Pharm

Question 1

Hypothyroidism tx strategy

Answer 1

Replacement of deficient thyroid hormone

Question 2

Hyperthyroidism tx strategy

Answer 2

Antagonism of excessive thyroid hormone by inhibiting steps in thyroid hormone synthesis and action

Question 3

Hypothyrodism drugs

Answer 3

Levothyroxine

Liothyronine

Question 4

Levothyroxine

Answer 4

Isomer of T4
TOC for thyroid hormone replacement and TSH suppression
Long half life

Question 5

Liothyronine

Answer 5

Isomer of T3
Shorter half life
Greater risk of cardiotoxicity
Preferred in myxedema coma

Question 6

Myxedema and the elderly

Answer 6

Make sure initial dose is low!

If too high may precipitate angina, MI, and arrhythmia

Question 7

Drugs that can induce hypothyroidism

Answer 7

Rifampin
Phenytoin
Amiodarone

Question 8

AE of Levothyroxine and Libothyronine

Answer 8

Hyperthyroidism
MI
Decreased bone density and hip fracture
Pseudotumor cerebri, seizure

Question 9

Hyperthyroidism management

Answer 9

Antithyroid drugs
Surgery
Radioactive iodine

Question 10

Antithyroid drugs

Answer 10

Methimazole

Propylthiouracil

Question 11

MOA of antithyroid drugs

Answer 11

Inhibit thyroid peroxidase

Propylthiouracil also inhibits peripheral deiodination of T4 to T3

Question 12

First line antithyroid drug

Answer 12

Methimazole

Question 13

Antithyroid drugs in preggers

Answer 13

Propylthiouracil in 1st trimester

Methimazole in 2nd and 3rd

Question 14

When do you use propyluracil over methimazole?

Answer 14

1st trimester
Thyrotoxicosis or thyroid storm
In pts with adverse rxns to methimazole other than agranulocytosis or hepatitis and are not candidates for radioiodine or surgery

Question 15

AEs of methimazole and propylthiouracil

Answer 15

Rash
Altered sense of taste or smell (methimazole)
Agranulocytosis (reversible)
Liver tox (propylthiouracil)

Question 16

Potassium Iodide

Answer 16

Inhibit organification and hormone release

Avoid in preggers as crosses placenta and causes fetal goiter

Question 17

Radioactive Iodine

Answer 17

Emits beta rays that destroy thyroid parenchyma
CI in preggers or nursing
In pts with heart dz, severe thyrotoxicosis, and in elderly tx with antithyroid drugs first until euthyroid

Question 18

Beta adrenergic blockers

Answer 18

Useful for symptoms of hyperthyroidism

Propranolol current DOC

Question 19

Paradoxical effects of tx with PTH

Answer 19

Stimulates bone resorption as well as stimulating mature osteoblasts via cAMP to have anti apoptotic effect and induces mature osteoblast formation via IGF-1

Question 20

Indication for Teriparatide

Answer 20

Postmenopausal osteoporosis

Increase bone mass in men with primary or hypogonadal osteoporosis

Question 21

MOA of oral phosphate binders

Answer 21

Calcium carbonate and calcium acetate bind to dietary phosphates and inhibit their absorption
Sevelamer is non absorbable cationic ion exchange resin that binds intestinal phosphates

Question 22

Vit D analogues

Answer 22

Calcitriol

Paricalcitol

Question 23

Site of action of Cinacalcet

Answer 23

Binds to transmembrane region of calcium sensing receptor in parathyroid and increases sensitivity of it to Ca++

Question 24

Indication for Cinacalcet

Answer 24

Secondary hyperparathyroidism

Hypercalcemia associated with parathyroid carcinoma

Question 25

Effect of bisphosphonates on bone

Answer 25

PCP bond rather than POP bond that retards formation and dissolution of hydroxyapatite crystals in and out of bone, inhibiting bone resorption

Question 26

Indications of Alandronate and Risedronate

Answer 26

Prevention and tx of postmenopausal and glucocorticoid induced osteoporosis

Question 27

Two beneficial effects of calcitonin

Answer 27

Increased BMD | Decreased vertebral fracture

Question 28

Indications for calcitonin

Answer 28

Tx of osteoporosis in women at least five years postmenopausal Paget disease

Question 29

Advantage of Raloxifene over estrogens

Answer 29

Does not stimulate endometrium | Estrogens increase risk of endometrail hyperplasia and endometrial cancer

Question 30

Ca++ supplements decrease the absorption of which meds?

Answer 30

Tetracyclines | Quinolones

Question 31

Two CIs of bisphosphonates

Answer 31

Hypocalcemia | Severe renal impairment

Question 32

Four diagnostic criteria for diabetes

Answer 32

FPG > 126 mg/dL x2 Random > 200 mg/dL and symptoms Abnormal GTT A1C > or equal 6.5%

Question 33

Rapid, short, intermediate, and long acting insulins

Answer 33

Rapid - Lispro, Aspart, Glulisine Short - Humulin Inter - NPH Long - Glargine, Detemir, Degludec

Question 34

Conventional insulin therapy

Answer 34

Two injections per day, before breakfast and before evening meal Combo of rapid or short and intermediate acting insulins

Question 35

Four actions of drugs for DM2

Answer 35

Decrease glucose production Increase insulin secretion Increase insulin sensitivity Decrease glucose absorption

Question 36

Two actions of Metformin

Answer 36

Decreases hepatic glucose production (gluconeogenesis) | Increases insulin sensitivity - increases peripheral glucose uptake and utilization

Question 37

Two advantages of Metformin

Answer 37

Does not produce hyperinsulinemia or hypoglycemia

Question 38

Two adverse rxns to sulfonylureas

Answer 38

Hypoglycemia | SIADH

Question 39

Actions of thiazolidinediones

Answer 39

Increase insulin sensitivity and glucose uptake (muscle and adipose) Decrease hepatic glucose production

Question 40

Action of alpha glucosidase inhibitors

Answer 40

Competitive, reversible inhibition of intestinal brush border enzymes

Question 41

Type of blood sugar levels most affected by alpha glucosidase inhibitors

Answer 41

Mild hyperglycemia | Postprandial hyperglycemia

Question 42

Effects of glinides versus sulfonylureas on insulin release

Answer 42

Shorter half life than sulfonylureas | Can take prior to meal for greater flexibility and may decrease postprandial hypoglycemia

Question 43

Effect of dipeptidyl peptidase inhibitors on insulin secretion

Answer 43

Increase incretins by inhibiting DPP_4 leading to increased glucose mediated insulin secretion and suppresses glucagon secretion

Question 44

Appropriate tx strategies for DM2

Answer 44

Increase dose of oral agent or add 2nd Add insulin to newly dx with symptomatic and/or elevated blood sugars Add insulin to oral antihyperglycemic agent regimen when needed Insulin therapy eventually

Question 45

Level of HbA1C expected with adequate glucose control

Answer 45

Under 7%

Question 46

Advantage of rDNA produced insulin over bovine insulin

Answer 46

Less allergenic

Question 47

Why are c-peptide levels indicator of endogenous insulin?

Answer 47

C-peptide is a portion of insulin precursor cut out in processing One c-peptide per insulin made Indicative of insulin production

Question 48

What change in insulin is done to compensate for Somogyi phenomenon

Answer 48

Decrease long acting insulin

Question 49

Three AEs of insulin

Answer 49

Hypoglycemia Weight gain Lipodystrophy

Question 50

Most potentially dangerous AE of Metformin

Answer 50

Lactic acidosis | Risk increased with renal dysfn and age

Question 51

Effect of Metformin on B12

Answer 51

Reduces B12 absorption

Question 52

CIs of Metformin

Answer 52

Renal failure | CHF

Question 53

AEs of thiazolidinediones

Answer 53

Exacerbates CHF | Check hepatic transaminases

Question 54

AE of sulfonylureas

Answer 54

Potential for severe, prolonged hypoglycemia

Question 55

AE of Thiazolinediones

Answer 55

``` Weight gain Fluid retention Increased fracture risk in women Cardio events Higher risk of bladder cancer ```

Question 56

AE of Alpha glucosidase inhibitors

Answer 56

Flatulence and diarrhea

Question 57

MOA of incretin mimetic

Answer 57

Stimulates beta cells to release insulin | Inhibits glucagon secretion