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PLAB Pharmacology > Endocrine Pharmacology > Flashcards

Endocrine Pharmacology Flashcards

1
Q

treatment strategies for type 1 diabetes mellitus

A

low carb diet insulin replacement

Ram

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2
Q

treatment strategies for type 2 diabetes mellitus

A

dietary modification and exercise for weight loss oral agents non insulin injectables insulin replacement

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3
Q

treatment strategies for gestational diabetes

A

dietary modifications exercise insulin replacement if lifestyle modification fails

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4
Q

name the 7 types of insuline

A

Lispro Aspart Glulisine regular NPH detemir glargine

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5
Q

which type of insulin is short acting?

A

only Regular insulin

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6
Q

which types of insulin are rapid acting?

A

Lispro

Aspart

Glulisine

“no LAG”

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7
Q

which insulins are intermediate acting?

A

only NPH

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8
Q

which insulins are long acting?

A

detemir

glargine

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9
Q

insulin, rapid acting–mechanism

A

binds insulin receptor (tyrosine kinase activity) rapidly, no LAG

liver: inc glucose stored as glycogen
muscle: inc glycogen, protein synthesis, inc K+ uptake
fat: inc triglyceride storage

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10
Q

insulin, rapid acting–use

A

Type I DM

type 2 DM

GDM (postprandial glucose control)

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11
Q

insulins, short acting–use

A

Type I DM

type 2 DM

GDM

DKA (IV)

hyperkalemia (+ glucose)

stress hyperglycemia

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12
Q

insulin, intermediate acting–use

A

Type 1 DM

type 2 DM

GDM

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13
Q

insulin, long acting–use

A

type 1 DM

type 2 DM

GDM (basal glucose control)

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14
Q

insulin–toxicity

A

hypoglycemia

lipodystrophy

rare hypersensitivity rxns

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15
Q

what drug is included in the drug class Biguanides and acts as an oral hypoglycemic drug?

A

metformin

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16
Q

biguanides–action

A

(metformin)

exact mechanism unknown

dec gluconeogenesis

inc glycolysis

inc peripheral glucose uptake (inc insulin sensitivity)

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17
Q

biguanides–use

A

(metformin)

oral

first line therapy in type 2 DM

causes modest weight loss

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18
Q

can biguanides (metformin) be used for patients w/o islet function?

A

yes (T1DM)

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19
Q

biguanides–toxicity

A

(metformin)

GI upset

most serious adverse rxn is lactic acidosis

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20
Q

when is biguanides (metformin) contraindicated?

A

renal insufficiency, b/c can lead to lactic acidosis

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21
Q

name the first generation sulfonylureas

A

chlorpropamide

tolbutamide

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22
Q

name the second generation sulfonylureas

A

glimepiride

glipizide

glyburide

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23
Q

sufonylureas–mechanism

A

close K+ channel in beta cell membrane –> cell depolarizes –> insulin release via inc Ca 2+ influx

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24
Q

sulfonylureas–use

A

stimulate release of endogenous insulin in type 2 DM

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25
can sulfonylureas be used in type 1 DM?
no, becuase requires some islet fcn to work
26
sulfonylureas--toxicity
risk of hypoglycemia inc in renal failure weight gain
27
first generation sulfonylureas--toxicity
disulfiram like effects
28
second generation sulfonylureas--toxicity
hypoglycemia
29
name glitazones/thiazolidinediones
pioglitazone rosiglitazine
30
glitazones/thiazolidinediones--mechanism
inc insulin sensitivity in peripheral tissue binds to PPAR-gamma nuclear transcription regulator which activates genes to regulate fatty acid storage and glucose metabolism
31
glitazones/thiazolidinediones--use
used as monotherapy in type 2 DM or combined with insulin, biguanides, or sulfonylureas safe to use in renal impairment
32
glitazones/thiazolidinediones--toxicity
weight gain edema hepatotoxicity HF inc risk of fractures
33
name meglitinides
nateglinide repaglinide
34
meglitinides--mechanism
stimulate postprandial insulin release by binding to K+ channels on beta cell membranes (different site than sulfonylureas)
35
meglitinides--use
used as a monotherapy in type 2 DM or combined with metformin
36
meglitinides--toxicity
hypoglycemia (inc risk with renal failure) weight gain
37
name GLP-1 analogs
exenatide liraglutide (SC injection)
38
GLP-1 analogs--mechanism
inc glucose dependent insulin release dec glucagon release dec gastric emptying inc satiety
39
GLP-1 analogs--use
Type 2 DM
40
GLP-1 analogs--toxicity
nausea vomiting pancreatitis modest weight loss
41
name the DPP-4 inhibitors
linagliptin saxagliptin sitagliptin
42
DPP-4 inhibitors--mechanism
inhibits DPP-4 enzyme that deactivates GLP-1, so... inc glucose dependent insulin release dec glucagon release dec gastric emptying inc satiety
43
DPP-4 inhibitors--use
Type 2 DM
44
DPP-4 inhibitors--toxicity
mild urinary or respiratory infections weight neutral
45
name the amylin analogs
pramlintide (sc injection)
46
amylin analogs--mechanism
dec gastric empyting dec glucagon
47
amylin analogs--use
Type 1 DM type 2 DM
48
amylin analogs--toxicity
hypoglycemia (in setting of mistimed prandial insulin) nausea
49
name the sodium glucose transporter 2 (SGLT-2) inhibitors
canagliflozin dapagliflozin empagliflozin
50
SGLT 2 inhibitors--mechanism
block reabsorption of glucose in PCT
51
SGLT 2 inhibitors--use
type 2 DM
52
SGLT 2 inhibitors--toxicity
glucosuria UTIs vaginal yeast infections hyperkalemia dehydration (ortostatic hypotension)
53
name the alpha glucosidase inhibitors
acarbose miglitol
54
alpha glucosidase inhibitors--mechanism
inhibit intestinal brush border alpha-glucosidases delayed carbohydrate hydrolysis and glucose absorption --\> dec postprandial hyperglycemia
55
alpha glucosidase inhibitors--use
type 2 DM
56
alpha glucosidase inhibitors--toxicity
GI disturbances
57
name the thionamides
propylthiouracil (PTU) methimazole
58
thionamides--mechanism
block thyroid peroxidase--inhibits the oxidation of iodide and organification (coupling) or iodine --\> inhibition of thyroid hormone synthesis
59
what does propylthiouracil block and what is the result?
(thionamides) blocks 5'-deiodinase causes dec peripheral conversion of T4 to T3
60
thionamides--use
hyperthyroidism **p**ropylthiouracil (**P**TU) blocks **p**eripheral conversion and is used in **p**regnancy
61
thionamides--toxicity
skin rash agranulocytosis (rare) aplastic anemia hepatotoxicity
62
adverse effect of methimazole
(thionamides) possible teratogen--can cause aplasia cutis
63
drug names for T4 and T3
T4: levothyroxine T3: triiodothyronine
64
levothyroxine, triiodothyronine--mechanism
thyroid hormone replacement
65
levothyroxine, triiodothyronine--use
hypothyroidism myxedena used off label as weight loss supplements
66
levothyroxine, triiodothyronine--toxicity
tachycardia, heat intolerance, tremors, arrhythmias
67
name the hypothalamic/pituitary drugs
ADH antagonists--conivaptan, tolvaptan desmopressin acetate GH oxytocin somatostatin (octreotide)
68
name 2 ADH Antagonists
conivaptan tolvaptan
69
ADH antagonists--use
SIADH--block action of ADH at V2 receptor
70
desmopressin acetate--use
central (not nephrogenic) DI
71
GH--use
GH deficiency turner syndrome
72
oxytocin--use
stimulate labor, uterine contractions, milk let down controls uterine hermorrhage
73
somatostatin (octretide)--use
acromegaly carcinoid syndrome gastrinoma glucagonoma esophageal varices
74
demeclocycline--mechanism
ADH antagonist (member of tetracycline family)
75
demeclocycline--use
SIADH
76
demeclocycline--toxicity
nephrogenic DI photosensitivity abnormalities of bone and teeth
77
name the glucocorticoids
beclomethasone dexamethasone hydrocortisone methlprednisolone prednisone triamcinolone
78
glucocorticoids--mechanism
metabolic, catabolic, anti-inflammatory, and immunosuppressive effect mediated by interactions with glucocorticoid response elements inhibition of phospholipase A2 inhibition of transcription factors such as NK-kappaB
79
glucocorticoids--use
adrenal insufficiency inflammation immunosuppression asthma
80
glucocorticoids--toxicity
iatrogenic cushing syndrome adrenocortical atrophy peptic ulcers steroid diabetes steroid psychosis cataracts adrenal insufficiency if stop drug abruptly after chronic use
81
Iatrogenic Cushing Syndrome
HTN weight gain mon facies truncal obesity buffalo hump thinning of skin striae acne osteoporosis hyperglycemia amenorrhea immunosuppression
82
fludrocortisone-mechanism
synthetic analog of aldosterone with little glucocorticoid effects
83
fludrocortisone--use
mineralocorticoid replacement in primary adrenal insufficiency
84
fludrocortisone--toxicity
similar to glucocorticoids edema exacerbation of heart failure hyperpigmentation
85
cinacalcet--mechanism
sensitizes Ca2+ sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ --\> dec PTH
86
cinacalcet--use
primary or secondary hyperparathyroidism
87
cinacalcet--toxicity
hypocalcemia

PLAB Pharmacology (17 decks)

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