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374 Cards in this Set
- Front
- Back
Will medications in the Biguanide drug class cause: 1) Neutral Effect on or Loss of Weight 2) Weight Gain |
Weight Loss / Neutral |
|
Will medications in the High-dose Meglitnide drug class cause: 1) Neutral Effect on or Loss of Weight 2) Weight Gain |
Weight Gain |
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Will medications in the DPP-4 Inhibitor drug class cause: 1) Neutral Effect on or Loss of Weight 2) Weight Gain |
Weight Loss / Neutral |
|
Will medications in the Thiazolidinediones (TZDs or Glitazones) drug class cause: 1) Neutral Effect on or Loss of Weight 2) Weight Gain |
Weight Gain |
|
Will medications in the Alpha glucosidase inhibitor drug class cause: 1) Neutral Effect on or Loss of Weight 2) Weight Gain |
Weight Loss / Neutral |
|
Will medications in the GLP-1 agonist drug class cause: 1) Neutral Effect on or Loss of Weight 2) Weight Gain |
Weight Loss / Neutral |
|
Will medications in the SGLT2-inhibitor drug class cause: 1) Neutral Effect on or Loss of Weight 2) Weight Gain |
Weight Loss / Neutral |
|
Will medications in the Basal insulin drug class cause: 1) Neutral Effect on or Loss of Weight 2) Weight Gain |
Weight Gain |
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Will medications in the Sulfonylurea drug class cause: 1) Neutral Effect on or Loss of Weight 2) Weight Gain |
Weight Gain |
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The most common adverse effect with amlodipine (Norvasc) -- a calcium channel blocker -- is? |
Peripheral edema |
|
The most common adverse effect with lisinopril (Prinivil) -- an ACE inhibitor -- is? |
Cough |
|
The most common adverse effects with metroprolol (Lopressor) -- a Beta Blocker -- are? |
Bradycardia or mask symptoms of hypoglycemia |
|
The most common adverse effect with atorvastatin (Lipitor) -- a statin -- is? |
Myalgia |
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Patients taking atenolol (Tenormin) -- a beta-blocker -- and verapamil (Calan) -- a calcium channel blocker -- have a risk for the following drug interaction... |
Bradycardia |
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Patients taking lisinopril (Prinivil) -- an ACE inhibitor -- and losartan (Cozaar) -- an ARB -- have a risk for the following drug interactions... |
Hyperkalemia, renal dysfunction |
|
Patients taking lovastatin (Altoprev) -- a statin -- and gemfibrozil (Lopid) -- a Fibrate -- have a risk for the following drug interaction... |
Risk of myopathy, rhabdomyolosis |
|
Patients taking ramipril (Altace) -- an ACE inhibitor -- and spironalactone (Aldactone) -- a potassium sparing diuretic -- have a risk for the following drug interaction... |
Hyperkalemia |
|
What drug class is simvastatin (Zocor) in? |
HMG CoA reductase inhibitors, or "statin" |
|
What drug class is amlodipine (Norvasc) in? |
Dihydropyndine calcium channel blocker |
|
What drug class is metroprolol (Toprol XL) in? |
Beta Blocker |
|
What drug class is diltiazem (Cardizem) in? |
Non-dihydropyridine calcium channel blocker
|
|
What drug class is aliskiren (Tekturna) in? |
Renin inhibitor
|
|
What drug class is lisinopril (Zestril) in? |
ACE inhibitor
|
|
What drug class is Losartan (Cozaar) in? |
Angiotensin receptor blocker (ARB)
|
|
What drug class is clonidine (Catapres) in? |
Central alpha-2 receptor agonist
|
|
What drug class is spironolactone (Aldactone) in? |
Aldosterone antagonist
|
|
What drug class is Doxazosin (Cardura) in? |
Peripheral alpha-1 receptor blocker
|
|
What drug class is Hydrochlorothiazide (HCTZ) in? |
Thiazide diuretic |
|
What drug class is furosemide (Lasix) in? |
Loop diuretic |
|
What drug class is metalozone (Zaroxolyn) in? |
Thiazide-like Diuretic
|
|
What drug class is Ezetimibe (Zetia) in? |
Cholesterol absorption inhibitor |
|
What drug class is gemfibrozil (Lopid) in? |
Fibrate |
|
What drug class is cholestyramine (Questran) in? |
Bile acid sequestrant |
|
What drug class is Torsemide (Demadex) in? |
Loop diuretic |
|
Will spironolactone increase or decrease potassium? |
Increase |
|
Will furosemide increase or decrease potassium? |
Decrease |
|
Will hydrochlorothiazide increase or decrease potassium? |
Decrease |
|
Will lisinopril increase or decrease potassium? |
Increase |
|
Will Losartan increase or decrease potassium? |
Increase |
|
Will Bumetanide (loop diuretic) increase or decrease potassium? |
Decrease |
|
Will eplerenone (potassium sparing diuretic) increase or decrease potassium? |
Increase |
|
Will Klor-Con increase or decrease potassium? |
Increase |
|
A representative drug for the GLP-1 Agonist drug class is? |
liraglutide (Victoza) |
|
A representative drug for the Basal insulin drug class is? |
insulin glargine (Lantus) |
|
A representative drug for the Sulfonylurea drug class is? |
glimepiride (Amaryl) |
|
A representative drug for the Biguanide drug class is? |
metformin (Glucophage) |
|
A representative drug for the SGLT2-inhibitor drug class is? |
Canagliflozin (Invokana) |
|
A representative drug for the Alpha glucosidase inhibitor drug class is? |
acarbose (Precose) |
|
A representative drug for the Thiazolidinediones (TZDs or Glitazones) drug class is? |
pioglitzaone (Actos) |
|
A representative drug for the DPP-4 Inhibitor drug class is? |
sitagliptin (Januvia) |
|
A representative drug for the Metglitinide drug class is? |
Prandin (Repaglinide) |
|
What diabetes medication may cause a B12 deficiency, is listed as a Preg. Category "B", and is contraindicated in patients with elevated serum creatinine due to potential for lactic acidosis? |
metformin (Glucophage) |
|
What diabetes medication may cause edema and is contraindicated in patient's with CHF? |
Pioglitazone (Actos) |
|
What diabetes medication is injectable with possible GI adverse effect? |
exanatide (Byetta) |
|
What diabetes medication should not be given to a patient with a sulfa allergy? |
glimepiride (Amaryl) |
|
What diabetes medication is basal insulin, has a Pregnancy Category "B", and is an injectable drug primarily bound to albumin? |
Insulin detemir (Levemir) |
|
What diabetes medication is an insulin that is usually administered multiple times daily before meals? |
Insulin aspart |
|
What diabetes medication is a PO incretin-based drug? |
sitagliptin (Januvia) |
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In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive treatment should include an _____ or _____ to improve kidney outcomes. |
ACE inhibitor or ARB |
|
In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include ... (choose from 4 types of medications) |
a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). |
|
In the general black population, including those with diabetes, initial antihypertensive treatment should include _______ or _______. |
a thiazide-type diuretic or CCB. |
|
In the general population aged ≥60 years, initiate pharmacologic treatment to lower SBP <____ mm Hg and goal DBP <____ mm Hg. |
SBP <150 mm Hg and goal DBP <90 mm Hg. |
|
NSAIDs can reduce _______ efficacy |
thiazide |
|
Hypercalcemia, hyponatremia, hypokalemia, hypomagnesemia, hyperlipidemia, hyperglycemia, hyperuricemia; increased toxicity risk of lithium, digoxin, andantiarrhythmic agents, and a decrease in efficacy of anticoagulants and drugs to treat gout r/t what drug class? |
Thiazide diuretics
|
|
What diuretic class is the most potent? |
loop diuretic |
|
Adverse drug effects: Hyponatremia, hypokalemia, hypomagnesemia, hypocalcemia,hypotension, hyperglycemia, hyperuricemia Cardiac arrhythmia potential... What drug class causes these adverse effects? |
Loop diuretic |
|
What is an adverse effect of potassium-sparing diuretics? |
hyperkalemia, especially in combination with ACE inhibitor or renal insufficiency |
|
What drug class affects BP complex in the following ways? -Modulation of renin -Reduction in CO and/or PR -Negative inotropic/chronotropic effects -Antagonise the effects of sympathetic nerve stimulation or circulating catecholamines -Vasodilatory properties -Reduce peripheral resistance |
Beta-blockers |
|
Initiation of ___________ may cause bradycardia, heart block, or s/s of heart failure. May also WORSEN depression. Other adverse effects of this medication are: -Hypotension, syncope -Bronchospasm, dyspnea -Fatigue -Electrolyte imbalances |
Beta-blockers |
|
Abrupt discontinuation of __________ may cause ischemic syndromes. Therefore, it is important to taper the dose over several days-weeks. Strong caution with heart rate < 60 bpm and respiratorydisease(s) |
Beta-blockers |
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There is a strong caution with heart rate < 60 bpm and respiratorydisease(s) for which class of HTN med? |
Beta-blocker |
|
Do nondihydropyridine CCB cause reflex tach? |
No. Dihydropyridine CCBs do. |
|
Dihydropyridine CCBs are commonly associated with ________ and _________. Can also cause reflex tach. |
edema and constipation |
|
Are Dihydropyridine CCBs useful for managing atrial dysrhythmias? |
No. There is no utility in managing atrial dysrhythmias with Dihydropyridine CCBs. |
|
Are Nondihydropyridine CCBs effective in atrial fibrillation? |
Yes. |
|
Are Nondihydropyridine CCBs useful for african americans with HTN? |
No. Dihydropyridine CCBs are. |
|
Amlodipine (Norvasc), Felodipine Plendil), Isradipine (Dyna CircSR), Nicardipine (Cardene), Nifedipine Adalat, (Procardia),Nisoldipine (Sular) are examples of what drug class? |
Dihydropyridine CCBs |
|
Diltiazem, (Cardizem, Dilacor, others), Verapamil (Calan) are examples of what drug class? |
Nondihydropyridine CCBs |
|
Atenolol (Tenormin), Bisoprolol Zebeta), Metoprolol (Lopressor,Toprol XL) Esmolol (Brevibloc) are examples of what drug class? |
cardioselective beta blocker |
|
Nadolol (Corgard), Nebivolol (Bystolic), Propranolol (Inderal),Timolol (Blocadren) are examples of what drug class? |
non-cardioselective beta blocker |
|
Consider a _________ beta-blocker in a patient with mild asthma, COPD, peripheral vascular disease, or diabetes (can mask hypoglycemia) |
cardioselective beta blocker |
|
ACE inhibitors and ARB are drugs of choice for what condition? |
Chronic kidney disease... NOT RENAL FAILURE |
|
Indications for this drug class include... •Heart failure • Post-myocardial infarction • Chronic kidney disease (This or ARB drug of choice [JNC8]). Not renalfailure. • Recurrent stroke prevention • Diabetes (but no longer recommended above other three initial drugs[JNC8]). |
ACE inhibitors |
|
True or False, ACE inhibitors are contraindicated in pregnancy? |
True. |
|
Common adverse effects of this drug class include: • Persistent dry cough • Angioedema • Hyperkalemia (anticipate elevations) • Decreased renal function • Blood dyscrasias • Hypotension *Contraindicated in Preg. |
ACE inhibitors |
|
These medications are in what drug class? Benazepril (Lotensin)• Captopril (Capoten)• Enalapril (Vasotec)• Fosinopril (Monopril)• Lisinopril (Zestril)• Moexipril (Univasc)• Perindopril (Aceon)• Quinapril (Accupril)• Ramipril (Altace)• Trandolopril (Mavik) |
ACE Inhibitors |
|
ARB effectiveness is enhanced when combined with _________. |
Diuretics |
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ARB are well tolerated alternatives to ______ in patientswith: Chronic kidney disease, Diabetes (type 2), Post-acutemyocardial infarction, Heart failure, Left Ventricular Hypertrophy |
ACE Inhibitors |
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Adverse effects of this drug class include: hyperkalemia, decrease renal function, angioedema, hypotension *Contraindicated in pregnancy |
ARB |
|
These medications are in what drug class? Candesartan (Atacand)• Eprosartan (Tevetan)• Irbesartan (Avapro)• Losartan (Cozaar)• Olmesartan (Benicar)• Telmisartan (Micardis)• Valsartan (Diovan) |
ARB |
|
Aliskiren (Tekturna) is an example of a ________ blocker. It is very similar to ACEI and ARB. Can cause angioedema,hypotension, hyperkalemia. May be effective alone or with HCTZ. |
Renin |
|
_________ are used in patients with benign prostate hyperplasia (BPH). Side effects include: syncope, dizziness, palpitations. |
Alpha Blockers |
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The following medications: Clonidine, methyldopa, guanfacine, guanabenz are ____________ that reduce sympathetic outflow and enhance parasympathetic activity. Side effects include: orthostasis, sedation, dry eyes/ mouth, visual disturbances |
centrally acting agents |
|
Hypertensive urgency is severe elevation in BP _________ evidence of acute or lifethreateningtarget organ damage |
without |
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The following is a treatment plan for ________: • Oral short acting medication • Captopril, clonidine, labetalol • Observation in emergency department • Discharge on oral medication • Follow-up within 24 hours as outpatient |
Hypertensive urgency |
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A short-acting CCB, such as Procardia, should be avoided in ___________ r/t increased risk for MI and Stroke. |
hypertensive urgency |
|
________ and ________ are two BP medications that are not very effective and are riskier in African American populations. |
ACE inhibitors and ARBs |
|
Give a ______ or ______ for BP if patient has CKD. |
ACE inhibitor or ARB |
|
The risk of atherosclerosis is directly related to increasinglevels of serum _________ |
cholesterol |
|
If a patient has Triglycerides from 150 to 500 mg/dL and serum HDLcholesterol < 40 mg/dL... evaluate for ________ syndrome. |
Metabolic |
|
The following drug class is recommended in these patient populations: • ASCVD • Elevations of LDL to 190mg/dl • 40-75yo with diabetes, LDL 70-189, no ASCVD • No ASCVD or diabetes 40-75 yo, with estimated 10 yrASCVD risk of 7.5 or above |
Statins |
|
________ are the medications of choice to treat highLDL cholesterol. ________ inhibit conversion of HMG-CoA to L-mevalonic acidand subsequently cholesterol. |
statins; statins |
|
In addition to improving cholesterol levels, ________ may: • Reduce inflammation • Decrease C-reactive protein (CRP) • Reduce lipoprotein oxidation • Chemically reduce oxidized LDL • Enhance endothelial synthesis of nitric oxide • Inhibit thrombosis |
statins |
|
Rosuvastatin (Crestor) and Atorvastatin (Lipitor) are statins that are used for __________ intensity treatment. |
moderate-high |
|
Two main side effects/adverse effects for statins are: |
1. increased LFT 2. myopathy/rhabdomyolosis |
|
_________ is a Cholesterol absorption inhibitor that typically is used in adjunctive therapy with statins. |
Ezetimibe (Zetia) |
|
Bile Acid sequestrants ______ LDL cholesterol. |
Lower |
|
The following medications are in which drug class? • Cholestyramine (Questran, Prevalite) • Colestipol (Colestid) • Colesevelam (Welchol) |
Bile Acid Sequestrants (BAS) |
|
Side effects of what drug class include: • GI problems, bloating, flatulence,constipation. Increase fluid intake • BAS’s may interfere with the absorption of someother drugs, and therefore should be separatedfrom them regarding times of administration. • Welchol not well-tested with other drugs, separateby at least 4 hours • Some evidence to show that this may reduce HgbA1Cin diabetics with dyslipidemias. |
Bile Acid Sequestrants |
|
Which drug class has these effects? • Reduce CHD events, and the progression of atherosclerosis when combined with a statin • Reduce LDL 5-25% • Reduce triglycerides 20-50% • Increase HDL 15-35% |
Niacin |
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With _________ (medication), start low dose to avoid flushing; can raise BSand uric acid level. |
Niacin |
|
The following medications are in what drug class? • Fenofibrate (Tricor, Triglide)• Gemfibrozil (Lopid)• Fenofibric Acid (Trilipix) |
Fibrates |
|
What drug class...? • Most effective triglyceride-lowering drugs • Used primarily in patients with elevated triglycerides andlow HDL • Stimulate the function of lipoprotein lipase • Decrease triglyceride levels by 20-50% • Increase HDL levels by 9-30% |
Fibrates |
|
What drug class causes the following adverse reactions / effects? • Generally well-tolerated • AR – GI upset, flatulence, abdominal pain,dypepsia, fatigue • May cause myopathies like statins, and esp. whencombined! Monitor closely • Do not tend to raise BS or uric acid levels |
Fibrates |
|
Omega 3 Fatty Acids are useful for patients with high....? |
triglycerides |
|
The following medications are indicated in treating ________: •Diuretics for edema – reduce fluid burden • ACE inhibitors (or ARB) – reduces afterload, definitely useful. Monitorkidney function. Interesting, ACC mentions combination. • Beta blockers (esp. if recent MI), but helpful in all HF stage B orgreater • In selected patients: • Aldosterone antagonists – broader use, now maybe earlier, BUTneed sufficient Cr (2.5 men, 2.0 women) monitor K+ • Hydralazine/nitrates – very effective in AA patients • Digoxin – may be beneficial, later stage, very carefully, will takeless. Careful with K+, especially if on ald. agent, ACE/ARB |
Heart Failure |
|
The following medications are CONTRAINDICATED in _________: • TZDs – contraindicated, fluid retention • Metformin – may be necessary, but extra caution d/tincreased risk of lactic acidosis • CCB – very risky with reduced CO, d/t reduced inotropiceffect. Especially concerning after MI with low EF. • NSIADs – cause fluid retention (also note for HTNtreatment) • Warfarin needs will be reduced in acute HF |
Heart Failure |
|
______ are indicated in heart failure r/t edema and reducing fluid burden. |
diuretics |
|
_______ or ______ are indicated in heart failure r/t reducing afterload. |
ACE inhibitors and ARB |
|
___________ (especially if recent MI) are indicated in heart failure and are helpful in all heart failure stage B or greater. |
Beta Blockers |
|
__________ antagonists can be used to treat heart failure but must need sufficient creatinine (2.5 men, 2.0 women); monitor potassium |
Aldosterone antagonists |
|
___________ or __________ are effective medication options in African Americans with heart failure. |
Hydralazine or Nitrates |
|
_______ may be a beneficial medication in later-stage heart failure. Be careful with K levels if patient is also on Aldosterone agent, ACE/ARB. |
Digoxin |
|
Monitor ________ levels if the patient is on an aldosterone agent, ACE, ARB. |
potassium |
|
_______ and ______ are contraindicated in heart failure r/t fluid retention. |
Thiazolidinediones (TZDs or Glitazones) and NSAIDs |
|
________ is contraindicated/must be used with extra caution r/t heart failure because of increased risk of lactic acidosis. |
Metformin (Glucophage) |
|
________ are risky in heart failure r/t reduced cardiac output because it can cause a reduced inotropic effect. Especially concerning after MI with low ejection fraction. |
calcium channel blockers |
|
What is a normal ejection fraction? |
A normal LVEF ranges from 55-70%. |
|
Warfarin doses need to be _________ in acute HF. |
reduced |
|
Tretinoin, Isotretinoin, Adapalene, Acitretin are medications in the ________ class. |
Retinoids |
|
True or False: Retinoids can be used with pregnant women?
|
FALSE |
|
Adverse effects for _________ (a Retinoid) include: Teratogenicity, extreme xerosis, increased liver function tests & triglycerides, etc. ** DO NOT PRESCRIBE RETINOIDS TO PREGNANT WOMEN |
Isotretinoin |
|
Class 1 and Class 2 topical steroids are extremely strong. They should never be applied to the _________ or _________. |
Face / skin folds |
|
True or False: Class VII topical steroids are safe for use on face / skin folds? |
True |
|
An example of a Class VII topical steroid is...? |
Hydrocortisone 0.5%, 1%, 2.5% oint and cream |
|
Two examples of Class I topical steroids are? |
-Betamethasone diproprionate 0.05 % oint (Diprolene) -Clobetasol propionate 0.05% oint & cream (Temovate) |
|
Class ___ and ___ steroids should be used for short-term (14-day) control. |
Class I and II |
|
True or False: Topical tazoretene (Tazorac) should be used in pregnant women? |
FALSE |
|
The therapy for __________ includes: - Identification of allergen and avoidance: drugs, pollen, chemicals, food, bacteria, preservatives, malignanttumor, etc. - Antihistamines (Avoid systemic steroids): * loratadine (Claritin) 10mg daily, cetirizine 10mg daily, fexofenadine 180mg daily (OTC now) * hydroxyzine (Atarax) 10mg-20mg q 6-8 hrs - If chronic (> 6 weeks) consider adding: * cimetidine (Tagamet) 400mg bid-tid |
urticaria |
|
For widespread skin involvement for a dermatophyte infection, consider ____ antifungal agents. |
oral |
|
True or False: Topical Agents are usually effective in T. captis ad T. unguium (nail) infections? |
False |
|
It may take 3-4 weeks for itching to completely resolve with ___________? |
Scabies |
|
In Tinea pedis, manuum, corporis, and cruris... what is the first-line treatment? |
Topical azone / allamine |
|
Griseofulvin is the first-line treatment in children with Tinea ________. |
Capitis |
|
___________ is the first-line treatment in patients with Onychomycosis (tinea unguium). |
Terbinafine(oral) |
|
Topical corticosteroids induce cutaneous _________. |
vasoconstriction |
|
For optimal absorption of most topical drugs, apply them to _______ skin either immediately after bathing / wet soak. |
moist |
|
______________ are indicated to treat contact dermatitis, atopic dermatitis/eczema, and psoriasis. |
topical corticosteroids |
|
For the _______ medication, cream formulations are usually stronger than lotions, but less potent than ointments. |
SAME lotions < cream < ointment |
|
True or False: Solutions (dermatology) tend to be drying. |
True |
|
Avoid fire, flame, and/or smoking during and immediately after application of _______ (dermatology vehicle). |
Foams |
|
____________ can enhance topical corticosteroid potency by as much as 100-fold. |
Occlusion |
|
USA classification system divides into __ potency groups (dermatology) |
seven, 7 |
|
Class ____ is the highest potency of topical corticosteroids. Class ____ has the lowest potency of topical corticosteroids. |
Class 1 = most potent Class 7 = least potent *Class 1 is 1000x more potent than Class 7 |
|
Consider ______ absorption with application to large area (r/t topical corticosteroids) |
systemic absorption |
|
True or False: The Genitalia and structures of the head absorb the highest % of the total dose for dermatological application. |
True |
|
______ risk areas for dermatology medication absorption include: face, groin, intertriginous, axillae. Risk increases with thinning of skin or atrophy of skin. Consider systemic effects. |
High Risk |
|
The maximum length for dermatological treatment utilizing topical steroids in pediatric clients is __________ weeks. |
1 to 2 |
|
The maximum length for dermatological treatment utilizing high-potency topical steroids is a max of ______ weeks. |
3 weeks MAX |
|
________ is a progressive decrease in clinical response due to repetitive use of a drug. Occurs when body becomes tolerate to effects of particular medication. |
Tachyphylaxis |
|
There is an increased risk for adverse effects r/t topical corticosteroid use when prescribed more than _____ weeks. |
3 weeks |
|
The following adverse effects apply to which dermatological drug class? -Local effects: Burning, pruritis, erythema -Skin changes ***Skin atrophy -Depressed, shiny, wrinkled skin with prominent telangiectasias -May recover within weeks to months if therapy is DC’d as soon as skinchange occurs -Ecchymosis, purpura -Striae -Aceneiform eruption -Hypo/Hyperpigmentation -Hirsutism -Hypersensitivity reaction to vehicle or drug -Photosensitization -Promotion of fungal growth |
Topical corticosteroids |
|
Skin atrophy is a potential side effect of _______. |
topical corticosteroids |
|
Hypothalamic-pituitary-adrenal (HPA) axis suppression is a potential systemic effect of ____________ that can occur with use for as little as a few weeks. |
topical corticosteroids |
|
Hypothalamic-pituitary-adrenal (HPA) axis suppression r/t topical corticosteroid use can lead to _______ atrophy and loss of cortisol secretory capability. |
adrenal |
|
The following are risks for HPA suppression r/t which drug class? Risks for HPA suppression -High-potency -Chronic/long duration of use -Children -Application to highly permeable areas -Treatment of large areas -Occlusion -Poor skin integrity -Liver failure |
topical corticosteroids |
|
Tapering of steroids if used >2 weeks permits recovery of ________ axis function. Can prevent rebound, systemic effects. |
Hypothalamic-pituitary-adrenal (HPA) axis |
|
The following systemic effects are possible with what drug class? Immunosuppression, impaired wound healing Hyperglycemia, unmask DM *Other possible systemic effects Glaucoma, cataracts, HTN, Necrosis of femoral head |
Topical corticosteroids |
|
Avoid potent topical steroid medications in children under age ____. |
12 |
|
For age-related dose considerations of ________ (dermatologic drug class), consider: 1/5 adult dose - infants 2/5 adult dose - children 2/3 adult dose - adolescents |
topical corticosteroids |
|
alcohol causes a __________ in blood glucose because of its effects on hepatic glucose production. |
decrease |
|
thiazide diuretics (usually higher dose) may __________ blood glucose r/t effect on insulin resistance. |
may increase BG |
|
steroids (oral, injectable) may ___________ blood glucose levels r/t effect on insulin. |
increase |
|
nicotinic acid may _________ blood glucose r/t effect on insulin action and resistance. |
increase |
|
antipsychotics (ex: clozaril, zyprexa) may _________ blood glucose levels r/t effect on insulin. Can cause weight gain. |
increase |
|
Beta blockers may _______ blood glucose levels r/t effects on insulin secretion. May also mask hypoglycemia. |
increase |
|
Unless contraindicated, _________ remains the optimal, first-line medication for Type II diabetes. |
metformin |
|
The following is the MoA of _____________. MOA– - *Decreases hepatic glucose production – Improves insulin sensitivity • increases peripheral glucose uptake and utilization – Decreases intestinal absorption of glucose |
Metformin (Glucophage) |
|
The following are benefits of _____________. (diabetes medication) Benefits – Works well – Favorable effect on serum lipids – Does not increase appetite or promote fat storage • Wt neutral or wt loss!!! – Does not cause hypoglycemia as monotherapy |
metformin |
|
True or False: metformin causes hypoglycemia as monotherapy. |
False |
|
The following are adverse effects for ________: Main: GI • Nausea, diarrhea, abd pain • Strategies to decrease GI side effects • ER version • Take with evening meal • Gradual titration Lesser • Vitamin B12 deficiency • Metallic taste • *Risk for Lactic acidosis |
metformin |
|
_______ (diabetes medication) is contraindicated in patients with Renal Impairment. -Avoid in patients with elevated serum creatinine (>1.4 Females or >1.5 Males) -Avoid in patients with GFR <30mL/min -In patients with GFR between 30-60 mL/min reduce dose by 1/2 |
metformin |
|
Aside from Renal Impairment, the following are contraindications to using ___________ for managing type II diabetes: – >80 years of age – Alcohol abuse – Hepatic dz – Surgery – Dehydration – Severe CHF, low EF – Severe hypoxia (ex: COPD, on O2) |
metformin |
|
For metformin dosing, start with _______mg QD with food. The max dose for metformin is ________mg per day. |
500mg start Max dose = 2000mg/day (high dose = more benefit) |
|
True or False: Hold metformin for IV iodinated contrast material r/t risk for contrast-induced renal failure |
True (hold until stable renal function established) |
|
Hold metformin until stable ________ function can be established. Patient must have normal urine output, serum creatinine, and no physical exam evidence of fluid overload or circulatory compromise. *Serum creatinine typically assessed 2-3 days after contrast administration. |
renal function |
|
Symptoms of _________ r/t metformin use may be vague. These vague symptoms include: anorexia, N/V, abdominal pain, lethargy,hyperventilation, hypotension |
lactic acidosis |
|
_________ are the oldest class of oral hypoglycemic agents and are used as a second line option if metformin is contraindicated. MoA = enhances insulin secretion |
Sulfonylureas |
|
The ______ generation of sulfonylureas is preferred. Medications in this generation include: • Glimepiride • Glyburide (CV risk?) • Glipizide (shorter acting) |
second generation |
|
____________ (diabetes medication class) are more effective earlier in the type II DM treatment process. Requires adequate beta cell function and are not as effective long-term. |
Sulfonylureas |
|
The following are adverse effects for ____________ (diabetes medication class): Common AE: hypoglycemia, weight gain, increased risk of hypoglycemia in combination with other DM meds Caution: sulfonamide allergy |
Sulfonylureas |
|
Meglitinides/Glinides are ______-acting secretagogues that increase insulin secretion. This class is an option for patients with sulfa allergy. Causes less hypoglycemia r/t ______-acting. |
short;short |
|
A con of Meglitinides/Glinides is the dosing schedule. This class of medication is dosed ______ with meals. *Adverse effects of Meglitinides/Glinides include: hypoglycemia/weight gain (but less than sulfonylurea) |
TID |
|
________-acting options for type II DM management are preferred for the elderly. |
short-acting |
|
______________ (diabetes medication class) work by increasing insulin receptor sensitivity, decreasing hepatic glucose production, and enhance glucose uptake in muscle cells. |
Thiazolidinediones (TZDs) |
|
Thiazolidinediones (TZDs) are a pregnancy category ______ medication. |
Pregnancy Category C |
|
Adverse effects of ____________ (diabetes drug class) include: • *Weight gain • *Edema • *Increased risk of fractures • Anemia • Hepatotoxicity (rare) – Monitor LFTs • Bladder cancer risk (pioglitazone) – Related to dose and long‐term use – Report adverse events to FDA MedWatch |
Thiazolidinediones (TZDs) |
|
Thiazolidinediones (TZDs) are CONTRAINDICATED in patients with ___________. Also avoid in patients with: – Increased fx risk – Active or hx of bladder cancer (Pioglitazone) – CVD (Rosiglitazone) – Active liver disease |
Heart failure |
|
Avoid prescribing Pioglitazone (Actos) -- a Thiazolidinediones (TZD) -- in a patient with active or hx of __________ cancer. |
bladder |
|
Rosiglitazone (Avandia) -- a Thiazolidinediones (TZD) -- may be contraindicated in patients with _______ or may cause related issues. |
Cardiovascular Disease |
|
The following is the MoA of ________________ (diabetes medication class): Inhibit upper GI enzymes (alpha‐glucosidases)that convert complex polysaccharide carbohydratesinto monosaccharides, thereby delaying glucoseabsorption and reduce PP BG. |
Alpha-Glucosidase Inhibitors |
|
_______________ (diabetes medication class) are not commonly used r/t poor tolerance, lower efficacy, and increased cost compared with alternatives. *Can cause severe GI adverse effects, including cramping, flatus, and diarrhea. |
Alpha-Glucosidase Inhibitors |
|
Acarbose (Precose); Miglitol (Glyset) are examples of medications in which diabetes drug class? |
Alpha-Glucosidase Inhibitors |
|
Canaglifozin (Invokana®), Dapaglifozin (Farxiga) are examples of medications in which diabetes drug class? |
Sodium-glucose co-transporter 2 inhibitors (or SGLT2 inhibitors) |
|
The following is the MoA for _________ (a diabetes drug class): promotes urinary excretion of glucose by preventing tubularreabsorption. Mild effect on HbA1c level– Decrease 0.5‐0.7% *additional benefits: low hypoglycemia risk, reduction in wt. 4-7 lbs, reduced systolic BP ~5mmHg |
Sodium-glucose co-transporter 2 inhibitors (or SGLT2 inhibitors) |
|
What is a contraindication of prescribing a Sodium-glucose co-transporter 2 inhibitor (SGLT2 inhibitor)? |
GFR <60 mL/min |
|
The following are adverse effects for __________: Primary: GU tract infections – Reports of DKA • Near normal BG, N/V, fatigue, abdominal pain |
Sodium-glucose co-transporter 2 inhibitor (SGLT2 inhibitor) |
|
__________ are hormones normally released in the gut throughout the day and are increasingly released after meals. Incretins promote glucose homeostasis and their release is often decreased in clients with Type II diabetes. |
Incretins |
|
The following is the MoA for ________ (a diabetes drug class): Inhibits the intestinal enzyme, DPP‐4 ... increasesendogenous incretins ... Glucose‐dependent release ofinsulin; suppression of glucagon |
DPP-4 Inhibitors |
|
Sitagliptin (Januvia), Saxagliptin(Onglyza), Linagliptin (Tradjenta) are examples of medications in which diabetes drug class? |
DPP-4 Inhibitors |
|
__________ (diabetes drug class) are more effective earlier in Type II DM treatment process. *Are generally well-tolerated; low chance of hypoglycemia or weight gain; weak effects on A1C and are expensive ***Possible link w/ severe joint pain, pancreatic-duct changes, and acute pancreatitis |
DPP-4 Inhibitors |
|
Exenatide (Byetta, BID), Liraglutide (Victoza, QD), Exenatide ER (Bydureon, weekly), Dulaglutide (Trulicity, weekly) are examples of medication in what drug class? |
GLP-1 Agonists |
|
The following is the MoA of ____________ (a diabetes drug class): MOA: Incretin‐based therapy, mimics GLP‐1 action, Glucose‐dependent release of insulin; suppression of glucagon – Additional MOA: Delays gastric emptying |
GLP-1 Agonists |
|
GLP-1 Agonists are administered in a _________ form. |
injection (subcutaneous); pen delivery system |
|
____________ are administered via a "Pen Delivery System." *Side effects of this diabetic drug class include N/V, increased satiety, and weight loss. |
GLP-1 Agonists |
|
Avoid ___________ (diabetic drug class) in patients w/ history of pancreatitis (or high risk), gastroparesis, Multiple endocrine neoplasia type 2, medullary thyroid carcinoma *This medication also can cause transient GI side effects, is expensive, and is available only in an injectable form. |
GLP-1 Agonists |
|
Benefits of ___________ (diabetic drug class) include: -decrease in postprandial glucose -no hypoglycemia -decrease in weight |
GLP-1 Agonist |
|
liraglutide (Victoza, Saxenda) is a diabetic medication in the _________ class that is used for weight loss. *treatment for obesity is usually at a higher dose (3mg/day) |
GLP-1 Agonist |
|
_________ GLP-1 Agonists to reduce GI side effects. Start at the lowest dose; increase SLOWLY. |
titrate |
|
The following is the MoA for ____________ (a diabetes medication class). MOA – Suppresses glucagon secretion – Slows gastric emptying – Promotes satiety – Decreases postprandial glucose rise |
Amylin Mimetic |
|
________ is peptide hormone that is co-secretedwith insulin by the pancreas. It is found to be decreased in T1DM and longstandingT2DM. |
Amylin |
|
Pramlintide/Symlin are medications in the following diabetic drug class: _____________. |
Amylin Mimetic |
|
The benefits of _____________ (diabetes drug class) include: Satiety, possible weight loss, targets PP BG,can reduce total insulin need The cons of ____________ include: Cost, Frequent injections, Frequent Self Monitoring BG (2 hr pp) Close follow-up required r/t hypoglycemia risk |
Amylin Mimetics (Pramlintide/Symlin ) |
|
Cut mealtime insulin in _____ when starting Pramlintide/Symlin (Amylin Mimetics) |
half |
|
Avoid prescribing ____________ (diabetes drug class) in pediatric patients and patients with: – Compliance issues – Gastroparesis – H/O recurrent severe hypoglycemia *Different dosing for T1 DM vs. T2 (Higher in T2) |
Pramlintide/Symlin (Amylin Mimetics) |
|
True or False: Amylin Mimetic dosing requirements are higher in patients with Type II DM? |
True |
|
___________ (oral DM drug class) MoA is: decreased Hepatic glucoseproduction and Increases insulin sensitivity Advantages: Extensive experience, No hypoglycemia, Weight neutral, may reduce risk of CVD, low cost Disadvantages: Gastrointestinal SE, Lactic acidosis (rare butserious), B‐12 deficiency, Contraindication in renal impairment. |
Biguanides |
|
___________ (oral DM drug class) MoA is: closes potassium ATP channels, increases insulin secretion Advantages: extensive experience, decreased microvascular risk, low cost Disadvantages: risk for hypoglycemia, increased wt., low durability, may blunt ischemic preconditioning, allergic sensitivity |
Sulfonylureas |
|
___________ (oral DM drug class) MoA is: closes potassium ATP channels, increases insulin secretion Advantages: decreased postprandial glucose, dosing flexibility, moderate cost Disadvantage: hypoglycemia, increased wt, blund ischemic preconditioning, dosing freq. |
Meglitinides
|
|
___________ (oral DM drug class) MoA is: PPAR-y activator, increased insulin sensitivity Advantages: no hypoglycemia, durability, increases HDL, decreases risk for cardiovascular events (pioglitazone), low cost Disadvantages: increased wt, edema/HF, bone fractures, LDL increase (rosiglitazone), increased MI risk (rosiglitazone) |
Thiazolidinediones (TZDs or Glitazones) |
|
___________ (oral DM drug class) MoA is: Inhibits DPP-4, increases incretin (GLP-1, GIP) levels Advantages: no hypoglycemia, well tolerated Disadvantages: may increase risk for HF or pancreatitis , high cost |
DPP-4 inhibitors |
|
___________ (oral DM drug class) MoA is: inhibits SGLT2 in proximal nephron, increases gluosuria Advantages: decreased wt, no hypoglycemia, lower BP, effective in all stages of DM Disadvantages: frequent GU infections, polyuria, volume depletion, increase LDL, increase creatinine, high cost |
SGLT2 inhibitors |
|
___________ (injectable DM drug class) MoA is: activates GLP-1 receptor, increases insulin production, decreases glucagon, decreases gastric emptying, increases satiety Advantages: decreases weight, no hypoglycemia, lower postprandial glucose, lowers risk for cardiovascular events Disadvantages: gastrointestinal SE, pancreatitis, increases HR, medullary cancer risk, injectable, high costs, training req. |
GLP-1 Receptor Agonists |
|
___________ (injectable DM drug class) MoA is: activates insulin receptor Advantages: universally effective, efficacious; low microvascular risk Disadvantages: hypoglycemia, wt. gain, injectable, patient reluctance, training req, variable cost |
Insulin |
|
___________ (injectable DM drug class) MoA is: activates amylin receptor, decreases glucagon, decreases gastric emptying, increases satiety Advantages: decreased wt, decreased postprandial glucose Disadvantages: GI side effects, modest reduction in A1C, high cost, injectable, hypoglycemia if insulin dose not reduced, dosing freq, training req. |
Amylin mimetics |
|
Prescribing ___________ and ____________ together is a common 2nd line option if A1C <9% due to strong efficacy, low cost, long term data *Two oral medications |
Metformin + Sulfonylurea |
|
Prescribing ________ and _________ together is a frequently recommended 2nd line if failure with Metformin monotherapy and A1C >9% |
Metformin + Basal Insulin |
|
Prescribing TZD and Basal Insulin together for management of DM contributes to high risk for weight ________. |
gain |
|
Discontinuing __________ is often recommended with concurrent insulin use r/t high risk for _____________. |
sulfonylurea; hypoglycemia |
|
True or False: It is possible to combine two incretin-based therapies, such as DPP-4 inhibitor and GLP-1 agonist for DM management. |
FALSE |
|
_________ (age group) considerations for DM: -start low, go slow with med. dosing -avoid combinations that increase hypoglycemia risk -check kidney function (creatinine clearance) -Metformin contraindicated, esp. in >80 y.o. |
Elderly |
|
_____________ is not an attractive DM management medication option in the elderly population. Especially avoid in patients >80 y/o. |
Metformin |
|
___________ is approved for pediatric DM treatment >10 y/o. Insulin is approved for use in pediatric patients with Type I and Type II DM. |
Metformin |
|
A pediatric A1C goal is usually less stringent and is around _________%. |
usually <7.5% |
|
A normal A1C level for a patient w/out diabetes is: ______________ |
4.5-6%, usually under 5.7% |
|
Consider unstable Type II DM tx if patient A1c is over _______, fasting plasma glucose >250 mg/dL, or random glucose >300mg/dL |
Over 8.5% consider T2DM instability... definitely over 10% |
|
_________ is indicated for all patients with Type I and Type II diabetes. |
Insulin |
|
___________ insulin is short-acting. Onset = 30 min Peak = 2-4 Hrs Duration = 5-8 Hrs |
Regular |
|
Novolog®, Humalog®, Apidra®... Newly FDA approved: Inhaled insulin, Afrezza® are all examples of what type of insulin? *Generic names: Lispro, Aspart,Glulisine |
Rapid Acting |
|
_____________ insulin has: Onset = 5-15 min Peak = 1-2 hrs Duration = 3-5 hrs |
Rapid Acting |
|
Lispro, Aspart,Glulisine are __________ insulins. What is the onset, peak, and duration? |
Rapid-Acting Onset = 5-15 min Peak = 1-2 hrs Duration = 3-5 hrs |
|
What is the onset, peak, and duration of "regular" or short-acting insulin? |
Onset = 30 min Peak = 2-4 Hrs Duration = 5-8 Hrs |
|
NPH is an example of an __________-acting insulin. |
intermediate-acting = NPH |
|
What is the onset, peak, and duration of NPH, an intermediate acting insulin? |
Onset = 2 hrs Peak = 4-12 hrs Duration = 18-28 hrs |
|
Insulin glargine (Lantus) and Insulin detemir (Levemir) are two examples of ______-acting or "Basal" insulins. |
Long-acting |
|
What is the onset/peak/duration of Insulin glargine (Lantus) -- a long-acting "Basal" insulin? |
Onset = 2 hrs Peak = No peak; flat Duration = 22-24 hrs |
|
What is the onset/peak/duration of Insulin detemir (Levemir) -- a long-acting "Basal" insulin? |
Onset = 2 hrs Peak = 3-9 hrs Duration 6-24 hrs (but can be dosed q12hr) |
|
_________ insulin cannot be mixed in syringe with other insulin. |
Basal or Long-Acting |
|
Insulin glargine (Lantus) is a "Basal" insulin that is in Pregnancy Category _____. |
Preg. Category C |
|
Insulin is absorbed fastest if injected in the _______. *Exercise increases absorption. *Smoking decreases absorption. |
abdomen |
|
Afrezza, an inhaled insulin is rapid-acting. It is indicated for _________ (age group). *contraindicated in children, women who are pregnant or breastfeeding, asthma, COPD, lung cancer hx, smokers |
Adults greater than or equal to 18 years old |
|
Most common side effect for ________ insulin is?
*concerns about pulmonary toxicity *avoid in pt. that smoke, have hx of lung cancer, or have chronic lung disease like asthma or COPD *must monitor pulmonary function |
Non-Productive Cough |
|
DC __________ insulin if patients have aconfirmed decline of ≥20% in FEV1 frombaseline. |
inhaled insulin
|
|
Adjust "Basal" insulin doses about __ days apart if suboptimal BG. Consider 10-20% adjustment increments. Initial Dose: 0.1-0.2 units/kg/day |
4 days apart |
|
When mixing two insulins in a syringe, draw up the __________ acting insulin first. *Clear before cloudy |
When mixing insulin in a syringe, draw up the quickest acting insulin first (e.g. draw up Humalog or Novolog before drawing up Regular Insulin, or draw up Regular insulin before Novolin N (NPH) or Lente insulin. |
|
There is a decreased support for ___________ r/t insulin therapy due to questionable benefit, safety concerns with lack of individualization, and complicated regimen. According to Beers List: This increases risk of hypoglycemia without improvement in hyperglycemia. |
Sliding Scales |
|
Glycemic targets & BG‐lowering therapies must be ____________, basedon a variety of patient and disease characteristics. |
individualized |
|
Unless contraindicated, _________ remains the optimalfirst‐line drug. |
metformin |
|
__________ is associated with decliningkidney function. It is usually progressive. To manage this, maintain optimal glycemic control, blood pressure control. *Use ACE/ARB |
Albuminuria |
|
Are oral contraceptives safe to use with isotretinoin (Accutane) for treatment of acne? |
Yes |
|
Do not use topical ___________ (tretinoin, benzoyl peroxide) to treat acne rosacea. |
comedolytics (No comedones) |
|
____________ presents as a well-defined plaque with thick silvery scale. Distribution and Pitting of nails are keys to Dx. |
Psoriasis |
|
The following are therapeutic modalities to treat _____________: - Topical steroid creams and ointments - Topical calcipotriene cream and ointment - Topical tazarotene (retinoid) gel - Topical tar containing ointments - Phototherapy (UVB & PUVA) - Oral methotrexate, acitretin (retinoid), or cyclosporine - Injectable biologic response modifiers: etanercept, infliximab, adalimumab, ustekinumab |
ezcema |
|
In treatment of mild to moderate eczema, use __________ only for flares. Class I or II for severe short-term (under 14 days) control in adults, class III or IV for children. Class IV-VII in adults/children for mild flares. |
Topical corticosteroids |
|
Consider ________ in treatment of Eczema if lesions are crusted, widespread, or grossly infected. |
antibiotics |
|
Therapy of severe and widespread ________ includes: *Dermatology referral *Oral or intramuscular steroids *Phototherapy *Oral methotrexate |
eczema |
|
__________ arepruritic transient plaques caused by local release of histamine in the skin.Key to dx is transient lesions (<12-24 hrs). R/t Type 1 Hypersensitivity Rxn. |
urticaria |
|
Treatment for _________ includes: - Identification of allergen and avoidance: drugs, pollen, chemicals, food, bacteria, preservatives, malignanttumor, etc. - Antihistamines (Avoid systemic steroids): * loratadine (Claritin) 10mg daily, cetirizine 10mg daily, fexofenadine 180mg daily (OTC now) * hydroxyzine (Atarax) 10mg-20mg q 6-8 hrs - If chronic (> 6 weeks) consider adding:* cimetidine (Tagamet) 400mg bid-tid |
Urticaria |
|
___________ infections are usually treated with a topical antifungal cream. If widespread, oral. *topical nystatin has no effect on this *avoid combination products r/t skin atrophy due to strong topical steroids *topical steroids in combo therapy cause localized immunosuppression which promote fungal growth |
dermatophyte skin infections |
|
Permethrin 5% cream is applied to all skin sparing face ror 8-12 hrs as a single application as primary tx for ____________. Topical steroids class III-IV and oral antihistamines are also possible for tx/reduction of s/s. |
scabies |
|
Is treatment necessary for Herpes Simplex Orificialis? |
No; same as cold sore. |
|
Topical bacitracin/polymyxin oint to prevent bacterial superinfection is the recommended tx for __________. (r/t dermatology) |
Herpes Genitalis |
|
_________ is a bacterial infection of the skin usually due to staphylococci / streptococci. To treat, obtain culture for bacterial identification but begin Clindamycin or Erythromycin before culture results return. Topical mupirocin (Bactroban) ointment has excellent staph/strep action. |
Pyroderma |
|
__________ is used primarily for pregnancy prevention but can also be used for: cycle regulation, decrease ovarian cysts, PMS and pre-menstrual dysphoric disorder, endometriosis, ovarian and endometrial cancer |
Contraception |
|
The following methods of contraception are ______ failure rates: • Combination pills 0.3‐8% • Depot medroxyprogesteroneacetate (Depo) 0.3‐3% • Intrauterine device 0.6‐2% • Ortho‐evra patch 0.3% • Progesterone mini‐pills 0.5‐3% • Sterilization 0.1‐0.4% |
Low |
|
The following methods are ______ failure rates:
• Cervical cap 9‐32% • Diaphragm 6‐18% • Periodic abstinence 1‐25% • Condoms & spermicides 2‐21% |
High |
|
________ contraceptives mean that the method contains both estrogen and progesterone. Works mainly by preventing ovulation. Examples: -_________ oral contraceptives -ortho evra (patch) -nuva ring |
Combined |
|
The MoA for ________ contraception methods: • Suppression of pituitary gonadotropins (FSH & LH) by the continuouslevels of estrogen and progesterone • Progesterone suppresses LH to prevent the mid‐cycle surge, whichstops ovulation • Progesterone also thickens cervical mucus to impair sperm travel • Estrogen suppresses FSH to prevent the selection and emergence of adominant follicle |
Combined |
|
All forms of _____________ can exhibit some estrogenic, androgenic, or anabolic activity. *Desogestrel and norgestimate are less androgenic than others |
Progesterone |
|
"________" combined oral contraceptives provide same amount of hormones every day for 21 days -- days 22-28 are placebo. *Modified ____‐phasic providesvery low dose estrogen on days24‐28 |
Mono |
|
"_____" and "_____" phasic combined oral contraceptives have varying levels of estrogen / progesterone every week. *Less progesterone in general than monophasics |
"Bi" and "Tri" phasic COC |
|
If an oral contraceptive pill is missed it is important to use __________ method of contraception as precaution. *Backup protection not required if 1 missed pill. Take both together as soon as remembered. |
Back-Up |
|
Combined oral contraceptives are _____________ in: -Smokers over age 35 -Strong fam. hx of heart disease -Clotting disorders |
Contraindicated |
|
The "ACHES" acronym applies to side effects with which medication class? A= Severe abdominal pain C= Chest Pain H= Headache E= Eye problems S= Severe leg pain |
Contraceptives |
|
"Mini-Pills" such as (Micronor, Errin, Nor‐QD, Orvette, Camila) and Depo-Provera injection are ____________ methods of contraception. |
Progestin-Only |
|
__________________ contraceptions provide 24 hrs of protection per pill and must be taken at the exact same time daily (within 30 min) -- if more than 3 hrs late, need backup. *Spotting common w/ first few backs Mini-Pill MOA: don’t consistently suppress the pituitary gonadotropins LHand FSH‐ they really work by changing the endometrial and cervicalmucus environments |
Progestin-Only |
|
The Depo-Provera injection is given every ______ weeks via IM route. Document weight and BP at visits as both can increase on this medication. Depa-Provera MOA: suppresses ovulation and changes cervical mucus. Suppressesestradiol levels, which can eventually lead to decreased bone mass(reversible). |
12 weeks |
|
Depa-Provera can suppress __________ levels, which eventually can lead to decreased bone mass (reversible). |
estradiol |
|
Short-Acting Reversible Contraceptives (Mini-Pill / Depo-Provera) are ____________ in the following patients: • Women who can’t take combined methods because of co‐morbiditiesor chronic disease • Undiagnosed vaginal bleeding • Active viral hepatitis or cirrhosis • Breastfeeding women • Hypertensives • Women over 35 that smoke |
Indicated |
|
Mirena and Skyla are examples of ___________ Long-Acting Reversible Contraception (LARCs). *Last 3-5 yrs *Check strings monthly after menses *Inserted in clinic MOA of LARCs: • Thickens cervical mucus • Suppresses ovarian function • Inhibits sperm movements • Thins the uterine lining |
Hormonal |
|
Nexplanon (Implanon) is a Hormonal LARC that is _________ into the patient's arm for 3 yrs. *SE: menstrual irregularities, weight gain, headache, vaginitis *Increased risk for blood clots MOA of nexplanon (Implanon): • Contains etonorgestrel (same progestin as in nuva ring) • Blocks the LH surge to prevent ovulation • Thickens the cervical mucus • Thins the endometrial lining *Few contraindications |
inserted/implanted |
|
nexplanon (Implanon) is a Hormonal LARC that is __________ in patients with: active liver disease or active venousthromboembolism women treated with CYP3A‐inducing orinhibiting meds |
Contraindicated |
|
Paragard (Copper IUD) is a __________ LARC. -Can be used for up to 10 years -SE: heavier mentrual bleeding/cramping |
Non-Hormonal |
|
Plan B is a high dose ________ that is used to prevent pregnancy for up to 3 days after unprotected intercourse... better chance of working the sooner it is taken. -2 pills ... take first as soon as possible, take second 12 hrs later -MOA: prevents ovulation... won't disturb an established pregnancy |
Progestin (levonorgestrel) |
|
_____________ women are at increased risk for: • Stroke • Heart disease • Fractures‐ especially hip • Colorectal cancer • Endometrial cancer |
Menopausal |
|
___________ is defined as the permanent cessation of menses and begins when the patient has an entire year without menses. |
Menopause |
|
The median age in the US for Menopause is ________ to _______. |
49 to 51 |
|
_____________ in menopause is due to the remaining follicles becoming resistant to the effects of FSH. Follicles decrease and atrophy with age. Less estrogen produced. |
Amenorrhea |
|
____________ is used to treat symptoms, not to prevent diseases that increase with menopause. *Not meant to be permanent and are usually taken 1-3 yrs after menopause. *Consider if pt. has uterus |
Oral hormone replacement therapy (HRT) |
|
True or False: Vaginal estrogen is systemically absorbed. *Used to help with vaginal symptoms of dryness, burning, or pain with intercourse. |
False |
|
Oral estrogen should be started at a _______ dose and ______ PRN if symptoms are not well controlled |
Low dose; increase PRN |
|
Do not apply ___________ estrogen to breast or waistline. *most common side effect is skin irritation |
Transdermal |
|
_________ estrogen has a greater effect on the liver due to the first‐passeffect. ____ estrogen administration increases hepatic production oftriglycerides, HDL, and clotting factors |
Oral; Oral |
|
______________ estrogen is as effective in preserving bone density and intreating menopausal symptoms. Also associated w/ a lower risk ofvenous thrombosis and stroke, and has less effect serum lipids |
Transdermal |
|
Vaginal creams have low ________absorption and are good for vaginalcomplaints. |
systemic |
|
Medroxyprogesterone acetate is the most commonly prescribed_________‐ typically given in a cyclic (5‐10mg/day) or continuousregimen (2.5mg/day) |
progestin |
|
Natural micronized progesterone (prometrium) has ____ impact onlipids and is associated with ____ bleeding. Usual dose 200mg/daycyclically or 100‐200mg/day continuously |
less; less |
|
Estrogen + progesterone combination is used <5 years because of increased risk for ______ cancer. |
breast |
|
___________ can protect against endometrial cancer and hyperplasia in menopausal women. |
Progesterone |
|
Long term use of __________ is associated with hepatocellular neoplasm, increasededema, and elevation of cholesterol level. Decrease in ____________ accompanies menopause; this can lead toloss of libido |
testosterone |
|
The ONLY indication for _________ is severe vasomotor symptoms and loss of libido |
testosterone |
|
The following medications are _____________ treatments for menopause symptoms: • Effexor (venlafaxine) • Paxil (paroxetine) • Zoloft (sertraline) • Neurontin (gabapentin) • Clonidine |
Non-Hormonal |
|
True or False: There is evidence that Bioidentical hormonesare safe / effective for menopause symptom resolution. |
False... limited evidence even though some are FDA approved. |
|
The following are examples of ____________ ... meaning that these foods contain levels of estrogen naturally. • Soybeans and soy products • Cashews • Peanuts • Oats • Corn • Wheat • Apples • almonds |
phytoestrogen |
|
_______________ is ABSOLUTELY NOT recommended for the following patients: • Personal history of breast cancer(esp. estrogen) • Personal history of endometrialcancer (esp. estrogen) • Undiagnosed genital bleeding • Acute liver disease • Active thromboembolic disease orhistory of • Known or suspected pregnancy There are relative CONTRAINDICATIONS for ____________ in the following patients: • Chronic liver dysfunction • Uncontrolled/poorly controlledHTN • Acute intermittent porphyria |
Hormone Replacement Therapy |
|
Are Pregnancy A Category medications safe to use while pregnant? |
Yes |
|
True or False: As a FNP, we should NOT treat HTN in pregnant woman. Refer this patient. |
True. Do not treat HTN pregnancy... refer. |
|
What medication is recommended for heartburn if the client is pregnant? |
Nexium |
|
Diclegis, Zofran, phenergen are recommended for _______ if the patient is pregnant. |
Nausea and Vomiting |
|
Azithromycin is used to treat __________ in a pregnant client. |
Chlamydia |
|
If a patient is pregnant and has a URI, Strep, etc. what antibiotics would you consider? |
Amoxicillin/Ampicillin |
|
True or False: Tessalon perles and Codeine are safe to use in a pregnant client with cough? |
True |
|
True or False: Macrobid, Keflex, and Bactrim are contraindicated in patient with UTI that is pregnant. |
False. Recommended... except for Bactrim which is contraindicated near-term. |
|
_______ is the drug of choice for post-partum depression. |
Zoloft |
|
True or False: Progesterone only or hormone-free (copper IUD) are safe contraceptives to use during lactation? |
True |
|
The first line treatment for a UTI is ________________ (alternative to Macrobid) *Less likely to cause vaginal yeast infection. *Caution: N/V, anorexia, INR prolongation, allergy to sulfa *Contraindicated: <2 y/o, pregnant, breast feeding, megaloblastic anemia |
Trimethoprim/Sulfamethoxazole (Bactrim/Septra) |
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The first-line treatment for a UTI (alternative to TMP/SMP) is __________. *Need 7 days for effect *SE: Nausea, Dizzyness, Pulmonary complications *Contraindications: Poor urinary output |
Nitrofurantoin (Macrobid, Macrodantin) |
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Second-Line treatment for UTI includes medications in the ____________ class. *may be 1st line for men, post-menopausal women, complicated, or pyelonephritis *SE: insomnia, drug interactions, Steven Johnson Syndrome, dizziness, Headache *Contraindication: NOT in children, AVOID in pregnant *Tendon rupture risk |
Flouroquinolones Ciprofloxacin (Cipro) OR Levofloxacin (Levoquin) |
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Avoid _____+_____ for UTI in geriatric populations... |
fluoroquinolones + nitrofurantoin |
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Consider abuse if _______ (age group) present with recurrent UTI. Consider genitourinary abnormality. Tx takes 7-14 days. |
children |
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The primary tx of bacterial prostatitis is __________. First line is __________ (medication class). Second line drug is Doxycycline (long-acting tetracycline). |
antibiotics; fluoroquinolones |
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_______ is the most common prostatic problem in men over age 50. *Causes difficulty with urination |
BPH |
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Alpha Blockers and 5a Reductase inhibitors are medications that can improve symptoms of ________. Alpha Blockers are contraindicated in preg., hepatic and renal insufficiency *Pregnant women should not handle 5a reductase inhibitors |
BPH |
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Examples of ____________ are finasteride (Proscar)+ Dutasteride (Avodart). *Block conversion of testosterone to DHT. This reduces size of prostate. *SE: impotence, decreased libido, lower ejaculatory volume |
5a reductase inhibitors |
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Examples of __________ are Terazosin (Hytrin), doxazocin (Cardura), tamulosin(Flomax). *Relax vasculature, prostate, and bladder neck *SE: tachyarrhythmia, ortho hypotension, syncope, dizzyness, fatigue *Best to take at BEDTIME |
alpha blocker |
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______________ is the most common sexual dysfunction in men. |
Erectile dysfunction |
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Risk factors for _____________ (sexual disorder) include: age, CV disease, chronic illness,certain medications, sedentary lifestyle, obesity andothers |
Erectile dysfunction |
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______________ are medications that improve development and function of erection. Examples of medications include: Sildinafil (Viagra) Vardenafil Levitra Tadalafil (Cialis) -- different chemically, longer acting |
PDE5 inhibitors |
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Contraindications for _____________ (sexual med) include: -high fat meal prior to dosing -concurrent use with nitrates/alpha blockers (Flomax can be taken with Cialis) SE include: headache, flushing, GI upset, nasal congestion, priapism |
PDE5 inhibitors |
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_______ bladder is defined as urinary frequency / urgency >8x/d and nocturia >2x/night *Not normal part of aging *Women report more |
Overactive |
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Medications to treat _________ are in the anticholinergic/antimuscarinic class. Examples include: oxybutinin (Ditropan) and tolterodine (Detrol) -- first line *Work by antagonizing muscarinic receptors,thus reducing frequency and strength detrusorcontraction *SE: blurry vision, dry mouth, constipation, urinary retention, cognitive dysfunction *Contraindicated in: glaucoma, urinary retention |
Overactive Bladder |
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______________ (r/t treating overactive bladder) are contraindicated in glaucoma and urinary retention. |
Anticholinergic/antimuscarinic |
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___________ may help symptoms of overactive bladder in males related toreduction of obstruction, but in females mayincrease stress incontinence. |
Alpha Blockers |
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True or False: Corticosteroids can cause secondary osteoporosis. |
True |
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A DXA scan is the gold standard for diagnosis of ___________ and assessment of bone health. *Should always be accompanied by health promotion -Calcium / Vitamin D intake -Smoking cessation -Moderation in EtOH consumption -Regular weight bearing exercise |
Osteoporosis |
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A ________ compares bone mineral density (BMD) to optimal peak BMD (age 30) for patient's gender. This is part of DXA interpretation. Normal BMD: 0 to -1.0 Osteopenia: -1.0 to -2.5 Osteoporosis: <2.5 |
T-Score |
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True or False: dietary supplemental calcium / vitamin D decrease risk for fractures and can impact bone mineral density. |
False |
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_________ supplement interferes with absorption of many medications and should ideally be taken 2 hours before/after other agents. *Avoid taking with PPI/caffeine *Common SE = dyspepsia and constipation |
Calcium |
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Vitamin ____ can impact levels of depression and heart disease. This vitamin assists in mineral absorption in the gut and assists in maintaining normal serum calcium and phosphorous levels. *25-hydroxy-vitamin ___ lab test is the one you want in order to assess deficiency |
D |
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Vitamin _______ deficiency is recognized as problematic for ALL ages. Causes of deficiency include: – Decreased sun exposure due to working indoors – Skin cancer prevention with increased sun block use – Malabsorption syndromes – Kidney and liver disease – Older adults with decreased fat stores – Poor nutrition |
Vitamin D |
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Does cholecalciferol (Vitamin D3) or ergocalciferol (Vitamin D2) have better absorption? |
Vitamin D3 or cholecalciferol |
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The primary goal of pharmacology r/t osteoporosis is ______ reduction. |
FRACTURE REDUCTION
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Bisphosphonates _________ bone resorption. |
inhibit |
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____________ (osteoporosis med class) are indicated in patients: -That have had a fragility fracture -T score <-2.5 (osteoporosis) -T score -1.0 to -2.5 with clinically significant risk factors for fracture *FRAX scaling tool assesses fracture risk factor |
Bisphosphonates |
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Alendronate (Fosamax) and Risdronate (Actonel) are examples of medications in the ___________ class. These are considered first-line. *Avoid in patients with advanced renal failure (CrCl < 30) *Tablets must be taken on an EMPTY stomach, first thing in morning with 8oz plain water. Must remain 30 min upright and cannot eat/drink anything else. |
Bisphosphonates |
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Potentially dangerous side effects of ____________ (osteoporosis med class) include: • Atypical subtrochanteric and diaphyseal femur fractures? (askabout thigh/groin pain before and during therapy) • Esophogeal cancer? (consider alternate class for patients withsignificant GERD or med‐related exacerbation of symptoms) • Reclast and ARF? (check renal function just prior toadministration, hold for CrCl<35) • Osteonecrosis of the jaw? (maintain good oral hygiene andnotify oral surgeon about therapy pre‐procedure) |
Bisphosphonates |
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_______________ (osteoporosis med) is indicated for patients that: -Do not tolerate bisphosphonates and have osteoporosis (T‐score < ‐2.5) OR – Have osteoporosis and additional fragility fracture while on bisphosphonate *use this med for 18-24 months and then resume bisphosphonate |
Teriparatid (Forteo)
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_________ is most effective after bisphosphonates. Used for prevention and treatment. Same risks/contraindications as in menopause. |
Estrogen |
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Raloxifene (Evista) is a Estrogen Agonist/Antagonist that increases bone mineral ________ and reduce the risk of vertebral fractures. *Used for prevention/treatment in post-menopausal women; less effective than bisphosphonate/estrogen but has favorable SE *Concerns: hot flashes, leg cramps, clots |
density |
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Denosumab (Prolia) MOA is: Human monoclonal antibody to the receptor activator of nuclearfactor kappaB ligand (RANKL), an osteoclast differentiating factor. Itinhibits osteoclast formation, decreases bone resorption, andincreases bone mineral density (BMD). It is indicated for those who cannot tolerate _____________ and is administered with a SQ injection q6month *Precautions: hypocalcemia (correct calcium prior to administration); rash/cellulitis at injection site; ONJ and atypical femur fx |
bisphosphonates |
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_________ is approved for treatment of osteoporosis in women who are atleast 5 years post‐menopausal when alternative treatments arenot suitable. 30% reduction in vertebral fx. |
Calcitonin |
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To follow-up treatment of ________________, re-scan patient after 1-2 yrs of therapy (if improvement, then q2-5 yrs); medicare covers 2 yrs |
Osteoporosis |
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If _____________ (Osteoporosis medication) is not tolerated, choose: – IV bisphosphonate if T‐score < ‐2.5 – Estrogen (for immediately post‐menopausal) – Raloxifene (Evista) (if no contraindications) – Calcitonin (for older/no other options) |
bisphosphonate |
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If patient has a ___________ while on bisphosphonate, start teriparatide (Forteo). |
fracture |