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BBDA > Diabetes/Thyroid/Respiratory > Flashcards

Diabetes/Thyroid/Respiratory Flashcards

1
Q

Thyroid gland function

A

Maintains optimal level of metabolism via production of thyroid hormones which affect virtually every organ system

Produces two main types of hormones:
Calcitonin
Thyroid hormone

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2
Q

Thyroid gland

A

Butterfly-shaped organ located on the anterior surface of the trachea

Function in the regulation of Ca2+ metabolism

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3
Q

Iodine-related Effects

A

Wolff-Chaikoff effect - iodine administration leads to HYPOTHYROIDISM

Jod-Basedow Phenomenon - iodine administration leads to HYPERTHYROIDISM; usually only happens in countries where they don’t have a lot of iodine in diet

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4
Q

Levothyroxine 0.025mg

A

Orange

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5
Q

Levothyroxine 0.050mg

A

White

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6
Q

Levothyroxine 0.075mg

A

Violet

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7
Q

Levothyroxine 0.088mg

A

Mint Green

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8
Q

Levothyroxine 0.1mg

A

Yellow

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9
Q

Levothyroxine 0.112mg

A

Rose

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10
Q

Levothyroxine 0.125mg

A

Brown

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11
Q

Levothyroxine 0.137mg

A

Not made

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12
Q

Levothyroxine 0.150mg

A

Blue

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13
Q

Levothyroxine 0.175mg

A

Lilac

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14
Q

Levothyroxine 0.200mg

A

Pink

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15
Q

Levothyroxine 0.300mg

A

Green

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16
Q

Patient counseling for Levothyroxine

A

Before breakfast
avoid antacids or vitamins within 2 hours
awareness of product used & color of tablet
effects will be seen in 2-4 weeks
follow up w/Dr. in 6-8 weeks and yearly
hypo/hyper effects if does not correct

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17
Q

Hyperthyroidism

A

also called thyrotoxicosis

excessive production of thyroid hormones

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18
Q

Thyroid Storm

A

Too much thyroid being produced

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19
Q

Role of Pancreas

A

Exocrine

  • secretes substances to a surface or through a duct
  • release of digestive enzymes in response to chyme that enters the duodenum

Endocrine
-secretes a hormone into the bloodstream

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20
Q

Alpha-cells

A

releases glucagon
-stimulated by decreasing blood glucose or a rise in amino acid level; raises our blood sugar

hyperglycemic hormone
liver is the target organ

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21
Q

Beta-cells

A

stimulated by elevated blood glucose (any carbohydrates)

Insulin producing cells
decrease blood glucose
increase transport of glucose into cells

Form glycogen from glucose
convert glucose to fat

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22
Q

Type 1 Diabetes

A

absolute deficiency of insulin (or very small amounts)

Usually happens at a young age
Results in hyperglycemia (normally presents as diabetic ketoacidosis (eating/drinking/urinating a lot)

Insulin MUST BE USED for survival

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23
Q

Type 2 Diabetes

A

Insulin resistance - abdominal obesity, visceral fat

Lack of insulin secretion (Progressively decreases over time)

High risk for CV disease

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24
Q

HbA1c

A

Hemoglobin A1c

long-term blood sugar number = average blood glucose over past 3 months

Normal: 4.5-5.7%
Goal: <7%

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25
Q

Prandial

A

relating to a meal

post-prandial blood glucose goal: <140mg/dL

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26
Q

Hypoglycemia

A

Glucose <70mg/dL

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27
Q

Carbohydrates

A

quick fuel
main food group that affects the blood glucose

simple - sugary stuff
complex - want people to have more of these because they’re harder to break down (last longer)

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28
Q

Rapid-Acting

A

used for control of prandial sugars, used in insulin pumps

administered prior to meals ~10 minutes before

onset: 10-15 minutes
peak: 1 hour
duration: 3-5 hours

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29
Q

Novolog

A

Insulin aspart

rapid-acting

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30
Q

Humalog

A

Insulin lispro

rapid-acting

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31
Q

Apidra

A

Insulin glulisine

rapid-acting

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32
Q

Short-Acting

A

usted for control of prandial sugars

administered prior to meals ~30 minutes before

onset: 0.5-1 hour
peak: 2-4 hours
duration: 6-8 hours

Used IV, IM, SQ

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33
Q

Novolin R, Humulin R

A

Insulin regular

Short-acting

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34
Q

Intermediate-Acting

A

used as basal and prandial coverage
-depends on WHEN it is given

onset: 2-4 hours
peak: 4-10 hours
duration: 10-18 hours

problem for use as basal coverage because it can cause hypoglycemia

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35
Q

Novolin N, Humulin N

A

Insulin NPH

intermediate-acting

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36
Q

Long-Acting

A

Mimic basal insulin release

dosed regularly regardless of meals/food

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37
Q

Lantus, Basaglar

A

Insulin glargine - can’t be mixed w/other insulins, soluble in acidic environment

onset: 2 hours
peakless
duration: 22-24 hours (usually given QD)

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38
Q

Toujeo (300 U/mL)

A

concentrated insulin glargine

onset: 6 hours
peakless
duration: 32-36 hours

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39
Q

Levemir

A

Insulin detemir

onset: 3 hours
peak: 6-8 hours
duration: 6-23 hours; variable w/dose (larger dose lasts longer)

smoother action when given BID

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40
Q

Tresiba

A

Insulin degludec
-can be considered ultra long-acting

onset: 1 hour
peakless
duration: 42 hours

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41
Q

Intermediate + Regular

A

Human 50/50 (50% NPH, 50% regular)

Novolin 70/30 (70% NPH, 30% regular)

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42
Q

Intermediate + Rapid

A

Humalog 75/25 (75% LPS, 25% lispro)

Humalog 50/50 (50% LPS, 50% lispro)

Novolog 70/30 (70% APS, 30% aspart)

43
Q

LPS/APS

A

Lispro protamine sulfate
Aspart protamine sulfate

NPH-like action (Intermediate-acting)

44
Q

Glucophage

A

Metformin
-1st line therapy, TWF

MOA - biguanide (class), decreases glucose production from the liver; makes insulin work better/more efficiently

ADR - abdominal discomfort, bloating, diarrhea; (minimized by titrating up slowly); weight loss, lactic acidosis, B12 deficiency

Full effect takes ~2 weeks

45
Q

Thiazolidinediones (TZDs)

A

add-on therapy to Metformin

MOA - binds to the peroxisome proliferator-activated receptor-gamma (PPAR-gamma) (modulate genes in DNA); enhances insulin sensitivity of muscle, liver, and fat tissues, increases glucose transporter expression, decreases hepatic glucose production

Pioglitazone (Actos) and Rosiglitazone (Avandia)

  • full effect 3-6 months
  • decrease in glucose may not be seen for 4 weeks
  • Actos has better lipid profile than Avandia

ADR - Fluid retention (start low/slow) caution w/use in HF, weight gain and macular edema (increased when used in combo w/insulin), fractures, bladder cancer

46
Q

Actos

A

Pioglitazone

Thiazolidinediones (TZD)

47
Q

Avandia

A

Rosiglitazone

Thiazolidinediones (TZD)

48
Q

Sulfonylureas

A

add-on therapy

MOA - binds to the beta cell on pancreas, inhibits efflux of K+ ions and depolarizes, opens voltage-gated Ca2+ channel (influx), release of insulin

ADR - hypoglycemia, weight gain, patients must have endogenous insulin so TYPE 1 DIABETICS CAN’T USE THESE

49
Q

Amaryl

A

Glimepiride

Sulfonylurea - 2nd generation

50
Q

Glucotrol

A

Glipizide

Sulfonylurea - 2nd generation

51
Q

Micronase

A

Glyburide

Sulfonylurea - 2nd generation

52
Q

Meglitinides

A

focus on prandial glucose only

MOA - like sulfonylureas
-very short onset and duration of action: half-life = 1 hour

ADR - hypoglycemia, dizziness

give prior to meals (15-30 minutes) DON’T TAKE IF DON’T EAT!!

53
Q

Prandin

A

Repaglinide

Meglitinide

54
Q

Starlix

A

Nateglinide

Meglitinide

55
Q

GLP-1 Agonists

A

2nd line therapy
used in combination w/Metformin, SU, or both

MOA - synthetic analog of GLP-1
SQ injection QD, BID, weekly

ADR - nausea (40%), vomiting, reduced apetite and weight loss, diarrhea or constipation, hypoglycemia (not on its own but in combo w/insulin or SU, pancreatitis

56
Q

Exenatide

A

Byetta

  • BID prior to breakfast/dinner
  • has the most ADR of GLP-1 Agonists

GLP-1 Agonist

57
Q

Exenatide Extended-Release

A

Bydureon
-once weekly

GLP-1 Agonist

58
Q

Victoza

A

Liraglutide

  • QD
  • has decreased mortality

GLP-1 Agonist

59
Q

Tanzeum

A

Albiglutide
-once weekly

GLP-1 Agonist

60
Q

Trulicity

A

Dulaglutide
-once weekly

GLP-1 Agonist

61
Q

DPP-4 Inhibitors

A

add-on therapy but not w/GLP-1 agonist

MOA - inhibits dipeptidyl peptidase-4 (DPP-4), decreases post-prandial glucose levels, increase insulin secretion and decrease glucagon secretion (doesn’t slow GI tract or promote satiety)

ADR - swelling, HA, URI

well tolerated but don’t lower A1C as much as they should

62
Q

Januvia

A

Sitagliptin

DPP-4 Inhibitor

63
Q

Onglyza

A

Saxagliptin

DPP-4 Inhibitor

64
Q

Tradjenta

A

Linagliptin

DPP-4 Inhibitor

65
Q

Nesina

A

Alogliptin

DPP-4 Inhibitor

66
Q

Amylin Analog

A

Amylin is co-secreted w/insulin from beta cells, slows gastric emptying, suppresses the release of glucagon, increases satiety

help w/post prandial blood glucose, used in combo w/insulin

MOA - mimics actions of amylin

ADR - GI: nausea, vomiting, anorexia; hypoglycemia, abdominal pain, headache

Given immediately prior to eating (titrate up)

67
Q

Symlin

A

Pamlintide

  • SQ injection
  • only drug in this class

Amylin analog

68
Q

SGLT-2 Inhibitor

A

Na+/glucose co-transporter 2 inhibitor

MOA - Inhibits Na+/glucose transporter in the kidney to increase urinary excretion of glucose, reduces absorption of filtered glucose, lowers renal threshold for glucose

ADR - Yeast infections, UTIs, increased urination, orthostasis, weight loss

69
Q

Invokana

A

Canaglifozin

SGLT-2 Inhibitor

70
Q

Farxiga

A

Dapaglifozin

SGLT-2 Inhibitor

71
Q

Jardiance

A

Empagliflozin

SGLT-2 Inhibitor

72
Q

Short-acting Beta-2-agonists (SABA)

A

Used for acute bronchospasm or exercise induced asthma

  • smooth muscle relaxation bronchodilation
  • no anti-inflammatory properties

ADR - tachycardia, cardiac dysrhythmias, shakiness, tachyphylaxis w/overuse (tolerance)

Greater efficacy and safety w/inhaled than oral - faster onset of action

73
Q

ProAir, Ventolin, Proventil

A

Albuterol

Short-acting Beta-2-agonists (SABA)

74
Q

Xopenex

A

Levalbuterol
-isomer of albuterol fewer side effects

Short-acting Beta-2-agonists (SABA)

75
Q

Long-acting Beta-agonists (LABA)

A

Not for acute exacerbations because the onset of action isn’t fast

MUST BE USED IN MORE SEVERE DISEASE IN COMBO W/ICS

76
Q

Inhaled Corticosteroids (ICS)

A

Preferred long-term therapy - protects Beta receptors

Low to medium dose ICS

  • reduce bronchial hyper-responsiveness
  • improve lung function
  • reduce severe exacerbations
  • more effective than other meds by inhaling it, reduces side effects

start seeing improvement 1-2 weeks
max improvement 4-8 weeks

ADR - oropharyngeal candidiasis (yeast in mouth), Dysphonia, systemic effects at high doses = growth retardation and osteoporosis and cataracts

77
Q

QVAR

A

Beclomethasone

ICS

78
Q

Pulmicort

A

Budesonide

ICS - inhaler and nebulizer

79
Q

Flovent

A

Fluticasone

ICS

80
Q

Asmanex

A

Mometasone

ICS

81
Q

Advair Diskus

A

Fluticasone + Salmeterol

82
Q

Symbicort

A

Budesonide + Formoterol

83
Q

Dulera

A

Mometasone + Formoterol

84
Q

Breo Ellipta

A

Vilanterol + Fluticasone

85
Q

Leukotriene Modifiers

A

Inhibit leukotriene actions

  • add-on therapy in asthma
  • well tolerated
  • adjunct therapy to ICS

ADR - headache, fatigue, mood disorders

86
Q

Singulair

A

Montelukast

leukotriene receptor antagonists

87
Q

Accolate

A

Zafirlukast

leukotriene receptor antagonists

88
Q

Zyflo

A

Zileuton

5-lipoxygenase inhibitor

89
Q

Methylxanthines

A

Bronchodilator
Non-selective PDE inhibition
Mild anti-inflammatory effects

ADR - nausea, vomiting, tachycardia, jitteriness, difficulty sleeping, cardiac tachyarrhythmias, seizures

90
Q

Theo-24/Uniphyl

A

Theophylline

Methylxanthines

91
Q

Medications used in COPD

A 
SABA
LABA
ICS
systemic corticosteroids
Methylxanthines (not often)
anti-muscarinics
PDE-4 inhibitors
92
Q

Anti-Muscarinics

A

reverse bronchoconstriction mediated through ACh
-block at M3 muscarinic receptor on airways

Short-acting
Long-acting

ADR - dry mouth, cough, dizziness (can’t see, spit, stool, pee)

93
Q

Atrovent

A

Ipratropium
-inhaler and nebulizer solution

short-acting anti-muscarinic

94
Q

Spiriva

A

Tiotropium

long-acting anti-muscarinic

95
Q

Tudorza

A

Aclidinium

long-acting anti-muscarinic

96
Q

Incruse

A

Umeclidinium

long-acting anti-muscarinic

97
Q

Seebri

A

Glycopyrrolate

long-acting anti-muscarinic

98
Q

Brovana

A

Arformoterol
LABA approved for COPD only

nebulizer solution

99
Q

Ipratropium/albuterol

A

Anti-muscarinic and Beta-agonist (SABA and SAMA)
Combivent - MDI
Duoneb - nebulizer solution

100
Q

Anoro Respimat

A

Vilanterol + Umeclidinium

LABA + LAMA

101
Q

Stiolto Respimat

A

Olodaterol + tiotropium

LABA + LAMA

102
Q

Utibron Neohaler

A

Indacaterol + glycopyrrolate

103
Q

Phosphodiesterase-4 Inhibitors

A

Seems to work better on those patients w/chronic bronchitis

No direct bronchodilator effects
-improves FEV1 in those on bronchodilators

ADR - diarrhea, nausea, reduced appetite and weight loss, sleep disturbance, abdominal pain, headache

104
Q

Daliresp

A

Roflumilast

selective inhibitor of PDE-4
-increases intracellular cAMP in lung cells

BBDA (6 decks)

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