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Pharmacology I JK > Endocrine Pharmacology > Flashcards

Endocrine Pharmacology Flashcards

1
Q

What are the drugs that can replace endogenous substances and cause REVERSE HYPO- effects?

A

Dextrose for hypoglycemia.
Calcium gluconate for hypocalcemia.
Levothyroxine for hypothyroidism.
DOCP/Fludrocortisone and prednisone for hypoadrenocorticism Addison’s.

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2
Q

Which drugs helps to regain normal calcium homeostasis?

A

Vitamin D/Calcitriol (for hypocalcemia from low PTH).

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3
Q

What is the underlying cause for the excess (HYPER)? What are the potential causes for the cause?

A

Lack of response to normal feedback!

Hyperplasia, benign neoplasia (Adenoma), malignant neoplasia (carcinoma).

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4
Q

What are the targets for drug therapy for HYPER- effects?

A

Destroy the abnormal tissue.
Inhibit production of the substance (METHIMAOLE: thyroid).
Increase elimination of the substance (saline diuresis: calcium).
Inhibit function of the substance (less common).

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5
Q

T/F. (Endocrine pharmacology) If there is an acute change, it needs to be reversed acutely, If it is an extremely gradual change then it should be reversed over a period of time.

A

True.

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6
Q

How do you know if it’s urgent to correct the disruption now?

A

Is the patient going to die now or has he/she had clinical signs for a long time?
Depends on the severity of the excess or deficiency and how rapidly it occurred (mild/gradual onset vs. severe/acute).
Have to know any consequences of correcting it too quickly.

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7
Q

T/F. You will be measuring numbers and numbers are important (numbers will inform your decisions) but treat the patient not their numbers.

A

True!!

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8
Q

What is an important question you need to ask yourself when considering endocrine drugs?

A

Negative feedback loops.

Is there hypo (lack of production of something) or hyper (lack of response to normal negative feedback)?

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9
Q

What is the goal of therapy in dogs that have hypothyroidism?

A

Replace hormone the body is not producing.

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10
Q

Which of the following is CORRECT about Levothyroxine (T4)/Soloxine?
A. A drug that is used to treat hyperthyroidism.
B. Requires less frequent dosing and has lower risk of causing thyrotoxicosis (Excessive T4 levels) than liothyronine.
C. Typically dosed in mg/ml.
D. Given topically BID (sometimes SID).

A

B. Requires less frequent dosing & has lower risk of causing thyrotoxicosis (Excessive T4 levels) than liothyronin.

  • USEd for hypothyroidism.
  • Typically dosed in mg/kg.
  • Given ORALLY BID (sometime SID).
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11
Q

Which of the following is CORRECT about pharmacologic considerations in dogs that have hypothyroidism?
A. Can be given once (and see if the patient gets better).
B. Phenobarbital, zonisamide, glucocorticoids, phenylbutazone, quinidine can interfere with thyroid test results.
C. Generic products are always better than Soloxine in dogs.
D. Do not need to monitor T4 levels.

A

B. Phenobarbital, zonisamide, glucocorticoids, phenylbutazone, quinidine can interfere with thyroid test results.

  • Must be given for the rest of the patient’s life.
  • Soloxine may give better control in some individuals.
  • Monitored by measuring T4 levels.
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12
Q

What is the goal of therapy for hyperthyroidism in cats?

A

Stop excessive hormone production.

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13
Q

Which of the following is CORRECT about pharmacologic considerations in cats that have hyperthyroidism? (Choose 2)
A. Tapazole is veterinary approved and Felimazole is human approved.
B. Thioureylenes (methimazole) used.
C. Side effects include neurological disorders.
D. Transdermal methimazole is compounded and has good bioavailability.

A

B. Thioureylenes (methimazole) used.
D. Transdermal methimazole is compounded and has good bioavailabity.

  • Tapazole: humans approves and Felimazole: veterinary approved.
  • Side effects: vomiting, hepatopathy, severe bone marrow suppression.
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14
Q

What are the clinical signs of acute hypocalcemia?

A

Hyperesthesia/pawing at face, tremors progressing to flaccid paralysis, seizures, hyperthermia, bradycardia.

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15
Q

What is periparturient hypocalcemia?

A

‘MILK FEVER’, eclampsia.

Sudden increase in calcium usage for which the patient cannot adapt rapidly enough (associated with birth/lactation).

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16
Q

What is CORRECT about pharmacologic considerations for acute hypocalcemia?

A. Parenteral calcium options: Ca Gluconate or Ca chloride.
B. Ca chloride should always be given SQ/IM.
C. Ca is compatible with all fluids and drugs.
D. Rapid IV administration of Ca can cause respiratory depression.

A

A. Parenteral calcium options: Ca Gluconate or Ca chloride.

  • Ca chloride should NEVER given SQ/IM.
  • Ca is incompatible with some fluids and drugs.
  • Rapid IV administration of Ca can cause arrhythmias (monitor ECG).
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17
Q

Which of the following is INCORRECT about Hypocalcemia from HypoPTH?
A. Oral calcium options: Ca carbonate, Ca proprionate
B. Hypoparathyroidism: inability of the body to convert vitamin D to its active form (Calcitriol).
C. May need to treat as for acute hypocalcemia in the short term (parenteral calcium, oral calcium).
D. There is no lifelong treatment.

A

D. There is no lifelong treatment.

Lifelong management exists: Calcitriol

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18
Q

Which of the following is CORRECT about calcitriol?

A. Most potent, activated form of vitamin E
B. Increase absorption of Ca from GIT and reduce loss through the kidney.
C. Side effect: hypocalcemia.
E. Easy to dose in smaller patients.

A

B. Increase absorption of Ca from GIT and reduce loss through the kidney.

  • Most potent, activated form of vitamin D.
  • Side effects: hypercalcemia.
  • Difficult to dose in smaller patients (no vet med approved).
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19
Q

Which of the following is CORRECT about Hypoglycemia?
A. You can never find the underlying issue of acute/transient hypoglycemia.
B. Dextrose 50% solution is given (bolus, IV, mucosal but not often SQ).
C. Glucagon is most commonly used and it’s given IV.
D. No tissue irritation when given SQ and IV dextrose must be less than 2.5-5.0%

A

B. Dextrose 50% solution is given (bolus, IV, mucosal but not often SQ).

  • Acute/Transient hypoglycemia: address the cause and supply exogenous glucose source.
  • Glucagon is rarely used and it’s given IV.
  • Tissue irritation when given SQ and IV dextrose must be >2.5-5.0%.
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20
Q

IF you had a patient on IV fluids with 600ml let in their bag and you wished to make it a 2.5% dextrose solution, how much 50% dextrose (stock solution) would you add to the bag?

A

Amount of stock to add = (%desired/%stock) x volume in bag

Need (ml) = (2.5%/50%) x 600ml = 30ML

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21
Q

T/F. 99% of T4 and T3 around bound to plasma proteins. The ramaining ~1% is free.

A

True.

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22
Q

Which of the following is INCORRECT regarding methimazole?
A. Methimazole only has an oral option
B. Mild GI signs (vomiting), severe and idiosyncratic reactions (facial excoriation)
C. Tapazole is human approved and Felimazole is vet approved.

A

A. Methimazole only has an oral option

Transdermal methimazole: compounded, good bioavailabiltiy.

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23
Q

T/F. Diabete mellitus = insulin deficiency and HYPOglycemia is a side-effect of not being able to put the glucose into tissue.

A

False.

Everything else is true except it’s HYPERglycemia

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24
Q

Which of the following is the cause of hyperglycemia?

A. The premise is false; none of them are causes of hyperglycemia.
B. Something does not require therapy (address the underlying issue - liver disease, stress, starvation, sepsis).
C. Diabete Mellitus.
D. Insulin deficiency.
E. All of the above.

A

E. All of the above

25
Q

What is the primary goal of hyperglycemia therapy?

A

To address the insulin (not “to bring down the blood glucose”).
In some situations, the glucose must come down very gradually.

26
Q

Which of the following is CORRECT about oral hypoglycemic agents (antidiabetic) regarding hyperglycemia therapy?

A. Cause hyperglycemia.
B. Sulfonylurea drugs such as glipizide is the only clinically relevant drug in vet med.
C. They are useful in Type I diabetes.
D. Used in both cats and dogs.
E. MOA: stimulate insulin secretion by the pancreatic beta-cells (via blocking Na+ channels to trigger AP) and decreases tissue sensitivity to insulin.

A

B. Sulfonylurea drugs such as glipizide is the only clinically relevant drug in vet med.

  • Cause HYPOglycemia (they don’t treat it).
  • Useful in Type II diabetes.
  • Used ONLY in cats.
  • MOA: Stimulate insulin secretion by the pancreatic beta-cells (via blocking K+ CHANNELS to trigger AP) and INCREASES tissue sensitivity to insulin.
27
Q

Which of the following is CORRECT about oral hypoglycemic agents (antidiabetic) regarding hyperglycemia?
A. Causes hypoglycemia but not significantly so these agents are safe.
B. Easier to pill than injecting.
C. May accelerate beta-cell loss.
D. Effective in all cats.

A

C. May accelerate beta-cell loss.

  • Causes SIGNIFICANT hypoglycemia so may not be safe.
  • Easier to inject than pill-ing
  • Effective in 20-30% of cats.
28
Q

Which of the following is FALSE about insulin?
A. Produced by beta-cells of the islets of Langerhans in the endocrine pancreas.
B. AA sequence highly preserved across species.
C. When blood GLC rises energy-dependent K+ channels close causing membrane depolarization and insulin release.
D. In peripheral tissues, the insulin binds to the receptors > GLC enter the cell.
E. High blood GLC suppresses insulin release > GLC transporters move back inside the cell.

A

E. High blood GLC suppresses insulin release > GLC transporters move back inside the cell.

LOW blood GLC suppresses insulin release > GLC transporters move back inside the cell.

29
Q

Which of the following is CORRECT about Insulin as a drug regarding hyperglycemia therapy?
A. Formulations: injectable (esp. SQ), Concentration differs between human and vet products.
B. Concentration is the same for humans and vet products (one type of syringes).
C. Stored on shelf.
D. Duration: only short acting insulins available for vet med.
E. Potency differs depending on formulations.

A

A. Formulations: injectable (esp. SQ), Concentration differs between human and vet products.

  • Concentration DIFFERS between humans and vet products (use appropriate syringes for the insulin type).
  • Duation: short, intermediate, long acting.
  • Potency: similar for various formulations (ONE EXCEPTION: Detemir).
30
Q

Which of the following is CORRECT about short-acting insulin?
A. “Crystalline” or neutral insulin (IV) and used in emergency cases.
B. Used as a rest-at-home drug.
C. Pharmacokinetics not predictable compared to other insulins.
D. IV in boluses

A

A. “Crystalline” or neutral insulin (IV) and used in emergency cases.

  • Used for hospitalized patients who are NOT eating.
  • Pharmacokinetics PREDICTABLE compared to other insulins.
  • IV CRI
31
Q

Which of the following statement is INCORRECT about Intermediate-acting insulins?
A. Drug: NPH, Vetsulin/Caninsulin
B. Given SC only and given BID (40 IU/mL).
C. Vetsulin/Caninsulin: human formation (not approved in vet med).
D. Good starting insulin types for dogs but may not be adequate in cats.

A

C. Vetsulin/Caninsulin: human formation (not approved in vet med).

Vetsulin/Caninsulin: vet med formulation (has special syringes).

32
Q

Which of the following is INCORRECT about Long-acting insulins?
A. Drugs: Protamine Zinc/PZI, Glargine, and detemir; Given BID.
B. Glargine: fast absorption.
C. PZI: shorter duration that other long-acting insulins.
D. PZI: vet approved drug.
E. Detemir: higher potency in dogs (4x) so requires special dosing and may be difficult to dose for small dogs.

A

B. Glargine: fast absorption.

Glargine: gradual absorption.

33
Q

T/F. There is a pen for Vetsulin/Caninsulin that is difficult to use and does not have precision of dosing.

A

False.

Pen for Vetsulin/Caninsulin: easy to use and precision of dosing.

34
Q

Match the following regarding coricosteroids.

A. Zona glomerulosa
B. Zona fasciculata
C. Zona reticularis
D. Medulla

  1. Glucocorticoids (cortisol)
  2. Sexual steroids (androgens)
  3. Mineralcorticoids (aldosterone)
  4. Catecholamines (epinephrine, Norepinephrine)
A

A - 3
B - 1
C - 2
D - 4

35
Q

Which of the following FALSE about corticosteroids?
A. Cortisol is an endogenous hormone.
B. Regulated by the hypothalamus/pituitary through release of CRH and ACTH.
C. Used for pain management.

A

C. Used for pain management.

Used for anti-inflammatory effects.

36
Q

What are corticosteroid drugs?

A

Prednisone, prednisolone, dexamethasone, triamcinolone, methyprednisolone.

37
Q

T/F. MOA of corticosteroids have non-genomic effects (glucocorticoid receptors in the membrane - rapid effects) and genomic effects (nuclear type CGRs > move into nucleus to increase/decrease gene expression).

A

True.

38
Q

Oral hypoglycemic agents

A

Glipizide

39
Q

Short acting insulin

A

Regular insulin (Humulin-R)

40
Q

Intermediate acting insulin

A

NPH (ISophane), Vetsulin/Caninsulin

41
Q

Long acting insulin

A

Protamine Zinc/PZI (Prozinc), Glargine (Lantus), Detemir (Levemir)

42
Q

T/F. Insulin deficiency can lead to loss of lean muscle.

A

True

43
Q

T/F. Hyperglycemia is a side effect of all the normal functions not working.

A

True

44
Q

Which of the following is CORRECT about physiologic effects of Glucocorticoids?
A. Decrease calcium excretion
B. Induce fever
C. Stimulate immune response (dose/duration dependent)
D. Lymphotoxic

A

D. Lymphotoxic

Lymphotoxic to treat cancer (lymphomas).

  • Increase calcium excretion (treat hypercalcemia).
  • Reduce fever
  • Suppress immune response (dose/duration dependent) -> high doses for a long time.
45
Q

Which of the following is NOT an adverse effect to glucocorticoids?
A. Cause PU/PD (MOST COMMON), impair healing
B. Catabolic in nature, inhibit fertility, abortion
C. Increase GI acid and decrease mucus (risk with NSAIDs).
D. Increase fat absorption/deposition, increase liver enzymes (ALP).
E. Polyphasia and deposit fat.
F. Agonize insulin (used in diabetics).

A

F. Agonize insulin (used in diabetics).

Antagonize insulin and should not be used in diabetics.

46
Q

What are the clinical uses of glucocorticoids?

A

Diagnostic testing (low dose dex suppression test, high dose dex suppression test), Physiologic replacement therapy (hypoadrenocorticism: Addison’s disease), Anti-inflammatory (allergies), Immunosuppressive (immune-mediated diseases).

47
Q

T/F. Non-genomic effects of corticosteroids take longer compared to genomic effects of corticosteroids.

A

False.

GENOMIC EFFECTS take longer.

48
Q

Which of the following is INCORRECT about pharmacokinetics of glucocorticoids?
A. Generally well absorbed orally or parenterally.
B. Protein bound.
C. Some must be hydrolyzed to release the steroid bone.
D. Metabolites excreted via lungs.

A

D. Metabolites excreted in urine.

  • Protein bound (Specific transporter: high affinity, low capacity; albumin secondary: low affinity, high capacity).
  • Hydrolysis: prednisone > prednisolone, Cortisone > cortisol, Methylprednisone > methylprednisolon.
49
Q

What are two pharmacologic considerations of glucocorticoids?

A

Potency and duration

50
Q

Which glucocorticoids has the highest potency?

A

Dexamethasone (~7.5x pred.)

  • For other steroids check if you are using them with a dosage designed for pred.
51
Q

T/F. Potency of glucocorticoids differ between products and most doses assume you are using pred.

A

True.

52
Q

Which of the glucocorticoids have the longest duration? Which ones are short acting?

A

Longest: Dexamethasone
Shortest: Hydrocortisone, Preds, Methylprednisolone

53
Q

T/F. You see side effects of short acting glucocorticoids after 24 hours. You do not see any side effects of long acting glucocorticoids since they had time to clear it from the body.

A

False.
You do not see any side effects of short acting glucocorticoids after 24 hours. YOU DO see side effects of long acting glucocorticoids because they accumulate.

54
Q

What are two categories ofd injectable steroids excipients?

A 
Salt esters (Na succinate, Na phosphate)
Insoluble esters (pivalate, acetate, acetonide)
55
Q

Which of the following is CORRECT about Salt esters (Na succinate, Na phosphate)?
A. Make the steroid insoluble.
B. Suitable for IV administration.
C. Onset may be faster with changed duration.

A

B. Suitable for IV administration.

  • Make the steroid MORE SOLUBLE.
  • Onset may be faster but UNCHANGED duration.
56
Q

Which of the following is INCORRECT about insoluble esters (privalate, acetate, acetonide)?
A. The premise is false; all choices are correct.
B. The less soluble the ester, the longer it will take to absorb (delayed onset, long duration) - depot.
C. NOT for ORAL use!

A

C. NOT for ORAL use

NOT for IV use (opaque suspensions)!!

57
Q

Match the correct glucocorticoids with its side effects.
A. Short term glucocorticoids
B. Long term glucocorticoids

  1. Not serious unless concurrent factors
  2. Hypertension, thromboembolic disease
  3. Panting, skin changes (hyperpigmentation, thinning, alopecia).
  4. PU/PD, fetal abrnomalities/abortion.
  5. Addisonian signs (dose must be tapered if on steroids more than a few days).
  6. Increased susceptibility infection due to immunosuppression.
  7. Labwork changes (stress leukogram, decreased thyroid values).
A

1, 4, 7 - A

2, 3, 5, 6 - B

58
Q

What are the two drugs of mineralocorticoids? What is the main purpose of these drugs?

A

Fludrocortisone, DOCP

To replace aldosterone (endogenous hormone)

59
Q

Which of the following is INCORRECT about Mineralcorticoids?
A. Produced by the zona glomerulosa
B. Regulate Na+ retention/K+ excretion by the kidney.
C. Fludrocortisone: given orally TID and has a small glucocorticoid activity.
D. DOCP: given IM, SC q25 days or longer.
E. Monitor by measuring K+/Na+.

A

C. Fludrocortisone: given orally TID and has a small glucocorticoid activity.

Given orally BID and has a small glucocorticoid activity.

Pharmacology I JK (7 decks)

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