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RUSVM PHARMACOLOGY- Pharm Final Sp 2017 > Endocrine Pharmacology > Flashcards

Endocrine Pharmacology Flashcards

1
Q

Goal of Tx for canine hypothyroidism

A

Replace hormone the body is not producing

  • Liothyronine: T3
  • LEVOTHYROXINE: T4 (soloxine)
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2
Q

Levothyroxine requires ____(more/less)____ frequent dosing & has ___(higher/lower)___ risk of causing thyrotoxicosis (excessive T4 levels) than liothyronine

A

less, higher (I think)

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3
Q

Levothyroxine pharmacologic considerations

A
  • Must be given for rest of pt life
  • Monitored by measuring T4 levels
  • Thyro tabs are the only vet approved

-Drugs that may interfere with T4 levels: phenobarbital, zonisamide, sulfonamides, lucocorticoids, phenylbutazone, quinidine

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4
Q

Goal of Tx in hyperthyroidism in cats

A

-stop excessive hormone productions

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5
Q

Pharmacologic tx options for feline hyperthyroidism

A
  • Thioureylenes

- Iodides

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6
Q

Thioureylenes- Methimazole & Carbimazole

A
  • inhibit thyroid hormone synthesis
  • Consistently efficacious
  • Side effects uncommon and most are manageable
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7
Q

Thioureylenes– PTU (propylthiouracil)

A
  • inhibit thyroid hormone synthesis
  • inhibit conversion of T4 -> T3 in tissues
  • also efficacious
  • Higher incidence of serious side effects
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8
Q

Iodides and Iodinated contrast agents

A
  • Inhibit thyroid hormone synthesis
  • inhibit release of pre-formed hormone
  • Inhibit T4> T3 conversion in periphery (contrast agents)
  • Efficacy is variable and often transient
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9
Q

Clinical signs of acute hypocalcemia

A

Hyperesthesia/pawing at the face, tremors, progressing flaccid paralysis, seizures, hyperthermia, bradycardia

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10
Q

Pariparturient hypocalcemia

A

Milk fever, eclampsia

  • sudden increase in calcium usage, patient can’t adapt rapidly enough
  • acute
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11
Q

Acute Hypocalcemia RoA

A
  • Oral vs IV (parenteral for emergencies)

- Parenteral ca options: Ca gluconate or Ca chloride

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12
Q

Acute Hypocalcemia, calcium RoA contraindications

A

-Ca Chloride is caustic: NO SQ/IM
-Ca Gluconate: dilute if giving Sq, IV IS BEST
Ca is incompatible with some fluids/drugs
-Rapid IV admin of Ca can cause arrhythmias (monitor ECG!)

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13
Q

Chronic Hypocalcemia (HypoPTH): oral Ca options

A

Ca Carbonate and Ca propionate: gi tract must be able to absorb calcium

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14
Q

Hypoparathyroidism results in inability of the body to convert _____ to it’s active form ________

A

Vit D –> Calcitrol

No PTH –> the GIT can’t absorb Ca

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15
Q

Biggest potential side effect of calcitriol is

A

hypercalemia

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16
Q

Hypoglycemia can be managed with (3 things)

A

1) Diet: Frequent, small carb meals
2) Dextrose 50% sol’n: Mucosal absorption is decent, no dextrose SQ, IV no more than 5%
3) Glucagon hormone: IV, not common

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17
Q

Chronic hypoglycemia goal and tx options (2)

A

Address the cause and if not alter the glucose produced and used

  • diet
  • Corticosteroids: prednisone
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18
Q

Hyperglycemia

A
  • Doesn’t require therapy

- Diabetes mellitus (DM)- insulin deficiency

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19
Q

Oral hypoglycemic agents

A
  • CAUSE hypo, don’t Tx hyper!
  • Glipzide(glucotrol): sulfonylurea – only effective in ~30% of cats; may accelerate B-cell loss
  • Only useful in type II diabetes where pancrease can still secrete some insulin (CATS ONLY)
20
Q

Oral hypoglycemic agents MoA

A

Stimulate insulin secretion by the pancreatic B-cells (blocking K channels)

-also increase tissue sensitivity to insulin

21
Q

T/F: all insulin are inectible and similar potency (except detemir)

A

TRUE

22
Q

Regular Insulin/Humulin-R/Crystalline/Neutral Insulin

A
  • short acting
  • IV, IM, SQ
  • Commonly used for hosp pt not eating
  • Duration: Short to long term mgmt
23
Q

NPH (Isophane), Lente, Vetsulin/Caninsulin

A
  • SQ only
  • Intermediate acting insulin
  • Protamine or zinc are added to delay absorption and extend clinical effect
  • good for starting insulin
  • not adequate control in felines
24
Q

Protamine zinc/PZI, Glargine, & Detemir

A
  • SQ only
  • Long acting insulin
  • Glargine: forms microprecipitate in physiologic pH, very gradual absorption (flat curve)
  • Prozinc: may have shorter duration than the rest; Long acting (particularly in cats)
  • Determir: has much higher potency in dogs (4x), requires special dosing and may be difficult to dose in smol doggos
25
Q

Two types of corticosteroids

A

1) glucocorticoids

2) mineralcorticoids

26
Q

Glucocorticoid general info

A
  • produced by zona fasciculata
  • cortisol in the endogenous hormone
  • regulated by hypo/pitu through CRH and ACTH
27
Q

Prednisone, dexamethason, triamcinolone, hydrocortisone are all ______

A

glucocorticoids

28
Q

Clinical uses of glucocorticoids

A
  • Diagnostics: low dose dexamethason suppression test, HDDS
  • Physiologic replacement therapy: Addisons (Hypoadrenocorticism)
  • Anti-inflammatory: allergies
  • Immunosuppressive: immune mediated dz
29
Q

Glucocorticoids pharmacokinetics

A

Generally well absorbed orally or paraenterally

  • Protein bound: transcortin, albumin
  • Some must be hydrolyzed: pred, cortisone, methylpred
30
Q

Salt/Soluble Esters

A
  • Na succinate, Na phosphate
  • Steroid is soluble = suitable for IV admin
  • onset may be faster but duration is unchanged
31
Q

Insoluble esters (pivalate, acetate, acetonide)

A
  • Less souble, takes longer to absorb
  • Delayed onset, longer duration
  • Opaque suspensions- NOT FOR IV USE
  • Methylprenisolone acetate (depomedrol)
32
Q

Side effects of glucocorticoids- short term (delayed wound healing)

A
  • Not serious
  • lab changes (stress leukogram, decrease thyroid)
  • pu/pd/polyphagia
  • fetal abnormalities, abortion
33
Q

Side effects of glucocorticoids- long term

A
  • increased susceptibility to infection
  • skin changes (hyperpigmentation, thinning, alopecia)
  • collagen dz (cruciate injury), delayed wound healing
  • hypertension, thromboembolic dz
  • iatrogenic Adison
  • Myopathy, calcinosis cutis, osteoporosis
34
Q

Mineralcorticoids

A
  • Zona glomerulosa
  • Aldosterone is the endogenous hormone
  • regulate Na+ retention/K+ excretion by the kidney
  • Monitor K/Na
35
Q

Two mineral corticoids:

A

1) Fludrocortisone (florinef) orally BID

2) DOCP: Parenterally (IM,Sq)

36
Q

Cushings disease is aka

A

Hyperadrenocorticism

37
Q

Hyperadrenocorticism cause

A

-Excess glucocorticoid produced (fn adrenal mass, fn pituitary mass)

38
Q

Mitotane (lysodren)

Adrenal gland tissue

A

cytotoxic to cells of the fasciculate

  • narrow therapeutic index
  • caution with owner handling
  • start with high dose (induction) then reduce to lower dose for maintenance
  • monitor adrenal function with ACTH
  • adverse effects related to oversuppression
39
Q

Trilostane (Vetoryl)

Prod of glucocorticoids

A
  • inhibit 3B-hydroxysteroid dehydrogenase in the cortisol production pathway
  • most commonly used drug to tx Cushings and other endocrine dermatopathies
  • Narrow therapeutic index
  • Monitored with ACTH
  • Dosed BID, start w/ low
40
Q

Ketoconazole

prod of glucocorticoids

A
  • inhibit enzymes in the steroid synthesis pathway
  • potential for hepatotoxicity
  • potent hepatic microsomal enzyme inhibitor
41
Q

Pergolide

Prod of ACTH by pituitary

A
  • dopamine agonist
  • will suppress production of ACTH and thus reduce cortisol production
  • used to tx pituitary pars intermedia dysfunction (PPID) in horses
42
Q

Selegiline

Prod of ACTH by pituitary

A
  • inhibits MAO-B which results in increased dopamine

- It is labeled for tx of canine cognitive dysfunction, sometimes used to attempt to tx Cushing’s

43
Q

Addison’s is aka

A

Hypoadrenocorticism

44
Q

Hypoadrenocorticism

A
  • Deficient production of glucocorticoids +/- mineral corticoids
  • Usually caused by chronic destruction of adrenal gland
45
Q

Typical Addisons

A

-Pt lacking BOTH gluco and mineral corticoids, therefore require prednison and either DOCP or Fludrocortisone

46
Q

Atypical Addisons

A

-lacking just the glucocorticoid therefore they only need prednisone therapy

47
Q

Iatrogenic adrena insufficiency

A
  • if EXOGENOUS glucocorticoids are used chronically then stopped abruptly pt may suffer insufficient adrenal output (chronic neg feedback)
  • Or adrenal glands may be damaged through excessive action of drugs used to tx hyperadrenocorticism (mitotane, trilostane)

RUSVM PHARMACOLOGY- Pharm Final Sp 2017 (5 decks)

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