Endocrine Flashcards
NPH insulin
intermediate acting insulin
used for type 1 or 2 DM and GDM
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Detemir
long acting insulin (used for Type 1 or 2 DM)
GDM or basal glucose control
Glyburide
second generation sulfonylurea
stimulate release of endogenous insulin in type 2 DM (not used in type 1)
close K+ channel in beta cell membrane - cell depolarizes- insulin release via Ca2+ influx
adverse effects: hypoglycaemia
glimepiride
second generation sulfonylurea
stimulate release of endogenous insulin in type 2 DM (not used in type 1)
close K+ channel in beta cell membrane - cell depolarizes- insulin release via Ca2+ influx
adverse effects: hypoglycaemia
demeclocycline
an ADH antagonist (member of tetracycline family)
used in SIADH
adverse effects: nephrogenic DI, photosensitivity, abnormalities of bone and teeth
Miglitol
alpha glucosidase inhibitor
type 2 diabetes
inhibit intestinal brush border alpha glucosidases
delayed carbohydrate hydrolysis and glucose absorption
decrease post-prandial hyperglycaemia
adverse effects: GI disturbances
Pioglitazone
glitazones/thiazolidinediones
used as monotherapy in type 2 DM or combined with sulfonylureas or meformin.
safe to use in renal impairment
increased insulin sensitivity to peripheral tissue. Binds to PPAR- gamma nuclear transcription regulator (genes activated by the PPAR- gamma regulate fatty acid storage and glucose metabolism. Activation of PPAR-gamma increass insulin sensitivity and levels of adiponectin)
adverse effects: weight gain, edema, HF , increased risk of fractures
Ocreotide
somatostatin
used in acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices
Lispro
Rapid Actin Insulin
- used type 1 or 2 diabetes
binds insulin receptor (tyrosine kinase receptor)
increases glycogenesis in liver
increases glycogenesis in muscle
increases muscular K+ intake
increases triglyceride storage in adipose tissue
Adverse symptoms: hypoglycaemia, lipodystrophy, rare hypersenstivity
Triiodothyronine
thyroid hormone replacemnt
used in hypothyroidism, myxedema. Used off-label as weight loss supplement
adverse effect: tachycardia, heat intolerance, tremors, and arrhythmias
Liraglutide (SC injection)
GLP-1 analog
used in type 2 DM
increase glucose dependent insulin release
decrease glucagon release
decrease gastric emptying
increase satiety
adverse effects: nausea, vomiting, pancreatitis, modest weight loss
glulisine
Rapid Actin Insulin
- used type 1 or 2 diabetes
binds insulin receptor (tyrosine kinase receptor)
increases glycogenesis in liver
increases glycogenesis in muscle
increases muscular K+ intake
increases triglyceride storage in adipose tissue
Adverse symptoms: hypoglycaemia, lipodystrophy, rare hypersenstivity
Levothyroxine
thyroid hormone replacemnt
used in hypothyroidism, myxedema. Used off-label as weight loss supplement
adverse effect: tachycardia, heat intolerance, tremors, and arrhythmias
chlorpropamide
first generation sulfonylurea
stimulate release of endogenous insulin in type 2 DM (not used in type 1)
close K+ channel in beta cell membrane - cell depolarizes- insulin release via Ca2+ influx
adverse effects: risk of hypoglycaemia increased in renal failure, weight gain.
Treatment strategy for Type 1 and Type 2 diabetes mellitus
Type 1 = dietary modifications and insulin replacement
Type 2 = dietary modification + exercise for weight loss, oral agents, non-insulin injectables, and insulin replacement as last step
Regular Insulin
short acting insulin
used for type 1 or 2 DM, GDM, DKA (IV), hyperkalemia (+ glucose), or stress hyperglycaemia
Fludrocortisone
synthetic analog of aldosterone with little glucocorticoid effects
used as mineralocorticoid replacement in primary adrenal insufficiency
adverse effects: similar to glucocorticoids, also edema, exacerbation of heart failure, and hyperpigmentation
Conivaptan
ADH antagonist
used in SIADH, block action of ADH at V2 receptor
GH
used in GH deficiency and turners syndrome
Glipizide
second generation sulfonylurea
stimulate release of endogenous insulin in type 2 DM (not used in type 1)
close K+ channel in beta cell membrane - cell depolarizes- insulin release via Ca2+ influx
adverse effects: hypoglycaemia
Pramlintide (SC injection)
amylin analogues
used in type 1 or 2 DM
decreases gastric emptying
decreases glucagon
adverse effects: hypoglycaemia (in setting of mistimed prandial insulin) and nausea
metformin
A Biguanide
first line therapy in type 2 DM - casues modest weight loss
can be used in patients wihtout islet function
inhibit hepatic gluconeogenesis and the action of glucagon
leads to decreased gluconeogensis, increased glycolysis, increased peripheral glucose uptake and increased insulin sensitivity
Adverse effects: GI upset, most serious adverse effect is lactic acidosis (thus contraindicated in renal insufficiency)
Repaglinide
a Meglitinide
used as monotherapy in type 2 DM or combined with metformin
stimulate postprandial insulin release by binding to K+ channels on beta cell membranes (site differs from sulfonylureas)
adverse effects: hypoglycaemia (increase risk with renal failure), weight gain
Empagliflozin
sodium-glucose co-transporter 2 inhibitor (SGLT2 inhibitor)
used in type 2 DM
block reabsorption of glucose in proximal convoluted tubule
adverse effects: glycosyuria (UTI, vaginal yeast infection), hyperkalaemia, dehydration (orthostatic hypotension), weight loss
Nateglinide
a Meglitinide
used as monotherapy in type 2 DM or combined with metformin
stimulate postprandial insulin release by binding to K+ channels on beta cell membranes (site differs from sulfonylureas)
adverse effects: hypoglycaemia (increase risk with renal failure), weight gain
Acarbose
alpha glucosidase inhibitor
type 2 diabetes
inhibit intestinal brush border alpha glucosidases
delayed carbohydrate hydrolysis and glucose absorption
decrease post-prandial hyperglycaemia
adverse effects: GI disturbances
Desmopressin acetate
central (not nephrogenic) DI.
used in von Willebrand disease and sleep enuresis
Exenatide
GLP-1 analog
used in type 2 DM
increase glucose dependent insulin release
decrease glucagon release
decrease gastric emptying
increase satiety
adverse effects: nausea, vomiting, pancreatitis, modest weight loss
propylthiouracil
Thioamide
block thyroid peroxidase, inhibiting the oxidation of iodide and the organification and coupling of iodine - inhibition of thyroid hormone synthesis- PTU also blocks 5’ deiodinase- leading to decreased peripheral conversion of T4 to T3
used in hyperthyroidism- used in first trimester of pregnancy due to methimazole teratogenicity - but methimazole used in second and third trimester of pregnancy (due to risk of PTU induced hepatotoxicity)
adverse effects: skin rash, agranulocytosis (rare), aplastic anaemia, hepatotoxicity, methimazole is a possible teratogen (can cause aplasia cutis)
tolbutamide
first generation sulfonylurea
stimulate release of endogenous insulin in type 2 DM (not used in type 1)
close K+ channel in beta cell membrane - cell depolarizes- insulin release via Ca2+ influx
adverse effects: risk of hypoglycaemia increased in renal failure, weight gain.
Cinacalcet
sensitizes Ca2+ sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ therefore decreasing PTH
used in primary or seconary hyperparathyroidism
adverse effect: hypoclacaemia
Dapagliflozin
sodium-glucose co-transporter 2 inhibitor (SGLT2 inhibitor)
used in type 2 DM
block reabsorption of glucose in proximal convoluted tubule
adverse effects: glycosyuria (UTI, vaginal yeast infection), hyperkalaemia, dehydration (orthostatic hypotension), weight loss
Oxytocin
stimulates labor, uterine contractions, milk-let down, controls uterine hemorrhage
Aspart
Rapid Actin Insulin
- used type 1 or 2 diabetes
binds insulin receptor (tyrosine kinase receptor)
increases glycogenesis in liver
increases glycogenesis in muscle
increases muscular K+ intake
increases triglyceride storage in adipose tissue
Adverse symptoms: hypoglycaemia, lipodystrophy, rare hypersenstivity
Rosiglitazone
used as monotherapy in type 2 DM or combined with other agents. Safe to use in renal impairment
increases insulin sensitivity in peripheral tissue. Binds to PPAR- gamma nuclear transcription regulator ((genes activated by the PPAR- gamma regulate fatty acid storage and glucose metabolism. Activation of PPAR-gamma increass insulin sensitivity and levels of adiponectin)
adverse effects: weight gain, edema, HF, increased risk of fracture
Sitagliptin
DPP-4 inhibitors
used in type 2 DM
inhibit DPP-4 enzyme that deactivates GLP-1 thereby
increases glucose-dependent insulin release
decrease glucagon release
decease gastric emptying
increase satiety
adverse effects: mild urinary or respiratory infections, weight neutral
Canagliflozin
sodium-glucose co-transporter 2 inhibitor (SGLT2 inhibitor)
used in type 2 DM
block reabsorption of glucose in proximal convoluted tubule
adverse effects: glycosyuria (UTI, vaginal yeast infection), hyperkalaemia, dehydration (orthostatic hypotension), weight loss
Saxagliptin
DPP-4 inhibitors
used in type 2 DM
inhibit DPP-4 enzyme that deactivates GLP-1 thereby
increases glucose-dependent insulin release
decrease glucagon release
decease gastric emptying
increase satiety
adverse effects: mild urinary or respiratory infections, weight neutral
Tolvaptan
ADH antagonist
used in SIADH, block action of ADH at V2 receptor
Linagliptin
DPP-4 inhibitors
used in type 2 DM
inhibit DPP-4 enzyme that deactivates GLP-1 thereby
increases glucose-dependent insulin release
decrease glucagon release
decease gastric emptying
increase satiety
adverse effects: mild urinary or respiratory infections, weight neutral
Methimazole
Thioamide
block thyroid peroxidase, inhibiting the oxidation of iodide and the organification and coupling of iodine - inhibition of thyroid hormone synthesis
used in hyperthyroidism- PTU used in first trimester of pregnancy due to methimazole teratogenicity - but methimazole used in second and third trimester of pregnancy (due to risk of PTU induced hepatotoxicity)
adverse effects: skin rash, agranulocytosis (rare), aplastic anaemia, hepatotoxicity, methimazole is a possible teratogen (can cause aplasia cutis)
