Pharm Flashcards
(218 cards)
1
Q
administration of testosterone
A
IM or transdermal
cannot be administered oral
2
Q
reason testosterone not oral
A
metabolized by small intestine and undergoes extensive first pass
low bioavailability
3
Q
topical gel
A
acts as 24 h depot
4
Q
no patch on scrotum
A
can absorb too much testosterone
5
Q
caution with MRI and testosterone patch
A
aluminum can cause burns
6
Q
adverse reactions in female partner of patch
A
acne and abnormal hair growth
7
Q
children coming in contact with gels and topical solutions
A
virilization can occur
8
Q
testosterone esters
A
testosterone cypionate and enanthate
more lipophilic
9
Q
administration of testosterone esters
A
IM longer duration (administer every 2-4 weeks)
10
Q
use of testosterone esters
A
hypogonadism
metastatic breast cancer in women
11
Q
17 alpha alkylated testosterone
A
methyltestosterone, fluoxymesterone
12
Q
use of 17 alpha testosterone
A
hypogonadism
metastatic breast cancer in women
13
Q
contraindications 17 alpha testosterone
A
male breast cancer
prostate cancer
pregnancy
14
Q
adverse reactions 17 alpha testosterone
A
cholestatic hepatitis and jaundice
edema
liver cancer
bleeding (decline in II, V, VII, and X)
15
Q
adverse reactions all testosterone analogs
A
salt and water retention leading to HTN
jaundice (greatest risk with 17 alpha)
hepatic carcinomas from high dose or prolonged use
16
Q
MOA danazol
A
depreses preovulatory surge in FSH and LH which results in reduction of estrogen and progesterone
anovulation
17
Q
uses danazol
A
endometriosis
hereditary angioedema
fibrocytic breast disease
18
Q
adverse effects danazol
A
weight gain acne thrombosis mood swings hepatic dysfunction
19
Q
contraindications danazol
A
pregnancy
breast feeding
20
Q
MOA stanazolol
A
derivative 17alpha
increases C1 inh and C4
21
Q
use stanazolol
A
hereditary angioedema
22
Q
drug contraindicated for hereditary angioedema
A
ACEi
23
Q
adverse effects stanazolol
A
increased bleeding times (decrease II, VII, IX, X) edema acne virilization in women, baldness hepatic toxicity
24
Q
contraindications stanazolol
A
pregnancy
male breast cancer or prostate cancer
female breast cancer with hypercalcemia
25
MOA oxandrolone
derivative of testosterone
| high anabolic to androgenic ratio
26
use oxandrolone
weight gain
27
side effects oxandrolone
edema, water retention
HTN
irritability, aggression, excitation
28
contraindications oxandrolone
```
breast cancer (men or women)
prostatic cancer
pregnancy
```
29
MOA finasteride and dutasteride
reduce DHT
finasteride type 2 competitive inhibitor
dutasteride type 1 and 2 competitive inhibitor
30
use finasteride and dutasteride
BPH (may take 6 weeks to reduce)
| male baldness
31
MOA tamsulosin and alfuzosin
alpha 1 adrenergic receptor inhibitors
| decrease smooth muscle tone in prostate and bladder neck
32
adverse effects finasteride and dutasteride
gynecomastia
decrease PSA
elevated T but decreased DHT
hepatic dysfunction-finasteride
33
contraindications finasteride and dutasteride
contraindicated in women and children
| should not handle tablets if pregnant
34
MOA leuprolide
GnRH agonist
| continuous GnRH leads to down regulation of LH and FSH and decreased T
35
use leuprolide
prostatic cancer
| endometriosis
36
adverse effects leuprolide
hot flashes/night sweats
gynecomastia
bone pain, higher risk of osteoporosis
greater risk of thrombosis
37
MOA flutamide
interferes with binding of DHT and T
38
use flutamide
```
prostatic cancer (oral)
acne (topical
```
39
side effects flutamide
gynecomastia
| elevated liver function tests
40
estrogen synthesis premenopausal
granulosa cells of ovary
41
estrogen synthesis pregnancy
fetoplacental unit
42
conversion of androstenedione and testosterone to estrone
hepatic tissue and adpisoe
43
most potent endogenous estrogen
17B estradiol
44
starting point of estrogen
cholesterol
45
excretion of estrogen
conjugated with glucuronide and sulfate conjugates
46
estrogen in ovary
follicular growth
47
estrogen in uterus
endometrial growth
48
estrogen in vagina
cornification of epithelial cells with thickening and stratification of epithelium
49
estrogen in cervix
lowers viscosity
| helps the swimmers
50
estrogen on external and internal genitalia
development and maintenance
51
estrogen on bone
osteoblastic
52
estrogen on cholesterol
hypocholesterolemic effect
53
estrogen on electrolytes
retention of NaCl and water by kidney
54
sites of synthesis progesterone
ovary (corpus luteum)
placenta
adrenal cortex
testis
55
physiological action of progesterone
secretory endometrium
increases viscosity
decline initiates mensturation
56
hormones in follicular phase
pulsatile GnRH leading to pulsatile FSH and LH
ovary leading to E and P
E inhibits release of FSH and LH from pituitary
57
hormones midcycle
E positive feedback on pituitary
| preovulatory surge of LH and FSH
58
hormones in luteal phase
E and P from corpus luteum
P controls LH, important for implantation
drop in P leads to menses
if pregnancy occurs, hCG maintains elevated E and P
59
therapeutic use of E and P
contraception and postmenopausal hormone therapy
60
therapeutic use of P only
dysmenorrhea
endometriosis
dysfunctional uterine bleeding
61
monophasic OCP
constant level of estrogen and progesterone
62
biphasic OCP
2 levels of progesterone and constant estrogen
63
triphasic OCP
3 levels of progesterone with estradiol
64
Mircette
2 days placebo
only 5 days of unopposed estrogen-prevents early folliculogenesis during placebo period
fewer estrogen-withdrawal HA
65
Yaz
4 days of placebo
24 days of EE and diospirenone
used for premenopausal dysphoric disorder
66
Seasonale
84 days with 7 days of placebo
67
Seasonique
10 EE instead of placebo
| better follicular suppression and less unscheduled bleeding
68
Lybrel
365 days without placebo or pill free days
69
Xulane
patch with norelgestromin
3 weeks on, 1 week off
localized rash
70
NuvaRing
EE and etonogestrel
| inserted for 3 weeks, 1 break week
71
synthetic estrogens
mestranol and EE
| mestranol metabolized to EE to be active
72
less weight gain progesterone component
drospirenone
| also less acne
73
monitor while on drospirenone
monitor K
| antimineralocorticoid component
74
highest androgenic activity progestins
levonorgestrel and norgestrel
| leads to acne and hirsutism
75
timing for effectiveness tricyclics
7 days
76
timing for effectiveness monophasics
21 days
77
starting of pack
first or fifth day of menses
78
timing of pills
same time of day to minimize adverse effects
| better therapeutic success
79
general adverse OCP effects
nausea, headache, breast tenderness, weight gain, bleeding, migraines, depression, lethargy
80
metabolic adverse OCP effects
decreased HDL, worsens abnormal glucose tolerance, increased gall stones
81
cardiovascular adverse OCP effects
increased coag factors II, VII, VIII, IX, X
greater platelet aggregation
higher incidence of thrmbophlebitis and thromboembolism
higher incidence of HTN and MI
higher incidence thrombotic strokes
82
contraindications OCP
pregnancy
thrombophlebitis or thromboembolic disease
breast or estrogen dependnet carcinoma
cerebrovascular or CAD
liver disease
cholestatic jaundice during pregnancy or with OC
estrogen associated benign or malignant hepatic tumors
diabetes with vascular disease
cigarette smoker (>15/day) over 35
83
non-contraceptive benefits OCP
```
cycle regulation
decreased flow
increased bone mineral density
decreased dysmenorrhea
decreased peri-menopausal symptoms
decreased acne
decreased hirsutism
decreased endometrial cancer
decreased epithelial ovarian cancer
decreased fibroids, fewer ovarian cysts
lower ectopic pregnancy
```
84
PID patient with past ectopic pregnancy put them on
OCP
85
side effects due to excess estrogen
```
nausea, bloating
HA
cyclic weight gain
irritability
chloasma, hyperpigmentation
hypermenorrhea
hypertension
breast fullness
leg cramps, edema
```
86
side effects due to too little estrogen
```
spotting and bleeding early
hypomenorrhea
nervousness
vasomotor symptoms
atrophic vaginitis
```
87
side effects due to progestin excess
depression, fatigue
breast regression
hirsutism
libido change
88
side effects due to too little progestin
late cycle bleeding
| hypermenorrhea
89
missed 1 pill
take immediately
90
missed 2 pills
take extra pill for 2 days
91
missed 2 pills in week 3
stop current pills and start new cycle
92
cigarette smoking and OCP
increase failure
| increase clearance
93
anticonvulsants and OCP
carbamazepine, phenytoin, phenobarbital, primidone
| enhance clearance
94
antibiotics and OCP
increase failure-estrogens undergo enterohepatic recirculation following conjugation
tetracycline, penicillin V, erythromycin, ampicillin
95
timing in non-nursing mother for OCP
4 weeks after delivery
| if breast feeding-progestrone only
96
minipill use
women who cannot take estrogen
CVD, migraines
nursing mothers
97
progesterone in minipill
norethindrone
| norgestrel
98
DMPA-medroxyprogesterone acetate
depot prep
| inject every 3 months
99
adverse effects DMPA
delay in fertility after withdrawal of drug
weight gain, insomnia, menstrual irregularities
increased risk of bone mineral density loss
100
nexplanon
progestin based rod
101
Mirena
replace in 5 years
high incidence of irregular bleeding in first 6 months
insert 7 days after onset of menstruation or first trimester abortion
102
ParaGard
copper containing-spermicidal
| insert for 10 years
103
Skyla
smallest IUD
| 3 years
104
Liletta
similar to Mirena
| 3 years
105
side effects plan B
headache, abdominal pain
106
decrease plan B efficacy
increasing BMI
107
effectiveness emergency contraceptive
within 72 hrs
108
combined ECP
2 doses 12 hrs apart
109
antiprogestin ECP
selective progesterone receptor modulator
prescription
approved for 5 days after unprotected sex
110
active ingredient vaginal spermicides
octoxynol-9 or nonoxynol-9
111
use vaginal spermicides
before intercourse
most effective when combined with diaphragm, condom, or cervical cap
perfumes and additives may be irritating
112
goal menopausal replacement therapy
delay or prevent osteoporosis
reduce CVD
reduce vasomotor disturbances
113
combined estrogen and progesterone in replacement therapy
unopposed estrogen associated with increased risk of endometrial cancer
114
adverse effects hormone replacement
blood clots
| HTN (dose dependent)
115
contraindications hormone replacement
estrogen dependent neoplasia
breast cancer
thrombophlebitis
116
conjugated estrogens/selective estrogen receptor modulator
prevent osteoporosis with combination of bazedoxifene
117
biosynthesis of insulin
prepro to pro in RER
granules proinsulin and Ca dependent endopeptidases
insulin, C peptide and amylin released from beta cell
118
biologically active form of insulin
monomer
119
stored form of insulin
hexamer
120
cellular mechanism insulin
glucose alters ATP/ADP
ATP sensitive K channels results in depolarization of beta cell
activation Ca channels, phosphatidyl inositol turnover
insulin secretion requires rise in intracellular calcium
121
agents that stimulate insulin release
```
glucose
glucagon
gastrin
secretin
ketones
amino acids
isopreterenol (beta 2)
vagal stimulation
fatty acids
sulfonylureas
```
122
agents that inhibit insulin release
beta-2 antagonists
alpha-2 agonists
somatostatin
diazoxide
123
advantages of rapid acting insulin
greater flexibility in dosing compared to regular
more effective at decreasing postprandial hyperglycemia
can be mixed with NPH insulin
124
aspart
aspartic acid
| inject prior to meal
125
lispro
lysine and proline
| inject 15 min prior to meal or after a meal
126
glulisin
glutamic acid and lysine
| inject 15 min after a meal or within 20 min of starting meal
127
neutral protamine hagedorn insulin
crystallized insulin complexed with protamine and zinc
128
detemir
constant level, no peak
| cannot mix with other insulins or use pump
129
degludec
duration 42 hrs
| depot prep
130
glargine
onset in 1 hr but constant response
for 24 hrs
precipitates at pH 7
131
factors influencing insulin action
abdomen>arm>thigh>buttocks
blood flow
insulin prep
physical activity
132
increased insulin requirements
fever, hyperthyroidism, surgery, trauma, infection
133
decreased insulin requirements
nausea/vomiting, hypothyroidism, renal impairment, liver impairment
134
symptoms hypoglycemia
sweating, dizziness, nervousness, tremor, hunger, progression to confusion, disorientation, unconsciousness
135
local signs of insulin allergy
redness, itching, swelling at injection site
| usually stops after a week
136
lipohypertrophy
accumulation of fat at injection site
| avoid by rotating injection sites
137
lipoatrophy
atrophy of subcutaneous fat at site of injection
138
MOA pramlintide
amylin analog
slows gastric emptying, suppresses glucagon secretion following a meal, leads to suppression of glucose output from the liver, satiety lowers calorie intake
139
use of pramlintide
type 1 and type 2 diabetics
140
adverse reactions pramlintide
hypoglycemia
| never mix with insulin in same syringe
141
contraindication pramlintide
diabetic with gastroparesis
142
MOA sulphonylureas
stimulate insulin release
| extrahepatic-increase receptors, stimulate glucose transporters, decrease hepatic gluconeogenesis
143
advantages of second gen
more potent
less binding displacement drug interactions
second generation has less water retention
144
uses sulphonylureas
T2DM ketosis resistant
| combined with insulin in evening to lower FBG
145
special uses chlorpropamide
diabetes insipidus
| used when patient cannot tolerate desmopressin
146
adverse reactions sulphonylureas
hypoglycemia
| contraindication in ketoacidosis
147
contraindications sulphonylureas
sulfonamide allergy
| DKA
148
drug interactions sulphonylureas
miconazole, erythromycin, ketoconazole inhibit p450 and have higher incidence of h ypoglycemia
beta blockers, salicylates, NSAIDS cause binding displacement
149
MOA meglitinides
stimulates pancreatic insulin release
150
use meglitinides
T2DM ketoacidosis resistant
151
drug interactions meglitinides
miconazole, eryhtromycin, and ketoconazole (inhibit p450)
| metabolism increased by inducers of cyp3A4 (rifampicin and carbamazepine)
152
phenoformin
increase glucose transport into skeletal muscle
153
meformin MOA
decrease hepatic glucose production
decreases intestinal glucose absorption
increases peripheral glucose uptake
does not affect insulin secretion
154
drugs that can be combined with metformin
sulphonylureas, metaglinides, thiazolinediones
155
contraindications metformin
renal or hepatic disease
CHF
ketoacidosis
history of lactic acidosis
156
adverse reactions to metformin
diarrhea, nasuea, vomiting, flatulence
decreased B12
lactic acidosis worsened by alcohol
157
other uses for metformin
PCOD
| prior to conception
158
MOA acarbose and miglitol
competitive reversible inhibitor intestinal amylase and alpha glucosidease
reduces absorption of starches, disaccharides, and dextrin
159
uses alpha glucosidase inhibitors
T2DM
160
adverse effects alpha glucosidase inhibitors
flatulence, abdominal pain, diarrhea
| acarbose-elevated transaminase levels, higher incidence of GI pain
161
contraindications alpha glucosidase inhibitors
DKA
| acarbose liver cirrhosis
162
mechanism thiazolinediones
increase insulin sensitivity
enhances insulin dependent glucose uptake into skeletal muscles
agonist for PPAR-stimulates transcription of insulin responsive genes
163
adverse effects thiazolinediones
hepatic dysfunction, elevated transaminase levels (monitor liver enzymes)
edema
may worsen liver enzymes
164
GLP-1 agonist MOA
stimulates glucose dependent insulin release and suppresses glucagon secretion
165
frequency doses GLP1 agonists
exenatide 2x/day with meal
liraglutide 1x/day
dulaglutide 1x/week
166
adverse effects GLP-1 agonists
hypoglycemia
| acute pancreatitis
167
contraindication GLP-1 agonists
family history of thyroid cancer (liraglutide)
168
DPP4 inhibitors MOA
inhibit degradation of GLP-1 increasing half life
169
adverse effects DPP4 inhibitors
hypoglycemia
pancreatitis
elevated liver enzymes
worsen renal impairment
170
dose of DPP4 with cyp3A4 inhibitors
reduce dose
171
MOA SGLT2 inhibitors
enhance urinary glucose excretion by inhibiting Na-glucose cotransporter
172
adverse effects SGLT2 inhibitors
increased GU infections
hyperkalemia
hypotension
173
precautions SGLT2 inhibitors
severe renal dysfunction
174
uses of glucagon
hypoglycemia or insulin shock
| radiograph (relaxes stomach, duodenum, small bowel)
175
diazoxide use
orally to induce hyperglycemia
used in insulin secreting tumors
can lead to sodium and water retention
176
sermorelin
synthetic GHRH
177
uses GH
Turner, Prader Willi, chronic renal insufficiency, children with short stature, AIDS wasting
178
side effects GH therapy
early-increase in ICP
| diabetogenic-decreased glucose utilization
179
Mecasermin
recombinant IGF-1
| used for Laron Dwarfism (defect in GH receptor)
180
adverse effects mecasermin
hypoglycemia and lipohypertrophy
181
somatostatin anaglogs
octreotide and lanreotide (longer acting)
182
side effects somatostatin analogs
GI (diarrhea, nausea, abdominal pain)
gallstones
reduce thyrotropin secretion
183
off label use somatostatin analogs
thyrotrope adenomas
184
pegvisomant
competitive GH receptor antagonist
| used for acromegaly
185
adverse effects pegvisomant
lipohypertrophy
| monitor liver function
186
advantage of cabergoline over bromocriptine
longer half life and greater selectivity for D2 receptors than bromocriptine
187
adverse effects bromocriptine and cabergoline
B>C nausea
cabergoline-valvular disease (ergot activity)
hypotension and dizziness
188
prob off label could use cabergoline to treat neuro
migraines due to ergot activity
189
protirelin
synthetic TRH
190
diagnostic use protirelin
normal levels-hypothalamic
increased-thyroid
not increased-pituitary failure
191
cosyntropin
ACTH analog to diagnose primary vs secondary adrenal insufficiency
192
use of hCG
mimics LH
| used for stimualtion of ovulation and to treat male infertility and cryptorchidism
193
menotropins
equal parts FSH and LH
| used for infertility and spermatogenesis
194
urofollitropin
only FSH component
| used for infertility
195
follitropin beta and alpha
FSH, similar to urofollitropin
196
choriogonadotropin alpha
similar to LH and hCG
197
clomiphene MOA
estrogen antagonist
| increases gonadotropin secretion and stimulates ovulation
198
use clomiphene
female infertility due to PCOS
199
side effects clomiphene
multiple births, antiestrogenic effects on the developing follicle, ovarian cysts endometrium and cervical mucosa
200
gonadorelin
synthetic GnRH
| administered via a pump
201
longer half life of synthetic GnRH agonists
substitution at position 6 confers resistance to proteolysis
202
use synthetic GnRH agonists (leuprolide, goserelin, naferlin, histrelin)
endometriosis, uterine fibroids, advanced prostate cancer, breast cancer, precocious puberty
203
adverse effects GnRH agonists
hot flashes, decreased bone density, vaginal dryness
| atrophy of vagina, erectile dysfunction
204
use and mechanism flutamide and bicalutamide
androgen antagonists given with GnRH analog for treatment of metastatic prostate therapy
205
black box warning flutamide and bicalutamide
reversible liver damage
206
finasteride MOA
5 alpha reductase inhibitor blocks conversion of testosterone to DHT
207
use finasteride
male pattern baldness
| BPH
208
diagnosis DI
increase urine osmolality by vasopressin-central DI
| no change-nephrogenic
209
desmopressin
enhanced anti-diuretic activity
210
other uses desmopressin
vWF deficiency and factor 8 (hemophilia A)
211
adverse effects desmopressin
facial pallor, increase GI activity, muscle cramps, vasoconstriction of coronary arteries due to V1
212
overstimulation V2
water intoxication
213
drug interactions desmopressin
chlorpropamide and carbamazepine increase sensitivity
| lithium and demeclocycline inhibit actions
214
treatment nephrogenic DI
adequate water intake-thiazide diuretics reduce polyuria
| amiloride blocks Li uptake
215
treatment SIADH
fluid restriction
demeclocyclin
vaptans
IV hypertonic saline and loop diuretics
216
conivaptan and tolvaptan selectivity
V1 and V2 antagonists for conivaptan
| V2 for tolvaptan
217
use oxytocin
abortion, induction of labor, postpartum hemorrhage, induction of lactation
218
adverse effects oxytocin
overstimulation=trauma to mother or fetus, uterine rupture, water intoxication, allergic reactions
