Pharmacology usmle step 1

Hyperprolactinemia:/Excess/prolactin/secretion/ Physiological/etiology:/Pregnancy/////////////Early/Nursing/////////////////////Stress/ Pathologic/etiology:/Prolactinoma:/Pituitary/adenoma/producing/prolactin// How/to/block/section/of/prolactin/Dopamine/=/PIF/(prolactin/inhibiting/Factor)/ Tumor/Dection:/MRI/or/CT/scan/ Diagnosis:// Normal/prolactin/level/in/500ng/ml/ Loss/of/sex/hormone/ Visual/loss:/bitemporal/hemianopia!compression/@chasm/ Gynecomastia/ Treatment:/dopamine/agonist/(80%/of/prolactinoma/respond)// Bromocriptine// Pergolide/ Carbergoline/ Excess/of/growth/hormone!Bony/and/soft/tissue/overgrowth// Acromegaly:/abnormal/growth/of/cartilage/and/bone/tissue(Adults)/ Gigantism:/abnormal/linear/growth/(Children/)/ Etiology://Tumor/(pituitary/adenoma)/producing/growth/hormone/ Enlargement/of/hands/and/feet,/nose/and/mandible/ Entrapment/neuropathies/(CTS!/carpal/tunnel/syndrome)/ Diabetes/and/Hypertension/ Visual/loss/(bitemporal/hemianopsia)// Diagnosis:/Screening/test:/Measure/GH/after/100g./Glucose/normal/if/GH/10.2/mg/dL/with/elevated/PTH/level// / Drugs/used/in/Rx/of/primary/hyperparathyroidism/ (((((Calcitonin/Hormone/that/decreases/calcium/level/ /////Bisphosphonates/ending/in/‘dronate’”/ IV/“drugs”/ / / Oral(Rx/of/osteoporosis( Etidronate( ( ( Alendronate( Pamidronate(–EMG(HyperCal( Ibandronate( Zoledronic(acid(( ( Risedronate((Pagets/disease)/ FDA/approved/for/hypercalcemia/of// malignancy/–/Multiple/Myeloma/ ( Mechanism/of/bisphosphonates://Prevent/bone/resorption/ Reduce/the/formation/and/dissolution/of/hydroxyapatite/crystals/ Site/of/action:/Osteoclasts( / New/treatment/of/osteoporosis/“Recombinant/PTH”/Teriparatide// / Emergency/treatment/for/severe/hypercalcemia//Ca++/>/15mg/dL/ Saline/diuresis/–/IV/normal/saline/ Furosemide/only/if/CHF/ IV/Pamidronate/(Bisphosphanates)/ Calcitonin,/gallium/nitrate( / ++ Primary(Hypoparathyroidism((Hypocalcemia)/////↓PTH/!/↓Ca /↑PO4/ Most/common/cause/of/hypoparathyroidism:/Surgical/removal//of/the/parathyroid// / ++ Pseudohypoparathyroidism//↓Ca !↑PTH/↑PO4…/Vitamin/D/is/low/ Abnormal/target/tissue/response/to/PTH…/receptors/are/defective/ Causes:/genetic/–/Type/Ia,/Type/Ib,/Type/II/ Clinical/finding://///Tetany:/Involuntary/contraction/of/muscle”/ //////////EKG:/QT/prolongation/ Rx:(IV(calcium(gluconate( ( Thyroid(gland/Function://Secretion/of/T4/(thyroxineN/stored/form/)/// T3/(triiodothyronineNactive/form)/ in/plasma/are/reversibly/bound/to/protein/thyroxineNbinding/globulin/~/99.7%/of/both/=bound/ 100%/T4/made/in/the/thyroid/gland/ 20%/of/T3/made/in/the/thyroid,/80%/peripherally/ ( Regulation(of(thyroid(hormone(Synthesis/ Hypothalamus/(TRH)/!/Anterior/Pituitary/(TSH)/!/Thyroid/!/↑T4/and/T3/ T4/and/T3/have/negative/feedback/to/anterior/pituitary/and/hypothalamus/ ( Thyroid(hormone(synthesis( 1. Uptake/of/Iodide/(iodide/trapping)/ 2. Iodide/organification/(oxidation/iodination)/!/thyroid/perioxidase*/ 3. Coupling/of/MIT/and/DIT/ 4. Secretion/of/thyroid/hormones/ 5. Conversion/of/T4/to/T3// / Preparations:(Levothyroxine((T4),(Liothyronine(T3),(Liotrix(combination(T3,(T4)( Levothyroxine(T4)(is(drug(of(choice(due(to(long(halfTlife/less/potent/than/Liothyronine(T3)( Liothyronine/used/for/(Myxedema/coma)/!causes/cardiotoxicity;// / Use:/Hypothyroid,/Adult,/Childhood,/Infancy/–/cretinismNgrowth/retardation(physical,/mental)/ / Hashimoto’s(disease://MC/cause/of/hypothyroidism/and/nonNtoxic/goiter/ Autoimmune/destruction/of/thyroid….Chronic/thyroiditis/ Antimicrosomal/and/antiNthyroglobulin/antibodies//Rx!/Levothyroxine/(T4)/ / Myxedema(Coma:/Severe/long/standing/hypothyroidism/ Precipitating/Factors,/caused/by:/Cold/exposure,/Infection,/and/trauma/ Clinically/present/:/Hypothermia,/and/Respiratory/depression../ Treatment:// Intubation/and/mechanical/ventilation/ Control/Hypothermia/ Levothyroxine/I.V/or/Liothyronine/I.V/ SE:/Bc/too/much/TH//inc/activity// Tachycardia,// Heat/intolerance// Tremors/ Arrthymia//

5`/doiodenase(T4!T3)/peripheral/conversion/// 5/Deiodenase(T4!RT3)/activated/when/need/to/save/energy…ie/sick/ Antithyroid(Drugs( Thioamides:/Inhibit/thyroid/peroxidase///Block/iodine/oxidation/and/Coupling/of/MIT/and/DIT// 1. Methimazole/ 2. Carbimazole// 3. Propylthiouracil/(PTU)–/inhibit/peripheral/conversion/of/T4/to/T3// Block/synthesis/T3/and/T4/no/release,/therefore/slow/onset/of/action// preferable/in/pregnancy:/(protein/bound,/so/does/not/cross/placenta)/ / Toxicity:///Maculopapular/pruritic/rash/ 3 ((((((*Agranulocytosis/(granulocyte/count/1)/ Indications:/Weight/gain/and/Enhancement/of/athletic/performance/ Side/Effects:/Oxandrolone/is/a/controlled/substance/schedule/III/ / Androgens/may/enhance/the/anticoagulant/effects/of/warfarin/ ( Drugs(used(in(management(of(BPH:((( 5/alpha/reductase/inhibitors((Finasteride/(proscar/Propecia)/ 5/alpha/reductase:/Testosterone/!/dihydrotestosterone/(DHT)/!/prostate/gland/growth/ Rx:/Male/pattern/baldness/ Adverse/effects:/Decrease/libido/and/impotence/ Use/of/St/John’s/wort/may/decrease/dinasteride/levels// Alpha/1/blockers:/Prazocin,/terazocin,/and/doxazocin:/they/also/reduce/blood/pressure/ Alternative/considerations:/Saw/palmetto:/Inhibits/DHT/from/binding/at/androgen/receptors/ Androgen/receptor/antagonists/Flutamide/and/Bicalutamide:// / Uses:/In/conjuction/with/a/GnRH/analog/in/the/treatment/of/metastatic/prostate/cancer/ Role/of/Autonomic/nervous/system/in/sexual/response/ Parasympathetic/(Cholinergic):/Erection/

Sympathetic/(adrenergic):/Ejaculation// / Drugs/affecting/sexual/functioning/ 1. Antihypertensives/(beta/blockers)/ 2. Diuretics:/(thiazide/and/spironolactone)/ 3. H1/and/H2/blockers,/anticholingeric/effects/ 4. Antipsychotics/ 5. Antidepressants/ 6. Anxiolytics/ 7. Ethanol/and/barbiturates/ 8. Anabolic/steroids/ ( Drugs(used(to(treat(erectile(dysfunction( 1. Sildenafil/(Viagra)/ 2. Tadalafil/(Cialis)/ 3. Vardenafil/(Levitra)/ They/all/are:/Phosphodiesterase/inhibitors/(PDE5),/they/inhibit/the/enzyme/that/metabolize/ cGMP,/leading/to/an/increase/in/cGMP/(Guanosine/monophosphate)/ In/the/corpus/cavernosum/enhancing/muscle/relaxation,/increasing/the/inflow/of/blood/ causing/erection/ Adverse/effects:/Headaches,/facial/flushing,/back/pain/ High/doses/may/cause/optic/neuropathy/ / Precautions/with/PDE5/inhibitors:/ 1. Absolutely/contraindicated/with/nitroglycerin./Why?/!/Severe/hypotension/ 2. Sildanefil/has/not/effect/in/the/absence/of/sexual/stimulation/ 3. Tadalafil/has/an/onset/of/action/w/in/1/hr/but/duration/of/action/up/to/36/hrs/ 4. Use/in/women/is/under/study//

Diabetes/Pharm//Drugs/used/in/Diabetes/Mellitus/ Pancreas/ Insulin/NBetaNcells/of/islets/of/Langerhans……Triggered/by:/Inc/blood/glucose/level/ GlucagonNAlphaNcells/of/the/islets/of/Langerhans……Triggered/by:/Dec/blood/glucose/level/ Type(I,(IDDM(No/insulin( Type(II,(NIDDM(Have/insulin/but/resistance( 40y/old/ Lean/ Obese/No/autoantibodies/ Autoantibodies/ Hyperosmolar/coma/(HHNS)/ Ketoacidosi/ Oral/hypoglycemic/ Gotta/give/insuliln/ +/N/insulin/ Diagnosis(of(diabetes(mellitus( Symptomatic/patients://Polyurea,/polydipsia,/ketonuria//Plasma/glucose/>/200mg/dL/ Asymptomatic/patients/:/Fast/blood/glucose/>/125mg/dL/on/2/occasions/ /

Normal/glucose/ tolerance/