7.1 - Endocrine System

Question 1

What does insulin do?

Answer 1

–> Stimulates glucose uptake in skeletal muscle and adipose tissue
–> Increase glycogen, triglyceride, and protein synthesis (anabolic hormone)
–> Inhibits gluconeogenesis and lipolysis

Question 2

What kid of insulin is lispro, aspart, and glulisine?

Answer 2

Rapid - onset 10-30 mins

Question 3

What kind of insulin is Toronto? When is it in tmax?

Answer 3

Regular
–> 2-4 hours max

Question 4

Name an intermediate insulin and how long it lasts?

Answer 4

NPH - 12-18 hours

Question 5

How long does detemir act?

Answer 5

Long acting - 16-24 hrs

Question 6

How long does glargine act?

Answer 6

Long acting - 20-26 hrs

Question 7

How long does degludec work?

Answer 7

Long acting - 36-42 hours.

Question 8

What are the clinical uses for insulin?

Answer 8

Treatment of DM 1/Later stage 2
–> Also hyperkalemia (given w glucose)

Question 9

What are the adverse effects of insulin?

Answer 9

Hypoglycemia
–> Tachycardia/palpitations, sweating, nervousness, headaches, confusion, drowsiness, convulsions, coma

Lipohypertrophy at injection site

Question 10

What kinds of drugs are gliclazide and glyburide? What is their mechanism of action?

Answer 10

Sulfonylureas (p.o.)
–> Promote insulin secretion by the pancreas

Question 11

What kind of drug is metformin? What is its route? Mechanism of Action?

Answer 11

Biguanide (p.o.)
–> Decreased production of glucose
–> Increased uptake of glucose in skeletal muscles and adipose tissue

Question 12

Rosiglitazone
–> Class
–> Route
–> Mech of action
–> Adverse effects

Answer 12

Glitazone
–> p.o
–> Decreased insulin resistance

Adverse effects:
Retention of fluid, not great for people with heart failure

Question 13

Liraglutide and Semaglutide
–> Route
–> Mech of action
–> Side/adverse effects

Answer 13

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

Question 14

What are the incretins? What do they do?

Answer 14

Glucagon Like Peptide & Glucose-dependent Insulinotropic peptide/gastric inhibitory peptide
–> Stimulate gluose-dependent release of insulin
–> Suppress postprandial release of glucagon

Question 15

Sitagliptin, Saxagliptin, Linagliptin
–> Route
–> Mechanism of action

Answer 15

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

Question 16

What percentage of glucose reabsorption takes place via the SGLT cotransporter in the proximal tubule?

Answer 16

90%

Question 17

What kinds of drugs are atorvastatin and rosuvastatin?

Answer 17

HMG-CoA Reductase Inhibitors
–> Lower LDLs and triglycerides

Question 18

What are the adverse effects of ator/rosuvastatin?

Answer 18

–> 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

Question 19

What is myalgia?

Answer 19

Muscle pain with normal creatine kinase levels

Question 20

What is myositis?

Answer 20

Muscle Inflammation:
Muscle pain + elevated creatine kinase (< 10X normal)

Question 21

What is rhabdomyolysis?

Answer 21

Muscle pain
Creatine kinase 10x > normal
Elevated myoglobin (blood, urine)

Question 22

What kind of medication is ezetimide?

Answer 22

A cholesterol absorption inhibitor
–> Lowers LDLs and triglycerides

Question 23

What kind of drugs are evolocumab and alircumab? Adverse effects?

Answer 23

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

Question 24

What kind of drug is cholestyramine? Adverse Effects?

Answer 24

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

Question 25

What kind of drug is Levothyroxine? What is its half life and adverse effects of a high dose?

Answer 25

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

Question 26

What are the principal actions of thyroid hormone?

Answer 26

1. Stimulation of energy use
2. Stimulation of the heart
3. Promotion of growth and development

Question 27

What kinds of drugs are methimazole and propylthiouracil? What adverse effects do they share?

Answer 27

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)

Question 28

What side effect is specific to propylthiouracil?

Answer 28

liver injury