Question | Answer |
Inhibitor of Na+-I- cotransporter | PERCHLORATE |
mechanism and main toxicity of perchlorate | Block uptake of iodide (I-), Aplastic Anemia |
Iodide mechanism | Inhibit organification, Inhibit release of T3 and T4 (via inhibition of proteases), decrease size and vascularity of gland |
Radioactive Iodine (131I) mechanism | Rapid uptake of Iodine, Emission of radioactive β-particle
Selective destruction of thyroid tissue |
how toxic is radio active Iodine | little to no toxicity |
PROPYLTHIOURACIL (PTU) mechanism | Block Organification, inhibit thyroid peroxidase |
PROPYLTHIOURACIL is a | Thioamide |
Levothyroxine is | t4 analogue |
Ketoconazole is | an antifungal |
ketoconazole mechanism | a non-selective inhibitor of steroid hormone biosynthesis.
It inhibits various enzymes in the biosynthetic pathway of cortisol |
Ketoconazole interacts with | statins ex: simvastatin |
Mifepristone | GC receptor antagonist |
Mitotane | chemically non-selective adrenalectomic agent |
OXYTOCIN actions | Induces contraction of smooth muscle in reproductive tracts, initiating labor, stimulates lactation |
DESMOPRESSIN ACETATE is | a long synthetic vasopressin anologue, it has minimal vasoconstrictor effects. The Antidiuretic : Pressor ratio is 4000x higher than native ADH |
CONIVAPTAN is | ADH ANTAGONISTS: Used in patients with hyponatremia or acute HF. It has a high affinity for V1A and V2 rec |
Chloropromide and Glyburide desctiption and MOA | its a Sulfonylurea, which inhibits the atpase sensitive k channel |
Chloropromide and Glyburide effect | INCREASE insulin release from pancreas
DECREASE Glucagon levels (mechanism unclear) |
Chloropromide and Glyburide TOXICITY/SIDE EFFECTS | Hypoglycemia (Most common side effect)
Weight Gain
Potentially Teratogenic |
PRAMLINITIDE is | Amylin Analog, a synthetic human amylin |
MOA and effects | Binds to the Amylin Receptor in specific regions of the brain.
Activation of the amylin receptor cause reductions in glucagon release
Promotes satiety, slows gastric emptying |
PRAMLINITIDE Drug-Drug Interaction | Contraindicated in patients with disorders of motility or on drugs that decrease gastric motility (i.e. OPIODE ANALGESICS) |
REPAGLINIDE is | Meglitinides |
REPAGLINIDE MOA | STIMULATE insulin release from pancreas
Similar mechanism to sulfonylureas |
NATEGLINIDE is | d-phenylalanine derivative |
NATEGLINIDE MOA | STIMULATE insulin release from pancreas
Similar mechanism to sulfonylureas |
NATEGLINIDE and REPAGLINIDE adverse effects | Hypoglycemia, diarrhea, nausea and weight gain |
Metformin is a | Biguanide that activates ampk |
METFORMIN effects | Liver: Decreases gluconeogenesis
Skeletal muscle: Increase glucose utilization
(lowers glucose levels)
DOES NOT DEPEND ON FUNCTIONING PANCREATIC BETA CELLS |
Metformin adverse effects and metabolism | IMPAIRS HEPATIC LACTIC ACID METABOLISM
Lactic acidosis
Muscle pain
Metabolism:
Not metabolized
Excreted unchanged in the urine |
PIOGLITAZONE | Insulin Sensitizer: Thiazolidinediones (TZD’s) |
PIOGLITAZONE MOA | acts on PPAR GAMMA
INCREASE INSULIN SENSITIVITY
DECREASE INSULIN RESISTANCE
INCREASE GLUCOSE UTILIZATION |
PIOGLITAZONE adverse effects | ASSOCIATED WITH BLADDER CANCER
FLUID RETENTION |
ACARBOSE | ALPHA-GLUCISIDASE INHIBITOR |
ACARBOSE MOA | Inhibit α-glucosidase in GI tract
Decrease absorption of Glucose |
Acarbose | GI disturbance
Excess carbohydrates in GI tract lead to increased bacterial digestion of polysaccharides.
Contraindicated in people with Inflammatory Bowel Disease |
EXENATIDE | GLUCAGON-LIKE PEPTIDE-1 (GLP-1) RECEPTOR AGONISTS |
EXENATIDE effects | promotes: STIMULATES INSULIN PRODUCTION
REDUCES APPETITE
INDUCES β-CELL GROWTH |
EXENATIDE adverse effects | GI disturbance |
SITAGLIPTIN | DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR |
sitagliptin effects | INCREASE CIRCULATING GLP-1
INCREASE INSULIN LEVCELS
DECREASE GLUCAGON LEVELS
Adverse effects:
GI disturbance |
CANAGLIFLOZIN | Sodium-Glucose transporter inhibitor (SGLT-2 inhibitor) |
Canagliflozin MOA | Inhibits the reabsorbtion of glucose
Results in loss of glucose (glycosuria) and water (osmotic diuresis) |
Canagliflozin Adverse effects | Increased urination
Increased urinary tract infections
Possible hypotension |
SIMVASTATIN is | a prodrug, absorbed in the small intestine, and activated in the liver |
DRUGS THAT INTERFERE WITH STATIN OXIDATION | Macrolide antibiotics: e.g. Erythromycin
Azole antifungals: e.g. Itraconazole
Cyclosporine (immunosuppressant)
Nefazodone (a phenylpiperazine antidepressant)
HIV protease inhibitors
Amiodarone (Antiarrhythmic agent) |
Adverse effects of statins (simvastatin) | MYOPATHY
The major adverse effect associated with statin use
Statin-induced rhabdomyolysis
Risk increased in proportion to dose and plasma concentrations
Associated with factors inhibiting statin catabolism |
CHOLESTYRAMINE | Bile-Acid Sequestrant |
CHOLESTYRAMINE MOA | Positively charged compounds
IONIC BOND with negatively charged bile acids
Block reabsorbtion and enhance excretion of cholesterol
ENHANCES bile acid synthesis
reduces hepatic cholesterol → INC LDL-R synthesis |
CHOLESTYRAMINE adverse | Relatively safe
Interfere with absorption of other drugs
FUROSEMIDE, THIAZIDE DIURETICS,PROPRANOLOL, DIGOXIN, WARFARIN |
niacin MOA | Inhibits hormone-sensitive lipase
DECREASES hepatic TG synthesis
Decreases VLDL production and release
Decreases HDL breakdown |
Niacin ADVERSE EFFECTS | Cutaneous vasodilation (flush)
A prostaglandin dependent phenomena
Treated with NSAIDs, salicylate-containing creams (i.e. Aspercreme™) and aspirin
Dyspepsia
May increase insulin resistance |
CLOFIBRATE MOA | Act as PPARα ligands |
Clofibrate effects | Increased FFA OXIDATION
Increased expression and release of ApoA1
INC expression of LPL
↓ HEPATIC VLDL SECRETION, ↓ TGs, modest ↓ LDL, ↑ HDL |
Clofibrate adverse effects | Displace oral anticoagulants from protein binding sites.
Myopathy when combined w/ statins (gemfibrozil only)
Gemfibrozil blocks OATP1B1 transporter
Associated w/ gallstone formation |
EZETIMIBE MOA | Inhibits luminal cholesterol uptake in the SMALL INTESTINE
Decreases cholesterol uptake into chylomicrons
Reduces cholesterol in liver
Increases LDL-Receptor expression
Inc plasma LDL clearance |
Ezetimibe interactions | BILE ACID SEQUESTRANTS INHIBIT ABSORBTION (ex: cholestyramine)
CONTRAINDICATED
No other interaction reported |
ALIROCUMAB is | a pcsk9 inhibitor. ( PCSK9 inhibitors have been shown to reduce LDL levels by up to 60 percent from baseline levels, (including in statin-intolerant) |
ALIROCUMAB MOA | Binds and inactivates PCSK9
Inhibits degradation of LDL-R
Increases LDL-R number |
ALIROCUMAB adverse effect | Itching and swelling at site of injection
Flu-like symptoms
Hypersensitivity-type reactions |
Somatotropin | is Identical to human GH |
Mecasermin | recombinant human IGF-I (rh IGF-I)
- Used for treatment of GH-resistant IGF-I deficiency |
Octreotide | Somatostatin analog |
Pegvisomant | GH receptor anatgonist, Binds only to one GH receptor, will stop dimerization |