Drugs- Basic High Yield Stuff for Boards > Endo > Flashcards

Endo Flashcards

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1
Q

treatment for prolactinoma MOA

A

Dopamine agonists (like bromocriptine/cabergoline)

or transsphenoidal resection

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2
Q

Adverse effect of anti-psychotics on prolactin

A

increase prolactin secretion (most anti-psychotics work via antagonizing dopamine)

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3
Q

treatment for Acromegaly/ Gigantism (2)

A
  1. somatostatin analogs (like Octreotide)

2. GH-R antagonist (pegvisomant)

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4
Q

treatment for central DI and nocturnal enuresis

A

desmopressin (ADH analog)

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5
Q

enzymes inhibited by Propylthiouracil

A
  1. thyroid peroxidase

2. 5’ deiodinase

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6
Q

enzyme inhibited by methimazole

A

thyroid peroxidase

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7
Q

Which endocrine hormones signal through cAMP? (12)

A

“FLAT ChAMP + cal+GHRH+glucagon”

  1. FSH/LH/TSH/hCG (these are all derived from same molecule)
  2. ACTH/CRH
  3. ADH(V2-R)
  4. MSH
  5. PTH/calcitonin
  6. GHRH
  7. Glucagon
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8
Q

Which endocrine hormones signal through cGMP? (2)

A

“BAD GraMPa” (GraMPa=GMP)

  1. BNP/ANP
  2. E’D’RF (NO)
  • think vasodilators
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9
Q

Which endocrine hormones signal through IP3 (Gq)? (7)

A

“GOAT HAG”

  1. GnRH
  2. Oxytocin
  3. ADH (V1-R)
  4. TRH
  5. Histamine (H1-R)
  6. Angiotensin II
  7. Gastrin
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10
Q

Which endocrine hormones have intracellular receptors? (7)

A

“PET CAT on TV”

  1. Progesterone
  2. Estrogen
  3. Testosterone
  4. Cortisonl
  5. Aldosterone
  6. T3/T4
  7. Vit D
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11
Q

Which endocrine hormones signal via Receptor tyrosine kinase? (5)

A

Think growth factors (MAP-kinase pathway)

  1. Insulin
  2. IGF-1
  3. FGF
  4. PDGF
  5. EGF
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12
Q

Which endocrine hormones signal via Non-receptor tyrosine kinase? (6)

A 
JAK/STAT pathway
"PIGGlET"
1. Prolactin
2. Immunomodulators (cytokines, IL-2, IL-6, IFN)
3. GH
4. G-CSF
5. Erythropoietin
6. Thrombopoietin
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13
Q

treatment for Pheochromocytoma?

MOA

A

Phenoxybenzamine (also has 16 letters like Pheo)
- irreversible a-antagoist

Follow this with a BB prior to tumor resection

  • Never BB before a-angtagonist (always in alphabetical order) to avoid Hypertensive crisis
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14
Q

treatment for Thyroid Storm? (4)

A

Treat with the 4P’s

  1. BB (propranolol)
  2. Propylthiouracil
  3. Prednisone (decreases conversion of T4–>T3)
  4. Potassium iodine
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15
Q

treatment for central DI? (2)

A
  1. desmopressin

2. hydration

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16
Q

treatment of nephrogenic DI? (5)

A
  1. hydrochlorothiazide (thiazide diuretic)
  2. indomethacin (NSAID= decrease renal flow)
  3. amiloride (K-sparing)
  4. hydration
  5. remove offending agent (like lithium)
  • scare body with volume depletion to cause increase proximal tubule saline reabsorption
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17
Q

Treatment of SIADH ?

A
  1. fluid restriction
  2. salt tablets
  3. IV hypertonic saline
  4. diuretics
  5. conivaptan
  6. tolvaptan
  7. demeclocyline
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18
Q

treatment for Hypopituitarism?

A

Hormone replacement

corticosteroids, thyroxine, sex steroids, HG

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19
Q

treatment for Diabetic ketoacidosis?

A

IV fluids
IV insulin
K to replace intracellular stores
Glucose as necessary to prevent hypoglycemia

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20
Q

Treatment of hyperosmolar hyperglycemia non-ketotic syndrome?

A

aggressive IV fluids

insulin therapy

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21
Q

treatment for glucagonoma

A

ocreotide or surgery

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22
Q

treatment of insulinoma

A

surgical resection

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23
Q

treatment for somatostatinoma

A
  1. surgical resection

2. somatostatin analog (octreotide) for symptom control

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24
Q

treatment for carcinoid syndrome

A
  1. surgical resection

2. somatostatin analog (octreotide)

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25
treatment for Zollinger-Ellison syndrome
PPi or surgery
26
treatment STRATEGIES for Type1 DM (2)
1. low carb diet | 2. insulin replacement
27
treatment STRATEGIES for Type2 DM (4)
1. dietary modification and exercise for weight loss 2. oral agents 3. non-insulin injectables 4. insulin replacementq
28
treatment STRATEGIES for Gestational DM (2)
1. dietary modification and exercise | 2. insulin replacement if lifestyle modification fails
29
Rapid-acting insulin: | Name 3
"LAG" 1. lispro 2. aspart 3. glulisine
30
Rapid-acting insulin: | MOA (liver, muscle, fat)
-binds Insulin-R rapidly Liver: increase glycogen stores Muscle: increase glycogen, increase protein synth, increase K+ uptake Fat: increase TG storage
31
Rapid-acting insulin: Clinical Use Risk/Concerns
Use: type 1, type 2, Gestational DM (postprandial glucose) 1. hypoglycemia 2. lipodystrophy/ weight gain 3. hypersensitivity rxn (rare)
32
Short acting Insulin: Alternative name Clinical use (4)
Regular Insuline Use: 1. Type 1, type 2, Gestational DM 2. DKA (IV) 3. hyperkalemia (+ glucose) 4. stress hyperglycemia
33
Intermediate acting Insulin: Alternative name Clinical use
NPH Use: Type 1, type 2, Gestational DM
34
Long-Acting Insulin: Name (2) clinical use
Detemir and Glargine Use: Type 1, type 2, Gestational DM (basal glucose control)
35
Metformin: Class MOA
Biguanide 1. decrease gluconeogenesis 2. increase glycolysis 3. increase peripheral glucose uptake/insulin sensitivity
36
Metformin: Admin Clinical Use Adverse
Oral -Type 2 DM (first line, also causes weight loss) (can be used in pt w/o islet function 1. GI upset 2. lactic acidosis (contra in Renal insufficiency)
37
Sulfonylureas: Name 1st generation (2) Name 2nd generation (3)
First gen: 1. chlorpropamide 2. tolbutamide Second gen: "lots of 'G's'" 1. glimepiride 2. glipizide 3. glyburide
38
Sulfonylureas: MOA Clinical Use (1)
- close K+ channels in Beta-cell membrane--> cell depot--> insulin release via increase Ca+2 - stimulate release of endogenous insulin Use: Type 2 DM (requires some islet function)
39
Sulfonylureas: | Adverse (4)
1. hypoglycemia (esp. in renal failure) 2. weight gain First gen: disulfiram-like Rxn 2nd gen: hypoglycemia
40
Glitazones/Thiazolidinediones: Name (2) MOA
1. Pioglitazone 2. Rosiglitazone increase insulin sensitivity in peripheral tissue via binding PPAR-g nuclear transcription regulator
41
Glitazones/Thiazolidinediones: Clinical Use Adverse
Mono or combo in Type2 DM **SAFE IN RENAL IMPAIRMENT 1. Weight gain/edema 2. Hepatotox 3. Heart failure 4. increase risk of fractures
42
Should patients with renal failure use Metformin?
NO
43
Meglitinides: Name 2 MOA
1. Nateglinide 2. Repaglinide Stimulate postprandial insulin release via binding K+ channels on Beta-cells (site differ from sulfonylureas)
44
Meglitinides: Clinical Use Adverse (2)
Monotherapy or w/ Metformin in Type2 DM 1. Hypoglycemia (increase with renal failure) 2. weight gain
45
GLP-1 analogs: Name 2. Which is SC injection? MOA (4)
``` 1. Exenatide 2 Liraglutide (sc injection) ``` increase glucose-dependent insulin release decrease glucagon release decrease insulin gastric emptying increase satiety
46
GLP-1 analog: Clinical Use Adverse (3)
Type 2 DM 1. N/V 2. Pancreatitis 3. modest weight loss
47
DPP-4 inhib: Name 3 MOA
1. Linagliptin 2. Saxagliptin 3. Sitagliptin inhib DPP-4 enzyme that deactivates GLP-1 --> increase glucose-dependent insulin release decrease glucagon decrease gastric emptying increase satiety
48
DPP-4 inhib: Clinical Use Adverse (1)
Type 2 DM | 1. Mild urinary or respiratory infections weight neutral
49
Amylin analogs: Name 1. Admin MOA
Pramlintide (SC injection decrease gastric emptying decrease glucagon
50
Amylin analogs: Use Adverse(2)
Type 1 & Type 2 DM 1. Hypoglycemia (in setting of mistimed prandial insulin) 2. N/D
51
Sodium-glucose Co Transporter 2 Inhib (SGLT-2): Name 3 MOA
1. Canagliflozin 2. Dapagliflozin 3. Empagliflozin Block reabsorption of Glucose in PCT
52
SGLT-2: Clinical Use Adverse (4)
Type 2 DM 1. Glucosuria 2. UTIs/ vaginal yeast infections 3. hyperkalemia 4. dehydration (orthostatic hypotension)
53
a-glucosidase inhib: Name 2 MOA
1. Acarbose 2. Miglitol inhib intestinal brush-border a-glucosidase delayed Carb hydrolysis and glucose absorption -->decresae postrandial hyperglycemia
54
a-glucosidase inhib: Clinical use Adverse(1)
Type 2 DM 1. GI disturbance
55
Thionamides: | Name 2
1. Propylthiouracil (PTU) | 2. Methimazole
56
Thionamides: | MOA
Both block Block thyroid peroxidase --inhib oxidation of Iodide & organification/coupling of iodine-->inhib thyroid hormone synthesis Propylthiouracil also blocks 5'-deiodinase-->decrease peripheral conversion of T4-to-T3
57
Thionamides: Clinical use / which is safe in pregnancy? Adverse
1. Hyperthyroidism 2. PTU=Pregnancy (methimazole= aplasia cutis teratogen) Adverse: 1. Skin rash 2. Agranulocytosis (rare) 3. aplastic anemia 4. hepatotox
58
Levothyroxine mimics
T4
59
Triiodothyronine mimics
T3
60
Levothyroxine/Triiodothyronine: MOA Clinical use (3) Adverse (4)
MOA: thyroid hormone replacement Use: 1. Hypothyroidism 2. Myxedema 3. Weight loss supplement (off label) Adverse: Tachycardia, Heat intolerance, tremors, arrhythmias
61
Conivaptan and Tolvaptan: MOA Clinical Use
ADH antagonists 1. SIADH (block action of ADH at V2-R)
62
Demopressin: | Clinical use
Central DI
63
``` GH: clinical use (2) ```
1. GH deficiency | 2. Turner syndrome
64
``` Oxytocin: Clinical use (3) ```
1. stimulates labor/ uterine contractions 2. control uterine hemorrhage 3. milk-let down
65
``` Somatostatin analog (octreotide): Clinical use (5) ```
1. acromegaly 2. carcinoid syndrome 3. gastrinoma 4. glucagonoma 5. esophageal varices
66
Demeclocycline: MOA Clinical Use Adverse (3)
``` ADH antagonist (member of tetracycline family) Tx: SIADH ``` Adverse: 1. Nephrogenic DI 2. Photosensitivity 3. Abnorm Bone/teeth
67
Glucocorticoids: | Name 6
1. Beclomethasone 2. Dexamethasone 3. Hydrocortisone 4. Mehtylpredisolone 5. Prednisone 6. triamcinolone
68
Glucocorticoids: | MOA
``` Metabolic/catabolic/anti-inflam/immunosuppressive mediated by: 1. glucocorticoid response elements 2. inhib phospholipase A2 3. inhib NF-kB ```
69
``` Glucocorticoids: Clinical Use (4) ```
1. Adrenal insuff/ Addison/ Cong. adrenal hyperplasia 2. inflamm 3. immunosuppression 4. asthma/allergies
70
Glucocorticoids: | Adverse (6)
1. Iatrogentic Cushings 2. Adrenal insuff when abruptly discontinued after chronic use 3. adrenocortical atrophy 4. peptic ulcers 5. steroid diabetes 6. steroid psychosis cateracts
71
Signs/Symp of Cushings
1. hypertension 2. weight gain/moon face/truncal obesity, buffalo hump 3. thinning of skin, striae 4. acne/amenorrhea 5. hyperglycemia 6. osteoporosis 7. immunosuppression
72
Fludrocortisone: MOA Clinical Use Adverse
- Synthetic analog of aldosterone w/ little glucocorticoid effects - Use: Mineralocorticoid replacement for primary adrenal insuff - Adverse: like glucocorticoids (edema/HF/hyperpigmentation)
73
Cinacalcet: MOA Clinical Use Adverse
- sensitizes Ca+2 sensing receptor in parathyroid gland to circulating Ca+2--> decrease PTH - primary/secondary hyperPTH - Hypocalcemia
74
treatment for Turner Syndrome
GH
75
Which DM drugs cause Weight gain?
1. insulin 2. Sulfonylureas (both generations) 3. Glitazones/Thiazolidinediones 4. Meglitinides
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