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endocrine Flashcards

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1
Q

Estradiols

A
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2
Q

estradiol cypionate

A
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3
Q

Premarin

A
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4
Q

ethinyl estradiol

A
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5
Q

biological affection of estradiols

A

female tract development
secondary sexual characteristic

reduce secretion of gonadotropin from pituitary

increase triglyceride, reduce LDL, increase HDL

increase coagulation of blood protein

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6
Q

diethylstilbestrol

A

we do not use it anymore
it was use unsuccessfully to prevent miscarriage

it causes severe toxicity
ectopic pregnancy
infertility
vaginal adenocarcinoma

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7
Q

DES daughter

A

have increase risk of develop breast cancer and cervical caner

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8
Q

DES son

A

have increase risk of develop cryptorchidism
hypospadias
transgenderism, gender dysphoria

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9
Q

emergency contraception / post coital contraceptive
( morning after pill )

A

prevent pregnancy if given within 72 hours

can be combination of estrogen and progestin
or progestin only

progesterone only product have fewer side effects

action - inhibit ovulation before LH surge
decrease receptivity in uterine tube endometrium
altered cervical mucous gland function

monophasic or
mulitphasic with placebo week ( sugar pill to get period )

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10
Q

oral estrogen

A

Non-contraceptive use

Tx for hypogonadism in sound females

Hormone replacement therapy in females with premature ovarian failure or surgical removal

Hormone replacement therapy in postmenopausal females

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11
Q

side effect of oral contraceptive agent / oral estrogen

A

increase risk of endometrial cancer ( prevented by combining with progestin )

increase risk in breast cancer (postmenopausal women)

increase in CV risk in postmenopausal women

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12
Q

toxicity / overdose effect of oral contraceptive agent / oral estrogen

A

nausea
great tenderness
migraine
thromboembolic disease
gallbladder disease
Hypertriglyceridemia
hypertension

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13
Q

progestins

A

progesterone is the major progestin in human

induces secretion of endometrium, healthy endometrium for pregnancy

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14
Q

medroxyprogesterone

A

prototypical oral synthetic progestin

synthetic progestin doesn’t support pregnancy

inhibit ovulation

in HRT use as adjunct to reduce the risk of endometrium cancer

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15
Q

side effect of progestin

A

affect carb metabolism

stimulate fat deposits
dec HDL
reduce boen density ( long term)

delayed ovulation after cessation

suppress GnRH and LH, FSH

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16
Q

Selective Estrogen Receptor Modulator ( SERMs)

A

Tamoxifen, Toremifene

Estrogen receptor antagonist in breast tissue - reduce risk of breast cancer

estrogen receptor agonist in endometrial tissue - promote endometrial hyperplasia

increase risk of endometrial cancer

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17
Q

side effect of SERMs

A

as antagonist - hot flash

as agonist - increase risk of venous thromboembolism
- increase risk of endometrial cancer

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18
Q

Selective Estrogen Receptor Modulator ( SERMs)

Raloxifene

A

approved of prevention and treatment of osteoporosis

antagonist effect - reduce breast cancer risk

agonist effect - no estrogenic effect on endometrial tissue ( unlike tamoxifen)

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19
Q

Selective Estrogen Receptor Modulator ( SERMs)

Bazedoxifene

A

use for menopause symptoms and osteoporosis prevention

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20
Q

Selective Estrogen Receptor Modulator ( SERMs)

Clomiphene

A

reduces negative feedback in pituitary increase LH and FSH
induce ovulation in anovulatory women

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21
Q

Pure estrogen receptor antagonist

Fulvestrant

A

use in breast cancer with resistance to tamoxifen

use in women with breast cancer with endometrial risk factor

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22
Q

non-steroidal competitive aromatase inhibitor ( synthesis inhibitors )

A

anastrozole, letrozole

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23
Q

irreversible aromatase inhibitor

A

Exemestane

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24
Q

Danazol

Study These Flashcards
A

inhibits enzyme involve in Gn synthesis

weak partial agonist of progestin, androgen and glucocorticoid receptor

use in tx of endometriosis and fibrocystic breast disease of the breast

25
Leuprolide
Gonadotropin- releasing hormone analogue MOA- cont’d stimulation of GnRh receptor suppresses secretion inhibits ovarian production of estrogen and progesterone use in Tx of - precocious puberty - short term tx of endometriosis - short term tx of fibrosis
26
Gonadotropin- releasing hormone antagonists
abarelix, degarelix use in tx of prostate cancer
27
Mifepristone
28
estrogen promotes
reproduction : ductal growth in Brest, thickening of vaginal epithelium proliferation of uterine epithelium copious secretion of thicken mucus form endocervical gland increase vaginal acidity promote endometrial restoration after menstruation metabolic : block bone reaborsptlon promotes epiphyseal closure lower the risk pf cardiovascular disease CNS neruprotective promotes insulin sensitivity and glucose uptake
29
three cause of insulin resistance
reduce binding of insulin to ties receptor reduce receptor numbers reduced receptor responsiveness
30
criteria for Dx of DM
fasting glucose > 126mg/dl random glucose > 200mg/dl plus symptoms oral glucose tolerance test: 2 hr plasma glucose > 200mg/dl or Hemoglobin A1c 6.5 or higher
31
criteria for Dx of DM
fasting glucose > 126mg/dl random glucose > 200mg/dl plus symptoms oral glucose tolerance test: 2 hr plasma glucose > 200mg/dl or Hemoglobin A1c 6.5 or higher
32
preferred agent to manage DM hypertension
ARB eg losartan
33
1- initiate life style change plus metformin 2- cont’d step 1 and add a second drug, either thiazolidinedione, a DDP-4 inhibitor, a GLp01 receptor agonist. a sulfonyulurea or basal insulin should be considered if pt doesn’t achieve glucose control goal 3- progress to three drug combination therapy 4
34
general glycemic treatment target
A1c < 7 peak postal plasma glucose < 180 mg/dl
35
regular insulin. humulin R , novolin R
onset 30 - 60 peak 1-5 duration 6-10 hr
36
insulin glargine ( Lantus )
long acting onset 70 min peak N/A duration 18-24 hours
37
insulin determir (levemir )
long acting onset 60 - 120 mins peak 12-24 hrs duration : depends on dose 0.2 unit / kg 12 hr 0.4 unit / kg 20-24 hr
38
insulin determir (levemir )
long acting onset 60 - 120 mins peak 12-24 hrs duration : depends on dose 0.2 unit / kg 12 hr 0.4 unit / kg 20-24 hr
39
NPH ( humbling H)
intermediate onset 60-120 peak 6-14 hrs duration 16-24hrs
40
MOA of Biguanide ( metformin )
decrease glucose production by liver increase tissue response to insulin
41
adverse effect of metformin
GI symptom - decrease appetite, Nausea, diarrhea lactic acidosis should be held at hospital to prevent adverse accumulation of drug such as can occur with renal impairment in patients with dehydration or exposed to iodine contrast studies during hospital stay.
42
second gen Sulfonylureas
Glimepir-ide Glipiz-ide Glybur-ide -ide take my sulfonylureas
43
MOA of sulfonylureas
promote insulin secretion by binding to the K channel
44
adverse effect of sulfonylureas
hypoglycemia weight gain
45
Meglitinides ( Glinides)
Nateglinide Repaglinide similar to sulfonylureas but binds to a different site Ca channel instead K )
46
Meglitinides ( Glinides)
Nateglinide Repaglinide
47
adverse effect of Meglitnides
48
adverse effect of Meglitinides
hypoglycemia weight gain
49
Thiazolidinedione (Glitazones )
Pioglitazone Rosiglitazone
50
MOA of Thiazolidinedione (Glitazones )
Thiazolidinedione (Glitazones ) increase insulin sensitivity , increase glucose uptake by muscle and adipose tissue and decrease glucose production by the liver binding to the proliferator activated receptor gamma (PPAR-gamma ) nuclear factor bring -glita to the PPAR-ty
51
adverse effect of Thiazolidinedione (Glitazones )
heart failure exacerbation in HF patient due to it increase fluid retention in the kidney fracture ovulation --> unintended pregnancy
52
DPP-4 inhibitors (gliptins)
Sita-gliptin Saxa-gliptin Lina-gliptin
53
DPP-4 inhibitors (gliptins)
Sita-gliptin Saxa-gliptin Lina-gliptin
54
MOA of
55
MOA of DPP-4 inhibitors (gliptins)
enhance the activity of incretins by inhibiting their breakdown by DPP-4 thereby increase insulin release, reduce glucagon release and decrease hepatic glucose production
56
adverse effect of DPP-4 inhibitors (gliptins)
upper respiratory tract infection pancreatitis
57
sodium - glucose co-transporter 2 inhibitor
Canagliflozin increase glucose excretion via urien by inhibiting SGLT-2 in the kidney tubule dec glucose level and inducing weight loss
58
Adverse effect of SGLT-2
Genital mycotic infection orthostasis

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