Bcacp Exam Study Guide Exam Questions And Answers.

how often do you screen for hypothyroidism after 35 YO every 5 years T4 Levothyroxine T3 Liothyronine Subclinical TSH range 5-9 Starting dose Levothyroxine in healthy adult 1.6 mcg/kg/day If elderly or CAD what is the starting dose levothyroxine 12.5-25 mcg/day Amiodarone can induce ____thyroidism in iodine deficiency hyperthyroidism TSH offers positive/negative feedback from _____ gland pituitary Definitive treatment for hyperthyroidism RAI Medications that inhibit coupling of thyroid hormone and conversion from T3--T4 methimazole (30-60 mg/day), propylthiouracil (300-600 mg BID-TID) Hyperthyroid treatment preferred during pregnancy and lactation propylthiouracil PCOS causes ______ insulin, _______ androgen, ______ testosterone increase, increase, increase Infertility in PCOS treatment options Clomiphene 5 days of treatment initiated on day 5 of cycle +/- letrozole or anastrozole + metformin Levothyroxine and warfarin DDI levo increases INR Levothyroxine and digoxin DDI Levo decreases dig concentration Digoxin and mirabegron DDI increases dig conc verapamil and simvastatin DDI inc simva conc MTX and PCN/Bactrim incr MTX conc Hep C and PPI DDI Dec conc antivirals Paroxitine/fluoxetine DDIs metoprolol, haloperidol, risperidone, tramadol, hydrocodone Valproic acid DDI carbapenems, phenytoin, warfarin, lamotrigine, ritonavir CBD DDI topiramate, zonisamide, eliscarbezapine What is the most common pituitary dysfunction prolactinoma Level of prolactin for diagnosis 30 GH function from pituitary cell growth ACTH function from pituitary cortisol and androgen production PRL function from pituitary lactation LH function from pituitary ovulation FSH function from pituitary follicle development and spermatogenesis Drugs that can induce prolactinoma dopamine antagonist (TCA, antipsychotics, metoclopramide), SSRI, methyldopa Prolactinoma side effects dec libido, hair loss, osteoporosis, infertility Treatment of prolactinoma D2 receptor agonists: bromocriptine if failed cabergoline Preferred prolactinoma treatment in pregnancy Bromocriptine avoid phenteramine and orlisat if a pt has a hx of _____ kidney stones Addison disease primary vs secondary Low cortisol - primary (@ site of adrenal gland, autoimmune), secondary (@ pituitary, after long term GC with abrupt stop) Addison disease symptoms weakness, anorexia, low Na, high K, salt craving, tan skin, dec volume and BP with orthostasis Sick days dose adjustment of GC in treatment of Addison's 2-3x dose Cushing's syndrome symptoms moon face, buffalo hump, HTN Cushing's syndrome diagnosis 24 H cortisol in urine -- 3-4X ULN, then determine if ACTH dependent (pituitary vs adrenal source) Treatment of Cushing's if not surgical candidate ketoconazole, mifepristone, metyrapone Hypogonadism dx T 300 in the AM x2 + symptoms Drugs that can worsen BPH testosterone, anticholinergics, decongestants, diuretics selective alpha 1 antagonists tamsulosin, silodosin, alfuzosin when is combination therapy indicated for BPH if prostate 40 g and symptoms (T/F) 5 alpha reductase inhibitors (finasteride) decrease PSA by 50% True avoid combination therapy with which drugs for the treatment of BPH alpha antagonism + PDE5 -- drop in BP alternative combination therapy for those with BPH tamsulosin + tolterdoine treatment for OAB oxybutinin, tolterdoine, solifenacin, mirabegron (T/F) duloxetine and fluoxetine may improve urethral tone in stress incontinence True mild hyponatremia 125-135 (T/F) Vit D may decrease falls in 65 YO True Stored form of Vit D should be measured in setting of deficiency which is: 25 (10) Vit d Kidney activate vit D to form: 1, 25 dihydroxy vit D Ca absorption plateaus at _____ mg elemental 500 mg Stage 2 HTN define as _____ or _____ should start ____ # of med(s) 20 SBP or 10 DBP, 2 meds HTN crisis diagnosis and outpatient tx 180/120, captopril, clonidine, labetolol Statin indicated if ASCVD risk score 7.5% DOAC approved for CAD/PAD riva 2.5 mg +/- ASA A fib + PCI approach to anticoagulation DOAC + clopidogrel (if warfarin target 2-2.5 INR), drop anti-platelet after 1 year Prasugrel contraindications (3) stroke, 75 YO, 60 kg CHANCE trial indications for DAPT post stroke DAPT x21 days, then continue clopidogrel non selective BBs (4) labetolol, carvedilol, nadolol, propanolol Antiphospholipid syndrome anticoagulation VKA Factor V leiden anticoagulation DOAC Goal HR for a fib without sx _____, goal if symptomatic ___ 110, 80 AC plan for cardioversion: _____ weeks prior to, continue ____ weeks post cardioversion 3 weeks, 4 weeks HFrEF GDMT ARNI (alt HYD + NIT), BB, MRA, SGLT2i HFpEF ARNI, SGLT2 outcomes with digoxin in HR decreased hospitalizations indication for ivabradine in HF pts if cannot do BB or baseline HR 70 BPM