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Pharmacology > Endocrine (Ex2) > Flashcards

Endocrine (Ex2) Flashcards

1
Q

What is the goal of therapy for hypothyroidism in dogs?

What drugs are used?

A

To replace hormone the body is not producing
Liothyronine (T3)
Levothyroxine (T4)

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2
Q

How is Levothyroxine dosed?
Explain the administration
How is it monitored?

A

Dosed mg/kg, reduce risk of oversupplementation in large patients by dosing mg/m2

  • given orally BID for rest of life
  • only injectable for rare situations like coma
  • monitor by measuring T4 levels, 4 weeks after start of therapy
  • some drugs interfere with test results
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3
Q

What are the non-pharmacological treatments for hyperthyroidism in cats?

A

Surgery: remove abnormal tissue
Radioactive Iodine: destroy abnormal tissue
Diet: Hill’s y/d, prevent iodine uptake

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4
Q

Which drugs are used to treat hyperthyroidism in cats?

A

Methimazole/Carbimazole
Propylthiouracil
Iodides/Iodinated contrast agents

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5
Q

What kind of drug is Methimazole, and what does it do?

What are 3 types?

A

Thioureylenes

  • inhibit thyroid hormone synthesis
  • Tapazole (humans)
  • Felimazole
  • Transdermal methimazole
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6
Q

What kind of drug is Proplythiouracil, and what does it do?

A

Thioureylene

  • inhibit thyroid hormone synthesis
  • inhibit conversion of T3 to T4 in tissues
  • higher risk of serious side effects
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7
Q

What are the actions of Iodides/Iodinated contrast agents?

A
  • inhibit thyroid hormone synthesis
  • inhibit release of preformed hormone
  • inhibit T3 to T4 conversion in periphery
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8
Q

What are some clinical signs of Acute Hypocalcemia?

A
  • hyperesthesia (pawing at face)
  • tremors progressing to flaccid paralysis
  • seizures
  • hyperthermia
  • bradycardia
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9
Q

Describe Periparturient Hypocalcemia

A
  • Milk Fever, eclampsia
  • sudden increase in calcium usage for which the patient cannot keep up
  • associated with birth/lactation
  • can replace calcium until the patient catches up
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10
Q

What are the parenteral options for treating acute hypocalcemia?
Which is caustic?

A
  • Ca Gluconate (dilute if giving SQ, better to give IV)

- Ca Chloride (caustic, do not give SQ/IM)

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11
Q

What is given to treat Chronic Hypocalcemia?

How is it administered?

A
  • Ca carbonate, Ca Propprionate

- orally

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12
Q

What is a main cause of Hypocalcemia?

A
  • Hypoparathyroidism
  • inability of the body to convert vitamin D to its active form, calcitriol
  • so the body cannot absorb calcium
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13
Q

What are the treatments of Acute Hypoglycemia?

A
  • diet: frequent, small meals with complex carbs
  • dextrose 50% solution to mucus membranes (not SQ, IV bolus in emergencies)
  • ongoing IV dextrose 5%
  • Glucagon IV
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14
Q

What are the usual causes of Hyperglycemia?

A
  • something that does not require therapy (stress, exercise, steroids)
  • Diabetes Mellitus
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15
Q

What is the primary goal in treating Diabetes Mellitus?

A

to address the insulin deficiency, not bring down blood glucose

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16
Q

What do Oral Hypoglycemic Agents cause?
What are they used to treat?
How do they work?

A
  • cause hypoglycemia
  • treat type 2 diabetes (only in cats)
  • stimulate insulin secretion by the pancreatic beta cells via blocking K+ channels
  • increase tissue sensitivity to insulin
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17
Q

What is Glipizide?

A

oral medication for diabetes mellitus

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18
Q

Explain the process of insulin release and its actions

A
  • formed by beta islet cells of pancreas
  • when blood glucose rises, energy-dependent K+ channels close, causing depolarization of membrane and insulin release
  • in peripheral tissues, insulin binds to insulin receptors, which make available glucose transporters that allow glucose into the cells
19
Q

Short-Acting Insulin

  • which drugs
  • administration
  • use
A
  • Regular Insulin (Humulin-R)
  • IV, IM, or SQ (only one IV)
  • used for hospitalized patients not eating
20
Q

Intermediate-Acting Insulin

  • which drugs
  • administration
  • use
A
  • NPH (Humulin-H), Lente, Vetsulin/Caninsulin
  • only SQ
  • good starting insulin for canines
21
Q

Long-Acting Insulin

  • which drugs
  • administration
  • feature of each drug
A
  • Protamine Zinc/PZI, Glargine, Detemir
  • only SQ
  • Prot: vet approved so 40 IU/mL
  • Glarg: microprecipitates so gradual absorption
  • Det: higher potency in dog
22
Q

What type of steroid does each of the zones of the adrenal cortex produce?

A

Glomerulosa: mineralocorticoids
Fasciculata: glucocorticoids
Reticularis: sex steroids

23
Q

Glucocorticoids

  • produced by?
  • endogenous hormone
  • regulated by?
  • main effect
  • drugs
A
  • zona fasciculata
  • Cortisol
  • regulated by hypothalamus/pituitary through release of CRH and ACTH
  • anti-inflammatory
  • prednisone, prednisolone, dexamethasone, triamcinolone, methylprednisolone
24
Q

What are the physiologic effects of glucocorticoids?

A
  • increase calcium excretion
  • reduce fever
  • suppress immune response
  • lymphotoxic
25
Q

Adverse effects/Cautions/Contraindications of glucocorticoids

A
  • cause PU-PD
  • avoid in diabetes (antagonize insulin)
  • impair healing
  • increase GI acid and decrease mucus
  • increase fat absorption/deposition, increase liver enzymes
26
Q

Clinical uses of glucocorticoids

A
  • diagnostic testing (dexamethasone suppression test)
  • physiological replacement therapy (Addison’s)
  • anti-inflammatory
  • immunsuppressive
27
Q

What is the relative potency of each glucocorticoid drug?

A

Cortisol/Hydrocortisone: 1
Prednisone/Prednisolone: 4
Dexamethasone: 30
Triamcinolone: 5

28
Q

Which glucocorticoids are short-acting?

A

Hydrocortisone
Prednisone/Prednisolone
Methylprednisolone

29
Q

Which glucocorticoids are intermediate-acting?

A

Triamcinolone

30
Q

Which glucocorticoids are long-acting?

A

Dexamethasone

31
Q

Which excipients are added to injectable steroids?

A 
Salt esters (succinate, phosphate)
Insoluble esters (pivalate, acetate, acetonide)
32
Q

What are the effects of adding salt esters to glucocorticoids?

A
  • makes the steroid soluble
  • makes suitable for IV administration
  • onset may be faster, duration unchanged
33
Q

What are the effects of adding insoluble esters to glucocorticoids?

A
  • less soluble, longer it takes to absorb
  • delayed onset, longer duration
  • not for IV use
34
Q

Mineralocorticoids

  • produced by?
  • endogenous hormone
  • action
  • drugs
A
  • zona glomerulosa
  • Aldosterone
  • regulate Na+ retention and K+ excretion by kidney
  • Fludrocortisone, DOCP
35
Q

Hypoadrenocorticism

  • disease
  • problem
  • usual cause
A
  • Addison’s disease
  • deficient production of glucocorticoids +/- mineralocorticoids
  • usually caused by chronic destruction of the adrenal gland
36
Q

What is typical Addison’s?

How is it treated?

A
  • lacking both glucocorticoids and mineralocorticoids

- prednisone + DOCP or Fludrocortisone

37
Q

What is atypical Addison’s?

How is it treated?

A
  • lacking just glucocorticoids

- only prednisone

38
Q

Hyperadrenocorticism

  • disease
  • problem
  • possible causes
A
  • Cushing’s Disease
  • excess glucocorticoid production by the adrenals
  • functional adrenal mass producing glucocorticoids or functional pituitary mass producing ACTH
39
Q

Mitotane

  • indication
  • action
  • administration
  • cautions
A
  • trtmt of Cushing’s
  • cytotoxic to cells of the fasciculata
  • start with high dose, then reduce to lower dose
  • narrow therapeutic index
  • caution with owner handling
40
Q

Trilostane

  • indication
  • action
  • administration
  • caution
A
  • trtmt of Cushing’s (most common)
  • inhibits 3beta-hydroxysteroid dehydrogenase in cortisol produciton pathway
  • dosed BID, start with low dose
  • narrow therapeutic index
41
Q

Ketoconazole

  • indication
  • action
  • caution
A
  • trtmt of Cushing’s
  • anti-fungal, inhibits enzymes in steroid synthesis pathway
  • hepatotoxicity
42
Q

Pergolide

  • indication
  • action
A
  • trtmt of Cushing’s (inhibit production of ACTH by pituitary)
  • treat pituitary pars intermedia dysfunction in horses
  • dopamine agonist, will suppress production of ACTH and reduce cortisol production
43
Q

Selegiline

  • indication
  • action
A
  • sometimes used to attempt to treat cushings
  • labeled for trtmt of canine cognitive dysfunction
  • inhibits MAO-B which results in increased dopamine

Pharmacology (14 decks)

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