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Endocrine drugs Flashcards

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1
Q

What is Endocrinopathy?

A

Disease of the Endocrine gland

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2
Q

Name 2 Diseases of the Thyroid

A
  1. Hyperthyroidism
  2. Hypothyrodisim
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3
Q

Name 2 Diseases of the Pancreas

A
  1. Diabetes Mellitus
  2. Insulinoma
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4
Q

Name 2 Diseases of the Adrenal gland

A
  1. Hyperadrenocorticism
  2. Hypoadrenocorticism
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5
Q

Name 2 Diseases of the Pituitary gland

A
  1. GSD Pituitary dwarfism
  2. Equine Cushing’s disease (PPID)
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6
Q

Name 8 Endocrinopathies

A
  1. Hyperthyroidism
  2. Hypothyroidism
  3. Diabetes Mellitus
  4. Insulinoma
  5. Hyperadrenocorticism
  6. Hypoadrenocorticism
  7. GSD Pituitary Dwarfism
  8. Equine Cushing’s disease (PPID)
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7
Q

What is T3 + T4 responsible for?

A
  1. Increased metabolism
  2. Growth + development
  3. Increased Catecholamine
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8
Q

Name the 2 hormones, the Thyroid produces?

A
  1. T3
  2. T4
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9
Q

What stimulates the Thyroid to releasee T3 + T4?

A

Thyroid-Stimulating Hormone
(TSH)

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10
Q

What stimulates the release of the Thyroid-Stimulating Hormone from the Hypothalamus?
(TSH)

A

The Thyrotropin-Releasing Hormone
(TRH)

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11
Q

Where is the Thyroid gland located?

A
  1. Lies midline
  2. On the ventral aspect
  3. Of the 1st few tracheal rings
  4. Either side of the Trachea
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12
Q

How is the Thyroid controlled?

A
  1. By TSH
  2. From the Anterior Pituitary gland
  3. Secreting the 3 hormones:
    * Thyroxine (T4)
    * Tri-iodothyronine (T3)
    * Calcitonin
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13
Q

Name the 3 hormones that the Thyroid gland secretes

A
  1. Thyroxine (T4)
  2. Tri-iodothyronine (T3)
  3. Calcitonin
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14
Q

What are Thyroxine (T4) + Tri-iodothyronine (T3) heavily involved in?

A
  1. Growth
  2. Metabolism
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15
Q

What is the other name given to Thyroxine?

A

T4

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16
Q

What is the other name given to Tri-iodothyronine?

A

T3

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17
Q

What is Calcitonin involved in?

A

Decreasing blood Calcium levels

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18
Q

What is Hypothyroidism?

A

An under-active Thyroid

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19
Q

What is Hyperthyroidism?

A

An over-active Thyroid

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20
Q

What happens in Hypothyroidism?

A
  1. Underactive Thyroid
  2. Thyroid gland doesn’t produce enough Thyroxine
  3. Therefore producing more TSH
  4. Stimulating the Thyroid gland
  5. To produce even more TSH
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21
Q

What drug is used to treat Hypothyroidism?

A
  1. A synthetic form of Thyroxine
  2. Levothyroxin
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22
Q

What is the mode of action for Levothyroxin?

A
  1. It mimics T4
  2. After admin, it is converted by T3
  3. T3 enters cell + binds to thyroid receptors in nucleus
  4. Affecting gene transcription + cellular metabolism

Exerting feedback to the Hypothalamus + restoring homeostasis

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23
Q

True or False.

Repletion of T4 via daily does of Levothroxine exerts feedback to the Hypothalamus + restores homeostasis.

A

True

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24
Q

Is Hypothyroidism seen more commonly in Cats or Dogs?

A

Dogs

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25
Is **Hyper**thyroidism seen more commonly in Cats or Dogs?
Cats
26
What is happening if a Cat has **Hyper**thyroidism?
The Cat's thyroid is producing **excessive** amounts of **Thyroxine**
27
Name the **2** drugs used to treat **Hyper**thyroidism in Cats
1. **Meth**imazole 2. **Carbi**mazole
28
What **type** of drugs are **Methimazole** + **Carbimazole**?
**Thioa**mides
29
What **2** ***Thioamides*** are used in Cats, to treat **Hyper**thyroidism?
1. **Meth**imazole 2. **Carb**imazole
30
How do the Thioamides, ***Methimazole*** + ***Carbimazole*** **work**, when treating Hyperthyroidism?
By ***blocking*** the Thyroxine **synthesis**!
31
How does Methimazole + Carbimazole **block** the **Thyroxine synthesis** in Hyperthyroidism?
1. By **inhibiting** ***Iodine*** from **binding** to the 2. Thyroid **Peroxidase** **enzyme** 3. ***Preventing*** **iodination** of 4. ***Thyroglobulin***, **T3** + **T4** **synthesis** ## Footnote *Thyroid Peroxidase enzyme = **catalyzes** the **oxidation** of Iodine*
32
Methimazole + Carbimazole block Iodine from binding to the thyroid Peroxidase enzyme, preventing Iodination of Thyroglobulin, T3 + T4. What is **Iodination**?
* The critical biochemical step in * Thyroid hormone synthesis * Where **Iodine** **binds** with **Tyrosine** ***residues*** * On a **protein**, called, **Thyroglobulin** * In the thyroid gland
33
Name the **exo**crine + **endo**crine ***lobular gland*** found in the **abdominal cavity** that **secretes** the hormones ***Insulin*** + ***Glucagon***
The Pancreas
34
What is this diagram demonstrating?
The **systemic effects** of **Insulin** ***resistance*** on organs + tissues
35
What can **Insulin** ***resistance*** have on the Brain?
1. **Inc**reases **hunger** * *Impairs signalling* 2. **Supresses** ***Hepatic*** glucose production * *Impairs controls > excess glucose output from Liver* 3. **Dec**reases **Lipoprotein** production * *Alters Lipid metabolism*
36
What can **Insulin** ***resistance*** have on the ***Peripheral*** **Muscles**?
1. **Dec**rease **Glucose** ***metabolism*** * *Muscles can't take up glucose efficiently* 2. Decrease ***Glycogen*** **synthesis** * *Less storage of glucose (as glycogen)* 3. Decreases **Muscle** **mass** * *Insulin resistance > Catabolism* 4. **Inc**reases **Mitochondrial** ***dysfunction*** * Reduced energy + metabolic health*
37
What can **Insulin** ***resistance*** have on the ***Adipose*** **tissues**?
1. **Dec**rease Glucose **metabolism** * *Fat tissue becomes insulin-resistant* 2. **Inc**reases **Lipogenesis** * *Inc fat synthesis* 3. **Dec**reases **Lipolysis** * *Reduced fat breakdown* 3. **Inc**reases **Inflammation** * *Chronic low-grade inflammation* 4. **Inc**reases **M2** > **M1** ***macrophage*** **switch** * *Pro-inflammatory immune profile*
38
What can **Insulin** ***resistance*** have on the **Liver**?
1. **Inc**reases Glucose synthesis (***Gluconeogenesis***) * *Overproduction of glucose* 2. **Dec**reases **Glycogen** synthesis * *Impaired glucose storage* 3. **Inc**reases ***Lipid*** ***accumulation*** * *Leads to fatty liver > Hepatic steatosis* 4. Increases **Inflammation** * *Contributes to Liver damage (NASH)*
39
What does Insulin resistance lead to?
* **Metabolic** ***dysfunction*** * Due to not being able to respond appropriately
40
What is this diagram showing?
How Insulin works/binds with its receptors
41
What is **responsbile** for controlling the uptake of Glucose into the cells?
Insulin
42
Where is **Insulin** secreted from?
**β**-cells of **Islets** of **Langerhans**
43
What is a **potent** ***stimulator*** for Insulin release?
Hyper**glycaemia**
44
How does **Insulin** work?
1. By **binding** to ***specific*** **cell**-***surface*** **receptors** 2. Which **stimulate** the ***uptake*** of **Glucose** 3. **Into** the cells 4. *Glycogen* > Glucose
45
What is Diabetes **Mellitus**?
The **relative** (T1) or ***total absence*** (T2) of Insulin
46
Simply, what happens to glucose in **DM**?
1. **Reduced** glucose **uptake** by ***Insulin sensitive tissues*** 1. Leading to serious consequences
47
# 4 ... What serious consequences can **DM** lead to?
Reduced glucose uptake by Insulin sensitive tissues, leading to: 1. **Lipolysis** 2. Muscle ***proteolysis*** 3. **Rise** in **blood** levels of ***free fatty acids*** + ***glycerol*** 4. **KETOACIDOSIS**
48
What is the function of the **Adrenal** gland?
1. Produce **hormones** (+ **Sex** hormones) 2. That **allow** the body to **respond** to **stress**, such as: * ***Glucocorticoids*** * ***Mineralocorticoids*** (Aldosterone)
49
What are these little top hats, sitting above the Kidneys?
The Adrenal glands!
50
Name **2** **Mineralocorticoids**
1. **Aldoste**rone 2. **Fludrocort**isone
51
Name **7** **Glucocorticoids**
1. **Hydro**cortisone 2. Prednis**olone** 3. **Prednisone** 4. **Methyl**prednisolone 5. **Betamethasone** 6. **Dexa**methasone 7. **Triamcinolone**
52
Name 1 **Glucocorticoid** ***Hormone***
***Hydrocortisone*** * Cortis**ol** * Cortis**one**
53
Name 6 **Glucocorticoid** ***Synthetics***
1. Prednisolone 2. **Prednisone** 3. **Methyl**prednisolone 4. **Beta**methasone 5. **Dexa**methasone 6. **Triamcinolone**
54
Name **2** Mineralcorticoid **effects** on the body
1. **Inc**reased **Sodium** ***re-absorption*** 2. Increased **Potassium** + **Hydrogen** ***excretion***
55
What **3** **adverse effects** can **Increased** ***Sodium re-absorption***, ***Potassium + Hydrogen*** **excretion** cause on the body?
1. Hypo**kalaemia** 2. **Hyper**tension 3. Muscle **weakness**
56
Name **10** effects of Corticosteroids
**Decreased** 1. **Inflammatory** **response** 1. **Immunological** response 1. Glucose **utilization** 1. ***Protein*** **catabolism** 1. **Bone** ***catabolism*** 1. ***Unstable*** **mood** **Increased** 1. **Gastric acid** + ***Pepsin*** 1. **Liver** ***glycogen deposition*** 1. **Gluconeogenesis** 1. Glucose **output** from **Liver**
57
What **adverse** effects can * ***Increased*** Glucose **output** from the Liver & * ***Decreased*** Glucose **utilization** lead to?
Diabetes Mellitus
58
What 2 **adverse** effects can ***Increased*** **Protein catabolism** lead to?
1. Muscle **wastage** 2. Growth ***suppression***
59
What adverse effect can **increased** **Bone** ***catabolism*** lead to?
Osteo**porosis**
60
What **adverse** effect can ***unstable mood*** lead to?
Psychosis
61
What **adverse** effect can ***Increased*** **Gastric acid + Pepsin** lead to?
Peptic **ulceration**
62
What are the functions of **Glucocorticoids**?
Supressing: 1. **inflammation** 2. ***Allergies*** 3. **Immune responses**
63
Name the **3** ***Glucocorticoids***
1. **Prednisolone** 2. **Dexa**methasone 3. **Beta**methasone
64
# 3 .. How do **Glucocorticoids** work?
1. By **alterting** the ***transcription*** of **DNA** 2. Altering cellular **metabolism** 3. There **decreasing** the ***Inflammatory response***
65
What **type** of drug should be used very **carefully** + **induce side effects**, if used ***long term***?
Glucocorticoids
66
What are the **2** potential **causes** for **Cushings** disease??
1. **Pituitary** gland ***Microadenoma*** * Creating **excessive** release of **ACTH** * **Stimulating** the ***adrenal*** gland 2. **Adrenal** gland ***tumour*** * Causing **excessive** **Cortisol** production
67
Give the other name for Cushings disease
Hyperadrenocorticism
68
How does a **Pituitary gland Microadenoma** cause Hyperadrenocorticism?
1. Creating **excessive** release of **ACTH** 1. **Stimulating** the ***adrenal*** gland
69
How does a **Adrenal gland tumour** cause Hyperadrenocorticism?
Tumour causes **excessive** **Cortisol** production
70
What is **Trilostane** used to treat?
Hyperadrenocorticism
71
How does **Trilostane** work?
1. It **selectively** + ***reversibly*** **inhibits** 2. The **enzyme** = **2** ***Beta*** **Hydroxysteroid** ***Isomerase*** 3. ***Blocking*** the **production** of: * ***Cortisol*** * **Corticosterone** * **Aldosterone**
72
# 3 .. How does **Trilostane** treat Hyperadrenocorticism?
1. It ***reduces*** the **production** of 2. **Glucocorticoid** + **Mineralocorticoid** ***steriods*** 3. **In** the **adrenal** ***cortex***
73
What do **Mineralocorticoids** do?
**Control** the ***Sodium*** + ***Potassium*** **levels** in the body
74
True or False. **Mineralocorticoids** control the sodium + potassium levels in the body, **increasing potassium excretion** + **sodium retention**.
True!
75
How do **Mineralocorticoids** control the Sodium + Potassium levels in the body?
By: 1. **Increasing** Potassium ***excretion*** 2. Increasing Sodium ***retention***
76
What does the release of **Aldosterone** affect?
Affects the: 1. **Plasma** Potassium 2. **Renin-Angiotensin** System
77
What **Endocrinopathy** are these breeds ***predisposed*** to?
* **Addison**'s disease * Otherwise known as ***Hypo***adrenocorticism
78
What is **Addison**'s disease caused by?
***Immune mediated*** **destruction** of the Adrenal glands
79
What endocrinopathy is classed as a **deficiency** of ***Mineralocorticoids*** + ***Glucocorticoids***?
**Hypo**adrenocorticism
80
What endocrinopathy presents with vague clinical signs, that ***wax + wane over time***, rarely becoming pathognomonic? ## Footnote *Pathognomonic = indicative of a specific disease*
Addison's disease
81
What endocrinopathy has a **highly succesful treatment**, but is often **lifelong**?
Addison's disease/Hypoadrenocorticism
82
What test **confirms** diagnosis of Addison's?
* **ACTH** ***stimulation*** **test** * To test adrenal function
83
What is the **Zycortal**® 25 mg/ml **Prolonged-release Suspension** for Injection for Dogs used to treat?
Hypoadrenocorticism
84
What is the brand name given to the prolonged-release suspension, containing **Desoxycortone pivalate** for Hypoadrenocorticism?
Zycortal
85
What is **Desoxycortone pivalate** used to treat?
Hypoadrenocorticism
86
What is **Desoxycortone pivalate**?
* A **Corticosteroid**, with ***primarily mineralocorticoid activity*** * Similar to **Aldosterone**
87
# 8 .. What does **Zycortal**, the corticosteroid do to treat Hypoadrenocorticism?
1. Causes: * ***Sodium*** + ***Chloride*** ion **retention** * ***Hydrogen*** + ***Potassium*** ion **excretion** 2. Causing an **osmotic gradient** 3. The osmotic gradient **promotes** ***water absorption*** 4. **From** the **renal tubules** 5. Which **increases** ***extracellular fluid volume*** 6. Leading to **blood volume** ***expansion*** 7. **Improving** ***venous return*** to the **heart** 8. **Increasing** Cardiac **output**
88
How is **Zycortal** administered to patients with Hypoadrenocorticism?
1. **SC** inj 2. Every **25 days** | *Requiring regular monitoring*..
89
What are the **2 endocrine** organs in the Brain?
1. Hypothalamus 2. Pituitary gland
90
What organ secretes the **enzymes** which aid **digestion**?
Pancreas
91
What **2** hormones do **Ovaries** secrete?
1. **Progesterone** 2. Oestrogen
92
What hormone do Testicles secrete?
Testosterone
93
What is Insulinoma?
1. Pancreas produces **too much Insulin** 2. Leading to **hypoglycaemia** 3. Leading to: * *Coma* * *Collapse* * *Weakness* * *Neurological signs*
94
Apart from medication, name **3 alternative treatments** for Hyperadrenocorticism
1. **Surgery** 2. ***Radioactive therapy*** 3. **Diet** of low/**no Iodine**
95
**What** leads to ***Hypertrophic cardiac muscle*** > leading to an ***increased risk in blood clots***?
Hyperadrenocorticism
96
True or False. Glycogen lowers blood sugar, Insulin raises it.
False. **Glycogen** ***increases*** blood sugars, **Insulin** ***lowers*** it.
97
What cells create the digestive enzymes?
Acinar cells
98
What cells create Glucagon?
Alpha-cells
99
What does Hyperglycaemia stimulate the release of?
Insulin
100
How is Insulin released?
1. Binds to receptors 2. Opens channels 3. Enter cells
101
How does Insulin become non-respondent, in DM?
* If enough Insulin enters over time into the cell * The receptors become **less responsive** * As they become **exhausted** * So they **can't bind**
102
If an owner tells you their pet, that has DM is being sick, what can this indicate?
They are ketoacidotic!!
103
True or False. Neutering can be a possible treatment option for Endocrinopathies, like Hyperadrenocorticism.
True-ish! * Chemical castration can suppress undesirable behaviours * Which can be seen in endocrinopathies
104
Why shouldn't patients be on Glucocorticoids for long periods of time?
* Because they are immunosuppresive * So can lead to auto-immune disease
105
Why should you never give steroids to a diabetic?
Because they: 1. Inc blood glucose > Hyperglycaemia 2. Counteract Insulin therapy > DKA 3. Can trigger induce DM (T2) ## Footnote DKA = Diabetic ketoacidosis
106
On its datasheet, what potent drug selectively inhibits + enzymes, is given to Cushiod dogs + can cause sudden death?
Trilostane
107
Complete the sentence. "In the RAA system, wherever Sodium goes..."
"In the RAA system, wherever Sodium goes **water follows**!"
108
What endocrinopathy is known as "***The Great Pretender***", as its so hard to diagnose?
Addisons
109
Name the 3 most common dog breeds that present with Addisons
1. Poodles 2. WHWT 3. Border collies

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