ERB Pharm PDF

Type Name Mechanism of action Use General side effects Specific Side Effects & Notes...

Type Name Mechanism of action Use General side effects Specific Side Effects & Notes very well tolerated in kids recombinant GH GH deficiency, Turner Syndrome, conditions of low stature with normal Somatropin mimics GH by stimulating IGF-1, supoorting linear bone intracranial HTN, antibody formation, hyperglycemia GH levels, fetal growth restriction Growth Hormone Agonist growth, increased bone/muscle mass, decreased fat mass in adults: arthralgias, myalgias, carpal tunnel impaired growth due to GH receptor mutations, people who develop GH Mecasermin recombinant IGF-1 hypoglycemia, lipohypodystrophy antibodies, primary IGF-1 deficiency Ocretrotide acromegaly, carcinoid tumors, VIPoma, GI fistulas, variceal bleeding, Lanreotide long acting somatostatin analog GI intolerance diarrhea, IBS Pasireotide Injection Growth Hormone Antagonist GH receptor antagonist antibody formation, injection site rxn, alterations in Pegvisomant 2nd line for those who have failed other IGF-1 normalization treatments daily SQ injection inhibits IGF-1, not GH production glucose metabolism inhibits prolactin release by stimulating postsynaptic Bromocriptine dopamine receptors in hypothalamus headache, dizziness, nervousness, fatigue, nausea, Dopamine Agonist inhibits prolactin release by stimulating postsynaptic pituitary adenoma, hyperprolactinemia abd pain, diarrhea, hypotension, heart valve dopamine receptors in hypothalamus abnormalities Cabergoline longer half life, more selectivity hCG triggers ovulation/LH surge hMG/menotropin highly purified FSH and LH stimulates follicle development, used with hCG to trigger ovulation Hypothalamic & Gonadotropin rFSH/urofollitropin (uFSH) purified FSH PCOS Pituitary LH hypogonadotropic hypogonadism with LH deficiency Leuprolide infertility, prostate cancer continuous administration: reduce LH and FSH preventing Gonadotropin Releasing Histrelin early LH surge prostate cancer Hormone Agonist Triptorelin Pulsitile administration: agonize LH/FSH secretion prostate cancer Cetrotide Gonadotropin Releasing prevents early LH surge, prevents ovulation in pts at risk of ovarian hyperstimulation/follicular overgrowth Ganirelix Hormone Antagonist ovarian hyperstimulation/excessive follicular growth Degarelix prostate cancer increased PGF2 -> increased uterine contraction induce/augment labor Oxytocin treat/prevent postpartum hemorrhage rare, overactive uterus GPCR -> Gq/PIP -> Ca -> PKC increase milk ejection increase water resorption in collecting ducts, lowers serum Arginine Vasopressin/ADH vasoconstrictor in cardiogenic shock osmo Vasopressin 10x antidiuretic action, less vasoconstriction water retention, hyponatremia, HTN, MI Desmopressin (DDAVP) synthetic analog of arginine vasopressin central diabetes insipidus (also von willebrand disease but that's off topic for this class) fluid loss, fatal liver injury Tolvaptan vasopressin antagonist (primarily V2) SIADH, heart failure don't correct hyponatremia too quickly -> central do NOT use with CYP3A4 inhibitors SIADH Drugs pontine demyelination photosensitivity, tooth discoloration tbh on uptodate apparently no one even uses Demeclocycline tetracycline derivative, impairs cAMP SIADH do NOT use in kids (tetracycline) this anymore for SIADH or hyponatremia synthetic ACTH ACTH/Corticotropin Cosyntropin stimulates the adrenal cortex to secrete adrenal steroids, assessment of HPA, administered in ACTH stimulation test adrogenic substances, and a small amount of aldosterone Hydrocortisone prototype drug, short acting Dexamethasone long acting, more antiinflammatory, no mineralocorticoid effects Glucocorticoids antiinflammatory, acts like endogenous cortisol immunosuppression, cushing syndrome Prednisone oral, intermediate acting, more antiinflammatory Prednisolone IV, intermediate acting, more antiinflammatory Triamcinolone intermediate, more antiinflammatory, no mineralocorticoid Glucocorticoid Receptor inhibits glucocorticoid and progesterone receptors, Cushings fatigue, nausea, headache, edema, endometrial Mifepristone Antagonist increases endogenous cortisol and ACTH? uptodate: abortion/passing of early pregnancy loss thickening, hypokalemia adrenocortial cancer (allegedly) Adrenal Drugs inhibitor of adrenal steroid synthesis (cortisol, aldosterone, Aminoglutethimide skin rash, sedation, nausea androgens), blocks conversion of cholesterol to pregnelone wikipedia says it isnt used in the US anymore since like 1970 Glucocorticoid Synthesis antifungal Cushings, prostate cancer (advanced, used off label), persistent fungal Inhibitors Ketoconazole gynecomastia, hypogonadism, LFT increase CYP inhibition leading to antiandrogenic activity infections, other adrenal cancers blocks cortisol production through 11B hydroxylase hirsutism, acne (ACTH increase) Metyrapone Cushings, adrenal insufficiency diagnosis, adrenal cancers inhibition HTN, electrolyte imbalances (aldosterone) Aldosterone resorb Na, excrete K Mineralocorticoids aldosterone receptor agonist hypokalemia, HTN, diabetes, gastic upset, insomnia Fludrocortisone adrenal insufficiency, including Addison's disease and adrenalectomy also glucocorticoid effects Mineralocorticoid Receptor Spironolactone aldosterone, progesterone, androgen receptor antagonist ascites, heart failure, resistent HTN, primary hyperaldosteronism, acne hyperkalemia, gynecomastia Antagonist Eplerenone aldosterone receptor antagonist Somatostatin Receptor 5 hyperglycemia, abd pain, nausea, cholelithiasis, Pasireotide somatostatin analog, suppresses GH, IGF1, ACTH acromegaly, Cushings Antagonist injection site rxns binds to alpha subunits ->tyrosine kinase phosphorylates on beta subunits -> IRS activates kinases -> ibncrease all diabetes Insulin lipodystrophy at injection site SQ injection glucose uptake (GLUT4), increased glycogen synthesis, short acting protein synthesis, lipogenesis, cell growth/division NPH contains protamine intermediate acting, basal insulin inhaled Insulin  Type Name Mechanism of action Use General side effects Specific Side Effects & Notes Lispro contains citrate and treprostinil for more rapid absorption Insulin rapid acting, after meals Aspart contains niacinamide for more rapid absorption Glulisine Glargine Detemir long acting, basal insulin Degludec Teplizumab monoclonal CD3 antibody high risk T1DM decrease in WBC count, rash, headache Liraglutide GLP1 receptor agonist Semaglutide stimulate glucose dependent insulin secretion, reduce post- N/V, diarrhea, acute pancreatitis, thyroid C-cell Incretin Analog meal glucagon secretion, increase satiety, delay gastric weight loss, T2DM tumors Dulaglutide emptying Tirzepatide GIP/GLP1 receptor agonist N/V, diarrhea, pancreatitis Diabetes synthetic analog T1DM with postprandial hyperglycemia Amylin Analog Pramlintide slows gastric emptying, reduces glucagon secretion, hypoglycemia, GI upset NOT useful in T2DM decreases appitite biguanide decreased appetite, nausea, diarrhea AMPK Activator Metformin OCT1 increases AMPK -> reduces gluconeogenesis and T2DM LACTIC ACIDOSIS lipogenesis competitive inhibitor of glucoamylase, amylase, sucrase α glucosidase inhibitors Acarbose reduce postprandial glucose flatulence, diarrhea, abd pain, hypoglycemia delay absorption of carbs Glipizide increase insulin release from pancreas, blocks potassium short half life Sulfonylureas hypoglycemia, weight gain, sulfa allergy Glyburide channel long half life interact with ATP-sensitive potassium channels -> increase Meglitinides Repaglinide reduce postprandial glucose hypoglycemia insulin release stimulates PPAR -> increases GLUT1/4 -> increase insulin fluid retention, edema, weight gain Thiazolidinediones Pioglitazone sensitivity and decrease hepatic glucose output can WORSEN heart failure Sitagliptin DPP4 Inhibitors Linagliptin inhibit DPP4 -> increase endogenous GLP1 glucose lowering postprandially headache, acute pancreatitis, hypersensitivity rxn Alogliptin Canagliflozin reduces reabsorption of glucose, more excretion of glucose SGLT2 Inhibitor Dapagliflozin T2DM w/ CV and renal risks, reduce albuminuria UTI, yeast infections, hypotension, ketoacidosis by kidneys Empagliflozin Hyperglycemic Agent Glucagon catabolism of stored glycogen, increase gluconeogenesis severe hypoglycemia nausea