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Natsumi - NPLEX 2 > Natsumi Pharm - Endo > Flashcards

Natsumi Pharm - Endo Flashcards

1
Q

Mineralocorticoid & Glucocorticoid

A

PREGNENOLONE

precursor of progestogens, mineralocorticoids, glucocorticoids, androgens, and estrogens

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2
Q

Fludrocortisone

A

Mineralocorticoid

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3
Q 
Prednisone
Dexamethasone
Hydrocortisone
Fluticasone
Methylprednisolone
Mometasone
Triamcinolone
Clobetasol propionate
Prednisolone
Beclomethasone
Budesonide
Fluocinonide
A

Glucocorticoid

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4
Q

Pills, Oral/nasal, or topica?

Dexamethasone
Prednisone
Methylprednisolone
Prednisolone 
Fluticasone
Mometasone
Beclomethasone
Budesonide 
Clobetasol propionate
Fluocinonide
Mometasone
Fluticasone
Triamcinolone
Hydrocortisone
A 
Pills
Dexamethasone
Prednisone
Methylprednisolone
Prednisolone 
Oral/Nasal sprays
Fluticasone
Mometasone
Beclomethasone
Budesonide 
Topicals
Clobetasol propionate
Fluocinonide
Mometasone
Fluticasone
Triamcinolone
Hydrocortisone
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5
Q

Estrone (E1)

A

marker post-menopause (stored in adipose) and for cancer (ovary, testes, adrenals)

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6
Q

Estradiol (E2)

A

most prevalent outside of pregnancy

Estriol (E3), considered “protective”—highest in pregnancy

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7
Q

Estriol (E3)

A

considered “protective”—highest in pregnancy

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8
Q

Ethinyl estradiol

A

The only estrogen used in oral contraceptive pills

Lowest effective dose of ethinyl estradiol preferred to reduce risk of DVT

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9
Q

Conjugated estrogens

A

Vaginal cream is Estrace

Pregnancy category X—no reason to use in a pregnant woman

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10
Q

Medroxyprogesterone acetate

A

Progesterone

Uses: prevention of endometrial hyperplasia in nonhysterectomized postmenopausal women who are receiving conjugated estrogens tablets; secondary amenorrhea; abnormal uterine bleeding (fibroids)
Bloating symptoms, migraine, weight change

Contraindicated in women with undiagnosed abnormal genital bleeding; known, suspected, or history of breast cancer; known or suspected estrogen- or progesterone-dependent neoplasia; active DVT, PE, or a history of these conditions; active arterial thromboembolic disease (for example, stroke and MI), or a history of these conditions; known liver impairment or disease; known or suspected pregnancy.

WARNINGS: cardiovascular disorders, breast cancer, probably dementia

Pregnancy category X (natural progesterone suppositories are sometimes used in the first trimester to help hold a pregnancy in a woman who has miscarried previously)

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11
Q

Levonorgestrel

A

Progestin

Mirena/Skyla/Kyleena (IUD); Plan B/My Way/Next Choice (“morning after” pill, 1.5mg); Norgeston (“mini”-pill 0.03mg/progestin-only birth control pill)

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12
Q

Norethindrone

A

Used alone or in combination with ethinyl estradiol for combination (progestin + estrogen) oral contraceptive and menopausal agent (norethindrone + EE)
Pregnancy category X

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13
Q

Drospirenone

A

Used in combination with ethinyl estradiol for combination oral contraception

Contraindicated in smokers, particularly over age 35 years; associated with increase in gall bladder disease

Pregnancy category X

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14
Q

Norgestimate

A

Used in combination with ethinyl estradiol for combination oral contraception

Contraindicated in smokers, particularly over age 35 years; associated with increase in gall bladder disease

Pregnancy category X

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15
Q

Norelgestromin

A

Used in combination with ethinyl estradiol for combination oral contraception

Contraindicated in smokers, particularly over age 35 years; associated with increase in gall bladder disease

Pregnancy category X

5 letter = pathch NOR EL GE STRO MIN (5 syllable)

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16
Q

OCP’s nutrient depletion

A 
Folic acid
B1, B2, B3 (variable), B6, B12
Vitamin C
Calcium
Magnesium
Selenium
Zinc
Tyrosine
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17
Q

Drospirenone/ethinyl estradiol
Norethindrone/ethinyl estradiol
Norgestimate/ethinyl estradiol

A

OCP

Black box warning: stroke, MI, PE, DVT, breast cancer, dementia

18
Q

Clomiphene

A

Ovulatory stimulant

Uses: treatment of ovulatory dysfunction in women desiring pregnancy after impediments to achieving pregnancy have been excluded or adequately treated

Best outcomes seen in women with polycystic ovary syndrome, amenorrhea-galactorrhea syndrome, psychogenic amenorrhea, post-oral-contraceptive amenorrhea, and certain cases of secondary amenorrhea of undetermined etiology.

Warnings: potential for ovarian hyper-stimulation syndrome and hepatic dysfunction.

Pregnancy category X

19
Q

Dehydroepiandrosterone (DHEA)

Testosterone

A

Androgen

(DHEA is a prescriptive agent—as is Melatonin—elsewhere in the world; here in the US, both are available over-the-counter.)

20
Q

Testosterone

A

Used for: primary hypogonadism (congenital or acquired)-testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy; hypogonadotropic hypogonadism (congenital or acquired)-gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation.

Routes: IM, patch, nasal gel, orally, topical cream
Should be given to men with consistent symptoms/signs of hypogonadism & low plasma testosterone levels (<3ng/ml). Safety and efficacy of Testosterone in men with “age-related hypogonadism” (also referred to as “late-onset hypogonadism”) have not been established!

SE: acne, gynecomastia, irritation at site of administration, headache, transfer to female partner; cholestatic jaundice syndrome, liver carcinoma, BPH, prostate cancer, DVT. [Women: clitoral hypertrophy, hirsutism, acne, amenorrhea]

  • Liver cell tumors
  • Peliosis hepatitis

Pregnancy category X; C-III

21
Q

Spironolactone

A

Aldosterone antagonist

22
Q

Regular
Lispro
Glargine

Which is fast acting?

A

Classic anabolic hormone: promotes carbohydrate metabolism; facilitates glucose, amino acid, triglyceride uptake & storage in liver, cardiac & skeletal muscle, adipose tissue

Insulin, regular, Actrapid/Humulin R/Novolin R—fast acting
Insulin, lispro, HumaLOG—very fast acting
Insulin, glargine, Lantus/Basaglar—basal level of insulin

Structurally similar to endogenous insulin; zinc ions provide stability; recombinant DNA technology
For use in insulin dependent diabetes mellitus

SE: injection site reaction, lipodystrophy; hypoglycemia
Nutrient considerations: alpha lipoic acid, vitamins C & E, n-acetyl cysteine protect insulin under oxidative stress; chromium improves insulin sensitivity (numerous ways); magnesium improves insulin sensitivity

Pregnancy category B

23
Q

Glucagon

A

For rescue of hypoglycemia
Recombinant DNA technology; IV, IM, or SQ administration
CI in pheochromocytoma

24
Q

Desmopressin

A

Modified arginine vasopressin: Desmopressin, DDAVP

Synthetic analogue of the natural pituitary hormone 8-arginine vasopressin (ADH), an antidiuretic hormone affecting renal water conservation

Limits amount of water eliminated in urine
Used for diabetes insipidus, coagulation disorders (hemophilia A, von Willebrand’s disease type I)

SE: headaches, facial flushing, nausea, seizures, hyponatremia
Available po, sl, nasal spray, IV

Pregnancy category B

25
Q

Oxytocin

A

Oxytocin, Pitocin/Syntocinon

The “love” hormone produced by posterior pituitary gland
Released during/after childbirth, with breastfeeding, at orgasm—creates bonding, evokes feelings of contentment, decreases anxiety; protects against stress
Used for medical (rather than elective) induction of labor, to control postpartum bleeding or hemorrhage

Available IV, nasal spray

Pregnancy category X

26
Q

Bromocriptine,

A

Ergot alkaloid: Prolactin blocker

Dopamine receptor agonist

Uses: hyper-prolactinemia associated dysfunctions (amenorrhea with or without galactorrhea, infertility or hypogonadism); prolactin-secreting adenomas; acromegaly; Parkinson’s disease

SE: hypotension

Pregnancy category B

27
Q

Somatropin

A

Growth hormone

Recombinant DNA growth hormone; assists growth of linear bone, skeletal muscle, and organs by stimulating chondrocyte proliferation and differentiation, lipolysis, protein synthesis, and hepatic glucose output; stimulates erythropoietin which increases red blood cell mass; exerts both insulin-like and diabetogenic effects; enhances the transmucosal transport of water, electrolytes, and nutrients across the gut

Labeled indications: growth failure in pediatrics; growth hormone deficiency in adults; cachexia of HIV; short bowel syndrome in patients receiving specialized nutritional support (Zorbtive).

SE: upper respiratory tract infection, arthralgia, arthropathy, headache, hypoesthesia, increased serum glucose, limb pain, myalgia, paresthesia, and peripheral edema; fatigue, fluid retention, gynecomastia, hyperglycemia, insomnia, joint stiffness, joint swelling, nausea, and anasarca (extreme generalized edema)

Pregnancy category C

28
Q

Metformin

reduction %?

A

Uses: adjunct to diet and exercise to improve glycemic control in adultsand children with type 2 diabetes mellitus
Decreases glucose production in the liver, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization
Activates energy-regulating enzyme AMPK, which inhibits gluconeogenesis, fatty acid synthesis, and cholesterol synthesis
Increases insulin signaling

Reduction in HbA1C: 1.5-2%

Common side effects: lactic acidosis, diarrhea, nausea, nausea and vomiting, flatulence, asthenia

Uncommon but serious: Lactic acidosis

Nutrient depletions: vitamin B-12, folate

Contraindicated in patients with renal disease/dysfunction; patients with acute or chronic metabolic acidosis

Pregnancy category B

29
Q

Metformin Considerations

A

Chromium enhances insulin activity and glucose control
Magnesium co-administered with sulfonylureas and/or metformin may improve insulin sensitivity and secretion—less drug warranted (850mg MgOH)
Vitamin E (natural, mixed tocopherols/tocotrienols) may enhance glycemic control

30
Q

Glyburide

Reduction %

A

Sulfonylurea - Stimulate insulin release from pancreatic β-cells to overcome insulin resistance

Orally available; metabolized by liver

Adverse reactions: hypoglycemia, weight gain

Generally considered effective, reasonably safe, inexpensive

Typical reduction in HbA1C: 1-2%

Adverse reactions:

  1. hypoglycemia
  2. weight gain
  3. GI upset

Contraindicated in diabetic ketoacidosis

31
Q

Nutrient Depletions, Sulfonylureas

A

CoQ10

Magnesium (diabetics tend to be deficient before drug therapy)

32
Q

Pioglitazone

A

Thiazolidinedione - insulin sensitizer

Typical reduction in HbA1C: 1.5-2%

SE: heart failure & bladder cancer

BLACK BOX WARNING: may cause or worsen heart failure

Not to be used in DMI/with exogenous insulin or in patients with class III or class IV heart failure
Caution in patients with edema
Drug interactions:  CYP2C8 Inhibitors and Inducers; no known nutrient wasting

Pregnancy category C

33
Q

Liraglutide

A

GLP-1 agonist - Increases glucose-dependent insulin secretion

INJECTION

Typical reduction in HbA1c: 1%

34
Q

Canaglifozin

A

SGLT-2 antagonist - reduces reabsorption of filtered glucose from the tubular lumen and lowers the renal threshold for glucose. Improvement of macrovascular vessels

Use in DMII with diet and exercise

SE: SUPER URINARY FREQUENCY (pollakiuria), necrotizing fasciitis, loss of genitalia, limb amputation

Pregnancy category C

**DIURETIC ON STEROID!! THIS SHIT IS DANGEROUS

35
Q

Stigliptin

A

DPP-4 inhibitor - Prolongs active incretin levels for glucose regulation

SE: Anxiety, blurred vision, chills, cold sweats, confusion, cool, pale skin, depression, dizziness, fast heartbeat, headache, increased hunger, loss of consciousness, nausea, nightmares, seizures, shakiness, slurred speech, unusual tiredness or weakness

Pregnancy category B

1% reduction
They do not perform as well
Another injectable

36
Q

Liothyronine, Levothyroxine, Lugol’s solution

A

Liothyronine, Cytomel (T3)
Levothyroxine, Synthroid/Levoxyl (T4)
Thyroid USP, (Armour) is a blend of T3 & T4 from dessicated pig thyroid
Lugol’s solution (LOW dose), elemental iodine and potassium iodide

Used in hypothyroidism & TSH pituitary suppression
Side effects are typically signs/symptoms of hyperthyroidism

Contraindicated in patients with untreated subclinical (suppressed serum TSH level with normal T3 and T4 levels) or overt thyrotoxicosis of any etiology and in patients with acute myocardial infarction. Levothyroxine is contraindicated in patients with uncorrected adrenal insufficiency.
Pregnancy category A

37
Q

Hormones T4 and T4 work better with which nutrients?

A

No known depletions, but the hormones (T3, T4) work better with associated nutrients:

Selenium
Zinc
Iodine
Copper
Tyrosine
(Adrenal support)
38
Q

Propylthiouracil, Methimazole, Lugol’s solution

A

Lugol’s solution (HIGH dose)
Methimazole - Inhibits synthesis of thyroid hormone
Propylthiouracil (PTU) - Preferred agent in thyroid storm
Inhibits thyroid peroxidase, Inhibits conversion of T4 to T3 in the periphery

Labeled uses: hyperthyroidism (Grave’s disease or toxic multinodular goiter) for whom surgery or radioactive iodine therapy is not an appropriate treatment option; symptom control in preparation for thyroidectomy or radioactive iodine therapy

SE: rash, arthralgia;
life-threatening hepatotoxicity,
agranulocytosis, vasculitis, hypoprothrombinemia

Pregnancy category D
(Generally, methimazole is considered the safer of the two; not in pregnancy.)

39
Q

If the pregnant woman is in thyroid storm, which hyperthyroid agent should you use? If not pregnant, which one is safer?

A

pregnant = PTU

Not pregnant = Methimazole

40
Q

Melatonin

A

Hormone produced by pineal gland
Release is inhibited by light; promoted by dark
Useful for circadian rhythm entrainment; powerful free-radical scavenger & antioxidant—cancer, CVD, autoimmune diseases, depression, SAD
Useful in learning and memory—ADD/ADHD, ASD, Alzheimer’s
Over-the-counter status in the US; prescription elsewhere

Pregnancy category not assigned

41
Q

hCG

A

Human chorionic gonadotropin (hCG)

Used to cause ovulation and treat infertility in women, increase sperm count in men, assist in testicular dropping into scrotum in young boys

SE: ovarian hyper-stimulation syndrome

Pregnancy category X

Natsumi - NPLEX 2 (37 decks)

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