Endocrine

Question 1

Metformin

Answer 1

Decreases gluconeogenesis, increases glycolysis, INCREASES INSULIN SENSITIVITY
first line in DM2, dont need islet function, no risk of hypoglycemia
Can cause lactic acidosis (GI lactate production) and thus contraindicated in renal failure

Question 2

Sulfonureas

Answer 2

1st gen- tolbutamide, chlorpropamide
2nd gen- glyburide, glimepiride, glipizide
Closes k channel in B cell, insulin release
useless in DM1
risk of hypoglycemia increased in RF
first gen- disulfram like effects
2nd gen- hypoglycemia

Question 3

Glitazones/thiazolinidones

Answer 3

Pioglitazone, rosiglitazone
increases peripheral insulin sensitivity
binds PPAR-y nuclear transcription regulator
increases adiponectin cytokine
used in DM2
Weight gain, edema, hepatotoxic, heart failure

Question 4

a-glucosidase inhibitors

Answer 4

acarbose, miglitol
inhibits brush border a-glucosidase, delayed glucose absorption, decreases post-prandial hypoglycemia
Used in DM2

Question 5

Pramlintide

Answer 5

decrease gastric emptying and glucagon

DM1 and DM2

Question 6

GLP-1 analogs

Answer 6

exenatide, liraglutide
increase insulin, decrease glucagon
DM2

Question 7

DPP-4 inhibitors

Answer 7

Linagliptin, saxagliptin, sitagliptin
increase insulin, decrease glucagon
DM2
can get mild urinary or respiratory infections

Question 8

Propylthiouracil and methimazole

Answer 8

Block thyroid peroxidase
propylthiouracil also blocks 5’ deiodinase (T4-T3)
rash, agranulocytosis, aplastic anemia
propylthioucacil- hepatotoxic but safe in preg
methimazole- teratogen (aplasia cutis)
Ptu- Peripheral and Pregnancy

Question 9

Levothyroxine and triiodothyronine

Answer 9

Thyroxine replacement

use in hypothyroid and myxedema

Question 10

Demelocycline

Answer 10

ADH antagonist (member of tetracycline)
Use in SIADH
can cause nephrogenic DI, photosensitivity, bone/teeth problems