S2 Pharm 1-38

Front 1

Dopamine agonist treatment for prolactinoma

Back 1

Bromocriptine (D2/D1) and Cabergoline (D2)

Front 2

Side effects of Cabergoline

Back 2

Headache, nausea, orthostatis HTN; discontinue for psychosis

Front 3

Treatment for Acromegaly: Octreotide

Back 3

Somatostatin analogue (cholesterol gallstones common)

Front 4

Treatment for Acromegaly: Bromocriptine

Back 4

Dopamine agonist (20% see improvement)

Front 5

Treatment for Acromegaly: Pegvisomant

Back 5

Competitive GH-receptor antagonist

Front 6

Dexamethasone testing for HPA differentiation on cortisol

Back 6

Adrenal/ectopic ACTH-production cortisol levels NOT suppressed by negative feedback

Front 7

Metyrapone testing

Back 7

If ACTH rises, but cortisol precursors don't, signals adrenal insufficency. If neither ACTH or precursors rise, impaired HPA axis. (MOA: blocks conversion of precursors to cortisol)

Front 8

Vasopressin receptors

Back 8

V1- vasoconstrictor (IP3,Low affinity); V2- antidiuretic (cAMP, high); V3- ACTH stimulation from pituitary

Front 9

Desmopressin receptor selectivity

Back 9

V2- antidiuretic

Front 10

Desmopressin in DI treatment

Back 10

Central (eliminates thirst/fluid intake), Dipsogenic (eliminates urination, not thirst/intake)

Front 11

Water deprivation test

Back 11

Central/polydipsia respond as normal. Central responds with Desmopressin. Nephrogenic never responds.

Front 12

Treatment for SIADH

Back 12

Cautious infusion of hypertonic saline / furosemide (diuretic) (not too quickly, avoid demyelination); fluid restriction if not severe, V2 receptor antagonists (Aquaretics)

Front 13

Somatropin MOA

Back 13

Recombinant human GH

Front 14

Mecasermin MOA

Back 14

Agonist directly at IGF-1 receptor in target tissues if somatropin fails

Front 15

Desmopressin MOA

Back 15

Selective V2 receptor agonist in kidney (antidiuretic)

Front 16

Cellular response to Desmopressin

Back 16

Activates G protein in V2 receptor; activation of kinases to receptor coupled aquaporin; increases transport of H2O to reverse hyperosmolality; dilutes concentration of sodium

Front 17

Vasopressin

Back 17

Non-selective V1/V2 receptor; corrects low bp; may lead to HTN / CNS toxicity

Front 18

Octreocide MOA

Back 18

Somatostatin receptor to inhibit GH release; injection; gallstones, GI, hyperglycemia, hypoinsulinemia

Front 19

Pegvisomant MOA

Back 19

Liver GH receptor antagonist; blocks IGF-1 production

Front 20

Conivaptan MOA

Back 20

Non-seletive vasopressin V1/V2 receptor antagonist (SIADH), reduces hyponatremia

Front 21

Tolvaptan MOA

Back 21

Oral V2 antagonist (SIADH)

Front 22

Common side-effects of dopamine receptor agonists

Back 22

Bromocriptine/Cabergoline- orthostatic HTN, ergot-related (burning), CV risk (arrythmia), CNS (delusions, hallucinations, psychosis)

Front 23

Mineralocorticoid MOA

Back 23

Alters transcription to increase Na+/K+ ATPase expression (inc. blood vol.)

Front 24

Glucocorticoid MOA

Back 24

Dislodged heat shock protein (HSP), activates receptor, activates glucocorticoid response element (GRE)

Front 25

Anti-inflammatory MOA of glucocorticoids

Back 25

Cortisol binds GRE, prevents transcription of cytokines and increases anti-inflammatory transcription (PLA2 inhibitor)

Front 26

Adrenal steroid agonist with 1:1 ratio

Back 26

Hydrocortisone (gluco:mineralo)

Front 27

Short-acting, low selectivity corticosteroids

Back 27

Prednisone (oral), prednisolone, methyprednisolone

Front 28

Intermediate-acting low selectivity corticosteroids

Back 28

Triamcinolone

Front 29

Long-acting, highly selective corticosteroids

Back 29

Betamethasone, dexamethasone, beclomethasone (antiinflammatory effect)

Front 30

MOA for corticosteroids

Back 30

Increase transcription of lipocortin-1 (inhibits PLA2)

Front 31

Long-term effects of corticosteroids

Back 31

Catabolic (growth suppression, muscle loss), osteoporosis, cataracts/glaucoma, neurological (hypomania, psychosis, insomnia, anxiety)

Front 32

Why must pt ween off of corticosteroids?

Back 32

Adrenal suppression

Front 33

Tx for Addison's

Back 33

Hydrocortisone, androgens, fludrocortisone (selective mineralocorticoid receptor agonist)

Front 34

Reason for iatrogenic Cushing's in pt on Ritonavir

Back 34

Ritonavir is a CYP3A4 inhibitor, required for corticosteroid metabolism

Front 35

Ketoconazole MOA

Back 35

Inhibits 17a-hydroxylase and 11B-hydroxylase

Front 36

Aminoglutethimide MOA

Back 36

Inhibits Cholesterol desmolase and aromatase; nausea, dizziness (decreased T4 -> T3 conversion)

Front 37

Major ketoconazole effect

Back 37

CYP3A4 inhibitor (drug interactions), hepatotoxicity

Front 38

Metyrapone MOA in Cushing's Tx

Back 38

11B-hydroxylase inhibitor, causes HTN (precursor build-up), androgenic