Endocrine Flashcards by Christelle Anne Almanon

Suppress GH, IGF1, serotonin and GI peptides
ACROMEGALY, PIT ADENOMA
Carcinoid Gastrinoma Glucagonona
Variceal bleeding

Octreotide

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Inc IGF1 release in liver and cartilage
GH DEFICIENCY
Short stature, failure to thrive, AIDS wasting
Performance enhancing drug

Somatotropin

GH analog

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Ovarian hyperstimulation syndrome

Ovarian enlargement
Ascites
Hypovolemia to shock

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OVARIAN STIMULATION
INFERTILITY
WOF ovarian hyperstimulation syndrome multiple pregnancies gynecomastia

Follitropin alfa

FSH analog

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OVARIAN INDUCTION
HYPOGONADOTROPIC GONADISM
WOF ovarian hyperstimulation syndrome multiple pregnancies gynecomastia

Choriogonadotropin alfa

LH analog

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Inc LH and FSH with intermittent
Dec LH and FSH with continuous
OVARIAN HYPERSTIMULATION
ENDOMETRIOSIS Myoma uteri Precocious puberty Prostate ca
WOF TEMPORARY EXACERBATION OF PRECOCIOUS PUBERTY

Leuprolide

GnRH analog

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PREVENTS PREMATURE LH SURGE in ovarian stimulation Prostate ca without tumor flare up

Ganirelix
GnRH antagonist

WOF Hypersensitivity ABARELIX

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Partial agonist at D2 receptor
Inhibits prolactin release
HYPERPROLACTINEMIA, PARKINSONS

Bromocriptine

Dopamine agonist

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LABOR INDUCTION
POSTPARTUM HEMORRHAGE
WOF fetal distress placental abruption uterine rupture fluid retention

Oxytocin

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CDI Hemophilia A von Willebrand disease

Desmopressin

ADH agonist

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Polyuria
Polydipsia
Hypernatremia

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SIADH

HYPONATREMIA

Conivaptan

ADH antagonist

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Thyroid Hormone synthesis

Transport
Organification
Coupling
Proteolysis

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HYPOTHYROIDISM

MYXEDEMA COMA

Levothyroxine

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Progressive weakness, stupor
Hypothermia
Hypoventilation
Hypoglycemia Hyponatremia Hypovolemia

Myxedema Coma
Untreated Hypothyroidism
- Levothyroxine

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HYPERTHYROIDISM
THYROID STORM
in pregnant women
WOF fulminant hepatitis agranulocytosis

PTU

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HYPERTHYROIDISM
WOF cholestatic jaundice altered taste and smell agranulocytosis
Prenatal exposure cuses APLASIA CUTIS CONGENITA

Methimazole

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Acute severe neutropenia

Sore throat or high fever

Agranulocytosis

- GCSF

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WOF HYPOTHYROIDISM
preferred definitive treatment
CI pregnant and lactating

RAI 131

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Reduce size and vascularity of thyroid
PRE THYROIDECTOMY
WOF IODISM
Prenatal exposure causes FETAL GOITER

Potassium iodide

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Ingestion of iodine causes
HYPOthyroidism
HYPERthyroidism

Wolf Chaikoff

Jod Basedow

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Inhibits peripheral conversion of T4 to T3
HYPERTHYROIDISM
THYROID STORM
Does not alter thyroid hormone levels

Propanolol

Thyrotoxicosis related arrhythmias - Esmolol

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Inhibit peripheral T4 to T3

PTU
Propanolol
Hydrocortisone

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Drug induced hyperthyroidism

Clofibrate
Amiodarone
Methadone

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Amiodarone induced thyroid disease HYPO HYPER

Levothyroxine | Thioamides or corticosteroids

Stronger anti inflammatory effect

Glucocorticoids

ACUTE ADRENAL INSUFFICIENCY | Insect bites THYROID STORM Status asthmaticus

Hydrocortisone | SA glucocorticoid

Adrenal suppression Growth inhibits | Glucose intolerance Salt retention Osteoporosis

Prednisone | glucocorticoid

Strong agonist of mineralocorticoid receptors. Moderate agonist of glucocorticoid receptors CHRONIC ADRENAL INSUFFICIENCY CAH Adrenal replacement therapy

Fludrocortisone | Mineralocorticoid

MCC Cushing's syndrome

Exogenous steroid intake

Inhibits desmolase CUSHING SYNDROME Breast Ca Abused by body builders

Aminogluthetimide | glucocorticoid inhibitor

Azole antifungal ADRENAL CARCINOMA WOF HEPATOTOXICITY

Ketoconazole | glucocorticoid inhibitor

Selective inhibitor of steroid 11 hydroxylation DIAGNOSTIC TESTING DOC PREGNANT WITH CUSHING'S

Metyrapone

Primary hypogonadism Post menopausal hormone replacement therapy WOF BREAKTHROUGH BLEEDING HYPERTG HYPERTENSION DVT ENDOMETRIAL CA

Ethinyl estradiol

CLEAR CELL VAGINAL ADENOCARCINOMA

Diethylstilbestrol | Non steroid

Hormone replacement therapy Contraception Assisted reproduction Anovulation induction PREVENTS ESTROGEN INDUCED ENDOMETRIAL CA WOF dec HDL, reversible dec in bone mineral density

Norgestrel Appetite stimulant - Megestrol

Primary action of hormonal contraceptives

Inhibition of ovulation

ACNE CONTRACEPTION ENDOMETRIOSIS | WOF BREAST CA earlier onset

Estradiol + Norethindrone | COC

WOF delayed return of fertility | Prevents conception by altering cervical mucus and hostile endometriun

Medroxyprogesterone acetate IM DMPA Progestin only

EMERGENCY CONTRACEPTION | YUZPE 72 hrs

Levonorgestrel

Estrogen antagonist action on breast and CNS. Estrogen agonist in uterus, liver and bone HORMONE RESPONSIVE BREAST CA WOF ENDOMETRIAL HYPERPLASIA/CA

Tamoxifen | SERM

Estrogen antagonist action on breast and CNS. Estrogen agonist in liver and bone BREAST CA PREVENTION

Raloxifene | SERM

Partial agonist of estrogen receptors in pituitary. Inc FSH and LH WOF MULTIPLE PREGNANCIES OVARIAN ENLARGEMENT

Clomiphene | SERM

Inhibit aromatase BREAST CA RESISTANT TO TAMOXIFEN PRECOCIOUS PUBERTY

Anastrozole | Estrogen synthesis inhibitor

ENDOMETRIOSIS Fibrocystic disease CI pregnancy and BF

Danazol | Antiandrogen

Glucocorticoid and progesterone receptor antagonist MEDICAL ABORTION CUSHING'S SYNDROME May cause sepsis due to Clostridium sordelli

Mifepristone RU 486

Male hypogonadism Wasting syndrome WOF virilization in women and paradoxical feminization in men

Testosterone

Inc ratio if anabolic to androgenic activity Performance enhancement in athletes WOF HCC CHOLESTATIC JAUNDICE

Oxandrolone | Anabolic steroid

Prostate ca SURGICAL CASTRATION Add leuprolide to prevent prostate ca flare up

Nilutamide | Androgen antagonist

Hirsutism DEC SEX DRIVE IN MEN orphan drug status

Cyproterone | Androgen antagonist

Inhibit 5a eeductase | BPH Male pattern baldness

Finasteride | Androgen synthesis inhibitor

Transporter for insulin mediated glucose uptake in muscle and adupose

GLUT4

Rapid insulin

Lispro Aspart Glulisine

Short insulin

Regular

Int insulin

NPH | Lente

LA insulin

Ultralente

Ultra LA insulin

Glargine Detemir Lantus

Hypoglycemia Neuroglycopenic sx Neurogenic sx

Changes in consciousness and behavior | Adrenergic and cholinergic

More prone to developing hypoglycemia in insulin use

Renal disease Elderly <7 yo

When the evening dose of int insulin is high, hypoglycemia develops around 3 am PreBF hypogly Tx dec evening dose

Somogyi effect

When the evening dose of int insulin is low, hypoglycemia develops around 3 am and 7 am Tx: inc evening dose

Waning insulin dose

Insulin sensitivity low between 6 am and 7 am due to GH spike Normal 3 am glucose Mild hyperglycemia in the morning

Dawn phenomenon

Hyperglycemia in 3 am < 7 am | Tx: inc evening dose

Waning + dawn

Period in type 1 DM when exogenous insulin requirements dec due to inc in endogenous insulin production Followed by total lack of insulin production

Honeymoon period

Most physiologic insulin strategy

Basal Bolus

Closure of K channels in pancreatic B cell membrane | Type II DM

Insulin Secretagogues

WOF HYPOGLYCEMIA WEIGHT GAIN DISULFIRAM

Chlororopramide | 1st gen sulfonylureas

WOF less hypoglycemia weight gain | CI hepatic and renal disease

Glipizide WOF cholestatic jayndice glibenclamide 2nd gen sulfonylureas

POSTPRANDIAL HYPERGLYCEMIA SULFA ALLERGIES Least incidence of hypoglycemia - for CKD patients

Nateglinide | Insulin secretagogue

Reduces fasting and postprandial glucose levels Inhibit hepatic and renal gluconeogenesis FIRST LINE T2DM DOC OBESE DM

Metformin | biguanide

``` Regulates gene expression by binding to PPAR gamma Diabetes prevention WOF CHF DEC HDL INC LDL INC TG reduces mortality in MI and stroke ```

Pioglitazone | Thiazolidinediones

Inhibits intestinal a glucosidases WOF GI disturbance Minor glucose lowering benefit

Acarbose

Amylin analog with anoretic effect | Adjunct to insulin

Pramlintide

Incretin modulator GLP1 agonist producing satiety | Adjunct to metformin or sulfonylurea

Exenatide

Incretin modulator DPP4 inhibitor

Sitagliptin

Inhibits GI and pancreatic lipases | Rebound weight gain upon discontinuation

Orlistat

Inhibits NE and serotonin reuptake Anorectic wffect WOF hpn, MI, stroke

Sibutramine

Block CB-1 receptor Anorectic effect WOF SUICIDALITY DEPRESSION

Rimonabant

Severe hypoglycemia | B blocker overdose

Glucagon