Endocrinology - Pharmacology Flashcards by Bill Readdy

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

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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

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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

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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

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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)

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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)

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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

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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

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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

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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

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Glulisine - Class + Use

Rapid Acting Insulin

Type I DM

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Glipizide - Class + Use

Sulfonylurea

Type II DM

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Acarbose - Class + Use

Alpha-Glucosidase Inhibitor

Type II DM

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Glargine - Class + Use

Long Acting Insulin

Type I DM

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Exenatide - Class + Use

GLP-1 Agonist

Type II DM

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Aspart - Class + Use

Rapid Acting Insulin

Type I DM

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Rosiglitazone - Class + Use

Thiazolidinediones

Type II DM - Increases Insulin Sensitivity in Adipose

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Metformin - Class + Use

Biguanides

Type II DM

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Detemir - Class + Use

Long Acting Insulin

Type I DM

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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

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