7.1 - Endocrine System Flashcards
What does insulin do?
–> Stimulates glucose uptake in skeletal muscle and adipose tissue
–> Increase glycogen, triglyceride, and protein synthesis (anabolic hormone)
–> Inhibits gluconeogenesis and lipolysis
What kid of insulin is lispro, aspart, and glulisine?
Rapid - onset 10-30 mins
What kind of insulin is Toronto? When is it in tmax?
Regular
–> 2-4 hours max
Name an intermediate insulin and how long it lasts?
NPH - 12-18 hours
How long does detemir act?
Long acting - 16-24 hrs
How long does glargine act?
Long acting - 20-26 hrs
How long does degludec work?
Long acting - 36-42 hours.
What are the clinical uses for insulin?
Treatment of DM 1/Later stage 2
–> Also hyperkalemia (given w glucose)
What are the adverse effects of insulin?
Hypoglycemia
–> Tachycardia/palpitations, sweating, nervousness, headaches, confusion, drowsiness, convulsions, coma
Lipohypertrophy at injection site
What kinds of drugs are gliclazide and glyburide? What is their mechanism of action?
Sulfonylureas (p.o.)
–> Promote insulin secretion by the pancreas
What kind of drug is metformin? What is its route? Mechanism of Action?
Biguanide (p.o.)
–> Decreased production of glucose
–> Increased uptake of glucose in skeletal muscles and adipose tissue
Rosiglitazone
–> Class
–> Route
–> Mech of action
–> Adverse effects
Glitazone
–> p.o
–> Decreased insulin resistance
Adverse effects:
Retention of fluid, not great for people with heart failure
Liraglutide and Semaglutide
–> Route
–> Mech of action
–> Side/adverse effects
GLP-1 Receptor Agonist (s.c)
–> Increases effects of incretins, increasing glucose-dependent release of insulin; Enterogastrone effect: results in reduced gastric motility and emptying
Side Effects:
–> Decreased appetite
–> Risk of thyroid cancer
What are the incretins? What do they do?
Glucagon Like Peptide & Glucose-dependent Insulinotropic peptide/gastric inhibitory peptide
–> Stimulate gluose-dependent release of insulin
–> Suppress postprandial release of glucagon
Sitagliptin, Saxagliptin, Linagliptin
–> Route
–> Mechanism of action
Dipeptide peptidase-4 (DPP-4) Inhibitors (p.o.)
–> Increases incretin levels by inhibiting enzyme that inactivates them (DPP-4); Increased incretins signal for increased release of insulin
What percentage of glucose reabsorption takes place via the SGLT cotransporter in the proximal tubule?
90%
What kinds of drugs are atorvastatin and rosuvastatin?
HMG-CoA Reductase Inhibitors
–> Lower LDLs and triglycerides
What are the adverse effects of ator/rosuvastatin?
–> Gastro-intestinal disturbances
–> Elevation of liver enzyme tests
Can cause myopathies
Myalgia
–> Muscle pain; normal creatine kinase plasma levels
Myositis
–> Muscle inflammation (pain + elevated CK, >10x normal)
Rhabdomyolysis
–> Muscle pain + CK 10X > normal
–> Elevated myoglobin (Blood, urine)
Avoid During Pregnancy
What is myalgia?
Muscle pain with normal creatine kinase levels
What is myositis?
Muscle Inflammation:
Muscle pain + elevated creatine kinase (< 10X normal)
What is rhabdomyolysis?
Muscle pain
Creatine kinase 10x > normal
Elevated myoglobin (blood, urine)
What kind of medication is ezetimide?
A cholesterol absorption inhibitor
–> Lowers LDLs and triglycerides
What kind of drugs are evolocumab and alircumab? Adverse effects?
PCSK9 Inhibitors
–> monoclonal antibodies that target proprotein convertase subtilisin/kexin type 9, resulting in more LDL receptors and less circulating in the blood
Adverse Effects:
Injection site reactions
What kind of drug is cholestyramine? Adverse Effects?
Bile Acid Sequestrant (resin)
–> nonabsorbable resin that binds to bile acids in the GI tract and promote their excretion; body will begin using cholesterol to replace lost bile
Can cause constipation and often administered with a laxative
What kind of drug is Levothyroxine? What is its half life and adverse effects of a high dose?
A synthetic T4, the precurser of active form (triiodothyronin, T3)
Used to treat hypothyroidism
Half life is 7 days, so it takes 4-6 weeks before maximum effect. High doses can lead to symptoms of hyperthyroidism:
Tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, increased intestinal motility and sweating
What are the principal actions of thyroid hormone?
- Stimulation of energy use
- Stimulation of the heart
- Promotion of growth and development
What kinds of drugs are methimazole and propylthiouracil? What adverse effects do they share?
Used to treat hyperthyroidism
–> inhibit iodination and coupling fo tyrosine precursors bound to thyroglobulin, ultimately reducing the production of thyroid hormones
Shared adverse effects?
Rash, arthralgia, hypothyroidism (at high doses), agranulocytosis (rare)
What side effect is specific to propylthiouracil?
liver injury
