Drugs

Question 1

Cabergoline

Answer 1

Hyperprolactinaemia and Acromegaly

Dopamine receptor (D2) agonists

Question 2

Bromocriptine

Answer 2

Hyperprolactinaemia

Dopamine receptor (D2) agonists

Question 3

Octreotide

Answer 3

Acromegaly

Somatostatin analogue

Question 4

Desmopressin (DDAVP)

Answer 4

Central DI

V2 receptor agonist

Question 5

Thiazides

Answer 5

Nephrogenic DI

Inhibits Na+/Cl- transport in DCT

Question 6

Terlipressin

Answer 6

V1 receptor agonist

Question 7

Demeclocyline

Answer 7

SIADH

Reduce renal water reabsorption

Question 8

VAPTANs

Answer 8

SIADH

Non-competitive V2 receptor antagonists

Question 9

Levothyroxine

Answer 9

Hypothyroidism -

1. Autoimmune primary hypothyroidism
2. Iatrogenic primary hypothyroidism (eg. post-thyroidectomy, post-radioactive iodine)
3. Secondary hypothyroidism (eg. pituitary tumour, post-pituitary surgery or radiotherapy)”

Thyroid hormone replacement therapy

Question 10

Liothyronine

Answer 10

Hypothyroidism - Myxoedema coma

Thyroid hormone replacement therapy

Question 11

Thionamides
eg.
propylthiouracil (PTU)
carbimazole (CBZ)

Answer 11

Hyperthyroidism -

1. Daily treatment of hyperthyroid conditions (eg. Grave’s disease)
2. Treatment prior to surgery
3. Reduction of symptoms while waiting for radioactive iodine to act

Inhibition of thyroperoxidase and hence T3/4 synthesis
Reduces conversion of T4 to T3 in peripheral tissues
May suppress antibody production in Graves’ disease

Question 12

Potassium Iodide

Answer 12

Hyperthyroidism -
Preparation of hyperthyroid patients for surgery
Severe thyrotoxic crisis (thyroid storm)

Inhibits iodination of thyroglobulin
Inhibits H2O2 generation

Question 13

Radioiodine

Answer 13

Hyperthyroidism (Graves’, toxic nodular disease) and thyroid cancers

Accumulates in colloid and emits β particles→ destroying follicular cells

Question 14

β-blockers (for endo)

Answer 14

Hyperthyroidism - Rapidly reduces anxiety, tremor and tachycardia (i.e. good in controlling symptoms)

Usually NON-selective β blocker (eg. propranolol)

Question 15

Dexamethasone

Answer 15

Investigation for Cushing’s - Low dose dexamethasone suppression test

Artificial steroid, pituitary should stop producing ACTH
Cortisol should suppress to zero
If it doesn’t→ Cushing’s

Question 16

Metyrapone

Answer 16

Cushing’s Syndrome - pre-surgery and post-radiotherapy

Inhibition of 11β-hydroxylase
CORTISOL SYNTHESIS BLOCKED
ACTH secretion increases
Plasma deoxycortisol increases

Question 17

Ketoconazole

Answer 17

Cushing’s Syndrome

Treatment and control of symptoms prior to surgery

Question 18

Spironolactone

Answer 18

Conn’s Syndrome - Primary hyperaldosteronism

Converted to canrenone
Competitive antagonist of MR receptor
Blocks Na+ resorption and K+ excretion in the kidney tubules (potassium sparing diuretic)

Question 19

Epleronone

Answer 19

Conn’s Syndrome - Primary hyperaldosteronism

Mineralocorticoid receptor (MR) antagonist

Question 20

synACTHen

Answer 20

Investigation for Addison’s
Addison’s patient will have no cortisol response

Synthetic ACTH
Body should begin to produce cortisol

Question 21

Hydrocortisone

Answer 21

Adrenocortical failure:

• Primary/Secondary adrenocortical failure
• Addisonian crisis (high dose)
• Congenital adrenal hyperplasia

Glucocorticoid with mineralocorticoid activity at high doses

Question 22

Prednisolone

Answer 22

Adrenocortical failure

Glucocorticoid with weak mineralocorticoid activity

Question 23

Dexamethasone

Answer 23

Adrenocortical failure - Congenital adrenal hyperplasia

Synthetic glucocorticoid with no mineralocorticoid activity

Question 24

Fludrocortisone

Answer 24

Adrenocortical failure

• Primary adrenocortical failure
• Congenital adrenal hyperplasia

Aldosterone analogue- used as an aldosterone substitute