Pharma Flashcards
Somatotropin side effects
Myalgia arthralgia
Perpheral edema
Mescarmine
Recombinant IGF1
Side effects : hypoglycaemia, IC HTN, Increased liver enzymes
Octreotide, lanreotide
Somatostatin receptor agonist
Octreotide side effects
GI disturbance
Gall stones
Bradycardia
Cardiac conduction anomalies
Pegvisomant
GH receptor antagonist
ACROMEGALY
Increased liver enzymes
Agonist of Vasopressin V2 receptors
Desmopressin
Uses: pituitary diabetes insipidus , haemophilia A nd vWBF
Side effect: hyponatremia
Vasopressin: DI plus esophageal varices
Conivaptan
Vasopressin receptor antagonists: V1a and V2 for hyponatremia
Tolvaptan: selective for V2(hepatotoxic if more than 30 days)
Atosiban
Antagonist of oxytocin receptor
Levothroxine T4
Liothyronine T3
Treatment for hypothyroidism
T4 more suitable
Toxicity= thyrotoxicosis, elderly, heart patients, ones wd long-standing myxedema (give lower doses)
Methimazole
Propyluracil(okay to give in pregnancy)
Inhibit peroxidase, iodination, coupling and peripheral conversion of T3 and T4.
Slow onset as will effect future formation
Agranulocytosis and hepatitis
Methimazol
PTU
What to give in thyroid storm and for surgical resection of hyperactive thyroid
Lugol solutions : iodine and KI
Saturated solution of KI
Iodide salts
Reduce release of thyroid
Inhibit iodination of tyrosine
Rapid onset
Escape= transient
Metallic taste, bleeding disorder
131 IODINE
Permanent cure to thyrotoxicosis
Wdout harm to other tissues
Contraindications in pregnancy
Inhibitors of iodide uptake
SCN -
CLO4- (aplastic anemia)
Thyrotoxicosis
I 131
B blockers : prpranolol (also inhibit periphery conversion of T4)
Amiodarone (anti arrhythmic) associated hypothyroidism
Give thyroid hormones
Amiodarone associated hypothyroidism
Thioamides like methimazole or PTU
Inhibitors of perpheral conversion of T4 to T3
Thioamides
Propranolol
Amiodarone
Iodinated radiocontrast media=
Oral diatrizoate
IV iohexol
Parenteraltreatment of osteoporosis
Teriparatide analog of PTH
Inhibitors of vitamin D
Phosphate
Fibroblast growth factor 23
Vit D metabolites
+PTH
Uses of Vitamin D, its metabolites
Nutritional deficiency
Intestinal dystrophy
CKD
Liver disease
Hypo parathyroidism
Nephrotic syndrome
With Ca supplements: osteoporosis
Psoriasis
Calcitriol active form
It is given in condition where Vit D activation is impaired e.g CKD, liver disease, hypoparathyroidism
Secondary hyperparathyroidism
Secondary hyperparathyroidism
Calcitriol is given but it increases hypercalcemia and hypercalciuria.
So we give
DOXERCALCIFEROL: converted in liver to 1,25 D
PARICALCITOL: 19-nor 1,25D2
CALCIPOTRIENE:
Calcitonin (injection/nasal spray)
When acute reduction of serum Ca is needed
✅paget disease
✅hypercalcemia
✅ osteoporosis
Raloxifene
Estrogen and SERM
Prevents and prevents bone loss in postmenopausal women
⚠️ hot flashes
Thromboembolism
Bisphosphonates
Inhibit osteoclasts (farnesyl pyrophosphate synthase)
Reduce both resorption and formation
Paget disease
Osteoporosis malignancy hyperCa
Diff dosages
⚠️gastric and esophageal irritation
Renal damage and osteonecrosis of jaw
Take water alot
Denosumab
- RANKL
-osteoclasts
✅menopause osteoporosis
SC inj. Every 6 months
Cinacalet
Activate Ca sensing receptors in parathyroid and reduce PTH
Secondary hyperparathyroidism in CKD
⚠️hypoCa
Toxicity of oestrogen
Endometrial cancer, breasr cancer
MI
Thromboembolism
Migraine
Oral gives more hepatic effects
Toxicity of progesterone
High BP
DECREASE HDL
Decreased bone density
Toxicity of OCPS
Thromboembolism
Breast cancer
Nausea, breast tenderness, headache, skin pigmentation, depression
Older progestins have an androgenic effect
L- norgestrel
Norethinedrone
Newer are. Norgestimate, desogestrel.
Tamoxifen
SERM
Antagonist: breast cancer✅, hot flushes,
Agonist: endometrial hyperplasia, venous thrombosis ,bone
Raloxifene
Osteoporosis in post menopause: partial agonist effect, venous thrombosis
Antagonist: breast CA, hot flushes,
No effect on endometrial lining
Clomiphene
Partial agonist
Induces ovulation who are trying
Block est receptors in pitutary, reduces negative feed back so FAH and LH increase : ovulation
To give in menopause
Bazedoxfene
What if breast cancer is resistant to tamoxifen
Fulvestrant : pure receptor antagonist
Aromatase inhibitors
Anastrozole
Exemestane
Danazol
Weak partial agonist of progestin, androgen glucocorticoids
Inhibit p450 cytochrome enzymes
Treats endometriosis, fibrocystic disease of breast
Leuprolide
GnRH agonist: supresses gonadotropin secretion
Inhibit ovarian production of est and prog
Treat fibroids, endometriosis (<6 months) precociously puberty
Ganirelix,cetrorelix: controlled ovarian hyperstimulation.
