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PC707 Pharmacology > Module 10 - Endocrine > Flashcards

Module 10 - Endocrine Flashcards

(96 cards)

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1
Q

What is the preferred drug for managing diabetes during pregnancy?

A

Insulin

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2
Q

Symptoms of type 1 DM result from _____________ of insulin caused by ________________ destruction of __________________ ___________ cells.

A

absence; autoimmune; pancreatic beta cells

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3
Q

What cells are our physiologic source of insulin?

A

pancreatic beta cells

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4
Q

T/F

Type 2 DM results from insulin deficiency.

A

False; there is insulin but there is a resistance to insulin or decreased insulin receptor activity

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5
Q

Symptoms of Type 2 DM result primarily from _____________ ______________ to insulin’s actions.

A

cellular resistance

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6
Q

T/F

Type 1 and Type 2 DM share the same long-term complications.

A

True, but risk & severity are higher and tends to occur faster with Type 1

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7
Q

Complications of DM:

A

Hypertension, heart disease, stroke, blindness, renal failure, neuropathy, lower limb amputations, erectile dysfunction, and gastroparesis

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8
Q 
Labs dx of DM:
Fasting:
2hr:
Random:
HgbA1c:
A

Fasting: >/=126
2hr: >/= 200
Random: >/= 200 with sx of DM- polyuria, polydipsia, sudden wt loss
HgbA1c: >/= 6.5%

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9
Q

Standard method for daily monitoring of diabetes therapy?

A

SMBG - self monitoring of blood glucose

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10
Q

How often should HgbA1c be measured? What is the target value?

A

Every 3-6 months; 7% or lower

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11
Q

Insulin is an _________ hormone.

A

anabolic

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12
Q

Two basic effects of insulin:

A
  1. stimulates uptake of glucose, amino acids and potassium

2. promotes synthesis of complex organic molecules (glycogen, proteins, triglycerides)

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13
Q

Insulin deficiency promotes ______________ by increasing _______________ and ________________ and decreasing ______________ utilization.

A

hyperglycemia; glycogenesis; glucogenesis; glucose

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14
Q

How many types of insulin are used in the USA? List.

A

7; Regular insulin (human insulin), NPH, and 5 human insulin analogs- insulin lispro, insulin aspart, insulin glulisine, insulin detemir, and insulin glargine

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15
Q

T/F

All insulin used in the US is synthetic (produced in lab).

A

True

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16
Q

Which 3 types of insulin have VERY rapid onset and short duration?

A

Lispro, aspart & glulisine

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17
Q

Rapid Acting Insulin - onset /lasts

A

Onset: 10-30min; Lasts: 3-6hrs

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18
Q

Which type of insulin has moderately rapid onset and short duration? What is this called?

A

Regular Insulin; Short Acting Insulin

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19
Q

Short Acting Insulin - onset/lasts

A

Onset: 30-60min; Lasts: 6-10hrs

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20
Q

Which type of insulin has intermediate duration?

A

NPH

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21
Q

Intermediate Acting Insulin - onset/lasts

A

Onset: 1-2hrs; Lasts: up to 24hrs

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22
Q

Which 2 types of insulin are long acting?

A

glargine & detemir

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23
Q

Long Acting Insulin (basal) - onset/lasts

A

Onset: 1-2hr; Lasts: 24hrs

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24
Q

T/F

Tight insulin control can be achieved with 1-2 injections/day.

A

False

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25
Glargine & detemir are given _______ daily.
once
26
Methods to achieve tight control include: 1. An evening injection of _________ supplemented with mealtime injections of ___________, _______, __________, or _______; or 2. Continuous subQ infusion of ___________, _________, ______, or ___________ supplemented with mealtime __________ doses.
1. Glargine; regular, lispro, aspart, or glulisine; or | 2. regular, lispro, aspart, or glulisine; bolus
27
What is the major risk of intensive glycemic control?
Increased risk for hypoglycemia
28
How often should blood glucose be measured on a person taking insulin?
3-5/day
29
____________ ______________ __________ carries a greater risk of hypoglycemia than __________ _____________ __________.
Intensive insulin therapy; conventional insulin therapy
30
Hypoglycemia is defined as :
blood glucose <50
31
Symptoms of hypoglycemia:
Tachycardia, palpitations, sweating, headache, confusion, drowsiness, and fatigue.
32
_________ ____________ can delay awareness of hypoglycemia by _________ hypoglycemia-induced signs that are caused by activation of the __________ nervous system.
Beta blockers; masking; sympathetic
33
Beta blockers __________ the breakdown of h.epatic ____________ to __________, which would help restore/normalize ___________ ______________ in the event of _______________.
inhibit; glycogen; glucose; blood glucose; hypoglycemia
34
MOA - oral | Stimulate pancreas to release insulin (2)
Sulfonylureas & meglitinides
35
MOA - oral
Biguanides & sulfonylureas
36
MOA - oral | Inhibit liver production of glucose (glucogenesis) and liver breakdown of glycogen into glucose (glycolysis). (1)
Biguanides
37
MOA- oral | Inhibit the enzyme alpha-glucosidase which causes a decrease in intestinal secretion of glucose (1)
Alpha glucosidase inhibitors
38
MOA- oral | Increase sensitivity to insulin in the skeletal muscle (1)
Thiazolidinediones
39
MOA- oral | Increase insulin release, reduce glucagon release, decrease hepatic glucose production (2)
Gliptins or DPP-4 Inhibitors
40
What oral meds cannot cause hypoglycemia?
Biguanides
41
Biguanide - MOA (3)
1. Enhance receptor sensitivity to insulin in muscle and fat 2. Inhibit glucogenesis and glycolysis; decreases hepatic glucose output; slows release from liver 3. Slightly reduces glucose absorption in gut
42
Biguanide - Side effects
Gi disturbance - diarrhea, N&V, gas, bloating - usually go away after 2wks
43
How can side effects of metformin (biguanide) be minimized?
Take with a meal; usually at night
44
Biguanide - Contraindications
Renal disease, liver disease, severe infection , excess ETOH, at risk for hypoxic episodes (COPD, HF).
45
There is a small risk for __________ ____________ _____________ with metformin (biguanide)
fatal lactic acidosis
46
Metformin (Biguanide) may cause _______________ anemia.
megaloblastic- affects folate and b12
47
Metformin (Biguanide) should be stopped the day before diagnostic tests where _______________. When can it be restarted?
dye is injected; May be restarted in 48hrs if creatinine was WNL after test.
48
What med is first line tx for DM 2 when diet & exercise modifications have failed?
Biguanide (metformin)
49
What med is used off label to treat pre-diabetes and PCOS
Biguanide (metformin)
50
In the elderly, check the drug resource for the acceptable level of ___________ before giving biguanide (metformin), because it may not be safe even if lab is WNL.
creatinine
51
Sulfonylureas - MOA (2)
1. Stimulate beta cells in pancreas to secrete insulin | 2. Increase sensitivity of tissues to insulin
52
Should 1st gen or 2nd gen sulfonylureas be used?
2nd generation
53
What is the main side effect of sulfonylureas ?
Hypoglycemia - more often with Glyburide; wt gain; increased risk of CV mortality
54
Are sulfonylureas safe in pregnancy
No longer contraindicated but should be used with caution; especially in 1st trimester and end or 3rd trimester. Category C.
55
Sulfonylureas have a _____________ efficacy over time.
reduced
56
Sulfonylureas are tier ______ due to _________cost and _____________.
one; low; efficacy
57
NSAIDs, sulfa antibiotics and ______________ are all protein bound; the competetive binding causes an ___________ in the free drug available which _______________ risk for ______________.
Sulfonylureas; increase; increases; hypoglycemia
58
Signs and symptoms of hypoglycemia may be masked in patients taking __________ ____________.
beta blockers.
59
T/F | Sulfonylureas are contraindicated in pts with a sulfa allergy.
False
60
___________ ,an oral DM med, may increase the risk of sudden cardiac death.
Sulfonylureas
61
Gliptins (DPP-4 Inhibitors) - MOA (1)
1. Inhibits degradation of endogenous incretins which increases insulin secretion, decreases glucagon secretion, and decreases hepatic glucose production.
62
Gliptins - Side Effects
URI, UTI, headache. In one can cause increase in pancreatitis
63
Gliptins - contraindications
Type 1 DM, hx of pancreatitis
64
______________ are considered 3rd line therapy in pts with HgbA1c >9%
Gliptins (DPP-4 Inhibitors)
65
Thiazolidinediones- MOA
Enhances insulin sensitivity in muscle and fat by increasing glucose transporter expression. **muscle uptake
66
Thiazolidinediones - side effects
promote water retention; anemia, edema, headache; reversible increase in ALT; edema; increase LFTs
67
Thiazolidinediones - contraindications
Children, ketoacidosis, active liver disease, caution with class III / IV HF. Oral contraceptives.
68
Meglitinides - MOA
Stimulate insulin release from beta cells - different action than sulfonylureas. **increase pancreatic insulin release
69
What oral DM med is known to lower triglycerides and increase HDL?
Thiazolidinediones
70
What oral DM med is taken with meals? Who are these good for?
Meglitinides; good for pts with erratic schedules and those with normal Fasting but high PP.
71
T/F | Meglitinides have an increased risk for hypoglycemia in comparison with other agents.
False; rapid onset and short half life so less hypoglycemia
72
What medication is often used in combination with meglitinides?
Metformin
73
Gliptins (DPP-4 inhibitors) are weight ___________.
neutral
74
Meglitinides - Side effects
hypoglycemia; wt gain; Bloating, abdominal cramping, diarrhea, and flatulence
75
Meglitinides are recommended as add on therapy ia A1c is _____ to _______%.
6.5-9%
76
T/F | Meglitinides have multiple drug interactions.`
True; esp gemfibrozil, NSAIDs & anti-hypertensives
77
What med can decrease triglycerides and LDL; also cause weight loss?
Metformin (biguanide)
78
Alpha glucose inhibitors: MOA
Work in small intestine to prevent glucose absorption
79
alpha glucose inhibitors: side effects
Increase LFT's; flatulence
80
GLP 1 agonist/incretin mimetics; MOA
1. stimulates GLP a receptors which stimulates insulin release 2. decreases pp glucagon secretion 3. slows gastric emptying
81
GLP 1 agonists are non insulin __________.
injectable
82
GLP 1 agonist side effects
hypoglycemia, nausea; wt loss
83
When should asa therapy be advised in DM? how much
Men >50, Women >60 with at least one other risk factor for CVD. Do NOT recommend for everyone. 75-162 mg
84
How many times SBGM during preg?
6-7 x/day
85
What is used to screen for osteoporosis?
DEXA scan
86
What BMD signifies osteopenia?
>-1 to -2.5
87
What BMD signifies osteoporosis
>-2.5
88
Who should be screened for osteoporosis?
women >65; younger or perimenopausal women or men with diseases assoc with bone loss (long term steroid, hyperparathyroid); any adult over 50 with fx
89
Recommended Calcium supplementation: ________mg/day
1200
90
T/F | It is better to divide calcium doses rather than take in one dose.
True
91
Biophosphonates ___________ bone resorption, cause ____ _________ and are contraindicated in ______________. Must be taken ____________ and then ________ for ______ min after.
decrease; GI upset; GERD. 30min before eating/drinking; stay upright; 30min
92
SERMs ________ bone resorption, are _________. Added benefit: decrease ________ and __________. May cause _______________
decrease; hormonal. total cholesterol and LDL. leg cramps and hot flashes.
93
Which med increases bone formation?
Hormone modifier - Forteo
94
Which osteoporosis med needs to be discontinued 72hr prior to surgery?
SERMs
95
Which osteoporosis med can cause issues with osteonecrosis of the jaw (no dental surgery!)
Biophosphonates
96
Calcitonin inhibits action of __________. Not effective in ____________ women. Decreases risk of ___________ compression fx. Has an _________ effect. Comes in _________ and _________.
oseteoclasts; early postmenopausal. vertebral. analgesic. injectable and nasal spray

PC707 Pharmacology (5 decks)

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