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Pharmacology Test 3 > Endocrine System 1 > Flashcards

Endocrine System 1 Flashcards

1
Q

Cause of hypopituitarism

A

deficiency in any hormones

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2
Q

Anterior Pituitary hypopituitarism

A

deficiency in GH = dwarfism

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3
Q

Tx for dwarfism

A

replace GH with synthetic form somatropin

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4
Q

MOA of somatropin

A

increase bone, skeletal and organ growth, RBC mass, transport of water, electrolytes and fluid

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5
Q

AE of somatropin

A
  1. fluid retention/edema

2. muscle and joint pain

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6
Q

Posterior pituitary hypopituitarism

A

decreased ADH = Diabetes Insipidus

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7
Q

what is ADH also called?

A

Vasopressin

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8
Q

What does ADH normally do?

A

decrease water excretion by increasing urine concentration

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9
Q

Tx of Diabetes Insipidus

A

Desmopressin (DDAVP)

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10
Q

what is desmopressin?

A

synthetic form of Vasopressin (ADH)

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11
Q

administration route for Desmopressin?

A

1) . subcut.
2) . PO
3) . intranasal

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12
Q

MOA of desmopressin

A

increase water reabsorption @ kidney by increasing aquaporin 2 channel permeability

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13
Q

other indications for Desmopressin?

A

nocturia

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14
Q

Desmopressin AE

A

1) . dry mouth

2) . hyponatremia

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15
Q

What hormones does the Anterior Pituitary normally secrete?

A

1) . GH
2) . LH and FSH
3) . TSH
4) . ACTH
5) . Pr

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16
Q

What hormones do the posterior pituitary normally secrete?

A

1) . oxytocin

2) . ADH

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17
Q

Hyperpituitarism

A

excessive production of hormones from pituitary (typically anterior)

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18
Q

Hyperpituitarism results in which disease(s)?

A

1) . Gigantism

2) . Acromegaly

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19
Q

T/F: Gigantism occurs in children not adults

A

TRUE

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20
Q

what is gigantism in adults called?

A

Acromegaly

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21
Q

What causes acromegaly?

A

excessive GH

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22
Q

physiologic effects of acromegaly

A

1) . affects bone and soft tissue growth
2) . hyperglycemia
3) . cardiomeglia (increase risk for HTN and arrhythmias)

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23
Q

T/F: individuals with acromegaly have an increased risk for HTN and arrhythmias?

A

TRUE

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24
Q

TX for acromegaly

A

1) . surgery is 1st line - typically remove a tumor that is the cause
2) . medications follow surgery

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25
Q

Medications used in Tx of acromegaly

A

1) . somatostatin analogue

2) . GH receptor anatagonist

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26
Q

Therapeutic Concerns with Hypopituitarism Tx

A

1) . easy to over treat
2) . watch for AE of increased hormone levels
3) . communicate with endocrinologist any changes
4) . decreased GH = decreased BMD

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27
Q

T/F: there is an increased risk of bone fractures in individuals with dwarfism?

A

TRUE

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28
Q

what is slipped capital femoral epiphyses and who is at greater risk for it?

A

essentially a hip condition that causes hip dislocations.

Hypopituitarism has increased risk for it

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29
Q

Suffix for synthetic GHs

A

-trope/tropin

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30
Q

Various brand names for synthetic GHs

A

1) . Humatrope
2) . Genotropin
3) . Norditropin

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31
Q

Hyperthyroidism disease

A

Graves disease

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32
Q

S/sx of Graves disease

A

goiter, expothalmos, increased metabolism, nervousness, weight loss despite increased appetite

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33
Q

T/F: graves disease can result in thyroid storm

A

TRUE

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34
Q

what is thyroid storm

A

fatal symptoms of dehydration, tachycardia, delirium and fever

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35
Q

TX for graves disease

A

1) . anti-thyroid meds
2) . Radioactive Iodine
3) . Thyroidectomy

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36
Q

Antithyroid meds

A

1) . Methimazole

2) . Propylthirouracil (PTU)

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37
Q

Which antithryoid med is the preferred option?

A

Methimazole - smaller dose needed and no black box warning

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38
Q

PTU black box warning

A

heptatoxicity

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39
Q

MOA of antithyroid meds

A

blocks formation of T4 to T3 by inhibiting iodine oxidation

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40
Q

When are antithyroid meds used?

A

1) . mild cases
2) . older
3) . avoid radioactive iodine

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41
Q

AE of antithyroid meds

A

1) . rash
2) . GI upset
3) . arthralgia

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42
Q

how often is methimazole dosed?

A

one or 2x daily

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43
Q

how often is propylthirouracil dosed?

A

initially dosed 4x/day

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44
Q

T/F: methimazole can cause birth defects in 1st trimester of pregnancy?

A

TRUE

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45
Q

When is PTU preferred over methimazole

A

1) . during 1st trimester of pregnancy

2) . while breastfeeding

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46
Q

Rare AE of antithyroid meds

A

1) . agrunulocytosis

2) . heptotoxicity

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47
Q

s/sxs of agrunlocytosis

A

1) . fever
2) . sore throat
3) . mouth ulcers

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48
Q

what is radioactive iodine?

A

radioactive destruction of thyroid

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49
Q

AE for radioactive iodine?

A

hypothyroidism (will require life long treatment)

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50
Q

What other med can be used in trx of hyperthyroidism?

A

Propanolol&raquo_space; used to trx symptoms

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51
Q

Types of Hypothyroidism

A

1) . primary

2) . secondary

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52
Q

What is primary hypothryoidism?

A

autoimmune destruction of thyroid gland

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53
Q

What is secondary hypothryoidism?

A

1) . reduced secretion of TRH (hypothalamus)

2) . reduced secretion of TSH (pituitary)

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54
Q

S/Sxs of hypothyroidism (8)

A

1) . bradycardia
2) . anemia
3) . lethargy
4) . wt gain
5) . cold intolerance
6) . menstrual irregularities
7) . general muscle weakness
8) . Goiter is possible

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55
Q

Tx for hypothyroidism

A

Levothyroxine (Synthroid)

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56
Q

What is levothyroxine

A

synthetic T4 > it is the DOC for hypothyroidism b/c it is cheap

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57
Q

MOA of Levothyroxine

A

synthetic T4 is converted to T3

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58
Q

T/F: Levothyroxine is an NTI drug?

A

TRUE&raquo_space; requires monitoring and dose adjustments

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59
Q

AE of Levothyroxine (Synthroid)?

A

overall well tolerated unless overtreated:

1) . sweating
2) . heat intolerance
3) . tachycardia
4) . diarrhea
5) . nervousness
6) . menstrual irregularities
7) . increased BMR

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60
Q

Special considerations for Levothyroxine (2)

A

1) . take on empty stomach

2) . don’t take along with Fe, Ca, Mg, Al containing products

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61
Q

T/F: chronic hypothyroidism can increase your risk of CV disease?

A

TRUE

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62
Q

Types of hyperparathyroidism

A

1) . primary

2) . seconday

63
Q

Cause of primary hyperparathyroidism

A

1) . parathyroid adenoma

2) . hyperplasia or carcinoma

64
Q

Causes of secondary hyperparathyroidism

A

underlying conditions such as chronic kidney disease > Ca lvls become low triggering release of PTH

65
Q

TX options of primary hyperparathyroidism

A

1) . surgery

2) . medications

66
Q

Medications used to trx hyperparathyroidism

A

1) . Calcimimetics

2) . Bisphosphonates

67
Q

MOA of calcimimetics

A

competitive antagonist of Ca receptors &raquo_space; decreases PTH secretion

68
Q

AE of calcimimetics

A

1) . most common: N/V

2) . monitor for hypocalcemia

69
Q

TX options for secondary hyperparathyroidism

A

treat underlying condition

70
Q

Causes of Hypoparathyroidism

A

All result in hypocalcemia

1) . injury during surgery
2) . autoimmune disease
3) . congenital defect

71
Q

TX for hypoparathyoidism

A

1) . Calcium 1-3 grams/day

2) . Vitamin D

72
Q

Over treatment of hypoparathyroidism can cause _________

A

1) . hypercalcemia

2) . hypercalciuria&raquo_space; leading to nephrolithiasis

73
Q

The adrenal glands secrete from what regions?

A

1) . Cortex

2) . medulla

74
Q

What is secreted from the medulla of the adrenal glands?

A

1) . NE

2) . epinephrine

75
Q

What is secreted from the cortex of the adrenal glands?

A

1) . mineralocorticoids
2) . glucorticooids
3) . some sex steroid

76
Q

What is an example of a mineralocorticoid?

A

Aldosterone

77
Q

What do mineralocorticoids do?

A

effects electrolyte/water balance

78
Q

What do glucocorticoids do?

A

effect carb/fat metabolism

79
Q

What are some examples of glucocorticoids?

A

1) . hydrocortisone

2) . cortisol

80
Q

A deficiency of mineralocorticoids is called _____

A

Hypoaldosteronism

81
Q

What disease is primarily associated with hypoaldosteronism?

A

Addison’s Disease

82
Q

What causes Addison’s disease?

A

1) . general adrenocoticoid insufficiency&raquo_space; autoimmune system destroys adrenal cortex (main cause)
2) . defective aldosterone producing enzyme (rare)

83
Q

TX for Addison’s disease

A

Fludrocortisone (synthetic aldosterone)

84
Q

What is excessive production of aldosterone called?

A

hyperaldosteronism

85
Q

causes of Hyperaldosteronism?

A

1) . Adrenal tumor (Conn’s syndrome)

2) . Adrenal hyperplasia

86
Q

Tx for Conn’s syndrome

A

Surgery

87
Q

Tx for adrenal hyperplasia

A

1) . Spironolactone

2) . Eplerenone

88
Q

why are diuretics used to treat hyperaldosteronism

A

they are aldosterone receptor antagonists

89
Q

which diuretic tx for hyperaldosteronism have less AE?

A

Eplerenon (selective for aldosterone receptors, Spironolactone is nonselective)

90
Q

S/Sxs of Hyperaldosteronism (7)

A

1) . muscle weakness
2) . fatigue
3) . paresthesias
4) . headache
5) . polydipsia
6) . nocturnal polyuria
7) . HTN

91
Q

What is excessive production of glucocorticoids called?

A

1). Cushing’s syndrome

92
Q

What is Cushing’s syndrome due to?

A

Hypercortisolism

93
Q

what can lead to hypercortisolism?

A

1) . take too much
2) . make too much
3) . tumor on pancreas/thyroid telling adrenal gland to make too much

94
Q

TX options for Cushing’s syndrome?

A

1) . surgery (1st line)

2) . meds surrounding surgery

95
Q

Medications used as adjunct TX in Cushing’s syndrome?

A

1) . Steroidogenesis inhibitors

2) . Glucocorticoid-antagonist

96
Q

Glucocortioid deficiency types

A

1) . primary adrenal insufficiency

2) . secondary adrenal insufficiency

97
Q

What is primary adrenal insufficiency?

A

Addison’s Disease&raquo_space; autoimmune destruction of adrenal cortex

98
Q

Primary adrenal insufficiency results in what ______?

A

deficiency of both mineralcorticoids and glucocorticoids

99
Q

What causes secondary adrenal insufficiency?

A

Too much exogenous corticosteroid admin&raquo_space; suppresses hypothalamic-pituitary-adrenal axis&raquo_space; decreased ACTH release

100
Q

What does secondary adrenal insufficiency tell us about steroid dosages?

A

It is important to taper off of steroids

101
Q

TX for primary and secondary adrenal insufficiency

A

1) . Both = replace glucocorticoids (hydrocortisone, prednisone, cortisone)
2) . primary = fludrocortisone as well (replace aldosterone)

102
Q

Short term AE of primary/secondary adrenal insufficiency TX

A

1) . increased blood glucose
2) . mood changes
3) . fluid retention

103
Q

Long term AE of primary/secondary adrenal insufficiency TX

A

1) . osteoporosis (increased fracture risk)
2) . thin skin
3) . muscle wasting
4) . poor wound healing
5) . Adrenal suppresion
6) . Cushing’s syndrome
7) . increased risk of infection

104
Q

T/F: exercise and increased stress will require higher med dosing for glucocortioid deficiencies?

A

TRUE

105
Q

Therapeutic Concerns of Adrenal Steroids

A

1) . lots of pts w/dif disorder use them (RA, lupus, bursitis, etc.)
2) . catabolic effect on supporting tissue&raquo_space; fall risk ! do not overload
3) . can cause HTN
4) . immunosupressive = increase infection risk
5) . drug toxicity&raquo_space; mood changes, psychoses

106
Q

Stimulation cascade for sex hormones

A

Hypothalamus releases GnRH –> Ant. pituitary gland releases LH and FSH –> stimulates gonads to release sex hormones

107
Q

Effects of testosterone (6)

A

1) . masculinizing effects
2) . development of male genitals in embryo
3) . increase muscle/bone size
4) . stimulates synthesis of clotting factors in liver
5) . stimulates production of erythropietin in kidneys
6) . regulates LH production from ant pituitary

108
Q

Types of testosterone deficiency

A

1) . primary

2) . secondary

109
Q

what causes primary testosterone deficiency?

A

testicular failure

110
Q

what cause secondary testosterone deficiency?

A

decreased GnRh

111
Q

S/Sxs of testosterone deficiency? (8)

A

1) . delay in puberty
2) . low energy
3) . decreased libido
4) . ED
5) . decreased pubic hair
6) . anemia
7) . osteoporosis
8) . muscle atrophy

112
Q

TX for testosterone deficiency

A

exogenous admin of testosterone (IM or topical)

113
Q

T/F: perfectly safe to administer testosterone PO?

A

FALSE&raquo_space; risk of heptatoxicity

114
Q

IM admin of testosterone considerations

A

1) . variable symptom relief (cycle between high to low)
2) . mood changes
3) . can cause hepatic adenomas

115
Q

topical admin of testosterone considerations

A

keep it covered so no contact

116
Q

Risks/AE with testosterone administration

A

1) . increased risk of MI, stroke, CV death
2) . hepatotoxicity (long-term)
3) . large doses may cause infertility

117
Q

AE of testosterone in Athletic populations (11)

A

1) . acne
2) . MI, CV death, VTE
3) . PE
4) . Cancer (testicular or prostate)
5) . injection site infections
6) . feminization
7) . menstrual irregularities (in women)
8) . tendon/ligament rupture
9) . insomnia
10) mood disorder
11) . aggressiveness

118
Q

Therapeutic concerns with testosterone TX

A

1) . monitor BP

2) . athletic use of androgens

119
Q

Role of estrogen (4)

A

1) . develops female genitals in embryo
2) . causes puberty and female specific changes
3) . deposition of subcutaneous fat stores
4) . widens pelvic girdle

120
Q

What is the menstrual cycle?

A

28 day cycle. regulated by interaction between pituitary and ovarian hormones

121
Q

Positive feedback loop in Menstrual cycle

A

1) . low estrogen levels increase LH release

2) . LH release further increases estrogen

122
Q

Negative feedback loop in Menstrual cycle

A

LH and FSH are inhibited during second half of cycle from high estrogen and progesterone levels

123
Q

What does the altering normal control between pituitary and ovarian hormones provide?

A

contraceptive control

124
Q

Estrogen and Progesterone Medical uses

A

1) . Contraceptives

2) . Post-menopausal hormone replacement therapy (HRT)

125
Q

Types of Contraceptives

A

1) . Combination Oral contraceptive (COC)

2) . Long-acting intrauterine device (IUD)

126
Q

common COC AEs (6)

A

1) . increased BO
2) . N/V
3) . weight gain
4) . acne
5) . depression
6) . topical rxn

127
Q

Rare COC AEs (3)

A

1) . DVT/PE
2) . Stroke
3) . MI

128
Q

T/F: the risk for MI from contraceptive use increases after 35 years of age?

A

TRUE, also if uncontrolled smoker and diabetic

129
Q

T/F: AE of N/V from COC generally improve after 2-3 cycles?

A

TRUE

130
Q

Complications from IUDs?

A

pelvic inflammatory disease

131
Q

Goals of HRT?

A

1) . decrease menopausal symptoms
2) . increase BMD
3) . decrease fracture risk

132
Q

TX for HRT

A

1) . estrogen only (if no uterus)

2) . estrogen + progestogens

133
Q

Route of admin for estrogen (4)

A

1) . PO
2) . transdermal patch/spray
3) . topical gel/solution
4) . vaginal ring/cream

134
Q

Estrogen AE (4)

A

1) . nausea
2) . HA
3) . breast tenderness
4) . vaginal bleeding

135
Q

Progestogens admin

A

1) . PO

2) . patch

136
Q

Progestogens AE (4)

A

1) . bloating
2) . headache
3) . weight gain
4) . irritability

137
Q

Known risks with HRT TXs

A

1) . DVT
2) . PE
3) . gallbladder disease
4) . breast cancer (with combo)
5) . endometrial cancer (with estrogen alone)

138
Q

General Men’s health disorder

A

Benign prostatic hypertrophy (BPH)

139
Q

TX options for BPH

A

1) . Alpha-adrenergic antagonists
2) . 5a-reductase inhibitors
3) . anticholinergic agents
4) . B3-adrenergic agonsit

140
Q

Alpha-adrenergic antagonist used for BPH

A

Tamsulosin

141
Q

MOA of tamsulosin

A

relax smooth muscle in prostate and bladder neck

142
Q

5a-reductase inhibitor used for BPH

A

finasteride

143
Q

MOA of finasteride

A

interfere with stimulatory effects of testosterone

144
Q

AE of tamsulosin and finasteride

A

Hypotension

145
Q

Anticholinergic agents used to treat BPH

A

oxybutynin

146
Q

MOA of oxybutynin

A

antispasmodic effect on smooth muscle&raquo_space; blocks acetylcholine on smooth muscle

147
Q

AE of oxybutynin

A

ABCDs

148
Q

B3-adrenergic agonist used to treat BPH

A

mirabegron (Myrbetriq)

149
Q

MOA of mirabegron (Myrbetriq)

A

relaxes detrusor muscle to decrease voiding symptoms

150
Q

AE of mirabegron (Myrbetriq)

A

may increase BP

151
Q

Other indication for mirabegron (Myrbetriq)

A

OAB

152
Q

Male to Female gender transition meds

A

1) . Estrogen and Progesterone
2) . Spironolactone (testosterone blocker)
3) . Finasteride (testosterone blocker)

153
Q

Female to Male gender transition meds

A

testosterone

154
Q

T/F: sex at birth still defines some risks for individuals undergoing gender transition?

A

TRUE

Pharmacology Test 3 (10 decks)

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