Copy of Endocrine Rx - Sheet1

Question 1

Lispro, aspart, gluisine

Answer 1

1) Type I DM, Type II DM, gestational DM, life-threatening hyperkalemia, stress-induced hyperglycemia
2) Insulin/Bind insulin receptor (tyrosine kinase activity)
- Liver: increase glucose stored as glycogen
- Muscle: increase glycogen and protien synthesis and K+ uptake
- Fat: aids in TG storage
3) Hypoglycemia, very rarely hypersensitivy rxns
4) Rapid-acting

Question 2

Regular

Answer 2

1) Type I DM, Type II DM, gestational DM, life-threatening hyperkalemia, stress-induced hyperglycemia
2) Insulin/Bind insulin receptor (tyrosine kinase activity)
- Liver: increase glucose stored as glycogen
- Muscle: increase glycogen and protien synthesis and K+ uptake
- Fat: aids in TG storage
3) Hypoglycemia, very rarely hypersensitivy rxns
4) Short-acting

Question 2

NPH

Answer 2

1) Type I DM, Type II DM, gestational DM, life-threatening hyperkalemia, stress-induced hyperglycemia
2) Insulin/Bind insulin receptor (tyrosine kinase activity)
- Liver: increase glucose stored as glycogen
- Muscle: increase glycogen and protien synthesis and K+ uptake
- Fat: aids in TG storage
3) Hypoglycemia, very rarely hypersensitivy rxns
4) Intermediate

Question 2

Glargine, detemir

Answer 2

1) Type I DM, Type II DM, gestational DM, life-threatening hyperkalemia, stress-induced hyperglycemia
2) Insulin/Bind insulin receptor (tyrosine kinase activity)
- Liver: increase glucose stored as glycogen
- Muscle: increase glycogen and protien synthesis and K+ uptake
- Fat: aids in TG storage
3) Hypoglycemia, very rarely hypersensitivy rxns
4) Long-acting

Question 3

Metformin

Answer 3

1) oral; First-line therapy in Type II DM, can be used in pts w/o islet function
2) Biguanide/ Exact MOA unknown –> decreases gluconeogenesis, increases glycolysis, increases peripheral glucose uptake (insulin sensitivity)
3) GI upset, lactic acidosis (most serious)
4) Contraindicated in renal failure

Question 4

Tolbutamide, chloropropamide

Answer 4

1) Type II DM –stimulate endogenous insulin release
2) Sulfonylureas (1st generation)/Close K+ channel in beta cell membrane so cell depolarizes –> triggers insulin release via Ca2+ influx
3) Disulfiram-like effects
4) Useless in Type I DM b/c requires some islet cell function

Question 5

Glyburide, glimepiride, glipizide

Answer 5

1) Type II DM – stimulates endogenous insulin release
2) Sulfonylureas (2nd generation)/Close K+ channel in beta cell membrane so cell depolarizes –> triggers insulin release via Ca2+ influx
3) Hypoglycemia
4) Useless in Type I DM b/c requires some islet cell funciton

Question 5

Pioglitazone, rosiglitazone

Answer 5

1) Monotherapy in Type II DM or in combination therapy
2) Glitazone/Thiazolidinedione: Incraeses insulin sensitivity in peripheral tissue;, binds PPAR-gamma nuclear transcription regulator–> activates genes that reg fa storage and glucose met–> inc insulin sensitivity & adiponectin
3) Weight gain, edema, hepatoxicity, heart failure

Question 6

Acarbose, miglitol

Answer 6

1) Monotherapy in Type II DM, or in combination therapy
2) Alpha-glucosidase Inhibitor/ Inhibits intestinal brush-border alpha-glucosidases –> get delayed sugar hydrolysis and glucose absorption
- decreases postprandial hyperglycemia
3) GI disturbances

Question 7

Pramlinitide

Answer 7

1) Type I and II DM
2) Amylin Analog/ Decreases glucagon
3) Hypoglycemia, nausea, diarrhea

Question 7

Exenatide, liraglutide

Answer 7

1) Type II DM
2) GLP-1 Analog/ Increase insulin and decrease glucagon release
3) Nausea, vomiting, pancreatitis

Question 8

Linagliptin, saxagliptin, sitagliptin

Answer 8

1) Type II DM
2) DPP-4 Inhibitors/ Increase insulin and decrease glucagon release
3) Mild urinary or respiratory infections

Question 8

Propylthiouracil, methimazole

Answer 8

1) Hyperthyroidism
2) Block peroxidase inhibiting organificatoin of iodide and coupling of thyroid hormone synthesis
- propylthiouracil also blocks 5’-deiodinase –> decreases peripheral conversion of T4 to T3
3) Skin rash, agranulocytosis (rare), aplastic anemia, hepatotoxicity (propylthiouracil), Teratogen (methimazole)

Question 8

Levothyroxine, triiodothyronine

Answer 8

1) Hypothyroidism, myxedema
2) THyroxine replacement
3) Tachycardia, heat intolerance, tremors, arrhythmias

Question 9

GH

Answer 9

1)GH deficiency, Turner’s Syndrome

Question 9

Somatostatin (octretodie)

Answer 9

1)Acromegaly, carcinoid, gastrinoma, glucagonoma, espohageal varices

Question 10

Oxytocin

Answer 10

1)Stimulate labor, uterine contractions, milk let-down, controls uterine hemorrhage

Question 10

ADH (Desmopressin)

Answer 10

1)Central DI

Question 11

Demeclocycline

Answer 11

1) SIADH
2) Tetracycline/ ADH antagonist
3) Nephrogenic DI, photosensitivity, abnormalities of bone and teeth

Question 12

Hydrocortisone, prednisone, triamcinolone, dexamethasone, beclomethasone

Answer 12

1) Addison’s Disease, inflammation, immune suppression, asthma
2) Glucocorticoid/Decrease production of leukotrienes and prostaglandins by inhibiting phospholipase A2 and COX-2 expression
3) Iatrogenic Cushing’s –> buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, bruise easily, osteoporosis, adrenocortical atrophy, peptic ulcers, DM (if chronic)
4) Can see adrenal insufficiency when drug is stopped abruptly after chronic use