Drugs

Question 1

Somatropin (admin?)

Answer 1

= Growth Hormone

SC (or IM)

Question 2

Mecasermin

Answer 2

Recombinant IGF-1 (SC and have carbs before to avoid hypoglycemia)

Question 3

Tesamorelin (admin and ADR)

Answer 3

GHRH analog (IV, nasal, SC)
ADR: face flushing

Question 4

Ocreotide (& admin)

Answer 4

Somatostatin analog (IM or SC)

Question 5

Effect of ghrelin?

Answer 5

Causes GH release! (like GHRH)

Question 6

Lanreotide

Answer 6

Somatostatin analog (SC) longer acting than ocreotide

Question 7

Somatostatin and analogs ADR?

Answer 7

Drops glucose tolerance so hyperglycemia

AND sinus bradycardia

Question 8

Pegvisomant

Answer 8

GH-R antagonist (SC)

Question 9

Cabergoline

Answer 9

Preferred DA (D2) agonist (inhibits GH secretion??? AND INCREASES inhibition on PRL so decreases PRL release)
ALSO USED FOR CUSHINGS

Question 10

Bromocriptine

Answer 10

DA agonist

FREQUENT SIDE EFFECTS

Question 11

Quinagolide

Answer 11

DA agonist

Question 12

Side effect of anti-psychotics
(and other class of drugs with same side-effects?)

Answer 12

Blocks D2 receptors in Hypothalamus, so can produce prolactinemia

Question 13

ADH

Answer 13

= Vasopressin (released in response to rising blood osm and decreasing blood volume)
Helps concentrate urine, via GPCR
Can be inhibited by ethanol

Question 14

DDAVP (aka Desmopressin)

Answer 14

ADH analog (more stable to degradation than ADH -longer half-life)

Question 15

Roles of ADH

Answer 15

Renal: V2 –> Gs
(increases aquaporins and increases urea and Na+ transporters)
Non-renal V2 (still –> Gs): release of coag factor VIII and von Willebrand
Vasonconstriction: (At much higher Cp) V1 –> Gq, constricts vascular smooth muscle

Question 16

Central DI (inadequate ADH secretion)

Answer 16

Give DDAVP (aka Desmopression)
And if intolerant give chlorpropamide

Question 17

Nephrogenic (inadequate DI actions)

Answer 17

Give thaizide diuretics and NSAIDS

Question 18

SIADH (too much ADH)

Answer 18

leads to hyponatremia
Give demeclocyline (blocks ADH action in cascade)
Or V2 receptor agonists Tolvpatan, Conivaptan
ALSO give 3% NaCl

Question 19

If hyponatremia corrected too quickly you get ..

Answer 19

cerebellar pontine myelinolysis

Question 20

Aldosterone Antagonists?

Answer 20

Spironolactone, Epleperone
Give for APA/IHA (i.e PRIMARY ALDOSTERONISM)
IHA with BP meds too
Cannot screen for APA/IHA if already on these drugs

Question 21

Drugs that cause Hypothryroidism?

Answer 21

Lithium, Amiodarone, Cholestyramine, Phenytoin, Carbamazepine
LAC and the PC anti-convulsives (that decreae TBG binding)

Question 22

When to treat hypothyroid? With what? and the risks?

Answer 22

when TSH >10, with levothyroxine (T4) and the big risk is CVD - it has narrow therapeutic range AND SYMPATHETIC OVERACTIVTY (so beware anticongestants)

Question 23

DDIs that impair Levothryroxine absorption?

Answer 23

cipro, BILE ACID SEQUESTRANTS, raloxifane, sucralfate

Question 24

Drugs that block/inhibit 5’deidoidinase?

Answer 24

glucocorticoids
B-blockers
AMIODARONE
And high doses of PTU (propothiouracil)
Also effected by malnutrition, illness, fetal/neonatal period

Question 25

Myxedema Coma (sx and treatment)

Answer 25

drop in CO, bradycardia, HYPOTHERMIA, low NA and low GLU | GIVE Large does of T4 and hydrocortisone to prevent and adrenal crisis

Question 26

Levothyroxine time to improvment?

Answer 26

6-8 weeks

Question 27

Liothyronine

Answer 27

synthetic T3

Question 28

Liotrix

Answer 28

mix of T4 and T3, not rec

Question 29

Liothyronine (T3) vs Levothyroxine (T4)

Answer 29

``` shorter half life greater oral bioavailability greater affinity for TH-R receptor (10x) higher cost may increase osterporosis risk greater risk of cardio tox ```

Question 30

Thyroid Storm treatment?

Answer 30

``` A-FIB, ans SUPERHYPERTHYROID, Give PTU (blocks T4-->T3), Propanolol (sx and blocks T4-->T3) and NaI or KI ```

Question 31

Methimazole vs PTU

Answer 31

for hyperthyroid (so first line Graves and FU with B-blocker) Mech: a thionamide that inhibits TPO Methimazole is QD compared to PTU that is TD PTU is T4-->T3 blocker and PREFERRED in PREG, but also has liver probs assoc. PTU has a longer half life, but METH is lower dose and more rapid to work BOTH RESOLVE IN 2 WEEKS

Question 32

Graves recurrence

Answer 32

60-70%

Question 33

Methimazole and PTU most dagerous side effect

Answer 33

agranulatomous cytosis - WBC count drops esp. neutrophils

Question 34

Ketoconazole

Answer 34

Cortisol synth inhib | for CUSHINGS

Question 35

ACTH secretion inhib

Answer 35

Cabergoline (D2 agonist) | Pasireotide (SST analog)

Question 36

Mitotane

Answer 36

Adrenolytic Agent | CUSHINGS

Question 37

Mifepristone

Answer 37

Cortisol Receptor Blocker | CUSHINGS

Question 38

Pheochromocytme treatment

Answer 38

a-blocker (-zosin) THEN B-blocker OR CCB alone Then surgery