Endocrine- Glucagon, Octreotide, Vasopressin, Oral Contraceptives

Question 1

What is Glucagon?

Answer 1

• Polypeptide Hormone
• Produced by alpha cells in pancreas and upper GI tract
• Secretion is decreased with hyperglycemia

Question 2

MOA Glucagon

Answer 2

Enhances cAMP formation

1. increased myocardial contractility
2. decreases gastric mobility
3. increased renal BF
4. increased insulin secretion
5. increased hepatic gluconeogenesis and glycogenlysis
6. RELAXATION of SMOOTH MUSCLE (biliary sphinctor)

• Enhances release of catacholamines (secondary)
• Vasodilator (One of many reasons for decreased SVR with live disease)

Question 3

Clinical Uses- Glucagon and dose

Answer 3

1-5 mg IV or 5 mcg/kg/min (20 mg/hr)

1. Increased CO (w/ B blockade)
2. Biliary dilation
3. improves CHR symptoms
4. Enhanced AV nodal conduction (dig tox)
5. diagnosis of pheochromocytoma

Question 4

Glucagon Side Effects

Answer 4

1. Hyperglycemia
2. Hypoglycemia (paradoxical form release of insulin)
3. Hypokalemia
4. N/V
5. Abrupt HR increase in Afib
6. Only useful in acute phase, Contractility and HR are not increased with chronic use

Question 5

Octreotide/Somatostatin- What is it? Action?

Answer 5

-GI regulatory peptide secreted by pacreatic delta cells

• Inhibit the production and release of hormones form GI and pancreas
  1. inhibit GH release
  2. inhibit secretion of insulin
  3. inhibit release of glucagon (vasodilator) and VIP (vasoactive intestinal peptide)

Question 6

Octreotide CLinical uses

Answer 6

Carcinoid Crisis

• decreases the release of vasoactive amines (esp Serotonin)
• Brady/ 2nd and 3rd HB possible w/ bolus (Give Slow)
• Dosing for Carcinoid
• —50-100 mcg/hr + PRN bolus of 25-100 mcg

Control of Esophageal Bleeding
- Dose 50 mcg/hr

Hepatorenal Syndrome

Question 7

Vasopressin Receptors and e1/2

Answer 7

V1, V2, V3

V1- arterial smooth muscle causes profound constriction

V2- Collecting ducts to increase H2O permeability and reabsoption back into circulation

e1/2- 10-20 minutes

Question 8

Vasopressin- Clinical Uses

Answer 8

1. Diabetes Insipidus (peeing too much)
2. Esophageal varices (decrease hemorrhaging)
3. hemmorhagic or septic shock
4. cardiac arrest resuscitation

Question 9

Vasopressin- Side Effects

Answer 9

1. Increased BP
2. CA vasoconstriction (angina, MI, etc)
3. GI HYPERperistalsis (N/V)

Question 10

Exagenous preparation of Vasopressin (name, receptor specificity, e1/2)

Answer 10

DDAVP
-e1/2 2.5-4.4 hrs

• More selective for V2 receptors than V1
• Also causes endothelial cells to increase secretion of VWF, tPA, and Prostaglandins

Question 11

Oxitocin What does it do? dose?

Answer 11

• Acts on Uterus to cause contractions
• -Induction of labor
• -Increase uterine tone post C-section
• • Decrease hemorhhage after birth

Dosed in units

• Labor induction 1-2 mU/min
• –increase q 15-30 min by 1-2 mU/min
• –Goal contractions 2-3 min apart

-For post partum atony up to 40 mU/min

Question 12

Oxytocin high dose side effects

Answer 12

Not seen in L&D doses

• Decreased SVR, SBP, and DBP
• weak AVP activity with H2O retention

Question 13

Ovarian Hormones- Contraceptives What do they do?

Answer 13

Usually combo of estrogen and progestin that inhibits ovulation

Estrogen- prevents release of FSH
Progesterone- Prevents the release of LH

Question 14

Oral Contraceptives- Side Effects

Answer 14

Thromboembolism- increased plt agg and clotting factors by estrogen

MI and Stroke

HTN

Question 15

Last New Notecard for Pharm!

Answer 15

Bitches