Endocrinology - Pharmacology Flashcards
Insulin - Mechanism (3) + Treatment Toxicities (3)
Mechanism - Binds Insulin Receptor 1
1) Increase liver glycogen production and glucose uptake
2) Increase muscle glycogen uptake
3) TG Storage
Toxicities
1) Hypogylcemia
2) Weight Gain
3) Lipodystrophy
4 Major Classes of Insulin Preparations (7 Names - 3,1,1,2)
1) Rapid Acting - Aspart + Glulisine + Lispro
2) Short Acting - Natural
3) Intermediate Acting - Neutral Protamine Hagedorn (NPH)
4) Long Acting - Detemir + Glargine
Sulfonylureas - Names (3) + Mechanism + Use + Toxicities (2)
Names - Glipizide + Glimepiride
Mechanism - Close B-Cell K+ Channels - Easier depolarization - Increased Ca2+ release - Increased Insulin release
Use - Type II DM (No DM i Use - needs functioning Beta-Cells
Toxicities - Hypoglycemia + Weight Gain + Renal Toxicity
Biguanindes - Names + Mechanism + Use + Toxicities (2)
Name - Metformin
Mechanism - Unknown - Increased Glycolosis + Reduces gluconeogenesis + Increased insulin sensitivity
Use - Type II DM
Toxicity - GI Disturbances + Risk of Lactic Acidosis (Anion Gap) - Don’t use in renal insufficiency + Alcoholics
Thizolinidediones - Names (2) + Mechanism + Use + Toxicities (5)
Names - Rosiglitazone + Pioglitazone
Mechanism - Binds PPAR-Gamma Nuclear Factor - Increases insulin sensitivity (esepcially in adipose tissue - Key for exam!)
Use - Type II DM
Toxicity - Weight Gain + Edema + Hepatotoxicity + Increased Bone Fxs + CHF/MI Warning (Especially in Rosiglitazone - Lower in Pioglizatone)
Alpha-Glucosidase Inhibitors - Name + Mechanism + Use + Toxicities (3)
Name - Acarbose
Mechanism - Inhibit intestinal brush border alpha-glucosiades - Delays carbohydrate absorption and decreases post-prandial hyperglycemia
Use - Type I and II DM
Toxicity - GI Disturbances (Diarrhea)
Glucagon Like Peptide 1 Therapy - Name + Mechanism + Use + Toxicities (3)
Name - Exenatide
Mechanism - Increased insulin with decreased glucagon release
Use - Type II DM
Toxicity - Nausea + Vomiting + Pancreatitis
DPP-4 Inhibitors - Name + Mechanism + Use + Toxicities (3)
Name - Sitagliptin
Mechanism - Increased insulin with decreased glucagon release
Use - Type II DM
Toxicity - Mild increase in UTI/Respiratory Infection - KEY FOR EXAM
Amylin Agonists - Name + Mechanism + Use + Toxicities (3)
Name - Pramlintide
Mechanism - Decrease gastric emptying and glucagon
Use - Type I and II DM
Toxicity - Hypoglyecemia + GI Disturbances + Headache
SGLT2 Inhibitors Name + Mechanism + Use + Toxicities (3)
Name - Canaglifozin
Mechanism - Reduce kidney glucose re absorption
Use - Type II DM
Toxicity - Glucosuria + UTIs + Vaginal Year Infections
Glulisine - Class + Use
Rapid Acting Insulin
Type I DM
Glipizide - Class + Use
Sulfonylurea
Type II DM
Acarbose - Class + Use
Alpha-Glucosidase Inhibitor
Type II DM
Glargine - Class + Use
Long Acting Insulin
Type I DM
Exenatide - Class + Use
GLP-1 Agonist
Type II DM
Aspart - Class + Use
Rapid Acting Insulin
Type I DM
Rosiglitazone - Class + Use
Thiazolidinediones
Type II DM - Increases Insulin Sensitivity in Adipose
Metformin - Class + Use
Biguanides
Type II DM
Detemir - Class + Use
Long Acting Insulin
Type I DM
Netrual Protamine Hagedorn - Class + Use
Intermediate Acting Insulin
Type I DM
Glimepiride - Class + Use
Sulfonylurea
Type II DM
Lispro - Class + Use
Short Acting Insulin
Type I DM
Pioglitazone - Class + Use
Thiazolidinediones
Type II DM - Increases Insulin Sensitivity in Adipose
Less Cardiotoxic vs. Rsiglitazone
Canaglifozin - Class + Use
SGLT-2 Inhibitor
Type II DM
Pramlintide - Class + Use
Amylin Agonist
Type I and II DM Sitagliptin
Sitagliptin - Class + Use
DPP-4 Inhibitor
Type II DM
Somatropin - Uses (2,2) + Toxicities (3,3)
Recombinant GH for Low GH
Children - GH Deficiency + Genetic Disorders (Turner’s + Prader Willi)
Adults - Anabolics + Reduce Generalized Obesity
Childhood AEs
1) Psuedotumor
2) Edema
3) Hyperglycemia
Adult AEs
1) Peripheral Edema
2) Arthralgias
3) Carpal tunnel
Mecasermin - Mechanism + Use + Toxicity
Recombinant IGF-1
IGF-1 Deficiency with no response to GH
Hypoglycemia - Take before a meal
Growth Hormone Antagonist - Name + Mechanism + Use + Toxicity
Pegvisomant
Blocks GH Receptor Signalling
Used for Acromegaly
AE = Increased Liver Enzymes
Somatonstatin Analog - Name + Mechanism + Uses (2) + Toxicities (3)
Octerotide
Mechanism - Inhibits GH Release via the dopamine pathway
Use - Acromegaly + Pituitary Tumors
AEs - GI Disturbances + Gallstones + Bradycardia/Conduction Abnormalities
Gonadotropin Analogs - Names (3) + Use + Toxicities (2)
Urofollitropin = FSH
Lutropin = LH
Choriogonadotropin Alpha = Recombinant hCG
Use - IVF with ovulatory hyperstimulation
AEs - Ovarian Hyperstimulation Syndrome (Ascites + Ovarian Enlargement + Hypovolumic Shock) + Multiple Pregnancies
GnRH Agonist - Names (3) + Mechanism + Uses (4)
Leuprolide + Gonadorelin + Goserelin
Increased GnRH reduces the Pulse –> No pulse results in less FSH/LH (need to pulse to produce)
Uses
1) Endometriosis (reduce LH = reduce E2)
2) Uterine Lieomyoma (reudce LH = reduce E2)
3) Prostate Cancer (reduce testosterone = reduce dihydro-testosterone = less prostate growth)
4) Central Precocious Puberty
GnRH Agonist Toxicities - Male (2) + Female (4)
Male
1) Decreased Libido
2) Reduced Bone Density
Female
1) Osteoporosis
2) Vaginal Dryness
3) Menopause S/Sx
4) Depression
Pegvisomant - Class + Use
Growth Hormone Antagonist
Acromegaly
Octerotide - Class + Use
Somatostatin Analog
Inhibit GH Release = Acromegaly + Pituitary Tumor
Leuprolide - Class + Use
GnRH Agonist
1) Endometriosis (reduce LH = reduce E2)
2) Uterine Lieomyoma (reudce LH = reduce E2)
3) Prostate Cancer (reduce testosterone = reduce dihydro-testosterone = less prostate growth)
4) Central Precocious Puberty
Dopamine (D2) Agonist - Names (2) + Uses + Mechanism + Toxicities (3)
Bromocriptine + Cabergoline
Prolactinemia
Dopamine inhibits prolactin production (normal function is to prevent premature lactation in female)
AEs
1) Nausea (Less with Cabergoline)
2) Headache
3) Orthostatic HTN
Oxytocin - Use (2) + Toxicity (3)
Used to induce + control uterine hemorrhage after delivery
Toxicity - Super Rare
1) Fetal Distress
2) Placental Abruption
3) Uterine Rupture (massive contractions)
Goserelin - Class + Use
GnRH Agonist
1) Endometriosis (reduce LH = reduce E2)
2) Uterine Lieomyoma (reudce LH = reduce E2)
3) Prostate Cancer (reduce testosterone = reduce dihydro-testosterone = less prostate growth)
4) Central Precocious Puberty
Bromocriptine - Class + Use
D2 Agonist
Prolactinoma
Cabergoline - Class + Use
D2 Agonist
Prolactinoma (less nausea)
Glucocoritcoids - Uses + Toxicities (3)
Uses - Inflammatory Disease + Organ Transplant
Toxicity - Cushingoid - Hyperglycemia + Purple Striae + Protein Catabolism
Primary Adrenal Insufficiency - Treatments (2)
1) Corticosteroid
2) Fludrocortisone (Aldosterone Mimic)
Acute Adrenal Insufficiency - Treatments (3)
1) Cortisol
2) Fluids
3) Potassium - Must give because even though hyperkalemic all the intracellular K+ has been depleted
Glucocorticoid that crosses the placenta?
Dexamethasone
Mifepristone - Class + Use + Mechanism
Glucocorticoid Receptor Antagonist
Used for Cushing Syndrome
Pasireotide - Class + Use + Mechanism
Somatostain Receptor Agonist
Increases somatostain which inhibits ACTH release and thus cortisol
Spironlactone - Treatment Uses (2) + Mechanism + Toxicities
Conn Syndrome (to reduce aldosterone)
Antagonizes aldosterone
AEs
1) Gynecomastia
2) Decreased Libido
3) Menstrual Irregularities
