ENDOCRINE Flashcards
1
Q
How do we treat hypopituitarism?
What are the hormones we are going to be replacing?
A
- Replacing missing hormones
- Growth hormone (somatropin) and Vasopressin (AVP, AKA: antidiuretic hormone)
2
Q
Growth Hormone (somatotropin):
- Growth hormone (somatropin) is a weight based ___________ _________.
- The MOA for GH is that it has a role in bone, ______ muscle and organ growth; increased ___ mass; and transport of ______, electrolytes, and fluid
- The AE of GH is that it can cause _______ ________/edema, and ________ and joint pain
A
- subcutaneous injection
- skeletal, RBC, water
- fluid retention, muscle
3
Q
Vasopressin (AVP) AKA ADH:
- Vasopressin has a role of ________ water excretion by _________ urine concentration.
- A deficiency in AVP can cause what?
- In order to treat a lack of vasopressin what do we give someone?
- DDAVP (desmopressin) is given _________, PO, or intranasal
- The MOA for DDAVP (desmopressin) is that it binds to __ receptors which causes an increase in ____ water channels on the cell membrane to make it more permeable; water enters in and then is released back into body by AQP_ and _ channels
- DDAVP is also used for ________
- What are the AE of DDAVP?
A
- decreased, increasing
- Diabetes insipidus (large production of urine)
- Synthetic pharmacological product= desmopressin (DDAVP)
- subcutaneous
- V2, AQP2, 3 and 4
- Nocturia
- dry mouth, hyponatremia
4
Q
When we have a AVP or DDAVP binding to the V2 receptors this results in water _________, meaning ____ urine.
A
reabsorption, less
5
Q
- For hyperpituitarism, ________ is in adults while _________ is in children.
- It is often characterized by _______ bone and soft tissue growth;_____glycemia due to insulin resistance; _______ is greatest concern due to CV risk
- What is the treatment for acromegaly?
A
- acromegaly, gigantism
- excessive, hyperglycemia, cardiomegaly
- surgery
6
Q
Therapeutic concerns with pituitary treatment:
- Drug treatment accuracy is _______ meaning that there could be altered hormone levels exceeding normal ranges (or low).
- Low GH levels will result in low _____ _______ which could cause bone fractures and slipped capital femoral epiphyses (ice cream falling off cone in hip joint)
A
- difficult
- bone density
7
Q
ADRENOCORTICOIDS
A
ADRENOCORTICOIDS
8
Q
-Adrenocortical hypofunction can result in _______ disease. This is an insufficient production of _______ and ________
Adrenocortical hyperfunction can result in _______ disease. This is an excessive glucocorticoids from ________ production and _______ intake
A
Addison’s disease
-corticol and aldosterone
Cushing’s disease
-endogenous, exogenous
9
Q
- Adrenocorticosteroid is a steroid produced in the ______ _______.
- This is further subdivided into whether it has more effect on ____/___ metabolism or _______/____ balance.
- The one that has a more metabolic effect is a ____corticoid while the one with an electrolyte effect is a _____corticoid.
A
- Adrenal medulla
- carb/fat metabolism, electrolyte/water balance
- glucocorticoid (hydrocortisone, cortisol), mineralocorticoid (aldosterone)
10
Q
- Excessive glucocorticoids can cause _______ syndrome.
- This is due to an excess ________ glucocorticoid administration or an excessive ________ production from the adrenal gland.
- The overall problem with this is hyper_________.
- The first line treatment for excessive glucocorticoids is ________ but they may need pre or post-op medication such as __________ inhibitors which block cortisol synthesis or ___________ antagonist which blocks cortisol binding to receptor
A
- Cushing’s
- exogenous, endogenous
- hypercorticolism
- surgery, steroidogenesis inhibitors or glucocorticoid antagonists
11
Q
-Glucocorticoid deficiency can be divided into a _______ and _______ adrenal insufficiency.
-If it is a primary insufficiency it can cause _______ disease. This disease is usually _______, destroying all regions of adrenal cortex.
-Secondary insufficiency is most often due to _______ corticosteroid administration, our body becomes reliant to the outside administration causing a decrease in ____ release.
Why is it important to taper off of steroids?
A
- primary and secondary
- Addison’s, autoimmune
- exogenous, ACTH
- Body isn’t making it, will cause a deficiency if taken off instantly.
12
Q
- What is the treatment for glucocorticoid deficiency?
- The short term AE are _______ glucose levels, mood or appetite changes, fluid retention (edema).
- Long term AE can include _________, thinning of skin, infection, poor would healing.
A
- replace glucocorticoids = hydrocortisone, cortisone, or prednisone
- increased
- osteoporosis
13
Q
- Since primary adrenal insufficiency (Addison’s disease) is causing a destruction of the adrenal cortex we have to replace glucocorticoids as well as the ___________ with __________ to decrease hyperkalemia.
- In times of acute stress, they may require significantly _____ med doses because stress increases adrenal requirements.
- They may also require additional hydrocortisone before ________
A
- mineralocorticoids with fludrocortisone
- increased
- strenuous exercise
14
Q
- Mineralocorticoid excess (hyper_________) can be caused by adrenal tumor (_____ syndrome) or adrenal hyperplasia.
- The S/Sx or hyperaldosteronism includes ______ weakness, _______, paresthesias, headache, polydipsia, nocturnal polyuria, ___
- If pharm treatment is needed we use ________ receptor antagonist (AKA: _______ _________ diuretic)
- What are the two drugs we would use for hyperaldosteronism? Are they selective or nonselective for aldosterone receptors?
- Which of these has less AE? What other disease states are these meds used for?
A
- hyperaldosteronism, Conn’s syndrome
- muscle weakness, fatigue, HTN
- aldosterone, potassium sparing diuretic
- Spironolactone (nonselective for aldosterone receptors), Eplerenone (selective for aldosterone receptors)
- eplerenone, also used for HTN and heart failure
15
Q
-Mineralocorticoid deficiency (hypo_________) is related to _______ disease and is treated with ____________.
A
-hypoaldosteronism, Addison’s disease, fludrocortisone
16
Q
Therapeutic concerns about Adrenal Steroids;
- ______ effect on supporting tissues, bone density which can lead to what?
- Glucocorticoids and mineralocorticoids may cause ___ due to Na+ retention
- Can cause an increased susceptibility to _______
- Drug toxicity can lead to ____ ______, phychosis
A
- Catabolic effects which can lead to weakness and osteoporosis
- HTN
- infection
- mood changes
17
Q
MALE AND FEMALE HORMONES
A
MALE AND FEMALE HORMONES
18
Q
- Testes produce testosterone which is regulated by which hormones?
- ___ and testosterone produce masculinizing effects
- Testosterone in puberty increases size of _____ and _____
A
- LH and FSH
- DHT
- muscle and bone
19
Q
- Androgen defeciency can be either primary or secondary. Primary involves ________ failure while secondary involves decreased _____.
- An excess in women can lead to ______ and acne
A
- testicular, GnRH
- hirsutism
20
Q
- If there is an androgen deficiency we must weight the benefits of treating symptoms vs the ___ risk associated.
- There are no __ options due to hepatotoxicity.
A
- CV
- PO
21
Q
- The reason we only use testosterone if its truly indicated is because its increased risks of __, stroke, or CV death.
- Prolonged use could result in _____ toxicity
- Large doses can suppress spermatogenesis resulting in ________.
A
- MI
- hepatic
- infertility
22
Q
AAS stands for what?
-Potential risks of anabolic-androgenic steroids includes derm, __, cancer, infection, endocrine, musculoskeletal, and psych issues.
A
- Anabolic-adrogenic steroids
- CV
23
Q
-Ovaries produce ______ and _________
A
-estrogen and progestins
24
Q
- The menstrual cycle is __ days and is regulated by an interaction between pituitary (__ and ___) and ovarian (______ and _______) hormones
- Altering normal control between pituitary and ovarian hormones provides ________ control
A
- 28 days
- LH and FSH, estrogen and progesterone
- contraceptive
25
- What is the main use of estrogen and progesterone?
- Which hormone functions to suppress FSH and LH surge?
- What are the AE associated with taking estrogen and progesterone?
- What are the rare but serious AE?
- What is another option for contraception?
- Contraception (COC)
- estrogen (ethinyl estradoil)
- increase BP, N/V, weight gain, depression
- DVT and PE (more common if obese or immobile), stroke, MI
- Long-acting intrauterine device (IUD)
26
- Another estrogen and progesteron use includes post-menopausal ____.
- This will cause a _______ in menopausal sx, an ________ in BMD, and a _______ fracture risk
- Estrogen can be taken in a variety of ways and includes AE of _______, ___, breast tenderness, and vaginal bleeding
- Progesterone can be take __ and by patch and includes AE of ______,___, weight gain, and irritability
- The known risks of these products are ___, PE, gallbladder disease, and breast/endometrial cancer.
- HRT (hormone replacement therapy)
- decrease, increase, decrease
- nausea, HA
- PO, bloating, HA
- DVT
27
- BPH stands for what?
- What are the 4 main drug classes used to treat BPH?
- Alpha-adrenergic antagonists MOA is to relax smooth muscle in prostate and bladder neck. What is the AE?
- 5a-reductase inhibitors MOA is to interfere with stimulatory effects of testosterone. This can result in what AE?
- Anticholinergic agents includes what drug? MOA is to have an antispasmodic effect on smooth muscle; blocks Ach on smooth muscle. What are the AE?
- B3-adrenergic agonists includes what drug? The MOA is to relax detrusor muscle to decrease voiding symptoms. What is the AE of this?
- Benign prostatic hypertrophy
- Alpha-adrenergic antagonists; 5a reductase inhibitors; anticholinergic agents; B3-adrenergic agonist
- Hypotension
- Hypotension
- oxybutynin/Cant see, spit, pee, or poop
- mirabegron (Myrbetriq)/ may increase BP
28
Gender transition can take _____ to achieve the full effect.
M to F would take what?
F to M would take what?
When looking at risks associated we have to look at both their ___ at birth and their ______ after transition.
- years
- estrogen w/ or w/out progesterone, spironolactone (T blockade), finasteride (T blockade)
- testosteronoe
- sex, gender
29
Therapeutic Concerns about Sex Hormones:
- Monitor BP since these hormones promote ___ and ______ retention.
- ______ abuse in athletes
- Na+ and water
| - androgen, be sure they know the risks associated
30
PARATHYROID DYSFUNCTION
PARATHYROID DYSFUNCTION
31
- Hyperparathyroidism can be divided into ______ and ________.
- Primary is due to parathyroid ______ (benign tumor), hyperplasia, or carcinoma. This is typically treated by ______.
- Secondary can be caused by things such as CKD (chronic kidney disease) in which calcium levels become low which prompts increased levels of ___
- Hyperparathyroidism is a common cause of _________
- One way to treat this is through ____mimetics which interact with calcium-sensing receptor (CaSR) so it has greater affinity for calcium resulting in a decrease ____
- What is the most common AE associated with calcimimetics?
- What other drug class may be used for hyperparathyroidism? Why is it used?
- primary and secondary
- adenoma, surgery
- PTH
- hypercalcemia
- calci, PTH
- N/V
- Bisphosphonates/ prevents calcium loss from bone
32
- Hypoparathyroidism is often due to injury to ________.
| - This will cause ____calcemia and we will treat it with what?
- parathyroid glands
| - hypocalcemia, will treat with Ca+ (1-3g/day) and vitamin D
33
HYPOTHYROIDISM
HYPOTHYROIDISM
34
-Hypothyroidism can be _______ or _________
-Primary is often from autoimmune destruction of the gland: ______
-Secondary hypothyroidism is from a reduction in secretion of ___ from pituitary or reduced ___ from hypothalamus
-Symptoms of hypothyroidism include _______, anemia, _______, weight gain, cold intolerance, menstrual irregularities, _____ weakness
What can also occur due to hypothyroidism?
- primary or secondary
- Hashimoto's thyroiditis
- TSH, TRH
- bradycardia, lethargy, muscle
- goiter
35
- What is the most common drug used to treat hypothyroidism?
- Its MOA is it is the synthetic version of _______ (__) that is converted to T3 which has its usual effects.
- Is it a NTI?
- Requires monitoring initially every _-_ weeks, then every _-_ months when stable.
- Levothyroxine is typically ___ _______ unless overtreated. The signs of overtreatment can include _______, heat intolerance, tachycardia, diarrhea, nervousness, menstrual irregularities, increase basal metabolic rate
- Levothyroxine
- thyroxine (T4)
- Yes
- Requires monitoring every 4-8 weeks, then 6-12 months when stable
- well tolerated, sweating
36
- It is ideal to take levothyroxine on a ______ ________ __-__ minutes before AM meal or _-_ hours after PM meal and seperate from other medications (iron, calcium, magnesium, and aluminum containing products)
- Chronic hypothyroidism has an increased risk of __ disease.
- This is more likely in people with baseline risk factors such as angina, tachycardia, abnormal heartbeat
- empty stomach, 30-60 minutes before AM, 3-4 hours after PM
| - CV
37
-What are the rarely used meds used for hypothyroidism?
-Thyroid USP, Liothyronine, Liotrix
38
Long term overtreatment of hypothyroidism can lead to decreased ____________ and increased _______________
-Make sure to maintain the _______ effective dose, especially in postmenopausal women
- bone density, risk of fractures
| - least
39
HYPERTHYROIDISM
HYPERTHYROIDISM
40
- A hyper active thyroid can lead to _______ disease which is identified by _______ eyes.
- If graves disease gets severe it can cause a _______ storm which can be fatal. Thyroid storm can be identified by dehydration, ________, delirium, fever, etc.
- Graves, bulging
| - thyroid storm, tachycardia
41
What are the three treatment options for hyperthyroidism?
- Antithyroid meds (thioamides)- sometimes 1st line
- Radioactive iodine- sometimes 1st line or after failing antithyroid meds
- Thyoidectomy- surgery
42
- The two antithyroid meds include what two drugs?
- They may be given as a monotherapy for ~1 year to induce remission (only effective in __%)
- These are usually given if ____ hyperthyroidism, elderly, small goiter, or need to avoid radioactive iodine
- The MOA of these drugs is they block formation of __ and __ by inhibiting oxidation of _____.
- The common AE of these medications are rash, _______, arthralgia (refer to provider due to risk of more rare but serious polyarthritis)
- The rare AE of these medications include ________ and ________.
- Treatment can cause ___________
- Methimazole and Propylthiouracil (PTU)
- 50%
- mild
- T4 and T3, iodine
- GI upset
- agranulocytosis, hepatotoxicity
43
- What drug is typically preferred to treat hyperthyroidism unless in the first trimester of pregnancy? Why?
- What is the black box warning for PTU (propylthiouracil)?
- methimazole, only needs to be dosed 1x or 2x a day as opposed to PTU being 4x/day
- hepatotoxicity
44
- Other treatments for hyperthyroidism include what?
- What is unique about radioactive iodine?
- Propranolol is used to treat _______ until thyroid levels normalize.
- radioactive iodine, propranalol
- causes destruction of thyoid which will result in hypothyroidism (requires lifelong treatment)
- symptoms
45
OSTEOPOROSIS
OSTEOPOROSIS
46
- Osteoporosis is a decreased ___ _____ occuring when formation of new bone doesn't keep up with bone resorption.
- With osteoporosis we have a decline in _______ function and increase in ________ function.
- Who is most at risk for this?
- bone density
- osteoblast (formation), osteoclast (resorption)
- women, especially postmenopausal
47
- Osteoporosis can be _______ and ________.
- Primary osteoporosis is ______ (cause unknown) while secondary onset is relates to another _________ ________,_________, __________.
- primary and secondary
- idiopathic
- medical condition, use of certain meds, or disease processes
48
Bone mass peaks between the ages of __ and __, after this time, bone reabsorption begins to ______ bone formation.
- 25 and 35
| - exceed
49
- Osteoporosis can result in what fracture?
- Osteoporis is generally "______"
- Osteoporosis results in increased kyphosis of the _______ spine
- compression (most common)
- silent
- thoracic
50
- Typically we will use medication for osteoporosis for men and women above the age of __ if: hip or vertebral fracture, osteoporosis, osteopenia
- Also used for patients taking long-term _________ and men receiving androgen-deprivation therapy for ________ cancer and have high fracture risk
- Antiresorptive therapy acts to block the _____________. This includes what drugs?
- Anabolic therapy is used to increase _____________. This includes the drug ________.
- 50
- steroids, prostate
- breakdown of bone; includes drugs bisphosphonates, denosumabs, SERMs, estrogen, and calcitonin
- formation of bone, teriparatide
51
- What supplements will they take if they aren't getting enough in their diets?
- Generally speaking, the calcium dosage will be ____mg in younger patients and _____mg in older patients.
- Generally speaking, the vitamin D dosage will be _____ international units daily for younger patients and _____ international units daily for older patients
- Calcium and vitamin D
- 1000, 1200
- 600, 800
52
- Bisphosphonates end in what?
- How often are these drugs taken?
- Bisphosphonates are the ______ and most common treatment
- Bisphosphonates MOA is to bind to a key enzyme to _______ natural bone turnover pathways which results in increased _______ apoptosis which decreases bone turnover.
- Ultimately we are decreasing the number of osteoclasts resulting in less ____ breakdown.
- end in -dronate
- 1st line
- inhibit, osteoclast
- bone
53
- Bisphosphonates are taken with plain water __-__ minutes before any food or medication.
- Food and meds can decrease absorption up to __%.
- When are GI AE increased?
- What are the contraindications for taking bisphosphonates?
- 30-60 minutes
- 90%
- GI AE are increased when not upright
- hypocalcemia, PO only if esophageal abnormalities, inability to remain upright for necessary time
54
What is a rare but serious risk associated with bisphosphonates?
-Atypical femur fracture (usually benefit>risk)
55
What is another rare but serious risk associated with bisphosphonates?
What population is this more common in?
- osteonecrosis of jaw (ONJ)
| - cancer patients
56
- What is the only drug associated with Anti-RANKL class?
- Denosumab (Prolia) has evidence to decrease risk of ________, non-__________ and hip _________ in postmenopausal women
- This drug is taken __________ every _ months in the provider's office
- Typically RANKL is excreted by ________, which binds to RANK on osteoclast surfaces and activates action to promote resorption.
- Denosumab binds to ______ which ultimately inhibits bone resorption.
- denosumab (Prolia)
- vertebral, non-vertebral, hip fracture
- subcutaneously every 6m
- osteoblasts
- RANKL
57
- Denosumab (Prolia) AE include ______, limb pain, derm reactions and less commonly ________ edema and hypocalcemia.
- Denosumab, like biphosphonates, has the rare but serious risk of what?
- What rare side effect is specific to denosumab?
- arthralgia
- peripheral
- atypical femur fracture and ONJ
- increased risk of infections because RANKL is also on T-cells
58
- Sclerostin Inhibitors drug is ______(Evenity).
- This drug is two injections taken ____ a month for __ months.
- This drug class MOA is to inhibit sclerostin which is a regulatory factor in bone metabolism which results in ___________
- What is the most common AE associated?
- The rare risks are hypocalcemia, ________ fractures, ___, increase risk of CV death if an event in the past year
- Romosozumab
- once a month for 12 months
- increased bone formation
- arthralgia
- atypical, ONJ
59
-What is teraparatide (Forteo)?
-This drug is taken _________ daily for 2 years.
-This drugs MOA is that it stimulates ________ function, increases GI calcium absorption, and increases renal tubular reabsorption of calcium. This all results in an increase in ___.
The AE related to this is transiest _______________ (within 4hrs of dose)
- synthetic version of PTH
- subcutaneously
- osteoblast, BMD
- orthostatic hypotension
60
Therapeutic Concerns about Thyroid and Parathyroid drugs:
- Excessive doses of drugs used to treat can produce symptoms of the _________ disorder.
- Avoid overexertion in patients with decreased CO and hypotension caused by ___________
- Excessive doses of calcium supplements for parathyroid dysfunction can alter CV function resulting in ________
- Take advantage of weight bearing activities to stimulate __________ AND be aware when high impact activities should be avoided (_______)
- opposite
- hypothyroidism
- arrhythmias
- bone formation, osteoporosis
61
DIABETES MELLITUS
DIABETES MELLITUS
62
-Type I diabetes mellitus is characterized by selective _____ cell destruction, beta cells are important because they are what produces _______.
Type I is due to a severe or _______ insulin deficiency
-Type I is typically diagnosed before age __
-The cause of Type I ______, _______, and possibly a _____ trigger. These patients ________ insulin.
- beta, insulin
- absolute
- 30
- autoimmune, genetics, require
63
- Type II diabetes mellitus is characterized by insulin _________.
- These patients have a ________ beta cell destruction that can progress to a more severe.
- This is usually diagnosed in _______, but we are seeing a growing incidence in youth.
- The cause for Type II is ________
- This can be treated with just ____, non-_______ medications, or insulin
- resistance
- moderate
- adults
- multifaceted
- diet, non-insulin meds,
64
The symptoms of diabetes include:
- ______
- increased _________ and hunger
- _______ dysfunction
- sudden weight loss (type I)
- ____ would healing
- vaginal infections
- ________ in hands or feet
- increased thirst
- blurry vision
- fatigue
- urination
- poor
- numbness/tingling
65
- What measurement is used to measure diabetes control?
- What are the levels associated with:
- diabetes
- prediabetes
- normal
- A1C
- diabetes=6.5 or above
- prediabetes=5.7-6.4
- normal=about 5
66
Type II Diabetes Pathophys S71
- Incretic hormones play a role in ____________ and _______
- The kidney increases glucose ________ meaning we are getting rid of less through our urine.
- insulin release and satiety
| - reabsorption
67
What are two other forms of diabetes mellitus?
- gestational diabetes (diagnosed during pregnancy)
| - LADA (type 1.5)- slower beta cell destruction
68
- People with Type II and Type I diabetes are at risk for ____glycemia. What level is considered ____glycemia?
- Symptoms of hypoglycemia are _____, sweaty, nervous or upset.
- ____-blockers may mask symptoms except for ______.
- Hypoglycemia is treated with quick-acting ________
- _________ is given in an emergency.
- hypo, blood glucose <70
- shaky
- Beta-blockers, sweating
- glucose
- glucagon
69
-What is the most common drug used for Type II diabetes? What class is this drug?
-The MOA isn't fully known but it does inhibit production of _______, inhibits _________ absorption of glucose and increases ________ sensitivity in muscle and fat
-This drug has a ____ risk of hypoglycemia
The common AE of this drug is ______ (N/D/abdominal cramping)
-This drug also has a risk of vitamin ____ deficiency that usually results after long term use. A deficiency in this is often misdiagnosed as peripheral neuropathy (numbness/tingling in hands or feet)
-What is the boxed warning associated with this drug?
- metformin (Glucophage), Biguanide
- glucose, intestinal, insulin
- low
- diarrrhea, GI issues
- B12
- lactic acidosis
70
- Sulfonylureas MOA is to bind to sulfonylurea receptor in the ________ which results in depolarization triggering ______ release
- This has AE of _________ (especially in elderly and renal dysfunction) and weight gain.
- This is typically taken before _________; immediate release must be __ minutes before meal, if not taken correctly it can increase _________ risk
- Some of these drugs are associated with the ______ List because of the hypoglycemia risk
- pancreas, insulin
- hypoglycemia
- breakfast,30 minutes, hypoglycemia
- Beers
71
- Thiazolidinedione (TZDs) MOA is increasing _______ sensitivity in muscle and fat by agonizing peroxisoe proliferator-activated receptor-gamma (PRARgamma) which ________ gene responses that influence glucose metabolism.
- This is sometimes referred to as an "______________"
- This class of drugs has a ____ hypoglycemia risk.
- The AE of this class includes edema, long term increased risk of ____________ (especially in females)
- insulin
- insulin sensitizer
- low
- bone fracture
72
- DPP-4 Inhibitors end in what?
- The MOA of this class of drugs is that it inhibits DPP-4 that typically breaks down incretin hormones (GLP-1 and GIP) which causes an ________ in insulin synthesis and release and also _________ glucagon secretion (which decreases hepatic glucose production)
- This class has a ____ risk of hypoglycemia
- These are generally well tolerated but there have been case reports of _______ occuring at any point during treatment
- end in -gliptin
- increase, decrease
- arthralgia
73
- SGLT2 inhibitors end in what?
- The MOA of this class is that they block glucose reabsorption in the ______ at SGLT2 in proximal renule tubules thus __________ urinary glucose excretion
- Common AE associated with this class are ________-depletion related AE, genitourinary infections, renal insufficiency
- This class also has the rare risk of euglycemic _______ __________
- What drug increases the risk of bone fracture and lower limb amputations (boxed warning- watch for signs of foot infection!)
- end in flozin
- kidney, increasing
- volume
- diabetic ketoacidosis (DKA, more if dehydrated)
- canagliflozin
74
- GLP1 rreceptor agonists are taken either ________ or PO either daily or _________.
- This class of drugs is used as an analog of endogenous GLP1 (incretin hormone) to ________ insulin secretion in presence of elevated glucose, ________ glucagon secretion, _____ gastric emptying
- What is the common AE associated with this drug class?
- A good way to remember this is GLP (gut, liver, pancreas)
- gut- gastric emptying
- liver- decrease hepatic glucose production
- pancreas- increase insulin secretion
- injectable, daily or weekly
- increase, decrease, slow
- GI (N/D, bloating)
75
- Insulin is used in people with more ________ type II diabetes or in type I.
- The MOA is that insulin binds to ______ ________ receptors in most tissues which triggers an increase expression of _____ receptor on muscle and fat cell surfaces to ______ glucose uptake; inhibits production of glucose
- Common AE associated with this are _________! and weight gain
- This is the only FDA approved treatment for _____
- The two types of insulin are ____ and _____
- Insulin is delivered as a _________ injection
- severe
- tyrosine kinase, GLUT4, increase
- hypoglycemia
- T1DM
- basal and bolus
- subcutaneous
76
Why are multiple insulins used?
- We are trying to mimic what the body is actually doing.
| - Some work all day long as our base and some work as the peak insulin like we have after we eat.
77
Basal insulin think "____" meaning what?
| This is generally though of as a __ hour insulin.
- Base, always working in the background.
| - 24
78
-Bolus insulin think of "____" of food.
-There are two types, ____ or _______
-Rapid has an onset of around __ minutes, and a duration of _-_ hours.
-Regular has an onset of around __ minutes, and has a duration lasting around _-_ hours.
-Bolus insulin is typically given __________
-This can also be given to correct _________
Which is used more commonly?
- bowl
- rapid or regular
- 10-30 minutes, 3-5 hours
- ~30 minutes, 4-12 hours
- before a meal
- hyperglycemia
- Rapid bolus insulin
79
- Other insulin injections includes intermediate (___).
- This is injected _-_ times daily
- Mixed insulin is also an example and is a combination of an ___________ with a rapid or regular acting
- This is usually injected before a meal
- This is given as a _, with the first number being the longer-acting and the second number being the shorter-acting (Ex: 70% intermediate and 30% regular acting / 70/30)
- NPH
- 1-2
- intermediate
- %`
80
- What are three other examples of insulin?
- U-500 is ____ concentrated
- U-500 is used for both ______ and _____ purposes
- Inhaled regular insulin is the only __________ product
- The most common AE associated with inhaled insulin is what?
- Concentrated insulin, U-500, Inhaled regular insulin
- ultra (hypoglycemia)
- basal and bolus
- non-injected
81
There are 3 miscellaneous drugs for diabetes, what are they?
-Pramlintide (Symlin), Alpha-glucosidase inhibitors, and Meglitidines
82
The first line treatment for diabetes is ________, and our 2nd line is ______________.
-metformin, patient specific
83
S93 OVERVIEW
S93 OVERVIEW
84
Therapeutic considerations for DM?
Does the patient have diabetic associated comorbities?
- diabetic retinopathy
- diabetic nephropathy
- diabetic neuropathy
- peripheral vascular disease
- CV disease
```
Beneficial effects of exercise?
-increased carbohydrate metabolism (which lowers blood glucose)
-body weight
-increased HDL
-decreased triglycerides
-decreased BP
=decreased stress and tension
```
Monitor blood glucose level
- below 100mg/dL: eat a snack before activity
- >300mg/dL NO PHYSICAL THERAPY
- monitor 6-12 hours after exercise
- know the symptoms of hypo and hyperglycemia
85
What is the leading cause of blindness in adults?
diabetes
