Endocrine Part II Flashcards

Question

Vasopressin releases what

Answer 1

ADH and Desmopressin [DDAVP]

Answer 2

◦ Has both antidiuretic & vasopressor effects ◦ In kidney it works to ↑ H2O permeability & reabsorption in collecting tubules ◦ Used to treat diabetes insipidus ◦ Can also be used in cardiac arrest & to ↓ bleeding in esophageal varices ◦ AE—H2O intoxication & low Na+

Answer 3

30 or more

Answer 4

40 or more

Answer 5

↓ risk of Type 2 DM, metabolic syndrome & slowing prevalence of HTN and dyslipidemia [DLP]

Answer 6

 Patient has a history of being unable to successfully lose weight & maintain weight loss AND  Meets indications for agents approved for long term management by FDA ◦ BMI >/= 27 with 1 or more weight associated complications [this is FDA language when drugs were approved, as you can see [slide #18]—recent guidelines suggest a lower BMI if patient has complications] OR ◦ BMI of >/= 30

Answer 7

◦ These are approved for short term use only [90 days] ◦ Diethylpropion [Tenuate] ◦ Phentermine [Adipex-P] ◦ Both of these agents ↑ norepinephrine [Phentermine also ↑ dopamine] & both inhibit the reuptake of NE [+/- Dp]; this ↑ in NE ↓appetite  Tolerance develops easily

Answer 8

Phentermine is excreted in kidney; Diethylpropion is metabolized in the liver, the active metabolites are excreted in kidney—these metabolites have a 4-8 hour 1⁄2 life

Answer 9

controlled substances [S IV] b/c of potential for dependence; common SE—dry mouth, HA, insomnia, constipation; can ↑ BP ◦ Avoid in those with uncontrolled BP, CV disease, arrhythmias, CHF or stroke hx

Answer 10

with other sympathomimetics [sudafed, excess caffeine, etc] & MAO inhibitors

Answer 11

◦ MOA—pentanoic acid ester that inhibits gastric and pancreatic lipases, ↓ breakdown of fat  ↓ fat absorption by 30%; main mechanism of weight loss—this loss of calories ◦ Pharmacokinetics—taken with food that contains fat; minimal absorption; excreted in feces ◦ AE—oily spotting, gas, interferes with absorption of fat soluble vitamins [A, E, D, K & β carotene] ◦ Separate use of vitamins by 20 & others agents by 40 ◦ CI—pregnancy, chronic malabsorption, cholestasis

Answer 12

◦ Selectively binds to 2C serotonin receptor [5-HT2c]  Previous drugs of this class caused valve disease— thought to be linked to their effect on 5-HT 2B receptors ◦ MOA—with 5HT-2c receptor activation, stimulates pro-opiomelanocortin neurons, which activate melanocortin receptors, causing a ↓ in appetite ◦ Pharmacokinetics—metabolized in liver—inactive metabolites are eliminated in the urine [not recommended in severe renal impairment]

Answer 13

-nausea, headache, dry mouth, constipation, lethargy ◦ Rarely, mood changes and SI ◦ Caution with use of other serotonergic agent— SNRIs, SSRIs, MAOIs—because of risk of NMS ◦ Monitor patient for development of valvular heart disease—assess for new or ∆ in murmur ◦ Avoid prescribing this agent in patients with hx of CHF, those with hx of known valve problems

Answer 14

◦ Because topiramate can be sedating, the stimulant | phentermine was added to counteract any sedation ◦ Dosed in stages & titrated ↑ over 2 weeks

Answer 15

sympathomimetic combined with AED; true mechanism unclear, but thought to be ↑ satiety & ↓ appetite through augmented GABA activity ◦ CI—pregnancy, glaucoma, hyperthyroidism, active suicidal ideations, cannot be used within 14 days of taking an MAOI

Answer 16

paresthesias, cognitive dysfunction, ↑ HR, diuretics that cause ↓ K+ can produce profound hypokalemia when given with Qsymia; can ↑ risk of renal stones [topiramate component] ; may ↓ efficacy of OCP

Answer 17

◦ For weight loss—exact MOA is unknown  Naltrexone antagonizes various opioid receptors, while Bupropion inhibits neuronal uptake of NE & dopamine ◦ CI—uncontrolled HTN, sz disorders, patients abruptly stopping ETOH, benzos, barbiturates or AEDs; patients on opioids ◦ AE—worsening depression, neuropsychiatric reactions; may need to ↓ dose of anti-diabetic agents; can ↑ levels of Paxil, Zoloft, Respirdol, Metoprolol

Answer 18

◦ 3 mg SQ daily ◦ MOA—GLP 1 receptor agonist; ↓ appetite & ↑ satiety ◦ CI—insulin, personal or family hx of thyroid cancers or mx endocrine neoplasia syndrome type 2, pancreatitis ◦ AE—constipation, diarrhea, dyspepsia, fatigue, increased HR, low BS [rare in nondiabetics], nausea ◦ Cannot administer 3 mg of Liraglutide as Victoza [must give 2 shots of 1.8 + 1.2 mg/ml]; but can give as one injection if you Rx patient with Saxenda

Answer 19

1. Orlistat 2. Lorcaserin 3. Phentermine/Topiramate ER 4. Naltraxone ER/Bupropion ER 5. Liraglutide

Answer 20

Drug class: none Dosage: 120 mg TID 60 mg TID [otc dosing] MOA: lipase inhibitor Therapeutic effect: fat excretion in stool

Answer 21

Drug class: Schedule IV Dosage: 10 mg BID MOA: seratonin 2C receptor agonist Therapeutic effect: appetite suppression

Answer 22

Drug class: Schedule IV Dosage: 7.5/46 mg QD [can increase to 15/92 mg QD if needed] MOA: Sympatho- mimetic/AED Therapeutic effect: Appetite suppression

Answer 23

Drug class: none Dosage: 16/180 mg BID MOA:Opioid antagonist/anti- depressant Therapeutic effect: Appetite regulation

Answer 24

Drug class: none Dosage: SQ 3mg daily MOA: GLP-1 receptor agonist Therapeutic effect: appetite suppression

Answer 25

Other drugs: ↓ cyclosporine exposure GI/Biliary: Cholestasis** Mal- absorption** Cholelitiasis High fat diets Must replace fat soluble vitamins Renal/GU: Increased urine oxalate—use caution

Answer 26

Caution with CV-Valvular heart dx seen with other seratonergic agents Priapism CNS: Seratonin syndrome Cognitive impair- ment Psych: Psychiatric disorders with super high doses May cause depression in some

Answer 27

Caution with other drugs- MAOI** Caution with CV-increased HR Caution with endocrine-Hyperthyroidism** Metabolic acidosis Low BS Caution with reproductive- Fetal toxicities [oral clefts] CNS-Cognitive impairment with rapid titration Visual-glaucoma Psych- AED may ↑ risk of SI Mood & sleep disorders Renal/GU-Increased creatinine—use caution

Answer 28

Caution with drugs-Other bupropion products, chronic** opioids**, MAOI** Caution with CV-Uncontrolled HTN** Increases BP and HR Caution with endocrine-Hypoglycemia GI/Biliary- hepatotoxic CNS-Seizures** Eating Disorder** Seizure Risk Visual-Angle closure glaucoma Psych-BB warnings on Bupropion— increased risk of SI [especially in those <24 yrs] Neuropsychiatric events have occurred when used for smoking cessation

Answer 29

``` Caution with other drugs-insulin Caution with CV-increased HR Caution with endocrine-Personal or HF of thyroid cancer** Multi-endocrine neoplasia syndrome II** Hypoglycemia Type I DM DKA GI/Biliary- Acute GB disease HX of acute pancreatitis Psych- SI or suicidal behaviors Renal/GU- Renal impairment— use caution ```

Answer 30

is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.