Renal and Endocrine Flashcards

Question

Progesterone therapy

Answer 1

For hormone replacement in menopause | - only for endometrial protection due reduce endometrial growth in women with uterus

Answer 2

For vaginal dryness in menopause

Answer 3

``` Anti-HER2/neu Use: - HER+ breast cancer Side effects: - CHF/cardiotoxicity ```

Answer 4

Doxorubicin/adriamycin Mechanism: - topo II inhibitor (stabilizes double strand DNA break) - intercalate btw DNA base pairs to block synthesis - oxygen free radical production via Fe Side effects: - CHF/cardiotoxic

Answer 5

``` Somatostatin analogs: - octreotide - lanreotide GH antagonist: - pegvisomant ```

Answer 6

Dopamine agonists: - cabergoline - bromocriptine

Answer 7

``` Drugs: - alendronate - best choice - risedronate - ibandronate - zoledronic acid Mechanism: - inhibits osteoclast activity and prevents osteoblast apoptosis Use: - rx of choice for osteoporosis - increase BMD, reduce all fx - rx of Paget's disease of bone - IV zoledronic acid - acute symptomatic hypercalcemia - IV zoledronic acid Ibandronate does not reduce hip fx Side effects: - iriis - bone pain - flu symptoms - osteonecrosis of the jaw - atypical subtrochanteric femur fx Contraindications: - renal failure - severe reflux - for oral - gastrectomy - for oral ```

Answer 8

``` Mechanism: - anti-RANKL - reduce activation of osteoclast precursor Use: - reduce all fx Sid effects: - increased risk of eczema - osteonecrosis of the jaw - atypical femur fx - risk of hypocalcemia in ESRD Can use in ESRD ```

Answer 9

``` Mechanism: - inhibits osteoclast fnx Effects: - BMD increase - decrease spine fx - no reduction in hip fx Use: - osteoporosis - not very effective, not 1st line - acute symptomatic hypercalcemia to inhibit bone breakdown Side effects: - nasal irritation - lightheadedness ```

Answer 10

``` Directly stimulates bone formation Mechanism: - stimulates osteoblast fnx Effects: - increase BMD - reduce all fx Risks: - rare hypercalcemia - lightheadedness from low BP - osteosarcoma in rats ```

Answer 11

Calcium sensor receptor agonist - binds to Ca sensing receptor on parathyroid cells - inhibits PTH release Use: - primary and secondary hyperparathyroidism

Answer 12

First line for thyroid hormone replacement | T4 replacement

Answer 13

``` T3 replacement Fast action, short half-life More potent than T4 IV used for myxedema coma - give with hydrocortisone for prophylactic stress dose in case of polyendocrine syndrome ```

Answer 14

4:1 ratio T4:T3

Answer 15

Animal source | Allergenicity

Answer 16

``` Anti-thyroid thioamide Mechanism: - inhibit thyroid peroxidase - block iodine organification - block coupling of iodotyrosines Slow onset cuz blocks synthesis, not release 1st line ```

Answer 17

``` Anti-thyroid thioamide Mechanism: - inhibit thyroid peroxidase - block iodine organification - block coupling of iodotyrosines - PTU also blocks T4 to T3 conversion Slow onset cuz blocks synthesis, not release Use: - use in 1st trimester of pregnancy cuz less placenta crossing - or if allergy to methimazole Can precipitate fulminant liver failure ```

Answer 18

Antithyroid anion inihbitor Mechanism: - block uptake of iodine via competitive inhibition of Na/I cotransporter

Answer 19

Antithyroid anion inihbitor Mechanism: - block uptake of iodine via competitive inhibition of Na/I cotransporter

Answer 20

Antithyroid iodide Mechanism: - block organification - inhibit thyroglobulin proteolysis so blocks hormone release - decrease size and vascularity of hyperplastic gland Take before surgery to reduce size of gland Rapid improvement in thyrotoxicosis symptoms Disadvantages: - increases intraglandular iodine stores - prevents use of radioactive iodine for wks - cannot use alone - gland escapes the block, get withdrawal toxicosis

Answer 21

Destruction of thyroid parenchyma witihn a few wks due to selective uptake by thyroid Don't give to pregnant or nursing Get some thyroid hormone release as thyroid is destroyed

Answer 22

For hyperthyroid - block symptoms of thyrotoxicosis cuz mimic symp stimulation Use propranolol - blocks peripheral T4 to T3 conversion

Answer 23

``` Iodine - immediate help BBs - propranolol Steroids PTU/methimazole but these take a while Rx the underlying cause Can do plasmapheresis, peritoneal dialysis, cholestyramine, lithium Acetaminophen, not ASA ```

Answer 24

IV thyroxine big bolus, then lower doses daily | Prophylactic hydrocortisone

Answer 25

``` First gen - tolbutamide - chlorpropamide - tolazamide - acetohexamide Second gen - glyburide - glipizide - glimepiride ```

Answer 26

``` Mechanism: - block KATP channel - no efflex - depolarizes beta cell - increased insulin secretion Big A1c reduction - 1-2% Side effects: - nausea - skin rxns - photosensitivity - abnormal LFTs - weight gain Can lead to hypoglycemia ```

Answer 27

``` Drugs: - repaglinide - nateglinide Mechanism: - stimulate insulin secretion Short acting Big A1c reduction - 1-2% Side effects: - URI - headache - weight gain No sulfur - can be used when allergic to sulfur or sulfonylureas ```

Answer 28

``` Metformin 1st line: - reduces diabetes related end points - reduces diabetes related deaths - reduces all cause mortality - MI reduction Mechanism: - decreases hepatic gluconeogenesis - lowers fasting glucose - increases insulin mediated glucose utilization in muscle/liver Big A1c reduction - 1-2% Side effects: - diarrhea, nausea, anorexia - lactic acidosis - vit B12 deficiency Weight loss No hypoglycemia Contraindications: - renal dysfnx - concurrent liver disease or alcohol abuse - heart failure - past hx of lactic acidosis - decrease tissue perfusion or hemodynamic instability ```

Answer 29

``` Drugs: - rosiglitazone - pioglitazone Mechanism: - PPAR y modulators - increase sensitivity of muscle, fat, and liver to insulin by increasing glucose transporter expression GLUT4 - modulate protein expression - do not work instantly - takes 4-6 wks for protein expression to be seen - inhibit hepatic gluconeogenesis A1c reduction good 1-1.5% Side effects: - large weight gain - fluid retention - peripheral edema - CHF - bladder cancer - pioglitazone - osteoporosis Contraindications: - heart failure ```

Answer 30

``` Drugs: - acarbose, miglitol Mechanism: - competitively inhibit alpha glucosidase enzymes at enterocyte brush border - reduce rate of polysaccharide absorption in proximal small intestine - lower post-prandial glucose levels - effect only on post-prandial glucose, not fasting Minor A1c reduction - 0.5-0.8% Side effects: - GI discomfort - flatulence, diarrhea Weight neutral Use this when run out of options ```

Answer 31

``` Drugs: - exenatide - liraglutide - albiglutide - dulaglutide Mechanism: - potentiates glucose stimulated insulin secretion - suppresses glucagon secretion and slows gatric motility Good A1c reduction - 1% Side effects: - nausea, vomit - diarrhea - risk of pancreatitis - C cell thyroid tumors/hyperplasia - liraglutide Big weight loss ```

Answer 32

``` Drugs: - sitagliptin - saxagliptin - linagliptin - alogliptin Mechanism: - inhibits DDP4 - increase endogenous GLP-1 A1c reduction okay - 0.6-0.9% Not as good as GLP1 agonist Side effects: - increased risk for URI and UTI - pancreatitis - C cell hyperplasia Weight neutral ```

Answer 33

``` Drugs: - canagliflozin - dapagliflozin - empagliflozin Mechanism: - selective inhibitor of SGLT2 - increases urinary glucose excretion by inhibiting glucose reabsorption A1c reduction okay - 0.5-0.7% Side effects: - hypotension - induces osmotic diuresis - hyerpkalemia - yeast infxn - UTI - DKA - can trigger in type 1 DM Good weight loss Reduce BP ```

Answer 34

``` Hyperglycemic hormone - causes rise in blood sugar Mechanism: - catabolism of stored glycogen and increase in gluconeogenesis and ketogenesis - increase in blood glucose Side effects: - transient nausea/vomit Clinical use: - reversal of hypoglycemia ```

Answer 35

``` Ultra short acting: - lispro - aspart - glulisine Long acting no peak: - glargine Long acting: - detemir NPH - old long acting Regular - old short acting ```

Answer 36

Blocks androgen and cortisol synthesis Use: - adrenal carcinoma, hirsutism, prostate cancer Side effects: - liver toxicity - adrenal insufficiency - headache, sedation, fatigue, decreased appetite, N/V - hypoandrogenism - gynecomastia, decreased libido, impotence

Answer 37

Inhibits CYP11B1 (11 B OHase) Use: - adrenal carcinoma - medical adrenalectomy

Answer 38

Blocks 11 B OHase Use: - hypercortisolism

Answer 39

GC receptor antagnoist - rx Cushing related hyperglycemia PR antagonist - don't use in pregnancy women - abortion pill

Answer 40

``` Aldo replacement Side effects: - HTN - hypoK - heart failure ```

Renal and Endocrine Flashcards

(64 cards)