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ENDOCRINE > ENDOCRINE- Pharmacology > Flashcards

ENDOCRINE- Pharmacology Flashcards

1
Q

Treatment strategy for DM1

A

Low sugar dier

Insulin replacement

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2
Q

Treatment strategies for DM2

A

Dietary modifications and exercise for weight loss; oeal agents, non insulin injectables, insulin replacement

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3
Q

How are Insulin classified?

A

Rapid Acting
Short Acting
Intermediate
Long acting

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4
Q

Which insulin are Rapid acting

A

Lispro
Aspart
Glulisine

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5
Q

Which kind of receptor is for all types of insulins?

A

Bind insulin receptor (tyrosine kinase activity)

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6
Q

Main organs where insulin acts

A

Liver
Muscle
Fat

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7
Q

Effect of insulin in Liver

A

↑ glucose stored as glycogen

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8
Q

Effect of Insulin in Muscle

A

↑ glycogen, protein synthesis, ↑ K+ uptake

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9
Q

Which effect does insulin has on Fat?

A

↑ TG storage

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10
Q

Clinical use for Insulin rapid acting

A

DM1, DM2, Gestational Diabetes Mellitus (GDM)

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11
Q

When is recommended to administer Insulin rapid acting?

A

Postpandrial glucose control

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12
Q

Toxic effects for insulins

A

Hypoglycemia, Rare hypersensitivity reactions

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13
Q

Short acting Insulin

A

Regular

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14
Q

Clinical use for short acting insulin

A

DM1, DM2, GDM, DKA (IV), hyperkalemia (+ glucose), stress hyperglycemia

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15
Q

Which insulin is recomended to administer in DKA patients? How?

A

Regular (Short acting insulin) IV

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16
Q

Insulin, intermediate acting

A

NPH

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17
Q

Clinical use for NPH insulin

A

DM1, DM2, GDM

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18
Q

Insulin long acting

A

Glargine

Detemir

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19
Q

When are Long acting insulin recommended?

A

DM1, DM2, GDM (basal glucose control)

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20
Q

Example of Biguanides

A

Metformin

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21
Q

What is the Metformin?

A

Biguanide

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22
Q

Which is the mechanism of action of Metformin?

A

Exact mechanism is unknown

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23
Q

What is the effect of Metformin?

A

↓ Gluconeogenesis
↑ Glycolysis
↑ peripheral glucose uptake (insulin sensitivity)

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24
Q

First line therapy in type 2 Diabetes

A

Metformin

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25
Q

Can Metformin be used in patients without islet functions?

A

Yes

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26
Q

Which is the most common toxic effect of Metformin?

A

GI upset

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27
Q

Most serious adverse effect of Metformin

A

Lactic acidosis

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28
Q

When is Metformin contraindicated?

A

Renal Failure, because have higher risk for lactic acidosis

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29
Q

First generation sulfonylureas

A

Tolbutamide

Chlorpropamide

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30
Q

Second generation sulfonylureas

A

Glyburide
Glimepiride
Glipizide

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31
Q

Mechanism of action of Sulfonylureas

A

Close K+ channel in β cell membrane, so cell depolarizes → triggering of insulin release via Ca2+ influx

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32
Q

Clinical use for Sulfonylureas

A

Stimulate release of endogenous insulin in type 2 DM

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33
Q

Are sulfonylureas useful in type 1 DM?

A

No, require some islet functions, so useless in type 1 DM

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34
Q

When is increased the risk of hypoglicemia when using Sulfonylureas?

A

In Renal failure

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35
Q

First generation Sulfonylureas toxic effects

A

Disulfiram like effects

36
Q

Second generation Sulfonylureas toxic effects

A

Hypoglycemia

37
Q

Alternative name for Thiazolidinediones

A

Glitazone

38
Q

Examples of Thiazolidinediones

A

Pioglitazone

Rosiglitazone

39
Q

Mechanism of action of Thiazolidinediones

A

↑ insulin sensitivity in peripheral tissue

40
Q

Where do Thiazolidinediones bind to?

A

PPAR-γ nuclear transcription regulator

41
Q

Clinical use for Thiazolidinediones

A

Used as monotherapy in type 2 DM or in combination

42
Q

Side effects of Thiazolidinediones

A

Weight gain, edema

Hepatotoxicity, heart failure

43
Q

α glucosidase inhibitors

A

Acarbose

Miglitol

44
Q

Mechanism of actions α glucosidase inhibitors

A

Inhibit intestinal brush border α glucosidases

Delayed sugar hydrolysis and glucose absorption → ↓ postpandrial hyperglycemia

45
Q

Clinical use for α glucosidase inhibitors

A

Used as monotherapy in type 2 DM or in combination

46
Q

Secondary effects of α glucosidase inhibitors

A

GI disturbances

47
Q

Amylin analog

A

Pramlintide

48
Q

Mechanism of action of Amylin analog

A

↓ gastric emptying, ↓ glucagon

49
Q

Clinical use for Amylin analogs

A

Type 1 and type 2 DM

50
Q

Toxic effects of Amylin Pramlintide

A

Hypoglicemia
Nausea
Diarrhea

51
Q

GLP-1 analogs

A

Exenatide

Liraglutide

52
Q

Mechanism of action of GLP-1 analogs

A

↑ insulin, ↓ glucagon release

53
Q

Which is the clinical use for GLP-1 analogs?

A

Type 2 DM

54
Q

Side effects of GLP-1 analogs

A

Nausea, vomiting; pancreatitis

55
Q

DDP-4 inhibitors

A

Linagliptin
Saxagliptin
Sitagliptin

56
Q

Mechanism of action of DPP-4 inhibitors

A

↑ insulin, ↓ glucagon release

57
Q

Clinical use for DPP-4 inhibitors

A

Type 2 DM

58
Q

Possible secondary effects of DPP-4 inhibitors

A

Mild urinary or respiratory infections

59
Q

What do genes activated by PPAR γ activate?

A

Fetty acid storage and glucose metabolism

60
Q

What is the effect of PPAR γ once is activated?

A

↑ insulin sensitivity and levels of adiponectin

61
Q

Which is the mechanism of action of propylthiouracil, methimazole?

A

Block thyroid peroxidase, inhibiting the oxidation of iodide and the organification (coupling) of iodine→ inhibition of thyroid hormone synthesis

62
Q

What else does Propylthiouracil blocks?

A

5’ deiodinase which ↓ peripheral conversion of T4 to T3

63
Q

Which is the clinical use for propylthiouracil and methimazole?

A

Hyperthyroidism

64
Q

Which treatment is used in hyperthyrodism in pregnancy?

A

PTU (propylthiouracil)

65
Q

Side effect of both propylthiouracil, methimazole

A

Skin rash, agranulocytosis (rare), aplastic anemia

66
Q

Possible Side effect of just propylthiouracil

A

Hepatotoxicity

67
Q

Why do tou need to be careful when using methimazole?

A

Methimazole is a possible teratogen (can cause aplasia acutis)

68
Q

Mechanism of action of Levothyroxine, triiodothyronine

A

Thyroxine replacement

69
Q

Clinical use for Levothyroxine, triiodothyronine

A

Hypothyrodism, myxedema

70
Q

Toxic effects caused by Levothyroxine, triiodothyronine

A

Tachycardia, heat intolerance, tremors, arrhytmias

71
Q

When is recommended the use of GH?

A

GH deficiency

Turner syndrome

72
Q

In this situations is recommended to use Somatostatin (ocreotide)

A

Acromegaly, carcinoid, gastrinoma, glucagonoma, esophageal varices

73
Q

Uses for Oxytocin

A

Stimulates labor, uternine contractions, milk let down; controls uterine hemorrhage

74
Q

Mechanism action of demeclocycline

A

ADH antagonist (member of the tetracycline family)

75
Q

Clinical of of demeclocycline

A

SIADH

76
Q

Toxic effects of Demeclocycline

A

Nephrogenic DI, photosensitivity, abnormalities of bone and teeth

77
Q

Toxic effects of Demeclocycline

A

Nephrogenic DI, photosensitivity, abnormalities of bone and teeth

78
Q

Which drugs are glicocoticoids?

A

Hydrocotisone, prednisone, triamcinolonem dexamethasone, beclomethasone, fluodrocortisone

79
Q

Mechanism of action of Glucocorticoids

A

Metabolic, catabolic, anti inflammatory and immunosuppressive effects mediated by interaction with glucocoritcoid response elements and inhibition of factors such as NF-kB

80
Q

Clinical use for glucocorticoids

A

Addison disease, inflammation, immune suppression, asthma

81
Q

Principal side effect of Glucocorticoids

A

Iatrogenic Cushing syndrome

82
Q

Clinical manifestations of iatrogenic cushing syndrome

A

Buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocotical atrophy, peptic ulcers

83
Q

Chronic effect of Glucocorticoids

A

Diabetes

84
Q

How is osteoporosis treated when caused by Glucocorticoids?

A

Biphosphonate

85
Q

Secondary effect when glucocorticoids stop ped abruptly after chronic use

A

Adrenal insufficiency

ENDOCRINE (4 decks)

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