Updated: 12/31/2021

Endocrine Medications

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Topic
  • Endocrine Drug Introduction
    • Endocrine medications can be broken down into the following categories
      • diabetic agents
      • hormone agonists
      • hormone antagonists
  • Endocrine Drug Table
    • Diabetic Agents
        • Sulfonylureas (1st Generation)
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Chlorpropamide
        • Tolazamide
        • Tolbutamide
        • Inhibits ATP-sensitive K+ channels resulting in β-cell depolarization and insulin release
        • Second-line treatment for type II diabetes
        • Hypoglycemia (long-lasting)
        •  Renal failure
        •  Disulfiram effects
        • Sulfonylureas (2nd Generation)
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Glipizide
        • Glyburide
        • Inhibits ATP-sensitive K+ channels resulting in β-cell depolarization and insulin release
        • Second-line treatment for type II diabetes
        • Hypoglycemia (long-lasting)
        • Renal failure
        • Disulfiram effects
        • Biguinides
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Exact mechanism unknown
        •  ↓ gluconeogenesis
        •  ↑ insulin sensitivity
        •  ↑ glycolysis
        •  ↓ serum glucose levels
        •  ↓ postprandial glucose levels
        • First-line treatment for type II diabetes and metabolic syndrome
        • Lactic acidosis in patients with poor renal function 
        • Alpha-Glucosidase Inhibitor
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Acarbose
        • Miglitol
        • Prevents breakdown of carbohydrates into single glucose molecules decreasing rate of absorption
        • Refractory type II diabetes mellitus
        • Osmotic diarrhea
        •  Flatulence
        • Thioglitazones
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Pioglitazone
        • Troglitazone
        • Rosiglitazone
        • Stimulates PPAR-γ which controls insulin-sensitive genes resulting in increased insulin sensitivity in peripheral tissues
        • Type II diabetes combination therapy
        • Heart failure
        •  Hepatotoxicity
        •  Weight gain
        • Other
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Repaglinide
        • Inhibits ATP-sensitive K+ channels resulting in β-cell depolarization and insulin release
        • Type II diabetes combination therapy
        • Hypoglycemia
    • Hormone Agonists
        • Estrogen
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Polyestradiol
        • Inhibits actions of dihydrotestosterone
        • Blocks LH secretion by pituitary
        • Decreases testosterone synthesis
        • Blocks testosterone uptake into prostate cells
        • Inhibits 5α-reductase
        • Induces chemical castration
        •  Palliative prostate cancer therapy
        • Feminization
        •  Nausea
        •  Headache
        •  Water retention
        • Diethylstilbestrol
        • Inhibits HPG axis
        •  Blocks testosterone synthesis
        •  Induces chemical castration
        • Believed to decrease incidence of stillbirth
        •  No longer used in the US
        • Clear cell carcinoma (of the fetus)
        •  Vaginal adenosis
        •  T-shaped uterus
        • Progestins
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Megestrol acetate
        • Synthetic progestin suppresses leuteinizing hormone by inhibition of pituitary function
        •  Anorexic mechanism unknown
        • Appetite stimulant
        •  Anti-neoplastic agent
        • Weight gain
        •  Nausea
        •  Vomiting
        • Gonadotropin Releasing Hormones
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Leuprorelin
        • Acts as a gonadotropin releasing hormone agonist which inhibits gonadotropin secretion
        • Hormone responsive cancer (non-pulsatile)
        •  Fertility (pulsatile)
        • Flushing
        •  Sweating
        •  Fatigue
        •  Edema
        •  Skin reaction
    • Hormone Antagonists
        • Anti-Estrogens
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Tamoxifen
        • Competitively binds to estrogen receptors inhibiting effects of estrogen
        • ER/PR positive breast cancer
        • Endometrial cancer
        •  Growth plate fusion
        •  Increased bone density
        • Anti-Androgens
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Flutamide
        • Blocks action of testosterone by binding to adrogen receptors
        • Prostate cancer (used prior to GnRH analogues)
        • Gynecomastia
        •  GI disturbance
        • Enzyme Inhibitors
        • Name
        • Mechanism of Action
        • Key Indication(s)
        • Key Toxicity
        • Anastrozole
        • Inhibits aromatase
        • ER/PR positive breast cancer
        •  Fertility
        • Osteoporosis
        •  Bone fracture
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Questions (2)

(M2.PH.15.8) A 45-year-old diabetic man presents to your office for routine follow-up. One year ago, the patient’s hemoglobin A1C was 7.2% and the patient was encouraged to modify his diet and increase exercise. Six months ago, the patient’s HA1C was 7.3%, and you initiated metformin. Today, the patient has no complaints. For which of the following co-morbidities would it be acceptable to continue metformin?

QID: 102587

Hepatitis C infection

5%

(2/39)

Mild chronic obstructive pulmonary disease

56%

(22/39)

Recent diagnosis of NYHA Class II congestive heart failure

5%

(2/39)

Prior hospitalization for alcoholic hepatitis

8%

(3/39)

Headache and family history of brain aneurysms requiring CT angiography

18%

(7/39)

M 7 E

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(M2.PH.14.70) A 66-year-old man presents to the emergency department with abdominal pain, nausea, and vomiting. He endorses diffuse abdominal tenderness. His past medical history is notable for diabetic nephropathy, hypertension, dyslipidemia, depression, and morbid obesity. He also is currently being treated for an outbreak of genital herpes. His temperature is 99.0°F (37.2°C), blood pressure is 184/102 mmHg, pulse is 89/min, respirations are 18/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man in no acute distress. A CT scan of the abdomen with contrast is performed and is unremarkable. The patient is admitted to the observation unit for monitoring of his pain. Notably, the patient's abdominal pain improves after an enema and multiple bowel movements. The patient's evening laboratory values are ordered and return as seen below.

Serum:
Na+: 141 mEq/L
Cl-: 99 mEq/L
K+: 4.8 mEq/L
HCO3-: 11 mEq/L
BUN: 65 mg/dL
Glucose: 177 mg/dL
Creatinine: 3.1 mg/dL

Which of the following is the most likely etiology of this patient's laboratory derangements?

QID: 104517

Acyclovir

23%

(8/35)

Atorvastatin

51%

(18/35)

Insulin

6%

(2/35)

Metformin

11%

(4/35)

Metoprolol

6%

(2/35)

M 6 E

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