Endo - Conrad Fischer Medquest Pharm Flashcards
SE of PTU and methimazole
neutropenia (agranulocytosis, aplastic anemia)
What rx is used as a adjunct to PTU/methimazole for a symptomatic hyperthyroid pt? and why?
Propranolol
used to (-) cardio tox (Afib Vtach) and HTN of the increased SNS activity
What is PTU effect on TSH, iodine avail, and target organ action by T3?
No effect on TSH, iodine avail, or target organ action by T3
PTU and methimazole has what MoA
(-) production and deiodination of T3
How is thyroid hormone stored in gland and transported?
Thyroglobulin storage in gland
Thryoid binding globulin transport in body
What proportion of T4 and T3 is made?
20 T4 : 1 T3
Inc T3 increases HR, BMR, etc, but what does it decrease?
period - hyperthyroidism leads to amenorrhea
What Rx works fastest in thyroid storm?
Propranolol
59 yr old man w/ prostate cancer @ ED w/ lethargy, constipation, and gen weakness for 4 days. Ca2+ = 14.5
What is the first step to Tx?
Hydration w. saline should fix the high Ca levels on its own, If they aren’t producing enough urine, add loop diuretic
Why does a volume deficit occur with Inc Ca2+
Inc Ca2+ (-) ADH effect @ V2 collecting duct = nephrogenic DBI
4 things that lead to nephrogenic DBI
hypercalcemia
hypOkalemia
Li
demeclocycline
What is the next best step in the hypercalcemic pt (after hydration/loops)? Which works fastest? Which works longer?
Bisphosphonates/Calcitonin
Calcitonin works faster but also wears off faster
Bisphosphonates take a few days to work, but effect will last longer.
List 5 Bisphosphonates
Pamidronate
Alendronate
Ibandronate
Risedronate
Zoledronic acid
Bisphosphonates are also used as osteoporosis when T score is?
2.5 std dev < N
MoA of Bisphosphonates
pyrophosphate analogs - bind hydroxyapetite inbone, (-) osteoclasts activity
Major SE of Bisphosphonates
pill induced esophagitis
osteonecrosis of jaw
What else causes pill induced esophagitis
bisphosphonates
ferrous sulfate
potassium chloride
NSAIDs
tetracyclins
Endogenous calcitonin made where?
parafollicular C cells
When is calcitonin used?
acute Inc Ca2+
paget’s disease of bone
Calcitonin MoA
(-)osteoclasts
also dec Ca absorption in GI
(+) renal excretion of Ca2+
SE of calcitonin
#1 rhinitis, flu-like symptoms flushing, rash, constipation rest - depression, bronchospasm
Denosumab MoA and use
vs RANK-L
RANK-L - is the primary signal that (+) bone removal will (+) osteoclasts
used in osteoporosis, prostate cancer
SE/ of Denosumab
Inc urinary and resp tract infections
DPP4(-)’rs - ex/
Linagliptin, Saxagliptin, Sitagliptin
Fxn of DPP4
dipeptidyl peptidase - breaks down integrins like GLP1, GIP
(-) DPP-4 leads to inc insulin from pancreas and dec glucagon
GLP1 analogs - ex/
MoA
Exenatide,
liraglutide
dec glucagon relsease, gastric emptying, inc glucose dep insulin release
How are GLP1 analogues > than endogenous incretins
Analogues will imitate the fxn of endogenous incretins, but last longer. Endogenous last a few min, but analogues last 10-12 hours
Liraglutide is also used for what other disease aside from DB?
Thyroid C cell cancer
Pramlintide - MoA
amylin analog
dec glucagon release, dec gastric emptying, inc satiety
by supressing glucagon release, delay gastric emptying (+) weight loss.
SE of both Pramlintide, and GLP1 analogs
bloating, constipation, hypoglycemia
List and MoA of Sulfonylureas
1st gen - chlorpropamide, tolbutamide
2nd gen - glimepiride, glipizide, glyburide
closes K+ channel in pancreatic B cell mem –> depol –> insulin release via Inc Ca2+ influx
SE/ of sulfonylureas
1st - disulfiram like effects
2nd - hypoglycemia
Only DB rx that doesn’t cause hypoglycemia and why?
metformin, bc it doesn’t (+) insulin release
Octreotide and Pegvisomant - major use and MoA
Acromegaly
Octreotide - somatostatin analogue
Pegvisomant - GH-R (-)’r
Other uses of Octreotide
Portal hypertension - esophageal varices
carcinoid syndrome
VIPoma, glucagonoma
Highest mortality of GI bleeds
esophageal varices
How to treat acromegaly - 1st, and 2nd?
Surgery 1st - remove adenoma
2nd - rx like somatostatin, or dopamine agonist (cabergoline, bromocriptine)
List a long acting octreotide
Lanreotide
Most common cause of death in acromegaly?
cardiomyopathy
1st choice of tx in DB after diet/exercise?
metformin
MoA of Metformin
(-) hepatic gluconeogenesis
Metformin is CI in?
patients with renal insufficiency - lactic acid accumulates
Metformin causes a def in which vitamin?
B12
MoA of Fludrocortisone
synthetic analog of aldosterone, with a little glucocorticoid effect
Fxn of Aldosterone
retain Na+, release K+. and H+ @ late collecting duct, salivary glands, sweat glands, and GI glands
How to treat an aldosterone def? (Addison)
Uncommon to have def of just one hormone of adrenals , usually all of them.
Give Fludrocortisone, and Cortisone, (glucocorticoids like effect)
Other use of fludrocortisone
Orthostatic hypotension
septic shock Tx (adjunct to hydrocortisone)
type IV renal acidosis
SE of Fludrocortisone
edema, inc pigmentation, dec K+, HTN –> alkalosis
bc of glucocorticoid effect
osteoporosis, impaired wound healing, easy bruising
Ex of α-glucosidase inhibitors
mech?
acarbose
miglitol
(-) intestinal brush border α-glucosidases –> delayed carb hydrolysis and glucose absorpion
SE of α-glucosidase inhibitors
basically like lactose intolerance
flatulence, GI upset
Ex and MoA of thiazolidinediones
Pioglitazone, Rosiglitazone
(+) PPAR-γ (a nuclear receptor) –> inc insulin sensitivity in musc, adipose, liver cells.
CI of glitazones
can lead to heart issues bc of fluid overload - CI in CHF
SE of glitazones
edema, weight gain, cardiac issues
Man with DB, glucose levels > 200 mg/dl despite max dose of several oral hypoglycemic agents
A1C >9%
Best rx for pt? how long should they be on it?
insulin - permanently
What A1C level is diagnostic?
What is the goal A1C for a DB under treatment
>6.5% is diagnostic
<7% is the goal
What combination of insulin do you prescribe? With or without oral hypoglycemics
Insulin is in addition to the oral hypoglycemics
Give one long acting insulin - like glargine 1x/d
and one short acting acting (lispro, aspart, glulisine) to be given with every meal.
Diff in onset, peak, and duration of long acting and rapid acting insulin
Glargine reaches peak level and stays constant for 24 hours
LAG (Lispro, aspart, glulisine) - is effective in minutes and lasts for 3-4 hours, peaks in 1 hr
