, Thyroid disorders .

1. .

4. .

2. .

5. .

3. .

1

(DM)

Rx Chlorpropamide (250) 1 tab ac qd # 30

1. DM

1. Blood glucose > 150 mg/dL

2. HbA1c > 7%

3. 3 /4. Insulin 5. Glucose tolerance test > 200 mg/dL2. HBA1c

1. 2. 2 3. ?

1. hypoglycemia

2. hyperglycemia

3. hypervolumia

4. hypovolumia

4. ?

1. 2. 3. 4. 5. 5.

1. retinopathy

2. nephropathy

3. neuropathy

4. glaucoma

5. atherosclerosis

6. glipizide MR 30 mg 15 mg ?

1. 2. 3. 4. 5. 7. glipizide film coat tablet 1. particle size

2. Solubility

3. crystalinity

4. friability 5. film thickness

8. HbA1c

1. ion-exchange chromatography

2. electropholosis

3. Gas chromatography 4. Electro focusing

5. Spectrophotometry

9. Chlorpropamide

1.

2.

3.

4. 5.

10. intermediate

1.Regular insulin

2.Neutral insulin

3. Isophane

4.insulin lispro

5.glargine 2

1. 40 FBS =140 1. DM type 2

2. DM type 1

2.Drug of choice DM Guideline 1. Metformin

2. Sulfonylurea

3.. HbA1C < 7

. 180

. HbA1C < 7 , 126

. HbA1C < 8 , 180

4. S/E 1. Lypoatrophy 2.hypoglycemia 3.Ketouria4.hepatotoxic

5.Lacticasidosis

5. 1.Rapid acting

2.short acting 3.inhaler4.Long acting

5.intermidiate

6.Charantin

1.

2. 3. 7.insulin 1.Soda-lime

2.Boro Silica3.Soda-lime4.Natural glass

8. 750 100000 30 9. sulfonylurea . gen.

.Gen 2 Metabolite

.Gen2 . gen.

. gen. 10. ..

.

.. 3

65 90 kg 165 cm 3-4 FH: : 20 1-2 1-2 1. 1. 2.

3.

4. 1-2

5.

2. 1. 2. 3. 20 4. 1-2 / 5. 1-2 /3. 1. 2.

3.

4.

5. 4. DTX 140% BP 130/80

1. pre-diabetes 1-3 2. 3. DM type 2 4. pre-diabetes 3 5. DM type 2 2 Lab FBS 210

Metformin 1x2 # 60

5. Hyperglycemia

1. FBS 210%

2.Cholesterol

3. LDL

4. HDL 35% 5. TGS6. 1. Biguanide 2. Glitazone 3. Sulfonylurea 4. GLP-1 analogue5. Incretin analogue

7. 1. Anorexia

2. Flatulence

3. Constipation

4. Lactic acidosis

5. Hypoglycemia

8.

1. Pediatric

2. Cirrhosis/Hepatitis

3. Pregnancy

4. Renal failure

5. Sulfa allergy9. DM type Odd ratio Nephropathy HbA1C ( 8% 2.2 95%CI 1.3-3.8 1. HbA1C ( 8% Nephropathy

2. HbA1C ( 8% Nephropathy

3. HbA1C ( 8% Nephropathy 2.2 HbA1C ( 8%

4. HbA1C ( 8% Nephropathy 55%

5. p-value

4 70 81 150 2 7 penicillin sulfonamide 2

LAB: FBS 180 mg%, HbA1C 9%

MED: Acarbose

50 mg tid

Salbutamol inhale MDI

Atenolol mg

1x2 pc

ASA 81 mg

1x1 pc

Prednisolone 5 mg 2x2 pc

1. 1) flatulence2) hypoglycemia 3) dizziness 4) headache 5) photosensitivity2. 1) glipizide

2) glibenclamide 3) metformin 4) insulin lispro 5) insulin gargine3. metformin

1) lactic acidosis 2) obesity 3) hypertension 4) hyperlipidemia 5) gastric ulcer4. 1) ACEIs 2) alpa-blockers 3) B-blockers4) loop diuretics 5) Thiazides

5. hypoglycemia 1) salbutamol inhale2) ASA 3) acarbose 4) atenolol 5) prednisolone

6. 2 amorphous 1)

2)

3)

4) 5) 7. amorphous 1) Differential Scanning Calorimetry

2) High Performance Liquid Chromatography

3) Mass Spectrometry

4) Polarization

5) Scanning Electron Microscope

5

35 Chlorpropamide 500 mg

1 tab bid # 60

1. 1. 2. 3. 4. 5. 1. 2. , 3. , , 4. 5.

2. 1. 2. 3. 4. 500 mg qd

5.

3. Chlorpropamide 1. 500 mg bid

2. 500 mg qd

3. 250 mg bid

4. 100 mg tid

5. 100 mg qd

4. 1. 100 mg/dl

2. 3. 200 mg/DL 4. Oral glucose tolerance test OGT 2 150 mg/DL

5.

5. Chlorpropamide 1. Insulin resistance 2. Insulin resistance 3. Insulin 4. 1 3 5. 2 3

2 100 mg/dl 2 6. 1. 2. 50 mg qd

3. 4. 5. 2 3

7. 1. 2. 3. 4. 2 3 5. 1, 2 3

8. 1. 2. 3. 4. 2 5.

1

Tolbutamide 250 mg

qd pc#30

hyponatremia chlorpropamide9. hyponatremia chlorpropamide 1. Allergic Reaction

2. Toxic Reaction

3. Overdose

4. 5.

10. 1 hypoglycemia hypoglycemia 1. Tolbutamide 2. chlorpropamide Tolbutamide Tolbutamide 3. 4. 11. hypoglycemia Duration of action sulfonylureas 1. Chlorpropamide > Glyburide > Glipizide > Tolbutamide

2. Tobutamide > Glipizide > Glyburide > Chlorpropramide

3. Glyburide > Tolbutamide > Glipizide > Chlorpropramide

4. Glipizide > Glyburide > Chlorpropramide > Tolbutamide

5. Tolbutamide > Chlorpropamide > Glyburide > Glipizide

12. 1. 2. 3. 4. 5.

Tolbutamide 13. 1. 2. 2 3. 4. 1 2 5. 14. 1. 5%

2. 10%

3. 15%

4. 20%

5. 25%

15. Insulin NPH Insulin Insulin 1. 2. 3. 2 4. 5.

6 58 BMI = 28 kg/m2 (1) glibenclamide tablet (5) 1x2 AC

(2) metformin tablet (500) 1x3 AC

(3) Isoserbide mononitrate tablet (20) 1x2 AC

(4) Aspirin tablet (300) 1x1 PC

1. DM

.

.

.

.

. 2.

. glibenclamide 30

. aspirin

. glibenclamide weight gain

. metforin hypoglycemia

. alcohol glibenclamine

3. Metformin glaucoma Metformin

. glucoside

. Rosiglitazone

. Chlorpropamide4. glibenclamide

. glucagon

. Insulin

. Insulin

. somatostatin

5. Glibenstermine . desensitization of sulfonylureas receptor

. up-regulation of sulfonylureas receptor

. down-regulation of sulfonylureas receptor

. hyperinsulinemia

. increase insulin sensitivity

6.

. aspirin

. metformin

. isosorbide mononitrate

. glibenclamide

. 7. 10 uniformity 125 mg. S (Sample standard deviation) RSD (relative standard deviation)

. 2% . 3%

. 4%

. 5%

. 6%

8. aspirin

. faking . Paling . Picking. Mottling. capping

9. . .

.

.

.

. 10. glibenclamide duration . polarized

. HPLC-UV detection

.

.

. 7CC: 68

HPI : PMH : 18

MED : Voglibose 1x3 pc

Glipizide 1x2 ac

Enalapril 1x1 pc

FH :

SH : LAB : BP 160/90 mmHg, FPG 160 mg/dl, HbA1c 8.2%1. 1. FPG 90-130, HbA1c < 10

2. FPG 90-150, HbA1c < 7

3. FPG 90-130, HbA1c < 7

4. FPG 90-150, HbA1c < 10

2. Voglibose

1. 2. 30 3. 4. 8 65 2 Diamicron (Gliclazide 80 mg) 1 2 1. 1. Type 1 2. Type 1 DKA

3. Type 2 4. Type 2 5. 2. 1. 2. metformin 3. 4. 5. 3. 1. 2. 3. 4. 5. 4. UKPDS (United Kingdom Prospective Diabetes Study) macrovascular complications 2 1. Acarbose

2. Pioglitazone

3. Metformin

4. Repaglinide

5. Glipizide

5. 2 (FPG = 200 mg/dL, HbA1c = 8.2%) Glipizide Rosiglitazone 1. metformin

2. glipizide nateglinide 3. rosiglitazone 70/30 insulin BID

4. glipizide insulin 5. 6. Glipizide 1. Biguanides

2. Nicotinic acids

3. Sulfonylurea compounds

4. Nucleoside analogue

5. Sulfones

7. glipizide Extended Release Tablet

1. 2. 3. 4. 5. 8. glipizide 1. glipizide non polar

2. glipizide 3. glipizide Extended Release Tablet salt form

4. Glipizide metformin

5. Glipizide second generatino drug type 2 diabetes

9. Rosiglitazone 1 1. insulin

2. insulin

3. insulin 4. hypoglycemia

5. insulin 10. Thaizolidinediones 1. Renal toxicity

2. Retionpathy

3. Hepatotoxicity

4. Hemolytic anemia

5. Cardiotoxicity 11. insulin 1. 2. 3. 4. 5. 12. insulin

1. Lispro amino acid pholine lysine 2. Protamine NHP 3. phosphate buffers Lente

4. Insulin 13. Acarbose

1. 2. 3. 4. 5. 14. hyperglycemia hypokalemia 1. hydrocortisone

2. Chlopropramide

3. Hydrochlorothiazde

4. Bumetanide

5. Prednisone

15. Glibenclamide

1. Ketoacidosis

2. DM type 2 3. DM type 2 4. DM type 1 or 2 5. DM type 1 16. insulin preparation 1. regular insulin amorphous insulin

2. ultralente insulin 3. semilente insulin amorphous precipitate insulin insulin zinc ion acetate buffer

4. isophane insulin lente insulin

5. preinsulin insulin Gluconeogenesis

17. 1. 2. beta cell 3. Insulin resistance

4. Craxaxis B4

5. autoimmune

18. Type I NPH insulin FBS = 40 mcg/dl (70-100) NPH 20 mcg/dl NPH insulin 10 mcg/dl 1. NSS

2. Sodium bicarbonate

3. Glucose

4. Regular insulin

5. Lispro insulin

19. NPH insulin 1. Rapid acting insulin

2. Short acting insulin

3. Intermediate acting insulin

4. Long acting insulin

5. Ultralente insulin

20. insulin

1. particle size

2. solubilizing

3. cristalinity

4. site of injection

5. site of action

21. hypoglecemia DRPs

1. Low dose

2. High dose

3. Uncessary therapy drug

4. Non-compliance

5. ADR(Adverse Drug Reaction)

9 65 1 ASA 325 mg/d, nifedipine 30 mg/d, metoprolol 50 mg bid and nitroglycerine patch 0.2 mg/h

1. 1. polyphagia

2. polydipsia

3. polyuria

4. myalgia

5. weight loss2. 1. polydipsia and polyuria

2. 1 , 3. 4. 5. 3. a. ASA, Nifedipine, glucophage

b. ASA, metoprolol, glucophage

c. Nifedipine, metoprolol, glucophage

d. Nifedipine, nitroglycerine patch, insulin

e. Metoprolol, nitroglycerine patch, insulin 1 2 4. metformin

a. b. c. 15 d. (Renal disease) lactic e. sulfonylurea insulin 5. a. b. 1 c. d. e. metformin 1 serum bicarbonate 19 mEq/L, anion gap 21 (122), serum lactic acid 3.6 mEq/L (0.3-1.3)

6. a. ASA

b. Metformin

c. Metoprolol

d. Nifedipine

e. Nitroglycerine

7.

. Drug hypersensitivity

. Drug interactions

. Drug induced hypoglycemia

. lactic acidosis

. respiratory alkalosis

8. 1. Iodoperoxidase inhibitor

2. Sulfonylurea

3. Thyroid hormone

4. Biguanide

5. Insulin analog

1 Glucophage 1x2 pc, Monotard SC 20-0-0

9. . Glucophage -. 15-30 20 . . 2 . 10. . . . . . 10 53 10 glipizide 10 mg bid 2 BP 125/80 mmHg, Wt 65 kg, Ht 160 cm

FBS 240 mg/dl, HbA1c 10.2% 6.9%, TC 185 mg/dl, LDL 104 mg/dl, HDL 45 mg/dl, TG 179 mg/dl

glipizide 20 mg bid 6 FBS 145 mg/dl, HbA1c 9.2% glipizide 20 mg bid metformin 500 mg bid 1. metformin 1. sulfa sulfonylurea metformin combination therapy

2. Metformin glipizide insulin

3. Metformin glipizide metformin glycolysis 4. Metformin glipizide metformin beta-cell glucose transporter

5. Metformin glipizide metformin glucosidase 2. metformin

1. Repaglinide

2. Insulin Lispro

3. Rosiglitazone

4. Acarbose

5. 3. Premixed insulin 30/70 1. Regular insulin 3:7

2. Insulin semilente 30% Ultralente 70%

3. Insulin Regular insulin NPH insulin 3:7

4. Insulin Regular insulin Lispro 3:7

5. Insulin Lispro insulin NPH insulin 3:7

4. insulin 1. Hypoglycemia

2. Lipoatrophy

3. 4. 5. 11 70 60 kg 160 cm 2-3 5 Enalapril 1*1 @ pc , Metformin 1*2 pc Glibenclamide *1 @ ac ( 91-100)

1. . FBG 80 130, HbA1C < 7.5 . FBG 90 130, HbA1C < 7.5

. FBG 80 130, HbA1C < 7 . FBG 90 130, HbA1C < 7

2. . Type 1 . Type 1 . Type 2 DKA

. Type 2

3. 2-3 . . . . 4. . . . . 5. . 100 mg/dl

. . 200 mg/DL . Oral glucose tolerance test OGT 2 150 mg/DL

6. Insulin NPH Insulin Insulin . . 2 . . 7. Metformin . . . . 8. . . . . 9. glibenclamide

. . . Weight loss . Weight gain

10. DRP . Non-compliance . Low dose

. High dose . Inappropriate treatment

11. Macrovascular complication . Acarbose Metformin . Glipizide Pioglitazone

. SU Metformin . Repaglinide SU

12. Acarbose . . 30 . . 13. Duration of action sulfonylureas . Chlorpropamide > Glyburide > Glipizide > Tolbutamide

. Tobutamide > Glipizide > Glyburide > Chlorpropramide

. Glyburide > Tolbutamide > Glipizide > Chlorpropramide

. Glipizide > Glyburide > Chlorpropramide > Tolbutamide 14. Chlorpropamide . Insulin resistance . Insulin resistance . Insulin . 1 3 15. . Retinopathy . Nephropathy

. Neuropathy . 16. . Polyuria . Weight gain

. Fatigue . Polydypsia

17. lispro insulin . Rapid acting insulin . Short acting insulin

. Intermediate acting insulin . Long acting insulin

18.

1. Glibenclamide

2. Metformin

3. Glipizide

4. Chlorpropramide

19. Thaizolidinedione . Renal toxicity . Retinopathy

. Hepatotoxicity . Cardiotoxicity

20. NPH/Regular insulin

. 2

. . 2/3

. 24 Regular insulin NPH

21. . plunger

. 1-2

. . alcohol 22. . (2-8oC). 1

. . 23. Regular insulin NPH

. Regular insulin NPH. . . .

. 24. Samogyi effect

. hypoglycemia (nocturnal hypoglycemia).

. . rebound hyperglycemia 25. .

.

. .

26. Insulin sensitizers

. Glibenclamide

. Metformin

. Repaglinide

.

27.

.

.

.

.

28. Metformin

. Metabolic acidosis

. Myocardial infraction. Liver failure

. Respiratory failure

29.

. Onset 15

. Duration 12 2

. Humalog, Aspart

. Nocturnal hypoglycemia Regular insulin

30. insulin . ketogenesis

. fatty acid

. glycogen

. glycogenolysis 31. DM . Tolbutamide (Crinase)

. Tolazomide (Tolenase) . Chlorpropramide (Diabinese)

. Glipizide (Minidiab)

. Acetohexamide (Dymetor) 32. sulfonylurea

.

. gluconeogenesis .

. insulin receptor sensitivity33. 1. glipizide2. Metformin3. Rosiglitazone

4. amlodipine

5. metformin rosiglitazone

34. 1. Enalapril 2. Losartan3. Metformin4. Nifedipine5. Aspirin

35. drug utilization evaluation

1. celecoxib 2. metformin megaloblastic anemia 3. clopidogrel 4. rosiglitazone 5. Imipenem

36. 1. 2. 3. 4. 5. 3-4

1

27 50 180/90 mmHg 110 / 24 / 4 Active hyperthyroidism Graves disease

1. paramitor 1. Free T3 TRH

2. Free T3 TRH

3. Total T4 TSH

4. Total T4 TSH

5. Free T4 TSH

2. Radioactive Iodine Radioactive Iodine Radioactive uptake 1. I123, 2. I123, 3. I123, 4. I131, 5. I131, 3. 1. Akathisia

2. Hyperthropic..

3. Pheochromocytoma

4. Tetralogy spells

5. Thyrotoxicosis

4. hyperthyroidism

5.

1. PTU

2. PTU + Propanolol

3. methimazole

4. lithium

5. Lugols solution6. Iodine first order K1= 0.0005 hr-1 Shelf life

1. 1347 hr 2. 550 hr 3. 168 hr 4. 220 hr 5. 150 hr

7. PTU

1. HPLC-UV

2. HPLC-MS

3. Radioimmunoassay

4. AA

5. AE

8. hyperthyroidism

......................................................................................9. 53 62 p-value=0.02 ......................................................................................................................................................................................... 2 35 (Esophthalmas) LAB: total T4 20 ug/dl(6-12) free T4 2.7 ng/dl(0.6-8) total T3 300 ng/dl(80-200) TSH 0.001 mu/ml (0.5-1)1. 1. Euthyroid

2. Thyroiditis 3. Hypothyroid4. Thyroid cancer5. Thyrotoxicosis

2. 1. Propanolol

2. Propythiouracil

3. KI

4. Liothyroxine sodium

5. Levethyroxine sodium

3. monitor ADR 1. AST2. Scr

3. CBC

4. Serum K

5. Serum Na

Rx Lactate ringer solution

Sig 2 drop. Tid (1 drop = 6.3 mg/drop) iodine

5

KI

10

Water qs 100

4. KI 1.Osmolarity2.Suspension 34.Complexation5.Tonicity adjusting5. 1. Patable water ()2. Purified water

3. Distilled water

4. Deionized water

5. Reverse osmotic water

6. iodine

1. 12

2. 18

3. 25

4. 37.8

5. 50

7. KI 1. Cough suppressant

2. Expectorant

3. Urinary antiseptic

4. analgesic

5. diuretic

8. 1. 2. 3. 4. 5.

9. ( PTU)

1. 6 propyl 3 thiouracil

2. 1 propyl 5 thiouracil 3. 2 propyl 6 thiouracil 4. 2 propyl 5 thiouracil 5. 6 propyl 2 thiouracil 10. propylthiouracil methimazole 135 1964 1990 PTU 99 methimazole 36 31. 1. 2. 3. 4. 2. ..........................................................................................................3. 1. 2. I131 3. Thyroxidosis Grave,s disease 4.

4. Carbimazole

...............................................................................................................................................................

5. Adjuvant drug 1. Iodine

2. Perglaride

3. vit B 1-6-12

4. Pergabide

5. Propranolol

6. 1. I1312. Salbutamol

3. Lugol,s solution

4. Dexamethasone

5. CaCo37. Lugols solution ( KI I2) 1. KI I2 2. I2 KI 3. KI I2 8. Carbimazole 35 ..........................................................................................................................................9. 27 .. 53

4 28

Thyroid stimulating hormone (TSH) Thyroxine

1. a. Goiter, constipation, lethargy, dry skin

b. Goiter, depression, puffy face, lethargy

c. Goiter, cold intolerance, decreased sweating, bradycardia

d. Goiter, loose bowels, insomnia, irritability

e. Goiter, fatigue, weight gain, decreased appetite

Propanolol 20 mg QID for 3 weeks

Propylthiouracil 100 mg TID for 6 weeks

2 1 cuthyroidal state

2. Propylthiouracil 2542 a. b. c. d. e. drug use evaluation 3. a. Propylthiouracil methimazole b. Propylthiouracil c. d. iodine

e. propranolol propylthiouracil

4. thiouracil

a. b. c. d. SLE like syndrome

e. Metallic taste

5. Propylthiouracil

a. thiourea

b. thyroid hormone

c. hypothyroid

d. thyroid peroxidase

e. T3

6. antithyroid a.

7. Lugols solution a. Iodine + KI

b. Manganese

c. Methimazole

d. Thiocyanate

e. Propylthiouracil

8. 3 methimazole carbimazole ropylthiouracil

methimazole, carbimazole propylthiouracil

a. methimazole, carbimazole propylthiouracil metabolized desulfunation b. propylthiouracil metabolized dealkylation Propyl group c. methimazole metabolized conjagation carbimazole d. amide hydrolysis carbimazole e. ester hydrolysis carbimazole 9. propanolol propylthiouracil

a. Propanolol alpha-adrenergic blocking agent b. Propanolol tremor tarchycardia thyrotoxicosis

c. Propanolol pharmacokinetic propylthiouracil propylthiouracil d. Propanolol propylthiouracil

e. Propanolol propylthiouracil T4

10. goiter

a. Ion thiocyanate goiter

b. Thiocyanate metabolize ... c. Lithium secretion Thyroxine thiiodothyroxine hyperthyroidism

d. Goitrin thyroid peroxidase

e. Percholate ion uptake iodide iodide thyroid 11. toxic goiter a. iodine b. iodine c. d. e. thiocyanide 5 30

Methimazole (5) 2 tab bid #1201. 1. 2. 3. 4. 5.

2. 1. 2. 3. 4. 1 5. 3. 1. methimazole propylthiouracil 2. methimazole peroxidase 3. 4. 5. 3 agranulocytosis Lugols solution 2 1 10 propanolol 4. 1. Lugols solution 2. propanolol 3. Lugols solution 4. 5. Lugols solution supersaturated potassium iodide solution (SSKI)

1 L-thyroxine sodium 10 microgram 1x1 OD #100

5. 1. 2. 3. 4. cholestyramine 5. 6. 1. L-thyroxine sodium isomer T42. L-liothyronine sodium L-thyroxine sodium

3. T4 T3 myxoedema coma

4. Liotrix T4 T3 5. T4 T3

7. 1. T4 active T32. T4 pKa T33. T4 protein T34. T4 T35. T4 phenolic hydroxy group T38. Propylthioouracil 1. 3-Thiouracil derivative

2. Tautomerization Keto form Thioenol form

3. Tautomerization 4. Enolic hydroxy gr. carbon 4

5. 6-Propylthiouracil 6-Methylthiouracil Hydrophilicity 6 A.

B. C.

Propanolol 20 mg

QID for 3 weeks

A 100 mg

TID for 6 weeks

2 1 Thyroid disorder Euthyroidal stage

1. A . 2542 . 1. 2. 3. 4. 5. 2. 1. A B 2. 3. 4. Radioactive Iodine

5. Propanolol

3. 1. Agranulocytosis

2. Arthritis

3. Dizziness

4. SLE like syndrome

5. Metallic test

71. hypothyroid

a. CHF

b. AF

c. Myxedema2. hormone hypothyroid a. levothyroxine first trimester

b. dose

c. first trimester

d. second trimester

e. levothyroxine 3. thyroid 2 1. TSH T4 2. TSH T4 3. TSH T4 4. 2 5. TSH T4 4. 1. PTU MTZ PTU T4 T3 2. 1 3. Beta-blocker thyroid 4. NaI131 5. 66 Hypothyroidism Subclinical hypothyroidism Thyroxine 50 mcg/day carbamazepine 200 mg tid Ferrous sulfate 200 mg/day 81. arrhythmia hyperthyroid . thyroid hormone

. Anti-thyroid drug

. Quinidine

. propranolol

. Verapamil

2. mineralocorticoid action

. beclomethasone

. Dexamethasone

. Fludrocortisone

. hydrocortisone

. Triamcinolone Lab FT4 TSH ....1. 2. / 3. / 4. drug of choice 5. receptor (I , D L DL form)6. ( T3)c.

d.

b.

Thyroid disorders

_1227185126.unknown