Pharm: Focus Drug List MOA and AE: Cook

Question 1

Acarbose

Answer 1

a-glucosidase inhibitor:

• -reduce intestinal disaccharide/starch absorption
• -reduce post-eating glucose elevation
• -not used alone

Use:
DM2

AE:
-Terrible gas…

Question 2

Alendronate
Ibandronate
Risedronate
Zoledronic acid (Zonedronate)

Answer 2

Bisphosphonates:

• non-hydrolyzable analog of pyrophosphate swallowed up by osteoclasts who die
• inhibit bone resorption

Use:
Paget’s
Osteoporosis

AE:

• Esophageal/GI ulcers (no food 30 min, sit upright)
• Osteonecrosis of jaw

Question 3

Breakdown of bisphosphonate potency?

Answer 3

10-100x: 2nd gen
    Alendronate
    Ibandronate
1k-10k x: 3rd Gen
    Risendronate
    Zonendronate/Zolendronic Acid

Question 4

Who do you give 3rd generation bisphosphonates to?

Answer 4

Cancer patients: Maybe 1 dose to stop bone resorption by mets. IV only!

• Risendronate
• Zonendronate

Question 5

Hydrocortisone
Prednisolone/Prednisone
Methylprednisolone
Betamethasone
Dexamethasone

Answer 5

Cortisol:

• Bind GCRs to modify transcription of GREs
• Inhibit: NFkB, AP-1, NFAT, Phospholipase A2
• Decrease: TNFa, IL1, IL6; (PLP: decrease LT, PGs)

Use: Adrenal removal, inflammation, etc…

AE: 
WEAN OFF!!!!! due to pituitary atrophy
Osteoporosis
DM
Peptic ulcers
CNS: euphoria
Men: Hypogonadism (pit. decrease)
Women: Dyrhythmic cycles, bleeding
Kids: GH inhibition, IGF1 decrease, decrease growth

Question 6

What is the potency of Hydrocortisone?

Answer 6

1x
Short acting
Cortisol equivolent
Oral/IV/IM

Question 7

What is the potency of prednisolone/prednisone?

Answer 7

4x
Short acting
0.3Na–>swelling
Oral ONLY

Question 8

What is the potency of methylprednisolone?

Answer 8

5x
Short acting
0.5 Na–>swelling
ALLERGIES?

Question 9

What is the potency of betamethasone?

Answer 9

25-40x
Powerful
Oral/Topical

Question 10

What is the potency of dexamethasone?

Answer 10

30x
All administrations
EYE disease

Question 11

What class of glucocorticoids have mineralocorticoid action?

Answer 11

Short acting: prednisolone/methyl

Question 12

Capergoline

Bromocriptine

Answer 12

Capergoline: D2 Dopamine agonist
Bromocriptine: poorly tolerated D2 agonist

Question 13

Calcipotriol

Answer 13

PSORIASIS Vit D!

Vit D derivative for calcium regulation, stimulates Ca and Phos. absorption in GI

Used for psoriasis, hypoparathyroidism, osteoporosis.

More effective than glucocorticoids for psoriasis?

Question 14

Calcitriol

Answer 14

Active 1,25 D3
Made in skin–>liver–>kidney

Vit D derivative for calcium regulation, stimulates Ca and Phos. absorption in GI

Question 15

Calcium supplements

Answer 15

Increase calcium in hypocalcemia

Question 16

Cetrorilix

Ganirelix

Answer 16

GnRH receptor antagonist:

-Block GnRH to delay LH surge and ovulation for in vitro ovulation.

Question 17

Degarelix

Answer 17

GnRH receptor antagonist for prostate cancer LH reduction.

Question 18

Menotropin

Answer 18

LH/FSH purification for infertility.

IM injection.

Question 19

Octreotide

Answer 19

Somatostatin analog:

Block GH, Insulin, Glucagon

Question 20

Goserelin

Answer 20

GnRH agonist for prostate cancer, give high dose to cause chemical castration and prevent T release.

Question 21

Levothyroxine (synthroid)

Answer 21

L-T4.
Higher doses required in kids.
Can take weeks for steady state.
Monitor T3/T4 closely: narrow TI

Question 22

Liothyronine sodium

Answer 22

L-T3

Tablets or injection

Question 23

Propylthiouracil

Methimazole

Answer 23

Thyroid peroxidase inhibitor (oxidation, ionidation, coupling)

Question 24

PTU or Methimazole in pregnancy?

Answer 24

Ptu=Pregnancy

Methimazole crosses the placental barrier

Question 25

More potent, PTU or Methimazole?

Answer 25

Methimazole: 10x with longer t1/2 | Will destroy fetal thyroid

Question 26

Peripheral thyronine 5' deionidase, PTU or Methimazole?

Answer 26

PTU only: tissues cannot convert T4 to T3

Question 27

AE of PTU?

Answer 27

Rash | Agranulocytosis

Question 28

What imaging material can kill fetal thyroid?

Answer 28

Radioactive iodine contrast

Question 29

What two insulin have 1x daily injection?

Answer 29

Insulin glargine | Insulin demetir

Question 30

How are insulins made to have such a long half life?

Answer 30

isoelectric point increase (with zinc?)

Question 31

What is the structure of insulin glargine?

Answer 31

B21 asparagine to glycine and 2 asparagines added to Bchain C terminus

Question 32

What is the pH of insulin demetir?

Answer 32

Acidic solution is neutralized, forming a precipitate

Question 33

Glucagon

Answer 33

Alpha cells secrete Opposite of insulin Elevated in fasting Used for hypoglycemia rarely, usually just use glucose solution

Question 34

Glyburide

Answer 34

Sulfonylurea: Block K/ATP channel, causing beta cell depolarization and Ca influx, leading to Insulin release. DM2 AE: Liver toxicity, hepatitis, hypoglycemia

Question 35

Repaglinide | Nateglinide

Answer 35

Meglitinides: ATP/K channel, like sulfonylureas. Benzoic acid derivative. Taken before meal to control BG after absorption. AE: Hypoglycemia

Question 36

Metformin (+glyburide)

Answer 36

Decrease PEPCK and PC in liver, decreasing glucose production. Stimulate Insulin sensitivity DM2 AE: lactic acidosis

Question 37

Fludrocortisone

Answer 37

Aldosterone synthetic

Question 38

Pioglitazone

Answer 38

Thiazolidinedioines: PPARy to increase GLUT4 activity Major drug for increasing insulin sensitivity

Question 39

What pancreatic tumor is octreotide used for ?

Answer 39

Glucagonoma Insulinoma GH release too!

Question 40

Exanitide

Answer 40

GLP-1 receptor agonist: decrease post prandial glucose 1. Make you feel full 2. Inhibit glycogen breakdown in liver 3. increase insulin secretion for digestion 4. Slows gastric emptying 5. decrease glucagon secretion

Question 41

Teriperidide

Answer 41

Pulsatile PTH stimulates bone formation due to PTH-->osteoblasts action without making RANKL. May stimulate IGF-1. Important for women post bisphosphonate tx.

Question 42

Raloxifen

Answer 42

SERM: Selective Estrogen Receptor Modulator Inhibit osteoclasts Prevent breast cancer Osteoporosis approved

Question 43

Desunomab

Answer 43

``` RANKL mAb. Blocks osteoclast activtion Prevent bone resorption. Increase bone mass in cancer patients Biannual dose administration ```

Question 44

Cincalcinet

Answer 44

Ca Sensing Receptor allosteric binding, allows PTH suppression at lower blood Ca levels. Lowers PTH. HyperPTH and PTadenoma Tx

Question 45

Fluoride

Answer 45

Prevent cavities Mottles enamel, prevents decay. Binds to Ca, can prevent clotting. Toxicity: Osteosclerosis

Question 46

Cosyntropin: Synthetic ACTH

Answer 46

aa1-24 | Prefered to natural due to decreased ADH/AVP content (impurity in animal ACTH)

Question 47

Cholesevalam

Answer 47

Bile acid sequestrate Prevent bile (cholesterol) cycling

Question 48

Semilenthe insulin

Answer 48

Short acting | 12 hour insulin

Question 49

Sitagliptin

Answer 49

Dipeptidyl peptidase 4 inhibitor: | prevents the degradation of incretin (GLP-1) hormones by DP4, allowing GLP-1 to act to increase insulin release

Question 50

Somatropin

Answer 50

Generic hGH

Question 51

Menotropin

Answer 51

Menopause FSH/LH purificaiton from urine of old lady used for in vitro ovulatio control

Question 52

Ganirelix

Answer 52

GnRH receptor antagonist used for in vitro fertilization delay of LH surge and ovulation