ANRS201 Pharmacology ATI-Style Exam Two Flashcards

Comprehensive 100-card vocabulary study set covering thyroid disorders, diabetes mellitus, insulins, diuretics, antihypertensives, antianginals, and antilipidemic medications from the ANRS201 Exam Two lecture review.

Hyperthyroidism

A hypermetabolic clinical state characterized by heat intolerance, sweating, weight loss despite appetite, tachycardia, palpitations, anxiety, tremor, frequent stools, and insomnia.

Hypothyroidism

A hypometabolic clinical state characterized by cold intolerance, fatigue, weight gain, dry skin, constipation, bradycardia, slowed thinking or depression, and possible facial puffiness.

Levothyroxine

A synthetic $T_4$ thyroid hormone replacement medication indicated for the management of hypothyroidism.

Levothyroxine Administration Timing

Administered consistently on an empty stomach with a full glass of water, usually $30\text{--}60\,\text{minutes}$ before breakfast.

Levothyroxine Mineral Separation Rule

The instruction to separate levothyroxine administration from calcium, iron, and certain antacids by approximately $4\,\text{hours}$ to prevent reduced drug absorption.

Levothyroxine Full Therapeutic Latency

The multi-week time period required for levothyroxine to achieve its full clinical and laboratory therapeutic response.

Levothyroxine Overdose Manifestations

Hyperthyroid-like signs and symptoms resulting from excessive replacement dosing, including chest pain, palpitations, tremor, insomnia, sweating, and heat intolerance.

Levothyroxine Dosing in Geriatric or Cardiac Patients

A cautious prescribing approach where therapy is initiated at a low dose and titrated slowly to avoid precipitation of myocardial ischemia or dysrhythmias.

Methimazole

An oral thionamide antithyroid drug commonly preferred for many patients with hyperthyroidism to inhibit thyroid hormone synthesis.

Propylthiouracil (PTU)

A thionamide antithyroid agent indicated during the first trimester of pregnancy and in thyroid storm protocols.

PTU Mechanism on Peripheral Conversion

The distinct pharmacologic property of propylthiouracil whereby it inhibits the peripheral deiodination of $T_4$ to the more active $T_3$, in addition to blocking thyroid hormone synthesis.

Antithyroid-Induced Agranulocytosis

A dangerous hematologic adverse effect of methimazole and PTU presenting clinically as sudden fever or sore throat that demands urgent evaluation and CBC testing.

Antithyroid Drug Hepatotoxicity

Liver injury associated with thionamide therapy presenting clinically with jaundice, dark urine, or severe abdominal discomfort requiring prompt provider evaluation.

Thyroid Storm

A life-threatening, decompensated form of severe thyrotoxicosis characterized by high fever, marked tachycardia, agitation, confusion, vomiting, diarrhea, and potential heart failure.

Thyroid Storm Emergency Regimen

An urgent clinical protocol involving beta-blockers, a thionamide, iodine administered after the thionamide, glucocorticoids, cooling measures, IV fluids, and treatment of the underlying trigger.

Graves Disease

An autoimmune etiology of hyperthyroidism that presents with diffuse goiter, exophthalmos (eye changes), heat intolerance, tremors, and tachycardia.

Radioactive Iodine ($^{131}\text{I}$)

An oral radioactive therapeutic modality that destroys hyperfunctioning thyroid tissue, frequently culminating in permanent hypothyroidism requiring lifelong levothyroxine.

Radioactive Iodine Contraindications

Absolute contraindications to radioactive iodine therapy consisting of pregnancy and breastfeeding.

Radioactive Iodine Radiation Precautions

Safety instructions post-treatment that mandate temporary avoidance of close contact with children and pregnant individuals, alongside meticulous hygiene practices.

Type 1 Diabetes Mellitus

An endocrine disease resulting from autoimmune destruction of pancreatic beta cells, causing absolute insulin deficiency that requires exogenous insulin replacement.

Type 2 Diabetes Mellitus

A metabolic disorder characterized by peripheral insulin resistance coupled with progressive beta-cell secretory dysfunction.

Chronic Complications of Diabetes

Long-term end-organ microvascular and macrovascular consequences of hyperglycemia involving the blood vessels, kidneys, eyes, nerves, and wound healing.

Rapid-Acting Insulins

Insulin formulations—including insulin lispro, insulin aspart, and insulin glulisine—utilized to cover prandial glycemic rises.

Rapid-Acting Insulin Pharmacokinetics

Action profile featuring an onset of $10\text{--}15\,\text{minutes}$, a peak of approximately $1\,\text{hour}$, and a duration of $3\text{--}5\,\text{hours}$.

Rapid-Acting Insulin Prandial Coordination

The nursing safety requirement to ensure the patient has an available meal and consumes food immediately following or during the administration of rapid-acting insulin.

Short-Acting Regular Insulin

An unmodified crystalline insulin formulation administered subcutaneously around $30\,\text{minutes}$ prior to meals or intravenously for glycemic emergencies.

Regular Insulin Pharmacokinetics

Subcutaneous profile characterized by an onset of $30\text{--}60\,\text{minutes}$, a peak of $2\text{--}4\,\text{hours}$, and a total duration of $5\text{--}8\,\text{hours}$.

Regular Insulin IV Indication

The sole standard human insulin preparation approved for continuous intravenous infusion during the management of diabetic ketoacidosis (DKA).

Intermediate NPH Insulin

Neutral Protamine Hagedorn insulin, an intermediate-acting cloudy suspension that provides basal-type coverage but carries a distinct peak and associated hypoglycemia risk.

NPH Insulin Pharmacokinetics

Action curve featuring an onset of $1\text{--}2\,\text{hours}$, a pronounced peak of $4\text{--}12\,\text{hours}$, and a duration of roughly $12\text{--}18\,\text{hours}$.

NPH Physical Appearance

The inherently cloudy, turbid suspension appearance characteristic of Neutral Protamine Hagedorn insulin.

Long-Acting Basal Insulins

Formulations including insulin glargine and insulin detemir that provide steady background glycemic coverage with little to no pronounced peak.

Long-Acting Insulin Duration

The extended pharmacologic duration of insulin glargine and detemir lasting approximately $20\text{--}24\,\text{hours}$.

Insulin Degludec

An ultra-long-acting basal insulin analogue that provides flat glycemic coverage lasting longer than $24\,\text{hours}$.

Basal Insulin Perioperative Protocol

The clinical rule stating that basal insulin should never be automatically discontinued when a patient is made NPO for surgery, requiring provider dose adjustment instead.

Clear Before Cloudy Rule

The precise sequence for drawing up combined insulins in a single syringe, where clear regular insulin is drawn up prior to cloudy NPH insulin.

Insulin Glargine Syringe Mixing Rule

The strict manufacturer and clinical contraindication prohibiting the mixing of insulin glargine with any other insulin product in the same syringe.

NPH 70/30 Premix

A commercially premixed insulin formulation containing $70\%$ NPH intermediate-acting insulin and $30\%$ regular short-acting insulin.

Diabetic Ketoacidosis (DKA) Triggers

Precipitating clinical events for DKA including missed insulin doses, infections or acute illness, new-onset type 1 diabetes, and physiologic stress.

Diabetic Ketoacidosis (DKA) Clinical Findings

Hallmark presentation comprising polyuria, polydipsia, dehydration, nausea, vomiting, abdominal pain, weakness, fruity breath, Kussmaul respirations, and high-anion-gap metabolic acidosis.

Kussmaul Respirations

A deep, rapid compensatory breathing pattern characteristic of severe metabolic acidosis seen in diabetic ketoacidosis.

DKA Priority Initial Treatment

The immediate administration of intravenous isotonic fluids followed by baseline evaluation of potassium, renal function, blood glucose, and acid-base parameters.

DKA Pre-Insulin Potassium Assessment

The vital safety requirement to obtain and verify serum potassium concentration before initiating intravenous regular insulin therapy.

DKA Potassium Threshold for Delaying Insulin

A serum potassium level below $3.3\,\text{mEq/L}$, which mandates administering potassium repletion and delaying insulin infusion until hypokalemia is corrected.

Insulin-Induced Potassium Shift

The cellular physiological action where insulin drives extracellular potassium ions into intracellular spaces, risking sudden, severe hypokalemia.

Hypoglycemia Definition

A clinical and laboratory state defined as a blood glucose concentration falling below $70\,\text{mg/dL}$.

Mild-to-Moderate Hypoglycemia Symptoms

Neurogenic and early neuroglycopenic manifestations including sweating, shakiness, hunger, headache, palpitations, irritability, and confusion.

Severe Hypoglycemia Findings

Advanced neuroglycopenic clinical crisis characterized by seizures, loss of consciousness, or inability to swallow.

Rule of 15 for Hypoglycemia

The protocol for a conscious patient able to swallow: administer $15\,\text{g}$ of fast-acting simple carbohydrate, wait $15\,\text{minutes}$, and recheck capillary blood glucose.

Unconscious Hypoglycemia Management

The emergency protocol mandating that nothing be given by mouth, requiring parenteral administration of glucagon or IV dextrose per facility protocol.

Beta-Blocker Masking of Hypoglycemia

The pharmacologic blunting of sympathetic autonomic warning symptoms—specifically tachycardia and tremor—in patients taking beta-adrenergic blockers.

Persisting Hypoglycemia Sign Under Beta Blockade

Diaphoresis (sweating), which is mediated by sympathetic cholinergic pathways and remains present even when beta blockers conceal tremors and tachycardia.

Metabolic Syndrome

A constellation of metabolic abnormalities that significantly raises an individual's risk for type 2 diabetes, atherosclerotic cardiovascular disease, and fatty liver disease.

Metabolic Syndrome Diagnostic Threshold

The requirement that an individual meet at least $3$ of the $5$ defined clinical criteria to be diagnosed with metabolic syndrome.

Metabolic Syndrome Abdominal Obesity Criterion

An increased waist circumference exceeding specific sex- and ethnicity-defined clinical thresholds.

Metabolic Syndrome Triglycerides Criterion

A fasting serum triglyceride level equal to or greater than $150\,\text{mg/dL}$ or receiving active drug therapy for hypertriglyceridemia.

Metabolic Syndrome HDL Criterion

A serum HDL cholesterol level below $40\,\text{mg/dL}$ in men or below $50\,\text{mg/dL}$ in women, or receiving specific therapy for reduced HDL.

Metabolic Syndrome Blood Pressure Criterion

A resting blood pressure equal to or exceeding $130/85\,\text{mmHg}$ or receiving ongoing antihypertensive pharmacological therapy.

Metabolic Syndrome Fasting Glucose Criterion

A fasting plasma glucose concentration equal to or greater than $100\,\text{mg/dL}$ or receiving pharmacologic treatment for elevated glucose.

Loop Diuretics (Furosemide)

The most potent commonly used diuretic class, utilized to treat significant edema, heart failure fluid overload, and pulmonary edema.

Furosemide Nursing Monitoring

Clinical evaluations including blood pressure, daily body weight, intake and output, renal function tests, and serum levels of potassium, sodium, and magnesium.

Furosemide Electrolyte Adverse Effects

Severe electrolyte losses caused by loop diuresis, specifically hypokalemia, hyponatremia, and hypomagnesemia.

Furosemide Ototoxicity

Inner ear sensory impairment manifesting as tinnitus or hearing changes, primarily associated with high intravenous doses or rapid IV push administration.

Thiazide Diuretics (Hydrochlorothiazide)

A diuretic class working at the distal tubule commonly utilized as foundational therapy for essential hypertension and mild peripheral edema.

Hydrochlorothiazide Adverse Effects

Metabolic complications including hypokalemia, hyponatremia, dehydration, hyperuricemia (gout attacks), and hyperglycemia.

Thiazide Effect on Urinary Calcium

The pharmacological property of thiazide diuretics that reduces renal calcium excretion, potentially causing an increase in serum calcium.

Thiazides in Recurrent Nephrolithiasis

The therapeutic utility of hydrochlorothiazide to diminish urinary calcium excretion in patients prone to calcium-based kidney stones.

Spironolactone

A potassium-sparing diuretic that competitively blocks mineralocorticoid aldosterone receptors in the renal distal tubule and collecting duct.

Spironolactone Clinical Indications

Therapeutic uses including congestive heart failure, hyperaldosteronism, liver ascites, and refractory hypertension.

Spironolactone Major Danger

Hyperkalemia, which carries the high risk of fatal cardiac dysrhythmias and requires strict potassium and renal monitoring.

Spironolactone Endocrine Side Effects

Steroid-receptor-mediated hormonal side effects including gynecomastia in men, breast tenderness, and menstrual irregularities in women.

Spironolactone Dietary Precaution

Patient education mandating the strict avoidance of oral potassium supplements and potassium-based salt substitutes.

Mannitol

An intravenous osmotic diuretic utilized primarily to reduce acutely elevated intracranial pressure and cerebral edema.

Mannitol Intravascular Expansion Risk

A transient shift of fluid into the vascular bed that can acutely exacerbate pre-existing congestive heart failure and pulmonary edema.

Mannitol Crystallization

The temperature-dependent physical precipitation of mannitol solution requiring inspection for crystals and the use of an in-line filter before administration.

Mannitol Nursing Assessments

Ongoing clinical assessments including neurological status, hourly urine output, serum electrolytes, serum osmolality, and auscultation of lung fields.

Initial Antihypertensive Teaching

Patient education instructing adherence without abrupt discontinuation, slow position changes, regular BP checks, and physician consultation regarding OTC medications.

Orthostatic Hypotension Prevention

Behavioral guidance advising patients on antihypertensive agents to change positions slowly from lying to sitting to standing to prevent dizziness and falls.

Hypertension OTC Drug Interactions

Non-prescription medications—specifically NSAIDs and oral decongestants—that can blunt antihypertensive drug effects and elevate systemic vascular resistance.

Lifestyle Measures for Blood Pressure

Foundational non-pharmacologic interventions including dietary sodium restriction, regular physical activity, body weight management, and moderation of alcohol intake.

ACE Inhibitors

Antihypertensive agents (e.g., lisinopril, enalapril) that block the conversion of angiotensin I to angiotensin II, decreasing vasoconstriction and aldosterone release.

Post-MI Benefit of ACE Inhibitors

The pharmacologic reduction of left ventricular afterload and inhibition of maladaptive ventricular remodeling following an acute myocardial infarction.

Ventricular Remodeling

Pathologic alterations in ventricular size, geometry, and thickness following myocardial injury that dilate the chamber and accelerate systolic heart failure.

ACE Inhibitor Cough

A persistent, dry, non-productive respiratory side effect resulting from the pulmonary accumulation of bradykinin during ACE inhibitor therapy.

ACE Inhibitor Adverse Effects

Clinical complications including dry cough, hyperkalemia, profound hypotension, elevated serum creatinine, and potential life-threatening angioedema.

ACE Inhibitor Contraindications

Absolute clinical contraindications consisting of pregnancy, previous history of ACE-inhibitor-induced angioedema, and bilateral renal artery stenosis.

Angiotensin II Receptor Blockers (ARBs)

Antihypertensive medications (e.g., valsartan, losartan) that selectively block $AT_1$ receptors, providing cardiovascular benefits with a lower incidence of dry cough.

ARB Adverse Effect Profile

Complications including hyperkalemia, hypotension, renal function alterations, and fetal toxicity, with uncommon occurrence of angioedema.

ACE Inhibitor and ARB Dual Therapy

A prescribing practice generally avoided in routine care due to increased incidence of adverse outcomes without proportional clinical benefit.

Angioedema

Sudden, dramatic submucosal or subcutaneous edema involving the lips, face, tongue, or pharynx that can produce hoarseness, dysphagia, and fatal airway compromise.

Angioedema Priority Emergency Action

The immediate discontinuation of the suspected medication, immediate airway assessment, and urgent escalation/activation of emergency rescue protocols.

Metformin

A first-line oral biguanide antidiabetic medication that inhibits hepatic gluconeogenesis and enhances peripheral insulin sensitivity.

Metformin Dosing Administration

The administration rule instructing patients to take metformin with or immediately after meals to reduce common gastrointestinal upset.

Metformin Gastrointestinal Side Effects

Frequent, self-limiting early symptoms consisting of nausea, watery diarrhea, abdominal discomfort, and flatulence.

Metformin-Associated Lactic Acidosis (MALA)

A rare but life-threatening metabolic emergency precipitated by severe renal failure, tissue hypoxia, severe sepsis, or acute hemodynamic collapse.

Metformin and Iodinated Radiocontrast

The safety guideline instructing that metformin be temporarily withheld prior to and following procedures using iodinated contrast to prevent contrast-induced nephropathy and lactic acidosis.

Metformin Long-Term Monitoring

Serial clinical assessments focused primarily on renal function tests (serum creatinine/eGFR) and glycemic control indicators (glucose and $\text{HbA}_{1\text{c}}$).

Normal Fasting Plasma Glucose

A baseline euglycemic fasting plasma glucose measurement falling within the reference interval of $70\text{--}99\,\text{mg/dL}$.

Diabetic Fasting Glucose Diagnostic Level

A fasting plasma glucose concentration equal to or greater than $126\,\text{mg/dL}$ on confirmatory repeat laboratory evaluation.

Normal Glycated Hemoglobin ($\text{HbA}_{1\text{c}}$)

An $\text{HbA}_{1\text{c}}$ level reflecting an estimated average blood glucose over the preceding $2\text{--}3\,\text{months}$ of less than $5.7\%$.