ENDOCRINE Flashcards

0
Q

Levothyroxine

A

Synthetic T4–Pro hormone for T3

USES: replacement therapy for hypothyroidism

SIDE EFFECTS: tachycardia, heat intolerance, tremors, arrhythmias

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1
Q

Propylthiouricil

A

Anti-thyroid drug

MOA: inhibits thyroid peroxidase, inhibiting the oxidation of iodide and organification (coupling) of iodine–>inhibition of thyroid hormone synthesis. Also blocks 5’-deiodinase, which decreases peripheral conversion of T4 to T3

USES: hyperthyroidism. Used in pregnancy

SIDE EFFECTS: skin rash, agranulocytosis (can present with infection since decreased neutrophils), aplastic anemia, hepatotoxicity, vasculitis, hypoprothrombinemia, rash

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2
Q

Cortisone

A

Glucocorticoid

MOA: metabolic, catabolic, anti-inflammatory, and immunosuppressive effects mediated by interactions with glucocorticoid response elements and inhibition of transcription factors such as NF-kB

USES: Addison’s disease, inflammation, immune suppression, asthma

TOXICITY: iatrogenic Cushing’s syndrome-buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcers, diabetes. Adrenal insufficiency when drug stopped abruptly after chronic use

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3
Q

Prednisone

A

Intermediate acting glucocorticoid

Converted to prednisolone in liver

Moe potent as glucocorticoid than mineralocorticoid

USES: to prevent rejection; anti-inflammatory effect is 4X more potent than cortisol

Avoid in patients with liver disease

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4
Q

Triamcinolone

A

Glucocorticoid

MOA: metabolic, catabolic, anti-inflammatory, and immunosuppressive effects mediated by interactions with glucocorticoid response elements and inhibition of transcription factors such as NF-kB

USES: Addison’s disease, inflammation, immune suppression, asthma

TOXICITY: iatrogenic Cushing’s syndrome-buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcers, diabetes. Adrenal insufficiency when drug stopped abruptly after chronic use

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5
Q

Dexamethasone

A

Glucocorticoid

MOA: metabolic, catabolic, anti-inflammatory, and immunosuppressive effects mediated by interactions with glucocorticoid response elements and inhibition of transcription factors such as NF-kB

USES: Addison’s disease, inflammation, immune suppression, asthma

TOXICITY: iatrogenic Cushing’s syndrome-buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcers, diabetes. Adrenal insufficiency when drug stopped abruptly after chronic use

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6
Q

Betamethasone

A

Long acting glucocorticoid–similar to dexamethasone

Not metabolized by placenta–can be used to induce lung surfactant production in preterm fetuses

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7
Q

Beclomethasone

A

Glucocorticoid

MOA: metabolic, catabolic, anti-inflammatory, and immunosuppressive effects mediated by interactions with glucocorticoid response elements and inhibition of transcription factors such as NF-kB

USES: Addison’s disease, inflammation, immune suppression, asthma

TOXICITY: iatrogenic Cushing’s syndrome-buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcers, diabetes. Adrenal insufficiency when drug stopped abruptly after chronic use

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8
Q

Fludrocortisone

A

mineralocorticoid and glucocorticoid activity

MOA: metabolic, catabolic, anti-inflammatory, and immunosuppressive effects mediated by interactions with glucocorticoid response elements and inhibition of transcription factors such as NF-kB

USES: Addison’s disease, inflammation, immune suppression, asthma

TOXICITY: iatrogenic Cushing’s syndrome-buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcers, diabetes. Adrenal insufficiency when drug stopped abruptly after chronic use

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9
Q

Mifepristone

A

Progesterone receptor antagonist used as abortion pill and at higher doses an antagonist of the glucocorticoid receptor

Used for Cushing’s syndrome

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10
Q

Cholecalciferol

A

Vitamin D3–decreases transcription of PTH gene and increases calcium absorption

USES: osteoporosis, osteomalacia, rickets, hypoparathyroidism, secondary hypoparathyroidism (chronic kidney disease)

SIDE EFFECTS: hypercalcemia, renal calculi, hyperphosphatemia

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11
Q

Ergocalciferol

A

Vitamin D2–decreases transcription of PTH gene and increases calcium absorption

USES: osteoporosis, osteomalacia, rickets, hypoparathyroidism, secondary hypoparathyroidism (chronic kidney disease)

SIDE EFFECTS: hypercalcemia, renal calculi, hyperphosphatemia

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12
Q

Calcitriol

A

ACTIVE form of vitamin D–decreases transcription of PTH gene and increases calcium absorption

USES: osteoporosis, osteomalacia, rickets, hypoparathyroidism, secondary hypoparathyroidism (chronic kidney disease)

SIDE EFFECTS: hypercalcemia, renal calculi, hyperphosphatemia

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13
Q

Cinacalcet

A

MOA: sensitized ca++ sensing receptor (CaSR) in parathyroid gland to circulating ca++ leading to decreased PTH

USES: hypercalcemia due to primary or secondary hyperparathyroidism

TOXICITY: hypocalcemia

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14
Q

Alendronate

A

Bisphosphonate

MOA: Synthetic analog of pyrophosphate–bind to hydroxyapatite in bone and selectively localize to areas of bone turnover and inhibit resorption

USES: osteoporosis, Paget’s disease

SIDE EFFECTS: esophageal erosion, jaw osteonecrosis, acid reflux, headache, atypical femur fractures

EFFICACY: decrease incidence of vertebral AND hip fractures

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15
Q

Risedronate

A

Bisphosphonate

MOA: Synthetic analog of pyrophosphate–bind to hydroxyapatite in bone and selectively localize to areas of bone turnover and inhibit resorption

USES: osteoporosis, Paget’s disease

SIDE EFFECTS: esophageal erosion, jaw osteonecrosis, acid reflux, headache, atypical femur fractures

EFFICACY: decrease incidence of vertebral AND hip fractures

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16
Q

Ibandronate

A

Bisphosphonate

MOA: Synthetic analog of pyrophosphate–bind to hydroxyapatite in bone and selectively localize to areas of bone turnover and inhibit resorption

USES: osteoporosis, Paget’s disease

SIDE EFFECTS: esophageal erosion, jaw osteonecrosis, acid reflux, headache, atypical femur fractures

EFFICACY: decrease incidence of vertebral AND hip fractures

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17
Q

Pamidronate

A

Bisphosphonate–IV only

MOA: Synthetic analog of pyrophosphate–bind to hydroxyapatite in bone and selectively localize to areas of bone turnover and inhibit resorption

USES: Paget’s disease, hypercalcemia of malignancy

SIDE EFFECTS: esophageal erosion, jaw osteonecrosis, acid reflux, headache, atypical femur fractures

EFFICACY: decrease incidence of vertebral AND hip fractures

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18
Q

Zoledronic acid

A

Bisphosphonate-IV only

MOA: Synthetic analog of pyrophosphate–bind to hydroxyapatite in bone and selectively localize to areas of bone turnover and inhibit resorption

USES: Paget’s disease, hypercalcemia of malignancy

SIDE EFFECTS: esophageal erosion, jaw osteonecrosis, acid reflux, headache, atypical femur fractures

EFFICACY: decrease incidence of vertebral AND hip fractures

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19
Q

Raloxifene

A

Selective estrogen receptor modulator–acts at estrogen receptor selectively in bone (does not increase risk for breast or uterine cancer)

USES: osteoporosis

SIDE EFFECTS: hot flashes, venous thromboembolism

EFFICACY: decreases vertebral but NOT hip fractures

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20
Q

Calcitonin nasal spray

A

MOA: binds to and activates the calcitonin receptor on osteoclasts and decreases resorptive activity

USES: post menopausal osteoporosis treatment NOT prevention

SIDE EFFECTS: rhinitis, nasal symptoms

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21
Q

Calcitonin injection

A

MOA: binds to and activates the calcitonin receptor on osteoclasts and decreases resorptive activity

USES: post menopausal osteoporosis treatment NOT prevention, Paget’s disease,

SIDE EFFECTS: nausea, flushing, diarrhea

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22
Q

Denosumab

A

Humanize monoclonal antibody to RANKL–prevents bone resorption

USES: osteoporosis

SIDE EFFECTS: hypocalcemia, infections, dermatitis, eczema, rash, jaw osteonecrosis, musculoskeletal pain

23
Q

PTH in pulses

A

Briefly stimulates osteoclasts, increases blood calcium, decreases blood phosphorus, and activates 1,25-vitamin D–> results in brief period of bone turnover followed by osteoblast recruitment of the BFUs

24
Q

PTH analogs

A

Blocks osteoblasts from undergoing apoptosis–cerastes trabecular connections, increases cortex thickness, makes bones stronger

USES: good for osteoporosis

25
Q

Regular insulin

A

Rapid-acting to be administered 30-45 minutes prior to meals; Duration of action 3-6h (increases with increasing doses)

USES: DM1/2, GDM, DKA (IV), hyperkalemia (+ glucose), stress hyperglycemia

26
Q

NPH

A

Intermediate-acting insulin analog

USES: DM1, DM2, GDM

27
Q

Glargine

A

Long acting insulin

USES: DM1/2, GDM

28
Q

Detemir

A

Long acting insulin

USES: DM1/2, GDM

29
Q

Pramlinitide

A

Amylin analog

MOA: decreases emptying and glucagon

USES: type 1/2 diabetes

TOXICITY: hypoglycemia, nausea, diarrhea

30
Q

Metformin

A

Biguanide diabetes drug

MOA: exact mechanism unknown–increases insulin sensitivity, decreases gluconeogenesis, increases glycolysis, increases peripheral glucose uptake

USES: drug of choice for T2DM. Can be used with patients without islet function

TOXICITY: GI upset; most serious adverse effect is lactic acidosis via anaerobic glycolysis (thus contraindicated in renal failure)

31
Q

Rosiglitazone

A

Glitazone/Thiazolidinedione

MOA: increases insulin sensitivity in peripheral tissues–binds PPARgamma nuclear transcription regulator and enhances glucose uptake into fat and muscle

USES: mono therapy in T2DM or combined

SIDE EFFECTS: edema, weight gain, CHF, hepatotoxicity. Takes days-weeks to see effects

32
Q

Pioglitazone

A

Glitazone/Thiazolidinedione

MOA: increases insulin sensitivity in peripheral tissues–binds PPARgamma nuclear transcription regulator and enhances glucose uptake into fat and muscle

USES: mono therapy in T2DM or combined

SIDE EFFECTS: edema, weight gain, CHF, hepatotoxicity. Takes days-weeks to see effects

33
Q

Acarbose

A

Alpha glucosidase inhibitor

MOA: inhibit intestinal brush border alpha glucosidase–>delayed sugar hydrolysis and glucose absorption–>decreases postprandial hyperglycemia

USES: Monotherapy in T2DM or in combination

TOXICITY: GI disturbances

34
Q

Miglitol

A

Alpha glucosidase inhibitor

MOA: inhibit intestinal brush border alpha glucosidase–>delayed sugar hydrolysis and glucose absorption–>decreases postprandial hyperglycemia

USES: Monotherapy in T2DM or in combination

TOXICITY: GI disturbances

35
Q

Exenatide

A

GLP-1 receptor agonist

MOA: slows gastric emptying, stimulates glucose-induced insulin secretion, and suppresses glucagon release

USES: T2DM

SIDE EFFECTS: nausea, vomiting, pancreatitis

36
Q

Liraglutide

A

GLP-1 receptor agonist

MOA: slows gastric emptying, stimulates glucose-induced insulin secretion, and suppresses glucagon release

USES: T2DM

SIDE EFFECTS: nausea, vomiting, pancreatitis

37
Q

Somatostatin

A

USES: acromegaly, carcinoid, gastronomy, glucagonoma, esophageal varices

38
Q

Oxytocin

A

USES: stimulates labor, uterine contractions, milk let-down; controls uterine hemorrhage

39
Q

ADH

A

USES: pituitary (central, not nephrogenic) DI

40
Q

Demeclocycline

A

MOA: ADH antagonist (member of the tetracycline family)

USES: SIADH

TOXICITY: nephrogenic DI, photosensitivity, abnormalities of bone and teeth

41
Q

Canagliflozin

A

Sodium-glucose co transporter (SGLT2) inhibitor

42
Q

Hydrocortisone

A

Glucocorticoid

MOA: metabolic, catabolic, anti-inflammatory, and immunosuppressive effects mediated by interactions with glucocorticoid response elements and inhibition of transcription factors such as NF-kB

USES: Addison’s disease, inflammation, immune suppression, asthma

TOXICITY: iatrogenic Cushing’s syndrome-buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcers, diabetes. Adrenal insufficiency when drug stopped abruptly after chronic use

43
Q

Growth hormone

A

USES: GH deficiency, turners syndrome

44
Q

Triiodothyronine

A

MOA: thyroxine replacement

USES: hypothyroidism, myxedema

TOXICITY: tachycardia, heat intolerance, tremors, arrhythmia

45
Q

Sitagliptin

A

DPP-4 inhibitor

MOA: increases insulin, decreases glucagon release

USES: T2DM

TOXICITY: mild urinary or respiratory infections

46
Q

Saxagliptin

A

DPP-4 inhibitor

MOA: increases insulin, decreases glucagon release

USES: T2DM

TOXICITY: mild urinary or respiratory infections

47
Q

Linagliptin

A

DPP-4 inhibitor

MOA: increases insulin, decreases glucagon release

USES: T2DM

TOXICITY: mild urinary or respiratory infections

48
Q

Glipizide

A

Second generation Sulfonylurea

MOA: closes K+ channel in B cell membrane, so cell depolarizes–>triggering of insulin release via increased calcium influx

USES: stimulate release of endogenous insulin on type 2 DM. Require some islet function, so useless in T1DM

TOXICITY: risk of hypoglycemia increased in renal failure. First generation: disulfiram-like effects. Second generation: hypoglycemia

49
Q

Glimepiride

A

Second generation Sulfonylurea

MOA: closes K+ channel in B cell membrane, so cell depolarizes–>triggering of insulin release via increased calcium influx

USES: stimulate release of endogenous insulin on type 2 DM. Require some islet function, so useless in T1DM

TOXICITY: risk of hypoglycemia increased in renal failure. First generation: disulfiram-like effects. Second generation: hypoglycemia

50
Q

Glyburide

A

Second generation Sulfonylurea

MOA: closes K+ channel in B cell membrane, so cell depolarizes–>triggering of insulin release via increased calcium influx

USES: stimulate release of endogenous insulin on type 2 DM. Require some islet function, so useless in T1DM

TOXICITY: risk of hypoglycemia increased in renal failure. First generation: disulfiram-like effects. Second generation: hypoglycemia

51
Q

Chlorpropamide

A

First generation Sulfonylurea

MOA: closes K+ channel in B cell membrane, so cell depolarizes–>triggering of insulin release via increased calcium influx

USES: stimulate release of endogenous insulin on type 2 DM. Require some islet function, so useless in T1DM

TOXICITY: risk of hypoglycemia increased in renal failure. First generation: disulfiram-like effects. Second generation: hypoglycemia

52
Q

Tolbutamide

A

First generation Sulfonylurea

MOA: closes K+ channel in B cell membrane, so cell depolarizes–>triggering of insulin release via increased calcium influx

USES: stimulate release of endogenous insulin on type 2 DM. Require some islet function, so useless in T1DM

TOXICITY: risk of hypoglycemia increased in renal failure. First generation: disulfiram-like effects. Second generation: hypoglycemia

53
Q

Methimazole

A

Anti-thyroid drug

MOA: thyroid peroxidase inhibitor–prevents incorporation of iodide ion onto tyrosyl residues of thyroglobulin, resulting in decreased production of T3/T4

USES: hyperthyroidism (action takes time due to large stores of thyroid hormone that must be exhausted)

SIDE EFFECTS: agranulocytosis, hepatotoxicity, vasculitis, hypoprothrombinemia, rash, associated with birth defects

54
Q

Tesamorelin

A

GHRH analog used to treat HIV-associated lipodystrophy

55
Q

Octreotide

A

Somatostatin analog used to treat GH excess.

56
Q

Pegvisomant

A

Growth hormone receptor antagonist used to treat GH excess