Oncology / Chemotherapy
Oncology / Chemotherapy
NAPLEX
PG 121
PG 121
What is Cancer?
• Group of over 100 different diseasesGroup of over 100 different diseases
•Characterized by uncontrolled cellular growth & Characterized by uncontrolled cellular growth & proliferationproliferation
• Local tissue invasionLocal tissue invasion
•Distant metastasesDistant metastases
•As a group, the second-leading cause of death in As a group, the second-leading cause of death in AmericansAmericans
PG 121
Cancer TreatmentsCancer Treatments Surgery---local disease
Radiation---local or “regional” disease Alpha & beta particles, neutrons penetrate cell wall
Chemotherapy- generally for metastatic disease or suspicion/high probability of micrometastatic dx can be used before surgery can cure some cancers (testicular & leukemias)
Hormonal therapy- use in prostate, breast, uterine cancers; i.e. Prostrate – delay the progression of androgen-dependent cancer i.e. Breast – estrogen/progesterone receptor positive tumors
Targeted therapy---most “mab”s (monoclonal antibodies) used alone or combination with chemo, targets a specific bioligic marker on the tumor or enzyme/compont
See table 2-24 and 2-25
Surgery---local disease
Radiation---local or “regional” disease Alpha & beta particles, neutrons penetrate cell wall
Chemotherapy- generally for metastatic disease or suspicion/high probability of micrometastatic dx can be used before surgery can cure some cancers (testicular & leukemias)
Hormonal therapy- use in prostate, breast, uterine cancers; i.e. Prostrate – delay the progression of androgen-dependent cancer i.e. Breast – estrogen/progesterone receptor positive tumors
Targeted therapy---most “mab”s (monoclonal antibodies) used alone or combination with chemo, targets a specific bioligic marker on the tumor or enzyme/compont
See table 2-24 and 2-25
Target “Arrow” USE Route Side EffectHER2 Trastuzumamb (Herbeptin) Breast IV Cardiotoxicity
CD33 Gemtuzumab (Mylotarg) AML IV Myleosuppression
EGFR Cetuximab Colorectal IV Diarrhea
CD52 Alemtuzumab CLL IV or SQ Myelosuppression
AngiogenesisAngiogenesis
Angiogensis – process of neovascularization – macrophages secrete angiogensis factor
Occurs from existing capillaries
Tumor cannot survive without adequate blood supply
Tumors secretes vascular endothelial growth factor (VEGF) which acts on the endothelial growth factor receptor (EGFR) to “recruit” a blood supply
MAB’s – target VEGF and EGFR Bevacizumab (VEGF) & Cetuximab (EGFR) target
Angiogensis – process of neovascularization – macrophages secrete angiogensis factor
Occurs from existing capillaries
Tumor cannot survive without adequate blood supply
Tumors secretes vascular endothelial growth factor (VEGF) which acts on the endothelial growth factor receptor (EGFR) to “recruit” a blood supply
MAB’s – target VEGF and EGFR Bevacizumab (VEGF) & Cetuximab (EGFR) target
PG 122
PG 122
Cell CycleSpecificityCell CycleSpecificity
M M (mitosis)(mitosis)
G1 phase G1 phase (Gap 1)(Gap 1)
S phase S phase (DNA synthesis)(DNA synthesis)
G2 G2 (Gap 2)(Gap 2)
SEE TABLE 2-26SEE TABLE 2-26
Phase-specific agentsPhase-specific agents
- Most active during a - Most active during a particular phaseparticular phase
-May be active during other May be active during other phasesphases
Nonphase-specific agentsNonphase-specific agents
- May favor a stage- May favor a stage
-Dose dependent agentsDose dependent agents
Cell CycleSpecificityCell CycleSpecificity
M M (mitosis)(mitosis)
Vinca alkaloidsVinca alkaloidstaxanestaxanes
G1 phase G1 phase (Gap 1)(Gap 1)
S phase S phase (DNA synthesis)(DNA synthesis)AntimetabolitesAntimetabolites
5-FU, cytarabine, methotrexate5-FU, cytarabine, methotrexate
G2 G2 (Gap 2)(Gap 2)
Alkylating Agents:Alkylating Agents:CisplatinCisplatinIfosfamideIfosfamidecyclophosphamidecyclophosphamide
Hormones:Hormones:GoserelinGoserelinTamoxifenTamoxifenAnastrozoleAnastrozole
Antibiotics:Antibiotics:BleomycinBleomycin““rubicins”rubicins”
SEE TABLE 2-26SEE TABLE 2-26
PG 122
Chemo Therapy ClassesChemo Therapy Classes Antimetabolites - Interferes with synthesis of pyrimidine bases thus DNA synthesis
Fluorouracil Folic Acid Analog – interferes with synthesis of pyrimidine bases thus DNA synthesis
Methotrexate Purine Analogs – interferes with synthesis of purine bases
Fludarabine Vinca Alkaloids – bind to tubulin to prevent formation of microtubules during mitosis
Vincristine Podophyllotoxins – bind to tubulin – inhibiting topoisomerase II to cause DNA strand breaks
Etoposide Taxanes – bind to tubulin – promotes synthesis of nonfunctional microtubules
Paclitaxel Camptothecins – inhibits topiosomerase I, stabilizing single strand breaks in DNA
Topotecan Antiandrogens – Inhibit uptake & binding of testosterone and didhydrotestosterone
Flutamide (Eulexin) Progestins – suppresses release of luteinizing hormone and increase estrogen metabolism
Megestrol (Megace) Antiestrogen – Bind to estrogen receptor in breast tissue – prevent binding of estrogen
Tamoxifen (Nolvadex) Gonadotropin-releasing hormone analog – turn off negative-feedback release of FSH & LH,
reduces testosterone and estrogen production Leuprolide (Lupron)
Antimetabolites - Interferes with synthesis of pyrimidine bases thus DNA synthesis Fluorouracil
Folic Acid Analog – interferes with synthesis of pyrimidine bases thus DNA synthesis Methotrexate
Purine Analogs – interferes with synthesis of purine bases Fludarabine
Vinca Alkaloids – bind to tubulin to prevent formation of microtubules during mitosis Vincristine
Podophyllotoxins – bind to tubulin – inhibiting topoisomerase II to cause DNA strand breaks Etoposide
Taxanes – bind to tubulin – promotes synthesis of nonfunctional microtubules Paclitaxel
Camptothecins – inhibits topiosomerase I, stabilizing single strand breaks in DNA Topotecan
Antiandrogens – Inhibit uptake & binding of testosterone and didhydrotestosterone Flutamide (Eulexin)
Progestins – suppresses release of luteinizing hormone and increase estrogen metabolism Megestrol (Megace)
Antiestrogen – Bind to estrogen receptor in breast tissue – prevent binding of estrogen Tamoxifen (Nolvadex)
Gonadotropin-releasing hormone analog – turn off negative-feedback release of FSH & LH, reduces testosterone and estrogen production
Leuprolide (Lupron)
PG 123
Common adverse events related Common adverse events related to chemotherapyto chemotherapy
Common adverse events related Common adverse events related to chemotherapyto chemotherapy
MyelosuppressionMyelosuppression• Neutropenia, anemia, Neutropenia, anemia,
thrombocytopeniathrombocytopenia
Nausea/vomitingNausea/vomiting• cisplatincisplatin
AlopeciaAlopecia• CyclophosphamideCyclophosphamide
MucositisMucositis Peripheral neuropathyPeripheral neuropathy
MyelosuppressionMyelosuppression• Neutropenia, anemia, Neutropenia, anemia,
thrombocytopeniathrombocytopenia
Nausea/vomitingNausea/vomiting• cisplatincisplatin
AlopeciaAlopecia• CyclophosphamideCyclophosphamide
MucositisMucositis Peripheral neuropathyPeripheral neuropathy
Renal dysfunctionRenal dysfunction RashRash Infusion reactionsInfusion reactions Flu-like syndromeFlu-like syndrome
• MAB’s, docetaxelMAB’s, docetaxel
Hemorrhagic CystitisHemorrhagic Cystitis• cylcophosphamidecylcophosphamide
Renal dysfunctionRenal dysfunction RashRash Infusion reactionsInfusion reactions Flu-like syndromeFlu-like syndrome
• MAB’s, docetaxelMAB’s, docetaxel
Hemorrhagic CystitisHemorrhagic Cystitis• cylcophosphamidecylcophosphamide
Common Adverse Effects Caused by Antineoplastic Drugs
** Information above is embedded in the tables p.125-130 **** Information above is embedded in the tables p.125-130 **
Common Adverse Effects Caused by Antineoplastic Drugs
** Information above is embedded in the tables p.125-130 **** Information above is embedded in the tables p.125-130 **
Which of the following medications for
cancer is associated with causing
cardiotoxicity?
a. tamoxifen (Nolvadex)
b. fluorouracil (5-FU)
c. paclitaxel (Taxol)
d. doxorubicin (Doxil)
e. methotrexate (Rheumatrex)
Which of the following medications for
cancer is associated with causing
cardiotoxicity?
a. tamoxifen (Nolvadex)
b. fluorouracil (5-FU)
c. paclitaxel (Taxol)
d. doxorubicin (Doxil)
e. methotrexate (Rheumatrex)
Which of the following medications for
cancer is associated with causing
cardiotoxicity?
a. tamoxifen (Nolvadex)
b. fluorouracil (5-FU)
c. paclitaxel (Taxol)
d. doxorubicin (Doxil)
e. methotrexate (Rheumatrex)
Which of the following medications for
cancer is associated with causing
cardiotoxicity?
a. tamoxifen (Nolvadex)
b. fluorouracil (5-FU)
c. paclitaxel (Taxol)
d. doxorubicin (Doxil)
e. methotrexate (Rheumatrex)
PG 135 – Drug Antagonist Chart
Drug for prevention of adverse Drug for prevention of adverse events related to chemotherapyevents related to chemotherapy
Drug ActionMesna (Mesnex) Inhibits hemorrhagic cystitis
caused by ifosfamide
Dexrazoxane (Zinecard) Reduces cardiotoxicity caused by doxorubicin
Leucovorin (Wellcovorin)Leucovorin (Wellcovorin) Reduced from of folic acid, dosed with MTX to preserve normal tissue, rescue dose based on MTX levels, also used with 5-FU
Amifostine (Ethyol) Reduces renal toxicity caused by cisplatin
Supportive Care – Nausea/VomitingSupportive Care – Nausea/Vomiting 5HT3 inhibitors – mod/high emetogenic regimens, give one dose prechemo and
sometimes oral dose for 3 days postchemo Not for PRN use----can cause HA Ondansetron (zofran) – inhibits 1A2, 2C9, 2D6 (weak) Granisetron (Kytril) - less drug interactions Dolesetron (Anzement)- QTc prolongation - 2D6 (weak) Palonosetron (Aloxi) - subtrate 1A2, 2D6, 3A4
NK1 (neurokinin) inhibitor - highly emetogenic regimens only- Aprepitant (Emend) Drug interactions – 3A4 inhibitor and inducer Combination with 5HTs inhibitors
Benzodiazepines – anticipatory N/V Lorazepem (Ativan)
Dexamethasone – moderately emetogenic regimens or in combo with 5HT3 for delayed N/V
5HT3 inhibitors – mod/high emetogenic regimens, give one dose prechemo and sometimes oral dose for 3 days postchemo
Not for PRN use----can cause HA Ondansetron (zofran) – inhibits 1A2, 2C9, 2D6 (weak) Granisetron (Kytril) - less drug interactions Dolesetron (Anzement)- QTc prolongation - 2D6 (weak) Palonosetron (Aloxi) - subtrate 1A2, 2D6, 3A4
NK1 (neurokinin) inhibitor - highly emetogenic regimens only- Aprepitant (Emend) Drug interactions – 3A4 inhibitor and inducer Combination with 5HTs inhibitors
Benzodiazepines – anticipatory N/V Lorazepem (Ativan)
Dexamethasone – moderately emetogenic regimens or in combo with 5HT3 for delayed N/V
PG 123-124
Supportive CareSupportive Care
Anemia
Hgb < 11 g/dL with symptoms; < 10 without symptoms
EPO (Procrit) 40,000 units sq qweek
Darbopoetin (Aranesp) 2.25 u/kg sq qweek
Don’t forget Iron supplements
Anemia
Hgb < 11 g/dL with symptoms; < 10 without symptoms
EPO (Procrit) 40,000 units sq qweek
Darbopoetin (Aranesp) 2.25 u/kg sq qweek
Don’t forget Iron supplements
Neutropenia
Nadir occurs 1-2 weeks after chemo
Absolute neutrophil count - ANC < 500
Filgrastim (Neupogen) 300 uq sq qd x 5-7 days
Pegfilgrastim (Neulasta) 6 mg sq once 24 h post chemo
Sargramostim (Leukine) 250 mcg SQ daily x 5-7 days
Neutropenia
Nadir occurs 1-2 weeks after chemo
Absolute neutrophil count - ANC < 500
Filgrastim (Neupogen) 300 uq sq qd x 5-7 days
Pegfilgrastim (Neulasta) 6 mg sq once 24 h post chemo
Sargramostim (Leukine) 250 mcg SQ daily x 5-7 days
PG 124
Which of the following is a therapeutic substitution for ondansetron? a. Adaptin
b. Kytrilc. Inderald. Seroquele. Neurontin
Which of the following is a therapeutic substitution for ondansetron? a. Adaptin
b. Kytrilc. Inderald. Seroquele. Neurontin
Which of the following is a therapeutic substitution for ondansetron? a. Adaptin
b. Kytrilc. Inderald. Seroquele. Neurontin
Which of the following is a therapeutic substitution for ondansetron? a. Adaptin
b. Kytrilc. Inderald. Seroquele. Neurontin
All of the following exhibit antiemetic properties EXCEPT:
a. granisetron
b. loratadine
c. ondansetron
d. prochlorperazine
e. trimethobenzamide
All of the following exhibit antiemetic properties EXCEPT:
a. granisetron
b. loratadine
c. ondansetron
d. prochlorperazine
e. trimethobenzamide
All of the following exhibit antiemetic properties EXCEPT:
a. granisetron
b. loratadine
c. ondansetron
d. prochlorperazine
e. trimethobenzamide
All of the following exhibit antiemetic properties EXCEPT:
a. granisetron
b. loratadine
c. ondansetron
d. prochlorperazine
e. trimethobenzamide
ContraceptionContraception
NAPLEX
PG 103
PG 103
ContraceptionContraception
Mechanism of action: inhibit ovulation via negative feedback Mechanism of action: inhibit ovulation via negative feedback on the hypothalmus affecting FSH/LH release. Also alter genital on the hypothalmus affecting FSH/LH release. Also alter genital tract, thicken cervical mucus. tract, thicken cervical mucus.
Hormonal AgentsHormonal Agents
EstrogenEstrogenethinyl estradiol, mestranolethinyl estradiol, mestranol
ProgestinProgestindesogestrel, norgestimate, desogestrel, norgestimate, levonorgestrel, levonorgestrel, norethindrone, norgesterelnorethindrone, norgesterel
Types of oral contraceptive products---various doses Types of oral contraceptive products---various doses but estrogen dose is held constant while progestin but estrogen dose is held constant while progestin variesvaries
MonophasicMonophasicDesogen, Yasmin, etc.Desogen, Yasmin, etc.
BiphasicBiphasicOrtho Novum 10/11, etc.Ortho Novum 10/11, etc.
TriphasicTriphasicTriphasil, tri-Norinyl, Cyclessa, etc.Triphasil, tri-Norinyl, Cyclessa, etc.
Progestin onlyProgestin onlyMicronor, Ovrette, Nor-qdMicronor, Ovrette, Nor-qd
Extended/continuous - SeasonaleExtended/continuous - Seasonale
Two Possible ComponentsTwo Possible Components
Estrogens – 2Estrogens – 2
• Ethinyl Estradiol (EE)
• Mestranol
Estrogens – 2Estrogens – 2
• Ethinyl Estradiol (EE)
• Mestranol
Progestins – 12Progestins – 12Progestins – 12Progestins – 12
Synthetic Estrogens Synthetic Progestins
PG 103
Contraception (cont’d)Contraception (cont’d)
- Treatment should be delayed one year post menarche to allow for normal cycle development
- Adverse effects of oral contraceptives- Adverse effects of oral contraceptives
Major:Major:
• • ThromboembolismThromboembolism
• • StrokeStroke
• • Myocardial infarctionMyocardial infarction
• • Endometrial carcinomaEndometrial carcinoma
• • Pregnancy category XPregnancy category X
• • Risk factorsRisk factors
- Smoking - Smoking
- Age > 35- Age > 35
PG 104
Contraception (cont’d)Contraception (cont’d)
Minor:Minor:
• • Weight gain, edemaWeight gain, edema
• • Breakthrough bleeding Breakthrough bleeding
- Early BTB: Insufficient estrogen activity; associated with amenorrhea
- Late BTB: Insufficient progestin activity
• • Nausea and vomitingNausea and vomiting
• • Mild depressionMild depression
Drug Interactions:Drug Interactions:
• • Antimicrobials (griseofulvin, penicillins, tetracyclines)Antimicrobials (griseofulvin, penicillins, tetracyclines)
• • Enzyme inducer (barbiturates, rifampin, PIs, St.Johns Enzyme inducer (barbiturates, rifampin, PIs, St.Johns Wart.)Wart.)
Anticonvulsants/Sedatives/Hypnotics: Induction of liver enzymes causes rapid metabolism of estrogen and increased binding of progestin and EE to SHBG - Sex hormone-binding globulin. Not a problem with valproic acid or some
newer anticonvulsants such as lamotrigine. Antibiotics cause enterohepatic circulation
disturbance. Rifampin increases the metabolism of progestins.
Anticonvulsants/Sedatives/Hypnotics: Induction of liver enzymes causes rapid metabolism of estrogen and increased binding of progestin and EE to SHBG - Sex hormone-binding globulin. Not a problem with valproic acid or some
newer anticonvulsants such as lamotrigine. Antibiotics cause enterohepatic circulation
disturbance. Rifampin increases the metabolism of progestins.
Drug Interactions with Oral Contraceptives
Drug Interactions with Oral Contraceptives
PG 104
Non-Oral Hormonal Contraceptives
- Medroxyprogesterone acetate injection (Depo-Provera) – - Medroxyprogesterone acetate injection (Depo-Provera) – q q 3 mths3 mths
- Estradiol cypionate and medroxyprogesterone acetate - Estradiol cypionate and medroxyprogesterone acetate (Lunelle) - DC(Lunelle) - DC
- Intrauterine progesterone contraceptive system - Intrauterine progesterone contraceptive system (Progestasert)(Progestasert)
- Levonorgestrel intrauterine system (Mirena) - Levonorgestrel intrauterine system (Mirena) – can last up to 5 years
- Ortho Evra patch – apply weekly for 3 weeks, 1 week off. Less effective if > 198 lbs.-------Think about general counseling points about patches
- Nuva Ring – intravaginal ring inserted for 3 weeks
PG 104
Contraception (cont’d)Contraception (cont’d)
Non-Hormonal MethodsNon-Hormonal Methods
Copper interuterine devide (ParaGard) – replaced every 10 Copper interuterine devide (ParaGard) – replaced every 10 yearsyears
Spermicidal foams or suppositories – do not protect from Spermicidal foams or suppositories – do not protect from sexual transmitted diseases.sexual transmitted diseases.
Barrier methods - condomsBarrier methods - condomslatex, animal membrane, latex, animal membrane, male versus female); cervical cap; diaphragmsmale versus female); cervical cap; diaphragms
Natural family planning - basal body temperature method; Natural family planning - basal body temperature method; symptothermal method; calendar (rhythm) methodsymptothermal method; calendar (rhythm) method
PG 104
Contraception (cont’d)Contraception (cont’d)
Abortion PillAbortion Pill
Mifepristone (Mifeprex-RU486)- generally used with Mifepristone (Mifeprex-RU486)- generally used with misoprostol (Cytotec); for termination of early pregnancy (<49 misoprostol (Cytotec); for termination of early pregnancy (<49 days)days)
- Increase for bacterial infections (sepsis), prolonged - Increase for bacterial infections (sepsis), prolonged vaginal vaginal bleedingbleeding
- Only be prescribe by physicians with a “Prescribers - Only be prescribe by physicians with a “Prescribers Agreement”Agreement”
- Not available in public pharmacies- Not available in public pharmacies
Emergency ContraceptiveEmergency Contraceptive
First dose within 72 hours of unprotected sex and a second First dose within 72 hours of unprotected sex and a second dose 12 hours laterdose 12 hours later
- Levonorgestrel (high dose) (Plan B) - 89% effective- Levonorgestrel (high dose) (Plan B) - 89% effective
-Yuzpe Regimen Reduces risk of pregnancy by 75%
-Lo/Ovral 30ug EE + 0.3mg norgestrel 4 now and 4 in 12 hrs
PG 105
Miscellaneous Hormonal Agents
Ovulation stimulantsOvulation stimulants
Estrogen antagonistEstrogen antagonist
Clomiphene citrate (Clomid, Serophene)Clomiphene citrate (Clomid, Serophene).
Induces the release of FSH & LH – 6 cycles only
Gonadotropins containing FSH (recombinant DNA technology)
Follitropin alfa (Gonal-F) – Follitropin alfa (Gonal-F) – FSH analogsFSH analogs
Follitropin beta (Follistim)Follitropin beta (Follistim)
Urofollitropin (Fertinex)
Human menopausal gonadotropinsHuman menopausal gonadotropins
Menotropins (Pergonal, Humegon) – Menotropins (Pergonal, Humegon) – mixture of mixture of FSH/LHFSH/LH
PG 105
Miscellaneous Hormonal Agents (cont’d)Miscellaneous Hormonal Agents (cont’d)
Posterior pituitary hormonesPosterior pituitary hormones
Vasopressin (Pitressin)Vasopressin (Pitressin)antidiuretic hormone for antidiuretic hormone for diabetes diabetes
insipidus (injection)insipidus (injection)
Lypressin (Diapid)Lypressin (Diapid)antidiuretic hormone for antidiuretic hormone for diabetes insipidus diabetes insipidus (intranasal)(intranasal)
Desmopressin (DDAVP)Desmopressin (DDAVP)antidiuretic hormone, antidiuretic hormone, used to treat used to treat primary nocturnal enuresis and diabetes primary nocturnal enuresis and diabetes insipidus (nasal spray insipidus (nasal spray
and tablets) – and tablets) – also useful for hemophilia A also useful for hemophilia A
Oxytocin (Pitocin)Oxytocin (Pitocin)uterine stimulant – (injection)uterine stimulant – (injection)
PG 106
Hormones (cont’d)Hormones (cont’d)
EstrogensEstrogens• • Conjugated estrogen (premarin, etc.)Conjugated estrogen (premarin, etc.)
- - synthetic forms : estradiol, estropipate synthetic forms : estradiol, estropipate
• • Estrogen dosage forms - tablet, cream, ring, Estrogen dosage forms - tablet, cream, ring, transdermal transdermal
patches, etc.patches, etc.
- HRT improves lipid levels, reduces fracture risk, - HRT improves lipid levels, reduces fracture risk, reduces reduces vasomotor symptoms,vasomotor symptoms, DOES NOT reduce CV DOES NOT reduce CV disease (WHI, disease (WHI, HERS)HERS)
- breast cancer risk - small, but there. Long-term - breast cancer risk - small, but there. Long-term use, family hxuse, family hx
- Black Cohosh herbal has been touted for - Black Cohosh herbal has been touted for treatment of hot treatment of hot flashes, SSRIs, Soy product and flashes, SSRIs, Soy product and clonidine are effective clonidine are effective
Selective estrogen receptor modulator (SERMs)Selective estrogen receptor modulator (SERMs)raloxifene raloxifene (Evista)(Evista)
- indicated for prevention and treatment of - indicated for prevention and treatment of osteoporosisosteoporosis
When counseling a patient about medroxyprogesterone what are the important factors to discuss?
I. Weight gainII. OsteoporosisIII. Risk of pulmonary embolism
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
When counseling a patient about medroxyprogesterone what are the important factors to discuss?
I. Weight gainII. OsteoporosisIII. Risk of pulmonary embolism
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
When counseling a patient about medroxyprogesterone what are the important factors to discuss?
I. Weight gainII. OsteoporosisIII. Risk of pulmonary embolism
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
When counseling a patient about medroxyprogesterone what are the important factors to discuss?
I. Weight gainII. OsteoporosisIII. Risk of pulmonary embolism
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
Low bone mass associated with age, hormone levels and medications.
DEXA T-score >-1 is normal, -1 to -2.5 is osteopenia, and <2.5 is
osteoporosis
Oral calcium and vitamin D requirement
Medications Oral Bisphosphonates ---1 st line Raloxifene Calcitonin Teriparitide Zoledronic acid (Reclast)
Low bone mass associated with age, hormone levels and medications.
DEXA T-score >-1 is normal, -1 to -2.5 is osteopenia, and <2.5 is
osteoporosis
Oral calcium and vitamin D requirement
Medications Oral Bisphosphonates ---1 st line Raloxifene Calcitonin Teriparitide Zoledronic acid (Reclast)
OsteoporosisOsteoporosis
PG 105-106
The medication Fosamax (alendronate):I. must be taken with a meal
II. is used to treat hot flashes
III. is available as a once weekly dose
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
The medication Fosamax (alendronate):I. must be taken with a meal
II. is used to treat hot flashes
III. is available as a once weekly dose
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
The medication Fosamax (alendronate):I. must be taken with a meal
II. is used to treat hot flashes
III. is available as a once weekly dose
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
The medication Fosamax (alendronate):I. must be taken with a meal
II. is used to treat hot flashes
III. is available as a once weekly dose
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
Drugs used in the prevention/treatment of osteoporosis include all of the following EXCEPT:
a. Evista
b. Actonel
c. Calcimar
d. Prempro
e. Proscar
Drugs used in the prevention/treatment of osteoporosis include all of the following EXCEPT:
a. Evista
b. Actonel
c. Calcimar
d. Prempro
e. Proscar
Drugs used in the prevention/treatment of osteoporosis include all of the following EXCEPT:
a. Evista
b. Actonel
c. Calcimar
d. Prempro
e. Proscar
Drugs used in the prevention/treatment of osteoporosis include all of the following EXCEPT:
a. Evista
b. Actonel
c. Calcimar
d. Prempro
e. Proscar
Which of the following is an alternative treatment for osteoporosis in patients unable to tolerate oral biphosphonates due to GI upset?
I. Zoledronic Acid
II. Raloxifene
III. Calcium + Vitamin D
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, III
Which of the following is an alternative treatment for osteoporosis in patients unable to tolerate oral biphosphonates due to GI upset?
I. Zoledronic Acid
II. Raloxifene
III. Calcium + Vitamin D
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, III
Which of the following is an alternative treatment for osteoporosis in patients unable to tolerate oral biphosphonates due to GI upset?
I. Zoledronic Acid
II. Raloxifene
III. Calcium + Vitamin D
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, III
Which of the following is an alternative treatment for osteoporosis in patients unable to tolerate oral biphosphonates due to GI upset?
I. Zoledronic Acid
II. Raloxifene
III. Calcium + Vitamin D
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, III
Which of the following products is a topical HRT?
a. Evamist
b. Cenestin
c. Premphase
d. Provera
e. FemHRT
Which of the following products is a topical HRT?
a. Evamist
b. Cenestin
c. Premphase
d. Provera
e. FemHRT
Which of the following products is a topical HRT?
a. Evamist
b. Cenestin
c. Premphase
d. Provera
e. FemHRT
Which of the following products is a topical HRT?
a. Evamist
b. Cenestin
c. Premphase
d. Provera
e. FemHRT
Thyroid Case StudyThyroid Case Study
NAPLEX
PG 106
Page 106Page 106
A goiter is caused by:
a. hypothyroidism
b. hyperthyroidism
c. deficient TSH
d. a thyroid tumor
e. a parathyroid dysfunction
A goiter is caused by:
a. hypothyroidism
b. hyperthyroidism
c. deficient TSH
d. a thyroid tumor
e. a parathyroid dysfunction
A goiter is caused by:
a. hypothyroidism
b. hyperthyroidism
c. deficient TSH
d. a thyroid tumor
e. a parathyroid dysfunction
A goiter is caused by:
a. hypothyroidism
b. hyperthyroidism
c. deficient TSH
d. a thyroid tumor
e. a parathyroid dysfunction
L-thyroxine is the same as:
a. T4
b. T3
c. liothyronine
d. liotrix
e. cytomel
L-thyroxine is the same as:
a. T4
b. T3
c. liothyronine
d. liotrix
e. cytomel
L-thyroxine is the same as:
a. T4
b. T3
c. liothyronine
d. liotrix
e. cytomel
L-thyroxine is the same as:
a. T4
b. T3
c. liothyronine
d. liotrix
e. cytomel
Which of the following is used as an antithyroid drug:
a. methamine
b. fluorouracil
c. aspartame
d. propylthiouracil
e. protamine sulfate
Which of the following is used as an antithyroid drug:
a. methamine
b. fluorouracil
c. aspartame
d. propylthiouracil
e. protamine sulfate
Which of the following is used as an antithyroid drug:
a. methamine
b. fluorouracil
c. aspartame
d. propylthiouracil
e. protamine sulfate
Which of the following is used as an antithyroid drug:
a. methamine
b. fluorouracil
c. aspartame
d. propylthiouracil
e. protamine sulfate
Iodine-131 is a radioisotope that has a half-life of 8 days. How many days after a dose is administered will less than 1% of the original dose remain?
a. 24
b. 32
c. 40
d. 56
e. 99
Iodine-131 is a radioisotope that has a half-life of 8 days. How many days after a dose is administered will less than 1% of the original dose remain?
a. 24
b. 32
c. 40
d. 56
e. 99
Iodine-131 is a radioisotope that has a half-life of 8 days. How many days after a dose is administered will less than 1% of the original dose remain?
a. 24
b. 32
c. 40
d. 56
e. 99
Iodine-131 is a radioisotope that has a half-life of 8 days. How many days after a dose is administered will less than 1% of the original dose remain?
a. 24
b. 32
c. 40
d. 56
e. 99
The parathyroid gland controls the body’s level of:
a. iron
b. calcium
c. iodine
d. potassium
e. glucose
The parathyroid gland controls the body’s level of:
a. iron
b. calcium
c. iodine
d. potassium
e. glucose
The parathyroid gland controls the body’s level of:
a. iron
b. calcium
c. iodine
d. potassium
e. glucose
The parathyroid gland controls the body’s level of:
a. iron
b. calcium
c. iodine
d. potassium
e. glucose