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USMLE Pharmacology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

NPH insulin

A

intermediate acting insulin

used for type 1 or 2 DM and GDM

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2
Q

Detemir

A

long acting insulin (used for Type 1 or 2 DM)

GDM or basal glucose control

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3
Q

Glyburide

A

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

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4
Q

glimepiride

A

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

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5
Q

demeclocycline

A

an ADH antagonist (member of tetracycline family)

used in SIADH

adverse effects: nephrogenic DI, photosensitivity, abnormalities of bone and teeth

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6
Q

Miglitol

A

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

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7
Q

Pioglitazone

A

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

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8
Q

Ocreotide

A

somatostatin

used in acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices

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9
Q

Lispro

A

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

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10
Q

Triiodothyronine

A

thyroid hormone replacemnt

used in hypothyroidism, myxedema. Used off-label as weight loss supplement

adverse effect: tachycardia, heat intolerance, tremors, and arrhythmias

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11
Q

Liraglutide (SC injection)

A

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

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12
Q

glulisine

A

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

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13
Q

Levothyroxine

A

thyroid hormone replacemnt

used in hypothyroidism, myxedema. Used off-label as weight loss supplement

adverse effect: tachycardia, heat intolerance, tremors, and arrhythmias

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14
Q

chlorpropamide

A

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.

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15
Q

Treatment strategy for Type 1 and Type 2 diabetes mellitus

A

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

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16
Q

Regular Insulin

A

short acting insulin

used for type 1 or 2 DM, GDM, DKA (IV), hyperkalemia (+ glucose), or stress hyperglycaemia

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17
Q

Fludrocortisone

A

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

18
Q

Conivaptan

A

ADH antagonist

used in SIADH, block action of ADH at V2 receptor

19
Q

GH

A

used in GH deficiency and turners syndrome

20
Q

Glipizide

A

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

21
Q

Pramlintide (SC injection)

A

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

22
Q

metformin

A

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)

23
Q

Repaglinide

A

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

24
Q

Empagliflozin

A

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

25
Q

Nateglinide

A

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

26
Q

Acarbose

A

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

27
Q

Desmopressin acetate

A

central (not nephrogenic) DI.

used in von Willebrand disease and sleep enuresis

28
Q

Exenatide

A

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

29
Q

propylthiouracil

A

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)

30
Q

tolbutamide

A

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.

31
Q

Cinacalcet

A

sensitizes Ca2+ sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ therefore decreasing PTH

used in primary or seconary hyperparathyroidism

adverse effect: hypoclacaemia

32
Q

Dapagliflozin

A

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

33
Q

Oxytocin

A

stimulates labor, uterine contractions, milk-let down, controls uterine hemorrhage

34
Q

Aspart

A

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

35
Q

Rosiglitazone

A

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

36
Q

Sitagliptin

A

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

37
Q

Canagliflozin

A

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

38
Q

Saxagliptin

A

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

39
Q

Tolvaptan

A

ADH antagonist

used in SIADH, block action of ADH at V2 receptor

40
Q

Linagliptin

A

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

41
Q

Methimazole

A

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)

USMLE Pharmacology (2 decks)

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