Final Review Flashcards Preview

Pharm 3 > Final Review > Flashcards

Flashcards in Final Review Deck (112)
Loading flashcards...
1

Diabetic agents that cause pancreatitis?

Exenatide - GLP-1 (incretin) analog

Sitaglipitin - DPP-IV inhibitor (inhibits incretin break down)

2

Diabetic agents that liver function needs to be monitored?

TZDs (Pioglitazone and Rosiglitazone) - increase insulin sensitivity [Pioglitazone has a good lipid profile, both also cause fluid retention]

Acarbose - a-glucosidase inhibitor

3

Metformin?

Inhibits gluconeogenic enzymes via AMPK -- weight loss os common

AE - B12 def, lactic acidosis, possible disulfiram rxn (in the sense that alcohol causes hypoglycemia and metformin decrease glucose production)

4

Sulfonylurea?

Binds SUR1 subunit and blocks ATP-sensitive K+ channels

1st gen - Chlorpropamide -- watch for SIADH and DISULFIRAM rxn

2nd gen - Glyburide, Glipizide, Glimepiride

5

Canagliflozin

SGLT2 inhibitor

AE - infections and osmotic imbalance

6

Pegvisomant?

Growth hormone antagonist

7

Octreotide?

Somatostatin analog - inhibits release of GH, TSH, glucagon, Insulin and gastrin

45x more potent in inhibiting GH release compared to somatostatin

2x more potent in reducing insulin secretion

t1/2 = 80 minutes

Octreotide acetate - long acting suspension given at 4 week intervals

Clinical application - reduce hormone-secretion tumor symptoms, localize neuroendocrine tumors, acute control of bleeding from esophageal varices

AE - nausea, vomiting, abdominal cramps, flatulence, steatorrhea, constipation, biliary sludge, gallstones, sinus bradycardia, vit B12 def (with long term use), pain at injection site (common)

8

GnRH antagonists?

Ganirelix and Cetrorelix

9

Desmopressin and Vasopressin?

ADH analogs -- MINIMAL V1 affinity (SM cells on efferent)

Clinical application...
1. DOC for diabetes insupidus
2. Esophageal bleeding and colonic diverticular bleeding (vasopressin)
3. Coagulopathy tx in hemophilia A and vWF disease (Desmopressin)

AE - headache, nausea, abdominal cramps, allergic reaction

10

Glucocorticoid agonists and antagonists?

Agonist...
Hydrocortisone (Cortisol) [equal amt of anti-inflammatory and salt-retaining activity]
Prednisone
Methylprednisolone
Triamcinolone (aerosol) [no salt retaining ability]
Dexamethasone [no salt retaining ability]
Beclamethosone (aerosol)

Antagonist.... Mifepristone

11

Mineralocorticoid agonists and antagonists?

Agonists... Aldosterone and Fludrocortisone

Antagonists... Spirnolactone (watch out for hyperkalemia)

12

Tx of cerebral edema and Hodgkins Lymphoma?

Cerebral edema = dexamethasone

Hodgkin's lymphoma = prednisone

13

Aminoglutethimide?

Desmolase inhibitor - used to block all adrenal cortex hormones (ex. adrenal cancer)

14

Ketoconazole in tx of cushings and prostate cancer?

Non-selective inhibitor - inhibits desmolase, 17 hydrox and 17,20 lyase

15

Metyrapone?

11B hydroxylase inhibitor -- tx PREGNANT women with cushings

AE... salt and water retention, hirsutism, transient dizziness, GI disturbances

16

B blockers used in the treatment of hyperthyroidism?

Propranolol, Nadolol, Esmolol (short acting)

MOA - competitive block of B receptors inhibiting conversion of T4 to T3

With pts with asthma, can be given calcium channels instead (diltiazem and verapamil) as alternatives.

17

Oral Diatrizoate and IV iohexol?

iodinated radiocontrat media that suppress the conversion of T4 to T3 (5-deiodinase) in the peripheral tissue, kidney and liver. It is useful in rapidly reducing the T3 concentration in thyrotoxicosis.

18

Perchlorate, thiocyanate, pertechnetate?

Rarely used antithyroid drugs that inhibit iodide concentration in the gland by blocking the transportation of iodine in to the thyroid gland.
Possible development of APLASTIC ANEMIA.

19

Drugs that may provoke autoimmune/destructive inflammatory thyroiditis which can induce hypothyroidism?

1. amiodaron
2. INF-a and IL-2
3. Lithium - inhibits release of hormones and thyroid enlarge (hypothyroidism)
4. imatinib, sunitnib (TKRI-tyrosine kinase receptor decrease)
5. aminoglutethimide, sulfonylurea

20

Prostaglandins used for cervical ripening; uterine contractions; postpartum hemorrhage?

Cervical ripening and contraction = misoprostol (PGE1), Dinoprostone (PGE2)

Postpartum hemorrhage = misoprostol and Carboprost Tromethamine (PGF2 analog give IM administration)

21

Methylergonovine?

-partial a-agonist and some serotonin receptor activity
-tx postpartum hemorrhage
-ergot alkaloid [says erg in the name..]
-contraindicated if pt has CV or cardiac issues

22

Tocolytics?

Magnesium sulfate - uncouples excitation-contraction in myometrium inhibiting AP - may cause resp depression or cardiac arrest in mom or baby

Indomethacin - NSAID - may cause oligohydramnios and close PDA early

Nifedipine - Calcium channel blocker - safer than other tocolytics

Atosiban - oxytocin competitive antagonists - not approved in the US

B2 adrenoceptor agonist - phosphorylation of SmMKLCK inhibiting its interaction with calcium-calmodulin complex -- black box warning in the US as it may cause maternal death

23

Fibroblast growth factor-23?

Produced by osteoblasts and osteoclasts. FGF-23 inhibits calcitriol (activated vit D) production decreasing calcium and phosphate reabsorption in the kidneys and intestines.

*PTH stimulates calcitriol (1a-hydroxylase) activity in kidney whereas FGF-23 inhibits it

24

Teriparatide?

PTH analog
-low levels cause bone anabolism
-high levels cause bone catabolism

AE - hypercalcemia, hypercalciuria, osteosarcoma

25

Doxercalciferol?

1a-hydroxyvitamin D2

26

Paricalcitol?

19-nor-1,25 - dihydroxyvitamin D2

27

Calcipotriol?

vit D derivative used to treat psoriasis

28

Bisphosphonates (Alendronate)?

Suppresses activity of osteoclasts and inhibits bone resorption. It inhibits osteoclastic activity via decreasing farnesyl pyrophosphate synthesis by disrupting mevalonate pathway decreasing osteoclast H+ ATPase.

Uses - osteoporosis and Paget's disease

AE - adhynamic bone, esophageal irritation (risk reduced by drinking water and remaining in upright position for 30 minutes after taking medication), osteonecrosis of jaw

Ex. Risedronate, Ibandronate, Pamidronate, Zoledronate -- all very similar to aledronate

29

Denosumab?

Monoclonal antibody that binds RANKL (rank ligand). Binding to the RANKL leads to inhibition of osteoclastic activity.

Uses - osteoporosis

Subcutaneous every 6 months

AE - increase risk of infections

30

Cinacalcet?

Calcimemtic that stimulates the calcium-sensing receptors (CaSR) in parathyroid to circulating Calcium leading to decrease in PTH. When the receptors is activated by cinaclcet or free ionized calcium, it activates a signaling pathway to suppress PTH synthesis and release.

Uses - hyperparathyroidism

Oral admin

AE - nausea, vomiting, hypocalcemia, adynamic bone