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PC612 Module 9 Endocrine > Module 9 Endocrine-PC612 > Flashcards

Module 9 Endocrine-PC612 Flashcards

(68 cards)

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1
Q

Blood Pressure in a Diabetic

A

Should be 130/80 or under

If renal damage 125/75

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2
Q

First generation sulfonylureas

A

Orinase, Diabinese, Tolinase

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3
Q

2nd generation sulfonyluureas

A

glyburide, micronized, Amaryl

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4
Q

Sulfonylureas

A

Stimulate pancreas insulin release

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5
Q

Sulfonylureas-not a contraindication if allergic to sulfa drugs!!

A

SE: hypoglycemia, weight gain, increased risk of cv

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6
Q

First Line-Biguanide

A

Metformin

  • decreases hepatic glucose output/slow release from liver
  • increases insulin sensitivity
  • decreases LDL and triglycerides
  • decreases C-reactive protein
  • causes weight loss or stabilization
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7
Q

Metformin

A 
No risk for hypoglycemia
causes nausea, cramps and diarrhea
TAKE WITH MEALS
-metallic taste in mouth
-lactic acidosis (rare)
-don't take is liver disease or renal impairment or if over 80 yrs of age
-Can interfere with folate & vitamin B-12 absorption causing megaloblastic anemia over time
Start at lower dose and then increase
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8
Q

Thiazolidinediones (Glitazones)

A

Increase muscle uptake of glucose, decrease FFA, incrase HDLs, decrease triglycerides
SE: may cause weight gain, and edema, may increase LFTs, decrease C-reactive protein

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9
Q

Thiazolidinediones (Glitazones)

A

Actos and Avandia

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10
Q

Meglitinides/Nateglinide

A

Increase pancreatic insulin release & act immendiately in response to fodd, short acting, take before meals,
SE: weight gain, and hypoglycemia

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11
Q

Meglitinides

A

Prandin and Starlix

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12
Q

Alpha-Glucose Inhibitors

Precose and Glyset

A

Decreases breakdown & absorption of CHO in the small intestine.
SE: cause flatulence, increase in LFTs

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13
Q

DPP-4 inhibitors

Januvia

A

affect incretin system, which in turn controls blood sugar by affecting alpha and beta cells. Works only when bs is elevated.
SE: seem to free of major side effects

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14
Q

GLP-1 Agonists?incretin mimetic

Byetta or Bydureon

A

Stimulates GLP receptors which increase insulin in response to high bs levels
inhibit postprandial glucagon release
Slows gastric emptying

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15
Q

Hep B vaccine

A

is a new recommendation for diabetics to receive

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16
Q

Recommend ASA therapy to

A

75-162 mg in type ! or II diabetics with CV risks.
Men>50 and women >60 who have at least one additional risk factor
smoking
HTN, CVD, FH of CVD
Do not recommend for CVD prevention in adults with low CVD risk ie: men <60 with no major additional risk factors

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17
Q

Diabetes in pregnancy

A

insulin is the drug of choice

Should be monitored 6-7 times per day

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18
Q

Intensive Insulin therapy

A

risk of causing hypoglycemia
Beta blockers can delay awareness of hypoglycemic by masking hypoglycemic induced signs that caused by activation of the sympathetic nervous system
(tachycardia, palpitations) Beta blockers inhibit the breakdown of hepatic glycogen to glucose, with otherwise would help restore or normalize bg levels if hypo should occur.

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19
Q

Diabetes in the elderly

A

Check Creatinine levels

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20
Q

Rapid-acting insulin

A

covers insulin needs for meals eaten at the same time as the injection. This type of insulin is used with longer-acting insulin

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21
Q

Short-acting

A

short acting covers insulin needs for meals eaten within 30-60 minutes

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22
Q

Intermediate -Acting

A

Insulin covers needs for about half the day or overnight. Often combined with rapid or short acting

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23
Q

Pre-mixed

A

Ususally taken twice a day before mealtime.

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24
Q

Osteoporosis

A

DEXA scan is best
For all women over 65
Any adult over 50 with a fracture
Younger if medical problems associated with bone loss

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25
Osteoporosis
risk factors female, older age, asian or white, petite family hx, low body weight, eraly menopause without HRT low calcium intake, smoker, amenorrhea, low testosterone in men
26
Calcium supplements
Post-menopausal women 1200-1500 per day Better in divided doses avoid taking with high fiber meal
27
Calcium carbonate
Tums are most common. Absorbed best when taken with food
28
Calcium Citrate
Citrical | absorbed when stomach ph is higher, as with older adults. can be taken anytime
29
Also 800-1000 mg of Vitamin D3 is recommended
Purpose of calcium is to decrease fractures
30
Drugs for Osteoporosis
Decrease bone resorption & called resorption inhibiting drugs
31
Meds for Osteoporosis
1. Biphosphonates 2. Estrogens 3. Calcitonin $ Selective estrogen receptor modulators (SERMs) Hormone modifiers
32
Biphosphonates
Alendronate (Fosamax) taken daily or once/week SE: upset stomach, GERD, abdominal pain calcium supplements and mag antacids prevent absorption. Take at different times
33
Biphosphonates
Riseronate (Actonal) taken daily or once/week | SE: arthralgia, GI, HA, leg cramps, abdominal pain, bone pain)
34
Both Biphophonates cause
GI problems. Must remain upright for 30 minutes after taking and should swallow whole and taken with 8 oz of water before eating or drinking at least 30 minutes
35
Boniva
po taken daily or once/month Can be given in a IV bolus 15-30 sec every 3 months Reclast taken once a year IV or 15 minutes BOTH are contraindicated in esophageal abnormalities, inability to sit upright for 30 min, hypoglycemia and a creatinine clearnace ,30
36
Al Biphosphonates
have the ability to cause osteonecrosis of the jaw and therefore patients taking them should avoid dental implants, tooth extractions, and dental surgery.
37
SERMs and Hormone modifiers
Evista Decrease bone resorption, lower total cholesterol and LDL -may cause hot flashes and leg cramps DC 72 hours before surgery with prolonged immobilization Hormone modifier (Forteo) only med that increases bone formation -may cause hypercalcemia, dizziness, leg cramps, et. Used in women with high risk of fracture who have failed with other therapies
38
Calcitonin
inhibits action of osteoclasts. Not effective in early post menopausal women -decreases risk of vertebral compression fxs has analgesic effect injectable or nasal spray
39
Hyperthyroidism
Graves- May be caused by thyroid stimulating antibodies directed against receptors on the surface of the thyroid cell May be due to TSH secreting tumors Results in hypermetabolic state: tremor, tachycardia, and heat intolerance. May have exopthalmos and pretibila edema
40
Hyperthyroidism Tx | Benefits of PTU may take 6-12 months
Surgical ablation of the thyroid tissue or antithyroid medications PTU-Propylthiouracil blocks thyroid stimulating hormone synthesis. Methimazole has a simialr mechanism of PTU. ANP may treat with Inderal to help with symptoms of tachycardia and anxiety
41
PTU is preferred in pregnancy even though Category D
Highly protein bound, so less transfer to the fetus.
42
PTU and Methimazole
both safe for breastfeeding. PTU is the safer of the two.
43
Hypothyroidism
hypometabolic state; lethargy, fatigue, weight gain, skin changes, sensitivity to cold, weight gain. Treat with Synthroid
44
Synthroid (Levothyroxine)- Take on empty stomach 30 minutes before meal. Calcium or iron seperate by two hours.
``` Treatment is usually lifelong Patients may not notice a difference for a week or more. 6-8 weeks to reach a steady state Absorbed in the GI tract Monitor serum TSH levels test 6-8 weeks after initial therapy then at 6 months, ```
45
Synthroid interactions
calcium reduces absorption Cholestyramine reduces absorption iron reduces absorption Anticoagulants are enhanced estrogen can reduce the availability of the Levothyroxine and the levothyroxine can increase metabolism of HRT and oral contraceptives may decrease effects of oral hypoglycemeics Some SSRIs and anticonvulsants increase metabolism of levothyroxine
46
Hypothyroidism and pregnancy
Category A =Synthroid First line in pregnancy monitor TSH levels Safe while breastfeeding
47
Testosterone Deficiency
It can improve sexual, physical and increase energy increase risk of prostate cancer TD is considered primary if it is testicular in origin Draw a LH level and a total testosterone in the morning after an overnight fast and values below normal 2 x are required for Dx
48
TD
HDL decreases with therpay Blood sugar may be lowered Can cause sleep apnea, acne, etc. Transdermal patches are preferred in older men due to convenience and reversible action
49
TD
prostate cancer and breast cancer are absolute contraindications TRT PSA levels quarterly for the first year then annually A DRE every 6 months TT every 3 months Hct >54% require discontinuation of the TRT
50
Glucocorticoids
Used to suppress immune function such as in asthma, COPD, allergic reactions, sever pain, RA, IBD, which is unresponsive to first line therapy Treat MS, and other autoimmune conditions Mainstay for treatment of Lupus
51
When used for prolonged periods of time
``` Cause adrenal insufficiency osteoporosis risk for infection muscle wasting thinning of skin electrolyte imbalance glucose intolerance, and possible PUD ```
52
Glucocorticoids
cause potassium loss and increase risk for Digoxin toxicity Used with NSAIDS cause PUD Taper to prevent adrenal problems Take before 0900 to reduce burst released naturally by adrenal glands in the body.
53
Glucocorticoids in Pregnancy
Betamethsone (most common) Dexamethasone for women betwee 24-34 weeks gestation. Avoid use longer than two weeks in . When prednisolone is needed for PUPPS use short time only. Taper if discontinued.During breastfeeding, never use a topical around mipple. Weight the risk for others if breastfeeding. Prednisone is considered safe with breastfeeding. Use for a short time only
54
Asthma
Albuterol is safe and considered 1st line. ICS is next. Systemic corticosteroids are contraindicated.
55
RA and DMARDS
Used to prevent joint destruction | Ideally treatment is started within 3 mos of Dx
56
Methotrexate (Rheumatrex)
first line and is a folic acid antagonist. It achieves 70-75% improvement in symptoms in 3 to 8 weeks. Contraindicated in breastfeeding and pregnant women Also contraindicated for those with leukopenia
57
Rheumatrex
SE: leukopenia, GI effects, oral ulcers, hepat and pulmonar toxicity
58
Drugs that are preferred are
Sulfasalazine, hydroxychloroquine and leflunomide
59
Newer DMARDs
from organic sources The tumor necrosis factor inhibitors are Etanercept (enbrel), infliximab (Remicade) Humira and Simponie. These produce rapid results within dayts to weeks.
60
Obesity
Screen over 6 and older and refer for conseling and behavioral interventions Grade B reccomendation
61
Obesity is BMI over 30
21-24% children and adolescents are overweight 16-18% obese BMI over 85th to 95th percentile need a discussion
62
First line
lower calories and increase physical activity
63
Two categories of medications
Studies show people gain weight right back after stopping the medications
64
Sympathomimeticamines
mimic amphetamines -Diethylproprion, Phentermine for short term use (addiction potential) Phentermine & Topiramiate ER- combines stimulant with suprresant
65
Lorcaserin (Belviq)
Seratonin 2C agonist that targets the stiety center of the brain. Modestly effective. coming out in 2013
66
Orlistat (Alli)
induction of lipid maldigestion, Causes gas, opily spotting, fecal incontinence pain, 2. Patients taking this should take a multivitamine containg A, D,E,K and beta carotene 2 hours before or after orlistat or at bedtime.
67
Bupropion
Byeta, Topamax, HCG, Thyroid hormone .
68
Gastric bypass
still the most effective 30% weight reduction | Band is 20%

PC612 Module 9 Endocrine (1 decks)

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