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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
Prandial
relating to a meal post-prandial blood glucose goal: <140mg/dL
26
Hypoglycemia
Glucose <70mg/dL
27
Carbohydrates
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)
28
Rapid-Acting
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
29
Novolog
Insulin aspart rapid-acting
30
Humalog
Insulin lispro rapid-acting
31
Apidra
Insulin glulisine rapid-acting
32
Short-Acting
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
33
Novolin R, Humulin R
Insulin regular Short-acting
34
Intermediate-Acting
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
35
Novolin N, Humulin N
Insulin NPH intermediate-acting
36
Long-Acting
Mimic basal insulin release dosed regularly regardless of meals/food
37
Lantus, Basaglar
Insulin glargine - can't be mixed w/other insulins, soluble in acidic environment onset: 2 hours peakless duration: 22-24 hours (usually given QD)
38
Toujeo (300 U/mL)
concentrated insulin glargine onset: 6 hours peakless duration: 32-36 hours
39
Levemir
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
40
Tresiba
Insulin degludec -can be considered ultra long-acting onset: 1 hour peakless duration: 42 hours
41
Intermediate + Regular
Human 50/50 (50% NPH, 50% regular) Novolin 70/30 (70% NPH, 30% regular)
42
Intermediate + Rapid
Humalog 75/25 (75% LPS, 25% lispro) Humalog 50/50 (50% LPS, 50% lispro) Novolog 70/30 (70% APS, 30% aspart)
43
LPS/APS
Lispro protamine sulfate Aspart protamine sulfate NPH-like action (Intermediate-acting)
44
Glucophage
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
Thiazolidinediones (TZDs)
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
Actos
Pioglitazone Thiazolidinediones (TZD)
47
Avandia
Rosiglitazone Thiazolidinediones (TZD)
48
Sulfonylureas
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
Amaryl
Glimepiride Sulfonylurea - 2nd generation
50
Glucotrol
Glipizide Sulfonylurea - 2nd generation
51
Micronase
Glyburide Sulfonylurea - 2nd generation
52
Meglitinides
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
Prandin
Repaglinide Meglitinide
54
Starlix
Nateglinide Meglitinide
55
GLP-1 Agonists
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
Exenatide
Byetta - BID prior to breakfast/dinner - has the most ADR of GLP-1 Agonists GLP-1 Agonist
57
Exenatide Extended-Release
Bydureon -once weekly GLP-1 Agonist
58
Victoza
Liraglutide - QD - has decreased mortality GLP-1 Agonist
59
Tanzeum
Albiglutide -once weekly GLP-1 Agonist
60
Trulicity
Dulaglutide -once weekly GLP-1 Agonist
61
DPP-4 Inhibitors
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
Januvia
Sitagliptin DPP-4 Inhibitor
63
Onglyza
Saxagliptin DPP-4 Inhibitor
64
Tradjenta
Linagliptin DPP-4 Inhibitor
65
Nesina
Alogliptin DPP-4 Inhibitor
66
Amylin Analog
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
Symlin
Pamlintide - SQ injection - only drug in this class Amylin analog
68
SGLT-2 Inhibitor
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
Invokana
Canaglifozin SGLT-2 Inhibitor
70
Farxiga
Dapaglifozin SGLT-2 Inhibitor
71
Jardiance
Empagliflozin SGLT-2 Inhibitor
72
Short-acting Beta-2-agonists (SABA)
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
ProAir, Ventolin, Proventil
Albuterol Short-acting Beta-2-agonists (SABA)
74
Xopenex
Levalbuterol -isomer of albuterol fewer side effects Short-acting Beta-2-agonists (SABA)
75
Long-acting Beta-agonists (LABA)
Not for acute exacerbations because the onset of action isn't fast ***MUST BE USED IN MORE SEVERE DISEASE IN COMBO W/ICS***
76
Inhaled Corticosteroids (ICS)
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
QVAR
Beclomethasone ICS
78
Pulmicort
Budesonide ICS - inhaler and nebulizer
79
Flovent
Fluticasone ICS
80
Asmanex
Mometasone ICS
81
Advair Diskus
Fluticasone + Salmeterol
82
Symbicort
Budesonide + Formoterol
83
Dulera
Mometasone + Formoterol
84
Breo Ellipta
Vilanterol + Fluticasone
85
Leukotriene Modifiers
Inhibit leukotriene actions - add-on therapy in asthma - well tolerated - adjunct therapy to ICS ADR - headache, fatigue, mood disorders
86
Singulair
Montelukast leukotriene receptor antagonists
87
Accolate
Zafirlukast leukotriene receptor antagonists
88
Zyflo
Zileuton 5-lipoxygenase inhibitor
89
Methylxanthines
Bronchodilator Non-selective PDE inhibition Mild anti-inflammatory effects ADR - nausea, vomiting, tachycardia, jitteriness, difficulty sleeping, cardiac tachyarrhythmias, seizures
90
Theo-24/Uniphyl
Theophylline Methylxanthines
91
Medications used in COPD
``` SABA LABA ICS systemic corticosteroids Methylxanthines (not often) anti-muscarinics PDE-4 inhibitors ```
92
Anti-Muscarinics
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
Atrovent
Ipratropium -inhaler and nebulizer solution short-acting anti-muscarinic
94
Spiriva
Tiotropium long-acting anti-muscarinic
95
Tudorza
Aclidinium long-acting anti-muscarinic
96
Incruse
Umeclidinium long-acting anti-muscarinic
97
Seebri
Glycopyrrolate long-acting anti-muscarinic
98
Brovana
Arformoterol LABA approved for COPD only nebulizer solution
99
Ipratropium/albuterol
Anti-muscarinic and Beta-agonist (SABA and SAMA) Combivent - MDI Duoneb - nebulizer solution
100
Anoro Respimat
Vilanterol + Umeclidinium | LABA + LAMA
101
Stiolto Respimat
Olodaterol + tiotropium | LABA + LAMA
102
Utibron Neohaler
Indacaterol + glycopyrrolate
103
Phosphodiesterase-4 Inhibitors
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
Daliresp
Roflumilast selective inhibitor of PDE-4 -increases intracellular cAMP in lung cells

BBDA (6 decks)

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