ENDOCRINE- Pharmacology

Question 1

Treatment strategy for DM1

Answer 1

Low sugar dier

Insulin replacement

Question 2

Treatment strategies for DM2

Answer 2

Dietary modifications and exercise for weight loss; oeal agents, non insulin injectables, insulin replacement

Question 3

How are Insulin classified?

Answer 3

Rapid Acting
Short Acting
Intermediate
Long acting

Question 4

Which insulin are Rapid acting

Answer 4

Lispro
Aspart
Glulisine

Question 5

Which kind of receptor is for all types of insulins?

Answer 5

Bind insulin receptor (tyrosine kinase activity)

Question 6

Main organs where insulin acts

Answer 6

Liver
Muscle
Fat

Question 7

Effect of insulin in Liver

Answer 7

↑ glucose stored as glycogen

Question 8

Effect of Insulin in Muscle

Answer 8

↑ glycogen, protein synthesis, ↑ K+ uptake

Question 9

Which effect does insulin has on Fat?

Answer 9

↑ TG storage

Question 10

Clinical use for Insulin rapid acting

Answer 10

DM1, DM2, Gestational Diabetes Mellitus (GDM)

Question 11

When is recommended to administer Insulin rapid acting?

Answer 11

Postpandrial glucose control

Question 12

Toxic effects for insulins

Answer 12

Hypoglycemia, Rare hypersensitivity reactions

Question 13

Short acting Insulin

Answer 13

Regular

Question 14

Clinical use for short acting insulin

Answer 14

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

Question 15

Which insulin is recomended to administer in DKA patients? How?

Answer 15

Regular (Short acting insulin) IV

Question 16

Insulin, intermediate acting

Answer 16

NPH

Question 17

Clinical use for NPH insulin

Answer 17

DM1, DM2, GDM

Question 18

Insulin long acting

Answer 18

Glargine

Detemir

Question 19

When are Long acting insulin recommended?

Answer 19

DM1, DM2, GDM (basal glucose control)

Question 20

Example of Biguanides

Answer 20

Metformin

Question 21

What is the Metformin?

Answer 21

Biguanide

Question 22

Which is the mechanism of action of Metformin?

Answer 22

Exact mechanism is unknown

Question 23

What is the effect of Metformin?

Answer 23

↓ Gluconeogenesis
↑ Glycolysis
↑ peripheral glucose uptake (insulin sensitivity)

Question 24

First line therapy in type 2 Diabetes

Answer 24

Metformin

Question 25

Can Metformin be used in patients without islet functions?

Answer 25

Yes

Question 26

Which is the most common toxic effect of Metformin?

Answer 26

GI upset

Question 27

Most serious adverse effect of Metformin

Answer 27

Lactic acidosis

Question 28

When is Metformin contraindicated?

Answer 28

Renal Failure, because have higher risk for lactic acidosis

Question 29

First generation sulfonylureas

Answer 29

Tolbutamide | Chlorpropamide

Question 30

Second generation sulfonylureas

Answer 30

Glyburide Glimepiride Glipizide

Question 31

Mechanism of action of Sulfonylureas

Answer 31

Close K+ channel in β cell membrane, so cell depolarizes → triggering of insulin release via Ca2+ influx

Question 32

Clinical use for Sulfonylureas

Answer 32

Stimulate release of endogenous insulin in type 2 DM

Question 33

Are sulfonylureas useful in type 1 DM?

Answer 33

No, require some islet functions, so useless in type 1 DM

Question 34

When is increased the risk of hypoglicemia when using Sulfonylureas?

Answer 34

In Renal failure

Question 35

First generation Sulfonylureas toxic effects

Answer 35

Disulfiram like effects

Question 36

Second generation Sulfonylureas toxic effects

Answer 36

Hypoglycemia

Question 37

Alternative name for Thiazolidinediones

Answer 37

Glitazone

Question 38

Examples of Thiazolidinediones

Answer 38

Pioglitazone | Rosiglitazone

Question 39

Mechanism of action of Thiazolidinediones

Answer 39

↑ insulin sensitivity in peripheral tissue

Question 40

Where do Thiazolidinediones bind to?

Answer 40

PPAR-γ nuclear transcription regulator

Question 41

Clinical use for Thiazolidinediones

Answer 41

Used as monotherapy in type 2 DM or in combination

Question 42

Side effects of Thiazolidinediones

Answer 42

Weight gain, edema | Hepatotoxicity, heart failure

Question 43

α glucosidase inhibitors

Answer 43

Acarbose | Miglitol

Question 44

Mechanism of actions α glucosidase inhibitors

Answer 44

Inhibit intestinal brush border α glucosidases | Delayed sugar hydrolysis and glucose absorption → ↓ postpandrial hyperglycemia

Question 45

Clinical use for α glucosidase inhibitors

Answer 45

Used as monotherapy in type 2 DM or in combination

Question 46

Secondary effects of α glucosidase inhibitors

Answer 46

GI disturbances

Question 47

Amylin analog

Answer 47

Pramlintide

Question 48

Mechanism of action of Amylin analog

Answer 48

↓ gastric emptying, ↓ glucagon

Question 49

Clinical use for Amylin analogs

Answer 49

Type 1 and type 2 DM

Question 50

Toxic effects of Amylin Pramlintide

Answer 50

Hypoglicemia Nausea Diarrhea

Question 51

GLP-1 analogs

Answer 51

Exenatide | Liraglutide

Question 52

Mechanism of action of GLP-1 analogs

Answer 52

↑ insulin, ↓ glucagon release

Question 53

Which is the clinical use for GLP-1 analogs?

Answer 53

Type 2 DM

Question 54

Side effects of GLP-1 analogs

Answer 54

Nausea, vomiting; pancreatitis

Question 55

DDP-4 inhibitors

Answer 55

Linagliptin Saxagliptin Sitagliptin

Question 56

Mechanism of action of DPP-4 inhibitors

Answer 56

↑ insulin, ↓ glucagon release

Question 57

Clinical use for DPP-4 inhibitors

Answer 57

Type 2 DM

Question 58

Possible secondary effects of DPP-4 inhibitors

Answer 58

Mild urinary or respiratory infections

Question 59

What do genes activated by PPAR γ activate?

Answer 59

Fetty acid storage and glucose metabolism

Question 60

What is the effect of PPAR γ once is activated?

Answer 60

↑ insulin sensitivity and levels of adiponectin

Question 61

Which is the mechanism of action of propylthiouracil, methimazole?

Answer 61

Block thyroid peroxidase, inhibiting the oxidation of iodide and the organification (coupling) of iodine→ inhibition of thyroid hormone synthesis

Question 62

What else does Propylthiouracil blocks?

Answer 62

5' deiodinase which ↓ peripheral conversion of T4 to T3

Question 63

Which is the clinical use for propylthiouracil and methimazole?

Answer 63

Hyperthyroidism

Question 64

Which treatment is used in hyperthyrodism in pregnancy?

Answer 64

PTU (propylthiouracil)

Question 65

Side effect of both propylthiouracil, methimazole

Answer 65

Skin rash, agranulocytosis (rare), aplastic anemia

Question 66

Possible Side effect of just propylthiouracil

Answer 66

Hepatotoxicity

Question 67

Why do tou need to be careful when using methimazole?

Answer 67

Methimazole is a possible teratogen (can cause aplasia acutis)

Question 68

Mechanism of action of Levothyroxine, triiodothyronine

Answer 68

Thyroxine replacement

Question 69

Clinical use for Levothyroxine, triiodothyronine

Answer 69

Hypothyrodism, myxedema

Question 70

Toxic effects caused by Levothyroxine, triiodothyronine

Answer 70

Tachycardia, heat intolerance, tremors, arrhytmias

Question 71

When is recommended the use of GH?

Answer 71

GH deficiency | Turner syndrome

Question 72

In this situations is recommended to use Somatostatin (ocreotide)

Answer 72

Acromegaly, carcinoid, gastrinoma, glucagonoma, esophageal varices

Question 73

Uses for Oxytocin

Answer 73

Stimulates labor, uternine contractions, milk let down; controls uterine hemorrhage

Question 74

Mechanism action of demeclocycline

Answer 74

ADH antagonist (member of the tetracycline family)

Question 75

Clinical of of demeclocycline

Answer 75

SIADH

Question 76

Toxic effects of Demeclocycline

Answer 76

Nephrogenic DI, photosensitivity, abnormalities of bone and teeth

Question 77

Toxic effects of Demeclocycline

Answer 77

Nephrogenic DI, photosensitivity, abnormalities of bone and teeth

Question 78

Which drugs are glicocoticoids?

Answer 78

Hydrocotisone, prednisone, triamcinolonem dexamethasone, beclomethasone, fluodrocortisone

Question 79

Mechanism of action of Glucocorticoids

Answer 79

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

Question 80

Clinical use for glucocorticoids

Answer 80

Addison disease, inflammation, immune suppression, asthma

Question 81

Principal side effect of Glucocorticoids

Answer 81

Iatrogenic Cushing syndrome

Question 82

Clinical manifestations of iatrogenic cushing syndrome

Answer 82

Buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocotical atrophy, peptic ulcers

Question 83

Chronic effect of Glucocorticoids

Answer 83

Diabetes

Question 84

How is osteoporosis treated when caused by Glucocorticoids?

Answer 84

Biphosphonate

Question 85

Secondary effect when glucocorticoids stop ped abruptly after chronic use

Answer 85

Adrenal insufficiency