PHARM BLESSINGS Flashcards by Paige LaPointe

endocrine?

more like endocrying

deep breath

here we go

GET PUMPED

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what 3 drugs have been shown to decrease mortality?

metformin

insulin

sulfonylureas

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what drug should all DM patients be on because it is cardioprotective and renoprotective?

ACE-I

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what is the maximum A1C @ diagnosis that you can treat someone on oral meds?

9 or 10

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what is the DOC for T2DM to decrease A1C?

metformin

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can you rx a diuretic and metformin together?

looks like nah

drug-drug interaction

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when do you give a diabetic aspirin?

when they have evidence of CVD

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at what GFR do you decrease the dose for metformin?

30-60

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at what GFR can you no longer prescribe metformin?

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what non-pharm treatment can you use to reduce A1C by a half point?

diet and exercise

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when a person is diagnosed with T2DM, should you start therapy immediately or try lifestyle changes first?

treat immediately

(people usually present when they’ve had DM for 10y and already have some “-opathies”)

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what chemical (that I drink excessively every single morning in order to be a pleasant human being) decreases bone mineralization and shouldn’t be consumed if a patient has osteoporosis?

caffeine

(fuck osteoporosis, coffee is bae)

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what happens if you drink alcohol on metformin?

increases risk of lactic acidosis

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how often do we check A1C levels?

every 3 months at first

then every 6 months

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there’s a lot going on in case 4

i’m not doing it

yes i know-ow-ow that i let you down

is it too late now to say sorry now

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this kid with T1DM had a boat load of insulin but he lost it and now he wants more

whatcha gonna do

DON’T PRESCRIBE HIM MORE, IT CAN BE USED AS AN INGREDIENT FOR METH

just kidding just give him 100U or 300U insulin glargine [lantus or toujeo solostar]

and short-acting insulin for before meals

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what can ETOH cause with insulin?

hypoglycemia

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can you mix different types of insulin?

sodium bromate

(“NaBro”)

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what if your pt is on metformin and isn’t showing A1C improvement after 3 months?

put on a sulfonylurea like glipizide [glucotrol]

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so you WANT to put your patient on a sulfonylurea but she’s allergic to sulfa

now what

tell her to suck it up

lol jk you could potentially kill her so give her repaglinide [prandin]

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what drug class is repaglinide [prandin]?

meglitinide: non-sulfa secretagogue

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does rapaglinide [prandin] make the B cells work harder or less hard?

harder harder harder

so will prob need insulin sooner

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your T2DM patient has an A1C of 12. does he need insulin?

yup

oral meds won’t cut it

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what’s important when you educate your patient on subQ insulin?

change the injection sites to prevent muscle atrophy

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which drug is most likely to cause hypoglycemia? a) metformin b) glipizide [glucotrol] c) acarbose [preclose]

how much insulin should a person be taking per day?

0.2-0.5units/kg total for the whole day

they just really wanna make sure you know this what drug has a s/e of hypoglycemia

glipizide [glucotrol] _{if you got this wrong then please take a break to work on your short-term memory} _{(just kidding you're still a beautiful human, keep doing you!)}

DID YOU KNOW that glipizide [glycotrol] can give a patient hypoglycemia? _{(omg no way!)} well what do you do if glipizide [glycotrol] is giving a patient hypoglycemia?

just reduce the dose!

name 3 drugs that have been shown to reduce the risk of hip fx

alendronate [fosamax] ibandronate risidronate _{...i don't even know what those last 2 drugs are so if you got all 3 correct on the 1st try then congrats you are officially superhuman}

hey

happy valentine's day \<3

what are the instructions for taking alendronate [fosomax]?

take 30min before breakfast sit up for 30 mins to prevent esophagitis

pt has hypothyroidism oh no what do you do

levothyroxine [synthroid]

what is the average supplementation of levothryroxine [synthroid]

120mcg

what is the MC regimen that we are going to START someone on levothyroxine [synthroid] on?

12.5-25mcg

what can a too-high dose of levothyroxine [synthroid] cause as s/e?

things like tachy and anxiety and angina

if a patient has hypothyroidism (oh no) what supplement should you make sure they're getting?

iodine _{(PS hypothyroidism is not a big deal, I don't know why I keep putting "oh no")} _{(it just felt right)} _{(don't mind me)}

when do you recheck thyroid levels

6 weeks

if you have a pt with hypothyroidism (oh no) and his TSH only decreases to 12 after 3 months, what lab levels should you check?

FT3 and FT4

what if a pt has hypothyroidism (oh no) and it's due to low T3 levels

give triiodo somethin somethin you ain't gonna be giving this drug (oh yes)

dude's 80 with orthostatic hypotension DOC?

the mineralcorticoid **fludricortisone** [florinef]

what's the MOA of fludrocortisone [florinef]?

increases absorption of Na at renal tubule increases intravascular volume

what drug do you need to double if your patient is on it, and begins fludrocortisone [flsomethingef]?

glipizide [glucotrol]

WHAT IS THE DIABETES HIERARCHY OF DRUGS FOR T2DM [**know this,** it was literally said so many times by Big B (AKA Blessington)]

1. metformin 2. sulfonylureas ^{(if allergic to sulfa then repaglinide [prandin])} 3. insulin and "other" drugs on the table

which drugs on the $4 list treat A1C and just diabetes things like dyslipidemia and heart/kidney issues etc.?

metformin ACE-Is (lisinopril) statins (lovastatin)

tru or nah: metformin can induce renal disease

truuuuuuu

why do **we discontinue metformin before giving CT scans with dye**?

could hurt the kidz ^(kidneys)

for real what is the eGFR cutoff with metformin because we mentioned it like 18 times today

**30**

which 3 supplements can you **not** take at the same time as levothyroxine [synthroid]?

Ca Mg Fe take 4 hours apart

so like what happens when you mix Ca, Fe, and Mg with levothyroxine at the same time?

YOU GET MAN BOOBS. _{just kidding.} YOU DIE _{just kidding again.} decreased absorption of levothyroxine ^{(see this answer is so much more boring)}

15% of the population has a hard time converting T4 to T3 so what do we treat them with?

triiodo somethin somethin (T3 rather than T4)

depression occurs with: a) hypothyroidism (oh no) b) hyperthyroidism c) both d) neither

c) both

when you start someone on metformin, what is the A1C goal?

patient has hyperthyroidism how do you treat?

**Beta blocker** like propanolol to treat sx! PTU or methimazole (^^^endo will rx that^^^)

if you're starting someone on any thyroid hormone what should you be monitoring?

thyroid levels hellloooooo

**What is the most significant cause of death in elderly diabetics taking oral agents?**

fatal hula hoop accidents but actually **\*hypoglycemic death due to sulfonylureas\***

can you go on canaglafoxin [invokana] for T2DM if you have kidney disease?

yahh. well nahhh. i mean kind of. if you eGFR is above **50**

if a patient is going on insulin, what are the 2 insulins you're prob gonna put them on?

insulin glargine regular [humilin-r]

which insulin is rapid acting

lisipro [humalog]

which insulin is short acting

regular [humulin-r]

which insulin is intermediate acting

neutral protamine [humulin-N]

which insulin(s) is/are long acting

insulin glargine [lantus] insulin glargine [toujeo solostar] _{who the eff comes up with these names... toujeo solostar? really?}

which insulin is a rapid-acting inhalation?

human rDNA insulin [afrezza]

which insulins can be given IV?

correct me if I'm wrong but I/Google THINK it's the rapid ones and regular

hey

smile

Patient Hx of fx Osteoporosis that has not responded to bisphosphonate therapy. DOC?

demosumab [prolia]

how do you administer denosumab [prolia] and how often?

subQ every 6 months

does/can denosumab [prolia] cause: a) hypo or hyper tension? b) hypo or hyper calcemia?

a) hyper b) hypo (^^^give Ca + Vit D while on this^^^)

what do osteoblasts do?

bone remodeling

what do osteoclasts do?

bone reabsorption

what is the ratio of osteoclastic activity to osteoblastic activity?

2 weeks clast : 12 weeks blast bone remodeling takes way longer than reaborption

how long should a low risk person be on bisphosphonates?

how long should a high risk pt be on bisphosphonates?

up to 10y

what T score defines osteoporosis?

greater than 2.5 SD

what can happen to patients who have been on bisphosphonates for a long time?

they turn lime green lol throwback joke no they make cortical bone, but can't make trabecular bone, so pts can get unusual fractures

does alendronate [fosomax] protect against: a) hip fx b) vertebral fx c) both d) neither

c) both

what if you want to put a patient on calcium and they are taking a PPI... what's the best doc?

calcium citrate

how many times per day can long acting insulin be given?

what is the Somoygi effect?

alternating phases of hyper and hypo and hyper and hypoglycemia

what is the Dawn effect?

a surge of hormones that they body produces around 4-5am if you don't have insulin, you will show a high fasting glucose level

for an elderly patient with comorbid conditions, where do you want the A1C?

7.5

what can you add for a T2DM patient who wants a 3rd oral agent to control his diabetes?

a TZD like pioglitizone [actos]

true or false: insulin does not cause weight gain

falsetto

true or false: metformin does not cause weight gain

das true!

what do alpha cells produce?

glucagon

what do beta cells produce?

insulin amylin c-protein

what do delta cells produce?

somatostatin

what cells are in the ileum and what do they produce?

GLP incretin

when PTH is high, calcitonin is \_\_\_\_\_

low

when PTH is high, Ca is \_\_\_\_\_

naked jk it's high too PTH and Ca smoked together

PTH stimulates osteo\_\_\_\_\_

osteoclasts

calcitonin inhibits osteo\_\_\_\_\_

osteoclasts

what cells produce calcitonin?

parafollicular cells in the thyroid

yay we're done! just remember... what does a spoonful of sugar do?

PHARM BLESSINGS Flashcards

(93 cards)