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Endocrine Flashcards

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1
Q

another name for Somatropin?

A

GH

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2
Q

Somatropin MOA? AE?

A

MOA: synthetic growth hormone that has a role in bone, skeletal muscle and organ growth; increased red blood cell mass; transport of water, electrolytes and fluid and other functions

AE: fluid retention/edema, muscle and joint pain

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3
Q

Another name for Vasopressin?

A

antidiuretic hormone (ADH)

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4
Q

What do you give for bed wetting?

A

DDAVP

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5
Q

How to DDAVP work?

A

Increase permeability of water

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6
Q

PT concerns with Hypopituitarism

A

Drug treatment accuracy is difficult –> altered hormone levels exceeding normal ranges
Be alert for AE of elevated hormone levels
Low GH level = low bone density –> bone fractures, slipped capital femoral epiphyses

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7
Q

Ex of glucocorticoid

A

hydrocortisone, cortisol

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8
Q

Ex. Mineralocorticoid

A

Aldosterone

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9
Q

what is Addison disease?

A

insufficient production of cortisol and aldosterone

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10
Q

Cushing disease

A

Excessive glucocorticoids (exogenous or endogenous)

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11
Q

what can cause secondary adrenal insufficiency?

A

Taking glucocorticoids for a long time then stopped abruptly without tapering

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12
Q

What are short-term AE for glucocorticoids use?

A

↑ blood glucose, mood changes, fluid retention

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13
Q

What are long-term AE for glucorticoids use?

A

osteoporosis/↑fracture risk, thin skin, muscle wasting, poor wound healing, adrenal suppression, Cushing’s disease(to much steroid), ↑ risk of infection due to immunosuppression

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14
Q

Person with Glucocorticoid Deficiency- in times of stress or strenous exercise what should they do?

A

may require significantly higher med doses or require additional hydrocortisone before strenuous exercise

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15
Q

How do you treat Mineralocorticoid Excess/Hyperaldosteronism?

A

potassium sparing diuretic)
Spironolactone: nonselective for aldosterone receptors
Eplerenone: selective for aldosterone receptors-

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16
Q

What do you replace when someone has Glucocorticoid Deficiency and Mineralocorticoid Deficiency?

A

fludrocortisone

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17
Q

Therapeutic Concerns about Adrenal Steroids?

A

Catabolic effect on supporting tissues- Breakdown of muscle tissue, bone density 🡪 weakness, osteoporosis
Use caution to not overload muscles/bones during strengthening
Glucocorticoids and mineralocorticoids may cause HTN due to NA+ retaining properties
Immunosuppression: increased susceptibility to infection

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18
Q

How do you treat hypogonadism?

A

Testosterone replacement

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19
Q

What to look for in testosterone replacement?

A

weigh benefits of treating symptoms vs CV risk
No PO option due to hepatotoxicity
Topical placement varies by product but should always be covered by clothes

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20
Q

Risk with testosterone?

A

Possible ↑ risk of MI, stroke or CV death = only use if truly indicated
Prolonged use = ↑ risk hepatic toxicity (hepatitis, jaundice)

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21
Q

Anabolic-androgenic steroids

A

CV, cancer, infection, Endocrine: males- feminization; females- menstrual irregularities, Musculoskeletal: tendon/ligament rupture, Psych

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22
Q

Combination oral contraceptive AE?

A

↑ BP, N/V (usually improves after 2-3 cycles), weight gain, acne, depression
Rare: stroke, MI (especially if >35 years, uncontrolled HTN, smoker, DM)

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23
Q

Long-acting intrauterine device (IUD) risk

Study These Flashcards
A

Monitor for device complications, copper associated with ↑ bleeding 🡪 anemia

24
Q

Post-menopausal hormone replacement therapy (HRT)

treatment

Study These Flashcards
A

Estrogen/progestogen combo or estrogen alone (if no uterus)

25
HRT risk
DVT, PE, breast cancer (with combo), endometrial cancer (with estrogen alone)
26
Therapeutic Concerns about Sex Hormones
Monitor blood pressure since these hormones promote Na+ and water retention (mineralocorticoid-like properties) Negative effects: increased aggression, increased LDLs, gynecomastia Other adverse effects: liver, cardiovascular, and reproductive abnormalities (reduce sperm count)
27
Hyperparathyroidism drug treatment
Calcimimetics and Bisphosphonates
28
Hypoparathyroidism drug treatment
calcium (1-3 grams per day) and vitamin D | Overtreatment may cause hypercalcemia and hypercalciuria (leading to nephrolithiasis/kidney stones)
29
Hashimoto’s disease symtoms
Hypothyroidism Symptoms: bradycardia, anemia, lethargy, weight gain, cold intolerance, menstrual irregularities, generalized muscle weakness Goiter may form from constant stimulation of TSH from lack of negative feedback
30
Levothyroxine (Synthroid) MOA, AE
MOA: convert T4 to T3 AE: typically well tolerated unless overtreat then will see symptoms of hyperthyroidism Sweating, heat intolerance, tachycardia, diarrhea, nervousness, menstrual irregularities, ↑ basal metabolic rate
31
Levothyroxine (Synthroid) what to look out for
NTI drug- Requires monitoring and dose adjustments (initially every 4-8 weeks, then every 6-12 months when stable) Take on empty stomach (30-60 minutes before AM meal, or 3-4 hours after PM meal, including coffee) Separate from iron, calcium, magnesium, and aluminum containing products, or bile acid sequestrants by 4 hours due to binding thus not absorbed and make TSH levels go up
32
Overtreatment Levothyroxine (Synthroid)
Must monitor levels to avoid overtreatment Refer to provider if symptoms of hyperthyroidism If very excessive overdose can ↑ risk MI, HF, angina Long-term overtreatment can lead to ↓ bone density and ↑ risk fractures Due to osteoporosis, maintain lowest effective dose, especially in postmenopausal women
33
Graves Disease symtoms
Hyperthyroidism- thyroid storm can be fatal: dehydration, tachycardia, delirium, fever etc. Goiter, exopthalmos (protruding eyes), high metabolism, nervousness, weight loss despite increased appetite
34
Graves disease drug treatment
Antithyroid meds- Methimazole
35
Methimazole MOA, AE
MOA: Blocks formation of T4 and T3 by inhibiting oxidation of iodine Common AE: rash, GI upset, arthralgia (refer to provider due to risk of rare but serious polyarthritis) Treatment can cause hypothyroidism
36
What causes osteoporosis?
Occurs when formation of new bone does not keep up with bone resorption, due to a decline in osteoblast function
37
Medications for osteoperisis
Bisphosphonates (most common) Denosumab Sclerostin Inhibitor
38
Calcium and Vitamin D AE | Vitamin D dosage vary
GI- constipation | dosage will vary upon age
39
Bisphosphonates (-dronate) MOA, AE
MOA: binds to a key enzyme to inhibit the natural bone turnover pathways 🡪 ultimately ↑ osteoclast apoptosis which ↓ bone turnover Most common AE: mild upper GI symptoms
40
Bisphosphonates (-dronate) what to look out for
Take with plain water 30-60 minutes before any food or medications and stay upright Food and meds (especially proton-pump inhibitors; calcium, magnesium and iron such as MVI, antacids, supplements) can ↓ absorption up to 90% GI AE are ↑ if not upright Atypical femur fracture
41
monitoring with bisphosphonates
Other monitoring: Hypocalcemia- refer to provider if muscle cramps/spasms, or numbness and tingling Reports of severe joint, muscle and bone pain- refer back to provider
42
Denosumab (Prolia) MOA, AE
denosumab binds to RANKL which ultimately inhibits bone resorption AE >10%: arthralgia, atypical fracture, increase risk of infection
43
Sclerostin Inhibitors MOA AE
MOA:  inhibits sclerostin, a regulatory factor in bone metabolism = ↑ bone formation Most common AE: arthralgia rare- atypical fractures
44
Therapeutic Concerns about Thyroid and Parathyroid drugs
Excessive doses of drugs used to treat either hyper- or hypofunction tend to produce symptoms of opposite disorder Avoid overexertion in patients with decreased CO and hypotension caused by hypothyroidism Excessive doses of calcium supplements for parathyroid dysfunction can alter cardiovascular function 🡪 arrhythmias
45
symptoms of hypoglycemia-
shakey, sweaty, dizzy, confused and difficulty speaking, hungry, weak or tired, hungry, nervous or upset
46
medication class to treat diabetes
Biguanide (metformin) Sulfonylureas (SU) Thiazolidinediones (TZD) Dipeptidyl-peptidase 4 inhibitors (DPP-4i) Sodium glucose co-transporter 2 inhibitors (SGLT2i) Glucagon-like peptide 1 agonist (GLP1a) Insulin
47
Metformin (Glucophage) MOA:
MOA: not fully known but inhibits production of glucose, inhibits intestinal absorption of glucose and increases insulin sensitivity in muscle and fat
48
Metformin (Glucophage) AE:
Common AE: GI (diarrhea, nausea, abdominal cramping/bloating) Vitamin B12 deficiency: typically after extended look, can be misdiagnosed as peripheral neuropathy
49
glipizide- Class, MOA, AE, what to look out for
MOA: binds sulfonylurea receptor in the pancreas --> depolarization causes insulin release AE: hypoglycemia (especially in elderly and renal dysfunction) Typically before breakfast; immediate release must be 30 minutes before meal --> if not taken correctly may ↑ hypo risk
50
Thiazolidinedione (TZD)
MOA- “insulin sensitizer” | lowest hypoglycemia risk
51
Sitagliptin (Januvia) Class, MOA, AE
DPP-4 Inhibitors increased incretin hormone levels → increase insulin synthesis/release and decrease glucagon secretion low hypoglycemia risk arthralgia
52
empagliflozin (Jardiance) Class, MOA, AE
SGLT2 inhibitor MOA; blocks glucose reabsorption in the kidney thus ↑ urinary glucose excretion Common AE: volume-depletion related AE (dehydration ) Some can reduce risk of renal complications, CV events
53
semaglutide (Ozempic)- Class, MOA, AE | other uses
GLP1 Receptor Agonist ↑ insulin secretion in presence of elevated glucose, ↓ glucagon secretion (which ↓ hepatic glucose production), slows gastric emptying (↑ satiety) Common AE: GI (nausea, bloating, diarrhea) obesity and CV events
54
Bolus rapid and regular onset/duration
Rapid: Onset 10-30 minutes, duration 3-5+ hours Regular (AKA: short) Onset ~30 minutes, duration 4-12 hours Typically inject before a meal (sometimes immediately after) can also be used to correct hyperglycemia
55
therapeutic concerns with DM
>300 mg/dL NO PHYSICAL THERAPY- Below 100 mg/dL: eat a snack before activity Monitor 6-12 hours after exercise Know the symptoms of hypo- and hyperglycemia Keep sugary drink/snack (orange juice, soda) readily available in case of hypoglycemia Is the patient aware of hypo- or hyperglycemia symptoms? Premeal insulin may need to be modified for postmeal exercise Avoid heat/massage to area that was recently injected with insulin Good footwear is critical!

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