Exam 7: Endo/MSK Flashcards
Somatropin
synthetic growth hormone
SQ/IM, give at night, start ASAP, stop w/growth plate closure
assessed w/x-ray monthly (or just wt/ht?)
prolonged tx leads to diabetes mellitus (antagonizes insulin)
Ocreotide
tx for acromegaly
natural GH inhibiting hormone -> suppress the release of GH from pituitary
Pegvisomant
tx for acromegaly/gigantism
GH receptor antagonist
Vasopressin
tx DI
identical to endogenous ADH
shorter duration of action (2-8), IM/SC, potent vasoconstrictor -> used in cardiac arrest
ADRs: water intoxication, excessive vasoconstriction, tachypnea
Desmopressin
tx DI -> drug of choice
synthetic form of vasopressin (ADH)
longer duration of action (8 - 20), less potent vasoconstrictor, INH/PO/SC/IV
less significant ADRs but same
Levothyroxine
synthetic T4 (much of the drug converts to T3, so don’t need that as well)
narrow thera range and takes long time to reach (1 month, 7 day half-life), in morning w/o food (30-60 min b4)
increases metabolic rate and oxygen demand/consumption (careful w/cardiac & HTN ->MI)
IV for myxedema coma
Liothyronine
synthetic T3
Methimazole
thionamide
inhibits the synthesis/release of T3/4 (doesn’t destroy existing, so can take 3-12 weeks to stabilize)
can lead to hypothyroidism, agranulocytosis (sore throat/fever, monitor WBCs -> high risk for infx)
Propylthiouracil (PTU)
thionamide
safer in pregnancy
Propanolol
for decreasing HR for Graves
Hydrocortisone
tx of Addisons/adrenal insufficiency
PO - chronic and IV - acute
may need to increase if known time of stress (hospitalization, etc.)
never stop abruptly - acut insufficiency s/s (N/V, profound fatigue, confusion, coma, fluid deficit, renal injury, and hypotension (hypoNa and hyperK)
synthetic steroid, drug of choice, both gluco & mineral
ADR: HTN, high BGL, impaired wound healing, leukocytosis, impaired immunity, osteoporosis– Cushing’s syndrome!
Fludrocortisone
the only mineralcorticoid available -> add if needed
for sodium loss and hypotension (K+ wasting) -> watch for fluid overload
Dexamethasone
tx inflammation from cerebral edema -> used often w/neuro surgery
also tx allergic reactions
Prednisone
inexpensive glucocorticoid and frequently prescribed
Ketoconazole
antifungal, but tx for Cushings -> inhibits synthesis of adrenal steroid hormones
not first choice -> treat underlying first, discontinue corticosteroids, adrenalectomy
Calcium/Vit D
decrease bone resorption (stop clast breakdown)
1000 mg/day for premenopausal
12-1500 mg/day postmenopausal
excess - hypercalcemia, kidney stones
Estrogen Replacement Therapy
decrease bone resorption (stop clast breakdown)
benefits don’t outweigh risks of cancer (not up to date, but on slides)
Raloxifene
Estrogen Receptor Modulators (SERM)
decrease bone resorption (stop clast breakdown)
binds to selective estrogen receptors (only bone receptors) and produce positive estrogen effects on bone
Black box: DVT/PE
Alendronate/Ibandronate
Biphosphonates (fosamax), PO/IV
decrease bone resorption (stop clast breakdown)
ADR: esophagitis/ulcer, atypical femur fractures, jaw necrosis, ocular issues
take on empty stomach, low bioavailability
full glass of water
must stay upright for 30 min after admin
Calcitonin
decrease bone resorption (stop clast breakdown)
SC/INH
lowers serum calcium level by moving calcium to bone, endogenous is secreted by thyroid
Teriparatide
(Forteo)
promote bone formation - increases bone deposition by blasts
form of endogenous parathyroid hormone, daily prefilled SQ
ADRs: arthralgias, back pain, leg cramps, ortho hypo
Black box: osteosarcoma
Denosumab
monoclonal antibody that decreases formation and function of clasts
decreases bone resorption, SQ
ADRs: Back pain/pain in extremities, Hypocalcemia, Serious infections, Dermatologic reactions, dermatitis, eczema, Osteonecrosis of the jaw
NSAIDs
starting at diagnosis and PRN for rapid relief
“prostaglandin inhibitors” -> reduce vasodilation, capillary permeability, fever, and pain
inhibit the COX enzymes - COX 1 = protects stomach lining, renal function, and platelet aggregation; COX 2 = triggers inflammation, pain, fever, maintains renal function
2nd gen like celecoxib select for only COX 2 and protect stomach/renal more but inc risk for MI/CVA
renal impairment, PUD (GI upset/bleed), bleeding tendency, peripheral edema
Glucocorticoids
rapid relief and can slow disease progression
short courses due to ADR
Methotrexate
DMARD
start at diagnosis and continue indefinitely - not rapid relief, but slows progression
reduce joint destruction, slow disease progression, onset typically weeks to months
sometimes used for cancer
labs: AST, ALT (hepatotoxic), BUN/creatinine (nephrotoxic) & CBC (bone marrow suppression)
Sulfasalazine
DMARD
tx IBD and RA
ADRs: GI, derm, **cannot give to pt w/sulfa allergy, hepatotoxic, bone marrow suppression
Hydroxychloroquine
DMARD
antimalarial agent - MOA w/RA is unknown
combo w/methotrexate
ADR: retinal damage
Adalimumab/Etanercept
TNF blockers
blocks inflammatory mediators -> worried about serious systemic infx (sepsis/fungal)
ADRs: systemic infx, hypersensitivity, hepatotoxic, heme (aplastic, neutro and thrombocytopenia)
Allopurinol
inhibits uric acid formation -> preferred agent
prophylactic
Naproxen/indomethacin
NSAIDs for gout
??
Probenecid
increases uric acid excretion
don’t use 2-3 weeks after acute attack
Prednisone
when NSAIDs not tolerated or contraindicated
Colchicine
anti-inflammatory
MOA: inhibits migration of leukocytes to inflamed site
not used as much bc NSAIDS more effective
ADRs: GI
Baclofen
CNS depressant - acts in spinal cord, no direct effect on skeletal muscles (spasticity)
PO or intrathecal
ADRs: drowsiness, fatigue, hypo-ventilate, dizzy, avoid alcohol, can have withdrawal -> hallucinations, ideations
Diazepam/tizanidine
central acting (CNS) skeletal muscle relaxant -> reduces tonic motor activity from the brainstem
works on both spasms and spasticity
do not drive car
ADR: CNS depressant, anticholinergic, dysrhythmias, serotonin syndrome
Dantrolene
directly on skeletal muscles (spasticity)
ADR: muscle weakness, hepatotoxic, drowsy
Cyclobenzaprine
central acting (CNS) skeletal muscle relaxant -> reduces tonic motor activity from the brainstem
only works on spasms, not spasticity
ADR: CNS depressant, anticholinergic, dysrhythmias, serotonin syndrome
