Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/138

Click to flip

138 Cards in this Set

  • Front
  • Back
Primary Hypothyroidism

main symptom
diagnostic test
treatment
Goiters present
high TSH and low T4
levothyroxine sodium is the drug of choice
Dx: TRH test: increase in TSH
Secondary hypothyroidism

main symptom
diagnostic test
treatment
No goiters
Low TSH and low T4
Levothyroxine sodium
TRH test: little or no response
Tertiary Hypothyroidism

main symptom
diagnostic test
treatment
Low TSH and Low T3
Levothyroxine sodium
TRH test: TSH has a delayed response
Hyperthyroidism (thyrotoxicosis)
Grave's Disease
symptoms and treatment
symptoms: nervous, sweating, hypersensitive to heat, decrease in weight with increase in appetite
treatment: thionamides, inoic inhibitors radio-iodine, iodide
GHRH use
treatment of patients with short stature
somatotropin release - inhibits what hormones
inhibits the release of insulin, glucagon, gastrin, thyrotropin, GH
GnRH used in
Pulsatile: stim. release of FSH and LH
Continuous: it inhibits their release
FSH clinical use
treatment of infertility
Female: gametogenesis, and follicle development
Male: spermatogenesis
LH clinical use
treatment of infertility
Male: gonadal steroid production
Female: ovulation
CRH
stimulates release of ACTH which is used in the treatment of adrenal insufficiency (Addison's Dz)
TRH
stimulates release of thyrotropin, prolactin, TSH
Dopamine (analog=bromocriptine)
inhibits release of prolactin
treatment: prolactinoma, acromegaly, amenorrhea
Levothyroxine sodium
treatment of hypothyroidism, prevent mental retardation in newborns with thyroid def., TSH suppression after treatment for thyroid cancer
levothyroxine sodium
adverse effects
tachycardia, heat intolerance, tremors
liothyronine sodium
reserved for treatment of myxedema in combination with levothyroxine
SE: same as levohyroxine but more cardiotoxic
Propylthouracil and Methimoazole (thioamides)
Stop iodination
MIT & DIT cant be produced
SE: agranulocytosis (rare, most imp.), Rash, Edema
Iodide
in large dose decreases thyroid hormone release
use before surgery or with a thioamide and propranolol in a thyrotoxic crisis
ionic inhibitors
perchlorate and thiocynate
competitive inhibition of iodide concentration by blocking transport
us in Graves Dz (use is decreased now)
Cortisol uses
Addison's Dz
Congenital adrenal hyperplasia
Asthma
Fetal lung maturation
Chemotherapy
diagnosis of Cushing's syndrom
Cortisol SE
adrenal suppression
metabolic disorders (diabetes)
euphoria
stim. peptic ulcer
iatrogenic Cushing's syndrome
(to avoid use as low a dose as possible)
Cushing's Syndrome
due to adrenal hyperfunction
low ACTH, High cortisol
symptoms: moon facies, buffalo hump, hyperglycemia
21-beta-hydroxylase deficiency
decrease cortisol causes adrenal hyperplasia
treatment: give cortisol to relieve ACTH and adrenal hyperplasia
Addison's Disease
symptoms: hyperpigmentation, hypoglycemia, hypotension
ACTH test: Primary-norm to high to start, give ACTH-low cortisol
Secondary-give ACTH levels of cortisol shoot up
Oxytocin
stim force & freq. of uterine contraction
milk ejection
clinical: induce & reinforce labor, control postpartum hemorrhage,
SE: hypertensive episodes, uterine rupture
Mineralcorticoids (aldosterone)

synthetic:fludrocortisone, desoxycorticosterone
ACTH & RAS control its secretion
function reabs. Na, HCO, H2O in exchange for excretion of K
Fludrocortisone
replacement therapy after adrenalectomy for primary and secondary adrenocortical insufficiency
SE: hypokalemia, CHF
Adrenocorticosteroid Antagonist
inhibit both mineralcorticods and glucocorticoids
Aminoglutethimide
decrease hypersecretion of cortisol in pt. with Cushing's syndrome
decrease estrogen production in treatment of breast cancer
SE: GI & neurologic transient maculopapular rash
Metyrapone
inhibits cytochrome P450
used in testing of renal function
SE: Hirsustism and salt + water retention
Estrogen
reg. growth and maturation of reproductive organs
Rx: Postmenopausal women (prevent bone loss, inc. HDL, dec. LDL and risk of CV disease)
Oral contraception (with progestin suppress FSH)
Morning after pill (hi dose)
treatment of prostate cancer
SE: thromboembolis, stroke, nausea, breast tenderness, migrains, postmenopausal bleeding
Estrogen inhibitors
Tamoxifen
Clomiphene
Tamoxifen
competitve inhibitor of estradiol
Rx: breast cancer in postmenopausal women
SE: hot flashes, nausea, vomit
Clomiphene
partial agonist at estrogen receptors in pituitary gland
prevent norm. feedback inhibition causing an inc. in LH & FSH release stim. ovulation
Rx: infertility
SE: hot flashes, ovarian enlargement, multiple simultaneous births,
Sex steriods
estrogen
progestin
androgens
Estrogen contraindications
breast cancer
pregnancy
liver disease
history of thrombophlebitis
Progestin
from progesterone
synthesized in ovary (some), testes, adrenal gland
modulates the effects of estrogen
Rx: oral contraception (no menstruation when used alone)
Synthetic Progestin
norethindrone acetate
norethindrone
medroxyprogesterone acetate
Physiologic effects of Progestin
increase fat deposition
promote glycogen storage
increase body temperature
reg. endometrium maturation
reg. breast secretory gland development
Clinical uses of progestin
contrception (alone or with estradiol)
hormone replacement therapy with estrogen
ovarian suppression (dysmenorrhea & endometriosis)
Dx of estrogen secretion
SE of progestin
increase weight
depression
edema
acne
hypertension
thrombophlebitis
cholestatic jaundice
Progestin inhibitors
mifepristone
danazol
Mifepristone
competitive inhibitor of progestin
morning after pill
SE: heavy bleeding, GI effects, abdominal cramps
Danazol
partial agonist at progesterone, androgen, glucocorticoid receptors
SE: inc. weight, edema, acne, dec. HDL
female contraception
estrogen-progestin tablets, constant dose
estrogen-progestin with inc. in progestin to mimic natural cycle
progestin only (norgestrel or progestert)
female contraception
contraindications
SE
pregnancy
history of thromboembolism
MI
coronary artery disease
SE: blood clots, inc. risk of breast cancer
Glossypol
male contraceptive
dec. in sperm density and motility
SE: hypokalemia
Androgens
produced by testes
testosterone
dihydrotestosterone
dehydroepiandrosterone
androstenedione
Androgens physiologic effects
anabolic: inc. muscle mass, inc. RBC production
androgenic: growth of larynx, skeleton, facial hair development,skin darkening
synthetic androgens
oxandrolone
stanozolol
fluoxymesterone
oxymetholone
nandrolone phenoropionate
clinical use of androgens
replacement therapy in hypogonadism
osteoporosis
growth stimulation
SE: over masculinization
Contraindicated: pregnancy
Androgen antagonist
gonadotroping-releasing analogues (leuprolide, gonadorolin)
receptor inhibitors (cyprotone, flutamide)
steroid synthesis (ketoconazole, spironolactone)
5-alpha-reductase inhibitors (finasteride)
clinical use of androgen antagonist
benign prostatic hyperplasia
(finasteride)
Cushing's disease (ketocongole)
hirsutism (finasteride)
prostatic cancer (leuprolide)
IDDM
insulin defective or not formed
Ab against pancreatic beta cell
ketosis prone
juvenile onset
polydipsia,polyphagia, polyuria
thin frame
req. insulin always
NEVER oral hypogylemics
NIDDM
insulin resistant
failure of pancreas to release insulin
Ketosis resistant
adult onset
obese
diet and exercise
oral hypoglycemics
Ketoacidosis
lack of insulin leads to lipolysis
Rx: crystalline zinc insulin
Cause: excess acetyl CoA not used in TCA cycle converts to ketone body production
Short acting insulin
regular
lispro insulin solution
intermediate acting insulin
isophane insulin suspension
insulin zinc suspension (lente)
long acting insulin
extended insulin zinc suspension (ultralente)
hyperglycemic emergency
lispo and regular
SE of insulin
hypoglycemia (diaphoresis, vertigo, tachycardia)
insulin allergy (IgE)
insuin Antibody
lipodystrophy
oral hypoglycemic agents
sulfonylureas
Biguanides
alpha-glucosidase inhibitors
thiazolidinedione derivatives
sulfonylureas
1st generation: chlorpropamide,tolbutamide
2nd generation: glyburide, glipizide, glimepiride
sulfonylureas MOA
stim. release of endogenous insulin from beta cells of pancreas
inc. insulin binding to target tissue
sulfonylureas SE
GI distress
hypoglycemia (due to OD)
pruritis
nausea
agranulocytosis and aplastic anemia (rare)
dec. in these effects with 2nd generation
drugs that potentiate sulfonylureas
aspirin
MAOI
ethanol
allopurinol
anticoagulants
phenylbutazone
drugs that reduce sulfonylureas
phenobarbital, beta adrenergic blockers,rifampin, cholestyramine, loop and thiazide diuretics
Biguanides
(Metformin)
doesn't ever cause hypoglycemia
containdicated: renal or liver disease, cardiac failure, chronic hypoxic lung disease
SE: lactic acidosis, GI effects, dec. vit. B12 and folate absorption
alpha-glucosidase inhibitors
(acarbose)
delays absorption of glucose from GI tract
doesn't produce hypoglycemia
SE: flautlence, bloating, diarrhea
thiazolidinedione derivatives
(troglitazone)
dec. blood glucose by inc. response of target cell to insulin
metabolized by cytochrome P450
SE: fairly safe
PTH
inc. serum calcium and dec. in serum phosphatase
inc. calcium reabs. from bone to inc. osteoclast activity
inc. calcium serum inhibits PTH secretion
inc. phosphatase serum de. free calcium leads to inc. PTH secretion
Regulation of plasma calcium level
PTH
Vitamin D
Calcitonin
Hypocalcemia
signs: tetany, paresthesias, laryngospasm, seizures, chvosek's & Trousseau's signs
Causes: chronic renal failure, hypoparathyroidism, Vit. D def., malabsorption
Rx: calcium salt preparation, Vit.D preparation
Calcium salt preparation
calcium chloride
calcium gluceptate
calcium gluconate
calcium carbonate
SE: peripheral VD or transient tingling, rapid infusion leads to cardiac arrhythmias
Hypocalcemia
signs: tetany, paresthesias, laryngospasm, seizures, chvosek's & Trousseau's signs
Causes: chronic renal failure, hypoparathyroidism, Vit. D def., malabsorption
Rx: calcium salt preparation, Vit.D preparation
Vitamin D Agents
calictrol - drug of choice
ergocalciferol
calciferol
Rx: osteoporosis, chronic reanl failure, rickets (metabolic and nutritional)
SE: vascular calcification, nephrocalcinosis, soft tissue calcification
Hypercalcemia
usually asymptomatic, may have renal stones, constipation, abdominal pain, weakness, confusion, delirium
Vitamin D Agents
calictrol - drug of choice
ergocalciferol
calciferol
Rx: osteoporosis, chronic reanl failure, rickets (metabolic and nutritional)
SE: vascular calcification, nephrocalcinosis, soft tissue calcification
hypercalcemia causes
C:calcium supplementation
H:hyperparathyroidism
I:iatrogenic (thiazide diuret)
M:milk alkali synd/malignancy
P:paget's disease
A:addison's disease
N:neoplasm
Z:zollinger-ellison syndrome
E:excess vitamin D
E:excess vitamin A
S:sarcoid
hypercalcemia treatment
rehydrate with saline
duresis with loop diuretics
bisphosphonates
calcitonin (drug of choice)
gallium nitrate
plicamycin
Bisphosphonates (etidronate & pamidronate)
inhibit osteoclastic activity
dec. reabs. & formation of hydroxyapatite crystals
Rx: malignancy assoc with hypercalcemia, Paget's dz of bone, osteoporosis
SE: bone pain (in paget's dz),
osteomalacia, nausea and diarrhea
calcitonin
dec. osteoclstic bone resorption, and calcium and phospate
Rx: paget's hypercalcemia, osteoporosis
SE: allergic reaction,GI, flush red face
Gallium nitrate
Hypercalcemia
dec. serum calcium inhibiting bone resorp.
Rx: hypercalcemias with malignancy
SE: nephrotoxicity
Plicamycin (mithracin)
dec. calcium concentration in serum
Rx: malignancy assoc. with hypercalcemia, Paget's dz of bone
SE: sudden thromboytopenia, hepatic and renal toxicity, nausea, vomiting, dec. weight
autocoids
serotonin
histamine
Serotonin physiologic actions
neurotransmission
reg. of pituitary gland
VC (except in heart and skeletal muscle=VD)
GI smooth muscle contraction
stim. pain receptors
precursor to melatonin
Serotonin agonist
Sumatriptan- treat migraines
SE: dizziness and muscle weakness
Serotonin inhibitors
Ketanserin: dec. bp
Ondansetron: treat N&V in surgery and chemo
Cyproheptadine: treat SM constriction in carcinoid tumor
Histamine physiologic role
constrict bronchioles
constrict intestinal SM
dec. BP
Stim gastric HCL secretion
Inc. permeability of skin capillaries
H1-receptor blockers clinical use
Diphenhydramine: allergic reaction, motion sickness
Hydroxyzine: allergic reaction
Promethazine: motion sickness
H2-receptor blockers
Cimetidine
Ranitidine
Famotidine
all are used to treat peptic ulcer disease
SE: headache, reversible gynecomastia, inc. serum prolaction levels, altered estrogen metabolism in men, inhibit P450 metabolism
Ergot alkaloids physiologic action
hallucination and psychoses at high dose
VC
stim of uterine muscle
Egot alkaloids
bromocriptine
ergonovine
ergotamine
ergot alkaloids clinical use
migraine-ergotamine
hyperprolactinemia-bromocriptine
postpartum hemorrhage-ergonovine and ergotamine
Ergot alkaloids SE
prolonged VC
diarrhea
N&V
unwanted uterine contraction
ergot alkaloids clinical use
migraine-ergotamine
hyperprolactinemia-bromocriptine
postpartum hemorrhage-ergonovine and ergotamine
Egot alkaloids
bromocriptine
ergonovine
ergotamine
Vasopressin(ADH)
ADds Hydration
V1 receptor: VC
V2 receptor: inc. permeability to water in distal tubules prod. concentrated urine
Rx: diabetes insipidus
SE: headache, N&V, abdominal cramp, hypertension, bradycardia
desmopressin
analog of vasopressin
activates V2 receptors
minimal effect on V1
Rx: diabetes insipidus, nocturnal enuresis
SE: headache, nausea, abdominal pain, hyponatremia, bradycardia
Asthma therapy
ALL ARE SAFE DURING PREGNANCY
sympathomimetic agents
corticosteroids
anticholinergics
leukotriene inhibitors
methylxanthines (thophylline)
cromolyn sodium and nedocromil
desmopressin
analog of vasopressin
activates V2 receptors
minimal effect on V1
Rx: diabetes insipidus, nocturnal enuresis
SE: headache, nausea, abdominal pain, hyponatremia, bradycardia
Ergot alkaloids
bromocriptine
ergonovine
ergotamine
Sympathomimetic agents
beta2 adrenergic agonist
inc. cAMP prod. bronchodilation
Pirbuterol
tertbutaline
albuterol
salmeterol (NOT for acute)
sympathomimetic agents
clinical use
rapid onset so drugs of choice for acute relief of asthma
SE: tremor and tachycardia
Corticosteroids
dec. infl. by reversing mucosal edema
dec. permeability of capillaries
inhibiting leukotriene and cytokine release
Rx: acute and maitenance of asthma
corticosteroids (inhaled and systemic)
Systemic: acute attacks,SE: inc. appetite, hypertension,adrenal suppression
Inhaled:maintenance (beclomethasone, flunisolide, triamcinolone,fluticasone)SE:cough, oral thrush, dysphoria
anticholinergic
(Ipratropiun)
block PS stimulus (bronchial constriction & mucous secretion)
inhaled
Rx: asthma and COPD
SE:dry mouth, and sedation
leukotriene inhibitors
chronic maintenance ONLY
Zileutron:5 lipoxygenase inhib
Zafirlukast: LTD4 recept.antagonist
Rx:prevent bronchoconstriction, airway inflammation
SE: Zileuton:hepatitis (some)
Zafirlukast: drug allergy
Methylxanthines theophylline
inc. cAMP by inhibiting phosphodiesterase prod. bronchodilation
leukotriene inhibitors
chronic maintenance ONLY
Zileutron:5 lipoxygenase inhib
Zafirlukast: LTD4 recept.antagonist
Rx:prevent bronchoconstriction, airway inflammation
SE: Zileuton:hepatitis (some)
Zafirlukast: drug allergy
Methylxanthines
drug interaction
toxicity
interacts with: cimetidine and erthyromycin prod. inc. theophylline
interacts with: phenytoin and quinolones prod. dec. in theophylline
toxicity: common: tremor, insomnia, GI, dangerous: seizures, arrhythmias
cromolyn sodium and nedocromil
stabilize membrane of mast cells
prevent mediator release by blocking calcium channels
Asthma treatments for mild, moderate, severe asthma?
Mild: 1-2 puffs beta-agonist, cromolyn prophylactically before exposure to allergen or exercise
Moderate: inhale bronchodilators 3-4x/day, prophylaxis with cromolyn or nedocromil
Severe: inhaled beta-agonist, inhaled steroids, combo of inhaled steroids+beta-agonist
Bronchodilators
beta-agonist: bronchiolar relaxation, tolerance with chronic use
SE:tachycardia,arrhythmia, dizziness, tremor
Xanthines
Anticholinergics
Anti-inflammatories
corticosteroids
cromolyn sodium
anti-leukotrienes
Acid-peptic disease
includes peptic ulcer, GERD, Zollinger-Ellison syndrome
Therapeutic options for peptic ulcer disease
antacids-neutralize gastric A.
H2 recpt. blocker & proton pump inhibitor-dec.gastric secretion
mucosalprotective agents-enhance mucosal protective agents
antacids
ingredients: calcium carbonate
aluminum hydroxide, magnesium hydroxide
SE: calcium carbonate: nephrolithiasis, fecal compaction, aluminum hydroxide: constipation, magnesium hydroxide: diarrhea
H2 receptor blocker
reduce more than 90% of basal secretions of gastric acid after a single dose
Proton Pump Inhibitors

SE
omeprazole
lansoprazole

SE: nausea or diarrhea
Mucosal Protective agents
sucralfate
bismuth
misoprostol
sucralfate
Rx: peptic ulcer disease
MOA: binds to necrotic ulcer tissure and is a barrier to acid pepsin bile
Contraindications:CANT be taken with H2recept. blockers or proton pump inhibitors
Bismuth
binds ulcer coating and protecting it from acid and pepsin
soem activity against H. pylori
Misoprostol
prostaglandin E1 analog-stim. gastric secretion of mucus and other protective factors
SE: diarrhea and unwanted uterine contractions
Prokinetic agents
Rx: gastroesophageal reflux and gastroparesis
cisapride
metoclopramide
cisapride
stim acetylcholine release prod. inc. esophageal sphincter tone
SE: diarrhea
Metoclopramide
5HT3 &D2 recept. in gastric smooth muscle causes accel. of gastric emptying
SE: parkinsonism,tardive dyskinesia, diarrhea, drowsiness
Antiemetic drugs
H1 antihistamines: diphenhydramine
Phenothiazines: prochlorperazien
Marijuana:dronabinol
5HT3 inhibitor: ondansetron
Rx:chemotherapy, GI infection, any condition that causes emesis
Gout
metabolic disease with hi blood levels of uric acid
attacks of arthritis and urinary calculi
hyperuricemia causes: idiopathis enzyme defect
disease states assoc with rapid prod. and destructionof cells,weakly acidic drugs, excessive alcohol, kidney disease, starvation, obesity
treatment: reduce inflammation (NSAIDs), facilitate excretionof uric acid, dec. prod. of purines
Antiemetic drugs
H1 antihistamines: diphenhydramine
Phenothiazines: prochlorperazien
Marijuana:dronabinol
5HT3 inhibitor: ondansetron
Rx:chemotherapy, GI infection, any condition that causes emesis
Acute Gout
Rx: indomethacin, phenylbutazone, colchicine
Aspirin: CANT be used in treatment b/c inhibits uric acid secretion into renal tubules
Indomethacin
drug of choice for acute attacks
MOA: inhibits cyclooxygenase
SE: headache, vertigo, abdominal distress, renal toxicity, hypersensitivity reaction
Acute Gout
Rx: indomethacin, phenylbutazone, colchicine
Aspirin: CANT be used in treatment b/c inhibits uric acid secretion into renal tubules
Phenylbutazone
NSAID
not used anymore freq. due to high number of SE
SE: vomit, rash, aplastic anemia, agranulocytosis
Colchicine
reduces infl. response by binding microtubular protein inhibiting neutrophil migration
Rx: treat both acut and chronic gout
SE: common-GI distress, Acute poisoning after large dose lead to nephrotoxicity, bloody diarrhea, shock, chronic use- agranulocytosis, alopecia, aplastic anemia
Contraindications: GI disease, hepatitis or renal disease
Chronic Gout
Colchicine
uricosuric agents (probenecid & sulfinpyrazone)
allopurinol
uricosuric agents
probenecid
sulfinpyrazone
MOA: inc. uric acid excretion by inhibiting uric acid reabs. in proximal tubule
Rx: chronic gout and hyperuricemia (NOT indicated in acute gout)
SE: GI distress, allergic dermatitis
allopurinol
competitively inhibit xanthine oxidase
Rx: chronic gout, hyperuricemia,
Combine with colchicine in early treatment
SE: usually well tolerated
What cannot be used in acute gout attacks?
allopurinol
probenecid
sulfinpyazone