FA Endocrine

Question 1

Insulin, Rapid Acting

Answer 1

Lispro, Aspart, Glulisine

Question 2

Insulin, Short Acting

Answer 2

Regular

Question 3

Insulin, Intermediate Acting

Answer 3

NPH

Question 4

Insulin, Long Acting

Answer 4

Glargine, Detemir

Question 5

Insulin Mechanism

Answer 5

Bind insulin receptor (tyrosine kinase activity).
Liver: ↑ glucose stored as glycogen.
Muscle: ↑ glycogen, protein synthesis; ↑ K+ uptake.
Fat: ↑ TG storage.

Question 6

Insulin, Rapid Acting Use

Answer 6

DM1, DM2, GDM (postprandial glucose control)

Question 7

Insulin, Short Acting Use

Answer 7

DM1, DM2, GDM, DKA (IV), hyperkalemia (+ glucose), stress hyperglycemia.

Question 8

Insulin, Intermediate Acting Use

Answer 8

DM1, DM2, GDM.

Question 9

Insulin, Long Acting Use

Answer 9

DM1, DM2, GDM (basal glucose control).

Question 10

Insulin Toxicity

Answer 10

Hypoglycemia, rare hypersensitivity reactions.

Question 11

Biguanides

Answer 11

Metformin

Question 12

Metformin Mechanism

Answer 12

Exact mechanism unknown. ↓ gluconeogenesis, ↑ glycolysis, ↑ peripheral glucose uptake (insulin sensitivity).

Question 13

Metformin Use

Answer 13

Oral. First-line therapy in type 2 DM. Can be used in patients without islet function.

Question 14

Metformin Toxicity

Answer 14

GI upset; most serious adverse effect is lactic acidosis (thus contraindicated in renal failure).

Question 15

Sulfonylureas

Answer 15

First generation: Tolbutamide, Chlorpropamide

Second generation: Glyburide, Glimepiride, Glipizide

Question 16

Sulfonylurea Mechanism

Answer 16

Close K+ channel in β-cell membrane, so cell depolarizes → triggering of insulin release via ↑ Ca2+ influx.

Question 17

Sulfonylurea Use

Answer 17

Stimulate release of endogenous insulin in type 2 DM. Require some islet function, so useless in type 1 DM.

Question 18

Sulfonylurea Toxicity

Answer 18

Risk of hypoglycemia ↑ in renal failure. First generation: disulfiram-like effects. Second generation: hypoglycemia.

Question 19

Glitazones/thiazolidinediones

Answer 19

Pioglitazone, Rosiglitazone

Question 20

Glitazone Mechanism

Answer 20

↑ insulin sensitivity in peripheral tissue. Binds to PPAR-γ nuclear transcription regulator.

Question 21

Glitazone Use

Answer 21

Used as monotherapy in type 2 DM or combined with other agents.

Question 22

Glitazone Toxicity

Answer 22

Weight gain, edema. Hepatotoxicity, heart failure.

Question 23

α-glucosidase Inhibitors

Answer 23

Acarbose, Miglitol

Question 24

α-glucosidase Inhibitor Mechanism

Answer 24

Inhibit intestinal brush-border α-glucosidases. Delayed sugar hydrolysis and glucose absorption → ↓ postprandial hyperglycemia.

Question 25

α-glucosidase Inhibitor Use

Answer 25

Used as monotherapy in type 2 DM or combined with other agents.

Question 26

α-glucosidase Inhibitor Toxicity

Answer 26

GI disturbances

Question 27

Amylin analogs

Answer 27

Pramlintide

Question 28

Pramlintide Mechanism

Answer 28

↓ gastric emptying, ↓ glucagon.

Question 29

Pramlintide Use

Answer 29

Type 1 and 2 DM.

Question 30

Pramlintide Toxicity

Answer 30

Hypoglycemia, nausea, diarrhea.

Question 31

GLP-1 Analogs

Answer 31

Exenatide, Liraglutide

Question 32

GLP-1 Analog Mechanism

Answer 32

↑ insulin, ↓ glucagon release.

Question 33

GLP-1 Analog Use

Answer 33

Type 2 DM.

Question 34

GLP-1 Analog Toxicity

Answer 34

Nausea, vomiting; pancreatitis.

Question 35

DPP-4 Inhibitors

Answer 35

Linagliptin, Saxagliptin, Sitagliptin

Question 36

DPP-4 Inhibitor Mechanism

Answer 36

↑ insulin, ↓ glucagon release.

Question 37

DPP-4 Inhibitor Use

Answer 37

Type 2 DM.

Question 38

DPP-4 Inhibitor Toxicity

Answer 38

Mild urinary or respiratory infections.

Question 39

PTU, Methimazole Mechanism

Answer 39

Block thyroid peroxidase, inhibiting oxidation of iodide and organification (coupling) of iodine → inhibition of thyroid hormone synthesis. PTU also blocks 5'-deiodinase, which ↓ peripheral conversion of T4 to T3.

Question 40

PTU, Methimazole Use

Answer 40

Hyperthyroidism. PTU blocks Peripheral conversion, used in Pregnancy.

Question 41

PTU, Methimazole Toxicity

Answer 41

Skin rash, agranulocytosis (rare), aplastic anemia, hepatotoxicity (PTU). Methimazole is a possible teratogen (can cause aplasia cutis).

Question 42

Levothyroxine, Triiodothyronine Mechanism

Answer 42

Thyroxine replacement.

Question 43

Levothyroxine, Triiodothyronine Use

Answer 43

Hypothyroidism, myxedema.

Question 44

Levothyroxine, Triiodothyronine Toxicity

Answer 44

Tachycardia, heat intolerance, tremors, arrhythmias.

Question 45

GH Use

Answer 45

GH deficiency, Turner syndrome

Question 46

Somatostatin (octreotide) Use

Answer 46

Acromegaly, carcinoid, gastrinoma, glucagonoma, esophageal varices.

Question 47

Oxytocin Use

Answer 47

Stimulates labor, uterine contractions, milk let-down; controls uterine hemorrhage.

Question 48

ADH (DDAVP) Use

Answer 48

Pituitary (central, not nephrogenic) DI.

Question 49

Demeclocycline Mechanism

Answer 49

ADH antagonist (member of tetracycline family).

Question 50

Demeclocycline Use

Answer 50

SIADH

Question 51

Demeclocycline Toxicity

Answer 51

Nephrogenic DI, photosensitivity, abnormalities of bone and teeth.

Question 52

Glucocorticoids

Answer 52

Hydrocortisone, prednisone, triamcinolone, dexamethasone, beclomethasone, fludrocortisone (mineralocorticoid and glucocorticoid activity).

Question 53

Glucocorticoid mechanism

Answer 53

Metabolic, catabolic, anti-inflammatory, and immunosuppressive effects mediated by interactions with glucocorticoid respones elements and inhibition of transcription factors such as NF-κB.

Question 54

Glucocorticoid Use

Answer 54

Addison disease, inflammation, immune suppression, asthma

Question 55

Glucocorticoid Toxicity

Answer 55

Iatrogenic Cushing syndrome - buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis (treat with bisphosphonates), adrenocortical atrophy, peptic ulcers, diabetes (if chronic). Adrenal insufficiency when drug stopped abruptly after chronic use.