Term
|
Definition
| hypothalamic pituitary axis |
|
|
Term
| what does it mean when said HPA is dinural |
|
Definition
| higher activity in morning |
|
|
Term
| what can increase the HPA axis activity the best |
|
Definition
| stress, which can over ride normal feedback controls |
|
|
Term
| what does ACTH stand for, what is its job |
|
Definition
adrenocorticotrophic hormones
stimylates adrenal cortex to secrete glucocorticoids, mineralcoricoids, weak androgens |
|
|
Term
| what are two weak androgens |
|
Definition
andeostendione
dehydropiandrosteone |
|
|
Term
| what are the three zones of the adrenal cortex |
|
Definition
zona glomerulosa - outer
zona fasculata - inner
zona reticularis - inner |
|
|
Term
| what enzymes does cortex outer zone have, what does it secrete |
|
Definition
| secretes aldosterone (mineralcorticoids) via aldosterone synthase |
|
|
Term
| how is mineralcorticoid production stimulated |
|
Definition
ACTH acutely stimulates
angiotensin II receptors with Gs protein initiate it |
|
|
Term
| what happens to the cortex if it does not get enough stimulation |
|
Definition
| does not atrophy without pituitary stimulation |
|
|
Term
| what enzymes does the cortex inner zones have, what do they secrete |
|
Definition
12-a-hydroxylase, 11-B0hydroxylase
secretes glyucocorticoids |
|
|
Term
| what stimulates inner cortex, what if there is too much stimulation |
|
Definition
| increases in ACTH cause hyperplasia, hypertrophy, increased cortisol and androgens |
|
|
Term
|
Definition
| ACTH increases due to impaired cortisol synthesis |
|
|
Term
| what happens if the inner cortex does not get stimulation |
|
Definition
|
|
Term
| what occurs in the acute phase of steroid production |
|
Definition
| within seconds increased supply of cholesterol to substrate (depends on amount of cholesterol) |
|
|
Term
| what occurs in the chronic phase of steroid production |
|
Definition
| within hours steridogenic enzyme transcription is increased |
|
|
Term
| where are most of the enzymes for steroid production |
|
Definition
|
|
Term
| explain the process of steroid hormone production (3 steps) |
|
Definition
1. cholesterol is turned into pregnilone via CHOLESTEROL SIDE CHAIN CLEVAGE ENZYME (P450 SCC) **RATE LIMIT
2. pregnilone is turned into cortisol, aldosterone, and adrenal androgens
3. products go to receptors and cause transcription. their structures are similar and they can activate e/o receptors |
|
|
Term
| how is production of cortisol stimulated |
|
Definition
| hypothalamus releases CRF and AVP which activate pituitary which releases ACTH which acrivates adrenal gland which releases cortisol |
|
|
Term
| what controls rate of cortisol production |
|
Definition
| ACTH release from pituitary corticotropes which are regulated by corticotropin releasing hormone (CRH) |
|
|
Term
| how is cortisol production/stimulation regulated (2) |
|
Definition
ACTH can stimulate production but will burn out so it stops activity in hypothalamus
cortisol (glucocorticoids) stop activity in pituitary and hypothalamus |
|
|
Term
| cortisol and aldosterone bind same receptors for same affinity, how does the body discriminate |
|
Definition
| in mineralcorticoid (ALD) receptors it has enzyme barrier with 11-B-hydroxy DH that metabolizes cortisol to cortisone which cannot bind ALD receptor |
|
|
Term
| what are the 7 areas / systems that corticosteroids effects |
|
Definition
carb and protein metabolism
lipid metabolism
cardiovascular
skeletal muscle
CNS
blood
immune supression/anti-inflammatory |
|
|
Term
| what do corticosteroids do to carb and protein metabolism |
|
Definition
protect glucose dependent tissues from starvation (brain and heart)
glucogenolysis
glyconeogenesis
diminish glucose utilization in tissue
cause protein break down |
|
|
Term
| what do corticosteroids to to lipid metabolism |
|
Definition
stimulate lipolysos
increase fat in neck (buffalo hump) and face (moon faces)
loss of fat in extremities |
|
|
Term
| what do corticosteroids to do skeletal muscle |
|
Definition
needed for normal function
decreased muscle work due to adrenocorticol insufficiency (addison's disease)
hypercorticism: causes muscle wasting |
|
|
Term
| what effects do corticosteroids have on CNS (5) |
|
Definition
mood, behavior, brain excitability
in cushings and addisons: neuroses, psychoses |
|
|
Term
| what does corticosteroids do to the immune system (7) |
|
Definition
decreases cytokine production, lymphocyte response, histamines, leukotrienes, arachadonic acid release via phospholipase A2 inhibition
supress inflammation
decrease WBC circulation |
|
|
Term
| what are the HPA axis drugs (2) |
|
Definition
|
|
Term
| what are the short acting glyucocorticoids (2) |
|
Definition
|
|
Term
| what are the intermediate acting glucocorticoids (3) |
|
Definition
prednisone
methylprednisolone
triamcinolone |
|
|
Term
| what are the long acting glucocorticoids (2) |
|
Definition
betamethazone
dexamethazone |
|
|
Term
| what are the corticosteroid inhibitors (3) |
|
Definition
aminoglytethimide
ketoconazole
spironolactone |
|
|
Term
| what are the mineral corticoids |
|
Definition
|
|
Term
|
Definition
| high concentrations affect hypothalamus, stimulate corticoid and androgen receptors testing HPA axis |
|
|
Term
|
Definition
| tests HPA axis ysing synthetic ACTH residues 1-24 |
|
|
Term
|
Definition
antigenic: comes from animals
vasopressin par causes hyponatremia |
|
|
Term
| short acting glucocorticoid MOA |
|
Definition
| metabolized via reduction in liver to 11-8-hydeoxyderivative to be active |
|
|
Term
| side effects of short acting glucocirticoids (4) |
|
Definition
antiinflammatory
salt retension
minteral corticoid effects
less potent |
|
|
Term
| side effects of intermediate acting glucocorticoids (3) |
|
Definition
more potent
low salt retension
low mineralcorticoid effect |
|
|
Term
| side effects of long acting glucocorticoids (3) |
|
Definition
most potent
no salt retension
no mineralcorticoid effect |
|
|
Term
| shared side effects of all glucocirticoids (12) |
|
Definition
withdrawl: flare of of disease
acute adrenal insufficiency
HPA supression
fluid and electrolyte imbalance
hypertension
hyperglycemia
fat redistribution
osteoperosis
myopathy
behavorial changes
cataracts
increased infection |
|
|
Term
| why do glucocirticoids cause acute adrenal insufficiency |
|
Definition
| due to rapid withdrawl after prolonged use |
|
|
Term
| who do glucocirticoids cause HPA supression |
|
Definition
| occurs with supraphysiologocal doses for 2wk + |
|
|
Term
| how do glucocirticoids cause osteoperosis |
|
Definition
| inhibit ostroblasts and decrease bone formation |
|
|
Term
| how are glucocirticoids administered (9) |
|
Definition
| oral, injected, inhaled, topical, optic, opthalamic, enema, rectal, retro rocket |
|
|
Term
| where are glucocirticoids metabolized and eliminated |
|
Definition
metabolized in liver
excreted in kidney |
|
|
Term
| what affects the distribution of glucocirticoids |
|
Definition
| 90% bound to proteins (corticosteroid binding globulin, transcortin, albumin) |
|
|
Term
| what are the clinical uses of glucocirticoids (15) |
|
Definition
adrenal insufficiency
chronic primary adrenal insufficiency
congenital adrenal hypoplasia
RA
SLE
degrnerative joint
regional pain syndrome (injection)
allergies
asthma
PJP
influenza virus
ocular disease: supresses inflammation but increases IOP
cerebral edema
stroke
spinal cord injuty |
|
|
Term
| what are 2 diseases that cause chronic primary adrenal insufficiency |
|
Definition
adrenal surgery
cortex lesion (addisons) |
|
|
Term
|
Definition
|
|
Term
| aminoglytethimide clinical use |
|
Definition
|
|
Term
|
Definition
|
|
Term
| ketoconazole clinical use |
|
Definition
|
|
Term
|
Definition
| competes for mineralcorticoid receptor and stops Na reabsorption |
|
|
Term
| spironolactone clinical use |
|
Definition
|
|
Term
|
Definition
| act on DCT to increase reabsorption of Na into plasma and excretion of K and H |
|
|
Term
| fludorcortisone clinical use (4) |
|
Definition
addisons
severe salt loss
adrenogenital syndrome
orthostatic hypotension |
|
|
Term
| 3 functions of FSH, which are the main ones |
|
Definition
main: spermatogenesis in seminiferous tubules
regulate testicular growth
steroidogenesis |
|
|
Term
| what are the 4 functions of LH, which is the main one |
|
Definition
main: regulate testosterone release from leydig cells
regulate resticular growth
steroidogenesis
spermatogenesis |
|
|
Term
| how is the release of testosterone regulated |
|
Definition
| it feeds back to hypothalamus and pituitary |
|
|
Term
| what is the process of testosterone production |
|
Definition
| cholesterol > progesterone > andostenedione or androstendione . testosterone |
|
|
Term
| what enzyme produces testosterone |
|
Definition
| 12B-hydrosteroid dehydrogenase |
|
|
Term
| how is testosterone transported in the body |
|
Definition
sex hormone binding globulin (can enter cell too may have role in action)
some on albumin
1-2% unbound |
|
|
Term
| what enzyme turns testosterone into DHT, where is it located |
|
Definition
steroid 2a-reductase in non-genital skin and liver
steroid 5a-reductase in urogenital tract |
|
|
Term
| what is the difference between testosterone and DHT |
|
Definition
| DHT has a higher binding affinity |
|
|
Term
| what are the 6 general functions of testosterone |
|
Definition
embryo: virilize urigenital tract of male
growth of testes, scrotum, penis
thicken and make skin more oily
increase height and muscle
axillary hair
larynd development |
|
|
Term
| what are the testosterone drugs (5) |
|
Definition
testosterone aq
testosterone cypionate
fluxymesterone
testosterone gel (androgel)
danzol |
|
|
Term
| what are the anti-androgens (5) |
|
Definition
spironolactone
flutamide
ketoconazole
cimetidine
finasteride |
|
|
Term
| what is used to treat impotence (3) |
|
Definition
sildenafil
vardenaful
tadalafil |
|
|
Term
|
Definition
stop androgen binding to receptor
stop synthesis of androgens
decrease p450enz 12a-hydroxylase C12-20 lyase complex which decreases testosterone |
|
|
Term
|
Definition
| non-steroid competitive inhibitor of DHT |
|
|
Term
|
Definition
| H2 receptor antagonist that competes for receptor |
|
|
Term
|
Definition
| 5a-reductase competitive inhibitor of conversion enzyme of DHT to testosterone |
|
|
Term
|
Definition
normally NO activates gyanulyl cyclase which causes smooth m. relaxation of corpus callosum letting blood in then phosphodiesterase (PDE) closes it off
drug inhibits PDE |
|
|
Term
| 11 uses of all testosterone drugs |
|
Definition
androgenic: hypogonadism, failure of hypo-pit-axis
anabolic: osteroperosis, burns, surgery recovery
counteract cortical hormone effects
growth: skeletal muscle growth in pre-pubescent boys and dwarfism
unapproved: increase lean body mass, muscle strength, agression |
|
|
Term
| clinical use of fluoxymesterone |
|
Definition
more focused on anabolic effects of androgens (little androgenic effects)
osteoperosis, burns, surgurical recovery |
|
|
Term
| clinical use of danzol (3) |
|
Definition
not very androgenic
endometrosis, fibrocystic breast disease, hereditary angioedema |
|
|
Term
| clinical use of spironolactone (2) |
|
Definition
women: hirsutism
men: causes impotence |
|
|
Term
| clinical use of flutamide (1) |
|
Definition
| prostate cancer (with GnRH blocker or an estrogen) |
|
|
Term
| clinical use of ketoconazole (1) |
|
Definition
| prostate cancer (high dose) |
|
|
Term
| clinical use of cimetidine |
|
Definition
|
|
Term
| clinical use of finasteride (3) |
|
Definition
prostatic hyperplasia
male pattern baldness (low dose) |
|
|
Term
| side effects flutamide (2) |
|
Definition
|
|
Term
| side effects ketoconazole |
|
Definition
|
|
Term
|
Definition
| males with zollinger ellison get cynecomastia |
|
|
Term
|
Definition
|
|
Term
| side effects impotence treatment (6) |
|
Definition
no effect in absence of stimulation
headache
flushing
dyspenia
change in color vision
decreased BP |
|
|
Term
| what is a major contraindication to impotence drugs |
|
Definition
|
|
Term
| what is the longest lasting impotence drug, how long |
|
Definition
|
|
Term
| side effects of all testosterone drugs in females only (8) |
|
Definition
masculinization
acne
facial hair
deeper voices
male pattern baldness
muscle development
menstural irregularities
virilization of fetus |
|
|
Term
| side effects of all testosterone drugs in males only (5) |
|
Definition
priapism
impotence
decreased spermatogenesis
gynecomastia |
|
|
Term
| side effects of all testosterone drugs in any sex or age (6) |
|
Definition
increased LDL
decreased HDL
coronary artery disease
fluid retention
edema
PANCREATITIS |
|
|
Term
| side effects of all testosterone drugs in kids only (4) |
|
Definition
abnormal sexual maturity
premature closure of epiphysis
hepatic abnormalities
psychosis |
|
|
Term
| side effect of testosterone gel |
|
Definition
| absorbed to skin, transfered to others on hands |
|
|
Term
|
Definition
| interacts with progesterone and androgen receptors and supresses pituitary-ovarian axis decreasing FSH and LH |
|
|
Term
| how are the 5 testosterone drugs administered |
|
Definition
testosterone aq- IM
testosterone cypionate- IM
fluxymesterone- oral
testosterone gel- topical
danzol- oral |
|
|
Term
| where is testosterone gel metabolized and excreted |
|
Definition
metabolized in liver
excreted in urine |
|
|
Term
| which testosterone has the shortest and longest half life, how long |
|
Definition
testosterone aq: short 10-100 min
testosterone cypopnate: long 8d |
|
|
Term
|
Definition
leuprolide
grosereline
nafarelin
histerlin
triptorelin |
|
|
Term
|
Definition
ganirelix
cetorelix
abarelix
degarelix |
|
|
Term
|
Definition
|
|
Term
| 2 GH antagonists / somatistatin agalons |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Lutropin / recombinant hCG |
|
|
Term
|
Definition
|
|
Term
| 2 prolactin antagonist, 1 AKA |
|
Definition
aka: dopamine agonist
bromocriptine
cabergoline |
|
|
Term
| 2 vasopressin agonist and their receptors |
|
Definition
8-L-arginine vasopressin (V1)
desmopressin (V2) (tetracycline antibiotic) |
|
|
Term
| 3 vasopressin antagonists and their receptors |
|
Definition
conivaptin (V1+V2)
tolvaptin (V2)
lithium (V2) |
|
|
Term
|
Definition
control FSH and LH release
pulsatile (replacement) therapy: increases release
continous (supression) therapy: inhibits release |
|
|
Term
|
Definition
| stops release of FSH and LH |
|
|
Term
|
Definition
| longitudinal growth via ILGF-1 and some ILGF-2 |
|
|
Term
|
Definition
| complex of ILGF-1 and ILGF binding protein 3 that causes growth |
|
|
Term
|
Definition
| somatostatin agonist stop GH, glucagon, insulin, and gastrin release |
|
|
Term
|
Definition
|
|
Term
| where do menotropins come from |
|
Definition
|
|
Term
| where does urofollitropin come from |
|
Definition
|
|
Term
| where does lutropin come from |
|
Definition
| recombinant LH (identical to hCG so it can be used) |
|
|
Term
|
Definition
|
|
Term
| how does a prolactin antagonist work |
|
Definition
| dopamine agonist decreases prolactin release |
|
|
Term
| why would some have increased prolactin (2) |
|
Definition
anti-psychotic drugs (dopamine receptor blockers)
prolactinoma |
|
|
Term
| what happens when prolactin is increased (4) |
|
Definition
amenorrhea
no ovulation
galactorhea
breast tenderness |
|
|
Term
|
Definition
| induces myometrial contraction by changing ion concentrations |
|
|
Term
| what does ADH to do V receptors (8), what type of receptor |
|
Definition
Gq receptors
V1a: vasoconstriction, glycogenolysis, platelet aggregation, ACTH release
V1b: ant pituitary, pancrease, brain, adrenal medulla |
|
|
Term
| what tissues have V2 ADH receptors on them, what type of receptor is it |
|
Definition
| Gs receptor on aquaporin 2 on collecting duct cells |
|
|
Term
| GnRH agonist side effects |
|
Definition
| continous therapy gives flare in condition prior to supression (desensitization) |
|
|
Term
| GH antagonist side effects (5) |
|
Definition
flatulence
steratorrhea
biliary sludge
gall stones
sinus bradycardia |
|
|
Term
|
Definition
simillar to ADH
water retension or intoxication (if on IV) |
|
|
Term
|
Definition
| mimics nephrogenic diabetes insupidus |
|
|
Term
| how can GnRH be administered |
|
Definition
pulastile: every 1-4 hours
continous |
|
|
Term
| why is administering GnRH different than just giving the hormone (gonadorelin) |
|
Definition
| the half life of the drug will be longer than administering the hormone |
|
|
Term
| what is the benifit of using a GnRH antagonist over agonist (2) |
|
Definition
no flare in hormone levels before supression
more rapid onset |
|
|
Term
|
Definition
B blockers
Mg sulfate
inhaled anasthetics |
|
|
Term
| what is pulsatile GnRH used for (3) |
|
Definition
infertility
delayed puberty
hypogonadism |
|
|
Term
| what is continous GnRH used for (4) |
|
Definition
endometrosis
uterine fibroids
prostate cancer
central precoious puberity |
|
|
Term
| when do you decide to treat central precoious puberty |
|
Definition
| before 8 in girls and before 9 in boys |
|
|
Term
| how is prostate cancer treated (2) |
|
Definition
GnRH agonist with androgen receptor blocker to inhibit flare
OR
GnRH antagonist |
|
|
Term
| what do GnRH antagonists treat |
|
Definition
prostate cancer
ovarian hyperstimulation
prep for in vitro fertilization |
|
|
Term
| why is GnRH antagonist used for prep for in vitro fertilization |
|
Definition
| prevents premature LH surge |
|
|
Term
| what is somatropin used for (3) |
|
Definition
GH deficiency (<4cm/y)
Growth failure: prader willi, turner syndrome, AIDS wasting
idiopathic short stature |
|
|
Term
| what is mecasermin used for |
|
Definition
| patient is deficient in ILGF-1 and exogenous GH isnt working |
|
|
Term
|
Definition
DOC for acromeagly and gigantism
hormone secreting tumors
bleeding esophageal varices |
|
|
Term
| what causes acromeagly and gigantism |
|
Definition
|
|
Term
| what are 4 GH secreting tumors |
|
Definition
gastrinoma
glucagonoma
carcinoid secreting tumors
carcinoid syndrome |
|
|
Term
| what is carcinoid syndrome |
|
Definition
| carcinoid tumor with liver metastasis and serotonin secretion |
|
|
Term
| what is the use for pegvisomant |
|
Definition
| acromeagly third alternative |
|
|
Term
|
Definition
| induce spermatogenesis or ovulation in infertility |
|
|
Term
| use of prolactin antagonist (2) |
|
Definition
hyperprolactinemia
bromocriptime: acromeagly 2nd alternative |
|
|
Term
|
Definition
lactation in natural doses
pharmacological doses: control post partum hemorrhage, induce labor but causing uterine contraction |
|
|
Term
|
Definition
| vasoconstriction stops bleeding esophageal varicies, post-op ileus, abdominal distension |
|
|
Term
|
Definition
central diabetes insipidus
SIADH |
|
|
Term
| use of V1/V2 antagonist (2) |
|
Definition
euvolumeic or hypervolemic hyponatremia
SIADH |
|
|
Term
| what is diabetes insipidus |
|
Definition
| increased ADH due to pituitary or hypothalamus trauma or tumor |
|
|
Term
| what is nephrogenic diabetes insiputis |
|
Definition
| broken V2 receptors on nephron |
|
|
Term
| what categories of drugs are hypothalamic hormone drugs (2) |
|
Definition
GnRH/gonadorelin agonist
GnRH antagonist |
|
|
Term
| what categories of drugs are anterior pituitary hormone drugs (8) |
|
Definition
GH agonist
GH antagonist
GH blocker
FSH + LH
FSH
LH
prolactin agonist
prolactin antagonist |
|
|
Term
| what categories of drugs are the posterior pituitary hormone drugs (4) |
|
Definition
oxytocin
vasopressin agonist
vasopressing antagonist
lithium |
|
|
Term
| explain thyroid hormones from ingestion of iodine to T3/4 production and storage (7 steps) |
|
Definition
1. ingest iodine
2. TSH stimulates iodine uptake and hormone production
3. iodine active transport into thyroid
4. activated with THYROID PEROXIDAZE (using Hb and H2O2)
5. monotyrostol and diiodotyrosyl are produced
6. THYROID PEROXIDASE links AA making T3 and T4 in a 1:4 ratio
7. T3 and T4 are stored in thyroglobulin |
|
|
Term
| explain thyroid hormone release from thyroglobulin to arrival at the tissues (7 steps) |
|
Definition
1. thyroglobulin fuses with lysoosme
2. proteolytic enzymes break it into...
- monotyrosyl and dioxotyrosyl which stay in thyroid
- T3/T4 which go into blood
- excess iodine which stays in thyroid
3. T3/4travel in blood on thyroxine binding globulin and albumin
4. T3/4 are released at tissues |
|
|
Term
| what motifications occur to T3/4 at the tissues (2) |
|
Definition
diodinase enzymes remove 5' outer ring...
- 5-DI and 5-DII turn T4 to T3 (41% of T3)
- 5-DIII turns T4 into reverse T3 |
|
|
Term
| where are T3 and T4 degraded |
|
Definition
|
|
Term
| what are the differences in T3 and T4 elimination |
|
Definition
T3 is eliminated in 2 d due to increased protein binding increasing hald life
T4 is eliminated in 6-7d |
|
|
Term
| how does iodine regulate thyroid hormone production |
|
Definition
| decreased iodine decrease thyroid hormones which stimulate TSH causing thyroid hypertrophy (gioter) and selective T3 formation |
|
|
Term
| how does the production of thyroid hormone reulate itself |
|
Definition
it doesnt
it stops TSH production but increases thyrotropin releasing hormone (TRH) production which cancel |
|
|
Term
| what is the difference in tissue binding and activity of T3 and T4 |
|
Definition
T3 binds with 5x higher affinity
T4 binds with lower affinity |
|
|
Term
| what are the 6 areas in general thyroid hormones affect |
|
Definition
growth and development
basal metabolic rate
released when cold to regulate body temp
heart
CNS
cholesterol metabolism |
|
|
Term
| how does the thyroid effect growth and development (5) |
|
Definition
differentiation and myelination of cnS
potentiation of GH, PTH, and calcitonin |
|
|
Term
| in what organs does the thyroid hormone effect on basal metabolic rate have the most effect (4) |
|
Definition
| heart, muscle, liver, kidney |
|
|
Term
| what changes do thyroid hormones cause in the heart (4) |
|
Definition
sensitize it (synergistic)
increase CO, HR, contractility |
|
|
Term
| what effects do thyroid hormones have on the CNS |
|
Definition
| sensitize catecholamine receptors (synergistic) |
|
|
Term
| what does thyroid hormone do to cholesterol metabolism |
|
Definition
stimulates metabolism of cholesterol to bile acids
important! lack can cause hypercholesterolemia |
|
|
Term
| what is the name for adult hypothyroidism |
|
Definition
|
|
Term
| what is the name for child hypothyroidism |
|
Definition
|
|
Term
| what are the 9 signs of child hypothyroidism |
|
Definition
impaired growth
mental retardation
pot belly
dwarfism
lethargy
hypothermia
slow HT
poor appetite
death if untreated |
|
|
Term
| what are the 8 signs of adult hypothyroiodism |
|
Definition
pallid expression
blank expression
dry skin
brittle nails
weakness
reduced CO
fatigue
cold intolerence |
|
|
Term
| what are two diseases of hyperthyroidism |
|
Definition
| graves and plummers disease |
|
|
Term
| what are 7 characteristics of graves disease |
|
Definition
diffuse toxic goiter
exophthalmos: big eyes
hot moist skin
forced rapid heart beat
angina
arrhythmia
heart failure |
|
|
Term
| what are 4 causes of graves disease |
|
Definition
autoimmune: IgG bind to TSH receptor
chorionic: placental secretion of TSG stimulates receptors in pregnancy |
|
|
Term
| what are 6 signs of plummer's disease |
|
Definition
toxic nodular goiter
hot moist skin
forced rapid heart beat
angina
arrhythmia
heart failure |
|
|
Term
| what are 5 general signs of hyperthyroidism |
|
Definition
hot moist skin
forced rapid heart beat
angina
arrhythmia
heart failure |
|
|
Term
| what are the 3 treatments for hyperthyroidism |
|
Definition
surgical removal of thyroid
local radiation with radioactive iodine
anti thyroid agents |
|
|
Term
| what causes a thyroid storm (7) |
|
Definition
| complication of hyperthyroidism triggered by stress, thyroid surgery, trauma, diabetic ketoacidosis, labor, heart disease, radioactive iodine |
|
|
Term
| what are the 7 treatments of a thyroid storm |
|
Definition
fluids
anti-pyretics
cooling blankets
propylithiouracil in large doses
iodates
B blockers and Ca can control tachyarrhytima
dexamethasone |
|
|
Term
| what are the three thyroid hormone drugs, what hormone is each |
|
Definition
desiccated thyroid - T3 and T4
levothyroxine - T4
liothyroxine - T3 |
|
|
Term
| what are the advantages of using liothyronlne over levothyroxine (4) |
|
Definition
| liothyroline does not have to be converted for full potential, fast onset, good absorption, good when someone has problem with T4 to T3 conversion enzyme |
|
|
Term
| what is the clinical use for thyroid hormones (3) |
|
Definition
hypothyroidism
non-toxic goiter
replacement therapy |
|
|
Term
| what are the contraindications to thyroid hormones (3) |
|
Definition
acute MI
increase anticoagulant effects
reduce digitalis effects |
|
|
Term
| what are the 3 side effects or problems with desiccated thyroid |
|
Definition
antigenic because it comes from pork
highly variable biological activity
religous objections to treatment |
|
|
Term
| what are the two anti-thyroid or thiroureylenes |
|
Definition
| propylthiouracil and methimazole |
|
|
Term
|
Definition
stop iodiniation of throsyl in thyroglobulin
block thyroid peroxidae inhibiting coupling reaction
prophylthiouracil- blocks conversion of T3 to T4 |
|
|
Term
| what are the three side effects of anti-thyroids |
|
Definition
agranulocytosis
marrow aplasic (improves on DC)
secreted into breast milk |
|
|
Term
| what can anti-thyroids be used to treat (7) |
|
Definition
graves disease
small goiters
mild hyperthyroidism
deplete thyroid hormone before radiation hyperthyroidism in elderly
after radiation
prethyrodectomy- prevent surge in surgery
thyroid storm - prophylthiouracil due to T3 to T4 ability |
|
|
Term
|
Definition
saturated potassium iodide prevents thyroid hormone release
inhibits hormone synthesis by decreasing TSG and blcking its action (wolff chickoff effect) |
|
|
Term
|
Definition
rebound hyperthyroidism
angioedema
hypersensitivity
iodism |
|
|
Term
| what is iodism, what are 7 signs |
|
Definition
chronic intoxication of iodine
burning bouth, throat, eyes, headache, productive cough, gastric irritation, skin lesions |
|
|
Term
| what are the three uses of iodine |
|
Definition
reduce vascularity and increase gland firmness
thyroid storm prevention
pre surgery |
|
|
Term
|
Definition
gets trapped in thyroid and B-rays destory parenchyma
B-rays only destory bad tissue |
|
|
Term
| what are three side effects of radioactive iodine |
|
Definition
cannot use in pregnancy
delayed hypothyroidism
chromosomal abberations (cannot use in kids and pregnancy) |
|
|
Term
| what is the half life of radioactive iodine |
|
Definition
|
|
Term
| what is the use of radioactive iodine |
|
Definition
|
|
Term
| what is another name for radioactive iodine |
|
Definition
|
|
Term
|
Definition
| growth and development of endochondral bone |
|
|
Term
| define remodeling, when does it occur |
|
Definition
continoous process of breakdown and renewal
final option after linear growth in finished |
|
|
Term
| what are the three steps in remodeling |
|
Definition
IL-1 and IL-6 released from osteoblast stimulate osteoclast to reabsorb tunnels in corticoid bone or scallops in trabecular bone
osteoclasts replaces bone areas with collagen, osteocalcin, and protein
mineralization occurs after osteoblasts achieve 20 microns of thickness |
|
|
Term
| what are three problems with bone remodeling |
|
Definition
deficits occur after each cycle
deficits increase with age
can never get back to origional bone mass after remodel |
|
|
Term
| what three things can alter remodeling |
|
Definition
|
|
Term
| what hormones alter remodeling (5) |
|
Definition
thyroid
PTH
vitamin D
glucocorticoids
estrogen |
|
|
Term
|
Definition
neuron excitability
neurotransmitter release
muscle contraction
membrane integrity
blood coagulation
secondary messenger for hormones |
|
|
Term
|
Definition
| skeleton in a pool exchangable with interstitial fluid |
|
|
Term
| what is stored in bone (5) |
|
Definition
|
|
Term
|
Definition
75% is from dairy intake
adults 45-50 yo should have supplement with vitamin D |
|
|
Term
| how does Ca get into the body |
|
Definition
| facilitated diffusion through SI |
|
|
Term
|
Definition
inversly proportional to intake
(not as good as we age) |
|
|
Term
| where and how much Ca is excreted |
|
Definition
150mg is loss via billiary and intestinal sloughing
9mg is secreted in kidney but 98% is reabsorbed |
|
|
Term
| what do loop diruetics do to Ca excretion |
|
Definition
| act on ascending limg to cause increased Ca loss (but its a better diruetic) |
|
|
Term
| what do thiazida diruetics do to Ca excretion |
|
Definition
| uncouple Na and Ca excretion causing reduced Ca loss |
|
|
Term
| where is phosphate located in the body |
|
Definition
80% in bone
15% in soft tissue |
|
|
Term
| what are 5 functions of phosphate |
|
Definition
membrane phospholipids
modifies Ca
role in renal H excretion
secondary messenger
energy metabolism |
|
|
Term
| where, how, and how much phosphate is absorbed in the gut |
|
Definition
active transport and vit D stimulate absorption
2/3 is absorbed |
|
|
Term
| where is phosphate is excreted, how much |
|
Definition
excreted in urine
80% is reabsorbed |
|
|
Term
|
Definition
| prehormone is cleaved in ER and in golgi it makes PTH which lives in secretory granules until secreted. if not secreted soon enough they undergo proteolysis and the gland gets hypertrophy and hyperplasia |
|
|
Term
| what is the half life of PTH |
|
Definition
|
|
Term
| how does PTH act on target cells |
|
Definition
|
|
Term
| what are the functions of PTH (4) |
|
Definition
increase Ca and P absorption in intestines by activating vitamin D
increase bone reabsorption bia osteoblast action on osteoclast
increase Ca reabsorption in kidney
inhibit kidney phosphate reabsorption |
|
|
Term
|
Definition
| parafollicular C cells in thyroid release it when plasma Ca is high |
|
|
Term
| what are the two actions of calcitonin |
|
Definition
inhibition of osteoclast bone reabsorption
increased urinary Ca and P excretion |
|
|
Term
| what are the two types of viramin D and where are they made |
|
Definition
D2: yeast
D3: animals and higher plants |
|
|
Term
|
Definition
| in the bodycholesterol is reduced and is converted by UV into D3 hich is procesed in liver to calcifediol and then to calcitrol in kidney |
|
|
Term
| what are 4 pieces of evidence suggesting vitamin D is a hormone |
|
Definition
made in body in skin
not needed in diet (in theory)
transported in blood to distant sites
specific receptors in target tissues on DNA |
|
|
Term
| how does vitamin D affect the body |
|
Definition
increases absorption of P and Ca in SI
increases mobalization of P and Ca from bone with PTH help
decreases P and Ca excretion in kidney |
|
|
Term
|
Definition
| prehormone is cleaved in ER and in golgi it makes PTH which lives in secretory granules until secreted. if not secreted soon enough they undergo proteolysis and the gland gets hypertrophy and hyperplasia |
|
|
Term
| what is the half life of PTH |
|
Definition
|
|
Term
| how does PTH act on target cells |
|
Definition
|
|
Term
| what are the functions of PTH (4) |
|
Definition
increase Ca and P absorption in intestines by activating vitamin D
increase bone reabsorption bia osteoblast action on osteoclast
increase Ca reabsorption in kidney
inhibit kidney phosphate reabsorption |
|
|
Term
|
Definition
| parafollicular C cells in thyroid release it when plasma Ca is high |
|
|
Term
| what are the two actions of calcitonin |
|
Definition
inhibition of osteoclast bone reabsorption
increased urinary Ca and P excretion |
|
|
Term
| what are the two types of viramin D and where are they made |
|
Definition
D2: yeast
D3: animals and higher plants |
|
|
Term
|
Definition
| in the bodycholesterol is reduced and is converted by UV into D3 hich is procesed in liver to calcifediol and then to calcitrol in kidney |
|
|
Term
| what are 4 pieces of evidence suggesting vitamin D is a hormone |
|
Definition
made in body in skin
not needed in diet (in theory)
transported in blood to distant sites
specific receptors on DNA |
|
|
Term
| what are three things vitamin D does in the body |
|
Definition
absorption of Ca and P in SI
increase mobalization of Ca and P from bone with PTH help
decrease P and Ca excretion in kidney |
|
|
Term
| 5 symptoms of hypocalcemia |
|
Definition
parasthesia
increased neuromuscular excitability
laryngospasm
muscle cramps
tonic clonic convulsions |
|
|
Term
| 2 symptoms of hypercalcemia |
|
Definition
diverse clinical conditions
dehydration due to compormised renal concentration |
|
|
Term
| 4 symptoms of hypophosphatemia |
|
Definition
malaise
muscle weakness
osteomalacia
decreases RBC ATP and 2,3-BPG causing hemolytic anemia and impaired oxygenation - rare |
|
|
Term
| what are 4 causes of hypercalcemia |
|
Definition
increased intake of Ca in hypothyroid pt
familial benign hypercalcemia
vitamin D toxicity
milk alkali syndrome |
|
|
Term
| what is used to treat hypercalcemia |
|
Definition
calcitonin
IV bisphosphate
corticosteroids - vitamin D toxicity |
|
|
Term
| what is wrong in familial benign hypercalcemia |
|
Definition
| parathyroid cannot sense Ca so it increases PTH |
|
|
Term
| how can you get vitamin D toxicity |
|
Definition
| overuse of hyperparathyroid drugs |
|
|
Term
| what is used to treat vitamin D toxicity |
|
Definition
calcitonin
IV bisphosphate
corticosteroids |
|
|
Term
| what causes milk alkali syndrome |
|
Definition
| milk alkali powder increases Ca reabsption |
|
|
Term
| what are two conditions that cause hypercalcemia and hypophosphatemia |
|
Definition
hyperparathyroidism
PTH secreting tumor |
|
|
Term
| what is used to treat hypercalcemia and hypophosphatemia |
|
Definition
calcitonin
IV bisphosphate
IV/oral phosphate - hyperparathyroid
corticosteroids - PTH tumor |
|
|
Term
| how does hyperparathyroid cause problems, what are two complications |
|
Definition
increases PTH secretion
renal stones, peptic ulcers |
|
|
Term
| what type of cancer is a PTH secreting tumor |
|
Definition
| squamous or epithelial cell |
|
|
Term
| what is used to treat PTH secreting tumor |
|
Definition
calcitonin
IV bisphosphate
corticosteroids |
|
|
Term
| what is used to treat hyperparathyroidism |
|
Definition
calcitonin
IV bisphosphate
IV/oral phosphate |
|
|
Term
| what causes paget's disease, 6 symptoms |
|
Definition
excessive remodeling
weak, mishape, painful bones
deafness
cord compression
cardiac failure |
|
|
Term
| what is used to treat paget's disease |
|
Definition
calcitonin
IV bisphosphate |
|
|
Term
| what are two conditions that cause hypophosphatemia |
|
Definition
aluminum antacid toxicity
normal children: mild childhood anemia due to decreased affinity of Hb to O2 |
|
|
Term
| what is used to treat hypophosphatemia |
|
Definition
|
|
Term
| what three conditions can cause hypocalcemia and hypophosphatemia |
|
Definition
familial benign hypophosphatemia
rickets/osteomalacia
hypophosphatemia |
|
|
Term
| what is used to treat hypocalcemia and hypophosphatemia |
|
Definition
IV/oral phosphate
vitamin D - rickets/osteomalacia |
|
|
Term
| what is wrong in familial benign hypophosphatemia, what is a complication |
|
Definition
impaired vitamin D production causes increased PTH which depletes bone of Ca and P
causes dwarfism |
|
|
Term
|
Definition
| impaired vitamin D production causes increased PTH which deplates bone of Ca and P |
|
|
Term
| what are signs of rickets in kids (2) |
|
Definition
|
|
Term
| what are signs of rickets in adults |
|
Definition
painful bones
weak muscles |
|
|
Term
| what are three conditions that cause hypocalcemia and hyperphosphatemia |
|
Definition
hypoparathyroidism
pseudohypoparathyroidism
renal disease |
|
|
Term
| what is wrong in hypoparathyroidism , what is the cause |
|
Definition
| decreased release o f PTH due to thyroid or neck surgery, autoimmune or genetic disease |
|
|
Term
| how is hypoparathyroidism treated |
|
Definition
|
|
Term
| what is wrong in pseudohypoparathyroidism, what other symptoms are there |
|
Definition
body does not respond to PTH
short stature, metacarpals, metatarsals |
|
|
Term
| what is the treatment for pseudohypoparathyroidism |
|
Definition
|
|
Term
| what does renal disease do to Ca and P |
|
Definition
|
|
Term
| how do we treat the Ca and P effects of renal disease |
|
Definition
aluminum antacids
calcitriol |
|
|
Term
|
Definition
acts on osteoclast to inhibit bone reabsorption
rapid Ca reduction |
|
|
Term
|
Definition
| in hypercalcemia body will become sensitized in a few days |
|
|
Term
| what are 4 uses of calcitonin |
|
Definition
hypercalcemia
hypercalcemia + hyperphosphatemia
paget's disease
osteoperosis |
|
|
Term
| what are the 2 IV bisphosphates |
|
Definition
|
|
Term
| what is the MOA of IV bisphosphate |
|
Definition
inhibit osteoclast bone reabsorption
reduction of Ca over several days |
|
|
Term
| what 4 things for IV bisphosphates treat |
|
Definition
hypercalcemia
hypercalcemia + hyperphosphatemia
paget's disease
osteoperosis |
|
|
Term
|
Definition
| takes 1-2 days to reduce Ca |
|
|
Term
| what two things do corticosteroids treat |
|
Definition
lymphoma (PTH secreting tumor)
vitamin D toxicity caused hypercalcemmia |
|
|
Term
|
Definition
| increases plasma phosphate levels |
|
|
Term
| what are 3 side effects of IV/oral phosphate |
|
Definition
mild laxative
if not needed is rapidly excreted (no storage)
excess can reduce Ca via percipitation in soft tissue and be toxic |
|
|
Term
| 4 uses of IV/oral phosphate |
|
Definition
hypophosphatemia
hypocalcemia + hypophosphatemia
hyperparathyroidism
mild laxative |
|
|
Term
|
Definition
| supression of PTH decreases bone turn over |
|
|
Term
| side effects of vitamin D analogs |
|
Definition
| possible vitamin D toxicity |
|
|
Term
| 4 uses of vitamin D analogs |
|
Definition
rickets / osteomalacia
osteoperosis
treat hypoparathyroidism due to thyroid or parathyroid operation
renal failure 0 calcitrol |
|
|
Term
| what are the three types of vitamin D analogs and their administration |
|
Definition
ergocalciferol: oral, iv, im
dihydrotachysterol: oral
calcitrol: oral, iv |
|
|
Term
| what molecule is ergocalciferol |
|
Definition
|
|
Term
| what molecule is dihydrotachysterol |
|
Definition
|
|
Term
| what are the three types of Ca analogs and their administeration and why |
|
Definition
Ca chlorida: IV (IM causes vasodilation and burning)
Ca glyconate IV (IM causes abscess)
CA gluceptate IV or IM (IM causes some irritation) |
|
|
Term
| what are two uses of calcium analogs |
|
Definition
hypocalcemia + hyperphosphatemia
malabsorption or malnutrition of Ca |
|
|
Term
|
Definition
| decrease plasma phosphate by decreasing phosphate absorption |
|
|
Term
| aluminum antacids side effects |
|
Definition
|
|
Term
| aluminum antacids clinical use |
|
Definition
| clearance of phosphate in kidney failure |
|
|
Term
| define osteoperosis, who is it normally seen in |
|
Definition
| low bone mass and microfractures with minimal trauma in older women |
|
|
Term
| what are the types of osteoperosis |
|
Definition
primary type 1
primary type 2
secondary |
|
|
Term
| what is the cause of osteoperosis primary type 1 |
|
Definition
| loss of trabecular bone due to estrogen lack at menopause |
|
|
Term
| what is the cause of osteoperosis primary type 2 |
|
Definition
| loss of cortical and trabecular bone in men and women due to remodeling inefficiency, diet, activation of parathyroid axis with age |
|
|
Term
| what is the cause ot secondary osteoperosis |
|
Definition
systemic illness
medication: glucocorticoids, phenytoin |
|
|
Term
| what are the three regulators of bone density |
|
Definition
physical activity
endocrine status
Ca intake |
|
|
Term
| what is the trend in bone density over time |
|
Definition
| stable until 50 then progressivel decline |
|
|
Term
| what are 8 drugs that treat osteoperosis, state if they are for a specific kind or patient |
|
Definition
calcitonin
IV bisphosphate
vitamin D analogs
Ca carbonate
estrogen - post menopause osteoperosis
raloxifene
thiazide diruetuc
testosterone - hypogonadal males |
|
|
Term
| what is a side effect of Ca carbonate |
|
Definition
| constipation when >2000 mg/d |
|
|
Term
| what estrogen is used for osteperosis |
|
Definition
| conjugated equine estrogen without progesterone |
|
|
Term
| side effect of raloxifene |
|
Definition
| anti-estrogen in breast tissue |
|
|
Term
|
Definition
selective estradiol receptor modulator
agonist in liver and bone |
|
|
Term
| how do thiazidie diruetics help osteoperosis |
|
Definition
|
|
Term
| what is the main way to distinguish between diabetes mellitus and insipidus |
|
Definition
| melllitus has glucose in the urine |
|
|
Term
| why is the glucose in the urine in diabetes |
|
Definition
| glucose in the blood exceeds capacity for reahsption so it is excreted in the urine |
|
|
Term
| what is the cause of type I diabetes (3) |
|
Definition
| B cells cant make enough insulin, destoried B cells dont respond to glucose, B cell lesions and necrosis |
|
|
Term
| what are 5 signs of type I diabetes |
|
Definition
polydipsia
polyphagia
polyuria
ketoacidosis
hyperglycemia |
|
|
Term
| describe the typical type I diabetes patient |
|
Definition
onset in childhood
looks undernourished |
|
|
Term
| does diabetes have a genetic predisposition |
|
Definition
| type II more than type I. but yes |
|
|
Term
| what is the treatment for type I diabetes |
|
Definition
|
|
Term
| describe the typical type II diabetes patient |
|
Definition
|
|
Term
| what is the cause of type II diabetes |
|
Definition
insulin resistant and inabilit to make enough insulin
can progress to be like type I |
|
|
Term
| what is the treatment for type II diabetes |
|
Definition
weight reduction, exercise, dietary modification
oral hypoglycemics
last resort: exogenous insulin |
|
|
Term
| what are 6 complications of diabetes |
|
Definition
hyperglycemia
increased BP
neuropathy
proteinuria
cardiovascular disease (more type II)
diabetic retinopathy
diabetic neuropathy |
|
|
Term
| what is the treatment for neuropathy and proteinuria |
|
Definition
|
|
Term
| what is the treatment for diabetic cardiovascular disease |
|
Definition
| statins lower lipid and cholesterol, stop smoking |
|
|
Term
| what is the treatment for diabetic neuropathy |
|
Definition
| foot care, ulcer care, erythromycin for vagus neuropathy causing GI immotility |
|
|
Term
| what are the two types of diabetes insipidus, what causes each |
|
Definition
central: deficiency in ADH
nephrogenic: lack of response to ADH |
|
|
Term
| how can you distinguish between central and nephrogenic diabetes insipidus |
|
Definition
| demopressin replaces ADH so if urine production decreases they have central |
|
|
Term
| how does diabetes insipidus cause disease (no matter which type) |
|
Definition
| causes lack of reabsorption of water in the CD |
|
|
Term
|
Definition
| B cells of islets of langerhans |
|
|
Term
| what are normal fasting insulin levels |
|
Definition
|
|
Term
| what occurs in fasting metabolism |
|
Definition
adipose releases FA which is processed in liver to glucose
pancreas releases glucagon which signals to the liver to make glucose
glucose is first used in the brain then other major organs |
|
|
Term
| what are normal prandial insulin levels |
|
Definition
|
|
Term
| what occurs in prandial metabolism |
|
Definition
carbs are ingested and turned into glucose which is ingested and distributed to the organs
pancreas releases insulin which tells the liver, muscle, and adipose to store glucose |
|
|
Term
| how does glucose get into the cell |
|
Definition
insulin turns on GLUT facilitated diffusion transporters which activate TK which intrinsically phosphorlyates various substrates
insulin stimulates translocation of GLUT4 transporters to the membrane allowing for glucose to get into the cell |
|
|
Term
| how are B cells activated to release insuln |
|
Definition
glucose comes through GLUT2 receptors and glucokinase phosphorlyates it so it can stay in the cell.
G6P is shuttled to ATP production which increases ATP in relation to ADP
ratio switches on K channel and cell moves from basal state (hyperpolarized and inhibited) to depolarized
this causes Ca cannels to open and Ca moves in stimulating release of insulin |
|
|
Term
|
Definition
| single chain precursor called preproinsuln (A and B chains connected by C peptide) is cleaved in ER to proinsulin, processed in golgi to insulin, and released with C peptide |
|
|
Term
| what is the clinical significance of C peptide |
|
Definition
| helps determine if insulin levels are due to edogenous (no C) or endogenous (has C) insulin |
|
|
Term
| what is the best determinant of insulin levels, why |
|
Definition
| HBA1C because it shows BG over several months |
|
|
Term
| what is the cycle of insulin |
|
Definition
| increases after a meal and is at low basal levels between meals |
|
|
Term
|
Definition
| B cells of islets of langerhans |
|
|
Term
| what are normal fasting insulin levels |
|
Definition
|
|
Term
| what occurs in fasting metabolism |
|
Definition
adipose releases FA which is processed in liver to glucose
pancreas releases glucagon which signals to the liver to make glucose
glucose is first used in the brain then other major organs |
|
|
Term
| what are normal prandial insulin levels |
|
Definition
|
|
Term
| what occurs in prandial metabolism |
|
Definition
carbs are ingested and turned into glucose which is ingested and distributed to the organs
pancreas releases insulin which tells the liver, muscle, and adipose to store glucose |
|
|
Term
| how does glucose get into the cell |
|
Definition
insulin turns on GLUT facilitated diffusion transporters which activate TK which intrinsically phosphorlyates various substrates
insulin stimulates translocation of GLUT4 transporters to the membrane allowing for glucose to get into the cell |
|
|
Term
| how are B cells activated to release insuln |
|
Definition
glucose comes through GLUT2 receptors and glucokinase phosphorlyates it so it can stay in the cell.
G6P is shuttled to ATP production which increases ATP in relation to ADP
ratio switches on K channel and cell moves from basal state (hyperpolarized and inhibited) to depolarized
this causes Ca cannels to open and Ca moves in stimulating release of insulin |
|
|
Term
|
Definition
| single chain precursor called preproinsuln (A and B chains connected by C peptide) is cleaved in ER to proinsulin, processed in golgi to insulin, and released with C peptide |
|
|
Term
| what is the clinical significance of C peptide |
|
Definition
| helps determine if insulin levels are due to edogenous (no C) or endogenous (has C) insulin |
|
|
Term
| what is the best determinant of insulin levels, why |
|
Definition
| HBA1C because it shows BG over several months |
|
|
Term
| what is the cycle of insulin |
|
Definition
| increases after a meal and is at low basal levels between meals |
|
|
Term
| what are the short acting insulins (4) |
|
Definition
insulin lispro
insulin aspart
insulin glulisine
insulin regular |
|
|
Term
| what are the long acting insulins (2) |
|
Definition
insulin glargine
insulin detemir |
|
|
Term
| what are the insulin AA combinations (3) |
|
Definition
lispro + protamine
asprt + protamine
NPH + R |
|
|
Term
| what insulins have the best HBA1C control |
|
Definition
|
|
Term
| what are the side effects of all insulin medications (2) |
|
Definition
hypooglycemia
lipodystrophy |
|
|
Term
| what are the ratings of the hypoglycemic effects of the different types of insulin |
|
Definition
short acting has most
long acting is second
no peak insulin has no effect |
|
|
Term
| what are three sources of insulin, which is used today |
|
Definition
beef - outdated
pork - outdated
E. coli produces human insulin |
|
|
Term
| how is insulin administered (2) |
|
Definition
subcutaneous
IV (emergency) |
|
|
Term
| which type of insulin is the most rapidly absorbed |
|
Definition
|
|
Term
| how well is insulin absorbed |
|
Definition
depends on prep
human is absorbed the best and most quickly |
|
|
Term
| where is insulin metabolized and by what |
|
Definition
| metabolized to be inactive in liver and kidney by insulinase |
|
|
Term
| how long does it take for short acting insulin to kick in, how long does it last |
|
Definition
onset <15 min
duration 3-6 hours |
|
|
Term
| why is long acting insulin long acting, what is the duration |
|
Definition
NPH (insulin isophane suspension complexed with zinc) allows slow release
12-18h |
|
|
Term
| which insulin has slow release and rapid onset, how does it work |
|
Definition
insulin combined with AA
onset <10min because insulin dosent stick together due to AA substitution and is more free for use |
|
|
Term
| how long does no peak insulin last |
|
Definition
| 24 hours of consistant plasma levels |
|
|
Term
| how is a pregnant woman with diabetes treated |
|
Definition
|
|
Term
| how do insulin pumps work |
|
Definition
| uses short acting insulin on continous infusion to provide steady basal insulin level and bolus injections depending on size and time of meal |
|
|
Term
|
Definition
emergency, when someone needs insulin fast
ketoacidosis |
|
|
Term
| what is a non-intensive diabetes treatment |
|
Definition
| NPH with lispro at breakfast and dinner |
|
|
Term
| what are the two most populat insulin redigmen, which is bettwe |
|
Definition
glargine x2 and lispro x4
or
insulin pump
best one depends on pt |
|
|
Term
| what is the general pathway in diabetes treatment |
|
Definition
diet and exercise (if type II)
check liver function - if abnormal use insulin
check kidney function (Cr)- if not abnormal use metformin
if still hyperglycemic- try sulfonylurea
if still hypoglycemic- try combo meal time + basal medication)
if still hyperglycemic- use insulin |
|
|
Term
| what drug is contraindicated with oral hypoglycemics |
|
Definition
|
|
Term
| what drugs antagonize insulin or oral hypoglycemics (4) |
|
Definition
corticosteroids, estrogen, thyroid hormones
thiazides |
|
|
Term
| what are the 4 sulfonylureases |
|
Definition
gen 1: chlorpropamide
gen 2: glipizide, glyburide, glomepiride |
|
|
Term
| what are the two thiazolidiendiones |
|
Definition
pioglitazone
rosiglitazone |
|
|
Term
| what are the two aa derivatives |
|
Definition
|
|
Term
| what are the two a-glycosidase inhibitors |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what drugs mimic incretin (2) |
|
Definition
|
|
Term
| what drugs inhibit DPP-4 (3) |
|
Definition
stilagliptin
saxagliptin
linagliptin |
|
|
Term
| what drug is synthetic amylin hormone |
|
Definition
|
|
Term
| what drig is a SGLT2 inhibitor |
|
Definition
|
|
Term
| what is used as a anti-hypoglycemic (2) |
|
Definition
glucagon
glucose tablets
glucose source - grape juice |
|
|
Term
| what are the 5 categories of oral hypoglycemics |
|
Definition
sulfonylureases
thiazolidiendiones
AA derivatives
a-glucosidase inhibitors
biguanides |
|
|
Term
|
Definition
bind and block K channel on B cells depolarizing, opening Ca channel letting it in and causing insulin release
reduce glucagon (indurect due to insulin decrease)
increase insulin blocking (maybe increasing receptors) |
|
|
Term
| MOA thiazolidiendiones (3) |
|
Definition
increase sensitivity to insulin in tissues
decrease hepatic glucose output
use PPARy in adipose to increase insulin receptors |
|
|
Term
|
Definition
|
|
Term
| a-glucosidase inhibitor MOA |
|
Definition
inhibit enzyme in SI brush border decreasing sugar absorption
prevents post-prandial rise in glucose |
|
|
Term
|
Definition
inhibits gluconeogenesis
stimulates glucolysis
increases glucose uptake in tissues |
|
|
Term
| exenatide and liraglutide MOA |
|
Definition
mimics incretins
incretins are released from intestines in response to food and increase insulin secretion |
|
|
Term
| sitagliptin, saxagliptin, linagliptin MOA |
|
Definition
| inhibit dipeptitdyl peptidase 4 (DPP-4) so incretin cannot be degradedand insulin increases |
|
|
Term
|
Definition
synthetic amylin hormone
normally made in pancreas after meal to slow rate of food absorption in intestines and reduce appetite |
|
|
Term
|
Definition
| blocks Na/glucose cotransporter 2 in PCT preventing reabsorption |
|
|
Term
|
Definition
| stops active hypoglycemia |
|
|
Term
| side effects sulfonylureases (4) |
|
Definition
all cause hypoglycemia
mostly 1st gen causes: hyponatremia, disulfram, hypotension (so basically don't use in old people) |
|
|
Term
| thiazolidiendione side effects (2) |
|
Definition
hypoglycemia
MI and other cardio events - dont use with CHF pt (especially rosiglitazone) |
|
|
Term
| AA derivative side effects |
|
Definition
|
|
Term
| a-glucosidase inhibitor side effects (3) |
|
Definition
flatulence
diarrhea
abdominal cramps
NO hypoglycemia |
|
|
Term
|
Definition
lactic acidosis in pt with renal or heart failure
NO hypoglycemia |
|
|
Term
| exenatide, liraglutide side effects (5) |
|
Definition
liragltide; weight loss
hyoiglycemia: low risk
nausea, vomiting, diarrhea |
|
|
Term
| sitagliptin, saxagliptin, linagliptin side effects (2) |
|
Definition
|
|
Term
| pramlintide side effects (3) |
|
Definition
weight loss
nausea
hypoglycemia |
|
|
Term
| SGLT2 inhibitor side effects (3) |
|
Definition
increased K
female GU infections |
|
|
Term
| how is glucagon administered |
|
Definition
|
|
Term
| how is canaglifolozin administered |
|
Definition
| oral once a day before first meal |
|
|
Term
| how is pramlintide administered |
|
Definition
|
|
Term
| how is sitagliptin, saxagliptin, linagliptin administered |
|
Definition
|
|
Term
| how is exenatide, liraglutide administered |
|
Definition
|
|
Term
| what is sitagliptin, saxagliptin, linagliptin used for |
|
Definition
| type II diabetes - need functioning B cells |
|
|
Term
| what is exenatide, liraglutide used for |
|
Definition
| type II diabetes - need functioning B cells |
|
|
Term
| what is pramlintide used for |
|
Definition
| adjunct to insulin in type I or II diabetes (lower insulin though) |
|
|
Term
| where is metformin metabolized and excreted |
|
Definition
not metabolized
excreted in urine |
|
|
Term
| what plasma protein is metformin bound to |
|
Definition
|
|
Term
| which oral hypoglycemic has the shortest half life |
|
Definition
|
|
Term
| how are thiazolidiendiones used |
|
Definition
| with insulin or in another combo (not enough alone) |
|
|
Term
| where are sulgonylureases metabolized and excreted |
|
Definition
|
|
Term
| which drug should you never use in pregnant diabetic patients, why |
|
Definition
thiazolidiendiones
can cross placenta and deplete fetal pancreas of insuln |
|
|
Term
| what are the 4 main uses for estrogen or progesterone drugs |
|
Definition
hormone replacement therapy / post-menopause
contraception
health benifits of contraception
receptor antagonist: breast cancer, infertility |
|
|
Term
| what is another name for the follicular phase, how long is it |
|
Definition
| proliferative phase, length varies |
|
|
Term
| what are the two phases of the menstural cycle |
|
Definition
|
|
Term
| what is another name for the lutela phase, how long is it |
|
Definition
|
|
Term
| explain the process of hormone production in the follicular phase |
|
Definition
pulses of GnRH cause release of LH and FSH
estrogen increases reduce LH and FSH release
inhibin is mad ein ovary and causes feedback decreasing FSH
mid cycle estrogen reaches peak for 36 hours and stops inhibiting gonadotropins and causes surge instead |
|
|
Term
| what happens in the luteal phase |
|
Definition
corpus luteum secretes progesterone (estrgen levels stay elevated)
if pregnancy does not occur corpus luteum regresses due to lack of LH and progesterone and falls so endometrium sheds causing menstural discharge |
|
|
Term
| what does progesterone do for the baby/uterus |
|
Definition
stops endometrium proliferation
helps with implantation and growth of blastocyst
causes growth of endometrial vessels |
|
|
Term
| what is the general structure of estrogen |
|
Definition
| 18C with an aromatic phenolic acid ring (required for selective high affinity binding) |
|
|
Term
| what is the natural form of estrogen, where is it made in men and women |
|
Definition
17B estradiol
women: ovarian granulosa cells
men and post-menopause; adipose tissue viea DHEA from adrenal cortex |
|
|
Term
| what stimulates for estrogen release |
|
Definition
| gonadotropins stimulate aromatase |
|
|
Term
| what are precursors for estrogen |
|
Definition
androstendione
testosterone |
|
|
Term
| estrogen needs aromatic ring to work, how does it get it |
|
Definition
| aromatase using NADPH and O |
|
|
Term
| where are estrogen receptors located |
|
Definition
| ovarian granulosa, sertoli and leydig cells, stroma of adipose, placenta, blastocyte, brain |
|
|
Term
| how is estrogen converted between its different forms |
|
Definition
estradiol oxidized to esterone via 12-hydroxysteroid DH
estradiol and esterone converted to estriol |
|
|
Term
| what is the down side of using natural progesterone |
|
Definition
|
|
Term
| what are the two types of synthetic progesterone |
|
Definition
21C progesterone skeletons
19-nortestosterone |
|
|
Term
| what is 19-nortestosterone |
|
Definition
progesterone without C19, 20, 21
resembles testosterone more so has effects of both |
|
|
Term
| where is progesterone made, when |
|
Definition
made in testis, adrenal cortex, placenta, and ovary corpus luteum
begins being made in follicular phase and increases in luteal phase later in pregnancy |
|
|
Term
| what is the relationship between progesterone and the cns |
|
Definition
| increases body temp 1 deg midcycle until onset of menstural flow (ovulation) |
|
|
Term
| what is the down side to using estrogen alone in hormone replacement |
|
Definition
| risk of endometrial carcinoma due to hyperplasia of the endometrium |
|
|
Term
| what is the benifit of combined estrogen progesterone therapy in hormone replacement |
|
Definition
| estrogen receptors dont get out of hand because it has to make some progesterone receptors too |
|
|
Term
| how is a post-menopausal women with a uterus treated forr hormone replacement |
|
Definition
| progesterone/estrogen combination |
|
|
Term
| what are contraindications to progesterone/estrogen hormon replacement |
|
Definition
unable to tolerate progestins
risk of cardiovascular disease
poorlipoproteins use estrogen alone |
|
|
Term
| how is a post-menopausal women with a hysterctomy treated for homeone replacement |
|
Definition
| estrogen alone, no where for it to cause carcinoma |
|
|
Term
| what are 4 ways to administer hormone replacement therapy |
|
Definition
cyclic
continous
transdermal patch
vaginal ring |
|
|
Term
| what is the redigmen for cyclic hormone replacement |
|
Definition
estrogen 15d
estrogen and progesterone 10d
repeat |
|
|
Term
| what is the redigmen for continous hormone replacement |
|
Definition
estrogen and progesterone daily
OR
estrogen and progesterone 10d
esteogrn 15d
repeat |
|
|
Term
| what are the contents of combination oral contraceptives |
|
Definition
estrogen: ethinyl estradiol or mestraol
progesterone: norethindrone or norgestrel |
|
|
Term
| what are the three types of oral contraceptives |
|
Definition
monophasic
biphasic
triphasic |
|
|
Term
| how are monophasic oral contraceptives administered |
|
Definition
| same amount of estrogen and progesterone in each tablet for 21d |
|
|
Term
| how are biphasic oral contraceptives administred |
|
Definition
| two tablets with different amounts for 21 days |
|
|
Term
| what is the benifit of biphasic oral contraceptives |
|
Definition
| reduce steroids administred because it approximates estrogen to progesterin ratio of menstural cycle |
|
|
Term
| how are triphasic oral contraceptives administered |
|
Definition
| three tablets with different amounts for 21 days |
|
|
Term
| what is the general MOA of contraceptives |
|
Definition
estrogen supresses FSH and stops follicular development
proteitiating action of progestrin which stops LH surfe
progesterin stops ovulation, thickens cervical mucous, and causes endometrial atrophy
estrogen stabilizes endometrial lining (bleeding control) |
|
|
Term
| what are 4 contraindications to oral contraceptives |
|
Definition
thrombotic disease
over 35 and smoking
hormone sensitive tumor (breast canceR)
pregnancy |
|
|
Term
| what are the 4 forms of estrogen, talk about the bioavailability and blood distribution of each |
|
Definition
natural: 12B estradiol, esterone, estriol: poor oral bioavailability high first pass effect
17B estradiol estrace: microcrystaline form, reduced first pass |
|
|
Term
| what are the benifits of a transdermal estrogen patch |
|
Definition
slow release
increased bioavailability
constant blood levels |
|
|
Term
| what are the 4 types of synthetic estrogens |
|
Definition
conjugated
ethinyl estradiol
menastrol
estradiol cruptionate |
|
|
Term
| what is conjugated estrogen made of where does it come from |
|
Definition
many conjugated estrogen metabolites
pregnant mares |
|
|
Term
| what is the structure of ethinyl estradiol |
|
Definition
| ethinyl group on C17 of estrace nucleus |
|
|
Term
| how is mestranol metabolized |
|
Definition
prodrug
converted to ethinyl estradiol |
|
|
Term
| what is a non-steroidal estrogen agonist |
|
Definition
|
|
Term
| what is the MOA of oestrogen contraceptives |
|
Definition
passivly diffuse into cell
bind nuclear receptors in genital, breast, HPA, bone, and liver
interact with estrogen response elements (ERE) which alter transcription
supress FSH stopping follicle development and stabilizing endometrial lining (bleeding control) |
|
|
Term
| what are the 12 negative side effects of estrogen contraceptives |
|
Definition
elevated TG
decrease bile acid (due to cholesterol secretion)
removal: hot flashes, chills, sweating, parasthesia
nausea
cramping
fluid retention
dizzy
headache
breast tenderness
Mi or thrombosis in women >35 who smoke |
|
|
Term
| what are the good side effects of estrogen contraceptives (and natural functions) (14) |
|
Definition
decrease cholesterol
increase HDL
decrease LDL
growth of uterus, vagina, fallopian tubes, breast, ducts, sexual development
fat distribution, growth spurt, fusion of epiphysis
increase plasma binding proteins
prevent bone loss: block reabsorption
decrease endometrial and ovarian cancer
decrease fibroadenomas, fibrocysts, PID
decrease blood loss and cause cycle regularity |
|
|
Term
| why are esgtrogen contraceptives used (7) |
|
Definition
contraception
replacement
fibroadenomas
fibrocysts
PID
cycle regularity
failure of ovarian development |
|
|
Term
| what are three diseases that include failure of ovarian development |
|
Definition
dwarfism
turner syndrome
hypopituitarism |
|
|
Term
| what is the administration of the 4 estrogen contraceptives |
|
Definition
conjugated: oral active
ethinyl estradiol: oral active
mestranol: not for replacement
estradiol crypionate: long acting given IM |
|
|
Term
| how are estrogen drugs excreted |
|
Definition
| in urine with glucourindes and sulfate conjugates |
|
|
Term
| what are the side effects of diethylstilbesterol |
|
Definition
| congenital abnormalities in fetus |
|
|
Term
| why would you use diethylstilbesterol |
|
Definition
|
|
Term
| what are the three antiestrogen drugs |
|
Definition
chlomiphene
tamoxifen
raloxifene |
|
|
Term
|
Definition
competitive agonist of estrogen binding
stimulates ovulation in women with normal HPA and estrogen levels by opposing negative feedback increasing gonadotropin pulse amplitude (not frequency) |
|
|
Term
|
Definition
competitive antagonist of estrogen binding
antagonizes receptor |
|
|
Term
|
Definition
partial agonist effect on bone reabsorption and plasma lipoproteins
NO effect on reproductive tissues
selective estrogen receptor modulator |
|
|
Term
| what is the structure of clomiphene |
|
Definition
mixed isomeres
cis has estrogenic activity
trans has anti-estrogenic activity |
|
|
Term
| what is the structure of tamoxifen |
|
Definition
| pure trans isomere (only the useful part of clomiphene) |
|
|
Term
| why would you use clomiphene |
|
Definition
|
|
Term
| why would you use tamoxifen |
|
Definition
block hormone induced breast tumors
adjunct with surgery or chemo |
|
|
Term
| why would you use raloxifene |
|
Definition
| osteoperosis post-menopause |
|
|
Term
| what are the side effects of clomiphene (6 |
|
Definition
ovarian hyperstimulation
increased multiple births
ovarian cysts
anti-estrogenic: follicle, endometrium, cervical mucous (counter active) |
|
|
Term
| what are the side effects of tamoxifen (3) |
|
Definition
decrease tumor development in other breast
endometrial carcinoma
hormone independent breast tumors |
|
|
Term
| how is clomiphene administered, half life, where metabolized, where excreted |
|
Definition
oral
t.5 = 5-7d
hepatic metabolism
GI excretion |
|
|
Term
| tamoxifen: aministration, metabolism, excretion |
|
Definition
oral
hepatic metabolism
Gi excretion |
|
|
Term
| explain how tamoxifen is eliminated |
|
Definition
phase 1: 4-11d
phase 2: 4d (hydroxytamoxifen) |
|
|
Term
| what are the two aromatase modifying drugs |
|
Definition
|
|
Term
|
Definition
selective aromatase inhibitor stops conversion of androgens to estrogens
reversible |
|
|
Term
|
Definition
aromatase inactivastor acts as false substrate for enzyme and intermediate irreversibly binding to acrive site (suicide inhibition) stopping conversion of androgens to estrogens
irreversible |
|
|
Term
| what is the clinical use of amastrazole |
|
Definition
| post-menopausal hormone dependent breast cancer |
|
|
Term
| what is the use of exemestane |
|
Definition
| post-menopausal hormone dependent breast cancer |
|
|
Term
| what is an anti-progesterin drug, what progesterin structure family is it from |
|
Definition
mifepristone
19-nortestosterone derivative |
|
|
Term
|
Definition
potent competitive inhibitor of progesterone and glucocorticoids
decrease in progesterone cause abortion by detaching blastocyst
myometrial contraction and cervical softening allow for expulsion |
|
|
Term
|
Definition
administer up until 49 days after pregnancy
abortion pill |
|
|
Term
| what are the 4 progesterone contraceptives and their progesterone structure family |
|
Definition
norethindrone: 19-nortestosterone
norgestrel: 19-nortestosterone
mexroxyprogesterone acetate: 21C progesterone
progestasert |
|
|
Term
| what is the admnistration of the 4 progesterone contraceptives |
|
Definition
norethindrone: oral
norgestrel: oral, subdermal (5y)
mexroxyprogesterone acetate: IM (3mo)
progestasert: intrauterine |
|
|
Term
| MOA progesterone contraceptives |
|
Definition
supresses LH surge
thickens cervical mucous
decreases endometrial proliferation
stops ovulation |
|
|
Term
| where are progesterone receptors |
|
Definition
| genital, mammary, CNS (hypothalamus) |
|
|
Term
| what is the role of progesterone in pregnancy |
|
Definition
maintains it
supresses mensturation and uterine contraction
proliferation of mammary acini |
|
|
Term
| why not use a progesterone contraceptive all alone |
|
Definition
|
|
Term
| what are the uses of progesterone contraceptives |
|
Definition
ovarian supression: dysmenorrhea, endometrosis, histurism, uterine bleeding
hormone replacement: combined with estrogen
fibroadenomas
fibrocysts
PID
cycle regulation |
|
|
Term
| in general why is progesterone added to estrogen contraceptives, why aernt progesterone side effects a big deal |
|
Definition
avoid side effects of estrogen
progesterone side effects usually go away after 1 year |
|
|
Term
| what are the side effects of progesterone contraceptives (11) |
|
Definition
spotting
amenorrhea
decreased HDL
increased LDL
edema
weight gain: fat deposition
bloating
acne
histuism
impaired glucose tolerance: longer term, short term increases basal insulin
MI and thrombosis in women >35 who smoke |
|
|
Term
| MOA of the morning after pill |
|
Definition
| combination oral contraceptive in a high dose |
|
|
Term
| administration of the morning after pill |
|
Definition
taken within 72 hours of intercourse
ineffective after 7 days (cannot un-implant) |
|
|
Term
| what is the 21 patch made of |
|
Definition
| ethinyl estradiol norelgestromin |
|
|
Term
| administration of 21 patch |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| drug that binds to the same site as the ligand and makes the same signal |
|
|
Term
| define allosteric agonist |
|
Definition
| drug that binds to different site than drug making no signal but causing drug to be more effective |
|
|
Term
|
Definition
| drug produces lesser response than the ligand and competes for ligand site |
|
|
Term
| define competitive agonist |
|
Definition
| drug binds reversibly to receptor but increase in ligand can overcome it |
|
|
Term
| define non-competitive agonist, what are the two types |
|
Definition
binds to receptor and prevents agonist from producing max effect
irreversible: more common, same receptor
allosteric: different receptor |
|
|
Term
| how can you tell if something on a graph is more potent or effective |
|
Definition
moving left on the X axis is more potent
moving up on the Y axis is more effective |
|
|
Term
| what does a partial agonist graph look like compared to agonist |
|
Definition
less effective
shorter, less high on the Y axis |
|
|
Term
| what does a allosteric agonist graph look like compared to agonist |
|
Definition
same effectiveness (height on Y axis)
increased potency (more left on X axis) |
|
|
Term
| what does a non-competitive agonist graph look like compared to agonist |
|
Definition
very short, sinking
less effective (height on Y axis)
less potent (more right on X axis) |
|
|
Term
| what does a antagonist graph look like compared to agonist |
|
Definition
same effectiveness (height on Y axis)
less potency (more right on X axis) |
|
|
Term
| how does a Gs protein work |
|
Definition
| activates cAMP which increases PKA |
|
|
Term
| how does a Gi protein work |
|
Definition
| decreases cAMP which decreases PKA |
|
|
Term
| how does a Gq protein work |
|
Definition
releases IP3 and DAG
IP3 releases Ca
DAG and Ca activate PKC |
|
|
Term
| what is the point of equal ionization |
|
Definition
|
|
Term
| what happens to an acid and base if you put it in stuff that is lower (more basic) than the pKa |
|
Definition
acid will ionize
base will not ionize |
|
|
Term
| what happens to an acid and base if you put it in stuff that is higher (more acidic) than the pKa |
|
Definition
acid will not ionize
base will ionize |
|
|
Term
| what form of a drug is best excreted |
|
Definition
WA will be excreted beter in a basic enivornment
WB will be excreted better in an acidic enivornment |
|
|
Term
| what form of a drug is best distributed in the body |
|
Definition
the same form
WA likes acid
WB likes base |
|
|
Term
| what is used to fix and WB or WB drug OD |
|
Definition
NaHCO3 is used to alkalize urine and fix WA OD
NH3CL is used to acidify urine and fix WB OD |
|
|
Term
|
Definition
| increases gene expression of P450 metabolizing enzymes which decreases the plasma level of the drug making it less effective and decreasing presence of symptoms |
|
|
Term
| what are 5 examples of inducers |
|
Definition
| rifampin, bensopyrine, chronic ethanol, phenytoin, barbituates |
|
|
Term
|
Definition
| decrease gene expression for metabolizing P450 enzymes increasing plasma concentration of the drug which increases symptoms |
|
|
Term
| what are 4 examples of inhibitors |
|
Definition
| cimetidine, erythromycin, ketonazole, grapefruit |
|
|
Term
| define first order metabolism |
|
Definition
rate of drug metabolism is proportional to concentration of the free drug
constant fraction of drug is metabolized per unit time |
|
|
Term
| define zero order metabolism |
|
Definition
drugs with large doses saturate metabolizing enzymes
constant amount of drug is metabolized per unit time |
|
|
Term
| what are 3 examples of drugs with zero order kinetics |
|
Definition
| aspirin, ethanol, phenytoin |
|
|
Term
| what is a maintience dose for, how is it calculated |
|
Definition
adjust rate so input equals rate of loss to keep a steady plasma level
(Cs)(Cl)/(F) |
|
|
Term
| what is loading dose for, how is it calculated |
|
Definition
load initial volume of drug needed
(Cp)(Vd)/(F) |
|
|
Term
| how long does it take to get to steady state, what is it dependent on(2) |
|
Definition
4-5 half lives
depends on half life and steady state is determined by first order kinetics |
|
|
Term
|
Definition
zidovudine
lamivudine
entricitabine |
|
|
Term
|
Definition
| host adds 3P then drug terminates DNA elongation |
|
|
Term
|
Definition
peripherial neuropathy
lactic acidosis
marrow supression - zidovudine |
|
|
Term
|
Definition
|
|
Term
|
Definition
| host adds 2P, drug terminates DNA elongation |
|
|
Term
|
Definition
|
|
Term
|
Definition
maculopapular rash
CNS effects - enfavirenz |
|
|
Term
|
Definition
| binds reverse transcriptase causing inactivation |
|
|
Term
| name a protease inhibitor, what is the MOA |
|
Definition
ritonavir
inhibits protease stopping viral replication |
|
|
Term
| protease inhibitor side effects (5) |
|
Definition
central fat deposition
insulin release
hyperglycemia
P450 inhibitor - increased in infants |
|
|
Term
|
Definition
| in combination with out PI because it is an extra good P450 inhibitor |
|
|
Term
| name an integrase inhibitor |
|
Definition
|
|
Term
|
Definition
| inhibits viral genetic integration into host chromosomes |
|
|
Term
| name three anti-herpes drugs |
|
Definition
acyclovir
gencyclovir
foscarnet |
|
|
Term
|
Definition
| TK adds 1P, host adds 2P, DNA chain termination |
|
|
Term
| acyclovir side effects (4) |
|
Definition
delerium
tremor
seizure
nephrotoxicity (crystal urea, drink water) |
|
|
Term
|
Definition
| TK adds 1P, host adds 2P, DNA chain termination |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stops reverse transcriptase and DNA polumerase |
|
|
Term
| fascarnet side effects (2) |
|
Definition
nephrotoxicity
altered Ca and P balance |
|
|
Term
| what two herpes drugs treat CMV |
|
Definition
|
|
Term
| name and influenza a and b drug |
|
Definition
|
|
Term
|
Definition
| neuroaminidase inhibitor that stopps viral budding |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stops mycolic acid assembly |
|
|
Term
|
Definition
| peripherial neuritis (take B6 to fix) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| rifampin side effects (5) |
|
Definition
P450 inhibitor
pseudomembrane colitis
renal failure
anemia
red/orange urine |
|
|
Term
|
Definition
|
|
