Endocrine system Flashcards
Solubility of peptide/proteins
Water
Solubility of catecholamines
Water
Solubility of Iodothyronines
Lipid
Solubility of steroids
Lipid
Anterior pituitary hormones
GH, LH/FSH, TSH, ACTH, PRL
Posterior pituitary hormones
ADH, oxytocin
Drug to replace ADH and indications
Desmopressin
Used for neurogenic DI, primary nocturnal enuresis, and hemophilia A
Drugs to replace dopamine
Bromocriptine, Cabergoline
Used for hyperprolactinemia
Drug to replace GH
Somatropin
Used for growth failure
Drug to replace somatostatin
Octreotide
Used for acromegaly/gigantism, pancreatic/GI tumors
Drug to replace ACTH
Cosyntropin
Used for infantile spasms
Major androgens
Testosterone, DHT, and estrogen
Testosterone action
Spermatogenesis, muscle growth, bone growth, increased RBC
DHT action
Acne, male pattern baldness, prostatic hyperplasia
Therapeutic uses for endogeneous androgens
Male hypogonadism, decrease in testosterone with aging, genetics
Testosterone derivatives used for anabolic steroids
Methyltestosterone and nandrolone
DHT derivatives
Oxandrolone and Stanozol
Adverse effects of anabolic steroids
Increased HR and htn, polycythemia, increased liver enzymes and decreased clotting factors, glucose intolerance, increased risk of BPH, acne, baldness, aggressiveness
Treatment of BPH
5a reductase inhibitors to block production of DHT
Finasteride and Dutasteride
Most prevalent natural estrogen
17B-estradiol
Clinical uses for estrogen
Oral contraceptives, postmenopausal, hypogonadism, dysmenorrhea, abnormal uterine bleeding
Adverse effects of giving estrogen
Nausea, bloating, HA, thromboembolism, increased breast cancer and endometrial cancer risk
Contraindications for estrogen
Thromboembolitic disease, cerebral vascular disease, MI, CAD, smoking, breast CA, endometrial CA, known or suspected pregnancy, impaired liver function
Conjugated equine estrogens
Used for hormone replacement therapy
Ethinyl Estradiol
Used in oral contraceptive pills
Raloxifene
Used to treat osteoporosis, does not increase risk of CA
Clomiphene
Increase ovulation
increases risk of multiple births
Natural progestins
Pregnenolone, 17a-hydroxypregnenolone, progesterone, 17a-hydroxyprogesterone
Progestins are precursors for
Androgens, estrogens, glucocorticoids
Effects of giving progestin
Maturation of endometrium, LH surge, breast growth
Clinical uses of progestin
Combo with estrogen to decrease risk of CA, progestin only OC for lactating women
Adverse effects of progestin
Weight gain, hirsutism, acne, tiredness, depression, glucose intolerance, increased LDL and decreased HDL
Adrenocortical steroids
Glucocorticoids and mineralocorticoids
Involved in metabolism, blood pressure due to salt retention, immune system and inflammation, CNS
Main endogenous glucocorticoid
Cortisol
Therapeutic uses for glucocorticoids
Management of inflammatory disorders, immunosupressants, congenital defects in steroid synthesis, treatment of glucocorticoid deficiency, fetal lung maturity
Most common synthetic glucocorticoids
Hydrocortison, prednisolone, prednisone, betamethasone
Adverse effects of synthetic glucocorticoids
Drug induced cushing syndrome, ACTH suppression
Main endogenous mineralocorticoids
Aldosterone
Fludrocortisone
Used in patients with adrenal insufficiency
Goal of tx of type 2 diabetes
HbA1c <7%
Lispro + Aspart
5-5 min onset
1-1.5 hour peak
3-4 hour duration
Human regular insulin
30-60 min onset
2 hour peak
6-8 hour duration
Human NPH
2-4 hour onset
6-7 hour peak
10-20 hour duration
Glargine
1.5 hour onset
flat- no peak
24 hour duration
Detemir
1 hour onset
flat-no peak
17 hour duration
MOA of insulin admin
Insulin receptor stimulation activates tyrosine kinase receptor
Causes up regulation of GLUT 4 increasing glucose uptake
Increases glucose utilization in liver and muscle
Metformin
given PO for type 2 diabetes
Does not increase insulin so does not cause hypoglycemia or weight gain
Increases tissue sensitivity to insulin
Adverse effects of metformin
lactic acidosis, decreased absorption of folate and B12, GI upset
Sulfonylureas
Increase insulin release
Block ATP dependent K+ channels in beta cells of pancreas
First generation: -amide
Second generation: gli -ide
Thiazolidinediones
Stimulate PPAR-gamma altering expression of insulin-responsive genes; sensitize tissues to insulin and decrease hepatic gluconeogenesis
Similar to metformin
GLP-1 agonist
-glutides
GLP-1 is released by gut after oral administration of glucose: increases insulin and decreases glucagon
DPP-4 inhibitors
Prolong action of endogenous GLP-1
-gliptins
Treatment of hypothyroidism
Levothyroxine- T4
Propylthiouracil and methimazole
Thyroid peroxidase inhibitors
Blocks formation of thyroid hormones– tx for hyperthyroidism
Propranolol
Blocks conversion of T4 to T3
Used for symptomatic relief of hyperthyroidism
Initial DOC in thyroid storm
Radioactive Iodine
Destroys thyroid gland
Vitamin D supplementation used for
Rickets, osteomalacia, hypothyroidism
No effect on osteoporosis
Biphosphanates
Stabilize hydroxyapatite bone structure
Used for Paget disease and osteoporosis
-dronate
Calcitonin
Inhibits osteoclastic bone resorption
Administered as intranasal spray for post menopausal osteoporosis
Teriparatide
PTH analog
Stimulates osteoblasts if taken only once a day
Increased risk of osteosarcoma