Dr. Call; Endocrine Pharmacology II & Insulin/Antidiabetic
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| Please describe the Hypothalamic-Pituitary-Adrenal (HPA) Axis. | CRH--ACTH--Cortisol. The corticotropin-releasing hormone (CRH) is released from the hypothalamus and stimulates the Adrenocorticotropic hormone (ACTH) form the pituitary. ACTH activates the adrenal cortex to produce corticosteroids.
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| What are three types of corticosteroids? | Mineralocorticoids, Glucocorticoids, Adrenal Androgens
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| What is hormone is a Glucocorticoid that is released in a daily rhythm and released to deal with stress? | Cortisol
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| What hormone stimulates corticosteroids? | ACTH
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| What hormone increases the circulating levels of glucose, free fatty acids, and amino acids? | Glucocorticoids
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| What can an glucocorticoid insufficiency cause? | Hypoglycemia (during stress)
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| What are some uses for corticosteroid? | Replacement therapy (when you lack them), Immunosupression (transplant therapy), Inflammatory state (rheumatoid arthritis, asthma), Dermatologic Conditions, Cancer (some leukemias).
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| What are some Adverse Effects that can occur with the use of glucocorticoids? | Infections (my mask symptoms,more prone to serious infections), Hyperglycemia (unmask diabetes in some), Osteoporosis (with chronic use),CNS (restlessness,insomnia, psychotic reactions,euphoria,and ncreased appetite),HPA depression (Adrenal Insufficiency)
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| What are some therapeutic guidlines for treatment of glucocorticoids? | Short-term, relatively high dose therapy is alright. -Give sufficient amount to control problem. -Use SMALLEST effective amount for the SHORTEST time. -LOCALLY is better. -Alternate days. -Slowly taper withdrawl.
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| What is the action for all sex hormones? | They act upon nuclear receptors.
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| Is the natural form of estrogen orally active? | The naturally occuring estrogens are not orally active so synthetic forms of astrogen have been made. (Ethinyl estradiol & mestranol)
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| What biological functions is Estrogen responsible for? | Ovary, Uterus, Vaginal Epithelium, Endocervical Glands, Breasts, Puberty, Bone, BLOOD CLOTTIGNGm METABOLIC.
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| What are some side effects of oral contraceptives? | Weight Gain, Nausea, Edema. Cardiovascular, Migraine, Depression.
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| What drug reduces your risk of ovarian and uterine cancer by 50% in just after 5 years of use? | Oral Contraceptives.
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| What are 2 antiestrogens? | Tamoxifen (Novaldex), Anastrozole (Arimidex)
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| What drug is used to treat breast cancer in post-menopausal women or women that have besome tamoxifen-resistant. | Anastrozole (Antiestrogen) (Aromatase Inhibitor)
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| What is the side effect for Anastrozole (antiestrogen) | Menopausal side effects.
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| What drug is an antiandrogen and what is it mechanism of action? | Finasteride (Inhibitor of the 5alpha-reductase enzyme) (converts testosterone into dihydrotestosterone (DHT) which is the most potent endrogenous androgen (large effects of the prostate and hair folicles)
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| What drug is used for prostatic hyperplasia and male pattern bladness? | Finasteride (Propecia) -- Antiandrogens
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| What happens when you ingest sugars? | Oral glucose stimulates release of insulin and inhibits the release of glucagon. Overall Result: Decreased glucose production, increased glucose uptake by tissues.
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| Is glucose dependent on Insulin? | NO
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| What does insulin do? | Insulin promotes entry of glucose into skeletal muscle, heart muscle, and fat tissue.
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| Where is insulin not required for glucose transport? | Brain & Liver
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| What are the differences between insulin and glucagon? | Insulin promotes the uptake, utilization, and storage of glucose and thereby lowers the blood glucose. Glucagon increases the hepatic glucose output and blood gluose concentration.
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| How does diabetes mellitus come about? | When there is not enough insulin secretion or activity to maintain normal blood glucose concnetration.
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| How is Glucagon produced and when is it released? | Glucagon is produced by alpha-cells of the pancreas in response to decreased blood glucose concentrations. It increases hepatic glucose production.
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| What type of diabetes is insulin dependent? | Type I
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| What type of diabetes is not insulin dependent? | Type II
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| What type of diabetes is involved the destruction of pancreatic insulin-producing cells? | Type I
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| What type of diabetes is, resistance of tissues to insulin? | Type II
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| What type of diabetes is gestational? | Type III
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| What type of diabetes mostly occurs in juveniles but can occasionally seen in non-obese adults and in the elderly. | Type I
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| In what type of diabetes will the Pancreatic beta-cells fail to respond to insulinogenic stimuli (glucose)(autoimmune)? | Type I
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| What type of diabetes is represented by an insensitivity to circulating insulin, or not enough insulin produced> | Type II
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| What type of diabetes is there chronic overfeeding? | Type II
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| Why does chronic overfeeding occur in Type II diabetics? | Hungry all the time b/c the glucose cannot get into their system. There is chronic overfeeding when the beta-cells are constanly stimulated because hyperinsulinism causes receptor insensitivity
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| What are the three P's of Diabetes Mellitus? | Polyuria: excessive urine output. Polydipsia:Excessive Thirst. Polyphagia:Excessive Hunger.
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| What type of diabetes is treated with insulin? | Type I
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| What is rapid acting insulin? | Insulin Lispro
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| What is the short acting Insulin? | Regular Humulin
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| What is the Intermediate acting Insulin? | NPH Humulin
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| What is the long acting insulin? | Insulin Glargine
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| What are some adverse effects of Insulin? | -Hypoglycemia (tachycardia, vertigo, confusion, sweating) -Lipodystrophy (big bumps of fatty tissue at site of infusion) -Hypersensitivity
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| What are some type II antidiabetic drugs? | -Tolbutamide -Metformin -Acarbose -Pioglitazone -Exenatide -Sitagliptin
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| What does Tolbutamide do? | Stimulates Insulin Release, Reduces Glucagon
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| What does Metformin do? | Decreases hepatic glucose output. Reduces LDL and VLDL
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| What antidiabetic drug causes Flatulene, diarrhea, and cramping? | Type II - Acarbose.
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| Which drug decrease absorption of starch and disacchrides from intestines? | Acarbose - Type II
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| What antidiabetic drug decreases hepatic glucose output? | Metformin. Type II
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| What antidiabetic drug stimulates insulin release, reduces glucagon, and increases insulin effects | Tolbutamide - Type II
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| What antidiabetic drug lowers insulin resistance? | Pioglitazone.
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| What antidiabetic drug has problems with edema and MI? (dangerous in CHF patient) | Pioglitazone
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| What are incretin memetics? | Exenatide- Resistant to enzymatic degradation by DPP-IV. Increases insulin and Inhibits glucagon. Injection.
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| What is the only type II drug that you need to inject? | Exenatide - Incretin Mimetic
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| What do DPP-IV inhibitors do? | Increase the effect of increntin hormones. Inhibit DPP-IV degredation of increntins. They bind to DPP-IV and do not allow the breakdown of increntins once a patient eats.
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| What is a DPP-IV inhibitor? | Sitagliptin -DPP-IV inhibitor
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| What is the Type II treatment pradigm? | Step 1: Metformin + Lifestyle. Step 2: Sulfonyurea (Tolbutamide), Thiazolidinedione (Pioglitazone), or Insulin. Step III: Add other drugs as needed.
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| This drug enhance reabsoprtion of water in the kidneys and enhances water permeability in the renal collecting ducts. | Antidiuretic Hormone
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| This drug for Diabetes Insipidus is given intramuscularly. | Pitressin
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