Endocrine Flashcards
Suppress GH, IGF1, serotonin and GI peptides
ACROMEGALY, PIT ADENOMA
Carcinoid Gastrinoma Glucagonona
Variceal bleeding
Octreotide
Inc IGF1 release in liver and cartilage
GH DEFICIENCY
Short stature, failure to thrive, AIDS wasting
Performance enhancing drug
Somatotropin
GH analog
Ovarian hyperstimulation syndrome
Ovarian enlargement
Ascites
Hypovolemia to shock
OVARIAN STIMULATION
INFERTILITY
WOF ovarian hyperstimulation syndrome multiple pregnancies gynecomastia
Follitropin alfa
FSH analog
OVARIAN INDUCTION
HYPOGONADOTROPIC GONADISM
WOF ovarian hyperstimulation syndrome multiple pregnancies gynecomastia
Choriogonadotropin alfa
LH analog
Inc LH and FSH with intermittent
Dec LH and FSH with continuous
OVARIAN HYPERSTIMULATION
ENDOMETRIOSIS Myoma uteri Precocious puberty Prostate ca
WOF TEMPORARY EXACERBATION OF PRECOCIOUS PUBERTY
Leuprolide
GnRH analog
PREVENTS PREMATURE LH SURGE in ovarian stimulation Prostate ca without tumor flare up
Ganirelix
GnRH antagonist
WOF Hypersensitivity ABARELIX
Partial agonist at D2 receptor
Inhibits prolactin release
HYPERPROLACTINEMIA, PARKINSONS
Bromocriptine
Dopamine agonist
LABOR INDUCTION
POSTPARTUM HEMORRHAGE
WOF fetal distress placental abruption uterine rupture fluid retention
Oxytocin
CDI Hemophilia A von Willebrand disease
Desmopressin
ADH agonist
DI
Polyuria
Polydipsia
Hypernatremia
SIADH
HYPONATREMIA
Conivaptan
ADH antagonist
Thyroid Hormone synthesis
Transport
Organification
Coupling
Proteolysis
HYPOTHYROIDISM
MYXEDEMA COMA
Levothyroxine
TH
Progressive weakness, stupor
Hypothermia
Hypoventilation
Hypoglycemia Hyponatremia Hypovolemia
Myxedema Coma
Untreated Hypothyroidism
- Levothyroxine
HYPERTHYROIDISM
THYROID STORM
in pregnant women
WOF fulminant hepatitis agranulocytosis
PTU
HYPERTHYROIDISM
WOF cholestatic jaundice altered taste and smell agranulocytosis
Prenatal exposure cuses APLASIA CUTIS CONGENITA
Methimazole
Acute severe neutropenia
Sore throat or high fever
Agranulocytosis
- GCSF
WOF HYPOTHYROIDISM
preferred definitive treatment
CI pregnant and lactating
RAI 131
Reduce size and vascularity of thyroid
PRE THYROIDECTOMY
WOF IODISM
Prenatal exposure causes FETAL GOITER
Potassium iodide
Ingestion of iodine causes
HYPOthyroidism
HYPERthyroidism
Wolf Chaikoff
Jod Basedow
Inhibits peripheral conversion of T4 to T3
HYPERTHYROIDISM
THYROID STORM
Does not alter thyroid hormone levels
Propanolol
Thyrotoxicosis related arrhythmias - Esmolol
Inhibit peripheral T4 to T3
PTU
Propanolol
Hydrocortisone
Drug induced hyperthyroidism
Clofibrate
Amiodarone
Methadone
Amiodarone induced thyroid disease
HYPO
HYPER
Levothyroxine
Thioamides or corticosteroids
Stronger anti inflammatory effect
Glucocorticoids
ACUTE ADRENAL INSUFFICIENCY
Insect bites THYROID STORM Status asthmaticus
Hydrocortisone
SA glucocorticoid
Adrenal suppression Growth inhibits
Glucose intolerance Salt retention Osteoporosis
Prednisone
glucocorticoid
Strong agonist of mineralocorticoid receptors. Moderate agonist of glucocorticoid receptors
CHRONIC ADRENAL INSUFFICIENCY
CAH Adrenal replacement therapy
Fludrocortisone
Mineralocorticoid
MCC Cushing’s syndrome
Exogenous steroid intake
Inhibits desmolase
CUSHING SYNDROME Breast Ca
Abused by body builders
Aminogluthetimide
glucocorticoid inhibitor
Azole antifungal
ADRENAL CARCINOMA
WOF HEPATOTOXICITY
Ketoconazole
glucocorticoid inhibitor
Selective inhibitor of steroid 11 hydroxylation
DIAGNOSTIC TESTING
DOC PREGNANT WITH CUSHING’S
Metyrapone
Primary hypogonadism
Post menopausal hormone replacement therapy
WOF BREAKTHROUGH BLEEDING HYPERTG HYPERTENSION DVT ENDOMETRIAL CA
Ethinyl estradiol
CLEAR CELL VAGINAL ADENOCARCINOMA
Diethylstilbestrol
Non steroid
Hormone replacement therapy
Contraception
Assisted reproduction Anovulation induction
PREVENTS ESTROGEN INDUCED ENDOMETRIAL CA
WOF dec HDL, reversible dec in bone mineral density
Norgestrel
Appetite stimulant - Megestrol
Primary action of hormonal contraceptives
Inhibition of ovulation
ACNE CONTRACEPTION ENDOMETRIOSIS
WOF BREAST CA earlier onset
Estradiol + Norethindrone
COC
WOF delayed return of fertility
Prevents conception by altering cervical mucus and hostile endometriun
Medroxyprogesterone acetate
IM DMPA
Progestin only
EMERGENCY CONTRACEPTION
YUZPE 72 hrs
Levonorgestrel
Estrogen antagonist action on breast and CNS. Estrogen agonist in uterus, liver and bone
HORMONE RESPONSIVE BREAST CA
WOF ENDOMETRIAL HYPERPLASIA/CA
Tamoxifen
SERM
Estrogen antagonist action on breast and CNS. Estrogen agonist in liver and bone
BREAST CA PREVENTION
Raloxifene
SERM
Partial agonist of estrogen receptors in pituitary. Inc FSH and LH
WOF MULTIPLE PREGNANCIES OVARIAN ENLARGEMENT
Clomiphene
SERM
Inhibit aromatase
BREAST CA RESISTANT TO TAMOXIFEN
PRECOCIOUS PUBERTY
Anastrozole
Estrogen synthesis inhibitor
ENDOMETRIOSIS
Fibrocystic disease
CI pregnancy and BF
Danazol
Antiandrogen
Glucocorticoid and progesterone receptor antagonist
MEDICAL ABORTION
CUSHING’S SYNDROME
May cause sepsis due to Clostridium sordelli
Mifepristone RU 486
Male hypogonadism
Wasting syndrome
WOF virilization in women and paradoxical feminization in men
Testosterone
Inc ratio if anabolic to androgenic activity
Performance enhancement in athletes
WOF HCC CHOLESTATIC JAUNDICE
Oxandrolone
Anabolic steroid
Prostate ca
SURGICAL CASTRATION
Add leuprolide to prevent prostate ca flare up
Nilutamide
Androgen antagonist
Hirsutism
DEC SEX DRIVE IN MEN
orphan drug status
Cyproterone
Androgen antagonist
Inhibit 5a eeductase
BPH Male pattern baldness
Finasteride
Androgen synthesis inhibitor
Transporter for insulin mediated glucose uptake in muscle and adupose
GLUT4
Rapid insulin
Lispro
Aspart
Glulisine
Short insulin
Regular
Int insulin
NPH
Lente
LA insulin
Ultralente
Ultra LA insulin
Glargine
Detemir
Lantus
Hypoglycemia
Neuroglycopenic sx
Neurogenic sx
Changes in consciousness and behavior
Adrenergic and cholinergic
More prone to developing hypoglycemia in insulin use
Renal disease
Elderly
<7 yo
When the evening dose of int insulin is high, hypoglycemia develops around 3 am
PreBF hypogly
Tx dec evening dose
Somogyi effect
When the evening dose of int insulin is low, hypoglycemia develops around 3 am and 7 am
Tx: inc evening dose
Waning insulin dose
Insulin sensitivity low between 6 am and 7 am due to GH spike
Normal 3 am glucose
Mild hyperglycemia in the morning
Dawn phenomenon
Hyperglycemia in 3 am < 7 am
Tx: inc evening dose
Waning + dawn
Period in type 1 DM when exogenous insulin requirements dec due to inc in endogenous insulin production
Followed by total lack of insulin production
Honeymoon period
Most physiologic insulin strategy
Basal Bolus
Closure of K channels in pancreatic B cell membrane
Type II DM
Insulin Secretagogues
WOF HYPOGLYCEMIA WEIGHT GAIN DISULFIRAM
Chlororopramide
1st gen sulfonylureas
WOF less hypoglycemia weight gain
CI hepatic and renal disease
Glipizide
WOF cholestatic jayndice glibenclamide
2nd gen sulfonylureas
POSTPRANDIAL HYPERGLYCEMIA
SULFA ALLERGIES
Least incidence of hypoglycemia - for CKD patients
Nateglinide
Insulin secretagogue
Reduces fasting and postprandial glucose levels
Inhibit hepatic and renal gluconeogenesis
FIRST LINE T2DM
DOC OBESE DM
Metformin
biguanide
Regulates gene expression by binding to PPAR gamma Diabetes prevention WOF CHF DEC HDL INC LDL INC TG reduces mortality in MI and stroke
Pioglitazone
Thiazolidinediones
Inhibits intestinal a glucosidases
WOF GI disturbance
Minor glucose lowering benefit
Acarbose
Amylin analog with anoretic effect
Adjunct to insulin
Pramlintide
Incretin modulator GLP1 agonist producing satiety
Adjunct to metformin or sulfonylurea
Exenatide
Incretin modulator DPP4 inhibitor
Sitagliptin
Inhibits GI and pancreatic lipases
Rebound weight gain upon discontinuation
Orlistat
Inhibits NE and serotonin reuptake
Anorectic wffect
WOF hpn, MI, stroke
Sibutramine
Block CB-1 receptor
Anorectic effect
WOF SUICIDALITY DEPRESSION
Rimonabant
Severe hypoglycemia
B blocker overdose
Glucagon
