Diabetes and Endocrine Flashcards by Emily Salazar

Levothyroxine MOA

synthetic T4 and some of the T4 is converted to T3

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Levothyroxine Use

any type of hypothyroidism
thyroidectomy
myxedema coma

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Levothyroxine A/E

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

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Levothyroxine patient education

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

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levothyroxine monitoring

Q3mo until maintenance dose is reached, then annually

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liothyronine

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

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Propylthiouracil (PTU) MOA

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

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PTU use

hyperthyroidism
thyrotoxicosis
preferred drug for pregnancy

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PTU A/E

agranulocytosis

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PTU dosing

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

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PTU and pregnancy

crosses the placenta more poorly than other drug

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Methimazole MOA

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

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Methimazole Use

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

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Methimazole contraindications

PREGNANCY

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Methimazole A/E

Agranulocytosis

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Sulfonylureas 1st gen drugs

Chlorpropamide

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Sulfonylureas 2nd gen drugs

Glimepiride
Glipizide
Glyburide

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Sulfonylureas MOA

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

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Sulfonylureas Uses

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

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Sulfonylureas contraindications

pregnancy– not approved but still given

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Sulfonylureas A/E

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

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Sulfonylureas Drug interactions

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

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Biguanide drug

Metformin

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Metformin MOA

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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Metformin Use

T2DM 1st line treatment prediabetes pregnancy

Metformin A/E

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

Metformin drug interactions

alcohol | cimetidine

Metformin contraindications

renal disease GFR <45 receiving contrast dye acutely ill

Metformin patient educations

does not cause hypoglycemia

Metformin nursing implementations

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

Thiazolidinediones (TZD) drugs

Pioglitazone | Rosiglitazone

TZD MOA

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

TZD A/E

fluid retention: wt gain, congestive HF hepatotoxicity hypoglycemia

TZD drug interactions

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

TZD monitoring

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

Alpha-glucosidase enzyme inhibitor drugs

Miglitol | Acarbose

A-glucosidase enzyme inhibitor MOA

delays breakdown of CHO in the small intestine | ** does not stimulate insulin secretion

A-glucosidase enzyme inhibitor A/E

wt. gain | GI effects

A-glucosidase enzyme inhibitor Patient education

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

Meglitinide drug

Repaglinide

Repaglinide MOA

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

Repaglinide A/E

``` hypoglycemia GI effects HA chest pain UTI ```

Repaglinide drug interactions

usually given with metformin

Repaglinide Patient education

take before a meal, dont take if dont eat

DPP4 inhibitor drug

Sitagliptin

Sitagliptin MOA

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

Sitagliptin Use

3rd line choice drug | only to be used in patients who produce insulin

Sitagliptin A/E

``` hypoglycemia HA pharyngitis arthritis pancreatitis angioedema anaphylaxis SJS ```

Sitagliptin dosing

decrease dose in renal impairment

Sitagliptin Patient education

can be taken with or without food

SGLT-2 drugs

Canagliflozin | Dapagliflozin

SGLT-2 MOA

blocks reabsorption of glucose in the renal tubules

SGLT -2 A/E

UTI fungal infections in women postural hypotension

SGLT-2 contraindiaction

GFR<45

Incretin mimetics drug

Exenatide

Exenatide MOA

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

Exenatide Use

T2DM only | injectable

Exenatide A/E

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

Exenatide drug interactions

decreases absorption of other PO drugs | hypoglycemia with alcohol

Exenatide nursing implementations

give PO drugs before this medication

regular insulin

short acting

regular insulin onset

30-60 min

regular insulin peak

1-5hr

regular insulin duration

6-10 hr

lispro, aspart

rapid acting insulin

lispro onset

15-30 min

lispro peak

0.5-2.5 hr

lispro duration

3-6hr

Aspart onset

10-20 min

Aspart peak

1-3 hr

Aspart duration

3-5 hr

Lispro, Aspart, regular insulins mix

with NPH only

Lispro good for

those who dont eat regularly

NPH

intermediate acting insulin

NPH onset

1-2 hr

NPH peak

6-14hr

NPH duration

16-24 hr

NPH dosing

BID morning and evening

70/30 mix

70% NPH, 30% regular insulin | given to people who cannot afford NPH and regular separately, and elderly people, poor dexterity

Glargine (lantus), levemir

long acting insulin

Glargine onset

2-4 hr

Glargine peak

peakless

Glargine duration

20-24

levemir onset

2hr

levemir peak

peakless

levemir duration

24hr

insulin patient education

``` 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 ```

Insulin A/E

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

regular insulin route

IV or subQ

Glargine/ Levemir education

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

refrigerated insulin causes

hyperdystrophy, and atrodystrophy

Thyrotoxicosis-- Afib treatment

propranolol