Everything Endocrine Flashcards
Sermorelin
Synthetic GHRH
Somatropin
Synthetic GH
SE: Leukemia, hypothyroid, insulin resistance
Somatrem
Synthetic GH (more stable)
SE: Leukemia, hypothyroid, insulin resistance
Mecasermin
Synthetic IGF-1
Octreotide
Somatostatin analog, inhibits GH (acromegaly, pituitary adenoma, carcinoid crisis)
SE: Sinus brady, conduction disturbances, hypoglycemia, gallstones
Lanreotide
Somatostatin analog, inhibits GH
Pegvisomant
GH receptor antagonist
SE: increase pit adenoma, elevated AST/ALT (CX in liver failure)
Bromocriptine
DA receptor agonist (anti prolactin)
SE: Orthostatic hypotension, CVA, seizure, acute MI
Cabergoline
DA receptor agonist (anti prolactin)
SE: Orthostatic hypotension, CVA, seizure, acute MI
Pergolide
DA receptor agonist (parkinsons)
SE: Orthostatic hypotension, CVA, seizure, acute MI
Urofollitropin
Gonadotropin (ovulation induction, PCOS)
SE: ovarian hyperstimulation, gynecomastia, ovarian CA/cysts
Follitropin
Gonadotropin (ovulation induction, PCOS)
SE: ovarian hyperstimulation, gynecomastia, ovarian CA/cysts
Gonadorelin
GnRH short t1/2 (infertility, dx of hypogonadism)
SE: anaphylaxis, lightheadness, flushing, dermatitis)
Goserelin
GnRH long t1/2 (endometriosis, fibroids, prostate CA, advanced breast and ovarian CA, PCOS)
SE: menopause symptoms
Histrelin
GnRH long t1/2 (prostate CA, advanced breast and ovarian CA, PCOS)
SE: menopause symptoms
Leuprolide
GnRH long t1/2 (controlled ovarian hyperstimulation, endometriosis, fibroids, prostate CA, central precocious puberty, advanced breast/ovarian CA, PCOS)
SE: menopause symptoms
Nafarelin
GnRH long t1/2 (controlled ovarian hyperstimulation, endometriosis, fibroids, central precocious puberty, advanced breast/ovarian CA, PCOS)
SE: menopause symptoms
Triptorelin
GnRH long t1/2 (prostate CA)
SE: menopause symptoms
Ganirelix
GnRH receptor antagonist (controlled ovarian hyperstimulation)
SE: ovarian hyperstimulation (ascites, enlargement, hypovolemia), ectopic pregnancy, thrombotic disorder
CX: pregnancy, lactation, ovarian cysts, promary ovarian failure, thyroid or adrenal dysfunction, vaginal bleeding of unknown etiology
Cetrorelix
GnRH receptor antagonist (controlled ovarian hyperstimulation)
SE: ovarian hyperstimulation (ascites, enlargement, hypovolemia), ectopic pregnancy, thrombotic disorder
CX: pregnancy, lactation, ovarian cysts, promary ovarian failure, thyroid or adrenal dysfunction, vaginal bleeding of unknown etiology
Abarelix
GnRH receptor antagonist (controlled ovarian hyperstimulation)
SE: ovarian hyperstimulation (ascites, enlargement, hypovolemia), ectopic pregnancy, thrombotic disorder
CX: pregnancy, lactation, ovarian cysts, promary ovarian failure, thyroid or adrenal dysfunction, vaginal bleeding of unknown etiology
Testosterone
Naturally occurring androgen
DHT
Naturally occurring androgen
Androstriedione
Naturally occurring androgen
DHEA
Naturally occurring androgen
Flutamide
Androgen receptor antagonist (metastatic prostate CA, BPH)
SE: hepatotoxicity, hematopoietic disorders
Spironolactone
Androgen receptor antagonist (hirsutism, HTN, acne, edema w CHF, cirrhosis, hypoK)
SE: GI hemorrhage, hyperK metabolic acidosis, agranulocytosis, SLE, gynecomastia, dyspepsia, lethary, abnormal menstruation, impotence
CX: HyperK, acute renal insufficiency
Finasteride
5a-reductase antagonist (BPH, androgenic alopecia)
SE: neoplasm of male breast, decreased libido, ED, breast tenderness
CX: Pregnancy
Estradiol
Endogenous estrogen
E2 most estrogenic
Estrone
Endogenous
E1 less estrogenic
Estriol
Endogenous estrogen
E3 not very active metabolite
Ethinyl estradiol
Synthetic steroidal estrogen
SE: endometrial hyperplasia and carcinoma (without protection of progesterone), venous thrombosis
Mestranol
Synthetic steroidal estrogen
SE: endometrial hyperplasia and carcinoma (without protection of progesterone), venous thrombosis
Quinestrol
Synthetic steroidal estrogen
SE: endometrial hyperplasia and carcinoma (without protection of progesterone), venous thrombosis
DES
Synthetic non-steroidal estrogen
SE: Adenocarcinoma of vagina
Chlorotrianisene
Synthetic non-steroidal estrogen
SE: endometrial hyperplasia and carcinoma (without protection of progesterone), venous thrombosis
Methallenestril
Synthetic non-steroidal estrogen
SE: endometrial hyperplasia and carcinoma (without protection of progesterone), venous thrombosis
Tamoxifen
SERM
Ant. in breast
Agonist in endometrium and bone
APPROVED IN PREMENOPAUSAL
SE: malignant neoplasm of endometrium, cataracts, PE
CX: DVT, PE, pregnancy
Clomiphene
SERM
Ant. in hypothalamus and pituitary
Partial agonist in ovaries
SE: thromboembolism, ovarian cysts/hypertrophy
CX: pregnancy, thyroid/adrenal, liver disease, endometrial carcinoma, organic intracranial lesion
Raloxifine
SERM
Agonist in bone
Ant. in uterus and breast
LESS RISK OF UTERINE CA AND THROMBOEMBOLISM
SE: retinal vascular occlusion, venous thromboembolism, leg cramps
CX: pregnancy, DVT
Anastrozole
Aromatase inhibitor (tx of ER+ early breast cancer)
SE: **osteoporosis, hypercholesterolemia, bone pain, thrombophlebitis
Letrozole
Aromatase inhibitor (tx of ER+ early breast cancer)
SE: **osteoporosis, hypercholesterolemia, bone pain, thrombophlebitis
Exemestane
Irreversible aromatase inhibitor (tx of ER+ early breast cancer)
SE: **osteoporosis, hypercholesterolemia, bone pain, thrombophlebitis
Formestane
Irreversible aromatase inhibitor (tx of ER+ early breast cancer)
SE: **osteoporosis, hypercholesterolemia, bone pain, thrombophlebitis
Norgestrel
Progestin only contraceptive
CX: acute liver disease, liver tumors, breast CA, pregnancy
Norethindrone
Progestin only contraceptive
CX: acute liver disease, liver tumors, breast CA, pregnancy
Medroxyprogesterone
Progestin only contraceptive injectable
CX: acute liver disease, liver tumors, breast CA, pregnancy
Etonogestrel
Progestin only contraceptive implant
CX: acute liver disease, liver tumors, breast CA, pregnancy
Mifepristone
Progestin receptor antagonist (abortion)
SE: bacterial infections, headaches
CX: Chronic adrenal failure, ectopic pregnancy, hemorrhagic disorders, anticoagulation, inherited porphyrias
Levonorgestrel
Potent progestin that blocks LH surge (prevention of unwanted pregnancy)
Premarin
Conjugated equine estrogen
SE: nausea, mastalgia, headache, fluid retention
Estrace
Micronized estradiol
SE: nausea, mastalgia, headache, fluid retention
Cenestrin
Conjugated synthetic estrogens
SE: nausea, mastalgia, headache, fluid retention
Vivelle, estraderm, estrogel
Transdermal estrogens
SE: nausea, mastalgia, headache, fluid retention
Aspart
Rapid acting insulin
Postprandial glucose
Lispro
Rapid acting insulin
Postprandial glucose
Glulisine
Rapid acting insulin
Postprandial glucose
Regular insulin
Needs to be injected 30-45 minutes prior to meal
NPH insulin aka isophane
Intermediate acting
Basal insulin and overnight coverage
Gargline
Long acting
Basal insulin and overnight coverage
Detmir
Long acting
Basal insulin and overnight coverage
Metformin
Inhibits mito complex (inc. AMP, dec AC, inc. AMPK)
Opposes glucagon, dec. hepatic neogenesis
FASTING GLUCOSE
SE: LACTIC ACIDOSIS, dec. absorption of B12, weight loss, improved lipid profile, no hypoglycemia
CX: Renal failure, MI, CHF, elderly
Chlorpropamide
Sulfonylurea
FASTING GLUCOSE
SE: Inc. hypoglycemia risk, weight gain
CX: Pregnancy, renal/liver disease
Tolbutamide
Sulfonylurea
FASTING GLUCOSE
SE: Inc. hypoglycemia risk, weight gain
CX: Pregnancy, renal/liver disease
Glimepiride
Sulfonylurea
FASTING GLUCOSE
SE: Inc. hypoglycemia risk, weight gain
CX: Pregnancy, renal/liver disease
Glipizide
Sulfonylurea
FASTING GLUCOSE
SE: Inc. hypoglycemia risk, weight gain
CX: Pregnancy, renal/liver disease
Glyburide
Sulfonylurea
FASTING GLUCOSE
SE: Inc. hypoglycemia risk, weight gain
CX: Pregnancy, renal/liver disease
Repaglinide
Meglitinides
Glucose dependent insulin secretion
POSTPRANDIAL GLUCOSE
SE: hypoglycemia, weight gain
CX: pregnancy, liver disease
Nateglinide
Meglitinides
Glucose dependent insulin secretion
POSTPRANDIAL GLUCOSE
SE: hypoglycemia, weight gain
CX: pregnancy, liver disease
Pioglitazone
Thiazolidinedione (agonist of PPARy, inc. insulin sensitivity, inc. glucose utilization, dec. insulin resistance)
FASTING GLUCOSE
SE: SubQ weight gain, HF RISK, BONE fx in women, (?) bladder CA
CX: Liver disease, STAGE 3/4 CHF, CVD, pregnancy
Rosiglitazone
Thiazolidinedione (agonist of PPARy, inc. insulin sensitivity, inc. glucose utilization, dec. insulin resistance)
FASTING GLUCOSE
SE: SubQ weight gain, HF RISK, BONE fx in women, (?) bladder CA
CX: Liver disease, STAGE 3/4 CHF, CVD, pregnancy
Acarbose
a-glucosidase inhibitor (inhibits carbohydrates digestion)
POSTPRANDIAL GLUCOSE
SE: GI
CX: Intestinal disease, inflammatory bowel, colonic ulceration
Miglitol
a-glucosidase inhibitor (inhibits carbohydrates digestion)
POSTPRANDIAL GLUCOSE
SE: GI
CX: Intestinal disease, inflammatory bowel, colonic ulceration
Exenatide
Incretin mimetic (GLP-1 analog, potentiates insulin) FASTING AND POSTPRANDIAL GLUCOSE
SE: nausea, requires IV, weight loss
No hypoglycemia
Liraglutide
Incretin mimetic (GLP-1 analog, potentiates insulin) FASTING AND POSTPRANDIAL GLUCOSE
SE: nausea, requires IV, weight loss
No hypoglycemia
Sitagliptin
DDP-IV inhibitor (inhibits GLP-1 breakdown)
FASTING AND POSTPRANDIAL GLUCOSE
Little risk for hypoglycemia
Saxagliptin
DDP-IV inhibitor (inhibits GLP-1 breakdown)
FASTING AND POSTPRANDIAL GLUCOSE
Little risk for hypoglycemia
Pramlintide
Amylin mimetic, dec. postprandial glucagon, dec. hepatic gluconeogenesis
POSTPRANDIAL GLUCOSE
SE: requires injections, nausea, hypoglycemia (reduce insulin), weight loss
Canagliflozin
SGLT2 Inhibitor (renal glucose excretion)
SE: UTI, dehydration, hypotension, inc. LDL, hyperK, weight loss
CX: Renal impairment
Dapaglifozin
SGLT2 Inhibitor (renal glucose excretion)
SE: UTI, dehydration, hypotension, inc. LDL, hyperK, weight loss
CX: Renal impairment
Covelesalam
Bile acid binding resin (bile acid bin TGR5 GPCR and induce GLP-1 secretion)
Levothyroxine
T4 pro-hormone converted to T3 in vivo
SE: Hyperthyroidism, a. fib, bone loss in premenopausal women
Tetraiodothyronine
T4 pro-hormone converted to T3 in vivo
SE: Hyperthyroidism, a. fib, bone loss in premenopausal women
Liothyronin
T3 active hormone agonist of VDR TF (for use when rapid hypothyroid correction is needed)
SE: Thyrotoxicosis
Tiiodothyronine
T3 active hormone agonist of VDR TF (for use when rapid hypothyroid correction is needed)
SE: Thyrotoxicosis
Propanolol
B-blocker (tx adrenergic symptoms of hyperthyroidism)
Also inhibits peripheral conversion of T4 to T3
SE: HF, airway resistance, PAD
CX: Asthma, COPD, HF (alternative diltiazem aka Ca blocker, metropolol/atenolol aka cardiac-selective B-blocker)
Esmolol
B-blocker (tx adrenergic symptoms of hyperthyroidism)
SE: HF, airway resistance, PAD
CX: Asthma, COPD, HF (alternative diltiazem aka Ca blocker, metropolol/atenolol aka cardiac-selective B-blocker)
Propylthiouracil
aka PTU, thionamides/thiourylenes, inhibit PTO
Partially inhibits peripheral conversion of T4 to T3
SE: Skin rash, joint pain, hepatotoxicity, ANCA-positive vasculitis, agranulocytosis
Methimazole
aka MMI, thionamides/thiourylenes, inhibit PTO
SE: Skin rash, joint pain, hepatotoxicity, agranlocytosis, teratogenicity
Iodide
Acutely inhibits TSH (Wolff-Chaikoff effect)
Indicated in thyroid storm, preoptive prep, post nuclear accidents
Radioactive iodide
Emission of beta particles cause necrosis of follicular cells
SE: radiation thyroiditis, exacerbation of Grave’s ophthalmopathy
CX: pregnancy, breast feeding, severe ophthalmopathy
Cholestyramine
Bile acid sequestrant
Prevents reabsorption of thyroid hormone in thyroid storm
Calcitriol
Vitamin D
SE: HyperCa
Do no give with hyperphosphatemia d/t risk of malignant calcification
Doxercalciferol
Vitamin D
SE: HyperCa
Do no give with hyperphosphatemia d/t risk of malignant calcification
Ergocholecalciferol
Vitamin D
SE: HyperCa
Do no give with hyperphosphatemia d/t risk of malignant calcification
Cholecalciferol
Vitamin D
SE: HyperCa
Do no give with hyperphosphatemia d/t risk of malignant calcification
Alendronate
Bisphosphonate
Inhibits farensyl pyrophosphate synthase (dec. osteoclast activity)
SE: Esophageal irritation, occular side effects, osteonecrosis of the jaw, renal impairment
CX: esophageal disease, CKD
Pamidronate
Bisphosphonate
Inhibits farensyl pyrophosphate synthase (dec. osteoclast activity)
SE: Esophageal irritation, occular side effects, osteonecrosis of the jaw, renal impairment
CX: esophageal disease, CKD
Risendronate
Bisphosphonate
Inhibits farensyl pyrophosphate synthase (dec. osteoclast activity)
SE: Esophageal irritation, occular side effects, osteonecrosis of the jaw, renal impairment
CX: esophageal disease, CKD
Zoledronate
Bisphosphonate
Inhibits farensyl pyrophosphate synthase (dec. osteoclast activity)
SE: Esophageal irritation, occular side effects, osteonecrosis of the jaw, renal impairment
CX: esophageal disease, CKD
Denosumab
Anti-RANKL mAB, dec. osteoclast bone resorption
SE: HypoCa, osteonecrosis of the jaw
CX: hypoCa
Teriparitide
PTH receptor antagonist, stimulates osteoblasts and promotes bone growth
SE: transient hyperCa, hyperuricemia, osteosarcoma
CX: hx gout, osteosarcoma risk, radiation therapy of bone, inc. ALP, paget’s disease, childrne/adolescents
Raloxifene
SERM, ER agonist in bone (dec. genes involved in osteoclast activation)
SE: venous thromboembolism
Calcitonin
Calcitonin receptor agonist, opposes PTH
SE: nausea, hand swelling, inc. rates of Ca
Cincacalcet
Calcimemetic, allosterically enhances affinity of CaSR for Ca2+
SE: HypoCa, seizure risk
CX: Serum Ca2
Tx HyperCa
Volume repletion with saline
Calcitonin
Bisphosphonates
Tx HypoCa
Vitamin D and Ca supplementation
Tx Rickets and Osteomalacia
Vitamin D supplementation
Tx Primary Hyperparathyroidism
Surgery
Cincacalcet
Bisphosphonates
Tx CKD/Hyperphosphatemia/Secondary Hyperparathyroidism
Phosphate binders - Sevelamer
Cinacalcet
Calcitriol
Tx Osteoporosis
Calcium/Vitamin D supplementaiton bisphosphonates Denosumabd Raloxifene Calcitonin Teriparitide
Tx Paget’s Disease
Bisphosphonates
Calcitonin
Hydrocortisone
Short acting replacement
Cortisone
Short acting replacement
Fludrocortisone
Intermediate acting replacement
Mineralcorticoid!
Prednisone
Intermediate acting replacement
Prednisolone
Intermediate acting replacement
Trimacinolone
Intermediate acting replacement
Dexamethasone
Long acting replacement
Respiratory distress syndrome!
Beclamethasone
Long acting replacement
Ketaconazole
Tx of Cushing’s
Dec. cortisol synthesis by inhibiting CYP11A1/CYP11B1
SE: hepatotoxicity, gynecomastia, impotence, teratogenic, renal insufficiency
Etomidate
Tx of Cushing’s
IV only dec. cortisol synthesis by CYP11A1/CYP11B1
SE: Renal insufficiency
Metyrapone
Tx of Cushing’s
Dec. cortisol synthesis by CYP11B1/CYP11B2
SE: Renal insufficiency
SAFE IN PREGNANCY
Mitotane
Tx of Cushing’s
Dec. cortisol synthesis by ablation of adrenocorticol cells
SE: rash, ataxia, GI, renal insufficiency
Mifepristone
Tx of Cushing’s
PR and glucocorticoid receptor antagonist (higher doses)
SE: abortifacient, renal insufficiency