Endocrine - Pharmacology Flashcards
What is the basis of treatment of diabetes mellitus type 1?
Low-sugar diet and insulin replacement
What is the basis of treatment for diabetes mellitus type 2?
Dietary modification and exercise for weight loss, oral hypoglycemics, insulin replacement (late)
Name three short-acting insulins.
Lispro, aspart, regular
Is neutral protamine Hagedorn (NPH) insulin considered a short-, intermediate-, or long-acting insulin?
Intermediate-acting insulin
Name two long-acting insulins.
Glargine, detemir
Insulin binds insulin receptors which have ______ _____ signaling pathways.
Tyrosine kinase
For what electrolyte disturbance can insulin be used as a treatment?
Hyperkalemia
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?
Insulin is effective in treating stress-induced hyperglycemia
What is the most common adverse effect of insulin treatment?
Hypoglycemia; very rarely, one may see a hypersensitivity reaction
Name two first generation sulfonylureas.
Tolbutamide, chlorpropamide
Name three second generation sulfonylureas.
Glyburide, glimepiride, glipizide
Which diabetes drugs can cause a disulfiram-like reaction?
First-generation sulfonylureas
To which class of diabetes drugs does metformin belong?
Biguanides
To which class of diabetes drugs do pioglitazone and rosiglitazone belong?
Glitazones
Name two -glucosidase inhibitors.
Acarbose, miglitol
Describe the mechanism of action of sulfonylureas.
Sulfonylureas close the K+channel on the -cell membrane leading to cell depolarization and causing insulin release by increased calcium influx
Will sulfonylureas work in type 1 diabetes mellitus?
No; these drugs require islet cell function and the ability to secrete endogenous insulin (defective in type 1 diabetes)
What is an adverse effect of second-generation sulfonylureas?
Hypoglycemia
What is the mechanism of action of metformin?
Unknown; may decrease gluconeogenesis, increase glycolysis, thereby decreasing serum glucose levels; overall, it acts as an insulin sensitizer
True or False: Metformin can be used in patients without islet function.
True
Before prescribing metformin, it is important to assess the function of what organ?
Kidney; if metformin cannot be excreted it may build up leading to lactic acidosis
How do glitazones work?
They increase target cell response to insulin via the peroxisome proliferator-activated receptor-γ pathway
What are the side effects of glitazones?
Glitazones can cause weight gain, edema, hepatotoxicity, and cardiovascular toxicity
Acarbose and miglitol work by inhibiting what enzyme?
α-Glucosidase, an intestinal brush border enzyme; this results in decreased postprandial hyperglycemia
What is the principal toxicity of -glucosidase inhibitors?
Gastrointestinal disturbances
What is the mechanism of action of pramlintide?
Pramlintide is a mimetic of an endogenous hormone and acts by inhibiting glucagon
What are some toxicities of pramlintide?
Hypoglycemia, nausea, diarrhea
Give an example of a glucagon-like peptide-1 mimetic drug.
Exenatide; this drug was discovered in the saliva of the gila monster
What is the mechanism of action of the GLP-1 mimetics?
Increases insulin and decreases glucagon
What are toxicities of exenatide use?
Nausea, vomiting and possibly pancreatitis
Orlistat works by inhibiting _____ _____.
Pancreatic lipases
Orlistat is properly used for the long-term management of obesity in conjunction with what other therapy?
A modified diet (remember: orlistat gets rid of fat)
What adverse effects are associated with the use of orlistat?
Steatorrhea, gastrointestinal discomfort, reduced fat-soluble vitamin absorption, and headache
Which drug used in the treatment of obesity may result in vitamin A, D, E, and K deficiency?
Orlistat, which can reduce the absorption of fat-soluble vitamins
Sibutramine works by inhibiting what processes?
The reuptake of serotonin and norepinephrine
What are side effects of sibutramine?
Hypertension, tachycardia
Sibutramine is used to treat what condition?
Sibutramine is used for the short-term and long-term management of obesity
Methimazole and propylthiouracil inhibit what process?
Thyroid hormone synthesis (by inhibiting the organification and coupling of thyroid hormone)
Propylthiouracil inhibits which biochemical pathway that methimazole does not?
Both affect thyroid hormone synthesis, but propylthiouracil also decreases the peripheral conversion of thyroxine to triiodothyronine
What disorder is treated using methimazole or propylthiouracil?
Hyperthyroidism
What are the known toxicities of methimazole and propylthiouracil?
Skin rash, aplastic anemia and agranulocytosis (rare)
What laboratory test should be ordered to avoid a rare but devastating adverse effect when starting a patient on methimazole or propylthiouracil?
Complete blood count, to monitor for aplastic anemia or agranulocytosis
What pharmacotherapies are used as thyroxine replacements in hypothyroidism?
Levothyroxine and triiodothyronine
A patient with hypothyroidism and myxedema is started on thyroid replacement therapy; what should you tell him about the prognosis of his myxedematous changes?
Myxoedema can be treated by levothyroxine or triiodothyronine therapy
What toxicities are associated with thyroid hormone replacement therapy?
Tachycardia, heat intolerance, tremors, arrhythmias (symptoms of hyperthyroidism)
What are two medical indications for use of growth hormone?
Growth hormone deficiency, Turners syndrome
List four indications for the use of octreotide.
Acromegaly, carcinoid tumor, gastrinoma, and glucagonoma
List three processes that can be stimulated with the use of exogenous oxytocin.
Labour, uterine contractions, and milk let-down
Following delivery, a woman continues to have uterine bleeding; what normally endogenous substance can be given to stop the blood loss?
Oxytocin (also known as pitocin)
Can desmopressin be used in the treatment of nephrogenic diabetes insipidus?
No; desmopressin is an antidiuretic hormone analog that requires renal response and thus is effective only in pituitary diabetes insipidus
A patient has hyponatremia with low serum osmolarity and high urine osmolarity; name a drug that works by antagonizing the defective pathway.
This is syndrome of inappropriate antidiuretic hormone secretion and can be treated by demeclocycline, which is an antidiuretic hormone antagonist
What are the adverse effects of demeclocycline?
Photosensitivity, abnormalities of bones and teeth (demeclocycline is in the tetracycline family)
What is the mechanism of action of glucocorticoids?
Decreases production of leukotrienes and prostaglandins by inhibiting phospholipase A2and expression of COX-2
List five examples of glucocorticoid drugs.
Hydrocortisone, prednisone, triamcinolone, dexamethasone, and beclomethasone
What endocrine disease causes hypotension and skin pigmentation and can be treated with glucocorticoids?
Addisons disease
What medication can be injected into a joint to treat the inflammation associated with degenerative arthritis?
Glucocorticoids, which are potent antiinflammatories
Give an example of a common pediatric pulmonary disease that can be treated with glucocorticoids.
Asthma
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?
This patient has iatrogenic diabetes mellitus secondary to long-term glucocorticoid use
Glucocorticoids can cause what iatrogenic endocrine disorder?
Cushings syndrome
What is the effect of chronic glucocorticoid use on fat distribution?
Patients develop truncal obesity, a buffalo hump, and moon facies
What effect does chronic glucocorticoid use have on the musculoskeletal system?
It can cause muscle wasting and lead to osteoporosis
What effect can glucocorticoid toxicity have on the skin?
Thin skin and easy bruisability
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?
Long-term glucocorticoid therapy may lead to adrenocortical atrophy and failure to mount a stress response during illness
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?
Peptic ulcers are an adverse effect of glucocorticoids
