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Golden Points

Endocrinal Drugs
  1. GnRH analogues (naferlin, goserlin, buserlin) are DOCs to suppress gonadotrohin secretions in precocious puberty, porstatic cancer, endometriosis, and fibroid uterus.
  2. Mode of administration of GnRH analogues can determine
  3. Bromocriptine (partial agonist of D1 receptors) is DOC for suppression of wanted lactation, hyperprolactenemia, acrolmegaly (carbergoline in pregnancy)
  4. Somatrem\somatropin are growth hormone analogues used in short stature patients e.g. Turner’s syndrome (XO)
  5. Cosyntropin (ACTH analogue) is DOC for infantile spasm
  6. Menotropins (FHS & LH) are used in hypogonadal states
  7. Oxytocin is used to induce or augment labour; CI renal failure, or hypertension with IHD
  8. Desmopressin (V2 agonist) is DOC for craniogenic diabestes insipidus; also useful in hemophilla and Von Willebrand’s disease
  9. Hydrocortisone (DOC for CAH, acute & Chronic adrenal insufficiency) is MC Glucocorticoid secreted endogenously (10mg\day) while aldosterone is most potent mineralocorticoid (even up to 30 times more potent than fludrocortisone)
  10. Dexamethasone has maximum topical activity while hydrocortisone has no topical activity
  11. Dexamethasone\betamethasone are longest acting Glucocorticoids (act for >24-36 hours); have no salt retaining activity but have maximum anti-inflammatory activity
  12. Des-oxy-corticosterone acetate has no glucocortcoids and is pure mineralocticoid
  13. Thyroxine (less active), T3 (more active) are DOCs for myxedema, cretinism (usual dose is 25 microgram\day)
  14. Thionamides (propylthiouracil, carbamezole etc methimazole) are antithyroid drugs acting by inhibiting thyroid hormone synthesis (thyroid peroxides)
  15. Propylthiouracil is least potent and shortest acting anti-thyroid drug (DOC for hyperthyroidism in pregnancy &thyroid storm)
  16. MC serious side effect of anti-thyroid drugs is agranulocytosis (indicated by sore throat or fever-withdraw the drug)
  17. Lugol’s iodine acts by inhibiting release of thyroid hormones (DOC for making gland firm before surgery)
  18. Radioactive iodine (I131 acts by delivering beta and gamma rays); destroys thyroid gland and is CI in young patients
  19. Propranolol is DOC of initial choice for toxic multi-nodular goiter
  20. Insulin is a polypeptde with mol. weight (5000) acting by tyrosine kinase receptors (autophosphorylation receptors)-Benting &Best discovered it
  21. Inhibits phosphoenolcarboxykinase, phosphorylase (musle & liver); stimulates hexokinase and lipoprotein lipase (LPL)
  22. MC side effect is hypoglycemia, beta-blockers can cause silent hypoglycemia as they can block sympathetic manifestations of hypoglyecemia.
  23. Human insulin causes lipodystrophy; zinc is added to insulin to increase self-life and stability of solution
  24. Insulin lipspro is shortest acting while insulin glargine is longest acting.
  25. Insulin Glarzine is an acidic insulin and therefore becomes polymerized upon injection into subcutaneous tissues. This ensures slow and sustained delivery of drug into circulation. Therefore, it is longest acting insulin. 
  26. Sulphonylureas increase insulin release also increase insulin sensitivity
  27. Tolbutamide is safest sulphonylureas, while chlorpropamide is worse (hypoglycemia is most likely, causes SIADH, dilsulfiram like reaction)
  28. Glimepride is most potent and longest acting sulphonylureas
  29. Bigunides (Metformin & phenformin) act by inhibiting hepatic output of glucose (inhibit glycogenolysis)
  30. Metformin causes less lactic acidosis, doesn’t cause hypoglycemia, and is DOC for obese diabetic patients (MC-s\e-dyspepsia)
  31. Acarbose is alpha-glucosidase inhibitor, can even be used in IDDM; hypoglyecemia is a mild problem. Its main use is in impaied glucose tolerance. 
  32. Thiozolidinediones (trogliatazone, piogliatazones) are insulin sensitizers
  33. Magletinide derivatives act in same manner as insulin (secretagogues)

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