thionamides on exogenously administered levothyroxine levels?
not affected
661
how does propylthiouracil affect peripheral conversion of T4 to T3?
partial inhibition
662
agranulocytosis and possible aplastic anemia- can occur with what endocrine drugs?
thionamides
663
agranulocytosis and aplastic anemia with thionamides should prompt what?
discontinuation of the drug
664
liver abnormality possible with thionamides?
hepatitis
665
effect of thionamides on hair growth?
abnormal hair loss
666
does abnormal hair loss from thionamides resolve with d/c of the drug?
yes
667
what is the black box warning for propylthiouracil?
liver failure
668
what should I consult if pregnant patient requires thionamide?
nationally-recognized guidelines
669
what thionamide is preferrred in children?
methimazole
670
what three thyroid levels should be monitored with thionamides?
T4, T3, and TSH
671
why should we monitor a CBC after initiating a thionamide?
to monitor for agranulocytosis
672
under what circumstances should we monitor LFTs after starting a thionamide?
after initiation of therapy if there is evidence of s/s of liver disease and in those with hx of liver dysfunction
673
what type of foods should be avoided with thionamides?
iodine-containing foods
674
class? Replacement of pancreatic enzymes
exocrine pancreatic enzyme replacement therapy
675
what drugs act like the body's endogenous pancreatic exocrine enzymes?
exocrine pancreatic enzyme replacement therapy
676
what is the purpose of exocrine pancreatic enzyme replacement therapy?
assistance with digestion of nutrients to maintain health
677
cystic fibrosis can result in what?
pancreatic exocrine enzyme deficiency
678
pancreatitis can result in deficiency of what?
exocrine pancreatic enzymes
