Exam 4 endocrine + Psych

Question 1

Neurotransmitters in major depressive disorder

Answer 1

Serotonin, NE, dopamine

Question 2

Treatment phases of depression

Answer 2

Acute: 6-12 weeks
Continuation: 9 months-1 year

Question 3

SSRI

Answer 3

Fluoxetine, citalopram, sertraline, fluvoxamine, paroxetine, escitalopram
Effective after 4-6 weeks
May decrease REM sleep
SE: Sexual dysfunction
Abrupt withdrawal causes flu like symptoms, insomnia, GI effects, anxiety

Question 4

Only SSRI approved for children

Answer 4

Fluoxetine (Prozac)

Question 5

SNRIs

Answer 5

Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran
For more resistant depression
Takes 4-6 weeks
Higher rates of anticholinergic effects

Question 6

TCAs

Answer 6

-triptyline and -amine
Worse SE than SSRI
Active at ACh and H receptors–anticholinergic effects

Question 7

MAOI

Answer 7

Phenlzine
Decrease degradation of nE, serotonin, and dopamine
Potential for life threatening hypertension
Last line treatment

Question 8

Neurotransmitters involved in anxiety disorders

Answer 8

NE, serotonin, GABA

Question 9

Antidepressants for anxierty

Answer 9

SSRI or SNRI or imipramine (TCA)

1st line tx of anxiety

Question 10

Benzodiazepines

Answer 10

Alprazolam (Xanax), clonazepam, diazepam, lorazepam (Ativan), oxazepam
bind to GABA A
Indicated for short term management (2-4 weeks) as well as exacerbations
Long term tx not recommended
SE: drowsiness and psychomotor impairment
Flumazenil for OD

Question 11

Azapirones

Answer 11

Buspirone
Partial agonist at 5-HT1a receptor and inhibits uptake of dopamine, serotonin and NE
Used as adjunct therapy
No hypnotic, muscle relaxant or anticonvulsant properties
Not useful for immediate relief
Minimal abuse potential

Question 12

Benzodiazepines for insomnia

Answer 12

Blocks thalamic, hypothalamic and limbic arousal
Tempazepam + Lorazpem–intermediate acting for sleep maintenance
Flurazepam–long acting and rapid onset for sleep initiation

Question 13

Benzodiazepine receptor agonists

Answer 13

Eszoplicone, zolpidem (ambien), zaleplon
Induces sleepiness but not anxiolysis or muscle relaxation
Can increase sleep walking, eating and driving

Question 14

Suvorexant

Answer 14

Blockage of orexin neuropeptides and results in severe sleepiness
Sleep induction and maintenance achieved

Question 15

Ramelteon

Answer 15

Melatonin receptor agonists

Shortens latency to sleep onset

Question 16

1st line therapy for insomnia

Answer 16

Benzo, benzo agonist, ramelteon

Question 17

Ropinirole or pramipexole

Answer 17

Dopaminergic agent for restless leg syndrome

Quicker onset than dopamine agonists–useful for relief of sleep onset insomnia

Question 18

Anticonvulsants for restless leg

Answer 18

Off label use

Considered when dopamine agonists have failed

Question 19

Narcolepsy triad

Answer 19

Excessive daytime sleepiness, cataplexy, sleep related hallucinations, sleep paralysis

Question 20

Modafenil and Armodafinil

Answer 20

Psychostimulant
Increase release of NE in hippocampus, thalamus and amygdala
Tx of narcolepsy

Question 21

Methylphenidate

Answer 21

amphetemaines
tx of narcolepsy
Stimulants CNS activity and blocks reuptake of NE

Question 22

Mirtazapine

Answer 22

Similar to TCA
Causes sedation
Alpha 2 antagonist/mixed serotonin blockers
Increases appetite and decreases insomnia

Question 23

Trazodone

Answer 23

Serotonin 2A antagonist and serotonin reuptake inhibitor
Highly sedating
Often used to treat insomnia in low doses

Question 24

Atarax and Visatril

Answer 24

Hydroxyzines
For anxiety
H1 receptor antagonist with low antihistaminic properties
SE: dry mouth and drowsiness

Question 25

1st line tx for insomnia

Answer 25

Zaleplom: help patient fall asleep Temazepam: stay asleep through night Antidepressant: for chronic insomnia Diphenhydramine: pregnancy

Question 26

1st line tx for restless legs

Answer 26

Dopaminergic agonist at low dose

Question 27

2nd line tx for restless legs

Answer 27

Anticonvulsant or opioid

Question 28

Sulfonylureas

Answer 28

Tolbutamide, chlorpropramide, tolazamide, gluburide, glipizide, glimepiride Binds to beta cell receptors causing Ca channels to open and release of inuslin SE: hypoglycemia

Question 29

Biguanides

Answer 29

Metformin Not hypoglycemic Used in conjunction with diet Inhibits hepatic glucose production and improves peripheral sensitivity to insulin CI: renal issues, HF, pregnancy, alcoholics, >80, children SE: GI upset

Question 30

Thiazolidinediones

Answer 30

``` Rosiflitazone + Ploglitazone Decreases insulin resistance Binds to nuclear steroir hormone SE: weight gain, edema, hepatic toxicity, hypoglycemia CI: HF patient , liver failure ```

Question 31

Alpha glucosidase inhibitors

Answer 31

Acarbose + Miglitol Decreases absorption of carbs at brush border of intestine Given as adjunct therapy CI: bowel disease

Question 32

Meglitinide Analogs

Answer 32

Repaglinide + Nateglinide Rapid acting insulin secretagogues stimulates release of insulin in response to meal CI: type 1 DM, DKA, Severe infecton, surgery, trauma, pregnancy, BF

Question 33

DPP4 inhibitors

Answer 33

-gliptin Increases amoint of circulating incretins and increases GLP-1 SE: URI, UTI, HA

Question 34

GLP-1 receptor agonists (incretins)

Answer 34

``` -Glutide and exenatide Used as adjunct therap Stimulates glucose dependent secretion of insulsin from pancreas while decreasing release of glucagon and slows gastric emptying Avoids hypoglycemia SE: GI distress ```

Question 35

Amylin analog

Answer 35

Pramlintide Synthetic of amylin--co-secreted with insulin in response to food, delays fastric emptying Type 1 and type 2 DM SE: nausea

Question 36

Sodium glucose co transporter 2 inhibitors

Answer 36

-Gliflozin Induces glycosuria CI: type 1 DM, DKA, severe kidney disease

Question 37

Rapid acting insulin

Answer 37

Lispro (Humalog) Onset <30 mins Duration 3-5 hours

Question 38

Short acting insulin

Answer 38

Regular insulin (Humulin R, Novolin R) Onset 30 mins Duration 6-8 hours

Question 39

Intermediate acting insulin

Answer 39

NPH (Humulin N, Novolin N) Onset 1-4 hours Durating 14-26 hours

Question 40

Long acting insulin

Answer 40

Glargine (Lantus) + Detemir Onset 2-4 hours Duration 24 hours

Question 41

Dawn phenomenon

Answer 41

Early morning increase in blood sugar between 2 and 8 am--give insulin

Question 42

Somogyi effect

Answer 42

Hypoglycemia in the middle of the night leading to rebound hyperglycemia in early morning -Do not increase insulin

Question 43

General stepwise tx for type 2 DM

Answer 43

Metformin first, titrate up, add sulfonylureas, add TZDs

Question 44

3 drugs diabetics should be on

Answer 44

Glucose lowering agent, statin, ACEI

Question 45

S/S hypothyroidism

Answer 45

fatigue, constipation, weight gain, bradycardia, peripheral edema Dx: increased TSH and decreased T4

Question 46

Tx of hypothyroidism

Answer 46

Levothyroxine, liothyronine, liotrix Give on empty stomach--interact with everthing; do not give with PPI MOA: increases basal metabolic rate, increases utilization of glycogen, promotes gluconeogenesis Start with lowest dose; titrate up every 4-6 weeks

Question 47

Most common cause of hyperthyroidism

Answer 47

Graves disease--autoimmune | Autoantibodies act like TSH

Question 48

S/S hyperthyroidism

Answer 48

Palpitations, sweating, heat intolerance, weight loss, increased BP, increased HR, exophthalmos

Question 49

3 main tx for hyperthyroidism

Answer 49

Antithyroid drugs, radioactive iodine, surgery

Question 50

Antithyroid drugs

Answer 50

Methimazole + Propylthiouracil | Inhibits iodine organification; blocks conversion of T4 to T3

Question 51

Ajunct therapy for hyperthyroidism

Answer 51

Beta blockers for palpitations (propranolol and atenolol) Iodine containing compounds (tx of thyrotoxic storm) Lithium Glucocorticoids

Question 52

Tx of exophthalmos

Answer 52

Anti-inflammatory drugs, immunosuppressive drugs, surgery

Question 53

Goal of diabetic therapy

Answer 53

A1C < 6.5

Question 54

Most common type 2 DM regimen

Answer 54

2/3 dose in morning, 1/3 dose in evening Morning dose is 2/3 intermediate acting and 1/3 short acting Evening dose is 1/2 intermediate acting and 1/2 short acting

Question 55

Length of tx for hypothyroidism

Answer 55

Usually lifelong

Question 56

Length of tx for hyperthyroidism

Answer 56

Usually 1-2 years max

Question 57

Hyperthyroidism for pregnant woman

Answer 57

Methimazol except during first trimester of pregnancy