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138 Cards in this Set
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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 |
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Secondary hypothyroidism
main symptom diagnostic test treatment |
No goiters
Low TSH and low T4 Levothyroxine sodium TRH test: little or no response |
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Tertiary Hypothyroidism
main symptom diagnostic test treatment |
Low TSH and Low T3
Levothyroxine sodium TRH test: TSH has a delayed response |
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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 |
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GHRH use
|
treatment of patients with short stature
|
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somatotropin release - inhibits what hormones
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inhibits the release of insulin, glucagon, gastrin, thyrotropin, GH
|
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GnRH used in
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Pulsatile: stim. release of FSH and LH
Continuous: it inhibits their release |
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FSH clinical use
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treatment of infertility
Female: gametogenesis, and follicle development Male: spermatogenesis |
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LH clinical use
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treatment of infertility
Male: gonadal steroid production Female: ovulation |
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CRH
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stimulates release of ACTH which is used in the treatment of adrenal insufficiency (Addison's Dz)
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TRH
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stimulates release of thyrotropin, prolactin, TSH
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Dopamine (analog=bromocriptine)
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inhibits release of prolactin
treatment: prolactinoma, acromegaly, amenorrhea |
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Levothyroxine sodium
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treatment of hypothyroidism, prevent mental retardation in newborns with thyroid def., TSH suppression after treatment for thyroid cancer
|
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levothyroxine sodium
adverse effects |
tachycardia, heat intolerance, tremors
|
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liothyronine sodium
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reserved for treatment of myxedema in combination with levothyroxine
SE: same as levohyroxine but more cardiotoxic |
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Propylthouracil and Methimoazole (thioamides)
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Stop iodination
MIT & DIT cant be produced SE: agranulocytosis (rare, most imp.), Rash, Edema |
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Iodide
|
in large dose decreases thyroid hormone release
use before surgery or with a thioamide and propranolol in a thyrotoxic crisis |
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ionic inhibitors
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perchlorate and thiocynate
competitive inhibition of iodide concentration by blocking transport us in Graves Dz (use is decreased now) |
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Cortisol uses
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Addison's Dz
Congenital adrenal hyperplasia Asthma Fetal lung maturation Chemotherapy diagnosis of Cushing's syndrom |
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Cortisol SE
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adrenal suppression
metabolic disorders (diabetes) euphoria stim. peptic ulcer iatrogenic Cushing's syndrome (to avoid use as low a dose as possible) |
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Cushing's Syndrome
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due to adrenal hyperfunction
low ACTH, High cortisol symptoms: moon facies, buffalo hump, hyperglycemia |
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21-beta-hydroxylase deficiency
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decrease cortisol causes adrenal hyperplasia
treatment: give cortisol to relieve ACTH and adrenal hyperplasia |
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Addison's Disease
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symptoms: hyperpigmentation, hypoglycemia, hypotension
ACTH test: Primary-norm to high to start, give ACTH-low cortisol Secondary-give ACTH levels of cortisol shoot up |
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Oxytocin
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stim force & freq. of uterine contraction
milk ejection clinical: induce & reinforce labor, control postpartum hemorrhage, SE: hypertensive episodes, uterine rupture |
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Mineralcorticoids (aldosterone)
synthetic:fludrocortisone, desoxycorticosterone |
ACTH & RAS control its secretion
function reabs. Na, HCO, H2O in exchange for excretion of K |
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Fludrocortisone
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replacement therapy after adrenalectomy for primary and secondary adrenocortical insufficiency
SE: hypokalemia, CHF |
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Adrenocorticosteroid Antagonist
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inhibit both mineralcorticods and glucocorticoids
|
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Aminoglutethimide
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decrease hypersecretion of cortisol in pt. with Cushing's syndrome
decrease estrogen production in treatment of breast cancer SE: GI & neurologic transient maculopapular rash |
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Metyrapone
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inhibits cytochrome P450
used in testing of renal function SE: Hirsustism and salt + water retention |
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Estrogen
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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 |
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Estrogen inhibitors
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Tamoxifen
Clomiphene |
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Tamoxifen
|
competitve inhibitor of estradiol
Rx: breast cancer in postmenopausal women SE: hot flashes, nausea, vomit |
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Clomiphene
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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, |
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Sex steriods
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estrogen
progestin androgens |
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Estrogen contraindications
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breast cancer
pregnancy liver disease history of thrombophlebitis |
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Progestin
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from progesterone
synthesized in ovary (some), testes, adrenal gland modulates the effects of estrogen Rx: oral contraception (no menstruation when used alone) |
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Synthetic Progestin
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norethindrone acetate
norethindrone medroxyprogesterone acetate |
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Physiologic effects of Progestin
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increase fat deposition
promote glycogen storage increase body temperature reg. endometrium maturation reg. breast secretory gland development |
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Clinical uses of progestin
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contrception (alone or with estradiol)
hormone replacement therapy with estrogen ovarian suppression (dysmenorrhea & endometriosis) Dx of estrogen secretion |
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SE of progestin
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increase weight
depression edema acne hypertension thrombophlebitis cholestatic jaundice |
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Progestin inhibitors
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mifepristone
danazol |
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Mifepristone
|
competitive inhibitor of progestin
morning after pill SE: heavy bleeding, GI effects, abdominal cramps |
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Danazol
|
partial agonist at progesterone, androgen, glucocorticoid receptors
SE: inc. weight, edema, acne, dec. HDL |
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female contraception
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estrogen-progestin tablets, constant dose
estrogen-progestin with inc. in progestin to mimic natural cycle progestin only (norgestrel or progestert) |
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female contraception
contraindications SE |
pregnancy
history of thromboembolism MI coronary artery disease SE: blood clots, inc. risk of breast cancer |
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Glossypol
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male contraceptive
dec. in sperm density and motility SE: hypokalemia |
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Androgens
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produced by testes
testosterone dihydrotestosterone dehydroepiandrosterone androstenedione |
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Androgens physiologic effects
|
anabolic: inc. muscle mass, inc. RBC production
androgenic: growth of larynx, skeleton, facial hair development,skin darkening |
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synthetic androgens
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oxandrolone
stanozolol fluoxymesterone oxymetholone nandrolone phenoropionate |
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clinical use of androgens
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replacement therapy in hypogonadism
osteoporosis growth stimulation SE: over masculinization Contraindicated: pregnancy |
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Androgen antagonist
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gonadotroping-releasing analogues (leuprolide, gonadorolin)
receptor inhibitors (cyprotone, flutamide) steroid synthesis (ketoconazole, spironolactone) 5-alpha-reductase inhibitors (finasteride) |
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clinical use of androgen antagonist
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benign prostatic hyperplasia
(finasteride) Cushing's disease (ketocongole) hirsutism (finasteride) prostatic cancer (leuprolide) |
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IDDM
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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 |
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NIDDM
|
insulin resistant
failure of pancreas to release insulin Ketosis resistant adult onset obese diet and exercise oral hypoglycemics |
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Ketoacidosis
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lack of insulin leads to lipolysis
Rx: crystalline zinc insulin Cause: excess acetyl CoA not used in TCA cycle converts to ketone body production |
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Short acting insulin
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regular
lispro insulin solution |
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intermediate acting insulin
|
isophane insulin suspension
insulin zinc suspension (lente) |
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long acting insulin
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extended insulin zinc suspension (ultralente)
|
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hyperglycemic emergency
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lispo and regular
|
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SE of insulin
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hypoglycemia (diaphoresis, vertigo, tachycardia)
insulin allergy (IgE) insuin Antibody lipodystrophy |
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oral hypoglycemic agents
|
sulfonylureas
Biguanides alpha-glucosidase inhibitors thiazolidinedione derivatives |
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sulfonylureas
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1st generation: chlorpropamide,tolbutamide
2nd generation: glyburide, glipizide, glimepiride |
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sulfonylureas MOA
|
stim. release of endogenous insulin from beta cells of pancreas
inc. insulin binding to target tissue |
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sulfonylureas SE
|
GI distress
hypoglycemia (due to OD) pruritis nausea agranulocytosis and aplastic anemia (rare) dec. in these effects with 2nd generation |
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drugs that potentiate sulfonylureas
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aspirin
MAOI ethanol allopurinol anticoagulants phenylbutazone |
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drugs that reduce sulfonylureas
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phenobarbital, beta adrenergic blockers,rifampin, cholestyramine, loop and thiazide diuretics
|
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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 |
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alpha-glucosidase inhibitors
(acarbose) |
delays absorption of glucose from GI tract
doesn't produce hypoglycemia SE: flautlence, bloating, diarrhea |
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thiazolidinedione derivatives
(troglitazone) |
dec. blood glucose by inc. response of target cell to insulin
metabolized by cytochrome P450 SE: fairly safe |
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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 |
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Regulation of plasma calcium level
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PTH
Vitamin D Calcitonin |
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Hypocalcemia
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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 |
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Calcium salt preparation
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calcium chloride
calcium gluceptate calcium gluconate calcium carbonate SE: peripheral VD or transient tingling, rapid infusion leads to cardiac arrhythmias |
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Hypocalcemia
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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 |
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Vitamin D Agents
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calictrol - drug of choice
ergocalciferol calciferol Rx: osteoporosis, chronic reanl failure, rickets (metabolic and nutritional) SE: vascular calcification, nephrocalcinosis, soft tissue calcification |
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Hypercalcemia
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usually asymptomatic, may have renal stones, constipation, abdominal pain, weakness, confusion, delirium
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Vitamin D Agents
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calictrol - drug of choice
ergocalciferol calciferol Rx: osteoporosis, chronic reanl failure, rickets (metabolic and nutritional) SE: vascular calcification, nephrocalcinosis, soft tissue calcification |
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hypercalcemia causes
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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 |
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hypercalcemia treatment
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rehydrate with saline
duresis with loop diuretics bisphosphonates calcitonin (drug of choice) gallium nitrate plicamycin |
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Bisphosphonates (etidronate & pamidronate)
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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 |
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calcitonin
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dec. osteoclstic bone resorption, and calcium and phospate
Rx: paget's hypercalcemia, osteoporosis SE: allergic reaction,GI, flush red face |
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Gallium nitrate
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Hypercalcemia
dec. serum calcium inhibiting bone resorp. Rx: hypercalcemias with malignancy SE: nephrotoxicity |
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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 |
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autocoids
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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 |
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Serotonin agonist
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Sumatriptan- treat migraines
SE: dizziness and muscle weakness |
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Serotonin inhibitors
|
Ketanserin: dec. bp
Ondansetron: treat N&V in surgery and chemo Cyproheptadine: treat SM constriction in carcinoid tumor |
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Histamine physiologic role
|
constrict bronchioles
constrict intestinal SM dec. BP Stim gastric HCL secretion Inc. permeability of skin capillaries |
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H1-receptor blockers clinical use
|
Diphenhydramine: allergic reaction, motion sickness
Hydroxyzine: allergic reaction Promethazine: motion sickness |
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H2-receptor blockers
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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 |
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Ergot alkaloids physiologic action
|
hallucination and psychoses at high dose
VC stim of uterine muscle |
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Egot alkaloids
|
bromocriptine
ergonovine ergotamine |
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ergot alkaloids clinical use
|
migraine-ergotamine
hyperprolactinemia-bromocriptine postpartum hemorrhage-ergonovine and ergotamine |
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Ergot alkaloids SE
|
prolonged VC
diarrhea N&V unwanted uterine contraction |
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ergot alkaloids clinical use
|
migraine-ergotamine
hyperprolactinemia-bromocriptine postpartum hemorrhage-ergonovine and ergotamine |
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Egot alkaloids
|
bromocriptine
ergonovine ergotamine |
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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 |
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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 |
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Ergot alkaloids
|
bromocriptine
ergonovine ergotamine |
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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 |
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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 |
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anticholinergic
(Ipratropiun) |
block PS stimulus (bronchial constriction & mucous secretion)
inhaled Rx: asthma and COPD SE:dry mouth, and sedation |
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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 |
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Methylxanthines theophylline
|
inc. cAMP by inhibiting phosphodiesterase prod. bronchodilation
|
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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 |
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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 |