Pharm Audio Review Flashcards
Estrogen low levels
negative feedback
Estrogen high levels
positive feedback
Testosterone and Progesterone
always negative feedback on HPA axis
Leuprolide
long acting gnrh agonist
Initial surge of gonadotropins, eventually inhibit
Use: DOC for endometriosis, Precocious puberty, PCOS, etc
SE of Long acting gnrh
Men: Testicular atrophy
Women: menopause like sx
What to use with long acting gnrh
Flutamide
Cetrorelix
long acting gnrh antagonist
Suppress HPA axis DIRECTLY
Use: IVF
FSH
HMG is prototype
Used with LH
LH
Hcg is prototype (human chorionictropic)
LH and FSH use
Induce spermatogeneis
LH 1st,
then FSH to increase spermatogenesisi
LH and FSH use
women
Start w FSH to stimulate development of follicles, THEN
Single LH dose to induce ovulation
SE of LH and FSH
Ovarian enlargement
Ovarian hyperstimulation syndrome!! emergency
Mult births
Gynecomastia in men
Estrogen
Estradiol is prototype- most imp in body
Transdermal: patch or cream
Estrogen use
Oral contraception Post-menopausal HRT Girls in primary hypogonadism (stimulate puberty) Tx dysmenorrhea Androgen dependent CA (silence HPA axis) Male-->Female
Estrogen SE
Uterine hyperplasia
add progesterine to prevent this!
Estrogens
TERATOGENIC
Anti Estrogen
Breast CA drugs
Anti Estrogens
Tamoxifen
Clomiphene
Raloxifen
Tamoxifen
Agonist in uterus and bone
Increased risk of uterus CA
Prevents bone loss! good
Tamoxifen
SERMS
selective estrogen reuptake ***?
Raloxifene
Agonist in Bone (good as well)
Use for: Post-menopausal osteoporosis
Antagonist in uterus and breast
Tamoxifen and Raloxifene are both agonist in
BONE
Antagonist to breast
The difference b/w the two: Tamoxifen is agonist in Uterus, Raloxifene is antagonist in uterus.
Aromatase Inhbiitor
inh synth of Estrogen specifically
DOC: estrogen dependent Breast CA in post-menopausal women
Mifepristone
Gluco and Progestine receptor ANTAGONIST
Mifepristone
Pregnancy termination (in combo with Prostaglandin)
Mifepristone
Large amt of GI side effects
CONTRA: breastfeeding, pregnancy
Combo birth control
Drosperinone Mineralo receptor antagonist *The one drug int his class that is FDA approved to reduce PMDD sx
Plan B
high does Levonorgestrol
After hysterectomy
DO NOT NEED To and should not give Progesterone
Use: Estrogen only
Replacement therapy MUST be used in pre-menopausal where
Ovaries no longer functioning or have been removed
Androgen use
Negative nitrogen balance
Protenemia of hydronephrosis
Flutamide
not used in monotherapy bc too much hepatotoxicity
USED with long acting gnRH agonist
Spironolactone
Use: Hirsutism, PMS, Precosious puberty
Finasteride
TERATOGENIC bc DHT is needed in fetal development
Prostaglandin–> Dinoprostine
Strong ON switch, stimulate contractions (3rd line after Oxytocin and Ergot)
STRONG AND DANGEROUS GI side effects (black box) must be give w hospital personel around
Mgsulfate
Only given IV
first line to prevent premie
Nifedipine
CCB- L type slow channel
Prevent premie
Can be given AT HOME, orally, long term chronic
Treat hypothyroid
LevothyroXine Na
Levethyronine Na
Dessicated thyroid
LevothyroXine Na
Will lead to normal levels
Dependent on Peripheral deiodonase enzyme
long half life, takes while to reach steady state
Levothyranine Na
T3 drug
quicker half life: 1 day, only 5 days to reach steady state
initial use or supplement in those who cant convert to T3
Methimazole and PTU
long term
can’t treat acute (this is why we use b-blockers in dangerous hyperthyroid situations)
PTU black box
Liver
PTU and Methimazole SE
Granulocytosis
Iodide
Inhibit SYNTH and RELEASE
Use: b4 surgery, nuclear emergency
131-I
Elderly w heart dz
DOC: Toxic nodular goiter
Calcitonin
can cause fish hyper sensitivity
Calcitonin
inhibit bone resorption
Antagonize PTH
Calcitonin can be administered
intranasal and Injection
PTH drugs
“paratide” and rhPTH
BLACK BOX: osteosarcoma (rats)
Paratide
PTH drugs
Intermittent administration NECESSARY!! to have osteoporosis function
Paratide
PTH drugs unique characteristic
NEW BONE GROWTH
Denosumab
RANK-L
SubQ inj every 6 months
SE: HYPOCALCEMIA and Teratogenic
Bisphonphonates
“dronate”
A: O
R: O
I: O,IV
Z: IV
Bisphonates oral administration
absorption is very poor
empty stomach, 1/2 glass water, remain upright for 30 min
Fludrocortisone
Aldosterone replacement (mineralocorticoid)
Addison’s dz
Equal part gluco(cortisol) and mineralo(aldo)
Hydrocortisone
start w this and try to get both levels normal. IF they need more of an Aldosterone boost, then can add Fludrocortisone
Prednisone
Most comm prescribed drug, GOOD FOR ANTI-INFLAMMATORY properties
Cortisone (inactive) must be converted to
Hydrocortisone (active)
Prednisone (inactive) must be converted to
Prednisolone (active)
Highest anti-inflammatory are the ones that
ONLY have glucocorticoid effects
DOC for Cushings dz (too much Cortisol)
Ketoconazole
Spironolactone
Tx for cushings (not 1st line) but can provide quicker relief
Reduce HF hospitalization
diabetic drugs
SLG2 “flozin”
CKD diabetic drugs
SLG2 “flozin”
Metformin
Top 5 diarrhea drug
Metformin SE
Lactic acidosis
CONTRA: GFR <30
Liraglutide
Comes to top for macrovascular event reduction
Weight loss
GLP RA
SLG2 “flozin”
Semaglutide unique bc:
1st and ONLY oral form of GLP-RA which is GAME CHANGER
GLP-RA black box
Thyroid CA!!!!!
Diff b/w GLP-RA and DPP-4 Inhibitor
GLP-RA (mostly injections, besides Semaglutide)
DPP4-I (mostly Oral)
Linagliptin unique (DPP4-I)
Kidney safe
Liver helps w excretion
SLG2 “flozins” are great bc they help w CKD, HF hospitalizations, and promote weight loss but
CANT use if person is on Dialysis
TZA
“tazone”
PPAR-y
insulin sensitivity
a-glucoside inhibitors
decrease post meal
never cause hypoglycemia
*GI effects- flatulence
SU
increase Ca flux of beta cells- increase Insulin release
1st generation not used much anymore
2nd gen known for GI SE and Hypoglycemia RISK!!
least preferred
Glyburide
Highest risk for hypoglycemia
Pramlintide
*1 and 2
bottom of barrel drug, not used often
MUST be given with Insulin
ONLY one that is FDA approved for Type 1 and Type 2
ABCs of diabetes treatment
A1C
Blood pressure
Cholesterol
