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Pharmacology 2 > Endocrine I > Flashcards

Endocrine I Flashcards

1
Q

most negative feedback inhibition of hormones is reversible, except what?

A

prolonged glucocorticoid therapy

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2
Q

which pancreatic cells release insulin into the blood when blood glucose levels rise?

A

beta cells

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3
Q

which pancreatic cells release glucagon into the blood when blood glucose levels drop?

A

alpha cells

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4
Q

insulin-dependent diabetes mellitus that results in no circulating insulin; needs insulin replacement

A

type 1 DM

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5
Q

what is type 1 diabetes mellitus also known as?

A

juvenile-onset diabetes

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6
Q

insulin resistance with relative insulin deficiency, but enough present to prevent ketoacidosis

A

type 2 DM

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7
Q

what is type 2 DM also known as?

A

non-insulin dependent DM
adult-onset DM

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8
Q

what are the first 3 things to try before insulin, in patients with type 2 DM?

A

oral Rx
diet
exercise

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9
Q

diabetes of non-pancreatic cause; can be drug induced

A

type 3 DM

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10
Q

what are 3 drug types that can cause type 3 DM?

A

glucocorticoids
immunosuppressants
atypical antipsychotics

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11
Q

gestational DM; glucose intolerance at onset or recognition of pregnancy

A

type 4 DM

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12
Q

a patient presents with polyuria, polydipsia, and fatigue. what are they likely experiencing?

A

acute hyperglycemia

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13
Q

a patient presents with capillary damage, neuropathy, decreased gastric emptying, arterial narrowing, PVD, and increased risk of infections. what are they likely experiencing?

A

chronic hyperglycemia

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14
Q

what should be monitored to manage hyperglycemia?

A

HbA1c

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15
Q

what does insulin inhibit? (2)

A

glycogenolysis
lipolysis

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16
Q

how does GLUT-4 and exercise help with hyperglycemia?

A

increases cellular uptake of glucose into muscles and fat

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17
Q

what are different insulin dosage regimens designed to mimic?

A

prandial and basal release of insulin from the pancreas

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18
Q

what is a bolus of insulin used for and what is the dose based on (3)?

A

postprandial hyperglycemia

BG, carbohydrate content, and concurrent activity

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19
Q

what can inhaled insulin cause? (3)

A

cough
decreased PFT
lung cancer

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20
Q

in which patient is inhaled insulin contraindicated in?

A

patients with COPD

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21
Q

what are 2 things that can cause hypoglycemia when taking meds?

A

dose
mismatch between maximal peak activity and food intake

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22
Q

what can exacerbate hypoglycemia? (2)

A

exercise
alcohol

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23
Q

what is the order in which to take medication to treat hypoglycemia?

A

Test blood
Inject insulin
Eat food

TIE

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24
Q

a patient presents with tachycardia, sweating, blurred vision, feeling warm, trembling, confusion, drowsiness, and weakness. what are they likely experiencing?

A

hypoglycemia

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25
Q

what drug class can mask the symptoms of hypoglycemia?

A

beta blocker

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26
Q

side effects that are common in bovine and porcine injections

A

lipohypertrophy
lipoatrophy

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27
Q

what are 4 main side effects that can present while using hypoglycemics to control hyperglycemia?

A

hypoglycemia
lipohypertrophy
lipoatrophy
weight gain

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28
Q

gut hormones (like glucagon-like peptide - GLP-1) that stimulate insulin release upon food intake; extent of release is proportional to glucose level

A

incretins

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29
Q

drug class that increases gene expression for GLUT-1 and GLUT-4 = increase glucose uptake, increase tissue sensitivity to insulin, and decrease hepatic glucose production

A

thiazolidinediones (glitazones)

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30
Q

-zone

A

glitazones (thiazolidinediones)

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31
Q

2 drug classes that stimulate insulin release from pancreas

A

sulfonylureas
meglitinides

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32
Q

which sulfonylurea causes hypoglycemia risk in elderly patients?

A

chlorpropamide

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33
Q

why should patients avoid alcohol if they take a 1st generation sulfonylurea?

A

can cause disulfiram reaction

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34
Q

-mide

A

1st gen sulfonylureas

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35
Q

4 G’s

A

2nd gen sulfonylureas

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36
Q

what are 4 ADR of sulfonylureas?

A

sulfonylureas give me hypoglycemia, diarrhea (GI disturbances), and
photosensitivity (PK DDI)

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37
Q

if a patient is taking a sulfonylurea, what should we educate about? (2)

A

sunscreen use
avoid alcohol

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38
Q

drug class that has a rapid onset and short DOA, and is used for patients with postprandial hyperglycemia

A

meglitinides

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39
Q

-nide

A

meglitinides

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40
Q

what are 3 ADR that can occur while taking a meglitinide?

A

Meg likes to eat so she has weight gain, but also hypoglycemia
(PK DDI)

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41
Q

first line medication for hyperglycemia that has the least potential of causing hypoglycemia

A

metformin (biguanide class)

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42
Q

what is the MOA of metformin?

A

decreases production of glucose by the liver

43
Q

what are 2 ADR for metformin?

A

(met) formin didn’t believe lactose intolerance (lactic acidosis) caused diarrhea

44
Q

drug class that slows carbohydrate absorption by the intestines

A

alpha glucosidase inhibitors

45
Q

what are the 2 drugs in the class alpha glucosidase inhibitors?

A

the alpha glucose inhibitor had a car(bose) and it was
mig(lit)ol

46
Q

what are the 2 ADR of alpha glucosidase inhibitors?

A

a car(bose) always makes me mig(lit)ol but gives me diarrhea/flatulence

47
Q

what are the 3 ADR/risk of glitazones?

A

the glitazones affect the cardiac zone = fluid retention/edema
MI
CHF

48
Q

in which patients should glitazones be avoided?

A

patients with heart failure

49
Q

drug class that inhibits secretion of glucagon and delays gastric emptying, decreases postprandial glucose and carbohydrate absorption in the gut

A

amylinomimetic

50
Q

what drug is an amylinomimetic?

A

pramlintide

51
Q

what are the 4 ADR of amylinomimetics?

A

Amy and Pram gave me such a HEADACHE, they made me NAUSEOUS (VOMITING) and ANOREXIC

52
Q

gut hormones (GLP-1) that stimulate release of insulin upon food intake

A

incretins

53
Q

-tide

A

GLP-1 analogs (agonists)

54
Q

in incretin mimetics, the extend of release of insulin is proportional to _____ levels

A

glucose

55
Q

what is an ADR of GLP-1 agonists (analogs)?

A

pancreatitis

56
Q

-gliptin

A

DDP-4 inhibitors

57
Q

what is the MOA of DDP-4 inhibitors?

A

inhibits the removal of GLP-1 by DDP-4 to increase the half-life of GLP-1

58
Q

what are the 2 ADRs of DDP-4 inhibitors?

A

headache
nausea

59
Q

drug class that inhibits glucose reabsorption from the nephron (kidney) = resultant glucosuria lower BG

A

SGLT 2 inhibitors

60
Q

-flozin

A

SGLT2 inhibitor

61
Q

in which patients should SGLT 2 inhibitors be avoided in?

A

patients with renal insufficiency

62
Q

a patient taking an SGLT 2 inhibitor has a significant risk of what?

A

ketoacidosis

63
Q

what are the 4 ADR of SGLT 2 inhibitors?

A

with all the peeing in SGLT 2 inhibitors, we have hypotension, dehydration, UTI and decreased bone density

64
Q

when does DKA usually occur when using a drug for hyperglycemia?

A

with off-label use of SGLT 2 inhibitors in type 1 DM

65
Q

which 2 meds have the highest risk and BBW for hypoglycemia?

A

insulin and pams

insulin
pramlintide + insulin injection

66
Q

how is pramlintide used?

A

with mealtime insulin as an injection

67
Q

which 2 drug classes have the 2nd highest risk for hypoglycemia?

A

sulfy’s and megs
(sulfonylureas and
meglitinides)

68
Q

what should be monitored while managing hyperglycemia in a patient? (3)

A

weight
BG
HbA1c

69
Q

what is the best emergency drug to manage hypoglycemia, via a parenteral route? (2)

A

parenteral glucagon
IV dextrose

70
Q

how does parenteral glucagon manage hypoglycemia in a patient?

A

binds to receptor in liver and increases cAMP = gluconeogenesis

71
Q

what route, besides IV, is glucagon now available in?

A

dry powder for nasal mucosa

72
Q

how can we manage a patient that presents with hyperglycemia crisis (DKA)?

A

IV infusion of regular insulin + fluid

73
Q

after giving a hyperglycemic patient insulin, what should we worry about?

A

hypokalemia due to shift of K into cells

74
Q

a patient presents with hyperglycemic crisis. We give insulin + fluids but they start to experience cramps and arrhythmias. what are they likely experiencing?

A

hypokalemia

75
Q

what are 3 meds that can cause a hyperglycemic crisis?

A

thiazide diuretics
glucocorticoids
off-label use of SGLT2 inhibitors in type 1 DM

76
Q

most circulating T3 and T4 bind significantly to what?

A

thyroxine-binding globulins

77
Q

which medication blocks organification of iodine, preventing the release of T4 and T3 and inhibits Na/I symporter?

A

lugol’s solution

78
Q

which drug class prevents iodide organification and the synthesis of T4 and T3?

A

thionamides

79
Q

which thionamide is the only one capable of preventing peripheral conversion of T4 to T3?

A

PTU

80
Q

what can be given to stop the production of T3 and T4 OR stop the release of T4?

A

radioactive iodine

81
Q

what are 2 ablative/currative treatments for hyperthyroidism?

A

radioactive iodine therapy
thyroidectomy

82
Q

what is the 1st line treatment for hyperthyroidism in pregnancy, children <12, and Graves disease?

A

palliative care = meds

83
Q

what is the most commonly used treatment for hyperthyroidism?

A

thionamides

84
Q

what are the 3 thionamides used for hyperthyroidism and which one is preferred/why?

A

methimazole - preferred d/t less hepatitis

carbimazole

propylthiouracil (PTU)

85
Q

what are the ADR of thionamides? (4)

A

Thanos was so itchy (rash) to taste/smell (altered in methimazole) revenge, that he killed everyone (polyarthritis) but it was (reversible agranulocytosis)

86
Q

if a patient is taking a thionamide, what should we check periodically/what they should watch out for?

A

CBC

fever
sore throat

87
Q

what should we check in any patient taking PTU for hyperthyroidism?

A

check LFT - can cause severe hepatitis

88
Q

what are anion inhibitors called? what do they do?

A

Na/I symporter inhibitors
block uptake of iodide

89
Q

-ate

A

Na/I symporter inhibitors

90
Q

2 iodides that inhibit hormone release and organification, often used with thionamides for thyroid storm

A

lugol’s solution
SSKI (potassium iodide)

91
Q

what are the ADR of iodides? (6)

A

hypersensitivity to iodide
reversible iodism - metallic taste
burning mouth
sore teeth
cross placenta

92
Q

which medications can be used for SNS symptoms in hyperthyroidism?

A

beta blockers (propranolol)

93
Q

what is important to remember when giving a patient a beta blocker to help with angina, HTN, or heart failure?

A

can mask hyperthyroidism

94
Q

in a patient that is experiencing thyroid storm, what would we given them to prevent adrenal insufficiency (decrease in cortisol)?

A

prednisolone

95
Q

what are 3 other drugs that inhibit the peripheral conversion of T4 to T3?

A

amiodarone
corticosteroids
iodinated contrast media

96
Q

what are 2 drugs used to treat hypothyroidism?

A

levothyroxine (DOC)
liothyronine

97
Q

what is the difference between levothyroxine and liothyronine?

A

levothyroxine is a synthetic and chemically pure T4

liothyronine is a synthetic and chemically pure T3

98
Q

liothyronine has a faster onset, but also has _____ _____

A

more ADR

99
Q

why does levothyroxine have a slow onset? (3)

A

converted to T3 in periphery
is metabolized by the liver
and is highly protein bound

100
Q

mnemonic for ADR of liothyronine

A

“since liothyronine is T3 and has faster onset, it has ADR that mimic hyperthyroidism”
increased HR/BP
arrhythmias
angina
tremor
heat intolerance
headache
weight loss

101
Q

if a patient is taking liothyronine, what should we monitor?

A

vital signs
weight

102
Q

T3 and T4 combination drug

A

liotrix

103
Q

thyroid extract from animals that is unstable and has protein antigenicity

A

desiccated thyroid

Pharmacology 2 (22 decks)

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