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Pharm Exam 3 > Endocrine stuff > Flashcards

Endocrine stuff Flashcards

1
Q

First line drug for Type II DM?

A

Metformin (Biguanide)

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2
Q

Main ADRs for Biguanide?

A

GI! NVD, bloating, anorexia…… Macrocystic Anemia B12 Deficiency

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3
Q

What Class are the follwing drugs?

Glyburide
Glypizide
Glimepiride

A

Sulfonylureas (2nd gen)

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4
Q

Mechanism of Sulfonylureas? (glypizide, glyburide)

A

Insulin Secretagogues!

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5
Q

Does Sulfonylureas target ppBG or FBG or both?

A

BOTH; sulfonylureas target both ppBG and FBG

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6
Q

Which Sulfonylurea has the highest incidence of Hypoglycemia?
Glyburide
Glypizide
Glimepiride

A

Glyburide has the highest incidence of hypoglycemia. (avoid in elderly)

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7
Q

Most common ADR of Sulfonylureas?

A

Hypoglycemia

Weight Gain

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8
Q

Which Sulfonylurea is the safest in pts with renal impairment?
Glyburide
Glypizide
Glimepiride

A

Glipizide is the safest sulfonylurea in pts with renal impairment.

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9
Q

What class are the following drugs?

Canagliflozin
Dapagliflozin
Empagliflozin

A

Sodium-Glucose Cotransporter 2 Inhibitors

SGLT2 Inhibitors

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10
Q

Mechanism of SGLT2 inhibitors

A

Reduces reabsorption of filtered glucose

lowers renal threshold for glucose, increases urinary glucose excretion

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11
Q

Most common ADR of SGLT2 inhibitors?

-gliflozins

A

UTI and Candidiasis

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12
Q

What class are the following drugs?

Liraglutide
Exenatide
Albiglutide
Dulaglutide
Lixisenatide
A

GLP 1 Agonisits

-tide

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13
Q

MOA of GLP 1 Agonists?

Exenatide, Liraglutide

A

Binds to/activates GLP-1 Receptor.
(Increases Insulin release from functioning Beta-cells)
(Decreases Glucagon release after meals)
(Decreases Hepatic Glucose production)

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14
Q

Use and Generic name of VICTOZA?

A

Liraglutide

Weight Loss

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15
Q

Contraindications for GLP 1 Agonists?

Exenatide, Liraglutide, Albiglutide

A

Gastroparesis
Pancreatitis
(ESRD - Exenatide)
(Thyroid CA - Liraglutide)

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16
Q

ADR of GLP 1 Agonists?

A 
GI problems (they decrease over time though)
May delay absorption of other drugs
(take 1 hr before or 3 hrs after eating)
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17
Q 
What class are the following?
                        (-gliptin)
Sitagliptin
Saxagliptin
Linagliptin
Alogliptin
A

DPP-4 inhibitors (-gliptin)

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18
Q

What Pathway do GLP 1 Agonists and DPP 4 Inhibitors affect?

A

INCRETIN pathway

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19
Q 
MOA of DPP-4 inhibitors? (-gliptin)
Sitagliptin
Saxagliptin
Linagliptin
Alogliptin
A

Prevents degradation and prolongs 1/2 life of GLP-1.

GLP-1 increases glucose-mediated insulin secretion, suppress glucagon secretion
(Glucose-dependent)

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20
Q

CI of DPP-4 inhibitors?

A

Pancreatitis hx (just like GLP-1 agonists)
DKA
Type 1 DM

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21
Q

Warnings for Saxagliptin (DPP-4 inhibitor)

A

Saxagliptin is more likely to decrease absolute lymphocyte counts…. increase incidence of CHF

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22
Q

ADRs for DPP-4 inhibitors? (-gliptin)

A

Requires adjustment for renal patients.

Alogliptin: pancreatitis, hepatotoxicity, SJS/TEN

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23
Q

DPP-4 inhibitors are WEIGHT NEUTRAL and do not cause Hypoglycemia as montherapy!

A

DPP-4 inhibitors lower A1C by 0.7%

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24
Q

Saxagliptin is metabolized by liver via P450!

A

Sitagliptin is not extensively metabolized (DPP-4 inhib)

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25
Q

How much do GLP-1 Agonits lower A1C?

Exenatide, Liraglutide, Albiglutide

A

1-1.5%

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26
Q

What class do Rosiglitazone and Pioglitazone belong?

-glitazone

A

Thiazolidinediones (-glitazone)

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27
Q

MOA of Thiazolidinediones?

Rosiglitazone
Pioglitazone

A

PPARg agonist
Increases Insulin sensitivity in Peripheral Tissues (fat, muscle, liver)
Decreases hepatic glucose output

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28
Q

Thiazolidinediones are endogenous insulin-dependent

A

Pt must be making insulin for process to work (Early type 2 DM)

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29
Q

How much can Thiazolidinediones lower A1C?

Rosiglitazone
Pioglitazone

A

0.8-1.5%

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30
Q

CI for Thiazolidinediones?

A 
CHF
Avoid in class 3 and 4 HR

CHF!

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31
Q

ADRs for Thiazolidinediones?

Rosiglitazone
Pioglitazone

A

Weight Gain
Anemia
Edema
CHF

potentialy bladder cancer for Pioglitazone
potentially MI for Rosiglitazone

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32
Q

Things to monitor when using Thiazolidinedons?

A

Rosiglitazone (Avandia)- increase LDL, TG, MI, Edema, HF, fractures

Pioglitazone (Actos)- increase HDL, Edema, HF, fx
decrease LDL, TG

Monitor LFTs!!! with both drugs

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33
Q

What class do the following belong?

Repaglinide
Nateglinide

A

Meglitinides (-glinide)

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34
Q

MOA of Meglitinides? (-glinide)

Repaglinide
Nateglinide

A

Stimulate insulin secretion from functioning Beta-cells

Glucose-Dependent stimulation of insulin secretion

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35
Q

How much do Meglintindes lower A1C?

A

0.5-1.5% (Repaglinide, Nateglinide)

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36
Q

Do Meglintinides target ppBG or FBG?

A

ppBG! (skip meal = skip dose) (add meal = add dose)

Repaglinide
Nateglinide

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37
Q

ADRs of Meglintinides (Repaglindie, Nateglinide)

A

Hypoglycemia

Weight gain

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38
Q

What class doe the following belong?

Acarbose
Miglitol

A

Alpha-Glucosidase Inhibitors

Acarbose, Miglitol

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39
Q

MOA of Alpha-Glucosidase Inhibitors?

Acarbose, Miglitol

A

Delay the breakdown and absorption of complex CHOs and sucrose.
Decrease ppBG

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40
Q

How much does Alpha-Glucosidase Inhibitors lower A1C?

A

0.5-1%

Acarbose, Miglitol

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41
Q

CI for Alpha-Glucosidase Inhibitors?

A

Bowel Stuff
(Inflammatory Bowel Dz, Short-bowel syndrom, Colonic ulceration, Partial Intestional Obstruction, Disorders of digestion/absorption)
Also Cirrhosis

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42
Q

ADRs of Alpha-Glucosidase Inhibitors?

Acarbose, Miglitol

A 
GI stuff (diarrhea, abd pain, FARTS!)
Elevated serum transaminases
43
Q

Can you use sucrose (soft drinks, candy) to treat Hypoglycemia on a patient taking Acarbose or Miglitol? (Alpha-Glucosidase Inhibitors)

A

NO!

Use a glucose tablet or gel, or fructose or lactose instead.

44
Q

Pramlintide belongs to what class of Diabetes meds?

A

Amylin Analog

Pramlintide

45
Q

MOA of Amylin Analog (Pramlintide)

A

Works w/ insulin to suppress postprandial glucagon secretions and slow gastric emptying.

(Reduces food intake -> weight loss)

46
Q

Can Pramlintide be used in T1DM?

amylin analog

A

Yes!

Can also be used in T2DM as adjunct therapy

47
Q

Which Amylin Analog:

Reduces A1C by 0.5-0.7%
Reduces ppBG in Type 1 DM
Weight loss by 1-1.5kg over 6 months

A

Pramlintide

the only Amylin Analog we have learned about.

48
Q

CI of Amylin Analog (Pramlintide)

A

Gastroparesis
Hypoglycemia unawarness
A1c > 9% (must be used early)
Pt unwilling to self monitor sugars

49
Q

T/F you must lower insulin dose by 30-50% before giving Pramlintide to T1DM.

(Amylin Analog)

A

True

50
Q

ADRs of Amylin Analog (Pramlintide)

A

Nausea, Vomiting, Anorexia, Hypoglycemia

51
Q

Caution using Pramlintide (Amylin Analog) in renal insufficiency.

A

BTW Its an injection into the abdomen or thigh.

52
Q

Colesevelam is a drug… whats it about?

A

Colesevelam lowers hepatic glucose production…. but its really used for cholesterol.

53
Q

Whats Bromocriptine about?

A

Bromocriptine improves glucose and energy metabolism….. but it’s really a dopamine agonist.

54
Q

How do you calculate average glucose from A1c?

A

(A1c - 2) x 30

55
Q

Classes of Diabetes drugs that Increase Insulin Sensitivity (2)

A
  1. Metformin

2. Thiazolidinediones

56
Q

Classes of Diabetes drugs that Increase Insulin Secretion (4)

A
  1. Sulfonylureas
  2. GLP-1 Agonists
  3. DPP-4 Inhibitors
  4. Meglitinides
57
Q

Classes of Diabetes drugs that decrease Hepatic Glucose Production (3)

A
  1. Metformin
  2. GLP-1 Agonist
  3. Thiazolidinediones
58
Q

Classes of Diabetes drugs that decrease glucagon secretion (3)

A
  1. GLP-1 Agonist
  2. DPP-4 Inhibitors
  3. Alpha-Glucosidase Inhibitors
59
Q

Classes of Diabetes drugs that reduce reabsorption of glucose in Kidneys (1)

A

SGLT2 Inhibitors

60
Q

Classes of Diabetes drugs that Delay breakdown/absorption of complex carbs & sucrose (1)

A

Alpha-Glucosidase Inhibitors

61
Q

What kinds of Insulins are these?
Aspart
Lispro
Glulisine

A

RAPID acting

Aspart, Lispro, Glulisine

62
Q

What kind of Insulins are these?

  1. Regular U-100
  2. Regular U-500
A

SHORT acting

  1. Orange cap (Novolin R)
  2. Brown cap (Humulin R)
63
Q

What kind of Insulin is this?

Neutral Protamine Hagedorn (NPH)

A

INTERMEDIATE acting

Humulin N, Novolin N

64
Q

What kind of Insulins are these?

  1. Glargine
  2. Detemir
  3. Degludec
A

LONG acting

65
Q

How are Short and Intermediate acting insulins produced?

Novolins and Humulins

A

Genetically altered E. Coli produce Human insulin.

66
Q

What is the name of T4?

A

Thyroxine (T4)

67
Q

What must most thyroid hormone (99%) be carried by?

A

Binding/Carrier Protein (Mostly TBG)

68
Q

What are the following drugs used to Treat?

Liothyronine
Thyroid USP
Levothyroxine

A

Hypothyroidism

69
Q

What are the following drugs used to Treat?

Methimazole
Propylthiouracil
B-Blockers

A

Hyperthyroidism

70
Q

Name a drug that is:

Synthetic T3
more stimulating than T4 (can be overstimulating)
Avoided in Pregnacy
Used to treat hypothyroidism

A

Liothyronine (Cytomel)

71
Q

Name a drug that is:

Desiccated pig thyroid
Contains T4, T3, T2, T1
Use to treat hypothyroidism

A

Thyroid USP (Armour Thyroid)

72
Q

Name a drug that is:

1st line tx for Hypothyroidism
Nearly bioidentical to native T4
Can be used in young healthy pts, preggers, and thyroid CA pts

A

Levothyroxine

73
Q

What are the ADRs for all hypothyroid drugs?

Liothyronine
Thyroid USP
Levothyroxine

A 
Palpitations, Insomnia, Nervousness
Iatrogenic Hyperthyroidism (Heart, Bone, Psych issues)
74
Q

Make sure to evaluate pt’s taking Levothyroxine at 5-6 week intervals until TSH normalizes.

A

Avoid Liothyronine (Cytomel) in pregnancy

75
Q

Name a drug that:

Blocks new thyroid hormone production
1st line in pts with Hyperthyroidism
Avoided in pregnancy/lactation
Can cause Rash, GI upset, arthralgias, HA

A

Methimazol (MMI)

76
Q

What is important to monitor in pts taking MMI?

Methimazol

A

LFTs, CBCs, TSH

Also stop drug if WBC is low (agranulocytosis)

77
Q

Name a drug that is:

Less effective than Methimazol (MMI)
Blocks thyroid hormone cnoversion and peripheral conversion of T4 to T3
Used EMERGENTLY for pts in thyroid storm who cannot tolerate MMI
Use during 1st trimester of pregnancy and lactation

A

Propylthiouracil (PTU)

78
Q

Warning with Propylthiouracil?

A

FDA warning due to liver failure.

79
Q

Name 4 beta-blockers that are used to treat Hyperthyroidism related Cardiac stuff.

A

Propanolol
Atenolol
Metoprolol
Nadolol

80
Q

Which beta-blocker helps the most with tremors associated with Hyperthyroidism.

Propanolol
Atenolol
Metoprolol
Nadolol

A

Propanolol

all decrease heart rate and tremors to some extent

81
Q

What must you be careful for when giving Beta-Blockers to pts with hyperthyroidism…. or any pt really

A

Beta-blockers affect the heart and Lung beta receptors (non-selective)…. be careful in heart and lung dz pts.

(-olol)

82
Q

What class do the following drugs belong?

Carbergoline
Bromocriptine

A

Dopamine Agonists

Used to treat Hyperprolactinemia and Acromegaly

83
Q

MOA of Cabergoline

A

Selective for Dopamine D2 receptors
Direct inhibiotry effect on prolactin secretion
Reduces serum prolactin 80-90%

84
Q

ADR of Carbegoline (Dostinex)

A

NV, Constipation, NA, Cardiac Valvulopathy (tricusp regurg)

85
Q

Half Life of Carbegoline?

A

65 hrs

86
Q

2 classes used to treat GH excess?

A

Somatostatin Analogue

GH Receptor Antagonist

87
Q

Octreotide and Lanreotide Autogel belong to what class of drug?

A

Somatostatin Analogue

used to treat GH excess (Acromegaly)

88
Q

Name the only GH receptor antagonist we learned about.

A

Pegvisomant (Somavert)

89
Q

MOA of Pegvisomant (Somavert)

A

Blocks GH effect of target tissues. Elevates GH concentration, lowers IGF-1. (Insulin-like growth factor)

Most Effective…. Expensive

90
Q

Name the drug used to treat GH deficiency.

A

Somatropin (humatrope, Genotropin, Nutropin)

91
Q

MOA of Somatropin?

A

GH replacement

92
Q

ADR of Somatropin? (GH replacement)

A

Intracranial tumors, glucose intolerance, diabetic retinopathy, fluid retension, intracranial HTN.

93
Q

What drug is used to treat ADH deficiency?

Diabetes insipidus

A

Desmopressin DDAVP

94
Q

MOA of Desmopressin DDAVP

A

Synthetic ADH analog (sub Q injectable)

95
Q

ADR of ADH deficiency treatment (Desmsopressin)

A

Nausea, Headache, Abd cramps, hyponatremia, thrombosis.

96
Q

Drug used to treat Pheochromocytoma while pt is waiting for 1st line tx which is surgical removal of tumor?

A

Phenoxybenzamine

97
Q

Phenoxybenzamin MOA?

A

Long acting Alpha Adrenergic Blocker
Increases blood flow
Lowers BP

98
Q

ADRs of Phenoxybenzain?

A

Hypotension, tachycardia, miosis, nasal congestion, ED

99
Q

Drug used to treat Adrenal Insufficiency Output?

Low cortisol levels

A

Hydrocortisone!

remember to stress dose!

100
Q

3 drugs used to treat Hypoparathyroidism?

A
  1. Calcium Gluconate
  2. Calcitriol
  3. Natpara (injection)
101
Q

MOA of Calcium Gluconate?

A

Raises Ca2+

used for calcium deficiency and black widow bites…

102
Q

MOA of Calcitriol?

A

Synthetic analog of Vit D3 (most potent), regulates Ca2+ absorption & utilization
(used after thyroid surgery hypocalcemia, dialysis)

103
Q

Indications of Natapara?

A

Hypocalcemia due to hypoarathyroidism

Last Line! - must use with Ca2+ and Vit D

104
Q

ADR of Calcitriol?

A

Hypercalcemia, Hypercalciuria, Hyperphosphatemia

Vit D intoxication

Pharm Exam 3 (3 decks)

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