Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endo II Pharm > Final > Flashcards

Final Flashcards

1
Q

Ant Pit/Hypothalamic Hormones-Receptors
GH and Prl activate?
TSH/FSH/LH/ACTH activate?

A

GH and Prl activate JAK-STAT

TSH/FSH/LH/ACTH activate GPCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Explain regulation of pituitary and hypothalamic hormones
TRH, TSH, T3/4
GnRH, FSH/LH, E/P
CRH, ACTH, cortisol
GHRH, GH/IGF1, somatostatin
Thyrotrophin-RH, secretin, glucagon, VIP, GIP, Prl, and dopamine

A

TRH stim TSH which stim T3/4 which inhibits TRH and TSH
GnRH stim FSH/LH which stim E/P which inhibit GnRH and FSH/LH
CRH stim ACTH which stim cortisol which inhibits CRH and ACTH
GHRH stim GH and IGF1 which inhibit GHRH; SST inhibits GHRH
ThyrotrophicRH, secretin, glucagon, VIP, and GIP stim Prl which is inhibited by dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q 
GH Drug- Somatropin
Kinetics? 
MOA?
Uses? (4)
AE? (Kids and adults)
CI?
A

Somatropin
Kinetics- somatropin is a rhGH, metabolized by liver, and induces p450
MOA- binds GH-R, activates JAK-STAT, leads to IGF1 mediated affects
Uses- GH deficiency (make short children nml size and reverse symptoms seen in adults like obesity and loss of m mass); short stature assoc w/ Prader Willi, Turners, or Noonan; wasting in AIDS pt; pt w/ short bowel syndrome
AE- kids- intracranial HTN, scoliosis, otitis media in Turners, hypothyroidism, gynecomastia, and pancreatitis
AE- adults- edema, myalgia, arthralgi, and carpal tunnel
CI- malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
Mecasermin
Uses?
What is it made of?
How is it given?
AE? How to prevent
A

Mecasermin
Used in children w/ growth failure whohave severe IGF1 deficiency not responsive to exogenous GH
Complex made of rhIGF1 and rhIGFBP3 (inc half life of rhIGF1)
Give subQ
AE- hypoglycemia (eat 20 min before injection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

GH Antagnoists
What are the 2 classes
What is the use?

A

GH Antagonists
SST Analogs (reotides) and Pegvisomant
used for somatotroph adenomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SST (somatostatin)Analogs
MOA
What are the 2 drugs and their uses
AE

A

SST Analogs
MOA- inhibit GH, glucagon, insulin, and gastrin
Octreotide- give subQ, use for acromegaly, carcinoid syndrome, gastrinomas, glucagonomas, VIPomas
Lanreotide- use for acromegaly
AE- GI, gallstones, b12 deficiency, and bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Peqvisomant
MOA
Uses

A

Peqvisomant
MOA- GH-R antagonist, binds GH-R but doesnt activate JAK-STAT
Uses- acromegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dopamine Agonists (2)
MOA
Uses
AE (when do you discontinue)

A 
Dopamine Agonists
Bromocriptine and Cabergoline
MOA- D2R agonist
uses- hyperprolactinemia
AE- NV, HA, hypotension, fatigue
Discontinue if prego w/ microadenoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Oxytocin uses?

A

Induce labor, limit post partum bleeding, and elicit milk ejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q 
ADH Agonists (2)
Kinetics
MOA
Uses
AE (use caution with which one in pt with what condition?)
A

ADH Agonists
Vasopressin and Desmopressin
Kinetics- desmopressin has longer half life and minimal V1 activity
MOA- activate GPCR V1R and V2R; V1 vasoconstricts; V2 inc water reabsorption
Uses- Central DI (desmo) and hemophilia A or von willebrand disease (desmo)
AE- HA, NV, abdominal pain, hyponatremia, seizure; use vasopressin w caution in pt with CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ADH Antagonists
Kinetics
MOA
Uses

A

ADH Antagonists
Vaptans (T and C)
T vaptan is v2 selective; metabolized by cyp3A4
MOA- inc water excretion w/o changing electrolyte excretion
Uses- hyponatremia and CHF (T vaptan dec wt and dec dyspnea; C vaptan inc water excretion w/o affecting vascular resistance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain effects of hyper/hypothyroidism on T3/4 clearnace and T3/4 half life

A

Hyperthyroid- inc clearance and dec half life

Hypothyroid- inc half life and dec clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What agents prevent the conversion of T4 into T3?

A

Iopanoic acid, ipodate, amiodarone, b-blockers, and corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What agents dec T4 absorption?

A

Antacids, ferrous sulfate, cholestyramine, and colestipol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What agents induce cyp450 to inc metabolism of T4/3?

A

Rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are thyroid hormone drugs MOA?

A

T4/3 enter cell -> T4 converted to T3 -> T3 enters nucleus and binds TR -> complex binds RXR ->gene transcription -> effects after a lag period

17
Q

What is the 1st line choice for T4 replacement?

A

Levothyroxine

18
Q

Thioamides (2)
Kinetics (kinetics of each then explain their use during pregnancy)
MOA
AE (when do you discontinue)

A

Thioamides
Propylthiouracil and methimazole
Kinetics- PTU- radpily absorbed, fast acting, 1st pass effect, requires multi doses
Kinetics- methimazole- completely absorbed, take once a day
Kinetics- can cross placenta and accumulate in fetal thyroid; take PTU in 1st trimester; methimazole in 2nd and 3rd trimester
MOA- inhibit thyroid peroxidase and iodide organification; inhibit thyroid hormone synthesis/release; PTU blocks conversion of t4 to t3; DOES NOT block iodide uptake
AE- maculopapular rash, urticarial rash, vasculitis, LAD, hepatitis (PTU), and jaundice (methimazole); agranulocytosis-reverse by discontinuing

19
Q

Lugols Iodide Solution
MOA
Uses
AE

A

Lugols Iodide Solution
MOA- inhibit organification and hormone release; dec size and vascularity of thyroid
Uses- thyroid storm, preop reduction of hyperthryoid gland, and block uptake of radioactive isotopes
AE- acneiform rash, swollen salivary glands, ulcers, conjunctivitis, and metallic taste

20
Q

Radioactive Iodine
Uses and kinetics
CI

A

Radioactive Iodine
I131
Used for thyrotoxicosis; give PO, rapidly absorbed; destroys parenchyma
CI- prego or breast feeding

21
Q

B-Blockers for thyroid

Uses

A

B-blockers
Propranolol, metoprolol, atenolol
Uses- improve symptoms, reduce T3 (propranolol) by preventing conversion of T4 to T3

22
Q 
Explain the treatment of Hypothyroidism 
Drug of choice? How do you give it?
If drug induced?
Myxedema coma?
Myxedema and CAD?
Prego?
A

Mgmt of Hypothyroidism
Levothyroxine is 1st choice; give on empty stomach
Drug induced- remove drug or add levo
Myxedema coma- large loading dose of levo followed by IV dosing
Myxedema and CAD-use levo w/ caution to avoid arrhythmia or MI
Prego- maintain nml level for fetal brain development

23
Q 
Explain mgmt of Graves
When do you use drugs? What drug is preferred?
When do you perform thyroidectomy?
When do you use radioiodine?
What are the adjuvant therapies?
A

Graves Mgmt
Use methimaxole in young pt
Thyroidectomy in pt w/ large thyroid or multinodular goiter
Use radioiodine in pt over 21 unless pt has heart disease or if elderly w/ thyroid storm
Adjuvant therapy- beta blockers for cardiac effects

24
Q

Explain multidrug therapy of thyroid storm

A

B-blockers for arrhythmias
K iodine to prevent thyroid hormone synthesis
PTU or methimazole to prevent synthesis
Hydrocortisone to prevent shock and block conversion of t4 to t3
Plasmapheresis or dialysis to dec t4

25
Q 
Menopause
Menopause transition?
Post menopause?
symptoms?
Comorbidities?
Treatment?
A

Menopause transition- variations in cycle w/ skipped cycles
Post menopause- 12 months complete amenorrhea
Symptoms- hot flash, night sweats, sexual dysfunction, dec QoL
Comorbidities- osteoporosis and fractures and CV events
Treatment- estrogen w/ or w/o progestin (women w/ intact uterus REQUIRE E and P)

26
Q

Menopause Hormone Therapy (MHT)
What are the estrogenic forms? (4)
What are the progestinic forms? (3)
MOA?

A

MTH
Estrogenic Forms
Estradiol, conjugated estrogen CE (many estrogen derivatives), esterified estrogen EE (Na esterone sulfate and Na equilin sulfate), estropipate (crystalline estrogen solubilized with sulfate and stabalized w/ piperazine)
Progestinic forms
Medroxyprogesterone MPA (MPA alone or w/ CE), methyltestosterone (alone or with EE), and progesterone
MOA- mimics effects of endogenous hormone by binding target R

27
Q

Estrogen only MHT effects

A

Endometrial prolif
Dec LDL, antithrombin 3, and osteoclast activity
Inc HDL, TAGS, clotting factors, platelet aggregation, Na retention, and TBG

28
Q

What are the goals of the Womens Health Initiative study with regards to MHT?

A

The goals were to examine MHTs effects on heart disease, osteoporosis, and risk of cancers

29
Q

What were the findings of the Womens Health Initiative study with regards to E/P therapy and E therapy alone; harms and benefits? What did they find with regards to age and therapy?

A

Estrogen and Progesterone
Harms- breast cancer, CAD, dementia, gall bladder disease, stroke, thromboembolism, and incontinence
Benefits- dec DM, fractures, and colorectal cancer

Estrogen Alone
Harms- dementia, gallbladder disease, stroke, thromboembolism, and incontinence
Benefits- dec breast cancer, fractures ,and DM

Benefits better in 50 > 60 > 70 yo

30
Q

What were the summary findings and recommendations from the Womens Health Initiative with regards to MHT?

  • what does it effectively treat
  • what should it not be used to treat
  • benefits vs risks for bone and colon cancer
A

MHT effectively treats vasomotor symptoms and vaginal change
MHT should not be used to treat CAD or dementia
Benefits of bone and colon cancer are outweighed by other risks

31
Q

List the 5 MHT Agreements

  • acceptable to treat?
  • what is preferred treatment for vaginal symptoms only
  • what treatment is preferred in women with uterus to prevent cancer
  • MHT inc risk of what?
  • MHT inc risk of what where the risk dec if MHT is stopped
A

MHT is acceptable to treat mod-severe menopause symptoms for women under 60 or w/in 10 years of menopause
Low dose topical estrogen is preferred treatment for women w/ vaginal symptoms alone
Women with uterus need combo E and P therapy to prevent uterine cancer
MHT inc risk of blood clots and stroke
MHT inc risk of breast cancer, risk dec if MHT is stopped

32
Q

What are SERMs? What do they do? What are the drug examples?

A

SERMs
Selective Estrogen R Modulators
Have pro-estrogenic actions in select tissues and anti-estrogenic actions in others
Drugs- ospemifene, clomiphene, and “fenes”

33
Q

What are TSECs? What are they made of? What is the drug example?

A

TSECs
Tissue selective estrogen complexes
Combo SERM and estrogen compound
Drug- Bazedoxifene (use in combo w/ CE)

34
Q 
Ospemifene
Uses
MOA
SE
CI
A

Ospemifene
Use to treat dyspareunia caused by vulvovaginal atrophy assoc w/ menopause
MOA- agonist at vaginal ER; antagonist in breast; inc superficial cell growth and vaginal secretions, dec pH and pain during sex
SE- hot flash, night sweats, inc risk of stroke and thromboembolism, endometrial thickening and hyperplasia
CI- unexplained vaginal bleeding, CV disease, or estrogen assoc neoplasia

35
Q

Clomiphene
Use
MOA
SE

A

Clomiphene
Anti-estrogen SERM used to treat infertility in anovulatory women
MOA- induce ovulation by blocking actions of estrogen on GnRH, FSH, and LH; inc gonadotropin rlease and occyte follicle development
SE- multi-births, ovarian cysts, hot flash, blurred vision, and luteal phase dysfunction (dec progresterone)

36
Q 
Bazedoxifene
Use
MOA
SE
CI
A

Bazedoxifene
used in women with intact uterus to treat vasomotor symptoms assoc w/ menopause and prevent osteoporosis
MOA- antagonists in endometrium and breast tissue; agonist in bone; does not cause endometrial prolife; destroys HER2 cells
SE- hot flash, night sweats, and estrogen assoc effects (used in combo with CE)
CI- same CI as with estrogens

Endo II Pharm (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions