GI and Endocrine Drugs Flashcards

1
Q

Name the Antiemetic drugs

A

Ondansterone
(“Ribbon dancer blocking the hammer throw”)

Metoclopramide
(“Tickler blocking the D-rings”)

Meclizine
Diphenhydramine

(“Bee swatters”)

Scopolamine
(“Telescope”)

Aprepitant
(““participants”)

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2
Q

Ondansetrone MOA /USE

(“Ribbon dancer blocking the hammer throw”)

A

antagonizes 5-HT3 receptor on vagal afferents in the GI tract

  • treats chemo-induced or post-op vomiting
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3
Q

Ondansetron Side Effects

(“Ribbon dancer blocking the hammer throw”)

A

-can cause constipation
(“Hammer tightening gut”)

-can cause headache and dizziness
(“Hammer hitting head”)

-can prolong the QT interval and induce torsade’s
(“Twisted torsade’s streamer”)

-can cause serotonin syndrome
(“Pile of smiley faces”)

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4
Q

Diphenhydramine
Meclizine
MOA

(“Bee Swatters”)

A

1st generation H1 receptor blockers

  • the vestibular system contains H1 histamine receptors coupled to Gq

(“Allergy inducing, Q shaped dandelions”)

  • treat vestibular nausea (motion sickness)
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5
Q

Scopolamine MOA

(“Telescope”)

A

blocks M1 muscarinic receptors found in the vestibular system

(“M1 motorcycle parking”)

  • treats vestibular nausea (motion sickness)
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6
Q

Metcoclopramide MOA

(“Tickler”)

A

antagonizes D2 receptors in the area postrema
(“Extreme posture 2 D-Ring ropes”)

  • treats chemotherapy induced vomiting
  • ​**also antipsychotics block D2**
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7
Q

Metoclopramide is useful because …

A
  • treats chemotherapy induced vomiting
  • has upper GI prokinetic effects
  • useful for treatment of delayed gastric emptying due to post- surgical disorders and diabetic gastroparesis

(“Contracted stomach”)

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8
Q

metoclopramide (D2 Antagonist) is contraindicated in …

A

small bowel obstruction
(“Do not obstruct”)

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9
Q

Metoclopramide

Side Effects

A

-can cause diarrhea -prokinetic effects

can cause drowsiness, especially in the elderly
(“Sleeping judge”)

-can cause depression (central D2 blockade)
(“Crying coach”)

-Can cause extrapyramidal effects due to central D2 blockade (dystonia, akathisia, parkinsonian features)
(“EXTRA pyramidal newspaper hat”)

  • can cause tardive dyskinesia with chronic use (central D2 blockade), especially in the elderly (“Sticking out tongue”)

-can cause neuroleptic malignant syndrome
(“Now More Spicy chicken”)

-can cause elevated prolactin levels (central D2 blockade), leading to gynecomastia, amenorrhea, and decreased libido
(“Elevated milk release”)

can cause QT prolongation and induce torsade’s
(“Twisted torsade’s streamer”)

(“Mud puddle”)

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10
Q

Aprepitant MOA

(“all participants subtance pee check”)

A

aprepitant antagonizes the NK1 receptors in the area postrema

(“plaNK1 pommel horse”)
(“Extreme posture”)

  • treats chemotherapy induced vomiting
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11
Q

what are the 2 mechanisms by which acid secretion can be inhibited ?

A

H2 histamine receptor antagonists
(“2 bee swatters”)

Proton Pump Inhibitors (PPI’s)
(“Girl scout blocking puree pump”)

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12
Q

H2 receptor Antagonists MOA
Ranitidine
Nizatidine
Cemitidine
Famotidine

(“Tie dye t-shirt”)

A
  • Inhibit acid secretion by parietal cells
  • Vagal stimulation will also stimulate the parietal cell directly to secrete acid during meals and therefore H2 antagonists has only a modest inhibitory effect on acid secretion during and after meals
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13
Q

H2 receptor antagonists can treat …

A

-prevent nocturnal secretion of acid that is largely dependent on histamine

-treat GERD
(“Gargling”)

-treat duodenal ulcers **PPI’s are first line**
(“Ulcerated sidewalk”)

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14
Q

Cimetidine

(“Tie dye kid on the cement”)

A

-H2 blocker with antiandrogenic side effects

-can cause gynecomastia when used long term or in high doses
(“Pot lids on chest”)

-can cause impotence
(“Droopy honey wand”)

-can cause elevated serum prolactin levels
(“Milk shooting from nose”)

-inhibits cytochrome P-450
(“Dented chrome bumper”)

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15
Q

Proton Pump Inhibitors (PPI’s)

Pantoprazole
Omeprazole

(“PRIZE”)
MOA

A

-irreversibly inhibit the H+/K+ ATPase (the final common pathway for H+ secretion)

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16
Q

Proton Pump Inhibitors (PPI’s) can treat …

Pantoprazole
Omeprazole

(“PRIZE”)

A
  • first line treatment GERD but PPI’s .
    (“Gargling”)

-faster symptom relief for gastric and duodenal ulcers
(“Ulcerated sidewalk”)

-gastrinoma causing hypersecretion of gastric acid

Zollinger-Ellison syndrome – treat with PPI’s
(“Jumbo gas tank on mower with crab logo”)

-PPI’s treat H.Pylori infection, with clarithromycin or amoxicillin/metronidazole
(“Helicopter hat”)

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17
Q

Proton Pump Inhibitors (PPI’s) Adverse Effects

Pantoprazole
Omeprazole

(“PRIZE”)

A
  • PPI’s increase the risk for C.Diff infection
  • Normally inactivated by acidic environment

-increase the risk for respiratory infections (pneumonia)
(“Dirty lung spots”)

-decrease the absorption of Ca2+, Mg2+, and Fe2+ (requires acidic environment)
(“Medals bound to wagon”)

-increase the risk of osteoporotic hip fractures
(due to decreased Ca2+ absorption)
(“Fractured Axel”)

-may worsen osteoporosis (due to decreased Ca2+ absorption)

-can cause hypomagnesia
(“Falling magnets on girl scout”)

(“Chocolate fondue fountain”)

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18
Q

Octreotide MOA

(“Octagon shape of stop sign”)

A

A long acting Somatostatin analoge

  • inhibits release of histamine by ECL cells
  • ​inhibits the release of gastrin by G cells
    ⇒ and SST receptor (+) gastrinomas
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19
Q

Name osmotic laxatives

A

magnesium hydroxide
magnesium sulfate
magnesium citrate

(“Magnets”)

polyethylene glycol (PEG)
(“PEG drain cover”)

lactulose
(“Relaxulose”)

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20
Q

Lactulose can be useful in treatment of…

(“relaxulose”)

A

hepatic encephalopathy - buildup of ammonia in brain

  • intestinal bacteria metabolize lactulose into acidic metabolites → ammonia (NH3) is trapped as ammonium (NH4+) in the acidic lumen and then excreted

(“Cirrhotic liver and brain coral”)

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21
Q

laxatives can cause …

A

diarrhea and dehydration

(“Spoiling mud bath”)

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22
Q

Name a bulk forming laxative

(“Bulky seaweed outside of the shop”)

A

Psyllium

  • indigestible hydrophilic colloid􏰀 absorbs water􏰀 → distension→ peristalsis
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23
Q

Name a stool softener

A

Docusate

  • surfactant agent that facilitates penetration Of stool by water and lipids

(“Water penetrating a canoe at the DOCK”)

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24
Q

Name a stimulant laxative a.k.a cathartic

A

Senna
(“Stimulating suntan lotion”)

(stimulation of enteric nervous system and colonic secretions)

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25
Q

chronic use of senna causes…

A

melanosis coli → brown pigmentation of the colon

(“Brown gut”)

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26
Q

Name Antidiarrheal Agents

(“Muddy slippers left outside”)

A

Diphenoxylate
(“Dolphins”)

Loperamide
(“Lop-eared rabbit”)

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27
Q

Antidiarrheal Agents MOA

(“Utopia”)

A

Opiate agonists activating mu-opioid receptors in the GI tract and treat diarrhea
(“MUssage”)

opioid agonists (loperamide) increase colonic phasic segmenting activity → 􏰀increased colonic transit time

  • Loperamide →does not cross the BBB→ 􏰀no analgesia or potential for addiction
  • Diphenoxylate some ability to cross the BBB􏰀combines with atropine to prevent abuse
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28
Q

antidiarrheal agents are contraindicated in patients with …

A

-bloody diarrhea or fever (treat the underlying cause)
(“Red stool and inflammatory candles outside door”)

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29
Q

Antidiarrheal agents Side Effects

A

opioids can cause constipation

(“Clogged”)

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30
Q

treats the symptoms of secretory diarrhea caused by VIPoma and carcinoid syndrome

(“VIP CUSTOMERS only crab”)

A

Octreotide

(“STOP sign”)

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31
Q

Name Prokinetic Agents

A

Bethanecol

Neostigmine

Metoclopramide

Arythromycin

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32
Q

Insulin effects

A

Glucose – the most potent stimulant of insulin secretion

  • sympathetic activation of adrenergic B2 receptors also induces insulin secretion
    (“Beta 2 tuba”)

-insulin increase hepatic glycogen stores
(“Full liver candy jar”)

  • increased glycogenesis
  • ​decreased glycogenolysis

-insulin increases glycogen storage and protein synthesis in muscle
(“Glycogen glazed ham”)

-increases triglyceride storage in adipocytes
(“Full fatty donut jar”)

-insulin decreases serum K+
(“Old lady Eating banana candy”)

  • increased Na+/K+ ATPaase in skeletal muscle drives K+ into the cells
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33
Q

Names Insulin Analogs Therapy

A

Rapid onset , Short acting (“Girls And Lads”)

(Insulin) Glulisine

  • *Aspart**
  • *Lispro**

Intermediate acting (“Rest Now”)

  • *Regular** Insulin
  • *NPH** Insulin

Long Acting (“Don’t Go”)

Insulin Detemir
Glargine

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34
Q

Rapid acting , Short duration insulin Properties
(“Girls And Lads”)

Glulisine
Aspart
Lispro

A
  • insulin glusine, aspart, and lispro control the postprandial glucose spike
  • have rapid onset and short duration of action, mimicking post prandial response.

(“Tall immediate peak on “girls and Lads”)
(“Birds nibbling the peak”)

-these do not polymerize into hexamers so they are absorbed rapidly

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35
Q

Intermediate acting insulin therapy Properties
(“Rest Now”)

  • *Regular** insulin
  • *NPH** insulin
A

-regular and NPH insulin have a delayed onset and intermediate duration of action (NPH is more delayed) this is due to the formation of dimers and hexamers, taking time to breakdown
(“Delayed peak on the house”)

-Regular insulin is only one to be administered IV
(“Ivy under R”)

  • IV regular insulin is useful in the management of DKA (watch K+ levels)
    (“Ivy next to Candy Cane Key”)
  • IV regular insulin is useful in the management of hyperkalemia (administer with glucose!)
    (“Ivy next to eaten banana”)
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36
Q

Long Acting Insulin Therapy
(“Don’t Go”)

Insulin Detemir
Insulin Glargine

A

-provide a steady background level of insulin-glargine has no peak (“Roof on hat is long and flat”)

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37
Q

General Side Effect of Insulin Therapy

A

-insulin therapy can cause hypoglycemia
(presents with tachycardia, palpitations, sweating, nausea)
(“Falling candy”)

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39
Q

other than Insulin Analoges , What other drugs can treat Diabetes ?

A

Sulfonylureas

  • 1st Generation-“amide”
    (“Mother swan in a maid outfit”)

→ Chlorpropamide
→ Tolbutamide

  • ​2nd Generation-“ride”
    (“Goslings riding on the mother swan’s back”)
    → Glyburide
    → Glimepiride
    → Glipizide

Meglitinides

  • *Repa**glinide
  • *Nate**glinide

GLP1- Agonists-“tide”
Exenatide
Liraglutide

DDP4 inhibitors-“gliptin”

Sitagliptin
Saxagliptin
Linagliptin

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41
Q

Sulfonylureas Properties

A

-Sulfa Drugs

1st Generation-“amide”

  • *Chlorprop**amide
  • *Tolbut**amide
  • long duration of action -rarely used

2nd Generation - “ride”

  • *Glybu**ride
  • *Glimepi**ride
  • smaller dosing, long duration of action

Glipizide

  • has the shortest duration of action (less risk of hypoglycemia)
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42
Q

Meglitinides Properties
(“Father goose gliding into the scene”)
Repaglinide
Nateglinide

A

-Meglitinides (glinides) are NOT sulfa drugs-can be used in patients with an allergy to sulfa
(“Father goose cannot lay eggs”)

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43
Q

Sulfonylureas / Meglitinides Side Effects

A
  • sulfonurease/meglitinides can cause hypoglycemia
  • sulfonureas/meglitinides can cause weight gain
  • 1st generation sulfonureas (cloropropramide) cause a disulfiram like reaction with ingestion of alcohol
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44
Q

Sulfonylureas/Meglitinides are used for

A

-sulfonylureas and Meglitinides are oral agents
used in the treatment of TYPE 2 diabetes requiring functional beta cells for endogenous insulin release
(“fat old lady raising 2 fingers”)

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45
Q

GLP1 Agonists MOA
(“TIDE” detergent”)

  • *Exena**tide
  • *Liraglu**tide
A

Activate GLP 1 receptor

  • increase insulin secretion/​increase satiety
  • decrease Glucagon /​decrease gastric emptying

(“Langerhansel “Gulp” activated when looking at Hag”)

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46
Q

DPP4 inhibitors MOA
(“4 DRIPPNG laundry items hanging”)

  • *Sita**gliptin
  • *Saxa**gliptin
  • *Lina**gliptin
A

inhibit DPP4 enzyme thus increase GLP-1 activity
(“Laundering old hag letting out endogenous gulps”)

  • Dipeptidyl peptidase (DPP4) is an enzyme that usually inactivates GLP-1
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47
Q

GLP1 agonists / DPP4 inhibitors Properties

A

-GLP-1 and DPP-4 inhibitors are oral agents used in the treatment of TYPE 2 diabetes requiring functional beta cells for endogenous insulin release
(“2 fingers hag”)

-GLP-1 agonists and DPP-4 inhibitors increase endogenous insulin release and C-Peptide levels
(“C-Wrapper”)

-GLP-1 agonists and DDP-4 inhibitors decrease glucagon secretion this aids in lowering serum glucose levels
(“Falling empty glucagon packets”)

-GLP-1 and DDP-4 inhibitors decrease gastric emptying leading to increase satiety and delayed glucose absorption
(“Sealed gastric container”)

-GLP-1 agonists and DPP-4 inhibitors do NOT cause hypoglycemia
(“Green candies NOT falling off the tree”)

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48
Q

GLP-1 agonists Side Effects

A

-GLP-1 agonists (exenatide) can cause pancreatitis, seek immediate medical care

(“Creepy detergent lady Squeezing pancreas sponge”)

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49
Q

DPP4 inhibitors Side Effects

(“DRIPPNG laundry items hanging”)

A

-DPP-4 inhibitors (gliptins) can increase risk for upper respiratory infections and nasopharyngitis

(“Clothespin clipping nose of 4 shirt lady “)

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54
Q

what should be administered in case of severe insulin induced hypoglycemia

A

-Gluca-gone for when your glucose is gone!

56
Q

Sulfonylureas/Meglitinides MOA

A

-bind ATP-dependent K+ channels on beta cells 􏰀 leading to depolarization of beta cells 􏰀 calcium influx 􏰀 release of endogenous insulin
(“Sulfa swan lake behind closed banana gate”)
(“Father goose gliding into the beta cell”)

57
Q

-is the first line oral agent for the management of type II diabetes

A

Metformin

(“Skinny Kid on his knee saying a metaphor”)

58
Q

Drug used in treatment of Diabetes Type 2

A

Biguanides (“Kid saying a metaphor”)
Metformin

Thiazolidinones (“Glitter zone”)

Rosiglitazone
Pioglitazone

Amylin Analogues (“Amy and Lynn”)
Pramlintide

α-Glucosidase inhibitors (“A-Carb wigglers”)
Acarbose
Miglitol

SGLT2 inhibitors (“Flossing teeth man”)

Canagliflozin
Dapagliflozin

59
Q

Metformin MOA

A

-metformin inhibits the mitochondrial enzyme glycerophosphate dehydrogenase (mGDP)􏰀decreasing hepatic gluconeogenesis
(“Girl eating the mitochondrial candy then puking”)

-metformin activates the enzyme AMP-activated protein Kinase (AMPK)􏰀 decreased gluconeogenesis, increased insulin sensitivity
(“AMPKandy”)

-metformin modulates enzyme function to decrease hepatic gluconeogenesis
(“Girl stopping candy release from liver bag”)

-Metformin increases insulin sensitivity
(valentines mailbox is to simulate “welcome inside”mat)

60
Q

Metformin Side Effects

A

-most common side effect with metformin use is GI side effects (nausea, anorexia, vomiting, diarrhea)
(“Nauseated girl had too many AMPKyandy”)

-metformin can cause lactic acidosis. This is due to metformin inhibiting lactic acid ability to enter gluconeogenic pathways into the liver
(“Spilled sour milk”)

-renal insufficiency increases the risk of metformin induced lactic acidosis
(“Cracked kidney tray”)

-metformin can cause modest weight reduction
(“Skinny kid saying a metaphor”)

61
Q

Thiazolidinones **MOA

Rosi**
glitazone
Pioglitazone

A

-thiazolidinones (glitazones) are ligands of peroxisome proliferator activated receptor gamma (PPARy) an intracellular nuclear receptor that regulates gene transcription causing increased insulin sensitivity, found in muscle, fat, and the liver
(“PPARy in circle”)

-PPAR-y upregulates adiponectin
(“Turtle neck”)

--hiazolidinedione’s (glitazones) upregulate GLUT4 in peripheral tissues (increased glucose uptake)
(“4 on open mailbox door”)

-thiazolidinedione’s (glitazones) increase insulin sensitivity
(“Inside open candy box”)

-thiazolidinones (glitazones) increase the differentiation and number of adipocytes
(“Elevated fatty donut jar”)

-thiazolidinones (glitazones) increase triglyceride storage and fatty acid oxidation􏰀 decreased serum triglycerides
(“Eating Fatty donut”)

62
Q

Thiazolidinones Side Effects
(“Glitter zone”)

  • *Rosi**glitazone
  • *Pio**glitazone
A

-thiazolidinedione (glitazones) can cause weight gain
(“Fat belly on PPAR-y kid”)

-thiazolidinediones (glitazones) can cause fluid retention and peripheral edema, and decompensation of CHF
(“Baggy pants on PPAR-y kid”)

-thiazolidinones induced fluid retention can exacerbate heart failure
(“Falling heart balloon”)

-thiazolidinediones (glitazones) can increase the risk of atypical extremity fractures in women due to decreased bone mineral density
(“Fractured chair leg”)

63
Q

Amylin Analogues MOA
(“Amy and Lynn”)

Pramlinitide

A

-Pramlinitide is Amylin Analog , a small peptide hormone that is released into the bloodstream by the β cells of the pancreas along with insulin after a meal.

-amylin analogues (pramlintide) decrease gastric emptying
(“Closed gastric water cooler”)

-amylin analogues decrease glucagon secretion
(“Falling empty glucagon packets”)

64
Q

Amylin Analogues such as Pramlinitide are useful in treating …

A

-amylin analogues can be useful in the management of type I and type II diabetes
(“1 and 2 fingers being held up by Amy and Lynn”)

-amylin analogues can be used to control the postprandial glucose spike
(“Eaten cupcake”)

65
Q

Amylin Analogues Side Effects
(“Amy and Lynn”)

Pramlinitide

A

-pramlintide can cause hypoglycemia
(“Fallin candy jar”)

-pramlintide can cause GI side effects
(“Nauseated”)

66
Q

α-glucosidase inhibitors MOA
(“A-Carb wigglers”)

Acarbose
Miglitol

A

-inhibition of alpha-glucosidase enzymes decreases the conversion of disaccharides into absorbable monosaccharides

  • alpha-glucosidase inhibitors decrease the activity of disaccharides on the intestinal brush border
    (“Brush border flags”)
  • alpha-glucosidase inhibitors delay carbohydrate absorption
    (“Kid can’t open the bag, delayed bag opening”)

(“monosaccharide free”)

67
Q

α-glucosidase inhibitors are useful in which cases ?
(“A-Carb wigglers”)

Acarbose
Miglitol

A

-alpha-glucosidase inhibitors can be used to control post prandial glucose spike

(“Eaten cupcake”)

68
Q

α-glucosidase inhibitors Side Effect
(“A-Carb wigglers”)

Acarbose
Miglitol

A

-alpha-glucosidease inhibitors can cause GI side effects (diarrhea, flatulence, abdominal pain) due to fermentation of the undigested carbs by the gut flora

(“Leaky bathroom puddle”)

69
Q

SGLT-2 inhibitors MOA
(“Flossing teeth man”)

Canagliflozin
Dapagliflozin

A
  • *2nd** or 3rd line drug
  • inhibit sodium glucose cotransporter 2
  • SGLT2 reabsorbs glucose in the proximal tubule (inhibition leads to urinary glucose loss)

(“Salty Glucose Co”)
(“Pro Cart Track”)

70
Q

SGLT-2 inhibitors Side Effects
(“Flossing teeth man”)

Canagliflozin
Dapagliflozin

A

-can increase the risk of UTI due to increased urine glucose concentration
(“Bladder cup”)

-can increase the risk of vaginal candidiasis
(“snow hitting crotch” , canadian flag )

-SGLT2 inhibitors can cause hypotension due to osmotic diuresis
(“Fainting blue kid”)

-SGLT2 inhibitors are contraindicated in renal insufficiency
(“Cracked kidney tray”)

71
Q

most common cause of Hyperthyoridism

A

Grave’s disease

72
Q

symptoms of hyperthyroidism

A

associated with hypermetabolic and hyperadrenergic symptoms

  • tachycardia
  • palpitations
  • heat intolerance
  • weight loss
  • increased BMR
  • exophthalmos →Grave’s ophthalmopathy
    (“Bulging infrared goggles”)
  • insomnia
  • anxiety
  • tremor

(“(“Anxious henchman with big bowtie”)

73
Q

hyperthyroidism due to Grave’s disease can be treated with…

A

-ablating doses of radioactive iodine (131-I)
(“green radioactive vial”)

74
Q

radioactive iodine treatment Side Effects

A

-can cause hypothyroidism
(“Undone bowtie”)

-can exacerbate HYPERthyroidism
(“Anxious radioactive henchman”)

-can exacerbate Grave’s ophthalmopathy
(“Bulging radioactive goggles”)

75
Q

Propylthiouracil MOA

(“PTU” ! Agent)

A

-treats hyperthyroidism by inhibiting TPO
(““PTU!” agent firing at the transporter”)

-treats hyperthyroidism by inhibiting 5’ deiodinase →

  • decreased conversion of T4 into T3
    (““PTU!” agent firing at the bomb trigger”)
76
Q

Methimazole MOA

(“evil math equations”)

A
  • inhibiting TPO
  • inhibit iodine organification

X10 TIMES MORE POTENT THAN PTU
→USE IN CHILDREN

(“Evil math equations striking transporter”)

77
Q

which class of drugs can be used to treat the hyperadrenergic symptoms of hyperthyroidism

A

Beta blockers

  • treat hyperthyroidism by inhibiting 5’ deiodinase → decreased conversion of T4 into T3

(“Silenced bugle gun pointed at catfish”)
(“Silenced bugle gun pointed at trigger”)

78
Q

Glucocorticoids are useful in hyperthyroidism therapy since they …

A

treats hyperthyroidism by inhibiting 5’ deiodinase → decreased conversion of T4 into T3
(“Moon face death coaster blocking trigger”)

treat Grave’s ophthalmopathy
(“Moon face death coaster hitting goggles”)

79
Q

Thyroid storm treatment

(“Thwarted Dr. Storm”)

A

1) Beta blockers

  • blocking sympathetic effects

​————————————————————————-​——-

2) blocking thyroid hormone synthesis
Propylthiouracil /Methimazole

  • By inhibiting TPO

3) Blocking conversion of T3 to T4 by inhibiting 5’ deiodinase in periphery

  • Beta blockers
  • Propylthiouracil
  • Glucocorticoids
80
Q

Propylthiouracil
Side Effects

A

Propylthiouracil

can cause severe hepatotoxicity
(“Broken liver beaker”)

can cause a maculopapular rash
(“Chemical spots”)

can cause ANCA-associated vasculitis
(“Inflamed leash”)

81
Q

Methimazole Side Effects

A

is a first trimester teratogen

(“Tarantula drawn on chalk board with evil math equations “)

82
Q

Propylthiouracil/Methimazole Side Effects

A

-Agranulocytosis
(“self destruct sand timer”)

-can cause aplastic anemia
(“Plastic chew bones”)

-can cause drug induced lupus
(“Guard wolf”)

83
Q

Symptoms of Hypothyroidism

(“Fat, cold, fatigued mixologist”)

A

-dry brittle hair, lethargy, fatigue, weakness, decreased BMR, cold intolerance, and myxedema

  • untreated hypothyroidism can lead to
    myxedema coma
    (“Mixing cold drinks”)

→progressive weakness, stupor,
hypothermia hypoventilation,
hypoglycemia, hyponatremia, death

(“Fat, cold, fatigued mixologist”)

84
Q

What can be used for treatment of HYPOthyroidism

(“fat, cold ,fatigued myxologist”)

A

Levothyroxine (synthetic T4) treats hypothyroidism
(“Synthetic T4 time bombs”)

85
Q

Levothyroxine therapy Side Effects

(“synthetic T4 bombs”)

A

-can cause HYPERthyroidism
(“Anxious agent taking cover”)

86
Q

treatment for accidental radioactive iodine exposure

A

Anions -such as perchlorate, pertechnetate and thiocyanate competitively inhibit the sodium-iodide transporter

(“Obstructive box of anions”)

87
Q

Resoprtion blocking Drugs useful in treatment of Osteoporosis

A

Bisphosphonates “-Dronate” suffix
Pamidronate
Alendronate
Zoledronate
(“DONATion box”)

Raloxifene
(entrance lady holding “Relax” sign)

Calcitonin
(“Curator toning it down”)

Denosumab
(“Dino suit man grabbing crank drill”)

88
Q

Bisphosphonates **MOA

Pamidronate
Alendronate
Zoledronate**

A

-bisphosphonates attach to hydroxyapatite in the bone
(“Large T-Rex appetite”)

-osteoclasts bind to the bisphosphonate, inhibiting their adherence to the bony surface
(“Classmate stuck in donation box”)

-bisphosphonates decrease the development and recruitment of osteoclast precursors
(“Preventing osteo-Class waiting to enter from entering”)

-bisphosphonates induce osteoclast apoptosis
(“Classmates popping balloon”)

89
Q

Bisphosphonates can treat …

A

-bisphosphonates are useful in the acute treatment of hypercalemia
(“Elevated calci-yum ice cream”)

  • hypercalcemia of malignancy is a common cause of _severe hypercalcemi_a requiring acute treatment with bisphosphonates and
    calcitonin

(“Massive calcified rock with metastatic crab fossils “)

​——————————————————————————–
​-Bisphosphonates and calcitonin are useful in the management of pagets disease

(“Disorganized bone homo paget display”)

  • uncontrolled osteoclast resorption with secondary disorganized bone formation
90
Q

Bisphosphonates Side Effects

A
  • can cause upper GI side effect
  • acid reflux, esophagitis, esophageal ulcers sit upright 30 min and drink water to treat
  • bisphosphonates can cause osteonecrosis of the jaw
    (“Crumbling jaw bone”)

-bisphosphonates can cause hypocalcemia
(“Falling calci-yum ice cream”)

(“Corroded neck of dinosaur”)

91
Q

postmenopausal osteoporosis can be treated and prevented with …

A

Estrogen therapy

  • estrogen therapy will inhibit osteoclast and osteoclast precursors differentiation

(“pre historic Female guarding class entrance”)

(“Female symbol”)

94
Q

Raloxifene MOA

(lady at entrance holding sign “RELAX”)

A

SERM - Selective Estrogen Receptor Modulator
(“Relaxing the waiting classmates”)

  • has estrogen agonist activity in bone
  • inhibits osteoclast differentiation
  • and estrogen antagonist activity in breast and uterus
  • reduced risk of breast cancer
95
Q

Denosumab MOA

(“Dino suit Man”)

A
  • PTH stimulates osteoBLASTS to express RANKL which then binds RANK on osteoCLASTS and activated them
  • Denosumab is a monoclonal Antibody against RANKL

(“Dino suit man grabbing crank drill”)
(“Antibody spikes on dino suit man”)

96
Q

Calcitonin MOA

(“Curator toning it down”)

A
  • released from the parafollicular cells of the thyroid
  • Calcitonin inhibits osteoclasts􏰀
  • decreased bone resorption
    (“Curator grabbing classmate”)

-calcitonin promotes Ca2+ excretion by the kidney
(“Calci-Yum ice cream pouring down flank”)

97
Q

Calcitonin clinical uses

A

-Used in the same clinical scenarios as
bisphosphonates but not 1st line [osteoporosis]

  • hypercalcemia of malignancy is a common cause of sever hypercalcemia requiring acute treatment with bisphosphonates and calcitonin

(“Massive calcified rock with crab fossils”)

98
Q

Calcitonin Side Effects

A

can cause hypocalcemia

(“Falling calci-yum ice cream”)

102
Q

Estrogen therapy is NOT recommended because ..

A

-due to increased risk of breast cancer and other side effects

103
Q

since Estrogen therapy is NOT recommended as a treatment of postmenopausal Osteoporosis , what other drug can be Administered to treat this condition? and why ?

A

Raloxifene since its an estorgen agonist in bone and estrogen antagonist in Breast and Uterus , it can treat postmenopausal osteoporosis while not increasing the risk for breast or uterine cancer seen with estrogen therapy.

104
Q

PTH MOA

(“PTHd student”)

A

-high serum calcium levels inhibit PTH production and secretion
(“PthD stuck behind bones”)
——————————————————————————–
-PTH stimulates osteoblasts to release receptor activator of nuclear factor kappa-B ligand (RANKL) → activates osteoclasts
(“PthD convincing osteo-builder to give up crank-drill”)

  • RANKL binds to RANK on the osteoclast surface → increased differentiation and activity → increased bone resorption
    (“Classmate receiving crank-drill”)

-PTH stimulates maturation of osteoblasts → increased bone formation
(“PthD teaching osteo-builders”)

-PTH increases calcium resorption by the kidney and increases phosphate excretion
(“PthD gathering bones and dropping P fossils”)

-PTH increases activity of 1-alpha-hydroxylase in the kidney → increased production of 1,25-dihydroxyvitamin D (calcitriol)
(“PthD adding final piece to Calci-TRON”)

105
Q

Teriparatide MOA

(“PTHd TA”)

A

-intermittent doses of teriparatide stimulates maturation of osteoblasts → increased bone formation
(“TA teaching osteo-builders”)

-teriparatide increases calcium resorption by the kidney and increases phosphate excretion
(“TA gathering bones and dropping P fossils”)

-teriparatide increases activity of 1-alpha-hydroxylase in the kidney → increased production of 1,25-dihydroxyvitamin D (calcitriol)

(“TA adding final piece to Calci-TRON”)

106
Q

Teriparatide can be used to treat ...

(“PTHd TA”)

A

-to treat osteoporosis (increase bone density)
(“Fresh piece of calcified chalk”)

107
Q

Calcitriol MOA

A

Synthesis
D3 (sun) / D2 ( plant) → 25hydroxyvitamin D [Liver] → 1alpha hydroxylase →1,25 dihydroxyvitamin D /Calcitriol [Kidney]
——————————————————————————–
-calcitriol stimulates reabsorption of calcium AND!!!! phosphate by the kidney

(“Calci-TRON gathering bones and fossils from dump site”)

-calcitriol stimulates intestinal absorption of calcium AND!!! phosphate

(“Calci-TRON gathering bones and fossils from GI truck”)

-calcitriol stimulates osteoblasts to release RANKL → activates osteoclasts
(“Calci-TRON delivering crank-drills”)

-calcitriol inhibits PTH production by the parathyroid gland
(“Calci-TRON collapsing PthD lab”)

-calcitriol stimulates maturation of osteoblasts → increased bone formation
(“Calci-TRON teaching osteo-builders”)

108
Q

Calcitriol is useful in treatment of …

(“Calci-TRON”)

A

-can be used to treat osteoporosis (increase bone density)
(“Fresh piece of calcified chalk”)

-can be used to treat Rickets in children and osteomalacia in adults (increase bone density)
(“Calci-TRON stabilizing rickety tower”)

-calcitriol can be useful in chronic kidney disease (prevent hypocalcemia)
(“Calci-TRON stabilizing broken kidney”)

-topical vitamin D can be used to treat psoriasis
(“Scaly knee and elbow pads”)

  • calcitriol is useful in the long term management of hypocalcemia (e.g. hypothyroidism)
    (“Calci-TRON saving falling calcified bones”)
109
Q

Hypocalcemia symptoms

A

-Hypocalcemia is commonly caused by hypoparathyroidism (decreased production of calcitriol by the kidney)

  • Thyroid surgery can cause hypoparathyroidism and hypocalcemia
    (“Undone bowtie on PthD”)

-hypocalcemia can cause seizure
(“Shaking structure”)

-hypocalcemia can cause
(“Tense fist”)

  • paresthesias,
  • muscle cramps,
  • trismus, and tetany

(“Falling PthD”)

112
Q

Cinacalcet is useful in treatment of …

(“Calculator at the calcified bone receptor”)

A

-Hypercalcemia due to hyperparathyroidism
(“Calculating pile of calcified bones”)

113
Q

Sevelamer MOA

(“Shoveler”)

A

-a Phosphate Binding Polymer decreases absorption of phosphate in the GI tract
(“Shoveling fossils in the GI truck”)

114
Q

Sevelamer is useful in the treatment of…

(“Shoveler”)

A

-hyperphosphatemia due to Chronic Kidney Disease

(“Shoveling pile of fossils”)

119
Q

Teriparatide / Calcitriol Side Effects

A

-can cause hypercalcemia
(“TA and CalciTRON raising Calcium Ice cream”)

-

120
Q

Cinacalcet MOA

(“Calculator at the calcified bone receptor”)

A

a Calcimimetic. mimics the action of calcium on tissues

  • Cinacalcet activates the calcium sensing receptor on the parathyroid gland → decreased production of PTH
    (High calcium inhibits PTH Secretion”)
121
Q

GH MOA

A

-The GH receptor is associated with JAK tyrosine kinase “jackin up that cell growth”

  • GH stimulates the liver to produce IGF-1 insulin-like growth factor which mediates the growth promoting effects of GH
    (“Vine sprouting from the Liver rock”)
  • IGF-1 is responsible for long bone growth​
    (pubertal growth spurt) think of a child shooting up just like the vine off the ground
    (“Tall growing vine”)

-GH has anabolic effects in muscle
(“Striated muscle leaf”)

-GH has catabolic effects in adipose tissue
(“Falling fatty donut jar”)

(“Tyrosine tire”)

122
Q

GH therapy can treat …

A

-useful in GH deficiency and idiopathic short stature (controversial)
(“Short kid”)

-GH therapy is useful for increasing growth in Prader-willi syndrome
(“Pradre willi”)

  • for increasing growth in turner syndrome,
  • transmittance of a single X chromosome (XO)

(“Turning X girl”)

123
Q

in cases in which the body doesn’t respond to GH treatment (GH Receptor defects etc.. ),what other treatment can be useful ?

A

Mecasermin-Recombinant IGF-1

  • treats growth failure due to severe IGF-1 deficiency
    (“sermon”)
124
Q

Mecasermin [recombinant IGF-1] Side Effects

(“Sermon”)

A

-can cause hypoglycemia
(“Falling candy”)

125
Q

GH secreting pituitary adenoma can cause gigantism in children and acromegaly in adults , what drug can be used to treat this condition?

(“Giant hanging on the Vine”)

A

Octreotide

  • somatostatin analog treats acromegaly and gigantism by inhibiting secretion of GH
    (“Giant hanging on the Vine”)

(“Octagon stop sign”)

126
Q

Octreotide is a Somatostatin analog used to treat…

(“Octagon stop sign”)

A

-treats acromegaly and gigantism

  • inhibits secretion of GH
    (“Giant”)

-octreotide treats VIPoma

  • neuroectoderm tumor secreting VIP
    (“VIP Customers only”)
  • treats carcinoid tumors
  • ileal tumor with hepatic mets secreting serotonin flushing, wheezing, and secretory diarrhea
    (“Customers only”)

-Octotreotide treats insulinoma

  • fasting hypoglycemia
    (BIG “welcome inside mat”)

-octreotide treats glucagonoma

  • manifests as weight loss and necrolytic migrator erythema affecting limbs and skin surrounding the lips
    (“Giant glucagon packet”)

-octreotide treats gastrinoma

  • Zollinger ellisson syndrome
    (“Giant gas tank”)

-can control bleeding of esophageal varices

  • decreased portal blood flow and variceal pressure
    (“Exposed variceal pipes”)
127
Q

Octreotide side effects

(“octagon stop sign”)

A

-AE’s include GI side effects, N&V, abdominal pain
(“Nauseated and pointing up”)

-octreotide can cause steatorrhea
(“Yellow stool”)

  • decreased pancreatic secretions and gall bladder contractility
128
Q

Name the D2 receptor agonists used in treatment of acromegaly

(“Double rope ladder”)

A

Reinforcing the inhibition of secretion of GH at the pituitary

(“Pituitary sack at the end of the broomstick holding in the beans”)
——————————————————————————–
Cabergoline

(“Burglar”)

Bromocriptine
(“broomstick”)

129
Q

ADH MOA

A

-ADH is released from the posterior pituitary
(“Posterior water jug”)

-the site of action - Collecting Duct
(“Collecting duct (CD)”)
——————————————————————————–
V1R activation

-ADH activates V1 receptor coupled to Gq activates PLC→ IP3 + DAG → increased intracellular Ca2+
(“V1 hole on the Q shaped green”)

  • ADH activation of V1 on vascular smooth muscle causes vasoconstriction and increased BP
    (“Constricted golf club”)

V2R activation

  • Renal

ADH activates V2 receptors coupled to Gs (activates adenylyl cyclase → increased cAMP)
(“V2 hole on the S shaped green”)

-ADH activation of V2 on the basolateral membrane of the CD causes translocation of aquaporin 2 to the apical membrane and reabsorption of free water
(“Translocation of pure water”)
* Extrarenal V2

  • located on the vascular endothelium
    (“Endothelial tile”)

-ADH activation of V2 on vascular endothelium causes release of von Willebrand factor (vWF)
(“Von Wille brand pool table”)

-ADH activation of V2 on vascular endothelium causes release of factor VIII
(“8-ball”)

130
Q

Nephrogenic Diabetes Insipidus MOA

A

-occurs when the nephron does not respond appropriately to ADH

  • lithium can cause drug-induced nephrogenic DI
    (“Lift-ium balloons”)

(“Ignoring water boy”)

131
Q

possible treatments of Nephrogenic Diabetes Insipidus

A

Thiazide diuretics
(“Chloro-thighs”)

Amiloride -a K+ sparing diuretic
(“Almond cart”)

  • amiloride treats lithium induced DI

NSAIDs (e.g. indomethacin)
(“Fire extinguisher”)

132
Q

Central Diabetes Insipidus MOA

A

occurs when the pituitary does not release adequate amounts of ADH
(“Absent waterboys”)

133
Q

treatment of Central Diabetes Insipidus

A

-exogenous ADH adminstration
(“Waterboy entering exogenously”)

-Desmopressin acetate
(“Desert-mobile”)

  • DDAVP- a long acting synthetic analog of ADH
  • DDAVP has high specificity for the V2 receptor
    (“V-2 engine”)
134
Q

DDAVP can be used to treat …

A

-treats von Willebrand disease releases vWF from vascular endothelium

  • can be associated with increased bruisability and muscosal bleeding
    (“Bruised with mucosal bleeding”)

-DDAVP treats hemophilia A
(“Missing 8-ball in “A” frame”)

  • releases factor VIII from vascular endothelium
  • can be associated with hemarthrosis and prolonged bleeding after minor procedures
    (“Bleeding knee joint”)

-DDAVP treats night enuresis
(“Wet mattress”)

  • decreased urine production

-ADH is useful in the management of esophageal variceal bleeding
(“Bulging venous golf clubs”)

  • constricts mesenteric arterioles→reduced portal pressure

(“Scratched von Wille brand felt”)

135
Q

DDAVP Side Effect

A

-can cause hyponatremia

(“Falling salty peanut shells”)

136
Q

SIADH MOA

A

-caused by the overproduction of ADH
(“Over-hydrating waterboy”)

137
Q

SIADH treatment

A

V2 ADH receptor antagonists “-vaptan” suffix
(“Vaporizer”)

Conivaptan
Tolvaptan
——————————————————————————–
Demeclocycline
(“Bicycle”)

  • vaptans are first line