Exam 4 endocrine + Psych Flashcards
Neurotransmitters in major depressive disorder
Serotonin, NE, dopamine
Treatment phases of depression
Acute: 6-12 weeks
Continuation: 9 months-1 year
SSRI
Fluoxetine, citalopram, sertraline, fluvoxamine, paroxetine, escitalopram
Effective after 4-6 weeks
May decrease REM sleep
SE: Sexual dysfunction
Abrupt withdrawal causes flu like symptoms, insomnia, GI effects, anxiety
Only SSRI approved for children
Fluoxetine (Prozac)
SNRIs
Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran
For more resistant depression
Takes 4-6 weeks
Higher rates of anticholinergic effects
TCAs
-triptyline and -amine
Worse SE than SSRI
Active at ACh and H receptors–anticholinergic effects
MAOI
Phenlzine
Decrease degradation of nE, serotonin, and dopamine
Potential for life threatening hypertension
Last line treatment
Neurotransmitters involved in anxiety disorders
NE, serotonin, GABA
Antidepressants for anxierty
SSRI or SNRI or imipramine (TCA)
1st line tx of anxiety
Benzodiazepines
Alprazolam (Xanax), clonazepam, diazepam, lorazepam (Ativan), oxazepam
bind to GABA A
Indicated for short term management (2-4 weeks) as well as exacerbations
Long term tx not recommended
SE: drowsiness and psychomotor impairment
Flumazenil for OD
Azapirones
Buspirone
Partial agonist at 5-HT1a receptor and inhibits uptake of dopamine, serotonin and NE
Used as adjunct therapy
No hypnotic, muscle relaxant or anticonvulsant properties
Not useful for immediate relief
Minimal abuse potential
Benzodiazepines for insomnia
Blocks thalamic, hypothalamic and limbic arousal
Tempazepam + Lorazpem–intermediate acting for sleep maintenance
Flurazepam–long acting and rapid onset for sleep initiation
Benzodiazepine receptor agonists
Eszoplicone, zolpidem (ambien), zaleplon
Induces sleepiness but not anxiolysis or muscle relaxation
Can increase sleep walking, eating and driving
Suvorexant
Blockage of orexin neuropeptides and results in severe sleepiness
Sleep induction and maintenance achieved
Ramelteon
Melatonin receptor agonists
Shortens latency to sleep onset
1st line therapy for insomnia
Benzo, benzo agonist, ramelteon
Ropinirole or pramipexole
Dopaminergic agent for restless leg syndrome
Quicker onset than dopamine agonists–useful for relief of sleep onset insomnia
Anticonvulsants for restless leg
Off label use
Considered when dopamine agonists have failed
Narcolepsy triad
Excessive daytime sleepiness, cataplexy, sleep related hallucinations, sleep paralysis
Modafenil and Armodafinil
Psychostimulant
Increase release of NE in hippocampus, thalamus and amygdala
Tx of narcolepsy
Methylphenidate
amphetemaines
tx of narcolepsy
Stimulants CNS activity and blocks reuptake of NE
Mirtazapine
Similar to TCA
Causes sedation
Alpha 2 antagonist/mixed serotonin blockers
Increases appetite and decreases insomnia
Trazodone
Serotonin 2A antagonist and serotonin reuptake inhibitor
Highly sedating
Often used to treat insomnia in low doses
Atarax and Visatril
Hydroxyzines
For anxiety
H1 receptor antagonist with low antihistaminic properties
SE: dry mouth and drowsiness
1st line tx for insomnia
Zaleplom: help patient fall asleep
Temazepam: stay asleep through night
Antidepressant: for chronic insomnia
Diphenhydramine: pregnancy
1st line tx for restless legs
Dopaminergic agonist at low dose
2nd line tx for restless legs
Anticonvulsant or opioid
Sulfonylureas
Tolbutamide, chlorpropramide, tolazamide, gluburide, glipizide, glimepiride
Binds to beta cell receptors causing Ca channels to open and release of inuslin
SE: hypoglycemia
Biguanides
Metformin
Not hypoglycemic
Used in conjunction with diet
Inhibits hepatic glucose production and improves peripheral sensitivity to insulin
CI: renal issues, HF, pregnancy, alcoholics, >80, children
SE: GI upset
Thiazolidinediones
Rosiflitazone + Ploglitazone Decreases insulin resistance Binds to nuclear steroir hormone SE: weight gain, edema, hepatic toxicity, hypoglycemia CI: HF patient , liver failure
Alpha glucosidase inhibitors
Acarbose + Miglitol
Decreases absorption of carbs at brush border of intestine
Given as adjunct therapy
CI: bowel disease
Meglitinide Analogs
Repaglinide + Nateglinide
Rapid acting insulin secretagogues stimulates release of insulin in response to meal
CI: type 1 DM, DKA, Severe infecton, surgery, trauma, pregnancy, BF
DPP4 inhibitors
-gliptin
Increases amoint of circulating incretins and increases GLP-1
SE: URI, UTI, HA
GLP-1 receptor agonists (incretins)
-Glutide and exenatide Used as adjunct therap Stimulates glucose dependent secretion of insulsin from pancreas while decreasing release of glucagon and slows gastric emptying Avoids hypoglycemia SE: GI distress
Amylin analog
Pramlintide
Synthetic of amylin–co-secreted with insulin in response to food, delays fastric emptying
Type 1 and type 2 DM
SE: nausea
Sodium glucose co transporter 2 inhibitors
-Gliflozin
Induces glycosuria
CI: type 1 DM, DKA, severe kidney disease
Rapid acting insulin
Lispro (Humalog)
Onset <30 mins
Duration 3-5 hours
Short acting insulin
Regular insulin (Humulin R, Novolin R)
Onset 30 mins
Duration 6-8 hours
Intermediate acting insulin
NPH (Humulin N, Novolin N)
Onset 1-4 hours
Durating 14-26 hours
Long acting insulin
Glargine (Lantus) + Detemir
Onset 2-4 hours
Duration 24 hours
Dawn phenomenon
Early morning increase in blood sugar between 2 and 8 am–give insulin
Somogyi effect
Hypoglycemia in the middle of the night leading to rebound hyperglycemia in early morning
-Do not increase insulin
General stepwise tx for type 2 DM
Metformin first, titrate up, add sulfonylureas, add TZDs
3 drugs diabetics should be on
Glucose lowering agent, statin, ACEI
S/S hypothyroidism
fatigue, constipation, weight gain, bradycardia, peripheral edema
Dx: increased TSH and decreased T4
Tx of hypothyroidism
Levothyroxine, liothyronine, liotrix
Give on empty stomach–interact with everthing; do not give with PPI
MOA: increases basal metabolic rate, increases utilization of glycogen, promotes gluconeogenesis
Start with lowest dose; titrate up every 4-6 weeks
Most common cause of hyperthyroidism
Graves disease–autoimmune
Autoantibodies act like TSH
S/S hyperthyroidism
Palpitations, sweating, heat intolerance, weight loss, increased BP, increased HR, exophthalmos
3 main tx for hyperthyroidism
Antithyroid drugs, radioactive iodine, surgery
Antithyroid drugs
Methimazole + Propylthiouracil
Inhibits iodine organification; blocks conversion of T4 to T3
Ajunct therapy for hyperthyroidism
Beta blockers for palpitations (propranolol and atenolol)
Iodine containing compounds (tx of thyrotoxic storm)
Lithium
Glucocorticoids
Tx of exophthalmos
Anti-inflammatory drugs, immunosuppressive drugs, surgery
Goal of diabetic therapy
A1C < 6.5
Most common type 2 DM regimen
2/3 dose in morning, 1/3 dose in evening
Morning dose is 2/3 intermediate acting and 1/3 short acting
Evening dose is 1/2 intermediate acting and 1/2 short acting
Length of tx for hypothyroidism
Usually lifelong
Length of tx for hyperthyroidism
Usually 1-2 years max
Hyperthyroidism for pregnant woman
Methimazol except during first trimester of pregnancy
