Important for exam 3

Question 1

What 2 drugs can both cause hypothyroidism and hyperthyroidism?

(exam Q)

Answer 1

Amiodarone ≈ 3% and Lithium ≈ 0.7%

Question 2

What are 2 reasons to d/c therapy with thionamides (MMI and PTU)?

Answer 2

1) Agranulocytosis (0.5-6%)
2) Immunoallergic hepatitis (1.3%) (almost exclusive to PTU)

Question 3

For Radioactive iodine I-131, what are the guidelines to prevent exposure to family members?

(this is a test question)

Answer 3

1) Do not kiss, exchange saliva or share food/utensils x 5d; Wash dishes in a dishwasher.
2) Avoid close contact with infants, young children (under 8 y/o), and pregnant women for 5 days.
3) Do not breast-feed.
4) Flush the toilet twice after urinating and wash your hands thoroughly.
5) If you have a sore throat or neck pain, take acetaminophen.
6) Contact your physician if you notice increased nervousness, tremulousness or palpitations.

Question 4

Absolute contraindications for radioactive iodine are what?

Answer 4

Pregnancy/lactation/planning pregnancy, thyroid cancer and inability to comply with radiation safety guidelines

Question 5

What is the initial and maintenance dose of PTU?

Answer 5

Initial dose: 150-450 mg/day
Maintenance dose: 100-150 mg/day

Question 6

What is the initial and maintenance dose of MMI?

Answer 6

Initial: 10-20 mg/day
Maintenance: 5-10 mg/day

Question 7

300 mg propylthiouracil is roughly equivalent to ___ to ____ mg methimazole

Answer 7

10 to 15

Question 8

If you are on X amount of grains of Nature thyroid, and you want to switch to levothyroxine, what dose do you do?

Answer 8

1 grain of Armour Thyroid, Nature Thyroid (T3 & T4) = 100mcg levothyroxine

Question 9

Moon face, striae, high BP, skin atrophy, easy bruising, bleeding, Androgen excess. More common in females, central obesity common. (think of the adverse effects of steroid use). Women may have hirsutism and menstrual irregularities. Temporal balding and mental disturbances may also be present

This describes what condition?

Answer 9

Cushing’s (hypercortisolism)

Question 10

1) How do you diagnose a pt with Cushing’s?
2) What is the treatment of choice?

Answer 10

1) Labs→ hypoK, proteinuria, increased bicarb, hyperNa, hypoMag
2) Treatment of Choice→ surgical resection of the tumor
Ketoconazole, may use with metyrapone for synergism

Question 11

A patient is tall, tan (hyperpigmentation), hypotension, weight loss, nausea, weakness, salt craving, depression. They have a Hx of an autoimmune disease, TB, infection, or new medication.
This describes what condition?

Answer 11

Addison’s disease (adrenal insufficiency)

Question 12

1) How do you diagnose a pt with Addison’s?
2) What is the treatment of choice?

Answer 12

1) Labs→ HyperK, hyperNa, increased BUN:Cr signaling dehydration (20:1 is indicative)
2) Treatment of Choice: short acting steroids BID
Hydrocortisone 15 mg daily
Cortisone 25 mg daily
Prednisone 2.5 mg daily

Question 13

A patient has exophthalmos, diffuse thyroid enlargement, pretibial myxedema, thyroid acropachy. They also have hyperthyroid symptoms (anxiety, fatigue, heat intolerance, weight loss, increased appetite, diarrhea, nervousness, palpitations)

What condition am I describing?

Answer 13

Grave’s

Question 14

1) How do you diagnose a pt with Grave’s?
2) What is the treatment of choice?

Answer 14

1) Labs→ High serum levels of T4 and/or T3, Low TSH, high levels of circulating antibodies against thyroglobulin and thyroid peroxidase
2) DOC→ Radioactive Iodine I-131 3-15mCi oral liquid
High Dose→ 10-15 mCi
Low Dose→ 3-7 mCi

Question 15

Older women, cold intolerance, losing outer ⅓ of eyebrows, myxedema, goiter, galactorrhea. Hx may include previous head, neck, or thyroid irradiation, maybe an autoimmune disorder

What condition is this?

Answer 15

Hashimoto’s

Question 16

1) How do you diagnose a pt with Hashimoto’s?
2) What is the treatment of choice?

Answer 16

1) Labs→ increased TSH, decreased T3/T4; positive TgAb and TPOAb
2) DOC→ Levothyroxine titrated to 12.5-25 mcg/day

Question 17

How do you convert Insulin detemir to insulin glargine?

Answer 17

Convert unit-to-unit

Question 18

How do you convert Novolin R to insulin degludec?

Answer 18

Add up total daily dose and start with 50% of total

Question 18

How do you convert Insulin aspart to Afrezza?

Answer 18

Round each mealtime insulin dose up to the nearest 4 units and then convert unit-per-unit

Question 18

How do you convert Novolin 70/30 to Novolin N if Qday?

Answer 18

Give 70-80% of total daily dose

Question 18

How do you convert Novolin 70/30 to Novolin N if BID?

Answer 18

Give 2/3 dose in AM and 1/3 dose in PM

Question 19

If A1C >7.5%, start how many agents?

Answer 19

Two

Question 20

If A1C >9.0%, or 1.5% above goal, start how many agents?

Answer 20

2-3

Question 21

Regarding mesalamine derivatives for UC, what is the most effective therapy?

Answer 21

Combination therapy (oral and rectal) more effective than either alone

Question 22

What are the 7 contraindications of methotrexate? (on exam 3)

Answer 22

1) Pregnancy & lactation 2) Chronic liver disease 3) Immunodeficiency 4) Active infections 5) Leukopenia 6) Thrombocytopenia 7) Renal impairment (<30mL/min) -50% dose reduction for CrCL <50mL/min

Question 23

Regarding TNF-alpha inhibitors, what are the 4 contraindications? (Test q)

Answer 23

1) Heart failure -Leads to new onset and exacerbations 2) Do NOT use with NYHA class III or IV with EF <50% 3) Malignancies (i.e., skin cancer or lymphoproliferative cancers) 4) Active hepatitis

Question 24

Regarding TNF-alpha inhibitors, what are the 5 adverse effects? (Test q)

Answer 24

1) MS exacerbation or MS-like symptoms 2) Neutropenia 3) Injection site reactions 4) Hepatotoxicity 5) Anaphylaxis

Question 25

What must be given with MTX (methotrexate) to ↓ antibody formation?

Answer 25

Infliximab

Question 26

Biologics (TNF-alpha inhibitors & Integrin receptor antagonists) have the risk of what things?

Answer 26

1) Legionella and listeria infections 2) Opportunistic fungal infections (histoplasmosis) 3) TB

Question 27

Which integrin receptor antagonist is associated with PML?

Answer 27

Natalizumab (Tysabri®)

Question 28

IL agents: Ustekinumab (Stelara®): 1) What is the MOA? 2) Uses? 3) 3 adverse effects? 4) Warnings?

Answer 28

1) MOA: monoclonal antibody that targets IL-12 and IL-23 2) Place in therapy: UC and CD 3) Increased risk of infections, neurotoxicity and malignancy 4) Antibody development and decreased efficacy