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Flashcards in Endocrine Drugs Deck (111):
1

Why is Propylthiouracil (PTU) less frequently used in treatment for hyperthyroidsim in cats

Higher incidence of serious side effects

2

What is the best way to dose large patients (>50lbs) for Levothyroxine?

mg/m2

________________________

To avoid oversupplementation

3

General targets of drug therapy for "hyper" endocrine diseases 

Destroy abnormal tissue/ get rid of the source

Inhibit production of the substance

Enhance elimination of the substance

Inhibit function of the substance

4

Commonly used long acting insulins

Glargine

Prozinc (PZI)

Detemir

5

Clinical signs of Acute Hypocalcemia

Hyperesthesia/ pawing at the face

Tremors progressing to flaccid paralysis, seizures, hyperthermia, bradycardia

6

Endogenous hormone of glucocorticoids

Cortisol

7

Non genomic effects of glucocorticoids

Glucocorticoid receptors in the membrane → Rapid Effects

8

Short term management of acute hypocalcemia

Parenteral Calcium

Oral Calcium

9

Pharmacokinetics of what type of insulin is generally most predictable

Short-Acting

10

Examples of glucocorticoids with salt ester excipeints

Dexamethasone sodium phosphate- Azium, DexSP

Methylprednisolone sodium succinate - Solu-Medrol

Hydrocortisone sodium phosphate - Solu-Delta-Cortef

11

Treatment of atypical addisons

Prednisone

12

Long term side effects of glucocorticoids

Increased susceptibility to infection

Skin changes - hyperpigmentation, thinning, alopecia

Collagen disease, delayed wound healing

Hypertension, thromboembolic disease

Panting

Addisonian signs

13

14

Oral calcium options for treating Chronic Hypocalcemia

Ca Carbonate

Ca Proprionate

15

Adverse effects of glucocorticoids

PU/PD

Catabolic

Antagonize Insulin

Inhibit fertility

"Stress" leukogram

Impair healing

Calcinosis cutis, osteoporosis, thin skin and alopecia

Increase GI acid and decreased mucus

Increase fat absorption/ deposition

16

Regulation of glucocorticoids

Regulated by the hypotalamus/pituitary through the release of CRH and ACTH

17

Drugs that target the production of ACTH by the pituitary gland

Pergolide- Permax

Selegiline- Anipryl

18

Mechanism of action of mineralcorticoids

Regulate Na retention / K excretion by the kidney

19

T/F: Ca Chloride can be given SQ/IM

False

__________________

Ca Chloride is caustic

20

Primary goal of Diabetes Melitus therapy

Address the insulin deficiency

21

Mechanism of action of oral hypoglycemic agents

Stimulate insulin secretion by the pancreatic beta-cells by blocking K channels

Increase tissue sensitivity to insulin

22

Physiologic effects of glucocorticoids

Increase calcium excretion

Reduce Fever

Suppress immune system

Lymphotoxic

23

Modes of administration for Regular Insulin- Humulin-R

IV

IM

SQ

24

Excipients that may be used for injectible glucocorticoids

Salt Esters

Insoluble Esters

25

Cabimazole is converted to what in the body

Methimazole

26

How does hypoparathyroidism effect calcium

Hypoparathyroidism results in inability of the body to convert vitamin D to calcitriol, thus the GI tract cannot absorb calcium

27

Treatment of typical addisions

Prednisone + either DOCP or Fludrocortisone

28

Most commonly used drug to treat Cushings disease

Trilostain - Vetoryl

29

Commonly used short acting insulin

Regular Insulin - Humulin-R

30

In the cases of "hypo" endocrine diseases we need our therapy to do what

Replace an endogenous substace

31

Likely cause of hypoglycemia

Diet

32

Hypoadrenocortisim is usually caused by

Chronic destructionof the adrenal gland

33

Side effects of drugs targeting "hypo" endocrine diseases are typically related to 

Excess of the endogenous substances

34

Examples of glucocorticoids with insoluble ester excipients

Methylprednisolone Acetate - Depo-Medrol

Triamcinolone Acetonide - Vetalog

35

Types of corticosteroids

Glucocorticoids

Mineralcorticoids

36

Hyperadrenocorticism can be cuased by

Functional adrenal cortical mass

Functional pituitary mass

37

Insulin pen is a new product designed for 

Vetsulin/Caninsulin

38

Pergolide - Permax

Dopamine agonist

Suppress production of ACTH thus reduces cortisol production

 

39

Endogenous hormone of mineralcorticoids

Aldosterone

40

Lifelong management of hypocalcemia

Replace Vitamin D

Calcitriol, DHT, Ergocalciferol

41

Biggest potential side effect of calcitriol

Hypercalcemia

42

Mechanism of action of Iodides and Iodinated Contrast Agents

Inhibit thyroid hormone synthesis

Inhibit the release of preformed hormone

Inhibit T3 > T4 conversion in periphery

43

Why would you choose to use Levothyroxine over Liothyronin

Levothyroxine requires less freqent dosing and has lower risk of causing thyrotoxicosis

44

Ketoconazole

Inhibits enzyme in the steroid synthesis pathway

Efficacy being questioned

Potential for hepatotoxicity - hepatic microsomal enzyme inhibitor

45

Diagnostic tests using glucocorticoids

Low dose dexamethasone suppression test

High dose dexamethasone suppression test

46

Most potent, activated form of vitamin D

Calcitriol

47

Salt esters as excipients for glucocorticoids

Make steroid soluble

Suitable for IV administration

Onset may be faster and duration unchanged

48

DOCP is administered

Parenterally

49

Selegiline - Anipryl

Inhibits MAO-B which results in increased dopamine.

 

50

Only insulin that can be given IV

Regular Insuin - Humulin-R

51

Insoluble esters as excipients for glucocorticoids

Delayed onset, long duration

Opaque - not for IV use

 

52

Glucocorticoids are used for what effect

Anti-Inflammatory

53

Trilostain - Vetoryl

Inhibits 3beta-hydroxysteroid-dehydrogenase in cortisol pathway

Narrow therapeutic index

54

Why is methimazole most commonly used in the treatment of hyperthyroid cats?

Consistently efficacious

Side effects are uncommon

55

T/F: Oral medications for Diabetes Melitus treat the cause

False

______________________

Cause hypoglycemia

56

Calcium Disorders

Acute Hypocalcemia

Chronic Hypocalcemia

57

Thioureylenes used to treat hyperthyroidism in cats

Methimaxole

Carbimazole

Propylthiouracil PTU

58

Mechanism of Insulin release

Blood glucose rises ​→ energy dependent K channels close → membrane depolarization → insulin release

59

Rapid IV administration of calcium can cause

Arrhythmias

60

Common glucocorticoids

Prednisone

Prednisolone

Dexamethasone

Triamcinolone

Methylprednisolone

61

Long acting insulin that forms microprecipitates in physiologic pH which results in very gradual absorption

Glargine

62

Treatment strategy for  chronic hypoglycemia

Address the cause if possible and if not alter glucose production or use by the body

63

Genomic effects of glucocorticoids

Nuclear type glucocorticoid receptors in the cytoplasm → move into the nucleus → increase or decrease gene expression

64

Fludrocortisone is administered

orally

65

Common mineralcorticoids

Fludrocortisone

DOCP - Desoxycorticosterone pivalate

66

Insulin is produced by

the beta cells and islet of Langerhands in endocrine pancreas

67

General concept when treating acute hypocalcemia

Replace the calcium dificient until the patient can catch up

68

Pharmacological options to treat hyperthyroidism in cats include

Thioureylenes

Iodides and Iodinated Contrast Agents

69

T/F: Hypothyroid drugs must be given for the duration of the patients life.

True

70

Goal of therapy for Hypothyroidism in dogs

Replace hormone the body is not producing

71

Short acting insulins are most commonly used for

Hospitalized patients who are not eating

72

Atypical Addisons

Patient lacking only glucocorticoids

73

Drugs that target the production of glucocorticoids in the adrenal gland

Trilostain

Ketoconazole

74

Short term side effects of glucocorticoids

Usually not serious unless concurrent factors

Lab changes - stress leukogram, decreased thyroid

PU/PD, polyphagia

Fetal abnormalities/ abortion

75

Mode of administration of Vetsulin/Canisulin

SQ only

76

Exogenous glucose sources used in the treatment of hypoglycemia

Dextrose 50% Solution

Glucagon

77

Most common pharmacutical agent used to treat hyperthyroidism in cats

Methimazole 

78

Clinical uses of glucocorticoids

Diagnostic testing

Physiologic replacement therapy

Anti-inflammatory

Immunosuppressive

79

Pharmacokinetics of glucocorticoids

Absorbed orally and parenterally

Protein bound

Some must be hydrolyzed to release the steroid base

Metabolites excreted in urine

80

Used to treat Pituitary pars intermedia dysfunction (PPID) in horses

Pergolide - Permax

81

Targets for drug therapy for hyperadrenocorticism

Adrenal gland itself

82

Veterinary approved long acting insulin

Prozinc (PZI)

_____________________

May have shorter duration than other long acting insulins - especially in cats

83

Lack of response to normal feedback due to what can cause "hyper" endocrine diseases

Hyperplasia

Benign neoplasia - adenoma

Malignatn neoplasia - carcinoma

84

T/F: Ca Gluconate can be given SQ

True

__________________________

Should be diluted if given SQ, better to give IV

85

Long acting insulin that has a much higher potency in dogs

Detemir

86

Commonly used intermediate acting insulin

Vetsulin/Canisulin

87

Why are idodies and iodide contrast agents less freqently used in the treatment of hyperthyroid cats

Efficacy is variable and often transient.

88

Categories of Insulin based on duration of action

Short Acting

Intermediate Acting

Long Acting

89

Used to treat Canine Cognitive Dysfunction and sometimes used in attempt to treat Cushings Disease

Selefiline- Anipryl

90

Glipizide

Oral hypoglycemic drug

Only effective in 20-30% of cats

May accelerate beta loss

91

General goals of drug therapy in "hypo" endocrine diseases

Drug replacing an endogenous substance

Drug replacing something that directly allows the body to regain normal homeostasis

92

Side effects of Methimazole

Mild - GI signs, transient hematologic changes on CBC

Severe - Refractory GI signs, Idiosyncratic reactions (facial excoriation, hepatopathy, bone marrow suppression)

93

Treatment strategy for Acute Hypoglycemia

Address the cause and supply exogenous glucose source

94

Goal of therapy for Hyperthyroidism in cats

Stop excessive hormone production

95

Drugs used in the treatement of Hypothyroidism in dogs

Liothyronin (T3)

Levothyroxine (T4)

Soloxine

96

Hypoadrenocorticism - "Addisons Disease"

Deficient production of glucocorticoids +/- mineralcorticoids

97

Pharmacologic considerations when using glucocorticoids

Potency

Duration

98

In the cases of "hyper" endocrine diseases we need our therapy to 

Decrease the amount of an endogenous substance that is in excess

99

T/F: Concentrations of human and veterinary insulin products are the same.

False

_____________________

Human - 100 IU/mL

Veterinary - 40 IU/mL

100

Glucocorticoids are produced by the 

Zona Fasciculata

101

Typical Addisons

Patient lacking both glucocorticoids and mineralcorticoids

102

Parenteral calcium options for treating acute hypocalcemia

Ca Gluconate

Ca Chloride

103

Hyperadrenocorticism - "Cushings Disease"

Excess glucocorticoid production by the adrenals

104

Drugs that can interfere with thyroid test results

Phenobarbital

Zonisamide

Sulfonamide

Glucocorticoids

Phenylbutazone

Quinidine

Others

105

Mineralcorticoids are produced by the

Zona glomerulosa

106

Mechanism of action of Propylthiouracil PTU

Inhibit thyroid hormone synthesis

Inhibit conversion of T4 to T3

107

Mechanism of action of Methimaxole and Carbimazole

Inhibit thyroid hormone synthesis

108

Mitotane (Lysodren)

Used in the treatment of hyperadrenocorticism

Cytotoxic to cells of the fasciculata

Narrow therapeutic index

Start with high dose reduce to lower dose

109

Causes of hyperglycemia

Something that does not require therapy

Diabetes Mellitus (DM)

110

Periparturient Hypocalcemia

"Milk Fever" "Eclampsia"

Acute hypocalcemia

Sudden increase in calcium usage for which the patient cannot adapt rapidly enough - generally associated with birth or lactation

111

Oral Hypoglycemic drugs are useful in what type of diabetes

Type II Diabetes

__________________________

Pancreas is still capable of secreting some insulin