SPRING Top 200

  1. How many Americans does diabetes affect? How many Americans are undiagnosed?
    • 23.6 Million
    • 25%
  2. What are the four different types of diabetes?
    • Type 1
    • Type 2
    • Gestational
    • Type 1.5
  3. Describe Type 1 Diabetes
    • Results from beta cell destruction
    • Autoimmune disorder
    • Failure to produce insulin
    • 5-10% of Americans
    • Diagnosed in children or young adults
  4. Describe the presentation of Type 1 Diabetes
    • Thin
    • Excessive Urination
    • Hunger
    • Thirst
    • Fruity Breath
  5. Describe Type 2 Diabetes
    • Results from a progressive insulin secretory defect on the background of insulin resistance
    • Most common form
    • Does not make enough or makes too much insulin
  6. Describe the presentation of Type 2 Diabetes
    • Obese
    • May be asymptomatic
    • Polydipsia
    • Polyphagia
    • Polyuria
  7. Describe Gestational Diabetes
    • Diabetes diagnosed during pregnancy
    • 4% of all pregnant women
    • Often goes away after baby is born
  8. Describe Type 1.5 Diabetes
    • Type 1 in someone older
    • Same presentation as Type 1 Diabetes
  9. What is the range for pre-diabetes?
    100-125 mg/dL
  10. What is optimal range for fasting glucose levels?
    70-110 mg / dL
  11. What does A1c measure?
    Glycosylated hemoglobin--average amount of glucose in the blood over the last 2 to 3 months
  12. What is the goal range for A1c?
    < 6.5%
  13. Glucose use requires the presence of _________
  14. What cells produce insulin?
    Pancreas beta cells
  15. Describe what happens in the case of low blood sugar.
    Low blood sugar--> pancreas releases glucagon from alpha cells--> liver releases glucose into blood--> normal blood levels
  16. Describe what happens in the case of high blood sugar.
    High blood glucose--> pancreas releases insulin from beta cells--> fat cells take in glucose from blood--> normal blood levels
  17. What are other causes of diabetes?
    • Genetic defects in beta cell function or insulin action
    • Diseases of the exocrine pancreas (i.e. cystic fibrosis)
    • Drug or chemical induced
  18. What are the criteria for diagnosing diabetes?
    • A1c > 6.5% OR
    • Fasting Blood Glucose > 126 mg/dL OR
    • 2 hour plasma glucose > 200 mg/dL OR
    • A random plasma glucose > 200 mg/dL
  19. What are the symptoms of hyperglycemia?
    • Increased thirst
    • Headaches
    • Difficulty concentrating
    • Blurred vision
    • Frequent urination
    • Fatigue
    • Weight Loss
  20. What are the symptoms of hypoglycemia?
    • Hot
    • Sweaty
    • Shaky
    • Dizzy
    • Headache
    • Pale skin
    • Stimulates stress in the body
  21. How can you treat hypoglycemia?
    • Use a glucagon kit
    • Glucose Tablets
    • Candy
  22. Is hyper- or hypoglycemia more dangerous in the short term?
  23. How does alcohol affect your blood sugar?
    • Increases the risk of low blood sugar.
    • Liver will not produce any glucose until it has rid the body of all alcohol
  24. Is insulin a hormone or protein?
  25. How does Insulin affect blood glucose?
    Binds to cells to allow glucose from the body to be absorbed--> reduces blood glucose
  26. Why does insulin cause weight gain in some people?
    Excess of insulin stimulates your fat cells to store more fat causing weight gain.
  27. How do sulfonylureas affect blood sugar?
    • Increase insulin secretion
    • Reduce rate of glucose production
  28. What are some adverse effects of sulfonylureas?
    • Hypoglycemia
    • Weight gain
  29. How do biguanides affect blood sugar?
    • Decreases glucose production
    • Increase sensitivity to insulin
  30. What are the adverse effects of biguanides?
    • Diarrhea
    • Abdominal Discomfort
    • Lactic Acidosis
  31. How do thiazolidinediones affect blood sugar?
    • Increases sensitivity to insulin
    • Decrease glucose production
  32. How long does it take to see a maximum affect for Thiazolidinediones?
    6 weeks
  33. What else do Thiazolidinediones help?
    Improves HDL and TG
  34. What are the adverse effects of Thiazolidinediones?
    • Weight gain
    • Edema
    • Hypoglycemia
  35. What patients should not take Thiazolidinediones?
    • Patients with abnormal liver functions
    • Patients with CHF
  36. How do alpha-glucosidase inhibitors affect blood sugar?
    Delays uptake of glucose by blocking enzymes that digest glucose in the small intestine
  37. Should alpha-glucosidase inhibitors be taken with or without food?
    WITH food
  38. What are the adverse effects of alpha-glucosidase inhibitors?
    Flatulence or abdominal discomfort
  39. What are some examples of alpha-glucosidase inhibitors?
    • Acarbose (Precose)
    • Miglitol (Glyset)
  40. How do dipeptidyl peptidase IV inhibitors affect blood sugar?
    • Increase insulin secretion
    • Decrease glucose production
  41. What lab values do dipeptidyl peptidase IV inhibitors affect and by how much?
    • FPG: Decrease by 10-15 mg/dL
    • A1c: Decrease by 0.5-0.6%
    • Post-Prandial Glucose: Decrease by 50 mg/dL
  42. What are adverse effects of DDP-IV Inhibitors?
    GI side effects
  43. How do meglitinides affect blood sugar?
    Increase insulin production
  44. Do meglitinides have a rapid or slow affect?
    Rapid for a short duration
  45. What are the adverse effects of meglitinides?
    • Hypoglycemia
    • Weight gain
  46. What are incretin mimetics?
    • Hormones in the gut which act on the pancreas to increase insulin production.
    • Increase B-cell growth/replication
  47. What type of diabetes are treated with insulin mimetics?
    Type 2
  48. What drugs sensitize the body to insulin and/or control hepatic glucose production?
    • TZD
    • Biguanides
  49. What drugs stimulate the pancreas to make more insulin?
    • Sulfonylureas
    • Meglitinides
    • DPP-IV inhibitors
    • Incretin mimetics
  50. What drugs slow the absorption of glucose from the gut?
    Alpha-glucosidase inhibitors
  51. What drugs reduce glucose production?
    • DPP-IV Inhibitors
    • TZD
    • Biguanides
    • Sulfonylureas (rate)
  52. What type of animals was insulin made from in the past?
    Pork and Beef
  53. What type of insulin can be given through an IV?
  54. Describe the onset, peak, and duration of rapid acting insulin.
    • Onset: 10-30 minutes
    • Peak: 30 minutes-3 hours
    • Duration: 3 to 5 hours
  55. Describe the onset, peak, and duration of short acting insulin.
    • Onset: 30-60 minutes
    • Peak: 2-5 hours
    • Duration: Up to 8 hours
  56. Describe the onset, peak, and duration of intermediate-acting insulin.
    • Onset: 1-2 hours
    • Peak: 4 to 12 hours
    • Duration: 16-24 hours
  57. Describe the onset, peak, and duration of long acting insulin.
    • Onset: 1-5 hours
    • Peak: No clear peak
    • Duration: Up to 24 hours
  58. What are the three types of rapid acting insulin?
    • Insulin aspart (NovoLog)
    • Insulin glulisine (Apidra)
    • Insulin lispro (Humalog)
  59. What are the types of short-acting insulin?
    Insulin Regular (Humulin R, Novolin R)
  60. What type of insulin is intermediate acting?
    Insulin NPH human (Humulin N, Novolin N)
  61. What types of insulin are long acting insulin?
    • Insulin glargine (Lantus)
    • Insulin detemir (Levemir)
  62. What do anti-inflammatory medications treat?
    • Inflammation
    • Mild to moderate pain
    • Fever
    • May affect platelets
  63. What do NSAIDs do?
    • Decrease inflammation
    • Decrease pain
    • Treat fever
  64. What do most NSAIDs inhibit?
    Cox-1 and Cox-2 enzymes
  65. What does COX stand for? What does it do?
    • The enzyme "cycloxgenase"
    • It catalyzes the conversion of free essential fatty acids to prostaglandins.
  66. What are prostaglandins? Are they good or bad?
    Prostaglandins are mediators in inflammatory reactions. Can be good or bad.
  67. What does inhibition of COX do?
    Provides relief from symptoms of inflammation and pain
  68. Is COX 1 good or bad?
  69. Where is COX 1 produced?
    • Kidneys
    • Gastric Mucosa
    • Platelets
  70. What does COX 1 do?
    Speeds up the production of prostaglandalins.
  71. Which COX promotes the production of the natural mucosa lining that protects the inner stomach and preserves it's integrity?
    COX 1
  72. What is mediated by COX 1?
    Platelet aggregation
  73. Is COX 2 good or bad?
  74. What has increase production in the presence of inflammation and tissue injury?
    COX 2
  75. What does COX 2 do?
    Leads to prostaglandin synthesis involved in pain and inflammation.
  76. What are the two main COX inhibitors?
    • Ibuprofen
    • Naproxen
  77. Are NSAIDs selective?
  78. What are the main adverse effects of NSAIDs?
    • Peptic ulceration
    • Dyspepsia
  79. What does "dual insult" refer to?
    NSAIDs irritate the gastric mucosa due to the acidity of the medicine as well as inhibiting COX 1.
  80. What can be caused by use of NSAIDs?
    • Renal insufficiency
    • Hyperkalkemia
  81. What are NSAIDs commonly used for?
    • Arthritis
    • Back pain
    • heavy periods
    • Sprains/ strains
    • Migraine
  82. What do all NSAIDs have in common?
    • Anti-inflammatory effects
    • Analgesic effects
    • Antipyretic effects
    • Gastric side effects (less in COX-2 selective)
    • Can cause renal toxicity
  83. What is the pediatric dosing for Motrin?
    • 6 months or older:
    • Temp < 102.5: 5 mg/kg/DOSE
    • Temp > 102.5: 10 mg/kg/DOSE
    • Dosed every 6-8 hours
  84. What is the maximum dose for Motrin?
    40 mg/kg/DAY
  85. Explain the body's response to a fever.
    • Hypothalamus receives info about the body temp from thermosensitive neurons in the CNS and skin.
    • Temperature levels increase and trigger physiologic and behavioral mechanisms to return temperature to normal such as: sweating, vasodilation, increased peripheral blood flow, hyperventilation
  86. What can cause a fever?
    Bacterial or viral infections.
  87. What is the most common symptom of a disease in children?
    • Fever
    • 1 out of 5 ER visits
    • 20-30% of MD calls
  88. What is the indication of antipyretic therapy?
    Aid patient in discomfort and parent anxiety.
  89. What is the range for a mild fever?
  90. What is the range for a high fever?
  91. What is the range for a very high fever?
    • > 106
    • rare but serious complications can occur
  92. What do you tell a patient if their child has a fever > 100 and are 2 months old or younger?
  93. How many days should a child go with a fever before calling MD?
    3 days
  94. What can be caused if aspirin is used in children under 16?
    Reye's Syndrome
  95. In what patients is aspirin contraindicated?
    Pregnant: promote premature closure of the ductus arteriosus in the fetus
  96. What is the usual adult dosage of aspirin?
    81 mg to 325 mg
  97. What are two COX 2 inhibitors that have been withdrawn from the market? Why?
    • Bextra, Vioxx
    • Increased risk of cardiovascular disorders
  98. What is the dosing of tylenol in children younger than 12?
    • 10-15 mg/kg/dose every 4 hours as needed
  99. What is the adult dosage of tylenol?
    • 235-650 mg every 4 hours
    • 1000 mg tid/qid
    • MAXIMUM DOSE: 4 g/ day
  100. What is allergic rhinitis?
    • Highly prevalent allergen-induced upper airway inflammatory disease
    • Can be seasonal or year round
  101. What is the most common atopic disease in the US?
    Allergic Rhinitis
  102. What factors increase your risk of allergic rhinitis?
    • Age
    • Early food exposure
    • Maternal smoking
    • Indoor allergen exposure
    • Parental allergic disorder
  103. Is there a cure for allergies?
  104. What is the goal of allergy treatment?
    • Reduce symptoms
    • Increase patient's QOL
  105. What types of treatment are available for allergic rhinitis?
    • Lifestyle changes
    • Pharmacologic treatment
  106. How do H-1 antihistamines work?
    • Bind to and stabilize the H-1 receptor
    • Inhibit mast cell and basophil mediator release
    • Reduces sneezing, itching, ocular irritation
  107. What is released during an allergic reaction? How do H-1s help with this?
    • Histamine
    • H-1 antagonists reduce or eliminate the effects of histamine
  108. What are some typical anti-cholineric effects?
    • Stops cramping of smooth muscle
    • Sedation
    • Dry Mouth
    • Trouble concentrating
    • Raises Temperature
  109. Does 1st generation anti histamines have more or less adverse effects?
  110. Can 1st generation anti-histamines cross the BBB?
  111. What are some CNS adverse effects of 1st generation antihistamines?
    • Dry Mouth
    • Dry Eyes
    • Constipation
    • Urinary Retention
  112. Do 1st generations have a short or long half-life?
    Short (dosed every 4-6 hours)
  113. What are some examples of first generation anti-histamines?
    • Brompheniramine
    • Chlorpheniramine
    • Diphenhydramine
    • Meclizine
    • Hydroxyzine
    • Promethazine
  114. What type of H-1 antihistamines are non-sedating?
    Second generation
  115. Do 2nd generation H-1 antihistamines cross the BBB?
    No, poor penetration. Therefore, less CNS effects
  116. What are some examples of 2nd generation H-1 antihistamines?
    • Fexofenadine
    • Loratadine
    • Desloratadine
  117. What are some indications of H-1 antihistamines?
    • Allergic rhinitis
    • Allergic conjunctivitis
    • Allergic dermatological conditions
    • Urticaria
    • Angioedema
    • Pruritus (insect bites)
    • Anaphylactic or anaphylactoic reactions
    • Nausea and vomiting
    • Sedation (1st generation)
  118. Is a cough a symptom or disease?
  119. What can cause a cough?
    • Allergies and asthma
    • Lung infections
    • COPD
    • Sinusitis leading to postnatal drip
    • Lung disease
    • GERD
    • Cigarette smoking
    • Exposure to secondhand smoke
    • Exposure to air pollutants
    • ACE Inhibitors
    • Croup
  120. What are some agents that are used to treat a cough?
    • Mucolytics
    • Expectorants
    • Suppressants
    • Decongestants
    • Antihistamines
    • Pain relievers
  121. What are the FDA recommendations on cough medicines?
    Not for children < 4 y.o.a. UNLESS under guidance of healthcare professionals
  122. How does guaifenesin help treat a cough?
    • Expectorant-- loosens phlegm
    • Increases the lubrication of your lungs allowing for a productive cough and decreased chest congestion
    • Many dosage forms
  123. How does Codeine (and it's derivatives) help treat a cough?
    Binds to opiate receptors in the CNS, causes cough suppression by direct central action in the medulla and produces a generalized CNS depression
  124. What type of muscles do muscle relaxants work on? Why are they used?
    • Relax striated muscles (pain management)
    • Skeletal muscles (relief of spasticity in neuromuscular disease or minor strain injuries)
  125. What are some examples of muscle relaxants?
    • Flexeril
    • Soma
    • Skelaxin
    • Zanaflex
    • Robaxin
  126. Describe Alzheimer's Disease
    • Progressive brain disorder
    • Most common form of dementia-- destroys brain cells
    • Advances at different rates: 3-20 years
  127. What are some functions that are affected by Alzheimer's?
    • Memory
    • Ability to learn
    • Reason
    • Judgement
    • Communication Skills
    • Ability to carry out daily activities
  128. What is the hallmark symptom of Alzheimer's?
  129. What are treatment options for Alzheimer's?
    • Cholinesterase Inhibitors
    • Uncompetitive NMDA receptor antagonist
    • Vitamin E
  130. What do cholinesterase inhibitors do? What are some examples?
    • Increase levels of Acetylcholine
    • Aricept
    • Exelon
    • Razadyne
  131. Why are cholinesterase inhibitors unable to work for an extended period of time?
    Because our bodies eventually stop producing acetylcholine
  132. What is an example of a NMDA receptor antagonist? What is it's MOA?
    • Namenda
    • MOA unknown--> regulates glutamate which is responsible for cell death
  133. What are common causes of headaches?
    • Eye strain
    • Sinusitis
    • Tension/stress induced
    • Brain tumors
    • Idiopathic
    • Head injury
    • Medication induced
    • Dehydration
    • Caffeine withdrawal
    • Food triggers
    • Environmental triggers
  134. What types of headache may or may not be accompanied by auras?
  135. What are examples of vascular headaches?
    • Cluster
    • Migraine
  136. What is an example of a muscular headache?
  137. What is an example of a cervicogenic headache?
    Neck disorder
  138. What is an example of a traction headache?
    Eye strain
  139. What is an example of a inflammatory headache?
  140. What are some treatment options for headaches?
    • Lower your body temperature
    • Chiropractic Care
    • Preventative Therapy
    • Medications
  141. What are some types of medications used to treat headaches?
    • NSAIDs
    • Triptans
    • BP meds
    • Antidepressants
    • Muscle Relaxers
  142. What type of receptor are triptans agonists of?
  143. What specific types of headaches are triptans used to treat?
    Vascular (migraine/cluster)
  144. What is the MOA of triptans?
    • Bind to serotonin receptors in the brain
    • Inhibit pro-inflammatory neuropeptide release
  145. What are some examples of triptan drugs?
    • Imitrex
    • Maxalt
    • Amerge
    • Zomig
    • Axert
  146. What are some common stomach disorders?
    • GERD
    • Ulcers
    • Esophagitis
    • Gastroparesis
    • Nausea/Vomiting
  147. What is the definition of GERD?
    symptoms or mucosal damage produced by the abnormal relux of gastric contents into the esophagus
  148. Why can gastric content damage the lining of the esophagus?
    Regurgitated liquid usually contains acid and pepsin that are produced by the stomach.
  149. Why is GERD common in pregnancy?
    • Increased hormone production
    • Growing fetus can cause pressure
  150. What are the 3 categories of GERD?
    • Erosive esophagitis
    • Non-erosive reflux disease
    • Barrett's esophagus
  151. What are the treatment goals of GERD?
    • Alleviate Symptoms
    • Decrease the frequency of recurrent disease
    • Promote healing of mucosal injury
    • Prevent complications
  152. What are treatment options for GERD?
    • Lifestyle changes
    • Pharmacologic intervention
    • Surgery
    • Endoscopic therapies
  153. What is the LES and it's function in GERD?
    • It is a specialized ring of muscle that surrounds the lower most end of the esophagus and it's function is to prevent reflux.
    • Laxity of LES: easier opening of the LES allows for a greater backward flow of acid
  154. What are the typical symptoms of GERD?
    • Heartburn (painful) HALLMARK
    • Belching
    • Regurgitation
  155. What are some atypical symptoms of GERD?
    • Cough
    • Asthma
    • Hoarseness
    • Chest pain
    • Pharyngitis
    • Dental erosions
    • Metallic taste in mouth
    • Nausea
  156. What are some lifestyle changes that can be made to treat GERD?
    • Upper body elevation while sleeping
    • Smaller and less fatty meals
    • Lose weight
    • Smoking cessation
    • Avoid alcohol
    • Earlier evening meals
    • Avoiding injurious foods
  157. How do antacids treat GERD?
    Neutralize acid in the stomach by mixing with HCL to form water and salt. Reduces gastric pH
  158. How does Gaiscovn (Alginic acid) work?
    Protective barrier that floats on the surface of gastric contents
  159. What are the adverse effects of antacids with a Mg base? Al? Ca?
    • Mg= diarrhea
    • Aluminum= constipation
    • Calcium= stimulates gastrin release
  160. What is the indication for H2 Antagonists?
    Treatment of mild to moderate GERD (mainly heart burn)
  161. What is the MOA of H2 antagonists?
    Bind H2 receptors on parietal cells preventing histamine-induced activation
  162. When should a H2 antagonist be taken?
    30 minutes before a meal
  163. Do H2 antagonist heal inflammation?
  164. How long should H2 antagonists be used?
    • 12 weeks of therapy
    • improvement in 60% of patients
  165. Which H2 antagonist can be used in children under 1 y.o.a.?
  166. Which H2 antagonists should be adjusted in renal insufficiency?
    Pepcid, Tagamet, Axid
  167. Which H2 antagonist is not usually used due to drug interactions?
  168. What are PPI used to treat?
    Moderate to severe GERD, May strengthen LES
  169. What is the MOA of PPI?
    Blocks the secretion of acid into the stomach by acid-secreting parietal cells
  170. Can the PPI help heal the esophagus?
    Yes-- protects the esophagus so it can heal
  171. When should PPIs be taken?
    1 hour before meals
  172. Due to GI irritation, patients should avoid what when using PPIs?
  173. Which PPIs can be sprinkled over applesauce?
    Prilosec, Nexium, Prevacid
  174. Which PPIs must be swallowed whole?
    • Dexilant
    • Protonix
    • Aciphex
    • Zegerid
  175. Which PPI can not be switched between 20 mg and 40 mg?
  176. Which PPI was formerly known as "Kapidex?"
  177. What are ulcers? How are they formed?
    A break in the lining of the esophagus that occurs in an area of inflammation.

    Acid reflux damages the cells that line the esophagus causing inflammation. IF damage is severe, ulcers form. May erode into the esophageal blood vessels and give rise to bleeding.
  178. How can H-pylori affect the stomach?
    • It is a bacteria that infects the mucus lining of the stomach and upper intestines that can cause ulcers and gastritis.
    • 2/3 of the world are infected but asymptomatic
  179. What are the primary treatment options for H-pylori?
    • Clarithromycin Triple Therapy x 14 days:
    • Clarithromycin
    • PPI
    • Amoxicillin OR metronidazole

    • Bismuth Quadruple Therapy x 10-14 days
    • Bismuth
    • PPIF or H2 Antagonist
    • Metronidazole
    • Tetracycline
  180. Describe the pathophysiology of Nausea and Vomiting.
    • Emetogenic stimuli to chemoreceptor trigger zone (CTZ) through blood or CSF
    • Vestibular stimuli--> motion sickness
    • Direct irritation of GI tract sending stimuli to vomiting center in brain and CTZ
    • CNS associated--> psychiatric disorders, stress, anticipation
  181. What medications can be used to treat N/V?
    • Phenergan
    • Zofran
  182. What is the MOA of Phenergan?
    • Promethazine (generic)
    • H1 antagonist, anticholinergic
    • Administration: PO, IM, PR
  183. What is the MOA of Zofran?
    • Ondansetron (generic)
    • 5-HT3 antagonist
    • Administration: PO, IV
    • Commonly used for chemotherapy induced nausea and vomiting
  184. How do promotility drugs help with stomach disorders?
    Increase the pressure in the lower esophageal sphincter and strengthen the contracts of the esophagus--> Speeds up emptying of the stomach
  185. Do pro-motility drugs help heal inflammation?
  186. When should pro-motility drugs be taken?
    30 minutes before meals and at bedtime
  187. What type of drug is Reglan (metoclopramide)? What are it's indications? Adverse Effects?
    • Pro-motility
    • GERD, nausea/vomiting, gastroparesis
    • AE: weakness, somnolence, tardive dyskinesia, neuroleptic malignant syndrome
  188. What is "a skeletal disorder characterized by loss of bone tissue, deterioration of bone architecture, and increased bone fragility leading to increased risk of fractures."
  189. Are men or women more likely to suffer from osteoporosis?
  190. What areas are of most concern in osteoporosis?
    Hips and spine
  191. What are the most important risk factors for fractures?
    • Low bone mineral density
    • Advanced age
    • History of adult fracture
  192. What are some complications of fractures?
    • Chronic Pain
    • Deformity
    • Disability
    • Deconditioning
    • Depression
    • NH placement
    • Death
  193. What are the classifications of osteoporosis?
    • Primary (unknown cause)
    • Secondary ( disease related, medication induced)
  194. What three factors cause a variation in prevalence?
    • Age
    • Gender
    • Ethnicity
  195. What are some risk factors for osteoporosis?
    • Too much caffeine
    • White or Asian ethnicity
    • Family History
  196. What are some prevention or treatment options for osteoporosis?
    • Balanced Diet
    • Adequate calcium and Vit D intake
    • Avoid smoking
    • Limit alcohol and caffeine
    • Weight-bearing exercise
    • Bone density test and medication
  197. What is the daily calcium intake and vitamin D intake for ages 1-3, 4-8, 9-18, 19-50, 51+?
    • 700, 600
    • 1000, 600
    • 1300, 600
    • 1000, 600
    • 1200, 800-1000
  198. What are some treatment goals for osteoporosis?
    • Prevent fractures by improving bone strength and reducing the risk of falling and injury
    • Relieve symptoms of fractures and skeletal deformity
    • Maximize physical function
  199. What are some bone formation modifiers?
    • Biphosphonates (first line)
    • SERM (post menopausal women only)
    • Monoclonal antibody
  200. How do biphosphonates work? What are some adverse effects?
    • Inhibit osteoclast activity and reduce bone resorption and turnover.
    • Heartburn, indigestion, jaw bone pain
  201. How should biphosphonates be taken?
    • First thing in the morning
    • With a full glass of water
    • Wait at least 30 minutes after to eat
    • Remain sitting or standing for at least 30 minutes
  202. Which biphosphonate medications can be taken by IV?
    • Boniva
    • Reclast
  203. Which biphosphonates are used to treat ostoporosis in men?
    • Fosamax
    • Actonel
    • Reclast
  204. What patients should not use biphosphonates?
    Those with renal insufficiency
  205. Which biphosphonate is available with a combination of Vit D?
  206. Which biphosphonate differs and should be taken 60 minutes before a meal and before laying down?
  207. What type of medicine is Raloxifene (Evista)? What is it indicated for? What are some common side effects?
    • SERM
    • Osteoporosis, Breast Cancer, Hormone Replacement Therapy
    • Hot flashes, night sweats, leg cramps, blood clots
  208. What are some other examples of SERMs?
    • Calcitonin (miacalcin)
    • Denosumab (prolia)
  209. What is menopause? When does it commonly occur?
    • Permanent cessation of menses due to dysfunction of the ovaries.
    • Between the ages of 47-53
  210. What are some common symptoms of menopause?
    Hot flashes, night sweats, abnormal uterine bleeding, vaginal dryness, incontinence, sleep disturbances, mood changes, depression, sexual changes, problems with concentration and memory
  211. What are some examples of Estrogen derivatives?
    • Premarin (Conjugates Estrogens; pregnant mare urine)
    • Estrace (Estradiol)
  212. What are estrogen derivatives indicated for?
    Relief of moderate to severe vasomotor symptoms
  213. What are some side effects of estrogen derivatives?
    • vaginal bleeding
    • venous thromboembolism
    • stroke
  214. Women ______ a uterus cannot use unopposed estrogen because of the increased risk of endometrial cancer.
  215. What women should not use an estrogen derivative?
    Those with a history of breast cancer.
  216. What are the indications of oral contraceptives?
    • Prevent pregnancy
    • Regulate menstrual cycle
    • Treat acne
  217. Oral contraceptives are a combined form of what?
    • Progestin and estrogens
    • Prevents ovulation and alters endometrium lining
  218. What risks are associated with oral contraceptives?
    • Women with pre-existing CV disease or risk: DVT, pulmonary embolism, stroke, MI
    • Higher estrogen containing pills may increase risk of breast cancer
  219. What are some benefits of birth control?
    • PCOS treatment
    • Endometriosis treatment
    • Dysmenorrhea treatment
    • Reduce ovarian cancer risk by 40%
    • Reduce endometrial cancer risk by 50%
  220. What is polycystic ovarian syndrome?
    • A hormone imbalance leading to overproduction of follicles each month by the ovaries with producing an egg.
    • Irregular/no periods, depression, excessive weight gain, acne, abnormal hair growth, infertility
    • Goes hand in hand with insulin resistance
    • Body begins to make more androgens
  221. What is endometriosis?
    • When endometrial tissue develops outside of the uterus. Tissue implants -> proliferates-> thickens-> sheds with each menstrual cycle-> tissue becomes trapped-> scar tissue formation
    • Symptoms: pelvic pain, infertility
  222. What are some estrogenic compounds?
    Ethinyl estradiol
  223. What are some progestational compounds?
    • Norgestimate
    • Drospirenone
    • Norelgestromin
    • Norethindrone
  224. What women should use progestational compounds?
    Those with a uterus.
  225. What is often associated with "nausea, breast tenderness, increased BP, headache, melasma"?
    Too much estrogen
  226. What are the common complains with too little estrogen?
    Early or mid-cycle breakthrough bleeding, increased spotting, hypomennorhea
  227. What are some common complains of progestin?
    Breast tenderness, headache, fatigue, changes in mood
  228. What is often associated with " increased appetite, weight gain, acne, oily skin, hirsutism, increased LDL, decreased HDL"?
    Too much androgen
  229. What is urinary incontinence? What increases the incidence of UI?
    • Involuntary loss of urine
    • Increased: Females, Obesity (BMI > 30), Advanced Age (> 50), Poor function status
  230. What are some acute causes of UI?
    • UTI
    • Medications
    • Constipation
    • Tumor
  231. What are some chronic causes of UI?
    • Muscle/tissue weakness
    • Urinary tract abnormality
    • Increased during menstrual cycle
    • Nerve damage
    • Idiopathic
  232. What are the 5 types of UI?
    • Urge (Overactive Bladder): urinary urgency with increased frequency and nocturia, with or without UI-- Increase bladder muscle contraction or nerve problems
    • Stress: loss of urine or exertion, sneezing, or coughing; bladder pressure > urethral pressure
    • Mixed
    • Overflow
    • Functional
  233. What are treatment options of UI?
    • Lifestyle modifications
    • Kegel exercise
    • Bladder training
    • Intravaginal Devices
    • Medications
    • Nerve Stimulation
    • Surgery
  234. What are Kegel exercises?
    • They tone the pelvic muscles that stop the flow of urine when you urinate (pubococcygeus muscles).
    • Squeeze and hold up to10 seconds x 20 reps tid
    • Contract ONLY pelvic muscles
  235. What medications urge UI?
    • Ditropan/Oxytrol/Gelnique
    • Detrol/Detrol LA
    • Toviaz
    • Vesicare
    • Sanctura/Sanctura XR
    • Enablex
  236. What medications that urge incontinence are antimuscarinic?
    • Ditropan/Oxytrol/Gelnique
    • Detrol/Detrol LA
    • Toviaz
  237. What medications that urge incontinence are selective antimuscarinics?
    • Detrol/ Detrol LA (high affinity for bladder receptors)
    • Vesicare (M3>M2)
    • Enablex (highly selective M3>M2)
  238. What is tolterodine indicated for? What is it's MOA? How should it be administered? What are it's AE?
    • Urge Incontinence/Overactive Bladder: competitive muscarinic receptor antagonist that decreases bladder contractions, detrusor pressure, and incomplete voiding
    • Administer once (ER) or twice (IR) daily (adjust in hepatic/renal insufficiency)
    • AE: dry mouth, headache, constipation, blurred vission, dizziness
    • May take weeks or months for full efficacy
  239. What is BPH?
    • Benign Prostatic Hyperplasia
    • Enlarged prostate that presses on the urethra leading to urination and bladder problems
  240. What are symptoms of BPH?
    • Dribbling at the end of urination
    • Urinary retention
    • Incomplete bladder emptying
    • Incontinence
    • Nocturia
    • Slowed/delayed/strained urination
  241. What are lifestyle changes that can help treat BPH?
    • urinate with initial urge
    • avoid alcohol and caffeine
    • avoid drinking close to bedtime
    • avoid OTC decongestants/antihistamines
    • regular exercise
    • kegel exercises
    • reduce stress
  242. What are pharmacologic treatments for BPH?
    • Alpha 1 Blockers
    • 5 alpha reductase Inhibitors
    • Muscarinic Blockers
  243. What are examples of Alpha 1 Blockers?
    • Doxazosin
    • Prazosin
    • Tamsulosin
    • Terazosin
    • Alfuzosin
    • Silodosin
  244. What are examples of 5 alpha reductase inhibitors?
    • Finasteride
    • Dutasteride
  245. What is Tamsulosin indicated for? What are some common side effects? How should it be taken?
    • Treatment of symptomatic BPH alone or in combination with 5 alpha reductase inhibitor
    • Side effects: orthostatic hypotension, dizziness, weakness, decreased libido, insomnia, rhinitis, abnormal ejaculations, ejaculatory problems, intraoperative floppy iris syndrome
    • Administer 30 minutes after the same meal each day
  246. What is Finasteride indicated for? What are common side effects? What is the pregnancy risk category?
    • Treatment of symptomatic BPH alone or in combination with an alpha adrenergic blocker (increase symptom relief and increase urine flow rate)
    • SE: erectile dysfunction, decreased libido, increase breast size/tenderness, rash
    • PCX: pregnant females should not handle crushed or broken tablets
  247. What is ED?
    • Inability to achieve or maintain an erection
    • Affects 65% of men between 40-70 years of age
  248. Describe the pathophysiology of ED
    arousal -> Ach released from pelvic nerve-> NO released from cavernosal nerves-> smooth muscle relaxation-> areterial inflow/decreased venous outflow-> penile rigidity

    Endothelial damage--> decreaseNO production
  249. What are risk factors for ED?
    • Medications
    • CV disease
    • Diabetes
    • Depression
    • Alcoholism
    • Smoking
    • Penile trauma
    • Neurologic disease
    • Obesity
    • Renal disease
  250. What are the goals of treating ED?
    • Increased sexual function
    • Improve quality and quantity of erections suitable for intercourse
    • Maintain adequate erection for patient and partner satisfaction
  251. What are treatment options for ED?
    • Lifestyle modifications: increase physical activity, dietary changes, disease state management
    • Medications: phosphodiesterase type 5 (PDE5) inhibitors, Yohimbine
    • Surgical: Vasoactive injection therapy, vaccum pump devices, penile prosthesis
  252. How do PDE5 inhibitors work?
    Inhibit cGMP --> build up of cGMP--> smooth muscle relaxation--> increased inflow of blood

    SE: headache, flushing, dyspepsia, rhinitis, impaired color discrimination, dizziness, hypotension, CV effects, sudden hearing loss
  253. What medication is PDE5 contraindicated?
  254. What may increase the concentration of PDE5?
    Grapefruit juice
  255. What are some examples of PDE5 Inhibitors?
    • Viagra
    • Levitra
    • Cialis
  256. How long does the effect of cialis work?
    24-36 hours
  257. Should PDE5 inhibitors be taken with or without food? When should they be taken?
    • Without
    • 30 minutes prior to intercourse; once daily
  258. Is Yohimbe recommended for ED?
    • Nope--efficacy not proven
    • SE: dizziness, anxiety, flushing, headache, hypertension, tachycardia, tremor
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