From Jen: Endocrine

Question 1

Short acting insulin

Answer 1

Lispro
Aspart
Regular

Question 2

Intermediate acting insulin

Answer 2

NPH

Question 3

Long acting insulin

Answer 3

Glargine

Detemir

Question 4

Insulin action and clinical use:

Answer 4

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

Question 5

Insulin toxicity

Answer 5

Hypoglycemia

Hypersensitivity rxns are rare

Question 6

Sulfonylurea

Drugs/toxicity

Answer 6

1st Gen: tolbutamide, chlorpropamide
***disulfiram-like rxn

2nd Gen: glyburide, glimepiride, glipizide
***hypoglycemia

Question 7

Sulfonylurea

MOA

Answer 7

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

Question 8

Biguanides

Answer 8

Metformin

Question 9

Biguanide

MOA
Toxicity

Answer 9

(Metformin)

MOA: unknown, poss ↓ gluconeogenesis, ↑ glycolysis, overall ↓ serum glucose
*** insulin sensitizer

Use: oral hypoglycemic in pts without islet cell function

Toxicity: lactic acidosis

Question 10

Glitazones

Answer 10

Pioglitazone

Rosiglitazone

Question 11

Glitazone

MOA
Toxicity

Answer 11

(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

Question 12

alpha-glucosidase inhibitors

Answer 12

acarbose

miglitol

Question 13

alpha-glucosidase inhibitors

MOA
Toxicity

Answer 13

(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

Question 14

Pramlintide

Answer 14

MOA: ↓ glucagon

Use: DM type 2

Toxicity: hypoglycemia, nausea, diarrhea

Question 15

GLP-1 mimetics

Answer 15

Exenetide

MOA: ↑ insulin, ↓ glucagon

Use: DM type 2

Toxicity: Nausea, vomiting, pancreatitis (?)

Question 16

Orlistat

Answer 16

MOA: alters fat metabolism by inhibiting pancreatic lipases

Use: long-term obesity management

Toxicity: steatorrhea, GI discomfort, reduced absorption of fat soluble vitamins, headache

Question 17

Sibutramine

Answer 17

MOA: sympathomimetic serotonin and NE reuptake inhibitor

Use: long term obesity management

Toxicity: HTN and tachycardia

Question 18

Propylthiouracil

Methimazole

Answer 18

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

Question 19

Growth hormone

Answer 19

Use: growth hormone deficiency

Turner syndrome

Question 20

Octreotide

Answer 20

Somatostatin analog

Use: acromegaly
carcinoid
gastrinoma
glucagonoma

Question 21

Oxytocin

Answer 21

Use: stimulate labor, uterine contractions, milk let-down, controls uterine hemorrhage

Question 22

ADH

Answer 22

Desmopressin

Use Central diabetes insipidus

Question 23

Triiodothyronine

Levothyroxine

Answer 23

MOA: Thyroxine replacement

Use: hypothyroidism, myxedema

Toxicity: tachycardia, heat intolerance, tremors, arrhythmia

Question 24

Glucocorticoids

Answer 24

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

Question 25

Glucocorticoid

Toxicity

Answer 25

Iatrogenic Cushing’s Syndrome:

• buffalo hump
• moon facies
• truncal obesity
• muscle wasting
• thin skin
• easy bruising
• osteoporosis
• adrenocortical atrophy
• peptic ulcers
• diabetes

Question 26

Demeclocycline

Answer 26

MOA: ADH antagonist (tetracycline family)

Use: SIADH

Toxicity: Photosensitivity, abnormalities of bone and teeth, nephrogenic DI