Endocrine Flashcards

Question

Gliptin – sitagliptin (Januvia) | NC

Answer 1

``` • URI • Inflamed nasal passages • Headache • Pancreatitis o N/V, severe abdominal pain, elevated amylase. ```

Answer 2

``` Contraindications • Type I DM • Lactic acidosis Precautions • Hemodialysis • Moderate/severe renal dysfunction • Hx of pancreatitis ```

Answer 3

 Can increase digoxin levels—dig lowers heart rate, hypoglycemia increases heart rate. Can mask hypoglycemia.

Answer 4

 Type 1, type 2 and gestational DM  Differing types based on onset, peak and duration of action • Promotes cellular uptake and use of glucose • Converts glucose to glycogen • Converts amino acids into proteins • Converts fatty acids into triglycerides • Promotes storage of glucose • Promote uptake of potassium into cells • Pushes glucose and potassium into cell o Hypoglycemia o hypokalemia

Answer 5

Illness, somogyi effect, gastroparesis

Answer 6

``` Lispro (humalog) Aspart(novalog) glulisine (apidra) onset: 10-30 mins peak: 30 min -3 hours duration: 3-5 hours ```

Answer 7

Regular (humulin R, Novolin R) Onset:30min-1hr Peak; 2-5 hours duration:5-8 hours

Answer 8

``` NPH (Humulin N, Novolin N) Onset:1.5-4 hours Peak: 4-12 hours Duration: 12-18 hour cloudy, can be mixed ```

Answer 9

Glargine (Lantus) onset: 0.8-4 hr No peak Duration: 24+ hr

Answer 10

* Hypoglycemia-especially want to check at the peak. * Hypokalemia * Lipohypertrophy *  Give SQ  Only regular Insulin can be given IV o Will give dextrose when they get to around 250. Don’t want them to crash.  Rotate sites  Adjust dose based on caloric intake, infection, exercise, stress, growth spurts, pregnancy  Storage – refrigerator or room temp

Answer 11

``` Contraindications • Hypersensitivity to insulin • Presence of hypoglycemia Precautions • Renal/hepatic dysfunction • Fever • Thyroid disease • Older adults ```

Answer 12

``` Hypoglycemia  Sulfonylureas  Meglitinides  Beta blockers – masks hypoglycemia  Salicylates  Alcohol Hyperglycemia  Loop and thiazide diuretics  Sympathomimetics  Thyroid hormones  Glucocorticoids ```

Answer 13

pramlintide (Symlin), don’t really see subscribed, used if other treatments aren’t working. 1. Type 1 and 2 DM • Insulin/oral hypoglycemic drug supplement • Mimic action of amylin – reduces glucose levels o Slows gastric emptying o Inhibits secretion of glucagon o Increases feelings of satiety

Answer 14

* Hypoglycemia – when given with insulin * Nausea * Injection site reactions * DO NOT mix in same syringe as insulin * Give before meals with at least 30 grams of CHO * Peak action – 20 min. after dosing * Similar storage as insulin

Answer 15

``` Contraindications • Renal failure • Hemodialysis • Poor insulin regimen adherence • A1C > 9% • Gastroparesis Precautions • Thyroid disease • Osteoporosis • Alcoholism ```

Answer 16

``` Hypoglycemia – insulin Slow gastric emptying  Oral drugs should be taken 1 hour before or 2 hours after pramlintide  Opioids  Acarbose (Precose)  Miglitol (Glyset) ```

Answer 17

liraglutide (Victoza) • For type 2 DM • Insulin/oral hypoglycemic drug supplement – for those without good glucose control via another agent • Dulaglutide (Trulicity) is injected once a week • Mimic action of GLP 1 (similar to glucagon) o Reduces glucose levels after meals  Slows gastric emptying  Stimulates release of insulin  Decreases secretion of glucagon  Increases feelings of satiety

Answer 18

* Hypoglycemia – when given with insulin * Nausea, vomiting, diarrhea * Pancreatitis  Do not mix in same syringe as insulin  Give before meals up to 60 minutes before morning and evening meals  Peak action 2 hours after dosing—check for hypoglycemia.

Answer 19

``` • Renal failure • Type 1 DM • DKA • Ulcerative colitis • Crohn’s disease • Gastroparesis Precautions • Thyroid disease • Older adults • Renal dysfunction ```

Answer 20

``` Hypoglycemia  Sulfonylureas Slow gastric emptying  Oral drugs should be taken 1 hour before or 2 hours after med  Contraceptives  Antibiotics ```

Answer 21

Glucagon  Treats hypoglycemia – converts liver glycogen to glucose  Can be given IV (takes ~20 min.), IM, SQ  Nausea, vomiting  Want to know what the blood sugar is. Have changes of LOC at <70 o Rule of 15 and 15  15 grams of carbs, 15 minutes  Can give IV, IM, SQ o IV- can cause vomiting, so need to roll pt on side if unconscious sedations.

Answer 22

``` Contraindications • Hypoglycemia from starvation – lack stored glycogen • Pheochromocytoma Precautions • Cardiovascular disorders • Adrenal insufficiency ```

Answer 23

oral anticoagulant effects are increase*

Answer 24

levothyroxine (Synthroid) mcg  Synthetic T4 – converted to T3 in the body • Induces changes in metabolic rate • Impacts rate of protein, carbohydrate, and lipid metabolism • Increase oxygen consumption, body temperature, blood volume, and overall cellular growth and differentiation • Increases sensitivity in heart to increase CO • Increases renal blood flow with a diuretic effect

Answer 25

``` • Monitor thyroid function • Monitor for hyperthyroidism o Anxiety o Tachycardia, palpitations o Tremors o Altered appetite, abdominal cramping o Diarrhea o Heat intolerance o Fever, diaphoresis o Weight loss o Menstrual irregularities  Give orally on empty stomach  Measure baseline – vitals, height, weight  Monitor cardiac status  Formulations are not interchangeable – notify pharmacy/provider if different product is dispensed****  Expect lifelong therapy*** ```

Answer 26

``` hyrotoxicosis • Recent MI Precautions • Older adults • Renal impairment • DM • Cardiovascular disorders ```

Answer 27

``` Hypothyroid state  Cholestyramine (Questran)  Antacids  Iron/calcium supplements  Sucralfate (Carafate)  Iodine containing food  Carbamazepine (Tegretol)  Phenytoin (Dilantin)  Phenobarbital  Sertraline (Zoloft) **Coumadin effects are increased **Epinephrine increases cardiac response ```

Answer 28

propylthiouracil (PTU) hyperthyroidism*** • Blocks iodine from being integrated into tyrosine which then blocks conversion of T4 to T3 Indicated for:  Hyperthyroidism/Graves’ disease  Suppression of thyroid hormone production in preparation for thyroidectomy  Thyrotoxic crisis

Answer 29

``` • Hypothyroidism • Agranulocytosis (rare and reversible) • Rash • Arthralgia, myalgia, headache  Monitor for thyroid function and CBC  Monitor for hypothyroidism o Drowsiness, depression o Weight gain, edema o Bradycardia o Anorexia o Cold intolerance o Dry skin o Menorrhagia ```  Give orally on a regular schedule – usually every 8 hrs. (short half-life)  Measure baseline vitals, height, weight  Monitor cardiac status  Formulations are not interchangeable – notify pharmacy/provider if different product is dispensed  Expect lifelong therapy o Expect 3-12 weeks of therapy to achieve euthyroid*** o 6-12 months to stabilized thyroid hormone production***

Answer 30

``` • Pregnancy category D Precautions • Immunosuppression • Bone marrow depression • Infection • Liver dysfunction ```

Answer 31

for:  Hyperthyroidism/Graves’ disease  Suppression of thyroid hormone production in preparation for thyroidectomy  Thyrotoxic crisis

Answer 32

Hyperthyroid state  K+ iodine  Na+ iodine  Amiodarone  Food – alters absorption, take on empty stomach **Coumadin effects are increased, bleeding risk.

Answer 33

```  Absorbed by thyroid gland o Gradually destroys/ablate thyroid tissue and decreases function of thyroid  Indicated for: o Hyperthyroidism/Graves’ disease o Thyroid cancer ```

Answer 34

 Monitor thyroid function  Hypothyroidism – symptoms listed above  CBC – rare bone marrow suppression  Radiation sickness – hematemesis, epistaxis, intense nausea and vomiting • Given orally once – some may require subsequent doses • Pregnancy test • Measure baseline vitals, height, weight • Initiate radiation precautions for large doses*** – limit contact, increase fluids, body waste disposal per facility protocol • 2-3 months to achieve full effect

Answer 35

• Pregnancy/lactation – category X Precautions • Prepubescent children

Answer 36

Interactions – other antithyroid drugs

Answer 37

 Stimulates release of GH  Indicated for: o Turner’s syndrome in children (genetic, girls)—helps them reach more normal height. o GH deficiency in adults – increased lean muscle mass after growth plates have closed o “Wasting syndrome” – AIDS patients

Answer 38

 Stimulates release of GH  Indicated for: o Turner’s syndrome in children (genetic, girls)—helps them reach more normal height. o GH deficiency in adults – increased lean muscle mass after growth plates have closed o “Wasting syndrome” – AIDS patients

Answer 39

 Hyperglycemia  Myalgia  Hypercalciuria – urine calcium and renal stones – first months of therapy • Give IM or SQ (preferred) educate about proper injection • Dosage based on weight • Obtain baseline height, weight, thyroid function, GH levels, yearly XRay of long bones (epiphyseal plates) • Length of treatment depends on indication.

Answer 40

``` • Severe obesity • Severe respiratory impairment • Closed epiphyses in children • Critical illness Precautions • Diabetes-monitor hypoglycemia. • Chronic renal failure • Hypothyroidism • Prader-Willi syndrome ```

Answer 41

 Glucocorticoids and adrenocorticotropic hormones counteract growth effects  Thyroid hormones, estrogen and androgens promote epiphyseal closure

Answer 42

 Replicates ADH o Causes kidneys to increase reabsorption of water o Concentrates urine and decreases urine volume – reduces water excretion o Fluid retention and hyponatremia  Indicated for: o Diabetes insipidus  Inadequate amount of ADH  Secretes excessive amount of fluid and Na+  electrolyte imbalance o Bleeding esophageal varices – vasopressin is a potent vasoconstrictor o Used to be part of ACLS protocol – not anymore – use epinephrine

Answer 43

• Fluid retention o Headache, confusion (cerebral edema) o Monitor I&O, creatinine clearance, BP, and Na+ levels o Restrict fluid intake when appropriate o Recommend diuretic therapy for moderate to severe fluid retention • Increased BP, fever • Abdominal pain, cramps, nausea  Administer PO, intranasal, SQ, IV (for shock) should use central line preferably.

Answer 44

``` • Renal failure—acts in kidneys • Nephrogenic diabetes insipidus • Electrolyte imbalance (oral form) Precautions • Older adults • Cardiovascular disease • HTN • Hx of hyponatremia • Hx of clots • Severe HF ```

Answer 45

 Carbamazepine increases antidiuretic action |  Lithium decreases antidiuretic action

Answer 46

 Mimics effects of steroid hormone cortisol  Regulates Na+/K+/H20 levels in body through kidneys • Replacement therapy for: o Acute and chronic adrenocortical insufficiency – Addison’s disease  Adrenal cortical levels deficient, ACTH elevated due to insufficient feedback o Primary hypoaldosteronism o Congenital adrenal hyperplasia  Hydrocortisone can be used in mild cases  Fludrocortisone may be used in those who do not obtain a sufficient salt-retaining effect from hydrocortisone

Answer 47

• High doses – fluid/electrolyte imbalances, HTN, HF, hypokalemia, ulcers, • Give orally daily OR three times a week • Lifelong therapy • Weight – think about impact of long-term steroid use o What is Cushing’s disease? • Medical identification bracelet • Baseline CBC and electrolytes – patients may need to be educated on salt intake • Must taper off when stopping, adrenal glands are asleep and don’t start right back up after stopping. Need to give them time to wake up.

Answer 48

``` • K+ depleting diuretics • Acute glomerulonephritis • Hypercortisolism • Viral or bacterial skin disease uncontrolled by abx Precautions • Heart failure • Systemic fungal infection • Thromboembolic disorders • Diabetes mellitus • Hypertension • Renal dysfunction ```

Answer 49

* Rifampin * Insulin and sulfonylureas – hyperglycemia * K+ depleting diuretics – hypokalemia

Answer 50

 Increase in weight  Fluid retention – heart failure  Increased BP  Hypokalemia

Answer 51

```  Weight loss  Poor appetite  Fatigue  Muscle weakness  Hypotension ```