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Pharmacology N322 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Oral Hypoglycemics

A

Type 2 DM
Sulfonylureas-Glipizide (glucotrol)

Meglitinides-repaglinide (Prandin)

Biguanides-Metformin (glucophage)

Thiazolidinediones-pioglitazone (Actos)

Alph-glucosidase inhibitors-Acarbose (precose)

Gliptin-Sitagliptin (januvia)

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2
Q

Sulfonylureas-Glipizide (glucotrol)

A
  • 1st used to treat DM
  • Stimulate release of insulin from Islet cells in pancreas and appears to decrease the secretion of glucagon (glucagon prevents blood sugar from dropping too low)
  • Works fast, take 30 minutes before first meal.
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3
Q

Sulfonylureas-Glipizide (glucotrol)

NC

A
  • Hypoglycemia with impaired kidney/liver function
  • Weight gain
  • Nausea
  • Hypoglycemia less than 70. Confusion, decreased LOC, behavioral changes
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4
Q

Sulfonylureas-Glipizide (glucotrol)

Contraindications

A 
•	Pregnancy, lactation
•	DKA—need insulin for DKA
Precautions
•	Thyroid disease
•	Renal/hepatic dysfunction
•	Adrenal/pituitary insufficiency
•	Alcohol – increases hypoglycemic effects
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5
Q

Sulfonylureas-Glipizide (glucotrol)

Interactions

A 
	Sulfonamide antibiotics 
	NSAIDS
	Oral anticoagulants
	Salicylates
	MAOI
	Cimetidine (Tagamet)
	Beta Blockers – masks hypoglycemia
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6
Q

Meglitinides-repaglinide (Prandin)

A

 Stimulate release of insulin from Islet cells in pancreas – more receptive to blood sugar fluctuations
o MUST have functioning pancreas
 Give 30 min before meals but DO NOT take if they skip a meal
 Usually TID dosing
Patients who do not respond to sulfonylureas will not respond to these

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7
Q

Meglitinides-repaglinide (Prandin)

NC

A

• Hypoglycemia with impaired kidney/liver function
• Nausea
• Diarrhea
• Check blood sugar
o 15 grams carbs, wait 15 minutes and check again. 15/15
o Do this until blood sugar is corrected.

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8
Q

Meglitinides-repaglinide (Prandin)

contraindications/precuations

A 
•	DKA
Precautions
•	Monitor for hypoglycemia
•	Older adults
•	Renal/hepatic dysfunction
o	BUN/Cr, LFTs
o	Decreased output.
•	Systemic infection
•	Weight gain
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9
Q

Meglitinides-repaglinide (Prandin)

Teaching

A

Exercise, diet changes, decrease alcohol consumption

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10
Q

Meglitinides-repaglinide (Prandin)

Interactions

A 
Hypoglycemia: these meds can contribute to hypoglycemia
	Gemfibrozil (Lopid)
	Erythromycin
	Ketoconazole
	More than 1 L of grapefruit juice/day
	Herbals – ginseng/garlic
Hyperglycemia:
	Barbiturates
	Carbamazepine (Tegretol)
	Rifampin (Rifadin)
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11
Q

Biguanides – metformin (Glucophage)

A
  1. Decreases absorption of glucose from the intestines
  2. Decreases synthesis of glucose by the liver
  3. Increases sensitivity of insulin receptors in tissues

 **Usually prescribed for newly diagnosed DM II
 Can be combined with other drugs
o Increased risk of hypoglycemia.
 Give with morning and evening meal (BID)
o Extended form with evening meal

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12
Q

Biguanides – metformin (Glucophage)

NC

A
  • Nausea
  • Diarrhea
  • Anorexia
  • Weight loss
  • Vitamin B12/folic acid deficiency – decrease absorption
  • Lactic acidosis (rare) in renal insufficiency – mitochondrial oxidation of lactic acid
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13
Q

Biguanides – metformin (Glucophage)

Contraidications

A
  • DKA
  • Cardiopulmonary, hepatic, renal insufficiency
  • Alcoholism
  • CHF
  • Severe infection
  • Shock
  • Acute MI
  • Hypoxemia
  • Lactic Acidosis
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14
Q

Biguanides – metformin (Glucophage)

Precautions

A
  • Monitor for hypoglycemia
  • Older adults
  • Patients with diarrhea, dehydration, anemia, gastroparesis
  • Patients with pituitary insufficiency, hypothyroidism, GI obstruction, polycystic ovary syndrome
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15
Q

Biguanides – metformin (Glucophage)

Ineractions

A 
Hypoglycemia:
	Captopril (Capoten)
	Nifedipine (Procardia)
	Furosemide (Lasix)
	Morphine
	Ranitidine (Zantac)
	Antifungals
	Herbals – ginseng/garlic
Lactic Acidosis:
	Alcohol
	Cimetidine (Tagamet)
	Contrast medium
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16
Q

Thiazolidinediones – pioglitazone (Actos)

A
  1. Type II DM with/without drug therapy with insulin/metformin
  2. Reduce insulin resistance of tissue
    a. Insulin must be available (endogenous or exogenous)
    • Give once daily with/without food
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17
Q

Thiazolidinediones – pioglitazone (Actos)

NC

A

• Fluid retention
o Crackles in lungs, sob, edema.
• Hepatoxicity
• Increased serum lipid levels

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18
Q

Thiazolidinediones – pioglitazone (Actos)

Contraindications

A 
•	Hypertension
•	CHF
•	Active hepatic disease
Precautions
•	Mild heart failure/Hx of HF
•	Hepatic impairment
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19
Q

Thiazolidinediones – pioglitazone (Actos)

Interactions

A 
Hypoglycemia
	Gemfibrozil (Lopid)
	Ketoconazole
	Green tea/herbals – ginseng/garlic
Heart Failure
	Insulin + Actos  heart failure/edema
o	Use when the risks outweigh the benefits
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20
Q

Alpha-glucosidase inhibitors – acarbose (Precose)

A
  1. Type II DM with/without drug therapy
    • Enzyme that breaks down carbohydrates in the intestine – slows CHO absorption
    o Prevents rise in glucose after a meal

 Only drug that does not depend on Insulin to work
 Give with food TID – skip dose if meal is skipped

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21
Q

Alpha-glucosidase inhibitors – acarbose (Precose)

NC

A
  • Distention
  • Flatus
  • Hyperactive bowel sounds
  • Diarrhea
  • Hypoglycemia with insulin/sulfonylurea
  • Liver dysfunction
  • Anemia
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22
Q

Alpha-glucosidase inhibitors – acarbose (Precose)

Contra/precaution

A 
•	GI disorders – inflammatory disease, obstruction, ulcerations
o	**Metformin can worsen GI effects
Precautions 
•	Hepatic impairment
•	GI distress
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23
Q

Alpha-glucosidase inhibitors – acarbose (Precose)

Interactions

A 
Hypoglycemia
	Insulin
	Sulfonylureas
	Herbals – ginseng/garlic
Hyperglycemia
	Estrogens
	Thiazides
	Corticosteroids
	Phenothiazines 
	Isoniazid
	Phenytoin (Dilantin)
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24
Q

Gliptin – sitagliptin (Januvia)

A
  1. Type II DM with/without drug therapy
    • Makes incretin available which increases presence of insulin and decreases presence of glucagon
    • Can take with/without food – only oral form
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25
Q

Gliptin – sitagliptin (Januvia)

NC

A 
•	URI
•	Inflamed nasal passages
•	Headache
•	Pancreatitis
o	N/V, severe abdominal pain, elevated amylase.
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26
Q

Gliptin – sitagliptin (Januvia)

Contra/precaution

A 
Contraindications
•	Type I DM
•	Lactic acidosis
Precautions
•	Hemodialysis
•	Moderate/severe renal dysfunction
•	Hx of pancreatitis
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27
Q

Gliptin – sitagliptin (Januvia)

Interactions

A

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

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28
Q

Injectable Hypoglycemics

Insulin

A

 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

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29
Q

Factors that affect insulin action

A

Illness, somogyi effect, gastroparesis

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30
Q

Rapid Acting

A 
Lispro (humalog)
Aspart(novalog)
glulisine (apidra)
onset: 10-30 mins
peak: 30 min -3 hours
duration: 3-5 hours
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31
Q

Short acting

A

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

32
Q

Intermediate

A 
NPH (Humulin N, Novolin N)
Onset:1.5-4 hours
Peak: 4-12 hours
Duration: 12-18 hour
cloudy, can be mixed
33
Q

Long acting

A

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

34
Q

Insulin NC

A
  • 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

35
Q

Insulin

Contra/precaution

A 
Contraindications
•	Hypersensitivity to insulin
•	Presence of hypoglycemia
Precautions
•	Renal/hepatic dysfunction
•	Fever
•	Thyroid disease
•	Older adults
36
Q

Insulin Interactions

A 
Hypoglycemia
	Sulfonylureas
	Meglitinides
	Beta blockers – masks hypoglycemia
	Salicylates
	Alcohol
Hyperglycemia
	Loop and thiazide diuretics
	Sympathomimetics
	Thyroid hormones
	Glucocorticoids
37
Q

Amylin Mimetics

A

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

38
Q

Pramlintide (Symlin)

NC

A
  • 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
39
Q

Pramlintide (Symlin)

Contra/precaut

A 
Contraindications
•	Renal failure
•	Hemodialysis
•	Poor insulin regimen adherence
•	A1C > 9%
•	Gastroparesis
Precautions
•	Thyroid disease 
•	Osteoporosis
•	Alcoholism
40
Q

Pramlintide (Symlin)

Interactions

A 
Hypoglycemia – insulin
	Slow gastric emptying
	Oral drugs should be taken 1 hour before or 2 hours after pramlintide
	Opioids
	Acarbose (Precose)
	Miglitol (Glyset)
41
Q

Incretin Mimetics

A

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

42
Q

liraglutide (Victoza)

NC

A
  • 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.

43
Q

liraglutide (Victoza)

Precautions/contra

A 
•	Renal failure
•	Type 1 DM
•	DKA
•	Ulcerative colitis
•	Crohn’s disease
•	Gastroparesis
Precautions
•	Thyroid disease
•	Older adults
•	Renal dysfunction
44
Q

liraglutide (Victoza)

Interactions

A 
Hypoglycemia
	Sulfonylureas
Slow gastric emptying
	Oral drugs should be taken 1 hour before or 2 hours after med
	Contraceptives
	Antibiotics
45
Q

Hyperglycemias

A

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.

46
Q

Glucagon

Contra/precaution

A 
Contraindications
•	Hypoglycemia from starvation – lack stored glycogen
•	Pheochromocytoma 
Precautions
•	Cardiovascular disorders
•	Adrenal insufficiency
47
Q

glucagon interactions

A

oral anticoagulant effects are increase*

48
Q

Thyroid replacement

A

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

49
Q

levothyroxine (Synthroid) mcg NC

A 
•	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***
50
Q

levothyroxine (Synthroid) mcg

Contra/prec

A 
hyrotoxicosis
•	Recent MI
Precautions
•	Older adults
•	Renal impairment
•	DM
•	Cardiovascular disorders
51
Q

levothyroxine (Synthroid) mcg

interactions

A 
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
52
Q

Anti-thyroid drugs

A

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

53
Q

propylthiouracil (PTU) hyperthyroidism***

NC

A 
•	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*

54
Q

propylthiouracil (PTU) hyperthyroidism***

contra/prec

A 
•	Pregnancy category D
Precautions
•	Immunosuppression
•	Bone marrow depression
•	Infection
•	Liver dysfunction
55
Q

propylthiouracil (PTU) hyperthyroidism***

indications

A

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

56
Q

propylthiouracil (PTU) hyperthyroidism***

interactions

A

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

57
Q

Radioactive Iodine 131

A 
	Absorbed by thyroid gland 
o	Gradually destroys/ablate thyroid tissue and decreases function of thyroid
	Indicated for:
o	Hyperthyroidism/Graves’ disease
o	Thyroid cancer
58
Q

Radioactive Iodine 131

NC

A

 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

59
Q

Radioactive Iodine 131

contra

A

• Pregnancy/lactation – category X
Precautions
• Prepubescent children

60
Q

Radioactive Iodine 131

interaction

A

Interactions – other antithyroid drugs

61
Q

Growth hormone – somatropin (Genotropin)

A

 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

62
Q

Growth hormone – somatropin (Genotropin)

A

 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

63
Q

Growth hormone – somatropin (Genotropin)

NC

A

 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.

64
Q

Growth hormone – somatropin (Genotropin)

Contra

A 
•	Severe obesity
•	Severe respiratory impairment
•	Closed epiphyses in children
•	Critical illness
Precautions
•	Diabetes-monitor hypoglycemia.
•	Chronic renal failure
•	Hypothyroidism
•	Prader-Willi syndrome
65
Q

Growth hormone – somatropin (Genotropin)

Interactions

A

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

66
Q

ADH- vasopressin

A

 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

67
Q

ADH- vasopressin

NC

A

• 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.

68
Q

ADH- vasopressin

Contra

A 
•	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
69
Q

ADH- vasopressin

interactions

A

 Carbamazepine increases antidiuretic action

 Lithium decreases antidiuretic action

70
Q

Glucocorticoid – hydrocortisone (minor); Mineralocorticoid – fludrocortisonen (used when don’t respond to hydrocortisone)

A

 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

71
Q

Glucocorticoid – hydrocortisone (minor); Mineralocorticoid – fludrocortisonen (used when don’t respond to hydrocortisone)
NC

A

• 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.

72
Q

Glucocorticoid – hydrocortisone (minor); Mineralocorticoid – fludrocortisonen (used when don’t respond to hydrocortisone)
Contra

A 
•	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
73
Q

Glucocorticoid – hydrocortisone (minor); Mineralocorticoid – fludrocortisonen (used when don’t respond to hydrocortisone)
Interactions

A
  • Rifampin
  • Insulin and sulfonylureas – hyperglycemia
  • K+ depleting diuretics – hypokalemia
74
Q

Glucocorticoid – hydrocortisone (minor); Mineralocorticoid – fludrocortisonen (used when don’t respond to hydrocortisone)
Interactions

Excess dosing

A

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

75
Q

Glucocorticoid – hydrocortisone (minor); Mineralocorticoid – fludrocortisonen (used when don’t respond to hydrocortisone)
Interactions

low dosing

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

Pharmacology N322 (11 decks)

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