Endocrine Flashcards Preview

Pharmacy > Endocrine > Flashcards

Flashcards in Endocrine Deck (45):
0

Hypothalamus

Releases Gonadotropin RH

Stimulate pituitary

1

Pituitary

Releases follicle SH

Stimulates ovaries/testes

2

Best predictor of menstruation onset

Weight

3

Peripheral early puberty

Decrease in GnRH

Results in shorter adult height

Treat with hormones that reduce estrogen/androgen (GnRH analog/antagonist)

4

Childhood obesity appetite suppressant

Phentermine
Orlistat: saturated lipstatin, inhibit lipases. Give multivitamin b/c less absorption of fat soluble vit.

Sibutramine inhibit 5HT,NE, reuptake
Mazindol inhibit NE

5

Satiety

Ghrelin increases hunger (inhibit)
Leptin decreases hunger

hypothalamus

Serotonergic

6

Anorexia nervosa

High cortisol, low 5HT, NE

Fluoxetine

Olanzapine atypical antipsych
Risperidone

Calcium vitD for bone health

7

Bulimia

Dehydration
Electrolyte imbalance

Fluoxetine
TCA
BZD
Ondansetron for N/V

8

Bone remodeling

Clast : chip
Blast : build

10 years to remodel entire skeleton

Constantly remodel BMUnits

9

Rank ligand

matures osteoclasts

Stimulated by PTH to increase calcium

OPG suppresses maturation

10

Calcium

Ionized=active

Most abundant mineral in human body

For neurotransmission
Muscle contraction
Bone formation

Regulated by parathyroid gland and VitD

Kidney, intestine, bone major organs involved in calcium-mineral processes

Affected by albumin, pH

11

Hypercalcemia >10.5

Primary hyperPTH

Confusion, dehydration, kidney stones

Fluids and loop diuretics
(Furosemide, bumetanide)

N-Biphosphonate: ARBZ
Have PCP backbone, inhibit FPPS and osteoclastgenesis

Non-N containing ECT- compete with ATP in osteoclasts, decrease resorption

Can give corticosteroids

May be due to lithium toxicity

12

6) Calcitonin

Produced in thyroid

Opposes parathyroid and reduces blood calcium

Negative feedback from high Ca levels

3rd line: only decreases vertebral fractures

13

Hypocalcemia <9

Hypoparathyroidism, vit D deficiency

CaCO3 give with meals

CaCitrate with or within meals

Cardio and muscle weakness, brittle hair, hand spasm

14

Active Vit D3

125 cholecalciferol or calcitriol

2 hydroxylase (renal) steps to add OH

Promotes Ca absorption
And reabsorption in kidney

15

Osteoporosis

Reassess BMD every 2 years
Height every year
DXA scan to monitor drug therapy
Non-pharm tai chi, exercise

Teriparatide (PTH)

Intermittent daily for treatment

For women with high risk of fracture

16

Antiresorptive agents

Biphophonates
Calcitonin
Estrogen replacement

17

Parathyroid hormone

Regulate ECF calcium

Increase bone resorption
GI Ca absorption (due to increased calcitriol production)
Kidney reabsorption (increase Ca transport proteins)

Increase RANKL osteoclastgenesis

Intermittent injections build bone

18

5) Denosumab

Refractory to biphosphonates

Inhibit RANKL to suppress osteoclastgenesis

Decrease risk of non vertebral and hip fractures

May cause hypocalcemia
Avoid if renal impairment

19

Compact bone

For strength

20

Trabecular/cancellous

Metabolically active

21

Osteoid

Collagen

22

Mineral

Calcium, phosphorus

Hydroxyapatite

23

Corrected calcium

Measured Ca + 0.8(4-albumin)

24

Osteomalacia

Defective bone mineralization
VitD deficiency

Softening of bones

Rickets in children, reduced renal hydroxylase activity, bowing

Elevated PTH in response and elevated alkaline phosphatase (high bone turnover)

Phenytoin, phenobarbital

25

Osteoporosis

Diagnose with DEXA X-ray for
women >65, men >70

BMD t score <-2.5

FRAX 10 year risk score

Fragility of bone decreased amount of bone, but normal cellular composition

Increased osteoclast activity

Menopause, aging, white, dementia, smoking alcohol

Decline of estrogen

Hip fracture is most serious

Corticosteroids, aluminum, lithium

26

Primary hyperparathyroidism labs

Causes hypercalcemia

High serum Ca
Low serum phosphate (excretion inc)
High PTH

HypoPTH: opposite and low Mg

27

Solidarity adenoma

Single PTH gland enlarged

Benign

28

PTH hyperplasia

All four glands enlarged

Cancer PTHrP

29

Pagets disease

Resorption with abnormal repair

Elevated alkaline phosphatase

30

Renalosteodystrophy

Bone mineral abnormality with renal failure

Lack of kidney hydroxylase causing decreased production of 125 Vit D (calcitriol)

31

Secondary hyper PTH

Response to hypocalcemia to normalize Ca

32

Tertiary hyperPTH

Hypertrophy parathyroid due to secondary PTH
and uncontrolled PTH secretion causing hypercalcemia

33

Calcium VitD supplementation

800 vit D, 1200 calcium in men and women >70

Women >50 need 1200 calcium

Space calcium from iron zinc, levothyroxine by at least 2 hours

Caution, increased risk of MI

34

1) Alendronate

ARBZ

Take in morning with water, without food

Decreases hip,spine, and vertebral fractures

Max 5 year treatment

35

2) Risedronate

Decreases vertebral and non-vertebral fractures

36

3) Ibandronate (boniva)

All of these biphosphonates can help those expected to take corticosteroids >1 year

Only decreases vertebral fractures

37

4) zoledronic acid

Prevent new fractures in patients with recent low trauma hip fracture

Decreases vertebral, non vertebral, and hip fractures

38

Osteonecrosis of the jaw

Due to biphosphonates

Treat with chlorhexidine mouth rinse

1-3 weeks of antibiotics

Prevent with dental hygiene

DC biphosphonates after 5 years

39

Estrogens with/without progestin

Approved for prevention of osteoporosis

40

Phenobarbital

Enzyme inducer

Decrease vit D levels

41

Delayed puberty

Give low dose estrogen/testosterone

42

Lithium

Increases set point of calcium levels

43

Osteoporosis risk factors

Low weight, female, Asian, white
Smoking, pregnant, menopause

Corticosteroids, aluminum
PPI decrease calcium absorption

No exercise

44

Duavee

CEE estrogen + bazedoxifine

Estrogen agonist in tissue
Antagonist in uterus
Decreases risk of endometrial hyperplasia