ENDOCRINE Flashcards
Levothyroxine
Synthetic T4–Pro hormone for T3
USES: replacement therapy for hypothyroidism
SIDE EFFECTS: tachycardia, heat intolerance, tremors, arrhythmias
Propylthiouricil
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
Cortisone
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
Prednisone
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
Triamcinolone
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
Dexamethasone
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
Betamethasone
Long acting glucocorticoid–similar to dexamethasone
Not metabolized by placenta–can be used to induce lung surfactant production in preterm fetuses
Beclomethasone
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
Fludrocortisone
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
Mifepristone
Progesterone receptor antagonist used as abortion pill and at higher doses an antagonist of the glucocorticoid receptor
Used for Cushing’s syndrome
Cholecalciferol
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
Ergocalciferol
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
Calcitriol
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
Cinacalcet
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
Alendronate
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
Risedronate
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
Ibandronate
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
Pamidronate
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
Zoledronic acid
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
Raloxifene
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
Calcitonin nasal spray
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
Calcitonin injection
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