Pharm endocrine

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scherk87
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134529
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Pharm endocrine
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2012-02-15 21:30:13
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Pharm
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Semester 2 Exam 2
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  1. Diabetes Characteristics
    • Hyperglycemia
    • Impaired metabolism of carbohydrates, fat, and protein
    • Impaired insulin secretion, insulin resistance, or both
  2. Complications of Diabetes
    • Nephropathy
    • Retinopathy
    • Amputation
    • Neuropathy
    • Cardiovascular disease
    • Decreased life expectancy
  3. Type I
    • Onset < 30 years
    • Weak genetic link
    • Absolute deficiency of Insulin Production
  4. Type II
    • Onset > 30 years
    • Strong genetic link
    • Insulin resistance, defective insulin release
  5. NPH Insulin
    • Absorbed slower after injection
    • Longer duration than regular
    • Shorter than glargine or detemirs
  6. Cloudy Insulin
    NPH Insulin Appearance
  7. Basal Insulin
    • Half total daily insulin dose
    • May use any long acting Insulin
  8. Meal-time Insulin
    • Other 50% of TDD
    • Divided between meals
    • Short-intermediate acting insulin
  9. Non-Mixing Insulins
    Lantus and Levemir cannot be mixed
  10. Mixing order
    Clear before cloudy
  11. Pros of Non-intensive Therapy
    Fewer Injections
  12. Cons of Non-intensive Therapy
    • Less control of sugars
    • More difficult to change to intenstive later
  13. Pros of Intensive Insulin Therapy
    • Tight glucose control
    • Allows flexibility in meal times and sizes
  14. Cons of Intensive Insulin Therapy
    • More daily injections
    • 3x risk for severe hypoglycemia
    • weight gain
  15. Candidate for Intensive Insulin Therapy
    • Type 1 > 7 years old
    • Willing to test/inject > 4x/day
    • Able to interpret readings/adjust doses
    • Understand importance of non-insulin components of therapy
  16. Lantus
    • Long duration
    • Peakless unlike NPH
  17. HbA1c
    • Glycemic control over 2-3 months
    • measured q3months not well controlled, q6months well controlled
  18. Pre-prandial glucose goals
    < 110-130 mg/dL
  19. 2-hour post-prandial glucose goals
    < 140-180 mg/dL
  20. HbA1c goals
    < 7%
  21. Disorder of insulin secretion
    Disorder of insulin resistance
    Disorder of excess glucose production
    Type II Diabetes
  22. Biguanides
    • Metformin
    • IR, ER, Combination
  23. Metformin MOA
    • Reduces hepatic glucose production
    • Reduces intestinal glucose absorption
    • Increase insulin sensitivity - improves peripheral glucose uptake and utilization
  24. Promotes modest weight loss or weight stabilization
    Less likely to cause hypoglycemia
    Metformin
  25. Adverse reactions of Metformin
    GI: Nause/vomiting, diarrhea, flatulence
  26. Precautions with Metformin
    • Renal or hepatic dysfunction
    • lactic acidosis
  27. MOA of Sulfonylureas
    • Stimulate release of insulin from pancreas
    • Requires presence of insulin
  28. Oldest and most popular class of oral hypoglycemic agents
    Sulfonylureas
  29. Adverse reaction of Sulfonylureas
    hypoglycemia
  30. Absent or diminished S&S of hypoglycemia with Beta-Blockers
    • Palpitations
    • tachycardia
    • sweating
  31. Adrenergic Manifestations S&S of hypoglycemia
    • Shakiness, nervous, anxiety
    • Palpitations, tachycardia, sweating
  32. Neuroglycopenic manifestations of hypoglycemia
    impaired judgement, mentationFatigue, lethargy, ataxiastupor, coma, seizures
  33. Glucagon manifestations of hypoglycemia
    hunger, n/v, headache
  34. Mild hypoglycemia (Glucose < 50 mg/dL) tx
    3 glucose tablets or 1/2 cup of fruit juice
  35. Severe hypoglycemia (glucose < 40 mg/dL) tx
    Glucagon injection
  36. Thiazolidinediones
    • First line as monotherapy
    • Synergistic when combined
  37. MOA of Thiazolidinediones
    • Increases insulin senesitivity in liver, fat and skeletal muscle by increasing glucose utilization and decreasing glucose production
    • Requires presence of insulin
  38. Adverse effects of Avandia
    • weight gain
    • Increased total cholesterol, LDL, and HDL
    • Edema
    • Hepatic metabolism
  39. Drug with increased risk of MI
    Avandia
  40. Adverse effects of Actos
    • Weight gain
    • Edema
  41. Favorable effect of Actos
    • Decreased TG
    • Increased HDL
  42. Thiazolidinediones precautions/contraindications
    • Hepatotoxicity
    • CHF
  43. Alpha Glycosidase Inhibitors
    • Precose
    • Glyset
    • Used in type I and II Diabetes
  44. MOA of Alpha Glycosidase Inhibitors
    • inhibits GI tract that convert carbohydrates to glucose
    • Slows intestinal absorption of glucose - slowe rrise in post-prandial glucose
  45. MOA of Rapid Acting Secretagogues
    • Stimulates insulin release fromt eh pancreas
    • Similar to sulfonylureas yet shorter half-life
  46. Adverse effects of Rapid Acting Secretagogues
    • Hypoglycemia - short-acting for skipping dose if skipping meal
    • High cost.
  47. Januvia
    • Dipeptidyl peptidase-4 inhibitor
    • Once daily oral tablet
  48. SE of Januvia
    • minimal hypoglycemia
    • weight neutral
  49. MOA of Byetta
    Incretin mimetic - inhibits release of glucagon, slows rate of gastric emptying, increases satiety
  50. Byetta Usage
    • Twice daily SubQ Injection
    • Requires Refigeration
  51. SE of Byetta
    Nausea and Vomiting
  52. Symlin
    Decreases post-prandial glucose levels - prolongs gastric emptying time, reduces caloric intake through appetite suppression
  53. Etiology of DKA
    • reduced insulin levels
    • decreased glucose utilization
    • Increased gluconeogenesis
    • Precipitated by omittion of tx, infection or EtOH abuse
  54. DKA Presentation
    • Poly's
    • Weakness
    • Kussmaul Respiration
    • "fruity breath"
    • N/V
    • Abdominal Pain
  55. DKA Treatment
    • Fluids
    • Insulin
    • Potassium
    • Bicarbonate
    • Phosphate
    • Magnesium
    • Sodium
  56. Most common primary hypothyroidism
    Hashimoto's thyroiditis
  57. Thyroid gland enlargement
    lymphocytic involvement
    gradual loss of thyroid function
    Autoimmune disorder
    Hashimoto's thyroditis
  58. Environmental triggers of Hashimoto's Thyroiditis
    • Infection
    • Stress
    • Sex steroids
    • Pregnancy
    • Ionizing radiation
  59. Presentation of Hypothyroidism
    • Enlarged thyroid (goiter)
    • dry/scaly skin
    • coarse hair, brittle nails
    • periorbital puffiness
    • Weakness, fatigue, slow speech
    • Weight gain
  60. Increased TSH
    Normal Free/Total T4
    Subclinical hypothyroidism
  61. Increased TSH
    Decreased Free/Total T4
    Hypothyroidism
  62. Decreased TSH
    Increased Free/Total T4
    Hyperthyroidism
  63. Normal TSH
    Decreased Free/Total T4
    Pituitary Problem
  64. Drug of choice for Hypothyroidism
    Levothyroxine
  65. Dosing for Hypothyroidism
    • Each morning
    • mcg/kg/day
  66. Causes of Hyperthyroidism
    • Graves' Disease
    • Autonomous thyroid nodule
    • Multinodular goiters
    • Subacute thyroiditis
    • Exogenous hormone ingestion
    • Tumor
  67. Presentation of Hyperthyroidism
    • Nervousness/anxiety/palpitations
    • Emotional lability
    • heat intolerance
    • onycholysis
    • finger tremor
    • weight loss with increased appetite
  68. Cardinal sign of Hyperthyroidism
    Loss of weight concurrent with an increased appetite
  69. Physical symptoms of Hyperthyroidism
    • Retraction of the eyelids/lagging of hte upper lid
    • Warm, smooth, moist skin
    • Unusually fine hair
  70. Most common cause of hyperthyroidism
    Graves' Disease
  71. Triad of Graves' Disease
    • Hyperhtyroidism
    • Opthalmopathy
    • Dermopathy
  72. Tx of Hyperthyroidism
    • Antithyroid medications
    • Radioactive iodine
    • Surgical removal of the thyroid gland
  73. First line hyperthyroid treatment for children, adolescents and pregnancy
    Antithyroid medications usage
  74. PTU MOA
    Pervents peripheral conversion of T4 to T3
  75. SE of Antithyroid Medications
    • Agranulocytosis
    • Aplastic anemia
    • Thrmobocytopenia
    • Lupus-like
    • Minor: rash, urticaria, fever, transient, leukopenia, GI discomfort

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