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Pharmacology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Thyroid Gland

A

Free and total thyroid
T4/T3

Primary effects:
Metabolism
Temperature management
Growth & Development

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2
Q

Hypothyroidism – Signs and Symptoms

A

Increased weight gain
Cold intolerance
Hair loss

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3
Q

Hypothyroidism treatment

A

Supplementation
-T4 (Levothyroxine) Synthroid ®
-T3 (Liothyronine) Cytomel®
-T4/T3 Combination - Armour Thyroid®

Long half-life of T4 (7-10 Days)

Onset of action:
-initial 3-5 days
-peak 4-6 weeks

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4
Q

Hashimoto’s Disease

A

Most prevalent
Inherited with unknown gene expression
Women>Men
40-60 years of age
Immune cells target and destroy thyroid tissue

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5
Q

Myxedema Coma

A

Severe form of hypothyroidism
No edema/no coma
Deteriorating mentation

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6
Q

Myxedema Coma treatment

A

Supportive care
IV levothyroxine
Reverse underlying cause if known

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7
Q

Hyperthyroidism – Signs and Symptoms

A

Atrial Fibrillation, Muscle Weakness, Heat Intolerance, neck swelling (Goiter)

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8
Q

Hyperthyroidism treatment

A

Propylthiouracil (PTU) - Blocks synthesis of new thyroid hormone, prevents conversion of T4 to T3

Methimazole - Block synthesis of new thyroid hormone

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9
Q

Graves Disease

A

Autoimmune disorder
-Hyperthyroidism

Rapid/irregular heart rate
Osteoporosis
Muscle weakness
Vision changes
Weight loss

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10
Q

Thyrotoxicosis – Umbrella Term

A

1% prevalence, Most common cause is Graves Disease (Autoimmune disease)

Of that population – 1% will experience thyrotoxicosis crisis “Thyroid Storm”
Extremely elevated T4 and T3
20% mortality rate

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11
Q

Thyrotoxicosis - Treatment

A

For Symptomatic Relief, beta blockers (propranolol, slows everything down and only used for symptom relief in this case)

Antithyroid agents (PTU or methimazole)

Other therapies
-Radioactive iodine
-Thyroidectomy (hypothyroidism is a concern after this)

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12
Q

Iodide

A

Blocks new hormone synthesis & release

Tachyphylaxis ~2 weeks

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13
Q

Parathyroid

A

Parathyroid Hormone (PTH)
Maintains calcium homeostasis

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14
Q

Hypoparathyroidism

A

Poor PTH secretion
Reduced bone resorption – hypocalcemia
Supplement
-Calcium & Vitamin D

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15
Q

Hyperparathyroidism

A

Excessive PTH secretion
-Tumors
-Hypercalcemia
Resection

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16
Q

Vitamin D

A

Supports bone mineralization
Calcitriol stimulates calcium absorption from the GI tract
Decreases PTH, promoting bone mineralization by decreasing catabolic effects of PTH

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17
Q

Calcitonin

A

Secreted by thyroid

Stimulated bone formation -> increases incorporation of calcium into skeletal storage

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18
Q

Bisphosphonates

A

often first line in therapy for bone mineralization homeostasis, inhibits osteoclastic activity

Side effects: GI upset, abdominal pain, nausea, flu-like symptoms

Rare side effects: Atypical fractures, osteonecrosis of the jaw (ONJ), bone/muscle/joint pain

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19
Q

Atypical Fractures

A

Subtrochanteric & diaphyseal femur fractures
Can be bilateral
Higher risk patients: long term therapy, Asian race, steroid use >1yr, femoral bowing
Prodrome of pain in weeks or months prior

20
Q

Osteonecrosis of the Jaw (ONJ)

A

Destruction and death of bone that affects the mandible
Most cases reported are with patients on bisphosphonates
Higher risk patients: Cancer, longer duration of therapy, concurrent steroid use

21
Q

Calcium

A

Supplements calcium to maintain adequate levels for bone formation
*Dietary is preferred source
*Target RDA based on patient specific factors
*Hypercalcemia is harmful

22
Q

Vitamin D analogs

A

Enhance bone formation by increased absorption of calcium
*Fat soluble vitamin = toxicity risk
*Weekly or daily dosing

23
Q

Adrenocorticosteroids

A

Cholesterol backbone

Glucocorticoids
-Cortisol (glucose metabolism)
-Inflammation
-Immune system

24
Q

Glucocorticoids

A

Receptor binding

Extra & Intra-cellular
-DNA expression
-Protein synthesis

Increase in glucose
-Liver
-Increased storage (glycogen)

Muscle/Adipose Tissue
-Increased breakdown
-Decreased storage

Immune system suppression

25
Q

Adverse Effects of steroids

A

Adrenocortical Suppression

Connective Tissue Breakdown
-Muscles & tendons

-Hyperglycemia
-Skin break down

26
Q

Mineralocorticoids

A

Aldosterone
Maintains fluid/electrolyte balance via sodium and water regulation in the kidneys

Example: fludrocortisone

27
Q

Sex Hormones

A

Androgen/testosterones- increase muscle mass
Androgen abuse- for athletic gains

Risk include
-Liver damage
-Cardiomyopathy, arrhythmias, ischemic heart disease
-Decrease HDL
-HTN, stroke, heart attack

28
Q

Diabetes Complications

A

Blindness, kidney failure, heart disease, stroke, neuropathy

29
Q

Hyperglycemia symptoms

A

extreme thirst, headache, frequent urination, hunger, abdominal pain, blurry vision, warm, flushed skin, irritability.

Symptoms of very high blood sugar include rapid shallow breathing, vomiting, and fruity breath

30
Q

Diabetes treatment

A

Non-pharmacologic 1st line
Diet & Exercise
T1DM: insulin
Pre-diabetes: Non-pharmacologic interventions
T2DM: diabetes meds (oral or injectable) +/- insulin

Targeting glycemic control and A1C goal

31
Q

Metformin MOA

A

Decrease glucose production from liver; increase insulin sensitivity

32
Q

Metformin side effects

A

Diarrhea - common, transient (significant, but gets better

Nausea and vomiting - transient

stomach cramping

lactic acidosis - rare; serious

33
Q

Sulfonylureas MOA (Glipizide, Glimepiride, Glyburide)

A

Increase insulin secretion from pancreas

34
Q

Sulfonylureas side effects

A

HYPOGYLCEMIA
Weight gain
Need to take this with a meal

35
Q

GLP-1 Receptor Agonist side effects (Exenatide (Byetta), Liraglutide (Victoza), Semaglutide (Ozempic))

A

Tachycardia (resting HR), weight loss, GI upset

36
Q

DPP-4 Inhibitor side effects (Sitagliptin (Januvia), Linagliptin (Tradjenta) )

A

well tolerated, weight neutral, pancreatitis (postmarketing, rare)

37
Q

SGLT-2 Inhibitors side effects (Empagliflozin (Jardiance), Dapagliflozin (Farxiga), Canagliflozin (Invokana))

A

UTI/Genital yeast infection / increased urine output
Weight loss

38
Q

Pioglitazone (Actos) MOA

A

increase insulin sensitivity

39
Q

Pioglitazone (Actos) side effects

A

Heart failure
Edema (LE extremity)
Weight gain
Bone fracture (?)
Increased LFTs

40
Q

NovoLog

A

Rapid acting insulin

onset 15 minutes, peak effects 35-50 mins, duration 3-5 hours

41
Q

HumaLog

A

Rapid acting insulin

onset: >30 minutes, peak effects 30 mins to hour and a half, duration 2-5 hours

42
Q

Lantus

A

Long-acting insulin,

onset: 2-5 hours
peak: 5-24 hours
duration: 18-24 hours

43
Q

Levemir

A

Long acting insulin,

Onset: 3-4 hours
Peak: 3-14 hours
Duration: 6-24 hours

44
Q

Hypoglycemia symptoms

A

sweating, hunger, headache, blurred vision, extreme tiredness and paleness, dizziness, trembling, mood change

Night time symptoms include night sweats, tiredness, irritability upon waking, morning headache

45
Q

Glucose monitoring

A

Rule of 15:
15 g carbs, check glucose in 15 minutes, repeat if <70 mg/dL

Anything less than 70 will present with symptoms

46
Q

Exercise induced hypoglycemia

A

Depends on intensity, type and duration of exercise

May require dose adjustment of short acting insulin prior to workout

Do not inject short acting insulin until at least 1 hour post workout

Inject insulin in stomach instead of arms or thighs to help slow absorption

Pharmacology (10 decks)

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