Endocrine Pharm- I made most multiple choice bc I hate learn mode, also rec doing in shuffle!!

which of these is not a fast acting insulin analog?

lispro

aspart

glulisine

degludec

degludec

stimulates amylin receptors

pramlintide

sulfonylurea

repaglinide

metformin

pramlintide is an amylin analog- stimulates amylin receptors to decrease postprandial glucose; slows gastric emptying and suppresses appetite

amylin, pramlin, kind of rhymes

glipizide is

sulfonylurea

thiazoliidinedione

D2 agonist

bile acid sequestrant

DPP4 inhibitor

GLP1 receptor agonist

sulfonylurea

increases target cell's response to insulin without increasing insulin secretion

metformin

repaglinide

glipizide

pramlintide

metformin

stimulates nuclear peroxisome proliferator activated receptor gamma, facilitating insulin action and glucose uptake/use

pioglitazone

metformin

glipizide

repaglinide

pioglitazone

BOXED WARNING FOR CHF

pioglitazone

which diabetes meds are contraindicated if pt has hx medullary thyroid tumor and/or hx MEN-2

GLP1 agonists

bile acid sequestrants

D2 agonists

thiazolidinediones

biguianides (metformin)

sulfonylureas

GLP1 agonists (semaglutide)

T/F: methimazole has a bozxed warning for fetal hypothyroidism and teratogenicity

T

what are the 2 main uses for oral ketoconazole

cushing's syndrome and advanced prostate cancer

______ has a boxed warning for adrenal insuffiency crisis

mitotane

metyrapone

ketoconazole

etomidate

mitotane

stimulates somatostatin receptor 5 in anterior pitutary, decreases ACTH and GH

mitotane

pasireotide

metyrapone

ketoconazole

etomidate

pasireotide

is ADH a treatment for central or nephrogenic diabetes insipidus

central

increased risk of osteosarcoma is an AE of

alendronate

HRT

raloxifene

salcatonin

denosumab

teriparatide

teriparatide

TERIparatide can give u TERible bone cancer

increases sensitivity of CaSR on parathyroid gland cells, decreasing PTH and thus decreasing serum Ca2+

cinacalcet

calcium choride

paricalcitol

teriparatide

denosumab

cinacalcet

increased risk of VTE and risk of death due to stroke in women w CAD is a boxed warning for

alendronate

HRT

raloxifene

salcatonin

denosumab

teriparatide

raloxifene

increases OPG and decreases RANKL

alendronate

HRT

raloxifene

salcatonin

denosumab

teriparatide

HRT

which of these medication classes increase insulin SECRETION independent of glucose intake

sulfonylureas

amylin analogs

SGLT2 inhibitors

GLP1 agonists

sulfonylureas!!

Ithought GP1 aogonists also secrete insulin? they do but only in response to glucose intake, whereas sulfonylrueas secrete insulin independent of food intake which is why u run the risk of having too low blood sugar w sulfonylreas

compared to glp1s which only secrete insulin if ur eating food and blood sugar spikes

insulin causes glucose uptake and ____ entry into the cell

K+

Na+

Cl-

Mg2+

K+

WHEN U GIVE SOMEONE INSULIN, UR MAKING GLUCOSE AND K+ GO OUT OF THE BLOODSTREAM INTO THE CELL

which of these insulins is not fast acting?

lispro

aspart

glulisine

degludec

degludec

the rapid acting ones- there is no LAG w these rapid acting insulin analogs (L- lispro, A- aspart, G- glulisine)

note- theres another one that starts w G (Glargine) that is a long acting, but I remember that glargine is long acting bc it has the word LARGE in it, so it takes a large amount of time to start working/has longer duration

which of these insulins is NOT considered safe during pregnancy?

lispro

aspart

nph

detemir

regular

glargine

glargine

note- thers just not much data on glargine its not that its been proven unsafe during pregnancy

but the ones that are considered safe during pregnancy:

think of a DARL'N (darling) pregnant person

D- Detemir (not Degludec)

A- Aspart

R- Regular

L- Lispro

N- NPH (isophane)

risk of insulin is it can lead to

hypokalemia

hyperkalemia

HYPOkalemia bc insulin draws glucose and K+ out from the blood into the cells, so if K+ is going into the cells, its leaving the blood

so blood K+ is lower

why is insulin contraindicated with digoxin

can mask hypoglycemia symptoms

can increase insulin sensitivity

ccan increase insulin requirements

can cuase hypokalemia, precipitates toxicity/arrythmias

can lead to hypokalemia

does alcohol increase or decrease the effects of hypoglycemia

increase

why?

Alcohol increases the effects of hypoglycemia by increasing your risk of low blood sugar. It does this by interfering with the liver's ability to produce and release glucose, and this effect is especially dangerous for people who take insulin or other diabetes medications

whcih class of diabetes meds stimulates amylin receptors to decrease postprandial glucagon

GLP1 agonists

meglitinides

pramlintide

sulfonylureas

pramlintide

think prAMYlintide, AMYlin analog

what even is amylin- decreases glucagon release after eating to prevent blood sugar spikes

which of these diabetes meds can lead to weight LOSS?

repaglinide

pioglitazone

colesevelam

pramlintide

glipizide

pramlintide

think of a girl named AMY who lost weight taking her prAMYlintide as an adjunt to insulin for her diabetes

note- Idont think amylin is used by itself, its used along with insulin

which of these meds has a boxed warning for risk of severe hypoglycemia?

pramlintide

glipizide

metformin

sitagliptin

pramlintide

why? Pramlintide carries a boxed warning for the risk of severe insulin-induced hypoglycemia because it is used as an adjunct to mealtime insulin therapy, and the combined effect significantly increases the risk of low blood sugar, particularly in patients with type 1 diabetes.

glipizide, glyburide, and glimepiride belong to which class of medications?

meglitinides

sulfonyluyreas

biguanides

thioazoldinediones

DDP4 inhibitors

sulfonylureas are on ur SIDE to help w ur diabetes

S for Sulfonylurea, IDE bc they end in IDE

and they all start with G

note- other meds also end in ide (repaglinide, nateglinide- these are meglitinides, and glp1 agonists end in ide but those end in TIDE which is how u can differentiate)

if a pt w CAD is prescribed a sulfonylurea for diabetes, which is the safest?

glipizide

glyburide

glimepiride

glimepiride

Ithink of glimePRIDE, take PRIDE in who u love, so think of love think of HEART, so glimePRIDE is safest for someone w coronary artery disease idk

KNOW

which sulfonylrea has the least amount of placental transfer and is "safer" in pregnancy/can be used in gestational diabetes

glipizide

glyburide

glimepiride

glyBuride is safest for the Baby

which sulfonylrea is safest to use in a pt w renal disease

glipizide

glyburide

glimepiride

GlipiZide !! it goes eaZy on ur kidneys-its is generally considered the safest sulfonylurea for patients with renal disease because it has a shorter half-life and is eliminated by the liver, not the kidneys; glipiZide is Zippy quick, so it has short half life

disulfiram-like reaction is an adverse reaction that occurs when certain medications or substances are combined with alcohol. which of these diabetes meds can this be seen in?

pioglitazone

pramlintide

semaglutide

glipizide

glipizide- sulfonylreas can cause disulfam like reactions- its mostly w the first gen ones which i dont think he mentioned, but glipizide, glyburide, glimeperide (2nd gen sulfonylreas can still cause)

which of these diabetes meds is contraindicated in someone with a sulfa allergy?

pioglitazone

metformin

pramlintide

semaglutide

glipizide

glipizide bc its a SULFonylurea

glipizide works by

blocking K+ channels, leading to ca2+ influx and increased insulin release

blocking K+ channels, leading to decreased insulin release

blocking Na+ channels

blocking K+ channels, leading to ca2+ influx and increased insulin release

T/F: cholestatic jaundice is an AE of sulfonylureas

T

what is the benefit of prescribing a meglitinide (repaglinide, nateglinide) over a sulfonylurea ?

Lower hypoglycemia risk!! Meglitinides are short-acting and work by stimulating a burst of insulin release to cover mealtimes, which reduces the risk of hypoglycemia that can occur several hours after a meal with longer-acting drugs like sulfonylureas.

if u eat a MEGA big meal and want extra coverage to control ur postrpandial hyperglycemia, consider a MEGlitinide over a sulfonylrae

IMPORTANT CONCEPT

does metformin increase insulin secretion?

NO- it improves the body's response to insulin by helping glucose enter the cells; it decreases glucose formation (gluconeogenesis) in the liver, and also increases GLP1 secretion which lowers glucagon

METFORMIN IS EUGLYCEMIC, IT DOES NOT RUN THE RISK OF CAUSING LOW BLOOD SUGAR , PART OF WHY ITS SO COMMONLY PRESCRIBED!!

which of these is NOT an indication for metformin?

PCOS

type 2 diabetes

gestational diabetes

type 1 diabates

type 1 diabetes

stimulates nuclear peroxisome proliferator activated receptor gamma (PPAR); facilitates insulin action and glucose uptake

pioglitazone

metformin

glipizide

semaglutide

PPPioglitazone stimmulates nuclear PPAR receptors, which helps insulin work better and increases glucose uptake into cells

shoutout emily c

which of these meds carries an increased risk for bladder cancer

pioglitazone

metformin

glipizide

semaglutide

Pioglitazone , P, affects ur PEE, so bladder cancer

note- dont get confused with the other diabetes meds that affects ur pee (causes UTIs)- those are the GLT2 inhibitors (end in gliFLOZIN)

KNOW

which of these medication classes has a BOXED WARNING for congestive heart failure

sulfonylureas

thioazolinediones

D2 agonists

SGLT2 inhibitors

DDp4 inhibitors

thiazolinediones

which of these diabates meds cause weight gain?

metformin

glipizide

pramlintide

colesevalm

glipizide bc its a sulfonylrea

cram the pance- if u SIT too much, you'll gain weight

S- sulfonylureas (glipizide, glyburide, glimepride)

I- insulin

T- thiazolidinediones (pioglitazone)

which of these medication classes blocks glucose reabsorption, leading to glycosuria?

glp1 agonists

alpha glucoseidase inhibitors

SGLT2 inhibitors

sulfonylureas

SGLT2 inhibitors

these end in FLOZIN, so glucose is FLOWIN, FLOZIN, out of ur body, leads to AEs of utis/ genital infections bc glucose is passing through ur urinary tract and bacteria love glucose

which of the SGLT2 inhibitors has a risk of lower limb amputations and fractures?

canagliflozin

empagliflozin

dapagliflozin

CANAglifozin, bc if ur a CANABAL, u eat someone's legs off idk

for the record I dont condone cannibalism

which of the SGLT2 inhibitors significantly reduces progression to renal disesae in a pt w type 2 diabetes that has a high risk of CV events?

canagliflozin

empagliflozin

dapagliflozin

empagliflozin (this is jardiance!! lots of commercials)

which of these diabetes meds works by inhibiting alpha-glucosidase at the intestinal brush border, decreasing carbohydrate digestion?

miglitol

canagliflozin

pramlintide

semaglutide

sitagliptin

miglitol

T/F: acarbose (alpha glucosidase inhibitor) is a diabetes med that inhibits pancreatic enzymes

T

which of these is a DUAL GIP/GLP1 agonist?

tirzepatide (mounjaro)

semaglutide (ozempic)

dulaglutide (trulicity)

empagliflozin (jardiance)

tirzepatide

what is the most common AE of alpha glucosidase inhibitors?

gi upset

hypoglycemia

weight gain

sleep disturbance

GI UPSET, so alpha Glucosidase inhibotors, cause Gi upset

which of these diabetes meds does not work by increasing effects of incretin?

bile acid sequestrants

DDP4 inhibitors

GLP1 agonists

amylin analogs

amylin analogs

what even is incretin and why would we want to increase its effects?

Incretins are hormones released from the gut after eating that stimulate insulin secretion in a glucose-dependent manner. We want to increase their effects because they also slow gastric emptying, reduce appetite, and suppress glucagon release, which helps manage blood sugar.

this medication works by decreasing glucagon secretion

pramlintide

metformin

glipizide

empagliflozin

bromocriptine

pramlintide

what does glucagon do? Glucagon raises blood glucose levels when they fall too low. It stimulates the liver to release stored glucose (glycogen) into the bloodstream.

why is the answer not metformin? metformin decreases gluconeogenesis in liver (prevents synthesis of new glucose molecules)

why not glipizide? glipizide is a sulfonylurea, which mainly works by increasing insulin release

why not empagliflozin? empagliflozinis a SGLT2 (sodium-glucose cotransporter 2) inhibitor. what is SGLT2? It is a protein found in the kidneys that helps the body reabsorb glucose (sugar) from the urine back into the bloodstream; so if we INHIBIT this protein, instead of body reabsorbing glucose, we pee it out

This medication's main mechanism is to improve blood glucose control by acting on the brain as a D2 agonist

bromocriptine

sitagliptin

acarbose

miglitol

canagliflozin

bromocriptine

_________Primarily lowers blood glucose by reducing glucose production in the liver and improving insulin sensitivity.

metformin

glyburide

repaglinide

pioglitazone

dulaglutide

metformin

which of these meds stimulates the pancreas to release more insulin to lower blood glucose?

metformin

glyburide

pioglitazone

dulaglutide

glyburide- how do we know that? bc glyburide is a sulfonylurea (sulfonylreas start with G and end in IDE)

and we know sulfonylureas are insulin secretagogues- they make ur body secrete insulin!

metformin increases target cell's RESPONSE to insulin and increases insulin binding to receptors, but it doesnt increase secretion of insulin from pancreas

pioglitazone stimulates nuclear ppar receptors, which facilitates insulin's actions and increases glucose absorption from blood into tissue

dulaglatide is a glp1 agaonist so it works by stimulating glp1 receptors to increase incretin's effects, which delays gastric emptying, increases fullness, decreases appetite, etc

which of these diabetes meds is given parenteral?

pioglitazone

bromocriptine

sitagliptin

pramlintide

glipizide

pramlintide

which class of diabetes meds are used as an ADJUNCT to insulin as opposed to being used as monotherapy?

amylin analogs

thiazolidinediones

GLP1 agonists

DDP4 inhibitors

amylin analogs

is metformin safe in pregnancy?

YES

which diabetes med must be discontinued 24 hours prior to getting IV contrast?

metformin

what is the most common AE of metformin?

B12 absorption shortly after starting

GI upset

lactic acidosis

hypoglycemia if taken with not enough calories/excessive exercise

weight gain

gi upset is a very common ae of metformin

B12 absorption occurs like years after starting

lactic acidosis can happen, and theres a boxed warning, but its not the most common ae

hypoglycemia can happen if person doesnt eat enough/exercises a lot, but not most common ae

weight gain isnt an ae of metformin

which of these diabetes medshas an AE of osteopenia/increased fracture risk?

pioglitazone

bromocriptine

metformin

colesevelam

sitagliptin

semaglutide

pioglitazone

orthostatic hypotension and syncope are AEs of which diabetes med?

bromocriptine

colesevelam

sitagliptin

semaglutide

bromocriptine

why? Inhibition of Norepinephrine Release:

D2 receptors inhibit the release of norepinephrine, and Bromocriptine is a dopamine D2 receptor agonist! by inhibiting the sympathetic nervous system activity, both centrally and peripherally, it results in blood vessel dilation and a drop in blood pressure when standing up.

which of these diabetes meds can decrease absorption of other meds and fat soluble vitamins?

bromocriptine

colesevelam

sitagliptin

semaglutide

colesevelam

its a bile acid sequestrant so it makes u poop out ur bile acids- they decrease the absorption of fat soluble vitamins (A, D, E, K) bc they bind to not only bile acids but also these vitamins

which of these diabetes med classes increases the risk of cholangiocarcinoma?

SGLT2 inhibitors

DDP4 inhibitors

alpha glucosidase inhibitors

insulin

DPP4 inhibitors

what does it mean if a drug is a DPP4 inhibitor what even is that

DPP4 is an enzyme that breaks down GLP1 (a type of incretin protein)

when GLP1 is broken down, body cant secrete insulin and lower blood sugar the way its supposed to

so if we INHIBIT glp1 breakdown by inhibiting the enzyme that breaks it down (DPP4), we can help control blood sugar

hence the DPP4 inhibitors (sitagliptin, linagliptin, etc)

semaglutide is a GLP1 receptor agonist , so it increases GLP1's effects of lowering blood sugar. but we know DPP4 enzymes break GLP1 down- how do we know that wont happen if we give semaglutide?

Semaglutide is not broken down by the DPP-4 enzyme because its molecular structure has been specifically modified to resist this enzymatic degradation

which of these diabetes med classes can cause suicidal thoughts/actions?

glp1 agonits

sglt2 inhibitors

sulfonylureas

dpp4 inhibitors

glp1 agonists

think of someone who starts ozempic (gp1 agonist) and u think theyd be happy bc theyre losing weight and getting their diabetes under control but actually it caused them to be suicidal

which of these diabetes med classes is discontinued a week prior to anesthesia to avoid aspiration (it can cause gastroporesis)

glp1 agonits

sglt2 inhibitors

sulfonylureas

dpp4 inhibitors

glp1 agonists

SO IF SOMEONE IS ON OZEMPIC AND IS HAVING SURGERY, THEY NEED TO NOT TAKE THEIR SHOT FOR ATLEAST A WEEK PRIOR TO SURGERY BC GLP1S CAN CAUSE GASTROPORESIS

T/F: pancreatitis is an AE of GLP1 agonists

T

with GLP1s, there is an increased risk of which type of thyroid cancer

papillary

medullary

follicular

medullary

empagliflozin is a

SGLT2 inhibitor

sulfonylurea

DPP4 inhibitor

GLP1 agonist

SGLT2 inhibitor

if a pt is on a thiazide diuretic for high BP- which diabetes med should be used with caution/avoided if possible, to avoid the risk of hypotension/dehydration?

sulfonylurea

DPP4 inhibitor

GLP1 agonist

SGLT2 inhibitor

SGLT2 inhibitor

which of these obesity meds is a pancreatic lipase inhibitor?

phentermine

orlistat

phentermine-topiramate

glp1 agonist

orlistat

increases norepinephrine release in the CNS; can cause tachycardia, HTN, insomnia, etc

phentermine

naltrxone-buproprion

orlistat

phentermine

in an obese pt with hypertension, which med would be contraindicated bc it decreases the effectiveness of HTN meds?

phentermine

naltrxone-buproprion

orlistat

semaglutide

phentermine

what medication can be combined with phentermine for weight loss

valproate

topiramate

amiodorone

naltrexone

buproprion

topiramate

KNOW risk of suicidal thoughts/behavior is a boxed warning for which obesity med

naltrexone-buproprion combo

phentermine-topiramate combo

phentermine

orlistat

naltrexone-buproption combo

which of these obesity meds decreases fat absorption

naltrexone-buproprion combo

phentermine-topiramate combo

phentermine

orlistat

orlistat

metallic taste is an AE of which diabetes med

METformin has a METallic taste

MOA for phentermine

DA blocker

increases NE release

inhibits NE and DA reuptake

inhibits pancreatic lipase

increases NE release

which has more rapid absorption, levothyroxine, or liothyronine?

liothyroinine bc liothyronine is T3, and levothyroxine is T4

why is liothyronine not preferred IV?

arrythmias

hypersensitivity reaction

precipitation in IV

risk of gangrene

arrythmias

if someone has hypothyroidism would u treat with levothyroxine or liothyronine usually

levothyroxine

why could thyroid hormones like levothyroxine or liothyronine cause osteoporisis?

High levels of thyroid hormone, including levothyroxine, can increase the activity of osteoclasts

T/F: levothyroxine can be used off label for weight loss in euthyroid patients due to increased metabolism as a result of increasing thyroid function

FALSE!! its a boxed warning not to give thyroid hormones for losing weight- esp if someone has normal thyroid funciton

if someone has hypothyroidism and gets pregnant, would u increase or decrease dose of their levothyroxine?

increase!! thyroid hormones are essential in first trimester especially

if a pt takes calcium supplements, how far apart should they take their levothyroxine?

30 minutes

2 hours

4 hours

12 hours

atleast 4 hours

if someone takes their levothyroxine alongside their calcium, vitamins, supplements, etc, the levothyroxine will not work as well as it should

methimazole and propylthiouracil are used for

acromegaly

hyperthyroidism

hypothyroidism

adrenal insufficiency

pituitary secreting adenoma

hyperthyroidism

which of these is NOT a treatment for hyperthyroidism?

iodide salts

methimazole

propylthiouracil

radioactive iodine

liothyronine

liothyronine

methimazole and propylthiouracil (PTU) are

synthetic thyroid hormones

animal thyroid extract

thioamides

iodide salts

beta blockers

mineralcorticoids

thioamides

what is an added benefit to PTU over methimazole

PTU can block Peripheral convrersion of T4 to T3; also it acts quicker

Agranulocytosis is an AE of methimazole and PTU- what does this mean tho

When a person develops agranulocytosis, their bone marrow stops producing enough neutrophils, or the existing ones are rapidly destroyed. This leaves the body essentially defenseless against even common pathogen

hepatotoxicity and vasculitis are more likely to be seen in methimazole or PTU?

PTU

methimazole and PTU work by

blocking oxidation of iodide, iodine organification, and coupling

attacking TSH receptor antibodies

inhibiting proteolysis

shrinking thyroid tissue via ionizing beta rays

blocking oxidation of iodide, iodine organification, and coupling (aka it blocks effects of TPO)

TPO is needed to make thyroid hormones, so methimazole and PTU prevent formation of thyroid hormones

IMPORTANT

which is used during the FIRST TRIMESTER of pregnancy in a pt w hyperthyroidism- methimazole, or PTU?

PTU

cram the pance- PTU , used in Pregnancy Trimester Uno, then switch to methimazole

which is used in a thyroid storm due to its faster onset and ability to convert T4 to T3 in peripheral tissues (tissues outside of the thyroid gland)?

methimazole

PTU

PTU

which of these meds is safer for LONG TERM THERAPY of hyeprthyroidism (1-2 years)

methimazole

PTU

methimazole

lugol's iodine and saturated solution of potassium iodide (SSKI) are

iodide salts

radioactive iodine

iodide salts

would iodide salts be used in a pt w hypo or hyperthyroidism?

hyper bc it blocks iodine organification, and decreases thyroid hormone release- it can be used in the preoperative preparation for thyroid surgery in patients with Graves' disease.

tx for toxic adenoma, toxic multinodular goiter, and graves disease, as an alternative to surgery

radioactive iodine

which of these hyperthyroid meds can aggravate graves opthalmopathy

radioactive iodine

beta blockers

iodide salts

methimazole

PTU

radioactive iodine

why? This is because TSH receptor antibodies may be stimulated after the treatment. In some cases, the worsening is temporary and can be managed with prednisone.

why would we give propranalol to someone with graves disease

bc its a beta blocker it can control symptoms related to the overdrive of sympathetic NS