Midterm 1 Flashcards
Taladafil
ED. Inhibits PDEi so cGMP not broken down. It has the longest duration of action and not affected by food
Sildenafil
ED. Inhibits PDEi so cGMP not broken down. It can have vision effects as it blocks PDEi5 and can cross react with PEDI6 in retina
SE of PDEI5
Nasal congestion, flushing, HA, loss of blue/green discrimination (sildenafil), and dyspepsia. Caution: cardiovascular, organic nitrates, alpha adrenergic antagonists
Aledronate
bisphosphanate-decrease osteoclastic activity/formation and increase apoptosis. Weakest formula
Ibandronate
Bisphosphanate-decrease osteoclastic formation/activation and increases apoptosis. Available as IV and oral. oral=30 min before food. IV=every 3 months. Must sit up 60 min after taking
Zoldronic Acid
Bisphosphante-decrease osteoclastic formation/activation and increases apoptosis. Available as an IV. q1y
Pt. Ed. with bisphosphantes
Must sit up 30 min. after taking to decrease esphogitis and esphogal ulcers
Raloxifene
SERM. Used in postmenopausal osteoporosis. Increases estrogen. Increases serum total and LDL []. Antagonizes estrogen receptors in breast tissue!
Calcitonin
Used to treat osteoporosis. Administered intranasally. Not as effective as bisphosphanates. Released by thyroid!
Teriparatide
Used to treat high risk osteoporosis (aren’t responding to other treatment). subcutaneous q1d. Recombinant PTH.
diethylpropyl
Anorexiant used to treat obesity. Short term and risk of abuse. caution with MAOi.
Orlistat
lipase inhibitor to treat obesity. Can use for up to 4 years. Must take fat soluble vitamins 2 hours after
Prostaglandins
GPCR. Create PGF2alpha, lukeotriens, and thormboxane. Balanced by different actions of eicosanoids
Prostaglandins
GPCR. Create PGF2alpha, lukeotriens, and thormboxane. Balanced by different actions of eicosanoids
TXA1 VS PGI2
TXA1 (Thromboxane) from platelet cells cause cell aggregation and vasoconstriction. PGI2 (prostacyclin) inhibits platelet aggregation and cause vasodilation.
Misoprostal
Prostaglandin analogue used to protect the stomach lining
Asprin
Irreversible acetylates cyclooxygenase and so platelets must be regenerated. Salcilylates! Baby aspirin=81 mg. Analgesic and antipyretic. Increase lung ventilation. Will also decrease renal blood flow! (prostglandins needed for renal BV dilation) Can’t use for preoperative care! Can cause Reyes syndrome in kids (other salicylates as well) Can also have salicylate intoxication with overdose.
Ibuprofen
Irreversible acetylates cyclooxygenase but not leukotrienes. It is a propionic acid so no risk of reyes.
Indomethacin
Acetic acid NSAID. VERY POTENT!
Sulindac
Acetic acid NSAID with long half life!
Acetominophen
Inhibits prostaglandin synthesis in the CNS. Bad anti-inflam effect but good anti-pyretic and analgesic effect. Have liver toxicity
Treating RA
NSAIDS COX2, Acetominophen, DMARDS, low dose corticosteroids
Methotrexate
DMARDS. Used in cancer. Must take with leucovorin (folic acid). An immunosupprent. Used once a week
Hydroxycholoquine
DMARDS. Used in malaria. Causes ocular toxicity (bull’s eye retinopathy). Safe with prey.
Leucovorin
Used with methotrexate. Essentially a folic acid supplement!
Leflunomide
DMARD. Used if methotrexate or hydroxycholoquine doesn’t work.
omab
murine monoclonal ab (biologics)
ximab
chimeric (biologics)
zumab
humanized monoclonal ab (biologics)
umab
Human monoclonal ab (biologics)
cept
receptor-ab mediated fusion protein (biologics)
Prednisolone
Topical steroid. keton based. Potent so use with severe uveitis or allergic conjunctivitis. strong!
Treating acute gout
Indomethacin or other NSAIDS (not aspirin) or intrarticular administration of glucocortiocoids
Betamethason
Long acting steroid. used for respiratory syndrome in infants
Hydrocortisone
Shorting acting steroid. used with addisons disease.
Treatment of chronic gout
- Probenecid (uricosuric agent) 2. Allopurinal or febuxostat to inhibit synthesis of uric acid 3. colchicine-distrupts granulocytes motility to affected site. Used for recurrent attacks
Probenecid
chronic gout. uricosuric agent- increases excretion of uric acid
Allopurinal
chronic gout. Inhibit uric acid synthesis
febuxostat
chronic gout. inhibit uric acid synthesis
Colchicine
chronic gout. Stops motility of granulocytes to affected area.
Prednisolone
Topical steroid. keton based. Potent so use with severe uveitis or allergic conjunctivitis.
When are topical steroid CI
- Herpes simplex infectious epithelial keratitis 2. acute bacterial infection 3. significant epithelial compromise
How to treat a corneal ulcer?
Treat with AB until corneal integrity is good and then apply steroids.
Why taper steroids?
To allow adrenals to begin producing endogenous steroids again. Can have rebound effect. Taper by 50% once under control.
Ocular topical NSAIDS
Mostly used to treat periopertive care. Topical steroids used largely.
Corneal toxicity
Can occur if NSAIDS are used too often. Prescribe NSAIDS for less then a week.
Diphenhydramine
Used for allergies
Fexofenadine
Used for allergies
Loratidine
Used for allergies
Ranitidine
Used for allergies
Gonadorelin
Gonadotropin releasing hormone. Essential for release of FSH and LH from pituitary. Pulsatile release. Analogues of it (leuprolide) used to treat prostatic cancer, endometriosis, precocious puberty
Leuprolide
Analog of GnRH. Suppresses production of gonadal hormones (LSH, LH). Used to treat prostatic cancer, endometriosis, precocious puberty.
Mifepristone
A progesterone antagonist with partial agonist activity. Administered and then followed by misoprostol administered vaginally will cause an abortion.
Cluster HA
No family history, M, Unilateral behind one eye, during sleep, constant and excruciating. 15-90 min.
Tension HA
Family history. F. Occurs under stress. Bilateral band around head. Dull and persistent
Common Migraine
AKA Migraine without aura. throbbing unilateral HA. Occurs with photpobia, phono phobia and nausea and vomiting.
Classic Migraine
AKA Migraine with aura. Prodromes 20-40 minutes prior. Can cause sensory, visual, and or speech or motor disturbance.
Biology of Migraines
Due to dilation of extra cranial and intracranial arteries. Aura due to decreased neural activity due to decreased blood flow to posterior cerebral hemisphere
Meclizine
Antiemetic. Can use with migraines.
Zolmitriptan
Seratonin agonist triptan. Treat Migraines. Nasal spray.
Dihydroergotamine
Seratonin agaonist. Used for migraines. Like sumatriptan but administered intravenously. Nausea is a common adverse effect. Vasoconstrictor. Give during prodromal stage.
Pathway for cortisol production
CRH (from HT)–>ACTH (ant pit)–>adrenal gland–>cholosterol–>progenenolone–>progesterone–>cortisol and other adrenal androgens. It is a GPCR and it is highest at 6 am
Somatotropin
Growth Hormone. A large polypeptide released during sleep. Used for GH deficiencies. Has a short duration but cause IGF1 to be released from the liver which has a longer duration. It declines at 55.
Octreotide (sandostatin)
A synthetic analogue of somatostatin. Used to treat acromegaly.
Glyburide
insulin secretagogue (sulfonylureas). Oral. Promote insulin release, stop hepatic glucose production, increase peripheral insulin sensitivity. SE: weight gain, hyperinsulinemia, and hypoglycemia. Block K channel and cause more ca to enter the cell.
Pegvisomant
An analogue of GH. Treats refractive acromegaly.
Goserelin
An agonist at GnRH (gonadorelin) receptors. Results in decreased release of LH and FSH as not pulsatory. Treat prostate cancer, endometrious, and precocious puberty
Bromocriptine
A dopamine agonist. Used to treat hyperprolactinemia as prolactin release is inhibited by dopamine. Prolactin decreases sex drive. Treat hyperprolactinemia.
Posterior Pit. hormones
No RH. Released during partition or high osmolarity.
Oxytocin
Used during labor to increased contractions. Also causes milk ejection.
Insulin Lispro
Rapid acting insulin analog. 30-90 minute peak. Take 15 minutes before meal.
Vasopressin
AKA anti-diuretic hormone. Released with high osmolarity. V1 receptor causes vasoconstriction. V2 causes increased
Triiodiothyronine
Thyroid hormone T3. More active.
Thyroxine
Thyroid hormone T4. Less active
Hyperthyroidism (thyrotoxicosis)
tachycardia, few menstral periods, irritability, tremor, nervousness. Associated with graves, toxic adenoma, and goiter. Decreased TSH.
Hypothyroidism
bradycardia, weight gain, depression, heavy menstral periods, fatigue, muscle pain, dry skin, infertility. Caused by autoimmune that destroys peroxidase or gland.
Thyroid hormone synthesis
Ribosomes in thyroid follicles create thyroglobulin in ribosomes and then secrete into lumen. TSHR stimulate more iodine pumps and iodine taking into the cells. Iodine is oxidized by peroxidase and then bound to tyrosine parts of thryoglobulin. Condensation of 2 triiodotyrosines=T4. Condensation of a monoiodotyrosine with a diiodotryrsoine=T3. They are released into the blood and bind thyroxine-binding globulin. Thionamides effect the oxidation or condensation.
Dutasteride
Antiandrogen. 5-alpha-reductase receptor antagonist. Decreases prostate size. Use for benign prostatic hypertrophy.
Action of TH
Unbind thyroxine-binding globulin. Enter the cell and T4 converted to T3. Enter nucleus and bind receptors. Slow acting but long duration
Levothyroxine
Synthetic T4. Treats hypotheyroidism.
Graves ocular components
Dry eyes, proptosis, eye pain, optic neuropathy. Occurs as AB bind extra ocular muscles.
Propylthiouracil (PTU)
Thioamide. Used to treat thyrotoxicosis. Inhibits condensation and conversion of T4 to T3. Used rarely as a short half life and toxic.
Methimazole
Thioamide. Used for thyrotoxicosis. Inhibits condensation. More safe and used more often. tid.
Thyroid Storm
Pt. presents with high levels of thyrotoxicosis. Can treat with high doses of drugs and more frequently.
Type 1 diabetes
Occurs in early adulthood or puberty. Autoimmune disease kills beta cells of the pancreas. Require insulin injections. Prone to ketoacidosis (from breaking down fat)
HBA1C
indicates how good glucose levels have been for the past 3 months
Pancreatic Hormones
Insulin, glucacon, somatostatin
Formation of insulin
Synthesized as proinsulin with a A,C,B chain. Cleaved to insulin and C-peptide. Check insulin levels by checking C-peptide as insulin immediately taken into the body once made.
Increatin
Made by small intestines when lots of glucose in diet. Will cause beta cells to secrete insulin.
SE of insulin
lipodystrophy (inj site), hypoglycemia (cause symp to kick in), confusion, vertigo, anxiety, tachycardia.
Hydrochlorothiazide
Thiazide. Acts on distal tubule. Increase Na/Cl secretion. Used for HTN. Can result in hypokalemia.
Nateglinide
Insulin secretagogue (glinide). oral. Promote insulin release, inhibit hepatic glucose creation, increase peripheral insulin sensitivity. Less hypoglycemia risk. use with metformin.
Metformin
Insulin sensitizer (biguanide). Oral.Decrease hepatic glucose production and increase glucose uptake. Drug of choice for new type 2. Use with polycycstic ovary disease. SE: pregnancy chance, weight loss.
Pioglitazone
Insulin sensitizer (thiazolidenediones/glitazone). Oral. Target the PPAR (peroxisome proliferative activated receptor) to increase GLUT4. increase insulin sensitivity in adipose, liver, and skeleton. Tier 2 as cardiac effects, heart attack, weight gain.
Insluin secretagogues
Glipizide (sulfonyureas) and nateglinide (glinide)
Insulin sensitizer
Metformin (bigunamide) and pioglitazone (thiazolidinediones/glitazones)
Sitagliptin
Dipeptidyl Peptidase IV inhibitior. oral. DDPV inactivates increatin hormones and so this drug stops inactivation of increatin. This furthers increatin’s action and results in increase insulin release. (GLP1).
Exenatide
Increatin mimetics. Increatin responsible for 60-70 percent of postprandial insulin secretion. An adjunct therapy. Take with a needle.
SE of glucose lowering drugs
hypoglycemia (glinades and sulfonylureas), GI distrubance (biguanides and alpha glucocosidase inhibitors) Weight gain (sulfynolureas, glinades, thiazolendiones), Nausea (biguanides), Cardiovascular risks (thiazoldiediones). Can also have exudates, neovascularization, etc.
Insulin glaragine
Long acting insulin analgoue. Subcutaneous action. Long acting insulin analgoue. Use with type 2 or with short acting in type 1.
Where do the hormones from the adrenals come from?
Outer zona glomerulus-minteralcorticoids Middle zone fasicularis-glucocorticoids Inner zona reticularis-adrenal androgens
Aldosterone
Secreated by adrenals. Controls the bodes water volume and concentration of ions. Resorbs bicarbonate, sodium, and water.
Ketoconazole
Anti-fungal agent that can inhibit enzymes envolved in adrenocorticosteroid synthesis so can use to treat cushing’s syndrome
spironolactone
An aldosterone antagonists. but also effects cortisone. Can be used to treat hirsuitism. Have SE of gynecomastia.
Eplerenone
An aldosterone antagonist but also effects cortisone. It is antihypertensive. Better as no SE of gynecomastia.
Estrogen uses
- postmenopausal (helps with osteoporosis, atrophy, and hot flashes-reestablishes HT feedback on no rep) 2. Birth control-higher dose and combine with progesterone.
Tamoxifene
SERM. Antagonizes estrogen receptors in the breast. Used for breast cancer. Can cause tamoxifene retinopathy
Clomiphene
SERM. Partial estrogen agonist. Used to cause ovulation and treat infertility
Medroxyprogesterone
Oral progesterone. Used for contraception, dysmenorrhea, endometrios, infertility. If conception doesn’t occur progesterone [] falls and menestration occurs.
Monophasic pills
Have a constant dose of estrogen and progesterone
Triphasic pills
Have estrogen and an increasing dose of progesterone to mimic actual cycle.
Progesterone
From adrenals. Used for contraceptive (less effected by first pass mech), dysmenorrhea, and endometirus, and infertility
Plan B
A high dose of estrogen or estrogen and progestrin 72 hours after sex
SE of Birth control
breast fullness, depression, blood clots, hypertension, HA, nausea, vomiting.
Androgen effect
Normal maturation in M, sperm production, decrease resportion, increase synthesis of hemoglobin and muscle proteins
5-alpha reductase
Converts testosterone to more potent dihydrotestosterone
Aromatise
Converts testosterone to estrogen
Furosemide
A loop diuretic. Acts on ascending to inhibit Na/K/Cl transport. It is most efficacious diuretic.
Alprostadil
Prostaglandin. Used for ED. Keep ductus arteries open. Intrapenile injection or intraurethal suppository.
Phentermine
Anorexiant. Similar to diethylproprion
Eplernone
Aldosterone antagonist. K sparing diuretics. Binds aldosterone receptor so don’t get response to aldosterone. Used with other diuretics. Less endocrine effects then spironolactone.
Levonorgestreal
Progestin (synthetic progesterine) Used with contraception.
