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Winter Pharm Exam 1 - Steven
Terms in this set (113)
Lecture 1 Sex Hormones
1. High sustained levels of estrogen (ethinyl estradiol, estriol, and estrone) have what effect on LH release?
a. Positive feedback, this increases LH to a LH surge
2. What effect does ethinyl estradiol have on the endometrial lining?
a. Thickening and development
3. Estrogen is conjugated by the liver and excreted in the bile, what happens to it when it goes through enterohepatic circulation?
a. Reverses the conjugation and increases the bioavailabity of the estrogen
4. What are the clinical uses of estrogen medications?
a. Oral contraceptive
b. Postmenopausal HRT
c. Stimulating pubertal development in hypogonadic girl
d. Decrease uterine bleeding
e. Suppressing ovulation in dysmenorrhea
5. What are the contraindications of estrogen use?
a. Estrogen-dependent neoplasm
b. Thromboembolic disorders
6. Tamoxifen is the DOC for what disease state?
a. Premenopausal breast cancer
7. Where does tamoxifen act as an agonist and what effects are seen?
a. Bone: limits bone loss
b. Uterus: may increase risk for uterine cancer
8. How is raloxifene different form tamoxifen?
a. It is an antagonist in the uterus, everything else is the same
b. Used for osteoporosis prevention
9. What drug can be used to induce pregnancy and potentially induce multiple pregnancies, it does this by antagonizing the negative feedback of estrogen?
10. What is the DOC drug for postmenopausal women with breast cancer?
b. Inhibits aromatase enzyme so endogenous estrogens can't be made
11. What are the biological functions of progesterone?
a. Maintain the pregnancy
b. Uterus: converts to a secretory state
12. What is the use of Mifepristone (RU 486)?
a. Terminate pregnancy
b. Prevent implantation
13. What is the DOC for treatment of endometriosis?
a. Danazol: antiprogestin
14. The combination pill drospirinone/ethinyl estradiol (yaz) is used as a contraceptive but is also the only combination approved to treat what?
a. Premenstrual dysphoric disorder (PMDD)
15. What are the absolute contraindications for combined oral contraceptives (COCs)?
a. Thromboembolism, thrombophlebitis
b. Cerebrovascular disorders
c. Estrogen dependent neoplasm
16. What effects do too much androgen have on men, women, and both?
a. Men: decrease spermatogenesis, may exacerbate prostate cancer
b. Women: masculinization, pseudo-hermaphroditism of fetus of pregnant women
c. Both: baldness, edema, oily skin, acne, decreased HDL and increase LDL, psychological changes
17. What is the androgen receptor antagonist that is used in prostate cancer?
18. What is the androgen receptor antagonist that is used for hirsutism and PMS in women?
19. What drug do we use to treat BPH and male pattern baldness?
Lecture 2 antidiabetic
20. What is the rapid acting insulin?
a. Insulin lispro
21. What is the long acting insulin?
a. Insulin glargine
b. Insulin detemir
22. What is the intermediate acting insulin?
a. NPH or isophane insulin
23. What are the physiological changes seen with insulin deficiencies?
24. How is the long-term blood glucose level measured?
a. Hemoglobin A1c level
25. What GLUT transporter is located on muscle and adipose tissue?
a. GLUT 4
b. Insulin dependent
26. What occurs with insulin overdose?
b. Can also get weight gain after a while because insulin is anabolic
27. What is the function of the sulfonylurea drugs?
a. Stimulates insulin release from the pancreatic beta cells
28. What are the first-generation sulfonylurea drugs?
29. What are the second-generation sulfonylurea drugs?
30. What sulfonylurea drug has the worst hypoglycemic effects associated with it?
31. What is the DOC for treating type II diabetes?
b. Remember this does not release insulin
32. What are the adverse effects of metformin?
a. Lactic acidosis
33. What are the contraindications for metformin?
a. Lactic acidosis conditions
b. Renal failure/impairment
34. What antidiabetic drug can be given if the patient has a sulfa allergy?
a. Repaglinide this is a meglitinide
35. What is the black box warning that comes with the thiazolidinedione Pioglitazone?
a. Edema ... increase risk of heart failure
b. Optometry: may cause macular edema
36. What antidiabetic drug inhibits the alpha glucosidases in the small intestine and can lead to GI problems such as gas?
37. What is the drug that can be used for both type I and type II diabetics as long as insulin is already onboard?
b. This is injection only
38. What are the incretin-affecting agents and how does each work?
a. Exenatide: GLP-1 agonist increases insulin release (weight loss)
b. Sitagliptin: increase insulin release by inhibiting breakdown of glucose-like peptide (no weight effect)
Lecture 3 Glucocorticoids
39. What are the glucocorticoid effects on carbohydrates, proteins and fats in the body?
a. Increase circulating glucose, free fatty acids and amino acids
b. Antagonizes insulin
c. Redistributes body fat to center
40. What effects do glucocorticoids have on bone?
a. Decrease calcium deposition by inhibiting vitamin D
b. Increase calcium loss from bone by increasing parathyroid hormone
c. Increases osteoporosis
41. What effects are seen on the immune system with high glucocorticoids in the body?
b. Blocks inflammation
c. Suppresses wound healing
42. What are the CNS effects of glucocorticoids?
a. Mood elevation
b. Insomnia, restlessness
43. What are the symptoms of adrenocortical insufficiency?
a. Weakness, anorexia, weight loss
b. Hyperpigmentation - ACTH
e. Poor stress response
44. What glucocorticoids are primary used as a replacement therapy in an insufficient patient?
a. Hydrocortisone (active)
b. Cortisone (Pro)
45. What is the most commonly prescribes oral glucocorticoid?
46. What glucocorticoids have no mineralocorticoid activity?
c. Used as anti-inflammatory
47. How much would the patient on corticosteroids for replacement therapy increase the dose before teeth extractions?
a. Double the dose
48. What are the therapeutic guidelines for treatment of inflammation?
a. Give sufficient amount to control problem
b. Use smallest effective amount for shortest time
c. Local is better
d. Alternate days
e. Slowly taper off
49. What are the ophthalmic adverse effects of corticosteroids?
b. Increased intraocular pressure
50. If you take a patient off of corticosteroid treatment too fast what can occur?
a. They can have acute adrenal insufficiency
51. What adverse side effects are seen in a patient on too high of a dose of corticosteroids?
a. Cushingoid side effects
i. Acne, striae, truncal obesity, buffalo hump
ii. Moon face, dysmenorrhea, skin atrophy and thinning
52. What are the contraindications for corticosteroid use in a patient with adrenal insufficiencies?
Lecture 4 Osteoporosis
53. The PTHR is located on osteoblasts which causes them to release _____ that activates osteoclasts to resorb the bone.
54. What effect does vitamin D have on circulating Ca2+?
a. Increases Ca2+
55. What effects does calcitonin have on calcium levels?
a. Decreases Ca2+ levels
56. Is calcium and vitamin D sufficient enough to treat osteoporosis?
a. No, it should have a hormone replacement with it.
57. What osteoporosis medication can have adverse effects in patients with fish hypersensitivity?
58. What is the only drug that focuses on the growth of new bone for osteoporosis?
b. This is a recombinant PTH parathyroid hormone
59. How is teriparatide given?
a. Subcutaneous injection given once a day. Intermittent
60. What drug has the black label warning of osteosarcoma?
61. What is the antibody drug against the RANKL receptor?
62. What are the indications for denosumab?
a. Osteoporosis in postmenopausal women and men
63. What are the contraindications for denosumab?
b. Pregnancy, category X
64. The is the DOC drug for postmenopausal osteoporosis?
- Alendronate (oral)
- Ibandronate (oral)
- Zolendronic acid (IV)
65. IV and oral administrations of bisphosphonates can lead to what in the bone, especially after dental work surgery?
Lecture 5 Thyroid Drugs
66. What feedback effect does high iodide levels have on the thyroid?
67. What effect does T3/T4 have on metabolism in the body?
68. Hypothyroidism in children can lead to what disorder?
69. What is the function of propylthiouracil and propranolol on the thyroid hormone?
a. Stops the conversion for T4 to T3
70. What is the function of rT3 in the body?
a. Nothing, it is inactive
71. What are the signs and symptoms of hypothyroidism?
a. Slow metabolic rate, weight gain, hypothermia
b. Poor memory, slow speech
c. Sensitive to cold!
72. What is the DOC for hypothyroidism?
a. Levothyroxine sodium
b. This drug must be carefully titrated to the individual
73. Is liothyronine sodium used as a long-term therapy for hypothyroidism?
a. No, it has a short half-life and duration of action
b. Can be used as initial therapy then switched to levothyroxine sodium
74. What are the signs and symptoms of hyperthyroidism?
a. Fast metabolism
d. Hot, sweating
f. Ocular: diplopia, ptosis, paralysis of extraocular muscles
75. What are some causes of hyperthyroidism?
a. Graves disease: antibodies to TSH receptor
b. Toxic nodular goiter
76. What is the DOC for graves disease?
77. What are the adverse effects seen with thioamides such as propylthiouracil and methimazole?
a. Itching and skin rash
b. PTU black box: severe liver injury, acute liver failure
c. Granulocytopenia and agranulocytosis
78. What drug is given 7-10 days before surgery to decrease the vascularity and thyroid gland content?
a. Iodide: it decreases the synthesis and release of T4/T3
b. Remember this can also be used in radioactive emergencies
79. If the patient cannot tolerate surgical resection of the thyroid, like with an elderly patient with heart disease, then what can be given to kill the thyroid if needed?
a. Radioactive iodine
Lecture 6 Allergies and COPD
80. What is a major side effect of the first-generation antihistamines that the second generation does not have?
a. Sedative properties
b. Effects on the muscarinic receptors and dry everything and good for motions sickness
81. What are the effects of histamine on the smooth muscle in lung?
b. Problematic in asthmatics
82. What effect does histamine have in the GI?
a. Increase gastric acid secretion (H2)
83. Are the second generation H1 antagonists useful in motion sickness?
a. Not useful for motion sickness
84. Cetirizine (2nd gen) is directly excreted by what?
a. The kidney
85. What are the topical antihistamines?
b. Ketotifen (eyedrop)
c. Epinastine (eyedrop)
86. What is the short acting beta 2 agonist?
87. What is the long acting beta 2 agonist?
88. What side effects are seen with patients on beta 2 agonists?
d. Tolerance due to down regulation
89. What is the DOC for COPD?
90. What is the mechanism of action for theophylline?
a. Increases cAMP by blocking PDE so increases bronchodilation
b. Blocks adenosine to block bronchoconstriction
c. Remember this drug has a narrow therapeutic index, and CYP3A4 inhibitors can lead to theophylline toxicity!
91. What are some of the side effects seen with leukotriene receptor blockers (-lukast)?
a. Sore throat
92. What are the steps to asthma therapy?
a. Beta agonist (rescue) (albuterol)
b. Inhaled corticosteroid chronically
c. Long acting beta agonist (salmeterol)
d. Leukotriene inhibitor
e. Add oral steroid when needed
f. Step down when possible
Lecture 7 GI
93. Patients on antacids such as magnesium may experience what side effects?
94. What side effects may be seen with aluminum?
95. What are the H2 antagonists that can decrease the GI acid formation?
96. What is the ending to the proton pump inhibitors?
b. Omeprazole, esomeprazole, lansoprazole
97. PPI's are the DOC for what?
98. What is the mechanism of action for bismuth subsalicylate?
b. Coats the stomach
c. Used to treat ulcers and H. pylori
Causes black tongue and stool
99. What antiemetics are highly sedating, can work for motions sickness and block the dopamine, muscarinic, and H1 receptor?
100. What are the different types of laxatives?
101. What type of laxative is lactulose?
102. What is the mechanism of action for Bisacodyl and Senna?
a. Irritate the wall of the intestine to stimulate peristalsis
b. May increase secretion of water and inhibit its absorption
103. What is the lubricant/softener that works as an emulsifying agent and allows water to penetrate the stool to soften it?
104. What are the contraindications for using a laxative?
a. Nausea and vomiting
b. Abdominal cramps
c. Undiagnosed abdominal pain
e. Intestinal obstruction
105. What are the DOCs for diarrhea?
i. Lomeramine (immodium) does not get into CNS
ii. Diphenoxylate/atropine (Lomotil) does get into CNS
106. What are the contraindications for opioid use?
b. Ulcerative colitis
c. Recovering drug addicts
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