Endocrine

Question 1

Insulin, rapid acting
Uses?
Toxicity?

Answer 1

Lispro
Aspart
Glulisine

Uses = DM1, DM2, GDM (postpradial glucose control)
Toxicity = hypoglycemia, rare hypersensitivity rxns

Question 2

Action of insulin in general

Effect on liver? Muscle? Fat?

Answer 2

Bind insulin receptor (tyrosine kinase activity)
Liver = increase glucose stored as glycogen
muscle = increase glycogen, protein synthesis, and K uptake
Fat = increase TG storage

Question 3

Insulin, short acting

Uses?

Answer 3

Regular

Uses = DM1, DM2, GDM, DKA (IV), hyperkalemia (+ glucose), stress hyperglycemia

Question 4

Insulin, intermediate acting

Answer 4

NPH = Neutral Protamine Hagedorn

Uses = DM1, DM2, GDM

Question 5

Insulin, long acting

Answer 5

Glargine
Detemir

Uses = DM1, DM2, GDM (basal glucose control)

Question 6

Biguanides

Answer 6

Metformin

Question 7

Metformin action and uses

Answer 7

Biguanide = MOA unknown
Decreases gluconeogenesis
Increases glycolysis and peripheral glucose uptake (insulin sensitivity)

Oral = first line therapy in type 2 DM
Can be used in patients without islet function

Question 8

Metformin toxicity

Answer 8

GI upset

LACTIC ACIDOSIS = most serious adverse effect (contraindicated in RENAL FAILURE)

Question 9

Sulfonylureas - first generation (2)

Toxicity?

Answer 9

Tolbutamide
Chlorpropamide

Disulfiram-like effects

Question 10

Sulfonylureas - second generation (3)

Toxicity?

Answer 10

Glyburide
Glimepiride
Glipizide

Hypoglycemia

Question 11

Sulfonylureas Action
Tolbutamide, Chlorpropamide
Glyburide, Glimepiride, Glipizide

Answer 11

Close K+ channel in B-cell membrane so cell depolarizes = triggers insulin release via increased Ca2+ influx

Question 12

Sulfonylureas Uses and Toxicity (general)
Tolbutamide, Chlorpropamide
Glyburide, Glimepiride, Glipizide

Answer 12

Stimulate release of endogenous insulin in type 2 DM
Require some islet function, so useless in type 1 DM

Toxicity = risk of hypoglycemia increased in renal failure

Question 13

Can sulfonylureas be used in type 1 DM?

Answer 13

NO - require some islet function as they stimulate endogenous insulin release

Question 14

Risk of hypoglycemia while taking sulfonylureas is increased in which type of patients?

Answer 14

Renal failure

Question 15

Glitazones/thiazolidinediones (2)

Answer 15

Pioglitazone

Rosiglitazone

Question 16

Pioglitazone, Rosiglitazone
Action?
Uses?

Answer 16

Glitazones/thiazolidinediones
Increase insulin sensitivity in peripheral tissue (also increases levels of adiponectin)
Binds to PPAR-gamma nuclear transcription regulator (activated genes regulate FA storage and glucose metabolism)

Question 17

Pioglitazone, Rosiglitazone

Toxicity?

Answer 17

Weight gain, edema

Hepatotoxicity, heart failure

Question 18

a-glucosidase inhibitors (2)

Answer 18

Acarbose

Miglitol

Question 19

Acarbose, Miglitol

Action?

Answer 19

Inhibit intestinal brush border a-glucosidases

Delayed sugar hydrolysis and glucose absorption = DECREASE postprandial hyperglycemia

Question 20

Acarbose, Miglitol
Uses?
Toxicity?

Answer 20

a-glucosidase inhibitors
Uses = monotherapy in type 2 DM or in combination
Toxicity = GI disturbances

Question 21

Amylin analogs

Answer 21

Pramlintide

Question 22

Pramlintide
Action?
Use?
Toxicity?

Answer 22

Amylin analog (co-secreted with insulin)
Decrease gastric emptying
Decrease glucagon

Uses = Type 1 and Type 2 DM
Toxicity = hypoglycemia, nausea, diarrhea

Question 23

GLP-1 analogs

Answer 23

Exenatide

Liraglutide

Question 24

Exenatide, Liraglutide
Action?
Use?
Toxicity?

Answer 24

GLP-1 analogs (glucagon like peptide)
Increase insulin
Decrease glucagon release

Uses = Type 2 DM
Toxicity = nausea, vomiting; pancreatitis

Question 25

DPP-4 inhibitors

Answer 25

Linagliptin Saxagliptin Sitagliptin "gliptin"

Question 26

Linagliptin, Saxagliptin, Sitagliptin Action? Use? Toxicity?

Answer 26

DPP-4 inhibitors (dipeptidyl peptidase CD26) Increase insulin Decrease glucagon release ``` Uses = Type 2 DM Toxicity = mild urinary or respiratory infections ```

Question 27

Which two diabetic classes of drugs increase insulin and decrease glucagon release?

Answer 27

GLP-1 analogs (exenatide, liraglutide) "tide" | DPP-4 inhibitors (linagliptin, saxagliptin, sitagliptin) "gliptin"

Question 28

Which diabetic drug can cause lactic acidosis?

Answer 28

Metformin

Question 29

Which diabetic drug(s) can cause disulfiram-like effects

Answer 29

First generation sulfonylureas: Tolbutamide Chlorpropamide

Question 30

Which diabetic drug(s) can cause weight gain/edema and hepatotoxicity/heart failure

Answer 30

Pioglitazone Rosiglitazone (Glitazones/thiazolidinediones)

Question 31

Which class of diabetic drugs can cause pancreatitis?

Answer 31

GLP-1 analogs | Exenatide, Liraglutide

Question 32

Propylthiouracil, Methimazole | Mechanism?

Answer 32

Block thyroid peroxidase = inhibit oxidation of iodide and organification (coupling) of iodine = inhibit thyroid hormone synthesis Propylthiouracil also blocks 5'-deiodinase, which decreases peripheral conversion of T4 to T3

Question 33

What additional function does propylthiouracil have that methimazole does not?

Answer 33

Propylthiouracil also blocks 5'-deiodinase, which decreases peripheral conversion of T4 to T3

Question 34

Propylthiouracil, Methimazole Uses? Which is safe in pregnancy? Toxicity?

Answer 34

Uses = HYPERthyroidism PTU used in pregnancy; Methimazole is a possible teratogen (aplasia cutis) Toxicity = skin rash, agranulocytosis, aplastic anemia, hepatotoxicity (PTU), teratogenic (methimazole)

Question 35

What is a possible teratogenic outcome of methimazole use in pregnancy?

Answer 35

Aplasia cutis

Question 36

Levothyroxine, triiodothyronine Mechanism? Uses?

Answer 36

Thyroxine replacement | HYPOthyroidism, myxedema

Question 37

Levothyroxine, triiodothyronine | Toxicity?

Answer 37

Tachycardia, heat intolerance, tremors, arrhythmias | Hyperthyroid symptoms

Question 38

Growth hormone uses (2)

Answer 38

GH deficiency | Turner syndrome

Question 39

Octreatide Agent? Uses?

Answer 39

Somatostatin (GHIH; growth hormone inhibitory hormone) Acromegaly, carcinoid, gastrinoma, glucagonoma, esophageal varices

Question 40

Oxytocin uses

Answer 40

Stimulates labor, uterine contractions, MILK LET-DOWN | controls uterine hemorrhage

Question 41

ADH (DDAVP) / Desmopressin

Answer 41

Pituitary (central, not nephrogenic) DI

Question 42

Demeclocycline Use? Toxicity?

Answer 42

``` ADH antagonists (tetracycline family) Use = SIAHD Toxicity = nephrogenic DI, photosensitivity, abnormalities of bone and teeth ```

Question 43

Glucocorticoids

Answer 43

``` Hydrocortisone Prednisone Triamcinolone Dexamethasone Beclomethasone Fludrocortisone (mineralocorticoid and glucocorticoid activity) ```

Question 44

Which steroid has both mineralocorticoid and glucocorticoid activity?

Answer 44

Fludrocortisone

Question 45

Glucocorticoids | Mechanism?

Answer 45

Metabolic, catabolic, anti-inflammatory, and immunosuppressive effects mediated by interactions with glucocorticoid response elements and inhibition of transcription factors such as NF-kB

Question 46

Glucocorticoids | Uses? (4)

Answer 46

Addison disease Inflammation Immune suppression Asthma

Question 47

Glucocorticoids | Toxicity?

Answer 47

Iatrogenic Cushing syndrome = buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis (treat with bisphosphonates), adrenocortical atrophy, peptic ulcers, diabetes (if chronic) Adrenal insufficiency when drug stopped abruptly after chronic use

Question 48

What can occur if glucocorticoids are stopped abruptly after chronic use?

Answer 48

Adrenal insufficiency