Hypo/Pituitary
This hormone, produced from the posterior pituitary, is used to prevent postpartum hemorrhage by inducing uterine contraction.
What are other uses of this hormone, and its adverse effects?
Oxytocin
Inducing labor, uterine rupture and hypertension
What thyroid drugs inhibit organification?
Iodides and thioamides (Propylthiouracil PTU, Methimazole)
-statin, lovatatin, simvastatin, atorvastatin, rosivastatin, fluvastatin
Reversibly/competitively binds HMG-CoA reductase resulting in low cholesterol synthesis, high LDL expression, low plasma LDLs, low VLDLs (20-55%)
What chemical messengers do pancreatic alpha and beta cells produce?
Alpha: glucagon
Beta- insulin
These first gen DM class of medications facilitate insulin release from pancreatic beta cells
What are the contraindications of these meds?
Sulfonylureas
Liver and kidney dysfunction (tolbutamide/glimepiride okay in renal probs)
What is a prolactinoma, and how do we treat it?
Benign tumor in anterior piuitary that releases high concentration of prolactin.
We use PIH (Dopamine agonists)
ergots: cabergoline, bromocriptine
non ergots: quinagolide
A 65 year old female patient comes in the clinic with complaints of polyuria and the inability to make it to the bathroom in time. She tells you she often wakes in the middle of the night to use the bathroom and has increased urgency. How would you treat this pt?
M3 blockers: Oxybutanin, tolterodine, trospium, fesoterodine, darfinacin, solifinacin
This posterior pituitary hormone acts on V1 and V2 receptors and is used in central diabetes insipidus as well as colonic bleeding, due to its vasoconstriction properties.
What are adverse reactions of this hormone?
Vasopressin
ADR: Hypertension and bradycardia
Which thyroid drugs inhibit proteolysis?
Iodides
What are some adverse effects of statins?
2. Liver damage: aminotransferase increases, avoid giving in chronic alcoholics
Allows cell to uptake glucose, promotes glycogen synthesis, and adipose tissue development
Insulin
What is the most important side effect of sulfonylureas?
Hypoglycemia, GI distress, agranulocytosis
A female patient comes into the office with a history of irregular menses, unusual hairgrowth, and obesity. What condition do you suspect?
PCOS
A patient with very good insurance comes in with OAB. What are some new treatments available to them because money is no issue.
Mirabegron - B3 agonist
Botox
What is desmopressin, and how does it differ to vasopressin?
What are common uses and adverse reactions?
Synthetic vasopressin that is specific to V2 receptors on the nephron tubules.
Uses: Central diabetes insipidus, nocturnal enuresis, clotting disorders.
ADR: Hyponatremia and bradycardia
PTU, Methimazole, B-blockers, corticosteroids, amiodarone, and radiocontrast media all inhibit at what step of thyroid hormone release?
Peripheral conversion T4-T3
What medication do you never give with statins due to CYP p450 inhibition?
Gemfibrozil
This hormone increases blood glucose by promoting the breakdown of glycogen
Glucagon
This drug causes SIADH and disulfiram like reactions and should not be given to elderly patients due to the risk of dehydration.
Chlorpropamide
In addition to diet/exercise and OC birth control, what other medications should be used to help control Hyperinsulinemia and PCOS in a patient that does not wish to become pregnant?
Metformin or TZDs such as pioglitazone/rosiglitazone to control hyperinsulinemia
Letrozole if patient still has symptoms
Elderly male patients are more liekly to have what condition, as opposed to overactive bladder?
Why do we never give M3 blockers to elderly men?
BPH
Makes it more difficult to urinate.
What medications are given to fix hyponatremia, and how does it work?
Conivaptan and tolvaptan; vasopressin receptor antagonists, allow for water excretion and sodium homeostasis
A patient comes in complaining of fatigue, cold intolerance, and weight gain despite lack of appetite. How would you treat this patient?
Levothyroxin sodium (Synthroid)
Colestipol, cholestyramine, colesevelam*fewest SE* are examples of what kind of medication?
What is the MOA and effect?
Bile acid binding resins
Bind to bile acids and remove them from hepatic circulation, allowing them to be exreted.
This lowers liver cholesterol, increases LDL receptors, lowers LDL by 20%
Absolute deficiency of insulin production
Type 1 DM
These sulfonylureas are safe to give to patients with renal disease because they are fully metabolized in the liver.
Tolbutamide and Glimepiride
What medication induces ovulation in patients with PCOS?
Clomiphene: partial agonist that acts as an antagonist in hypothalamus at estrogen receptors, prompting mass production of GnRH- LH/FSH and ovulation
An older male patient comes in with dysuria and pelvic pain x2 weeks. Urine test comes back negative for WBCs and nitrites. What is this pts likely condition, and how do you treat them?
Acute prostatitis
Bactrim
Fluoroquinolone
Octreotide and lantreotide are medications that inhibit growht hormone production and are used to treat what conditions?
What other medication can be used to treat acromegaly?
Gigantism and acromegaly
Pegvisomant
How long does a patient have to be taking levothyroxin before adjusting their dose? Why?
6-8 weeks. Half life of 7 days, takes a lon time to reach the therapeutic window
What are some adverse effects of cholestyramine, colestipol, and colesevelam?
What are contraindications for these medications?
Adverse effects of bile acid binding resins are an increase in VLDLs, TGs, constipation, and gas. These meds also mess with drug absorption.
Do not use in hypertriglyceridemia and patients with history of gallstones.
Insulin binds to this receptor, which triggers GLUT channels to embed into cell membranes allowing for glucose uptake
Tyrosine kinase receptors
This sulfonylurea has weaker insulin releasing properties but promotes peripheral glucose uptake, making it lower risk for hyperinsulinemia and hypoglycemia
Glimepiride
SERMs: Tamoxifen and Raloxifene
and aromatase inhibitors
A 76 yr old male patient comes to clinic with complaints of increased frequency of urination and dysuria. The patient tells you that he feels like he needs to go pee, but when he gets to the toilet, only a little bit comes out. His urine dip stick is normal. He says this has been happening for several months. What is the likely cause, and how do you treat?
Chronic prostatitis
Tami's Fluo is Fine
Tamsulosin, Fluoroquinolone, Finasteride
This hormone stimulates the production of IGF-1.
What conditions is this used for?
Contraindication?
Growth hormone
Growth hormone deficiency, Prader-willi syndrome, Turner syndrome, idiopathic short stature
Malignancy
What are some adverse reactions to supplemental T4 (synthroid)?
Tachycardia, heat intolerance, tremors (hyperthyroidism symptoms)
How can we treat pruritus in patients with cholecystitis and digitalis toxicity?
What are post prandial insulins?
Rapid insulins: lispro, aspart, glulisine
These medications have sulfonylureas like action but are molecularly different, allowing them to be given to patients allergic to sulfas.
Repaglinide, nateglinide
Which SERM is bone sparring, and used to treat ER+ BC?
Raloxifene
What is the MOA of finasteride and dutasteride?
What do they do?
5alpha-reductase inhibitors: decrease production of androgens (T and DHT) used to decrease prostate hyperplasia
An IGF-1 analog, used to treat conditions of poor growth that do not respond to growth hormone directly.
Mecasermin
When is Liothyroxine sodium (Cytonel) used?
What are the symptoms of this condition?
Used in hypothyroid coma (myxedema coma).
Hypothermia, respiratory depression, unconsciousness.
Gemfibrozil, clofibrate, fenofibrate, and bezafibrate are medications used to treat what condition?
Which fibrate is the safes to combine with a statin?
Which fibrate can never be combined with a statin?
Hypertriglyceridemia
fenofibrate
gemfibrozil
Give examples of long acting insulins (basal insulin)
Detemir, glargine, degludec, icodec
This medications MOA is not clearly known, but it stimulates glycolysis in peripheral tissues and reduces hepatic gluconeogenesis. This medication is first line treatment for T2DM
Metformin
Which SERM should never be given to patients with a uterus, and why?
Tamoxifen: promotes endometrial growth that can lead to cancer
Tamsculocin, silalocin, -Zocins, spirinolactone, flutamide, tadafalil,
Describe somatotropin vs somatostatin
Growth hormone vs growth hormone inhibitor
This medication, used in emergent hypothyroidism, can cause what adverse reactions?
What is a contraindication of this medication?
Tachycardia, tremors, heat intolerance, cardiotoxic
Do not use in patients with heart disease.
What are some adverse effects of fibrates?
Can we use statins or bile acid binding resins with fibrates?
Liver injury, gallstones
No
Intermittent insulin
NPH
What are the contraindications of Metformin?
What are potential adverse effects?
Renal/liver disease, cardiac fialure, IV contrast
Lactic acidosis, GI upset, decreased abs of vit b12 and folate - macrocytosis
What is a risk factor of using non competitive aromatase inhibitors?
C: anastrozole, letrozole
NC: Exemestane, Formestane - can cause osteoporosis
Can you give nitrates and PDE-F inhibitors together?
Why or why not?
No, extra hypotension
How do we treat hyperprolactinemia?
Bromocriptine, pergolide: dopamine agonists (prolactin inhibiting hormone)
Nervousness, sweating, heat intolerance, irritability, weight loss despite increased appetite, tremors, and palpitation are all signs/symptoms of what condition?
Hyperthyroidism.
What medication lowers LDLs and slightly increases HDLs by inhibiting dietary cholesterol absorption?
Ezetimibe
What do we give patients in DKA?
Short acting regular insulin (crystalline zinc) via IV
Lispro via IV
Describe the MOA of thiazolidinediones and the effects
Activates PPAR-gamma nuclear receptors
increases insulin sensitivity in target cells
decreases hepatic glucose output
increases uptake of glucose in adipose tissues
A patient comes into clinic with complaints of severe abdominal pain, nausea, and vomiting that occurs once a month. She notes abnormal bleeding despite being on OC birth control pills. She takes NSAIDs for pain and uses a heating pad, but the pain persists. What are some treatment options?
Progestin only BC
Danazol (SPRM)
Continious GnRH agonists: leuprolide, goserelin, naferelin
Continuous GnRH antagonists: cetrorelix, ganirelix
What are hypothalamic hormones used for?
Used to test pituitary gland insufficiency, infertility, and to antagonize hormonal activity (restart button)
A patient comes in with excessive sweating and irritability. Pt complains of recent weight loss and hunger pains that won't go away. What condition are you concerned about and what medications might you use to treat this condition?
PTU, methimazole
Describe the MOA of Niacin and its effects.
Inhibits lipolysis in peripheral tissues, decreasing TG synthesis, VLDL, and LDLs.
What are some characteristics of Glargine?
Peakless basal insulin that cannot be mixed, onset 1-3 hours and lasts for 24 hours.
Pioglitazone: osteoporosis, bladder cancer
Rosiglitazone: MI, water retention, edema
Weight gain, liver injury
Contraindications: pregnancy, liver damage, heart failure
Agonists - rise in LH/FSH, pain may become more severe initially and then level off
Antagonists - no rise, inhibits immediately
What hypothalamic hormone can be used in a continuous dose to inhibit LH and FHS release from the pituitary?
How can we use the same hormone to induce ovulation?
GnRH
Use in a pulsatile manner.
A patient with chronic alcoholism comes in for treatment of their hyperthyroidism. What thioamide is safest for this patient and why?
Methimazole, PTU is more potent and can cause liver damage
Which medication raises HDLs by the highest percent?
Niacin
This medication is an amylin analog found to reduce post prandial blood sugar peaks
What are some adverse effects of this medication?
Pramlintide
n/v, slows absorption of other oral meds
These adjunct medications inhbits the breakdown of polysaccharides into monosaccharides and delays glucose absorption from the gut (alpha-glucosidase inhibitors)
Acarbose, Miglitol
Ethinyl estradiol and mestranol are what kind of hormones?
What complications arise if these are given to women over 45 with a history of smoking?
Estrogen
PE, DVT, hypertension, gall bladder disease
What are the most important adverse reactions of using supplemental growth hormone?
Increased CYP p450 inhibition, increasing drug to drug interactions/toxicity
Higher risk of malignancy
*other ADRs: myalgias, scoliosis, edema, carpal tunnel*
Which thioamide can cause agranulocytosis?
Methimazole
Which cholesterol medication causes hepatotoxicity, impaired glucose tolerance, flushing, pruritus, and rashes?
How do we treat the pruritus and rash in these pts?
Niacin
NSAIDs 30 mins prior
What is the longest lasting insulin injected once a week?
Icodec
Compare and contrast GLP-1s and DPP-4 inhibitors.
What do they do and how do they do it?
Incretins (GLP-1s) are GLP-1 receptor agonists (exenatide, liraglutide, Dulaglutide, semaglutide) which stimulate insulin release and inhibit glucagon release, effectively lowering blood sugar.
DPP-4 inhibitors (Sitagliptin, saxagliptin, vildagliptin) inhibits the enzyme that breaks down GLP-1s allowing them to keep working. -liptins
What medication are given together to induce abortion?
Mifepristone (prostoglandin analog, blocks progesterone)
Misoprostol: induces expulsion
How do we treat infantile spasms?
ACTH, Cosyntropin
How do we treat Grave's disease in a pregnant woman?
PTU 1st trimester
Methimazole 2nd and 3rd
Both are category D meds
A patient comes in with high LDLs and admits to daily exercise and a balanced diet. They have been on atorvastatin for two months with little improvement. What medication is added to help lower LDLs?
Ezetimibe
What kind of insulin is used in insulin pumps?
Regular insulin, novolin/velosulin
Canagliflozin, dapagliflozin, empagliflozin and ertugliflozin (-flozin) work in what way?
What are some adverse effects of these meds?
Inhibition of the SGLT2 transporter allowing for glucose to spill from urine instead of being retained.
Genital infections, UTIs, diuresis, hypotension
This medication is used to treat prostate cancer, BPH, and hirsutism. Explain the mechanism of action.
Spironolactone: blocks T and DHT from binding onto tissues
How to treat pituitary dwarfism and osteoporosis?
GH: somatrem, somatropin
What is used to treat thyroid storm?
PTU + methimazole +Iodide
A patient comes in with a family history of hypertriglyceridemia and high TGs. Their current blood work shows low HDLs and high TGs. Along with diet and exercise, what medication would you prescribe this patient?
Niacin
What is a typical insulin regimen for a type 1 diabetic?
Basal insulin + 3 injections of post-prandial insulin
A patient comes to the ER with confusion, fatigue, and weakness. BG=50, what can you give IM to treat their hypoglycemia?
If the patient has an IV from the medic
glucagon
50% dextrose
Levonogestrel
(this is a thyroid question lol)
What does radioactive iodide do and when is it contraindicated?
Oral medication that ablates thyroid tissue via radiation. Not to be used in pregnancy.
Which medications are used pre thyroidectomy and what does each medication do?
Iodide: devascularizes thyroid, decreases organifiation and proteolysis
Lugol's soln- Makes thyroid hardened and easily removed, less chance of thyroid storm
A patient comes in with muscle aches, fatigue, and dark brown urine. They had a recent wound infection and began taking erythromycin to treat it. This patient takes a daily aspirin, albuterol PRN, ezetimibe, and fluvastatin daily. Which drug interaction could be responsible for this pts symptoms?
Fluvastatin and erythromycin = higher chance of rhabdo
What are some adverse effects of insulin?
insulin allergy, hypoglycemia (tachycardia, diaphoresis, vertigo) lipodystrophy, insulin resistance
Which hormone can inhibit cyclosporine, antidepressants, and glucocorticoids if taken together?
What other potentially deadly effect does this hormone have?
Estrogen
Increased vit K dependent clotting factors, blood clots!