More exam 3 questions (non-DM)

Question 1

When taking radioactive iodine, _________ may affect protein binding of T3 and T4

Answer 1

ASA

Question 2

What is contraindicated in multinodular goiter?

Answer 2

Iodides

Question 3

List the 3 MOAs of iodides

Answer 3

1) Acutely blocks thyroid hormone release
2) Inhibits thyroid hormone biosynthesis
3) Decrease in the size of the gland

Question 4

What should you use 10 days prior to thyroidectomy, but avoid before RAI Tx?

Answer 4

Lugol’s solution

Question 5

T/F: You should use propranolol before and after RAI

Answer 5

True

Question 6

A patient has low serum TSH and normal free T4 and T3 . What is this condition? When do you treat?

Answer 6

Subclinical hyperthyroidism
1) Pts >65 years with TSH <0.1 mIU/L
2) Pts <65 years with TSH <0.1 mIU/L + high risk of cardiovascular events or bone fractures
3) Pt is >/= 65 years with TSH 0.1-0.4 mIU/L + high risk of cardiovascular events or bone fractures

Question 7

Secondary Hypothyroidism may be induced by what 2 drugs?

Answer 7

Lithium or amiodarone

Question 8

Levothyroxine (Synthroid®) is a supplement for what?

Answer 8

T4

Question 9

Liothyronine (Cytomel®) is supplemental what?

Answer 9

T3

Question 10

What is the most common cause of hypothyroidism?

Answer 10

Hashimotos

Question 11

What is the IV: PO ratio of levothyroxine?

Answer 11

0.75:1

Question 12

Give some counseling points for levothyroxine (hypothyroidism Tx)

Answer 12

Take first thing in the morning with water, take 4 hours apart from antacids, iron, and calcium supplements, take the same brand

Question 13

1 grain of Nature Thyroid = 100mcg __________

Answer 13

levothyroxine

Question 14

How do you increase or decrease levothyroxine dose?

Answer 14

Dose adjusted per TSH 12.5-25mcg/day every 4-8 weeks

Question 15

Fluoroquinolones and Tetracyclines interfere with the absorption of what?

Answer 15

Levothyroxine

Question 16

What are the 2 meds for myxedema coma?

Answer 16

IV bolus levothyroxine 300 – 500 mcg; IV 75-100 mcg/day
IV hydrocortisone 100mg q 8 hours

Question 17

List the zones of the adrenal gland and what meds act on them

Answer 17

Zona Glomerulosa → mineralocorticoids (minerals glo)
-aldosterone
Zona Fasciculata → glucocorticoid (glucose is fascinating)
-cortisol
Zona Reticularis → androgens (men are rt**)

Question 18

___________ is necessary for release of aldosterone but little effect on its rate of secretion

Answer 18

ACTH

Question 19

In a pt with hypothyroidism:
1) If they’re on Digoxin you should ______ the dose
2) If they’re on Insulin you should ______ the dose.
3) If they’re on Warfarin you should _______ the dose.
4) If they’re on resp depressants you should ______ the dose.

Answer 19

1) Decrease
2) Decrease
3) Increase
4) Decrease

Question 20

What adrenal drug can cause reversible increase in liver transaminases, GI and dermatologic effects & requires frequent LFT monitoring?

Answer 20

Ketoconazole

Question 21

What adrenal drug can cause acne and hirsutism & can also cause HTN, HypoK+, and edema (rare)?

Answer 21

Metyrapone

Question 22

What adrenal drug is cytotoxic (atrophy of adrenal cortex), & can severely reduce cortisol production, major GI effects (N/V/D/Anorexia), lethargy, somnolence, vertigo, ataxia, and confusion, hypercholesterolemia ?

Answer 22

Mitotane

Question 23

Which adrenal drug should you not use within 5 yrs before pregnancy?

Answer 23

Mitotane

Question 24

Which adrenal drug has the following risks?: (Severe) adrenal insufficiency, hypoK+, vaginal bleeding, QT prolongation, exacerbation of conditions treated w/ corticosteroids, Pneumocystis jiroveci infections, endometrial hyperplasia , reduced HDL, increases in TSH

Answer 24

Mifepristone

Question 25

Adrenal drugs: What are some side effects of spironolactone?

Answer 25

GI discomfort, impotence, gynecomastia, menstrual irregularities, and hyperK+

Question 26

Adrenal drugs: What are some side effects of fludrocortisone?

Answer 26

GI upset, edema, HTN, hypoK+, insomnia, excitability, diabetes

Question 27

List the main adrenal drugs

Answer 27

1) Mitotane 2) Mifepristone 3) Spironolactone 4) Fludrocortisone 5) Metyrapone 6) Ketoconazole 7) Corticosteroids 8) Neuromodulators: Pasireotide or Cyproheptadine

Question 28

What steroid should you give for IBDs?

Answer 28

Hydrocortisone IV or budesonide foam

Question 29

What steroids should you give for adrenal insufficiency?

Answer 29

hydrocortisone or prednisolone (can add fludrocortisone if MC deficiency like in Addison’s)

Question 30

List the short term steroid adverse effects

Answer 30

Emotional instability, increased BP, hyperglycemia, insomnia, indigestion, increased intraocular pressure, hyperglycemia, oropharyngeal candidiasis, epistaxis, skin thinning (route dependent)

Question 31

List the long term steroid adverse effects

Answer 31

Increased susceptibility to infection, redistribution of fat, suppression of osteoblast function, avascular necrosis of bone, menstrual irregularities and hirsutism

Question 32

List 3 drug interactions of steroids

Answer 32

1) Increased tendon rupture risk with fluoroquinolones 2) GI upset with NSAIDs 3) Increase or decrease in INR w/ Warfarin

Question 33

Your body makes glucagon via what cells? Where?

Answer 33

alpha cells in the pancreas.

Question 34

___________________ are the first line for mild to moderate UC.

Answer 34

Mesalamine derivatives

Question 35

What drugs interfere with absorption of levothyroxine (T4)?

Answer 35

Bile acid sequestrants, sucralfate Oral bisphosphonates PPIs, H2RAs (acid suppressive tx) Divalent cations → multivitamins, ferrous sulfate, phosphate binders, calcium salts, fluoroquinolones, tetracycline

Question 36

What drugs may decrease the efficacy of T4/ Levothyroxine?

Answer 36

Cholestyramine, calcium carbonate, sucralfate, aluminum hydroxide, espresso coffee, ferrous sulfate, H2 blockers, PPIs, Rifampin, carbamazepine, and possibly phenytoin

Question 37

What is the most common use of Mitotane? What is another use?

Answer 37

Adrenocortical carcinoma; medical adrenalectomy during or after pituitary irradiation

Question 38

T/F: Mitotane is cytotoxic and may cause hypercholesterolemia

Answer 38

True

Question 39

Name 2 adrenal drugs that interfere with CYP3A4

Answer 39

Mifepristone & Ketoconazole

Question 40

List some side effects of spironolactone (a Tx for Bilateral adrenal hyperplasia (BAH))

Answer 40

GI discomfort, impotence, gynecomastia, menstrual irregularities, hyperkalemia

Question 41

Metoclopramide (reglan) and Ondansetron (zofran) have what in common?

Answer 41

They're serotonin receptor antagonists

Question 42

Promethazine (Phenergan) and Zofran have what in common?

Answer 42

QT prolongation

Question 43

What is available OTC as Vitamin B6 and Unisom 25mg? What is it first-line Tx for?

Answer 43

Pyridoxine (Rx Diclegis); nausea in pregnancy

Question 44

Sulfasalazine, Mesalamine, Osalazine, all have what in common?

Answer 44

They're mesalamine derivatives and should be avoided with salicylate allergy

Question 45

What are the immunosuppressive agents for IBDs?

Answer 45

1) Azathioprine (Imuran®) and Mercaptopurine (Purinethol®) 2) Methotrexate 3) Cyclosporine (Sandimmune®) 4) Tacrolimus (Prograf®)

Question 46

What are the baselines studies for methotrexate? (mainly used for Crohns Tx)

Answer 46

DMARD labs (CBC w/platelets, LFTs and SCr) PLUS albumin, Hepatitis B/C studies, chest radiograph

Question 47

What last-line UC drug has a boxed warning for renal impairment w high doses?

Answer 47

Cyclosporine (Sandimmune®)

Question 48

What do Cyclosporine (Sandimmune®) and Tacrolimus (Prograf®) have in common?

Answer 48

Strong CYP3A4 inhibitors; p-gp drug interactions -Both are IBD drugs

Question 49

Give some examples of TNF-alpha inhibitors (biologics)

Answer 49

1) Infliximab (Remicade®) (UC and CD) (inflicts both)(need meth) 2) Adalimumab (Humira®) (CD) 3) Certolizumab pegol (Cimzia®) (CD) 4) Golimumab (Simponi®)

Question 50

Name 2 integrin receptor antagonists. Which is only available through REMS?

Answer 50

1) Natalizumab (Tysabri®): only thru REMS bc severe hepatic toxicity -can also cause PML 2) Vedolizumab (Entyvio®)

Question 51

What increases level of methotrexate?

Answer 51

NSAIDs

Question 52

What can cause Anaphylaxis and make MS worse?

Answer 52

TNF-alpha inhibitors (-mabs)

Question 53

What are the 3 C. Diff meds? (important)

Answer 53

FMV Fidaxomicin (dificid) Metronidazole Vancomycin PO

Question 54

How do you Tx diverticulitis?

Answer 54

Duel therapy with ciprofloxacin and metronidazole