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Flashcards in Pharm 2 - Exam 3 Deck (141):
1

Which thyroid hormone(s) does Levothyroxine/Synthroid replace?

T4

2

Which thyroid hormone(s) does Thyroid USP/Armour thyroid replace?

T4 and T3

3

Which thyroid hormone(s) does Liothyronine/Cytomel replace?

T3

4

Which form of thyroid hormone is active?

T3

5

What is the normal T4:T3 ratio?

4:1

6

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.

7

In what unit doses are Armour and Synthroid given?

Armour: mg
Synthroid: mcg

8

60mg of Thyroid USP/Armour is equivalent to how much Levothyroxine/Synthroid and how much Liothyronine/Cytomel?

100mcg Levothyroxine/Synthroid
25mcg Liothyronine/Cytomel

9

Long term elevation of T4 (such as from Levothyroxine/Synthroid use) increases the risk of what two pathologies?

Osteoporosis
CVD

10

This hypothyroid med is also indicated for Wilson's Syndrome.

Liothyronine/Cytomel (T3)

11

In what class of drugs are Methimazole/Tapazole and PTU?

Thionamide

12

What is the MOA of Methimazole/Tapazole and PTU?

Blocks conversion of T4 to T3

13

What is the most feared side effect of Methimazole/Tapazole and PTU?

agranulocytosis

14

What is the result of super physiologic doses of iodine?

stuns the thyroid into inactivity for days to weeks

15

Name the two thionamide drugs.

Methimazole/Tapazole
Propylthiouricil (PTU)

16

Of the two thionamide drugs, which is most effective in preventing the conversion of T4 to T3 in peripheral tissues?

PTU

17

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

18

Which of the thionamide drugs is more appropriate for pregnancy?

PTU. Both are category D though.

19

Which drugs would be most appropriate for the treatment of thyroid storm?

Propanolol/Inderal
IV Iodine/SSKI

20

How long do the beneficial side effects of iodine/SSKI last?

2-3 weeks

21

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

22

How long is radioactive iodine typically in the body after a dose is taken?

3-5 days.

23

What is the drug classification of radioactive iodine?

category x

24

How long should pregnancy be delayed following radioactive iodine treatment?

6-12 months

25

What are the s/sx of a thyroid storm?

high fever, irritability, delerium, vomiting, diarrhea, hypotension, dehydration, vascular collapse

26

Diabetes diagnoses all rely on what form of testing?

Serum glucose

27

What might be the problem with calcium derived from oyster or bone?

Lead and other heavy metal contamination

28

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?

bisphosphonates

29

In what class of drugs is Alendronate/Fosamax?

Bisphosphonates

30

What are the two major SE of Alendronate/Fosamax?

Osteonecrosis of the jaw
Atypical femur fractures (ex. in the shaft)

31

In what class is Raloxifene/Evista?

SERM

32

What is the MOA of the SERM class of drugs?

Binds to select estrogen receptor sites to beneficial estrogen activity

33

What is the MOA of bisphosphonates?

inhibits osteoclastic activity

34

This drug is a synthetic hormone that inhibits osteoclastic activity.

Calcitonin/Miacalcin

35

This osteoporosis drug is available in a nasal spray.

Calcitonin/Miacalcin

36

Name the synthetic PTH analogue.

Teriparatide/Forteo

37

This drug activates bone turnover with osteoblasts being activate to a much greater extent than osteoclasts

Teriparatide/Forteo

38

Which to drugs have been shown to reduce the spinal fracture risk in individuals with osteoporosis.

Calcitonin/Miacalcin
Teriparatide/Forteo
Estrogen/HRT

39

What is Estrogen/HRT combined with to reduce the risk of endometrial CA?

Progestin

40

Name the human monoclonal Ab approved for the treatment of osteoporosis.

Denosumab/Prolia

41

How is Denosumab/Prolia administered?

SQ injection once every 6 months

42

MOA of Metformin

inhibits glucose production by the liver and decreases insulin resistance

43

MOA of Sulfonylureas and Meglitinides

increases secretion of insulin by interaction with ATP sensitive K+ channels in beta cell membrane

44

MOA of alpha-glucosidase inhibitors

delays absorption of glucose by inhibiting alpha-glucosidase enzyme at brush border

45

MOA of Thiazolidinediones/Glitazones

improves insulin sensitivity in skeletal muscle cells, fat cells, liver cells and decreases hepatic glucose production

46

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/

47

In what two instances may patients on oral diabetic medications be switched to insulin?

acute infections
in-patient surgery

48

What medication is used for women with gestational diabetes?

insulin

49

In what class of drugs is Metformin/Glycophage?

Biguanides

50

T/F. Metformin is likely to cause weight gain

False. Metformin can cause modest weight loss (unlike sulfonylureas)

51

If you put a patient on Metformin, what side effects might you want to tell them to expect?

abdominal cramping
nausea
metallic taste in mouth
increased risk for B12 deficiency
lactic acidosis (fatal)

52

To prevent lactic acidosis, what population of people should not use Metformin/Glycophage.

those with impaired renal function

53

What is the most concerning side effect of Sulfonylureas?

hypoglycemia (esp. in patients with impaired renal or liver function)

54

What is the most common SE of Sulfonylureas?

weight gain

55

In general, how long are sulfonylureas effective?

5-10 years

56

Name the 1st generation Sulfonylureas.

Chlorpropamide/Diabinese
Tolbutamide/Orinase

57

Name the 2nd generation sulfanylurea drugs.

Glipizide/Glucotrol
Glyburide/Micronase/Diabeta
Glimepiride/Amaryl

58

How is Metformin/Glucophage dosed?

BID
QD if extended release

59

Name the two Meglitinides

Nateglinide/Starlix
Repaglinide/Prandin

60

Which Meglitinide is more effective?

Repaglinide/Prandin

61

What classes of DM drugs cause weight gain?

Sulfonylureas
Meglintinides
Glitazones

62

Which class of drugs should Meglitinides not be combined with?

Sulfonylureas

63

Name the TZD/Glitazones

Rosiglitazone/Avandia
Pioglitazone/ACTOS

64

Of the Glitazones, which is approved for concurrent use with insulin?

Pioglitazone/ACTOS

65

Can both Glitazones be combined with Metformin or Sulfonylurea?

yes

66

What do the Glitazones increase the risk for?

CHF
inc. liver enzymes
dec. bone density, inc. fracture
weight gain

67

Name the alpha-glucosidase inhibitors.

Acarbose/Precose
Miglitol/Glyset

68

How is Alpha-glucosidase inhibitors dosed?

with each meal

69

When might Alpha-glucosidase inhibitors cause hypoglycemia?

when combined with Sulfonylurea or insulin

70

To correct hypoglycemia when taking Alpha-glucosidase inhibitors, what form of sugar should be used?

glucose

71

What population of people should not take Alpha-glucosidase inhibitors?

IBD, chx intestinal dz, any intestinal obstruction

72

Name the DPP-4 inhibitor

Sitagliptin/Januvia

73

Which other drug should Sitagliptin/Januvia not be combined with?

insulin

74

This injectable drug is a synthetic form of amylin, which is produced along with insulin by the beta cells.

Pramlintide/Symlin

75

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.

Exenatide

76

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.

77

What are the only two drugs approved by the FDA for lowering blood sugar in type 1 diabetics?

Insulin
Pramlintide/Symlin

78

Which DM drugs promote weight loss?

Metformin
Pramlintide/Symlin
Exenatide/Byetta

79

T/F. Insulin and Pramlintide/Symlin can be combined and injected from the same vial.

False.

80

In what class of drugs is Exenatide/Byetta? What is the MOA?

incretin mimetics
lowers blood glucose by increasing insulin secretion

81

Insulin is never given ______(SQ/IM/IV/Orally).

orally

82

What is the onset speed and duration of action of Lispro/Aspart and Humulog/Novalog.

Rapid acting
3-5 hours

83

What is the action time and duration of action of Regular Insulin/Humulin R?

Short acting
4-12 hours

84

What is the action time and duration of action of NPH/Humulin N?

Intermediate acting
10-18 hours

85

What is the action time and duration of action of Glargine/Lantus?

Long acting
24 hours

86

What are some SE of insulin therapy?

weight gain
hypoglycemia
hypokalemia
fibrosis of injection site
muscle/fat atrophy at injection site

87

What agent is used for treatment of severe hypoglycemia?

Glucagon

88

In what class of drugs is Leuprolide/Lupron?

Anti-androgenic hormone and anti-estrogenic hormone

89

T/F Leuprolide/Lupron is given PO, SQ, IM.

False. It is only given SQ and IM

90

Name the anti-androgen med

Finasteride/Proscar

91

MOA of Finasteride/Proscar

limits conversion of testosterone to DHT by inhibiting type II 5-alphareductase

92

What must the PARQ of Finasteride/Proscar include?

That pregnant women should not handle crushed or broken tablets because of risk of birth defects

93

What is the name of the low dose versions of Finasteride/Proscar?

Propecia

94

What two drug categories are used to treat BPH?

5 alpha reductase inhibitors and alpha blockers

95

Which alpha blocker should not be used by those who are allergic to sulfa drugs?

Tamulosin/Urimax/Flomax

96

What drug is indicated for ED and pulmonary hypertension?

Sildenafil citrate/Viagra

97

What is the MOA of Sildenafil citrate/Viagra?

inhibits cGMP specific phosphodiesterase type 5 which keeps blood in the in the corpus cavernosum

98

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
hypotension
Hereditary degenerative retinal disorders

99

Which drug may cause cyanopsia?

Sildenafil citrate/Viagra

100

Which form of estrogen is the most potent?

Estradiol

101

Regarding potency, how do the other major forms of estrogen compare to estradiol?

They are 1/10th as strong

102

Is endogenous estrogen or synthetic estrogen more subject to first pass metabolism and thus less effective when given orally?

endogenous/naturally produced estrogen

103

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.

104

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

105

What kind of CA may occur in unopposed estrogen therapy?

endometrial CA

106

What is the hormone ratio of BiEst?

80:20 estriol to estradiol

107

What is the hormone ration of TriEst?

80:10:10 estriol, estradiol, estrone

108

What is the MOA of the progesterone drugs?

alters gene transcription

109

What is the source of conjugated estrogens/Premarin and how is it delivered?

mare urine
oral or topical

110

What are the contraindications for the use of progesterone drugs?

hx of DVT or breast, ovarian or uterine CA

111

What is the FDA drug classification for conjugated estrogens/Premarin?

Category X

112

How is Medroxyprogesterone/Provera administered?

PO
Depp-Form is IM

113

What are the roles of estrogen and progestin in COCPs?

Estrogen: suppresses ovulation
Progestin: prevents implantation and makes cervical mucus impenetrable to sperm

114

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

115

What is the most commonly used estrogen in COCPs?

ethinyl estradiol

116

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.

117

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

118

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%

119

The use of OCPs for 10 yrs or more decreases the risk of ovarian and endometrial CA by a combined _____%

80%

120

Which synthetic progestin is more similar to natural progesterone?

Drospirenone/Yaz

121

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

122

How often is Medroxyprogesterone acetate/Depo-Provera administered?

4x a year

123

How soon after a Medroxyprogesterone acetate/Depo-Provera is the woman protected from becoming pregnant?

immediately

124

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.

125

Does Medroxyprogesterone acetate/Depo-Provera reduce the risk of endometrial CA?

yes. By 80%

126

How long after the last injection of Medroxyprogesterone acetate/Depo-Provera can a woman expect to achieve pregnancy?

9-10 months

127

Name the implant contraceptive and how long it remains effective.

Implanon
3 years

128

Name the contraceptive patch and how often it is replaced

Ortha Evra
weekly for 3 weeks, one week off

129

Which contraceptive option contains the hormone etonogestrel, the active metabolite of the pro-drug desogestrel?

NuvaRing

130

What in what class of drugs is Ulipristal acetate/Ella?

SPRM: selective progesterone receptor modulator

131

What is the timeline for the use of Ulipristal acetate/Ella?

should be given within 120 hours (5 days) after unprotected intercourse/contraceptive failure.

132

What is the MOA for Ulipristal acetate/Ella?

delays ovulation and inhibits follicle rupture.

133

Name the abortifacient pills and the timeline for use.

Mifepristone/Mifeprex
Within the first two months of pregnancy

134

What is the efficacy of Mifepristone during the first trimester of pregnancy?

85%

135

What is the MOA of Mifepristone/Mifeprex?

blocks progesterone receptors and decreases HCG levels, which leads to decreased progesterone production by the corpus luteum

136

What are the likely side effects of Mifepristone/Mifeprex?

abdominal pain
cramping
vaginal bleeding (9-16 days on average)

137

What are the contraindications of Mifepristone/Mifeprex?

IUD, ectopic pregnancy, pts with hemorrhagic disorders, anticoagulant therapy, long-term prednisone use

138

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

139

What is the side effect profile of Clomiphene/Clomid?

Looks like menopause
vag dryness, bleeding, breast tenderness, anxiety, hot flashes

140

Of the second generation Sulfonylureas, which is most likely to cause hypoglycemia?

Glyburide/Micronause/Diabeta

141

Of the Meglitinides, which drug is more effective?

Repaglinide/Prandin