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Endocrine Flashcards

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1
Q

Somatropin (Genotropin, Humatrope)
Octreotide
Pegvisomant
are all examples of what type of medications

A

growth hormone release modulators

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2
Q

Corticotropin
Cosyntropin
are all examples of what type of medications

A

ACTH release modulators

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3
Q

Leuprolide
Groserelin
Nafarelin
Histrelin
are all examples of what type of medications

A

FSH-LH release modulators

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4
Q

Bromocriptine
Cabergoline
Octreotide
Pegvisomant
Somatropin
are all examples of what type of medications

A

prolactin release modulators

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5
Q

Oxytocin
vasopressin
Desmopressin
are all examples of what type of medications

A

posterior pituitary hormones

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6
Q

Growth hormone has an effect on the

A

liver

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7
Q

ACTH has an affect on the

A

adrenal gland to make cortisol

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8
Q

TSH has an affect on

A

the thyroid gland - producing T4 and T3

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9
Q

FSH/LH has affects on

A

the gonads to produce estrogen, progesterone or testosterone

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10
Q

PRL has effects on

A

the breast to produce milk

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11
Q

GH is required for normal

A

growth

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12
Q

GH target tissues (BALM)

A

bone
adipose - reduction
liver - somatomedins
muscle
growth plates

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13
Q

Somatropin (GH) indications

A

GH deficiency
growth failure
HIV patients with cachexia

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14
Q

Somatropin (GH) adverse effects

A

pain at injection site
edema
arthralgia and myalgia
nausea
glucose tolerance - insulin insensitivity

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15
Q

Somatropin (GH) warning

A

do not use in peds pts with closed epiphyses
increased intracranial pressure

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16
Q

Somatostatin is an

A

inhibitory hormone that suppresses GH and TSH release in the hypothalamus (anterior pituitary gland)
suppresses secretions and motility in the GI tract

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17
Q

Octreotide (long acting synthetic somatostatin analog) indications

A

acromegaly
severe diarrhea caused by carcinoid tumors
bleeding esophageal varices

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18
Q

Octreotide MOA

A

long acting synthetic somatostatin analog to suppress GH release

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19
Q

Octreotide (long acting synthetic somatostatin analog) adverse effects

A

CVS - bradycardia and conduction disturbances
GI - diarrhea, abdominal pain, flatulence, nausea and steatorrhea (fatty stool)
Gallbladder emptying is delayed

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20
Q

Pegvisomant MOA

A

GH receptor antagonist - modified GH with receptor blocking properties

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21
Q

Pegvisomant (GH receptor antagonist) indications

A

acromegaly that is refractory to other pharm, surgical or radiological intervention

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22
Q

Pegvisomant (GH receptor antagonist) adverse effects

A

diarrhea and nausea
CNS - pain
abnormal hepatic function tests

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23
Q

Corticotropin MOA

A

anterior pituitary hormone stimulates steroid biosynthesis - naturally occurring hormone

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24
Q

Cosyntropin MOA

A

Synthetic ACTH - stimulates adrenal cortex to secrete adrenal steroids (cortisol), androgenic substances and a small amount of aldosterone

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25
Cosyntropin (synthetic ACTH) indications
diagnostic tool - ACTH stimulation test - screening for adrenocorticosteroid deficiency
26
cortisol is like
adrenaline
27
Cosyntropin (synthetic ACTH) Adverse effects
excess glucocorticoid toxicities - HTN, peripheral edema, hypokalemia, osteoporosis
28
Cosyntropin is a precursor to _____ essentially
steroids - like prednisone
29
Gonadotropin - releasing hormone is secreted from
the hypothalamus - binds to receptors in anterior pituitary gland
30
FSH-LH release modulators adverse effects: males and females
male - transient increase in testosterone, hot flashes, sweats, edema, gynecomastia, decreased libido, decreased HCT and bone density female - generalized menopausal symptoms, ovarian cysts
31
Leuprolide (FSH-LH release modulator) indications
used to treat prostate cancer, breast cancer, endometriosis, uterine fibroids, early puberty can delay onset of puberty in transgender youth prior to HRT can delay or prevent early ovulation to allow for development of mature eggs for retrieval in IVF
32
Goserelin (FSH-LH release modulator) indications
suppress production of the sex hormones, particularly in the treatment of breast and prostate cancer
33
Nafarelin (FSH-LH release modulator) indications
used in the treatment of endometriosis and early puberty
34
Histrelin (FSH-LH release modulator) indications
used to treat advanced prostate cancer in adults - will reduce levels of testosterone
35
Prolactin is a hormone secreted from the
anterior pituitary
36
Prolactin stimulates and maintains
lactation
37
Prolactin is increased by _____ and is also stimulated to release by _______
dopamine antagonists TRH
38
Prolactin release modulators include
Bromocriptine and Cabergoline
39
Bromocriptine and Cabergoline MOA
Dopamine D2 receptor agonists - suppress prolactin release
40
Bromocriptine and Cabergoline indications
lactotroph adenomas (prolactinomas) - hyperprolactinemia T2DM (theoretically)
41
Bromocriptine and Cabergoline adverse effects
HA, dizziness, psychosis Nausea
42
When giving FSH-LH release modulators Continuous = Pulsatile =
will decrease production will increase/ stimulate production
43
Posterior Pituitary gland hormones are not
regulated by releasing hormones
44
Target tissues of: Oxytocin Vasopressin (ADH)
Oxytocin = uterus and breast Vasopressin = nephron and vascular smooth muscle
45
Oxytocin acting on breast and uterus causes
contraction and milk production
46
Vasopressin acting on nephron and vascular smooth muscle causes
water reabsorption, hyponatremia vasoconstriction
47
Oxytocin indications
labor induction postpartum hemorrhage
48
Oxytocin adverse effects
hypotension and arrhythmias fluid retention placental abruption or uterine rupture fetal distress and death
49
oxytocin MOA
binds to oxytocin receptors
50
Vasopressin MOA
stimulates arginine vasopressin receptors desmopressin = selective V2 activity (minimal V1)
51
V1 receptor = V2 receptor =
V1 = vascular smooth muscle V2 = nephron
52
Vasopressin indications
central diabetes insipidus nocturnal enuresis
53
Vasopressin adverse effects
water intoxication and hyponatremia HA, bronchoconstriction and tremor clots because of the extra renal V2 receptors that increase blood coag factors
54
Vasopressin warnings
caution when using vasopressin in pts with CAD, epilepsy and asthma nasal spray has been linked to increased seizures in children
55
Naturally occurring Glucocorticoids
Cortisol (hydrocortisone) Cortisone (less potent)
56
Primary action of naturally occurring glucocorticoids
stress hormone
57
betamethasone Cortisone dexamethasone hydrocortisone prednisone methylprednisone triamcinolone are all examples of what type of medication
corticosteroids
58
Fludrocortisone spironolactone eplerenone are examples of what type of medications
mineralocorticoid agonist and antagonists
59
Short acting (1-12 hours) glucocorticoids
hydrocortisone cortisone
60
intermediate acting (12-35 hours) glucocorticoids
prednisone prednisolone methylprednisone triamcinolone
61
long acting (36-55 hours) glucocorticoids
betamethasone dexamethasone
62
mineralocorticoid properties - high salt retaining effect
fludrocortisone
63
similar glucocorticoid and mineralocorticoid properties
short acting steroids - hydrocortisone and cortisone
64
more glucocorticoid activity and minimal to no mineralocorticoid activity
intermediate acting steroids - prednisone, prednisolone, methylprednisolone, triamcinolone (no mineralocorticoid effect)
65
Glucocorticoid activity and no mineralocorticoid activity
long acting steroids - betamethasone and dexamethasone
66
Therapeutic use of steroids: Adrenal use - replacement therapy or dx of cushing's syndrome
replacement therapy = hydrocortisone dx of cushing's = dexamethasone
67
Therapeutic use: non adrenal therapy - anti inflammatory, anti-allergy = acceleration of lung maturation-antenatal (surfactant production) =
anti inflammatory, anti allergy = several acceleration of lung maturation-antenatal = betamethasone and dexamethasone
68
Low dose dexamethasone suppression test
positive low dose test dx/confirms hypercortisolemia (cushing's syndrome) = no suppression of cortisol - normal or high negative test = decreased/ suppressed cortisol production after administration
69
Naturally occuring Mineralocorticoids
aldosterone
70
Action of aldosterone
regulate salt and water metabolism - increase salt reabsorption - increase potassium excretion - increase hydrogen ion excretion
71
Fludrocortisone MOA
synthetic mineralocorticoid salt and water retaining properties some glucocorticoid activity
72
Fludrocortisone indications
treatment of addison's disease and associated mineralocorticoid deficiency
73
Hypothyroidism drugs
T4- Levothyroxine T3- Liothyronine T3+T4 LioTrix
74
Hyperthyroidism drugs
Methimazole Propylthiouracil Propranolol Iodine and potassium iodide
75
T4 - Levothyroxine absorption
stable, well absorbed (taken on an empty stomach) with some exceptions - aluminum, magnesium containing antacids may decrease absorption
76
Levothyroxine is synthetic
T4
77
T4- Levothyroxine has a half life of
7 days
78
T4- Levothyroxine is associated with
toxicity (increased levels of T4)
79
Liothyronine is
synthetic T3
80
T3- Liothyronine has _______ oral absorption
rapid
81
T3- Liothyronine has a ______ half life
short
82
T3- Liothyronine has an increased risk of
cardiotoxicity
83
T3 + T4 Liotrix was developed to
try and mimic normal, physiologic hormone levels
84
T3 + T4 Liotrix is made up of
12.5 mcg levothyroxine and 3.1 mcg liothyronine
85
Indications for what drug = tried and failed levothyroxine, have no thyroid left or has gone through radioiodine
T3 + T4 Liotrix
86
Thioamides include
Propylthiouracil Methimazole
87
Propylthiouracil MOA
Inhibits thyroid hormone synthesis - inhibits thyroperoxidase and D1 (iodothyronine deiodinase) which decreases T4 to T3 conversion
88
Propylthiouracil has a ______ half life
fast
89
Propylthiouracil toxicity
teratogenic - preferred early in pregnancy hepatotoxicity bone marrow suppression - agranulocytosis
90
Methimazole MOA
inhibits thyroid hormone synthesis - inhibits thyroperoxidase, does not affect D1
91
Methimazole toxicity
teratogenic - preferred in the 2nd and 3rd trimester hepatotoxicity bone marrow suppression - agranulocytosis
92
Propanolol MOA
non-selecetive b-blocker symptomatic control in thyroid storm inhibits deiodination of T4 - reduces circulation of T3
93
Propanolol is administered in
IV in emergency setting for thyroid storm symptom control
94
Iodine and KI MOA
inhibition of biosynthesis - inhibition of the iodination of tyrosine inhibition of secretion/ release of T4/T3
95
Iodine and KI effects on serum thyroid hormone are maximal at
10 days
96
Iodine and KI adverse effects
exacerbation of hyperthyroidism mucosal injury - mouth, pharynx, esophageal or duodenal lesions
97
Potassium Iodide used to treat
severe hyperthyroidism and to protect the thyroid gland when using radiopharmaceuticals preoperative preparation for thyroidectomy in graves disease to decrease gland vascularity thyroid storm short term control of graves disease
98
Radioactive Iodine MOA
administered orally as sodium iodine in solution or capsule, rapidly absorbed into the thyroid gland causing local tissue destruction Thyroid is rendered inactive over 6-18 wks
99
Indications for radioactive iodine
graves disease toxic adenoma multinodular goiter
100
Bisphosphonates MOA
Inhibit osteoclast activity, reducing bone resorption and turnover
101
Alendronate indications
osteoporosis, pagets disease of bone, osteopenia (in non-ambulatory patients)
102
Risedronate indications
osteoporosis, pagets disease of the bone
103
Hypercalcemia clinical presentation
bones, moans, stones and muscle psychiatric overtones ECG - shorted QT, ST depression, AV blocks
104
Ibandronate indications
Osteoporosis
105
Zoledronic Acid indications
Osteoporosis, malignant hypercalcemia, bone metastases, multiple myeloma
106
Common causes of Hypercalcemia
hyperparathyroidism, malignancy, granulomatous disease, thiazides, lithium, pancreatitis
107
Hypercalcemia interventions
IV hydration, calcitonin, bisphosphonates, loop diuretics, glucocorticoids, denosumab, dialysis
108
Bisphosphonates side effects
bone, joint, muscle pain GI upset HA atypical femur fractures, osteonecrosis of the jaw Irritation to upper GI mucosa - take and remain upright for at least 30 min hypocalcemia - Ca and Vit D supplementation recommended
109
Contraindications of Bisphosphonates
esophageal disorders renal insufficiency hypocalcemia food interferes with absorption - take with water on empty stomach and wait 30-60 min before eating
110
Calcitonin MOA
antagonizes the effects of PTH, inhibits osteoclast activity and promotes the renal excretion of Ca2+
111
Calcitonin indications
hypercalcemia pagets disease of the bone postmenopausal osteoporosis pain from osteoporotic fracture
112
Calcitonin adverse effects
rhinitis epistaxis back pain n/v bronchospasms hypocalcemia anaphylaxis (rare)
113
Vit D MOA
Cholecalciferol is a provitamin stimulates Ca absorption from the small intestines, promotes bone mineralization
114
Indications for Vit D
Vit D deficiency Osteoporosis Hypoparathyroidism
115
Contraindications to Vit D
hypercalcemia primary hyperparathyroidism sarcoidosis
116
Calcitrol MOA
Vit D analog - stimulates intestinal Ca and P aborption, decrease PTH synthesis, stimulates bone mineralization
117
Calcitrol indications
renal failure hypoparathyroidism rickets hypophosphatemia
118
Adverse effects of Calcitriol
hypercalcemia hyperphosphatemia N/V
119
Contraindications of Calcitriol
pancreatitis soft tissue calcifications arrhythmias
120
Denosumab MOA
recombinant antibody that inhibits RANK-ligand to bind to RANK (antiresorptive)
121
Denosumab indications
osteoporosis, cannot tolerate or unresponsive to bisphosphonates, renal impairment
122
Side effects of Denosumab
osteonecrosis of the jaw, atypical subtrochanteric fracture, bone pain
123
Contraindications to denosumab
hypocalcemia
124
Teriparatide - recombinant PTH MOA
anabolic effect on bone metabolism by stimulating bone formation and activating bone remodeling treatment duration < 2 years in lifetime
125
Teriparatide indications
osteoporosis (not used often), if they have failed bisphosphonates and other options
126
Side effects of Teriparatide
generally well tolerated hypercalcemia and hypercalciuria orthostatic hypotension BLACK BOX WARNING - potential risk of osteosarcoma
127
Contraindications of teriparatide
hypercalcemia severe renal impairment
128
Raloxifene MOA
selective estrogen receptor modifier acts like an estrogen agonist in the bone thereby decreasing bone resorption and overall bone turnover bone density is increased
129
indications for raloxifene
osteoporosis in postmenopausal women
130
Adverse effects of raloxifene
hot flashes, leg cramps, peripheral edema, DVT/PE
131
Contraindications for raloxifene
history of DVT/PE, pregnancy
132
Effects of diuretics on calcium levels
Thiasizes (HCTZ) - decreased urinary Ca excretion, inhibits secretion of Ca sometimes leading to elevated levels of Ca in blood Loop diuretics (furosemide) - increased urinary Ca concentration, useful in treatment of hypercalcemia because it stimulates tubular Ca excretion
133
therapeutic and toxic effects of fluoride ion
appears to increase osteoblast activity, increase bone density but fracture risk is not reduced toxicity sxs - Gi effects such as N/V, diarrhea, severe cases renal or cardiac dysfunction

Pharmacology (7 decks)

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