Endocrine I Flashcards by Sarah Sanchez

most negative feedback inhibition of hormones is reversible, except what?

prolonged glucocorticoid therapy

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which pancreatic cells release insulin into the blood when blood glucose levels rise?

beta cells

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which pancreatic cells release glucagon into the blood when blood glucose levels drop?

alpha cells

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insulin-dependent diabetes mellitus that results in no circulating insulin; needs insulin replacement

type 1 DM

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what is type 1 diabetes mellitus also known as?

juvenile-onset diabetes

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insulin resistance with relative insulin deficiency, but enough present to prevent ketoacidosis

type 2 DM

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what is type 2 DM also known as?

non-insulin dependent DM
adult-onset DM

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what are the first 3 things to try before insulin, in patients with type 2 DM?

oral Rx
diet
exercise

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diabetes of non-pancreatic cause; can be drug induced

type 3 DM

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what are 3 drug types that can cause type 3 DM?

glucocorticoids
immunosuppressants
atypical antipsychotics

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gestational DM; glucose intolerance at onset or recognition of pregnancy

type 4 DM

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a patient presents with polyuria, polydipsia, and fatigue. what are they likely experiencing?

acute hyperglycemia

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a patient presents with capillary damage, neuropathy, decreased gastric emptying, arterial narrowing, PVD, and increased risk of infections. what are they likely experiencing?

chronic hyperglycemia

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what should be monitored to manage hyperglycemia?

HbA1c

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what does insulin inhibit? (2)

glycogenolysis
lipolysis

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how does GLUT-4 and exercise help with hyperglycemia?

increases cellular uptake of glucose into muscles and fat

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what are different insulin dosage regimens designed to mimic?

prandial and basal release of insulin from the pancreas

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what is a bolus of insulin used for and what is the dose based on (3)?

postprandial hyperglycemia

BG, carbohydrate content, and concurrent activity

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what can inhaled insulin cause? (3)

cough
decreased PFT
lung cancer

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in which patient is inhaled insulin contraindicated in?

patients with COPD

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what are 2 things that can cause hypoglycemia when taking meds?

dose
mismatch between maximal peak activity and food intake

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what can exacerbate hypoglycemia? (2)

exercise
alcohol

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what is the order in which to take medication to treat hypoglycemia?

Test blood
Inject insulin
Eat food

TIE

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a patient presents with tachycardia, sweating, blurred vision, feeling warm, trembling, confusion, drowsiness, and weakness. what are they likely experiencing?

hypoglycemia

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what drug class can mask the symptoms of hypoglycemia?

beta blocker

side effects that are common in bovine and porcine injections

lipohypertrophy lipoatrophy

what are 4 main side effects that can present while using hypoglycemics to control hyperglycemia?

hypoglycemia lipohypertrophy lipoatrophy weight gain

gut hormones (like glucagon-like peptide - GLP-1) that stimulate insulin release upon food intake; extent of release is proportional to glucose level

incretins

drug class that increases gene expression for GLUT-1 and GLUT-4 = increase glucose uptake, increase tissue sensitivity to insulin, and decrease hepatic glucose production

thiazolidinediones (glitazones)

-zone

glitazones (thiazolidinediones)

2 drug classes that stimulate insulin release from pancreas

sulfonylureas meglitinides

which sulfonylurea causes hypoglycemia risk in elderly patients?

chlorpropamide

why should patients avoid alcohol if they take a 1st generation sulfonylurea?

can cause disulfiram reaction

-mide

1st gen sulfonylureas

4 G's

2nd gen sulfonylureas

what are 4 ADR of sulfonylureas?

sulfonylureas give me hypoglycemia, diarrhea (GI disturbances), and photosensitivity (PK DDI)

if a patient is taking a sulfonylurea, what should we educate about? (2)

sunscreen use avoid alcohol

drug class that has a rapid onset and short DOA, and is used for patients with postprandial hyperglycemia

meglitinides

-nide

meglitinides

what are 3 ADR that can occur while taking a meglitinide?

Meg likes to eat so she has weight gain, but also hypoglycemia (PK DDI)

first line medication for hyperglycemia that has the least potential of causing hypoglycemia

metformin (biguanide class)

what is the MOA of metformin?

decreases production of glucose by the liver

what are 2 ADR for metformin?

(met) formin didn't believe lactose intolerance (lactic acidosis) caused diarrhea

drug class that slows carbohydrate absorption by the intestines

alpha glucosidase inhibitors

what are the 2 drugs in the class alpha glucosidase inhibitors?

the alpha glucose inhibitor had a car(bose) and it was mig(lit)ol

what are the 2 ADR of alpha glucosidase inhibitors?

a car(bose) always makes me mig(lit)ol but gives me diarrhea/flatulence

what are the 3 ADR/risk of glitazones?

the glitazones affect the cardiac zone = fluid retention/edema MI CHF

in which patients should glitazones be avoided?

patients with heart failure

drug class that inhibits secretion of glucagon and delays gastric emptying, decreases postprandial glucose and carbohydrate absorption in the gut

amylinomimetic

what drug is an amylinomimetic?

pramlintide

what are the 4 ADR of amylinomimetics?

Amy and Pram gave me such a HEADACHE, they made me NAUSEOUS (VOMITING) and ANOREXIC

gut hormones (GLP-1) that stimulate release of insulin upon food intake

incretins

-tide

GLP-1 analogs (agonists)

in incretin mimetics, the extend of release of insulin is proportional to _____ levels

glucose

what is an ADR of GLP-1 agonists (analogs)?

pancreatitis

-gliptin

DDP-4 inhibitors

what is the MOA of DDP-4 inhibitors?

inhibits the removal of GLP-1 by DDP-4 to increase the half-life of GLP-1

what are the 2 ADRs of DDP-4 inhibitors?

headache nausea

drug class that inhibits glucose reabsorption from the nephron (kidney) = resultant glucosuria lower BG

SGLT 2 inhibitors

-flozin

SGLT2 inhibitor

in which patients should SGLT 2 inhibitors be avoided in?

patients with renal insufficiency

a patient taking an SGLT 2 inhibitor has a significant risk of what?

ketoacidosis

what are the 4 ADR of SGLT 2 inhibitors?

with all the peeing in SGLT 2 inhibitors, we have hypotension, dehydration, UTI and decreased bone density

when does DKA usually occur when using a drug for hyperglycemia?

with off-label use of SGLT 2 inhibitors in type 1 DM

which 2 meds have the highest risk and BBW for hypoglycemia?

insulin and pams insulin pramlintide + insulin injection

how is pramlintide used?

with mealtime insulin as an injection

which 2 drug classes have the 2nd highest risk for hypoglycemia?

sulfy's and megs (sulfonylureas and meglitinides)

what should be monitored while managing hyperglycemia in a patient? (3)

weight BG HbA1c

what is the best emergency drug to manage hypoglycemia, via a parenteral route? (2)

parenteral glucagon IV dextrose

how does parenteral glucagon manage hypoglycemia in a patient?

binds to receptor in liver and increases cAMP = gluconeogenesis

what route, besides IV, is glucagon now available in?

dry powder for nasal mucosa

how can we manage a patient that presents with hyperglycemia crisis (DKA)?

IV infusion of regular insulin + fluid

after giving a hyperglycemic patient insulin, what should we worry about?

hypokalemia due to shift of K into cells

a patient presents with hyperglycemic crisis. We give insulin + fluids but they start to experience cramps and arrhythmias. what are they likely experiencing?

hypokalemia

what are 3 meds that can cause a hyperglycemic crisis?

thiazide diuretics glucocorticoids off-label use of SGLT2 inhibitors in type 1 DM

most circulating T3 and T4 bind significantly to what?

thyroxine-binding globulins

which medication blocks organification of iodine, preventing the release of T4 and T3 and inhibits Na/I symporter?

lugol's solution

which drug class prevents iodide organification and the synthesis of T4 and T3?

thionamides

which thionamide is the only one capable of preventing peripheral conversion of T4 to T3?

PTU

what can be given to stop the production of T3 and T4 OR stop the release of T4?

radioactive iodine

what are 2 ablative/currative treatments for hyperthyroidism?

radioactive iodine therapy thyroidectomy

what is the 1st line treatment for hyperthyroidism in pregnancy, children <12, and Graves disease?

palliative care = meds

what is the most commonly used treatment for hyperthyroidism?

thionamides

what are the 3 thionamides used for hyperthyroidism and which one is preferred/why?

methimazole - preferred d/t less hepatitis carbimazole propylthiouracil (PTU)

what are the ADR of thionamides? (4)

Thanos was so itchy (rash) to taste/smell (altered in methimazole) revenge, that he killed everyone (polyarthritis) but it was (reversible agranulocytosis)

if a patient is taking a thionamide, what should we check periodically/what they should watch out for?

CBC fever sore throat

what should we check in any patient taking PTU for hyperthyroidism?

check LFT - can cause severe hepatitis

what are anion inhibitors called? what do they do?

Na/I symporter inhibitors block uptake of iodide

-ate

Na/I symporter inhibitors

2 iodides that inhibit hormone release and organification, often used with thionamides for thyroid storm

lugol's solution SSKI (potassium iodide)

what are the ADR of iodides? (6)

hypersensitivity to iodide reversible iodism - metallic taste burning mouth sore teeth cross placenta

which medications can be used for SNS symptoms in hyperthyroidism?

beta blockers (propranolol)

what is important to remember when giving a patient a beta blocker to help with angina, HTN, or heart failure?

can mask hyperthyroidism

in a patient that is experiencing thyroid storm, what would we given them to prevent adrenal insufficiency (decrease in cortisol)?

prednisolone

what are 3 other drugs that inhibit the peripheral conversion of T4 to T3?

amiodarone corticosteroids iodinated contrast media

what are 2 drugs used to treat hypothyroidism?

levothyroxine (DOC) liothyronine

what is the difference between levothyroxine and liothyronine?

levothyroxine is a synthetic and chemically pure T4 liothyronine is a synthetic and chemically pure T3

liothyronine has a faster onset, but also has _____ _____

more ADR

why does levothyroxine have a slow onset? (3)

converted to T3 in periphery is metabolized by the liver and is highly protein bound

mnemonic for ADR of liothyronine

"since liothyronine is T3 and has faster onset, it has ADR that mimic hyperthyroidism" increased HR/BP arrhythmias angina tremor heat intolerance headache weight loss

if a patient is taking liothyronine, what should we monitor?

vital signs weight

T3 and T4 combination drug

liotrix

thyroid extract from animals that is unstable and has protein antigenicity

desiccated thyroid

Endocrine I Flashcards

(103 cards)