Endo - FA Pharm p348 - 350 Flashcards
what is the treatment strategy for type 1 DM?
low carb diet, insulin replacement
treatment strategy for type 2 DM?
dietary modification, exercise for weight loss, oral agents
name 2 long acting insulin
Detemir, glargine
intermediate acting insulin? How often does a pt take it?
NPH (2x day)
name 3 rapid acting insulin - how long is the peak? When does a patient take it?
aspart, glulisine, lispro
2-3 hr peak, with each meal
When is metformin contraindicated?
renal insufficiency
Name 3 oral hypoglycemics that dec glucagon release and gastric emptying
Pramlintide
Exenatide, Liraglutide
DPP4 (-)’rs (gliptins)
MoA of Metformin
(-) hepatic gluconeogenesis and glucagon
Inc glycolysis, and insulin sensitivity
Major SE of Metformin - causes which vitamin def?
lactic acidosis, GI issues, B12 def (no hypoglycemia)
name 5 drugs that inc insulin and dec glucagon release
GLP-1 analog - exenatide - liraglutide - these are incretin analogues
DPP-4 inhibitors - linagliptin - saxagliptin - sitagliptin - inhibits the breakdown of incretins
inc INCretINs - INC INsulin
name two 1st generation sulfonylureas
chlorpropamide, tolbutamide
side effects of 1st generation sulfonylureas (chlorpropamide, tolbutamide)?
disulfiram like effects
other drugs that lead to disulfiram like effects
metronidazole, griseofulvin, procarbazine (Hodgkins anti alkylating agent), some cephalosporin
Sulfonylureas
DiSulfiraM
name three 2nd generation sulfonylureas
glimepiride, glipizide, glyburide
what is the mech of sulfonylureas?
close K+ channel of beta cell –> cell depolarizes –> insulin release via Ca2+ influx
name the general side effect of sulfonylureas
risk of hypoglycemia ( esp in renal failure)
List DPP4 (-)’rs and their MoA
Linagliptin, Saxagliptin, Sitagliptin
Inhibit dipeptidyl peptidase that deactivates incretins like GLP1 ( remove the inhibition)
dec glucagon rel, gastric emptyin
inc glucagon dep insulin rel, satiety
Major SE of DPP4 (-)’rs
urinary or respiratory infections
Drugs that (+) PPAR-γ
Rosiglitazones, Pioglitazones
gamma looks like a y - followed by z for zones
what are the 2 roles of genes activated by PPAR-gamma
- fatty acid storage 2. glucose metabolism
what are the drugs that bind to PPAR-gamma nuclear transcription regulator to inc insulin sensitivity?
glitazones/thiazolidinediones - pioglitazone - rosiglitazone
what drug blocks the reabsorption of glucose in PCT?
SGLT-2 inhibitors (canagliflozin)
flo - like urinary flow in tubules
drug that dec postprandial hyperglycemia
acarbose, miglitol (alpha glucosidase inhibitors)
activation of what gene increases insulin sensitivity and levels of adiponectin?
PPAR-gamma
what gene activation leads to HDL synthesis?
Which rx targets PPAR -alpha
PPAR - alpha;
fibrates
name of the enzyme that propylthiouracil blocks
5’ deiodinase, thyroid peroxidase
side effects of propylthiouracil?
skin rash, agranulocytosis, aplastic anemia, hepatotoxicity
unique side effect of methimazole?
aplasia cutis
name of the enzyme that methimazole blocks
thyroid peroxidase
How does one differentiate between exogenous vs endogenous hyperthyroidism
using a combination of TSH receptor antibodies, radioactive iodine uptake, and/or measurement of thyroid blood flow on ultrasound.
name 3 ADH antagonists (V2 blockers) - use them to tx what disease?
conivaptan, tolvaptan, demeclocycline
SIADH
clinical application of somatostatin (octreotide)
acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices
SE of Demeclocycline
Nephrogenic DI, photosensitivity, abnormalities of bone and teeth.
Use of Desmopressin
Central DI, von Willebrand disease, sleep enuresis, hemophilia A.
what drug is used for central DI?
desmopressin acetate
what is the clinical application of fludrocortisone?
mineralocorticoid replacement in primary adrenal insufficiency
name 3 side effects of fludrocortisone
edema, exacerbation of heart failure, hyperpigmentation
name of the drug that sensitizes Ca2+ sensing receptor (CaSR) in parathyroid gland to circulating Ca2+?
cinacalcet - leads to dec PTH
how does cinacalcet change the level of PTH?
dec PTH
Nonabsorbable phosphate binder that prevents phosphate absorption from the GI tract.
Sevelamer
Use of Sevelamer
Hyperphosphatemia in CKD.
Sevelamer - Saves you from high phosphate
Q. what drug is used for Turner syndrome?
GH
DOC to control uterine hemorrhage?
Oxytocin
if glucocorticoids are suddenly stopped after the chronic usage, what is the consequence?
adrenal insufficiency
what is triamcinolone?
glucocorticoids
