Pharm- Anemias, Anticoagulation, Thyroid

Front 1

ferrous gluconate
1. % elemental iron
2. with/without food
3. Form
4. DDI

Back 1

1. 12%
2. empty stomach (1 hour ac)
3. tablets only
4. most decrease absorption; vit C increases absorption

Front 2

ferrous gluconate
1. class
2. ADE
3. antacids

Back 2

1. oral iron supplement
2. dyspepsia, DVCD, dark stools
3. 1 hour before, 4 hours after antacids.

Front 3

ferrous sulfate
1. class
2. % elemental iron
3. forms

Back 3

1. oral iron supplement
2. 20%
3. tablets, drops, elixer, syrup:suspension

Front 4

ferrous fumerate
1. class
2. % elemental iron
3. forms

Back 4

1. oral iron supplement
2. 33%
3. tablets, drops, or suspension.

Front 5

name oral iron supplements from most to least elemental iron

Back 5

1. ferrous fumerate
2. ferrous sulfate
3. ferrous gluconate

Front 6

FSG-359

Back 6

F= fumerate
S= Sulfate
G= Gluconate

take mg and divide by the corresponding number to get percentage of elemental iron

Front 7

Parenteral iron indications

Back 7

severe iron deficiency anemia

Front 8

which IV iron supplement has the most elemental, iron?

Back 8

ferrlecit

Front 9

Which IV iron supplement has the least elemental iron?

Back 9

Sucrose

Front 10

Name 3 IV iron supplements

Back 10

1. Ferrlecit
2. Dextran
3. Sucrose

Front 11

indications for Ferrlecit

Back 11

chronic hemodialysis and EPO

Front 12

ADE of ferrlecit

Back 12

cramps
NV
flushing
hypotension
rash

Front 13

indications for IV Dextran

Back 13

oral iron supplementation not possible or ineffecient.

Front 14

BBW of Dextran

Back 14

give test dose- many anaphylaxis reactions

Front 15

ADE of Iron Dextran

Back 15

injection site pain & discoloration
hypotension
fever
chills

Front 16

Iron Sucrose- indications

Back 16

chronic hemodialysis and EPO

Front 17

Iron Sucrose BBW

Back 17

anaphylactic reaction: give test dose first

Front 18

ADE of iron sucrose

Back 18

leg cramps
hypotension

Front 19

how is dosing decisions made for parenteral iron supplementation?

Back 19

weight-based

Front 20

in comparison to oral iron supplements, what SE do IV iron supplements have more frequently?

Back 20

hypotension
cramps

Front 21

What do you give for a vit B12 deficiency

Back 21

cyanocobalamin

Front 22

what do you give to treat pernicious anemia

Back 22

cyanocobalamin

Front 23

If a patient has B12 deficiency and no neurological symptoms: tx =

Back 23

OTC B12

Front 24

if a patient has B12 deficiency and neurological symptoms (memory & psychosis)

Back 24

subQ or IM injection B12

Front 25

what is important to do regarding the administration of B12 injections?

Back 25

titrate up: 1 per week, then 1 per month, then every month (ultimately)

Front 26

ADE of cyanocobalamin

Back 26

headache
nausea/vomiting
hypok

Front 27

monitor k levels for B12 patients for how long?

Back 27

1-2 weeks post initiation of B12 injections, then 1-2 times per year

Front 28

what ways can B12 injections be administered?

Back 28

1. subQ
2. IM

Front 29

What must you remember to prescribe when writing an Rx for cyanocobalamin?

Back 29

needle: gauge and length
IM: long
SubQ: short

Front 30

If altering diet to correct mild B12 deficiency, which patients should not add clams, oyster, and tuna to their diet to improve B12 levels?

Back 30

someone with Gout

Front 31

for iron-deficiency anemia and oral iron supplementation, peds patients require what form?

Back 31

drops

Front 32

Normal folate-deficiency patients have what dose?

Back 32

1 mg every day

Front 33

folate-deficiency anemia is common in what syndrome?

Back 33

alcoholism

Front 34

folic acid deficiency is often drug induced by:

Back 34

1. antiseizure medications
2. MTX
3. HTN meds

Front 35

What two drugs can you prescribe for anemia of chronic disease?

Back 35

Procrit & Aranesp

Front 36

when writing an Rx for Procrit/Aranesp, what else must you provide?

Back 36

iron supplementation

Front 37

MOA of Procrit/Aranesp?

Back 37

stimulate erythroid progenitor division and differentiation

Front 38

BBW of Procrit/Aranesp?

Back 38

1. increase CV risk in CRF
2. increase risk of death & tumor progression in cancer
3. increase risk of thromboembolic events in surgery patients.

Front 39

CI for Procrit/Aranesp?

Back 39

1. uncontrolled HTN
2. Ab-mediated anemia

Front 40

ADEs of Procrit/Aranesp?

Back 40

1. HTN
2. Edema
3. Tachycardia
4. Thrombosis
5. NVD

Front 41

Serious ADEs of Procrit/Aranesp?

Back 41

1. tumor progression
2. increased mortality
3. CHF
4. Stroke
5. MI
6. Seizure
7. embolism

Front 42

route of administration for Procrit/Aranesp?

Back 42

SubQ or IV

Front 43

Dosing of procrit/aranesp is dependent on?

Back 43

disease

Front 44

target Hb level when treating anemia of chronic disease with Procrit/Aranesp?

Back 44

10-12

Front 45

When can you increase a dose of Procrit/Aranesp 25%?

Back 45

if Hb response <1 gm in 4 weeks or Hb <10

Front 46

when can you decrease a dose of Procrit/Aranesp by 25%?

Back 46

If Hb response >1gm within 2 weeks or hb >12

Front 47

Extrinsic clotting cascade activated by:

Back 47

tissue thromboplastin

Front 48

intrinsic clotting cascade activated by:

Back 48

activation of Factor XII by contact

Front 49

common clotting cascade:

Back 49

converge on factor X-- leading to activation--generation of thrombin and prothrombin

Front 50

Thromboembolism occurs in what 3 conditions?

Back 50

1. DVT
2. PE
3. VTE

Front 51

What are some risks associated with developing a thromboembolism?

Back 51

1. older than 50
2. major surgery
3. history of VTE
4. trauma
5. obesity
6. catheter (dialysis patients)
8. estrogen (OCP or HRT)
9. hypercoagguable states

Front 52

MOA of Unfractioned Heparin

Back 52

1. potentiates actions of antithrombin III-- leading to inactivation of thrombin factors & plasmin
2. prevents conversion of fibrinogen to fibrin
3. stimulates release of lipoprotein lipase
4. binds platelets: prevents platelet aggregation.

Front 53

administration of unfractioned heparin

Back 53

1. treatment: IV- reliable absorption
2. prophylaxis: SubQ- erratic absorption
3. bolus flush

Front 54

what should you monitor when putting a patient on unfractioned heparin?

Back 54

1. aPTT
2. antifactor Xa activity
3. [plasma]

Front 55

CI for unfractioned heparin

Back 55

1. severe thrombocytopenia
2. uncontrolled active bleed/ hemorrhage
3. heparin-induced thrombocytopenia (monitor platelets)

Front 56

What is important to know when administering unfractioned heparin?

Back 56

the concentration

Front 57

Lovenox
1. class

Back 57

LMW heparin

Front 58

Fragmin
1. class

Back 58

LMW Heparin

Front 59

LMW Heparin
1. two drugs
2. MOA changes from unfractioned H

Back 59

1. Lovenox & Fragmin
2. more predictable anticoagulation dose response, longer half-life, decreased thrombocytopenia & need for monitoring, less erratic subQ abrosption, more antifactor Xa activity.

Front 60

CI of LMW Heparin

Back 60

1. history of HIT (heparin-induced-thrombocytopenia)
2. hypersensitivity to pork

Front 61

Dosing of LMW Heparin
1. based on
2. adjusted

Back 61

1. actual BW
2. renal

Front 62

Administration of LMW Heparin

Back 62

pinch skin- inject at 90* angle

Front 63

What should you monitor when giving LMW heparin?

Back 63

1. CBC: q5-10 days for 1-2 weeks; then 2-4 weeks
2. PT
3. antifactor Xa
4. platelets
5. occult blood

Front 64

ADEs of LMW heparin

Back 64

1. bruising
2. increased liver enzymes & triglycerides
3. hyperK
4. hemorrhage/hematoma
5. fever/confusion

Front 65

if you have arrhythmias or HyperK and you are prescribing LMW heparin, you should:

Back 65

bump up the calcium

Front 66

T3:
T4:

Back 66

T3: Thiodothyronine
T4: Thryoxine

Front 67

T3 is _____ in plasma and _______ bioactive than T3. It comprises ____________- % of free thyroid hormones

Back 67

unbound
more
10-25%

Front 68

T4 is _______ to plasma proteins and represents ______% of free thyroid hormones

Back 68

bound
75-95%

Front 69

the hypothalamus responds by releasing TRH in situations where ______ levels are decreased

Back 69

T4

Front 70

Hypothyroidism Disease spectrum

Back 70

high TSH, low free T4

Front 71

Mild thyroid failure disease spectrum

Back 71

high TSH, normal free T4

Front 72

euthyroid disease spectrum

Back 72

normal TSH, normal free T4

Front 73

Thyrotoxicosis (hyperthroidism) disease spectrum

Back 73

low TSH, normal/elevated free T3/T4

Front 74

Propylthiouriacil (PTU)
1. Use
2. MOA
3. Duration of treatment

Back 74

1. Graves disease; prep for surgery until euthyroidic
2. inhibits thyroid hormone synthesis
3. depends on severity of disease (from 6 months-3 years)

Front 75

PTU for surgical prep- once euthyroid levels are reached, what must you do?

Back 75

give iodine to decrease vascularity.

Front 76

PTU
1. dose
2. BBW
3. Pregnancy Category-max dose

Back 76

1. adjust based on TFTs (begin QID)
2. hepatotoxic
3. Cat D: max dose 200 mg/day

Front 77

PTU
1. SE/ADE

Back 77

1. dem
2. GI
3. Arthritis
4. granulocytopenia
4. leukopenia

Front 78

Methimazole
1. use
2. MOA
3. potency

Back 78

1. hyperthyroidism
2. inhibits thyroid hormone synthesis
3. more potent than PTU

Front 79

compare Methimazole and PTU

Back 79

MMI is:
1. more potent
2. longer lasting
3. faster acting

Front 80

Methimazole
1. dose
2. Pregnancy category- max dose & implications

Back 80

1. based on TFTs
2. D- max dose: 20 mg/day: excreted in breastmilk

Front 81

Methimazole
SE

Back 81

1. derm
2. myalgia/arthralgia
3. jaundice
4. edema
5. nephritis
6. agranulocytosis
7. hepatotoxicity

Front 82

Potassium Iodide
4 brands

Back 82

1. SSKI
2. Lugols
3. Thyrosafe
4. Thyroshield

Front 83

Potassium Iodide
1. use
2. MOA
3. FDA pregnancy category

Back 83

1. hyperthyroidism
2. inhibits thyroid hormone synthesis and release; increases the volume and decreases the viscosity of respiratory secretions
3. D

Front 84

potassium iodide
CI

Back 84

1. hyperkalemia
2. severe dehydration
3. hypothyroidism
4. renal impairment

Front 85

potassium Iodide
SE/ADE

Back 85

1. metallic taste
2. GI-upset & bleed
3. arrythmias
4. goiter
5. angioedema

Front 86

if your patient has an adverse drug reaction and complains of "metallic taste" he probably took:

Back 86

Potassium Iodide for hyperthyroidism tx

Front 87

1. Form of SSKI
2. Lugals: form
3. general administration of both:

Back 87

1. iodide drop
2. solution: iodide per drop
3. mix in water or juice

Front 88

Propranolol (inderal)
1. use
2. MOA
3. formulations

Back 88

1. symptomatic treatment associated with hyperthyroidism: anxiety, tremor, sweating, increased HR
2. MOA: non-selective beta antagonish: partially blocks conversion of T4 into T3
3. ER

Front 89

Propranolol (Inderal)
1. dose
2. BBW
3. CI

Back 89

1. titrate up and then back down, and off.
2. angina exacerbation, MI, or ventricular arrhythmias with abrupt discontinuance
3. cardiogenic shock or sinus bradycardia

Front 90

Propranolol (Inderal)
precautions

Back 90

1. bronchial asthma
2. DM
3. uncompensated heart failure
4. abrupt withdrawal
5. pregnancy: 2nd and 3rd trimester

Front 91

SE/ADE of Propranolol

Back 91

1. dizziness
2. bradycardia
3. hypotension
4. bronchospasm

Front 92

What do you use to treat hypothyroidism?

Back 92

thyroid hormone supplementation (crude or synthetic)

Front 93

Crude Thyroid
1. origin
2. T4:T3 ratio
3. Importance:
4. Food

Back 93

1. crushed animal thyroid
2. 2-5:1
3. brand names are not bioequivalent
4. take 30 minutes before eating

Front 94

Name 3 synthetic thyroid hormones

Back 94

1. levothyroxine
2. liothyronine (cytomel)
3. Liotrix (Thyrolar)

Front 95

Levothyroxine
1. class
2. thyroid hormone
3. dosing

Back 95

1. synthetic thyroid hormone
2. PURE T4
3. start low, titrate up; adjust dose q 4-8 weeks based on TFTs

Front 96

Levothyroxine
1. food
2. DDI- 4 categories

Back 96

1. take on empty stomach
2. malabsorption syndromes, decreased absorption due to foods/meds, increased clearence due to drugs, or decreased T4-T3 clearance, due to drugs.

Front 97

what drugs increase the clearance of levothyroxine?

Back 97

rifampin
carbamazepine
phenytoin

Front 98

what drugs decrease the clearance of T4 into T3

Back 98

amiodarone
selenium deficiency

Front 99

Liothyronine (Cytomel)
1. Thyroid Hormone
2. ADEs

Back 99

1. PURE T3
2. cardiac

Front 100

which synthetic thyroid hormone is pure T3?

Back 100

Liothyronine (Cytomel)

Front 101

which synthetic thyroid hormone is pure T4?

Back 101

Levothyroxine

Front 102

Liotrix (Thyrolar)
1. class
2. T4:T3 ratio

Back 102

1. synthetic thyroid hormone
2. 4:1

Front 103

Thyroid Hormones
1. BBW
2. CI

Back 103

1. not for weight loss (does increase metabolism)
2. acute MI, thyrotoxicosis, adrenal insufficiency

Front 104

Thyroid hormones
SE/ADE

Back 104

1. increased appetite
2. tachycardia
3. weight loss
4. nervousness
5. insomnia
6. heat intolerance
7. tremor
8. arhythmias
9. CHF
10. HTN
11. Angina

Front 105

Thyroid Hormone:
Pregnancy Category

Back 105

A