Pharmacology Exam: Corticosteroids and Herbs
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Questions and Answers

Which effect is associated with long-term corticosteroid therapy?

  • Increased immune function
  • Weight loss over time
  • Improved inflammatory response
  • Adrenal atrophy (correct)

What is a critical consideration for patients receiving corticosteroid therapy?

  • Live vaccines can be administered safely
  • Daily weight gains over 1 pound are normal
  • Oral route is preferred for chronic treatment (correct)
  • Immediate discontinuation of therapy if side effects appear

Which of the following are adverse effects of chronic corticosteroid use?

  • Osteoporosis (correct)
  • Enhanced immune system activity
  • Increased inflammatory responses
  • Weight loss

What is the preferred lab value for diagnosing thyroid disorders?

<p>TSH levels (A)</p> Signup and view all the answers

Which food interaction can decrease the effectiveness of hypothyroid medications?

<p>Calcium-rich foods (C)</p> Signup and view all the answers

What common medication can accelerate the metabolism of levothyroxine?

<p>Phenytoin (A)</p> Signup and view all the answers

Which statement is true regarding Ginkgo Biloba?

<p>It can cause dangerous interactions with anticoagulants. (C)</p> Signup and view all the answers

Which of the following symptoms should be monitored in infants treated for thyroid deficiency?

<p>Height and weight changes (B)</p> Signup and view all the answers

Which herb is known to increase energy and decrease blood sugar levels?

<p>Ginseng (B)</p> Signup and view all the answers

What effect does Ginkgo-biloba have on blood pressure?

<p>Decreases blood pressure (C)</p> Signup and view all the answers

Which herb can lead to an increased risk of serotonin syndrome when taken with tricyclic antidepressants?

<p>St John's wort (C)</p> Signup and view all the answers

What hazardous effect can result from large amounts of black licorice?

<p>Increased headache and blood pressure (D)</p> Signup and view all the answers

Which vitamin is primarily involved in synthesizing clotting factors and producing red blood cells?

<p>Vitamin K (D)</p> Signup and view all the answers

Which diuretic is known to be the most potent among those listed?

<p>Torsemide (Demadex) (D)</p> Signup and view all the answers

What is a potential effect of taking turmeric?

<p>Decreased inflammation (B)</p> Signup and view all the answers

What should be monitored to ensure safety when administering loop diuretics?

<p>Vital signs, including BP and HR (C)</p> Signup and view all the answers

Which herb is taken to alleviate anxiety and sleep disorders but increases the effects of CNS depressants?

<p>Kava Kava (D)</p> Signup and view all the answers

What is a common indication for administering loop diuretics?

<p>Fluid retention due to edema (D)</p> Signup and view all the answers

What is Pyridoxine (Vitamin B6) known to caution against?

<p>Decreasing the efficacy of Parkinson's medications (A)</p> Signup and view all the answers

Ginger is known to decrease which of the following conditions?

<p>Nausea (C)</p> Signup and view all the answers

Which of the following is a potential adverse interaction of potassium-sparing diuretics?

<p>Increased potassium levels with ACE inhibitors (D)</p> Signup and view all the answers

What effect does melatonin have when taken with certain antidepressants?

<p>Decreases their antidepressant effects (C)</p> Signup and view all the answers

Which strategy is recommended for optimizing the administration of diuretics?

<p>Always monitor serum electrolytes periodically (C)</p> Signup and view all the answers

What is hyperkalemia characterized by?

<p>Serum potassium level greater than 5 mEq/L (A)</p> Signup and view all the answers

Which mineral is most abundant in the body?

<p>Calcium (C)</p> Signup and view all the answers

What is a common adverse effect of magnesium therapy?

<p>Flushing of the skin (C)</p> Signup and view all the answers

What causes hypocalcemia?

<p>Lack of calcium or vitamin D (D)</p> Signup and view all the answers

Which of the following medications is used to treat Parkinson’s disease symptoms?

<p>Levodopa (A)</p> Signup and view all the answers

What is one of the treatment goals for Alzheimer’s disease?

<p>Improving function in ADLs (A)</p> Signup and view all the answers

What side effect is NOT associated with Benztropine?

<p>Weight gain (A)</p> Signup and view all the answers

What is the primary cause of hypermagnesemia?

<p>Advanced renal failure (C)</p> Signup and view all the answers

Which medication should be taken on an empty stomach to enhance absorption?

<p>Levodopa (B)</p> Signup and view all the answers

What is the most common cause of hypokalemia?

<p>Use of loop and thiazide diuretics (D)</p> Signup and view all the answers

Which condition is characterized by muscle weakness and difficulty maintaining balance?

<p>Multiple sclerosis (C)</p> Signup and view all the answers

What severe side effect should be monitored during magnesium therapy?

<p>Neuromuscular blockade (C)</p> Signup and view all the answers

Which of the following conditions is a contraindication for the use of Benztropine?

<p>Closed-angle glaucoma (D)</p> Signup and view all the answers

Flashcards

Long-term Steroid Therapy: Adrenal Atrophy

Prolonged corticosteroid use can lead to adrenal atrophy due to suppressed adrenal gland stimulation.

Long-term Steroid Therapy: Live Vaccines

Patients on long-term steroid therapy should avoid live vaccines (attenuated) due to an impaired immune response.

Long-term Steroid Therapy: Weight Gain

Patients on long-term steroid therapy should report any sudden weight gain of over 2 pounds in a day.

Adverse Effects of Chronic Corticosteroids: Immune Suppression

Chronic corticosteroids suppress the immune system, making the body more susceptible to infections.

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Adverse Effects of Chronic Corticosteroids: Osteoporosis

Chronic corticosteroid use can lead to osteoporosis due to decreased bone density.

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Hypothalamus-Pituitary-Thyroid Axis

The hypothalamus releases TRH (thyrotropin-releasing hormone), stimulating the pituitary to release TSH (thyroid-stimulating hormone), which in turn stimulates the thyroid to produce T3 and T4.

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TSH (Thyroid-Stimulating Hormone): A Key Indicator

TSH is a preferred lab value for diagnosing thyroid disorders. Low TSH indicates hyperthyroidism, while elevated TSH suggests hypothyroidism.

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Hashimoto Thyroiditis: Antithyroid Antibodies

Hashimoto thyroiditis is an autoimmune disorder where the body produces antibodies that attack the thyroid gland, leading to hypothyroidism.

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Ginseng and Insulin/Oral Hypoglycemic Agents

Ginseng can decrease blood sugar levels, potentially interacting with insulin and oral hypoglycemic agents used to manage diabetes. This interaction can lead to dangerously low blood sugar levels.

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Ginkgo Biloba and Anticoagulants

Ginkgo biloba increases blood flow, which can enhance the effects of anticoagulants, increasing the risk of bleeding.

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Black Licorice and Potassium Loss

Long-term consumption (4 weeks+) of black licorice can increase blood pressure, decrease potassium levels, and interact with drugs like digoxin, aspirin, steroids, and laxatives, potentially leading to dangerous side effects.

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Ginger and Anticoagulants

Ginger's anti-inflammatory properties can interact with anticoagulants, increasing the risk of bleeding.

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Feverfew and Anticoagulants/NSAIDs

Feverfew's anti-inflammatory properties can interact with both anticoagulants and NSAIDs, potentially increasing the risk of bleeding and digestive issues.

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Garlic and Anticoagulants

Garlic's blood-thinning properties can enhance the effects of anticoagulants, increasing the risk of bleeding.

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Valerian and CNS Depressants

Valerian, known for its calming effects, can potentially enhance the effects of CNS depressants like benzodiazepines, barbiturates, anticonvulsants, and sedatives, leading to excessive sedation and drowsiness.

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Kava Kava and CNS Depressants

Kava Kava's calming effects can interact with CNS depressants, leading to excessive sedation and drowsiness.

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St. John's Wort and CNS Depressants

St. John's Wort can enhance the effects of CNS depressants, leading to increased sedation and potential drug interactions.

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Melatonin and Medications

Melatonin can interact with other medications, potentially increasing the effects of antidepressants like desipramine and fluoxetine. Certain medications like calcium channel blockers can also decrease melatonin levels.

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Electrolyte Imbalance: Key Feature

Electrolyte imbalances indicate a medical condition requiring diagnosis and treatment of the underlying cause.

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Sodium (Na+): Importance

Sodium is a crucial electrolyte for maintaining fluid balance, nerve impulses, and muscle contractions.

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Hypernatremia: What Happens?

Hypernatremia occurs when serum sodium levels are too high (above 145 mEq/L), leading to signs like lethargy, confusion, and neurological changes.

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Potassium (K+): Key Role

Potassium is the most abundant intracellular cation, essential for normal heart rhythm, muscle function, and nerve impulses.

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Hyperkalemia: Causes

Hyperkalemia, with serum K+ levels higher than 5 mEq/L, can be caused by excessive potassium intake or kidney problems.

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Hypokalemia: Common Cause

Hypokalemia, with serum K+ levels below 3.5 mEq/L, is often caused by diuretic medications.

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Magnesium (Mg2+): Muscle Function

Magnesium is crucial for proper neuromuscular function, maintaining nerve function, and muscle relaxation.

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Hypomagnesemia: Key Causes

Hypomagnesemia, with serum Mg2+ below 0.65 mmol/L, can be caused by kidney problems or loop diuretics.

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Calcium (Ca2+): Strong Bones

Calcium is the most abundant mineral in the body, vital for bone health, muscle contraction, and nerve function.

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Hypercalcemia: Common Cause

Hypercalcemia, with serum Ca2+ above 2.5 mmol/L, is often caused by overactive parathyroid glands.

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Hypocalcemia: Various Causes

Hypocalcemia occurs when serum Ca2+ levels are below 2.1 mmol/L, caused by various factors like calcium deficiency, vitamin D deficiency, or hypothyroidism.

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Neurodegenerative Diseases: What are they?

Neurodegenerative diseases involve progressive, irreversible loss of neurons, affecting any age group and causing difficulty with movement, memory, and thinking.

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Parkinson's Disease: Pharmacotherapy Goal

Treatment for Parkinson's disease aims to balance dopamine (movement stimulator) and acetylcholine (movement inhibitor).

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Levodopa: Important Considerations

When taking Levodopa, avoid multivitamins, high-protein diets, and alcohol. Watch for dizziness, mood changes, and monitor liver and kidney function.

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Alzheimer's Disease: Treatment Limitations

Current pharmacotherapy for Alzheimer's disease only provides modest results and cannot stop the disease progression.

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Cholinesterase Inhibitors: How they work

Cholinesterase inhibitors block the breakdown of acetylcholine, increasing its levels in the brain and potentially improving cognitive function.

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Loop Diuretics: Action

Loop diuretics block sodium reabsorption in the loop of Henle, leading to increased urine production and decreased fluid volume in the body.

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Loop Diuretics: Side Effects

Loop diuretics can cause electrolyte imbalances, especially hypokalemia. They can also lead to dehydration and hypotension.

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Potassium-Sparing Diuretics: What they do

Potassium-sparing diuretics work differently than loop diuretics. They block sodium reabsorption in the distal convoluted tubule while sparing potassium.

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Fluid Imbalance: Intracellular vs Extracellular

Fluid Imbalance occurs when the body fluid distribution between the intra and extracellular spaces gets disturbed. This can happen due to various factors like dehydration or electrolyte imbalance.

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Fluid Movement: Water and Electrolytes

The movement of fluids between these compartments relies on the concentration of electrolytes, primarily sodium, which influences water movement.

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Study Notes

Long-Term Corticosteroid Treatment

  • Corticosteroids suppress inflammation and immune responses.
  • Prolonged use leads to adrenal atrophy.
  • Avoid live vaccines while on steroids.
  • Weight gain of over 2 lbs in a day warrants attention.
  • Oral route is preferable for chronic conditions.
  • Higher doses accelerate adrenal atrophy (2-4 weeks).

Adverse Effects of Chronic Corticosteroids

  • Suppressed immune system.
  • Reduced inflammatory response.
  • Increased risk of GI bleeds and peptic ulcers.
  • Increased risk of osteoporosis.
  • Behavioral changes.
  • Metabolic changes and fluid retention.

Replacement Therapy and Drug Interactions

  • Interactions with potassium-wasting drugs and anticholinesterase agents.
  • Avoid live vaccines.
  • Interactions with insulin and oral medications.

Thyroid Physiology and Disorders

  • Low blood thyroid levels trigger negative feedback loops via TRH (thyrotropin-releasing hormone) and TSH (thyroid-stimulating hormone).
  • Thyroid releases T3 and T4 (hormones).
  • TSH is the preferred lab value.
  • Low TSH is considered "good" for thyroid function.
  • Primary hypothyroidism involves low T4 and high TSH.
  • Hashimoto's thyroiditis shows abnormal antithyroid antibody levels.

Pharmacotherapy of Hypothyroid Disorders

  • Phenytoin accelerates the metabolism of levothyroxine.
  • Certain foods can interact with levothyroxine.
  • Monitor patients taking warfarin for bleeding risk.
  • Monitor infants, especially for growth and development.
  • Ginkgo Biloba's flavonoids are dangerous for anticoagulant users.

Herb-Drug Interactions

  • Saw Palmetto can decrease BPH symptoms, urination, iron absorption, and oral contraceptive effectiveness.
  • Turmeric can help decrease inflammation, infection, and stomach problems but can enhance anticoagulant effectiveness.
  • Vitamin K (AquaMEPHYTON) helps the body produce RBCs and clotting factors.
  • Pyridoxine (Vitamin B6) may decrease the effectiveness of Parkinson's medications.
  • Ascorbic Acid (Vitamin C) enhances iron absorption.

Fluid Imbalance

  • Body fluids travel between intracellular and extracellular compartments.
  • Imbalance between intake and output can cause shock and dehydration.
  • Electrolyte Imbalances involve monitoring K+, Mg2+, and Ca2+ electrolyte levels.

Pulmonary Edema

  • Maintaining potassium balance is important for pulmonary edema.
  • Insulin plays a key role in maintaining potassium balance.
  • Hyperkalemia has a serum level >5 mEq/L.
  • Hypokalemia has a serum level < 3.5 mEq/L.

Electrolyte Imbalances (Continued)

  • Hypermagnesemia involves serum levels > 1.05 mmol/L.
  • Hypomagnesemia has serum levels < 0.65 mmol/L, and is caused by renal problems and loop diuretics.
  • Hypercalcemia has serum values > 2.5 mmol/L.
  • Hypocalcemia has serum values < 2.1 mmol/L.
  • Adverse effects for Magnesium imbalances include diarrhea, flushing, sedation or confusion.
  • Adverse effects for Calcium imbalances include constipation, nausea, and vomiting.

Parkinson's Disease

  • The goal is to balance dopamine and acetylcholine.
  • Dopamine agonists increase dopamine, and anticholinergics block acetylcholine.
  • Levodopa is taken on an empty stomach, and high protein diets should be avoided.

Benztropine Use

  • Used to treat extrapyramidal side effects.
  • Adverse effects include sedation, constipation, blurred vision etc.
  • Avoid use in patients with closed-angle glaucoma, myasthenia gravis, and urinary obstruction.
  • Risk of paralytic ileus is present.

Multiple Sclerosis

  • Exact cause unknown; characterized by demyelination.
  • Muscle spasms can be treated with NSAIDs and skeletal muscle relaxants.
  • Cyclobenzaprine is a muscle relaxant; used to treat muscle spasms.
  • Consider drug safety and precautions like avoid driving or operating heavy machinery.

Liver Function Tests and Nonpharmacological Therapies

  • Check liver function when necessary.
  • Avoid alcohol with many treatments.
  • Physical therapies, such as exercises, increase movement and prevent contractures.
  • Herbal remedies like black cohosh, castor oil packs and capsaicin can be used topically.
  • B-complex vitamins, specifically B6, may be helpful.

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Description

This quiz covers important topics related to corticosteroid therapy, including its effects, critical patient considerations, and interactions with thyroid medications. Additionally, it addresses the use of herbal supplements and their potential effects and interactions. Test your knowledge on these essential pharmacological concepts.

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