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Flashcards in Endocrine Deck (47):
1

cAMP

FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2 receptor), MSH, PTH, calcitonin, GHRH, glucagon

"FLAT CHAMP"

2

cGMP

ANP, NO "think vasodilators"

3

IP3

GnRH, Oxytocin, ADH (V1 receptor), TRH "GOAT"

4

Steroid receptor (cytosolic)

Vitamin D, Estrogen, Testosterone, Cortisol, Aldosterone, Progesterone
"VET CAP"

5

Steroid receptor (nuclear)

T3/T4

6

Intrinsic tyrosine kinase (MAP kinase pathway)

Insulin, IGF-1, FGF, PDGF (think growth factors)

7

Receptor-associated tyrosine kinase (JAK/STAT pathway)

GH, prolactin (also cytokine Il-2)

8

For the pituitary gland, what hormones is the alpha subunit common to?

TSH, LH, FSH, hCG

9

What are the four functions of T3?

4B's: brain maturation, bone growth, increased basal metabolic rate, beta-adrenergic

10

Conn's syndrome

primary hyperaldosteronism; caused by an aldosterone-secreting tumor --> hypertension, hypokalemia, metabolic alkalosis, and LOW plasma renin

11

What is secondary hyperaldosteronism?

Kidney perception of low intravascular volume --> overactive renin-angiotensin system (HIGH plasma renin); due to renal artery stenosis, chronic renal failure, CHF, cirrhosis, or nephrotic syndrome

12

What is Waterhouse-Friderichsen syndrome?

acute primary adrenal insufficiency due to adrenal hemorrhage associated with N. meningitis septicemia, DIC, endotoxin shock

13

phenoxygbenzamine

nonselective, irreversible alpha-blocker; used for treatment of pheochromocytoma

14

What are the five episodic hyperadrenergic symptoms of pheochromocytoma?

5 P's: pressure (elevated), pain (headache), perspiration, palpitations (tachycardia), pallor

15

What is the rule of 10's for pheochromocytoma?

10%: malignant, bilateral, extra-adrenal, calcify, kids, familial

16

Neuroblastoma

most common tumor of the adrenal medulla in children; HVA (breakdown of dopamine) is elevated in urine; overexpression of N-myc associated with rapid tumor progression

17

What are the features of cretinism?

pot-bellied, pale, puffy-faced child with protruding umbilicus and protuberant tongue (due to severe fetal hypothyroidism, lack of dietary iodine)

18

What is the action of insulin?

Binds insulin receptor (tyrosine kinase activity

Liver: increases glucose stored as glycogen

Muscle: increases glycogen and protein synthesis, K uptake

Fat: aids TG storage

19

What is the clinical use and toxicities of insulin?

Type 1 and 2 DM, gestational diabetes, life-threatening hyperkalemia, stress-induced hyperglycemia

Toxicities: hypoglycemia, hypersensitivity reaction (very rare)

20

What is the action of sulfonylureas?

Close K channel in the B-cell --> depolarizes --> triggering of insulin release via increased calcium influx

"Kicking the pancreas" to increase insulin output

21

What are the clinical use and toxicities of sulfonylureas?

Clinical use: stimulate release of endogenous insulin in type 2 DM; requires some islet fxn, so useless in DM type 1.

Toxicities; first generation: disulfiram-like effects, second generation: hypoglycemia

22

What is the action of biguanides (metformin)?

Decrease gluconeogenesis, increase glycolysis and increase peripheral insulin sensitivity

23

What are the clinical use and toxicities of biguanides?

Clinical use: oral, can be used with pts w/out islet fxn

Toxicities: most grave adverse effect is lactic acidosis (contraindicated for those with renal failure)

24

What is the action of glitazones/thiazolidinediones?

increase insulin sensitivity in peripheral tissue; binds to PPAR-gamma nuclear transcription regulator

25

What are the clinical use and toxicities of glitazones/TZDs?

Clinical use: used as monotherapy in type 2 DM or combined with other agents

Toxicity: weight gain, edema, hepatotoxicity, CV toxicity

26

What is the action of alpha-glucosidase inhibitors?

inhibit intestinal brush border alpha-glucosides; delayed sugar hydrolysis and glucose absorption lead to decreased postprandial hyperglycemia

27

What are the clinical use and toxicities of alpha-glucosidase inhibitors?

Clinical use: monotherapy in type 2 DM or in combination with other agents

Toxicities: GI disturbance

28

How are mimetics (pramlintide) used?

Action: decrease glucagon
Clinical use: Type 2 DM
Toxicities: hypoglycemia, nausea, diarrhea

29

How are GLP-1 analogs (exenatide) used?

Action: increased insulin, decreased glucagon release
Clinical use: Type 2 DM
Toxicities: nausea, vomiting, pancreatitis

30

Lispro

rapid acting insulin

31

Aspart

rapid acting insulin

32

NPH

intermediate acting insulin

33

Glargine

long acting insulin

34

Detemir

long acting insulin

35

Tolbutamide

first generation sulfonylurea

36

Chlorpropamide

first generation sulfonylurea

37

Glyburide

second generation sulfonylurea

38

Glimepiride

second generation sulfonylurea

39

Glipizide

second generation sulfonylurea

40

Pioglitazone

Glitazone/ TZD

41

Rosiglitazone

Glitazone/ TZD

42

Acarbose

alpha-glucosidase inhibitor

43

Miglitol

alpha-glucosidase inhibitor

44

Propylthiouracil, methimazole

Mechanism: inhibit organification of iodide and coupling of thyroid hormone synthesis. Propylthiouracil also decreases conversion of T4 to T3.

Clinical use: hyperthyroidism

Toxicity: skin rase, agranulocytosis (rare), aplastic anemia, methimazole (possible teratogen), hepatotoxicity (propylthiouracil)

45

Levothyroxine, trioodothyronine

Mechanism: thyroxine replacement

Clinical use: hypothyroidism, myxedema

Toxicity: tachycardia, heat intolerance, tremors, arrhythmias

46

demeclocycline

Mechanism: ADH antagonist (member of tetracycline)

Clinical use: SIADH

Toxicity: nephrogenic DI, photosensitivity, abnormalities of bone and teeth

47

glucocorticoids

Mechanism: decrease production of leukotrienes and prostaglandins by inhibiting phospholipase A2 and expression of cox-2

Clinical use: Addison's, inflammation, immune suppression, asthma

Toxicities: Cushings syndrome, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcer disease, diabetes, adrenal insufficiency when drug stopped after chronic use