Endocrinology and Toxicology - Drugs Overview Flashcards by Guy Ben Arie

Cyanide Poisoning:

What are the possible drugs for treatment?(3)

1) Amyl nitrite (inhaled antidote)
2) Sodium nitrite (IV antidote)
3) Sodium thiosulfate (IV antidote)

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Cyanide Poisoning:
Treatment Mechanism of Amyl nitrite (inhaled antidote)
and Sodium nitrite (IV antidote)

Nitrites oxidize some of the hemoglobin’s iron
(ferrous → ferric), converting Hgb into methemoglobin.
Cyanide binds to methemoglobin, forming
cyanmethemoglobin, thus releasing cyanide from
cytochrome oxidase

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Cyanide Poisoning:
Treatment Mechanism of Sodium thiosulfate
(IV antidote)

Induces a metabolising enzyme, producing sodium

thiocyanate, which is excreted in urine

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Cholinesterase inhibitors poisoning:

What are the possible drugs for treatment?(2)

Atropine and Pralidoxime

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Cholinesterase inhibitors poisoning:

Treatment Mechanism of Atropine

Muscarinic receptor antagonist

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Cholinesterase inhibitors poisoning:

Treatment Mechanism of Pralidoxime

Reactivation of cholinesterase enzyme

alters interaction between poison and Ach

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Benzodiazepine poisoning:

What are the possible drugs for treatment?

Flumazenil

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Benzodiazepine poisoning:

Treatment Mechanism of Flumazenil

Benzodiazepine binding site antagonist

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Methanol Poisoning:

What are the possible drugs for treatment?

Fomepizole (Also Ethanol)

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Methanol Poisoning:

Treatment Mechanism of Fomepizole

Competitive inhibitor of alcohol dehydrogenase

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Lead Poisoning:

What are the possible drugs for treatment?(2)

Calcium EDTA and Dimercaprol (BAL)

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Lead Poisoning:

Treatment Mechanism of Calcium EDTA and Dimercaprol (BAL)?

Chelating Agents

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Opioids Poisoning:

What are the possible drugs for treatment?(2)

Nalorphine and Naloxone

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Opioids Poisoning:

Treatment Mechanism of Nalorphine

μ-receptor antagonist

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Opioids Poisoning:

Treatment Mechanism of Naloxone

Opioid antagonist

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Digoxin toxicity:

What are the possible drugs for treatment?(2)

Lidocaine and Anti-Digoxin Antibodies

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Digoxin toxicity:

Treatment Mechanism of Anti-Digoxin Antibodies

Neutralize the effect of the drug

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Digoxin toxicity:

Treatment Mechanism of Lidocaine

Antiarrhythmic (Na+-channel blocker)

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β-blockers - Mode of action:

Blood pressure ↓

- Cardiovascular effects

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ACE inhibitors - Mode of action:

Blood pressure ↓

- Cardiovascular effects

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Angiotensin inhibitors - Mode of action:

Blood pressure ↓

- Cardiovascular effects

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Ca2+ channel blockers - Mode of action:

Blood pressure ↓

- Cardiovascular effects

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Diuretics - Mode of action:

Reduce edema and fluid retention

- Improves CHF

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Statin - Mode of action:

Reduce cholesterol absorption

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Aspirin - Mode of action:

Anti-Platelet Aggregation

Clopidogrel - Mode of action:

Anti-Platelet Aggregation

Hyperprolactinemia: | What are the possible drugs for treatment?

Bromocriptine

Hyperprolactinemia: | Treatment Mechanism of Bromocriptine

Dopamine agonist (inhibits PRL release)

Acromegaly: | What are the possible drugs for treatment?(3)

1) Bromocriptine 2) SST Analogues 3) GH Analogues

Acromegaly: | Treatment Mechanism of Bromocriptine

Dopamine agonist | potential GH release inhibitor

Acromegaly: | Treatment Mechanism of Somatostatin analogues

Inhibition of GH release

Acromegaly: | Treatment Mechanism of GH Analogues

Antagonizes endogenous GH by blocking | GH binding to its receptor in the liver

Central Diabetes Insipidus: | What are the possible drugs for treatment?

Desmopressin

Central Diabetes Insipidus: | Treatment Mechanism of Desmopressin

ADH analogue (V2 receptor agonist)

Nephrogenic Diabetes Insipidus: | What are the possible drugs for treatment?

Hydrochlorothiazide (HCTZ)

Nephrogenic Diabetes Insipidus: | Treatment Mechanism of Hydrochlorothiazide?

Enhance fluid reabsorption in proximal tubule

SIADH: | Treatment Mechanism of Demeclocycline?

ADH inhibitor; V2 receptor antagonist

SIADH: | What are the possible drugs for treatment?

Demeclocycline

Adrenocortical Hypofunction: | What are the possible drugs for treatment?(2)

Hydrocortisone Dexamethasone

Adrenocortical Hypofunction: | Treatment Mechanism of Hydrocortisone ?

Synthetic Cortisol

Adrenocortical Hypofunction: | Treatment Mechanism of Dexamethasone?

Glucocorticoid analogue

Hyperthyroidism: | What are the possible drugs for treatment?(2)

Carbimazole and Propylthiouracil (PTU)

Hyperthyroidism: | Treatment Mechanism of Propylthiouracil (PTU)?

Inhibits thyroid peroxidase | Inhibits deiodinase enzyme (T4 → T3)

Hyperthyroidism: | Treatment Mechanism of Methimazole (Carbimazole)?

Inhibits thyroid peroxidase enzyme

Hypothyroidism: | What are the possible drugs for treatment?

Levothyroxine

Hypothyroidism: | Treatment Mechanism of Levothyroxine?

Synthetic T4

Hypercalcemia (Hyperparathyroidism): | What are the possible drugs for treatment?(4)

1) Loop diuretics (Furosemide) 2) Calcitonin 3) Bisphosphonate 4) Calcimimetic agent (Cinacalcet)

Hypercalcemia (Hyperparathyroidism): | Treatment Mechanism of Furosemide?

Decreases Ca2+ renal reabsorption

Hypercalcemia (Hyperparathyroidism): | Treatment Mechanism of Calcitonin?

Inhibits osteoclast activity

Hypercalcemia (Hyperparathyroidism): | Treatment Mechanism of Bisphosphonate?

Inhibits osteoclast activity | by inducing Apoptosis after phagocytosed

Hypercalcemia (Hyperparathyroidism): | Treatment Mechanism of Cinacalcet?

Shunting-off parathyroid activity | Increases sensitivity of Ca2+ sensing

Hyperlipidemia: | What are the possible drugs for treatment?(7)

1) HMG-CoA reductase inhibitor (Statin) 2) Cholesterol absorption inhibitor (Ezetimibe) 3) Bile acid sequestrants 4) MTP inhibitor (microsomal triglyceride transfer protein) 5) Apo-B inhibitor 6) Nicotinic acid 7) Omega-3 fatty acids

Hyperlipidemia: | Treatment Mechanism of Statin?

HMG-CoA reductase inhibitor: Cholesterol synthesis ↓ Hepatic LDL receptors ↑ VLDL production ↓

Hyperlipidemia: | Treatment Mechanism of Ezetimibe?

Cholesterol absorption inhibitor: Cholesterol absorption ↓ (NPC1L1 inhibitor) LDL receptors ↑

Hyperlipidemia: | Treatment Mechanism of Bile acid sequestrants?

Bile acid excretion ↑ | LDL receptors ↑

Hyperlipidemia: | Treatment Mechanism of MTP inhibitor?

Microsomal Triglyceride Transfer Protein | VLDL production ↓

Hyperlipidemia: | Treatment Mechanism of Apo-B inhibitor?

VLDL production ↓

Hyperlipidemia: | Treatment Mechanism of Nicotinic acid?

VLDL production ↓ | TG synthesis ↓

Hyperlipidemia: | Treatment Mechanism of Omega-3 fatty acids?

TG catabolism ↑

Acute Gout Arthritis: | What are the possible drugs for treatment?(3)

1) NSAIDs 2) Steroids 3) Colchicine

Acute Gout Arthritis: | Treatment Mechanism of NSAIDs?

COX inhibitor

Acute Gout Arthritis: | Treatment Mechanism of Steroids?

Anti-inflammatory

Acute Gout Arthritis: | Treatment Mechanism of Colchicine?

Interfere with gout inflammation

Chronic Hyperuricemic Arthritis: | Treatment Mechanism of Allopurinol?

Inhibits xanthine oxidase (uric acid synthesis ↓)

Chronic Hyperuricemic Arthritis: | Treatment Mechanism of Probenecid?

Uricosuric effect - increased renal excretion

Chronic Hyperuricemic Arthritis: | Treatment Mechanism of Colchicine?

Interfere with gout inflammation

Chronic Hyperuricemic Arthritis: | What are the possible drugs for treatment?(3)

1) Allopurinol 2) Probenecid 3) Colchicine

Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of Biguanides (Metformin)?

- Hepatic gluconeogenesis ↓ | - Peripheral glucose uptake ↑

Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of Sulfonylurea?

Closes ATP-sensitive K+ channel → Insulin secretion ↑

Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of Thiazolidinediones (TZD)?

- PPAR-γ agonist - Insulin resistance ↓ - Glucose utilization ↑ - Improves lipid profile

Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of GLP-1 receptor agonist?

- Insulin secretion ↑ - Glucagon secretion ↓ - Slow gastric emptying - Satiety

Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of DPP-4 inhibitor (dipeptidyl peptidase)?

Prolong endogenous GLP-1 action (inhibits | degradation)

Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of SGLT-2 inhibitor?

Activation-Na+/glucose co-transporter → Urinary glucose excretion ↑

Anti-Hyperglycemic (DM) therapy - Treatment Mechanism of Insulin?

- Glucose utilization ↑ - Hepatic gluconeogenesis ↓ - Anabolic actions

What is the drug treatment for Chronic Fibrous - | Riedel’s Thyroiditis?

Prednisone

Why is Metformin (biguanide) the best treatment for T2DM treatment ?

Activates AMP kinase→ ↓Gluconeogenesis and Insulin resistance . Also, Cardiovascular protection↑

What is the effect of Short-acting insulin on DM Patients?

``` Absorbed slowly (reaching peak after 60-90 minutes) and may predispose for hypoglycemia. Could be used in Medical Emergencies. ```

What are the Short-acting insulin analogues? (3)

● Insulin-Lispro ● Insulin-Aspart ● Insulin-Glulisine

Short-acting insulin analogues are engineered to:

Dissociate more rapidly (than the original)

Long-acting insulin: The action of human insulin can be _______ by the addition of zinc or protamine.

Long-acting insulin: The action of human insulin can be prolonged by the addition of zinc or protamine.

What is the most widely used protamine used for Long-acting insulin?

NPH

What are the Long-acting insulin analogues? (2)

● Insulin-Glargine | ● Insulin-Detemir

What drug would be used as a heme replacement in Acute Porphyria?

Heme-arginate

What are the Drugs used as Copper chelators for Wilson's Disease?(2)

1) D-penicillamine + vitamin B6 | 2) Trientine

What is the Vitamin should be AVOIDED for patients with Hemochromatosis? Why?

Vitamin C - Increase Iron absorption

What are emergency drug given to people with Hypocalcemic Tetany?

Ca-gluconate (Should be given slowly)

What is the common Antidote for Diethylene glycol, Ethylene glycol and Methanol Intoxication?

Ethanol

What is the drug given to reduce Immune mediated damage in Gout?

Prednisone

Drug-induced Diabetes Mellitus - What are the eliciting drugs? (High Doses over a long period of time)

Corticosteroides: Hydrocortisone, Dexamethasone and Prednisone

What is the drug of choice for Acetaminophen Intoxication?

N-Acetylcysteine

Endocrinology and Toxicology - Drugs Overview Flashcards

(90 cards)