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Oncology / Chemotherapy NAPLEX PG 121. What is Cancer? Group of over 100 different diseases Group of over 100 different diseases Characterized by uncontrolled.

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Presentation on theme: "Oncology / Chemotherapy NAPLEX PG 121. What is Cancer? Group of over 100 different diseases Group of over 100 different diseases Characterized by uncontrolled."— Presentation transcript:

1 Oncology / Chemotherapy NAPLEX PG 121

2 What is Cancer? Group of over 100 different diseases Group of over 100 different diseases Characterized by uncontrolled cellular growth & proliferationCharacterized by uncontrolled cellular growth & proliferation Local tissue invasion Local tissue invasion Distant metastasesDistant metastases As a group, the second-leading cause of death in AmericansAs a group, the second-leading cause of death in Americans

3 PG 121 Cancer 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 mabs (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 mabs (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 TargetArrowUSERouteSide Effect HER2Trastuzumamb (Herbeptin)BreastIVCardiotoxicity CD33Gemtuzumab (Mylotarg)AMLIVMyleosuppression EGFRCetuximabColorectalIVDiarrhea CD52AlemtuzumabCLLIV or SQMyelosuppression

4 Angiogenesis 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 MABs – 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 MABs – target VEGF and EGFR Bevacizumab (VEGF) & Cetuximab (EGFR) target PG 122

5 Cell Cycle SpecificityM(mitosis) G1 phase (Gap 1) S phase (DNA synthesis) G2 (Gap 2) SEE TABLE 2-26 Phase-specific agents - Most active during a particular phase - Most active during a particular phase -May be active during other phases Nonphase-specific agents - May favor a stage - May favor a stage -Dose dependent agents

6 Cell Cycle SpecificityM(mitosis) Vinca alkaloids taxanes G1 phase (Gap 1) S phase (DNA synthesis) Antimetabolites 5-FU, cytarabine, methotrexate G2 (Gap 2) Alkylating Agents: CisplatinIfosfamidecyclophosphamide Hormones:GoserelinTamoxifenAnastrozole Antibiotics:Bleomycinrubicins SEE TABLE 2-26 PG 122

7 Chemo 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)

8 PG 123 Common adverse events related to chemotherapy Myelosuppression Myelosuppression Neutropenia, anemia, thrombocytopeniaNeutropenia, anemia, thrombocytopenia Nausea/vomiting Nausea/vomiting cisplatincisplatin Alopecia Alopecia CyclophosphamideCyclophosphamide Mucositis Mucositis Peripheral neuropathy Peripheral neuropathy Myelosuppression Myelosuppression Neutropenia, anemia, thrombocytopeniaNeutropenia, anemia, thrombocytopenia Nausea/vomiting Nausea/vomiting cisplatincisplatin Alopecia Alopecia CyclophosphamideCyclophosphamide Mucositis Mucositis Peripheral neuropathy Peripheral neuropathy Renal dysfunction Renal dysfunction Rash Rash Infusion reactions Infusion reactions Flu-like syndrome Flu-like syndrome MABs, docetaxelMABs, docetaxel Hemorrhagic Cystitis Hemorrhagic Cystitis cylcophosphamidecylcophosphamide

9 Common Adverse Effects Caused by Antineoplastic Drugs ** Information above is embedded in the tables p **

10 Common Adverse Effects Caused by Antineoplastic Drugs ** Information above is embedded in the tables p **

11 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)

12 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)

13 PG 135 – Drug Antagonist Chart Drug for prevention of adverse events related to chemotherapy DrugAction Mesna (Mesnex)Inhibits hemorrhagic cystitis caused by ifosfamide Dexrazoxane (Zinecard)Reduces cardiotoxicity caused by doxorubicin 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

14 Supportive 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

15 Supportive Care – N & V (continued) Metoclopramide ADRs: sedation, explosive diarrhea, EPS Phenothiazines (prochloperazine [Compazine] promethazine [Phenergan]) Used PRN ADRs: drowsiness, dry mouth, akathesia, dystonia Metoclopramide ADRs: sedation, explosive diarrhea, EPS Phenothiazines (prochloperazine [Compazine] promethazine [Phenergan]) Used PRN ADRs: drowsiness, dry mouth, akathesia, dystonia PG 124

16 Supportive 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 Dont 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 Dont 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 PG 124

17 Which of the following is a therapeutic substitution for ondansetron? a. Adaptin b. Kytril c. Inderal d. Seroquel e. Neurontin Which of the following is a therapeutic substitution for ondansetron? a. Adaptin b. Kytril c. Inderal d. Seroquel e. Neurontin

18 Which of the following is a therapeutic substitution for ondansetron? a. Adaptin b. Kytril c. Inderal d. Seroquel e. Neurontin Which of the following is a therapeutic substitution for ondansetron? a. Adaptin b. Kytril c. Inderal d. Seroquel e. Neurontin

19 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

20 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

21 Contraception NAPLEX PG 103

22 Contraception Mechanism of action: inhibit ovulation via negative feedback on the hypothalmus affecting FSH/LH release. Also alter genital tract, thicken cervical mucus. Mechanism of action: inhibit ovulation via negative feedback on the hypothalmus affecting FSH/LH release. Also alter genital tract, thicken cervical mucus. Hormonal Agents Estrogen ethinyl estradiol, mestranol Progestin desogestrel, norgestimate, levonorgestrel, norethindrone, norgesterel Types of oral contraceptive products---various doses but estrogen dose is held constant while progestin varies Monophasic Desogen, Yasmin, etc. Biphasic Ortho Novum 10/11, etc. Triphasic Triphasil, tri-Norinyl, Cyclessa, etc. Progestin only Micronor, Ovrette, Nor-qd Extended/continuous - Seasonale

23 Two Possible Components Estrogens – 2 Ethinyl Estradiol (EE) Mestranol Estrogens – 2 Ethinyl Estradiol (EE) Mestranol Progestins – 12 Synthetic Estrogens Synthetic Progestins

24 PG 103 Contraception (contd) - Treatment should be delayed one year post menarche to allow for normal cycle development - Adverse effects of oral contraceptives - Adverse effects of oral contraceptivesMajor: Thromboembolism Thromboembolism Stroke Stroke Myocardial infarction Myocardial infarction Endometrial carcinoma Endometrial carcinoma Pregnancy category X Pregnancy category X Risk factors Risk factors - Smoking - Age > 35

25 PG 104 Contraception (contd) Minor: Weight gain, edema Weight gain, edema Breakthrough bleeding Breakthrough bleeding - Early BTB: Insufficient estrogen activity; associated with amenorrhea - Late BTB: Insufficient progestin activity Nausea and vomiting Nausea and vomiting Mild depression Mild depression Drug Interactions: Antimicrobials (griseofulvin, penicillins, tetracyclines) Antimicrobials (griseofulvin, penicillins, tetracyclines) Enzyme inducer (barbiturates, rifampin, PIs, St.Johns Wart.) Enzyme inducer (barbiturates, rifampin, PIs, St.Johns Wart.)

26 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

27 PG 104 Non-Oral Hormonal Contraceptives - Medroxyprogesterone acetate injection (Depo-Provera) – q 3 mths - Estradiol cypionate and medroxyprogesterone acetate (Lunelle) - DC - Intrauterine progesterone contraceptive system (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

28 PG 104 Contraception (contd) Non-Hormonal Methods Non-Hormonal Methods Copper interuterine devide (ParaGard) – replaced every 10 years Spermicidal foams or suppositories – do not protect from sexual transmitted diseases. Barrier methods - condoms latex, animal membrane, male versus female); cervical cap; diaphragms Natural family planning - basal body temperature method; symptothermal method; calendar (rhythm) method

29 PG 104 Contraception (contd) Abortion Pill Mifepristone (Mifeprex-RU486)- generally used with misoprostol (Cytotec); for termination of early pregnancy (<49 days) Mifepristone (Mifeprex-RU486)- generally used with misoprostol (Cytotec); for termination of early pregnancy (<49 days) - Increase for bacterial infections (sepsis), prolonged vaginal bleeding - Increase for bacterial infections (sepsis), prolonged vaginal bleeding - Only be prescribe by physicians with a Prescribers Agreement - Not available in public pharmacies - Not available in public pharmacies Emergency Contraceptive Emergency Contraceptive First dose within 72 hours of unprotected sex and a second dose 12 hours later - Levonorgestrel (high dose) (Plan B) - 89% effective - -Yuzpe Regimen Reduces risk of pregnancy by 75% - -Lo/Ovral30ug EE + 0.3mg norgestrel 4 now and 4 in 12 hrs

30

31 PG 105 Miscellaneous Hormonal Agents Ovulation stimulants Estrogen antagonist Estrogen 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) – FSH analogs Follitropin beta (Follistim) Urofollitropin (Fertinex) Human menopausal gonadotropins Human menopausal gonadotropins Menotropins (Pergonal, Humegon) – mixture of FSH/LH

32 PG 105 Miscellaneous Hormonal Agents (contd) Posterior pituitary hormones Vasopressin (Pitressin) antidiuretic hormone for diabetes Vasopressin (Pitressin) antidiuretic hormone for diabetes insipidus (injection) insipidus (injection) Lypressin (Diapid) antidiuretic hormone for diabetes insipidus (intranasal) Lypressin (Diapid) antidiuretic hormone for diabetes insipidus (intranasal) Desmopressin (DDAVP) antidiuretic hormone, used to treat primary nocturnal enuresis and diabetes insipidus (nasal spray Desmopressin (DDAVP) antidiuretic hormone, used to treat primary nocturnal enuresis and diabetes insipidus (nasal spray and tablets) – also useful for hemophilia A and tablets) – also useful for hemophilia A Oxytocin (Pitocin) uterine stimulant – (injection) Oxytocin (Pitocin) uterine stimulant – (injection)

33 PG 106 Hormones (contd) Estrogens Conjugated estrogen (premarin, etc.) Conjugated estrogen (premarin, etc.) - synthetic forms : estradiol, estropipate Estrogen dosage forms - tablet, cream, ring, transdermal Estrogen dosage forms - tablet, cream, ring, transdermal patches, etc. patches, etc. - HRT improves lipid levels, reduces fracture risk, reduces vasomotor symptoms, DOES NOT reduce CV disease (WHI, HERS) - breast cancer risk - small, but there. Long-term use, family hx - Black Cohosh herbal has been touted for treatment of hot flashes, SSRIs, Soy product and clonidine are effective Selective estrogen receptor modulator (SERMs) raloxifene (Evista) - indicated for prevention and treatment of osteoporosis

34 When counseling a patient about medroxyprogesterone what are the important factors to discuss? I. Weight gain II. Osteoporosis III. 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 gain II. Osteoporosis III. 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

35 When counseling a patient about medroxyprogesterone what are the important factors to discuss? I. Weight gain II. Osteoporosis III. 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 gain II. Osteoporosis III. 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

36 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) Osteoporosis

37 PG

38 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

39 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

40 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

41 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

42 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

43 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

44 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

45 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

46 Thyroid Case Study NAPLEX PG 106 Page 106

47 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

48 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

49 L-thyroxine is the same as: a. T 4 b. T 3 c. liothyronine d. liotrix e. cytomel L-thyroxine is the same as: a. T 4 b. T 3 c. liothyronine d. liotrix e. cytomel

50 L-thyroxine is the same as: a. T 4 b. T 3 c. liothyronine d. liotrix e. cytomel L-thyroxine is the same as: a. T 4 b. T 3 c. liothyronine d. liotrix e. cytomel

51 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

52 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

53 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

54 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

55 The parathyroid gland controls the bodys level of: a. iron b. calcium c. iodine d. potassium e. glucose The parathyroid gland controls the bodys level of: a. iron b. calcium c. iodine d. potassium e. glucose

56 The parathyroid gland controls the bodys level of: a. iron b. calcium c. iodine d. potassium e. glucose The parathyroid gland controls the bodys level of: a. iron b. calcium c. iodine d. potassium e. glucose


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