Diabetes Pharm

Question 1

Regular Crystalline

Answer 1

Treat DKA, diabetes at home
IV, IM, SC
causes rapid decrease in blood glucose concentration
ay cause hypokalemia
DOSE: SC q 6-8 h, @ home q 8 hr
IM=4-6 hr
SC=6-8

Question 2

NPH

Answer 2

treat diabetes at home, SC q 12 h (dog 6-12, cats 6-10)

short duration in dogs and cats

Question 3

Lente

Answer 3

diabetes at home, SC q 12 hr (D-8-14, C-6-12), short duration o effect in cats

Question 4

PZI

Answer 4

treat diabetes at home, good initial insulin for cats, SC q 12 hr (D- 10-16, C-10-14). duration of effect too long for q 12hr in some dogs, unpredictable glucose nadir (lowest BG value) in some dogs

Question 5

Glargine

Answer 5

diabetes at home, good initial insulin for cats, SC q 12 hr-24 hr (D& C 8-24)
Duration of effect too long for q 12 hr w/ some cats and dogs, weak glucose lowering effect and unpredictable timing of glucose nadir in some dogs

Question 6

Detemir

Answer 6

Treat diabetes at home, SC q 12-24 hr, (D&C=8-24 hr), duration of effect too long for q 12 hr in some cats and dogs, insulin dosage requirements considerably lower than those seen w/ other

Question 7

Trilostane

Answer 7

inhibits enzymes of adrenal cortical synthesis of cortisol in dogs but does not cause adrenal cell death
can be used in pituitary dependent hyperadrenocorticism, as well as in managing clinical signs from adrenal tumors in dogs
Trilostane also has been effective in cats with hyperadrenocorticism, with no reported adverse effects. Trilostane can decrease clinical signs of hyperadrenocorticism in cats but cannot produce resolution of clinical signs. It can also improve regulation of diabetes, which is often found concurrently in cats with hyperadrenocorticism.

Question 8

AE of Trilostane?

Answer 8

Several adverse effects may be related to reductions in cortisol (inappetence, vomiting, lethargy)
May interfere with aldosterone synthesis (dehydration, weakness, hyponatremia, hyperkalemia). Caution if used with drugs that impair RAAS.
Uncommonly, adrenal necrosis (those patients get treated as for Addison’s)

Question 9

Mitotane

Answer 9

Impairs cholesterol metabolism causing cell death
Cytotoxic agent causing necrosis of adrenal cortical tissue, with preference for glucocorticoid production (zona fasiculata & reticularis)
can be used in pituitary dependent hyperadrenocorticism, as well as in managing clinical signs from adrenal tumors in dogs
Use has been largely replaced by trilostane, but may be preferred

Question 10

AE of Mitotane?

Answer 10

ADVERSE EFFECTS
lethargy, weakness, inappetence, vomiting (may be in part due to reduced cortisol)
hepatotoxic
ataxia, head pressing, blindness in some dogs
caution owners regarding exposure, pregnant women/children should not handle.

Question 11

Levothyroxine

Answer 11

Synthetic T4
replacement therapy for hypothyroidism
blood levels unpredictable from a given dose, should use therapeutic monitoring
MANY drugs can affect baseline serum thyroid hormone levels
low serum thyroid levels in medicated patients without clinical signs may not be true hypothyroidism

Question 12

AE of Levothyroxine?

Answer 12

ADVERSE EFFECTS:
thyrotoxicosis from excessive plasma levels (likely), or paradoxical individual sensitivity (unusual)
nervousness, panting, tachypnea, tachycardia, aggression, pu/pd, polyphagia

Question 13

Methimazole

Answer 13

inhibits peroxidase-dependent incorporation of iodide into T3 & T4
therapeutic effect may take 2-4 weeks
transdermal gel for cats available

Question 14

AE of Methimazole?

Answer 14

ADVERSE EFFECTS:
most methimazole adverse effects can be reduced by reducing dose
possible hypersensitivity, dermatitis, polyarthropathy, vasculitis, blood dyscrasias
do not administer to patients with thrombocytopenia, coagulopathy
teratogen, do not administer to pregnant animals
advise client to use gloves with transdermal exposure, no exposure for pregnant women