Endocrine Drugs Flashcards
Green Hormone Regulation produced by which specific cells
T3 & T4
What is stated below:
▪️Aka. Sleep-woke cycle/Diurnal Cycle
▪️24h cycle in hormone release
▪️”schedule” of hormone release
Circadian Rhythm
What are the two feedback mechanism of the Endocrine System
- Negative Feedback
- Positive Feedback
What type of feedback mechanism is stated below:
▪️Majority
▪️Prevents further hormones secretion once a set point is achieved
▪️Ex. Thyroid Gland
Negative Feedback
▪️Stimulus: ↑ PH
▪️Response: ↓RH=↓SH=↓PH
What type of feedback mechanism is stated below:
▪️Rare/uncommon
▪️Only happens in menstrual cycle (ovulation)
Positive Feedback
▪️Stimulus: ↑ PH
▪️Response: ↑RH=↑SH=↑PH
What is stated below:
[Hypothalamic or Pituitary]
▪️Drugs: GnRH Analogues [Gonadorelin, Buserelin, Goserelin, Nafarelin, Triptorelin, Histrelin] -relin
- Intermittent/Pulsatile
- POSITIVE feedback
- ↑ FSH = ↑ Estrogen
- ↑ LH = ↑ Progesterone
- mgt. of hypothalamic & hypogonadism
- Continuous/Sustained (IM Depot)
- NEGATIVE feedback
- ↓FSH & LH =↓Estrogen, Progeste.
- mgt. of hormone excess states
(breast CA, prostate CA)
Hypothalamic Hormones & Agents
What is stated below:
[Hypothalamic or Pituitary]
▪️ It compose of Anterior and Posterior
Pituitary Hormones
Is it Anterior or Posterior PH
▪️From Adenohypophysis
▪️follow the H -> P portal axis system
▪️Ex. Prolactin & Growth Hormone
Anterior Pituitary Hormone
Is it Prolactin or Growth Hormone
▪️Regulation composed of Inhibit Dop. with the end product of mammary gland
▪️Effects: TOP & BOTTOM
TOP=GO!
- breast development
- milk production (lactation)
BOTTOM=STOP!
- (-) ovulation & spermatogenesis
[Infertility]
Prolactin (PRL)
What is stated below: (under Prolactin of Pituitary Hormone)
▪️ increase prolactin in the blood
▪️causes: prolactinomas (tumor), drug-induced ex. 1st Gen Antipsychotics
▪️sign/sx: Galactorrhea, amenorrhea, infertility
Hyperprolactinemia
Is the treatment for hyperprolactinemia
Bromocriptine (D2 Agonist)
Is it Prolactin or Growth Hormone
▪️Effects:
- Liver: ↑ somatomedin
- Muscles: ↑ CHON synthesis
- Adipocytes: lipolysis->weight loss
- cells = (-) glucose uptake
▪️ effect of Growth Hormone is inhibiting blood cell that leads to hyperglycemia
▪️Conditions (Deficiency & Excess)
Growth Hormone (Somatotropin)
Under Growth Hormone
- Deficient
Onset:
Pre-puberty: ?
Post-puberty: ? - Excess
Onset:
Pre-puberty: ?
Post-puberty: ?
- Deficient
Onset:
Pre-puberty: Pituitary Dwarfism
Post-puberty: ↑ risk of CV Death - Excess
Onset:
Pre-puberty: Pituitary Gigantism
Post-puberty: Acromegaly=Cardiomegaly
What drugs used for Deficiency Disease of Dwarfism (under GH)
- GHRH (in Hypothalamic Defect)
- Somatropin
- Mecasermin
What drugs used for Excess Disease of Gigantism & Acromegaly (under GH)
- Octreotide
- Lanreotide
- Pegvisomant (GH receptor antagonist)
Is it Anterior or Postetior PH
▪️From Neurohypophysis
▪️Do not follow an axis
▪️Ex. Oxytocin, Vasopressin
Posterior Pituitary Hormone
What drug under Posterior Pituitary Hormone is stated below:
▪️Effects:
- stimulates milk-letdown
- stimulus: nipple suckling
- uterine contraction (oxytosis)
Oxytocin
What drug under Posterior Pituitary Hormone is stated below:
▪️nasal spray: to stimulate milk let-down
▪️IV: Oxytocic = induction of labor
Oxytocin
What drug under Posterior Pituitary Hormone is stated below:
▪️ oxytocin antagonist
▪️ uterine relaxant: Tocolytic
(Tx: Pre-term labor)
Atosiban
What drug under Posterior Pituitary Hormone is stated below:
▪️ Antidiuretic Hormone
▪️Effects
- V1 = vasoconstriction
- V2 = H2O reabsorption
▪️Clinical Conditions
1. Deficiency: Diabetes Insipidus
2. Excess: SIADH
Vasopressin
2 Forms of Diabetes Insipidus
- Central/Neurogenic DI
- Nephrogenic
What Forms of DI is stated below:
▪️absolute lack of vasopressin (ADH)
▪️tx: V agonist (-pressin)
- Non-selective: Vasopressin
- V2-selective: Desmopressin
Central/Neurogenic DI
What Forms of DI is stated below:
▪️ relative lack of vasopressin (ADH)
▪️ normal vasopressin (ADH) but receptors are resistant or non-responsive
▪️tx: thiazide diuretics = paradoxical
Nephrogenic Diabetes Insipidus
What disease is stated below:
▪️Excess
▪️Tx: V-Antagonists: (-vaptan)
- Non-Selective: Conivaptan
- V2-Selective: Tolvaptan
Tetracycline: Demeclocycline
Syndrome of Inappropriate ADH Secretion (SIADH)
What is the regulatory mechanism of iodide
Wolf-chaikoff effect
Duration: (Wolf-Chaikoff Effect)
▪️<10-14 days: ↓T3, T4
▪️>14 days: ↑ T3, T4
▪️ Hypothyroidism
▪️ Hyperthyroidism
What Clinical Conditions is stated below:
▪️Causes: Post-procedural (thyroiodectomy, RAI), Iodine Deficiency, Autoimmune: Hashimoto’s, Drug-induced: Antithyroid Agents-Amiodarone (<10-14 days)
▪️s/sx: weight gain despite ↓ appetite
Deficiency: Hypothyroidism
What are the Tx: Supplementation for Hypothyroidism?
▪️Thyroxine (T4)
- Levothyroxine (Euthyrox): prep of choice; maintenance therapy
- Dextrothyroxine: 4% of the activity of Levo
▪️Liothyronine: 3-4x more potent than Levothyroxine
What Clinical Conditions is stated below:
▪️Causes: Autoimmune (Grave’s Disease), Hyperfunctioning Nodules, Drug-induced: Amiodarone Iodide = >14 days
▪️s/sx: weight loss despite ↑ appetite
Excess: Hyperthyroidism
What are the Antithyroid Agents for Hyperthyroidism?
▪️Thoamides-(-)peroxidase enzyme
1. PTU (Propylthiouracil)
2. Methimazole/Thiamazole (Tapdin) (Tapazole)
3. Carbimazole - prodrug of Methimazole
▪️Anion Inh.
1. Perchlorate, Pertechnetate, Thiocyanate
▪️Iodides
1. SSKI (Saturated asolution of Potassium Iodide) Lugol’s Soln.
▪️ RAI (Radioactive Iodide)
1. 131-I
▪️B-Blockers
1. Propranolol, Carvedilol
▪️Dexamethasone
PTU vs Methimazole
▪️DOA: Short
▪️USE: Emergency
▪️SAFETY (pregnancy): ✅️
▪️T/E: Hepatitis
PTU (Propyluracil)
PTU vs Methimazole
▪️DOA: Long
▪️USE: Maitenance
▪️SAFETY (pregnancy): ❌️
[Teratogenic: Aplasia Cutis]
▪️T/E: Obstructive Jaundice
Methimazole (Tapdin)
DOC for Amiodarone-induced hyperthyroidism (>14 days)
Anion Inhibitors
- Perchlorate, Pertechnetate, Thiocyanate
Mgt. of Thyroid Storm (initial use)
▪️Saturates Solution of Potassium Iodide (SSKI)
▪️Lugol’s Soln.
▪️Iodides
Preferred tx for Hyperthyroidism except pregnancy
1st line tx for Hyperthyroidism induced by Grave’s disease
RAI Therapy (131-I)
Adrenocortical Hormones
Zona Glomerulosa
Mineralocorticoids (Aldosterone)
Adrenocortical Hormones
Zona Fasciculata
Glucocorticoids (Cortisol)
Adrenocortical Hormones
Zona Reticularis
Sex Hormones/ Androgens
What is stated below:
- Major: Aldosterone
- Tx for HyPERaldosteronism
- Tx for HyPOaldosteronism
- Mineralocorticoids
- Aldosterone Antagonists (Spironolactone, Eplerenone)
- Fludrocortisone - salt retaining agent
What drug is given for the management of mineralocorticoid deficiency
Fludrocortisone
Major: Cortisol
Glucocorticoids
What kind of disease is Glucocorticoid excess?
Cushing Syndrome
What kind of disease is Glucocorticoid deficiency?
Addison’s Disease
What type of Glucocorticoids Drug is the ff:
▪️Prednisone
▪️Hydrocortisone
▪️Meprednisone
▪️Meprednisolone
▪️Cortisone
Short Acting
What type of Glucocorticoids Drug is the ff:
▪️Triamcinolone
▪️Fluocinolone
▪️Paramethasone
Intermeciate Acting
What type of Glucocorticoids Drug is the ff:
▪️Bethamethasone
▪️Paramethasone
▪️Dexamethasone
Long Acting
