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Pharm Exam 1 > Diabetes and Endocrine > Flashcards

Diabetes and Endocrine Flashcards

1
Q

Levothyroxine MOA

A

synthetic T4 and some of the T4 is converted to T3

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2
Q

Levothyroxine Use

A

any type of hypothyroidism
thyroidectomy
myxedema coma

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3
Q

Levothyroxine A/E

A

thyrotoxicosis: (hyperthyroidism) increased HR, A fib, angina, chest pain, tremors, wt. loss, diarrhea

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4
Q

Levothyroxine patient education

A

take on an empty stomach about 30-60 minutes before a meal, avoid changing brands

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5
Q

levothyroxine monitoring

A

Q3mo until maintenance dose is reached, then annually

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6
Q

liothyronine

A

synthetic T3, works faster and is used for myxedema coma when a faster action is needed

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7
Q

Propylthiouracil (PTU) MOA

A

inhibits thyroid hormone synthesis and also decreases conversion of T4 to T3

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8
Q

PTU use

A

hyperthyroidism
thyrotoxicosis
preferred drug for pregnancy

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9
Q

PTU A/E

A

agranulocytosis

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10
Q

PTU dosing

A

2-3 times a day, could be concern for nonadherence

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11
Q

PTU and pregnancy

A

crosses the placenta more poorly than other drug

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12
Q

Methimazole MOA

A

prevents oxidation of iodine and incorporation of iodine into tyrosine
inhibits peroxidase, the enzyme that catalyzes the oxidation process

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13
Q

Methimazole Use

A

overall the safer antithyroid drug
graves disease
thyroid cancer, per surgery for thyroidectomy

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14
Q

Methimazole contraindications

A

PREGNANCY

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15
Q

Methimazole A/E

A

Agranulocytosis

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16
Q

Sulfonylureas 1st gen drugs

A

Chlorpropamide

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17
Q

Sulfonylureas 2nd gen drugs

A

Glimepiride
Glipizide
Glyburide

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18
Q

Sulfonylureas MOA

A

stimulates the pancreas to release insulin, increases sensitivity to insulin at the receptor sites (muscle cells),
decrease hepatic glucose production

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19
Q

Sulfonylureas Uses

A

T2DM only, not the first line drug– 2nd line drug

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20
Q

Sulfonylureas contraindications

A

pregnancy– not approved but still given

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21
Q

Sulfonylureas A/E

A 
hypoglycemia
cardiotoxicity/ cardiac effects 
hepatotoxicity/ liver effects 
wt. gain
GI disturbances are #1--lasting about 3 wk (diarrhea, nausea, flatas)
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22
Q

Sulfonylureas Drug interactions

A

Disulfiram like reaction with alcohol
Beta blockers – mask effects of hypoglycemia
antifungals, corticosteroids, thiazide diuretics, antidepressants all increase BG

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23
Q

Biguanide drug

A

Metformin

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24
Q

Metformin MOA

A 
increase sensitivity to insulin 
decrease hepatic production of glucose
decrease intestinal absorption of glucose
decreases need for insulin
decreases postprandial BG
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25
Q

Metformin Use

A

T2DM
1st line treatment
prediabetes
pregnancy

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26
Q

Metformin A/E

A 
diarrhea
decreased appetite
nausea -- GI effects will go away after a tolerance is built up
wt loss
*lactic acidosis -- must stop drug
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27
Q

Metformin drug interactions

A

alcohol

cimetidine

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28
Q

Metformin contraindications

A

renal disease
GFR <45
receiving contrast dye
acutely ill

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29
Q

Metformin patient educations

A

does not cause hypoglycemia

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30
Q

Metformin nursing implementations

A

delay T2Dm, more effective in <60 y/o and underweight, stop 1-2 days before and after procedure where contrast dye is used

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31
Q

Thiazolidinediones (TZD) drugs

A

Pioglitazone

Rosiglitazone

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32
Q

TZD MOA

A

decreases insulin resistance by increasing insulin action at receptors and post receptor level in hepatic and peripheral tissues

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33
Q

TZD A/E

A

fluid retention: wt gain, congestive HF
hepatotoxicity
hypoglycemia

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34
Q

TZD drug interactions

A

decrease effects of birth controls
often used in combo with other drugs
can be used as monotherapy

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35
Q

TZD monitoring

A

wt gain, SOB, chest pain, fluid retention
can be used in mild CHF only
check LFTs

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36
Q

Alpha-glucosidase enzyme inhibitor drugs

A

Miglitol

Acarbose

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37
Q

A-glucosidase enzyme inhibitor MOA

A

delays breakdown of CHO in the small intestine

** does not stimulate insulin secretion

38
Q

A-glucosidase enzyme inhibitor A/E

A

wt. gain

GI effects

39
Q

A-glucosidase enzyme inhibitor Patient education

A

dont eat, dont take
blocks breakdown of sucrose
if hypoglycemic give glucose tabs because candy will not work

40
Q

Meglitinide drug

A

Repaglinide

41
Q

Repaglinide MOA

A

stimulates insulin secretion by inhibition of ATP sensitive K channels in beta cells

42
Q

Repaglinide A/E

A 
hypoglycemia
GI effects 
HA
chest pain
UTI
43
Q

Repaglinide drug interactions

A

usually given with metformin

44
Q

Repaglinide Patient education

A

take before a meal, dont take if dont eat

45
Q

DPP4 inhibitor drug

A

Sitagliptin

46
Q

Sitagliptin MOA

A

Blocks enzyme, increasing the release of insulin
inactivates incretin hormones GIP-1 and GLP

inhibits the inhibitor increasing insulin

47
Q

Sitagliptin Use

A

3rd line choice drug

only to be used in patients who produce insulin

48
Q

Sitagliptin A/E

A 
hypoglycemia
HA
pharyngitis
arthritis
pancreatitis
angioedema
anaphylaxis
SJS
49
Q

Sitagliptin dosing

A

decrease dose in renal impairment

50
Q

Sitagliptin Patient education

A

can be taken with or without food

51
Q

SGLT-2 drugs

A

Canagliflozin

Dapagliflozin

52
Q

SGLT-2 MOA

A

blocks reabsorption of glucose in the renal tubules

53
Q

SGLT -2 A/E

A

UTI
fungal infections in women
postural hypotension

54
Q

SGLT-2 contraindiaction

A

GFR<45

55
Q

Incretin mimetics drug

A

Exenatide

56
Q

Exenatide MOA

A

causes release of endogenous incretin hormones (GIP-1)
slows gastric emptying
stimulates release of glucose dependant insulin
inhibits postprandial glucose release

57
Q

Exenatide Use

A

T2DM only

injectable

58
Q

Exenatide A/E

A 
hypoglycemia with sulfonylureas 
injection site reaction
**pancreatitis 
renal impairment
fetal harm
 angioedema
anaphylaxis
**thyroid C-cell tumor (cancer)
59
Q

Exenatide drug interactions

A

decreases absorption of other PO drugs

hypoglycemia with alcohol

60
Q

Exenatide nursing implementations

A

give PO drugs before this medication

61
Q

regular insulin

A

short acting

62
Q

regular insulin onset

A

30-60 min

63
Q

regular insulin peak

A

1-5hr

64
Q

regular insulin duration

A

6-10 hr

65
Q

lispro, aspart

A

rapid acting insulin

66
Q

lispro onset

A

15-30 min

67
Q

lispro peak

A

0.5-2.5 hr

68
Q

lispro duration

A

3-6hr

69
Q

Aspart onset

A

10-20 min

70
Q

Aspart peak

A

1-3 hr

71
Q

Aspart duration

A

3-5 hr

72
Q

Lispro, Aspart, regular insulins mix

A

with NPH only

73
Q

Lispro good for

A

those who dont eat regularly

74
Q

NPH

A

intermediate acting insulin

75
Q

NPH onset

A

1-2 hr

76
Q

NPH peak

A

6-14hr

77
Q

NPH duration

A

16-24 hr

78
Q

NPH dosing

A

BID morning and evening

79
Q

70/30 mix

A

70% NPH, 30% regular insulin

given to people who cannot afford NPH and regular separately, and elderly people, poor dexterity

80
Q

Glargine (lantus), levemir

A

long acting insulin

81
Q

Glargine onset

A

2-4 hr

82
Q

Glargine peak

A

peakless

83
Q

Glargine duration

A

20-24

84
Q

levemir onset

A

2hr

85
Q

levemir peak

A

peakless

86
Q

levemir duration

A

24hr

87
Q

insulin patient education

A 
disposal of needles and syringes
storage of syringes 
do not reuse needles 
calculation of insulin adjustment: 1-2 unit increase every 3-4 days
correct lows first
88
Q

Insulin A/E

A

hypoglycemia
lipodystrophy – give less injections at the site
atrodystrophy – give more injections at the site

89
Q

regular insulin route

A

IV or subQ

90
Q

Glargine/ Levemir education

A

keep extra bottles in refrigerator, any bottle that is being used should be kept outside of the refrigerator and is good for 30 days

91
Q

refrigerated insulin causes

A

hyperdystrophy, and atrodystrophy

92
Q

Thyrotoxicosis– Afib treatment

A

propranolol

Pharm Exam 1 (2 decks)

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