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Pharm Final review > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What are some characteristics of type 1 DM?

A

Before Age 30 (Child)
Abrupt Onset
Requires exogenous insulin to treat
Ketoacidosis prone
Wide fluctuations in BG concentration
Thin body habitus

Altered Human Lymphocyte Antigen on the short arm of chromosome 6
Defect causes “insulinitis”
Autoantibodies may be detected at the time of diagnosis but maybe absent years later.

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2
Q

What are some characteristics of type 2 diabetes?

A

Adult onset: historically
May require exogenous insulin
Not ketoacidosis prone
Relatively stable BG concentration
Obese body habitus

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3
Q

How do you diagnose DM?

A

Fasting BS 126mg/dl or greater (usually x 2)

Random BS >200mg/dl

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4
Q

What is HgA1C?

A

Measure of the percent of Hgb that has been non-enzymatically glycosylated by glucose on the Beta chain

Normal: 4-6%

ADA recommends <7-8.5% depending on the age of the diabetic patient.

Gives an idea of the degree of control of BG levels over the past 3 months.

Assesses the long-range effectiveness of glucose control.

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5
Q

Urinary ketones

A

Monitor patients at risk of going into diabetic ketoacidosis (Type I DM)

Used by patients if they develop symptoms of cold, flu, vomiting, abdominal pain, polyuria, or on finding an unexpectedly high glucose lev

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6
Q

What does insulin do to electrolytes?

A

Potassium in
Magnesium in
Phosphorus in
Sodium out

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7
Q

Does insulin facilitate glycogenesis, gluconeogenesis, or glycogenolysis?

A

Shift intracellular glucose metabolism toward storage (Glycogenesis)

glycogenolysis - the breakdown of glycogen into glucose. gluconeogenesis - the manufacture of glucose from non carbohydrate sources, mostly protein.

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8
Q

When does insulin resistance occur?

A

Occurs when there is an impaired intracellular insulin signal that results in decreased recruitment of glucose transport proteins to the plasma membrane and subsequent decrease glucose uptake.

Compensatory hyperinsulinemia occurs to overcome this resistance

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9
Q

When does insulin receptor saturation occur?

Insulin receptors are ______ related to plasma concentrations of insulin

A

Occurs with low circulating concentrations of insulin

Body increases insulin receptors in response to insulin resistance. INVERSELY related to the plasma concentration of insulin.

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10
Q

How much insulin does the body secrete per day?

A

Normally release about 1 unit of insulin an/hr… per day about 40-50 units

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11
Q

What types of insulin can you give via IV pump?

A

Any short acting

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12
Q

What are symptoms of hypoglycemia?

A

Symptoms reflect the compensatory effects of increased epinephrine (body kicks out epi in response to hypoglycemia)(beta blockers hide this and mask hypoglycemia symptoms):
Diaphoresis
Tachycardia
Hypertension

Basically epinephrine’s effects

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13
Q

What is re-feeding syndrome?

A

When the body up-regulates insulin receptors in response to not eating in a LONG time and then that person smashes several double quarter pounders and a few kit-kat bars and all those new insulin receptors move in ALL the electrolytes and kicks out sodium and that person dies

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14
Q

What defines insulin resistance?

A

Patients requiring > 100 units/day

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15
Q

Has immunoresistance been eliminated with the switch from animal insulin to human insulin?

A

YES

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16
Q

Method of insulin injection

A

Administer 70% of total dose as intermediate or long acting at bedtime (basal insulin)

Type I DM may require intermediate or long acting insulin in the AM as well

Additional doses (30%) based on meals size

Administer a rapid acting prep before each meal or snack (4 doses)

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17
Q

What is inhaled insulin (afreeza) used for?

A

People VERY frightened of injections

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18
Q

Can you ever use sliding scale alone?

A

NEVER NEVER use sliding scales alone

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19
Q

What are some risks of hyperglycemia?

A

Microangiopathy
Impaired leukocyte function
Cerebral edema
Impaired wound healing
Postoperative sepsis
Hyponatremia

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20
Q

Wha are perioperative goals for blood sugar?

A

Optimal BG levels 110-180mg/dl
<150mg/dl for total joints
Glucose infusion if BG decreases to <80mg/dl

Loose control: ¼ to ½ the dose of intermediate or long acting insulin – the last dose prior to procedure
If the procedure is short, may give regular daily dose

Tight control: infusion

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21
Q

How do you treat someone with an insulin pump?

A

Prior to surgery clear liquids with or without sugar

Maintain basal infusion rate

Turn off preprandial boluses

Measure BG every hour

Know the typical bolus for the patient to decrease BG 50mg/dl

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22
Q

Which class of oral hypoglycemics has the highest risk of hypoglycemia?

A

Sulfonylureas (Ex: Glipizide)

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23
Q

What class of oral hypoglycemics have a high rate of failure?

A

Sulfonylureas

sul”fail”ureas

24
Q

Is there any cross-sensitivity with sulfonylureas and sulfa drugs?

A

YES. Not necessarily sulfa antibiotics

25
Q

True/False The risk of hypoglycemia is worse with sulfonylureas in kidney patients because this class is excreted by the kidneys?

A

TRUE

26
Q

Which sulfonylurea is the worst for kidney patients?

A

Glyburide longest acting and most touchY with kidneys GFR LESS THAN 50 CONTRAINDICATED.

27
Q

Which sulfonylurea is the least safe?

A

Glyburide (DiaBeta®, Micronase®):

Gly”bad”uride

28
Q

Which sulfonylurea is the longest lasting and can cause severe hyponatremia?

A

Chlorpropamide (Diabinese®)

Ch”longlasting”rpropamide

29
Q

Which med reduces Absorption of carbs by inhibiting the breakdown of carbs?

A

Alpha- Glucosidase Inhibitors

Acarbose (Precose®)
Miglitol (Glyset®)

30
Q

Which med should you NEVER give while fasting because it secretes insulin?

A

Meglitinides

megliti”nevergivewhilefasting”idines

Repaglinide (Prandin ®)
Nateglinide (Starlix®)

31
Q

Metformin has a black box warning for which of the following side effects?

A

Lactic acidosis

32
Q

What is the #1 med for DM II

A

Metformin

33
Q

Why is metformin great?

A

Decrease BG concentrations with only a very low risk of hypoglycemia.

Have a positive effect on lipid concentrations.

Lead to mild weight reduction in obese pts.

NO weight gain

Risk of hypoglycemia FAR lower

Dec hepatic glucose production
Reduces glucose absorption from the intestine
Increases insulin sensitivity

34
Q

Discontinue metformin _____ days before elective surgery and ____ before contrast dye.

A

48 hours before both…also hold 48 hours post-dye

35
Q

What are the parameters for metformin contraindication?

A

Contraindicated SCr >1.5 (males), 1.4 (females) (old recommendations)

STOP IF Contraindicated eGFR <30 ml/min,

do not initiate for new patients or re-evaluate patients with eGFR <45 ml/min (new recommendations)

Age > 80 years old
Hepatic impairment
CHF

36
Q

What the heck do DPP (Dipeptidyl peptidase)-4 Inhibitors do?

A

Dipeptidyl peptidase-4 (DPP-4) inhibitors block the breakdown of GLP-1 and GIP to increase levels of the active hormones. In clinical trials, DPP-4 inhibitors have a modest impact on glycemic control. They are generally well-tolerated, weight neutral and do not increase the risk of hypoglycemia

37
Q

Which class delays gastric emptying and is made from guila monsters?

A

Amylin analog (GLP-1?)

Amylin analoguila-monster

38
Q

Although sulfonylureas are the worst for hypoglycemia, which other class has a black-box warning for hypoglycemia and causes severe gastroparesis?

A

Amylin analog (GLP-1)?

39
Q

Which class increases urinary excretion of glucose and sodium?

A

SGLT2 Inhibitor

SG”Let it go” T2 inhibitors

Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)

40
Q

Which class of med increases the risk of increased risk of perioperative euglycemic ketoacidosis as well as
amputations (primarily toe) AND can cause hypotension??

A

SGLT2 Inhibitor

SGLow ph, low pressure, low toe” T2 inhibitors

Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)

41
Q

Which two meds are contraindicated with a GFR under 30?

A

metformin and SGLT2 inhibitors

42
Q

Because of increased risk of ketoacidosis, how long should SGLT2 inhibitors be held prior to surgery?

A

Canagliflozin, dapagliflozin, and empagliflozin should be discontinued 3 days before scheduled surgery.

“C,D,Empa, THREE”

Ertugliflozin should be stopped at least 4 days before scheduled surgery.

“Ertu for EFFORT”

43
Q

What two meds can delay the onset of type 1 diabetes?

A

Teplizumab-mzwv (Tzield) and verapamil

44
Q

Which thyroid med is a combo of T3 AND T4?

A

Armour Thyroid (combo T3&T4)

45
Q

Which thyroid med is just T4, and is the most commonly prescribed med for hypothyroidism?

A

Levothyroxine (T4) (Synthroid®)

46
Q

Which thyroid med is just T3 and has increased cardiovascular side-effects?

A

Liothyronine (T3) (Cytomel®)

47
Q

Here’s a laundry list of anesthetic considerations for patients with hypothyroidism

A

Basically, your body and metabolism are SLOW so meds effect you more…

Increased sensitivity to depressant drugs
Including inhaled anesthetics.

Hypodynamic cardiovascular system.
Decreased CO due to decreased HR and SV.

Slowed metabolism of drugs, particularly opioids.

Unresponsive baroreceptor reflexes.

Decreased intravascular fluid volume.

Impaired ventilatory response to low PaO2 and/or increased PaCO2…

Delayed gastric emptying.

Hyponatremic.

Hypothermic.

Anemic.

Hypoglycemic.

Primary adrenal insufficiency.

48
Q

Which antithyroid meds are useful in treating hyperthyroidism (including thyroid storm) before elective thyroidectomy?

A

Propylthiouracil (PTU)
Methimazole (Tapazole®)

49
Q

What is the oldest effective treatment for hyperthyoid?

A

Iodines:

Lugol’s Solution
Saturated KI solution

50
Q

Here’s the treatment for thyroid storm

A

I.V. infusion of cold crystalloid solns.

Sodium iodide I.V.:
Reduce the release of active hormones from the thyroid gland.

Cortisol I.V.:
Treat acute primary adrenal insufficiency from increased metabolism and use of corticosteroids.

Propranolol I.V.:
Alleviate the cardiovascular effects of thyroid hormones.

Propylthiouracil P.O.:
Reduce the synthesis of new thyroid hormone.

Avoid ASA/NASID for elevated temperature because it may displace thyroxine from carrier proteins.

51
Q

Which oral hypoglycemic may exacerbate hypotension?

A

Canagliflozin (Invokana)

52
Q

Insulin produces all of the following effects except…

A

Stimulate glycogenolysis

53
Q

Which of the following is not significantly shifted intracellularly when insulin binds to its cellular receptors?

A

Sodium

54
Q

SGLT2 inhibitors may increase the risk of perioperative euglycemic ketoacidosis. The FDA recommends stopping this class of medications how many days prior to a procedure to reduce this risk?

A

3 days

55
Q

Which insulin is the most rapid acting?

A

Humalog (Lispro)

56
Q

A patient uses 20 units of Lantus (Glargine) at bedtime and has surgery scheduled in the morning. How much Lantus should be administered the night before the procedure?

A

10 units

57
Q

Reduces absorption of carbs by inhibiting the breakdown of carbs?

Which med should you NEVER give while fasting because it secretes insulin?

A

Alpha- Glucosidase Inhibitors (Acarbose (Precose®)
Miglitol (Glyset®)

Meglitinides (megliti”nevergivewhilefasting”idines)

Amylin analog (GLP-1?) (Amylin analoguila-monster)

Pharm Final review (24 decks)

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