Endocrinology Pharmacology Flashcards
1
Q
Ending for Somatostatin analogs
A
reotide
2
Q
Calcitonin mechanism
A
inhibit osteoclast bone resporption avaliable SC or nasal spra
3
Q
Plant Sterols and Stanols - uses
A
inhibits 50% of cholesterol absorption to decrease TG and LDL, not HDL.
Dyslipidemia
4
Q
Calcitonin ADRs
A
N, hand swelling, urticaria cramps
Rhinitis, epistaxis
5
Q
Bromocriptine - Class
A
DA Agonist
6
Q
Kinetics Octreotide vs. Lanreotide
A
Octreotide: SC every 6-12 hours or IM 1x month
Lanreotide: SX 1x month
7
Q
ADRs of thionamids
A
Pruritic rash, gastric intolerance, arthralgia
Agranulocytosis
PTU _ hepatotoxicity - rare!
8
Q
Phenoxybenxamine
A
irreverisble alpha antagonist
used for HTN control in pheochromocytoma
9
Q
Demeclocycline - mechanism
A
Inhibits ADH on distal tubule
10
Q
ADRs of Vitamin D
A
toxicity Hypercalcemia and hypercalciuria
11
Q
Sclerostin
A
also romosozumab that blacks osteoblast differential and stimu
increase formation and resportion. still in trial
12
Q
what causes SIADH?
A
Tumors, pulmonary dz, CNS trauma, infection.
SSRIs, halperidol, TCADs
13
Q
Coenzyme Q10
A
Antioxidant used for hypertension.
Statins, BB, and diuretics can lower level of this in the body.
Must take with fatty meal
14
Q
Dihydrotachysterol
A
1,25 (OH)2 Vitamin D3
15
Q
Mecasermin - uses
A
use if growth hormone insensitive - Laron Dwarfism
16
Q
Metoprolol
A
selective Beta blocker to control tachycardia
17
Q
Action of bisphosphonate
A
Pyrophosphate analog that incorporated into hydroxyapettie of bone to promote osteoclast apoptosis and inhibit osteoclast fxn
18
Q
Chlorpropamide - use
A
central diabetes insipidus pts that are DDAVP intolerant
risk of hypoglycemia
19
Q
Treatments for Central Diabetes Insipidus
A
ADH Analog - Desmopressin (DDAVP)
Chlorporpamide
20
Q
Somatropin - ADRS
A
Safe in kids
Insulin resistance, glucose intolerance, slight risk of pseudotumor cerebri
21
Q
Somatropin uses
A
Replacement therapy for GH deficient kids - SC or 3x/week IM
Poor growth with turner’s, prader willi, renal insufficiency
wasting or cachexia in AIDS
Controversial for adults with GH deficiency
Controversial for kids with idiopathic short stature
22
Q
Uses of calcitonin
A
treatmeny.t of osteoporosis - NOT prevention!
Useful if back pain
23
Q
Ergocalciferol
A
D2
Less efficient than D3
24
Q
Mechanism of thionamides
A
blocks thyroid peroxidase
PTU also inhibits 5’deiodinase to decrease peripheral conversion
25
Somatropin Kinetics
IM
| T1/2 is 25 minutes but lasts for 36 hours
26
Treatment of SIADH
Demeclocycline
| V2 Antagonists
27
Mechanism of Desmopressin
ADH analog that has V1- Vasocontrictive effects on Gq and antidiruetic effect V2 (Gs)
28
when should Thionamides be used
mild hyperthyroidism, small glands, or young patients
29
Teriparatide uses
treatment of sever osteoprosis
| not recommended for greater than2 years
30
Somatostatin analog - Uses
Growth Hormone excess - Acromegaly and Gigantism
Meds following surgery
Octeotride is used to control bleeding of esophageal varices and GI hemorrhage
31
Use of calcium gluconate
severe hypocalcemia (IV
32
Iodide and thionamide tx
iodide can delay the effect of thionamide tx, so start after the effects take place.
33
Metyrosine
Competitive inhibitor of Catecholamine synthesis
| inhibits tyrosine hydroxylase
34
Recommended dietary intake of calcium
Adolescent 1300 mg
29-50 and men 50-70: 1000 mg
Men >70 and women >50: 1200 mg
35
Calcium and loop diuretics
increase calcium excretion.
| used for hypercalcemia
36
Strength of GCC anti-inflammatory
DEX> Triamcinolone>Pred>cortisol
37
Trilostane
inhbits 3Beta hydroxysteroid dehydrogenase - inhibits progesterone formation
late
38
Iodide - SSKI and Lugol's mechanism
high doses of iodine inhbiits thyroid hormone synthesis with rapid action
39
Sterols and Stanols - ADRs and DDIs
GI - nausea, vomiting, constipation, diarrhea,
takes 2-3 weeks to be effective, and only effective as long as you take it.
DDI: Zetia
40
Conivaptan - class
V2 Receptor antagonist
41
Liotrix
4:1 T4/T3 combination
| rarely required or recommended.
42
Mecasermin - class
Recombinant IGF-1
43
Contraindications with Fish Oil
Limit to 12oz per week with pregnancy
increases risk of bleeding
DDIs: antihypertensives, antigcoagulatns, contraceptives, orlistat
Ginger, Garlic, Ginkgo, and Ginseng
44
Metyrapone
Inhibits 11B hydroxylase to inhibit cortisol formation.
| Late
45
131 iodine tx vs surgery
80% of iodine are hypothyroid
| 50-60% post surgery are hypothyroid
46
Treatment for hyperprolactinomas
Cabergoline and bromocriptine - DA agonists
47
Treatments of nephrogenic diabetes insipidus
Thiazide diuretics
| NSAIDS
48
Calcitriol
1,25 (OH)2 Vitamin D3
| for pts with decrease VD synthesis - CRF and Vit D dependent rickets
49
Uses of Desmopressin
Central Diabetes Incipidus due to inadeqate ADH secretion.
| Nocturnal emesis
50
Denosumab
RANKL antibody that prevents stimuation of osteoclast acitivt
give SC q 6 months
51
Bisphosphonate action
1-10% oral absoprtion
| not recommended for low GFR
52
Mifepristone
Glucocorticoid Receptor antagonists at high doses.
| used to control hyperglycemia secondary to elevated cortisol
53
Prednisone ratio of GCC: MCC
4:0.3 -
54
Which calcium do you take iwth meals?
calcium carbonate
55
Teriparatide
PTH analog
Anabolid tx for osteoporosis
synthetic PTH administered intermittently (SC QD) to increase osteoblastic activity.
56
Cholecalciferol
D3
| preferred replacement agent due to modest cost and efficacy
57
Kinetics of Pegvisomant
SC 1x day
58
Niacin - uses
lower LDL and TG, increase HDL, but no decrease in all cause mortality.
59
11Beta-HSD1
Activation of cortisone to cortisol in LIVER
| inactive in fetus
60
131 iodine
radioactive iodine used for hyperthyrodism.
Preferred in pts >21
CI in pregnancy
80% progress to hypothyroidism
61
Kinetics Tolvaptan vs. Convivaptan
Tolvaptan is Oral and Convivaptan is IV
62
Adverse effects of Levothyroxine
Caution for pts with heart disease
Hyperthyroid:
Kids: restless, insomnia, accelerated bone maturation
Adults: anxiety, heart palpitations, exacerbate cardiac symptoms.
DDI: will increase adrenergic effects or decongestants.
63
Ending for bisphosphonates
dronate
64
Aldosterone ratio of GCC: MCC
0.3:3000
65
HTN supplement uses
Garlic
| CoEnzyme 10
66
Raloxifine uses
second line for osteoporosis and for increased risk of invasive breast cancer
tx and prevention
67
Fludrocortisone ratio of GCC: MCC
10:125-500
68
Garlic - uses
Allicin is active ingredient to inhibit hepatic cholesterol synthesis for HTN and dyslipidemia treatment
Need 4g per day -
odorless product does NOT have allicin
69
Tolvaptan - class
V2 Receptor antagonist
70
risks of somatropin in athelets
acromegaly, arthropathy, viceromegaly due to higher than physiology GH levels
71
Raloxifine ADRs
hot flashes, leg cramps, thromboembolic disorders
72
Raloxifine
Selective estrogen receptor modulator
to decrease osteoclast avitiy and increase OPG
works in bone and liver, but antagonist in uterus and breast
73
Pharmacologic use of glucocorticoids
use those without MCC acitvity
74
Kinetics - Desmopressin
Nasal 1-2x/day
Oral 2-3x/day
T1/2 is 2 hours
75
Somatropin - class
Recombinant GH
76
Propylthiouracil -class
Thionamide
77
Miacalcin
Nasal calcitonin
78
Mitotane
Inhibits Cholesterol Oxidase early in Glucocorticoid synthesis.
for cushings
79
Bitter Orange uses
created in response to ephedra ban
contains 1-6% synephrine. used for weight loss
not recommended due to potential for death.
80
PTU absorption vs. Methimazole
PTU is 50-80% and methimazole is 100%
81
Vanadium - uses and ADRs
T2D
DDI: anticoagulants and antiplatelets
Risk of kidney toxicity
82
Physiologic replacement of glucocorticoids
need both GCC and MCC acitivty
83
Calcium - uses
people with low calcium, gain more weight.
| but calcium supplementation does not make make up for fat intake.
84
Desmopressin - class
ADH analog
85
Ketoconazole
Inhibits 17,20 demolase that inhibits formation of pregenenolone.
to inhibit early glucocorticoid synthesis
86
Ephedra - use
moderate weight loss
| stimulated nervous system
87
Hydrochlorothiazide
thiazide diuretic to decrease Ca excretion. used for hypercalciuria
88
Mecasermin - ADRS
hypoglycemia
| take with carbs to avoid
89
Treatment of pheochromocytoma before surgery?
1) phenoxybenzamine
2) meoprolol
3) Nefedipine
4) Metyrosine
90
Pegvisomant - mechanism
mutated GH that competitively inhibits GH receptor
91
Orlistat
FDA approved for long term weight loss.
Take MVitamin 2 hours before or after dose.
ADR: liver damage/failure
92
Garlic ADRs
discontinue 2-3 weeks prior to surgery.
Ginger, Ginko and Vitamin E
Anticoagulant and Antiplatelet drugs
93
Cabergoline - class
DA agonist - used for GH excess and Hyperprolacinemia
94
Dexamethosone ratio of GCC: MCC
30: 0 no mineralcorticoid
95
Treatment of thyroid storm
1) propanolol to block t4-T3 conversion
2) sodium iodide or KI (oral)
3) PTU to block synthesis
4) hydrocortisone to protect against shock
96
V2 Receptor atagonist - mechanism
inhibits antidiuretic effect of ADH
97
Liothyronine
Synthetic T3
Shorter T1/2 1 day
Used in T3 suppression test...
98
Chlorpropamide - class
1st generation sulfonylurea
99
Management of CAH in kids vs. adults
kids: hydrocortisone
| Adults; pred or dexa
100
Somatostatin analog - mechanism
Inhibits GH release via Gi protein receptor to decrease cAMP.
Also decreases Insulin and glucagon, intereferes with TRH, and decreases GI motilit
101
Chromium - uses and mechanism
Reduction of blood glucose, HbA1C and FFA and reduces oxidative stress with mixed data.
several salt forms exist
risk of renal and liver dysfunction
102
when should levothyroxine be taken?
on an empty stomach with water for best absoprtion - impaired by metal ions, cipro, dietary fiber, and soy
103
Denosumab
high risk of fractures or unresponsive to bisphosphonates
| Tx NOT prevention
104
Triamcinolone ratio of GCC: MCC
5:0 - no mineralcorticoid activity
105
Lanreotide - classy
somatostatin analog - inhibits GH
106
Somatostatin Analogs - ADRs
transient hyperglycemia
107
Iodomethacin - mechanism
a NSAID that inhibits PG synthesis
To increase ADH activity in nephrogenic DI
used in combo with hydrochlorothiazide
108
Teriparatide ADRs
nausea, HA, dizzy, sever muscle pain
109
Fish oil - indication and mechanism
Hypertriglyceridemia
| decreases hepatic secretion of VLDL and increases VLDL clearance.
110
What supplements are taken for weight loss
Calcium
Ephedra
Bitter orange
Alli/Orlistat
111
Chlorpropamide - mechanism
mechanism of sulonylurea K block potentiates ADH action
112
What are the medicine treatments for GH excess
1) Somatostatin Analogs
2) DA agonists
3) GH receptor antagonist
113
Diabetes supplement meds
Chromium
| Vanadium
114
Methimazole - class
Thionamide
115
Nefdipine
Ca channel blocker
116
ADRs with Desmopression
GI upset, Headache, allergy
| Nasal irritation with nasal administration
117
Use of Iodide
Rarely used alone
KI and NaI are used in thyroid storm
KI is protective against radioative iodide uptake
118
What alternative meds are used to treat dyslipidemia?
Fish Oil
Fiber
Niacin
Plant sterols and stanols
119
Thyroid USP
porcine thyroid extract
| NOT recommended due to unexpected toxicity and antigenicity
120
Drugs that cause central diabetes insipidus
Lithium
| Demeclocycline
121
Hydrocortisone - ratio of GCC: MCC
1:1
122
DA agonists - uses
Second line: Cabergoline for GH excess, oral intake
| First line for Hyperprolactinoma - Cabergoline is perferred due to less side effects. But Bromocriptine for pregnancy
123
DA agonist - mechanism
Binds to D2 receptor to decrease GH secretion and prolactin secretion. Also reduces size of prolactinoma
124
What is a good steroid to give fetus?
Betamethosone - poor substrate to 11B-HSD2 - less deactivation
125
ADRs with bisphosphonates
Esophagitis!
Atypical femur fractures
Osteonecrosis of jaw
126
Bisphosphonate uses
First line therapy for osteoporosis
and hypercalcemia of malignancy
Prevention and treatment
127
Calcifediol
25 OH Vitamin D3
| doesn't require liver hydroxylation, useful in liver Dz
128
PTU vs. Methimazole pregnancy
PTU is preferred due to higher binding and decreased crossing placenta
129
AD agonists Side Effects
N/V, Head ache, postural hypertension
130
Pegvisomant - class
GH receptor antagonist
131
Recommended vitamin D intake
<70 is 600 IU
| >70 is 800 IU
132
Hydrochlorothiazide - uses
Nephrogenic DI - due to inadequate ADH action - paradoxically reduces polyuria.
133
11Beta - HSD2
Inactivating from Cortisol to cortisone in Kidney
| active in fetus
134
Coenzyme Q10
Anticoagulants
| Increase T4/T8 ratio
135
Ephedra = ADRS
dizziness, N/D, papitations, HTN, MI, arrhythmias, suddent death.
Benefits do not outweigh the risks
136
Niacin Side effects
Flushing, increased uric acid, increased blood glucose, headache.
Hepatotoxicity
137
Doing of T4 across the continuum
Infants: require more T4
Adults: start at 50-100 ug and titrate up
Elderly: low dose to prevent subclinical cardiac disease
pregnancy: increase dose due to high TBG
138
Octreotide - class
Somatostatin analog - inhibits GH
