Updated: 7/1/2019

Endocrine Medications

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Questions
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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
Name Mechanism of Action  Key Indication(s)
 Key Toxicity
Sulfonylureas (1st Generation)
Chlorpropamide
  • 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
Tolazamide
Tolbutamide
Sulfonylureas (2nd Generation)
Glipizide
  • 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
Glyburide
Biguinides
Metformin 
  • 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
Acarbose
  • Prevents breakdown of carbohydrates into single glucose molecules decreasing rate of absorption
  • Refractory type II diabetes mellitus
  • Osmotic diarrhea
  • Flatulence
Miglitol
Thioglitazones
Pioglitazone
  • 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
Troglitazone
Rosiglitazone
Other
Repaglinide
  • Inhibits ATP-sensitive K+ channels resulting in β-cell depolarization and insulin release
  • Type II diabetes combination therapy
  • Hypoglycemia
Hormone Agonists
Estrogen
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
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
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
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
Flutamide
  • Blocks action of testosterone by binding to adrogen receptors
  • Prostate cancer (used prior to GnRH analogues)
  • Gynecomastia
  • GI disturbance
Enzyme Inhibitors
Anastrozole
  • Inhibits aromatase
  • ER/PR positive breast cancer
  • Fertility
  • Osteoporosis
  • Bone fracture

Please rate topic.

Average 3.0 of 1 Ratings

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
1

Hepatitis C infection

6%

(2/33)

2

Mild chronic obstructive pulmonary disease

52%

(17/33)

3

Recent diagnosis of NYHA Class II congestive heart failure

3%

(1/33)

4

Prior hospitalization for alcoholic hepatitis

9%

(3/33)

5

Headache and family history of brain aneurysms requiring CT angiography

21%

(7/33)

M 7 E

Select Answer to see Preferred Response

(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
1

Acyclovir

17%

(5/29)

2

Atorvastatin

62%

(18/29)

3

Insulin

7%

(2/29)

4

Metformin

10%

(3/29)

5

Metoprolol

0%

(0/29)

M 6 E

Select Answer to see Preferred Response

Evidence (5)
EXPERT COMMENTS (18)
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