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  /Title (pharm250-endocrine-and-genitourinary-systems.pdf)
  /Creator (Cheatography)
  /Author (kjaniskevich)
  /Subject (PHARM250 Endocrine \& Genitourinary Systems Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{PHARM250 Endocrine \& Genitourinary Systems Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{kjaniskevich} via \textcolor{DarkBackground}{\uline{cheatography.com/132444/cs/27519/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}kjaniskevich \\
  \uline{cheatography.com/kjaniskevich} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 14th April, 2021.\\
   Updated 14th April, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Thyroid Disorders - Classes of medication}}  \tn
% Row 0
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Thyroid Agents (HYPOthyroid)}}} \tn 
% Row Count 1 (+ 1)
% Row 1
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Levothyroxine (T4) \{\{nl\}\} {\emph{Synthroid® OR Eltroxin®}} & Synthetically made T4 hormone (body then converts to T3 in peripheral tissues as needed)\{\{nl\}\} Identical to endogenously made T4\{\{nl\}\} All adverse effects are rare \{\{nl\}\} May see signs of HYPERthyroidism with doses too high \{\{nl\}\} Dosed according to body weight, then adjusted according to TSH levels \{\{nl\}\} Takes 1-3 weeks for full therapeutic benefit \tn 
% Row Count 19 (+ 18)
% Row 2
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Other thyroid products & Liothyronine (synthetic T3)\{\{nl\}\}  Desiccated thyroid (mixture of T3 \& T4 obtained from dried thyroid glands of pigs)\{\{nl\}\}  Both products have been largely replaced by levothyroxine \tn 
% Row Count 29 (+ 10)
% Row 3
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Anti-thyroid Agents (HYPERthyroid)}}} \tn 
% Row Count 30 (+ 1)
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Thyroid Disorders - Classes of medication (cont)}}  \tn
% Row 4
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Propylthiouracil & Inhibits synthesis of thyroid hormone, as well as conversion of T4 -\textgreater{} T3 \{\{nl\}\} Used to control thyroid function until surgery (short-term) \tn 
% Row Count 7 (+ 7)
% Row 5
\SetRowColor{white}
Methimazole & Inhibits synthesis of thyroid hormone, but does NOT inhibit conversion of T4 -\textgreater{} T3 \{\{nl\}\} Safer than propylthiouracil, but takes longer to work (could be months) \{\{nl\}\} Taken once a day \{\{nl\}\} A long-term option if patient has opted out of surgery \tn 
% Row Count 20 (+ 13)
% Row 6
\SetRowColor{LightBackground}
Radioactive iodide & Iodine is taken up by only the thyroid \{\{nl\}\} Radioactivity destroys the thyroid gland – attempt to only destroy some of it, but many result in HYPOthyroid state \{\{nl\}\} Once/if they are HYPOthyroid, we replace thyroid hormone (likely levothyroxine) \{\{nl\}\} Can also treat thyroid cancer – there have been no known cases of cancer caused by 131I \{\{nl\}\} 2/3 of patients respond to one treatment – used when opposed to surgery \{\{nl\}\} Can take 3-6 months after 1 dose (3 months between doses) \{\{nl\}\}Tissue damage limited to thyroid gland only with no surrounding structures affected \tn 
% Row Count 50 (+ 30)
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\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects}}  \tn
% Row 0
\SetRowColor{LightBackground}
Levothyroxine \{\{nobreak\}\} & All adverse effects are rare \{\{nl\}\} May see signs of HYPERthyroidism with doses too high\{\{nl\}\} Avoid with minerals such as calcium, magnesium, aluminum – blocks absorption – separate by 2h \tn 
% Row Count 8 (+ 8)
% Row 1
\SetRowColor{white}
\seqsplit{Propylthiouracil} (PTU) & rash, symptoms of HYPOthyroidism, agranulocytosis, hepatotoxicity, many drug interactions (anticoagulants, digoxin)\{\{nl\}\} Must be taken multiple times a day (short t$\frac{1}{2}$) \{\{nl\}\} Can take up to 3 weeks to exert effect (does not affect hormone already released) \tn 
% Row Count 19 (+ 11)
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Metformin & nausea (take with food), diarrhea (transient), lactic acidosis (rare) \tn 
% Row Count 22 (+ 3)
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Sulfonylureas & hypoglycemia, weight gain, nausea, rash, hepatotoxicity (don't take with alcohol) \{\{nl\}\} Can cause hypoglycemia on its own (most likely of all classes besides insulin) \{\{nl\}\} Avoid in elderly (more susceptible to hypoglycemia) \tn 
% Row Count 32 (+ 10)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects (cont)}}  \tn
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Replaglinide & hypoglycemia (less than sulfonylureas), weight gain \{\{nl\}\} Generally only cause hypoglycemia when combined with another hypoglycemic drug \tn 
% Row Count 6 (+ 6)
% Row 5
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\seqsplit{Thiazolidinediones} & edema and fluid retention, headache, weight gain \{\{nl\}\} Post-marketing surveillance: may increase risk of fractures, concern about ↑ cardiovascular events \{\{nl\}\} Not likely to cause hypoglycemia on its own \tn 
% Row Count 15 (+ 9)
% Row 6
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Acarbose & abdominal cramping, diarrhea, flatulence, malabsorption of vitamins/minerals or other drugs (separate by 2h); potential hepatotoxicity \{\{nl\}\} Does not cause hypoglycemia on its own \{\{nl\}\} IF hypoglycemic, and need to give sugar, must take glucose tabs, milk, or honey; NOT SUCROSE \tn 
% Row Count 27 (+ 12)
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DPP4 Inhibitors & hypoglycemia, cough, nasopharyngitis, rash, hypersensitivity, muscle aches, joint pain\{\{nl\}\} Not likely to cause hypoglycemia on its own\{\{nl\}\} Rare: pancreatitis (severe abdominal pain that may be accompanied by vomiting)\{\{nl\}\} Oral tablets taken once daily \tn 
% Row Count 38 (+ 11)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects (cont)}}  \tn
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GLP-1 Agonists & nausea, diarrhea, hypoglycemia, infusion site reactions, pain in stomach area, decreased appetite, indigestion, burping, flatulence, joint and muscle pain, dizziness, headache, cough, rash, pancreatitis, dehydration, increases in heart rate \{\{nl\}\} Can cause hypoglycemia on its own \{\{nl\}\} Rare: anaphylactic reaction, nephrotoxicity, thyroid cancer \tn 
% Row Count 15 (+ 15)
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SGLT-2 Inhibitors & weight loss, diuretic effect, hypotension, polydipsia (thirst), increased rate of urinary tract infections, must have adequate kidney function \{\{nl\}\} Not likely to cause hypoglycemia on its own \tn 
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Corticosteroids Local Administration adverse effects}}} \tn 
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Opthalmic & Stinging, redness, tearing, burning, secondary infection \{\{nl\}\} Long-term: cataracts, glaucoma \tn 
% Row Count 30 (+ 4)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects (cont)}}  \tn
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Oral Inhalation & Thrush, hoarseness, dry mouth, dysphoria (change in voice), dysphagia (difficulty swallowing), taste disturbance \tn 
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% Row 13
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Nasal Inhalation & Rhinorrhea, burning, sneezing, dry mucous membranes, epistaxis, loss of smell \tn 
% Row Count 9 (+ 4)
% Row 14
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Topical & Burning, irritation, skin atrophy (thinning of skin), telangiectasia () \{\{nl\}\}  To Prevent: lowest dose possible, shortest duration possible, applying very thin layer of product only on affected area, do not apply to open skin \tn 
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Adverse Effects of Corticosteroids Systemic Administration}}} \tn 
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CNS & euphoria, insomnia, restlessness, increased appetite, altered mood (depression, mania, psychosis) \tn 
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% Row 17
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Eye & cataracts, glaucoma \tn 
% Row Count 27 (+ 1)
% Row 18
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Face/Trunk & redistribution of fat -\textgreater{} moon face, buffalo hump, protruding abdomen \tn 
% Row Count 30 (+ 3)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects (cont)}}  \tn
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Heart & hypertension, enlarged heart \tn 
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% Row 20
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GI & stomach upset, may ↑ risk of ulcer \tn 
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% Row 21
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Blood & glucose intolerance -\textgreater{} diabetes; leukocytosis \tn 
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% Row 22
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Kidneys & fluid \& water retention (if mineralocorticoid activity) \tn 
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% Row 23
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Growth inhibition & use in kids only if necessary (inhalers safe) \tn 
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Muscle & wasting of muscle tissue (myopathy) \tn 
% Row Count 13 (+ 2)
% Row 25
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Bones & osteoporosis \tn 
% Row Count 14 (+ 1)
% Row 26
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Skin & easy bruising, poor wound healing, acne, striae \tn 
% Row Count 16 (+ 2)
% Row 27
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Prednisone & nausea, hypertension, hyperglycemia, insomnia, psychosis, redistribution of fat, osteoporosis, easy bruising, edema, infections, HPA-axis suppression \tn 
% Row Count 23 (+ 7)
% Row 28
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Contraception – Adverse Effects}}} \tn 
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Estrogen & Nausea, Breast tenderness, Headache, Bloating, Thrombosis \tn 
% Row Count 27 (+ 3)
% Row 30
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Progestin & Irritability, Fatigue,  Breast tenderness, Bloating, Withdrawal bleeding (cyclical), Headache, Adverse lipid alterations, "PMS-like symptoms" \tn 
% Row Count 34 (+ 7)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects (cont)}}  \tn
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Emergency Contraception & Nausea – if vomit within 2 hours of dose – take dose again; may give with anti-emetic (dimenhydrinate – Gravol®) \{\{nl\}\} Irregular bleeding – spotting after taking dose; regular menses may be off by a few days (early or late) \{\{nl\}\} Abdominal pain, cramping – use acetaminophen (not NSAID in case of pregnancy)\{\{nl\}\} Diarrhea, breast tenderness, fatigue, headache – all possible and transient \tn 
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α1-Blockers & Retrograde ejaculation, Dizziness, fatigue, rhinitis, Orthostatic hypotension, Syncope "first-dose syncope" \tn 
% Row Count 22 (+ 5)
% Row 33
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α-reductase Inhibitors & Ejaculatory dysfunction, Loss of libido, Impotence, Gynecomastia,  )All effects due to ↓ DHT levels) Can cause birth defects in male children \tn 
% Row Count 28 (+ 6)
% Row 34
\SetRowColor{white}
PDE-5 Inhibitors & : hypotension, headache, back and muscle pain, hearing loss, visual changes, priapism (erection \textgreater{} 4h) \tn 
% Row Count 33 (+ 5)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Classes of Oral Hypoglycemics}}  \tn
% Row 0
\SetRowColor{LightBackground}
Metformin & A biguanide (only one in it's class)\{\{nl\}\} Mechanism: Enhances tissue sensitivity to insulin -\textgreater{} reducing insulin resistance, Also decreases hepatic gluconeogenesis \{\{nl\}\} Often first drug prescribed \tn 
% Row Count 10 (+ 10)
% Row 1
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Sulfonylureas \{\{nl\}\} {\emph{Glyburide, gliclazide, glimepiride}} & Enhance insulin secretion from the pancreas (aka insulin secretagogue)\{\{nl\}\} Also increase insulin sensitivity at target tissues (like metformin) \tn 
% Row Count 18 (+ 8)
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Repaglinide & A meglitinide  \{\{nl\}\} Stimulate release of insulin from pancreas (insulin secretagogue) \{\{nl\}\} Requires presence of glucose to exert action, therefore MUST BE TAKEN BEFORE (within 30 mins) OR WITH A MEAL \tn 
% Row Count 29 (+ 11)
% Row 3
\SetRowColor{white}
Thiazolidinediones \{\{nl\}\}{\emph{Rosiglitazone, pioglitazone}} & Enhance insulin sensitivity at target tissues (similar to metformin)\{\{nl\}\} Food has no direct effect (can be taken with or without food) \tn 
% Row Count 36 (+ 7)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Classes of Oral Hypoglycemics (cont)}}  \tn
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Acarbose & Inhibits α–glucosidase, which reduces the rate of absorption of carbohydrates from the GI tract, preventing hyperglycemia – therefore TAKE WITH MEALS \tn 
% Row Count 8 (+ 8)
% Row 5
\SetRowColor{white}
Dipeptidyl Dipeptidase 4 (DPP4) inhibitors \{\{nl\}\}{\emph{linagliptin, alogliptin, sitigliptin, saxagliptin }} & Incretins are a group of hormones that tell the pancreas to release insulin (from pituitary); basal rate and elevated in response to food \{\{nl\}\} Drugs particularly target glucagon-like peptide 1 (an incretin) and others \{\{nl\}\} DPP-4 inhibitors inhibit the breakdown of incretins, which increases and prolongs their activity -\textgreater{} instructs pancreas to release more insulin for longer \tn 
% Row Count 27 (+ 19)
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Glucagon-like peptide 1 (GLP-1) agonists \{\{nl\}\}{\emph{exenatide, liraglutide, dulaglutide, semaglutide, lixisenatide}} & GLP-1 agonists mimic endogenous GLP-1 (an incretin)\{\{nl\}\} Results in increased satiety, reduced gastric emptying, and greater insulin secretion\{\{nl\}\} GLP-1 agonists are resistant to degradation by DPP4 enzymes\{\{nl\}\} Given as SC injections\{\{nl\}\} 1st Gen are administered daily or BID; 2nd Gen are weekly \{\{nl\}\} Varying t $\frac{1}{2}$ of 2.4 hours - 2 weeks \tn 
% Row Count 45 (+ 18)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Classes of Oral Hypoglycemics (cont)}}  \tn
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SGLT-2 Inhibitors \{\{nl\}\} {\emph{Canagliflozin, dapagliflozin, empagliflozin, ertugliflozin}} & Increases excretion of glucose in the kidney by preventing glucose reabsorption, therefore reducing blood glucose levels \tn 
% Row Count 6 (+ 6)
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\begin{tabularx}{8.4cm}{x{3.12 cm} x{4.88 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diabetes medications and treatments}}  \tn
% Row 0
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Glucose homeostasis factors}}} \tn 
% Row Count 1 (+ 1)
% Row 1
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Insulin & Released in response to HIGH blood sugar\{\{nl\}\}Promotes the uptake, utilization, and storage of glucose → lowers blood glucose concentration\{\{nl\}\}Suppresses endogenous glucose and Inhibits glucagon release \{\{nl\}\} Causes rapid uptake, storage, and use of glucose by insulin sensitive tissues (Muscle, liver, adipose (fat), brain) \tn 
% Row Count 15 (+ 14)
% Row 2
\SetRowColor{LightBackground}
 & Basal release rate of 0.5 – 1.0 unit / hour \tn 
% Row Count 17 (+ 2)
% Row 3
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 & Rate of release increases when blood glucose (BG) \textgreater{} 5.5mmol/L (in response to eating - bolus) \tn 
% Row Count 21 (+ 4)
% Row 4
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 & Usual secretion: 25-50 units / day \tn 
% Row Count 23 (+ 2)
% Row 5
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Glucagon & Released in response to LOW blood sugar\{\{nl\}\}Increases the hepatic glucose output → increases blood glucose concentration \tn 
% Row Count 29 (+ 6)
% Row 6
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{\bf{Diabetes Mellitus}} & A metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, insulin action, or both \tn 
% Row Count 35 (+ 6)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diabetes medications and treatments (cont)}}  \tn
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Type 1 & due to defective insulin secretion \{\{nl\}\}An autoimmune destruction of pancreatic β–cells, causing an absolute lack of insulin secretion \tn 
% Row Count 6 (+ 6)
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Type 2 & due to insulin resistance, eventually leading to defective insulin secretion \tn 
% Row Count 10 (+ 4)
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Hyperglycemia & HYPERglycemia would occur if a patient did not have enough insulin \{\{nl\}\} FPG \textgreater{} 7.0mmol/L \tn 
% Row Count 14 (+ 4)
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Hypoglycemia & HYPOglycemia would occur if: too much insulin, improper timing of insulin, or patient skipped a meal \{\{nl\}\} FPG \textless{} 4mmol/L \tn 
% Row Count 20 (+ 6)
% Row 11
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{\bf{Insulin Treatment}} & Insulin preparations vary by: \{\{nl\}\} Onset of action, Time to peak glycemic effect, Duration of action, Appearance \tn 
% Row Count 25 (+ 5)
% Row 12
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Long-Acting Insulin Analogues (LAIA)}}} \tn 
% Row Count 26 (+ 1)
% Row 13
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Insulin detemir (Levemir) & After injection, the molecules self-associate and bind to albumin  slowly released from subcutaneous tissue into blood stream at a slow, predictable rate \tn 
% Row Count 33 (+ 7)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diabetes medications and treatments (cont)}}  \tn
% Row 14
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Insulin degludec (Tresiba) & Forms multihexamers following SC injection, leading to a depot  delayed absorption from SC tissue and also binding to albumin leads to longer time profile \tn 
% Row Count 7 (+ 7)
% Row 15
\SetRowColor{white}
Insulin glargine (Lantus) & An acidic (pH of 4) product in the vial, and once injected subcutaneously, the acidic solution is neutralized, and forms micro-precipitates  these slowly dissolve over at a slow, predictable rate \tn 
% Row Count 16 (+ 9)
% Row 16
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Insulin Routes of Administration}}} \tn 
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% Row 17
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Subcutaneously \{\{nobreak\}\} & most common \tn 
% Row Count 19 (+ 2)
% Row 18
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With an insulin pump & continuous subcutaneously \tn 
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Inhaled dry powder & not yet approved in Canada \tn 
% Row Count 23 (+ 2)
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Intravenous & only regular (R or Toronto) for emergencies \tn 
% Row Count 25 (+ 2)
% Row 21
\SetRowColor{white}
{\bf{Mixing Insulins}} & Important note regarding administration: not all insulins can be mixed \{\{nl\}\} ALWAYS CHECK \tn 
% Row Count 29 (+ 4)
% Row 22
\SetRowColor{LightBackground}
R/Toronto + N/NPH & may be pre-mixed and stored together \tn 
% Row Count 31 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.12 cm} x{4.88 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diabetes medications and treatments (cont)}}  \tn
% Row 23
\SetRowColor{LightBackground}
RAIA + N/NPH & may mix, but administer immediately (do not store mixed) \tn 
% Row Count 3 (+ 3)
% Row 24
\SetRowColor{white}
LAIA & do not mix in same syringe with any other insulins – due to specific mechanism of action and pH \tn 
% Row Count 8 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}