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Advanced pharmacology > DM, Thyroid, Osteoporsis > Flashcards

DM, Thyroid, Osteoporsis Flashcards

(50 cards)

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1
Q

Type 1 diabetes

A

Insulin deficiency cause by beta cell destruction. Dependency on exogenous insulin for survival

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2
Q

Type II DM

A

Insulin resistance, linked to obesity. Exogenous insulin not necessary for survival but may be required as the disease progresses

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3
Q

Gestational DM

A

Glucose intolerance with onset during pregnancy

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4
Q

Pre - diabetic

A

Intermediate stage in which glucose levels abnormal but does not meet the criteria for official dx. Impaired fasting glucose and glucose intolerance

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5
Q

Type I symptoms

A

Brief period of profound symptoms : polyuria, polydipsia, polyphagia, weight loss , blurred vision / fatigue

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6
Q

Type II symptoms

A

Relatively symptom free or only subtle symptoms that may persist fir weeks months or years

Polyuria, polydipsia, blurred vision, slow healing wound, freq infection

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7
Q

Pre-diabetic fasting plasma glucose , oral glucose tolerance test, and HbGAiC

A

Fasting : 100-125
Oral : 140-199
H1C : 5.7-6.4 %

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8
Q

NORMAL fasting plasma glucose , oral glucose tolerance test, and HbGAiC

A

Fasting : < 100
Oral : < 140
H1C : < 5.7

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9
Q

DM fasting plasma glucose , oral glucose tolerance test, and HbGAiC

A

Fasting > 126
Oral > 200
H1C ; > 6.5

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10
Q

Management and proper treaments for DM

A

Nutritional therapy :
Exercise and physical activity : causes increased glucose uptake in skeletal muscle and improved insulin sensitivity ; in type II also decreases insulin resistance and increases glucose uptake into cells

Current goals : are individualized and are based on what is acceptable to the medical provider and patient while preventing acute complication and progression of chronic complication

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11
Q

insulin

A

Insulin receptor allow utilization of glucose by cells

Exogenous insulin should closely mimic endogenous insulin ( basal + bolus)

of insulin receptor mitigated by obesity and long standing hyperglycemia

Theory to administer early on in type II may reduce progression

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12
Q

Rapid acting insulin

A

Novolog , Glulisine, Lispro

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13
Q

Novolog

A

Onset : 10-20 min Peak : 1-3 hours Duration : 3-5 hours

Meal and correction

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14
Q

Lispro

A

Onset : 15-30 min
Peak L 1.5-2.5 hours
Duration : 5 hours

Meal and correction

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15
Q

Short acting insulin

A

Regular

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16
Q

Regular insulin

A

Onset : 30-60 m in
Peak : 2-4 hours
Duration : 5-8 hours

May mix with NPH, MUST be given 20-30 min before a meal

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17
Q

Long acting

A

Langues, Levemir, Teresiba

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18
Q

Lantus

A

Onset: 50-120 min
Peakless
Duration : 24 hours

Do not mix with other insulin’s . Given once daily or 12 hours apart if BID

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19
Q

Individualized A1C targets

A

A1C < 6.5 % for patient w/o cocurrent serious illness and at low hypoglycemic risk

A1C > 6.5 % for pt with concurrent serious illness and at risk for hypoglycemia

7-7.9 % : in older adults with polypharmacy and other comorbidtities

8-8.9 % - end of life

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20
Q

Metformin

A

MAO: decreases hepatic glucose production and intestinal glucose absorption : increases insulin sensitivity

Adverse: N/V/D ( take with food ) Vitamin B12 depletion

Serious adverse effects : lactic acidosis, megablastic anemia , hepatotoxicity

Pearls: hold for acute MI, CHF , surgery or CT with contrast , take extended release tablets with evening meals

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21
Q

Exantatide

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A

MOA: stimulates insulin secretion, slows gastric emptying and decrease food intake

Brand name : Byetta

Adverse : n/v/d weight loss

Serious : pancreatitis , nephrotoxicity

Contraindication : IM/IV use

Pearls: use Byetta within 60 min before eating the meal

22
Q

Liraglutide

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A

MOA: stimulates insulin secretion, decreases glucagon levels

Brand name: Victoza

Pearls: may be taken at anytime of the day ( w/ or w/o meal) .

Only GLP-1 RA approved for cardiac event risk reduction

23
Q

Dapaglifozin , Canagliflozin Empagliflozin

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A

SGLT2
Oral

MOA: promotes the renal excretion of glucose

Adverse: UTI

Clinical pearls: should be taken before 1 st meal of day

Black box warning for toe and foot amputations with - Canagliflozin

Possible ASCVD risk reduction with Jardiance

24
Q

Rosiglitazone and Pioglitazone

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A

Oral

Increases insulin sensitivity and decreases hepatic glucose output

contraindication: HF and MI

Not recommended for use with insulin … may cause anovulatory women to resume ovulation

25
Glipizide, Glyburide and Glimepiride
Sulfonylureas Oral MOA: stimulates islet cells to secrete insulin, prolonged administration may reduce hepatic glucose output and improve insulin sensitivity Clinical pearls : take 30 min before meal . Therapy may fail after 10-15 years
26
Normal TSH and T4 levels
TSH - .3-.52 | T4 .7-1.85
27
Values in hyperthyroidism
TSH = low t4 = high
28
Values in hypothyroidism
``` TSH = high T4 = low ```
29
Hypothyroidism effects on the body
Brain fog, thinning hair, goiter, heart attack risk, gallstones, mental health, high blood pressure, heartburn, dry skin, weakness
30
Diagnosing hypothyroidism
Most times symptoms may not be present Primary : high TSH and low T4 - after repeat —> replacement therapy with t4 should be initiated Sub Clinical : high TSH T4 - WNL — > replacement therapy a case by case
31
Goals of therapy for hypothyroidism
Amelioration of symptoms Normalization of serum TSH secretion Reduction in the side of goiter Avoidance of over treatment
32
Treatment - hypothyroidism
Levothyroxine MOA: de-iodinates in peripheral tissues to form T3, the active thyroid hormone Clinical pearls: take on empty stomach , ideally 1 hour before breakfast and do not take with other medications Monitoring: check levels 6 weeks after initial dose and increase by 12-25 mcg/day Dose increase when : preg, weight gain, diminished absorption , increased rate of metabolism Dose decrease : normal aging, weight loss
33
Pediatrics and hypothyroidism
Look for pt with slow growth patterns, decreasing school performance and delayed puberty
34
Pregnancy and hypothyroidism
They will need a higher dose of T4 during pregnancy to maintain normal TSH secretion Give levothyroxine dosage should be returned to the pre-pregnancy dose
35
Treatment for hyperthyroidism
Symptom control : beta-blocker initiation w/ diagnosis to decrease palpitations, tachycardia, tremulousness, anxiety and heat intolerance Decrease thyroid hormone synthesis : anti thyroid / thionamide drugs , radiodine or surgery
36
Thionamides
Advantages = chance of permanent remission lower initial cost Disadvantage : requires frequent monitoring
37
Radioiodine
Advantage : permanent resolution of hyperthyroidism Disadvantage : permanent hypothyroidism
38
Surgery
A: rapid, permanent cure D: high cost
39
Treatment for significant treatment of hyperthyroidism ( older age, CV risk )
Thionamide with beta blockers followed by radioiodine or surgery
40
TD for mild hyperthyroidism , minimal thyroid enlargement an no orbitopathy
Radioiodine w/o thionamide pretreatment or gluccorticoid Or 1-2 yr course of thionamides
41
Mild hyperthyroidism minimal thyroid englarment and milt orbitopathy
Radioiodine with glucocorticoid coverage but w/o thionamide pretreatment Or 1-2 yr course of thionamides
42
Severe and moderate to severe
Surgery rather than radioiodine w/ glucocorticoid
43
Pregnancy hyperthyroidism
1 st = PTU 2nd and 3rd = methimazole Methimazole > PTU with teratogencity Heptatoxicity ; PTU > methimazole Gestational weeks 6-10 highest incidence of birth defects Switch to methimazole at week 16
44
Major clinical recommendations for osteoporosis
Assure ca .1200 and vit D 800-100 IU intake after age 50+ Weight and muscle strengthening intake Preforms BMD females 65 + every two years Initiate tax for BMD Y scores < 2.5 Initiate in postmenopausal with T score -1.0 and -2.5
45
Osteoporosis risk factors
Decrease calcium intake / vitamin D insufficieny Immobilization 3 + alcohol drinks Females Low BMI Active or passive smoking Medication use
46
Medications that affect bone density
``` Heparin Anticonvulsants Glucocorticoid Chemo Psychotropics Narcotics Barbiturates PPI ```
47
Defining osteoporosis by BMD
Normal T = -1.0 Low bone mass : t score -1.0 and -2.5 Osteoporosis : T score at or below -2.5
48
Pharmacotherapy for osteoporosis
First line is bisphosphonates Calcitonin SERM
49
Fosamax
Bisphosphonates Remain upright at least 30 min before eating, drinking or taking any other medication Consider drug holiday after 3-5 years Don’t use PO with comorbid GI issues
50
Calcitonin
Approval for women > post menopausal when alt not suitable

Advanced pharmacology (12 decks)

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