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RUSVM Pharmacology > Endocrine Drugs > Flashcards

Endocrine Drugs Flashcards

1
Q

Why is Propylthiouracil (PTU) less frequently used in treatment for hyperthyroidsim in cats

A

Higher incidence of serious side effects

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2
Q

What is the best way to dose large patients (>50lbs) for Levothyroxine?

A

mg/m2

________________________

To avoid oversupplementation

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3
Q

General targets of drug therapy for “hyper” endocrine diseases

A

Destroy abnormal tissue/ get rid of the source

Inhibit production of the substance

Enhance elimination of the substance

Inhibit function of the substance

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4
Q

Commonly used long acting insulins

A

Glargine

Prozinc (PZI)

Detemir

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5
Q

Clinical signs of Acute Hypocalcemia

A

Hyperesthesia/ pawing at the face

Tremors progressing to flaccid paralysis, seizures, hyperthermia, bradycardia

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6
Q

Endogenous hormone of glucocorticoids

A

Cortisol

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7
Q

Non genomic effects of glucocorticoids

A

Glucocorticoid receptors in the membrane → Rapid Effects

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8
Q

Short term management of acute hypocalcemia

A

Parenteral Calcium

Oral Calcium

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9
Q

Pharmacokinetics of what type of insulin is generally most predictable

A

Short-Acting

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10
Q

Examples of glucocorticoids with salt ester excipeints

A

Dexamethasone sodium phosphate- Azium, DexSP

Methylprednisolone sodium succinate - Solu-Medrol

Hydrocortisone sodium phosphate - Solu-Delta-Cortef

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11
Q

Treatment of atypical addisons

A

Prednisone

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12
Q

Long term side effects of glucocorticoids

A

Increased susceptibility to infection

Skin changes - hyperpigmentation, thinning, alopecia

Collagen disease, delayed wound healing

Hypertension, thromboembolic disease

Panting

Addisonian signs

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13
Q
A
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14
Q

Oral calcium options for treating Chronic Hypocalcemia

A

Ca Carbonate

Ca Proprionate

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15
Q

Adverse effects of glucocorticoids

A

PU/PD

Catabolic

Antagonize Insulin

Inhibit fertility

“Stress” leukogram

Impair healing

Calcinosis cutis, osteoporosis, thin skin and alopecia

Increase GI acid and decreased mucus

Increase fat absorption/ deposition

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16
Q

Regulation of glucocorticoids

A

Regulated by the hypotalamus/pituitary through the release of CRH and ACTH

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17
Q

Drugs that target the production of ACTH by the pituitary gland

A

Pergolide- Permax

Selegiline- Anipryl

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18
Q

Mechanism of action of mineralcorticoids

A

Regulate Na retention / K excretion by the kidney

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19
Q

T/F: Ca Chloride can be given SQ/IM

A

False

__________________

Ca Chloride is caustic

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20
Q

Primary goal of Diabetes Melitus therapy

A

Address the insulin deficiency

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21
Q

Mechanism of action of oral hypoglycemic agents

A

Stimulate insulin secretion by the pancreatic beta-cells by blocking K channels

Increase tissue sensitivity to insulin

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22
Q

Physiologic effects of glucocorticoids

A

Increase calcium excretion

Reduce Fever

Suppress immune system

Lymphotoxic

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23
Q

Modes of administration for Regular Insulin- Humulin-R

A

IV

IM

SQ

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24
Q

Excipients that may be used for injectible glucocorticoids

A

Salt Esters

Insoluble Esters

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25
Q

Cabimazole is converted to what in the body

A

Methimazole

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26
Q

How does hypoparathyroidism effect calcium

A

Hypoparathyroidism results in inability of the body to convert vitamin D to calcitriol, thus the GI tract cannot absorb calcium

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27
Q

Treatment of typical addisions

A

Prednisone + either DOCP or Fludrocortisone

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28
Q

Most commonly used drug to treat Cushings disease

A

Trilostain - Vetoryl

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29
Q

Commonly used short acting insulin

A

Regular Insulin - Humulin-R

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30
Q

In the cases of “hypo” endocrine diseases we need our therapy to do what

A

Replace an endogenous substace

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31
Q

Likely cause of hypoglycemia

A

Diet

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32
Q

Hypoadrenocortisim is usually caused by

A

Chronic destructionof the adrenal gland

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33
Q

Side effects of drugs targeting “hypo” endocrine diseases are typically related to

A

Excess of the endogenous substances

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34
Q

Examples of glucocorticoids with insoluble ester excipients

A

Methylprednisolone Acetate - Depo-Medrol

Triamcinolone Acetonide - Vetalog

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35
Q

Types of corticosteroids

A

Glucocorticoids

Mineralcorticoids

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36
Q

Hyperadrenocorticism can be cuased by

A

Functional adrenal cortical mass

Functional pituitary mass

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37
Q

Insulin pen is a new product designed for

A

Vetsulin/Caninsulin

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38
Q

Pergolide - Permax

A

Dopamine agonist

Suppress production of ACTH thus reduces cortisol production

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39
Q

Endogenous hormone of mineralcorticoids

A

Aldosterone

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40
Q

Lifelong management of hypocalcemia

A

Replace Vitamin D

Calcitriol, DHT, Ergocalciferol

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41
Q

Biggest potential side effect of calcitriol

A

Hypercalcemia

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42
Q

Mechanism of action of Iodides and Iodinated Contrast Agents

A

Inhibit thyroid hormone synthesis

Inhibit the release of preformed hormone

Inhibit T3 > T4 conversion in periphery

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43
Q

Why would you choose to use Levothyroxine over Liothyronin

A

Levothyroxine requires less freqent dosing and has lower risk of causing thyrotoxicosis

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44
Q

Ketoconazole

A

Inhibits enzyme in the steroid synthesis pathway

Efficacy being questioned

Potential for hepatotoxicity - hepatic microsomal enzyme inhibitor

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45
Q

Diagnostic tests using glucocorticoids

A

Low dose dexamethasone suppression test

High dose dexamethasone suppression test

46
Q

Most potent, activated form of vitamin D

A

Calcitriol

47
Q

Salt esters as excipients for glucocorticoids

A

Make steroid soluble

Suitable for IV administration

Onset may be faster and duration unchanged

48
Q

DOCP is administered

A

Parenterally

49
Q

Selegiline - Anipryl

A

Inhibits MAO-B which results in increased dopamine.

50
Q

Only insulin that can be given IV

A

Regular Insuin - Humulin-R

51
Q

Insoluble esters as excipients for glucocorticoids

A

Delayed onset, long duration

Opaque - not for IV use

52
Q

Glucocorticoids are used for what effect

A

Anti-Inflammatory

53
Q

Trilostain - Vetoryl

A

Inhibits 3beta-hydroxysteroid-dehydrogenase in cortisol pathway

Narrow therapeutic index

54
Q

Why is methimazole most commonly used in the treatment of hyperthyroid cats?

A

Consistently efficacious

Side effects are uncommon

55
Q

T/F: Oral medications for Diabetes Melitus treat the cause

A

False

______________________

Cause hypoglycemia

56
Q

Calcium Disorders

A

Acute Hypocalcemia

Chronic Hypocalcemia

57
Q

Thioureylenes used to treat hyperthyroidism in cats

A

Methimaxole

Carbimazole

Propylthiouracil PTU

58
Q

Mechanism of Insulin release

A

Blood glucose rises ​→ energy dependent K channels close → membrane depolarization → insulin release

59
Q

Rapid IV administration of calcium can cause

A

Arrhythmias

60
Q

Common glucocorticoids

A

Prednisone

Prednisolone

Dexamethasone

Triamcinolone

Methylprednisolone

61
Q

Long acting insulin that forms microprecipitates in physiologic pH which results in very gradual absorption

A

Glargine

62
Q

Treatment strategy for chronic hypoglycemia

A

Address the cause if possible and if not alter glucose production or use by the body

63
Q

Genomic effects of glucocorticoids

A

Nuclear type glucocorticoid receptors in the cytoplasm → move into the nucleus → increase or decrease gene expression

64
Q

Fludrocortisone is administered

A

orally

65
Q

Common mineralcorticoids

A

Fludrocortisone

DOCP - Desoxycorticosterone pivalate

66
Q

Insulin is produced by

A

the beta cells and islet of Langerhands in endocrine pancreas

67
Q

General concept when treating acute hypocalcemia

A

Replace the calcium dificient until the patient can catch up

68
Q

Pharmacological options to treat hyperthyroidism in cats include

A

Thioureylenes

Iodides and Iodinated Contrast Agents

69
Q

T/F: Hypothyroid drugs must be given for the duration of the patients life.

A

True

70
Q

Goal of therapy for Hypothyroidism in dogs

A

Replace hormone the body is not producing

71
Q

Short acting insulins are most commonly used for

A

Hospitalized patients who are not eating

72
Q

Atypical Addisons

A

Patient lacking only glucocorticoids

73
Q

Drugs that target the production of glucocorticoids in the adrenal gland

A

Trilostain

Ketoconazole

74
Q

Short term side effects of glucocorticoids

A

Usually not serious unless concurrent factors

Lab changes - stress leukogram, decreased thyroid

PU/PD, polyphagia

Fetal abnormalities/ abortion

75
Q

Mode of administration of Vetsulin/Canisulin

A

SQ only

76
Q

Exogenous glucose sources used in the treatment of hypoglycemia

A

Dextrose 50% Solution

Glucagon

77
Q

Most common pharmacutical agent used to treat hyperthyroidism in cats

A

Methimazole

78
Q

Clinical uses of glucocorticoids

A

Diagnostic testing

Physiologic replacement therapy

Anti-inflammatory

Immunosuppressive

79
Q

Pharmacokinetics of glucocorticoids

A

Absorbed orally and parenterally

Protein bound

Some must be hydrolyzed to release the steroid base

Metabolites excreted in urine

80
Q

Used to treat Pituitary pars intermedia dysfunction (PPID) in horses

A

Pergolide - Permax

81
Q

Targets for drug therapy for hyperadrenocorticism

A

Adrenal gland itself

82
Q

Veterinary approved long acting insulin

A

Prozinc (PZI)

_____________________

May have shorter duration than other long acting insulins - especially in cats

83
Q

Lack of response to normal feedback due to what can cause “hyper” endocrine diseases

A

Hyperplasia

Benign neoplasia - adenoma

Malignatn neoplasia - carcinoma

84
Q

T/F: Ca Gluconate can be given SQ

A

True

__________________________

Should be diluted if given SQ, better to give IV

85
Q

Long acting insulin that has a much higher potency in dogs

A

Detemir

86
Q

Commonly used intermediate acting insulin

A

Vetsulin/Canisulin

87
Q

Why are idodies and iodide contrast agents less freqently used in the treatment of hyperthyroid cats

A

Efficacy is variable and often transient.

88
Q

Categories of Insulin based on duration of action

A

Short Acting

Intermediate Acting

Long Acting

89
Q

Used to treat Canine Cognitive Dysfunction and sometimes used in attempt to treat Cushings Disease

A

Selefiline- Anipryl

90
Q

Glipizide

A

Oral hypoglycemic drug

Only effective in 20-30% of cats

May accelerate beta loss

91
Q

General goals of drug therapy in “hypo” endocrine diseases

A

Drug replacing an endogenous substance

Drug replacing something that directly allows the body to regain normal homeostasis

92
Q

Side effects of Methimazole

A

Mild - GI signs, transient hematologic changes on CBC

Severe - Refractory GI signs, Idiosyncratic reactions (facial excoriation, hepatopathy, bone marrow suppression)

93
Q

Treatment strategy for Acute Hypoglycemia

A

Address the cause and supply exogenous glucose source

94
Q

Goal of therapy for Hyperthyroidism in cats

A

Stop excessive hormone production

95
Q

Drugs used in the treatement of Hypothyroidism in dogs

A

Liothyronin (T3)

Levothyroxine (T4)

Soloxine

96
Q

Hypoadrenocorticism - “Addisons Disease”

A

Deficient production of glucocorticoids +/- mineralcorticoids

97
Q

Pharmacologic considerations when using glucocorticoids

A

Potency

Duration

98
Q

In the cases of “hyper” endocrine diseases we need our therapy to

A

Decrease the amount of an endogenous substance that is in excess

99
Q

T/F: Concentrations of human and veterinary insulin products are the same.

A

False

_____________________

Human - 100 IU/mL

Veterinary - 40 IU/mL

100
Q

Glucocorticoids are produced by the

A

Zona Fasciculata

101
Q

Typical Addisons

A

Patient lacking both glucocorticoids and mineralcorticoids

102
Q

Parenteral calcium options for treating acute hypocalcemia

A

Ca Gluconate

Ca Chloride

103
Q

Hyperadrenocorticism - “Cushings Disease”

A

Excess glucocorticoid production by the adrenals

104
Q

Drugs that can interfere with thyroid test results

A

Phenobarbital

Zonisamide

Sulfonamide

Glucocorticoids

Phenylbutazone

Quinidine

Others

105
Q

Mineralcorticoids are produced by the

A

Zona glomerulosa

106
Q

Mechanism of action of Propylthiouracil PTU

A

Inhibit thyroid hormone synthesis

Inhibit conversion of T4 to T3

107
Q

Mechanism of action of Methimaxole and Carbimazole

A

Inhibit thyroid hormone synthesis

108
Q

Mitotane (Lysodren)

A

Used in the treatment of hyperadrenocorticism

Cytotoxic to cells of the fasciculata

Narrow therapeutic index

Start with high dose reduce to lower dose

109
Q

Causes of hyperglycemia

A

Something that does not require therapy

Diabetes Mellitus (DM)

110
Q

Periparturient Hypocalcemia

A

“Milk Fever” “Eclampsia”

Acute hypocalcemia

Sudden increase in calcium usage for which the patient cannot adapt rapidly enough - generally associated with birth or lactation

111
Q

Oral Hypoglycemic drugs are useful in what type of diabetes

A

Type II Diabetes

__________________________

Pancreas is still capable of secreting some insulin

RUSVM Pharmacology (19 decks)

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