Exam 3 Endocrine Drugs Flashcards
1
Q
methods for treating hypotitutiarism
A
- replace missing hormones
- ACTH, TSH, FSH/LH
- growth hormone (somatropin)
- vasopressin (AVP akak ADH)
2
Q
growth hormone indication
A
hypopituitarism
3
Q
growth hormone MOA
A
synthetic growth hormone, acts on bone, skeletal muscle, fat.
increase RBC mass, transport of water, electrolyte and other fluid functions
4
Q
growth hormone AE
A
fluid retention
muscle and joint pain
5
Q
growth hormone drug
A
Somatotropin
6
Q
vasopressin (AVP) indication
A
hypopituitarism
7
Q
vasopressin (AVP) MOA
A
increases aquaporins on cell membrane, water is reabsorbed
8
Q
vasopressin (AVP) drugs
A
DDAVP
9
Q
What is DDAVP also used for
A
nocturia
10
Q
vasopressin (AVP) AEs
A
dry mouth
hyponatremia
11
Q
vasopressin (AVP) main role
A
decrease water excretion by causing increased urine concentration
12
Q
vasopressin (AVP) is aka….
A
ADH
13
Q
1st line treatment for excessive glucorticoids
A
surgery
14
Q
2nd line treatment for excessive glucocorticoids
A
medication (usually pre or post op or if surgery is contraindicated or fails)
- steriodgenesius inhibitors (block cortisol synthesis)
- glucocorticoid antagonist (blocks cortisol binding to receptor)
15
Q
treatment used for glucocorticoid deficiency
A
replace glucocorticoids with steroids
hydrocortisone
16
Q
treatment for mineralocorticoid excess
A
use aldosterone receptor antagonist
- spironolactone
- eplerenone
17
Q
treatment for mineralocorticoid deficiency
A
use fludrocortisone
18
Q
testosterone replacement indication
A
androgen deficiency
19
Q
testosterone replacement route
A
IM, subcut injection or pellet, patch, gel, solution, nasal spray, buccal
20
Q
testosterone replacement IM concerns
A
variable sx relief, mood changes
21
Q
testosterone replacement AE
A
- possible increased risk of MI, stroke, CV death
- prolonged use can cause hepatoxicity
(IM associated with hepatic adenomas) - infertility with large doses
22
Q
anabolic-androgenic steroids (AAS)
A
DHEA - banned by FDA but markets as a nutritional supplement
23
Q
anabolic-androgenic steroids (AAS) AE
A
acne MI, CV death from arrhythmia, VTE Cancer Infection Musculoskeletal - tendon/ligament rupture insomnia, mood disorders
24
Q
Forms of contraception
A
- combo oral
- IUD
- injection
- progestin only pill
- progestin only implant
25
combined oral contraceptive AEs
```
increased BP
n/v
weight gain
acne
depression
topical rxn
RARE: DVT/PE, stroke, MI
```
26
IUD AE
rare pelvic inflammatory disease
| - copper associated with increased bleeding (anemia)
27
estrogen and progesterone indication
post-menopausal hormone replacement therapy
28
estrogen alone indication
if no uterus
29
estrogen route
PO, transdermal patch/spray, topical gel/solution, vaginal ring/cream
30
estrogen AE
```
nausea
HA
breast tenderness
vaginal bleeding
endometrial cancer
```
31
progesterone route
PO, patch
32
progesterone AE
bloating, headache, weight gain, irritability
33
estrogen and progesterone known risks
DVT, PE, breast cancer
34
alpha-adrenergic antagonists indication
benign prostatic hypertrophy (enlarged prostate gland)
35
alpha-adrenergic antagonists MOA
relax smooth muscle in prostate and bladder neck (urination is easier)
36
alpha-adrenergic antagonists AE
hypotension
37
5a-reductase inhibitor MOA
interfere with stimulatory effects of testosterone
38
5a-reductase inhibitor AE
hypotension
39
anticholinergic agents drugs
oxybutynin
40
anticholinergic agents MOA
antispasmodic effect on smooth muscle
| - blocks acetylcholine on smooth muscle
41
anticholinergic agents AE
cant see, spit, pee, shit
42
B3-agrengic agonist MOA
relaxes detrusor muscle to decrease voiding sx
43
B3-agrengic agonist AE
increased BP
44
B3-agrengic agonist indication
benign prostatic hypertrophy
45
medication classes for benign prostatic hypertrophy
- alpha-adrenergic antagonists
- 5a reductase inhibitors
- anticholinergic agents
- b3-adrenergic agonist
46
calcimemtics indication
hyperparathyroidism
47
calcimemtics moa
interacts with CaSR to increase calcium affinity and decreases PTH
48
calcimemtics AE
monitor for hypocalcemia
49
bisphonates MOA
prevents calcium loss from bone
50
what do you take for hypoparathyroidism
calcium and vitamin d
51
levothyroxine indication
hypothyroidism
52
levothyroxine MOA
synthetic version of T4 that is converted T3
53
levothyroxine AE
NTI drug
- requires monitoring and dose adjustments
- generally well tolerated unless you over treat (pushes you into hyperthyroidism sx)
54
levothyroxine dosing
take on an empty stomach.
30-60 minutes before a mean or 3-4 hours after a meal
- do not take within 4 hours of certain supplements
55
levothyroxine over treatment
can increase risk of CVD issues
| - long term over treatment can lead to decreased bone density and increased risk of fractures
56
drug classes to treat hyperthyroidism
1. antithyroid meds
2. radioactive iodine
3. thyroidectomy
57
antithyroid indication
hyperthyroidism
58
antithyroid drug
methimazole
59
antithyroid MOA
blocks formation of T4 and T3 -- by inhibiting oxidation of iodine
60
antithyroid AE
common: rash GI upset, arthralgia (joint pain)
rare: agranulyctyes, heptatoxicity
- can cause hypothyroidism but less less likely than other treatments
61
what antithyroid medication is preferred in pregnancy
PTU over methimazole
62
types of osteoporosis treatment
- anitresorptive therapy
| - anabolic therapy
63
antiresoprtive therapy MOA
blocks the breakdown of bone
64
anabolic therapy MOA
increases bone formation
65
calcium and vitamin D indication
osteoporosis
66
bisphosphonates indication
osteoporosis
67
bisphosphonates MOA
inhibits the natural bone turnover pathway, increases osteoclasts, to decrease bone turnover
68
what is 1st line treatment for osteoporosis
bisphosphonates
69
bisphosphonates AE
mild upper GI sx (GERD)
70
bisphosphonates dosing
take w plain water 30-60 minutes before any food or meds
- stay upright
- absorption can be decreased by up to 90% if taken w food or water
71
bisphosphonates contraindications
- hypoglycemia
- inability to remain upright
- esophageal abnormalities with PO
72
bisphosphonates rare but serious risks
- atypical femur fracture
- osetonecrosis of jaw
monitor: hypocalcemia, reports of sever joint, muscle, and bone pain
73
anti-RANKL dosing
every 6 month in the providers office
74
anti-RANKL indication
osteoporosis
75
bisphosphonates ending
-dronate
76
anti-RANKL MOA
ultimately inhibits bone resorption
77
anti-RANKL AE
arthralgia, limb pain, derm reactions
Rare: atypical femur fraction, increased risk of infections
78
Sclerosin inhibitors indication
osteoporosis
79
Sclerosin inhibitors MOA
inhibits sclerotin to increase bone formation
80
Sclerosin inhibitors AE
arthralgia
rare: hypocalcemia, atypical fractures, ONJ, incase CVD issues
81
Common Oral Diabetic medication classes
1. Binguanide (metformin)
2. sulfonylureas (SU)
3. Thiazolidinediones (TZD)
4. Dipeptidyl-peptidase 4 inhibitors (DPP-4i)
5. Sodium glucose co-transporter 2 inhibitors (SGLT2i)
6. Glucagon-like peptide 1 agonist (GLP1a)
82
common injectable diabetic medication classes
1. glucagon-like peptide 1 agonists (GLP1a)
| 2. insulin
83
what is the only medication will discuss for T1DM
insulin
84
Biguanide (metformin) indication
T2DM
85
Biguanide (metformin) MOA
not fully known -
1. inhibits the production of glucose
2. inhibits intestinal absorption of glucose
3. increases insulin sensitivity in muscle and fat
86
Biguanide (metformin) AEs
low risk of hypoglycemia!!
common AEs: GI (n/d/cramping/bloating)
Vitamin B12 deficiency - but don't assume! Can be misdiagnosed as peripheral neuropathy
87
Biguanide (metformin) route
oral, oldest oral drug for T2DM
88
sulfonylereas (SU) indication
T2DM
89
sulfonylereas (SU) MOA
binda sulfonylurea receptor in the pancreas
| - depolarization causes insulin release
90
sulfonylereas (SU) AE
SUPER high risk hypoglycemia (esp in elderly and renal dysfunction)
weight gain
BEERS LIST
91
sulfonylereas (SU) route
-typically taken before breakfast (must be 30 mins before a meal)
If not taken correctly can increase hypoglycemia risk
92
Thiazolidinedione (TZD) indication
T2DM
93
Thiazolidinedione (TZD) MOA
increases insulin sensitivity in muscle and fat, increases gene responses that influence glucose metabolism
"insulin sensitizer"
- no diuretic effect
94
sulfonylereas (SU) drug
glipizide
95
Thiazolidinedione (TZD) AEs
low hypoglycemia risk!!
edema
long term increase bone fracture risk (esp females)
boxed warning! (HF, monitor and avoid in pre-existing HF)
96
DPP-4 Inhibitors indication
T2DM
97
DPP-4 Inhibitors MOA
inhibits DPP-4 (an enzyme we all have that typically breaks down incretin hormones)
- increases insulin synthesis and release and decreases glucagon secretion
98
DPP-4 Inhibitors AE
low risk for hypoglycemia
- very well tolerated
case reports of arthralgia (also genetic component)
99
SGLT2 inhibitor indication
T2DM
100
SGLT2 inhibitor MOA
blocks glucose reabsorption in the kidney at SGLT2
| - increases urinary glucose excretion
101
SGLT2 inhibitor AE
volume depletion related AEs
| rare risk: DKA (more so if dehydrated or used off-label in T1DM)
102
SGLT2 inhibitor "pros"
some can reduce risk of renal complications, CV events and HF hospitalizations
103
GLP1 Receptor Agonist route
injectable or PO
- sometimes used in combo with basal insulin
- can be daily or weekly
104
GLP1 Receptor Agonist MOA
increases insulin secretion
decreases glucagon secretion
slows gastric emptying (to increase satiety)
105
GLP1 Receptor Agonist AEs
nausea, bloating, diarrhea
some reduce risk of CV event
106
insulin indication
T1DM
| more advanced T2DM
107
insulin MOA
bind tyrosine kinase receptors
triggers intracellular effects
increase expression of GLUT4 receptor
increase glucose uptake
can also...
inhibit production of glucose
108
insulin AEs
hypoglycemia! and weight gain
109
basal insulin
always working in background
| - usually once daily (sometimes twice)
110
rapid bolus insulin
onset : 10-30 mins
| duration 3-5+ hours
111
regular bolus insulin
onset: 30 mins
direction: 4-12 hours
112
bolus insulin
typically given before a meal (sometimes immediately after)
can be given to correct hyperglycemia
"correction insulin"
"sliding scale insulin"
113
intermediate insulin (NPH)
direction: 12-24 hours
| inject once or twice daily
114
mixed insulin
```
combo of intermediate w rapid or regular acting
- inject before meal
70/30
70% intermediate 30% regular acting
longer acting/shorter acting
```
115
first line T2DM treatment
metformin
116
2nd line T2DM treatment
pt specific
117
which medication classes have the highest risk of hypoglycemia
sulfonyrias and insulin
