Science Quiz / Clinical Pharm, Midterm 2 part 1

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Can you name the Clinical Pharm, Midterm 2 part 1

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What enzyme is responsible for the movement of iodine around on tyrosine residues to create thyroid hormones?
 
How many molecules of T4 are released per T3 molecule, roughly?
 
In circulation, thyroid hormones are usually bound to?
 
True or false: 5'-deiodinase is responsible for the conversion peripherally of T3 to T4?
 
Thyroxine is AKA __, Triiodotyronine as __
__, __ 
In what species is hypothyroidism most common? What is the most common form in this species?
 
 
This condition makes up around half of all canine acquired primary hypothyroidism cases?
 
Which of the following would you not expect as a sign of hypothyroidism?
a)cold intolerance b)hyperpigmentation, poor coat quality c)bradycardia d)weight loss e)abnormal estrus/infertility f)alopecia, secondary pyoderma 
Which of the following would you consider a congenital pituitary based cause of hypothyroidism?
a)pituitary masses b)receptor defects c)idiopathic follicular atrophy d)lymphocytic thyroiditis e)disorders of dyshormonogenesis 
This is the drug of choice for replacement therapy in clinical hypothyroidism?
Longer halflife allows once daily dosing, easily monitored in plasma, does not bypass cellular regulatory processes. 
True or false: It is recommended to use brand-name products in the treatment of hypothyroidism, at least initially, starting 2x per day?
 
When would be an appropriate time for the first monitoring of serum T4 levels after therapy for hypothyroidism begins?
a)1 week in b)2-3 weeks c)4-6 weeks d)2-3 months e) none of the above 
What sign of clinical improvement would be evident after 1-2 weeks of successful L-thyroxine therapy? After around 8 weeks? After several months?
 
 
 
The use of this drug is not recommended in hypothyroidism patients because of the risk of iatrogenic hyperthyroidism and increased dosing frequency?
 
For what reason might you opt for T3 treatment over T4 for hypothyroid patients?
 
This is the drug of choice for a case of severe hypothyroidism presenting as a medical emergency?
 
This drug is a mixture of T4 and T3 in the physiologic 4:1 ratio. It is rarely used due to expense and iatrogenic hyperthyroidism?
 
What is the most common endocrine disease of the cat?
 
True or false: hyperthyroidism is usually caused by functional adenocarcinoma?
 
Which of the following is a clinical sign of hyperthyroidism?
a)polyphagia b)PU/PD c)tachycardia d)hyperactivity e)diarrhea f)all of the above 
This thioureylene antithyroid drug accumulates in the thyroid gland and inhibits TPO.
Good for chronic medical management, stabilization prior to surgery, radioactive iodine therapy. Noncurative, a control measure only 
This antithyroid drug is contraindicated prior to radioiodine therapy, and is best suited for rapid, short-lived reduction in hormone release?
 
This drug may be used to symptomatically control tachycardia and hypertension resulting from hyperthyroidism?
Often used in concert with iodine or methimazole 
This drug is considered the safest and most effective therapy for CURING hyperthyroidism?
Uncommonly may cause hypothyroidism, involves hospitalization while isotope is eliminated. 
Generally speaking, drug therapy for endocrine disorders is provided for one of three reasons. Name them?
 
 
 
True or false: dogs, pigs and cats have the same insulin protein?
 
Fill in the blanks to explain the release of insulin from beta cells in islets of pancreas?
1)Glucose enters through glucose transporter 2)Hexokinase works on it to produce ATP and ADP 3) ____ ______ as ATP-K+ channel closes 4)_____ floods into the cell through a voltage gated channel 5)These ____ ions allow the release of insulin 
 
True or false: Type 1 diabetes is far more common in dogs and cats than large animals or exotics?
 
Which of the following would NOT form part of the pathogenesis of IDDM?
a)intracellular glucose deficiency b)extracellular hyperglycemia c)intracellular hyperglycemia d)none of the above 
Name a potential complication of glucose toxicity during IDDM?
 
True or false: insulin can be frozen for convenient storage?
 
Regular insulin preparations can be described as ___ or ___ acting?
Used as initial insulin therapy to stabilize patient in emergencies. Examples include humulin and novolin 
This drug (2 possible answers) is an intermediate acting insulin preparation, administered SC, and less likely to stimulate immune responses.
 
Name one of the two long-acting insulin preparations?
the first named in the answer mostly limited to cats, the second more popular in that species. 
True or false: the duration of action of insulin is generally longer in cats than dogs?
 
Name something you could monitor to control IDDM and adjust the dosage of insulin?
 
What are the two ways you might get NIDDM (type 2) diabetes?
 
 
Which of the following has NOT been linked as a risk factor for type 2 diabetes in cats?
a)genetics b)inactivity c)obesity d)diet e)none of the above 
What is necessary to use oral hypoglycemics like insulin secretagogues effectively?
 
Glipizide and Glyburide are both sulphonylureas, block ATP-sensitive K+ channels on beta cells to?
 
Give the only example we were taught of a biguanide? (An insulin sensitizer)
 
True or false: you may use metformin in combination with secretagogues?
 
Acarbose is an _-______ inhibitor which inhibits post-prandial digestion and absorption of starches and disaccharides.
May cause abdominal pain, flatulence and diarrhea. 
What is the most common complication of insulin therapy?
 
What is the scientific name for the rebound hyperglycemia sometimes seen as a complication of insulin therapy?
 
Cushing's syndrome is a common name for this ailment?
Most common in dogs, rare in cats. Also seen in horses.  
What is usually the direct cause of pituitary dependent HAC?
 
This less common cause of HAC is 15-20% of cases in dogs and cats
Hint: secretes cortisol independent of ACTH regulation 
True or false: surgical hypophysectomy is frequently used to control pituitary dependent hyperadrenocorticism in animals?
 
Which of the following drugs would you not associate with treating hyperadrenocorticism by action on adrenal cortex?
a)mitotane b)selegiline c)trilostane d)ketoconazole e)none of the above 
This drug causes selective necrosis of zona fasciculata and reticularis, and should be administered with a fatty meal?
More effective in pituitary dependent HAC (achieve a balance of pituitary mediated adrenal hyperplasia and adrenocorticolysis) than in adrenal dependent, since the tumors are often resistant.  
Name a sign of adrenal insufficiency that you would watch for when beginning treatment with mitotane?
 
This drug works by blocking 3Beta-17-hydroxysteroid dehydrogenase enzyme in the adrenal cortex.
Prevents conversion of pregnenolone to progesterone, so there is less production of glucocorticoid, androgen and mineralocorticoid. Best for PD-HAC. 
This drug works by blocking cytochrome P450 3A4 enzymes, inhibiting androgen and glucocorticoid production.
Generally less effective than other adrenal-targetted medications, may cause anorexia and elevation of liver enzymes, use as last resort if unresponsive to other meds. 
Decreased levels of ______ can reduce inhibition of release of ACTH by intermediate anterior pituitary.
Treat with _____ receptor agonists and MAO-B inhibitors 
This Monamine Oxidase-Type B inhibitor is used for PD-HAC and cognitive dysfunction (old dog dementia)
Slows the breakdown of dopamine, may use in combination with mitotane. Potential first line choice for PD-HAC 
This dopamine receptor agonist is long acting, and is mainly used for equine Cushing's disease.
Not curative, it's a for-life treatment. Expensive, but recommended over cyproheptadine 
Primary Hypoadrenocorticism is also known as ______ disease.
 
True or false: bilateral adrenalectomy, though curative in most cases for hyperadrenocorticism, leads to a lifelong requirement for supplements?
 
The uncommon natural form of Addison's disease is a result of?
 
Which is not a secondary form of hypoadrenocorticism?
a)glucocorticoid therapy or progestins b)destructive pituitary lesions c)mitotane-induced damage to adrenals d) none of the above 
True or false: mineralocorticoids usually need to be addressed with acute addisonian crisis as well as glucocorticoids?
 
Normal ratio for sodium ions to potassium is __-__:1?
 
Name a glucocorticoid supplement option for acute addison's?
 
Desoxycorticosterone pivalate is given orally twice a week. True or false?
 
True or false: fludrocortisone acetate is given orally daily?
 
You would administer glucocorticoids (prednisolone preferably) with which mineralocorticoid supplement?
 
Which of the following is not wise to prevent adverse effects of steroid therapy (iatrogenic adrenal dysfunction)?
a)using the lowest dose possible b)considering use of low vs high potency drugs c)immediate cessation once goals of therapy are achieved, to limit exposure d)alternating day therapy e)all of the above are legit 
Which of the following drugs is not classed as intermediate acting (24-48 hours)?
a)hydrocortisone b)prednisolone c)methlprednisolone d)isoflupredone 
True or false: both flumethasone and dexamethasone are long acting anti-inflammatory glucocorticoids?
 
Which mineralocorticoid has glucocorticoid antiinflammatory properties as well?
 

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