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piggy > Endocrine - Pharmacology > Flashcards

Endocrine - Pharmacology Flashcards

1
Q

What is the basis of treatment of diabetes mellitus type 1?

A

Low-sugar diet and insulin replacement

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2
Q

What is the basis of treatment for diabetes mellitus type 2?

A

Dietary modification and exercise for weight loss, oral hypoglycemics, insulin replacement (late)

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3
Q

Name three short-acting insulins.

A

Lispro, aspart, regular

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4
Q

Is neutral protamine Hagedorn (NPH) insulin considered a short-, intermediate-, or long-acting insulin?

A

Intermediate-acting insulin

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5
Q

Name two long-acting insulins.

A

Glargine, detemir

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6
Q

Insulin binds insulin receptors which have ______ _____ signaling pathways.

A

Tyrosine kinase

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7
Q

For what electrolyte disturbance can insulin be used as a treatment?

A

Hyperkalemia

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8
Q

A patient is in the intensive care unit and noted to have a blood glucose of 225 mg/dL; what medication is appropriate for this condition?

A

Insulin is effective in treating stress-induced hyperglycemia

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9
Q

What is the most common adverse effect of insulin treatment?

A

Hypoglycemia; very rarely, one may see a hypersensitivity reaction

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10
Q

Name two first generation sulfonylureas.

A

Tolbutamide, chlorpropamide

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11
Q

Name three second generation sulfonylureas.

A

Glyburide, glimepiride, glipizide

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12
Q

Which diabetes drugs can cause a disulfiram-like reaction?

A

First-generation sulfonylureas

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13
Q

To which class of diabetes drugs does metformin belong?

A

Biguanides

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14
Q

To which class of diabetes drugs do pioglitazone and rosiglitazone belong?

A

Glitazones

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15
Q

Name two -glucosidase inhibitors.

A

Acarbose, miglitol

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16
Q

Describe the mechanism of action of sulfonylureas.

A

Sulfonylureas close the K+channel on the -cell membrane leading to cell depolarization and causing insulin release by increased calcium influx

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17
Q

Will sulfonylureas work in type 1 diabetes mellitus?

A

No; these drugs require islet cell function and the ability to secrete endogenous insulin (defective in type 1 diabetes)

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18
Q

What is an adverse effect of second-generation sulfonylureas?

A

Hypoglycemia

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19
Q

What is the mechanism of action of metformin?

A

Unknown; may decrease gluconeogenesis, increase glycolysis, thereby decreasing serum glucose levels; overall, it acts as an insulin sensitizer

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20
Q

True or False: Metformin can be used in patients without islet function.

A

True

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21
Q

Before prescribing metformin, it is important to assess the function of what organ?

A

Kidney; if metformin cannot be excreted it may build up leading to lactic acidosis

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22
Q

How do glitazones work?

A

They increase target cell response to insulin via the peroxisome proliferator-activated receptor-γ pathway

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23
Q

What are the side effects of glitazones?

A

Glitazones can cause weight gain, edema, hepatotoxicity, and cardiovascular toxicity

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24
Q

Acarbose and miglitol work by inhibiting what enzyme?

A

α-Glucosidase, an intestinal brush border enzyme; this results in decreased postprandial hyperglycemia

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25
Q

What is the principal toxicity of -glucosidase inhibitors?

A

Gastrointestinal disturbances

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26
Q

What is the mechanism of action of pramlintide?

A

Pramlintide is a mimetic of an endogenous hormone and acts by inhibiting glucagon

27
Q

What are some toxicities of pramlintide?

A

Hypoglycemia, nausea, diarrhea

28
Q

Give an example of a glucagon-like peptide-1 mimetic drug.

A

Exenatide; this drug was discovered in the saliva of the gila monster

29
Q

What is the mechanism of action of the GLP-1 mimetics?

A

Increases insulin and decreases glucagon

30
Q

What are toxicities of exenatide use?

A

Nausea, vomiting and possibly pancreatitis

31
Q

Orlistat works by inhibiting _____ _____.

A

Pancreatic lipases

32
Q

Orlistat is properly used for the long-term management of obesity in conjunction with what other therapy?

A

A modified diet (remember: orlistat gets rid of fat)

33
Q

What adverse effects are associated with the use of orlistat?

A

Steatorrhea, gastrointestinal discomfort, reduced fat-soluble vitamin absorption, and headache

34
Q

Which drug used in the treatment of obesity may result in vitamin A, D, E, and K deficiency?

A

Orlistat, which can reduce the absorption of fat-soluble vitamins

35
Q

Sibutramine works by inhibiting what processes?

A

The reuptake of serotonin and norepinephrine

36
Q

What are side effects of sibutramine?

A

Hypertension, tachycardia

37
Q

Sibutramine is used to treat what condition?

A

Sibutramine is used for the short-term and long-term management of obesity

38
Q

Methimazole and propylthiouracil inhibit what process?

A

Thyroid hormone synthesis (by inhibiting the organification and coupling of thyroid hormone)

39
Q

Propylthiouracil inhibits which biochemical pathway that methimazole does not?

A

Both affect thyroid hormone synthesis, but propylthiouracil also decreases the peripheral conversion of thyroxine to triiodothyronine

40
Q

What disorder is treated using methimazole or propylthiouracil?

A

Hyperthyroidism

41
Q

What are the known toxicities of methimazole and propylthiouracil?

A

Skin rash, aplastic anemia and agranulocytosis (rare)

42
Q

What laboratory test should be ordered to avoid a rare but devastating adverse effect when starting a patient on methimazole or propylthiouracil?

A

Complete blood count, to monitor for aplastic anemia or agranulocytosis

43
Q

What pharmacotherapies are used as thyroxine replacements in hypothyroidism?

A

Levothyroxine and triiodothyronine

44
Q

A patient with hypothyroidism and myxedema is started on thyroid replacement therapy; what should you tell him about the prognosis of his myxedematous changes?

A

Myxoedema can be treated by levothyroxine or triiodothyronine therapy

45
Q

What toxicities are associated with thyroid hormone replacement therapy?

A

Tachycardia, heat intolerance, tremors, arrhythmias (symptoms of hyperthyroidism)

46
Q

What are two medical indications for use of growth hormone?

A

Growth hormone deficiency, Turners syndrome

47
Q

List four indications for the use of octreotide.

A

Acromegaly, carcinoid tumor, gastrinoma, and glucagonoma

48
Q

List three processes that can be stimulated with the use of exogenous oxytocin.

A

Labour, uterine contractions, and milk let-down

49
Q

Following delivery, a woman continues to have uterine bleeding; what normally endogenous substance can be given to stop the blood loss?

A

Oxytocin (also known as pitocin)

50
Q

Can desmopressin be used in the treatment of nephrogenic diabetes insipidus?

A

No; desmopressin is an antidiuretic hormone analog that requires renal response and thus is effective only in pituitary diabetes insipidus

51
Q

A patient has hyponatremia with low serum osmolarity and high urine osmolarity; name a drug that works by antagonizing the defective pathway.

A

This is syndrome of inappropriate antidiuretic hormone secretion and can be treated by demeclocycline, which is an antidiuretic hormone antagonist

52
Q

What are the adverse effects of demeclocycline?

A

Photosensitivity, abnormalities of bones and teeth (demeclocycline is in the tetracycline family)

53
Q

What is the mechanism of action of glucocorticoids?

A

Decreases production of leukotrienes and prostaglandins by inhibiting phospholipase A2and expression of COX-2

54
Q

List five examples of glucocorticoid drugs.

A

Hydrocortisone, prednisone, triamcinolone, dexamethasone, and beclomethasone

55
Q

What endocrine disease causes hypotension and skin pigmentation and can be treated with glucocorticoids?

A

Addisons disease

56
Q

What medication can be injected into a joint to treat the inflammation associated with degenerative arthritis?

A

Glucocorticoids, which are potent antiinflammatories

57
Q

Give an example of a common pediatric pulmonary disease that can be treated with glucocorticoids.

A

Asthma

58
Q

A patient with a longstanding history of severe asthma, rheumatoid arthritis, and psoriasis has a buffalo hump and a blood glucose of 230 mg/dL; what is the likely cause of the hyperglycemia?

A

This patient has iatrogenic diabetes mellitus secondary to long-term glucocorticoid use

59
Q

Glucocorticoids can cause what iatrogenic endocrine disorder?

A

Cushings syndrome

60
Q

What is the effect of chronic glucocorticoid use on fat distribution?

A

Patients develop truncal obesity, a buffalo hump, and moon facies

61
Q

What effect does chronic glucocorticoid use have on the musculoskeletal system?

A

It can cause muscle wasting and lead to osteoporosis

62
Q

What effect can glucocorticoid toxicity have on the skin?

A

Thin skin and easy bruisability

63
Q

A patient who is on chronic glucocorticoid therapy becomes ill and is found to have very low blood pressure; how might this be related to the medication history?

A

Long-term glucocorticoid therapy may lead to adrenocortical atrophy and failure to mount a stress response during illness

64
Q

A patient is found to have peptic ulcer disease. His medications include hydrochlorothiazide, oral prednisone, and atenolol; which is most likely to cause his ulcers?

A

Peptic ulcers are an adverse effect of glucocorticoids

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