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Pharm > Endocrine * > Flashcards

Endocrine * Flashcards

1
Q

Other agents for DM *

A

Dopamine agonists- Bromocriptine
-MOA unknown
-Modest a1c decrease
Bile acid sequestration-colesevelam

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2
Q

Sodium glucose cotransportor 2 inhibitors *

A

Drugs- canagliflozin (invokana) dapagliflozin (farxiga) empagliflozin (jardiance), ertugliflozin (steglatro)
Uses- DM and CHF
MOA- sodium glucose co transporter 2 is responsible for transposing glucose in the kidney, this inhibits it increasing urinary glucose excretion
ADE-UTI, yeast infection, hypotension, bone fracture, Fournier gangrene

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3
Q

Alpha glucosidase inhibitors *

A

Drugs- acarbose, miglitol (glyset)
Uses- DM
MOA- enzyme breaks down carbs into glucose and other sugars that can be absorbed this inhibits this function; delays digestion of carbs, does not cause hypoglycemic
ADE- GI distress, flatulence, diarrhea, cramping
DO NOT USE IN IBD, colonic ulcers, obstruction

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4
Q

Thiazolidinediones *

A

Drugs- pioglitazone (actos), rosiglitazone (avandia)
Uses- DM
MOA- lower insulin resistance by acting as agonist for peroxisome proliferator activated receptor Y which regulates transcription of several insulin receptors
Not used a lot due to CV ADE
ADE- weight gain, increased SQ fat, osteopenia, fractures, increased risk of bladder cancer, liver toxicity, fluid tension
DO NOT ISE IN CHF
BLACK BOX WARNINF FOR RISIGLITAZONE- INCREASED RISK OF MI/ANGINA

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5
Q

Dipeptidyl peptidase 4 inhibitors *

A

Drugs- alogliptin (nesina), linaglipton (tradjenta), saxagliptin (onglyza), sitagliptin (januvia)
Uses- DM
MOA- inhibits DPP4 which is responsible for inactivating GLP1
so do not use with GLP1
ADE- HA, nasopharyngitis, hypersensitivity
Saxa can increase risk for CHF exacerbation

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6
Q

Sulfonylureas *

A

Drugs- glyburide (diabeta, glynase), glipizide (glucotrol), glimepiride (amaryl)
Uses- DM
MOA- stimulation of insulin release from beta cell in pancreas, decrease hepatic glucose production, increase peripheral insulin sensitivity
ADE- hypoglycemia, hyper insulinemia, weight gain
Uses caution in kidney liver insufficiency,
Glipizide and glimepiride can be used for decreased renal function

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7
Q

Meglitinides *

A

Drugs- repaglinide, nateglinide
Uses- DM
MOA- stimulate insulin secretion, rapid onset
DO NOT USE WIRG SULFONYLUREAS
Take prior to meal
ADE- hypoglycemia, worker gain
D-D- sulfonylureas
DO NOT GIVEN IN LIVER INSUFFICIENCY

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8
Q

Amylin analog *

A

Drugs- pramlintide (symlin, SQ)
Uses- DM
MOA- Amylin is a hormone that is co secreted with insulin, delays gastric emptying, decrease post prandial glucagon secretion, improves satiety
ADE- n/v, anorexia
DO NOT MIX WITH INSULIN IN PREP
AVOID IN delayed gastric emptying, gastroparesis, cresol hypersensitivity, hypoglycemic unaware

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9
Q

Biguanides *

A

Drugs- metformin (glumetza, roimet)
Uses- DOC for initial therapy for DM or pre DM
MOA- decrease hepatic gluconeogenesis, slow intestinal absorption of sugars, improve peripheral glucose uptake, risk of hypoglycemia is less
ADE- GI, N/V/D, weight loss, decreases appetite
DO NOT GIVE IN severe renal function (GFR less than 30), DC in acute MI, CHF exacerbation, AKI, DO NOT GIVE WITH IV CONTRAST
Use caution for those over 80 years of age and alcohol abuse

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10
Q

GLP1 agonist *

A

Drugs- liraglutide (victoza), semaglutide (Ozempic, rybelsus), dulaglutide (trulicity), exanatide (Byetta, bydurdeon), lixisenatide (adlyxin)
Uses- DM, obesity
MOA- GLP 1 is important for appetite and food regulation, decrease hunger
Liragluride is QD
semaglutide is Q week injection
Semaglutide, dulaglutide, litaglutide also decrease CV risk in DM/CVD
ADE- n/v/d, constipation, avoid in chronic pancreatitis pts
BLACK BOX WARNING FOR THYROID CA RISK

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11
Q

Weight loss combination drugs *

A

Drug- Phentermine and topiramate (qsymia)
If not significant weight loss, greater than 5% in 12 weeks, then DC
DO NOT abrupt stop
Contraindicated in pregnancy
Drug- bupropion and naltrexone (contrave)
Contraindicated in HTN

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12
Q

Long acting insulin *

A

-insulin glargine (basaglar, lantus, semglee, toujeo)- slower, flat, prolonged effect
- insulin determir (levemir)- binds to albumin, slow dissociation
DO NOT MIX WITH OTHER INSULINS IN PREP

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13
Q

Combination insulin

A

70% NPH and 30% regular insulin

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14
Q

Goal for DM

A

A1C less than 7
Mean BG less than 154

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15
Q

Insulin (all types)

A

drugs- multiple-long acting, short acting, intermediate acting
MOA- replace absent secretion in type 1 or insufficient in type 2
ADE- hypoglycemia, weight gain, injection site reactions, lipodystrophy (rotate sites)

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16
Q

Rapid and short acting insulin *

A

-regular (humulin R, novolin R) short acting, quick onset peaks in 50-120 minutes, given 30 minutes prior to meal
-insulin aspart (fiasp, novolog), insulin glulisine (apidra), insulin lispro (admelog, humalog, lyumuev) -rapid acting, peaks in 30-90 minutes, given 15-20 minutes before meals, common in insulin pumps or IV

17
Q

Intermediate insulin *

A

Neutral protamine nagedorn (NPH, humulin N, novolin N)-
Basal insulin, SQ only, not for rapid glucose lowering

18
Q

Vasopressin *

A

Drugs- desmopressin (DDAVP), vasopressin (vasostrict)
MOA- ADH
USES- DI, shock, control bleeding
ADE- water toxicity, decreased sodium, abd pain, tremor, vertigo

19
Q

Hypothyroid tx *

A

Drugs- levothyroxine (synthroid), liothyronine (cytomel)
MOA- synthetic replacement of thyroid T3, T4
ADE- related to toxicity-nervousness, palpitations, tachycardia, heat intolerance, weight loss
D-D- phenytoin, rifampin, phenobarbital

20
Q

Hyperthyroidism tx *

A

Drugs- methimazole (tapazole), iodine therapy, propylthiouracil (PTU)
MOA- inhibits oxidative process for T3, T4
ADE- agranulocytosis, liver toxicity, rash, itching
Methimazole is tetrogenic
PTU can be used 1 st trimester
If in thyroid storm, use high dose plus beta blocker to control S/S

21
Q

Prolactin *

A

stimulate and maintain lactation
Drugs that act on dopamine antagonist like antipsychotics, metoclopramide can increase prolactin
Otherwise body naturally makes in pregnancy/BF
Hyperprolactiemia- treatment with dopamine 2 receptors agonist like bromocriptine, cabergoline
ADE-nausea, HA: psychosis

22
Q

Oxytocin *

A

Drugs- pitocin
MOA- synthetic dose used to stimulate uterine contractions and induce labor
ADE- HTN, uterine rupture, water retention, fetal death

23
Q

Gonadotropin releasing hormone *

A

Drugs- leuprolide (lupron), goserelin (zoladex), nafarelin (synarel)
MOA- suppresses release of FSH, LH, from anterior pituitary, decreased production of gonadal steroid hormones like androgen, estrogens
Uses- prostate CA, endometriosis, pre cocious puberty, suppress LH for women undergoing controlled ovulation for infertility tx
ADE- women-hot flashes, sweating; decreased libido, depression, ovarian cyst, men-same as above, edema, gynecomastia, bone pain
Contraindicated in breast feeding/pregnancy

24
Q

Gonadotropin releasing hormone antagonist *

A

Drugs- cetrorelix, gabireli
Used for infertility for controlled ovulation

25
Q

Gonadotrophins *

A

Drugs- menotropins (menopur), urofollitropin (bravelle), follitropin (gonal, follistim)
Uses- infertility
MOA- FSH, LH produced in anterior pituitary stimulation.
IM/SQ
ADE- ovarian enlargement/hyper stimulation, multiple births

26
Q

Somatotropin *

A

Drugs- synthetic growth hormones
MOA- normal release by anterior pituitary GH
Uses- GH deficiency, growth failure, HIV cachexia, off label use for athlete enhancement as it increase lean muscle mass
SQ/IM
ADE- pain at injection site, edema, arthralgia, myalgia, nausea, increased risk for DM
DO NOT USE IN children with closed plates, diabetic retinopathy, obese patients with prader willi syndrome

27
Q

Somatostatins *

A

Drugs- octreotide (sandostatin), lanreotide (somatuline)
MOA- growth inhibiting hormone, along with insulin, glucagon, gastric
Uses- tx for acromegaly, severe diarrhea, flushing with carcinoid tumors, IV octreotide-esophageal varices bleed
ADE- bradycardia, diarrhea; abd pain, n/v, steatorrhea, asymptomatic cholesterol gallstone

28
Q

Corticotropin releasing hormone *

A

Drugs- corticotropin (HP acthar), cosyntropin (cortosyn)
MOA- normal ACTH is released form pituitary, to bind to surface of adrenals, pathway ends with synthesis and release of adenocorticosteroids, adrenal androgens
Uses- DX for primary adrenal insufficiency (addisons) or secondary adrenal insufficiency (decrease ATCH by pituitary)
ADE- short term well tolerated
Long term- toxicity similar to glucocorticoids, HTN, hyperkalemia, edema, bone loss, emotional disturbances, increased risk of infection

29
Q

Anorexins/appetite suppressions *

A

Drugs- phentermine (adipex-P), diethylpropion (tenuate)
Uses- weight loss
MOA-CNA stimulants, increase NE, and dopamine and signal fight or flight
Tolerance can develop
Use for short term
Controlled substance due to dependence/misuse
SE- dry mouth, HA, constipation, insomnia, elevated HR/BP
Avoid in those with HTN/CVD/arrhythmias/ CVA
DO NOT GIVE WITH MOAIs or SYMPATHOMIMETICS

30
Q

Lipase inhibitors *

A

Drugs- orlistat (Alli, xenical)
Uses- weight loss
MOA- pentatonic acid ester that inhibits gastric and pancreatic lipase, decreased breakdown of dietary fat
ADE- GI distress
CONTRAINDICATED in pregnancy, chronic malabsorption syndrome, cholestasis
D-D any fat soluble vitamins (pt should take supplemental multivitamin), amiodarone, cyclosporine, levothyroxine

31
Q

Corticosteroids *

A

Drugs- Betamethasone (celestone, diprolene), cortisone, dexamethasone (decadron), fludrocortisone, hydrocortisone (cortef), methylprednisolone (medrol), prednisolone (orapred, pepiapred), prednisone (deltasone), triaminolone (kenalog, nasacort, aritospan)
Uses- antiinflammatory agents, asthma, allergies, Addison, replacement for secondary and tertiary adrenal insufficiency , dx of cushings, congenital adrenal hyperplasia, lung maturation
IM/PO/IV/topical/inhaled/nasal/intraarticulatory
ADE- dose and long term dependent- osteoporosis, Cushing like syndrome, cataracts, hyperglycemia, DM, oral candida
prednisone preferred in pregnancy
DC- DO NOT ABRUPT STOP due to acute adrenal insufficiency, taper down

32
Q

Inhibitors of adenocorticoids *

A

Drugs- eplernone (inspra), ketoconaozle (nizoral), spironolactone (aldactone)
Keto- anti fungal that inhibits all gonadal and adrenal steroid hormone synthesis, used for cushings
Spiro- anti HTN, competes for mineral corticoid receptor, inhibits sodium reabsorption, used for hyper aldosteroneism, HTN, cirrhosis, CHF, ADE- hyperkalemia, gynecomastia, rash, menstrual irregularities
Epelerone- selective aldosterone agonist less potential for ADE associated with spiro, used for HTN, MI, CHF

Pharm (16 decks)

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