pharm exam 4 Endocrine

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  1. Diabetes
    • type I- insulin diff. autoimmune resp to beta cells in pancreas. childhood onset
    • type II-non insulin dep. gradual onset usually in adults, obesity common
    • Normal FBS= <100, 100-126= preDM
  2. Long termcomplications
    • Macrovascular- HTN, heart d., Stroke
    • Microvascular- Renal d., Retinopathy (blindness), neuropathy, limb amputation
    • CVD is what kills most DM pt
  3. Insulin
    • promotes uptake of glucose >glycogen
    • "         "         "   of amino acid > proteins
    • "         "         "   of fatty acid > triglycerides
    • "         "         "   of  K+ >cells
    • promotes cell growth & division
    • source=recombinant DNA
    •       Human/ human analogs
    • all insulin is clear except NPH
  4. short duration-Rapid acting
    • Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
    • usually sub c but can be admin IV if nec
    • give before meal, 15m +- onset
    • duration 3-6hr
  5. regular insulin (short dur-slower acting)
    • Humulin R, Novolin R
    • resembles natural insulin
    • admin 30-60m before meal
    • SC, can be IV
    • 6-10hr duration
  6. Intermediate
    • NPH (humulin N, Novolin R)
    • Insulin Detemir (Levemir)
    • regular insulin altered, removing 1 aa & replacing w/ large protein (protamine) to >duration/ slow absorbtion
    • slow onset, usually dose 2x/d (16-24hr)
    • used for baseline glucose control, not before meals
  7. Long Duration
    • Glargine (Lantus)
    • modified human insulin (recomb DNA tech)
    • micro precipitates slowly evenly release insulin over time, eliminating peak/trough
    • admin 1x/d
  8. SC injection
    • ab, thigh, buttocks, upper arm (ab pref bc of faster, more consistant absorbtion)
    • rotate sites <chance of lipohypertrophy. site used only 1x/month, sites should be 1" apart 
  9. Dosing adjustments
    • decrease dose in: >exercise, <caloric intake, 1st trimester prego
    • increase dose in: >caloric intake, infection, surgery, stress, wt gain/obesity, adolescent growth spurt, prego after 1st trimester
  10. Dosing
    • Conventional-2 shots/d combo short & intermediate. good for less compliant people (elderly & young)
    • Tight glucose control- 4 shots/d- 1 long acting, 3 short. more risk for hypoglycemia, frequent monitoring req
  11. Complications
    • Hypoglycemia- (BS <50-60)- causes: insulin OD, <caloric intake, V/D, alcohol excess, > exercise. SS: HA, confusion, fatigue,* >HR, palpitations, sweating, nervous, *seizure, coma, death. Tx: glucose tab, OJ, sugar, honey. unconcious: IV glucose
    •       *chk for gag reflex
    • Lipohypertrophy- > fat accum. from not rotating site (not permenant)
    • Lipotrophy-depression in skin from <fat (rare now that pork/beef insulin no longer used)
    • allergic reaction- rare now that pork/beef not used
    • DD interactions- oral hypoglycemics, alcohol, beta blockers can lower glucose. Thiazide diuretics, glucocorticoids can increase glucose
  12. Glucagon
    • promotes release of glucose from glucose stores (glycogen)
    • tx for hypoglycemia
    • short term effects... follow w/ iv/oral glucose
    • doesnt work well w/ starvation, newborn (esp preemies) where <glucose stores 
  13. Oral Hypoglycemics
    • Sulfonylureas
    • Biguanides
    • Meglitinides
    • Alpha-glucosidase inhibitors
    • Thiazolidinediones (glitzones)
  14. Sulfonylureas
    • Most used
    • 1st gen- tolbutamide (orinase), chlorpropamide (diabinese)
    • 2nd gen- glyburide (micronase), glipizide (glucotrol):for poor renal fc, glimepimide (amaryl)
    • *stimulate release of insulin from pancreas
    •     *Sulfa allergy
  15. Meglitinides
    • Repaglinide (prandin), Nateglinide (starlix)
    • acts similarly to sulfonylureas but can be used w/ sulfa allergy
  16. Biguanides
    • metformin (glucophage)
    • <glucose production in liver
    • lactic acidosis (rare but 50% fatal):avoid in renal pt, alcohol >risk
    • hold >48hrs if recieving iv contrast
  17. Alpha-Glucosidase inhibitors
    • acarbose (precose), miglitol (glyset)
    • delays absorbtion of dietary carbs
    • ADR: flatulence, diarrhea common, avoid in IBS
    • hypoglycemia: tx=glucose (not sugar)
  18. Thiazolidinediones (Glitazones)
    • Rosiglitazone (avandia), Pioglitazone (actos)
    • reduce insulin resistance
    • cardio effect, bladder cancer link- slowly coming off of mkt
  19. new injectable drugs for DM
    • Pramlintide (symlin)- reduces glucose levels after meals by delaying gastric emptying, <glucagon secretion
    • suppresses appetite (dont take if not eating)
    • admin- SC prior to meal
    • ADR: hypoglycemia
    • Exenatide (byetta)- delays gastric emptying in DM II who take metformin, sulfonylurea or both
    • admin- SC prior to meal
    • ADR: hypoglycemia, GI common N/V/D
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pharm exam 4 Endocrine
2012-12-02 20:22:31

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