Endocrine

Question 1

Drugs that impact the endocrine system:

Answer 1

Bisphosphonates (reviewed later in the course)
Antidiabetic agents (reviewed part 1)
Hypothalamic and pituitary hormones (reviewed part 2)
Exocrine pancreatic enzymes (reviewed part 2)
Thyroid and antithyroid agents (reviewed part 2)

Question 2

Diabetes Mellitus (DM)

Answer 2

Chronic, progressive metabolic disorder resulting from abnormalities in glucose, protein, and fat metabolism

Question 3

DM Type One

Answer 3

diabetes, which results from beta-cell destruction, leading to absolute insulin deficiency

Question 4

DM Type 2

Answer 4

diabetes, which results from a progressive insulin secretory defect or insulin resistance

Question 5

Diabetes resulting from other causes

Answer 5

e.g., genetic defects in beta-cell function or insulin action; diseases of the exocrine pancreas, such as cystic fibrosis; and drug- or chemical-induced

Question 6

Gestational diabetes mellitus (GDM), which is diagnosed during

Answer 6

pregnancy

Question 7

Insulin phamacodynamics

Answer 7

Binds at insulin receptor sites on cell membrane allowing glucose to enter cells

Question 8

insulin acts on liver to

Answer 8

increase storage of glucose as glycogen

Question 9

insulin promotes

Answer 9

protein synthesis on muscle cells

Question 10

Inculin reduces

Answer 10

circulation of free fatty acids and promotes storage of triglycerides in adipose tissue

Question 11

Rapid-acting examples and peak

Answer 11

lispro (Humalog), aspart (NovoLog), or glulisine (Apidra), onset about 5 minutes, peaks in 1 hour, duration about 4 to 5 hours

Question 12

short acting examples and peak

Answer 12

regular“ (Humulin) insulin sometimes used around mealtime. Taken about 30 to 45 minutes before eating, peaks in 3 to 4 hours, duration 4 to 10 hours

Question 13

Intermediate-acting: Name, peak, onset and duration

Answer 13

NPH mixed with protamine, delaying absorption; insulin looks cloudy and has to be mixed before it is injected; onset one-half to 1 hour, peak 4 to 10 hours, duration 12 to 24 hours

Question 14

Long acting, name peak, onset, duration

Answer 14

glargine (Lantus),detemir (Levemir), degludec (Tresiba) insulins onset 2 to 4 hours, duration 24 hours with little or no peak

Question 15

Insulin absorption determed by

Answer 15

type of insulin, injection site, and volume injected

Question 16

insulin abdominal sites absorbes

Answer 16

50% more than other sites

Question 17

insulin excretion

Answer 17

urine

Question 18

inslusin should be injected with

Answer 18

standardized U 100/mL, needs U100 needles

Question 19

Inslulin ADR

Answer 19

hypoglycemia, diabetic ketoacidosis
Watch alcohol use; increases hypoglycemia
Beta blockers mask hypoglycemia symptoms

Question 20

Pregant women insulin

Answer 20

can use rapid- or short-acting insulin; does not cross placenta
Insulin aspart, insulin glargine, and insulin glulisine

Question 21

insulin and hypothyroidism

Answer 21

delays insulin breakdown; therefore may require less insulin units

Question 22

insulin and hyperthyroidism

Answer 22

increases renal clearance, requiring more insulin than baseline

Question 23

Insulin monitoring

Answer 23

Glycohemoglobin, renal function, CBC
A1C test twice a year in patients who are meeting treatment goals and have stable glycemic controls
A1C test quarterly in patients whose treatment has changed/not meeting goals
Point-of-care testing for A1C allows for timely decisions on treatments changes

Question 24

A1C as an average of the patients glucose in the last

Answer 24

90 days and comes in a percentage

Question 25

goal for A1C for most nonpregnant adults

Answer 25

less than 7%

Question 26

insulin patient education

Answer 26

Individualized goals for older adults with long-time diagnoses Administration, understanding types of insulin Glucose monitoring frequency and recording Emergency plan for glucose readings and “flu” Lifestyle management, diet, exercise Injection site selection

Question 27

Look at insulin peak, onset, duration, and names

Answer 27

chat in book

Question 28

Insulin is dosed on a

Answer 28

total daily insulin need. Calculation is done that gives you a total daily dose. 50% goes into the short acting pool. That is divided between the three meals a day. The remainder is given as a long acting.

Question 29

Insufficient production of endogenous insulin

Answer 29

Sulfonylureas: cause an increase in insulin production

Question 30

Tissue insensitivity to insulin

Answer 30

Thiazolidinediones: improve insulin sensitivity Biguanides: do the same

Question 31

Impaired response of beta cells

Answer 31

Meglitinides: increase secretion of insulin

Question 32

Excessive production of glucose by the liver drugs and MOA

Answer 32

Metformin: improves hepatic response to elevated blood glucose (BG), decreases glucose production, and decreases GI absorption Alpha-glucosidase inhibitors: inhibit absorption of carbohydrate in GI tract

Question 33

Impaired glucagon-like peptide-1 (GLP-1) activity: rapid intestinal glucose dumping

Answer 33

Use of dipeptidyl peptidase 4 (DPP-4) medications to slow inactivation

Question 34

Continuous weight gain

Answer 34

DPP-4 may stop it or be weight neutral

Question 35

Sulfonylureas examples

Answer 35

Glipizide (Glucotrol), glyburide (Diabeta), glimepiride (Amaryl)

Question 36

Sulfonylureas

Answer 36

All stimulate insulin release from beta cells All potentiate effects of antidiuretic hormone Hypoglycemia is major side effect

Question 37

Sulfonylureas Precautions and contraindications

Answer 37

Cross-sensitivity with sulfonamides or thiazide diuretics Avoid in pregnant women Older adults more sensitive to hypoglycemia events Pediatric: use in children 10 to 18 years, but it is unlabeled

Question 38

Sulfonylureas ADRs

Answer 38

Hypoglycemia, GI, dermatological rashes, syndrome of inappropriate antidiuretic hormone secretion, hemolytic anemia, leukopenia, thrombocytopenia, weight gain

Question 39

Sulfonylureas Drug Interactions

Answer 39

many may increase or decrease hypoglycemic effect

Question 40

Sulfonylureas Clinical use and dosing

Answer 40

Use second-generation agents most of the time. Individualized dose progression is based on response. Start with lowest dose and increase every 4 to 7 days.

Question 41

Sulfonylureas neurogenic diabetes insipidus

Answer 41

Chlorpropamide is used off-label.

Question 42

Sulfonylureas rational drug selection dosing

Answer 42

Age: chlorpropamide and glyburide used in older adults (use short-acting glipizide) Cost: many generics available Concurrent renal disease Glipizide or tolbutamide, or glyburide Concurrent insulin: only glimepiride FDA labeled for co-administration, but most second-generation agents used

Question 43

Monitoring Sulfonylurea

Answer 43

HgA1C: baseline, then every 3 months while adjusting, then every 6 months CBC at onset, then annual unless more if symptoms

Question 44

Patient Education

Answer 44

Administration ADR Lifestyle managment