Endocrine Pharm Flashcards
What are the treatment strategies for Type 1 diabetes, Type 2 diabetes, gestational diabetes
Type 1: low carb diet, insulin replacement
Type 2: dietary modification and exercise for weight loss; oral agents, non-insulin injectables, insulin replacement
Gestational DM: dietary modifications, exercise, insulin replacement if lifestyle modification fails.
Insulin can be broken down into rapid acting, short acting, intermediate acting, and long-acting. List them out
Rapid acting: Aspart, Glulisine, Lispro
Short acting: Insulin
Intermediate: NPH
Long acting: Detemir, Glargine
What’s the mech of action of insulin?
binds insulin receptor (tyrosine kinase activity).
Liver: increases glycogenesis
Muscle: increases glycogenesis and protein synthesis; increases K+ uptake
Fat: increases TG storage
Which insulin do you give to establish basal glucose control?
Insulin, long acting like detemir and glargine
Which insulin do you give when someone has diabetic ketoacidosis?
regular insulin
Which insulin to give to treat hyperkalemia, stress hyperglycemia?
regular insulin
for hyperkalmeia, add glucose
Biguanides = metformin can decrease gluconeogensis, increase glycosis, and increase peripheral glucose uptake (increasing insulin sensitivity). It’s oral and first-line in type 2 DM, can lead to modest weight loss. What are some side effects?
- GI upset
- lactic acidosis (therefore, contraindicated in renal insufficiency)
There are 2 generations of sulfonylureas to treat type 2 diabetes. How do they work?
close K+ channels in beta-cell membrane –> cell depolarizes –> insulin release via increase Ca2+ influx
used to stimulate release of endogenous insulin in type 2
Can metformin and sulfonylureas be used to treat Type 1?
metformin can be used in type 1 but sufonylureas cannot because require some islet function.
List the 1st and 2nd generation sulfonylureas and their respective side effects.
-both have increase risk of hypoglycemia in renal failure
first generation: chlorpropamide, tolbutamide = di-sulfiram like effects
second generation: glimepiride, glipizide, gylburide = hypoglycemia; also contraindicated in liver and renal failure b/c metabolized by liver and excreted by kidneys
What do the glitazones/thiazolidinediones do? TOxicities?
Pioglitazone, Rosiglitazone increases insulin sensitivity in peripheral tissue by binding to PPAR-y nuclear tx regulator. It is used as monotherapy in type 2 DM or combined with another oral hypoglycemic drug
toxicities: weight gain, edema, hepatotoxicity, heart failure, increase risk of fractures
GLP-1 analogs increase insulin, and decrease glucagon release for type 2 diabetes. List the 2 drugs and 3 side effects.
exenatide, liraglutide
nausea, vomiting, pancreatitis
DPP-4 inhibitors increase insulin and decrease glucagon release. List the 3 and their side effects
- linagliptin
- saxagliptin
- sitagliptin
mild urinary or respiratory infections
What is the amylin analog? What does it do. What are side effects?
Amylin analog named pramlinitide decreases gastric emptying and decreases glucagon, used in type 1 and 2 diabetes.
Side effects: hypoglycemia, nausea, diarrhea
What is the SGLT-2 inhibitor? what does it do?
Canagliflozin blocks reabsorption of glucose in PCT for type 2 DM; can cause glucosuria, UTIs, vaginal yeast infections (b/c increase glucose passing)
What are the 2 a-glucosidase inhibitors? What do they do?
Acarbose, miglitol inhibit intestinal brush-border alpha-glucosidase to decrease glucose spike after meal b/c of delayed carbohydrate hydrolysis and glucose absorption.
Used as monotherapy or combined for Type II
Side effects: GI
What can you use to treat the exothalmpos present in graves?
steroids b/c exophathmos is due to infiltration of lymphocytes
Proplthiouracil and methimazole are used to treat hyperthyroidism. Explain mech of action. Which one also blocks peripheral conversion and can be used in pregnancy while the other cannot?
they block thyroid peroxidase, inhibiting the oxidation of iodine and the organification (coupling) of iodine –> inhibition of thyroid hormone synthesis
propylthiouracil also blocks 5’-deiodinase decreasing peripheral conversion of T4 –> T3. Propylthiouracil can also be used in pregnancy while methimazole is a teratogen that can cause aplasia cutis (absence of portion of skin)
List toxicities assoc with methimazole and propylthiouracil
- skin rash
- agranulocytosis (propylthiouracil more so than methimazole)
- aplastic anemia
- hepatotoxicity (propylthiouracil)
- teratogen (methimazole)
Levothyroxine (T4) and triiodothyronine (T3) can be used to treat hypothyroidism, myxedema and can be used off label as weight loss supplements. What are 4 side effects
- tachycardia
- heat intolerance
- tremors
- arrhythmias
List the 2 ADH antagonists. What can they be used for?
Conivaptan, tolvaptan
-used in SIADH by blocking ADH at V2 receptors (Gs-coupled receptors)
Growth hormone can be used for which 2 conditions?
GH deficiency
Turner syndrome
What are the effects of oxytocin?
stimulates labor, uterine contractions, milk let-down, and controls uterine hemorrhage
List the 5 conditions octreotide can be used for
- acromegaly
- VIPoma
- carcinoid syndrome
- glucagonoma
- esophageal varices
Desmopressin (synthetic ADH) can be used to treat central or nephrogenic diabetes insipidus or both?
central
b/c nephrogenic means the kidneys aren’t responding to ADH; not that they’re not being made while central means ADH isn’t being made by hypothalamus
What is Demeclocycline? Can be used in? Toxicities?
It’s a tetracycline that is an ADH antagonist that is used for SIADH.
Can cause nephrogenic diabetes insipidus, photosensitivity, abnormalities of bone and teeth (like the other tetracycline abx)
What is Cinacalcet? What is it used in?
Cinacalcet sensitizes Ca2+ sensing receptor in parathyroid gland to circulating Ca2+ leading to decreased PTH.
It is used in hypercalcemia due to primary or secondary hyperparathyroidism.
Can lead to hypocalcemia
List symptoms of iatrogenic cushing syndrome.
HTN weight gain moon facies truncal obesity buffalo hump thinning of skin striae osteoporosis hyperglycemia amenorrhea immunosuppression
T/F: glucocorticoids toxicity include peptic ulcers, steroid diabetes, steroid psychosis, adrenocortical atrophy.
True
