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168 Cards in this Set
- Front
- Back
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what is serotin involved in normally
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sleep and depression
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Symptoms of Carcinoid Syndrome
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-bronchospasm
-GI cramping and diarrhea -"odd" flushing of the skin -hypotension -increased urinary excretion of 5-HIAA |
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TX for carcinoid
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Tx with Cyproheptadine (blocks 5-HT1 and 5-HT2 receptors) or the somatostatin analog octreotide which inhibits the release of 5-HT from the tumor
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Serotonin Drugs
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-Metoclopramide
-Ondansetron -Cisapride -sumatriptan -buspirone |
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Metoclopramide
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1.blocks D2 receptors in CTZ--prevents nausea, but causes EPS and hyperprolactinemia
2.blocks 5HT3 receptors in CTZ and at vagal affs--prevents nausea/emesis 3.Stimulates 5HT4 on pre-j cholinergic neurons to amplify the release of ACh-> ACh stimulates musc. in GI tract 4.used to tx GERD and empty stomach prior to SX |
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ondansetron
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antiemetic drug which blocks 5HT3 receptors in the CTZ and at vagal affs
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cisapride
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-agonist of 5HT4 receptors on pre-j choli neurons
-amplifies the release of ACh to inc. tone in the LES -used to tx GERD and empty stomach prior to SX |
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sumatriptan
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-agonist at 5HT1b and 5HT1a receptors to inhibit release of inflammtory peptides
-used to tx migraine and cluster h/a |
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Antihistamines (woohoo)!!!
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-can work at H1 or H2 receptors
- |
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histamine H1 receptors
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H1 receptors:
-dilate arterioles -contracts vascular endo cells to inc cap perm -contract GI sm->diarrhea -contracts bronchial sm-> asthma -stimulates aff pain receptors-> pain/itch |
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hist H2 receptors
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-dilates arterioles
-inc gastric H+ secretion |
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cromolyn sodium
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inhibits mast cell degranulation by preventing inc in intracellular ca2+
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olapatidine
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inhibits mast cell degranulation and blocks h1
-used in tx of conjunctivits and seasonal allergy |
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Sedating Antihistamines
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-diphenhydramine
-meclizine |
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Non-sedating antihistamines
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-terfenadine
-fexofenadine -clemastine |
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drugs for prophylaxis of motion sickness (need to block central Musc ACh receptors)
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-dimenhydrinate
-meclizine -scopolamine |
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DOC for tx of meniere's DZ (hearing loss, vertigo, tinnitus from non-suppurative dz of the labyrinth)
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meclizine
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H2 receptor blockers
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-cimetidine
-famotidine -ranitidine -BLOCKS GASTRIC ACID SECRETION, ALSO BLOCKS ALLERGIC RESPONSES IN THE SKIN |
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what do you give a pt exposed to poison oak?
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-give diphenhydramine (h1 blocker) and cimetidine (h2 blocker) to prevent itching and pain
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your pt is taking cimetidine for GERD, but he must go to the allergist for some skin rxn shit...what do you put him on?
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TX GERD with omeprazole during allergy testing
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random clinical pearl that i cannot put in decent question form...
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pt has insomnia from depression
-tx with TCA, but patient still has insomnia-> give an antihistamine to induce sleep -oops, now ur pt has urinary retention from the combined atropine-like fx of the drug combo |
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GI drugs
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poopy!
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ipecac
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-induces vomiting by and action at the CTZ and by an irritant in the stomach which is NOT BLOCKED by antihistamines
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what drug induces emesis by stimulating D2 receptors in the CTZ?
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-apomorphine induces emesis by D2 receptors in the CTZ
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lactulose (synthetic dissacharide)
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-slow-acting laxative which is conveted to small organix acids in the bowel
-these acids exert an osmotic effect to slowly draw water into the feces |
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A pt with S/S (confusion/coma) of hepatic portal encepholapathy needs tx...?
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-use lactulose
-acidifies bowel to trap ammonia and ammonium ions -ammonium lost in feces-> plasma ammonia falls-> coma and confusion dissappear |
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docusate sodium
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-stool softener
-an anionic surfactant: detergent allows water to enter feces -soften the stoll w/o increasing its bulk |
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how to treat diarrhea (and dizzlerhea)
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-tx w/loperamide or diphenoxylate which stimulate mu opiate receptors
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pt with ULCERS
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-tx with H2 blockers (cimetidine)
-antacids (Al or Mg hydroxides) -PGE receptor agonists (misoprostol) -ppi (omeprazole) -sulcralfate (mixture of AlOH and sucrose which forms a viscous gel at acidic pH->gel coats ulcerated tissue |
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more pt with ULCERS
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-modern tx is to eradicate H.pylori w/triple Ab tx
1.clarithromycin 2.amoxacillin 3.omeprazole |
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what antiulcer drug does not alter stomach pH?
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sucralfate
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pt on propranolo takes cimetidine for heartburn and develops bradycardia...why?
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-cimetidine inhibits cyp450 and thus blocks the metabolism of propranol
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antacids and GI tract...
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AlOH=constipation
MgOH=diarrhea |
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pt. being tx with doxycycline...which drug is contraindicated?
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Al/Mg antacids
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pt needs emergency surgery; need to empty stomach with the quickness and prevent reflux...what drug?
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-use metoclopramide
-prokinetic in stomach (moves stuff out) and tightens the LES (doesn't let stuff go back) |
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chemo pt with n/v and noctural acid reflux...what drug?
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metoclopramide
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pt has post-op paralytic ileus...what drug?
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-metoclopramide
-bethanechol -cisapride |
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pt is being tx for Crohn's or for UC...develops hepatic damage/bone marrow suppression. what drug is this homebay taking?
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-sulfasalazine
-homeboy is a slow acetylator -sulfasalazine is sulfapyridine conjugated to 5-aminosalicylic acid -5-asa is an NSAID -sulfapyridine->metabolized by acetylation->suppresses bone marrow |
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signs and symptoms of laxative abuse w/castor oil or bisacodyl...?
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-constipation
-hypokalemia -muscle weakness -abnl architecure of inner GI wall |
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NSAIDS
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NSAID time is really fine and DON'T YOU FORGET IT!!!
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Aspirin (this will go on forever, i promise)
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1.inhibits platelet agg by irreversible inhibiting COX1 in plets via acetylation to prevent the synthesis og TXA2
-inc bleeding time |
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Aspirin
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2. aspirin blocks plet agg caused by arachidonic acid but not the agg caused by PGG2 and PGH2 (cyclic endoperoxidases)
3. inhibition of plet agg relieves CP in unstable angina: plet count is NORMAL, but INCREASED bleeding time |
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aspirin (what happend during 1st pass metabolism?)
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4. converted to salicylate during 1st pass metabolism
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Aspirin (kinetics)
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5.Lg doses exhibit non-linear kinetics--how to recognize? use disappearance of plasma salicylate
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aspirin (more kinetics)
-plasma salicylate during po dosing? |
-when the dose is doubled, the plasma conc should double
-if the doubling causes salicylate conc to inc more than two-fold, the hepatic enzymes will become saturated and elimination will change from 1st order to zero-order -the dec Clearance will cause the t1/2 to increase |
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Aspirin OD (OH NO!!)
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-n/v, tinnitus
-resp alkalosis:aspirin uncouples oxidative phosphorylation in Sk M -inc pCO2 from increased respirations -metabolic acidosis->as CO2 production increases -children skip the alkalosis step and go straight toacidosis with low blood pH and low bicarb |
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TX of aspirin OD
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-make urine alkaline
-acetazolamide or NaHCO3 to enhance the renal clearance of salicylate -infuse bicarb to correct acidosis |
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dipyrimadole
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-an inhibitor of PDEase in plets
-potentiates the antiplatelet effect of aspirin and PGI2 |
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t1/2 of aspirin is only 1hr, why does it inhibit platelet agg for a longer period?
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-aspirin irreversibly acetylates active site of COX1 in plets
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how does aspirin prevent plet agg when it is not taken in doses large enough to maintain a steady-state plasma conc?
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-irreversibly acetylates active site of COX1
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pt has intermittent episodes of hemiplegia which resolve spontaneously; would like to tx with aspirin, but pt has aspiring hypersensnitvity..what drug do you use?
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ticlopidine
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what is the causative compound in aspirin hypersensitivity?
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leukotrienes
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DOC for menstrual cramps
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ibuprofen
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baby has patent ductus arteriosus...?
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close with indomethacin
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what if you wanted to keep the PDA open prior to surgery (such is in TOF) what drug will do this?
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-alprostadil (PGE1 analog)
-dilated the ductus arteriosus |
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pt with NSAID tx develops GI ulceration...what is the MOA
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-MOA is inhibition of gastric PG synthesis
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pt with nasal polyps who has wheezing with aspirin needs an antipyretic?
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DOC=acetominophen
-acetominophen is antipyretic, but not antiinflammatory |
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Drug OD pt, initially blood chemistry is normal...36hr later...inc in AST and ALT. what is the drug?
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-acetominophen
-tx with n-acetylcysteine to replenmish glutathione |
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DRUGS FOR GOUT
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-colchicine
-allopurinol -probenecid -aspirin |
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colchicine
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-binds to tubulin to block formation of microtubules and thus inhibit phagocytosis of urate crystals by WBCs
-used to tx the pain of acute attacks |
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Allopurinol
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-inhibits xanthine oxidase to block synthesis of uric acid purines
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pt with renal transplant is taking the immunosupressnt azathioprine. pt dev gout. which gout drug is contraindicated?
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-allopurinol is c/i b/c azathioprine is converted to the cytotoxic agent 6-mercaptopurine (6mp)
-6-mp kills antigen presenting cells and T/B lymphs -6-mp is INACTIVATED BY XANTHINE OXIDASE |
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lymphoma pt is tx with chemo. which drug will prevent decrease in renal function?
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-allopurinol
-chemo kills lymphoma cells which release nucleic acids that are converted to urate -excessive urate in urine crystallizes to occlude the collecting ducts, pelvis and ureters -rapid progressive renal dysfxn develops |
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Probenecid+large dose aspirin
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-probenecid and aspirin enhance the renal clearanc eof urate
-urate stones may form, so keep the urine alkaline with sodium citrate |
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which drugs are not uricosuric?
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-allopurinol and colchicine
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DOC for hyperuricemia?
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-allopurinol
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pt with gout tx w/probenicid get remineralization of bone. why?
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-inc urinary excretion rate of urate
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pt taking a small daily dose of aspirin may develop gout, whereas lg dose is used to tx gout...what's the deal?
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-small doses of aspirin enhance urate absorption in the renal tubule whereas lg doses are uricosuric
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pt tx for gouty arthritis develops luekopenia. which drug is he on?
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-colchicine can cause leukopenia
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Adverse effects of NSAIDS
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-gastric ulceration:results from dec PG synthesis in stomach; prevent or tx w/misoprostol (PGE1)
-interstitial nephritis: hematuria, proteinuria, flank pain, dec RBF and dec GFR->oliguria |
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pt on NSAID for tendonitis for 2 weeks develops fever and hematuria. Dx?
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-acute interstitial nephritis
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pt with CHF takes ibuprofen; effect of kidney?
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-constriction of aff arteriole lowers RBF and GFR to cause Na+/H20 retention
-no PG's to partially inhibit the effects of ADH in the collecting duct=water retention |
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histologic photoof kidney tissue with lots of lymphs. Dx?
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-interstitial nephritis caused by apirin or another NSAID
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pt tx w/NSAID for arthritis has decHb and HCT and has occult blood in his stool. Which drug will reverse this pathology?
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-misoprostol
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Thyroid crap
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-PTU
-Propranolol |
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Preg woman develops hyperthy...tx?
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-PTU
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What are the usual causes of hyperprolactinemia and their tx?
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-blockade of D2 receptors and inc TRH in hypothy can cause hyperprolactinemia
-in hypothy, tx w/thyroxine to suppress plasma prolactin conc |
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pt w/recurrent v-tach/fib develops recurrent hyper/hypothy while taking amiodarone. WHY?
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-amiodarone is 37% iodide by weight
-this iodide can either prevent the conversion of T4 to T3 (hypothy), or it can serve as a substrate for the synthesis of T3 by thyroid peroxidase |
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ADH/AVP CRAP
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-i hate myself
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Central DI
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-tx with desmopressin
-has long t1/2 but it is resistant to degradation bu peptidases -very selective for renal V2-receptors |
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Nephrogenic DI
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-tx w/HCTZ
-if that doesn't work try indomethacin |
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Lithium induced DI
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-tx w/amiloride
-prevents entry of LI+ into principal cells of LDT/CD) -can also try HCTZ |
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SIADH
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-tx w/demeclocycline
-inhibits action of ADH in LDT/CD |
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Respiratory Drugs
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PUT PICTURE FROM RESP LECT WITH STUPID DIAGRAM WHERE THESE STUPID THINGS WORK. KNOW WHERE THEY WORK
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Resp Drugs
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just another back in case that f-ing chart thing is to f-ing big!
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pt tx w/propranol; which drug will still bronchodilate?
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-theophylline or aminophylline act via inctracellular inhibition of PDEase
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asthmatic pt tx w/theophylline develops a sinus infxn which requires tx w/ an AB. which AB would require adjustment of his theoph doses?
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-erythromycin
-inhibits cyp450 which is the enxyme that metabolizes theophylline |
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asthmatic pt taking theopylline has a seizure after taking otc drug for Heartburn...what is this stupid-ass drug?
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-cimetidine
-blocks cyp450 which metablozies theoph |
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which drug causes the greatest increase in FEV1 with the smallest increase in HR?
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-albuterol
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pt w/excercise-induced asthma uses cromolyn prophylactically. MOA?
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-cromolyn prevents Ca2+ influx into mast cells when IgE bridges form
-=no mast cell degranulation |
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Immunopharmacology
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-glucocorticoids
-cyclosporine -mycophenolate -cytotoxic immunosuppresants -my white ass |
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Glucocorticoids
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GLUCOCORTICOIDS
1.inhibit the production of IL-1 and IL-6 by macros and monos 2.inhibit Antibody synthesis by B-cells 3.Prevent fxns of cytotoxic t-cells 4. NO bone marrow depression |
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which drug suprresses cellular immunity, blocks the synthesis of PGs and LTs and inc neutrophil count in the blood?
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- A GLUCOCORTICOID
-glucocorticoids dec the # of B/T lymphs,monos,eos,basos by stimulating their mvmt from the blood into lymphoid tissue -however, glucocoritcoids acutely inc the release of PMNs from bone marrow and prevent their migration out of the blood and into tissue |
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Cyclosporine
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-inhibits calcineurin to prevent the production of IL-2 by Helper T-cells
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mycophenolate
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-inhibits inosine monophosphate dehydrogenase which prevents the synth of purines in T/B lymphs
-unlike other cells from the bone marroaw T/B lymphs lack the enzyme HGPRTase for purine synthesis |
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Cytotoxic Immunosuppressants
-Azathioprine -Cyclophosphamide |
-Azathioprine:converted to 6-maercaptopurine, which interferes with the nucleic acid synthesis that is needed for prolif of B/T cells
-Cyclophosphamide:alkylates DNA; S/E=hemorrhagic cystitis |
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CALCIUM METABOLISM
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-Vit D
-Alendronate -Etidronate |
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Ca2+ Metabolism
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-Vit D acts via gene trxn and ion channels in the Gi brush border
-Osteocalcin reflects the activity of osteoblasts (i have no clue what that means!!^%@#$!%@#!^#) |
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what does pt with VitD toxicity exhibit?
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-hypercalcemia w/hypercalcinuria; hyperphosphatemia
-anorexia,n/v,weakness -dehydration b/c renal conc ability is impaired |
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Tx for VitD toxicity
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-aggreissive hydration w/isotonic saline
-furosemide to enhance urinary Ca2+ excretion -plicamycin (mithrmycin=a cytotoxic antibiotic drug that inhibits bone resorption |
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Pt w/renal failure has low plasma Ca2+...how do you tx them?
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-tx w/1,25 diOH-VitD
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pt w/pagets dz exhibits hearing loss, bone pain, bone deformity, inc serum alkaline phosphatase, inc urinary hydroxyproline, high output HF and immobilization hypercalcemia...tx w?
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-tx w/calcitonin to dec bone pain,deformity,hearing loss, and hypercal
-calcitonin will dec serum Ca2+ and PO4- by inhibition of osteoclastic bone resorption and dec resorption of Ca2+ and PO4- by the kidney |
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Alendronate and Etidronate (bisphosphonates)
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-bisphosphs inhibit the resorption of bone by inhibiting the ability of osteoclasts to dissolve hydroxy appatite crystals
-bis's inc bone mass and dec fracture's -used to prevent glucocorticoid-induced osteoporosis and used with calcitonin to tx paget's dz -used as an alternative to HRT to prevent post-meno bone loss |
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post-meno women requires tx to maintain bone mass, but cannot take estrogen b/c her mother and sister had breast cancer...tx with?
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-alendronate or etidronate
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pt tx w/steroids develops hypocalcemia. why?
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-steroids antagoniza the effects of vitD on the GI absoprtion of Ca2+
->less ca2+ absorption-> inc PTH conc-> inc bone resorption-> inc renal excretion of Ca2+->hypocalcemia and osteoporosis |
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Therapies of Anemia
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TWO KINDS COVERED
1. hypochromic, microcytic anemia= Fe deficiency anemia 2.normochromic,macrocytic (megaloblastic anemia) |
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Hypochromic, Microcytic Anemia= Fe deficiency anemia
1.cause |
1.caused by inc FE req, dec GI absorption or blood loss
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Hypochromic, Microcytic Anemia= Fe deficiency anemia
2.signs and symptoms |
S/S
-pallor, fatigue, light-headed -pica=craving for clay, laundry starch, ice |
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Hypochromic, Microcytic Anemia= Fe deficiency anemia
3.Labs |
Labs
-decreased serum ferritin conc -inc TIBC |
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Hypochromic, Microcytic Anemia= Fe deficiency anemia
4.Tx |
Tx
-ferrous iron -vitC enhances the GI absorption of ferrous iron |
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Normochromic, Macrocytic (Megaloblastic) anemia
1.Cause |
-deficiency of folate (lack of dietary intake)
-def of vitB12 (no GI absorption) |
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Normochromic, Macrocytic (Megaloblastic) anemia
2. Blood Cells |
-all blood cells affected
-large RBCs -segmented neutrophils -abnml platelets |
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Normochromic, Macrocytic (Megaloblastic) anemia
3.S/S of folate deficiency |
S/S (dec folate)
-diarrhea -anorexia -sore tongue -irritability -forgetfulness |
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Normochromic, Macrocytic (Megaloblastic) anemia
4.S/S of vitB12 deficiency |
S/S (dec B12)
-same as folate +neuro symptoms -parasthesias of distal extremities -sensory disturbances my progress caused by demyelination of nerve fibers in the dorsolateral spinal column -B12 is necessary for the conversion of methylmalony coA to succinyl CoA which is needed for the syntheseis of myelin |
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Normochromic, Macrocytic (Megaloblastic) anemia
5.peripheral blood smears |
-peripheral blood smears CANNOT be used to differentiate b/t the two
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Normochromic, Macrocytic (Megaloblastic) anemia
6. folate intake |
-folate intake is gauged by measuring RBD folate
-this reflects dietary intake over the past 2-3mos |
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Normochromic, Macrocytic (Megaloblastic) anemia
7.vitB12 GI stuff |
-B12 deficiency usually occurs from lack of GI absoption
-a schilling's test is used to measure the efficiency of B12 absoprtion from the GI tract |
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Normochromic, Macrocytic (Megaloblastic) anemia
8.Folate Def tx |
-tx folate deficiency with...po FOLATE!!!
-some pts cannot absorb folate from the GI tract and must be tx with iv folate |
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Normochromic, Macrocytic (Megaloblastic) anemia
9.B12 def tx |
-tx B12 def w/im injection of cyanocobalamin or hydrocxycobalamin
-this tx is continued for LIFE |
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pt w/normochromic,macrocytic anemia has distal paresthesias. pt is tx with po folate and the anemia dissapears, but the neuro S/S worsen. WHat happened?
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-folate will correct the megaloblastic anemia
-neuro symptoms must be tx with B12 |
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pt tx with phenytoin,isoniazid, pyrimethamine, trimethoprim or methotraxate develops normochromic, macrocytic anemia. WHY?
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-phenytoin and isoniazid interfere with GI absorption of folate
-pyrimethamine,trim, and methotrexate inhibit DHF reductase |
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pt on hemodialysis develops normo,macro anemia. Why and what to do about it?
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WHY?
-hd removes plasma folate WHAT TO DO? -pts on hd must be tx with EPO, folate and ferrous iron |
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pt w/HCT 24 is started on hd. After tx w/EPO, folate and ferrous iron, the pt develops HTN. WHY?
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-the HCT is inc by inc production of RBC's-> viscosity of blood rises.
-accoring to Poiseulle's law, resistance is directly related to viscosity -BP increases |
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which drug could be used for "blood doping" (inc HCT) in competitive cycling?
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-EPO, epoetin alfa, darbepoetin
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Glucocorticoids
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place crap here
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Glucocorticoids
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place crap here
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Glucocorticoids
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place crap here
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Glucocorticoids
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place crap here
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Glucocorticoids
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place crap here
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Glucocorticoids
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place crap here
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pt with malar rash, arthritis, polyserositis, proteinuria and hematuria. Dx and TX?
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Dx=SLE
Tx -a prednisone or any other -sone or -lone drug |
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Which synthetic glucocorticoid is used to differentiate bilateral adrenal hyperplasia from adrenal carcinoma?
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-DEXAMETHASONE: b/c it will depress serum cotisol by 50% in adrenal hypeerplais caused by pituitary adenoma, but have no effect on serum cortisol in adrenal carcinoma
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which drug will inc the urinary excretion of 17-ketosteroids (testosterone) in a pt w/bilatyeral adrenal hyperplasia (Cushings dz) w/o affecting the urinary 17-OH-steroids (cortisol) in a pt with adrenal carcinoma?
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-Metyrapone blosck the cyp45011 that converts 11-DOC to cortisol so there is no cortisol feedback to inhibit the pituitary
-ACTH rises and stimulates adrenal steroid synthesis causing even more 11-DOC to be prodeuced -this generalized inc in adrenal steroid synth also inc the synth of testosterone which is metabloized to 17ketosteroids->so the urinary excretion of 17ks also inc -in a pt with adrenal CA, cortisol produced by the tumor suppresses ACTH release so the nml adrenal cortex atrophies and thus cannot respond to the inc in ACTH |
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which drug will suppress plasma cortisol in a pt with normal pituitary/adrenal fxn?
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-ketoconazole blocks the cyp450scc
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which drug can cause a "medical adrenalectomy"?
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-aminogluthemide blocks all adrenal and extra-adrenal steroid synthesis
-prevents the conversion of cholesterol to pregenelone -can be used to tx cushings |
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pt txw/steroids develops a GI ulcer. MOA?
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-inhibition of gastric PG synthesis
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Estrogens
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estro crap
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Estrogens
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estro crap
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Estrogens
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estro crap
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Estrogens
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estro crap
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Estrogens
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estro crap
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MOA of RU486 (mifepristone)
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-progesterone receptor antagonist
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pt with S/S hyperestrogenism (breast tenderness) is on a drug to enhance fertility. Drug?
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-clomiphene
-clomiphene blocks CNS estrogen receptors causing increased pulsatile release of GnRH which enhances the secretion of FSH->ovulation |
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estradiol contrindicated in a pt w/a hx of thromboembolic dz. WHy?
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-b/c extradiol inc the synthesis of clotting factors
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pt has breast cancer. Tx?
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-tamoxifen: blocks estrogen receptors
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Why do OCPs which contain estrgen also contain a progestin?
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-the progestin prevents the endometrial hyperplasia caused by estrogen
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which compound can be used to maintain bone mass in a postmeno woman who has had breats cancer?
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raloxifene (a SERM) or alendronate (a bisphosphonate)
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tx with an estrogen decreases the risk of osteoporosis and colorectal cancer
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poopy pants
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Androgens
-Fluoxymesterone -Nandrolone |
-Fluoxymesteron and Nandrolone are androgens which are used for their anabolic effects
-they act by preventing the catabolic actions of cortisol -they stimulate protein synthesis and erythropoiesis |
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a body builder treats himself with fluoxymesterone. how is his spermatogensis affected?
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-spermatogensis is suppressed b/c the fluoxystimulates hypothalamic androgen recptrs which inhibit the release of GnRH so no FSH is secreted by the pituitary
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a body builder has an enlarged heart and spleen,borderline DM and mild HTN...BUT, steroids are not present in his urine. What drug is he using (and how can i get some)?
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-he is using a growth hormone
-increases the production of IGFs |
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older man has arthralgia, fluid retention, and hyperglycemia. What drug has this affect?
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-growth hormone
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what drug will suppres the secretion of GH in a pt with acromegaly?
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-bromocriptin or octreotide
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pt w/BPH or hair loss. Tx?
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-finasteride blocks the synthesis of DHT by inhibiting 5-alpha-reductase
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which drug is an androgen receptor antagonist?
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-flutamide
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how to tx a young boy w/cryptorchidism?
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-hCG
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Leuprolide, goserelin and nafarelin
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-used to tx prostate cancer, endometriosis and leiomyomas
-their continuous administration via im depot injxn desenstizes the GnRH receptors of the pituitary-> shuts off release of LH and FSH |
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Leuprolide, goserelin and nafarelin
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-used in protocals for IVF
-used to suppress ovarian fxn followed by tx w/exogenous gonadotropins (hCG) to achieve synchronous follicular development |
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Glucagon
synthesis |
synthesized by pancreatic alpha-cells
-a 29 AA polypeptide |
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Glucagon
metabolic effects |
metabolic effects:inc plasma glucose at the expense of liver glycogen stores
-inc hepatic cAMP to activate phosphorylase activity and the enzymes of gluconeogenesis. -NO effect on glycogen stores in Sk M |
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Glucagon
Cardiac Effects |
Cardiac effect
-increased contractility and inc HR via cAMP |
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Glucagon
Medical Uses |
-tx of hypoglycemia
-tx of poisoning w/beta-blocker -dx of DM, lg dose of glucagon inc insulin and c-peptide release from beta-islet cells:to c-pep release in TIDM |
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TX of DM
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put chart here
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pt w/DKA. Tx?
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-lispro or regular insulin Iv
-iv fluids for rehydration -K+ to prevent hypokalemia as insulin drives glucose into liver,Sk m, and fat cells |
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Sulfonylureas
-tolbutamide -chlorpropamide -glyburide -glipizide |
Sulfonylureas:tolbutamide,chlorpropamide,glyburide,glipizide
-MOA: depolarize beta-islet cells by blocking ATP-sensitive K+ channels; insulin released -Used to tx T2DM -S/E: hypoglycemia |
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Metformin and Rosiglitazone
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-the glitazones dec insulin resistance primarily in Sk m and fat cells
-used to tx T2DM |
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pt w/T2DM develops lactic acidosis while taking a drug. what drug is it?
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-metformin
-b/c metformin increases glucose utilization via anaerobic pathways -glucose->lactate |
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which drug decreases hepatic glucaose production in T2DM w/o enhancing the pancreatic secretion of insulin?
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-metformin
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