Neuroendocrine Obesity Pharm 2

43問 • 1年前

問題一覧

Uncontrolled HTN, sz disorders, patients abruptly stopping ETOH, benzos, barbiturates or AEDs; patients on opioids

CI for Combination Agents

Worsening depression, neuropsychiatric reactions; may need to ↓ dose of anti-diabetic agents; can ↑ levels of Paxil, Zoloft, Risperdal, Metoprolol

AE of Combination Agents

GLP-1 Receptor Agonists

High Dose Liraglutide [Victoza or Saxenda]

3 mg SQ daily, GLP 1 receptor agonist; ↓ appetite & ↑ satiety

MOA of GLP-1 Receptor Agonists

Insulin, personal or family hx of thyroid cancers or mx endocrine neoplasia syndrome type 2, pancreatitis

CI for GLP-1 Receptor Agonists

Constipation, diarrhea, dyspepsia, fatigue, increased HR, low BS [rare in nondiabetics], nausea

AE for GLP-1 Receptor Agonists

Cannot administer 3 mg of Liraglutide as Victoza [must give 2 shots of 1.8 + 1.2 mg/ml]; but can give as one injection if you Rx patient with Saxenda

Considerations for GLP-1 Receptor Agonists

Depression medications that contribute to weight gain

citalopram (Celexa) fluoxetine (Prozac) fluvoxamine (Luvox) mirtazapine (Remeron) paroxetine (Paxil) sertraline (Zoloft)

Mood Stabilizers that contribute to weight gain

clozapine (Clozaril) lithium (Eskalith, Lithobid) olanzapine (Zyprexa) quetiapine (Seroquel) risperidone (Risperdal)

Diabetic medications that contribute to weight gain

glimepiride (Amaryl) glipizide (Glucotrol) glyburide (Diabeta, Micronase) insulin nateglinide (Starlix) pioglitazone (Actos) repaglinide (Prandin)

Corticosteriods that contribute to weight gain

methylprednisolone (Medrol) prednisolone (Orapred, Pediapred, Prelone, and others) prednisone (Deltasone, Prednicot, Sterapred, and others)

Anti-Seizure & Anti-Migraine Medications that contribute to weight gain

amitriptyline (Elavil) nortriptyline (Aventyl, Pamelor) valproic acid (Depacon, Depakote, Stavzor)

Which part of the adrenal gland is correctly paired with the type of substance it secretes?

Zona fascciculata - cortisol

Corticosteroids are useful in the treatment of which of the following disorders?

Inflammatory bowel disease

Which of the following is a long-acting glucocorticoid?

Dexamethasone

A 35-year old man is prescribed a short course of oral prednisone for an exaberation of asthma. Which of the following adverse effects is the most likely in this patient?

Mood changes

A young boy is diagnosed with congenital adrenal hyperplasia. Which is the most appropriate for treatment of this patient?

Prednisone

A patient with Addison's disease treated with hydrocortisone is experiencing dehydration and hyponatremia. Which drug is best to add to the current therapy?

Fludrocortisone

Which of the folllowing strategies is effective to minimize development of HPA axis suppression in a patient with RA on long-term high-dose corticosteroid therapy?

Alternative-day administration

A 33-year old woman is in preterm labor. Which of the following is most appropriate to administer to her to accelerate fetal lung maturation and prevent respiratory distress syndrome in her newborn?

Betamethasone

A paient with resistant hypertension is found to have high aldosterone level. Which of the following agents would be most appropriate to add to the current antihypertensive regimen for management of the blood pressure?

Spironolactone

On physical examination, a 34-year old woman is noted to have central obesity, elevated blood pressure, mood facies, a dorsal fat pad, and striae. The provider believes she may have Cushing syndrome. Administration of which of the following agents would be beneficial in the diagnosis of Cushing syndrome in this patient?

Dexamethasone

Which of the following hormones is correctly matched with its primary effect?

FSH - stimulates ovarian follicle growth

Which of the following agents is correctly paried with an appropriate clinical use of the drug?

Desmopressin - treatment of DI

A 31-year old man presents to his endocrinologist for the management of a new diagnosis of acromegaly. Which of the following drugs would be most beneficial in the treatment of this patient?

Lanretotide

A 40-year old woman is undergoing infertility treatments. Which of the following drugs is most likely to be included in her treatment regimen?

Follitropin

A 51-year old woman with HIV complains of involuntary weight loss and weakness for the past month. Which of the following agents could be prescribed for the treatment of the patient's HIV-related cachexia?

Somatropin

A 29-year old woman with complaints of fatigue and weight gain presents for her annual physical exam. Her TSH is 13.5 mlU/L (normal 0.5-4.7 mlU/L). Which of the following agents is most appropriate to treat the TSH abnormality?

Levothyroxine

A 45-year old woman requires levotheyroxine for a new diagnosis of hypothyroidism. Her current medications include metoprolol and pravastatin. She also takes calcium carbonate and vitamin D supplements. Which of her new medications may affect the levothyroxine dosage requirements?

Calcium carbonate

Which of the following symptoms indicates that a patient may need a lower dosage of levothyroxine?

Palpitations

A 36-year old woman presents with complaints of irritability, tremor, and heart palpitations. A laboratory evaluation reveals a low TSH and high free T4 concentrations. She is currently in her first trimester of pregnancy. Which of the following treatment options is most appropriate for this patient?

Propylthiouracil

A 24-year old patient is given iodine to decrease the vascularity of the thyroid gland prior to surgery. What adverse effect is the patient most likely to experience?

Sore throat

Optimally, at what interval should the TSH be reassessed after a Levothyroxine dosage is adjusted?

6-8 weeks

The use of which of the following medications can induce thyroid dysfunction?

Lithium

You are prescribing Levothyroxine to an elderly 82 year old. Which of the following should you keep in mind?

The Levothyroxine dose needed by the elderly is 75% or less of what would be needed by a younger adult

Consider holding the Levothyroxine dose if the heart rate is which of the following?

>100 bpm

Methimazole [Tapazole] is primarily excreted via:

Urine

Patients taking anti-thyroid drugs should avoid which of the following?

Seafood

Which of the following should be monitored in a patient taking PTU?

CBC

Your patient has been on exogenous Prednisone 20 mg a day [for the last 7 days] for joint pain; do you need to taper the medication before discontinuing?

Your patient has been on exogenous Prednisone 40 mg a day [for the last 12 days] for rhus dermatitis; do you need to taper the medication before discontinuing?

Your patient has been on exogenous Prednisone 20 mg a day [for the last 30 days] for polymyalgia rheumatica. The disease is now in remission; do you need to taper the medication before discontinuing?

Yes

-GIabsorption is 50-80% -Drug has narrow therapeutic range and absorption changes can make changes in blood level -Cautious use with recent MI -Do not stop drug abruptly -Diabetes mellitus can be aggravated with initiation of the drug

Levothyroxine

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