SA Endocrine Flashcards
(123 cards)
1
Q
Steroid hormones Action
A
- Diffuse through cell membranes and work directly on the nucleus to regulate gene expression and resulting protein synthesis
- Relatively stable
2
Q
Steroid hormone Examples
A
- Aldosterone
- Cortisol
- Androgens
3
Q
Peptide hormones Action
A
- Interact with cell membrane receptors and work through 2nd messenger systems
4
Q
Fragility of peptide hormones
A
- Shorter acting
- More difficult to measure in blood
5
Q
Peptide hormone examples
A
- Thyroxine
- Insulin
- ACTH
6
Q
What proportion of the pancreas is endocrine?
A
- 2-3% of pancreatic mass
7
Q
Insulin secretion style
A
- Pulsatile
8
Q
Insulin is released in response to what?
A
- High blood glucose levels
- Some amino acids
- Intestinal hormones
- Parasympathetic stimulation
9
Q
Insulin release is inhibited by what?
A
- Somatostatin
- Sympathetic nervous system
- Fasting
10
Q
Is insulin catabolic or anabolic?
A
- Anabolic hormone
11
Q
Insulin stimulates what?
A
- Glycogen synthesis
- Lipogenesis
- Protein synthesis and storage
12
Q
Insulin inhibits what?
A
- Glycogenolysis
- Lipolysis
- Protein catabolism
13
Q
Where are insulin receptors found?
A
- Most cells in the body
14
Q
What will up or down-regulate insulin receptors?
A
- Levels of circulating insulin
15
Q
Diabetogenic hormones
A
- Glucagon
- Growth hormone
- Cortisol
- Epinephrine and norepinephrine
16
Q
Diabetes mellitus in dogs
A
- Combination of factors leads to irreversible beta cell destruction and lack of insulin production
17
Q
Diabetes mellitus in cats
A
- Combination of factors (including amyloid deposition) leads to either irreversible beta cell loss or more commonly significant insulin resistance and beta cell dysfunction which can be reversible
18
Q
Acarbose Class
A
- Alpha-glucosidase inhibitor
19
Q
Acarbose MOA
A
- Slows post-prandial glucose absorption
20
Q
Acarbose indications
A
- Cats that won’t eat a low carbohydrate diet
- Dogs with poor glycemic control for which a cause cannot be found or treated
- Not generally recommended for use, especially as a sole therapy
21
Q
Adverse effects of Acarbose
A
- Dose dependent
- Up to 35% of patients
- Hypoglycemia only when used with other hypoglycemic agents (insulin)
- Dogs: diarrhea and weight loss
- Cats: flatulence and soft stool/diarrhea
22
Q
Contraindications and cautions with Acarbose
A
- Caution with kidney or liver disease
- Contraindicated with underweight animals, DKA, IBD/intestinal malabsorptive disease
23
Q
Acarbose Drug interactions
A
- Hypoglycemic agents - may cause hypoglycemia
- Hyperglycemic agents (e.g. corticosteroids) as they may reduce or negate the effect
24
Q
Other considerations with acarbose
A
- Not considered effective in cats with advanced kidney disease, especially with poor appetites and on low protein diets
- Not effective in animals fed ad libitum
- May see two weeks to see peak effect
25
Glipizide class
- Sulfonylurea antidiabetic agent
26
Glipizide MOA
- Stimulates beta cell secretion of insulin
| - Must have functional beta cells for this drug to work
27
Indications for use of Glipizide
- Only considered useful in cats with non-insulin dependent diabetes (type II)
- 20-30% of cats
- If insulin cannot be given or very small doses of insulin are needed to control the DM
28
Contraindications of Glipizide
- DKA, acidosis, severe trauma/infection, surgery
- Caution with untreated adrenal or pituitary insufficiency, thyroid impairment, kidney or liver disease, vomiting, fever, malnourishment
29
Adverse effects of Glipizide
- GI signs: seen in 15% of cats
- Hypoglycemia - rare, more likely when given with other hypoglycemic agents (insulin)
- Increased amyloid deposition which can worsen beta cell function
- Elevated liver enzymes and jaundice (8%), which should be monitored every 1-2 weeks initially
30
Drug interactions of Glipizide
- Many! Either reduce or potentiate the effects
| - Always check before starting
31
How long until you see an effect with glipizide?
- May take 1-2 months to see effect
32
Route of administration of acarbose and glipizide
- Oral
33
What are some of the drawbacks for oral hypoglycemic therapy in general?
- In general, oral hypoglycemic agents are not recommended for use
- Response to therapy is minimal: must select patients properly.
- 15% good response (some develop resistance over time)
- 15% partial response
- Cats will have a better chance of going into remission if treated with insulin therapy instead
34
Insulin types
- Human, porcine, and bovine (only compounded)
35
Canine insulin similarity to pig, human, and bovine insulin
- Canine insulin = porcine insulin
- 1 amino acid different than human
- 3 amino acids different from bovine
36
Feline insulin similarity to pig, human, and bovine insulin
- 1 amino acid different from bovine
- 3 amino acids different from porcine
- 4 amino acids different from human
- However they tend to do well with this
37
What are the four formulations of insulin and the routes?
- Regular (IV, IM, OR SC)
- NPH (SC only, never IV)
- PZI (SC only)
- Lente/Ultralente (SC only)
38
Regular insulin
- Recombinant human insulin with no chemical modification
- Onset and duration basically the same as endogenous insulin (short onset)
- IV, IM, or SC
ONLY ONE WE CAN GIVE IV
39
NPH Insulin
- Combined with protein (protamine) to delay absorption after SC administration
- Administered SC (never IV)
40
PZI Insulin
- Combined with protamine and zinc
- Greater delay in absorption than NPH after SC
- Administer SC (never IV)
41
Lente/Ultralente Insulin
- Insulin molecules combined into crystals of various sizes
| - Small crystals (semi-lente) or large crystals (ultra-lente)
42
Difference between semi-lente and ultralente for absorption
- Smaller crystals delay absorption for a short time
| - Larger crystals result in longer delay
43
Lente combination
- Lente is combo of 30% semi-lente crystals and 70% lente crystals
44
Lente route
- SC
45
Synthetic insulins/insulin analogs
- Basically human insulins
- Chemical modification of human insulin structures
- Amino acids added, substituted, modified
- Altered structure slows absorption and degradation
46
Adverse effects of insulin in general
- HYPOGLYCEMIA
- Somogyi effect (insulin induced hyperglycemia)
- Injection site reactions
47
Drug interactions with insulin
- Many! May potentiate or decrease hypoglycemic effects
| - Always check Plumbs before starting
48
Humulin R/Novalin R
- Recombinant Human Insulin
| - Insulin of choice for DKA, hyperkalemia
49
Duration of Humulin R/Novalin R
- Short acting
50
Route of Humulin R/Novalin R
- Can be given IV or IM
51
Indications for Humulin R/Novalin R
- DKA
- Urethral obstruction with high potassium
- In those cats they often give with dextrose to drive potassium into the cells
52
Considerations for Humulin R/Novalin R
- Refrigerate
| - Do not shake bottle but role gently to mix
53
Vetsulin
- Porcine Lente Insulin
54
Vetsulin indication
- Insulin of choice for dogs
55
Vetsulin duration of action
- Generally about 12 hours
56
What type of syringe do you use with vetsulin?
U-40!
57
Dosing frequency and route for Vetsulin
- BID
| - SC with meals
58
Other considerations for vetsulin
- Refrigerate
| - Shake thoroughly before drawing up****** (THE ONLY ONE YOU SHAKE)
59
Novolin-N, Humulin-N
- NPH insulin, human recombinant
60
Indication for Novolin-N, Humulin-N
- Commonly used insulin for dogs if Vetsulin is not an option
61
Duration of Novolin-N, Humulin-N
- Intermediate acting
62
Dose frequency and Route for Novolin-N and Humulin-N
- BID
- SC with meals
- Use U-100 syringes
63
Novolin-N and Humulin-N other considerations
- Refrigerate
| - Do not shake the bottle - roll gently to mix
64
Levemir/Detemir
- Human recombinant insulin analog
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Indication for levemir/detemir
- More potent - canine insulin receptors 4x more sensitive to detemir than humans
66
Duration of detemir/levemir
- Intermediate acting
67
Dose frequency and route of Detemir/Levemir
- U-100 syringes
| - BID SC with meals
68
Other considerations for detemir/levemir
- Not generally used for cats
- Do not shake the bottle - roll gently to mix
- Refrigerate
69
Glargine/Lantus
- Human recombinant, insulin analog
70
Glargine/lantus Indication
- You use this a LOT with cats; insulin of choice for cats
71
Duration of action of glargine/lantus
- Potentially long acting (12-24hr)
| - Usually start BID and some can go to SID
72
Dose frequency and route of glargine/lantus
- BID
- SC with meals
- Use U-100 syringes
73
Other considerations for Glargine/Lantus
- Vials good for up to 6 months in refrigerator
- Pens good for 1 month unrefrigerated
- Do not shake the bottle - roll gently to mix
74
Glargine/Lantus Bonus for cats
- Can put them into remission potentially
75
ProZinc
- PZI insulin, Human recombinant
76
ProZinc Indication
- Often 2nd line choice after glargine for cats
| - FDA approved for cats
77
ProZinc Dose Frequency and syringe type
- U40
- BID
- SC with meals
78
Other considerations for ProZinc
- Refrigerate
- Do not shake the bottle
- Roll gently to mix
79
Treatment overview for Hypercalcemia
- 1st: address and treat underlying cause if possible
| - 2nd: provide non-specific therapy if no cause is found or can be treated
80
Physiologic saline Diuresis overview
- Non-specific
- Fast and easy to do
- Corrects dehydration, improves GFR, and improves hypercalcemia
81
MOA of Physiologic Saline Diuresis
- Corrects dehydration if present
- Dehydration reduces GFR
- Causes hemoconcentration which increases relative calcium plasma concentrations
- Also decreases renal tubular calcium reabsorption as more calcium is excreted or lost
82
Considerations for physiologic Saline Diuresis and Rate of action
- Give IV or SC
| - Fast acting
83
Furosemide for Hypercalcemia Site of action
- Loop of Henle
84
Furosemide for Hypercalcemia MOA
- Inhibits Na+/K+/2Cl- symporter
| - Inhibits calcium reabsorption in the thick ascending limb of Loop of Henle
85
Furosemide for Hypercalcemia Dose requirements
- Animal must be hydrated/volume expanded prior to use
86
Furosemide for Hypercalcemia Rate of action
- VERY fast acting
87
Glucocorticoids for hypercalcemia
- Prednisone/Prednisolone
| - Dexamethasone
88
Glucocorticoids MOA
- Reduce bone resorption of calcium
- Increase renal calcium excretion
- Decrease intestinal absorption of calcium
- Cytotoxic to neoplastic lymphocytes (USE for lymphoma)
89
Other considerations for glucocorticoids
- Delay use of this drug until a diagnosis of lymphoma has been established or ruled out
- Not very effective in patients with primary hyperparathyroidism or non-hematologic neoplasias
- Depending on underlying cause may be fast acting
90
Alendronate or Pamidronate, Zoledronate drug type
- Bisphosphonates
| - Alendronate is oral and the other two are injectable
91
MOA of Alendronate or Pamidronate, Zoledronate
- Inhibits osteoclast activity and bone resorption
| - Promotes apoptosis and inhibits osteoclastogenesis, angiogenesis, and cancer cell proliferation
92
Speed of Alendronate or Pamidronate, Zoledronate
- Generally slow acting
93
Alendronate Dose Intervals
- For dog is SID
| - For cat is once a week
94
Adverse effects of Alendronate
- GI signs
| - Esophagitis
95
Considerations for Alendronate
- Fast 12 hrs before and 2 hrs after as food reduces absorption
- Esophagitis: follow with water, butter the lips (cat), exercise for 30 min after (dogs)
96
Pamidronate Dosing and route
- IV diluted and given as CRI every 5-28 days
97
Pamidronate Adverse effects
- Electrolyte abnormalities (hypomagnesemia)
| - Renal toxicity
98
Considerations for pamidromate
- Give over 2-4 hours to reduce renal effects
99
Zoledronate dosing
- Dilute and give as IV CRI over 15 min every 28 days
100
Zoledronate adverse effects
- Possible renal toxicity, but lower potential than with pamidronate
101
Calcitonin origin
- Salmon
102
Calcitonin MOA
- Inhibits osteoclastic bone resorption
| - Reduces tubular reabsorption and promotes excretion of calcium, phosphorus, and other electrolytes
103
Calcitonin usage in general
- Not recommended
- Dogs only
- SC 2-3x a day
104
Adverse effects of Calcitonin
- GI, hypersensitivity
105
Drug interactions with Calcitonin
- Pamidronate
| - No benefit and may worsen outcomes in dogs
106
Other Considerations of Calcitonin
- Very short duration of action, poor efficacy, expensive, development of resistance
107
Hypocalcemia emergency treatment
- Calcium gluconate 10% solution
| - Calcium salt
108
MOA of Calcium gluconate
- Direct replacement
109
Dosing instructions for Calcium Gluconate
- Based on elemental calcium (contains 9.3 mg/mL)
- SQ - dilute in equal volumes of saline
- Must administer very slowly!!! ******
110
Adverse effects of calcium gluconate 10% solution
- Hypotension
- Cardiac arrhythmias or arrest
- SQ or IM administration could result in mild to severe tissue reactions
111
Other considerations of calcium gluconate
- Always check the formulation being used and dose off of elemental calcium content
- monitor patients with an ECG during administration
112
Chronic hypocalcemia cause
- Most common cause is hypoparathyroidism
| - lack of PTH production
113
Absence of PTH
- Vitamin D is not activated in kidneys
| - Intestinal absorption, bone release, and renal retention of calcium are reduced
114
- Chronic hypocalcemia general principles
- Generally combines a direct calcium supplement and vitamin D supplement
115
Calcium carbonate
- Tums
116
MOA calcium carbonate
- Direct replacement of calcium
| - Also binds dietary phosphate
117
Route of calcium carbonate
- orally
118
Considerations with Calcium Carbonate
- Give with food
119
Calcitriol
- 1,25 dihydroxy vitamin D
- Activated vitamin D
- You need calcitriol to get oral calcium
120
MOA of calcitriol
- Vitamin D analog - direct replacement
121
Indications of use for calcitriol
- Hypoparathyroidism
| - Renal secondary hyperparathyroidism (decreased renal activation of Vitamin D)
122
Adverse effects of calcitriol
- Hypercalcemia
- Tissue mineralization
- DO NOT give in hyperphosphatemic animals or those with Ca/Phos products >70 (Ca x Phos)
- Development of calcium oxalate uroliths
123
Other considerations of calcitriol
- Combine with oral calcium supplementations to reduce dose needs
