Endocrine Drugs

Question 1

Growth Hormone

Answer 1

Somatropin

Indication = hypopituitarism
Route = weight based injection 

MOA = synthetic growth hormone that has role in bone, muscle, and organ growth; increased red blood cell mass, transport of water, electrolytes, fluid and other functions

AE = fluid retention/edema, muscle/joint pain

Question 2

Vasopressin (AVP)

Answer 2

Desmopressin (DDAVP)

Indication = hypopituitarism ; also used for nocturia 
Route = subcut, PO, Intranasal

MOA = DDAVP binds V2 receptors in kidney = increase aquaporin 2 channels = more water retention.

AE = Dry mouth, hyponatremia

Question 3

Mineralocorticoid #1

Answer 3

Spironolactone

Indication = hyperaldosteronism; Gender transition to block testosterone

MOA = non-selective for aldosterone receptors

AE = signs of hyperaldosteronism: muscle weakness, fatigue, HA, HTN, paresthesias, polydipsia, nocturnal polyuria

Question 4

Mineralocorticoid #2

Answer 4

Eplereone

Indication = hyperaldosteronism (causes: adrenal tumor or adrenal hyperplasia)

MOA = greater affinity for aldosterone receptors

AE = signs of hyperaldosteronism: muscle weakness, fatigue, HA, HTN, paresthesias, polydipsia, nocturnal polyuria
Less AEs than spironolactone

Question 5

Mineralocorticoid #3

Answer 5

Fludocortisone

Indication = hypoaldosteronism (Addison’s Disease)

MOA = used to reduce hypokalemia

Question 6

Glucocorticoids

Answer 6

Hydrocortisone

Indication = glucocorticoid deficiency (secondary adrenal insufficiency)

Question 7

Testosterone

Answer 7

Produced in the testes and regulates LH, FSH
Causes development of male embryos genital tract
Anabolic agent = increases size of muscle and bone

Question 8

Oxybutynin

Has nothing to do with endocrine, just mens health

Answer 8

Anticholinergic

Indication = benign prostatic hypertrophy (BPH)

MOA = antispsmodic effects on smooth muscle, blocks ACh on smooth muscle

AE = agitation, blurred vision, constipation, dry mouth, stasis of urine

Question 9

Levothyroxine

Answer 9

Indication = hypothyroidism

MOA = synthetic version of thyroxine (T4) that is converted to T3, which has its usual effect

Take on an empty stomach (30-60 minute before AM meal, 3-4 hours after PM meal)
Want to separate from other meds by 4 hrs

NTI drug (monitor every 4-8 weeks at first, 6-12 months when stable)

Well tolerated unless overtreated: sweating, heat intolerance, tachycardia, diarrhea, nervous, menstrual irregularities, increase basal metabolic rate.

Question 10

Thioamide

Answer 10

methimazole

Indication = hyperthyroidism
**for mild hyperthyroidism, elderly, small goiter, that need to avoid radioactive iodine

MOA = blocks formation of T4 and T3 by inhibiting oxidation of iodine

Monotherapy for 1 year to induce remission or used when prepping for another

AE = Rash, GI upset, arthralgia (refer to provider)
Rare = agranulocytosis (after initiation)

Question 11

Osteoporosis Medication

Answer 11

Calcium and Vitamin D

Route = ideally from diet but supplement if needed

Other info:
Calcium ranges
- women <50 and men <70 1000mg/day;
- women >50 and men >70 1200mg/day

Vitamin D ranges

• men/women <70: 600 international units/day
• men/women >70: 800 international units/day

Question 12

Biguamide

Answer 12

metformin (Glucophage)

Indication = Diabetes Type 2
**First line

MOA = not fully known; inhibits production of glucose, intestinal absorption of glucose and increase insulin sensitivity in muscle and fat.

AE = decrease risk of hypoglycemia; GI; B12 deficiency after extended use (years), can look like peripheral neuropathy

Question 13

Sulfonylureas

Answer 13

glipizide

Indication = Diabetes type 2

MOA = binds sulfonylurea receptor in pancreas –> depolarization causes insulin release.

AE = hypoglycemia (elderly, renal dysfunction), weight gain.
*If not taken before first meal of day may increase hyoglycemia risk.

Question 14

DDP-4 Inhibitors

Answer 14

“-glipin”

sitagliptin (Januvia)

Indication = Type 2 Diabetes

MOA = inhibits dipeptidyl peptidase IV (DDP-IV) enzyme that breaks down incretin hormone = prolonged active incretin hormone levels = increase insulin synthesis and release and decrease glucagon secretion

AE = decrease risk of hypoglycemia; well tolerated

Question 15

SGLT2 Inhibitors

Answer 15

“-flozin”

empagliflozin (Jardiance)

Indication = Type 2 Diabetes

MOA = block glucose reabsorption in the kidney at SGLT2 in proximal renal tubules = increase urinary glucose excretion.

AE = volume-depletion; dizziness, genitourinary infection
Rare = euglycemic diabetic , ketoacidosis

Question 16

GLP1 Receptor Antagonist

Answer 16

“-tide”

semaglutide (Ozempic)

Indication = Type 2 Diabetes
Route = injectable or PO (combo w/ basal insulin) Given weekly

MOA = analog of endogenous GLP1 = increase insulin secretion in presence of elevated glucose, decrease glucagon secretion, slows gastric emptying (increase satiety)

AE = GI (N/D, bloating); reduce risk of CV events

• Can be used for obesity treatment
• *Only increases insulin release when we eat or blood sugar is high