Drugs Flashcards
Somatropin (admin?)
= Growth Hormone
SC (or IM)
Mecasermin
Recombinant IGF-1 (SC and have carbs before to avoid hypoglycemia)
Tesamorelin (admin and ADR)
GHRH analog (IV, nasal, SC) ADR: face flushing
Ocreotide (& admin)
Somatostatin analog (IM or SC)
Effect of ghrelin?
Causes GH release! (like GHRH)
Lanreotide
Somatostatin analog (SC) longer acting than ocreotide
Somatostatin and analogs ADR?
Drops glucose tolerance so hyperglycemia
AND sinus bradycardia
Pegvisomant
GH-R antagonist (SC)
Cabergoline
Preferred DA (D2) agonist (inhibits GH secretion??? AND INCREASES inhibition on PRL so decreases PRL release) ALSO USED FOR CUSHINGS
Bromocriptine
DA agonist
FREQUENT SIDE EFFECTS
Quinagolide
DA agonist
Side effect of anti-psychotics (and other class of drugs with same side-effects?)
Blocks D2 receptors in Hypothalamus, so can produce prolactinemia
ADH
= Vasopressin (released in response to rising blood osm and decreasing blood volume)
Helps concentrate urine, via GPCR
Can be inhibited by ethanol
DDAVP (aka Desmopressin)
ADH analog (more stable to degradation than ADH -longer half-life)
Roles of ADH
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
Central DI (inadequate ADH secretion)
Give DDAVP (aka Desmopression) And if intolerant give chlorpropamide
Nephrogenic (inadequate DI actions)
Give thaizide diuretics and NSAIDS
SIADH (too much ADH)
leads to hyponatremia
Give demeclocyline (blocks ADH action in cascade)
Or V2 receptor agonists Tolvpatan, Conivaptan
ALSO give 3% NaCl
If hyponatremia corrected too quickly you get ..
cerebellar pontine myelinolysis
Aldosterone Antagonists?
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
Drugs that cause Hypothryroidism?
Lithium, Amiodarone, Cholestyramine, Phenytoin, Carbamazepine
LAC and the PC anti-convulsives (that decreae TBG binding)
When to treat hypothyroid? With what? and the risks?
when TSH >10, with levothyroxine (T4) and the big risk is CVD - it has narrow therapeutic range AND SYMPATHETIC OVERACTIVTY (so beware anticongestants)
DDIs that impair Levothryroxine absorption?
cipro, BILE ACID SEQUESTRANTS, raloxifane, sucralfate
Drugs that block/inhibit 5’deidoidinase?
glucocorticoids B-blockers AMIODARONE And high doses of PTU (propothiouracil) Also effected by malnutrition, illness, fetal/neonatal period
Myxedema Coma (sx and treatment)
drop in CO, bradycardia, HYPOTHERMIA, low NA and low GLU
GIVE Large does of T4 and hydrocortisone to prevent and adrenal crisis
Levothyroxine time to improvment?
6-8 weeks
Liothyronine
synthetic T3
Liotrix
mix of T4 and T3, not rec
Liothyronine (T3) vs Levothyroxine (T4)
shorter half life greater oral bioavailability greater affinity for TH-R receptor (10x) higher cost may increase osterporosis risk greater risk of cardio tox
Thyroid Storm treatment?
A-FIB, ans SUPERHYPERTHYROID, Give PTU (blocks T4-->T3), Propanolol (sx and blocks T4-->T3) and NaI or KI
Methimazole vs PTU
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
Graves recurrence
60-70%
Methimazole and PTU most dagerous side effect
agranulatomous cytosis - WBC count drops esp. neutrophils
Ketoconazole
Cortisol synth inhib
for CUSHINGS
ACTH secretion inhib
Cabergoline (D2 agonist)
Pasireotide (SST analog)
Mitotane
Adrenolytic Agent
CUSHINGS
Mifepristone
Cortisol Receptor Blocker
CUSHINGS
Pheochromocytme treatment
a-blocker (-zosin)
THEN B-blocker
OR CCB alone
Then surgery
