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USMLE Step I Pharmacology > Endocrine Pharmacology > Flashcards

Endocrine Pharmacology Flashcards

1
Q

treatment strategies for type 1 diabetes mellitus

A

low carb diet insulin replacement

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2
Q

treatment strategies for type 2 diabetes mellitus

A

dietary modification and exercise for weight loss oral agents non insulin injectables insulin replacement

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3
Q

treatment strategies for gestational diabetes

A

dietary modifications exercise insulin replacement if lifestyle modification fails

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4
Q

name the 7 types of insuline

A

Lispro Aspart Glulisine regular NPH detemir glargine

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5
Q

which type of insulin is short acting?

A

only Regular insulin

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6
Q

which types of insulin are rapid acting?

A

Lispro

Aspart

Glulisine

“no LAG”

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7
Q

which insulins are intermediate acting?

A

only NPH

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8
Q

which insulins are long acting?

A

detemir

glargine

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9
Q

insulin, rapid acting–mechanism

A

binds insulin receptor (tyrosine kinase activity) rapidly, no LAG

liver: inc glucose stored as glycogen
muscle: inc glycogen, protein synthesis, inc K+ uptake
fat: inc triglyceride storage

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10
Q

insulin, rapid acting–use

A

Type I DM

type 2 DM

GDM (postprandial glucose control)

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11
Q

insulins, short acting–use

A

Type I DM

type 2 DM

GDM

DKA (IV)

hyperkalemia (+ glucose)

stress hyperglycemia

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12
Q

insulin, intermediate acting–use

A

Type 1 DM

type 2 DM

GDM

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13
Q

insulin, long acting–use

A

type 1 DM

type 2 DM

GDM (basal glucose control)

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14
Q

insulin–toxicity

A

hypoglycemia

lipodystrophy

rare hypersensitivity rxns

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15
Q

what drug is included in the drug class Biguanides and acts as an oral hypoglycemic drug?

A

metformin

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16
Q

biguanides–action

A

(metformin)

exact mechanism unknown

dec gluconeogenesis

inc glycolysis

inc peripheral glucose uptake (inc insulin sensitivity)

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17
Q

biguanides–use

A

(metformin)

oral

first line therapy in type 2 DM

causes modest weight loss

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18
Q

can biguanides (metformin) be used for patients w/o islet function?

A

yes (T1DM)

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19
Q

biguanides–toxicity

A

(metformin)

GI upset

most serious adverse rxn is lactic acidosis

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20
Q

when is biguanides (metformin) contraindicated?

A

renal insufficiency, b/c can lead to lactic acidosis

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21
Q

name the first generation sulfonylureas

A

chlorpropamide

tolbutamide

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22
Q

name the second generation sulfonylureas

A

glimepiride

glipizide

glyburide

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23
Q

sufonylureas–mechanism

A

close K+ channel in beta cell membrane –> cell depolarizes –> insulin release via inc Ca 2+ influx

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24
Q

sulfonylureas–use

A

stimulate release of endogenous insulin in type 2 DM

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25
Q

can sulfonylureas be used in type 1 DM?

A

no, becuase requires some islet fcn to work

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26
Q

sulfonylureas–toxicity

A

risk of hypoglycemia inc in renal failure

weight gain

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27
Q

first generation sulfonylureas–toxicity

A

disulfiram like effects

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28
Q

second generation sulfonylureas–toxicity

A

hypoglycemia

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29
Q

name glitazones/thiazolidinediones

A

pioglitazone

rosiglitazine

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30
Q

glitazones/thiazolidinediones–mechanism

A

inc insulin sensitivity in peripheral tissue

binds to PPAR-gamma nuclear transcription regulator which activates genes to regulate fatty acid storage and glucose metabolism

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31
Q

glitazones/thiazolidinediones–use

A

used as monotherapy in type 2 DM or combined with insulin, biguanides, or sulfonylureas

safe to use in renal impairment

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32
Q

glitazones/thiazolidinediones–toxicity

A

weight gain

edema

hepatotoxicity

HF
inc risk of fractures

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33
Q

name meglitinides

A

nateglinide

repaglinide

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34
Q

meglitinides–mechanism

A

stimulate postprandial insulin release by binding to K+ channels on beta cell membranes (different site than sulfonylureas)

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35
Q

meglitinides–use

A

used as a monotherapy in type 2 DM or combined with metformin

36
Q

meglitinides–toxicity

A

hypoglycemia (inc risk with renal failure)

weight gain

37
Q

name GLP-1 analogs

A

exenatide

liraglutide (SC injection)

38
Q

GLP-1 analogs–mechanism

A

inc glucose dependent insulin release

dec glucagon release

dec gastric emptying

inc satiety

39
Q

GLP-1 analogs–use

A

Type 2 DM

40
Q

GLP-1 analogs–toxicity

A

nausea

vomiting

pancreatitis

modest weight loss

41
Q

name the DPP-4 inhibitors

A

linagliptin

saxagliptin

sitagliptin

42
Q

DPP-4 inhibitors–mechanism

A

inhibits DPP-4 enzyme that deactivates GLP-1, so…

inc glucose dependent insulin release

dec glucagon release

dec gastric emptying

inc satiety

43
Q

DPP-4 inhibitors–use

A

Type 2 DM

44
Q

DPP-4 inhibitors–toxicity

A

mild urinary or respiratory infections

weight neutral

45
Q

name the amylin analogs

A

pramlintide (sc injection)

46
Q

amylin analogs–mechanism

A

dec gastric empyting

dec glucagon

47
Q

amylin analogs–use

A

Type 1 DM

type 2 DM

48
Q

amylin analogs–toxicity

A

hypoglycemia (in setting of mistimed prandial insulin)

nausea

49
Q

name the sodium glucose transporter 2 (SGLT-2) inhibitors

A

canagliflozin

dapagliflozin

empagliflozin

50
Q

SGLT 2 inhibitors–mechanism

A

block reabsorption of glucose in PCT

51
Q

SGLT 2 inhibitors–use

A

type 2 DM

52
Q

SGLT 2 inhibitors–toxicity

A

glucosuria

UTIs

vaginal yeast infections

hyperkalemia

dehydration (ortostatic hypotension)

53
Q

name the alpha glucosidase inhibitors

A

acarbose

miglitol

54
Q

alpha glucosidase inhibitors–mechanism

A

inhibit intestinal brush border alpha-glucosidases

delayed carbohydrate hydrolysis and glucose absorption –> dec postprandial hyperglycemia

55
Q

alpha glucosidase inhibitors–use

A

type 2 DM

56
Q

alpha glucosidase inhibitors–toxicity

A

GI disturbances

57
Q

name the thionamides

A

propylthiouracil (PTU)

methimazole

58
Q

thionamides–mechanism

A

block thyroid peroxidase–inhibits the oxidation of iodide and organification (coupling) or iodine –> inhibition of thyroid hormone synthesis

59
Q

what does propylthiouracil block and what is the result?

A

(thionamides)

blocks 5’-deiodinase

causes dec peripheral conversion of T4 to T3

60
Q

thionamides–use

A

hyperthyroidism

propylthiouracil (PTU) blocks peripheral conversion and is used in pregnancy

61
Q

thionamides–toxicity

A

skin rash

agranulocytosis (rare)

aplastic anemia

hepatotoxicity

62
Q

adverse effect of methimazole

A

(thionamides)

possible teratogen–can cause aplasia cutis

63
Q

drug names for T4 and T3

A

T4: levothyroxine

T3: triiodothyronine

64
Q

levothyroxine, triiodothyronine–mechanism

A

thyroid hormone replacement

65
Q

levothyroxine, triiodothyronine–use

A

hypothyroidism

myxedena

used off label as weight loss supplements

66
Q

levothyroxine, triiodothyronine–toxicity

A

tachycardia, heat intolerance, tremors, arrhythmias

67
Q

name the hypothalamic/pituitary drugs

A

ADH antagonists–conivaptan, tolvaptan

desmopressin acetate

GH

oxytocin

somatostatin (octreotide)

68
Q

name 2 ADH Antagonists

A

conivaptan

tolvaptan

69
Q

ADH antagonists–use

A

SIADH–block action of ADH at V2 receptor

70
Q

desmopressin acetate–use

A

central (not nephrogenic) DI

71
Q

GH–use

A

GH deficiency

turner syndrome

72
Q

oxytocin–use

A

stimulate labor, uterine contractions, milk let down

controls uterine hermorrhage

73
Q

somatostatin (octretide)–use

A

acromegaly

carcinoid syndrome

gastrinoma

glucagonoma

esophageal varices

74
Q

demeclocycline–mechanism

A

ADH antagonist (member of tetracycline family)

75
Q

demeclocycline–use

A

SIADH

76
Q

demeclocycline–toxicity

A

nephrogenic DI

photosensitivity

abnormalities of bone and teeth

77
Q

name the glucocorticoids

A

beclomethasone

dexamethasone

hydrocortisone

methlprednisolone

prednisone

triamcinolone

78
Q

glucocorticoids–mechanism

A

metabolic, catabolic, anti-inflammatory, and immunosuppressive effect mediated by interactions with glucocorticoid response elements

inhibition of phospholipase A2

inhibition of transcription factors such as NK-kappaB

79
Q

glucocorticoids–use

A

adrenal insufficiency

inflammation

immunosuppression

asthma

80
Q

glucocorticoids–toxicity

A

iatrogenic cushing syndrome

adrenocortical atrophy

peptic ulcers

steroid diabetes

steroid psychosis

cataracts

adrenal insufficiency if stop drug abruptly after chronic use

81
Q

Iatrogenic Cushing Syndrome

A

HTN

weight gain

mon facies

truncal obesity

buffalo hump

thinning of skin

striae

acne

osteoporosis

hyperglycemia

amenorrhea

immunosuppression

82
Q

fludrocortisone-mechanism

A

synthetic analog of aldosterone with little glucocorticoid effects

83
Q

fludrocortisone–use

A

mineralocorticoid replacement in primary adrenal insufficiency

84
Q

fludrocortisone–toxicity

A

similar to glucocorticoids

edema

exacerbation of heart failure

hyperpigmentation

85
Q

cinacalcet–mechanism

A

sensitizes Ca2+ sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ –> dec PTH

86
Q

cinacalcet–use

A

primary or secondary hyperparathyroidism

87
Q

cinacalcet–toxicity

A

hypocalcemia

USMLE Step I Pharmacology (17 decks)

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