Term
| cirticotropin releasing hormone (CRH) has a positive effect on what target organ to release what hormone |
|
Definition
| CRH has a positive effect on the anterior pituitary to secrete adrenocorticotropin hormone |
|
|
Term
| growth hormone releasing hormone has a positive effect on what target organ to release what hormone |
|
Definition
| GHRH has a positive effect on the anterior pituitary to release growth hormone (aka - somatotropin) |
|
|
Term
| somatostatin has a positive or negative effect on the anterior pituitary? |
|
Definition
| has a negative effect on the anterior pituitary |
|
|
Term
| somatostatin has a negative effect on what target organ, causing the inhibition of what hormone |
|
Definition
| somatostatin inhibits the release of GH from the anterior pituitary |
|
|
Term
| gonadotropin releasing hormone has a positive effect on what target organ to release what hormone |
|
Definition
| GnRH has a positive effect on the anterior pituitary to release FSH and LH |
|
|
Term
| thyrotropin releasing hormone has a positive effect on what target organ to release what hormone |
|
Definition
| TRH has a positive effect on the anterior pituitary to release TSH |
|
|
Term
| dopamine has a negative effect on what target organ to cause the inhibition of what hormone |
|
Definition
| dopamine has a negative effect on the anterior pituitary inhibiting the release of prolactin |
|
|
Term
| which pituitary gland is connected to the hypothalamus via a portal system |
|
Definition
| the anterior pituitary is connected to the hypothalamus via a special portal system, allowing for direct communication between both glands |
|
|
Term
| the target organ hormone of growth hormone |
|
Definition
| insulin like growth factor 1 |
|
|
Term
| the target organ hormone of TSH |
|
Definition
| thyroixine (T4) and thriiodothyronin (T3) |
|
|
Term
| the target organ hormone of ACTH |
|
Definition
| glucocorticoids, mineralocorticoids, and androgens |
|
|
Term
| the target organ hormone of FSH |
|
Definition
| estrogen, testosterone, and progesterone |
|
|
Term
| the target organ hormone of LH |
|
Definition
| estrogen, testosterone, and progesterone |
|
|
Term
| the target organ hormone of prolactin |
|
Definition
| none, it does not target an organ |
|
|
Term
| treatment of GH deficiency |
|
Definition
somatropin
somatrem
sermorelin |
|
|
Term
| side effects to the treatment of GH deficiency |
|
Definition
treating with somatropin, somatrem or sermorelin can cause:
muscle or joint pain, swelling, pain or numbness in hands
indicates the GH replacement levels are too high for the pt |
|
|
Term
| what are the differences in the manifestation of gonadotropin deficiency depending on whether the deficiency occured before or after puberty |
|
Definition
deficiency prior to puberty -> prevents normal sexual maturity causing a lack in secondary sex characteristics
deficiency after puberty -> early menopause in women or sexual dysfunction in men |
|
|
Term
| treatment of gonodotropin deficiency |
|
Definition
menotropins
human chorionic gonadotropin
urofollitropin (uFHS)
follitropin alpha and beta
lutropin alpha (rLH)
GnRH agonists
estrogen receptor agonist-antagonists |
|
|
Term
| which class of drugs, used for the treatment of gonadotropin deficiency, is formed from human menopausal gonadotropin, from the urine of menopausal women, and contains both FSH and LH |
|
Definition
| menotropins (repronex, pergonal humegon) |
|
|
Term
| which drug, used for the treatment of gonadotropin deficiency, is formed from the placenta and isolated from urine of pregnant women, and contains primarily LH |
|
Definition
| human chorionic gonadotropin |
|
|
Term
| which drug, used for the treatment of gonadotropin deficiency, is purified FSH extracted from urine of postmenopausal women and has the LH removed |
|
Definition
|
|
Term
| which drug, used for the treatment of gonadotropin deficiency, is recombinant forms of FSH (and not from the urine of women) |
|
Definition
| follitropin alpha and beta (rFHS) |
|
|
Term
| which drug, used for the treatment of gonadotropin deficiency, is the recombinant form of LH, and is approved only for use in combination with follitropin alpha to stimulate follicular development in infertile women with profound LH deficiency |
|
Definition
|
|
Term
| pulsatile or nonpulsatile release of GnRH leads to hypogonadism |
|
Definition
| NONpulsatile release/secretion leads to hypogonadism |
|
|
Term
| pulsatile or nonpulsatile release of GnRH leads to stimulation of FSH and LH release |
|
Definition
| pulsatile release of GnRH leads to the stimulation of FSH and LH release |
|
|
Term
| which drug, used for the treatment of FSH and LH deficiency, must be administered in such a manner, that it mimics a pulsatile secretion of FSH and LH, and is acetate salt of human GnRH |
|
Definition
|
|
Term
| what are the synthetic analogs of GnRH that are used in the treatment of FSH and LH deficiency/gonadotropin deficiency |
|
Definition
| goserelin, histrelin, leuprolide, nafarelin, triptorelin |
|
|
Term
| which drug is an estrogen receptor agonist-antagonist used in the treatment of gonadotropin deficiency/FHS and LH deficiency |
|
Definition
| clomiphene - actos on estrogen receptors in the hypothalamus to increase the release of FSH and LH |
|
|
Term
| a somatotrope adenoma (of the anterior pituitary) that develops during adulthood results in what condition |
|
Definition
|
|
Term
| a somatotrope adenoma (of the anterior pituitary) that develops before the closing of the long bone epiphyses results in what condition |
|
Definition
|
|
Term
| what are the different possible lines of treatment for hypersecretion of GH (hyperpituitartism) |
|
Definition
somatostatin analogues (octreotide acetate, lanreotide)
GH receptor antagonists (pegvisomant)
dopamine agonists (bromocriptine, cabergoline) |
|
|
Term
| what drug is most often used in the treatment of GH excess |
|
Definition
|
|
Term
| which drugs must be used in combination with octreotide for the treatment of GH, because if used by themselves would require extremely large doses |
|
Definition
the dopamine agonists:
bromocriptine
cabergoline |
|
|
Term
| which pegilated drug is used for the treatment of GH excess |
|
Definition
GH receptor antagonist:
pegvisomant |
|
|
Term
| treatments for GnRH excess |
|
Definition
GnRH antagonists (ganirelix, centrorelix, abarelix, degarelix)
continual administration of GnRH (gonadotropin, goserelin, leuprolide, nafarelin) |
|
|
Term
| what drugs are approved for the treatment of controlled ovarian hyperstimulation |
|
Definition
| genirelix and centrorelix (GnRH antagonists) are approved for controlled ovarian hyperstimulation |
|
|
Term
| what drugs are approved for men with advanced prostate cancer |
|
Definition
| abarelix and degarelix (GnRH antagonists) |
|
|
Term
| which drugs can be used as continual administration for the treatment of GnRH hyperpituitarism |
|
Definition
GnRH agonists:
gonadorelin
goserelin
leuprolide
nafarelin |
|
|
Term
| what is the most common pituitary hormone hypersecretion in both males and females |
|
Definition
|
|
Term
| what are the treatments for hypersecretion of prolactin |
|
Definition
| dopoamine agonists (cabergoline, bromocriptine, and others: pergolide, mesylate, lisuride, quinagolide |
|
|
Term
| which hormone is released in response to elevated tonicity or falling blood pressure |
|
Definition
| vasopressin (antidiuretic hormone/ADH) |
|
|
Term
| which vasopression receptors are found on vascular smooth muscle cells and mediate vasoconstriction (the vasopressor property of the hormone) - V1 or V2 receptors? |
|
Definition
|
|
Term
| which vasopressin receptors are found on tuble cells and reduce diuresis by increasing water permeability and resorption in collecting tubules (the antidiuretic property of ADH) - V1 or V2 receptors? |
|
Definition
|
|
Term
| what are the treatments for vasopressin deficiency |
|
Definition
|
|
Term
| what is the treatment for diabetes insipidus |
|
Definition
|
|
Term
| which drug is used for the treatment of nocturnal enuresis |
|
Definition
|
|
Term
| what are the treatments for vasopressin excess |
|
Definition
|
|
Term
| which drug, used for the treatment of vasopressin excess, has an affinity for both V1alpha and V2 receptors |
|
Definition
conivaptan
(tolvaptan - has an affinity for V2 receptors only) |
|
|
Term
what drugs can be given to induce labor
what are the differences in clinical manifestations between giving low doses and high doses of these drugs |
|
Definition
oxytocin and pitocin
low doses: increase frequency and force of uterine contractions
high doses: provide for sustained contraction |
|
|
Term
| what is the treatment of choice for hypothyroidism |
|
Definition
replacement therapy:
levothyroxine
liothyronine
liotrix |
|
|
Term
| which drug, used for the treatment of hypothyroidism, is more potent and consists of only T3 |
|
Definition
|
|
Term
| which drug, used for the treatment of hypothyroidism, is synthetic T4 |
|
Definition
|
|
Term
| which drug, used for the treatment of hypothyroidism, is a mixture of T3 and T4 |
|
Definition
|
|
Term
| what is the first line of treatment for thyrotoxicosis in the US |
|
Definition
|
|
Term
| what are all the possible treatments for thyrotoxicosis |
|
Definition
| radioiodine, propylthiouracil (PTU), carbimazole, and methimazole |
|
|
Term
| which drug, used for the treatment of hyperthyroidism, inhibits the converson of T4 to T3 |
|
Definition
| beta-adrenoceptor antagonists (propanolol) |
|
|
Term
| which drugs, used for the treatment of hyperthyroidism, inhibit the organification and hormone release and reduce size and vasculatiry of thyroid |
|
Definition
| lugol's solution, potassium iodide |
|
|
Term
| the zona glomerulosa, of the adrenal gland, produces what molecule |
|
Definition
| mineralocorticoids (aldosterone) |
|
|
Term
| the zona fasciculata produces what compounds |
|
Definition
| glucocorticoids (cortisol) |
|
|
Term
| the zona reticularis produces what molecule |
|
Definition
| androgens (DHEA and testosterone, and others) |
|
|
Term
| treatments of adrenal insufficiency |
|
Definition
| hydrocortisone, cortisone, prednisone, prednisolone, methylprednisolone, meprednisone, triamcinolone, paramethasone, fluprednisone, (betamethasone, dexamethasone), fludrocortisone, desoxycorticosterone acetate |
|
|
Term
| pharmacologic treatments for secondary and tertiary adrenal insufficiency |
|
Definition
| hormone replacement therapy for glucocorticoids, but not usually for mineralocorticoids as aldosterone secretion is preserved. however, replacement of other pituitary hormones may be necessary |
|
|
Term
| treatment of hyperaldosteronism |
|
Definition
aldosterone antagonist (spironolactone)
MR antagonist (eplerenone) |
|
|
Term
| treatment of virilization and hirsutism because of adrenal hypersecretion |
|
Definition
oral contraceptives
glucocorticoids (dexamethasone, prednisone)
antiandrogens (spironolacton, flutamide) |
|
|
Term
| treatment of cushing's syndrome |
|
Definition
glucocorticoid synthesis inhibitors:
aminoglutethimide
ketoconazole
metyrapone
receptor antagonists:
mifepristone
spironolactone |
|
|
Term
| which drug, used for the treatment of adrenal hypersecretion, blocks conversion of cholesterol to pregnenolone, which is rate limiting step in all hormonaly active steroids |
|
Definition
|
|
Term
| in the pancreatic beta cell, the presence of glucose (aka - after a meal) causes an an increase in intracellular ATP which leads to what |
|
Definition
| the closing of K+ channels, from the increased levels of ATP kinding to the SUR1 receptor on the K+ channel |
|
|
Term
| in the pancreatic beta cell, after a meal, the binding of ATP to the K+ channel causes a hyperpolarization or a depolarization of the cell |
|
Definition
| ATP binds to the SUR1 receptor on the K+ channel, causing the channels to close, which leads to depolarization of the beta cell |
|
|
Term
| in the pancreatic beta cell, after a meal, the closure of the K+ channels causes a depolarization of the cell which leads to what |
|
Definition
| the depolarization of the beta cell causes the Ca2+ channels to open, causing an influx of Ca into the cell, which results in the movement of vesicles from the golgi to move to the membrane, fuse, and release insulin into circulation |
|
|
Term
| when insulin binds to the insulin receptor on the muscle cell, it causes an increase in what type of glucose transporter |
|
Definition
GLUT4
(the insulin binding to the insuline receptor, causes autophosphorylation of the receptor which causes a signal cascade, that results in GLUT4-containing vesicles to fuse with with membrane, increasing the numer of glucose transporters in the cell membrane) |
|
|
Term
| one international unit of insulin (IU) = |
|
Definition
| 1 IU is the "biological equivalent" of about 45.5 mcg of insulin |
|
|
Term
| list the different drugs used as insulin therapy that have the fastest onset and duration of action, and are typically taken as boluses with food |
|
Definition
insulin aspart (novolog)
lispro (humalog)
insulin glulisine (apidra) |
|
|
Term
| list the different drugs used as insulin therapy that have the longest onset and duration of action, and are typically taken as basal insulin therapy |
|
Definition
insulin detemir (levemir)
insulin glargine (lantus) |
|
|
Term
| what is the MOA of the sulfonylureas |
|
Definition
| the sulfonylureas close the K+ channels on the beta cell plasma membrane causing depolarization of the cell, resulting in release of insulin |
|
|
Term
| list the 2nd generatoin sulfonylureas |
|
Definition
glyburide (diabeta)
glipizide (glucotrol)
glimepiride (amaryl) |
|
|
Term
| what drug can you use as an "antidote" for the overdose of a sulfonylurea or meglitinide |
|
Definition
|
|
Term
| what are the disadvantages of using sulfonylureas for the treatment of DM |
|
Definition
they cause:
weight gain
hypoglycemia
they do NOT preserve the beta cells of the pancreas
cannot be used in pts with sulfonamide allergy
|
|
|
Term
| list the meglitinide drugs used for the treatment of DM |
|
Definition
nateglinide (starlix)
repaglinide (prandin) |
|
|
Term
| what is the MOA of the meglitinides and how is their MOA different from the sulfonylureas |
|
Definition
(nateglindine and repaglinide)
close the K+ channels on the beta cell plasma membrane, causing depolarization of the cell, resulting in the release of insulin
they require glucose present in order to bind to the K+ channel to cause the conformation change of the K+ channel, and they do not bond as tightly to the channel and therefore have a shorter duration of action |
|
|
Term
| what are the disadvantages of using a meglitinide for the treatment of DM |
|
Definition
(nateglinide and repaglinide)
weight gain
hypoglycemia
dosing frequency
medium cost
pts with hepatic and renal insufficiency
no beta-cell protection |
|
|
Term
| list the biguanide used for the treatment of DM |
|
Definition
|
|
Term
| what is the MOA of metformin |
|
Definition
it is an insulin sensitizer, by activating the AMP kinase which stimulates/favors catabolic pathways:
decreasing hepatic glucose production, decreasing intestinal glucose absorption, increasing insulin action, reduces visceral fat depots |
|
|
Term
| what are the disadvantages of taking metformin for the treatment of DM |
|
Definition
GI side effects (diarrhea)
contraindicated in reduced kidney function
can result in lactic acidosis
no beta cell preservation |
|
|
Term
| which drug, normally used for the treatment of DM, can also be used for the treatment of polycystic ovarian syndrome as well as improving acne by decreasing androgen levels |
|
Definition
|
|
Term
| list the thiazolidinediones (TZDs) |
|
Definition
rosiglitazone (avandia)
pioglitazone (actos) |
|
|
Term
|
Definition
(rosiglitazone and pioglitazone)
activate the nuclear transcription factor PPAR-y modulating transcription for the GLUT4 transporter, resulting in an increase in peripheral insulin sensitivity |
|
|
Term
| which drug, used for the treatment of DM, is metabolized by CYP2C8 and CYP2C9, and which one is metabolized by CYP 2C8 and CYP3A4 |
|
Definition
rosiglitazone
pioglitazone |
|
|
Term
| which drug, used for the treatment of DM, weakly induces CYP3A4 |
|
Definition
|
|
Term
| which drug, used for the treatment of DM, has the adverse effects of possibly causing heart failure, bone fractures, and liver toxicity, but does NOT cause hypoglycemia when taken |
|
Definition
|
|
Term
| which class of drugs, used for the treatment of DM, takes approx 8 - 12 weeks to see see maximal effects |
|
Definition
| thiazolidinediones (TZDs) |
|
|
Term
| list the GLP-1 receptor agonists |
|
Definition
exenatide (byetta)
liraglutide (victoza) |
|
|
Term
| list the different effects of GLP-1 receptor agonists |
|
Definition
(exanatide and liraglutide)
increases insulin biosynthesis and preserved beta-cell function
decreases appetite
decreases hepatic glucose production
slows gastric emptying
increases muscle insulin sensitivity |
|
|
Term
| what are the disadvantages to taking GLP-1 receptor agonists (incretin mimetics) |
|
Definition
(exanatide and liraglutide)
GI side effects (N/V/D)
acute pancreatitis
injectable
hypoglycemia
long term effects unknown - pancreatic CA
|
|
|
Term
| list the DDP 4 inhibitors and its MOA |
|
Definition
sitagliptan (januvia)
saxagliptan (onglyza)
inhibits DDP 4 activity and prolongs endogenously released incretin hormones; GLP1 is not degraded as fast and has a longer duraction of action, increasing insulin secretion |
|
|
Term
| what are the disadvantages to using DPP4 inhibitors for the treatment of DM |
|
Definition
pancreatitis observed
long term safety unkown (pancreatic CA)
expensive/high cost |
|
|
Term
| list the alpha-glucosidase inhibitors |
|
Definition
acarbose (precose)
miglitol (glyset)
voglibose (basen) |
|
|
Term
| what is the MOA of the alpha-glucosidase inhibitors |
|
Definition
(acarbose, miglitol, voglibose)
competitively inhibit intestinal alpha-glucosidase and delay hydrolysis and absorption of sugars |
|
|
Term
| what are the disadvantages to alpha-glucosidase inhibitors |
|
Definition
GI side effects (gas, flatulence, diarrhea)
dosing frequency
medium cost |
|
|
Term
| list the dopamine-2 agonists used for the treatment of DM |
|
Definition
|
|
Term
| what is the MOA of the dopamine-2 agonists that are used for the treatment of DM |
|
Definition
| activates dopaminergic receptors and resets the circadian organization/biological clock (which alters the hypothalamic regulation of metabolism and increases insulin sensitivity) |
|
|
Term
| what are the disadvantaged to dopamine-2 agonists for the treatment of DM |
|
Definition
(bromocriptine)
dizziness, nausea, fatigue
rhinitis
long term safety unknown
medium cost |
|
|
Term
| what is the MOA of pramlintide (symlin) |
|
Definition
| it is a synthetic analog of amylin that works with insulin to delay gastric empyting and inhibit glucagon release |
|
|
Term
| what are the disadvantages to pramlintide for the treatment of DM |
|
Definition
hypoglycemia
nausea and HA
can delay absorption of oral drugs
don't combine with other drugs that slow GI motility (atropine-like)
given by injection before meal and must be given by a syringe different than the one used for injecting insulin |
|
|
Term
| list some drugs that can cause drug induced osteoporosis |
|
Definition
steroids (glucocorticoids)
barbituates, phenytoin
L-thyroxine over-replacement
anticoagulants (warfarin)
PPIs
TZDs
chronic lithium therapy
some drugs to treat HIV |
|
|
Term
| list the possible causes of osteoporosis |
|
Definition
being confined to a bed
chronic RA, CKD, eating disorders
hyperPTH
Vit D deficiency
drug induced osteoporosis |
|
|
Term
| agents used to treat osteoporosis |
|
Definition
calcium and vitamin D
calcitonin
estrogen
raloxifene (SERM)
teriparatide (forteo)
denosumab (prolia)
bisphosphonates |
|
|
Term
| what are the possible calcium agents used to CA supplementation |
|
Definition
calcium carbonate
calcium lactate
calcium gluconate
calcium citrate
calcium phosphate
calcium levulinate
these all must be administered with Vit D |
|
|
Term
| what is the calcium recommendation for men, premenopausal women, and postmenopausal women who are also taking estrogen |
|
Definition
|
|
Term
| what is the calcium recommendation for teenagers and young adults 11 - 24 years of age |
|
Definition
|
|
Term
| what is the calcium recommendation for postmenopausal women not taking estrogen |
|
Definition
|
|
Term
| which drug, used for the treatment of osteoporosis, primarily has the effect of inhibiting osteoclastic bone resorption, as well as possibly stimulating osteoblasts, and may be more effective for increasing vertebral density as opposed to hip or femoral density; however this drug is biphasic and should be temporarily be stopped during middle of treatment plan |
|
Definition
|
|
Term
| which calcitonin agent has a longer half life and comes in the form of injectable or nasal spray |
|
Definition
| salmon calcitonin -> calcimar, miracalcic |
|
|
Term
| which drug, used for the treatment of osteoporosis, reduces the bone-resorbing actions of PTH and stimulates osteoblasts, but can increase the risk of MI, stroke, breast cancer, and DVTs, but does decrease vertebral and hip fractures |
|
Definition
|
|
Term
| which drug, used for the treatment of osteoporosis, preserves bone density without increasing breast cancer risk, lowers total and LDL cholesterol, reduces vertebral and nonvertebral fractures, and increases lumbar and femoral bone densities, but will increase the incidence of hot flashes |
|
Definition
raloxifene
(acts like estrogen in the bone, but does NOT act like estrogen in uterus and breast, acts as estrogen blocker) |
|
|
Term
| which drug, used for the treatment of osteoporosis, is the first 34 amino acids of the parathyroid hormone, and when given in low and intermittent doses cauess an increase in bone density by stimulating production of cAMP which stimulates osteoblasts, but is limited to only two years of use by the FDA |
|
Definition
|
|
Term
| which drug, used for the treatment of osteoporosis, has a black box warning for causing osteosarcomas when used in high dosages in rats, and therefore is limited to two years of use |
|
Definition
|
|
Term
| which drug, used for the treatment of osteoporosis, mimics the effects of osteoprotegerin by binding to the RANK ligand inhibiting osteoclasts from differentiating and decreasing their survival |
|
Definition
|
|
Term
| which drug, used for the treatment of osteoporosis, in injected every 6 months, but has has incidences reported of rare osteonecrosis of the jaw |
|
Definition
|
|
Term
| which drugs, used for the treatment of osteoporosis, are absorbed into the bone matrix, and inhibit bone resoprtion, by inhibiting osteoclast function, promoting their apoptosis; some of the drugs in this class have a N in the side chain, making them more potent than the other drugs within this class that do NOT have a N in the side chain |
|
Definition
|
|
Term
| list the bisphosphonates used for the treatment of osteoporosis |
|
Definition
etidronate
pamidronate
alendronate (fosamax)
tiludronate (skelid)
risendronate (actonel)
ibandronate (boniva)
zoledronic acid (reclast) - newest, IV |
|
|
Term
| what are the possible side effects of bisphosphonates |
|
Definition
*esophagitis - upper GI problems*
some osteonecrosis of the jaw
musculoskeletal pain
possible nephrotoxicity - only with zoledronic acid |
|
|
