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150 Cards in this Set
- Front
- Back
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- mimics the action of LH
- women: promotes ovulation - men: promotes sexual maturation, tx cryptorchisidism - given IM |
Human chorionic Gonadotropin (HcG)
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- equal parts partially degraded FSH & LH
- women: promotes follicular growth and maturation - men: promotes spermatogenesis, tx cryptorchidism - given IM |
Human Menopausal Gonadotropins (hMG)
[menotropins] |
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- menotropin from which most of the LH has been removed
- Tx: infertility, cryptorchidism -IM |
Urofollitropin
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- estrogen receptor antagonist (increases LH/FSH secretion)
- Tx infertility, promotes ovulation - Can lead to multiple births - Oral |
Clomiphene
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- synthetic GnRH (so need functional pituitary)
- women: induces ovulation - men: promotes testes growth and spermatogenesis - Given via pulsitile pump |
Gonadorelin
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- long acting synthetic GnRH agonist
- initially increase LH/FSH, but then decrease it b/c receptors desensitize - so decreased LH/FSh, testosterone & estrogen - TX: prostate CA, endometriosis, precocious puberty |
Leuprolide*
Goserelin Nafarelin Histrelin |
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- Androgen Receptor Antagonists
- block testosteron/DHT receptors - Tx: Prostate CA with Leuprolide combo - S/E: reversible liver damage (monitor LFTs) |
Flutamide
Bicalutamide |
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- 5a-reductase inhibitor
- blocks synth of DHT from testosterone - Tx: BPH, possible pattern baldness |
Finasteride
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- human recominant growth hormones (Hgh)
- Tx: hypopituitary dwarfism (<15yo and +IGF-1), CRF in kids, AIDS wasting, Turner's Synd - S/E: may be Diabetogenic |
Somatropin (HgH)
Somatrem (Meth-HgH) |
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- synthetic GHRH
- Used to asses pituitary VS hypothalamic defect or to TX GH deficiencies, CRF in kids, AIDS wasting, Turner's syndrome |
Sermorelin
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- Dopamine agonist, synthetic ergot alkaloid
- paradoxically decreases GH secretion w/adenomas - TX: gigantism, acromegaly (GH excess), hyperprolactinemia (PRL excess) - S/E: Gl, HA, dizziness |
Bromocriptine
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- Somatostatin analog (more resistant to degredation)
- decreases GH secretion more effective than bromo - t.i.d. injection (bad!) - Tx: gigantism, acromegaly (GH excess); antidiarrheal (esp AIDS, CA) * inhibits gastric acid secretion |
Octreotide
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- competitive GH-R antagonist
- lowers IGF-1 levels - Tx: gigantism, acromegaly (GH excess) |
Pegvisomant
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- Women: amenorrhea, galactorrhea, infertility
- Men: impotence, infertility, galactorrhea Tx: Bromocriptine |
Prolactin excess S&SQ
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- Synthetic TRH, stimulates release of TSH
- Dx of hypothalmic (TSH, T3/T4 normalize), pituitary gland (TSH, T3/T4 no change), or thyroid gland (TSH increase, T3/t4 no change) problem |
Protirelin
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- used to Dx DI
- UrOsm increased then central, UrOsm no change then nephrogenic - DI: polyuria, polydipsia, low UrOsm, hypernatremia |
Vasopressin
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- synthetic ADH analog, but much better antidiuretic than pressor
- Tx: Central DI, bedwetting due to low ADH - S/E: cramps, angina, water intox |
Desmopressin Acetate (dDAVP)
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- Tx: nephrogenic DI (restrict Na intake)
- Lithium can cause Nephro DI (inhibits ADH in CDs) |
Thiazides
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- tetracycline antibiotic
- inhibits ADH in Cds (EtOH also decreases ADH) - Tx: SIADH (water intoxication) (can also use hypertonic saline, loop diuretics, water restric) |
Demecloncycline
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- induce labor (IV), induce lactation (nasal), induce abortion, prevent/control post-abortion hemorrhage (IM)
- S/E: uterine rupture, water intox, allergic rxn - decreased bt EtOH |
Oxytocin
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- marketed to lower cholesterol & for heart health
- ALLIN to ALLICIN via ALLINASE - AJOENE & DIALLYL TRISULFIDE inhibit TXA so PLT aggregation is blocked (essentially HMG-CoA inhibit like statin) - Caution use w/antiplt drugs; store chopped in frig (C. diff) |
Garlic
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- Improve vasculature, varicose veins
- ESCIN lowers led edema, decreased vasc perm - AESCULIN increases bleeding (similar to coumarins) - CI w/ Asprin, NSAIDS, Anticoags; CAT X in Preg & BF |
Horse Chestnut
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- sharpen mental focuse, memory improvement
- improves cerebral, capillary profusion; inhibits PLT aggre by action on PAF; increases energy utilization - KAEMPFEROL (Apigenin) is antioxidant and MAO A/B inhibitor - S/E: bleeding, Seeds are toxic - CI: antiplts, heparin, warfarin, clopidogrel |
Ginko Biloba
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- Improve Mood, sleep quality, weight loss
- SSRI (mood), MAO inhibitor (mood), GABA activator (antianxiety) - HYPERFORIN: SSRI, MAO-I, GABA - HYPERICIN: MAO-I - S/E: HA, loss of apetite - CI: MAO-Is, SSRIs * induces CYP3A4 (OCPs, warfarin, theophylline adj) |
St. John's Wort (check this!!)
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- For Insomnia, Anxiety
- bind to GABA-A CL channel and open it, similar to Benzos - S/E: drowsy, sedated - CI: EtoH, Barbs, benzos, MAO-Is |
Valerian
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- Stimulate immune system
- HETEROXLYAN stimulates phagocytosis - ARABINOGALACTAN promotes TNF, IL-1 release - Does not prevent colds, but helps reduce syx (NOT effective in kids) - EtoH extract best - CI: allergies (ragweed), immune suppressents, don't use longer than 8 weeks |
Echinacea
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- Improves Prostate Health (BPH), Diuretic
- 5aReductase Inhibitor (like Finasteride), similar results when taken for 6 mos with less side effects |
Saw Palmetto
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- Antioxidant, antiCA, antiage
- GINSENOSIDES (>100 active ingreds) - decrease cortisol and NTs during stress, vasodilates - RED increases HDL - PANAX inhibits PLT aggre - S/E: nervousness, avoid w/caffeine, abuse syndrome |
Ginseng
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- sedation, relaxation, alt to EtoH
- GABA-R interaction - S/E: yellow skin/nails, hepatotoxic, don't mix with EtoH |
Kava
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- Migraines, arthritis pain
- inhibits PhospholA, PLT serotonin release - S/E: withdrawal syndrome (insomnia, joint pain); menstrual irreg; avoid prior to surg |
Feverfew
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Feverfew
Garlic Ginko Ginseng Horse Chestnut St. John's Wort |
Herbs to Avoid with Surgery
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Valerian
Kava |
Herbs to Avoid mixing with EtoH
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St. Johns Wort
Valerian |
Herbs to Avoid w/SSRI, MAOi
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- Monomer is active form
- release req's rise in Ca - Glucose principle stimulus for release (oral best) - Insulin-R is tyrosine kinase |
Insulin
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- 10%
- juvenile - prone to ketoacidosis - don't make insulin (antibodies to islet cells - Tx with insulin |
Type I DM
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- 90%
- "adult" - assoc w/obesity - have elevated insulin, resistant and low num or receptors - Tx with diet, exercise, insulin |
Type II DM
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- Rapid onset, duration 5-8h
- IV, IM, SC, - have to admin 3-45min prior to meal |
Regular Insulin
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- insulin analog
- Rapid onset, 3x faster than regular (when SC): flexibility! - 3-5 h duration - give 15 min prior to meal - insulin pumps |
Aspart
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- Rapid onset analog (inversion at AA 28/29 keeps a monomer)
- fast absorption, duration 2-5h - exists as monomer mostly - insulin pumps |
Lispro
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- rapid onset analog (glut ac replaces lys...)
- fast absorption, duration 1-2h - SC, insulin pumps |
Glulisine
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- intermediate acting insulin (1-2h onset, 18-24h dur)
- crystallized insulin w/protamine & zinc - variable response b/w patients - some allergy to protamine |
NPH
Isophane |
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- intermediate acting insulin (1-2h onset, 18-24h dur)
- mix of insulin & zinc |
Lente
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- long acting insulin (4-6h on, 20-36 h dur)
- crytalized hexamer of insulin and zinc |
Ultralente
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- long acting insulin (4-6h on, 24-36h dur)
- zinc, insulin hexamer with protamine |
PZI
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- long acting insulin analog(2-5h on, 18-24 h dur)
- sort of depot insulin, single shot provides flat level of response |
Glargine
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Increase: stress, fever, hyperthyroid, surgery, trauma, infection
Decrease: n/v, hypothyroid, CRF, liver impair +/- physical activity, site of injection, blood flow changes, prep |
Changes in insulin requirements
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- hypoglycemia (S&S can be masked by propanolol)
- hyperglycemia - allergy - lipodystrophies |
Insulin SE
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- 1st Gen sulphonylurea
- stimulate insulin release (receptor binding) - increase # of insulin receptors and glucose txps - HM, RE - Tx: Type II DM (ketoacidosis resis), Central DI (enhances ADH) - S/E: water retention, rash, chole jaundice - DDRx: Miconazole, BBlock, aspirin, NSAIDs |
Chlorpropamide
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- 2nd Gen sulphonylurea
- stimulate insulin release (receptor binding) - increase # of insulin receptors and glucose txps - HM, RE - Tx: Type II DM (ketoacidosis resis), combo w/insulin - S/E: -pizide, HAs, drowsiness - more potent, less SE, less DDRx than 1st gen (esp less inter w/aspr, NSAIDs |
Glimepiride, Glyburide
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- Biguanide, increases peripheral glucose uptake, decreases production & absorption
- NO effect on insulin secretion - Tx: DM not controlled by diet (combo with sulphon, thiazolin.), most common oral agent - CI: Renal, Hepatic, CHF, ketoacidosis, Hx Lactic acidosis - S/E: GI in 30%, decreased b12, folate absorption [phenformin taken off market] |
Metformin
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- aGlucodise/amylase inhibitor, starch blocker
- works in GI tract (poor abs) - Tx: Type II DM, can use in combos, must take before meals - S/E: dose dependent GI effects (most don't tolerate), elevateds LFTs |
Acarbose
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- Meglitinide
- works like sulphony., binds to receptor and releases insulin - Tx: Type II DM (ketoac resistant), combo with metformin but NOT sulphon. - S/E: hypoglycemia - CI: Type I DM, Ketoacid - DDRxs: miconazole, erythro, keto inhibit p450 (increase hypogly); rifampin, carbam. induce 3A4 and increase meta |
Repaglinide
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- Thiazolinediones
- PPAR agonists, increases trans of insulin responsive genes, enhances uptake in SKM (not pancreas) - Tx: DM, w/metformin - S/E: elevated LFTs, edema, fluid retention (CHF) |
Rosiglitazone
Pioglitazone |
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- hyperglycemic agents
- to raise blood glucose - to induce hyperglycemia in patients with insulin secreting tumors |
Glucagon
Diazoxide |
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- RL step: cholesterol to pregnolone
- Glucocorticoids: Cortisol (21C), ZF - Mineralcorticoids: Aldosterone (21C), ZG - Adrenal Androgens: DHEA (19C), ZR |
Endogenous Corticosteroids
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- synth & released in response to ACTH
- ACTH (release stim by CRF) synth in pit from POMC - ACTH-R is Gs, increase cAMP - release highest in AM (8), lowest in PM(4); stress; trauma; -feeback loops |
Cortisol (Glucocort) release
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- stimulate plasma glucose/gluconeogenesis (decrease uptake in periphery)
- stimulate protein catbolism - stimulate lipolysis, fat redistribution - decrease cir immune cells - increase Hg, PMNs, RBS from BM * suppress inflammation & immune resp (inhibit synth, release of cytos, increase IKB) * induce lipocortion, inhibits AA release - promote calcium loss |
Cortisol properties
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- release modulated by RAA system
- stim by hyperkalemia, decreased plasma volume - act on DT, CD, enhance Na, H20 resorption (na/k/atpase0, promote K excretion - constant level of release |
Aldosterone (Mineralcort) release/prop
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- high ACTH (lack normal -feeback)
- low gluco/mineralcorticoids - disease of adrenal cortex - weakness, wt loss, anorexia, hypotension, *skin pigmentation, hyponatremia - Dx: Cosyntropin, still see high ACTH, low all else - Tx: hydrocortisone or cortisone + fludrocortisone |
Primary Adrenal Insuff (Addison's)
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- low ACTH
- normal mineralcorticoids - +/- glucocorticoids & androgens - pituary (ACTH) or hypothalimic disease (CRF) - weakness, wt loss - NO PIGMENTATION - Dx: cosyntropin, cortisol up - Tx: hydrocortisone or cortisone only |
Secondary Adrenal Insuff
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- Long acting corticosteroids
- NO mineralcorticoid activity, potent anti-inflamm -Intermediate corticosteroid with no mineralcorticoid -all have added F to B, added hydroxy or methyl to D |
Betamethasone
Dexamethasone Triamcinolone |
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- Intermediate acting corticosteriods with nl mineralcorticoid activity (methyl slightly less)
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Predinsone
Predinsolone Methylprednisone |
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- short acting corticosteroids with nl mineralcorticoid activity
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Cortisol
Hyrdocortisone Cortisone |
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- overproduction of cortisol
- moon face, buffalo hump, etc - Dx: Dexamethasone challenge (should lower cortisol via neg feedback) - Tx: aminoglutethimide, ketoconazole, metyrapone |
Cushings
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- blocks all (cortisol, DHEA and androgens) by blocking conversion of cholesterol and CYP 11A1
- Tx: cushings secondary to secretion tumor |
Aminoglutethimide
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- blocks form of DHEA and cortisol by blocking CYP 17
- Tx: Cushings (higher doses than used as an antifungal) |
Ketoconazole
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- blocks form. of cortisol by blocking CYP11B1
- Tx: cushings secondary to secreting tumor |
Metyrapone
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- anything inflammatory
- allergies - repiratory dis. - collage/dermatological - GI - immunosuppression (transplant) - spinal cord injury - cancers |
Uses of glucocorticoids
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- HTN, edema, na/water retension, hypokalemia
- CNS syx - increase sus. to infection - GI ulcers - hyperglycemia, hyperlipidemia - cataracts, glaucoma - Bone loss, destruction - HPA suppression |
Glucorticoid adverse effects
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- used to mature lungs in utero prior to delivery of pre-term fetus
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Beclomethasone
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- premenopause: granulosa cells
- pregnancy: fetoplacental - menopause/men: adipose and hepatic tissue |
Estrogen production
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- most potent (17B), converted by liver to estrone-estriol
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Estradiol
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- premenopause: corpus luteum
- pregnancy: placenta, fetus - menopause/men: adrenal cortex, testes |
Progestin production
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- develop secretory endometrium
- maintain uterus of pregnancy - abrupt fall triggers menses |
Progesterone functions
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- follicular growth, endometrial growth
- thicken and stratify epithelium of vagina - increase cervical mucous - maintain skin - increase osteoblasts - retain water & salts - hypocholesterol |
Estrogen functions
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- GnRh pulsitile from Hypothal
- FSH/LH pusaltile from AP - FSH: maturation and estrogen from granulosa cells (thecal cells, androstendione) - LH surge causes follicle rupture (elevated estrogen) |
Follicular Phase
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- LH: stays high, progesterone produced by corpus luteum
- if preg doesn't occur, LH & progesterone fall to trigger menses - preg does occur LH/proge maintain endometrium until HCG |
Luteal Phase
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- synthetic estrogens in OCPs
- generally constant amounts with varied progesterone |
Ethinyl Estradiol
Mestranol* |
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- most common progestins in OCPs
- these two have most androgenic activity, levo more potent |
Norgestrel
Levonorgestrel |
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- OCP progestin with antiandrogen and antimineral corticoid activity (eq to spironolactone)
- less weight gain - good for acne - monitor for K levels |
Dropirenone
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- patch
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Norelgestromin + EE
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- inhibit ovulation by negative feedback on hypothal (block FSH/LH surges)
- thicken cervical mucous - make endometrium unsuitable - 7 days for tris, 21 for monos |
MOA of OCPs
Dosing |
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- nausea, bloating, vomiting, headache, hypermennorhea
- early spotting, hot flashes |
Estrogen Excess
Estrogen Too Low |
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- depression, noncyclic weight gain
- late bleeding, weight loss |
Progesterone Excess
Progesterone Too low |
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- pregnancy
- Thromboembolic disease - cancers - coronary artery disease - liver disease - cholestatic jaundice - diabetes with vascular disease - cigarette smoker over 35 y.o |
OCP contraindications
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- VTEs
- MI - Stroke - Gall Bladder Dieases - Breast CA (controversial) ** all ass with higher doses |
OCP Risks
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- smoking
- rifampin, barbs (increase clearance by CYPs) - tetracycline, Pen V, erythromicin, ampicillin (decrease GI flora needed for conjugation) |
OCP failure
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- progesterone only
- decreased release of FSH/LH, inhibits 70-80% of ovulations - alters endometrium - used in migraines, nursing moms, women with cardiovascular disease, smokers |
Minipill MOA
(norethindrone, norgestrel) |
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- depot prep, 1 every 3 mons
- inhibits ovulation, suppresses LH surge - causes atropy, delays fertility recoverys - weight gainm insomnia, osteoporosis |
DMPA
(Medroxyprogesterone acetate) |
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- depot, 1 a month
- less side effects |
Estradiol Cypionate/DMPA
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- effective for 5 years
- effects implant of egg, sperm migration |
Progesterone IUD
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- ethinyl estradiol, etonogestrel
- 3 weeks on, 1 off |
Vaginal Ring
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- nonoxynol9 or octoxynol9
- nonionic detergent - most effective used with other methods |
Spermacides
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Premarin
Prempro Premphase - estrogen + progesterone at low doses |
HRT
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- synth from histidine by HDC
- synth/stored mostly in masts, ECL cells - released response to IgE, curare, morphine, AcH, gastrin (ECLs) - slow turnover - 4 receptor subtypes |
Histamine
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- SM, endothelium, brain
- Gg, increases Ip3, DAG - vasodilation (indirect release of NO, PGI), edema, red/wheal/flare, bronchoconstriction, pain, itching - like M receptors |
H1
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- gastric mucosa, cardiac, mast cells, barin
- Gs, increases cAMP - vasodilation (direct relax of SM), increase HR and contratility, increase acid secretion - like 5HT receptors |
H2
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- both Gi, decrease cAMP
- H3 are presynaptic, H4 are eos, PMNs, Tcells - specific agonists (clobenpropit H4) and antagonists not commercially available (thioperamide) |
H3&H4
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- epinephrine: physiological antagonist
- cromolyn, nedocromil inhibit release - receptor antagonists (detailed) |
Histamine Antagonists
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- 1st Gen H1 Receptor Antagonists
- Tx: inhibit vasodilation, block edema, partially block bronchoconstriction, inhibit itching S/E: CNS depression, antimuscarinic* effects, GI irritation |
Chlorpheniramine
Diphenhydramine Dimenhydrinate Hydroxyzine Promethazine* |
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- 2nd Gen H1 Receptor Antagonists
- Tx: inhibit vasodilation, block edema, partially block bronchoconstriction, inhibit itching - prolonged action compared to 1st gen, less CNS (only Cet), less GI, less antimuuscar |
Cetirizine
Loratadine (+des) Fexofenidine Acrivastine Azelastine Levocabastine Ebastine Mizolastine |
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- H2 Receptor Antagonist (compet)
- decrease gastric acid secretion, decrease H content - Tx: GERD, prevent stress ulcers, Peptid/duodenal ulcers, ZE Syn - S/E: HA, GI, fatigue, lethargy (esp if RF) - DDR: Cimetidine inhibits P450 and will alter other drugs -nizatidine only renal, all others HM, RE |
Cimetidine
Ranitidine Famotidine Nizatidine |
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- NaHCO3 (systemic)
- CaCO3, Al(OH)3, Mg(OH)2 (nonsystemic) - basic group neuts acid to water, CO2 and salts - simethicone to reduce foaming - AL constipates, Mg diarrhea - if RF, can cause toxicity - can affect absorb/F of other drugs |
Antacids
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- PPIs irrevers. inhibit H/K ATPase, 90% reduction in acid secretion
- Tx: peptic ulcers, GERD, DOC for ZE Syn, NSAID ulcers - S/E: mild, some GI/CNS, possible cancers - DRDs: can inhibit p450s, alter absorb/F of other drugs |
Omeprazole
Lansoprazole |
|
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- analog of PGE
- decreases acid secretion, increases mucous and bicarb secretion - Tx: prevent NSAID ulcers in high risk -S/E: GI, cramps, uterine contractions (NO 4 Preggers!) |
Misopristol
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- at low pH forms polymers/sticky gel that adheres to GI, forms protective barrier
- S/E: constipation, antagonized by agents that lower acid |
Sucralfate
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- coats ulcer craters, increases mucous and bicarb, inhibits pepsin & is ANTIBac to Hpylori
- S/E: darken stool and mouth * Used to tx traveler's diarrhea (antiinflammatory and antiobiotic) |
Colloid Bismuth subcitrate
Bismuth subsalicylate* |
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- cholinergic agonist, dopamine antagonist -- prokinetic
- increases esophageal clearance, increases LES pressure and gastric emptying - decreases reflux |
Metclopramide
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- dietary fibers, bulk forming agents
- laxatation by absorb water, soften stool - can cause obstruction, impaction |
Bran, Whole Grains
Psyllium Prep (metamucil) Methycellulose (citrucel) Calcium Polycarbophil (fibercon) |
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- saline laxatives
- act via osmotic pressure to retain water in colon - oral or rectal |
Magnesium salts
Phosphate salts |
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- stimulant laxatives
- stimulate mucosal water and electrolyte secretion |
Biscodyl
Phenophthalein (off market) |
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- surfactant laxative
- wetting and emulsifying agent to soften stool |
Docusates
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- surfactatn laxative
- cleaved to ricinoleic acid that is an anionic surfactant, prokinetic irritant, purging effect |
Castor Oil
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- non absorbed lubricant
- can decrease absorp of ADEK - if aspirated, can cause pneuomonitis |
Mineral Oil
|
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- opiods stimulate mu receptors
- decrease GI motility, increase transit time/absorb, antidiarrheals - atropine side effects discourage abuse (loperamide has poor CNS) |
Diphenoxylate/Atropine
Diphenoxin/Atropine Loperamide |
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- B2 agonists
- Short acting (rescue) airway relaxation and anti-inflam, oral or inhaled (*only inhaled) - S/E: CNS stim, HR stim |
Albuterol
Metaproteronol Terbutaline Levabuterol* |
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- B2 agonists
- Long acting (preventative) airway relaxation (not much anti-inflam so not sole agent) - often combo with steroid (advair) - S/E: CNS stim, HR stim |
Salmeterol
Formoterol |
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- inhaled corticosteroids
- Tx: prophy for mod/sev asthma, blocks leukotris so better control |
Beclomethasone
Triamcinolone Budesodine Flunisolide Fluticasone |
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- oral/parenteral corticosteroids for chronic severe asthma, COPD b/c decrease inflammation
|
Prednisone (+methyl)
Prednisolone (+methyl) Dexamethasone |
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- blocks 5-lipoxygenase, so blocks leukotri.
- Tx: asthma prophy - S/E: increases LFTs, inhibits P450s q.i.d dosing |
Zileuton
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- competitively block leukotriene receptors
- Tx: asthma, allergy - S/E: HAs, GI, myalgias; Z inhibits P450s |
Zafirlukast
Montelukast |
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- competitive Ach-Muscarinic receptors, decreases parasympathetic tone, decreases bronchoconstriction (esp large airways)
- effects vary b/c of varied innervation - combination with B2 more effective than either alone (esp COPD) - few side effects b/c does not cross BBB |
Ipratropium
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- Mast cell stabilizers, decrease release of inflam meds.
- Prophy for asthma, allergies - inhalation only, take a while |
Cromolyn
Nedocromil |
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- methylxanthines
- inhibit cyclide PDEs, so cAMP is not broken down and antagonize adenosine receptors - cheap but massive variability in pharmokin, absorpt, halflife, narrow thera window, CYP 450 effects - CNS, CV, Diuretic side effects |
Theophylline
Caffeine Theobromine |
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- depot theophylline
|
Aminophylline
|
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- AntiIgE therapy
- moderate/severe asthma - SubQ injection, relatively new, maybe CA causing |
Omalizumab
|
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- stop smoking
- O2 - B2 agonist (with ipratropium) - IV dexa when bad - antibiotics |
COPD tx
|
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- opiods used as antitussives (MOA unknown)
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Codeine
Hydrocodone |
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- codeine but w/o analgesia or sedation at normal dose
- antitussive |
Dextromethorphan
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- antihistamine
- antitussive (unknown MOA) |
Diphenhydramine
|
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- expectorant (loosens, thins secretions, reduces viscosity, promotes ciliary action)
- expel more, cough less - Oral, rapid - S/e: kidney stones, not to be used under 6 yo |
Guafenesin
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- inhaled, used in pts with abnl viscous (CF)
- reduces disulfide bonds in proteins (mucolytic) - S/E: irritant may cause reflex constriction, bad tasts/smell |
Acetylcysteine
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- inhaled, adjunct for CF
- recomb deoxyribonuclease, breaks down polymerized DNA from PMNs and other cells in CF mucous (mucolytic) S/E: minimal |
Dornase alfa
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- active txp of Iodide into cells
- inhibited by thiocynanate and percholorate - Iodide oxidized to Iodine by thryoid peroxidase (with H202) on apical membrane - Iodide negatively feedsback to inhibit TH secretion - lithium also inhibits Th secretion |
Iodide Uptake/conversion
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- txp bound to TBG (inactive)
- T4 to T3 by 5diodinase in liver - T3 much more active, T4 much more prevalent - metabolized by P450s |
Thyroid hormones
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- Primary (TSH high, TH low)
*Hashimotos (abs to peroxidase) *Cretenism (congenital) *Radioactive damage - Secondary (TSH low) - Tx: T4 |
Hypothyroidism
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- Oral or IV T4
- Tx: hypothyroid, MNG, Hashimoto, thyroid carcinoma (- feedback) - DDRs: estrogens increase TBGs, TCA increase effects, warfarin activity increase) |
Levothyroxine
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Graves: autoimmune, antibodies to cells or TSH receptors
- high T4, T3 low TSH Tx: NSAIDS, Propanolol, Prednisone, antithyroid agents |
Hyperthyroidism
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- antithyroid agents
- inhibit Iodide incorporation, inhibit coupling, inhibit conversion to T3 - Tx: hyperthyroid, presurgical tx, preg (propyl doesn't x placenta) - S/E: agranulocytosis |
Propylthiouracil
Methimazole |
|
|
- radioisotope used to treat hyperthyroidism, thyroid CA, Graves Disease
- can induce hypothyroidism |
Iodine131
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- presurg to reduce vasc of gland
- block radioactive uptake in nuclear accidents - crosses placenta |
iodide
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- less than 300 ng/dl testosterone
- loss of energy, decrease libido, osteoporosis, wasting, anemia - Tx: testosterone/esters |
Hypogonadism
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transdermal (not oral)
- Testoderm scrotal patch, Dermal/Androderm skin patch, buccal tablet IM injection 2-3 times a week |
Testosterone
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-esters given IM, like depot testosterone
|
Testosterone proprionate
-cypionate -enanthate |
|
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- 17a-alkylated testoterone
- orally effective - high abuse potential, anabolic - S/E: cholestatic hep, jaundice, hepatotoxic; salt and water retention * used to treat herid angioedema b/c increase C1 INH |
methyltestoterone
fluoxymesterone *stanazolol |
|
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- suppresses FSH/LH surge
- causes weight gain in women but doesn't affect aromatase Tx: endometriosis, fibrocystic breasts |
danazol
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- testosterone derivative
- high anabolic ratio (abused) - Tx: weight again with muscle wasting, severe burns, AIDS - S/E: edema, water retention, roid rage (NOT for use with breast or prostate ca) |
oxandrolone
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|
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- antiandrogen, compet inhib of 5a reductase in liver and periphery (blocks making of DHT)
- Tx: BPH, baldness - S/E: not for women, kids, lowers PSA by 50% but increased risk of male Breast CA |
Finasteride
|
|
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-antiandrogen, GnRN agonist, continuous secretion downregs Lh/FSH, decreases testosterone
- Tx: prostate CA, endometriosis (with danazol) - S/E: hot flashese, edema, gynecomastia * combo with flutamide |
Leuprolide
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- antiandrogen, inhibits DHT
- Tx: prostate CA |
flutamide
bicalutamide nilutamide |
