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Pharm Endocrine
| Question | Answer |
|---|---|
| Thyroid Gland regulation | T3(active) and T4 -- stimulation of energy use (calorigenic), stimulation of heart (increases HR and blood flow), promote growth and development |
| hypothyroidism | not enough thyroid hormone, can occur at any age, maternal (retardation, cretinism) |
| causes of hypothyroidism | malfunction of thyroid, autoimmune (Hashimotos), surgical removal of thyroid, insufficient iodine diet |
| symptoms of hypothyroidism | fatigue, lethargy, intolerance to cold, bradycardia, myxedema |
| Levothyroxine (Synthroid) | synthetic prep of T4, converts to T3, highly protein bound, half life 7 days (longer), concentration at steady state (~1month) |
| Liothyronine (Cytomel) | synthetic prep of T3, more potent but shorter half life, higher cost, and increased cardiotoxicity |
| thyroid hormone replacement- adverse effects | tachycardia, tremor, nervousness, insomnia |
| Hyeprthyroidism forms | Graves Disease (autoimmune) and Toxic nodular goiter (Plummers disease) |
| Graves Disease | thyroid stimulating immunoglobulin (TSIs)- autoantibodies that mimic TSH effects- overstimulates the thyroid |
| Plummer's disease (nodular goiter) | result of thyroid autonomy (nodules create thyroid hormone independent of TSH stimulation) |
| Symptoms of hyperthyroidism | tachycardia, irritability, nervousness, heat intolerance, goiter, exopthalmos (protrusion of eyeballs) in Grave's disease |
| Methimazole (Tapazole) | suppression of thyroid hormone synthesis |
| Propylthiouracil (PTU) | 2nd line, suppresses thyroid hormone synthesis (shorter half life than methimazole) |
| Beta Blockers for hyperthyroidism | suppress tahcycardia and other symtpoms |
| Radioactive iodine | destroys thyroid tissue- but hypothyroidism occur in 80% (1st choice in elderly and post menopausal) |
| non radioactive iodine (Lugol's solution) | at high concentrations, iodide suppresses thyroid |
| Surgical removal of thyroid tissue | 80-90% will require supplementation |
| Growth Hormone (somatropin) | promote growth, promotes protein synthesis, carbohydrate metabolism |
| Therapeutic uses of Growth hormone (somatropin) | IM or SubQ- pediatric GH deficiency, Pediatric short stature, adult GH deficiency, sports "doping" |
| Somatostatin | inhibitor of growth hormone (synthetic form is Sandostatin) |
| Adverse effects of Growth hormone | edema, musculoskeletal pain, hyperglycemia |
| Prolactin | stimulates milk production after giving birth |
| hypersecretion of prolactin (female) | amenorrhea, galatorrhea, infertility |
| hyeprsecretion of prolactin (male) | libido and potency reduced (lowers testosterone), galactorrhea |
| Cabergoline (Dostinex) | dopamine agonist, suppression of prolactin release |
| Oxytocin | promotes uterine contractions during labor, stimulate milk ejection during breast feeding |
| Pitocin | synthetic oxytocin, used to induce labor near term |
| Desmopressin | agent of choice to treat diabetes insipidus (ADH deficiency)- long duration of action |
| Therapeutic uses of desmopressin | diabetes insipidus, cardiac arrest (enhance CPR), nocturnal enuresis (bedwetting) |
| adrenal medulla | releases catecholaminesin coordination with SNS |
| adrenal cortex | produces steroid hormones |
| 3 classes of adrenocortical hormones (steroid hormones) | 1) glucocorticoids 2) mineralocorticoids (aldosterone) 3) Androgens (androstenedione) |
| Metabolic effects of Glucocorticoids (cortisol) | carbohydrate metabolism (promote glucose availability), protein metabolism, fat metabolism, maintain integrity of vascular system, promote renal sodium and water retention |
| Pharmacologic Effects of glucocorticoids | antiinflammatory at high doses in therapy of non endocrine diseases (rheumatoid arthritic, lupus, IBD, others), immunosuppressant effects |
| Cushing's Syndrome | adrenal hormone excess; caused by hypersecretion of ACTH, hypersecretion of glucocorticoids, or glucocorticoid therapy in large doses |
| symptoms of Cushing's syndrome | obesity, moon face, buffalo hump, hyperglycemia, glycosuria, hypertension, fluid and electrolyte disturbances |
| Treatment of Cushing's syndrome | surgical removal of adrenal gland, aldosterone antagonist (spironolactone), Mifepristone |
| Mifepristone (Korlym) | cortisol receptor blocker; high daily dose treatment of hyperglycemia secondary to hypercortisolism in adults with endogenous cushing's syndrome |
| Off label indications of Mifepristone | emergency contraception, spontaneous abortion- in combo with misoprostol = abortion < 49 days of pregnancy. |
| Adverse effects of Mifepristone | reproductive (abnormal bleeding), CV (HTN,edema) |
| Addison's Disease | adrenal hormone deficiency |
| symptoms of addison's disease | weakness, emaciation, hypoglycemia, increased pigmentation of skin and mucous membranes |
| Treatment of Addisons disease | replacement therapy with adrenocorticoids, hydrocortisone, mineralcorticoid replacement (Florinef) |
| Florinef- MOA | binds to aldosterone receptor; mineralcorticoid property and glucocorticoid activity- retains sodium and excretes potassium |
| Florinef- indications | Addison's disease, adrenogenital disorder |
| Florinef- adverse effects | edema, hyperglycemia, decreased body growth |
| Long term therapy with glucocorticoids- problem | therapy >2 weeks- adrenal suppression by negative feedback regulation |
| adverse effects of glucocorticoids | adrenal insufficiency with long term therapy, susceptibility to infection, osteoporosis, hyperglycemia, fluid and electrolyte disturbance, edema, hypokalemia, cardiac enlargement, hypertension, myopathy, muscle weakness, PUD, growth retardation, Cushings |
| short to medium acting glucocorticoid | Hydrocortisone (cortef) |
| Intermediate Acting glucocorticoids | prednisone, methylprednisolone, triacinolone (Kenalog) |
| Long acting glucocorticoids | dexamethasone (Dex Pax) |
Created by:
alexadianna
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