Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
38 Cards in this Set
- Front
- Back
|
For which questions are PTU and methimazole the correct answers?
|
Propylthiouracil and methimazole are the best initial therapies for hyperthyroidism. They are used to lower the level of thyroid hormone. They do not block the target organ effect. PTU is safe during pregnancy.
|
|
|
How do PTU and methimazole work?
|
PTU and methimazole inhibit the peroxidase enzyme. This blocks the oxidation of iodine, inhibits the incorporation of iodine onto tyrosine, and stops the coupling of these compounds into T3 and T4. Hence, these medications block three essential steps in the formation of thryroid hormone.
|
|
|
What are the most common adverse effects of PTU and methimazole?
|
The most important adveres effect of these compounds is neutropenia. Both lower granulocytes levels by inhibiting the bone marrow. Purpuric skin lesions may also occur.
|
|
|
A 59 yo male with prostate cancer comes to the emergency department having experienced lethargy, constipation, and generalized weakness for four days. His calcium is markedly elevated at 14.5, and the EKG shows a short QT. Hydration with saline and a loop diuretic have been given.
What is the next best step in therapy? |
Bisphosphonates are the best initial therapy to lower calcium levels after fluids and diuretics have been initiated. Bisphosphonates are also used for osteoporosis when the T-score is 2.5 standard deviations below normal.
|
|
|
A 59 yo male with prostate cancer comes to the emergency department having experienced lethargy, constipatin, and generalized weakness for four days. His calcium is markedly elevated at 14.5, and the EKG shows a short QT. Hydration with saline and a loop diuretic have been given.
How does next best step in therapy work? |
Bisphosphonates work by inhibiting osteoclasts, preventing bone resorption. They bind to calcium hydroxyapatite in the bone and prevent its dissolution.
|
|
|
A 59 yo male with prostate cancer comes to the emergency department having experienced lethargy, constipatin, and generalized weakness for four days. His calcium is markedly elevated at 14.5, and the EKG shows a short QT. Hydration with saline and a loop diuretic have been given.
What are the adverse effects of the next best step in therapy? |
Oral administration can result in esophagitis, and for this reason, they should be taken sitting up while drinking a lot of water. Rarer adverse effects are hypocalcemia and osteomalacia. Osteonecrosis of the jaw has been associated with the use of bisphosphonates.
|
|
|
List five bisphosphonates.
|
Pamidronate
Zolendronic acid Alendronate Ibandronate Risendronate |
|
|
For what question is calcitonin the best initial therapy?
|
Calcitonin is indicated for the following:
Acute hypercalcemia Paget's disease Osteoporosis |
|
|
How does calcitonin work?
|
Calcitonin works predominantly by inhibiting osteoclast activity. There may also be some effect on promoting osteoblast activity.
|
|
|
What are the most common adverse effects of calcitonin?
|
Calcitonin can cause flushing, rash, and constipation. It rarely causes depression and bronchospasm. The most common adverse effects are rhinitis and flulike symptoms.
|
|
|
When are sitagliptin, exenatide, and pramlintide the answer?
|
Sitagliptin, exenatide, and pramlintide are used predominently as adjunctive therapies for diabetes in addition to a sulfonylurea, metformin, or both. Pramlintide can also be combined with insulin.
|
|
|
How do exenatide, sitagliptin and pramlintide work?
|
Exenatide is an "incretin" mimetic. Incretin is released by the intestinal tract and increases after you eat. Incretin increases insulin synthesis and release by pancreatic beta cells. Incretin decreases glucagon prodution.
2) Sitagliptin blocks the degradation of incretin. 3) Pramlintide suppresses glucagon release via undetermined mechanisms, delays gastric emptying, and has central nervous system-mediated anorectic effects. |
|
|
What are their most common adverse effects?
|
The most common adverse effect of these medications is hypoglycemia
|
|
|
What conditions does orlistat treat?
|
Orlistat is used to treat obesity.
|
|
|
How does orlistat work?
|
Orlistat is a reversible inhibitor of pancreatic lipases. This action blocks the absorption of fat in the intestine. Fecal fat excretion is increased. This may cause a mild decrease in fat-soluble vitamins, such as A, D, E, and K.
|
|
|
What are the most common adverse effects of orlistat?
|
Adverse effects are oily stool, diarrhea, flatuls, abdominal pain, and other symptoms that would be similar to celiac disease and steatorrhea.
|
|
|
What is fludrocortisone?
|
Fludrocortisone is a steroid with very potent mineralocorticoid activity. Being administered fludrocortisone is the closest thing to eating aldosterone.
|
|
|
How does fludrocortisone work?
|
Fludrocortisone causes sodium retention and potassium excretion in the distal tubule. It also causes hydrogen ion (acid) excretion leading to metabolic alkalosis.
|
|
|
When is fludrocortisone the answer?
|
Fludrocortisone is the treatment for the following conditions:
1) Addison's disease (adrenal insufficiency) 2) Orthostatic hypotension 3) Septic shock treatment (adjunct to hydrocortisone) 4) Type IV renal tubular acidosis |
|
|
What are the most common adverse effects associated with fludrocortisone?
|
Fludrocortisone can lead to hypokalemia, edema, and hypertension. Like all steroids, fludrocortisone can lead to osteoporosis, impaired wound healing, and easy bruising.
|
|
|
List two alpha glucosidase inhibitors.
|
Acarbose
Miglitol |
|
|
What are alpha glucosidase inhibitors?
|
Acarbose and miglitol are oral hypoglycemic agents that are used in the treatment of diabetes.
|
|
|
How do alpha glucosidase inhibitors work?
|
Alpha glucosidase inhibitors inhibit the degradation of complex sugars and starches to monosaccharides at the intestinal brush border. This prevents the absorption of glucose. They prevent the weight-gaining effect of sulfonylureas.
|
|
|
When are alpha glucosidase inhibitors the answer?
|
Glucosidase inhibitors are an adjunctive therapy for diabetes when a sulfonylurea, metformin, or both are not able to control the patient's glucose level. The pill must be taken with each meal to prevent glucose absorption
|
|
|
What are the most common adverse effects of alpha glucosidase inhibitors?
|
The adverse effects of glucosidase inhibitors are bloating, diarrhea, and flatulance.
|
|
|
What is metformin?
|
Metformin is a biguanide that is used in the treatment of diabetes.
|
|
|
How does metformin work?
|
Metformin decreases hepatic gluconeogenesis and increases peripheral sensitivity to insulin. It does not require functional beta cells and will NOT cause hypoglycemia.
|
|
|
What are metformin's most common adverse effects?
|
Metformin may be associaed with lactic acidosis. Metformin is renally cleared and so a rise in creatinine will cause the level to rise. Therefore, metformin is contraindicated in renal failure.
|
|
|
When is metformin the answer?
|
Metformin is the drug of choice as the initial therapy for type II diabetes. This is particularly true for obese patients who have peripheral insulin resistance. Metformin does not result in weight gain, as can happen with sulfonylureas.
|
|
|
List four sulfonylureas.
|
glyburide
Glipizide Gliclazide Glimepiride |
|
|
What are sulfonylureas?
|
Sulfonylureas are sulfa-derived oral hypoglycemic medications used for diabetes.
|
|
|
How do sulfonylureas work?
|
They lower blood glucose by stimulating pancreatic beta cells to release insulin. They bind to the ATP-dependent potassium channel on the beta cell, which inhibits the outflux of potassium. This depolarization opens voltage-gated calcium channels, leading to increased fusion of insulin with the cell membrane. Unlike metformin, sulfonylureas require functional beta cells.
|
|
|
What are the most common adverse effects of sulfonylureas?
|
All sulfonylureas can cause hypoglycemia and weight gain. The increased insulin release prompts adipocytes to pick up more glucose. They are teratogenic and can cause syndrome of inappropriate antidiuretic hormone secretion. They are sulfa derivatives and therefore, are contraindicated with sulfa allergies.
|
|
|
When are sulfonylureas the answer?
|
Sulfonylureas are first-line oral hypoglycemics. Metformin is preferred in obese patients.
|
|
|
A 63 yo female with diabetes is seen for her routine annual evaluation. Her urine shows microalbuminuria. Her dilated eye exam shows background retinopathy as well as some neovascularization.
What therapy will protect her kidneys? |
Microalbuminuria in a diabetic should be treated with an angiotensin converting enzyme inhibitor.
|
|
|
A 63 yo female with diabetes is seen for her routine annual evaluation. Her urine shows microalbuminuria. Her dilated eye exam shows background retinopathy as well as some neovascularization.
What therapy will protect her eyes? |
Diabetic retinopathy can be controlled with tight control of her glucose level. Laser photocoagulation is indicated for proliferative retinopathy, defined as the presence of neovascularization or vitreal hemorrhages. Diabetic retinopathy is NOT controlled with lipid control. Aspirin will NOT control diabetic retinopathy.
|
|
|
A man with diabetes has glucose levels >200 md/dl despite the use of maximal doses of several oral hypoglycemic agents. His hemoglobin A1c is >9 percent. In addition, his glucose levels fluctuate during the day.
What is the best therapy for this patient? |
Insulin glargine should be given as a once-a-day injection combined with one of the rapidly acting insulins (glulisine, aspart, or lispro) with meals.
|
|
|
A man with diabetes has glucose levels >200 md/dl despite the use of maximal doses of several oral hypoglycemic agents. His hemoglobin A1c is >9 percent. In addition, his glucose levels fluctuate during the day. What is the duration of these therapies?
|
Insulin glargine rapidly reaches a peak level and maintains a constant level for 24 hours. Glargine is similar in effect to an insulin infusion pump The short-acting insulins (glulisine, aspart, and lispro) reach a peak effect in 50-60 minutes and last for about 4 hours. They seem to be equal in efficacy.
|
