From Jen: Endocrine Flashcards
Short acting insulin
Lispro
Aspart
Regular
Intermediate acting insulin
NPH
Long acting insulin
Glargine
Detemir
Insulin action and clinical use:
Bind insulin receptor (tyrosine kinase activity)
Liver: ↑ glucose stored as glycogen
Muscle: ↑ glycogen and protein synthesis; K+uptake
Fat: aids TG storage
Use: Type I and 2 DM, stress induced hyperglycemia
Insulin toxicity
Hypoglycemia
Hypersensitivity rxns are rare
Sulfonylurea
Drugs/toxicity
1st Gen: tolbutamide, chlorpropamide
***disulfiram-like rxn
2nd Gen: glyburide, glimepiride, glipizide
***hypoglycemia
Sulfonylurea
MOA
MOA: Close K+ channel in beta-cell membrane so cell depolarized, triggering insulin release via Ca2+ influx
Use: stimulate release of endogenous insulin in DM type 2
**requires islet cell function so useless in DM type 1
Biguanides
Metformin
Biguanide
MOA
Toxicity
(Metformin)
MOA: unknown, poss ↓ gluconeogenesis, ↑ glycolysis, overall ↓ serum glucose
*** insulin sensitizer
Use: oral hypoglycemic in pts without islet cell function
Toxicity: lactic acidosis
Glitazones
Pioglitazone
Rosiglitazone
Glitazone
MOA
Toxicity
(pioglitazone, rosiglitazone)
MOA: ↑ target cell response to insulin
Use: monotherapy in DM type 2 or combined with metformin and/or sulfonylureas
Toxicity: weight gain, edema, hepatotoxicity, CV toxicity
alpha-glucosidase inhibitors
acarbose
miglitol
alpha-glucosidase inhibitors
MOA
Toxicity
(acarbose, miglitol)
MOA: inhibit brush border at alpha-glucosidases. Delayed sugar hydrolysis and glucose absorption leading to ↓ post-prandial hyperglycemia
Use: Monotherapy or combined for DM type 2
Toxicity: GI upset
Pramlintide
MOA: ↓ glucagon
Use: DM type 2
Toxicity: hypoglycemia, nausea, diarrhea
GLP-1 mimetics
Exenetide
MOA: ↑ insulin, ↓ glucagon
Use: DM type 2
Toxicity: Nausea, vomiting, pancreatitis (?)
Orlistat
MOA: alters fat metabolism by inhibiting pancreatic lipases
Use: long-term obesity management
Toxicity: steatorrhea, GI discomfort, reduced absorption of fat soluble vitamins, headache
Sibutramine
MOA: sympathomimetic serotonin and NE reuptake inhibitor
Use: long term obesity management
Toxicity: HTN and tachycardia
Propylthiouracil
Methimazole
MOA: inhibit organification and coupling of thyroid hormone synthesis
PTU also ↓ peripheral conversion of T4 to T3
Use: hyperthyroidism
Toxicity: skin rash, agranulocytosis, aplastic anemia
Growth hormone
Use: growth hormone deficiency
Turner syndrome
Octreotide
Somatostatin analog
Use: acromegaly
carcinoid
gastrinoma
glucagonoma
Oxytocin
Use: stimulate labor, uterine contractions, milk let-down, controls uterine hemorrhage
ADH
Desmopressin
Use Central diabetes insipidus
Triiodothyronine
Levothyroxine
MOA: Thyroxine replacement
Use: hypothyroidism, myxedema
Toxicity: tachycardia, heat intolerance, tremors, arrhythmia
Glucocorticoids
Hydrocortisone, prednisone, triamcinolone, dexamethasone, beclomethasone
MOA: ↓ production of leukotrienes and prostaglandins by inhibiting phospholipase A2 and expression of COX-2
Use: Addison’s disease, inflammation, immune suppression, asthma
Glucocorticoid
Toxicity
Iatrogenic Cushing’s Syndrome:
- buffalo hump
- moon facies
- truncal obesity
- muscle wasting
- thin skin
- easy bruising
- osteoporosis
- adrenocortical atrophy
- peptic ulcers
- diabetes
Demeclocycline
MOA: ADH antagonist (tetracycline family)
Use: SIADH
Toxicity: Photosensitivity, abnormalities of bone and teeth, nephrogenic DI
