Pharmacology Flashcards
Growth hormone analog used in growth hormone deficiency
Somatropin
Somatostatin analog used for acromegaly, carcinoid, glucagonoma and other growth hormone-producing pituitary tumors
Octreotide
Gonadotropin-releasing hormone analog used for infertility (pulsatile administration) or suppression of gonadotropin production (continuous administration)
Leuprolide
Competitive antagonists at gonadotropin releasing hormone receptors used to prevent LH surge during controlled ovarian hyperstimulation
Ganirelix
Ergot dopamine agonist used to suppress prolactin release
Bromocriptine
Synthetic human corticotropin used for diagnosis of adrenal insufficiency
Cosyntropin
Agent used to stimulate uterine contraction and labor, milk letdowns, and control postpartum bleeding
Oxytocin
Agent of choice for the treatment of hypothyroidism
Levothyroxine (T4)
An isomer of T3 which may be used in myxedema coma
Liothyronine (T3)
Thioamide agents used in hyperthyroidism
Methimazole and propylthiouracil (PTU)
Thioamide less likely to cross placenta, inhibits peripheral conversion of T4 to T3 in high doses, and indicated for pregnant women in 1st trimester
Propylthiouracil (PTU)
Propylthiouracil (PTU) mechanism of action
Inhibits thyroid peroxidase
Can be effective for short term therapy of thyroid storm, but after several weeks of therapy causes an exacerbation of hyperthyroidism
Iodide salts (potassium iodide)
Permanently cures thyrotoxicosis, patients will need thyroid replacement therapy thereafter. Contraindicated in pregnancy
Radioactive iodine
Used for the symptomatic treatment of thyrotoxicosis by blocking cardiac adverse effects
Propranolol and Esmolol
Used for Addison’s disease, congenital adrenal hyperplasia inflammation, immune suppression, and asthma
Glucocorticoids
Two short-acting glucocorticoids
Hydrocortisone (cortisol), cortisone
Four intermediate-acting glucocorticoids
Prednisone, Prednisolone, Methylprednisolone and Triamcinolone
Two long-acting glucocorticoids
Betamethasone, dexamethasone
Mineralocorticoids
Fludrocortisone and deoxycorticosterone
Side effects of corticosteroids
Iatrogenic Cushing’s syndrome, hyperglycemia, impaired wound healing, osteoporosis, peptic ulcers, myopathy, adrenal suppression (> 2 week treatment)
Inhibits conversion of cholesterol to pregnenolone therefore inhibiting corticosteroid synthesis
Aminoglutethimide
Antifungal agent used to inhibit adrenal and gonadal steroid synthesis
Ketoconazole
Selective inhibitor of 11-hydroxylation and interferes with cortisol and corticoterone synthesis; used for adrenal function tests and is the only adrenal-inhibiting medication that can be administered to pregnant women with Cushing’s syndrome
Metyrapone
Glucoroticoid receptor antagonist that is used as an antiabortifacient due to its strong antiprogestin activity
Mifepristone (RU486)
Three rapid-acting insulin used for postprandial glycemia
Aspart, lispro, glulisine
Short-acting insulin used intravenously for ketoacidosis
Regular insulin
Intermediate-acting insulin with variable pharmacokinetics; use is mostly replaced by long-acting insulin
Neutral protamine Hagedorn (NPH) insulin
Two long-acting insulin preparations that provide basal glycemia control
Glargine, detemir
Major side effect of insulin
Hypoglycemia
First generation sulfonylurea that is safest for elderly diabetics due to its short half-life
Tolbutamide
First generation sulfonylurea contraindicated in elderly diabetics because of very long half-life
Chlorpropamide
Three second generation sulfonylureas
Glyburide, glipizide, glimepiride
Mechanism of action of sulfonylureas
Close K+ channels, depolarize cell, open voltage-gated Ca2+ channels, release insulin
Common side effect of first generation sulfonylureas
Disulfiram-like reactions with alcohol use
Common side effect of second generation sulfonylureas
Hypoglycemia
A meglitinide insulin secretagogue that has no sulfur in its structure and may be used in type 2 diabetics with sulfonylurea allergy
Repaglinide
A D-phenylalanine derivative insulin secretagogue that is useful for type 2 diabetics with very reduced renal function
Nateglinide
Mechanism of action of repaglinide and nateglinide
Close K+ channels, depolarize cell, open voltage-gated Ca2+ channels, release insulin
First line drug for the treatment of type 2 diabetes
Metformin
Mechanism of action of metformin
decrease gluconeogenesis, increase peripheral glucose uptake; increase insulin sensitivity
Most serious side effect of metformin
Lactic acidosis
Two thiazolidinediones
Pioglitazone, rosiglitazone
Mechanism of action of thiazolindinediones
Activate PPAR-gamma, increase transcription of insulin-responsive genes, increase GLUT4 glucose transporter, increase insulin sensitivity
Side effect of thiazolindinediones
Weight gain, edema, heart failure, hepatotoxicity
Two alpha-glucosidase inhibitors
Acarbose, miglitol
Mechanism of action of alpha-glucosidase inhibitors
Act on intestine, delay digestion and absorption of glucose
Side effect of alpha-glucosidase inhibitors
Flatulence , diarrhea, abdominal cramps
Amylin analog that delays gastric emptying and suppresses glucagon release
Pramlintide
Two glucagon-like polypeptide-1 (GLP-1) analogs that increase insulin secretion and suppress postprandial glucagon release
Exenatide, liraglutide
Three dipeptidyl peptidase-4 (DPP-4) inhibitors that reduce breakdown of glucagon-like polypeptide-1, resulting in increased insulin secretion and suppress postprandial glucagon release
Sitagliptin, saxagliptin, linagliptin
Bisphosphonates
Alendronate and -dronates
Mechanism of action of bisphosphonates
Inhibits osteoclast activity and prevent bone resorption
Uses of bisphosphonates
Osteoporosis, Paget’s disease, hyperglycemia
Major side effects of bisphosphonates
Corrosive esophagitis, osteonecrosis of the jaw
First generation bisphosphonate when used long-term causes osteomalacia
Etidronate
May be used intranasally to decreases bone resorption
Calcitonin (salmon prep)
Vitamin given with calcium to ensure proper absorption
Vitamin D
Tx for Gestational DM
dietary modifications, exercise, insulin replacement if lifestyles modification fails
GLP-1 analog toxicities
N/V and pancreatitis
DPP-4 inhibitors
mild urinary or respiratory infections
Propylthiouracil Toxicity
Skin rash, agranulocytosis, aplastic anemia, hepatotoxicity
aplasia cutis
Methimazole toxicity
tx Central DI
ADH (DDAVP)
Demeclocycline
ADH antagonist used for SIADH
Toxicity of Demeclocycline
Nephrogenic DI, photosensitivity, abnormalities in bone teeth
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at the sea shore