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Insulin
- Short acting: lispro, regular insulin
- Intermediate: NPH
- Long acting: glargine
- Bind insulin receptor, increased glycogen storage in liver and muscle, protein synthesis, K uptake, TG storage
- Useful in Type I and II, hyperkalemia, hyperglycemia
- Can cause hypoglycemia, hypophosphatemia, hypersensitivity
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Sulfonylureas
- First generation: tolbutamide
- Second generation: glipizide
- Close K channel -> triggers insulin release
- Only useful in Type II (need beta cells)
- Disulfiram-like reaction (tolbutamide), hypoglycemia (glipizide)
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Metformin
- Biguanide
- Decrease gluconeogenesis in liver, insulin sensitizer
- Can be used in Type I and II
- Can cause lactiv acidosis
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Glitazones/thiazoladinediones
- Increases insulin sensitivity in peripheral tissue
- Used in T2DM
- Can cause weight gain, edema, hepatotoxicity, CV toxicity
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Acarbose, miglitol
- Alpha-glucosidase inhibitors; delayed sugar hydrolysis and glucose absorption -> decreased postprandial hyperglycemia
- T2DM
- Can cause GI disturbances
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Orlistat
- Inhibit pancreatic lipases (Orlistat gets rid of fat)
- Can cause steatorrhea, GI discomfort, reduced absorption of fat-soluble vitamins
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Sibutramine
- Serotonin and NE reuptake inhibitor
- Obesity management
- Can cause HTN and tachycardia
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Propylthiouracil, methimazole
- Inhibit organification of iodide and coupling of thyroid hormone synthesis
- Used in hyperthyroidism
- Can cause agranulocytosis
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Levothyroxine, triiodothyronine
- Thyroxine replacement
- Can cause tachycardia, heat intolerance, tremors, arrythmias
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GH
GH deficiency, Turner's syndrome
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Octreotide
- Smoatostatin
- Used in acromegaly, carcinoid, gastrinoma, glucagonoma
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Oxytocin
- Stimulates labor, uterine contractions, milk let-down
- Controls uterine hemorrhage
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Desmopressin
- ADH
- Used in pituitary (central) DI
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Demeclocycline
- ADH antagonist (tetracycline family)
- Used in SIADH
- Can cause nephrogenic DI, abnormalities of bone and teeth
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Glucocorticoids
- Decreased production of leukotrienes and prostaglandins by inhibiting phospholipase A2 and expression of COX-2
- Used in Addison's dz, inflammation, immune suppression, asthma
- Can cause iatrogenic Cushing's syndrome
- Increase osteoclastic bone resorption and decreased osteoblastic bone formation
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Leuprolide
- GnRH analog - agonist when pulsatile, antagonist when continuous
- Infertility (pulsatile), prostate cancer (continuous), uterine fibroids, precocious puberty
- Antiandrogen, nausea, vomiting
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Testosterone
- Agonist at androgen receptors
- Used for hypogonadism and promotion of secondary sex characteristics; stimuation of anabolism after burn or injury; treat ER-positive breast cancer
- Masculinization in females, gonadal atrophy, premature closure of epiphyseal plates
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Finasteride
- 5 alpha-reductase inhibitor - decreases dihydrotestosterone
- Used in BPH, male-pattern baldness
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Flutamide
- Competitive androgen inhibitor at testosterone receptor
- Used in prostate carcinoma
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Ketoconazole
- Inhibits steroid synthesis (inhibits desmolase)
- Used in PCOS to prevent hirsutism
- can cause gynecomastia and amenorrhea
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Spinronolactone
- Inhibits steroid binding
- Used in PCOS to prevent hirsutism
- Can cause geynecomastia and amenorrhea
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Estrogens
- Used in hypogonadism or ovarian failure, menstrual abnormalities, HRT, men with adrogen-dependent prostate cancer
- Increased risk of endometrial carcinoma, bleeding in postmenopausal women, increased risk of thrombi
- Don't use in ER + breast cancer, history of DVTs
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Clomiphene
- Partial estrogen agonist
- Increases release of LH and FSH -> ovulation
- Used to treat infertility and PCOS
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Tamoxifen
- Estrogen antagonist on breast tissue
- Used to treat and prevent recurrence of ER + breast cancer
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Raloxifene
- Estrogen agonist on bone
- Reduces resorption of bone - used to treat osteoporosis
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Anastrozole
Aromatase inhibitor used in postmenopausal women with breast cancer
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Progestin
- Increased vascularization of edometrium
- Used in OCs, treatment of endometrial cancer and abnormal uterine bleeding
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Mifepristone
- RU-486
- Competitive inhibitor of progestins
- Used for termination of pregnancy, administered with misoprostol (PGE1)
- Can cause heavy bleeding, GI effects, abdominal pain
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Ritodrine/terbutaline
- B2 agaonist
- Relax uterus - reduce premature uterine contractions
- (Fetus can "return to dreams")
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Tamsulosin
Alpha 1 A,D-antagonist used to treat BPH
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Sildenafil, vardenafil
- Inhibit cGMP phosphodiesterase -> increased cGMP
- Treatment for erectile dysfunction
- Can cause headache, flushing, dyspepsia, impaired blue-green color vision; risk of life-threatening hypotension in pts taking nitrates
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