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PAM Semester 2 > Pharm Endocrine Exam > Flashcards

Pharm Endocrine Exam Flashcards

1
Q

Bisphosphonates

A

Prevent loss of bone density and decrease the risk of fractures
Decrease in osteoclast mediated bone reabsorption

MOA

Stimulates osteoclast apoptosis
decreases the number of osteoclasts
decrease in bone reabsorption

2nd/3rd generation
Inhibit Cholesterol synthetic pathway
Decrease in osteoclast function
Decrease in bone reabsorption

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2
Q

Bisphosphonates meds

A 
Alendronate = Fosamax
Risedronate
Etidronate
Tiludronate
Pamidronate
Ibandronate
Zoledronate

All end in -dronate

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3
Q

Calcium carbonate

A

Calcium carbonate is cheapest and therefore a good first choice

Absorption is better when taken with meals
(calcium citrate is better fasting)

Calcium carbonate is poorly absorbed in patients on PPI’s or H2 blockers.
(use Calcium citrate)

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4
Q

Calcitriol Indications

A

Rocaltrol (Vitamin D Analog)

Indications

Secondary hyperparathyroidism
and resultant metabolic bone disease in predialysis patients (CrCl 15–55mL/min).

Hypocalcemia and resultant metabolic bone disease in patients on chronic renal dialysis.

Hypocalcemia in hypoparathyroidism

pseudohypoparathyroidism.

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5
Q

Calcitriol Contraindications / interactions

A 
Contraindications:
Hypercalcemia, 
Vitamin D Therapy, 
Vitamin D toxicity, 
Nursing mothers

Interactions
Hypermagnesemia
Magnesium containing antacids
Arrhythmias with digitalis if hypercalcemia occurs

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6
Q

Recombinant PTH

A

Natpara (hormone)

Adjunct to calcium and vitamin D to control hypocalcemia in hypoparathyroidism

Warning: Osteosarcoma

Interactions:
alendronate, digoxin: monitor serum calcium, digoxin levels, and for digitalis toxicity

Adverse reactions:
Paresthesia, hypocalcemia, headache, hypercalcemia, nausea

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7
Q

MOA of Recombinant PTH

A

Bone = Losing calcium
Small intestine = Absorption of calcium
Kidney = Reabsorption calcium

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8
Q

MOA of Calcitriol

A

Increases Ca2+ and PO4- absorption in small intestine

Active form of Vitamin D

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9
Q

For patients with significant symptoms of hyperthyroidism or patients with hyperthyroidism complications like elderly, cardiovascular disease

A

First line Beta blockers (atenolol 25-50) (200 max) QD

Along with a thionamide
Specifically Methimazole

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10
Q

For women who wish to become pregnant with hyperthyroidism

A

Propylthiouracil (PTU would be the preferred drug during the first trimester of pregnancy and can be continued throughout pregnancy

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11
Q

Management of Hyperthyroidism flow chart

A

Control symptoms with Beta blockers
(*asthma)
Stop @ euthyroid

Control hyperthyroid with Thionamides or PTU
(*agranulocytosis)
Remission in 50% cases of GD After 6-18 months

Radioactive iodine
(*pregnancy, incontinence, breastfeeding)
Euthyroid or hypothyroid in 90% cases after first dose

Surgery
(*Hypoparathyroidism, Bleeding, Laryngeal nerve palsy
Hypothyroidism, possibly Hypocalcemia

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12
Q

Beta Blockers and hyperthyroidism

A

End in -lol

Atenolol 50-100 QD
Propranolol 20-40 TID

Help reduce symptoms quickly until other treatments can take effect

(help with tremors, Tachycardia and nervousness)

(don’t stop thyroid hormone production)

(usually feel better within hours)

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13
Q

Methimazole

A

Tapazole (antithyroid)

For Hyperthyroidism

Not for nursing mothers

Warnings:
Discontinue if agranulocytosis, aplastic anemia, exfoliate dermatitis, hepatitis, elevated liver enzymes

Interactions: Potentiates anti coagulants

Adverse: Arthralgia, paresthesia, hair/taste loss, agranulocytosis, aplastic anemia, liver dysfunction, lupus like syndrome

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14
Q

Proppylthiouracil

A

PTU
Hyperthyroidism

Warning:
Hepatic reactions (injury, failure, transplant)

Interactions:
May potentiate anti coagulants,
May need to reduce beta blockers and digitalis
Caution with drugs that also cause agranulocytosis

Adverse: Arthralgia, paresthesia, hair/taste loss, myalgia, lupus like syndrome

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15
Q

MOA of Thionamides
Methimazole
Propylthiouracil

A

Inhibits thyroid hormone synthesis
Inhibit the oxidation of iodine

PTU: inhibits peripheral conversion of T4 to T3

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16
Q

Thyroid Storm

A

Slide 40

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17
Q

Hypothyroidism

Primary vs Secondary

A 
Primary:
Iodine deficiency
Excess iodide intake
Thyroid ablation
Hashimotos
Sub acute thyroiditis
Genetic abnormalities
Goiterogenic food
Drugs: Lithium, Amiodarone, Antithyroid agents

Secondary:
Adenoma
Ablative therapy
Pituitary destruction

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18
Q

Primary hypothyroidism goals

A

The goals of therapy are improvement of symptoms,

normalization of TSH secretion,

reduction in size of goiter (if present),

and avoidance of overtreatment (iatrogenic thyrotoxicosis).

Goal to keep serum TSH within the normal range (approximately 0.5 to 5.0 mU/L).

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19
Q

Treatment of choice for primary hypothyroidism

A

Synthetic T4
Levothyroxine

Either a generic or a brand-name formulation is acceptable.

If a switch from one manufacturer to another is made

Measure a serum TSH six weeks after changing to verify TSH is still within the therapeutic target.

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20
Q

Initial dose of Levothyroxine for

Primary Hypothyroidism

A

Young healthy patients = Full dose
1.6mcg/kg/day

Taken on empty stomach 30-60 mins before breakfast

T4 serum should be reevaluated in 6 weeks
(adjust if needed)

Symptoms begin to resolve in 2-3 weeks

Regular concentrations are not achieved for 6 weeks)

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21
Q

Dosing for Levothyroxine

A

Initial = 1.6mcg/kg/day (a few months)

Adjust dose in 12.5-25mcg increments
every 4-6 weeks until TSH returns to normal (euthyroid
Normal TSH = 0.5-5.0)

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22
Q

Levothyroxine sodium

A

Synthroid (synthetic T4)

Take 30-60 mins before breakfast

Contra: uncorrected adrenal insufficiency

Warning: Not for obesity or weight loss
Underlying cardiovascular disease,
arrhythmias during surgery in CAD patients

Adverse: Arrhythmias, MI, Dyspnea, Muscle spasms

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23
Q

Thyroiditis

A

Subacute painful
(de Quervain’s, granulomatous, giant cell)

Drug induced
(usually amiodarone)

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24
Q

MOA of antidiabetic drugs

Biguanides
Thiazolidines
-diones

A

Liver

Decrease glucose production

= Less glucose in the blood

Helps restore normal glucose level in blood

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25
Q

MOA of antidiabetic drugs

Alpha-glucosidase inhibitors

A

Intestine

Delay glucose absorption in gut

= Less glucose in the blood

Helps restore normal glucose level in blood

***delay carb absorption,

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26
Q

MOA of antidiabetic drugs

Meglitinides
Sulfonylureas
Phenylalanine derivatives
insulin

A

Pancreas

Increase insulin secretion

Helps restore normal glucose level in blood

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27
Q

MOA of antidiabetic drugs

Biguanide
Thiazolidinediones

A

Adipose tissue / Muscle

Peripheral Glucose uptake

More glucose leaves the blood and goes into tissue

Helps restore normal glucose level in blood

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28
Q

MOA location

GLP1 receptor agonists

A

Gut to pancreas

Pancreas

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29
Q

MOA location

Colesevelam

A

Gut

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30
Q

MOA location

Alpha glucosidase inhibitors

A

Gut

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31
Q

MOA location

Sulphonylureas meglitinides

A

Pancreas

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32
Q

MOA location
Pramlintide
Bromocriptine

A

Brain

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33
Q

MOA location

Metformin

A

Liver

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34
Q

MOA location

Thiazolidinediones

A

Muscle / adipose tissue

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35
Q

Type 2 Diabetes treatment

A

Patients with newly diagnosed diabetes

Comprehensive diabetes self-management education

includes nutrition and eating pattern, physical activity, optimizing metabolic control, and preventing complications.

Weight reduction through diet (for patients with overweight or obesity),

exercise, and behavioral modification can all be used to improve glycemic control,

(the majority of patients with type 2 diabetes will require medication over the course of their diabetes)

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36
Q

A1C target in Diabetes type 2 patients

A

should be tailored to the individual,

balancing the anticipated reduction in microvascular complications over time with the immediate risks of hypoglycemia.

A reasonable goal of therapy might be an A1C value of ≤7.0 percent (53.0 mmol/mol) for most patients.

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37
Q

Initial treatment for Diabetes Type 2

A

In the absence of specific contraindications, we suggestmetforminas initial therapy in most patients.

We suggest initiatingmetforminat the time of diabetes diagnosis, along with consultation for lifestyle intervention.

However, for those patients who have clear and modifiable contributors to hyperglycemia and who are motivated to change them

(eg, commitment to reduce consumption of sugar-sweetened beverages) or an A1C near target (ie, <7.5 percent),

a three- to six-month trial of lifestyle modification prior to initiation of pharmacologic therapy is reasonable.

Lifestyle mods, Metformin (after 3-6 months)

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38
Q

Metformin Dosage for

Initial treatment for Diabetes Type 2

A

The dose ofmetforminshould be titrated to its maximally effective dose

(usually 2000 mg per day in divided doses)

over one to two months, as tolerated.

Metformin should not be administered when estimated glomerular filtration rate (eGFR) is <30mL/min/1.73 m2

or conditions otherwise predisposing to lactic acidosis are present.

500 BID initial Dose??????????? (Up to Date)

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39
Q

For patients with clinical CVD or high cardiovascular risk who cannot takemetformin

Diabetes Type 2

A

we suggest a glucagon-like peptide-1 (GLP-1) receptor agonist (liraglutide,semaglutide, ordulaglutide)

or

sodium-glucose co-transporter 2 (SGLT2) inhibitor (empagliflozinorcanagliflozin)

that has demonstrated cardiovascular benefit

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40
Q

For patients without clinical CVD and with A1C levels <9 percent

Diabetes Type 2

A

(in addition to insulin or GLP-1 receptor agonists) include sulfonylureas, SGLT2 inhibitors, DPP-4 inhibitors,repaglinide, orpioglitazone.

Each one of these choices has individual advantages and risks

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41
Q

For patients presenting with symptomatic (eg, weight loss) or severe hyperglycemia with ketonuria,

Diabetes Type 2

A

Insulin is indicated for initial treatment.

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42
Q

For patients presenting with severe hyperglycemia but without ketonuria or spontaneous weight loss, in whom type 1 diabetes is not likely,

(fasting plasma glucose >250 mg/dL [13.9 mmol/L],

random glucose consistently >300 mg/dL [16.7 mmol/L],

A1C > 9 to 10 percent [74.9 to 85.8 mmol/mol])

Diabetes Type 2

A

we suggest insulin or a GLP-1 receptor agonist

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43
Q

If inadequate control is achieved (A1C remains >7.0 percent [53.0 mmol/mol] or an alternative patient-specific target level)

Diabetes Type 2

A

Another medication should be added within two to three months of initiation of the lifestyle intervention andmetformin.

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44
Q

Metformin

A

Glucophage (Biguanide)
Adjunct to diet and exercise for DM type 2

Monotherapy = 500 BID or 850 QD (with food)

Contra
Sever renal impairment (GFR <30)
Metabolic Acidosis, Diabetic Ketoacidosis

Warning: Lactic acidosis

Interactions:
Increased risk of lactic acidosis with topiramate

Adverse:
N/V/D, flatulence, Asthenia, indigestion, Abdominal discomfort, Lactic acidosis (may be fatal)

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45
Q

MOA of Metformin

A 
Oral diabetic drug
Biguanide class (only drug in this class)

Activates the enzyme AMP dependent protein kinase

Primary action; Inhiibts Gluconeogenesis in liver

Decreasing glucose production

(metformin does not cause release of insulin)

Other actions:
Increases glucose uptake insulin sensitivity, fatty acid oxidation
Decreases intestinal glucose absorption

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46
Q

Glucagon like peptide 1 receptor agonist
(GLP-1 agonist)
Drugs

A

-Glutides

liraglutide (Victoza)
Semaglutide (Ozempic)
Dulaglutide (Trulicity)

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47
Q

Liraglutide (Victoza)

Dose

A

Give by SC inj in abdomen, thigh, or upper arm once daily.

Initially 0.6mg/day for 1 week,

then increase to 1.2mg/day;

may increase to 1.8mg/day after ≥1 week if additional control is required

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48
Q

GLP-1 Agonist MOA

A

Food enters small intestine

Small intestine secrets GLP-1 in response to food

GLP-1 slows gastric emptying from stomach
and
goes to pancreas which stimulates insulin secretion
(and suppresses glucagon secretion from pancreas)

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49
Q

Sodium glucose co transporter 2 (SGLT2) inhibitor

Drugs

A

-gliflozin

empagliflozin (Jardiance)
Canagliflozin (Invokana)

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50
Q

Sulfonylureas

Drugs

A

Glipizide (Glucotrol) Short action

Glimeride (Amaryl) Short action

Glyburide (Diabeta) Long action

Combinations of this drug with metformin include
Glucovance and Metaglip

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51
Q

Sulfonylureas MOA

A

Sulfonylureas bind to the sulfonylurea receptor on the adenosine triphosphate (ATP)-sensitive potassium channel (K-ATP channel) of the pancreatic beta cells,

This causes the pancreas to increase insulin secretion
(Insulin secretogogues)

(like an oral insulin)

(can cause hypoglycemia)

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52
Q

Sulfonylureas

Which ones to start with

A

When a decision has been made to treat with a sulfonylurea,

we suggest a shorter-duration sulfonylurea or one with relatively lower risk for hypoglycemia, such asglipizide,orglimepiride.

Glyburideand other long-acting sulfonylureas have a higher incidence of hypoglycemia.

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53
Q

Dipeptidyl peptidase 4 (DDP-4) inhibitors

A

-gliptin

sitagliptin (Januvia)
saxagliptin (Onglyza)
linagliptin (Tradjenta)
alogliptin (Nesina)

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54
Q

sitagliptin

A

(Januvia) (Dipeptidyl peptidase-4 (DPP-4) inhibitor)

Adjunct to diet and exercise in type 2 diabetes, as monotherapy or combination therapy.

Warnings:
Assess renal function before starting therapy and periodically thereafter.

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55
Q

DDP-4 inhibitor MOA

A

GLP-1 stimulates insulin and suppresses Glucagon

DDP-4 inactivates GLP-1

DDP-4 inhibitors inhibit the DDP-4 enzyme allowing GLP-1 to activate pancreas and lower glucose levels

56
Q

repaglinide

A

Prandin (glinide)

Adjunct to diet and exercise in type 2 diabetes

Not for treatment of Type 1 or diabetic ketoacidosis

57
Q

thiazolidinedione (TZD)

Drugs

A

-glitazone

pioglitazone (Actos)
rosiglitazone (Avandia)

58
Q

pioglitazone

A

Actos (thiazolidinedione) (TZD)

Adjunct to diet and exercise in type 2 diabetes, as monotherapy or in combination with metformin, insulin, or a sulfonylurea.

Not for treating type 1 diabetes or diabetic ketoacidosis.

Contra:
NYHA class 3 or IV Heart Failure

Warning:
Congestive Heart Failure

59
Q

thiazolidinedione (TZD)

MOA

A

Ligand of the nuclear receptor
peroxisome proliferator activator receptor-y (PPAR-Y)
in liver, muscle and adipose tissue

PPAR-Y receptors in the nucleus
Regulates genes related to glucose and lipid metabolism
Increases insulin sensitivity
Increase insulin mediated glucose uptake by 30-50%

Requires the presence of insulin to work

Other actions: (PPAR-Alpha)
Decreases triglycerides
Increased HDL cholesterol
Decrease in plasma fatty acid level

60
Q

Misc diabetes meds

A

Alpha-Glucosidase inhibitors
Acarbose (Precose)
miglitol (glyset)

Bile acid sequestrants (mainly for high lipid panel)
colesevelam

Amylin mimetics
Pramlintide (Symlin)

61
Q

acarbose

A

Precose (Alpha-glucosidase inhibitor)

Adjunct to diet in type 2 diabetes, alone or with insulin, metformin, or a sulfonylurea

Take with first bite of each main meal

Contraindications:
Ketoacidosis. Cirrhosis. Inflammatory bowel disease.

Contra:
Transient flatulence, diarrhea, abdominal pain.

62
Q

Alpha-glucosidase inhibitor MOA / side effects

A

delays carbohydrate absorption

Sie effects: flatulence

63
Q

colesevlam

A

Welchol (Bile acid sequestrant)

Adjunct to diet and exercise in type 2 diabetes mellitus.

Not for the treatment of type 1 diabetes or diabetic ketoacidosis

Contraindications:
History of bowel obstruction. Serum TG>500mg/dL. History of hypertriglyceridemia-induced pancreatitis.

Adverse:
Constipation, dyspepsia, nausea; dysphagia, pancreatitis.

64
Q

colesevlam (Welchol) Dose

A

Take with a meal and liquid.

3 tabs twice daily or 6 tabs once daily.

Susp: one 3.75g pkt once daily.

Empty contents into a glass or cup, add 8oz of water, fruit juice, or diet soft drinks; stir and drink.

Do not take susp in its dry form.

65
Q

colesevlam (Welchol) MOA

A

Unknown in diabetes

Mainly used for lipids

66
Q

pramlintide

A

Symlin (Amylin analogue/amylinomimetic)

Adjunctive treatment in patients with type 1 or type 2 diabetes who use mealtime insulin and who have failed to achieve blood glucose control despite optimal insulin therapy.

Contraindications:
Gastroparesis. Hypoglycemia unawareness.

Warning:
Severe hypoglycemia.
Increased risk of severe hypoglycemia with insulin (esp. type 1 diabetics).

67
Q

pramlintide Symlin MOA

A

Liver:
Suppresses the release of glucagon

Stomach:
Slows the food moving from stomach to small intestine

Brain:
Makes you feel full at meals which make you eat less

68
Q

insulin

A

The insulin analogs (lispro, aspart, glulisine, glargine, detemir, degludec) were developed to provide more physiologic insulin profiles.

The rapid-acting insulin analogs (insulin lispro, aspart, faster aspart, and glulisine)

have both faster onset and shorter duration of action thanregular insulinfor pre-meal coverage,

while the long-acting analogs have a longer and flatter profile than NPH for basal coverage

69
Q

Effective use of insulin requires

A

An understanding of the major variables that affect the degree of glycemic control:

insulin preparation,
injection site, 
injection technique, 
the size of the subcutaneous depot, 
and subcutaneous blood flow.
70
Q

Insulin Onset and peak
Lispro (Humalog)
Aspart (Novolog)
Glulisine (apidra)

A

Onset
3-15 min

Peak
45-75 min

71
Q

Insulin Onset and peak
Humulin-R
(regular)

A

Onset
30 min

Peak
2-4 hours

72
Q

Insulin Onset and peak
NPH
Humulin - N

A

Onset
2 hours

Peak
4-12 hours

73
Q

Insulin Onset and peak
Lantus
(Glargine)

A

Onset
2 hours

Peak
No peak

74
Q

Insulin Onset and peak
Detemir
(Levemir)

A

Onset
2 hours

Peak
3-9 hours

75
Q

Hoe to prevent lipodystrophy

A

Rotate injection sites

76
Q

Humalog adverse reaction

A

Hypoglycemia

77
Q

Regular insulin Contraindications

novolin R

A

During episodes of hypoglycemia

78
Q

DKA Management

A

Managed in the inpatient setting (ICU)

Fix metabolic abnormalities

Restore acid base balance

aggressive IV hydration

Treat related conditions and causative factors

79
Q

HHS Management

A

Managed in the inpatient setting (ICU)

Assertive rehydration with IV fluids

Monitoring electrolyte balance

Correct hypoglycemia

Correct electrolyte disturbance

Treat related conditions and causative factors

80
Q

Kussmaul breathing in DKA

A

Rapid Deep breathing

81
Q

DKA vs HHS

A 
DKA: (Type 1)
Polyuria/Polydipsia
Dyspnea
Abdominal pain
N/V
Moderate/severe dehydration
Develops in less than 1 day
HHS: (Type 2)
Polyuria +/- polydipsia
Confusion/ lethargy
Severe/Profound dehydration
Develops in longer than 1 day
82
Q

DKA treatment

A

Continuous IV infusion of regular insulin

same as HHS

83
Q

HHS treatment

A

Continuous IV infusion of regular insulin

same as DKA

84
Q

What is an alert value for hypoglycemia

A

BGL <70

85
Q

Treatment tor a hypoglycemic patient with impaired consciousness and no IV access

A

Glucagon

86
Q

Glucagon

Contra/adverse

A

Glucagen
Severe hypoglycemia

Contra: pheochromocytoma

Adverse:
N/V,
Allergic reactions
(urticaria, respiratory distress, hypotension)

87
Q

Glucagon MOA

A

Brain:
decreased food intake, appetitie
increased feeling of fullness (satiety)

Pancreas:
Increased insulin secretion

Liver:
Increased glucose production, lipid breakdown
Decreased glucose breakdown, lipid production
Increased ketone body production, AA breakdown

Brown adipose tissue:
Increased resting energy expenditure

Heart:
Increased HR and contractility

88
Q

Which of the following DM medication is associated with Vitamin B12 deficiency?

repaglinide (Prandin)
acarbose (Precose)
metformin (Glucophage)
pioglitazone (Actos)

A

metformin (Glucophage)

89
Q

Which of the following DM medication is associated with CHF?

repaglinide (Prandin)
acarbose (Precose)
metformin (Glucophage)
pioglitazone (Actos)

A

pioglitazone (Actos)

90
Q

Which of the following is considered a long-acting insulin

Insulin glargine (Lantus)
Insulin lispro (Humalog)
Insulin regular (Humulin R)
Insulin NPH (Humulin N)
A

Insulin glargine (Lantus)

91
Q

A PA administers NPH insulin to a patient who has diabetes at 6:00 AM. When will the patient be at highest risk of experiencing hypoglycemia?

7AM
8AM
9AM
10AM

A

10AM

92
Q

Insulin forces which of the following electrolytes out of the plasma and into the cells?

Calcium
Magnesium
Phosphorous
Potassium

A

Potassium

93
Q

Rotating injection sites when administering insulin prevents which of the following complications?

Insulin edema
Insulin lipodystrophy
Insulin resistance
Systemic allergic reaction

A

Insulin lipodystrophy

94
Q

Which of the following should be taken for a patient who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?

Give subcutaneous insulin and monitor blood glucose
Monitor blood glucose closely, and look for signs of hypoglycemia
Monitor blood glucose, and assess for signs of hyperglycemia
Give Orange juice immediately

A

Monitor blood glucose closely, and look for signs of hypoglycemia

95
Q

When a patient is in diabetic ketoacidosis, the insulin that would be administered is:

vHuman NPH insulin
Human regular insulin
Insulin lispro injection
Insulin glargine injection

A

Human regular insulin

96
Q

A patient with diabetes mellitus visits a health care clinic. The patient’s diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia?

Prednisone (Deltasone)
Atenolol (Tenormin)
Phenelzine (Nardil)
Allopurinol (Zyloprim)

A

Prednisone (Deltasone)

97
Q

Which of the following DM medications has a black box warning of the risk of thyroid C-cell tumors?

sitagliptin (Januvia) (DPP4)
colesevelam (Welchol)
liraglutide (Victoza) (GLP-1)
canogliflozin (Invokana) (SGLT2)

A

liraglutide (Victoza) (SGLT2)

98
Q

Diabetes Insipidus vs SIADH

A 
DI:
High urine output
Low levels of ADH
Hypernatremia
Dehydrated
Lose too much fluid
SIADH:
Low urinary output
High levels of ADH
Hyponatremia
Overhydrated
Retain too much fluid

(Both will present with excessive thirst)

99
Q

testosterone gel

A

Androgel
Schedule 3

Warning:
Secondary exposure to testosterone.

Virilization has been reported in children who were secondarily exposed to topical testosterone producrs

Children should avoid contact with unwashed or unclothed application sites

Adverse Reactions:
Acne, prostate disorders, increased PSA, emotional lability, hypertension, gynecomastia, virilization in children.

100
Q

tolvaptan

A

Samsca (Selective vasopressin V2-receptor antagonist)

Contraindications:
Autosomal dominant polycystic kidney disease (ADPKD)

Warning:
Initiate and re-initiate in a hospital and monitor serum sodium.

101
Q

Tolvaptan MOA

A

Vasopressin attaches to the V2 receptors

This increases the permeability of the aquaporins

Vaptans are a V2 receptor antagonist

They block the V2 receptor so vasopressin cant bind

This causes
dilute urine
Increased free water clearance
Raises serum sodium

Anti vasopressin, increased dilute urine output, increased sodium retention

102
Q

desmopressin

A

DDAVP (Vasopressin (synthetic))

Contraindications:
Moderate to severe renal impairment
(CrCl <50mL/min).
Hyponatremia, or history of.

103
Q

Diabetes insipidus drugs

Carbamazepine

A

Stimulates the releases of vasopressin from the pituitary gland

May act directly on the renal tubules

104
Q

Diabetes insipidus drugs

Thiazides

A

Inhibits co transport of sodium and chloride

inducing natriuresis

105
Q

Diabetes insipidus drugs

Amiloride

A

Blocking of ENaA with amiloride reduces the lithium induced down regulation of AQP2 expression and protects the cellular composition of the collecting duct

106
Q

Vasopressin antagonists for SIADH

A

-Vaptans

Conivaptan
Tolvaptan
Lixivaptan
Relcovaptan
Satavaptan
Mozavaptan
SSR-149415
107
Q

Vasopressin agonists for Diabetes insipidus

A

-pressins

Felypressin
Lypressin
Desmopressin
Terlipressin

108
Q

Drugs that act on the Hypothalamus

A

Somatostatin analogs
octreotide

Dopamine agonists (D2)
Bromocriptine
Cabergoline

109
Q

Drugs that act on the Anterior pituitary

A

Recombinant GH
Somatropin

Insulin like growth factor 1
Mecasermin

GH antagonists
Pegvisomant

110
Q

Drugs that act on the Posterior pituitary

A

Oxytocin

Antidiuretic hormone and analogs
Vasopressin
Desmopressin

Vasopressin antagonists
Conivaptan

**Pressins and vaptans

111
Q

cabergoline

A

Dostinex (Dopamine agonist)

Hyperprolactinemic disorders, either idiopathic or due to pituitary tumors.

Uncontrolled hypertension. Sensitivity to ergot alkaloids.

Adverse Reactions:
GI upset, dizziness, fatigue, postural hypotension

112
Q

Dopamine agonist MOA

A

Suppress GH levels via direct activation of dopamine receptors

113
Q

pegvisomant

A

Somavert (GH receptor antagonist)

Treatment of acromegaly when response to surgery and/or radiation therapy and/or other medical therapies is inadequate or inappropriate.

Interactions:
May need to reduce dose of inulin & oral hypoglycemics

Adverse:
Infection, pain, N/V/D, Elevated LFT’s, Flu syndrome

114
Q

pegvisomant

A

Somavert (GH receptor antagonist)

Treatment of acromegaly when response to surgery and/or radiation therapy and/or other medical therapies is inadequate or inappropriate.

Interactions:
May need to reduce dose of inulin & oral hypoglycemics

Adverse:
Infection, pain, N/V/D, Elevated LFT’s, Flu syndrome

115
Q

pegvisomant MOA

Slide 229 ????

A

Blocks the GH binding site
causing a G120K mutation in binding site
Peg polymer

Stops the JAK/STAT signaling

116
Q

Octreotideand other long acting analogues of somatostatin, have a number of established clinical indications including

A

The treatment of

secretory diarrhea,

gastrointestinal bleeding,

inhibition of tumor growth,

and imaging neuroendocrine and other solid tumors.

***Diarrhea, GI bleed, Tumor inhibition

117
Q

Octreotide

A

Sandostatin (somatostatin analog)

Acromegaly unresponsive to or cannot be treated with surgical resection

Warnings:
Diabetes, Hypothyroidism, CVD

Interaction:
Potentiates bromocriptine

Adverse:
Gallbladder abnormalities (gallstones, biliary sludge)
GI upset, bradycardia

118
Q

Growth Hormone

A

Hypothalamus secretes
GHRH (growth hormone releasing factor
Which goes to anterior pituitary

Anterior pituitary secretes
GH (growth hormone)
Which goes to liver

Liver secretes IGF-1
Which goes to bone, muscle and fat tissues

119
Q

Somatropin recominant

A

Nutropin

Treatment of children with growth failure due to growth hormone deficiency (GHD), idiopathic short stature (ISS),

Contraindications:
Acute critical illness due to surgical complications or multiple accidental trauma or those with acute respiratory failure. Children with closed epiphysis. Active malignancy.

Warnings/Precautions:
Increased mortality in those with acute critical illness

120
Q

Cortisol control mechanism

A 
Hypothalamus secretes CRH
CRH stimulates Anterior pituitary
Anterior pituitary secretes ACTH
ACTH stimulates Adrenal cortex
Adrenal cortex secretes cortisol

As cortisol increases it is a negative feedback to control the release of CRH and ACTH

121
Q

Addison’s disease (adrenal crisis)

In a patientwithouta previous diagnosis of adrenal insufficiency what is initial treatment?

A

Dexamethasone, which is not measured in cortisol assays, should be used rather thanhydrocortisonewhile biochemical testing is performed

122
Q

Addison’s disease (adrenal crisis)

After initial treatment and testing

A

The vast majority of patients with primary adrenal insufficiency eventually require mineralocorticoid replacement withfludrocortisone.

We suggest adjusting the fludrocortisone dose to lower the plasma renin activity to the upper normal range

123
Q

Steroids for Addison’s Disease

A

Glucocorticoids
Prednisone 3-5mg QD
Hydrocortisone 15-25mg divided into 2-3 doses QD
Dexamethasone 05.mg QD

Mineralocorticoids
Fludrocortisone .05 - .2 mg QD

Androgen
DHEA 25-50 mg QD

124
Q

Steroid withdrawal syndrome

A

Adrenal insufficiency with too rapid withdrawal of corticosteroids after prolonged therapy

Fever
Myalgia
Arthralgia
Malaises
Itchy skin nodules
Rhinitis
Conjunctivitis
125
Q

Dexamethasone Suppression test

A

Dexamethasone acts like cortisol, lowers the amount of ACTH released by the pituitary gland

Normal
Pituitary makes less ACTH
Adrenals make less Cortisol

Cushing’s syndrome
Give Dexamethasone
Pituitary makes less ACTH
Adrenals still make cortisol

126
Q

Cushing Syndrome Treatment

A

In patients with Cushing’s disease who were not cured by pituitary surgery,

medical therapy targeting the corticotroph tumor

Metastatic or occult ectopic ACTH-secreting tumors may respond to

somatostatin analog treatment, adrenal enzyme inhibitors ormitotane

127
Q

pasireotide

A

Signifor (somatostatin analog)

Patients with Cushing’s disease for whom pituitary surgery is not an option or has not been curative

Interactions:
Caution with antiarrhythmics or other drugs that may prolong the QT interval

Adverse Reactions:
Diarrhea, nausea, hyperglycemia, cholelithiasis, QT prolongation

128
Q

Mitotane

A

Lysodren
Inoperable adrenal cortical carcinoma

Interactions
Concomitant oral anticoagulants

129
Q

Which of the following is not a MOA of bisphosphonates?

Stimulate osteoclast apoptosis
Increase in osteoclast-mediated bone resorption
Decrease in osteoclast function
Inhibit cholesterol synthetic pathway

A

Increase in osteoclast-mediated bone resorption

130
Q

Which of the following hypoparathyroidism medications has a boxed warning of a potential risk of osteosarcoma?

Recombinant PTH (Natpara)
Alendronate (Fosamax)
Calcitriol (Rocaltrol)
Vitamin D

A

Recombinant PTH (Natpara)

131
Q

Which of the following is not a MOA of PTH?

Increase calcitriol formation in kidney
Release calcium via bones
Decreases absorption of dietary phosphorus in small intestine
Decreases excretion of calcium in kidney

A

Decreases absorption of dietary phosphorus in small intestine

132
Q

Which thyroid medication is safe for pregnant females with hyperthyroidism?

Methimazole (Tapazole)
Propylthiouracil (PTU)
Radioactive iodine
Levothyroxine (Synthroid)

A

Propylthiouracil (PTU)

133
Q

Which drug is not considered a cause of primary hypothyroidism?

Amiodarone (Cardarone)
Amoxicillin (Amoxil)
Lithium (Lithobid)
Levothyroxine (Synthroid)

A

Amoxicillin (Amoxil)

Levothyroxine (Synthroid)

134
Q

Which of the following is the initial dose for healthy younger people who have been hypothyroid for a few months?

  1. 4 mcg/kg/day
  2. 5 mcg/kg/day
  3. 6 mcg/kg/day
  4. 7 mcg/kg/day
A

1.6 mcg/kg/day

135
Q

Which of the following type of thyroiditis is associated with supportive treatment involving ASA and no steroids?

Subacute thyroiditis
Fibrous (Reidel) thyroiditis
Hashimoto thyroiditis
Suppurative thyroiditis

A

Subacute thyroiditis

136
Q

Which of the following is considered a somatostatin analog?

Carbergoline
Somatropin
Pegvisomant
Octreotide

A

Octreotide

137
Q

Which of the following is considered a mineralocorticoid medication?

Hydrocortisone
Fludrocortisone
Dexamethasone
Prednisone

A

Fludrocortisone

PAM Semester 2 (22 decks)

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