Firecracker Endo V Flashcards
D3 is converted to 25-OH-vit D3 by
hepatic 25-hydroxylase.
25-OH-vitD3 is converted to 1,25-OH2-vitD3 by
1-alpha-hydroxylase
What side effects are seen with the use of Orlistat?
steatorrhea and fecal urgency
–> coordinated increase in both [Ca2+] and [phosphate] in the ECF in order to form a solubility product that favors the mineralization of bone.
vitamin D
activates AMPK (AMP-activated protein kinase) → ↑ expression of orphan nuclear receptor SHP (small heterodimer partner) → inhibits expression of liver PEPCK and glucose-6-phosphatase, thus repressing hepatic gluconeogenesis. It also increases peripheral insulin sensitivity and utilization of glucose.
Metformin
1,25-OH2 vitamin D also inhibits its own production by inhibiting .
1α-hydroxylase
Improves insulin target sensitivity. It binds to PPAR-γ (peroxisome proliferator activating receptor-gamma), causing increased insulin receptor number and sensitivity, as well as decreased hepatic gluconeogenesis.
Thiazolidinediones: rosiglitazone, and pioglitazone
Side effects include hepatotoxicity and cardiovascular toxicity (i.e. crazy edema that can precipitate CHF). Absolute contraindication in pts with liver failure or CHF.
Thiazolidinediones: Commonly used medications include rosiglitazone, and pioglitazone
ANP, NO (EDRF) use what kind of signaling mechanism?
guanylate cyclase-cGMP mechanism
What are the common diagnostic tests in the work up of thyroid cancer?
- ultrasound
- FNA
- scintigram
scaly thickening and induration of the skin overlying the shins with nonpitting edema; this only occurs in 1-2% of patients with Graves
pretibial myxedema
In patients with liver or kidney disorder, D2 and D3 will be ineffective. In these cases, active metabolites (i.e. WHAT?) are available to compensate for inability to provide hydroxylation steps.
calcitriol
- Benzphetamine
- Phendimetrazine
- Diethylpropion
- Mazindol
- Phentermine
Sympathomimetics are prescribed for short-term weight loss
When leuprolide is given in a pulsatile fashion, it mimics physiological stimulation and can increase release of FSH, and LH. This is used to treat
infertility
At high levels, leuprolide acts as a superagonist, causing desensitization and decreased release of FSH and LH, resulting in chemical castration. This is particularly useful for the treatment of
hormone sensitive malignancies such as breast and prostate cancer, as well other conditions such as BPH, fibroids, and endometriosis.
What is the treatment of carcinoid syndrome?
Octreotide – somatostatin analogue;
Surgical resection and chemotherapy with 5-FU (fluorouracil) and doxorubicin
Where in the cell does a prohormone become a hormone?
Golgi apparatus
Name 2 short acting insulins
Regular, and Semilente
Has anti-diuretic properties similar to ADH, so can lead to hyponatremia and seizures. Can also cause subarachnoid hemorrhage. Note in pregnant patients, it can also cause uterine rupture!
Adverse effects of oxytocin
Name 2 intermediate acting insulins. What is their onset and duration of action?
Lente, Isophane (NPH)
GnRH, Oxytocin, ADH (V1 receptor), and TRH signaling mechanism
IP3-Ca2+
What is the treatment of secondary hyperparathyroidism?
Calcitriol (vitamin D) and phosphate binders such as aluminum hydroxide or calcium carbonate
Can you describe how/why C-peptide is useful?
C-peptide is essential for proper folding of insulin. Also, because of its longer half-life, C-peptide is a good indicator of insulin production and secretion in early diabetes.
What is the synthetic form of PTH?
teriparatide
Vitamin D, Estrogen, Testosterone, Cortisol, Aldosterone, Progesterone.
Which steroid hormones have cytosolic receptors?
Is used to treat SIADH because it Induces a state of nephrogenic diabetes insipidus by inhibiting the actions of ADH in the kidney. This allows diuresis to take place and thus results in less retention of water.
Demeclocycline
What is a rare but important side effect of metformin administration?
Lactic acidosis
reversible inhibitor of gastric and pancreatic lipases → decreased absorption of dietary fats.
Orlistat
Name 3 long acting insulins
Ultralente (Insulin glargine, insulin detemir, Protamine-zinc)
What is the major potential side effect of sulfonylureas?
hypoglycemia
a drug that inhibits 11β-hydroxlase (the final enzyme required to make cortisol), is used to determine cause of hypofunctional pituitary.
Metyrapone
suppression test is used to diagnose Cushing’s
Dexamethasone
Can you name 2 commonly used TZDs?
rosiglitazone, and pioglitazone
What is the pharmacologic treatment for central diabetes insipidus?
intranasal desmopressin (DDAVP)
is the only widely used mineralocorticoid, used as aldosterone replacement.
Fludrocortisone
Name the 3 rapid acting insulins.
Insulin glulisine, insulin aspart, and insulin lispro (GAL).
These drugs act to halt bone remodeling. Due to their negative charge, they bind to calcium in bones, then are engulfed by osteoclasts (which are specialized macrophages) and effectively kill them.
bisphosphonates
Oxytocin’s clinical formulation, widely used for its inotropic and chronotropic effects on labor contractions.
pitocin,
What is a tetrameric RTK (receptor tyrosine kinase) consisting of two α and two β subunits that is found on the target tissues of insulin and initiates an intracellular phosphorylation cascade when it binds insulin.
Insulin receptor
What is the treatment for gonadal hypofunctionality not related to pituitary insufficiency?
hCG, the placental analogue to LH
What is a urinary degradation product of serotonin that is elevated in carcinoid syndrome?
5 HIAA
What increases intracellular nutrient breakdown thereby ↑ plasma glucose, fatty acids, ketones and BUN.
cortisol
somatostatin analogue used to block diarrhea associated with VIPomas, or high levels of GH or TSH from pituitary adenomas.
octreotide
What are 2 common disorders treated with bisphosphonates?
osteoporosis or Paget’s disease.
Prolactin, IL-2 and GH use this mechanism.
JAK/STAT pathway
Name 3 dopamine agonists.
cabergoline (first line), bromocriptine, and Pergolide
Through which two general mechanisms do anti-obesity drugs function?
appetite suppression or lipase inhibition
What are the 2 GLP-1 analogs commonly used in DM2 treatment?
exenatide and liraglutide
How do exenatide and liraglutide work?
GLP-1 analogs work by increasing insulin and decreasing glucagon output.
Name three drugs with antagonistic effects on dopamine
Haloperidol (antipsychotic)
Diazepam (aka Valium) (anxiolytic)
Imipramine (TCA)
Name 3 clinical applications of DDAVP other than diabetes insipidus.
Hemophilia A
- von Willebrand Disease
- Primary nocturnal enuresis
Prevents disaccharides in the gut from their final degradation into monosaccharide by brush border enzymes prior to absorption.
α-glucosidase inhibitors: The 2 commonly used medications include Acarbose and Miglitol.
Drug that simulates disaccharidase deficiency (e.g. lactose intolerance), causing osmotic diarrhea and presenting more sugars to the colonic flora, which digests them, releasing gas and causing flatulence and is thus poorly tolerated by patients.
α-glucosidase inhibitors
What are 2 prototypical thioamide medications?
PTU (propylthiouracil) and methimazole
Name 3 common conditions treated with adrenocortical anti-inflammatory agents.
RA, SLE, and ulcerative colitis.
↑ Insulin secretion by closure of ATP-gated K channel in pancreatic β cell membrane.
Sulfonylureas
