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76 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Which drug has anabolic effects in muscle and catabolic effects in lipid cells to shift balance of body mass to muscle mass and reduce central adiposity?
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Growth hormone
(Somatotropin) |
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Primary effects of GH (somatotropin) are mediated by what?
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Insulin-like growth factor 1 (IGF-1) and IGF-2
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Adverse effects of GH
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intracranial HTN, scoliosis, hypothyroidism, pancreatitis, gynecomastia, peripheral edema, mylagias, arthragias, carpal tunnel syndrome
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Clinical uses of GH
(4) |
1) Peds pts with short stature
2) GH deficiency in adults 3) Wasting in AIDS pts 4) Short bowel syndrome (improves GI function) |
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What are uses for Dopamine agonists?
(Bromocriptine, Cabergoline, Pergolide) |
1) suppress prolactin release
2) Parkinson's - reduce levodopa requirements 3) Tx of hyperprolactinemia and acromegaly |
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SE of dopamine agonists
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Nausea
Headache Light headedness orthostatic hypotension fatigue psychiatric manifestations |
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How much more potent is T3 than T4?
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3-4 times
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What happens to T4 and T3 in hyperthyroidism?
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Production T4/T3 increased;
half-lives decreased |
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What happens to T4 and T3 in hypothyroidism?
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Production T4/T3 decreased;
Half-lives increased |
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What are the S/S of toxicity of thyroxine in both childrena and adults?
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Children: restlessness, insomnia, accelerated bone maturation and growth
Adults: Increased nervousness, heat intolerance, episodes of palpitation and tachycardia, unexplained wt. loss. |
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What do you do if you see S/S of toxicity with thyroxine?
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Monitor TSH
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What does chronic overtreatment of thyroxine increase the risk of?
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A fib
accelerated osteoporosis |
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What drugs can induce hypothyroidism?
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Iodides
Lithium Fluoride Thioamides ASA Amiodarone Perchlorate Ethionamide Thiocynate Cytokines (interferons/Interleukins) Bexarotene |
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Which are short-medium acting corticosteroids?
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hydrocortisone
cortisone prednisone methylprednisolone |
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Which are medium acting corticosteroids?
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Triamcinolone
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Which are the long acting corticosteroids?
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Betamethasone
Dexamethasone |
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Which are the mineralcorticoids?
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Fludrocortisone
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TRUE/FALSE
There are the same potency ratios of glucocorticoids to mineralcorticoids? |
False
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What developments do you monitor for with adrenocortical agents?
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Hyperglycemia
Glycosuria Na retention with edema or HTN Hypokalemia Peptic ulcer Osteoporosis Hidden infections |
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When would you use great caution when prescribing adrenocortical agents?
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Peptic ulcer
heart disease HTN with HF infection psychosis DM osteoporosis glaucoma |
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What are the properties of mineralcorticoids?
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Promotes reabsorption of Na from distal convoluted tubule, cortical collecting renal tubules, and coupled to K and hydrogen ion excretion
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Where is aldosterone synthesized?
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zona glomerulosa of the adrenal cortex
ACTH produces moderate stimulation of release of aldosterone, but in the abscence of ACTH 50% is produced (by RAAS or other factors) |
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What is a steroid hormone produced by adrenal gland, which is a precursor of aldosterone? It's secretion is under control of ACTH.
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Deoxycorticosterone
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Which drug is a synthetic steroid used for treatment of adrenal insufficiency and orthostatic hypotension?
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Fludrocortisone (florinef)
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Name 3 rapidly acting insulin preparations
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Lispro
Aspart Glulisine |
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Name 3 benefits of rapid-acting insulins
Lispro Aspart Glulisine |
1) more closely mimics normal endogenous prandial insulin secretion (than regular)
2) can use immediately before meals 3) perfered insulin for pumps |
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What are the onset, peak and duration of rapid-acting insulins?
Lispro Aspart Glulisine |
Onset: 5-15 min
Peak: 1-2 hrs Duration: 3-5 hrs |
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Name the 3 short acting insulins
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Regular Novolin R
Regular Hunulin R Regular Exubra |
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Which insulin is taken 30-45 minutes before meals to avoid mismatch?
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Regular Novolin R and Humulin R
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What drug is inhaled (1-4mg) powder premeal; determined by body weight?
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Exubera
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What is the conversion from mg to units for exubera?
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1mg=3units regular insulin
3mg=8units regular insulin |
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What other med besides exubera is given to type 1 diabetics?
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longer acting insulin
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Can type 2 diabetics use exubera as monotherapy?
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Si
(or with oral agents or with longer acting insulin) |
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What are the pharmacokinetics of short-acting insulins?
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onset: within 30 min
peak: 2-3 hrs duration: 4-12 hrs |
Regular Novolin R
Regular Hunulin R Regular Exubra |
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What has absorption and onset which are delayed by combining appropriate amounts of insulin and protamine?
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Intermediate-acting insulins
NPH Humulin N NPH Novolin N (they are mixed with rapid or short-acting insulins) |
Intermediate-acting insulins
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What are premixed insulins made of?
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Rapid or short-acting mixed with NPH
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What does Novolin 70/30 or Humulin 70/30 mean?
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70% NPH
30% regular insulin |
what % NPH/Regular
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What does 75/25 NPL, lispro mean?
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75% Neutral protamine lispro/
25% insulin lispro |
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What does 70/30 NPA, Aspart mean?
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70% Neutral protamine aspart/
30% insulin aspart |
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TRUE/FALSE
Insulin glargine and detemir are given separately. |
TRUE
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What kind of insulins are detemir (Levemir) and glargine (Lantus)?
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long-acting insulins
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How does insulin detemir (Levemir) work?
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Availablility is prolonged by increasing self-aggregaion in SQ tissue and reversible albumin binding.
(less hypoglycemia than NPH) [given 2 x a day] |
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How does insulin glargine (Lantus) work?
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Insulin molecules slowly dissolve away from the crystalline depot and provide slow, continuous level of circulating insulin.
[given once daily, 2 times if necessary] |
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What are the pharmacokinetics of long-acting insulins?
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Onset: 1-3 hrs
Peak: none, max effect 4-6 hrs Duration: 24+ hrs |
Levemir
Lantus |
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What are the S/S of hypoglycemia?
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Tachycardia, palpitations, sweating, tremulousness, nausea, hunger, convulsions, coma
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What are the causes of hypoglycemia?
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Meal delay, inadequate carbo intake, unusual physical exertion, larger dose than immediate need
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What is the treatment for hypoglycemia?
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1) Oral glucose tabs, sugar containing beverage or food.
2) 20-50 mL D50 IV over 2-3 min 3) Glucagon 1 mg SQ or IM |
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Name 3 second generation oral diabetic agents
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Glyburide
Glipizide Glimepiride |
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Which oral diabetic agent is contraindicated in hepatic and renal impairment?
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Glyburide (diabeta, micronase, glynase)
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Which oral diabetic agent makes you hypoglycemic and flush if you drink ETOH with it?
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Glyburide (diabeta, micronase, glynase)
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What is the dose of Glyburide (diabeta, micronase, glynase)?
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2.5-10 mg QD in am
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What is the dose of Glipizide (Glucotrol, Glucotrol XL)?
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5-15 mg 30 min prior to breakfast
Max 40mg, divide doses XL provides 24hr action |
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Which oral diabetic agent causes less hypoglycemia per lecture?
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Glipizide (Glucotrol, Glucotrol XL)
shorter half-life |
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Which oral diabetic agent is 90% metabolized in liver and 10% in urine, and is contraindicated in hepatic impairment?
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Glipizide (Glucotrol, Glucotrol XL)
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Which oral diabetic agent is completely metabolized by the liver, has the lowest dose and the longest 1/2 life?
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Glimepiride (Amaryl)
dose=1-8mg QD |
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What is a caution to administration of oral diabetic agents?
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Elderly and CV disease
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What are meglitinides?
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Oral diabetic agents that modulate beta-cell insulin release by regulating K efflux through K channels. They have 2 common binding sites to sulfonylureas and 1 unique binding site.
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What is the dose of Repaglinide (prandin) and cautions?
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0.25-4mg 15-30 min before meals
caution with renal or hepatic disfunction - CYP3A4 |
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What are the adverse effects of Repaglinide (Prandin)?
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Hypoglycemia - if meal skipped/delayed
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Which oral diabetic agent has no sulfur structure?
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Repaglinide (Prandin)
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What is Sitagliptin (januvia)?
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-Inhibitor of DPP4
-enzyme that degrades incretin and other GLP1 like molecules -increases insulin release and decreases hepatic glucose production |
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What is the dose for Sitagliptin (januvia)?
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100mg PO QD, with diet and exercise
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Does Sitagliptin (januvia) require a renal adjustment?
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YES
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Can Sitagliptin (januvia) be used for Type I diabetics?
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nope, only for type 2
monotherapy or combo with other oral agents |
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What drug can be used for severe hypoglycemia, endocrine diagnosis, beta-blocker poisioning, or radiology of the bowel?
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Glucagon
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What are the pharmacologic effects of glucagon?
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1) producton of cAMP, facilitating catabolism of stored glycogen and increased gluconeogeneis and ketogenesis.
2) potent inotropic and chronotropic effect on heart 3) large doses cause relaxation of the intestine |
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What is a peptide produced in the parathyroid gland that has rapid clearance in liver and kidney and regulates Ca and Phos flux across the membranes in bone and kidney?
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Parathyroid hormone (PTH)
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What is a steroid produced in the skin and found in food; hydroxylated in the liver and further converted in the kidney; cleared in the liver - determined by binding affinity?
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Vitamin D
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What is the net effect on serum levels of PTH?
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Increased serum Ca
Decreased serum Phos |
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What is the net effect on serum levels of Vitamin D?
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Increased serum Ca
Increased serum Phos |
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What are the major causes of hypocalcemia?
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Hypoparathyroidism, Vitamin D deficiency, kidney disease, and malabsorption.
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What are the major causes of hypercalcemia?
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Hyperparathyroidism, cancer, thiazide therapy
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What are the major causes of hyperphosphatemia?
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renal failure, hypoparathyroidism, vit D intoxication, tumoral calcinosis
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What is the clinical presentation of hyperphospatemia?
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due to the effects of hypocalcemia
(neuromuscular - tetany, muscle cramps, etc) |
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What are the major causes of hypophosphatemia?
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Primary hyperparathyroidism, vit D deficiency, idiopathic hypercalciuria, vit D resistant rickets, other renal phos. wasting, overuse of binders, TPN without proper Phos.
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What is the clinical presentation of hypophospatemia?
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Muscle weakness, rhabdo, osteomalacia
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