Endocrine Flashcards
Exam2
S/Sx of Hyperglycemia?
Dry mouth
Increased thirst
Weakness
Headache
Blurred vision
Frequent Urination
Tx: insulin administration
S/Sx of Hypoglycemia?
Fatigue
Shakiness
Dizziness
Tachycardia
Excess hunger
Profuse sweating
Numbness of extremities
Severe -> ketoacidosis
Tx: consuming carbs (15g/15min ex. 1/2 banana) or glucagon
Normal blood sugar range?
Pre-meal: 80-130mg/dL
Post-meal: <180mg/dL
What drug is a biguanide?
Metformin
What drug class is metformin in?
Biguanides
Metformin- indication?
T2DM (paired w/ diet & exercise
(Biguanides)
Metformin- MOA?
Activates AMPK enzyme in liver -> decreases glucose production
decreases GI glucose absorption
increases insulin sensitivity
Decreases A1C 1-2%
(Biguanides)
Metformin- side effects?
Lactic acidosis- higher risk in renal dysfunction
Contraindicated for eGFR<30 AKA kidney disease
Contraindicated for metabolic acidosis
GI upset- take w/ food to avoid
Hold 48hrs for iodinated contrast studies
(Biguanides)
What drug is a sodium glucose co-transporter 2 inhibitor?
Dapagliflozin
What drug class is dapagliflozin in?
Sodium glucose co-transporter 2 inhibitor
Dapagliflozin- MOA?
Inhibits SGLT-2 in kidneys -> decreased reabsorption of glucose -> increases urinary excretion of glucose -> decreases glucose in blood -> lowers blood sugar
Decreases A1C 0.7-1%
(SGLT2i)
Dapagliflozin- indications?
T2DM
HF
CKD
(SGLT2i)
Dapagliflozin- side effects?
Glucosuria- risk of UTIs - counsel on urinary hygiene
Increased urination/thirst
Euglycemic ketoacidosis d/t NPO
Necrotizing fasciitis risk
What drug is a glucagon-like peptide 1 agonist (GLP-1)?
Liraglutide
What drug class is liraglutide in?
Glucagon-like peptide 1 agonists
Liraglutide- indications?
T2DM
Weight loss
(GLP-1 agonist)
Tiers of A1C lowering drugs?
Metformin (biguanine): 1-2%
Glipizide (sulfonylureas): 1-2%
Insulin: 0.9-1.2%
Dapagliflozin (SGLT2i): 0.7-1%
Liraglutide (GLP-1 agonist): 0.5-1.5%
Pioglitazone (TZDS): 0.5-1.4%
Sitagliptin (DPP-4i): 0.5-0.8%
The lower A1C effect, the less the risk of hypoglycemia
Liraglutide- MOA?
Like GLP-1 hormone (released from GI in response to ingestion of food) -> increase glucose-dependent insulin secretion / decreases glucagon decrease -> lowers blood sugar
Slows gastric emptying -> decreased appetite
Decreases A1C 0.5-1.5%
(GLP-1)
Insulin function?
Insulin allows transport of glucose from blood into cells to be used as energy
Opposite of glucagon
Regulates blood sugar levels
Energy storage of glucose in liver when there is excess
Glucagon function?
Glucagon stimulates the release of glucose stored in the liver - raises blood sugar levels
Opposite of insulin
Liraglutide- side effects?
Weight loss/decreased appetite
Rebound weight gain w/ d/c
GI discomfort- occurs w/ increased dosing
Pancreatitis
(GLP-1 agonist)
What drug is a sulfonylureas?
Glipizide
What drug class is glipizide in?
Sulfonylureas
Glipizide- indications?
T2DM
(Sulfonylureas)
Glipizide- MOA?
Blocks potassium channels -> increases insulin secretion -> decreases blood sugar
Glipizide- side effects?
Weight gain
Hypoglycemia - counsel, esp. if w/ beta blockers
Contraindicated for T1DM
Must be taken WITH first meal (if IR, 30min prior)- hold if NPO
(Sulfonylureas)
What drug is a dipeptidyl peptidase 4 inhibitor (DPP-4i)?
Sitagliptin
What drug class is sitagliptin in?
Dipeptidyl peptidase 4 inhibitor (DPP-4i)
Sitagliptin- indications?
T2DM
(DPP-4i)
Sitagliptin- MOA?
Inhibits DPP-4 -> prolonged activity of incretin (GLP-1/GIP) -> increases insulin secretion / decreases glucagon secretion -> decreases blood sugar
(DPP-4i)
Sitagliptin- side effects?
Pancreatitis
Arthralgia (joint pain) AKI
Dermatologic hypersensitivity reactions - serious reactions
HF
Not taken with GLP-1 Liraglutide- similar MOA
Avoid grapefruit juice d/t accumulative effect
(DPP-4i)
What drug is a thiazolidinedione (TZDS)?
Pioglitazone
What drug class is pioglitazone?
Thiazolidinediones (TZDS)
Pioglitazone- indications?
T2DM
Pioglitazone- MOA?
Increases insulin sensitivity
Increases glucose uptake
Decreases hepatic glucose production
-> lowers blood sugar
(TZDS)
Pioglitazone- side effects?
HF
Peripheral edema
Weight gain
Contraindicated in HF
Avoid grapefruit d/t accumulation effect
(TZDS)
Insulin types and onset?
Lispro- Rapid acting
Regular- short acting
NPH- intermediate
Glargine- long acting
Basal (long-acting)
Bolus (short-acting/ meal-time)
Insulin- side effects?
Hypoglycemia
Hypokalemia
Weight gain
Rapid insulin name, onset and duration?
Lispro
Onset: 15min
Peak: 1-2hours
Duration: 3-5hours
Bolus dose
Can be used in pumps
Clear & colorless
What type of insulin is Lispro?
Rapid acting
Onset: 15min
Peak: 1-2hours
Duration: 3-5hours
Short acting insulin name, onset, peak and duration?
Regular insulin
Onset: 30min
Peak: 2hours
Duration: 6-10hours
Preferred for IV and parenteral nutrition
Bolus dose
Taken 30min before meals
What type of insulin is regular insulin?
Short acting
Onset: 30min (take 30min prior to eating)
Peak: 2hours
Duration: 6-10hours
Bolus/IV/parenteral
Intermediate acting insulin name, onset, peak and duration?
NPH
Onset: 1-2hours
Peak: 4-12hours
Duration: 14-24hours (unpredictable)
SubQ only, basal insulin BID
Cloudy
Mixing: draw LAST
What type of insulin is NPH?
Intermediate acting insulin
Onset: 1-2hours
Peak: 4-12hours
Duration: 14-24hours (unpredictable)
SubQ only, basal BID
Cloudy
Mixing: draw LAST
Long acting insulin name, onset, peak and duration?
Insulin Glargine
Onset: 3-4hours
Peak: none
Duration: >24hours
SubQ 1/day
Not to be mixed
What type of insulin is glargine?
Long acting insulin
Onset: 3-4hours
Peak: none
Duration: > 24hours
SubQ only, 1/day
Premixed insulin- what is the mix?
70/30
NPH / short or rapid acting
What drugs can affect blood glucose?
Increased:
Beta blockers (metoprolol)
Thiazide/loop diuretics (hydrochlorothiazide/furosemide)
Decreased:
Beta blockers (can mask hypoglycemia)
Main effect of thyroid hormones?
Main determinant of basal metabolic rate
Sx of hypothyroidism?
Weight gain
Increased fatigue
Hair loss, dry skin
Cold intolerance
Increased BP/cholesterol
Constipation/nausea
Decreased T4 -> elevated TSH
Hashimoto’s disease- autoimmune attacks thyroid
What hormone does levothyroxine target?
Increases T4
Levothyroxine- indication?
Thyroid hormone replacement (T4)
Levothyroxine- side effects?
High doses have life threatening toxic effects- not to be used for weight loss
Decrease dose in CAD
May decrease bone mineral density
If dose too high- hyperthyroid Sx
Taken w/ water at same time each day, 60min before breakfast or 3 hours after last meal
Can increase effects of warfarin- increased INR
Beta blockers can decrease effects
Sx of Hyperthyroidism?
Overproduction of thyroid hormone (low TSH)
Grave’s disease- autoimmune, stimulates thyroid -> increased T4
Heart arrythmias
thirst
increased urination
weight loss
Propylthiouracil- MOA?
Blocks oxygenation of iodine in thyroid gland -> Inhibits synthesis of thyroid hormones
Inhibits conversion of T4 to T3
Propylthiouracil- indication?
Hyperthyroidism
Propylthiouracil- side effects?
Preferred in 1st tri of pregnancy
May cause severe liver injury/acute liver failure - hepatotoxicity
