Medications for Infectious and Neoplastic Diseases and Endocrine Disorders Flashcards
What is the body’s response to a hypoglycemic state?
decreased glucose signals the pancreas to release glucagon. Glucagon stimulates gluconeogenesis and glycogenolysis to release glucose into the plasma to restore glucose plasma levels.
Glycogen is broken down in to glucose
What is the body’s response to a hyperglycemic state?
increased glucose plasma levels signals the pancreas to release insulin. Insulin stimulates Glucose take up by cells in the liver and forms glycogen (Glucose>glycogen= glycogenesis ) Glucose levels return to normal.
What is the age/speed of onset, family hx, primary defect , etiology for type 1 and 2 Diabetes
1: young onset, abrupt, negative family hx, autoimmune. Primary defect = destruction of Beta cells that secrete insulin
2: older onset, gradual, family hx usually present, unknown etiology heredity?, primary defect is tissue resistance and impaired insulin secretion. Majority of symptoms.
What are the insulin levels for Type 1 and 2 diabetes
I: reduced early in the disease and absent later
II: levels may be low (deficient) normal or high(resistance)
What is the treatment for type 1 DM and what makes glucose levels fluxuate?
insulin.
Infection, exercise caloric intake and insulin dose
what does a T1DM patient presentation look like ?
usually thin, malnourished
S/S: Polyuria, polydipsia, polyphagia, weight loss
keytosis is common 2/2 the break down of fats for energy utilization and keytones are left as byproduct
What are DM2 risk factors?
pro: obesity, sedentary, pro diabetes meds, aging, medical comorbidites
anti: balanced diet, lean, active, anti diabetes rx
risk fxs: fam hx, overweight
pacific islander, AA, Hispanic, pre diabetes, high BP, high lipids, diabetes with pregnancy >9lbs bb
What is the impairment in diabetes 2
impaired insulin secretion and tissue resistance
-As the dx progresses, secretion does not match the plasma glucose level
target tissue dont take up glucose
-Decr binding, receptors, and responsiveness
- beta cells decr production and secretion
what is the treatment for T2DM ?
Reduced caloric diet + exercise
Oral antidiabetic
Non-insulin injectable agent with or without insulin
What does a T2DM presentation look like
Polyuria, polydipsia, polyphagia(may asymptomatic at first)
obese
keytosis in uncommon,
What are microvascular compilations of DM?
Retinopathy Nephropathy -decr GFR and incr BP Sensory and motor neuropathy Gastroparesis Amputations secondary to infection Erectile dysfunction
What are macrovascular complications of DM?
CV risk
Peripheral vascular disease
Brain: TIA, Cognitive impatient, stroke, CVA
What are two acute medical emergencies you should watch out for with DM and how does this happen?
- Diabetic Ketoacidosis (DKA)
- Hyperosmolar Hyperglycemic State (HHS)
insulin circulation is poor which leads to counter regulatory levels of glucagon , catecholamines, growth hormone and cortisol. This leads to increase glucose production and impaired utilization by the peripheral tissues
- Dehydration, E- abnormalities are caused 2/2 diuretic, lots of peeing.
- coma seizure or death can happen by increased glucose levels
DKA is a concern for which population?
TYPE 1
- blood glucose >250
- pH <7.3
- Plasma osmolality <320
- large increase in keytones
- breath may smell sweet, rotten apples or nail polish
HHS is a concern for which population?
type 2
- blood glucose >600
- pH >7.3
- Plasma osmolality >320
- minimal/ no change in keytones
A patient is weak, SOB, N/V, is hyperglycemic and has fruity breath. What your be wrong and what should you do?
DKA - emergency situation Signs & Symptoms •hyperglycemia •High ketone levels in your urine & blood •Abdominal pain •Weakness or fatigue •Shortness of breath •Fruity-scented breath •Confusion
A patient has Blood sugar level of ≥ 600, what could be the cause and what shoudl you do?
HSS, this is a medical emergency •Blood sugar level of ≥ 600 mg/dL •Excessive thirst •Dry mouth •Increased urination •Warm, dry skin •Fever •Drowsiness, confusion •Hallucinations •Vision loss •Convulsions •Coma
How do you Dx Dm?
Glucose levels are tested on 2 seprate occasions with HbA1c, a measuremetn of longterm glucose and no need to fast, or a fasting glucose test. Diabetes if: HbA1c >6.5 Fasting >126 oral glucose> 200 Normal id 5.7, <99, <139
How often do patients check their blood glucose levels
Therapies vary widely:
Metformin monotherapy: possibly ~1-2x/week
T1DM on intensive insulin therapy: ≥ ~8x/day
What are target values for blood glucose?
Before meals: ~90-130 mg/dL
At bedtime: ~100-140 mg/dL
What are 4 different types of insulin preparation drugs?
Insulin lispro (short, duration, rapid acting)
Regular insulin (short duration, slower acting)
NPH insulin (intermediate duration)
Insulin glargine (long duration)
What drugs are Oral Insulin Secretagogues ?
Sulfonylureas
Meglinitides (Glinides)
What does insulin do?
Insulin stimulates Glucose take up by cells in the liver and forms glycogen
What causes insulin to be released into the blood?
rise in blood glucose
- normally there is a close relationship btwn increased blood glucose and insulin secretion
-insulin has anabolic actions:
transport of G, Aminos, nucleotides and K
When should you take Lispro? Regular insulin? NPH? Lantus ?
Lispro- one meal at a time (15 mins before or after)
Regular insulin- with breakfast lunch and dinner 30mins before
NPH- 2x day with break and dinner
Lantus - 1-2x day regardless of meals
how is insulin administered ?
Sub subcutaneously with needle or pump or IV infussion
What are the symptoms of low blood sugar?
trembling pounding heart sweating hunger numbness/ tingling sleepy irritable headache VERY LOW confusion, blurred vision, difficulty speaking, seizure/coma
Your patient has a hypoglycemic episode, what should you do?
•Fast-acting oral sugar: glucose tablets, orange juice, non-diet soda, sugar cubes, honey, corn syrup •Patients should always have oral carbohydrates available •15/15 rule ~15g of carbohydrates: 3-4 glucose tablets 1 tube of glucose gel 4 oz of juice 4 oz sweetened soda 5 life savers
What are factors/ reasons that a hypoglycemic issue can go undetected and which symptom wont be masked ?
Diabetic Autonomic Neuropathy (DAN)
Frequent hypoglycemia
Patients using beta-blockers
Tachycardia, palpitations, tremors can be masked, but sweating wont be.
DONT USE HR AS EX INDICATOR, RPE is better
What and Who is metformin used for?
1st line tx for T2DM
↓ hepatic glucose production
↑ tissue response to insulin
↑ anaerobic metabolism of glucose in intestine
Side effects: weight loss, GI symptoms—decrease appetite, nausea, diarrhea NOT HYPOGLYCEMIA
What and Who is Glimepiride used for?
T2DM, 2nd choice
Promotes insulin secretion by pancreas
•Side effects: Hypoglycemia, weight gain
What and Who is Meglitinides (Glinides) used for?
T2DM - 2nd line
Promote insulin secretion
Side effects: Hypoglycemia, weight gain
What and Who is Thiazolidinediones (TZDs/Glitazones) used for?
T2DM - 2nd line
↓ insulin resistance (i.e. ↑ glucose uptake by muscle & adipose tissue)
↓ hepatic glucose production
similar to metformin but has SE
Adverse effects: worsens heart failure, bladder cx, fractures, ovulation
Do we have to know the oterh drugs?
DPP-4 Inhibitors (Gliptins) DPP-4 Inhibitors (Gliptins) GLP-1 Agonists (Incretin Mimetic)* Amylin Mimetics* * hypoG concern SE
Your patient has DM, what questions should you ask them?
When was the last time they exercised?
What signs and symptoms does the patient usually experience during a hypoglycemic episode?
Does the patient have rescue food readily available?
What should you do if the patient has S/S of DM ?
Send to PCP if they do have it and they come in - ask about non pharma options -is their DM well controlled? -are they compliant with med regimen?
