Pharm test 2 Flashcards
somatostatin analogs
inhibit release of GH, glucagon, insulin and gastrin
Octreotide (Sandostatin)
a long acting somatostatin analog- inhibits release of GH, glucagon, insulin, and gastrin
Bromocriptine (Parlodel)
dompamine D2 receptor agonists- effective at inhibiting prolactin release (more than GH) but high does have some efficacy in small GH secreting Tumors
(use: agromegaly, hypeprolactinemia)
Dopamine
physiologic inhibitor of prolactin release
thyroid hypofunction
(trh HIGH) tsh HIGH, t3-t4 LOW
pituitary hypofunction
(trh HIGH) tsh LOW
T3-T4 LOW
Thyroid hyperfunction
(trh low) TSH low, t3-t4 HIGH
Pituitary hyperfunction
(trh low) tsh HIGH
t3-t4 HIGH
Levothyroxine
and adverse effects
synthetic T4 thyroid replacement
AE: nervousness, heat intolerance, palpitation/ tachycardia, weight loss
131 I (radio active iodine)
treat thyrotoxicosis
rapidly absorbed, concentrated in the thyroid, and incorporated into storage follicles
crosses the placenta and excreted in breat milk (contraindicated)
Methimazole (Tapazole)
thioamide- antithyroid agent
Propylthiouracil
- mechanism
- adverse effects
Thioamide- also inhibits conversion of T4–>T3 so brings level down faster
Mechanism: inhibit thyroid peroxidase- catalyzed reactions and blocking iodine organification (prevents binding of iodine to tyrosine)
AE: rash, SEVER HEPATITIS (PTU), Agranulocytosis (infrequent but potentially fatal)
Potassium Iodine
SSKI- super saturated KI
mechanism: block release of t4/t3 and inhibit Iodine from being used in new hormone synthesis
- given a week after RAI, normalizes thyroid function earlier than RAI alone
- given to protect thyroid from radioactive iodine fallout (uptake of RAI is inversely proportional to serum concentration of stable iodine
cross placenta—fetal goiter
Beta Blockers
useful in controlling tachycardia and other cardiac abnormalities of severe thyrotoxicosis
Propranolo
beta blocker- inhibits peripheral conversion of t4 to t3
Aspirin & NSAIDs
decrease protein binding (ass. with displacement of thyroid hormone from TBG)
cause increase in free thyroid hormone
old people’s heart is very sensitive to levels of circulating ______?
thyroxine- becareful when treating long standing hypothyroidism with cardiac issues
Hypothyroid in pregnancy
early fetal brain development depends on maternal thyroxine
-May have to increase in dose to normalize TSH levels
most patients with primary hyperparathyroidism also have _______________?
hypercalcemia
estrogen replacement
risk
breast cancer, stroke, and heart attack
BisphosphoNATES
use is osteoporosis, hypercalcemia, hyper-parathyroidism
inhibits bone reabsorption by suppressing osteoclast activity
Calciminetic (cinacalcet)
treat hypercalcemia
allosterically increase the sensitivity of the Ca sensing receptor (CaSR) in the parathyroid gland to calcium
calciminetic side effects
nausea vomiting
secondary hyper-parathyroidism
usually caused by chronic renal failure
-PTH and decreased GFR increase proximal tubular reabsorption of phosphate
- formation of insoluble calcium phosphate
- reduces circulating free calcium, rather as insoluble calcium phosphate
Treatment of Secondary hyper- parathyroidism
phosphate binders-
- non calcium containing
SEVELAMER CARBONATE
phosphate binders actions and side effects
actions: bind to dietary phosphate, form insoluble complex, carry through bowel unabsorbed
SE: hypercalcemia (ca load plus unbinding of circulating Ca-Phoshate complexes)
non calcium containing phosphate binders
sevelamer carbonate
seelamer hydrocholride
lanthanum carbonate
Vit. D active
Calcitriol (d3)
most potent agent
-also can be a treatment for hypoparathyroidism
vit D inactive
Cholecalciferol (vit d3)
ergocalciferol (vit d2)
Calcium Carbonate (Caltrate)
40% ca
better absorption in acidic environment
calcium citrate (Citracal)
21% calcium
better for patients taking acid reducing medications
Sodium Fluoride
deposits in bone and teeth
makes bones hard but “brittle” fewer breaks but more shattering
HMG CoA Reductase Inhibitors (statins)
- Atorvastatin
- Fluvastatin
- Lovastatin
ATP pReference: statins block early step in cholesterol synthesis
-improves endothelial function (non-lipid effect)
do not drink what when taking statins
grapefruit juice! contains furanocoumarin (inhibit cyp 450)
Bile acid sequestrants (aka Bile acid resins) "COLES" -cholestyramine -colestipol -colesevelam
reduce gastric reabsorption of cholesterol
-inhibit enterohepatic recirculation of bile acids leading and increased expression of LDL receptors
what vitamin may be deficient with bile acid sequestrants
K
nicotinic acid
- niacor
- niaspan
- nicobid
- nicolar
- slo-niacin
SE?
SE: high dose/ fast release promote flushing!
- sustained release preparations minimize flushing episodes, but have higher incidence of hepatic toxicities (monitor liver functions)
- trigger gout attacks
- now questionable if niacin really does much
fibric acid derivatives (fibrates)
“FIBR”
increase LDL receptor expression
markedly reduce triglycerides
- drive uptake utilization, and catabolism of fatty acids
Fibrates - side effects
Rhabdomyolysis
Ezatimibe (Zetia) component of Vytorin
reduces LDL-C, but there is limited evidence on improvement in clinical outcomes
- not evidence it improves long term outcomes. has been combined with statins
Fish Oil- omega 3
triglycerides exceed 500mg.dl
