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Medical Pharmacology of Endocrinology and Bone Metabolism
A medical student approach the the drugs used in conditions of the pancreas, thyroid, adrenals, pituitary etc.
61
Medical
Undergraduate 3
09/09/2013

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Term
Diabetes mellitus and the cells of the pancreas
Definition
is a inability to synthesise and/or desensitisation of cells to insulin.

The pancrease has three types of endocrine cells. B cells produce insulin. A cells produce glucagon. D cells produce somatastatin (this inhibits secretion of insulin and glucagon).
Term
What is amylin?
Definition
Amylin is a peptide produced by the B cells that delays gastric emptying and opposes insulin by encouraging breakdown of stored glycogen from the striated muscle.
Term
Mechanism of insulin release?
Definition
Insulin is released as a prodrug from the B cells in response to increases in BGL. There are two states of insulin release bolus and basal, reflecting stored release and slower continued release and production.
Term
Three examples of GIT hormones released by eating and their effect on insulin release.
Definition
Cholecystokinin, gastrin, secretin - these increase insulin secretion
Term
MoA of insulin?
Definition
Insulin increases the glucose uptake by glut-4 receptors in adipose tissue and muscle. It inhibits glycogenolysis and gluconeogenesis but increases glucose utilisation.
Term
Initiation of glucagon release? MoA
Definition
Increased levels of amino acids in the plasma. Glucagon increases blood glucose, it has the opposite effects to insulin.
Term
Glucagon
Definition
is indicated in the treatment of hypoglycaemia, acute cardiac failure precipitated by B adrenoreceptor antagonists.
Term
Guidelines for DM diagnosis
Definition
Random BGL of >7mmol/L
2 hr post meal BGL >11.1mmol/L
Hyperglycemia occurs because of unregulated release of hepatic glucose and inability of skeletal muscle to uptake.
Term
Symptoms of DM
Definition
Polyuria, polyphagia, weight gain, proteinuria, glycosuria, polydipsia.
Term
Diabetic ketoacidosis
Definition
is a diabetic emergency caused by uncontrolled hyperglycaemia resulting in accelerated breakdown of Acetyle CoA, which in anaerobic metabolism produces acetone (ketone) and acetoacetate (causing acidosis)
Term
Counter insulin hormones?
Definition
Glucagon, adrenalin, glucocorticoids, growth hormone
Term
Insulin dosing regimes
Definition
Once daily injections with long acting insulin
Twice daily injections with long acting insulin
Multiple daily injections consists of a combination of basal and bonus insulin
Insulin pump is a methods of avoiding confusing and time costly MDI
Term
Clinical scenario of once daily LA injection
Definition
This is only used in very rare cases in which only part of the islet cell function is lost. Alternatively it is a means of treating patients when and if they reach a "honeymoon" phase. This however is not a permanent respite from the disease process and most commonly will relapse and worsen within 12 months.
Term
Clinical scenario of twice daily LA injection
Definition
This attempts to maintain a relatively stable basal insulin level by injecting morning and night. Again this is ineffective for the majority of cases and is only suitable for an extremely strict routine, with predictable exercise, carb (g) and meal times.
Term
Clinical scenarion of MDI
Definition
using both long and short acting can accommodate for a more versatile lifestyle but requires regular BSL monitoring, carb counting and appropriate education.
Term
Clinical scenario of an insulin pump
Definition
A pump is fitted to a patient which releases insulin continuously to mimic the activity of the pancreas. If fitted early it is an effective way of reducing the HbA1C and is becoming the method of choice for newly diagnosed type I diabetics.
Term
Actrapid, Novorapid
Definition
are short acting insulins (insulin lispro)
Term
Levemir, Lantus
Definition
are long acting insulins (insulin glargine)
Term
AEs insulin
Definition
THe only AE of importance with insulin are hyoglycemic episodes.
Term
Metformin
Definition
Class- Biguanide: is an oral hypoglycaemic agent. Increase glucose uptake, decreases hepatic production of glucose and increases utilisation in skeletal muscle. Does not cause hypoglycaemia. Reduces VLDL and LDL.
AEs: dose related GI upset. CI in renal or hepatic impairment, pregnancy and shock. Decrease appetite.
Term
Glipizide, Gilbenclamide
Definition
Class - Sulfonylureas. second generation. are hypoglycaemics which act on B cell to stimulate insulin release. CI in pregnancy and breast feeding. Can cause hypoglycaemia and accumulate in renal failure. Stimulate appetite. Interactions with antibacterials, alcohol, NSAIDs, diuretics and corticosteroids
Term
Repaglinide, Nateglinide
Definition
Non-Sulfonylurea pro insulin secretion drugs.
Term
Ciglitazone, Rosiglitazone
Definition
Glitazones. These drugs decrease BGL long term (2-3 months) They increase the efficiency of endogenous insulin, decrease hepatic output and increase skeletal muscle uptake. Commonly AES weight gain and fluid retention. Wary with combination.
Term
Acarbose
Definition
Reduces carbohydrate absorption and causes flatulence and diarrhea.
Term
Action and target of Leptin?
Definition
Leptin is an important hormone in regulation of body weight. It acts on the hypothalamus. Rising leptin increases energy expenditure, decreases intake. Falling levels increase intake, synthesis and storage of fat. Released in pulsatile fashion and inversely related to hydrocortisone.
Term
Sibutramine
Definition
Inhibits the reuptake of serotonin and dopamine at the appetite centers of the hypothalamus. Increasing satiety and decreasing food intake. Indicated in those who have actively tried to lose weight. AEs p450 interactions, anticholinergic effects and increased HR and BP. Good for weight maintenance.
Term
Orlistat
Definition
Prevents the breakdown of dietary fats dose related effect. Increased fecal fat excretion. AEs are gastric disturbances, abdo cramps, flatus, steatorrhea.
Term
Two parts of the pituitary and the hormones each secretes?
Definition
Anterior - FSH (ovum growth), LH (ovulation), TSH (T3 T4 production), GH (protein synthesis), ACTH (adrenal cortex hormones), Prolactin (milk production)
Posterior - Oxytocin and ADH
Term
Hypothalamic hormones and how they work?
Definition
Hypothalamic hormones are secreted into the blood which drains into the hypophyseal vessel network which runs through the anterior pituitary and has local effects. GnRH, TRH, CRH, GHRF, GHIF, PRIF, PRF, Melanocyte stimulating releasing factor.
Term
Sermorelin
Definition
Is an effective diagnostic test for growth hormone secretion, it forces anterior pituitary to produce peak plasma concentration of GH in 60 min.
Term
Octreotide / Lanreotide
Definition
Long actine somatostatin analogue (inhibits release of GH, insulin, glucagon and TSH and most gastric hormones) Indicated in secreting carcinoid tumours and pituitary adenomas. Lanreotide is also indicated in thyroid tumours.
Term
Protirelin
Definition
is synthetic TSH used to diagnose thyroid activity. NOrmal will raise thyroxine conc. Hyperthyroidism will decrease because of negative feedback. Hypothyroidism will increase thyroxine conc.
Term
Bromocriptine in the endocrine system?
Definition
Bromocrptine is a dopamine antagonist which can be used to inhibit the release of prolactin indicated in prolactinomas. AEs vomiting, nausea, OH, dizzyness and constipation.
Term
Action of ACTH and its synthetic compound Tetrasactide?
Definition
Stimulation of glucocorticoid production by the adrenal cortex. USed in the diagnosis of adrenal cortical insufficiency.
Term
Mineralo- Gluco- corticoids and androgens?
Definition
aldosterone, hydrocortisone, and testosterone. Produced by the adrenal cortex.
Term
Stimulus for ADH release?
Definition
Increasing plasma osmalality. Secreted by post. pit. Hypovolemia.
Term
Vasopressin, Desmopressin, Terlipressin, Felypressin.
Definition
ADH analogues indicated in lengthening action of ADH i.e. diabetes insipid us.

Vaso - short DOA, weak selectivity given IM, SC, IV. anti bleeding.
Desmo - increased DOA, selective, nasal spray. Nocturnal enuresis
Terli - increased DOA, low but protracted. Esophogeal varices.
Fely - Short DOA. vasoconstrictor
Cause angina.
Term
Zones of the adrenal cortex and products?
Definition
Zona GFR
MGA
M - water and electrolyte balance
G - regulation of metabolism
Term
Adrenal deficiency?
Definition
Addison's disease
Term
Excessive glucocorticoids?
Definition
Cushing's disease
Term
Metyrapone, Trilostane, Aminoglutethimide
Definition
Prevents the formation of the glucocorticoids
Term
Compare and contrast corticosteroid therapies?
Definition
Hydrocortisone (cortisol) - minimal antiinflam, minimal sodium retention, short DOA, good for replacement therapy.
Cortisone - cheap, similar profile, not for systemic antiinflamm
Prednisolone/ Methylprednisolone - systemic anti inflamm and immunosuppresive, intermediate DOA
Dexamethasone/ Betamethasone - potent antiinflamm, minimal water retention, long DOA, antiinflam and immunosuppression, used for ACTH suppression.
Fludrocortisone - high mineralocorticoid effects i.e. fluid retention.
Term
AEs of corticosteroids?
Definition
osteoporosis, hyperglycemia, central obesity, thinning of skin, hypertension, poor wound healing, buffalo hump, moon face
Term
Thyroid secretes three hormones?
Definition
T3, T4 (thyroxine) - critical fro growth and metabolism
calcitonin - controls plasma calcium concentration
Term
Which element is essential in thyroid hormone synthesis and storage?
Definition
Iodine, iodination activates thyroid hormones.
Term
Describe the effect on the size and vascularity of the thyroid of high and low plasma iodide concentration?
Definition
High iodide concentration results in decreasing size and vascularity.
Low iodide results in an increase in size and vacs --> goitre, caused by lack of thyroid hormone production and loss of negative feedback --> increased TSH
Term
T3 an T4 in the blood?
Definition
Both are bound to thyroxine binding globulin when transported in the blood, but T3 is metabolised 20 x faster due to T4s stronger binding. The liver is the site of metabolism of the hormones resulting in the excreteing of free and conjugated forms in bile. To be used the mut be unbound, deiodinised etc.
Term
Symptoms of thyroxicosi? (hyperthyroidism)
Definition
high metabolic rate, sweating, tremor, anxiety, tachycardia.
Term
Why is amiodirone implicated in thyrotoxicosis?
Definition
It is high in iodine.
Term
Radioiodine
Definition
is first line treatment in hyperthyroidism. Absorbed by the thyroid and has cytotoxic effects on the thyroid follicles.half life of 8 days.
Term
Carbimazole, Methimazole, Propylthiouracil
Definition
Class - thioureylenes. decrease the output of thyroid hormones. May take long time because it only stops production of new hormones and cant rid of long lived T4. ++ reduces activation at peripheral tissues. (Prop) Causes granulocytopenia. and rashes.
Term
Iodine/Iodide
Definition
Has short term quick onset reduction in size and vascularity indicated in preparation for thyroid resection.
Term
Thyroxine
Definition
is the first line treatment of uncomplicted hypothyroidism. it is a replacement therapy. (T4)
Term
Triodothyronine
Definition
is faster onset but shorter action and is reserved for acute emergencies. AEs cardiac (T3) myxodema coma.
Term
Alendronate/ Risedronate
Definition
class: bisphosphonates. inhibit bone reabsorption by binding to bony matrix and on absorption by osteoclasts inducing apoptosis. given orally but poorly absorbed. Impaired by milk and food. GI disturbances. Indicated in pagers, hypercalcemia of malignancy, osteoporosis.
Term
Raloxifene
Definition
estrogen receptor agonist in bones increasing osteoblast activity and reducing osteoclasts. Hot flushes and leg cramps.
Term
Teriparatide
Definition
PTH peptide fragment, anabolic effect on bone mass and integrity. normal AEs + mild hypercalcemia and leg cramps.
Term
Strontium ranelate
Definition
inhibits bone reabsorption and stimulates bone formation used in osteoporosis. well tolerated.
Term
Ergocalciferol
Definition
is a vit D preparation often given with calcitriol. It increases calcium concentration and is indicated in osteoporosis prevention.
Term
Calcitonin
Definition
calcium preparation. nausea and vomiting and tingling in hands funny taste..
Term
Calcium gluconate IV
Definition
used is the emergency treatmet of hyperkalemia, NO IM causes LOCAL NECROSIS.
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