Endocrine drugs (mostly diabetes)

Question 1

Rapid acting insulins?

Answer 1

Lispro, Aspart, Glulisine. Conjugated to amino acids. 15 min onset

Question 2

Short acting insulin?

Answer 2

Regular insulin, 1h onset. Not rapid-acting because of polymerization.

Question 3

Intermediate acting insulin?

Answer 3

NPH insulin. Complexed with protamine to form slower releasing crystals.

Question 4

Long-acting insulins?

Answer 4

Glargine and detemir. Glargine forms slowly-releasing crystals. Detemir is bound to myristic acid; the compound binds to albumin.

Question 5

Glucocorticoid effects?

Answer 5

• Blood pressure - increased alpha sensitivity
• Anti-Inflammatory effects:
  
  • blocks phosphlipase A2 via lipocortin-1 gene, which prevents production of arachidonic acid and its leukotriene and prostaglandin metabolites
  • Inhibits leukocyte adhesion - neutrophilia
  • Blocks IL-2 production
  • Stabilizes mast cells (like cromolyn)
  • Reduces eosinophil count
• ​Gluconeogenesis, lipolysis & fat redistribution, proteolysis (muscle wasting)
• Fibroblast activity - abdominal striae
• **Insulin **resistance
• Bone resoprtion

Question 6

Uses and mechanisms for

1. growth hormone
2. somatostatin (what drug?)
3. oxytocin, and
4. desmopressin

Answer 6

1. Growth hormone: GH deficiency, Turner syndrome
2. Octreotide
   
   • Acromegaly, carcinoid, gastrinoma, glucagonoma, VIPoma - blocks hormone release
   • Esophageal varices - lowers portal pressure
3. Oxytocin: stimulates labor, controls uterine hemorrhage
4. Desmopressin:
   
   • von-Willebrand dz
   • central DI, nocturia
   • Desmopressin has minimal vasoconstriction activity

Question 7

alpha-glucosidase inhibitors?

Answer 7

Acarbose, miglitol

Question 8

Incretins (2 kinds)

Answer 8

Exenatide, liraglutide - GLP1 antagonists

-gliptins - DPP4 inhibitors

Question 9

Sulfonylureas

Answer 9

Inhibit ATP-sensitive K+ channel

• 1st generation: tolbutamide, chlorpropamide
• 2nd generation: glyburide, glimeripide, glipizide