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Advanced pharmacology > DM, Thyroid, Osteoporsis > Flashcards

DM, Thyroid, Osteoporsis Flashcards

1
Q

Type 1 diabetes

A

Insulin deficiency cause by beta cell destruction. Dependency on exogenous insulin for survival

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2
Q

Type II DM

A

Insulin resistance, linked to obesity. Exogenous insulin not necessary for survival but may be required as the disease progresses

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3
Q

Gestational DM

A

Glucose intolerance with onset during pregnancy

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4
Q

Pre - diabetic

A

Intermediate stage in which glucose levels abnormal but does not meet the criteria for official dx. Impaired fasting glucose and glucose intolerance

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5
Q

Type I symptoms

A

Brief period of profound symptoms : polyuria, polydipsia, polyphagia, weight loss , blurred vision / fatigue

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6
Q

Type II symptoms

A

Relatively symptom free or only subtle symptoms that may persist fir weeks months or years

Polyuria, polydipsia, blurred vision, slow healing wound, freq infection

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7
Q

Pre-diabetic fasting plasma glucose , oral glucose tolerance test, and HbGAiC

A

Fasting : 100-125
Oral : 140-199
H1C : 5.7-6.4 %

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8
Q

NORMAL fasting plasma glucose , oral glucose tolerance test, and HbGAiC

A

Fasting : < 100
Oral : < 140
H1C : < 5.7

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9
Q

DM fasting plasma glucose , oral glucose tolerance test, and HbGAiC

A

Fasting > 126
Oral > 200
H1C ; > 6.5

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10
Q

Management and proper treaments for DM

A

Nutritional therapy :
Exercise and physical activity : causes increased glucose uptake in skeletal muscle and improved insulin sensitivity ; in type II also decreases insulin resistance and increases glucose uptake into cells

Current goals : are individualized and are based on what is acceptable to the medical provider and patient while preventing acute complication and progression of chronic complication

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11
Q

insulin

A

Insulin receptor allow utilization of glucose by cells

Exogenous insulin should closely mimic endogenous insulin ( basal + bolus)

of insulin receptor mitigated by obesity and long standing hyperglycemia

Theory to administer early on in type II may reduce progression

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12
Q

Rapid acting insulin

A

Novolog , Glulisine, Lispro

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13
Q

Novolog

A

Onset : 10-20 min Peak : 1-3 hours Duration : 3-5 hours

Meal and correction

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14
Q

Lispro

A

Onset : 15-30 min
Peak L 1.5-2.5 hours
Duration : 5 hours

Meal and correction

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15
Q

Short acting insulin

A

Regular

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16
Q

Regular insulin

A

Onset : 30-60 m in
Peak : 2-4 hours
Duration : 5-8 hours

May mix with NPH, MUST be given 20-30 min before a meal

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17
Q

Long acting

A

Langues, Levemir, Teresiba

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18
Q

Lantus

A

Onset: 50-120 min
Peakless
Duration : 24 hours

Do not mix with other insulin’s . Given once daily or 12 hours apart if BID

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19
Q

Individualized A1C targets

A

A1C < 6.5 % for patient w/o cocurrent serious illness and at low hypoglycemic risk

A1C > 6.5 % for pt with concurrent serious illness and at risk for hypoglycemia

7-7.9 % : in older adults with polypharmacy and other comorbidtities

8-8.9 % - end of life

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20
Q

Metformin

A

MAO: decreases hepatic glucose production and intestinal glucose absorption : increases insulin sensitivity

Adverse: N/V/D ( take with food ) Vitamin B12 depletion

Serious adverse effects : lactic acidosis, megablastic anemia , hepatotoxicity

Pearls: hold for acute MI, CHF , surgery or CT with contrast , take extended release tablets with evening meals

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21
Q

Exantatide

A

MOA: stimulates insulin secretion, slows gastric emptying and decrease food intake

Brand name : Byetta

Adverse : n/v/d weight loss

Serious : pancreatitis , nephrotoxicity

Contraindication : IM/IV use

Pearls: use Byetta within 60 min before eating the meal

22
Q

Liraglutide

A

MOA: stimulates insulin secretion, decreases glucagon levels

Brand name: Victoza

Pearls: may be taken at anytime of the day ( w/ or w/o meal) .

Only GLP-1 RA approved for cardiac event risk reduction

23
Q

Dapaglifozin , Canagliflozin Empagliflozin

A

SGLT2
Oral

MOA: promotes the renal excretion of glucose

Adverse: UTI

Clinical pearls: should be taken before 1 st meal of day

Black box warning for toe and foot amputations with - Canagliflozin

Possible ASCVD risk reduction with Jardiance

24
Q

Rosiglitazone and Pioglitazone

A

Oral

Increases insulin sensitivity and decreases hepatic glucose output

contraindication: HF and MI

Not recommended for use with insulin … may cause anovulatory women to resume ovulation

25
Q

Glipizide, Glyburide and Glimepiride

A

Sulfonylureas

Oral

MOA: stimulates islet cells to secrete insulin, prolonged administration may reduce hepatic glucose output and improve insulin sensitivity

Clinical pearls : take 30 min before meal . Therapy may fail after 10-15 years

26
Q

Normal TSH and T4 levels

A

TSH - .3-.52

T4 .7-1.85

27
Q

Values in hyperthyroidism

A

TSH = low t4 = high

28
Q

Values in hypothyroidism

A 
TSH = high 
T4 = low
29
Q

Hypothyroidism effects on the body

A

Brain fog, thinning hair, goiter, heart attack risk, gallstones, mental health, high blood pressure, heartburn, dry skin, weakness

30
Q

Diagnosing hypothyroidism

A

Most times symptoms may not be present

Primary : high TSH and low T4
- after repeat —> replacement therapy with t4 should be initiated

Sub Clinical : high TSH T4 - WNL
— > replacement therapy a case by case

31
Q

Goals of therapy for hypothyroidism

A

Amelioration of symptoms

Normalization of serum TSH secretion

Reduction in the side of goiter

Avoidance of over treatment

32
Q

Treatment - hypothyroidism

A

Levothyroxine

MOA: de-iodinates in peripheral tissues to form T3, the active thyroid hormone

Clinical pearls: take on empty stomach , ideally 1 hour before breakfast and do not take with other medications

Monitoring: check levels 6 weeks after initial dose and increase by 12-25 mcg/day

Dose increase when : preg, weight gain, diminished absorption , increased rate of metabolism

Dose decrease : normal aging, weight loss

33
Q

Pediatrics and hypothyroidism

A

Look for pt with slow growth patterns, decreasing school performance and delayed puberty

34
Q

Pregnancy and hypothyroidism

A

They will need a higher dose of T4 during pregnancy to maintain normal TSH secretion

Give levothyroxine dosage should be returned to the pre-pregnancy dose

35
Q

Treatment for hyperthyroidism

A

Symptom control : beta-blocker initiation w/ diagnosis to decrease palpitations, tachycardia, tremulousness, anxiety and heat intolerance

Decrease thyroid hormone synthesis : anti thyroid / thionamide drugs , radiodine or surgery

36
Q

Thionamides

A

Advantages = chance of permanent remission lower initial cost

Disadvantage : requires frequent monitoring

37
Q

Radioiodine

A

Advantage : permanent resolution of hyperthyroidism

Disadvantage : permanent hypothyroidism

38
Q

Surgery

A

A: rapid, permanent cure

D: high cost

39
Q

Treatment for significant treatment of hyperthyroidism ( older age, CV risk )

A

Thionamide with beta blockers followed by radioiodine or surgery

40
Q

TD for mild hyperthyroidism , minimal thyroid enlargement an no orbitopathy

A

Radioiodine w/o thionamide pretreatment or gluccorticoid

Or

1-2 yr course of thionamides

41
Q

Mild hyperthyroidism minimal thyroid englarment and milt orbitopathy

A

Radioiodine with glucocorticoid coverage but w/o thionamide pretreatment

Or

1-2 yr course of thionamides

42
Q

Severe and moderate to severe

A

Surgery rather than radioiodine w/ glucocorticoid

43
Q

Pregnancy hyperthyroidism

A

1 st = PTU
2nd and 3rd = methimazole

Methimazole > PTU with teratogencity

Heptatoxicity ; PTU > methimazole

Gestational weeks 6-10 highest incidence of birth defects

Switch to methimazole at week 16

44
Q

Major clinical recommendations for osteoporosis

A

Assure ca .1200 and vit D 800-100 IU intake after age 50+

Weight and muscle strengthening intake

Preforms BMD females 65 + every two years

Initiate tax for BMD Y scores < 2.5

Initiate in postmenopausal with T score -1.0 and -2.5

45
Q

Osteoporosis risk factors

A

Decrease calcium intake / vitamin D insufficieny

Immobilization

3 + alcohol drinks

Females

Low BMI

Active or passive smoking

Medication use

46
Q

Medications that affect bone density

A 
Heparin 
Anticonvulsants 
Glucocorticoid 
Chemo 
Psychotropics
Narcotics 
Barbiturates 
PPI
47
Q

Defining osteoporosis by BMD

A

Normal T = -1.0

Low bone mass : t score -1.0 and -2.5

Osteoporosis : T score at or below -2.5

48
Q

Pharmacotherapy for osteoporosis

A

First line is bisphosphonates
Calcitonin
SERM

49
Q

Fosamax

A

Bisphosphonates

Remain upright at least 30 min before eating, drinking or taking any other medication

Consider drug holiday after 3-5 years

Don’t use PO with comorbid GI issues

50
Q

Calcitonin

A

Approval for women > post menopausal when alt not suitable

Advanced pharmacology (12 decks)

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