Diabetes, thyroid not covered in sketchy Flashcards
When are sulfanyl ureas contraindicated?
Pregnancy *Renal/Liver disease* Sulfa allergies Type-1 diabetes Elderly
When are meglitinides contraindicated?
Pregnancy
*Liver disease
What is the difference b/w the indications for sulfanyl ureas and meglitinides?
Sulfas: Slow onset
Long duration
Lowers fasting glucose
Meglitinides: Fast acting
Short duration
Lowers postprandial glucose
Can use when allergic to sulfas
When is metformin contraindicated?
Elderly >80 yrs Pregnancy *Renal failure, MI, CHF* Liver disease/alcohol abuse Hypoxia/Shock/septicemia Iodinated contrast agent Serious acute illness (eg viral infection) Hypoxic/ischemic states (eg COPD, lung dz)
Besides lactic acidosis and GI side effects, what is the 3rd minor SE of metformin?
v B12 absorption
When are the thiazolidinediones contraindicated?
Liver disease
CHF (stage III, stage IV; due to edema)
CVD
Pregnancy
How is pramlintide administered?
Requires injections (SQ)
When are alpha-glucosidase inhibitors contraindicated?
Chronic intestinal disease
IBD
Colonic ulceration
Besides being contraindicated in renal impairment, when else are SGLT2 inhibitors contraindicated?
T1DM
Besides UTIs and hypotension, what are some other adverse effects of SGLT2 inhibitors?
Thirst/dehydration
^ LDL
Hyperkalemi
What is the MoA of bromocriptine in treating DM?
Dopamine D2 agonist acts on the CNS to normalize hypothalamic DA levels, thereby decreasing sympathetic tone, resulting in: v Hepatic GNG v Lipolysis/FFA v Lipogenesis/TG ^ Glucose tolerance ^ Insulin sensitivity
~0.5% decrease in HbA1C
What is the MoA of colvelesalam in treating DM?
Prevents bile acid reabsorption. Allows bile acids to enter the colon.
Bile acids bind TGR5 GPCR expressed on intestinal cells and induce GLP-1 secretion.
~0.5% decrease in HbA1C
When is radioactive iodine contraindicated?
Pregnancy
Breast feeding
Severe ophthalmopathy
What are some adverse affects a/w using beta-blockers to treat hyperthyroidism sx?
Exacerbation of HF
^ Airway resistance
Exacerbation of peripheral artery disease
When are beta-blockers contraindicated?
Asthma, COPD, HF
What is an alternative drug choice to beta-blockers when treating hyperthyroid sx?
Which beta-blockers are cardioselective?
Diltiazem (Ca2+ blocker)
Metropolol/atenolol (cardiac-selective beta blocker)
What is the name of synthetic T3? T4?
Which is more useful and why?
T3: liothyronine/triiodothyronine
T4: levothyroxine/tetraiodothyronine
Levothyroxine (has smoother dosing, less peaks and troughs)
What is the MoA for liothyronine and levothyroxine?
- Liothyronine: Active hormone acts as an agonists of the TR transcription factor
- Levothyroxine: Pro-hormone converted in vivo to the active T3 form, which acts as an agonists of the TR transcription factor
What are the indications for T3 vs T4?
- Liothyronine (T3): Hypothyroidism when rapid onset of action is required, e.g.
1. Myxedema coma
2. Preparation of thyroid cancer pt for radioiodine therapy to avoid extended period of thyroid hormone withdrawal - Levothyroxine (T4): Hypothyroidism
Adverse affects of liothyronine vs. levothyroxine?
Risk of thyrotoxicosis w/OD
Hyperthyroidism w/OD
^ risk a-fib
^ Bone loss in postmenopausal women
Name 2 formulations of iodide.
- Saturated potassium iodide [SSKI]
- Potassium iodide-iodine [Lugol’s solution]
What is the MoA for iodide?
Acutely and rapidly inhibits thyroid hormone secretion
Inhibits hormone synthesis via
Wolff-Chaikoff effect (Transient- 10 days)
Decreases thyroid organ vascularity
What are the indications for iodide therapy?
a) Severe hyperthyroidism, e.g. thyroid storm
b) Preoperative prep of pts for thyroidectomy (decreases vascularity)
c) Adjunct therapy following radioiodide or antithyroid drugs
d) After major nuclear accidents to prevent radioiodine uptake
What adverse effect is a/w iodide therapy?
Can exacerbate hyperthyroid sx if given alone. Prevent by using as an adjunct therapy following either radioiodide or antithyroid drugs.
