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Endocrine Flashcards

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1
Q

What medications are used for Diabetes?

A

Sulfonyureas
Medglitinides
Biguanides
TZDs
DPP4I
SGLT2I
GLP-1 RA
GIP + GLP-1 RA
Amylin analog
α-Glucosidase Inhibitors
Insulin

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2
Q

What drugs are considered sulfonyureas?

A

Glyburide (DiaBeta, Micronase, Glynase)
Glipizide (Glucotrol)
Glimepiride (Amaryl)

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3
Q

How does Glipizide work?

A

Stimulate insulin release from β cells

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4
Q

What are the side effects of Glipizide?

A

Hypoglycemia, dizziness, weight gain, Hemolytic anemia, hepatotoxicity, disulfiram reaction

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5
Q

When cant you use Glipizide?

A

Hypersensitivity, T1DM, DKA

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6
Q

What are the counseling points for Glipizide?

A

Best to take 30 minutes before eating, first thing in the morning
Beware of signs/symptoms of hypoglycemia
Avoid Alcohol use

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7
Q

What are the meglitinides?

A

Repaglinide (Prandin) & Nateglinide (Starlix)

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8
Q

How does Repaglanide work?

A

Stimulate insulin release from β cells
think of them like a short acting form of sulfonyureas

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9
Q

When cant you use Repaglanide?

A

T1DM, DKA , Hypersensitivity, using gemfibrozil

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10
Q

What are the side effects of Repaglanide?

A

hypoglycemia, headache, N/V, weight gain, Chest pain, ischemia, hypersensitivity (SJS)

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11
Q

What are the counseling points for Repaglanide?

A
  • Needs to be taken with each meal (15-30 min before each meal)
  • If patient skips a meal, skip that dose
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12
Q

How does Metformin work?

A

Primary: ↓ glucose output from the liver (hepatic glucose production)

Secondary: ↑ peripheral muscle glucose sensitivity (glucose uptake and utilization)

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13
Q

When cant you use Metformin

A

eGFR <30 mL/min, metabolic acidosis, use with contrast media

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14
Q

What are the BBW associated with Metformin?

A

Lactic acidosis

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15
Q

What are the side effects of Metformin

A

GI upset, diarrhea, N/V, flatulence, Lactic acidosis, hemolytic anemia

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16
Q

What are the counseling points for Metformin?

A
  • Take with food to reduce GI upset
  • Avoid use within 48 hours of iodinated contrast media
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17
Q

What are the TZDs?

A

Pioglitazone (Actos), Rosiglitazone (Avandia)

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18
Q

When cant you use Pioglitazone?

A

NYHA Class III/IV heart failure

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19
Q

How does Pioglitazone work?

A

Primary: ↑ peripheral muscle glucose sensitivity (glucose uptake and utilization)

Secondary: ↓ glucose output from liver (hepatic glucose output)

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20
Q

What are the BBW for Pioglitazone?

A

Can exacerbate congestive heart failure (CHF)

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21
Q

What are the side effects of Pioglitazone?

A

Edema, weight gain,CHF, bladder cancer, fractures, hepatotoxicity

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22
Q

What are the counseling points associated with Pioglitazone?

A
  • Take once daily, without regard to meals
  • Monitor for weight gain and/or swelling of legs
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23
Q

What drugs are considered DPP4I?

A

Linagliptin (Tradjenta), Saxagliptin (Onglyza), Sitagliptin (Januvia)

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24
Q

How does Linagliptin work?

A

Binds to and inhibits the DPP-4 enzyme, resulting in prolonged incretin hormone levels

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25
When cant you use Linagliptin?
T1DM, DKA, hypersensitivity
26
What are the side effects of Linagliptin?
nasopharyngitis, hypoglycemia, Pancreatitis, heart failure
27
What are the side effects of Lingaliptin?
* Take once daily, at same time each day * May be taken with or without food
28
What drugs are considered SGLT2I?
Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance)
29
How does Canagliflozin work?
By inhibiting SGLT2, reabsorption of filtered glucose is reduced and the renal threshold for glucose (glucose reabsorption) is lowered= increasing urinary glucose excretion
30
When cant you use Canagliflozin?
Severe renal impairment (ESRD, Dialysis)
31
What are the side effects of Canagliflozin?
Dehydration, hypotension, UTI, yeast infection, Euglycemic DKA, AKI, bone fracture, perineal necrotizing fasciitis
32
What are the counseling points for Canagliflozin?
* Take once daily (in the morning) * Stay well hydrated while taking
33
What are the Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists?
Dulaglutide (Trulicity) Liraglutide (Victoza, Saxenda) Semaglutide (Ozempic, Wegovy, Ryeblsus) Exenatide (Byetta, Bydureon) *Note: Ryeblsus is a PO formulation, while the rest are SC*
34
How does Dulagltuide work?
binds to human GLP-1 receptor → augments glucose dependent insulin secretion and slows gastric emptying
35
When cant you use Dulaglutide?
personal or family history of medullary thyroid carcinoma (MTC), multiple endocrine neoplasia syndrome type 2 (MEN2)
36
What are the BBW associated with Dulagltuide?
Risk of thyroid C-cell tumors
37
What are the side effects of Dulaglutide?
N/V, diarrhea, GI upset, weight loss, ↓ appetite, Pancreatitis, Gallbladder disease, AKI
38
What are the counseling points for the different GLP-1 RA?
Byetta (IR) * Formulation: multi-dose pens, daily * Counseling: give BID, 30-60 min before eating, need needle RX * Key points: do not use if CrCl <30 Bydureon BCise(ER) * Formulation: single-use pen, weekly * Counseling: auto-injector, given weekly without regard to meals, needle in device * Key points: do not use if Crcl <30 Liraglutide (Victoza, Saxenda) * Formulation: multi-dose pens, daily * Counseling: give once daily without regards to meals, need needle RX, requires titration, reusable pen * Key points: restart titration after 3 missed days Dulaglutide (Trulicity) * Formulation: single use pens, weekly * Counseling: give once weekly without regard to meals, needle in device, requires titration, discard entire pen after each dose Semaglutide * Ozempic(SC) -Formulation: multi-dose pens, weekly - Counseling: give once weekly without regard to meals, needle in device, requires titration, reusable pen Rybelsus * Counseling: taken PO once a day with 4 oz of water 30 minutes before 1st meal of day
39
What are the long acting/basal insulin?
Insulin glargine (Lantus, Basaglar, Toujeo) Insulin degludec (Tresiba)
40
How does insulin glargine work?
Insulin promotes cellular uptake of glucose, fatty acids, and amino acids, and their conversion to glycogen, triglycerides, and proteins
41
What are the side effects of insulin glargine?
Hypoglycemia, weight gain, injection site reactions, insulin resistance
42
What are the counseling points associated with insulin glargine?
* SQ injection, rotate injection sites * Use new needle for each insulin injection * Dosing dial for insulin pens; draw up dose in syringe for insulin vials
43
What medications are used for osteoperosis?
Bisphosophonates and SERMs
44
What medications are considered Bisphosphonates?
Alendronate (Fosamax, Binosto) Ibandronate (Boniva) Risendronate (Actonel, Atelvia)
45
How does alendronate work?
Binds to bone hydroxyapatite and inhibits osteoclast activity= ↓ bone resorption, modulates bone metabolism, ↑ bone mineral density
46
When cant you use alendronate?
hypocalcemia, esophageal abnormalities, inability to stand or sit upright for at least 30 minutes
47
What are the side effects of alendronate?
N/V, Dyspepsia, ↓ serum Ca2+Atypical femur fracture, osteonecrosis of the jaw, GI ulcer
48
What are the counseling points for aldendronate?
* Take first thing in the morning, ≥30 minutes before the first food, beverage (except plain water), or other medication(s) of the day * Remain upright for ≥30 minutes after taking to reduce esophageal irritation
49
What drug is considered a SERM?
Raloxifene (Evista)
50
How does Raloxifene work?
Binds to estrogen receptors, resulting in activation of estrogenic pathways in some tissues (agonism) and blockade of estrogenic pathways in others (antagonism) Acts as an estrogen agonist in bone, decreasing bone resorption and bone turnover and increasing BMD
51
When cant you use Raloxifene?
Pregnancy, Current or history of thromboembolic disorders
52
What are the BBW associated with Raloxifene?
↑ Risk of VTE; ↑ Risk of Stroke
53
What are the side effects of Raloxifene?
Hot flashes, Arthralgia, Leg cramps, Peripheral edema, VTE, Hypertriglyceridemia, Stroke, PE
54
What are the counseling points for Raloxifene?
Take once daily, at the same time each day (May take with or without food) Increases the risk of blood clots, especially during the first 4 months of therapy. Avoid sitting for long periods and monitor for symptoms of DVT
55
What medications are used for the thyroid?
Synthetic Thyroxine Desiccated Thyroid Antithyroid Agents
56
What is the brand name of synthetic thyroxine?
Levothyroxine (Synthroid)
57
How does Levothyroxine work?
T4 is a synthetic form of thyroxine, an endogenous hormone secreted by the thyroid gland
57
When cant you use Levothyroxine?
Uncorrected adrenal insufficiency, Thyrotoxicosis, Benign thyroid nodules, acute MI
58
What is the BBW associated with Levothyroxine?
Should not be used for weight reduction
59
What are the side effects of Levothyroxine?
Anxiety, ↓ Appetite, Diarrhea, Insomnia, Aggravation of pre-existing CV disease, hyperthyroidism
60
What are the counseling points associated with Levothyroxine?
* Take consistently on an empty stomach each day (with water and at least 30 min before food) * Separate calcium and iron-containing products by at least 4 hours
61
What type of drug is thyroid?
Desiccated Thyroid
62
What is the brand name of thyroid
Armour Thyroid
63
How does armour thyroid work?
Naturally derived thyroid replacement containing both levothyroxine (T4) and liothyronine (T3)
64
When cant you use armour thyroid?
Untreated thyrotoxicosis, Uncorrected adrenal insufficiency, Myxedema(severe, untreated, or poorly managed hypothyroidism)
65
What are the BBW associated with armour thyroid?
Should not be used for weight reduction
66
What are the side effects with using armour thyroid?
Hair loss, Diarrhea, N/V, weight loss, Aggravation of pre-existing CV disease, hyperthyroidism
67
What are the counseling points for armour thyroid?
Take consistently each day on an empty stomach (30 to 60 minutes prior to breakfast) to increase absorption Some desiccated thyroid products are acquired from porcine thyroid gland
68
What type of drug is Potassium Iodide
69
What is the brand name of Potassium Iodide
SSKI, ThyroShield
70
How does Potassium Iodide work?
Inhibits the release of thyroid hormones via direct effect on thyroid gland
71
When cant you use Potassium Iodide
Nodular thyroid condition with heart disease
72
What are the side effects associated with Potassium Iodide?
GI upset, diarrhea, N/V, salivary gland swelling, Hypersensitivity Reaction, Hypothyroidism, Thyroid adenoma/Goiter(tumor)
73
What are the counseling points for Potassium Iodide?
* Take with food to minimize GI upset * Take with 4 oz of water. Other liquids can be used; dilution in chocolate milk can help mask the taste

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