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Endocrinology > Endo Exam 2 Drugs > Flashcards

Endo Exam 2 Drugs Flashcards

1
Q

options for acromegaly

A

somatostatin analogs
dopamine receptor antagonists
GH receptor antagonist

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2
Q

what are the somatostatin analogs

A

octreotide
lanreotide
pasireotide

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3
Q

what are the dopamine receptor agonists

A

bromocriptine
cabergoline

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4
Q

what is the GH receptor antagonist

A

pegvisomat

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5
Q

what are the GnRH analogs

A

leuprolide
goserelin
histrelin
nafarelin
triptorelin

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6
Q

what are the GnRH antagonists

A

ganirelix
cetrorelix

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7
Q

what are the SERMs

A

tamoxifen
toremifene
raloxifene
bazedoxifene
ospemifene

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8
Q

what are the antiestrogens/ estrogen antagonists

A

clomiphene
fulvestrant

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9
Q

what are the aromatase inhibitors

A

anastrazole
letrozole
exemestane

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10
Q

antiprogestin

A

mifepristone

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11
Q

androgen receptor antagonists

A

bicalutamide
flutamide
nilutamide
enzalutamide

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12
Q

PDE5 inhibitors

A

sildenafil
vardenafil
tadalafil
avanafil

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13
Q

prostaglandin E1

A

alprostadil

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14
Q

what side effects does vardenafil have

A

peripheral vasodilation, lower blood pressure, flushing and reflex tachycardia

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15
Q

what side effects does tadalafil have

A

myalgia and back muscle pain

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16
Q

what side effects does sildenafil have

A

blurred vision and cyanopsia-blue tinted vision
also peripheral vasodilation, lower blood pressure, flushing and reflex tachycardia

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17
Q

which PDE5 inhibitors should you avoid a fatty meal

A

sildenafil and vardenafil

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18
Q

tadalafil time to peak

A

2 hours

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19
Q

which PDE5 has the longest half life

A

tadalafil (18h)

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20
Q

which PDE5 does NOT have an active metabolite

A

tadalafil

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21
Q

which PDE5 has a sublingual form

A

vardenafil

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22
Q

which PDE5 has the longest duration

A

tadalafil (24-36h)

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23
Q

food interaction with PDE5 inhibitors

A

grapefruit juice: avoid

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24
Q

timing of administration for PDE5 inhibitors

A

sildenafil and vardenafil 1 hour before intercourse
tadalafil can be 30 minutes prior to intercourse or once daily
avanafil 15-30 minutes prior

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25
Q

which PDE5 inhibitor can be dosed once daily

A

tadalafil

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26
Q

what is the PDE5 dose limit

A

one dose per day

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27
Q

PDE5 inhibitor drug interactions

A

do not administer nitrates after PDE5 inhibitor
within 24 hours for most PDE5i
within 48 hours for tadalafil

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28
Q

failure to respond to first dose PDE5i?

A

should continue for 7 doses before declaration of failure

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29
Q

dosage forms of alprostadil

A

intracavernosal injection
intraurethral insert

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30
Q

who gets alprostadil

A

-failed to respond to PDE5 inhibitors
- ED due to diseases that are associated with an impaired nitric oxide pathway (DM)

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31
Q

dose limits intracavernosal alprostadil

A

no more than one per day
no more than three per week

32
Q

intraurethral alprostadil counseling

A

empty bladder before administration
avoid if the partner is pregnant

33
Q

testosterone adverse effects

A

sodium retention
increase risk MI/stroke
gynecomastia
increase LFTs
erythrocytosis

34
Q

general drugs causing erectile dysfunction

A

anticholinergics
dopamine antagonists (metoclopramide phenothiazines)
digoxin, spirono, ketoconazole
CNS depressants
Diuretics
Beta blockers
central sympatholytics (methyldopa, clonidine)

35
Q

somatostatin analog adverse effects

A

nausea, vomiting, flatulence, gallstones

36
Q

dopamine receptor agonist side effects

A

CNS effects: headache, lightheaded, dizzy, nervous, fatigue

37
Q

options for treatment of dwarfism

A

Recombinant GH (somatotropin): genotropin, humatrope, norditropin, nutropin, etc

or IGF-1 (Somatomedins): rhIRG-1, mecasermin

38
Q

what are the adverse effects of Recombinant GH

A

kids: intracranial hypertension, scoliosis, hypothyroidism
adults: edema, arthralgia, myalgia, hyperglycemia

39
Q

adverse effects of IGF-1

A

hypoglycemia

40
Q

what makes the prolactin axis unique

A

a. the only anterior pituitary hormone that does not have an endocrine target tissue and thus lacks a classical hormonal feedback system
b. inhibitory rather than stimulatory
c. involves dopamine which is a neurotransmitter rather than a pepttide

41
Q

what meds cause hyperprolactinemia

A

antipsychotics, methyldopa, reserpine, verapamil

42
Q

treatment for hyperprolactinemia

A

cabergoline

43
Q

GnRH analog if given continuously?

A

acts as an antagonists– inhibits FSH and LH release eventually

44
Q

GnRH analog side effects

A

hot flashes, sweats, headache, bone loss & osteoporosis, decreased libido
initial flare (prostate cancer)
contraindicated pregnancy

45
Q

main use of GnRH analogs and antagonists??

A

during ovulation induction to prevent natural ovulation

but can also be for endometriosis, prostate cancer, etc

46
Q

describe how FSH and LH are used in fertility treatments like IVF

A

injections of gonadotropins (menotropins and follitropins) started early in menstrual cycle to cause multiple eggs to grow to mature size– then hCG is used to trigger the release of the mature eggs

47
Q

true or false: estrogen alone is effective for contraception

A

false: has to be with a progestin for contraception

48
Q

estrogen adverse effects

A

nausea, breast tenderness, migraine headache, thromboembolic events, HTG, HTN, gallbladder dx

inc risk of endometrial cancer

postmenopausal ppl: small inc risk of breast cancer and CV events

49
Q

what is clomiphene used for

A

to treat infertility due to no ovulation

50
Q

treatment of amenorrhea: underlying cause is anorexia or excessive exercise

A

gain weight, decrease exercise, therapy
if ineffective: consider estrogen (CHC)

51
Q

treatment of amenorrhea: underlying cause is hyperprolactinemia

A

dopamine agonist

52
Q

treatment of amenorrhea: underlying cause is anovulation secondary to PCOS

A

pregnancy desired: letrozole
pregnancy not desired: CHC with the progesterone with antiandrogenic effects

53
Q

treatment of amenorrhea: unknown cause

A

progestin to induce withdrawal bleeding
followed by estrogen/progestin therapy

54
Q

how does letrozole help anovulation

A

aromatase inhibitor- decreases levels of estrogen– which increases release of FSH– which stimulates the ovary to produce eggs and follicles

55
Q

options for menstrual irregularity in PCOS

A

first line– combined hormonal contraception
second line– metformin

56
Q

options for hirsutism in PCOS

A

if desire to conceive– electrolysis
first line– hormonal contraception with non-androgenic progestin
second line– spironolactone, flutamide, eflornithine
third line– metformin

57
Q

options for acne in PCOS

A

desire to conceive– topical creams

first line– hormonal contraception
second line– spironolactone or antiandrogens

58
Q

options for anovulation/infertility in PCOS

A

letrozole
clomiphene

59
Q

how are letrozole and clomiphene dosed for anovulation and infertility in PCOS

A

daily for 5 days
beginning cycle day 3
after induced withdrawal bleeding with a progesterone such as MPA 10 mg daily orally for 10 days

60
Q

endometriosis– what is first line

A

NSAIDs

61
Q

endometriosis– what is second line

A

CHC
Depo Provera
Mirena

62
Q

endometriosis– what is 3rd line

A

GnRH agonists (since they inhibit FSH and LH)

63
Q

what to know when using GnRH agonists for endometriosis

A

you can use add-back therapy to minimize the hypoestrogenic effects (bone mineral density loss and vasomotor symptoms)

Need to use MHT (dose is too low in CHC)

64
Q

MHT options: had hysterectomy

A

can get unopposed estrogen therapy since they don’t have a uterus

65
Q

MHT: no hysterectomy
aka has a uterus

A

estrogen + protestogen
estrogen + bazedoxifene
vaginal estrogen low dose (don’t need progestogen)

66
Q

intravaginal estrogen: systemic or local action?

A

local action
except for femring which is systemic

67
Q

transdermal estradiol in formulations used for HRT: incidence of breast tenderness and DVT?

A

lower incidence than oral estrogen

68
Q

progestogen for MHT: continuous or cyclic????

A

cyclic regimens often cause withdrawal bleeding

continuous regimens result in the absence of vaginal bleeding

69
Q

contraindications to MHT

A

unexplained vaginal bleeding
active liver disease/failure
prior estrogen-sensitive breast or endometrial cancer
history of CHD or stroke
history of/high risk VTE
untreated HTN

70
Q

instances where transdermal estrogen is preferred over oral

A

hypertriglyceridemia
active gallbladder dx
thrombophilia
migraine headaches w/ aura

71
Q

MHT risks vs benefits: CV disease

A

reduce risk: estrogen only, newly menopausal
no increase: estrogen-progestin, within 10 years menopause
increase risk: greater than 10 years menopause

72
Q

MHT risks vs benefits: breast cancer

A

increased risk estrogen/progestin >10 years

estrogen alone maybe reduced risk

73
Q

MHT risks vs benefits: osteoporosis

A

estrogen decreases bone turnover and increases bone density

reduces fractures

74
Q

MHT risks vs benefits: ischemic stroke

A

increased risk estrogen alone and estrogen w/ progestin

75
Q

MHT risks vs benefits: VTE

A

increased risk with personal risk factors like obesity

Endocrinology (10 decks)

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