Pharm 2

Front 1

What are the Zones of the Adrenal Cortex and the hormones each zone produce?

Back 1

Outer Zona Glomerulosa --> Mineralcorticoids, Aldosterone
-Salt retaining activity
~Middle Zona Fasciculata --> Glucocorticoids, Cortisol
-Intermediary metabolism
~Inner Zona Reticularis --> Adrenal androgens

Front 2

What substance serve as the feedback inhibitor of Corticotropic Releasing Hormone?

Back 2

Glucocorticoids

Front 3

What is the MOST Important therapeutic action of Glucocorticoids?

Back 3

Anti-Inflammatory Action

Front 4

What is the MOA of Glucocorticoids?

Back 4

~Inhibit peripheral lymphocytes and macrophages (immunosuppressive effect)
~Indirect inhibition of phospholipase A2 blocking the release of arachidonic acid the precursor to prostaglandins and leukotrienes

Front 5

What type of Glucocorticoid (Steroid) is used in the Tx of Addisons Dz (adrenocortical insufficiency)?

Back 5

Hydrocortisone

Front 6

What type of Glucocorticoid (Steroid) is used in the Tx of Cushing’s syndrome (Hypersecretion of glucocorticoids)?

Back 6

Dexamethosone

Front 7

Glucocorticoids can als provide relief of inflammatory symptoms such as?

Back 7

~Rheumatoid arthritis,
~Inflammation of the skin
~Asthma
~Allergies

Front 8

Corticosteroid-binding globulin (CBG) normally binds about 90% of corticosteroid and prevents binding to receptors. What conditions cause Increase/Decrease in CBG?

Back 8

~Increase CBG --> Estrogen administration and pregnancy
~Deccrease CBG --> Hypothyroidism, protein deficiency states

Front 9

****What is the Potency and Duration of the following Short-Med Acting Glucocorticoids:
~Hydrocortisone?
~Cortisone?

Back 9

Hydrocortisone (Potency- 1; Duration- 12 hrs)
~Cortisone (Potency- 0.8; Duration- 12 hrs)

Front 10

****What is the Potency and Duration of the following Short-Med Acting Glucocorticoids:
~Prednisone?
~Prednisolone?
~Methylprednisolone?
~Meprednisone?

Back 10

~Prednisone (Potency- 4; Duration- 12-36 hrs)
~Prednisolone (Potency- 5; Duration- 12-36 hrs)
~Methylprednisolone (Potency- 5; Duration- 12-36 hrs)
~Meprednisone (Potency- 5; Duration- 12-36 hrs)

Front 11

****What is the Potency and Duration of the following Intermediate Acting Glucocorticoids:
~Triamcinolone?

Back 11

~Triamcinolone (Potency- 5; Duration- 12-36 hrs)

Front 12

****What is the Potency and Duration of the following Long Acting Glucocorticoids:
~Betamethasone?
~Dexamethasone?

Back 12

~Betamethasone (Potency- 25-40; Duration- 36-55 hrs)
~Dexamethasone (Potency- 30; Duration- 36-55 hrs)

Front 13

****What is the Potency and Duration of the following Mineralcorticoids:
~Flucrocortisone?
~Desoxycorticosterone Acetate?

Back 13

~Flucrocortisone (Potency- 10; Duration- 36-55 hrs)
~Desoxycorticosterone Acetate (Potency- 0; Duration- 36-55 hrs)

Front 14

What are some Adverse Effects of Systemic Corticosteroid when used Short Term at High Dose?

Back 14

~Facial flushing, appetite stimulation, GI Irritation, headache, mood changes
~Can worsen acne and possibly cause weight gain due to sodium and water retention

Front 15

What are some Adverse Effects of Systemic Corticosteroid when used Long Term (daily)?

Back 15

Anmenorrhea, aseptic necrosis of bone, cataracts, centripetal obesity (fat body with thin limbs), growth failure, hyperlipidemia, hypertension, hyperglycemia, immunosuppression, mood disorders, muscle weakness, osteoporosis, seizures

Front 16

When wanting to D/C Steroid, but the course of Tx was longer than 2 weeks, why do you want to Taper Down the Dasage?

Back 16

~Endogenous cortisol production is suppressed from exogenous corticosteroid (negative feedback)
~Taper will allow endogenous cortisol production to come back on line before exogenous corticosteroids are discontinued

Front 17

What are some recommended was to taper Steroid dosages?

Back 17

~Decrease 2.5-5mg every 3 to 7 days
~Decrease 2.5mg every 1-2 weeks
~Length of taper should be proportional to length of therapy
~Consider doing cortisol level before therapy is D/C'ed

Front 18

Why do you want to taper Dosages?

Back 18

Avoid Adrenal Crisis

Front 19

What are the Short Acting Glucocorticoid Agents? What are their indicated uses?

Back 19

~Cortisone --> Primary/Secondary Adrenal Insufficiency
~Hydrocortisone (Westcort, Cortizone)--> Primary/Secondary Adrenal Cortical Insufficiency, joint injections, acute asthma and UC

Front 20

What are the Medium Acting Glucocorticoid Agents? What are their indicated uses?

Back 20

~Prednisone -Most Rx'ed short term inflammatory disorders
~Prednisolone (Prelone)
~Triamcinolone (Kenalog) -IM and joint use
~Methylprednisolone (Medrol)
~Methylprednisolone acetate (Depo-Medrol) -IM and joint injections
~Methylprednisolone sodium succinate (Solu-Medrol)
-IV glucocorticoid most used for acute asthma attacks and allergic reactions

Front 21

What Mineralocorticoid is used to replace aldosterone activity in primary and secondary adrenocortical insufficiency, i.e. Addison’s disease, but is NOT used as a Glucocorticoid b/c it has 15x's more glucocorticoid activity than hydrocortisone?

Back 21

Fludrocortisone (Florinef) (<-- P10/D36-55hrs)

Front 22

What Glucocorticoid Antagonist is FDA approved as an antifungal but is unapproved for the use to Tx Cushing’s disease when surgery is not possible?

Back 22

Ketoconazole (Nizoral)
note: best Tx for Cushings is Transphenoidal resection of pituitary

Front 23

What are some of the SE's associated w/ Ketoconazole?

Back 23

Adrenal suppression
gynecomastia
hypocholesterolemia
hypothyroidism

Front 24

What Mineralocorticoid / Aldosterone Antagonist is an agent for congestive heart failure, but can also be used in the Tx of Primary Aldosteronism (hyperaldosteronism)?

Back 24

Spironolactone (Aldactone)

Front 25

What other Mineralocorticoid /Aldosterone Antagonist is Similar to Spironolactone, but does NOT have the Gynacomastia SE?

Back 25

Eplerenone (Inspra)

Front 26

Of the different layers of Epidermis, which is MOST important regarding absorption?

Back 26

Stratum Corneum

Front 27

What are some of the different vairiables that can affect Absorption through the Skin?

Back 27

Regional Variability --> Thickness of Stratum Corneum determines absorption Medictation (i.e. soles = not good)
~Dosage
~Altered barrier Function
~Hydration of Skin
~Age
~Application Frequency (more=more)

Front 28

What are the different forms of Topical Hydrocortisone?

Back 28

~Ointment 1% (Cortizone 10)
~Cream 1% (Penecort)
~Lotion 1% (Dermacort)
~Gel 1% (CortaGel)
~Solution 1% (Penecort)
~Spray 1% (Procort)
~Roll-on Stick 1% (Cortaid Faststick)

Front 29

-Provide evaporative cooling and cause vasoconstriction
-Used for acutely inflamed, oozing lesions, and ulcers
-Provides Drying effect by pulling out moisture

Back 29

Wet Dressings

Front 30

Delivery System absorbs moisture and create more surface

Back 30

Powders

Front 31

MC Delivery System, oil in water emulsions

Back 31

Creams

Front 32

Delivery System Relieve dryness, brittleness, protect fissures, occlusive

Back 32

Ointments

Front 33

Which delivery system is Good for hair covered areas or the face

Back 33

Gels

Front 34

What are the General Rules for selecting Specific Vehicles?

Back 34

~If its WET (acute inflammation) --> Dry it
-i.e. the area is oozing, crusting, or has vesiculation
~If its DRY (chronic inflammation) --> Wet it
-i.e. scaling, xerosis, or lichenification

Front 35

-Severe dryness

Back 35

Ointment

Front 36

Less dry areas

Back 36

Cream

Front 37

Generally speaking, Topical Corticosteroids are the DOC for what type of Skin Conditions?

Back 37

~Inflammatory and Pruritic Eruptions
-i.e.allergic contact dermatitis, atopic eczema, seborrheic
dermatitis and many more indications

Front 38

What type of Skin Conditions are Topical Steroids CI'ed in?

Back 38

~Topical Corticosteroids makes the following worse:
-Acne vulgaris, warts, fungal infections and ulcers
-Think local immunosuppression

Front 39

What are some common SE's of Topical Steroids? Which is the MC?

Back 39

~Dermal atrophy (<-- MC)
~Fine hair growth
~Bruising
~Striae
~Irritation

Front 40

Before you Rx Topical Steroids to a Pt, what do you want to verify first? How?

Back 40

~Verify inflammatory condition is not infection (will make worse)
~Skin scraping and KOH test to confirm

Front 41

What are the Different types of Low Potency Topical Steroids?

Back 41

~Hydrocortisone Acetate -Good first line agent
~Desonide (Tridesilon)

Front 42

First line low potency topical steroids?

Back 42

Hydrocortisone Acetate

Front 43

low potency topical steroids used on the face or body folds?

Back 43

Desonide (Tridesilon)

Front 44

What other form of Hydrocortisone is an increased salt form that is more potent and considered a Medium Potency Agent?

Back 44

Hydrocortisone Valerate (Westcort)

Front 45

What Medium Potency Topical Steroid is used for eczema, psoriasis or dermatitis?
Tx for these conditions should be limited to how many months?

Back 45

~Triamcinolone acetonide (Aristocort, Kenalog)
~Limit Tx to 3 months

Front 46

What is the High Potency Topical Steroid used for lesions that are resistance to medium-potency steroids?

Back 46

~Fluocinonide (Lidex)

Front 47

What is the Ultra High Potency Topical Steroid that should ONLY be used if you’re a Dermatologist?

Back 47

Clobetasol (Temovate)

Front 48

What steroid is safest for long term use over large areas and BABIES?

Back 48

Desonide (Tridesilon)

Front 49

What meds are indicated for atopic dermatitis and chronic inflammatory skin disease for pt's who cannot tolerate topical corticosteroids?

Back 49

Topical Immunomodulators (TIMS)
-Pimecrolimus cream (Elidel)
-Tacrolimus ointment (Protopic)

Front 50

What are the BBW for Topical Immunomodulators (TIMS)?

Back 50

-BBW for both agents is malignancy --> Limit dosing to <2 months (CI in <2 yrs)

Front 51

What is the Potency of the TIMS Agents?

Back 51

~Pimecrolimus cream (Elidel) -->
Low Potency Agent
~Tacrolimus ointment (Protopic) --> Med Potecny Agent

Front 52

What is the Acute Tx for a Pt w/ Contact Derm?

Back 52

~Wet dressings w/ astringents or drying agents
-Aluminum acetate- astringent
-Witch hazel- astringent
-Calamine- drying
-Zinc oxide- drying

Front 53

What are the SE for Topical Immunomodulators

Back 53

skin burning/warmth in up to 50% of patients, photosensitivity
CANNOT USE IN CHILDREN <2

Front 54

What are some other Tx's of Contact Derm? What Tx should be avoided?

Back 54

~Low potency topical steroid (Hydrocortisone)
-Creams or Gels are a suitable option
-Oral products can be used in severe cases
~Oral Antihistamines for itching
~AVOID ointment on weeping lesions

Front 55

What is the Tx for Impetigo?

Back 55

~NO PLACE IN THERAPY FOR STEROIDS!!!!!
DOC ~Systemic abx--> Dicloxacillin or Cephalexin
~Topical antibiotic --> Bactroban

Front 56

What is the topical abx tx for Impetigo

Back 56

Bactroban

Front 57

What is the Tx for Normalizing follicular keratinization

Back 57

benzoyl peroxide
azelaic acid
topical retinoids
isotretinoin

Front 58

What is the Tx for decreasing sebum production

Back 58

isotretinoin
topical/oral abx,
corticosteroids
hormone

Front 59

What is the Tx for suppressing bacteria in acne

Back 59

benzoyl peroxide
topical/oral abx
azelaic acid
isotretinoin

Front 60

What is the Tx for preventing inflammatory response in acne

Back 60

antibiotics
retinoids
intralesional corticosteroids

Front 61

MOST effective acne treatments

Back 61

Benzoyl Peroxide (Desquam®, Clearasil®),

Front 62

What are the Topical Abx used in the Tx of Acne?

Back 62

~Clindamycin 1% topical solution (Cleocin-T)
~Erythromycin 2% topical solution (T-Stat)

Front 63

What are the Systemic Abx used in the Tx of Acne?

Back 63

~Macrolides (Erythromycin or Azithromycin)
~Tetracyclines

Front 64

What systemic Abx are used to Tx acne in pt's that are unresponsive to topicals?

Back 64

TMP/SMX, & metronidazole

Front 65

What type of Acne Tx reduces the production of sebum which is required by Propionibacterium acnes

Back 65

Isotretinoin (Accutane®)

Front 66

What Acne Tx reduces obstruction within follicle, reverse abnormal keratinocyte desquamation by loosening & decreasing corneocytes, they increase absorption of other agents

Back 66

~Topical Retinoids
Tretinoin (Retin-A®):

Front 67

agent of choice for topical Retinoids

Back 67

Tretinoin (Retin-A®):

Front 68

What med is as effective as Retin-A but causes less skin irritation

Back 68

Adapalene (Differin®):

Front 69

topical acne tx that is pregnancy Cat X

Back 69

Tazarotene (Avage®, Tazorac®):

Front 70

ONLY agent that is effective in severe cystic acne

Back 70

Isotretinoin (Accutane®)

Front 71

oral acne tx that is pregnancy Cat X

Back 71

Isotretinoin (Accutane®)

Front 72

2nd line acne agent – minimal toxicity particularly in patients intolerant or unresponsive to topical or oral therapy, with antibiotics or benzoyl peroxide

Back 72

Azelaic acid (Azelex®)

Front 73

Which acne med has action against all 4 pathogenic factors that produce acne

Back 73

Azelaic acid (Azelex®)

Front 74

Adverse Effects: hypopigmentation in patients with a dark complexion & possible pruritus, burning, stinging, & tingling in all patients

Back 74

Azelaic acid (Azelex®)

Front 75

Azelaic acid (Azelex®) topical cream for acne vulgaris

Back 75

Azelex

Front 76

Azelaic acid (Azelex®) topical gel for acne rosacea

Back 76

Finacea

Front 77

topical agent of choice for Acne Rosacea

Back 77

Metronidazole

Front 78

topical abx agent for Acne Rosacea

Back 78

Clindamycin
Erythromycin

Front 79

systemic abx tx for Acne Rosacea

Back 79

Tetracycline
doxycycline
erythromycin

Front 80

What are the Recommended Tx's for head lice (Pediculosis)?

Back 80

~Permethrin
-Nix 1% cream rinse (OTC)
-Elimite Cream 5% for scabies and refractory head lice
~Rid [0.3% pyrethrins/3% piperony butoxide (OTC)]
~Ovide (Malathion 0.5% lotion) (Rx)

Front 81

What is the Agent used after the Pediculosis Tx to help loosen the bond that holds the eggs to hair?

Back 81

Step 2 (8% formic acid)

Front 82

What is the Tx for Pubic Lice? What is the BBW for the Agent used?

Back 82

~Lindane (Kwell, G-well) 1% cream shampoo, lotion (Rx) ~BBW --> can penetrate human skin and cause CNS toxicity (seizures)

Front 83

What is the Tx for Body Lice?

Back 83

permethrin
Destroy infected clothing
Bath in hot water

Front 84

Pediculosis infections that occur in people living in overcrowded conditions with poor hygiene

Back 84

Body lice

Front 85

What are the MC Method used to Tx Warts in the Primary Care Setting.

Back 85

Keratolytic Agents
~Salicylic acid products
DuoFilm, Compound W - liquid
Mediplast Plaster – 2”X3” patches

Front 86

What wart tx is clinic use ONLY – AVOID use in pregnancy

Back 86

Podophyllum resin

Front 87

What wart tx is for outpatient use

Back 87

Podofilox (Condylox®)

Front 88

What wart tx is more effective in women than men and safer in pregnancy (Cat B) than podophyllum

Back 88

Imiquimod (Aldara®)

Front 89

soap free cleaner used in patients sensitive to drying soap

Back 89

Cetaphil® (cetyl alcohol

Front 90

Drying agent used in Atopic Dermatitis

Back 90

Aluminum subacetate (Domeboro® tablets

Front 91

Soothing agent used in Atopic Dermatitis

Back 91

Colloidal Oatmeal (Aveeno®):

Front 92

oral antihistamine used in Atopic Dermatitis

Back 92

Hydroxyzine

Front 93

Estrogen deficiency results in what conditions?

Back 93

~Vasomotor symptoms (including hot flashes, HA, dizziness, palpitations, N/V and night sweats)
~Genitourinary atrophy
~Osteoporosis
~Cardiovascular disease

Front 94

What is the Tx for Seborrheic Derm and Dandruff?

Back 94

~Selenium, ketoconazole, coal tar <--Shampoos
~Topical steroids may be used for symptoms

Front 95

When Tx'ing Vasomotor Sx's w/ ERT/HRT, the Tx should only last _____ months and NOT exceed ____ yrs?

Back 95

Tx should only last 6-12 months and NOT exceed 4yrs?

Front 96

The Two types of Progestin dosing are Continuous or Cyclic. Describe the dosing for each type?

Back 96

~Continuous therapy --> amenorrhea for most women p 1 yr
~Cyclic therapy --> take estrogen on calendar days 1-25 and medroxyprogesterone 2.5mg on day 14-25 and withhold hormone therapy from day 26 to the end of the month

Front 97

What type of Cancer was associated w/ the long term (10 years or more) use of Estrogen (ERT)?

Back 97

Ovarian Cancer

Front 98

Women with an intact uterus, use

Back 98

estrogen combined with a progestin (HRT)

Front 99

continuous HRT therapy DECREASES the incidences of

Back 99

endometrial hyperplasia

Front 100

SHORT term use in menopause NOT osteoporosis

Back 100

~ Synthetic conjugated estrogen Cenestin

Front 101

Standard product that most facilities carry used in women without a uterus

Back 101

~ Conjugated estrogen
Premarin

Front 102

synthetic HUMAN estrogen used in both menopause & osteoporosis

Back 102

Estropipate (Ogen)

Front 103

What are the types of ERT vaginal Ring Agents?

Back 103

~Estradiol Acetate (Femring)
~Estradiol (Estring)
-Vaginal rings that provide cont release over 90 days
-Tx local symptoms only, no significant systemic effects

Front 104

Name the ERT Topical Agents?

Back 104

~Estrasorb
-Lotion applied to the thighs and calves once daily
~EstroGel
-Gel applied on one arm (wrist to shoulder) qd
~Both products provide systemic effects

Front 105

ERT Topical lotion applied to the thighs and calves once daily

Back 105

~Estrasorb

Front 106

ERT Topical Gel applied on one arm (wrist to shoulder) qd

Back 106

~EstroGel

Front 107

What is the ONLY ERT Transdermal Agent that is dosed ONCE Weekly, whereas all the others are TWICE Weekly?

Back 107

Climara

Front 108

which combo HRT decreases endometrial bleeding and breast pain

Back 108

Prempro 1.5

Front 109

which combo HRT are Transdermal Patches

Back 109

Combipatch
Climara Pro

Front 110

What are the Different types of Estrogenic Vaginal Cream?

Back 110

~Premarin (Conjugated Estrogens)
~Ortho Dienestrol (Dienestrol)
~Ogen (Estropipate)

NO systemic effects

Front 111

Which medication for osteoporosis has been shown to relieve acute pain related to bone fractures?

Back 111

Calcitonin salmon; daily snort - alternate nostrils

Front 112

What product is very effective for vaginal atrophy and may be used on a long term basis with little risk of systemic side effects

Back 112

Estrogenic vaginal cream
Premarin (Conjugated Estrogens)
~Ortho Dienestrol (Dienestrol)
~Ogen (Estropipate)

Front 113

What are the Partial Estrogen Agonist/Antagonists?

Back 113

Clomiphene (Clomid)
Tamoxifen (Nolvadex) – breast cancer

Front 114

What is the MOA of Clomiphene?

Back 114

Mediates ovulation through increased output of pituitary gonadotropins and estrogens by inhibiting the action of stronger estrogens on the body’s negative feedback system

Front 115

Tx of Ovulatory failure in women desiring pregnancy (Infertility Drug)

Back 115

Clomiphene

Front 116

blurring spots or flashes in eyes, vasomotor flushes, abdominal symptoms & at high dose possible ovarian enlargement

Back 116

Clomiphene

Front 117

UNLABELED use for Clomiphene

Back 117

treat male infertility

Front 118

What is the Selective Estrogen Receptor Modulators (SERM) agent?

Back 118

~Raloxifene (Evista) – Tx of osteoporosis &  breast cancer

Front 119

Tx of osteoporosis & dec breast cancer

Back 119

Raloxifene (Evista)

Front 120

Tx for breast cancer

Back 120

Tamoxifen (Nolvadex)

Front 121

What ADR occurs in Tamoxifene that does not occur in Raloxifene? Vica versa?

Back 121

~Tamoxifene Increased risk of endometrial hyperplasia
~Raloxifene  Teratogenic (Cat X)

Front 122

Aromatase Inhibitors are used in the Tx of Breast Cancer by inhibiting the production of Estrogen by blocking Aromatase. What are the Different Aromatase Inhibitor Agents?

Back 122

~Letrozole (Femara)
Anastrozole (Arimidex)
Exemestane (Aromasin)

Front 123

Progestin Antagonists used to Terminate Early Pregnancy by Inhibiting Progesterone activity and bind to glucocorticoid receptors.
( anti-MILF)

Back 123

Mifepristone (Mifeprex)

Front 124

Progestin Antagonsist/Androgen used to Tx Endometriosis and Fibrocystic Breast Dz

Back 124

Danazol (Danocrine)

Front 125

The Main Therapeutic Androgen is Testosterone. What are some of its Indicated Uses?

Back 125

~Males --> Replacement Therapy (hypogonadism), delayed puberty
~Females --> METS Breast Cancer

Front 126

What are the different types of Androgen Products?

Back 126

~Testosterone inj (CIII)
~Testosterone Pellets --> SC every
~Testosterone Transdermal system (Patches)
-Testoderm --> apply to scrotum,
-Striant --> apply to buccal
~Topical Gel (Androgel)

Front 127

What would Antiandrogens be used to Tx?

Back 127

~BPH
~Prostate CA
~Endometriosis
~Advanced Breast CA

Front 128

Halts BPH progression and Reduces Prostate Size over time

Back 128

Finasteride

Front 129

What two Alpha Blockers have a High Risk of HoTN?

Back 129

~Terazosin
~Doxazosin

Front 130

What are the SE's of Finasteride?

Back 130

~Decreased libido, erectile dysfunction and ejaculation dysfunction
~Pregnancy Cat X

Front 131

What are the Different types of GnRH Analogs?

Back 131

~Leuprolide (Lupron) --> Multiple injections
~Goserelin (Zoladex)

Front 132

androgenetic alopecia (male pattern baldness)

Back 132

Finasteride (Propecia)

Front 133

UNAPPROVED used for: hirsutism in women

Back 133

Finasteride (Propecia)

Front 134

Tx for prostate cancer, endometriosis, advanced breast cancer;

Back 134

Goserelin (Zoladex)
Leuprolide (Lupron®)

Front 135

Tx of metastatic prostate cancer

Back 135

Eulexin (flutamide)
Casodex (bicalutimide)
Nilandron (nilutamide)

Front 136

What are the Recommended Methods for preventing Osteoporosis BEFORE Menopause?

Back 136

~Calcium and Vitamin D intake
~Exercise
~Limit cigarette smoking and alcohol ingestion

Front 137

What are the Recommended Methods for preventing Osteoporosis POST-Menopause?

Back 137

~Exercise
~Vit D intake
~Calcium intake

Front 138

What is the MOA of Bisphosphonates?

Back 138

~Decrease bone resorption, increase bone density, shown to prevent fractures
~Selectively bind to the antiresorptive surfaces of bone and may be incorporated into the bone
~Very long half lives (possibly up to 10 years)

Front 139

alternative to ERT/HRT for OSTEOPOROSIS but NO effect on vasomotor symptoms or genitourinary symptoms

Back 139

Alendronate (Fosamax®)

Front 140

What pts is Fosamax CI'ed in?

Back 140

Pts w/ Renal Insufficiency

Front 141

Due to the Fact that Fosamax can cause Hypocalcemia, what two medications should ALWAYS be Rx'ed w/ it?

Back 141

Calcium and Vitamin D

Front 142

What are the advantages of Actonel and Boniva tabs over Fosamax?

Back 142

~Actonel --> two consecutive days once-a-month dosing
~Boniva --> available in a monthly tablet

Front 143

Bisphosphonates have recently been associated w/ what condition?

Back 143

Osteonecrosis of the Jaw

Front 144

Which medication for osteoporosis has been shown to relieve acute pain related to bone fractures?

Back 144

Calcitonin salmon; daily snort - alternate nostrils

Front 145

What is the name of the New Human parathyroid hormone agent that was the First agent that stimulates new bone growth, reduces vertebral fractures

Back 145

Teriparatide (Forteo)

Front 146

used in Pts w/ high risk of fractures due to history of fractures or very low bone mineral density

Back 146

Teriparatide (Forteo)

Front 147

approved for primary osteoporosis in men

Back 147

~Alendronate (Fosamax)

Front 148

Men being Tx'ed w/ GnRH Agonists for prostate cancer are at risk of developing?

Back 148

High rate of developing Osteoporosis

Front 149

What are the Different types of drugs used in the Tx of Erectile Dysfunction?

Back 149

~Sildenafil (Viagra)
~Vardenafil (Levitra)
~Tadalafil (Cialis)
PDE5 Agents Increases blood flow to the corpus cavernosum

Front 150

What are the different Non-PDE5 Agents?

Back 150

~Androgens
-Danazol, Fluoxymesterone, Methyltestosterone,
Testosterone Enanthate, Testosterone Propionate
~Alprostadil (Prostaglandin)
-Caverject & Edex injectables
-Muse urethral pellet

Front 151

What is a Spermicide implanted barrier?

Back 151

~Contraceptive sponge (Today Sponge) that lasts 24 hours regardless of intercourse frequency
~Leave in place 6 hours post intercourse NLT 30 hours

Front 152

rogestins provide most of the contraceptive effect by creating a “hostile environment”. How does it create this environment?

Back 152

~Thickens cervical mucus
~Slows tubal mobility
~Induces endometrial atrophy
~Inhibit Ovulation by blocking LH surge

Front 153

What are the Available types of Progestin Dominant Agents?

Back 153

~Desogestrel* (<-- 3rd Gen)
~Drospirenone* (<-- 4th Gen)
~Norgestimate* (<-- 3rd Gen)
~Norelgestromin (patch)
~Etonogestrel (ring)

Front 154

What are some common ADRs w/ Excess Estrogen?

Back 154

~Nausea, breast tenderness, headaches, fluid retention
~Consider --> Decrease EE, IUD or Progestin only

Front 155

What are some common ADRs w/ Estrogen Deficiency?

Back 155

~Early cycle break through bleeding (days 1-9)
~Vasomotor symptoms
~Nervousness, decreases libido
~Consider --> Increase EE

Front 156

What are some common ADRs w/ Excess Progestin?

Back 156

inc appetite, weight gain, bloating, constipation, depression, fatigue, irritability --> Decrease proG

Front 157

What are some common ADRs w/ Progestin Deficiency?

Back 157

~Late cycle (days 10-21) breakthrough bleeding & spotting --> Increase proG
~Dysmenorrhea, menorrhagia --> Increase proG, consider extended cycle, consider progestin only or IUD

Front 158

What are the agents used in the OrthoEvra Transdermal patch? How is it dosed? What are the CI's?

Back 158

~Ethinyl Estradiol and Norelgestromin
-Higher estrogen exposure (~60% increase)
~Patch applied weekly for 3 weeks to abdomen, buttocks, upper torso, or upper arm
~CI in pts >198 lbs

Front 159

What are the Benefits of Combined Hormonal Contraceptives?

Back 159

~Ethinyl Estradiol and Etonorgestrel
~Increased Vaginal discharge
~Ring inserted vaginally and left in place for 3 weeks; removed for 1 week
-If falls out = re-insert within 3 hrs

Front 160

What is the ONLY Combined OCP that contains Iron?

Back 160

~Loestrin Fe

Front 161

What are the Combined OCPs that have ACNE Indications?

Back 161

~Ortho Tri Cyclen
~Beyaz
~Estrostep Fe
~Yaz

Front 162

For a Pt who is > 35 yrs, what type of Contraceptive should they be put on if they are Nonsmoker vs. Smoker?

Back 162

~Nonsmoker --> Low dose CHC
~Smoker --> Progestin-ONLY oral, injection, or implant

Front 163

For a Pt who has HTN, what type of Contraceptive should they be put on?

Back 163

Progestin-ONLY oral, injection, or implant

Front 164

For a Pt who has HLD, what type of Contraceptive should they be put on if their HLD is Controlled vs. Uncontrolled?

Back 164

~Controlled --> Low dose CHC
~Uncontrolled --> Progestin-ONLY oral, injection, or implant

Front 165

For a Pt who is Obese, what type of Contraceptive should they be put on?

Back 165

Low dose CHC

Front 166

For a Pt who has DM, what type of Contraceptive should they be put on if their DM is Nonvascular vs. Vascular?

Back 166

~Nonvascular --> Low dose CHC
~Vascular --> Progestin-ONLY oral, injection, or implant

Front 167

For a Pt who has Migraines, what type of Contraceptive should they be put on if their Migraine is:
~w/o Aura <35yrs?
~w/o Aura >35yrs?
~w/ Aura?

Back 167

~w/o Aura <35yrs --> Low dose CHC
~w/o Aura >35yrs --> Progestin-ONLY oral, injection, or implant
~w/ Aura --> Caution (None)

Front 168

For a Pt who has Hx of VTE, what type of Contraceptive should they be put on?

Back 168

Progestin-ONLY oral, injection, or implant

Front 169

For a Pt who has Breast Cancer, what type of Contraceptive should they be put on?

Back 169

NONE

Front 170

What are the ADRs of Depo?

Back 170

~Menstrual irregularity
~Weight gain
~Osteoporosis (boxed warning)
-Rx for Calcium/Vit D
-Weight bearing Exercises

Front 171

What is the BBW for Depo

Back 171

Osteoporosis (boxed warning)

Front 172

What is the Subdermal Progestin Agent?

Back 172

Implanon rod
<130% BMI

Front 173

What are the Two types of IUDs?

Back 173

~Mirena <-- Progestin Only
~ParaGard <-- Copper Only

Front 174

What is the ONLY FDA Approved Abortifacient? What is the MOA?

Back 174

~Mifepristone (Mifeprex)
~Binds to progesterone receptor, blocking the effects of progesterone, leading to contraction-inducing activity in the myometrium

Front 175

What is the Dosing Method for Mifepristone?

Back 175

~Used in conjunction with Misoprostol
~May be used up to 49 days menstrual period, 92-95% effective

Front 176

What are the ADRs of Mifepristone?

Back 176

~Bleeding and cramping for up to 16 days
~N/V, Diarrhea
~H/A
~Back pain

Front 177

Tx N/V in Pregnant women

Back 177

Pyridoxine (vitamin B6)
~Promethazine (Phenergan)
~Prochlorperazine (Compazine)

Front 178

What Drugs are considered to be safe when Tx'ing Reflux Esophagitis in a Pregnant women?

Back 178

~Antacid --> Calcium Carbonate
Sucralfate

Front 179

What meds should Pregnant women avoid using for Reflux Esophagitis

Back 179

sodium bicarbonate - chance of metabolic alkalosis
Magnesium containing antacids: may slow or stop labor late in pregnancy
nizatidine (Axid®)

Front 180

What Drugs are considered to be safe when Tx'ing constipation in a Pregnant women?

Back 180

Metamucil®
Docusate (Colace®) - stool softener
• Occasional use:
Simulant laxatives: Bisacodyl or Senna
Osmotic laxitives: Sorbitol or Laculose

Front 181

What meds should Pregnant women avoid using for contipation

Back 181

~ Avoid
Mineral oil
Cator oil
Enemas

Front 182

For pts who have pre-existing DM in pregnancy, what is the recommended Tx?

Back 182

Insulin

Front 183

What are they Tx'ed w/ if they have Gestational DM?

Back 183

Insulin

Front 184

A Pregnant Pt is concidered to have Chronic HTN if it is Dx'ed before what week gestation?

Back 184

Before 20 weeks Gestation

Front 185

What are the different HTN Agents used to Tx HTN in Pregnant Women?

Back 185

~Methyldopa
~Labetalol (AB Blocker)
~Nifedipine (CCB)

Front 186

What Agents should be avoided in the Tx of HTN in Pregnant Pts?

Back 186

~B-blockers have been linked to intrauterine fetal growth retardation
~ACEI and ARBs- Potential teratogens

Front 187

HTN w/ Edema, Proteinuria occurring after 20 weeks of gestation

Back 187

Pre-Eclampsia

Front 188

What are the Criteria for Eclampsia?

Back 188

Pre-Eclampsia s/s + Seizures

Front 189

What is the Definative Tx for Preeclampsia/Eclampsia if the Pt is >36 weeks EGA?

Back 189

Delivery

Front 190

If the Pt is <36 weeks in mild to moderate preeclampsia, what is the Tx?

Back 190

~Bed rest
~Antihypertensive Drug therapy
-Methyldopa
-Nifedipine (CCB)

Front 191

What is the Tx of Eclampsia?

Back 191

~Magnesium Sulfate

Front 192

What are the Different types of Inhaled Anesthetics?

Back 192

~Nitrous Oxide
~Volatile liquids

Front 193

What are some of the Different IV Agents used for Induction?

Back 193

~Thiopental
~Midazolam (Versed)
~Ketamine (Ketalar)
~Etomidate (Amidate)
~Propofol (Diprivan)

Front 194

Most widely used IV general anesthetic, and is a Short acting barbiturate?

Back 194

Thiopental

Front 195

Which IV Induction Agent is a Benzo?

Back 195

Midazolam (Versed)

Front 196

Which IV Induction Agent is not only used for Induction, but is also used for Maintenance?

Back 196

Propofol (Diprivan)

Front 197

Which is the ONLY IV Induction Agent that has good Analgesic Properties and is also the only one w/ NMDA Receptor action?

Back 197

Ketamine (Ketalar)

Front 198

Involves blockade of excitatory membrane effects of NMDA that produces a dissociated state in which the pt appears awake but is unconscious and feels no pain (PCP)

Back 198

Ketamine

Front 199

Considered useful for poor-risk geriatric patients and unstable shock
~Low dose with Propofol in children undergoing painful procedures i.e. burn dressing changes

Back 199

Ketamine

Front 200

What are some of the SE's of Ketamine?

Back 200

~Increased cerebral blood flow and O2 consumption
~Increased intracranial pressure
~Decreased respiratory rate
~Post-op disorientation

Front 201

What is the MOA of Propofol?

Back 201

Potentiates the actions of GABA and has an Onset of approx 20 sec

Front 202

What are some of the SE's of Propofol?

Back 202

~Use in children in ICU has led to severe acidosis in presence of respiratory infection
~Apnea & pain at injection site with
~Hypotension
~Bacterial infections

Front 203

What is the MOA of Etomidate?

Back 203

Works on GABA receptor complex like the Benzos and is used in induction of anesthesia
(Very rapid onset --> 30-60 seconds)

Front 204

What are some of the Advantages of Etomidate?

Back 204

~Less cardiovascular & respiratory depression
-Use in pts w/ compromised CV function or Intracranial
bleeds

Front 205

What are some of the SE's of Etomidate?

Back 205

~Post-op Nausea & Vomiting
~Pain at injection site
~Adrenocortical suppression (â plasma cortisol)
~Myoclonus

Front 206

What are the Indicated uses of Inhaled Anesthetic Agents?

Back 206

Used for the maintenance of anesthesia after administration of an intravenous agents

Front 207

What are the Advantages of Inhaled Anesthetics?

Back 207

~Advantage of rapid anesthesia depth changes
-Absorbed and eliminated through the lungs
~Rapidly eliminated which prevents postoperative respiratory depression
~Potency is related to their lipid solubility

Front 208

What are the Different Inhaled Anesthetic Agents?

Back 208

~Non-Halogenated Gas --> Nitrous Oxide
~Halogenated Gases --> Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane

Front 209

What are some of the ADRs of Inhaled Anesthetics?

Back 209

~Malignant Hyperthermia
~Arrhythmias
~Uterine relaxation

Front 210

What is the Reversal Agent for Malignant Hyperthermia?

Back 210

Dantrolene

Front 211

What are the Indicated uses for NeuroMuscular Blocking Agents as a Preanesthetic?

Back 211

Facilitate intubation and suppress muscle tone

Front 212

What are the Indicated uses for Benzodiazepines as a Preanesthetic? What are the Different agents used?

Back 212

~Used to relieve anxiety, facilitate amnesia and produce sedation
~Diazepam, Lorazepam, and Midazolam

Front 213

What are the Indicated uses for Opioid Agents as a Preanesthetic? What are the Different Agents used?

Back 213

~Used for analgesia and sedation
~Morphine, Meperidine (Demerol) and Fentanyl

Front 214

What are the Indicated uses for Anticholinergic Agents as a Preanesthetic? What are the Different Agents used?

Back 214

~Inhibits secretions, promotes sedation and amnesia
~Atropine, Scopolamine, and Glycopyrrolate

Front 215

What are the Indicated uses for Gastric Motility Stimulants as a Preanesthetic? What are the Different Agents used?

Back 215

~Reduce gastric volume and act as an antiemetic
~Metoclopramide (Reglan)

Front 216

What are the Indicated uses for H2 Blockers as a Preanesthetic? What are the Different Agents used?

Back 216

~Used to increase the gastric pH
~Cimetidine, Ranitidine, and Famotidine

Front 217

What is the Very important fact about NeuroMuscular Blocking Agents? How is this Agent administered?

Back 217

~Do not effect consciousness or pain threshold
-i.e. they are PARALYZED, but can still feel pain!!!
~Relax skeletal muscles during surgery AFTER general anesthesia has been induced

Front 218

What are the Two Types of NeuroMuscular Blockers?

Back 218

~Nondepolarizing (competitive)
~Depolarizing

Front 219

What is the MOA of Nondepolarizing (competitive) NeuroMuscular Blockers? What is used to Reverse their effects?

Back 219

~Competitively blocks access of ACh at the neuromuscular end plates of the neuromuscular junction
~Reversed w/ administration of AChE inhibitors

Front 220

All of the Nondepolarizing Agents end in what?

Back 220

"-ium"

Front 221

What are some of the SE's of Nondepolarizing Agents?

Back 221

~Respiratory depression
~HoTN
~Tachycardia
~Bronchospasm

Front 222

If a Pt were to Overdose on a Nondepolarizing Agent, administer cholinesterase inhibitors which increases ACh concentration at motor end plate. What are the Different AChE Inhibitors?

Back 222

~Neostigmine
~Pyridostigmine
~Edrophonium

Front 223

What is the ONLY Depolarizing NeuroMuscular Agent?

Back 223

Succinylcholine (Quelicin or Anectine)

Front 224

~Procedures lasting <3 minutes
~Rapid Intubation – follow with nondepolarizer
~Endoscopic exams
~Pharmacologically induced convulsive therapy

Back 224

Succinylcholine (Quelicin or Anectine)

Front 225

What are the SE's of Succinylcholine?

Back 225

~Respiratory depression
~Hyperkalemia
-á in pts w/ burns, nerve damage, head injury, NM DO's
~Increased Ocular Pressure
~Increased Intragastric Pressure
~Muscle Pain

Front 226

What are the Different Types of Ester Agents?

Back 226

~Benzocaine (Americaine)
~Chloroprocaine (Nesacaine)
~Cocaine
~Procaine (Novocaine)
~Tetracaine (Pontocaine)

Front 227

What is the ONLY Ester Agent that is LONG Acting?

Back 227

Tetracaine (Pontocaine)

Front 228

What is the Indicated use of the EMLA Cream?

Back 228

Topical anesthetic for use on intact skin for local analgesia, genital mucous membranes for superficial minor surgery, and pretreatment for infiltration anesthesia

Front 229

Topical anesthetic for use on intact skin for relief of pain associated with post-herpetic neuralgia

Back 229

Lidoderm

Front 230

What does DSHEA stand for?

Back 230

Dietary Supplement and Health Education Act

Front 231

What Supplement has been Banned from U.S. since April 1994, acts as an indirect and direct sympathomimetic, and was Marketed as a stimulant and appetite suppressant?

Back 231

Ephedra

Front 232

What Supplement was Marketed for “cerebral insufficiency” , but was mainly good for intermittent claudication from its Antiplatelet properties;

Back 232

Ginko Biloba

Front 233

What supplement is not fully understood but claims to have several antidepressant effects and was Marketed for depression

Back 233

St John's Wart (Hypericum perforatum)

Front 234

What supplement tx Cardiovascular immune, and CNS properties; physical/mental performance and for stimulating sexual function and increasing energy; and lastly helps to Decrease glucose postprandially for the Tx of T2 DM?

Back 234

Ginseng

Front 235

Allicin is formed when this Supplement is crushed exposing alliin to allinase --> Allicin inhibits HMG-CoA reductase and so this product was marketed for HLD Reduction. What supplement am I?

Back 235

Garlic

Front 236

his Supplement claims to enhance immune function (stimulatory effects) and was Marketed to decrease cold Sx's or enhance recovery

Back 236

Echinacea

Front 237

Who is Echinecea CI'ed in?

Back 237

Immunocompromised pts

Front 238

What Supplements MOA is not totally understood but it may inhibit 5 alpha-reductase activity and dihydrotestosterone binding at the androgen receptor

Back 238

Saw Palmetto

Front 239

Saw Palmetto has similar effects as

Back 239

Finasteride (Proscar)

Front 240

What Supplement claims to enhance GABA and acts as a Dopamine antagonist; it was Marketed for anxiety, stress, insomnia,

Back 240

Kava

Front 241

What Supplement claims to Tx in leukemia and ovarian cancer?

Back 241

Kava

Front 242

What are the ADRs of Kava?

Back 242

~Blocks several types of cytochrome P-450
-Interactions with other medications
~Liver issues/toxicity (Hep/Cirrhosis/Failure)