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Pharmacology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Somatropin (Genotropin, Humatrope)
Octreotide
Pegvisomant
are all examples of what type of medications

A

growth hormone release modulators

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2
Q

Corticotropin
Cosyntropin
are all examples of what type of medications

A

ACTH release modulators

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3
Q

Leuprolide
Groserelin
Nafarelin
Histrelin
are all examples of what type of medications

A

FSH-LH release modulators

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4
Q

Bromocriptine
Cabergoline
Octreotide
Pegvisomant
Somatropin
are all examples of what type of medications

A

prolactin release modulators

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5
Q

Oxytocin
vasopressin
Desmopressin
are all examples of what type of medications

A

posterior pituitary hormones

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6
Q

Growth hormone has an effect on the

A

liver

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7
Q

ACTH has an affect on the

A

adrenal gland to make cortisol

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8
Q

TSH has an affect on

A

the thyroid gland - producing T4 and T3

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9
Q

FSH/LH has affects on

A

the gonads to produce estrogen, progesterone or testosterone

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10
Q

PRL has effects on

A

the breast to produce milk

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11
Q

GH is required for normal

A

growth

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12
Q

GH target tissues (BALM)

A

bone
adipose - reduction
liver - somatomedins
muscle
growth plates

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13
Q

Somatropin (GH) indications

A

GH deficiency
growth failure
HIV patients with cachexia

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14
Q

Somatropin (GH) adverse effects

A

pain at injection site
edema
arthralgia and myalgia
nausea
glucose tolerance - insulin insensitivity

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15
Q

Somatropin (GH) warning

A

do not use in peds pts with closed epiphyses
increased intracranial pressure

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16
Q

Somatostatin is an

A

inhibitory hormone that suppresses GH and TSH release in the hypothalamus (anterior pituitary gland)
suppresses secretions and motility in the GI tract

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17
Q

Octreotide (long acting synthetic somatostatin analog) indications

A

acromegaly
severe diarrhea caused by carcinoid tumors
bleeding esophageal varices

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18
Q

Octreotide MOA

A

long acting synthetic somatostatin analog to suppress GH release

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19
Q

Octreotide (long acting synthetic somatostatin analog) adverse effects

A

CVS - bradycardia and conduction disturbances
GI - diarrhea, abdominal pain, flatulence, nausea and steatorrhea (fatty stool)
Gallbladder emptying is delayed

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20
Q

Pegvisomant MOA

A

GH receptor antagonist - modified GH with receptor blocking properties

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21
Q

Pegvisomant (GH receptor antagonist) indications

A

acromegaly that is refractory to other pharm, surgical or radiological intervention

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22
Q

Pegvisomant (GH receptor antagonist) adverse effects

A

diarrhea and nausea
CNS - pain
abnormal hepatic function tests

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23
Q

Corticotropin MOA

A

anterior pituitary hormone stimulates steroid biosynthesis - naturally occurring hormone

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24
Q

Cosyntropin MOA

A

Synthetic ACTH - stimulates adrenal cortex to secrete adrenal steroids (cortisol), androgenic substances and a small amount of aldosterone

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25
Q

Cosyntropin (synthetic ACTH) indications

A

diagnostic tool - ACTH stimulation test - screening for adrenocorticosteroid deficiency

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26
Q

cortisol is like

A

adrenaline

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27
Q

Cosyntropin (synthetic ACTH) Adverse effects

A

excess glucocorticoid toxicities -
HTN, peripheral edema, hypokalemia, osteoporosis

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28
Q

Cosyntropin is a precursor to _____ essentially

A

steroids - like prednisone

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29
Q

Gonadotropin - releasing hormone is secreted from

A

the hypothalamus - binds to receptors in anterior pituitary gland

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30
Q

FSH-LH release modulators adverse effects: males and females

A

male - transient increase in testosterone, hot flashes, sweats, edema, gynecomastia, decreased libido, decreased HCT and bone density
female - generalized menopausal symptoms, ovarian cysts

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31
Q

Leuprolide (FSH-LH release modulator) indications

A

used to treat prostate cancer, breast cancer, endometriosis, uterine fibroids, early puberty
can delay onset of puberty in transgender youth prior to HRT
can delay or prevent early ovulation to allow for development of mature eggs for retrieval in IVF

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32
Q

Goserelin (FSH-LH release modulator) indications

A

suppress production of the sex hormones, particularly in the treatment of breast and prostate cancer

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33
Q

Nafarelin (FSH-LH release modulator) indications

A

used in the treatment of endometriosis and early puberty

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34
Q

Histrelin (FSH-LH release modulator) indications

A

used to treat advanced prostate cancer in adults - will reduce levels of testosterone

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35
Q

Prolactin is a hormone secreted from the

A

anterior pituitary

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36
Q

Prolactin stimulates and maintains

A

lactation

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37
Q

Prolactin is increased by _____ and is also stimulated to release by _______

A

dopamine antagonists
TRH

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38
Q

Prolactin release modulators include

A

Bromocriptine and Cabergoline

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39
Q

Bromocriptine and Cabergoline MOA

A

Dopamine D2 receptor agonists - suppress prolactin release

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40
Q

Bromocriptine and Cabergoline indications

A

lactotroph adenomas (prolactinomas) - hyperprolactinemia
T2DM (theoretically)

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41
Q

Bromocriptine and Cabergoline adverse effects

A

HA, dizziness, psychosis
Nausea

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42
Q

When giving FSH-LH release modulators
Continuous =
Pulsatile =

A

will decrease production
will increase/ stimulate production

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43
Q

Posterior Pituitary gland hormones are not

A

regulated by releasing hormones

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44
Q

Target tissues of:
Oxytocin
Vasopressin (ADH)

A

Oxytocin = uterus and breast
Vasopressin = nephron and vascular smooth muscle

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45
Q

Oxytocin acting on breast and uterus causes

A

contraction and milk production

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46
Q

Vasopressin acting on nephron and vascular smooth muscle causes

A

water reabsorption, hyponatremia
vasoconstriction

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47
Q

Oxytocin indications

A

labor induction
postpartum hemorrhage

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48
Q

Oxytocin adverse effects

A

hypotension and arrhythmias
fluid retention
placental abruption or uterine rupture
fetal distress and death

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49
Q

oxytocin MOA

A

binds to oxytocin receptors

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50
Q

Vasopressin MOA

A

stimulates arginine vasopressin receptors
desmopressin = selective V2 activity (minimal V1)

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51
Q

V1 receptor =
V2 receptor =

A

V1 = vascular smooth muscle
V2 = nephron

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52
Q

Vasopressin indications

A

central diabetes insipidus
nocturnal enuresis

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53
Q

Vasopressin adverse effects

A

water intoxication and hyponatremia
HA, bronchoconstriction and tremor
clots because of the extra renal V2 receptors that increase blood coag factors

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54
Q

Vasopressin warnings

A

caution when using vasopressin in pts with CAD, epilepsy and asthma
nasal spray has been linked to increased seizures in children

55
Q

Naturally occurring Glucocorticoids

A

Cortisol (hydrocortisone)
Cortisone (less potent)

56
Q

Primary action of naturally occurring glucocorticoids

A

stress hormone

57
Q

betamethasone
Cortisone
dexamethasone
hydrocortisone
prednisone
methylprednisone
triamcinolone
are all examples of what type of medication

A

corticosteroids

58
Q

Fludrocortisone
spironolactone
eplerenone
are examples of what type of medications

A

mineralocorticoid agonist and antagonists

59
Q

Short acting (1-12 hours) glucocorticoids

A

hydrocortisone
cortisone

60
Q

intermediate acting (12-35 hours) glucocorticoids

A

prednisone
prednisolone
methylprednisone
triamcinolone

61
Q

long acting (36-55 hours) glucocorticoids

A

betamethasone
dexamethasone

62
Q

mineralocorticoid properties - high salt retaining effect

A

fludrocortisone

63
Q

similar glucocorticoid and mineralocorticoid properties

A

short acting steroids - hydrocortisone and cortisone

64
Q

more glucocorticoid activity and minimal to no mineralocorticoid activity

A

intermediate acting steroids - prednisone, prednisolone, methylprednisolone, triamcinolone (no mineralocorticoid effect)

65
Q

Glucocorticoid activity and no mineralocorticoid activity

A

long acting steroids - betamethasone and dexamethasone

66
Q

Therapeutic use of steroids:
Adrenal use - replacement therapy or dx of cushing’s syndrome

A

replacement therapy = hydrocortisone
dx of cushing’s = dexamethasone

67
Q

Therapeutic use:
non adrenal therapy - anti inflammatory, anti-allergy =
acceleration of lung maturation-antenatal (surfactant production) =

A

anti inflammatory, anti allergy = several
acceleration of lung maturation-antenatal = betamethasone and dexamethasone

68
Q

Low dose dexamethasone suppression test

A

positive low dose test dx/confirms hypercortisolemia (cushing’s syndrome) = no suppression of cortisol - normal or high

negative test = decreased/ suppressed cortisol production after administration

69
Q

Naturally occuring Mineralocorticoids

A

aldosterone

70
Q

Action of aldosterone

A

regulate salt and water metabolism
- increase salt reabsorption
- increase potassium excretion
- increase hydrogen ion excretion

71
Q

Fludrocortisone MOA

A

synthetic mineralocorticoid
salt and water retaining properties
some glucocorticoid activity

72
Q

Fludrocortisone indications

A

treatment of addison’s disease and associated mineralocorticoid deficiency

73
Q

Hypothyroidism drugs

A

T4- Levothyroxine
T3- Liothyronine
T3+T4 LioTrix

74
Q

Hyperthyroidism drugs

A

Methimazole
Propylthiouracil
Propranolol
Iodine and potassium iodide

75
Q

T4 - Levothyroxine absorption

A

stable, well absorbed (taken on an empty stomach) with some exceptions - aluminum, magnesium containing antacids may decrease absorption

76
Q

Levothyroxine is synthetic

77
Q

T4- Levothyroxine has a half life of

78
Q

T4- Levothyroxine is associated with

A

toxicity (increased levels of T4)

79
Q

Liothyronine is

A

synthetic T3

80
Q

T3- Liothyronine has _______ oral absorption

81
Q

T3- Liothyronine has a ______ half life

82
Q

T3- Liothyronine has an increased risk of

A

cardiotoxicity

83
Q

T3 + T4 Liotrix was developed to

A

try and mimic normal, physiologic hormone levels

84
Q

T3 + T4 Liotrix is made up of

A

12.5 mcg levothyroxine and 3.1 mcg liothyronine

85
Q

Indications for what drug = tried and failed levothyroxine, have no thyroid left or has gone through radioiodine

A

T3 + T4 Liotrix

86
Q

Thioamides include

A

Propylthiouracil
Methimazole

87
Q

Propylthiouracil MOA

A

Inhibits thyroid hormone synthesis - inhibits thyroperoxidase and D1 (iodothyronine deiodinase) which decreases T4 to T3 conversion

88
Q

Propylthiouracil has a ______ half life

89
Q

Propylthiouracil toxicity

A

teratogenic - preferred early in pregnancy
hepatotoxicity
bone marrow suppression - agranulocytosis

90
Q

Methimazole MOA

A

inhibits thyroid hormone synthesis - inhibits thyroperoxidase, does not affect D1

91
Q

Methimazole toxicity

A

teratogenic - preferred in the 2nd and 3rd trimester
hepatotoxicity
bone marrow suppression - agranulocytosis

92
Q

Propanolol MOA

A

non-selecetive b-blocker
symptomatic control in thyroid storm
inhibits deiodination of T4 - reduces circulation of T3

93
Q

Propanolol is administered in

A

IV in emergency setting for thyroid storm symptom control

94
Q

Iodine and KI MOA

A

inhibition of biosynthesis - inhibition of the iodination of tyrosine
inhibition of secretion/ release of T4/T3

95
Q

Iodine and KI effects on serum thyroid hormone are maximal at

96
Q

Iodine and KI adverse effects

A

exacerbation of hyperthyroidism
mucosal injury - mouth, pharynx, esophageal or duodenal lesions

97
Q

Potassium Iodide used to treat

A

severe hyperthyroidism and to protect the thyroid gland when using radiopharmaceuticals
preoperative preparation for thyroidectomy in graves disease to decrease gland vascularity
thyroid storm
short term control of graves disease

98
Q

Radioactive Iodine MOA

A

administered orally as sodium iodine in solution or capsule, rapidly absorbed into the thyroid gland causing local tissue destruction
Thyroid is rendered inactive over 6-18 wks

99
Q

Indications for radioactive iodine

A

graves disease
toxic adenoma
multinodular goiter

100
Q

Bisphosphonates MOA

A

Inhibit osteoclast activity, reducing bone resorption and turnover

101
Q

Alendronate indications

A

osteoporosis, pagets disease of bone, osteopenia (in non-ambulatory patients)

102
Q

Risedronate indications

A

osteoporosis, pagets disease of the bone

103
Q

Hypercalcemia clinical presentation

A

bones, moans, stones and muscle psychiatric overtones
ECG - shorted QT, ST depression, AV blocks

104
Q

Ibandronate indications

A

Osteoporosis

105
Q

Zoledronic Acid indications

A

Osteoporosis, malignant hypercalcemia, bone metastases, multiple myeloma

106
Q

Common causes of Hypercalcemia

A

hyperparathyroidism, malignancy, granulomatous disease, thiazides, lithium, pancreatitis

107
Q

Hypercalcemia interventions

A

IV hydration, calcitonin, bisphosphonates, loop diuretics, glucocorticoids, denosumab, dialysis

108
Q

Bisphosphonates side effects

A

bone, joint, muscle pain
GI upset
HA
atypical femur fractures, osteonecrosis of the jaw
Irritation to upper GI mucosa - take and remain upright for at least 30 min
hypocalcemia - Ca and Vit D supplementation recommended

109
Q

Contraindications of Bisphosphonates

A

esophageal disorders
renal insufficiency
hypocalcemia
food interferes with absorption - take with water on empty stomach and wait 30-60 min before eating

110
Q

Calcitonin MOA

A

antagonizes the effects of PTH, inhibits osteoclast activity and promotes the renal excretion of Ca2+

111
Q

Calcitonin indications

A

hypercalcemia
pagets disease of the bone
postmenopausal osteoporosis
pain from osteoporotic fracture

112
Q

Calcitonin adverse effects

A

rhinitis
epistaxis
back pain
n/v
bronchospasms
hypocalcemia
anaphylaxis (rare)

113
Q

Vit D MOA

A

Cholecalciferol is a provitamin
stimulates Ca absorption from the small intestines, promotes bone mineralization

114
Q

Indications for Vit D

A

Vit D deficiency
Osteoporosis
Hypoparathyroidism

115
Q

Contraindications to Vit D

A

hypercalcemia
primary hyperparathyroidism
sarcoidosis

116
Q

Calcitrol MOA

A

Vit D analog - stimulates intestinal Ca and P aborption, decrease PTH synthesis, stimulates bone mineralization

117
Q

Calcitrol indications

A

renal failure
hypoparathyroidism
rickets
hypophosphatemia

118
Q

Adverse effects of Calcitriol

A

hypercalcemia
hyperphosphatemia
N/V

119
Q

Contraindications of Calcitriol

A

pancreatitis
soft tissue calcifications
arrhythmias

120
Q

Denosumab MOA

A

recombinant antibody that inhibits RANK-ligand to bind to RANK (antiresorptive)

121
Q

Denosumab indications

A

osteoporosis, cannot tolerate or unresponsive to bisphosphonates, renal impairment

122
Q

Side effects of Denosumab

A

osteonecrosis of the jaw, atypical subtrochanteric fracture, bone pain

123
Q

Contraindications to denosumab

A

hypocalcemia

124
Q

Teriparatide - recombinant PTH MOA

A

anabolic effect on bone metabolism by stimulating bone formation and activating bone remodeling
treatment duration < 2 years in lifetime

125
Q

Teriparatide indications

A

osteoporosis (not used often), if they have failed bisphosphonates and other options

126
Q

Side effects of Teriparatide

A

generally well tolerated
hypercalcemia and hypercalciuria
orthostatic hypotension
BLACK BOX WARNING - potential risk of osteosarcoma

127
Q

Contraindications of teriparatide

A

hypercalcemia
severe renal impairment

128
Q

Raloxifene MOA

A

selective estrogen receptor modifier
acts like an estrogen agonist in the bone thereby decreasing bone resorption and overall bone turnover
bone density is increased

129
Q

indications for raloxifene

A

osteoporosis in postmenopausal women

130
Q

Adverse effects of raloxifene

A

hot flashes, leg cramps, peripheral edema, DVT/PE

131
Q

Contraindications for raloxifene

A

history of DVT/PE, pregnancy

132
Q

Effects of diuretics on calcium levels

A

Thiasizes (HCTZ) - decreased urinary Ca excretion, inhibits secretion of Ca sometimes leading to elevated levels of Ca in blood
Loop diuretics (furosemide) - increased urinary Ca concentration, useful in treatment of hypercalcemia because it stimulates tubular Ca excretion

133
Q

therapeutic and toxic effects of fluoride ion

A

appears to increase osteoblast activity, increase bone density but fracture risk is not reduced
toxicity sxs - Gi effects such as N/V, diarrhea, severe cases renal or cardiac dysfunction

Pharmacology (7 decks)

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