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USMLE Pharmacology > Endocrine > Flashcards

Endocrine Flashcards

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USMLE® Step 1 flashcards
1
Q

Insulin, rapid acting
Uses?
Toxicity?

A

Lispro
Aspart
Glulisine

Uses = DM1, DM2, GDM (postpradial glucose control)
Toxicity = hypoglycemia, rare hypersensitivity rxns
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2
Q

Action of insulin in general

Effect on liver? Muscle? Fat?

A

Bind insulin receptor (tyrosine kinase activity)
Liver = increase glucose stored as glycogen
muscle = increase glycogen, protein synthesis, and K uptake
Fat = increase TG storage

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3
Q

Insulin, short acting

Uses?

A

Regular

Uses = DM1, DM2, GDM, DKA (IV), hyperkalemia (+ glucose), stress hyperglycemia

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4
Q

Insulin, intermediate acting

A

NPH = Neutral Protamine Hagedorn

Uses = DM1, DM2, GDM

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5
Q

Insulin, long acting

A

Glargine
Detemir

Uses = DM1, DM2, GDM (basal glucose control)

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6
Q

Biguanides

A

Metformin

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7
Q

Metformin action and uses

A

Biguanide = MOA unknown
Decreases gluconeogenesis
Increases glycolysis and peripheral glucose uptake (insulin sensitivity)

Oral = first line therapy in type 2 DM
Can be used in patients without islet function

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8
Q

Metformin toxicity

A

GI upset

LACTIC ACIDOSIS = most serious adverse effect (contraindicated in RENAL FAILURE)

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9
Q

Sulfonylureas - first generation (2)

Toxicity?

A

Tolbutamide
Chlorpropamide

Disulfiram-like effects

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10
Q

Sulfonylureas - second generation (3)

Toxicity?

A

Glyburide
Glimepiride
Glipizide

Hypoglycemia

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11
Q

Sulfonylureas Action
Tolbutamide, Chlorpropamide
Glyburide, Glimepiride, Glipizide

A

Close K+ channel in B-cell membrane so cell depolarizes = triggers insulin release via increased Ca2+ influx

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12
Q

Sulfonylureas Uses and Toxicity (general)
Tolbutamide, Chlorpropamide
Glyburide, Glimepiride, Glipizide

A

Stimulate release of endogenous insulin in type 2 DM
Require some islet function, so useless in type 1 DM

Toxicity = risk of hypoglycemia increased in renal failure

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13
Q

Can sulfonylureas be used in type 1 DM?

A

NO - require some islet function as they stimulate endogenous insulin release

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14
Q

Risk of hypoglycemia while taking sulfonylureas is increased in which type of patients?

A

Renal failure

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15
Q

Glitazones/thiazolidinediones (2)

A

Pioglitazone

Rosiglitazone

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16
Q

Pioglitazone, Rosiglitazone
Action?
Uses?

A

Glitazones/thiazolidinediones
Increase insulin sensitivity in peripheral tissue (also increases levels of adiponectin)
Binds to PPAR-gamma nuclear transcription regulator (activated genes regulate FA storage and glucose metabolism)

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17
Q

Pioglitazone, Rosiglitazone

Toxicity?

A

Weight gain, edema

Hepatotoxicity, heart failure

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18
Q

a-glucosidase inhibitors (2)

A

Acarbose

Miglitol

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19
Q

Acarbose, Miglitol

Action?

A

Inhibit intestinal brush border a-glucosidases

Delayed sugar hydrolysis and glucose absorption = DECREASE postprandial hyperglycemia

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20
Q

Acarbose, Miglitol
Uses?
Toxicity?

A

a-glucosidase inhibitors
Uses = monotherapy in type 2 DM or in combination
Toxicity = GI disturbances

21
Q

Amylin analogs

A

Pramlintide

22
Q

Pramlintide
Action?
Use?
Toxicity?

A

Amylin analog (co-secreted with insulin)
Decrease gastric emptying
Decrease glucagon

Uses = Type 1 and Type 2 DM
Toxicity = hypoglycemia, nausea, diarrhea
23
Q

GLP-1 analogs

A

Exenatide

Liraglutide

24
Q

Exenatide, Liraglutide
Action?
Use?
Toxicity?

A

GLP-1 analogs (glucagon like peptide)
Increase insulin
Decrease glucagon release

Uses = Type 2 DM
Toxicity = nausea, vomiting; pancreatitis
25
Q

DPP-4 inhibitors

A

Linagliptin
Saxagliptin
Sitagliptin
“gliptin”

26
Q

Linagliptin, Saxagliptin, Sitagliptin
Action?
Use?
Toxicity?

A

DPP-4 inhibitors (dipeptidyl peptidase CD26)
Increase insulin
Decrease glucagon release

Uses = Type 2 DM
Toxicity = mild urinary or respiratory infections
27
Q

Which two diabetic classes of drugs increase insulin and decrease glucagon release?

A

GLP-1 analogs (exenatide, liraglutide) “tide”

DPP-4 inhibitors (linagliptin, saxagliptin, sitagliptin) “gliptin”

28
Q

Which diabetic drug can cause lactic acidosis?

A

Metformin

29
Q

Which diabetic drug(s) can cause disulfiram-like effects

A

First generation sulfonylureas:
Tolbutamide
Chlorpropamide

30
Q

Which diabetic drug(s) can cause weight gain/edema and hepatotoxicity/heart failure

A

Pioglitazone
Rosiglitazone
(Glitazones/thiazolidinediones)

31
Q

Which class of diabetic drugs can cause pancreatitis?

A

GLP-1 analogs

Exenatide, Liraglutide

32
Q

Propylthiouracil, Methimazole

Mechanism?

A

Block thyroid peroxidase = inhibit oxidation of iodide and organification (coupling) of iodine = inhibit thyroid hormone synthesis
Propylthiouracil also blocks 5’-deiodinase, which decreases peripheral conversion of T4 to T3

33
Q

What additional function does propylthiouracil have that methimazole does not?

A

Propylthiouracil also blocks 5’-deiodinase, which decreases peripheral conversion of T4 to T3

34
Q

Propylthiouracil, Methimazole
Uses? Which is safe in pregnancy?
Toxicity?

A

Uses = HYPERthyroidism
PTU used in pregnancy; Methimazole is a possible teratogen (aplasia cutis)

Toxicity = skin rash, agranulocytosis, aplastic anemia, hepatotoxicity (PTU), teratogenic (methimazole)

35
Q

What is a possible teratogenic outcome of methimazole use in pregnancy?

A

Aplasia cutis

36
Q

Levothyroxine, triiodothyronine
Mechanism?
Uses?

A

Thyroxine replacement

HYPOthyroidism, myxedema

37
Q

Levothyroxine, triiodothyronine

Toxicity?

A

Tachycardia, heat intolerance, tremors, arrhythmias

Hyperthyroid symptoms

38
Q

Growth hormone uses (2)

A

GH deficiency

Turner syndrome

39
Q

Octreatide
Agent?
Uses?

A

Somatostatin (GHIH; growth hormone inhibitory hormone)

Acromegaly, carcinoid, gastrinoma, glucagonoma, esophageal varices

40
Q

Oxytocin uses

A

Stimulates labor, uterine contractions, MILK LET-DOWN

controls uterine hemorrhage

41
Q

ADH (DDAVP) / Desmopressin

A

Pituitary (central, not nephrogenic) DI

42
Q

Demeclocycline
Use?
Toxicity?

A 
ADH antagonists (tetracycline family)
Use = SIAHD
Toxicity = nephrogenic DI, photosensitivity, abnormalities of bone and teeth
43
Q

Glucocorticoids

A 
Hydrocortisone
Prednisone
Triamcinolone
Dexamethasone
Beclomethasone
Fludrocortisone (mineralocorticoid and glucocorticoid activity)
44
Q

Which steroid has both mineralocorticoid and glucocorticoid activity?

A

Fludrocortisone

45
Q

Glucocorticoids

Mechanism?

A

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

46
Q

Glucocorticoids

Uses? (4)

A

Addison disease
Inflammation
Immune suppression
Asthma

47
Q

Glucocorticoids

Toxicity?

A

Iatrogenic Cushing syndrome = buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis (treat with bisphosphonates), adrenocortical atrophy, peptic ulcers, diabetes (if chronic)
Adrenal insufficiency when drug stopped abruptly after chronic use

48
Q

What can occur if glucocorticoids are stopped abruptly after chronic use?

A

Adrenal insufficiency

USMLE Pharmacology (15 decks)

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