Endocrine Flashcards
Bromocriptine
Dopamine agonist
use: hyperprolacitnemia, prolactin secreting adenomas, early parkinson syndrome, acromegaly
how: ergot derived dopamine D2 recepto and serotonin receptor agonist
ci: breast carcinoma, hypersensitivity to ergot alkaloids, uncontrolled hypertension, ischemic heart disease, lactation
interactions; azole antifungals, macrolide antibiotics, concomitant use with other ergot alkaloids
se: disco like dyskinesia, hypotension, psychosis, agitated GI, arrhythmias
ergot like effects: raynauds, pulmonary fibrosis in high doses
Propylthiouracil
thiomide derivative
antithyroid
use: hyperthyroidism
how: binds to thyroid peroxidase and inhibits the conversion of iodide to iodine – inhibits the production of new thyroid hormones
ci: hypothyroid, pregnancy
interaction: potentiates warfarin
se: agranulocytosis (sever and dangerous leukopenia alopecia arthralgia skin rash hepatitis and cholestatic jaundice
Lugol solution
anti hyperthyroid, iodine replenisher, radiation protectant
use: hyperthyroid, thyroid storm, protect thyroid after radioactive iodine treatment or radiation exposure emergency
how: strong iodine reduces vascularity, firms the glandular tissue, shrinks the size of individual cells, reaccumulation of colloid in the follicles and increases in bound iodine
blocks thyroid upstate of radioactive isotopes of iodine
ci: excessive iodine can cause hypothyroid due to feedback inhibition of hormone production and conversion f t3 to t4
interactions: ACE, ARB, Diuretics, lithium, potassium drugs
se: nausea vomiting, stomach ache, diarrhea, metallic taste in mouth, fever, headache, runny nose, sneezing or acne
Levothyroxine
synthetic thyroid hormone, T4
use: hypothyroid
how: converted to t3 in peripheral tissues and does all the things it should
ci: acute MI, subclinical hypothyroid, overt thyrotoxicosis, adrenal insufficiency
interactions: bile acid sequestrates decrease absorption, estrogens can increase thyroid requirement (adjust dosing for pregnancy), potentiates warfarin
se: insomnia, irritability, tachycardia, anxiety, weight loss, decreased appetite
Liothyronine
synthetic thyroid hormone, T3
use: hypothyroid, non-toxic goiter, myxedema
how: does the things T3 do
ci: hypersensitivity, acute MI, thyrotoxicosis, adrenal insufficiency, angina, cardiovascular disease, hypopituitarism, DM
interactions: do not take with sodium iodine
se: tachycardia, hypotension, MI
Canagliflozin
SGLT 2 inhibitor
use: T2DM
how: SGLT2 inhibition lowers renal threshold for glucose and leads to increased excretion
ci: 2 fold increase of lower limb amputation reported with this drug in patients with CVD or at risk for CVD. Do not use if severe renal impairment eGFR below 30, end stage renal disease or dialysis
Keep in mind the first line treatment for DM is lifestyle and metformin
interactions: increase risk for dehydration, hypotension, additive effect with insulin and sulfonylureas
se: female genital mycotic infections, increased urination, male mycotic infections, vulvovaginal pruritus, thirst
Liraglutide
GLP-1 receptor agonist
antidiabetic
use: T2DM, obesity
how: incretin mimetic; analog of human glucagon-like peptide increases insulin secretion, delays gastric emptying to decrease post prandial glucose, decreases glucagon secretion
ci: personal or family history of medullary thyroid cancer, multiple endocrine neoplasia type 2 (MEN 2), pregnancy as it will cause weight loss
interactions: slows gastric emptying and could impact absorption or oral meds
se: nausea, diarrhea, vomiting, constipation, headache and anti-liraglutide antibodies
Glyburide
sulfonylurea
antidiabetic
use: T2DM
how: closes ATP-sensitive potassium channels preventing efflux and depolarization of pancreatic b cells ==> increases amount of insulin secreted
administered QD or BID with meals
ci: T1DM, hypoglycemia, DKA, SULFA DRUG ALLERGY
interactions: potentiated by alcohol, anti-inflammatory drugs, salicylate, and sulfonamides
decreased by diuretics, steroids, thyroid and phytoin
se: hypoglycemia, photosensitivity, weight gain
Metformin
biguanide
anti diabetic
use: T2DM
how: increases the number and affinity of insulin receptors in peripheral tissues, decreases hepatic glucose output, decreases glucose absorption from the guy, increases glucose uptake and utilization in skeletal muscle and adipose tissue, does not usually cause hypoglycemia
ci: renal failure, metabolic acidosis, T1DM
interactions: alcohol increases risk of lactic acidosis, cimetidine and furosemide compete for proximal renal tubule secretion that reduces metformin clearance leading to increased effects, bet blockers can alter glucose metabolism and increase risk of hypoglycemia, Psyllium may delay absorption from meal and may allow for a lower dose
drink plenty of water to enhance the elimination of metformin
se: Lactic acidosis, GI irritation, stable glucose levels (no hypoglycemia), B12 deficiency with higher doses and long term use
Pioglitazone
thiazolidenedione antihyperglycemic agent
use: T2DM, second line choice used alone or with metformin or insuling
ci: CHF, Pregnancy (insulin is preferred), liver disease
interactions: drugs that inhibit or stimulate cytochrome P450 3A4 can increase or decrease effects, may reduce OCP effectiveness
se: weight gain, liver toxicity, edema (increases risk for heart failure), lowers TG but also raises HDL and LDL
Sitagliptin phosphate
Dipeptidyl peptidase-4, antidiabetic
use: T2DM
How: inhibits DPP-4 which normally inactivates incretin hormones, this prolongs the active incretin level and increases insulin release and decreases circulating glucose
ci: T1DM, DKA
interactions: additive effect with glyburide insulin and
se: nasopharyngitis, diarrhea, headache, constipation, peripheral edema, nausea, pharyngitis, osteoarthritis
Insulin
pancreatic hormone, anti diabetic
use; DM 1 AND 2
how: insulin
ci: hypoglycemia
interactions: b blockers mask signs of hypoglycemia and prolong recovery from hypoglycemic events
thiazides and steroids increase insulin demands
alcohol, NSAIDs, glyburide and warfarin can decrease insulin requirements
psyllium may lead to decreased need for insulin
LISPRO; rapid onset, peaks in 1 hour and lasts 3-4 hours
REGULAR: peaks in 2-3 hours, lasts 5-7 hours
GLARGINE: peaks in 12 hours, lasts one day
