Pharmacology: Endocrine
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| show | C peptide
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| 2 things insulin does | show 🗑
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| 3 types of people who need insulin | show 🗑
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| show | Analog, most used insulin onset w/in 10-20 min (premeal) lasting 3-5 hours. Rx only.
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| Short acting (regular) | show 🗑
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| Type of insulin used for patients on high doses of insulin. | show 🗑
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| show | NPH, onset 1-2 hours, lasts 10-20 hours. Cloudy. No Rx.
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| show | Onset 1-2 hours, insulin Glargine with pH 4.0 or insulin Detemir (long flat curve, no sharp uptake). Lasts 24 hours. Rx only
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| Initial fluctuating levels of glucose due to increased sensitivity insulin as the body adjusts | show 🗑
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| show | .5 units per kg Ex: If you had 60 kg pt, you would have 30 units to give. Divide it up by half so 2 15 unit doses. 15 Basal at the beginning of the day and 15/3 for each meal.
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| show | Isophane basally and one of the rapid actings to cover meals
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| Shortest duration of insulin stability at room temperature | show 🗑
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| show | 1) Wt gain 2) Nodules 3) Lipohypertrophy 4) Lipoatrophy
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| T/F: Continuous pump > Long acting insulin (glargine)? | show 🗑
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| show | for hypoglycemic emergency; helps the liver release of glucose store in bloodstream. Injectable good for the unconscious pts. Also good for BB overdose
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| show | Dawn Phenomenon
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| show | Working beta cells are required. MOA: stimulates release by blocking K+ resulting in depolarization of Ca2+ influx promotes insulin secretion; effective for 24 hours (O/D requires 24 hour glucose support). A: hepatic/renal insufficiency ->hypoglycemia
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| show | amylin agonist; delays gastric emptying, inhibits secretion of glucagon, wt loss, N/V
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| Meglitinides | show 🗑
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| show | insulin sensitizer (increases glucose uptake and use), inhibits hepatic gluconeogenesis, decreases appetite. Adverse: lactic acidosis esp w/ CHF, renal pts. Metallic taste, D/N
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| TZDs (Thiazolidinediones): MOA, Action, Adverse | show 🗑
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| show | Inhibits AG in intestinal brush border that delays carb digestion. Adverse: flatulence, GI, metformin bioavailability decreased. Tx overdoses w/ pure glucose as sucrase also inhibited.
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| Incretin therapy: MOA and what is inhibited, adverse | show 🗑
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| show | MOA: mimic prolonged action of GLP-1, slows gastric emptyhing, enhances insulin, reduces glucagon, reduces appetite A: N/V/wt loss, pancreatitis
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| show | stops metabolism of GLP-1 which has the same actions as GLP-1 agonists. Adverse: HAs, vasculitis, pancreatitis, risk for viral infection.
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| Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors: What do they do? Adverse? | show 🗑
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| show | Diabetic Ketoacidosis (DKA)
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| DKA Tx (4) | show 🗑
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| Marked hyperglycemia, azotemia, profound dehydration with NO acidosis or ketotic usually in unattended elderly, alcohol abusers, acute infection. Very high glucose, serum ketones not present, usually in type 2 diabetics. | show 🗑
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| HHS Tx | show 🗑
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| show | Thyroxine Binding Globulin (TBG)
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| Inactive thyroid hormone | show 🗑
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| show | T3
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| SLUGGISH acronym; for hyper or hypothyroidism? | show 🗑
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| show | Pure T4 (obviously a med for hypothyroidism)
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| show | True; typical dose is 1.5μg T4 per kg body weight
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| What is the principal effect of thyroid hormone effects? | show 🗑
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| T4 given to older/younger patients and T3 given to older/younger patients? | show 🗑
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| show | only pure T3 replacement...fast acting.
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| What is Liotrix? | show 🗑
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| Transient use of anti-thyroid drugs? How do they work? Examples of drugs? | show 🗑
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| Main two options for hyperthyroidism? | show 🗑
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| show | Exogenous excessive iodides will decrease serum T4/T3 by negative feedback. Paradoxical increase in hormone release when iodides are used for prolonged time. Effective for thyroid storm.
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| T/F: Anti-thyroid drugs push synthesis of coagulation factors | show 🗑
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| Inhibits incorporation of iodine into thyroid hormones, but doesn't interfere w/ exogenous thyroid supplementation (conversion). CONTRA in pregnancy: cutis aplasia in fetus. Adverse: insulin autoimmune syndrome (which can result in hypoglycemic coma) | show 🗑
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| show | Propylthiouracil; despite being category D...interferes w/ iodine incorporation into thyroid hormone AND in large doses can prevent conversion of T4->T3. A: bitter taste, RPGN rash
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| show | True, 29% of pts relapse.
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| Most common procedure other than those discussed earlier in study stack? | show 🗑
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| show | 1/4 of the dose
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| Two main drugs that REDUCE thyroid hormone production? Not necessarily anti-thyroid drugs | show 🗑
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| Two main drugs that increase thyroid amounts in large doses? | show 🗑
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| show | Thyroid Storm; 1) Acetominophen for fever preferable. 2) IV BB to control adrenergic tone THEN 3) Iodinated radiocontrast agent to inhibit conversion of T4 to T3 and iodine solution to block the release of thyroid hormone
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| Interacts w/ cell surface receptor and exerts an anabolic effect on cells within body, promotes gluconeogenesis in liver, stimulates immune system. | show 🗑
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| show | Growth Hormone Deficiency. Tx: HGH (Growth hormone; makes energy available for growth) IGF-1 (induces cells to grow).
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| show | Acromegaly
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| show | 1) HTN/HD 2) Sleep apnea 3) Type 2 DM 4) Irreversible arthritis 5) CVAs and HAs
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| Where is Vasopressin Receptor 2 and what does it do? | show 🗑
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| Where is Vasopressin Receptor 1A? 1B? | show 🗑
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| Insensitivity of kidney to vasopressin: Receptor 2 does not function properly | show 🗑
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| Name of synthetic vasopressin and where is it administered? Adverse? | show 🗑
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| show | Binds to V2 receptors in collecting ducts increasing water reabsorption. Stimulates release of factor VIII. More specific to V2 than vasopressin is and concentrates urine without vasoconstricting. A: facial flushing, nausea, hyponatremia
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| Inappropriate release of vasopressin resulting in fluid retention, ECV expansion, hyponatremia. Tx (3)? | show 🗑
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| Peak bone mass affected by: (4) | show 🗑
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| Secondary problem of lack of calcium or vitamin D | show 🗑
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| show | FALSE, there are many fractures that occur before the -2.5 level
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| show | RF: 1) Bone loss 2) Tendency to fall; Tx: 1) Increase BMD w/ supplementation 2) Fall prevention w/ strength/balance exercises
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| show | D: 4,000 IUs; Ca: 2,000mg
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| show | Parathyroid Hormone
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| Endogenous peptide that partially inhibits osteoclast activity and produces rapid decrease in bone resorption. Not very effective...Risk>Benefit | show 🗑
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| show | Strontium Ranelate
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| show | Bisphosphonates
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| show | 1) Hypocalcemia (osteoblasts can't make new bone) 2) Inability to stand or sit upright for 30 minutes. 3) GI disorders
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| 2 uses for hormone replacement therapy | show 🗑
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| Why did hormone replacement fall out of favor and why are they coming back into it? | show 🗑
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| show | SERMS or Raloxifene
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| show | Antibody to RANKL that prevents osteoclast precursor differentiation
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| show | Synthetic PTH best. Bisphosphonate (alendronate) is first.
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| Worthwhile combos for osteoporosis? | show 🗑
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| A necessary follow up test (initial and follow up) | show 🗑
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| show | FALSE, can't close bone trauma w/ bisphosphonates. Can lead to osteonecrosis of the jaw
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| T/F: Androgens anabolic effects (steroids) will not work unless you work out | show 🗑
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| show | Enhances libido, energy, immune function and protects against osteoporosis
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| show | Hypogonadism and delayed onset of male puberty
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| Normal ratio for epimers in urine for testosterone? (testosterone: epitestosterone) | show 🗑
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| Steroid used by veterinarians on livestock? | show 🗑
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| show | Gen: Increase LDL/decreases HDL, increases BP. Males: reduced sperm count/shrunken testicles, gyneocomastia. Adolescents: premature skeletal maturation and precocious puberty leaving them w/short stature.
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| What is ovulation triggered by? | show 🗑
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| show | Progesterone
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| What do oral contraceptives do? | show 🗑
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| show | 1) Breastfeeding 2) 15+ cigs/day 3) >160/100 mm Hg 4) venous thromboembolism 5) Ischemic HD 6) valvular HD 7) migraine w/focal neuro Sx 8) Breast Ca 9) DM w/Sx 10) significant liver disease
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| Relative CONTRAs of contraception (7, don't memorize all) | show 🗑
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| show | Rifampin and anti-seizures
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| show | 1) Menstrual cycle regulation/decreased flow 2) increased bone mineral density 3) decreased acne, hirsutism, endometrial cancer 4) decreased moliminal/PMS Sx
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| show | Breakthrough bleeding (amenorrhea), decreased libido, THROMBOEMBOLIC events, may trigger vascular HAs, wt gain
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| show | True: <15 cigs: 3x and >15 cigs: 21x average risk
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| Missed one or 2 pills? | show 🗑
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| 2 options when missing 3 or more active pills? What should you consider for both methods? | show 🗑
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| Formulation for majority of today's oral contraceptives | show 🗑
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| show | N, bloating, breast tenderness, ^BP, HA, melasma
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| Too little estrogen? | show 🗑
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| Too much progestin? | show 🗑
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| show | late breakthrough bleeding
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| ACHES acronym | show 🗑
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| show | loss of bone mineral density...significant loss in bone mineral density possible. Other adverse: significant wt gain
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| How does the implanon rod work? Main active ingredient? | show 🗑
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| show | Benefits: anti-tumor and bone preservation. Adverse: vaginal bleeding, hypercalcemia, thromboembolism
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| show | competitive progesterone receptor antagonist. Combined with prostaglandin is most effective abortifacient less than 7 weeks. MOA: leads to high likelihood of trophoblast detachment and facilitates uterine contractions. (prostaglandin dump ->menstration)
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| Methotrexate: MOA and Use | show 🗑
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| show | in combo w/ mifepristone and methotrexate: causes uterine contractions in large doses
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| How long do you have to use emergency contraception? Best method? | show 🗑
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| Intrauterine devices (IUDs): what do they contain? | show 🗑
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| What happens to estrogen and progesterone levels in menopause? | show 🗑
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| show | Risk of thromboembolic disease and breast cancer
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| show | Role: cell proliferation around lactation and pregnancy. Can lead to cancer...why we use tamoxifen (anti-estrogens)
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| show | semen quality in men
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| Environmental compounds that interfere w/ normal function of endogenous hormones...stimulate or block actions | show 🗑
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| DNA modifications that do not involve changes in sequence of DNA | show 🗑
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| show | True
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| What is DDT? Risks: | show 🗑
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| show | Perfluorinated compounds: found in non-stick cookware (Teflon) and insecticides
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| What was DES (diethylstilbestrol) initially prescribed for? What were the complications? | show 🗑
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| What do PCBs or Polychlorinated Biphenyls do to thyroid levels? | show 🗑
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| What happened to offspring of veterans exposed to agent orange or dioxin? | show 🗑
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| What chemical is in hospital equipment like IV bags and tubing and long-term exposure increases risk? | show 🗑
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| Impedes sexual maturation in boys, accelerates in girls | show 🗑
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| T/F: in USGS studies, many contaminants were found from samples. As many as 40 contaminants in 1 sample found. | show 🗑
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| Where are endocrine disruptors being found? | show 🗑
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| show | Atenolol
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