Endocrine Flashcards
How to treat DMI
Low sugar diet, insulin replacement
How to treat DM II
Weight loss, then metformin, then other agents
How to treat gestational diabetes
Diet modifications, exercise, insulin. NOT metformin
Three short acting insulins
Insulin aspart, insulin glulisine, insulin lispro
Bind insulin receptor (tyrosine kinase). Increase glucose stored as glycogen, increase synthesis of glycogen in muscle, protein synthesis and K intake.
Increases triglyceride storage in fat cells.
Short acting insulin
Given IV for DM I II and gestational. Can also be given for hyperkalemia. Causes hypoglycemia and weight gain.
Intermediate acting insulin
NPH
Long acting insulin
Glargine and detemir. Glargine is more stable
Metformin
A biguanide that increases glycolysis and decreases gluconeogenesis. Increases peripheral glucose uptake in states of insulin insensitivity.
Can be used in patients without islet function.
Metformin side effects
GI upset. Does not cause hypoglycemia. Can cause some weight loss
Most important side effect is lactic acidosis because it blocks the breakdown of lactate in liver. DO NOT USE in renal patients.
When not to use metformin
In renal patients
Sulfonylureas
and Mechanism
First generation: Tolbutamide, chlorpromamide
Second generation: Glyburide, Glimepiride, Glipizide
Close the ATP dependent K channel to depolarize the cell . Leads to Ca influx and release of insulin.
Requires some islet function so can’t use for DM1.
Sulfonylureas side effects
Risk of hypoglycemia increases with renal failure.
Disulfiram like reaction with tolbutamide/chlorpromamide.
Glitazones
Pioglitazone, rosiglitazone. Increase insulin sensitivity by binding to PPAR gamma.
Pioglitasone, rosiglitazone side effects
Hepatotoxicity, bone loss, heart failure.
Alpha glucosidase inhibitors
Acarbose, miglitol. Prevent breakdown of disaccharides. Side effects are basically like lactose intolerance.
Pramlintide (amylin analog)
Decreases gastric emptying and decreases glucagon. PRevents huge glucose spike. Good for T1Dm and T2.
Can cause hypoglycemia and pancreatitis.
GLP-1 Analogs (exenatide, liraglutide)
Exenatide, liraglutide. Increase insulin and decrease glucagon release. Treat for T2 DM. Can cause pancreatitis.
DPP4 inhibitors (Gliptins)
Gliptins Increase insulin, decrease glucagon release. Used for T2. Can cause urinary or respiratory treact infections
SGLT2 inhibitors (canagliflozin)
leads to increased glucose in tubules. Can lead to yeast infections and utis.
Propylthiouracil, methimazole
Block thyroid peroxidase, inhibits oxidation of iodide and the organification of iodine. Inhibits thyroid hormone synthesis. Propylthiouracil also decreases peripheral conversion of T4 to T3. Used in hyperthyroidism.
Which drug to treat hyperthyroidism is used in pregnancy?
Propylthiouracil, because methimazole can cause aplastica cutis in babies.
Side effects of propylthiouracil and methimazole
Agranulocytosis, aplastic anemia, hepatotoxicity
Levothyroxine
Thyroid replacment. Can be abused as a weight loss aid. Used for hypothyroidism/myexedema.
Levothyroxine side effects
Tachy cardia, heat intolerance, tremors arrhythmias.
Growth hormone used for
turner syndrome
Somatostatin used for
Gastrinoma, glucagonoma, carcinoid, acromegaly
Oxytocin
Stimulates labor, uterine contractions, milk let down. Controls uterine hemorrhage
DDAVP
ADH analog used for central DI
Vaptans
ADH antagonists used for SIADH. Can cause nephrogenic DI. Also demeclocycline
Cinacalcet
Sensitizes calcium receptors on the parathyroid to decrease PTH. Used in 1 or 2 hyperparathyroidism.
