exam 4 Flashcards by jehanzab siddiqui

ultra fast and short acting insulins

lispro

aspart

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ultra long acting insulins

glargine (lantus-bedtime dose)

determir

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slows gastric emptying and appetite modulator

amylin-pramlintide

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incretin analog
decrease blood glucose
inhibits glucagon secretion
take with sulfonylurea/metformin

exenetide

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best for obese type 2
dec liver gluconeogenesis
dec insulin resistance
doesn’t induce hypoglycermia

metformin

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sulfonylureas
increase insulin secretion
affects atp sensitive k channels

which one is used for gestational diabetes?

glipizide and glyburide

glyburide is good for gestational

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thiazolidinediones
-anti hyperglycemic
increase insulin sensitivity without inc release

pioglitazone

rossiglitazone

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alpha-glucosidase inhibitor
-for mild to moderate fasting hyperglycemia
slows carb digestion and absorption which blunts blood glucose

acarbose

miglitol

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ddp-iv inhibitors
prevent breakdown of incretin
inc insulin

sitagliptin

saxagliptin

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opposite of sulfonylurea, opens atp sensitive k+
inhibits insulin release
also a antidiuretic

diazoxide

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for severe hypoglycemia

inc liver glucose output

glucagon

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for GH deficiency, sematopause, mitogenic-anti-apoptotic

subQ at night

somatotropin

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long term tx for skeletal muscle, organ growth
mitogenic and anti apoptotic effects
subq with meal

mecasermin IGF-1

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inhibit GH secretion
for acromegaly, carcinoid and pancreatic tumors
dec cAMP and Ca2+

octreotide-somatostatin, SRIF

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gh analog of HGH

**normalizes IGF-1 and best drug for acromegaly

Pegvisomat

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ergot da agonist for GH/PRL

normalizes IGF-1

bromocriptine

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stimulated by inc ecf osmolality, dec bp, hemorrhage, RA2 system

treat diabetes insipidus (reduced water permability and polyuria)

Vasopressin-ADH

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which moa of vasopressin is this?

phospholipase c-> IP3 ca2+ ->contraction of vascular and gi smooth muscle

V1a

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which moa of vasopressin is this?

adenylate cyclase -> cAMP-> aquaporin insertion into luminal membrane of collecting ducts

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synthetic analog of adh, longer duration, more potent v2

desmopressin

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uterine contraction

oxytocin

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synthetic acth
evaluate adrenal sufficiency
no therapeutic use

cosyntropin

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glucocorticoid receptor antagonist

adrenal hyperfunction, symptom control, assess acth secretion

mifepristone

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mineralocorticoid antagonist

for hypersecretion

spironiolactone

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glucocorticoid antagonist | -block cholesterol -> pregnolone

aminoglutethimide

glucocorticoid antagonist | block cortisol synthesis

metyrapone

glucocorticoid antagonist | inhibit p450 required for steroid synthesis

ketaconazole

active transport of iodide

iodide trapping

iodination of tyrosine residues of thyroglobulin

iodine organification

converts T4 to T3

-5' deiodinase

extreme iodide excess inhibits organification and hormone secretion

wolff-chaikoff effect

t4-prodrug

thyroxine

t3-potent active hormone

triiodothyronine

synthetic t4=drug of choice tx for myxedema coma-usually elderly with h/o hypothyroidism

levothyroxine

synthetitc t3 with rapid absorption

liothyronine

mixture of t4 and t3

liotrix

contraindications of T4 therapy?

adrenal insufficiency coumarin anticoags DM CV dz

anti-thyroidal agent with thiocarbamide group | inhibits thyroid peroxidase

thionamides =propylthiouracil methimazole

anti-thyroidal also partially inhibits t4->t3 faster acting -indicated for preggers

propylthiouracil

anti-thyroidal | longer duragion of action

methimazole

``` anti-thyroidal most common tx in US -for complete or partial destruction of thyroid with no injury to adjacent tissue -no preggers can use with BB, ca2+ channel antags ```

Radioactive iodine (131)I

raises serum ca2+ g protein-coupled receptor -induces osteoclast -increase reabsorption of ca2+ and mg2+

PTH

lowers serum ca2+

calcitonin

increases intestinal ca2+ absorption

vitamin d

abnormality of bone remodeling excessive bone turnover disruption of normal architecture deformities

pagets

defect of bone mineralization vitamin d deficiency or resistance rickets

osteomalacia

increases extracellular ca2+ increase new bone formation decrease fracture risk (osteoporosis) not used to treat hypocalcemia

teriparatide acetate (PTH analog)

use: pseudo/hypoparathyroidism, osteoporosis, rickets moa: intracellular nuclear hormone receptor superfamily -facilitates intestinal ca2+ absorption, increases calbindins expression, stimulates ca efflux into blood and synthesis of osteocalcin to produce bone matrix

calcitriol cholecalciferol

use: severe hypercalcemia, osteoporosis (when hrt is CI), pagets inactivates osteoclasts and increases renal excretion of ca2+ secreted by c cells of thyroid, stimulated by inc serum ca+

calcitonin

- bind to hydroxyapatite crystals, incorporated into bone matrix, taken up by osteoclasts - incapacitate osteoclasts and inhibits bone resorption - for osteoporosis in postmeno women, pagets, hypercalcemia ae: hypo, jaw osteonecrosis

bisphosphonates | -alendronate, ibandronic acid, zoledronic acid

- increase bone mineral density | - human anit-rank ligand monoclonal antibody that inhibits proliferation, differentiation, maturation of pre-osteoclasts

denosumab

tissues that express 5alpha-reductase->dihydrotestosterone (DHT)

type 1: skin, bone, liver | type 2: urogenital tissues, genital skin

tissues that express p450 aromatase ->estradiol (estrogen)

fat liver bone

- binds androgen receptor | - nuclear receptor

testosterone moa

-weak androgen, progestin, glucocorticoid activity -inhibits gonadal steroidogenesis -in females, inhibits midcycle gonadotropin surge for endometriosis, fibrocystic breast dz, hematological disorders

danazol

5alpha-reductase inhibitor -blocks production of dht use for benign prostatic hyperplasia

finasteride

used for pituitary suppression to inhibit gonadotropin release

estradiol

- antiandrogen with progestin activity | - use with estrogen to treat hirutism

cyproterone acetate

non-steroidal competitive antagonists -use for prostate cancer with GnRH agonist block action of adrenal androgens

flutamide

blocks both aldosterone and androgen receptors | inhibits 17alpha-hydroxylase

spironolactone | hirsutism

commonly abused anabolic steroid, to avoid detection on earlier drug tests

tetrahydrogesterone

what is IVRA

intarvenous regional anesthesia

where is IVRA used?

UE and LE surgery

advantage of IVRA

simple, reliable, rapid return to function, cost effective

Concerns of IVRA

duration of surgery, TQ time, LA toxicity

Locals used with IVRA

lidocaine, bupivacaine, ropivacaine, prilocaine

IVRA technique

``` IV contralateral limb butterfly in injured limb, in foot prepare la two TQ applied distal to fib head exsanguinate the limb inflate prox tq inject la through access if tq pain- inflast distal and release proximal ```

Adjuncts to IVRA

opiods, muscle relaxants, nsaids, clonidine, potassium, alkalizing agents

IVRA complications

``` seizures cardiac arrest/death incomplete anesthesia injection pain tq pain compartment syndrome neuro damage dysphoria, dizziness, facial tingling mistakenly deflating cuff injecting wrong drug ```

stimulate DA receptors

ABPR apomorphine bromocriptine-ERGOT pramipexole ropininole

``` anti-parkinsonion antiviral young anti cholinergic block uptake of DA while stim DA release ```

Amantidine

increases synthesis of DA

levodopa/carbidopa

inhibits da catabolism (MAO-B inhibitor) dont take with SSRI

selegiline

block breakdown of DA for pt with motor side effects from L-DOPA

Tolcapone-cns/peripheral | Entacapone-peripheral

neuroleptic for tourette's

haloperidol

alpha-2 agonists | first line tx for tourettes

clonidine

block da receptors | tourettes tx

fluoxetine

gaba-b receptor agonist | for als

baclofen

reduce glutamate release | for als

riluzole

I.A. - halogenated hydrocarbon - slow onset - recovery must be accompanied with opiod/no

halothane

I.A. - halogenated hydrocarbon - rapid onset/recovery - most widely used

isoflurane

I.A. - halogenated hydrocarbon - medium onset/recovery - deep anesthesia

enflurane

I.A. - halogenated hydrocarbon - rapid - good induction agent

sevoflurane

I.A. - analgesic - poor muscle relaxant - incomplete anesthesia - rapid, vasoconstrictor

nitrous oxide

- ultra short acting barbituate | - induce anesthesia prior to administration of another agent

thiopental

- benzodiazepine - slower than barbituates - anterograde amnesia - sedative

midazolam

-opioid analgesics

fentanyl | sufentanil

- gaba-rapid | - most common inducer

propofol

ultra short acting agent | -no analgesia, inducer

etomidate

dissociative anesthesia, catatonia, amnesia, unresponsiveness, ANALGESIC, no loss of conscousness blocks NMDA receptors

ketamine

Ester derived local anesthesias

procaine | chloroprocaine

amide derived locals

all the other caines

order of Locals from fast to slow onset

RLP, P, ME, BL, C | rop, lido, prilo

order of locals from short to longer duration

PCL, M,P,R,BL,E | pro, chloro, lido

1% solution =

1g/100ml or 10mg/ml

enhances the duration of L.A.'s

epinephrine

exam 4 Flashcards

(96 cards)