Endocrinology and Toxicology - Drugs Overview Flashcards
Cyanide Poisoning:
What are the possible drugs for treatment?(3)
1) Amyl nitrite (inhaled antidote)
2) Sodium nitrite (IV antidote)
3) Sodium thiosulfate (IV antidote)
Cyanide Poisoning:
Treatment Mechanism of Amyl nitrite (inhaled antidote)
and Sodium nitrite (IV antidote)
Nitrites oxidize some of the hemoglobin’s iron
(ferrous → ferric), converting Hgb into methemoglobin.
Cyanide binds to methemoglobin, forming
cyanmethemoglobin, thus releasing cyanide from
cytochrome oxidase
Cyanide Poisoning:
Treatment Mechanism of Sodium thiosulfate
(IV antidote)
Induces a metabolising enzyme, producing sodium
thiocyanate, which is excreted in urine
Cholinesterase inhibitors poisoning:
What are the possible drugs for treatment?(2)
Atropine and Pralidoxime
Cholinesterase inhibitors poisoning:
Treatment Mechanism of Atropine
Muscarinic receptor antagonist
Cholinesterase inhibitors poisoning:
Treatment Mechanism of Pralidoxime
Reactivation of cholinesterase enzyme
alters interaction between poison and Ach
Benzodiazepine poisoning:
What are the possible drugs for treatment?
Flumazenil
Benzodiazepine poisoning:
Treatment Mechanism of Flumazenil
Benzodiazepine binding site antagonist
Methanol Poisoning:
What are the possible drugs for treatment?
Fomepizole (Also Ethanol)
Methanol Poisoning:
Treatment Mechanism of Fomepizole
Competitive inhibitor of alcohol dehydrogenase
Lead Poisoning:
What are the possible drugs for treatment?(2)
Calcium EDTA and Dimercaprol (BAL)
Lead Poisoning:
Treatment Mechanism of Calcium EDTA and Dimercaprol (BAL)?
Chelating Agents
Opioids Poisoning:
What are the possible drugs for treatment?(2)
Nalorphine and Naloxone
Opioids Poisoning:
Treatment Mechanism of Nalorphine
μ-receptor antagonist
Opioids Poisoning:
Treatment Mechanism of Naloxone
Opioid antagonist
Digoxin toxicity:
What are the possible drugs for treatment?(2)
Lidocaine and Anti-Digoxin Antibodies
Digoxin toxicity:
Treatment Mechanism of Anti-Digoxin Antibodies
Neutralize the effect of the drug
Digoxin toxicity:
Treatment Mechanism of Lidocaine
Antiarrhythmic (Na+-channel blocker)
β-blockers - Mode of action:
- Blood pressure ↓
- Cardiovascular effects
ACE inhibitors - Mode of action:
- Blood pressure ↓
- Cardiovascular effects
Angiotensin inhibitors - Mode of action:
- Blood pressure ↓
- Cardiovascular effects
Ca2+ channel blockers - Mode of action:
- Blood pressure ↓
- Cardiovascular effects
Diuretics - Mode of action:
- Reduce edema and fluid retention
- Improves CHF
Statin - Mode of action:
Reduce cholesterol absorption
Aspirin - Mode of action:
Anti-Platelet Aggregation
Clopidogrel - Mode of action:
Anti-Platelet Aggregation
Hyperprolactinemia:
What are the possible drugs for treatment?
Bromocriptine
Hyperprolactinemia:
Treatment Mechanism of Bromocriptine
Dopamine agonist (inhibits PRL release)
Acromegaly:
What are the possible drugs for treatment?(3)
1) Bromocriptine
2) SST Analogues
3) GH Analogues
Acromegaly:
Treatment Mechanism of Bromocriptine
Dopamine agonist
potential GH release inhibitor
Acromegaly:
Treatment Mechanism of Somatostatin analogues
Inhibition of GH release
Acromegaly:
Treatment Mechanism of GH Analogues
Antagonizes endogenous GH by blocking
GH binding to its receptor in the liver
Central Diabetes Insipidus:
What are the possible drugs for treatment?
Desmopressin
Central Diabetes Insipidus:
Treatment Mechanism of Desmopressin
ADH analogue (V2 receptor agonist)
Nephrogenic Diabetes Insipidus:
What are the possible drugs for treatment?
Hydrochlorothiazide (HCTZ)
Nephrogenic Diabetes Insipidus:
Treatment Mechanism of Hydrochlorothiazide?
Enhance fluid reabsorption in proximal tubule
SIADH:
Treatment Mechanism of Demeclocycline?
ADH inhibitor; V2 receptor antagonist
SIADH:
What are the possible drugs for treatment?
Demeclocycline
Adrenocortical Hypofunction:
What are the possible drugs for treatment?(2)
Hydrocortisone Dexamethasone
Adrenocortical Hypofunction:
Treatment Mechanism of Hydrocortisone ?
Synthetic Cortisol
Adrenocortical Hypofunction:
Treatment Mechanism of Dexamethasone?
Glucocorticoid analogue
Hyperthyroidism:
What are the possible drugs for treatment?(2)
Carbimazole and Propylthiouracil (PTU)
Hyperthyroidism:
Treatment Mechanism of Propylthiouracil (PTU)?
Inhibits thyroid peroxidase
Inhibits deiodinase enzyme (T4 → T3)
Hyperthyroidism:
Treatment Mechanism of Methimazole (Carbimazole)?
Inhibits thyroid peroxidase enzyme
Hypothyroidism:
What are the possible drugs for treatment?
Levothyroxine
Hypothyroidism:
Treatment Mechanism of Levothyroxine?
Synthetic T4
Hypercalcemia (Hyperparathyroidism):
What are the possible drugs for treatment?(4)
1) Loop diuretics (Furosemide)
2) Calcitonin
3) Bisphosphonate
4) Calcimimetic agent (Cinacalcet)
Hypercalcemia (Hyperparathyroidism):
Treatment Mechanism of Furosemide?
Decreases Ca2+ renal reabsorption
Hypercalcemia (Hyperparathyroidism):
Treatment Mechanism of Calcitonin?
Inhibits osteoclast activity
Hypercalcemia (Hyperparathyroidism):
Treatment Mechanism of Bisphosphonate?
Inhibits osteoclast activity
by inducing Apoptosis after phagocytosed
Hypercalcemia (Hyperparathyroidism):
Treatment Mechanism of Cinacalcet?
Shunting-off parathyroid activity
Increases sensitivity of Ca2+ sensing
Hyperlipidemia:
What are the possible drugs for treatment?(7)
1) HMG-CoA reductase inhibitor (Statin)
2) Cholesterol absorption inhibitor (Ezetimibe)
3) Bile acid sequestrants
4) MTP inhibitor (microsomal triglyceride transfer protein)
5) Apo-B inhibitor
6) Nicotinic acid
7) Omega-3 fatty acids
Hyperlipidemia:
Treatment Mechanism of Statin?
HMG-CoA reductase inhibitor:
Cholesterol synthesis ↓
Hepatic LDL receptors ↑
VLDL production ↓
Hyperlipidemia:
Treatment Mechanism of Ezetimibe?
Cholesterol absorption inhibitor:
Cholesterol absorption ↓ (NPC1L1 inhibitor)
LDL receptors ↑
Hyperlipidemia:
Treatment Mechanism of Bile acid sequestrants?
Bile acid excretion ↑
LDL receptors ↑
Hyperlipidemia:
Treatment Mechanism of MTP inhibitor?
Microsomal Triglyceride Transfer Protein
VLDL production ↓
Hyperlipidemia:
Treatment Mechanism of Apo-B inhibitor?
VLDL production ↓
Hyperlipidemia:
Treatment Mechanism of Nicotinic acid?
VLDL production ↓
TG synthesis ↓
Hyperlipidemia:
Treatment Mechanism of Omega-3 fatty acids?
TG catabolism ↑
Acute Gout Arthritis:
What are the possible drugs for treatment?(3)
1) NSAIDs
2) Steroids
3) Colchicine
Acute Gout Arthritis:
Treatment Mechanism of NSAIDs?
COX inhibitor
Acute Gout Arthritis:
Treatment Mechanism of Steroids?
Anti-inflammatory
Acute Gout Arthritis:
Treatment Mechanism of Colchicine?
Interfere with gout inflammation
Chronic Hyperuricemic Arthritis:
Treatment Mechanism of Allopurinol?
Inhibits xanthine oxidase (uric acid synthesis ↓)
Chronic Hyperuricemic Arthritis:
Treatment Mechanism of Probenecid?
Uricosuric effect - increased renal excretion
Chronic Hyperuricemic Arthritis:
Treatment Mechanism of Colchicine?
Interfere with gout inflammation
Chronic Hyperuricemic Arthritis:
What are the possible drugs for treatment?(3)
1) Allopurinol
2) Probenecid
3) Colchicine
Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of Biguanides (Metformin)?
- Hepatic gluconeogenesis ↓
- Peripheral glucose uptake ↑
Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of Sulfonylurea?
Closes ATP-sensitive K+ channel → Insulin secretion ↑
Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of Thiazolidinediones (TZD)?
- PPAR-γ agonist
- Insulin resistance ↓
- Glucose utilization ↑
- Improves lipid profile
Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of GLP-1 receptor agonist?
- Insulin secretion ↑
- Glucagon secretion ↓
- Slow gastric emptying
- Satiety
Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of DPP-4 inhibitor (dipeptidyl peptidase)?
Prolong endogenous GLP-1 action (inhibits
degradation)
Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of SGLT-2 inhibitor?
Activation-Na+/glucose co-transporter → Urinary glucose excretion ↑
Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of Insulin?
- Glucose utilization ↑
- Hepatic gluconeogenesis ↓
- Anabolic actions
What is the drug treatment for Chronic Fibrous -
Riedel’s Thyroiditis?
Prednisone
Why is Metformin (biguanide) the best treatment for T2DM treatment ?
Activates AMP kinase→ ↓Gluconeogenesis and Insulin resistance .
Also, Cardiovascular protection↑
What is the effect of Short-acting insulin on DM Patients?
Absorbed slowly (reaching peak after 60-90 minutes) and may predispose for hypoglycemia. Could be used in Medical Emergencies.
What are the Short-acting insulin analogues? (3)
● Insulin-Lispro
● Insulin-Aspart
● Insulin-Glulisine
Short-acting insulin analogues are engineered to:
Dissociate more rapidly (than the original)
Long-acting insulin:
The action of human insulin can be _______ by the
addition of zinc or protamine.
Long-acting insulin:
The action of human insulin can be prolonged by the
addition of zinc or protamine.
What is the most widely used protamine used for Long-acting insulin?
NPH
What are the Long-acting insulin analogues? (2)
● Insulin-Glargine
● Insulin-Detemir
What drug would be used as a heme replacement in Acute Porphyria?
Heme-arginate
What are the Drugs used as Copper chelators for Wilson’s Disease?(2)
1) D-penicillamine + vitamin B6
2) Trientine
What is the Vitamin should be AVOIDED for patients with Hemochromatosis? Why?
Vitamin C - Increase Iron absorption
What are emergency drug given to people with Hypocalcemic Tetany?
Ca-gluconate (Should be given slowly)
What is the common Antidote for Diethylene glycol, Ethylene glycol and Methanol Intoxication?
Ethanol
What is the drug given to reduce Immune mediated damage in Gout?
Prednisone
Drug-induced Diabetes Mellitus - What are the eliciting drugs?
(High Doses over a long period of time)
Corticosteroides: Hydrocortisone, Dexamethasone and Prednisone
What is the drug of choice for Acetaminophen Intoxication?
N-Acetylcysteine