BONE breakers
Name 3 different meds that can cause osteoporosis and what is their mechanism behind it?
CYP enzyme inducing anti-epileptics: ↑ vitamin D catabolism
Aromatase inhibitors and Medroxyprogesterone: ↓ estrogen activity
PPIs: ↓ calcium absorption
GnRH agonists: ↓ estrogen & testosterone
‘Glitazones’, Glucocorticoids, Heparin: ↓ bone formation
3 major targets for insulin?
Which insulin does NOT have a peak?
Which class of insulin are best for post prandial BG?
Liver, muscle, adipose
Glargine
Short acting
Statins decrease what? What are their 2 ADEs?
Prefix of bile acid binding resins? What organ pathology should they be avoided in?
LDL/VLDL; myopathy, rhabdo, liver damage
Gallbladder dz (specifically gallstones)
If a pt comes in with PCOS sx, what meds can you give for menstrual cycle regulation, DM, and fertility?
What is the MOA of the fertility drug and what ADE should you look out for?
OCPs, Metformin, Clomiphene
Acts as estrogen receptor antagonist in hypothalamus/ant.pit and a partial agonist in ovaries - disrupts negative feedback - ↑ GnRH and LH/FSH - super active gonads - stimulates follicle growth and ovulation
Vision changes and Ovarian hyperstimulation syndrome
Name 2 classes of drugs that cause urinary retention and 2 that cause incontinence
retention: Anticholinergics, Antidepressants, Antipsychotics, Beta-adrenergic agonists, Calcium channel blockers, Opioids
incontinence: Alcohol, caffeine, diuretics, α-adrenergic blockers, Sedatives, hypnotics.
What are the four major hormones involved in bone remodeling?
Name 3 ADEs of calcium salts
Suffix of Bisphosphonates and SERMs
PTH, Vitamin D, calcitonin, FGF-23
Constipation, Dec. absorption of ciprofloxacin, phenytoin, levothyroxine, and tetracycline drugs, MI, High risk of prostate cancer
-dronate and -oxifene
Name 2 short acting and 2 long acting insulins
MOA of Pramlintide
3 type of of tx for hypoglycemic crisis?
Short: Lispro, Aspart, Glulisine, Regular. Long: Detemir, Glargine, NPH
Amylin analog - ↓ postprandial glycemic excursion in pts taking insulin - slows gastric emptying - suppresses glucagon but doesn’t alter insulin levels
50% Dextrose IV (in hospital), Glucagon IM (outside hospital), oral glucose (at home)
Bile acid binding resins increase what and decrease what?
What HLD drug inhibits cholesterol absorption in intestinal brush border? What does it increase and decrease
-↓ blood LDL and Inc. VLDL and TG production
Ezetimibe - decrease LDL and increase HDL
What suffix of aromatase inhibitors are competitive and what suffix are irreversible covalent bound?
What are the name of some GnRH agonist that can be used for Endometriosis? And what are some GnRH antagonists?
-ozole and -methane/-masthane
Continuous/high dose of GnRH agonists (leuprolide, goserelin, naferelin)
regular dose of GnRH antagonists (cetrorelix or ganirelix)
What receptor do the Anticholinergics for OAB act on? and which drug is the most selective?
Mirabegron MOA and it's benefits of use?
M3- Tolterodine
Beta 3 adrenergic agonist - no anticholinergic effects!
What is the most active form of Vitamin D?
What 3 main organs are effected by Vitamin D?
Vitamin D MOA?
1, 25 dihydroxyvitamin D3 (calcitriol)
Bones, Intestine, Kidney: Bone: ↑ resorption of Ca and PO4 from bone. Intestines: No direct effect. ↑ Ca and PO4 absorption indirectly by enhancing formation of calcitriol in kidney
Enhances absorption of Ca and PO4 from intestine. Enhances proximal tubular reabsorption of Ca and PO4 in the kidneys
Name 2 ADEs and 2 contraindications of Metformin
Suffix for TZDs? and what receptor is activated in their MOA?
2 ADEs for all TZDs and one specific ADE for Pio and one for Rosi?
Contraindications: Renal/liver dz, CHF, Chronic lung dz, IV contrast. ADEs: Lactic acidosis, DIARRHEA, aplastic anemia
-glitazone: PPAR-y
All: Fluid retention, Weight gain, Osteoporosis, Liver injury. Pio: Bladder cancer. Rosi: CV risk
Main ADE of Niacin and how do you prevent it?
What does Niacin increase and decrease?
When do you use fibrates?
Flushing, pruritus - take NSAIDs 30 minutes before
↑ HDL and ↓ LDL/VLDL
DOC for menopausal symptoms?
Name the 2 androgen receptor antagonists and their uses?
Mifepristone is a progesterone receptor agonist OR antagonist? What drug must you give with it for a complete chemical abortion?
Flutamide- Prostate cancer, BPH
Spironolactone- HTN/diuretic, Hirsutism
ANTAGONIST. Misoprostol
What drugs for BPH effect sx and size?
Name the non selective alpha adrenergic antagonists and the selective? Whats the benefits for using both?
Finasteride, Dutasteride
Doxazosin,Terazosin, Alfuzosin
Tamsulosin, Silodosin
If pt has HTN for non selective. For more concentration/focus only on prostate for selective
2 ADEs of Bisphosphates and what kind of disease would be contraindicated?
What monoclonal antibody is used for osteoporosis and what population of people is it particularly good for?
What med is a PTH analog? What is it's contraindications and why isn't it good for long term use?
Esophagitis/erosion (prevent by taking with water in upright position), Osteomalacia, osteonecrosis of jaw, Atypical subtrochanteric fx
pts with active upper GI dz should NOT be given
Denosumab - CKD pts
Teriparatide - Paget's, elevated Alk Phos, Radiation -- bc it will start to stimulate osteoclasts!
Which suffix of GLP-1 agonists are full GLP-1 agonist?
Which suffix of GLP-1 agonist are indirect agonists via DPP-4?
Suffix for SGLT2 inhibitors? and what is the main ADE?
MOA of glucagon?
-tide
-gliptin
-gliflozin; genital yeast infections
inc. force of contraction of heart and inc. glycogenolysis and relaxes SM
Contraindication for fibrates and which is safest to combine with a statin?
What drugs are PCSK9 inhibitors and what do they decrease? What population is ideal for them?
chronic liver dz and Gallstones – do NOT combine with bile acid binding resins. Fenofibrate
Alirocumab, Evolocumab - decrease LDL. Good in CAD pts!
MOA for which combo OCPs cause thrombolytic events and its effects on warfarin
Suffix for birth control with high levels of progesterone?
PDE-5 inhibitors relax arteries by metabolizing what enzyme?
Which PDE-5 inhibitor is known for back pain and muscle aches and what PDE is it acting on to cause this?
↑ synthesis of Vit. K dependent clotting factors: Antagonize warfarin effects
-gestrel
c-GMP
Tadalafil - PDE-11 on skeletal muscle
How does Tadalafil help BPH?
What herb can be used to decrease prostatic size?
Relaxes prostatic urethra
Saw palmetto
MOA of Tamoxifen with the target organs?
MOA of Raloxifen with the target organs?
Which SERM should only be used in postmenopausal osteoporosis?
Calcitonin is the opposite of what other bone remodeling hormone?
ADE of calcitonin?
Tamo- ER antagonist in breast but partial agonist in endometrium and bone
Ralo- agonist in bone and antagonist in breast AND endometrium
Raloxifen
PTH
Allergic reaction
MOA of alpha glucosidase inhibitors?
2 ADEs of sulfonylureas? Which 2 SUs can be used in CKD?
What class of DM meds is similar to sulonylureas but less likely to cause significant ADE?
Delay absorption of glucose from GIT by inhibiting GI apical brush membrane-bound α-Glucosidase --> prevents postprandial hyperBG
ADE – hypoglycemia, GI, agranulocytosis, aplastic anemia. Tolbutamide and Glimepiride
Meglitinides
State all three methods to the lipid tx strategy
High LDL: exercise - statin - ezetimibe
High TG: exercise - fibrate - niacin
Low HDL: exercise - niacin
What long acting injection is used in ED and what is its MOA?
Name 3 med classes that cause ED
Name 5 ADE of testosterone therapy
Alprostadil - Prostaglandin E2
Beta/alpha blockers, Spirololactone, Opioids, Alcohol, 5 alpha reductase inhibitors, Corticosteroids, Cimetidine
↑ prostate and breast cancer, ↑ in prostate growth, Polycythemia, Infertility, Hepatic toxicity – adenoma/carcinoma, Cardiovascular toxicity - MI, stroke, Thrombophlebitis, Lower HDL
Name all 4 MOA of bladder control and micturation and their function
•Parasympathetic tone (cholinergic M3 - detrusor constriction)
•Sympathetic tone (adrenergic B2/B3) relax bladder
•Alpha adrenergic in internal sphincter (a1) cause contraction
•Somatic (voluntary control) via pudendal nerve (Nm)