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Pharm Exam 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

How do you test for pre-diabetes? (Labs)

A

FBG: 100-125mg/dL
Impaired glucose tolerance (2hr OGTT) 140-199 mg/dL
HgA1c: 5.7% -6.4%

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2
Q

How do you test for diabetes?

A

Glucose blood levels (2 separate days)
- FBG: _>_126mg/dL
-random BG: 200 mg/dL
-OGTT: 200 mg/dL
-Hg A1c: > 6.5%

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3
Q

What do you test for sub clinical hypothyroidism?

A

TSH > 6mU/L

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4
Q

Whatr do you test for Hypothyroidism?

A

TSH: > 6mU/L
Free T4: <0.9mg/dL
+ TPO antibody for Hashimoto’s disease

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5
Q

Normal diabetes serum values

A

FBG: <100 mg/dL
Random BG: <200 mg/dL
OGGT: < 140 mg/dL
Hbg A1c: < 5.6% (not always accurate)

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6
Q

Normal thyroid serum values

A

TSH: 0.3-6 mU/L
Free T4: 0.9-2 ng/dL
Free T3: 230-620 ng/dL
TPO antibody (-)

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7
Q

What is the cause for hypothyroidism?

A
  • can occur at any age, more common in women
  • World-wide: iodine insufficiency
  • Iodine sufficient countries: Hashimoto’s thyroiditis (autoimmune)
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8
Q

What are the different types of hypothyroidism ?

A
  • mild: hypothyroidism
  • severe: myxedema
  • infants: congenital hypothyroidism
  • maternal: decrease infant IQ; other neuropsychological dysfunction
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9
Q

S/S of hypothyroidism; what is needed?

A
  • pale, expressionless, puffy face, cold/dry skin, brittle/ loss of hair, decrease HR & temp, fatigue, lethargy, weight gain, constipation, menstrual irregularities, diastolic HTN, cold intolerance, delayed DTR, & possible thyroid enlargement
  • thyroid hormone replacement is needed
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10
Q

What is the drug of choice for hypothyroidism?

A
  • LEVOTHYROXINE
  • usually taken for life
    -oral
  • IV is for myxedema coma
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11
Q

LEVOTHYROXINE PO Mechanism of action

A
  • Moa: convert levothyroxine to T3
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12
Q

LEVOTHYROXINE PO dosage

A
  • Dose: 1.6 mcg/kg/ daily; may increase by 12.5- 25mcg/day every 4-6 days
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13
Q

LEVOTHYROXINE half-life

A
  • prolonged half-life is 7days d/t high protein bound
  • takes 4 half-lives (4wks) to reach a plateau
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14
Q

LEVOTHYROXINE ADRs

A
  • d/t acute OD (thyrotoxicosis)
  • tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, sweating
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15
Q

LEVOTHYROXINE PO education

A
  • give 30-60 min in am prior to eating (absorption is reduced by food)
  • take 4hrs apart from antacids, fe, ca supplements
  • grapefruit juice delays absorption
  • pregnancy may require an increase in dose
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16
Q

LEVOTHYROXINE assessments

A
  • asses: apical HR, BP, tachydysrythmias, chest pain
  • monitor: TSH levels 6-8wks after starting therapy and then yearly when stabilized (target 0.5-2 mU/L)
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17
Q

What is Type 1 diabetes?

A
  • an autoimmune destruction of pancreatic B -cells; leading to not enough insulin
  • mostly childhood disease but can be seen in adults
  • 5-10% of DM population
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18
Q

What is type 2 diabetes?

A
  • insulin deficiency; progressive loss of B-cells secretion and tissue insulin resistance
  • asymptomatic periods
  • 90-95% of DM population
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19
Q

What are metabolic consequences of insulin deficiency?

A
  • Hyperglycemia r/t catabolic state
    (Normal insulin levels = anabolic state)
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20
Q

Diabetes clinical presentation (3 P’s)

A

Polyuria (glucose >180)
Polydipsia
Polyphagia
(Nocturia, blurred vision, weight loss)

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21
Q

Hypersosmolar hyperglycemic state (HHS) & diabetic ketoacidosis

A
  • 3 P’s + sever hyperglycemia w/ dehydration, lethargy, obtundation, coma, abdominal pain, hyperventilation, fruity breath odor, deep breathing
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22
Q

What is continuous glucose monitoring?

A
  • a sensor under the skin; change every 7-14 days
  • improves glycemic control
  • transmits results to device or phone
  • gives warning and trends
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23
Q

Treatment for DM

A

-lifestyle modifications
- insulin (all type 1; some type 2)
- metformin; metformin + DDP-4, inhibitor, thiazolidinedione, SGLT-2, GLP-1 receptor agonist; combo injectable therapy

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24
Q

What is used for type 2 DM with hg A1c levels < 9%

A

Metformin

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25
Q

What is used for type 2 DM with hg A1c levels >9 %

A

Metformin + DDP-4, inhibitor, thiazolidinedione, SGLT-2 inhibitor, GLP-1 receptor agonist

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26
Q

What is used for type 2 DM with hg A1c levels >10%

A

Combo injectable therapy

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27
Q

What is the MOA of insulin?

A

-Synthesized in the pancreas by B-cells w/ in islets of Langerhans.
-precursor= proinsulin (insulin + c-peptide loop)
- C-peptide is measured in the the blood to determine if the pancreas is producing insulin

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28
Q

Secretion of insulin

A
  • rise in BG= insulin secretion
  • triggered by meals, gut hormones (GLP-1), SNS (b2- adrenergic receptors in pancreas)
  • inhibits insulin realease: a-adrenergic receptors
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29
Q

Drug interactions with insulin (decrease)

A

Use with Sulfonylureas, glinides and alcohol can decrease BG

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30
Q

Drug interactions with insulin (raise)

A

Thiazides diuretics, glucocorticoids and sympathomimetics can raise BG

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31
Q

What meds delay awareness and response to hypoglycemia when taken with insulin

A

Beta blockers

32
Q

What is the typical dosage for insulin?

A

0.1 units/kg - 2.5 units/kg
Type 1: basal and bolus
Type 2: start insulin when HgA1c is >9

33
Q

When should patients increase insulin?

A

When there is an increase in carbs ingested, stress, infection, adolescent growth spurt, pregnancy (after 1st trimester)

34
Q

When should insulin be decreased?

A

Missed meals, increased physical activity, pregnancy (1st trimester)

35
Q

How should insulin be drawn up?

A

Short acting (regular) -> NPH
To avoid vial contamination

36
Q

Insulin patient education

A
  • medication is not a cure
    -proper insulin administration technique
  • s/s of hypoglycemia: anxiety, restlessness, tingly, chills, cold sweats, confusion , cool/pale skin, drowsiness, excessive hunger, tremor, tachycardia, weakness, unsteady gait
  • carry sugar source: glucose tablet, orange juice, sugar cubes, honey , soda, corn syrup
    -severe: IV glucose
37
Q

Nursing considerations for insulin

A
  • assess pts dexterity, vision, finances, health education level
  • use insulin syringes ONLY
  • roll vial between palms
  • observe pts at risk for hypoglycemia (missed meals) and hypokalemia (IV insulin; K diuretics)
  • monitor weight
38
Q

Short duration insulin

A
  • rapid acting (AC)
  • Lispro (humalog), aspart (novolog), Glulisine (Aprida), regular insulin injection
  • short acting (30-60 min ac)
    -peaks 0.5- 2.5hrs
  • lasts 3-6hrs
39
Q

Intermediate short duration insulin

A
  • neutral protamine hagedorn (NPH)
    -protamine helps delay absorption
  • 2–3x in between meals
    -peaks 6-14hrs
    -lasts 16-24hrs
40
Q

Long duration insulin

A
  • gLARGine (U-100) 1-2x/ day
  • (Lantus, basaglar)
    -peak none
  • duration 18-24 hrs
41
Q

Ultra long duration insulin

A
  • gLARGine (U-300)
    -(toujeo) 3x more concentrated
    -lasts up to 48hrs
  • no peak
42
Q

Non insulin medications for type 2 DM

A
  • biguanides (metformin)
  • sulfonylureas
  • meglitinides (Glinides)
  • a-glucosidase inhibitors
    -DDP-4 inhibitors (Gliptins)
  • SGLT-2
    -oral combo drugs
    -non-insulin injectables (GLP-1; pramlinitide )
43
Q

Biguanides (metformin)

Type 2 only

A
  • Glucophage, Glucophage XR, fortamet, Glumetza, riomet
  • inital drug of choice
  • can be used for prevention
44
Q

MOA for Biguanides

metformin

A
  • inhibits glucose production in liver
  • reduces glucose in the gut (slightly)
  • increases glucose in fat/skeletal muscle (does not stimulate insulin receptors)
45
Q

Biguanides nursing consideration

metformin

A
  • low risk for hypoglycemia
  • absorbed in small intestine
  • No metabolism
  • stage 3 CKD; half dose
  • stage 4 CKD contraindicted
  • hold before IV contrast and 48hrs after
46
Q

SE of biguanides

metformin

A
  • n/v, bloating, diarrhea, possible weight loss, lactic acidosis, B12/ folic acid deficit, metobolic taste
47
Q

Sulfonylureas (general info)

only for type 2 DM

A
  • 1st oral antidiabetic drug
  • requires some pancreatic function
  • first gen- SIGNIFICANT drug-drug interaction MORE common
  • second gen- MORE potent
48
Q

MOA of sulfonylureas

2 generic 4 trades

A
  • GlipizIDE (Glucotrol/glucotrol XL)
  • GlyburIDE (diabeta or glynase)
  • stimulates insulin release from pancreas iselts by blocking ATP sensitixing k channels; permits ca influx- insulin then released
  • may increas insulin cell target sensitivity
49
Q

contraindications of sulfonylureas

Glipizide, glyburide

A
  • pregancy/ breastfeeding
50
Q

SE of sulfonylureas

glipizide, glyburide

A
  • HYPOglycemia, photosensitivty
51
Q

nursing assessment of sulfonylureas

glipizide, glyburide

A
  • assess hypoglycemia
  • beta blcoker may maks s/s of hypoglycemia
52
Q

nursing implementation for sulfonylureas

glipizide, glyburide

A
  • adminster 30min AC
  • higher alert med DO NOT confuse
53
Q

patient/family teaching for sulfonylureas

glipizide, glyburide

A
  • sunscreen protection
  • s/s hypoglycemia
54
Q

meglitinides (Glinides) MOA

2generic/trade

A
  • same MOA as sulfonylureas
  • differnce in pharmacokinetics (shorter acting & taken with meals)
  • Repaglinide (prandin); thiazolidinediones (Pioglitazone)

type 2 DM only

55
Q

pioglitazone contraindications

thiazolidinediones

A
  • liver disease, bladder cancer, moderate/severe HF, pregnancy/ breastfeeding
56
Q

SE of meglitinides

repaglinide, thiazolidinediones

A
  • low risk for hypoglycemia w/ monotherapy
57
Q

nursing assesment for meglitinides

repaglinide, thiazolidinediones

A
  • s/s of HF, BNP, s/s liver disease, AST, ALT, alk phosphorate, total bilirubin
58
Q

a-Glucosidase inhibitor

2 generic 1 trade

A
  • acarbose (precose) and miglitol

type 2 DM only

59
Q

a-Glucosidase inhibitor MOA

acarbose, miglitol

A
  • delay carb absoprtion by inhibiting a-glucosidase enzyme in the brush border cells
60
Q

SE of a-Glucosidase inhibitor

acarbose, miglitol

A
  • flatulence, cramps, abd distention, borborygmus, diarrhea
61
Q

education for a-glucosidase inhibitor

acarbose, miglitol

A
  • low hypoglycemia risk (unless combined w/ insulin or sulfonylureas)
  • long term, high dose can cause liver dysfunction
62
Q

Dipeptidyl Peptidase-4 inhibitors (Gliptins)

4 generic, 4trade

A
  • excellent 2nd line choice in conjunction w/ metformin
  • SitaGLIPTIN (januvia), saxagliptin (onglyza), linagliptin (tradjenta), alogliptin (nesina)

Type 2 DM only

63
Q

DPP-4 inhibitors MOA

sitagliptin, saxagliptin, linagliptin, alogliptin

A
  • enchance incretin hormone
  • simulate insulin release
  • supress glucagon release from liver
64
Q

SE of DPP-4 inhibtors

sitagliptin, saxagliptin, lingliptin, alogliptin

A
  • may cause pancreatitis
  • okay in pregnancy
65
Q

sodium glucose cotransporter inhibitors (general info)

3 generic 3trade

A
  • Canagliflozin (invokana), Dapaglifozin (farxiga), Empagliflozin (jardiance)
  • a high capacity, low afinity transporter in the kidney accounting for 90% glucose reabsorption
66
Q

SGLT-2 MOA

canagliflozin, dapagliflozin, empagliflozin

A
  • promote glucosuria; improves glucose control and reduces CVD deaths
67
Q

SE of SGLT-2

canagliflozin, dapagliflozin, empagliflozin

A
  • UTI, female genital fungal infection, increased urination
68
Q

Nursing assessment for SGLT-2

canagliflozin, dapagliflozin, empagliflozin

A
  • monitor for infection, ketoacidosis, volume depletion
69
Q

Non-insulin injectables

A
  • glucagon-like peptide 1 receptor agonsits (GLP-1)
  • amylin memetic: pramlintide (type 1&2)
70
Q

GLP-1 receptor agonist meds

liraglutide , exenatide, dulaglutide, semaglutide, rybelsus

A
  • liraglutide (victoza), exenatide (byetta), dulaglutide (trulicity), semaglutide (ozempic), rybelsus (oral)
71
Q

GLP-1 MOA

liraglutide, exenatide, dulaglutide, semaglutide, rybelsus

A
  • stimulates GLP-1 by stimulating insulin realease and decreasing glucogon secreation
  • delays gastric emptying= low blood sugar
72
Q

GLP-1 dosage

liraglutide, exenatide, dulaglutide, semaglutide

A
  • ozempic 0.25 mg weekly for 4wks
  • then 0.5 mg once weekly then may increase after 4wks to 1mg
73
Q

GLP-1 contraindication

liraglutide, exenatide, dulaglutide, semaglutide

A
  • personal/family hx
  • medullary thyroid carcinoma
74
Q

SE of GLP-1

liraglutide, exenatide, dulaglutide, rybelsus

A
  • pancreatitis, thyroid c-cell tumors, abd pain, diarrhea, nausea
  • dose r/t weight loss 8-14lbs
75
Q

nursing implementation for GLP-1

liraglutide, exenatide, dulaglutide, semaglutide

A
  • adminster on same day of the week , any time of day, rotate sites
  • never mix insulin and semaglutide
  • notify provider, d/c for s/s of pancreatits
  • notify for neck lumps, hoarseness, dysphagia, SOB
76
Q

amylin memetic

type 1 and 2 DM

A
  • pramlintide (symlin)
  • used in conjuction w/ insulin and immediatley prior to meals
  • do not mix pramlintide and insulin
77
Q

MOA and SE of amylin memetric

pramlintide

A
  • cause delay gastric emptying, supression of secretion
  • hypoglycemia, nausea

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