Y2B4 Pharm- All Drugs

Front 1

55 year old female presents complaining of being cold all the time, weight gain and brittle nails. Her TSH, FT4 and FT3 levels were taken showing elevated TSH, and decreased FT4 and FT3. What drug are you most likely to prescribe the pt?

Back 1

Levothyroxine sodium T4

- metabolized by cytochrome p450 system which is affected by drugs that induce the cyp450 system like phenytoin, rifampin and phenobarbitol.

Front 2

55 year old female presents complaining of being cold all the time, weight gain and brittle nails. Her TSH, FT4 and FT3 levels were taken showing elevated TSH, and decreased FT4 and FT3. What drug are you most likely to prescribe the pt?

Back 2

Levothyroxine sodium T4

- metabolized by cytochrome p450 system which is affected by drugs that induce the cyp450 system like phenytoin, rifampin and phenobarbitol.

Front 3

75 year old female presents complaining of being cold all the time, weight gain and brittle nails. Her TSH, FT4 and FT3 levels were taken showing elevated TSH, and decreased FT4 and FT3. What drug are you most likely to prescribe the pt and how would you prescribe it?

Back 3

levothyroxine sodium T4

initiate T4 cautiously and incr doses in small increments

Front 4

75 year old female presents complaining of being cold all the time, weight gain and brittle nails. Her TSH, FT4 and FT3 levels were taken showing elevated TSH, and decreased FT4 and FT3. What drug are you most likely to prescribe the pt and how would you prescribe it?

Back 4

levothyroxine sodium T4

initiate T4 cautiously and incr doses in small increments

Front 5

52 yo F is a new pt of yours. She tells you that she was diagnosed w/ hypothyroidism a long time ago, but couldn't afford medication for it until recently. What drug are you most likely to prescribe the pt and how would you prescribe it?

Back 5

levothyroxine sodium T4

1/2 life is longer d/t dec clearance and they are very sensitive to CV effects. Recommended dose 25 microg/day and inc by same amount over 4-6 weeks as tolerated

Front 6

52 yo F is a new pt of yours. She tells you that she was diagnosed w/ hypothyroidism a long time ago, but couldn't afford medication for it until recently. What drug are you most likely to prescribe the pt and how would you prescribe it?

Back 6

levothyroxine sodium T4

1/2 life is longer d/t dec clearance and they are very sensitive to CV effects. Recommended dose 25 microg/day and inc by same amount over 4-6 weeks as tolerated

Front 7

55 year old female presents complaining of being cold all the time, weight gain and brittle nails. She has a history of an MI when she was 50. Her TSH, FT4 and FT3 levels were taken showing elevated TSH, and decreased FT4 and FT3. What drug are you most likely to prescribe the pt?

Back 7

levothyroxine sodium T4

replace thyroid deficit slowly, cautiously & suboptimally
12.5-25 microg/day and inc by same amount over 2-4 weeks as tolerated.

Front 8

55 year old female presents complaining of being cold all the time, weight gain and brittle nails. She has a history of an MI when she was 50. Her TSH, FT4 and FT3 levels were taken showing elevated TSH, and decreased FT4 and FT3. What drug are you most likely to prescribe the pt?

Back 8

levothyroxine sodium T4

replace thyroid deficit slowly, cautiously & suboptimally
12.5-25 microg/day and inc by same amount over 2-4 weeks as tolerated.

Front 9

48 yo F comes to your office complaining of weight gain and brittle hair. You also notice that although its june in vegas, the pt is wearing sweatpants and a hoodie. You give the pt levothyroxine. 6 weeks later she comes back into your office for a check up and nothing has changed. What drug would now be indicated and what's the problem? what are the risks?

Back 9

Liothyronin sodium T3

the pt has an inability to convert T4 to T3

increased incidence of cardiac SEs

Front 10

48 yo F comes to your office complaining of weight gain and brittle hair. You also notice that although its june in vegas, the pt is wearing sweatpants and a hoodie. You give the pt levothyroxine. 6 weeks later she comes back into your office for a check up and nothing has changed. What drug would now be indicated and what's the problem? what are the risks?

Back 10

Liothyronin sodium T3

the pt has an inability to convert T4 to T3

increased incidence of cardiac SEs

Front 11

34 yoF presents to your ER complaining of tachycardia, palpitations, and dizziness. She is diaphoretic and has a fever of 101.4. ECG comes back clear, free Thyroid hormones come back highly elevated. what is the protocal?

Back 11

1st stabilize pt (fluid, cooling, acetaminophen)
manage sxs:
propranolol- used for sympatomatic relief till thyrotoxicosis can be controlled. (Blocks B-adrenergic receptors, inhibits 5' deiodinase & conversion of T4 --> T3 in peripheral tissue)

anti-thyroid drugs- preferably PTU d/t the peripheral conversion of T3->T4
corticosteroids
abs

Front 12

46 yoF presents to your office complaining of always being hot, recent weight loss and palpitations. You do a thyroid test and it shows elevated free thyroid hormones. WHat drug do you prescribe her?

Back 12

Metimazole (thioamides)
bc less freq dosing and less risk of liver complications

MOA: reduce synthesis of thyroid hormones (inhibit TPO--> inhibiting oxidation, condensation) no effect on release of preformed thyroid hormone.

Front 13

23 yoF G1P0 presents to your office complaining of always being hot, recent weight loss and palpitations. You do a thyroid test and it shows elevated free thyroid hormones. WHat drug do you prescribe her?

Back 13

Propylthiouracil (PTU)

d/t less complications

extra bonus: blocks conversion of T4-T3 in peripheral tissue by inhibiting 5'deiodinase

Front 14

35 yoF presents with signs of hyperthyroidism. You prescribe her a drug that will prepare her thyroid for surgery. 2 months later, the pt presents to your office complaining of a fever, rash, some edema. What drug did you prescribe her?

Back 14

thionamide

HSN rxns occur w/n 3months of tx --> rash, joint pain, fever, edema. pts are usually just allergic to one of them, not both.

Front 15

which drug's MOA is the wolff-chaikoff effect?

Back 15

potassium iodide

wolff-chaikoff effect: transient ↓ in T3/T4 levels d/t excess ingestion of iodide, which inhibits iodide pump activity.

Front 16

45 yoF with hyperthyroidism that isn't responding to thionamides comes to your office. You decide that you need to prepare the thyroid for surgery. you prescribe a drug to your pt and within a months time she returns to your office complaininig of ulcers on the gum line of her mouth, a sore throat and a metallic taste in her mouth all the time. what drug did you prescribe her?

Back 16

Potassium Iodide

AE: sore throat, mucus membrane ulcers, rashes, metallic taste in the mouth (like metronidazole)

Front 17

53 yoF is diagnosed w/ subacute thyroiditis but is intolerant to the thionamides. what can you give her instead?

Back 17

Iodinated contrast agents (lopanoic acid & lopadate)

MOA: prevent release of T4 & T3 and inhibit peripheral conversion of T4--> T3, T3 levels reduced by 60% in 24 hrs.

Front 18

what is the best tx that will prevent the progression of exophthalmos?

Back 18

I131 radioiodine

MOA: radioisotope emits B particles causing destruction of thyroid follicles.

Front 19

24 yoF G1P0 presents with graves disease that is intolerant to thionamides and is getting worse. What can you do next?

Back 19

Surgery.

I131 is contraindicated in preggers and breast feeding Mom's

Front 20

24 yoF with a BP of 145/90 wants to get on birth control. You take a look at her records and notice that her bp has been fairly stable while on captopril. What drug do you give her?

Back 20

Oral contraceptives.

Stable HTN is not a risk factor for OCPs, uncontrolled BP and ESRD are risk factors for OCPS.

Front 21

45 yoF with a 60 pack year wants to get on birth control. What do you prescribe her?

Back 21

mini-pill

oral contraceptives are contraindicated in heavy smokers over the age of 35 d/t incr coagulability, venous thromboembolism, and DVT formation.

Front 22

30 yoF with epilepsy comes into your office stating that she got pregnant when on the pill. what might have caused that?

Back 22

antiepileptic drugs like carbamezepine and phenytoin are cyp450 induces and increase metabolism of drugs that use the cyp450 system like oral contraceptives. this degraded the pill and made it less effective.

Front 23

28 yoF comes to your ER complaining of abdominal pain, chest pain, headache, eye problems and severe leg pain. There was no trauma, no significant family history, no recent travel and lab work came up normal except for a slightly elevated T4. The pt was recently prescribe a form of birth control that may have sometime to do with, what is it?

Back 23

combined- oral contraceptive pills

seirous SE: ACHES (abdominal pain, chest pain, HA, eye problems, and severe leg pain)

Front 24

22 yoF comes to office complaining of breakthrough bleeding early in her cycle while on the pill. what might be the reason?

Back 24

deficiency of estrogen in the combined pill

Front 25

22 yoF comes to office complaining of breakthrough bleeding late in her cycle while on the pill. what might be the reason?

Back 25

deficiency of progestin in the pill

Front 26

35 yoF is a traveling saleperson from the UK. She is brought into the ER after experiencing chest pain and difficulty breathing. You diagnosed her with a DVT that became a pulmonary embolism. What form of birth control has an increased risk of DVT?

Back 26

transdermal patches

Front 27

37 yoF comes to your office complaining that the birth control that she is currently on is giving her headaches, has spiked up her BP, and is causing age spots. You consider suggestive an alternative. what are the contraindications to the alternative drug for birth control?

Back 27

alternative drug: mini-pill
CI: personal hx of breast CA, undiagnosed vaginal bleeding ad hepatic dz.

Front 28

25 yoF presents to your office asking for a drug that provides infertility for months after stopping the drug. what is this drug?

Back 28

Depot medroxyprogesterone acetate (DMPA)

Front 29

26 yoF just had a baby girl and does not want to get pregnant for another 3 years, but she also wants to make sure that when she does decide to stop the medicine, that her fertility returns rapidly. Which form of birth control should she be on?

Back 29

progestin implants

subdermal capsules
*cheaper, easy compliance

Front 30

57 yoF presents to your office complaining of hot flashes, hair in strange places and vaginal dryness. She underwent a hysterectomy after her last child 25 years ago. What drug do you prescribe her?

Back 30

Conjugated equine estrogens (CEE) to tx menopause.

also recommended for women w/ intact uterus (must incl progestin to dec risk of endometrial CA)

Front 31

25yoF presents to your office complaining of disabling pain w/ menstruation. The pain goes after after the cycle is over. She says that the pain interferes with her daily life. what drug can be given that inhibits the GnRH release?

Back 31

Danazol: 6-12 months

inhibits GnRH release, mid cycle LH & FSH surge, enzymes in the ovary to prevent E production, inhibits growth of endometrial tissue.

pt has endometriosis

Front 32

what 5 hormonal therapies can you give to tx endometriosis? non hormonal therapies?

Back 32

OCP, progestins, danazol, GnRH, aromatase inhibitors

non: analgesic and surgery

Front 33

65 yoM is in your ICU bc of renal dysfunction. While there, he developes hypercalcemia. How do you tx him?

Back 33

Calcitonin

Front 34

60 yoF w/ CHF presents to your ER w/ elevated calcium levels, how do you tx her?

Back 34

calcitonin

Front 35

hypercalcemia + parathyroid Ca. tx?

Back 35

cinacalcet

Front 36

DOC for malignancy associated hypercalcemia with a normal therapeutic index

Back 36

Pamidronate (give w/ furosimide)

Front 37

this drug mimics ionized ca on Parathyroid gland and incr sensitivity to calcium which causes a decrease in PTH secretion

Back 37

cincalcelet

Front 38

a pt w/ GERD presents to you office with hypercalcemia. What can you NOT give the pt?

Back 38

bisphosphanates

inhibit osteoclastic proton pump
inhibit osteoclastic activity
decr osteoclast formation
incr osteoclast apoptosis

Front 39

what drug can you give a pt w/ o any underlying factors for a long term tx of hypercalcemia? what should you tell them before taking them?

Back 39

bisphosphanates

this can cause esophageal an gastric irritation and bleeding, so take with a glass of water and stay fully upright for 30 minutes after taking it

Front 40

which drug decreases serum ca 2+, inhibits bone turnover, causes an increase in renal excretion of calcium and antagonizes PTH effects? who is this drug CI in?

Back 40

calcitonin

salmon calcitonin is contraindicated in any one with a hx of allergies.

Front 41

you are doing rounds in the ICU on your 65 yoM with severe pancreatic cancer. you notice that he has hypercalcemia, what drug do you prescribe this pt? what are the worries about this drug?

Back 41

plicamycin

cytotoxic ab that inhibits Vit D and effect of PTH on osteoclast.
this is highly toxic and has a very low therapeutic index. so give one low dose.

Front 42

you are doing rounds on your 25 yoF G1P0 pt with severe breast cancer, what drug is completely contraindicated with this pt?

Back 42

plicamycin

CI: electrolyte imbalance, preggers, BMS, bleeding disorders

Front 43

40 yoF presents to the ER with hypocalcemia. She has no other medical issues. what drug do you give her?

Back 43

calcium gluconate (parenteral)- DOC

required: acidic environment for absorption

Front 44

60 yoM with a hx of PUD presents with hypocalcemia. What drug do you prescribe him?

Back 44

calcium citrate

no acidic environment needed

he's probably on a PPI which makes the environment alkalytic rendering other calcium treatments useless.

Front 45

65 yoF with diabetic nephropathy presents with hypocalcemia. What drug do you give her?

Back 45

calcitriol

inc absorption of calcium in GI and renal calcium reabsorption
incr plasma ca
dec PTH levels/ bone resorption

Front 46

55 yoM who is currently being tx for his A. Fib has glomeruloproliferative glomerulonephritis as well as hypocalcemia. what can you NOT prescribe him?

Back 46

Calcitriol

A fib is tx with Digoxin and digoxin is contraindicated in calcitriol txs.

Front 47

what is the DOC for hyperparathyroidism?hypoparathyroidism? hypophosphatemia?

Back 47

doxercalciferol: inc absorption of calcium in GI; dec PTH
hypo: calcitriol
PO4: ergocalciferol: inc plasma ca levels (inc intestinal reabs). v slow activation

Front 48

47 yoF comes into your office for a regular check up and you notice that her height has decreased considerably over the years. On the T score, she rated a -2.7. What is your first line drug of choice?

Back 48

Bisphosphanates

Front 49

62 yoF with lupus has her dexa scan done and it shows osteoporosis, what is the DOC?

Back 49

alendronate -- chronic GC users.

lupus- prenidsolone

Front 50

your 67 yoF pt with osteoporosis comes into your office after being prescribed 2 years ago alendronate. The dexa scan shows no improvement, what drug do you give her? what are the concerns surrounding this one?

Back 50

teriparatide: pulsatile doses infrequently of PTH= bone formation, incr osteoblastic activity, new bone fomration & bone mineral density.

can only use it up to 21 months--> beyond 21 --> inc risk of osteosarcoma

Front 51

what two vit D drugs can only be described to pts w/ normal kidneys?

Back 51

ergocalciferol and doxercalciferol

Front 52

what is the DOC for post-menopausal women with osteoporosis?

Back 52

raloxifen

Front 53

what can you give to someone who is experiencing osteolysis associated with a tumor?

Back 53

bisphosphanates

Front 54

tx for osteomalacia and rickets?

Back 54

vit D- ergocalciferol

Front 55

tx for pagets

Back 55

calcitonin and bisphosphanates

Front 56

how does raloxifen work?

Back 56

acts like an agonist in bone and decreases Rank L proliferation & expression

Front 57

35 yoM presents to your office with a rounded face, HTN, centripetal fat deposition and striae. you suspect cushings. How would you diagnose cushings?

Back 57

w/ dexamethasone

Front 58

27 yoF G1P0 comes into your office with a rounded face and HTN. You notice that she is developing a centripetal fat distribution that is abnormal even for a pregnant woman. what drug should you put her on and how does it work?

Back 58

Metyrapone

decrease 11b hydroxylase which will decrease HTN and allow androgen production

Front 59

with what drug do you tx ectopic acth syndrome?

Back 59

metyrapone

Front 60

with what drug do you tx ectopic acth tumors?

Back 60

aminoglutethimide

Front 61

you have a pt that has cushings d/t to his adrenal cancer, what can you give him? how does it work?

Back 61

aminoglutethimide

inhibits conversion of cholesterol to pregnenolone

Front 62

with what drug do you tx adrenal hyperplasia?

Back 62

aminoglutethimide

Front 63

how do you tx cushing's syndrome and hyperaldosteronism? how does this drug work? what is its famous SE that it shares w/ ketoconazole?

Back 63

spironolactone

antagonist against the mineralocorticoid receptor and dec resorption of sodium and secretion of K.

se:gynecomastia

Front 64

how do you tx cushing's disease?

Back 64

ketoconazole

inhibits all of the adrenal and gonadal steroid horone synthesis

Front 65

35 yoF presents with a darkened hue to their skin, hypotension and hypoglycemia. How would you confirm you hunch?

Back 65

cosyntropin

Front 66

how do you tx addison's dz?

Back 66

hydrocortisone and fludrocortisone

Front 67

35 yoF presents with a darkened hue to their skinand hypoglycemia. You do a confirmatory test and it comes back showing a decreased cortisol w a decreased/ normal ACTH. what is the cause? what do you expect the BP to be?

Back 67

cause: exogenous CS administration (sudden w/ drawal after prolonged use)- atrophy of ant pit & hypothalamus

BP- normal d/t zona glomerulosa still intact

Front 68

32 yoM during rounds complains of nausea and abdominal pain. His mucus membranes are dry and his bp is 80/50. you learn that he was hospitalized d/ t an acute attack of crohn's disease. What is happening? how do you tx it?

Back 68

acute adrenal insufficiency
d/t abrupt w/drawl of GC. He was being tx for an exacerbation of crohn's disease with either prendisone or prednisonolone.

tx: hydrocortisone
iv isotonic NaCl
appropriate thx for precipitating cause

Front 69

what two drugs do you use to suppress release of CRH and ACTH to decrease production of androgens?

Back 69

dexamthasone and hydrocortisone

Front 70

what drugs can you give all congenital adrenal hyperplasia pts? what drug can you give to replace the 21 hydroxylase deficiency?

Back 70

all: hydrocortisone and dexamethasone -> all need to increase cortisol
21: fludrocortisone: Mineralocorticoid activity

Front 71

which drugs can be used to prevent aromatization of androgens to estrogens?

Back 71

aromatase inhibitos

Front 72

what does flutamide do?

Back 72

nonsteroidal competitive inhibitor of androgens at the testosterone receptor.

Front 73

Name the drug:
Growth hormone agonist that is a recombinant GH

Back 73

somatropin

Front 74

Name the drug:
GH + add'l methionine group at amino terminus

Back 74

somatrem

Front 75

Name the drug:
GHRH agonist

Back 75

sermorelin

Front 76

Name the drug:
Recombinant IGF-1

Back 76

mecasermin

Front 77

Name the drug:
Binds SSTR2 and 5, used to tx acromegaly and TSH secreting adenomas

Back 77

somatostatin agonists:
ocreotide

Front 78

Name the drug:
produces internalization of the receptor w/o activating it

Back 78

Pegvisomant (somatotstatin agonist)

Front 79

Name the drug:
decreases direct & indirect activity d/t GH or IGF-1 receptor activation. Used to tx: acromegaly, CI in elevated liver transaminases

Back 79

pegvisomant (somatostatin agonist)

Front 80

Name the drug:
Gi coupled receptors

Back 80

dopamine receptor agonists

Front 81

Name the drug:
agonist of D2 receptor and antagonists of D1 receptors, albumin bound

Back 81

bromocriptine

Front 82

Name the drug:
lower tendency to cause nausea, potent D2 agonist w/ greater selectivity.

Back 82

cabergoline

Front 83

Name the drug:
used for chemical castration

Back 83

GnRH agonists-- nonpulsatile admin w/ flare of FSH and LH for 7-10 days and then subsequent admin will inhibit FSH and LH release.

Front 84

Name the drug:
CI in pregnancy and breast feeding

Back 84

GnRH agonist

Front 85

Name the drug:
tx for male infertility, identical in sequence to endogenous GnRH

Back 85

gonadorelin

Front 86

Name the drug:
increased 1/2 life, used for prostate caner, endometriosis, fibroids and hirsuitism

Back 86

Gosrelin

Front 87

Name the drug:
200x more potent used for endometriosis and central precocious puberty

Back 87

nafarelin

Front 88

what drug category is great for txing infertility and doing chemical castration?

Back 88

GnRH agonists: gonadorelin, gosrelin, nafarelin

Front 89

what drug category is used to prevent LH surge during ovarian hyperstimulation?

Back 89

GnRH antagonists: Ganirelix, cetrorelix

Front 90

Name the drug:
competitive antagonists as GnRH receptor?

Back 90

Ganirelix and cetrorelix

Front 91

what is ovarian hyperstimulation syndrome? what can cause it?

Back 91

ovarian enlargment + ascites + hypovolemia + hemoperitoneum

caused by GnRH antagonists, LH agonists, FSH agonists, and hCG agonists

Front 92

what drugs are reserved for women failing other tx for ovulation?

Back 92

LH, FSH, and hCG

Front 93

Name the drug:
only approved use w/ follitropon alpha

Back 93

lutropin (LH agonist)

use in infertile women d/t profound LH deficiency to cause follicular development

Front 94

Name the drug:
extract of urine from post menopausal women

Back 94

urofollitropin

Front 95

Name the drug:
sim to urofollitropin but more expensive

Back 95

follitropin alpha and beta

Front 96

which drugs are Gq receptors? (hypothalamus and pit hormones lecture)

Back 96

oxytocin and vasopressin agonists (vasopressin and desmopressin)

Front 97

Name the drug:
aids in milk letdown and contraction

Back 97

oxytocin

Front 98

9 yoM continues wetting his bed at night. Mom brings him to your office to see if there is something you can do about it. what drug do you prescribe?

Back 98

vasopressin

bc it activates on both V1 receptor (which is for the vasculature) and V2 (which is for collecting tubules). V2 also regulates release of coag factor VIII and vWF.
You wouldn't give him DDAVP bc that focuses more on V2 receptor.

Front 99

6 yoM with a known bleeding disorder comes to your office with a bleed that won't stop. What can you give him?

Back 99

DDAVP- desmopressin-- long acting synthetic analog whose main action is on V2 which regulates the release of coag factor VIII and vWF.

Front 100

what do you give someone to tx hyponatremia? (besides saline)

Back 100

conivaptan: nonpeptide antagonist at V1 and 2.

Front 101

Name the drug:
extracts from urine of a pregnant women

Back 101

Propasi, pregnyl, otehrs

recomb form of hCG = choriogonadotropin alfa

Front 102

which form of insulin has the fastest rate of injection? why?

Back 102

rapid acting: lispro and aspart

the injection is full of monomers which enters circulation and does not slow down absorption

Front 103

what is NPH?

Back 103

it is insulin + protamine, after injection, the subq proteases degrade protamine releasing insulin. It is an intermediate insulin.

Front 104

what form of insulin is the best for post prandial hyperglycemia?

Back 104

regular or short acting insulin


- full of heptamers

Front 105

how do the insulin drugs work?

Back 105

by binding to the insulin receptor (tyrosine kinase) and causing incr in glucose storage as glucogen in the liver, conversion of aa to proteins in the muscle and ffa to fat in the adipose tissue.
also incr K+ uptake in muscles.

Front 106

which insulin drug is peakless?

Back 106

Glargine (long acting)

Front 107

what are the two categories of insulin secretagogues?

Back 107

Sulfonylureas and meglitarides
SUs: glyburide, glipizide, glimepiride
Meg: repaglinide

Front 108

what is MOA of sulfonylureas?

Back 108

Close K+ channel by binding the SUR 1 subunit on the K+ chennel which will cause the cell to depolarize triggering insulin release via Ca influx.

Front 109

which drug in CI: in type 1 DM?

Back 109

sulfonylureas

also CI: hepatic/ renal insufficiency and preggers

Front 110

T/F

Adding 2 SUs to a regiment for a particularly challenging DM type 2 pt is acceptable.

Back 110

FALSE


NEVER COMBINE 2 INSULINE SECRETAGOGUES----- HYPOGLYCEMIA.

Front 111

35 yoF presents to your office with a BMI of 32 and a glucose reading of 600. Her HbA1c is 8.5%. What is your DOC? what is a worrisome SE of this drug?

Back 111

metformin- the insulin sensitizer bc it is #1 for decreasing HbA1c and a first line thx for type 2 DM.

se: lactic acidosis
CI in renal and hepatic failure and cadiac failure

Front 112

a 45 yoF was just diagnosed w/ type 2 DM and given a drug to help manage it. She comes back 3 weeks later complaining of increased flatulence, N/V, and abdominal pain. what medication was she put on?

Back 112

metformin-- can cause B12 anemia, N/V, flatulence and abdominal pain in up to 50% of pt. Must be titrated before given.

Front 113

what is the MOA of metformin?

Back 113

antihyperglycemic:

decreases gluconeogenesis, inc glycolysis and peripheral glucose uptake.

Front 114

which drug bind to the PPAR-gamma nuclear transcription regulator? how does it work?

Back 114

the Thiazolidinediones (pioglitazone, rosiglitazone)

works by causing activation of the PPAR-y receptors which incr insulin sensitivity and levels of adiponectin --> incr fatty acid storage and glucose metabolism.

Front 115

36 yoF is prescribed pioglitazone for her type 2 DM, what drug might she be on that would interfere with the efficacy of this drug?

Back 115

ocp-- they decrease affectiveness

Front 116

What side effect do both insulin sensitizers have in common?

Back 116

anemia

Front 117

what are the main serious side effects associated with the thiazolidinediones?

Back 117

weight gain ( not as much as SUs), edema, hepatotoxicity, heart failure

Front 118

which antidiabetic drug inhibits intestinal brush-border enzymes?

Back 118

alpha-glucosidase inhibitors: acarbose and miglitol

Front 119

which antidiabetic drug has not only anti-glucagon affects but also affects on the CNS causing anorexic tendencies?

Back 119

pramlintide

amylin-analog--- delays gastric emptying
anorexic effect via hypothalamic receptors

Front 120

which antidiabetic drug causes an increas in insulin and a decrease in glucagon release by stimulating the GLP-1 receptor?

Back 120

exenatide

stim glp-1 receptor which is a Gs coupled receptor which increases insulin gene expression and B cell mass

Front 121

which drug is associated with weight gain (lots of weight) and B cell burn out?

Back 121

sulfonylureas

Front 122

which antidiabetic drug inhibits DPP-IV? how does that stimulate glucose dependent insulin secretion?

Back 122

Sitagliptin

DPP-IV is inhibited which prevents the degradation of GLP-1 and other GLP-1 like molecules.

Front 123

what two receptors will be antagonized in order to be used as an antiemetic?

Back 123

dopamine (D2) and serotonin (5-HT3)

Front 124

what are the three commonly used drugs for antiemetics?

Back 124

phenothiazines
5HT3 inhibitors
metoclopramide

Front 125

what drug is a dopamine antagonist that is also a prokinetic agent? what does it do?

Back 125

metoclopramide

increases lower esophageal sphincter pressure and increases gastric emptying.

Front 126

what is the problem w/ phenothiazines (prochlorperazine)?

Back 126

increased dose improves antiemetic affect but limited by adverse effects: sedation and extrapyramidal sxs

Front 127

your pt is vomiting d/t their leukemia tx, what drug should you prescribe them? what about prophylactically?

Back 127

antiemetics (-setrons) for both before and after

esp: ondansetron

also: granisetron and dolasetron

Front 128

your pt is a DM and comes into your office coming of N/V/ dyspepsia. you diagnose them with having gastroperesis. what drug do you prescribe to them? why?

Back 128

Metoclopramide

its a central dopamine antagonist and it elevates the CTZ threshold. It will increase gastric emptying and increase lower esophageal sphincter pressure.

Front 129

which H1 antihhistamine has the fewest SEs and is specific for motion sickness?

Back 129

meclizine

Front 130

you have a pt who is on chronic morphine for fibromyalgia, they come into your office complaining of constipation, abdominal distention and bloating. What do you prescribe them?

Back 130

docusate-- will effectively control constropation assoc w/ chronic morphine use

Front 131

Pt w/ traveler’s diarrhea– pt has stopped traveling and has had diarrhea for past 72 hrs and is severely dehydrated. This pt needs to sleep and needs to stop defecating, what antidiarrheal can answer both of these wants?

Back 131

diphenoxylate d/t its peripheral and CNS opiate effects

Front 132

what is combined w/ diphenoxylate to prevent abuse?

Back 132

atropine

Front 133

which antidiarrheal agent only has peripheral nervous system effects?

Back 133

loperamide

Front 134

You have a pt who has IBD, but is also able to sleep inbtwn bowel movements, what drug would you prescribe him?

Back 134

loperamide

no CNS effects-- no sedation

Front 135

which antidiarrheal agent is primarily an antisecretory and antiinflammatory agent?

Back 135

bismuth

inhibits PG synthesis and reduces hypermotility and inflammation

Front 136

what is the triad assoc w/ IBD?

Back 136

assoc w/ immune dysregulation, bacterial pathogenesis and genetic presdisposition

Front 137

which disease has just colonic and rectal inflammation? which one has transmural inflammation of the entire intestinal tract?

Back 137

Ulcerative colitis- colonic and rectal inflammation

crohns: transmural inflammation

Front 138

what is the stepwise approach (algorithm) for tx IBD?

Back 138

1) aminosalicylates
2) corticosteroids
3) immunosuppressive antimetabolites
4) monoclonal abs

Front 139

what is the DOC for the aminosalicylates in IBD?

Back 139

sulfasalazine-- release of 5 aminosalicyclic acid in the large intestine inhibiting synthesis of PGs and inflammatory LTS

Front 140

what is the stepwise approach (algorithm) for tx IBD?

Back 140

1) aminosalicylates
2) corticosteroids
3) immunosuppressive antimetabolites
4) monoclonal abs

Front 141

What is the DOC for the mesalamine compounds for tx IBD? what does it do?

Back 141

pentasa

FR scavenger or an inhibitor of TNF by decreasing PGs

Front 142

what is the DOC for the aminosalicylates in IBD?

Back 142

sulfasalazine-- release of 5 aminosalicyclic acid in the large intestine inhibiting synthesis of PGs and inflammatory LTS

Front 143

you have a crohn's pt who is in remission and then undergoes an exacerbation, what do you do?

Back 143

tx them with a corticosteroid (hydrocortisone) during the exacerbation

Front 144

What is the DOC for the mesalamine compounds for tx IBD? what does it do?

Back 144

pentasa

FR scavenger or an inhibitor of TNF by decreasing PGs

Front 145

what are the 2 immunosuppressant highlighted for IBD?

Back 145

azathioprine and MTX

Front 146

you have a crohn's pt who is in remission and then undergoes an exacerbation, what do you do?

Back 146

tx them with a corticosteroid (hydrocortisone) during the exacerbation

Front 147

what are the 2 immunosuppressant highlighted for IBD?

Back 147

azathioprine and MTX

Front 148

your pt who has crohn's and is on mesalamine is given CS during ane exacerbation, but prior to this situation the pt was placed on MTX d/t their mega colon, what drug is considered a step up?

Back 148

infliximab: TNF-alpha antagonists

used in tx of severe exacerbation & ongoing crohn's dz where pt has failed conventional therapy

Front 149

what are the 3 steps to tx IBS?

Back 149

dietary modification
antispasmodic agents (dicyclomine and scopolamine)
antidiarrheal agents

Front 150

which antidepressant is the chosen group of antidepressants to tx IBS? why?

Back 150

SSRI's bc they are more rapid and have fewer SEs as compared to TCAs

DOC: fluoxetine- very long half life

modulation of pain via effects on neurotransmitter reuptake.

Front 151

what drug is the most efficacious of all the antisecretory agents

Back 151

Proton pump inhibitors

Front 152

what are the three causative factors of PUD? which one has the greatest pathogenicity?

Back 152

1) NSAID use, alcohol, smoking, stress
2) zollinger ellison syndrome
3) H. pylori-- assoc w/ 90-95% of duodenal ulcers---greatest pathogenicity.

Front 153

what is helicobacter pylori? what is the biggest worry associated with H. pylori?

Back 153

gram negative spiral bacterium with flagella that it uses the burrow its way through the GI tract.

biggest worry: 50% of these strains produce vacuolating cytotoxins associated w/ gastric CA

Front 154

If the pH of the GI tract is 1.4, how does H. pylori survive?

Back 154

its a urease producing organism

Front 155

what are the 4 ways in which you can diagnose H. pylori infection? which is the least invasive?

Back 155

upper endoscopy
serologic ab detection tests
urea breath test- least invasive
stool antigen test

Front 156

how do you tx peptic ulcer disease?

Back 156

eliminate H pylori
reduce gastric acid secretion or acid neutralization
protect gastric mucosa from further damage & back diffusion of acid

Front 157

what can prolonged use of antacids cause in a pt? who should you avoid magnesium containing antacids in?

Back 157

systemic alkalosis; pts w/ renal impairment

Front 158

Pt on cardiac drug goes home and takes and OTC suddenly presents w/ cardiotoxicity and in that cardiotoxicity, pt presents w/ GI disorders, tinnitus, deafness. What is the drug?

Back 158

Quinidine

fun fact from Krishna

Front 159

what 3 drugs do antacids interfere with?

Back 159

digoxin, ketoconazole and isoniazid--- they need an acidic environment and antacids are ruining it

Front 160

which drugs are chelated leading to their reduction in drug bioavailability when your pt is taking an antacid?

Back 160

tetracycline, ciprofloxacillin

Front 161

which H2 antagonists is highly selective for H2 receptors on parietal cells? what affect does it have on other drugs? what is the effect of chronic use of this drug?

Back 161

cimetidine
dec hepatic metabolism of warfarin, phenobarbital, phenytoin, diazepam, propranolo---> anything hat uses the cyp450 system, cimetidine is an inhibitor

chronic use= antiandrogen effects

Front 162

which H2 antagonist blocks daytime and nocturnal basal gastric acid secretion?

Back 162

ranitidine

Front 163

what is the MOA of PPIs?

Back 163

noncompetitive antagonist -irreversible inhibitors of H+/K+ ATPase

Front 164

what is the issue when combining an antacid and a PPI?

Back 164

the PPI is rapidly absorbed in its inactive form, but in order for it to be activated, it needs to be in an acidic environment. Antacids neutralize acidic environments.

Front 165

when is a PPI most effective?

Back 165

30 minutes before meals.

Front 166

which PPI has a better eradication rate of H. pylori when given in combo w/ antibacterial agent?

Back 166

omeprazole

Front 167

what two PPIs selectively inhibit CYP450-2c19? what can this lead to? what are the alternatives?

Back 167

omeprazole and esomeprazole- CYP450 inhibitors which can lead to a decreased elimination of phenyoin, diazepam and warfarin which can cause toxicity.

rabeprazole and pantoprazole have no interaction with the CYP450 system and can be used.

Front 168

what is the cytoprotective agent used to tx PUD?

Back 168

bismuth subsalicylate

Front 169

what is the 1st line therapy for pts colonized with H. pylori? with what drug?

Back 169

ERADICATE H. PYLORI

drug: combo therapy ("triple therapy") PPI w/ metronidazole or amoxicillin plus clarithromycin 7-14 days

Front 170

what is the tx regement for pts with severe ulceration and colonization w/ H. pylori?

Back 170

Omeprazole + bismuth subsalicylate + metronidazole + tetracycline (amoxillin/ clarithromycin)

Front 171

Ulcer that is NSAID induced and needs to continue NSAID therapy- what drug should we use? what if they have underlining CV disorder?

Back 171

1) celecoxib
2) omeprazole

Front 172

what IS the DOC for zollinger-ellison syndrome?

Back 172

PPI esp omeprazole

Front 173

what fxn do PPI's have in zollinger-ellison syndrome?

Back 173

reduce size, vascularity, and acid secretion of the tumor before surgery.

Front 174

what do you give to pts who were treated with the triple therapy but it did not eradicate the h. pylori? or pts who had an ulcer than had nothing to do w/ H pylori

Back 174

low does H2 antagonist of PPI