Flashcards in Pharm 2 - Exam 3 Deck (141):
Which thyroid hormone(s) does Levothyroxine/Synthroid replace?
Which thyroid hormone(s) does Thyroid USP/Armour thyroid replace?
T4 and T3
Which thyroid hormone(s) does Liothyronine/Cytomel replace?
Which form of thyroid hormone is active?
What is the normal T4:T3 ratio?
If a patient has Addison's Disease and hypothyroidism, which disease must be addressed first in terms of treatment with medication?
Addison's. Replace cortisol before replacing thyroid hormone.
In what unit doses are Armour and Synthroid given?
60mg of Thyroid USP/Armour is equivalent to how much Levothyroxine/Synthroid and how much Liothyronine/Cytomel?
Long term elevation of T4 (such as from Levothyroxine/Synthroid use) increases the risk of what two pathologies?
This hypothyroid med is also indicated for Wilson's Syndrome.
In what class of drugs are Methimazole/Tapazole and PTU?
What is the MOA of Methimazole/Tapazole and PTU?
Blocks conversion of T4 to T3
What is the most feared side effect of Methimazole/Tapazole and PTU?
What is the result of super physiologic doses of iodine?
stuns the thyroid into inactivity for days to weeks
Name the two thionamide drugs.
Of the two thionamide drugs, which is most effective in preventing the conversion of T4 to T3 in peripheral tissues?
What is the MOA of the thionamide drugs?
1. inhibits conversion of inorganic iodine to organic iodine which prevents the formation of thyroxine.
2. blocks the coupling of iodotyrosine, therefore stopping the production of T3 and T4
Which of the thionamide drugs is more appropriate for pregnancy?
PTU. Both are category D though.
Which drugs would be most appropriate for the treatment of thyroid storm?
How long do the beneficial side effects of iodine/SSKI last?
Compare the onset of action and half-life of Levothyroxine/Synthroid to Liothyronine/Cytomel?
L/S: slow onset, half-life of ~1 week
L/C: rapid onset, half-life of several hours
How long is radioactive iodine typically in the body after a dose is taken?
What is the drug classification of radioactive iodine?
How long should pregnancy be delayed following radioactive iodine treatment?
What are the s/sx of a thyroid storm?
high fever, irritability, delerium, vomiting, diarrhea, hypotension, dehydration, vascular collapse
Diabetes diagnoses all rely on what form of testing?
What might be the problem with calcium derived from oyster or bone?
Lead and other heavy metal contamination
What drug class requires that a patient is able to stand or sit upright for 30-60 minutes due to its propensity to cause inflammations and erosion of the esophagus?
In what class of drugs is Alendronate/Fosamax?
What are the two major SE of Alendronate/Fosamax?
Osteonecrosis of the jaw
Atypical femur fractures (ex. in the shaft)
In what class is Raloxifene/Evista?
What is the MOA of the SERM class of drugs?
Binds to select estrogen receptor sites to beneficial estrogen activity
What is the MOA of bisphosphonates?
inhibits osteoclastic activity
This drug is a synthetic hormone that inhibits osteoclastic activity.
This osteoporosis drug is available in a nasal spray.
Name the synthetic PTH analogue.
This drug activates bone turnover with osteoblasts being activate to a much greater extent than osteoclasts
Which to drugs have been shown to reduce the spinal fracture risk in individuals with osteoporosis.
What is Estrogen/HRT combined with to reduce the risk of endometrial CA?
Name the human monoclonal Ab approved for the treatment of osteoporosis.
How is Denosumab/Prolia administered?
SQ injection once every 6 months
MOA of Metformin
inhibits glucose production by the liver and decreases insulin resistance
MOA of Sulfonylureas and Meglitinides
increases secretion of insulin by interaction with ATP sensitive K+ channels in beta cell membrane
MOA of alpha-glucosidase inhibitors
delays absorption of glucose by inhibiting alpha-glucosidase enzyme at brush border
MOA of Thiazolidinediones/Glitazones
improves insulin sensitivity in skeletal muscle cells, fat cells, liver cells and decreases hepatic glucose production
MOA of DPP-4 inhibitors
promote release of insulin by inhibiting the enzyme that breaks down GI hormones released in response to meal. Also suppresses release of glucagon by the pancreas/
In what two instances may patients on oral diabetic medications be switched to insulin?
What medication is used for women with gestational diabetes?
In what class of drugs is Metformin/Glycophage?
T/F. Metformin is likely to cause weight gain
False. Metformin can cause modest weight loss (unlike sulfonylureas)
If you put a patient on Metformin, what side effects might you want to tell them to expect?
metallic taste in mouth
increased risk for B12 deficiency
lactic acidosis (fatal)
To prevent lactic acidosis, what population of people should not use Metformin/Glycophage.
those with impaired renal function
What is the most concerning side effect of Sulfonylureas?
hypoglycemia (esp. in patients with impaired renal or liver function)
What is the most common SE of Sulfonylureas?
In general, how long are sulfonylureas effective?
Name the 1st generation Sulfonylureas.
Name the 2nd generation sulfanylurea drugs.
How is Metformin/Glucophage dosed?
QD if extended release
Name the two Meglitinides
Which Meglitinide is more effective?
What classes of DM drugs cause weight gain?
Which class of drugs should Meglitinides not be combined with?
Name the TZD/Glitazones
Of the Glitazones, which is approved for concurrent use with insulin?
Can both Glitazones be combined with Metformin or Sulfonylurea?
What do the Glitazones increase the risk for?
inc. liver enzymes
dec. bone density, inc. fracture
Name the alpha-glucosidase inhibitors.
How is Alpha-glucosidase inhibitors dosed?
with each meal
When might Alpha-glucosidase inhibitors cause hypoglycemia?
when combined with Sulfonylurea or insulin
To correct hypoglycemia when taking Alpha-glucosidase inhibitors, what form of sugar should be used?
What population of people should not take Alpha-glucosidase inhibitors?
IBD, chx intestinal dz, any intestinal obstruction
Name the DPP-4 inhibitor
Which other drug should Sitagliptin/Januvia not be combined with?
This injectable drug is a synthetic form of amylin, which is produced along with insulin by the beta cells.
This injectable drug is a synthetic form of exendin-4, a naturally occurring hormone that was first isolated from the saliva of the Gila monster.
When is Pramlintide/Symlin used?
In DM Type 1 or 2 when insulin is being used but goal levels of HGbA1c are still not being reached.
What are the only two drugs approved by the FDA for lowering blood sugar in type 1 diabetics?
Which DM drugs promote weight loss?
T/F. Insulin and Pramlintide/Symlin can be combined and injected from the same vial.
In what class of drugs is Exenatide/Byetta? What is the MOA?
lowers blood glucose by increasing insulin secretion
Insulin is never given ______(SQ/IM/IV/Orally).
What is the onset speed and duration of action of Lispro/Aspart and Humulog/Novalog.
What is the action time and duration of action of Regular Insulin/Humulin R?
What is the action time and duration of action of NPH/Humulin N?
What is the action time and duration of action of Glargine/Lantus?
What are some SE of insulin therapy?
fibrosis of injection site
muscle/fat atrophy at injection site
What agent is used for treatment of severe hypoglycemia?
In what class of drugs is Leuprolide/Lupron?
Anti-androgenic hormone and anti-estrogenic hormone
T/F Leuprolide/Lupron is given PO, SQ, IM.
False. It is only given SQ and IM
Name the anti-androgen med
MOA of Finasteride/Proscar
limits conversion of testosterone to DHT by inhibiting type II 5-alphareductase
What must the PARQ of Finasteride/Proscar include?
That pregnant women should not handle crushed or broken tablets because of risk of birth defects
What is the name of the low dose versions of Finasteride/Proscar?
What two drug categories are used to treat BPH?
5 alpha reductase inhibitors and alpha blockers
Which alpha blocker should not be used by those who are allergic to sulfa drugs?
What drug is indicated for ED and pulmonary hypertension?
What is the MOA of Sildenafil citrate/Viagra?
inhibits cGMP specific phosphodiesterase type 5 which keeps blood in the in the corpus cavernosum
Who should not use Sildenafil citrate/Viagra?
those on NO donors, organic nitrites and nitrates (nitroglycerin and isosorbide dinitrate)
those with CV risk factors
severe liver or renal impairment
Hereditary degenerative retinal disorders
Which drug may cause cyanopsia?
Which form of estrogen is the most potent?
Regarding potency, how do the other major forms of estrogen compare to estradiol?
They are 1/10th as strong
Is endogenous estrogen or synthetic estrogen more subject to first pass metabolism and thus less effective when given orally?
endogenous/naturally produced estrogen
What are the risks for women taking estrogen only?
Inc. risk of stroke, blood clots, fracture. No difference in risk of MI or colorectal CA.
What are the risks for women taking estrogen plus progestin?
Inc. risk of MI, stroke, DVT, PE, breast CA. Decreased risk of colorectal CA and fractures
What kind of CA may occur in unopposed estrogen therapy?
What is the hormone ratio of BiEst?
80:20 estriol to estradiol
What is the hormone ration of TriEst?
80:10:10 estriol, estradiol, estrone
What is the MOA of the progesterone drugs?
alters gene transcription
What is the source of conjugated estrogens/Premarin and how is it delivered?
oral or topical
What are the contraindications for the use of progesterone drugs?
hx of DVT or breast, ovarian or uterine CA
What is the FDA drug classification for conjugated estrogens/Premarin?
How is Medroxyprogesterone/Provera administered?
Depp-Form is IM
What are the roles of estrogen and progestin in COCPs?
Estrogen: suppresses ovulation
Progestin: prevents implantation and makes cervical mucus impenetrable to sperm
What is the time frame regarding when missed COCPs lead to reduced contraceptive protection?
If one or more tablets are forgotten for more than 12 hours
What is the most commonly used estrogen in COCPs?
Describe how triphasic COCPs work.
Constant estrogen for 21 days plus a concurrent but increasing dose of progestin given over 3 successive 7 day periods. Iron or placebo pills are given during the last week of the pack.
T/F. Other medications rarely decrease the efficacy of OCPs.
False. So many drugs/herbs interact with OCPs. Especially antibiotics, seizure meds, St. John's Wort
The use of OCPs for five yrs or more decreases the risk of: ovarian CA in later life by ____%
ovarian CA overall by ___40%
endometrial CA overall by ___% compared to non-users.
50%, 40%, 50%
The use of OCPs for 10 yrs or more decreases the risk of ovarian and endometrial CA by a combined _____%
Which synthetic progestin is more similar to natural progesterone?
What is the degree of increased risk of DVT with the use of Drospirenone/Yaz compared to women who don't take the pill?
6 to 7 fold increased risk
How often is Medroxyprogesterone acetate/Depo-Provera administered?
4x a year
How soon after a Medroxyprogesterone acetate/Depo-Provera is the woman protected from becoming pregnant?
What is the MOA of Medroxyprogesterone acetate/Depo-Provera?
Prevents ovulation by decreasing release of GnRH by the hypothalamus which decreases the release of FSH and LH by the ant. pituitary.
Does Medroxyprogesterone acetate/Depo-Provera reduce the risk of endometrial CA?
yes. By 80%
How long after the last injection of Medroxyprogesterone acetate/Depo-Provera can a woman expect to achieve pregnancy?
Name the implant contraceptive and how long it remains effective.
Name the contraceptive patch and how often it is replaced
weekly for 3 weeks, one week off
Which contraceptive option contains the hormone etonogestrel, the active metabolite of the pro-drug desogestrel?
What in what class of drugs is Ulipristal acetate/Ella?
SPRM: selective progesterone receptor modulator
What is the timeline for the use of Ulipristal acetate/Ella?
should be given within 120 hours (5 days) after unprotected intercourse/contraceptive failure.
What is the MOA for Ulipristal acetate/Ella?
delays ovulation and inhibits follicle rupture.
Name the abortifacient pills and the timeline for use.
Within the first two months of pregnancy
What is the efficacy of Mifepristone during the first trimester of pregnancy?
What is the MOA of Mifepristone/Mifeprex?
blocks progesterone receptors and decreases HCG levels, which leads to decreased progesterone production by the corpus luteum
What are the likely side effects of Mifepristone/Mifeprex?
vaginal bleeding (9-16 days on average)
What are the contraindications of Mifepristone/Mifeprex?
IUD, ectopic pregnancy, pts with hemorrhagic disorders, anticoagulant therapy, long-term prednisone use
Class and MOA of Clomiphene/Clomid
Estrogen receptor agonist
Binds estrogen receptors in the brain>>alters negative feedback of estrogen on GnRH>>>increased GnRH secretion>>>increased LH and FSH>>>ovulation
What is the side effect profile of Clomiphene/Clomid?
Looks like menopause
vag dryness, bleeding, breast tenderness, anxiety, hot flashes
Of the second generation Sulfonylureas, which is most likely to cause hypoglycemia?