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pharm#3test
endocrine
| Question | Answer |
|---|---|
| what gland regulates calcium in the body | parathyroid |
| recommended daily intake calcium 19-50 | 1,000mg/dy or more 1200 for over age 50 |
| disorders associated with deficient in Vitamin D | Rickets and osteomalacia |
| how many mg of calcium are 8 oz glass of milk | 300mg |
| take in am before breakfast on an empty stomach, no food including OJ or coffee for at least 30 minutes after administration. take with a full glass of water. remain upright (sitting or standing) for at least 30 minutes. | instructions for alendronate (fosamax) |
| AE of greatest concern using biphosphonates for treatment of osteoporosis/ | esophagitis |
| when are biphosphonates contraindicated | when individuals can not sit up for 30 minutes or have esophogeal disorders |
| what are the uses for selective estrogen receptor modulators (SERMs) such as raloxifene (Evista) | post menopausal, osteoporosis, breast ca |
| AE of selective estrogen receptor modulators (SERMS) | venous emboli, fetal harm and hot flashes |
| at what age do women experience accelerated bone loss | after menopause with continued loss for several years _2-3% per year) |
| lifestyles aimed to promote bone health | smoking cessation and ETOH, regular weight bearing excercise prevents |
| define osteoporosis | bone marrow density BMD value 2.5 below the mean |
| sustained hyperglycemia, polyuria, polydipsia, ketouria, and weight loss are signs of | DM-diabete mellitus |
| How is DM diagnosed | fasting bld glucose greater then or equal to 126 or random check greater then 200 |
| glucose interacts spontaneously with Hgb in RBC to form glycated derivatives that can be measured in blood. What is the name of this test that serves as an index of average glucose levels over 2-3 months | glycosated hemoglobin (HbgA1C)---less then 7, ideal 6.5 |
| purpose of measuring C-peptide levels in diabetics | normal C-peptides level means pancreas is producing insulin |
| patient injects normal insulin and then eats breakfast when would I be worried about hypoglycemia | before lunch when insulin is at its peak |
| which types of insulin are always cloudy | NPH and any type of premix 70/30-75/25 |
| why important to agitate NPH insulin prior to administration | to disperse the particles in the suspension |
| why important to draw up regular insulin prior to combinations insulin | NPH will inactivate or contaminate the rapid acting insulin |
| how many units are in 1 ml | 100 units |
| new rapid acting insulins have an earlier onset of action then regular insulin and need to be injected 10 minutes prior to eating | insulin lispro (Humalog) insulin aspart (Novolog) insulin glulisine (Apidra) |
| can you mix insulin glargine (lantus) with rapid acting insulin | NO |
| what is the most important complication from insulin treatment | profound hypoglycemia |
| clinical signs of hypoglycemia | tachycardia, palpitations, diaphoresis, nervousness, fatigue, headache |
| class of drug that mask hypoglycemia events by suppressing tachycardia and palpitations | beta blockers |
| 3 drug classes that increase blood sugar levels | thiazide diuretics, sympathomimetics, gluccocorticoids |
| major AE from oral hypoglycemics for type II diabetics called sulfonylureas | hypoglycemia |
| MOA of sulfonylureas | stimulate release of insulin from pancreas |
| which oral hypoglycemic is approved during pregnancy | none at this moment |
| stimulates the release of insulin from pancreas, can lead to hypoglycemia, and must be given before meals | meglitinides such as repaglinide (Prandin) and nateglinide (Starlix) |
| suppresses glucogenesis, enhances glucose uptake and utilization by muscle and does not promote insulin secretion or cause hypoglycemia | metformin (glucophage) |
| most important rare side effect of metformin | inhibits lactic acid oxidation leading to lactic acidosis |
| conditions that pt more prone to lactic acidosis | renal insufficiency, liver disease, severe infection, and hypoxemia |
| clinical sign of lactic acidosis | hyperventilation, myalgia, malaise, and unusual somnolence |
| why is it necessary to hold metformin prior to dx test using dyes and prior to surgery | decrease risk of lactic acidosis |
| why is metformin contraindicated with renal impairment | risk lactic acidosis with increased serum creatinine levels |
| 2 drugs that lower blood sugar y inhibiting digestion and absorption of dietary carbohydrates thereby reducing the rise in blood sugar that occurs after meals | Acarbose (precose) and miglitol (glyset) alpha-glucosidase inhibitors |
| MOA of thiazolidinediones TZD such as rosiglitatazone (Avandia) | reduce sugar by increasing insulin sensitivity |
| TZD ---thiazolidinediones can cause weight gain | major weight gain----- contraindicated with heart failure |
| black box warning issued for rosiglitazone (Avandia) | increased cardiovascular events |
| treatment of diabetic ketoacidosis DK | fluid and electrolyte replacement and regular insulin IV |
| treatment for insulin OD | IV DEXTROSE OR GLUCAGON |
| why is it important to place the patient on their side after administration of glucagon | N and V can occur after administration |
| incretins are hormones that are released from the GI tract after meals. They slow gastric emptying, stimulate insulin release from the pancreas, inhibit postprandial release of glucagon, and suppress appetite. | Byetta(exenatide) mimics this |
| a drug that slows the breakdown of naturally occurring incretins to improve glucose control is | Junuvia |
| flat affect, puffy pale face, dry, skin, brittle hair and hair loss, decreased heart rate and temperature, lethargy, fatigue, intolerance to cold, elevated TSH and depressed T4 | hypothyroid |
| TSH levels in hypothyroid are | elevated |
| condition associated with hypothyroid | hashimotos disease |
| excessive levels of thyroid hormone, depressed TSH and elevated T4 | hyperthyroid or Graves disease |
| rapid pounding pulse, dysrythmias, angina, nervousness, insomnia, rapid thought flow and speech, increase metabolism and temp. muscle atrophy, intolerance to heat, warm moist skin, wght loss despite appetite, exophthalmus | hyperthyroid or Graves disease |
| TSH levels in a patient with Graves disease are | depressed |
| how is hypothyroid treated | thyroid hormone replacement |
| how is oral levothyroxine administered | on an empty stomach to enhance absorption |
| why avoid taking levothyroxine with calcium, iron or antacids | absorption of lovothyroxine will be diminished |
| why important to start levothyroxine with low doses in elders | excess dose can cause tachycardia, angina, dysrhythmias |
| how long does it take levothyroxine to reach plateau | 4 weeks |
| how is graves disease treated | with antithyroid drugs until radioactive iodine can be given |
| propylthiouracil (PTU), methimazole (Tapazole) and radioactive iodine-131 are used to treat____________ | hyperthyroid |
| what drug is commonly used to suppress tachycardia in pt with hyerthyroid | propanolol |
| very young children, pregnant or nursing mothers are candidates for radioactive iodine | false |
| what disorder is associated with excessive levels of growth hormones (GH) | Gigantism is an excess GH |
| serum levels of growth hormone in children who are candidates for GH replacement should be below normal | true |
| treatment of GH can lead to | hyperglycemia |
| can GH be used once epiphyseal plates are closed | not recommended |
| name a drug used to inhibit excessive production of prolactin (hyperprolactinemia) | cabergoline (Dostinex) |
| a pituitary tumor can cause excessive levels of prolactin that stimulate production of breast milk. this condition is called | galactorrhea |
| patients with diabetes insipidous have ___________ levels of antidiuretic hormone ADH | decreased |
| name a pharmacologic treatment for diabetes insipidous | vasopressin |
| why is vasopressin avoided in patients with coronary artery disease or hypertension | powerful vasoconstrictor and can cause angina or MI |
| where are gluccocorticoids produced | adrenal cortex |
| name of disorder characterized by excessive levels of gluccocorticoids | cushing's syndrome |
| obesity, hyperglycemia, glucosuria, HTN, fluid and electrolyte imbalance, osteoporosis, muscle weakness, myopathy, hirsutism, menstrual irregularities and decreased resistance to infection are all signs of | Cushing syndrome |
| Addisons disease is a ____________ in gluccocorticoids and mineralcorticoids | deficiency |
| What is the treatment of Addison's Disease | hydrocortisone---which is both a mineralcorticoid and and gluccocorticoid. |
| why do patients with Adrenal insufficiency need increased doses of gluccocorticoids during times of stress | to prevent adrenal crisis---hypotension and shock |
| why are gluccocorticoids gradually withdrawn | to prevent adrenal suppression |
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andreafuturefnp
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