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Endocrine Flashcards

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1
Q

down regulation

A

medication may act as hormones
body recognizes excess and cells will down regulate the number of receptors
causes desensitization
cells less responsive to the hormone

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2
Q

endocrine negative feedback mechanism

A

endocrine system works by negative feedback
endocrine tissue will stop secreting hormone when homeostasis is restored

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3
Q

Diabetes

A

syndrome characterized by hyperglycemia resulting from an absolute or relative impairment in insulin secretion/ action
disorder of carbohydrate metabolism: deficiency of insulin, resistance to action of insulin

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4
Q

body system of diabetes

A

liver, pancreas, skeletal muscles

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5
Q

role of liver in diabetes/ sugar

A

turns stored glycogen into glucose

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6
Q

Glucose

A

most important energy source
brian is highly dependent on it for energy, other tissues as well
comes from food and from production by liver( glycogenesis)
2 hormones exert most influence: glucagon and insulin

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7
Q

glucagon

A

hormone produced by alpha cells of pancreas
released when glucose levels in blood are too low
cause liver to convert stored glycogen into glucose and release into blood stream
raises blood sugar levels

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8
Q

how does the body respond to high blood glucose

A

pancreas releases insulin
liver produces glycogen, cells take up glucose from blood
blood glucose falls

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9
Q

how does the body respond to low blood glucose

A

pancreas releases glucagon
liver breaks down glycogen
blood glucose rises

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10
Q

glycogen

A

storage form of glucose
function as a shrt term energy storage
can be quickly mobilized to meet sudden need of of glucose
made primarily in liver

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11
Q

Insulin

A

hormone that regulates carbohydrate metabolism
lower blood glucose
released rapidly in response to high glucose levels
stimulates uptake of glucose into cells, especially in muscle and fat

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12
Q

insulin in the liver

A

stores glucose in form of glycogen
converts excess glucose into fat
suppresses hepatic glucogenesis and glycogenolysis

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13
Q

insulin release

A

plasma- glucose in most important factor in controlling release
quick so carbs are absorebed/ used/stroed in liver to prevent serum glucose levels from rising to high

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14
Q

postprandial

A

after eating, typically refers to the increase in glucose that causes insulin to be released by beta cells

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15
Q

what happens without insulin

A

blood glucose levels elevate, causing increased urination, hunger, thirst
muscle used for energy: weight loss
fat is used for energy: ketones, which can cause diabetic ketoacidosis

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16
Q

3 Ps of insulin shortage/ resistance

A

polyuria (increased urination)
polyphagia (increased hunger)
polydipsia (increased thirst)

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17
Q

Indications for insulin

A

type 1/2 diabetes
DKA
hyperosmolar hyperglycemic state
surgery
use of glucocorticoids/ corticosteroids and vasopressors
illness/ infection
stress
parental/enteral nutrition
pancreatitis and diseases that decrease beta cell function
hyperkalemic pt
gestational diabetes

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18
Q

DM type 1

A

absolute deficiency of Insulin
autoimmune destruction of pancreatic beta cells
increased glucose cant get into cells, body mistake that there isnt enough glucose
body break down lipid and proteins to gain energy
insulin is indicated in all cases of Type 1
occurs mainly in childhood or puberty, but can happen anytime
rapid onset
underweight

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19
Q

DM type 2

A

insulin resistance
plasma insulin normal or increased
tissues resistant to insulin
adult onset, linked to obesity, sedentary lifestyle, lack of exercise, race
initially controlled with lifestyle changes, may need oral drug therapy, than insulin
gradual onset
overweight

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20
Q

T1 symptoms

A

polydipsia, polyuria, polyphagia, weight loss

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21
Q

T2 symptoms

A

3 Ps, blurred visions, fatigue recurrent infections

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22
Q

pregnancy effecting diabetes

A

placenta produces hormone that antagonize the action of insulin
production of cortisol increases threefold
glucose can pass freely from the maternal to the fetal circulation (fetak hyperinsuliinemia)

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23
Q

Gestational diabetes

A

diabetes that devlops during pregnancy
2-10% of pregnancies in US
subsides rapidly after delivery
treated with Insulin, diet, exercise

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24
Q

fasting blood glucose levels

A

70-110

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25
normal non fasting blood glucose
less than 140
26
pre diabetes blood glucose fasting
110-125
27
diabetes blood glucose fasting
greater than 126
28
diabetes non fasting blood glucose levels
more than 200
29
diabetes complications
renal failure cardiovascular complication blindness nerve damage amputation
30
non-pharm diabetes treatment
lifestyle modification diet exercise weight loss
31
Drugs used in conjunction for DM
ace inhibitors or ARB for hypertension statins for lipida
32
insulin sources
From pork: differs from human by 1 amino acid Human: made from recombinant tech, human like should be non-allergenic synthetic insulin analogs
33
basal insulin
continuous secretion that maintains glucose bodys baseline of level of insulin
34
prandial insulin
insulin secretion in response to meals
35
correctional supplemental insulin
correct any elevation in blood glucose usually due to illness or stress
36
rapid/short acting insulin
covers meal intake used for elevated BG
37
intermediate/ long acting insulin
used for basal insulin needs not intended to cover meals
38
rapid acting insulin kinetics
Onset: 10-30 min peak: 1hr duration: 3-5 hr clear before eating or with meals
39
types of rapid acting insulin
Humalog: lispro NovoLog: aspart Apidra: glulisine
40
short acting insulin kinetics
onset: 30-60 min peak: 1-5 hrs Duration: 6-10hr IM IV: half life of 4-5 min`
41
short acting insulin types
regular: humulin, novalin
42
intermediate acting inulin kinetics
onset: 1-2 hrs peak: 6-14hrs duration: 16-24hrs cloudy appearance BID TID only given SubQ cannot be mixed with short acting insulins
43
intermediate acting insulin
type: NPH insulin N, Humulin N, Novolin N
44
long acting insulin kinetics
onset 1-2 hrs peak: flat duration: 12-24hrs clear not given IV used with other Insulins
45
why are long acting insulins not mixed
they do not mix because of low pH
46
long acting insulin types
Lantus (glargine)- qd U-1100 Levemir (detemir) qd, Bid dosing
47
lantus duration
18-24 hrs
48
levemir
12-24 hrs
49
concentrated insulin
for large amounts of insulin 500 U/ml can cause severe hypoglycemia
50
what insulin is cloudy
NPH
51
sliding scale
for correctional insulin treatment rapid or short acting insulin to correct BG before meals not effective as sole source of insulin treat BG post hyperglycemia
52
insulin general kinetics
destroyed by gastric acid, not given orally subq- abdomen fastest rate of absorption, then arm,tthigh, buttocks in IV- up to 80% absorbed by IV tubing
53
Insulin storage
refrigerate, kept up to 1 month without significant loss of activity out of direct sunlight and extreme heat
54
S/S of hypoglycemia
tachycardia tremulousness, confusion, agitation, seizures, muscle weakness, blurred vision, diaphoresis, seizures, LOC, Death
55
treatment of hypoglycemia
if swallow: sugar (OJ, candy, glucose) no swallow: IV glucose or D5W, glucagon IM
56
Lipohypertrophy
increased fat mass at injection site causing spongey area insulin absorption delayed from this site
57
lipoatrophy
antibody formation causes destruction of fat at injection site can cause depression in skin and dleayed absorption
58
insulin on potassium
helps move potassium inside the cells Insulin used for treatment of hyperkalemia, can also couse hypokalemia
59
Insulin drug-drug interaction
any hypoglycemic agent, diuretics, glucocorticoids, phenytoin, beta blockers
60
barriers to insulin
fear of needles/unknown, cost, inconvenience, weight gain
61
agb A1C to blood glucose
goal of under 7
62
insulin monitoring
by self, or HgbA1C over span of time
63
Insulin Pens
hold 150-300 units reusable or disposable dial dosage and inject
64
insulin pen pros
portable, discreet, convenient, saves time, accurate dosing
65
insulin pen cons
expensive, waste, cant mix insulins, size of numbers on dial, strength/ dexterity to use
66
insulin pump
usually rapid/short acting insulin basal insulin over 25 hrs mimics physiological secretion of insulin insertion site q3 days, same as injection
67
insulin pump candidates
motivated for better control, can be type 1/2 test BG QID high A1c blood glucose swings those with frequent hypoglycemia
68
Pros of insulin pumps
less needle pricks dose calculations convenience and spontaneity imporoves A1C and glucose control bettery quality
69
Cons of insulin pumps
cost steep learning curve complication worn all the time skin infections/rash
70
biguanides
drug of choice for most type 2 P-metformin
71
metformin MOa
decreases hepatic glucose production sensitizes insulin receptors decreases intestinal glucose absorption does dot increase insulin secretion insulin must be present already for drugs to work
72
metformin kinetics
absorption: orally, absorbed slowly but incompletely results in bioavailability of 50-60% food delays absorption Onset: peak in 2-3 hrs metabolism: does not undergo hepatic metabolism elimination: excreted unchanged by kidneys, bad for renal
73
metformin adverse effects
GI distress most common decreased appetitie, nausea, diarrhea metallic taste not associated with hypoglycemia in therapeutic doses
74
Metformin BBW
can cause lactic acidosis- can keep lactic acid from being destroyed LA risk increased with renal insufficiany patients S/S hyperventilation, myalgia, malaise, GI distress hold before/ after studies using iodine IV contrast avoid alcohol
75
metformin drug interactions
cimetidine, digoxin, procainamide, vancomycin increased metformin concentration due to competition for renal tubular secretion W/ iodine, increased incidence of lactic acidosis W/ herbals increased incidenc of hypoglycemia
76
pearls of metformin contraindications
with liver disease, alcoholics, acute or chronic metabolic acidosis, chronic heart failure, renal impairment with meals drug of choice with new diagnosis
77
first generation sulfonylureas
chlorpropamide tolbutamide
78
second generation sulfonyleureas
P- glyburide (diabeta, micronase) glipizide glymepiride
79
sulfonylureas MOA
stimulate pancreatic beta cells to secrete insulin, aka secretagogue reduces glucose output from liver by decreasing glycogenolysis and gluconeogenesis increases insulin sensitivity at cellular sites only used in Type 2
80
sulfonyereus kinetics
half life- 10 hrs onset 2 hrs peaks 2-4 hrs duration 24 hrs
81
sulfonylereus adverse effects
hypoglycemia weight gain hyponatremia skin rash GI upset cholestasis hemolytic anemia
82
pearls of sulfaneyrleurus
warning with sulfa allergiea, thiazide diuretic caution with renal/hepatic disease 30-60 min before meals, in morning avoid alcohol, supplements, alternative therapies because increased risk of hypoglycemia
83
meglitinides
P- repaglinide (prandin) nateglinide (starlix)
84
meglitinides MOA
stimulate secretion of insulin provide quick insulin burst with onset of action in 20 minutes minimal renal exretion, good for renal pts for lowering post prandial glucose levels
85
thiazolidinediones
p- piogllitazone ( actos) rosiglitazone ( avandia)
86
thiazolidinediones MOA
reduces insulin resistance (insulin sensitizer) insulin must be present for it to work inhibit hepatic cluconeogenesis adverse effects: edema, weight gain, HF, decreased liver function, anemia may increase ovulation in women
87
Alpha- glucosidase inhibitors
P- acarbose (precose) miglitol (glyset)
88
alpha- glucosidase inhibitors MOA
do not secrete nor sensitize to insulin inhibits glucosidase in small intestine leads to delayed absorption of carbs decreased post-prandial blood glucose rise takes 2-3 months w/ first bite of meal cannot use candy if become hypoglycemis b/c will not be absorbed
89
alpha- glucosidase inhibitors adverse effects
flatuence, cramps, diarrhea, abdominal pain, iron deficiency anemia, increased hepatic enzymes
90
Incretin hormone (GLP-1)
released by small intestine increases amount of insulin secreted decrease amount og glucagon secreted delay gastric emptying decrease food intake
91
GLP-1 agonists
p- exenatide (byetta) exenalide (bydureon) lireglutide (victoza) dulaglutide (trulicity) albigluitide (tanzeum) samaglutide (ozempic)
92

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