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Pharmacology for Advanced Practice Nurses > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Drugs that impact the endocrine system:

A

Bisphosphonates (reviewed later in the course)
Antidiabetic agents (reviewed part 1)
Hypothalamic and pituitary hormones (reviewed part 2)
Exocrine pancreatic enzymes (reviewed part 2)
Thyroid and antithyroid agents (reviewed part 2)

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2
Q

Diabetes Mellitus (DM)

A

Chronic, progressive metabolic disorder resulting from abnormalities in glucose, protein, and fat metabolism

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3
Q

DM Type One

A

diabetes, which results from beta-cell destruction, leading to absolute insulin deficiency

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4
Q

DM Type 2

A

diabetes, which results from a progressive insulin secretory defect or insulin resistance

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5
Q

Diabetes resulting from other causes

A

e.g., genetic defects in beta-cell function or insulin action; diseases of the exocrine pancreas, such as cystic fibrosis; and drug- or chemical-induced

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6
Q

Gestational diabetes mellitus (GDM), which is diagnosed during

A

pregnancy

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7
Q

Insulin phamacodynamics

A

Binds at insulin receptor sites on cell membrane allowing glucose to enter cells

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8
Q

insulin acts on liver to

A

increase storage of glucose as glycogen

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9
Q

insulin promotes

A

protein synthesis on muscle cells

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10
Q

Inculin reduces

A

circulation of free fatty acids and promotes storage of triglycerides in adipose tissue

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11
Q

Rapid-acting examples and peak

A

lispro (Humalog), aspart (NovoLog), or glulisine (Apidra), onset about 5 minutes, peaks in 1 hour, duration about 4 to 5 hours

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12
Q

short acting examples and peak

A

regular“ (Humulin) insulin sometimes used around mealtime. Taken about 30 to 45 minutes before eating, peaks in 3 to 4 hours, duration 4 to 10 hours

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13
Q

Intermediate-acting: Name, peak, onset and duration

A

NPH mixed with protamine, delaying absorption; insulin looks cloudy and has to be mixed before it is injected; onset one-half to 1 hour, peak 4 to 10 hours, duration 12 to 24 hours

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14
Q

Long acting, name peak, onset, duration

A

glargine (Lantus),detemir (Levemir), degludec (Tresiba) insulins onset 2 to 4 hours, duration 24 hours with little or no peak

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15
Q

Insulin absorption determed by

A

type of insulin, injection site, and volume injected

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16
Q

insulin abdominal sites absorbes

A

50% more than other sites

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17
Q

insulin excretion

A

urine

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18
Q

inslusin should be injected with

A

standardized U 100/mL, needs U100 needles

19
Q

Inslulin ADR

A

hypoglycemia, diabetic ketoacidosis
Watch alcohol use; increases hypoglycemia
Beta blockers mask hypoglycemia symptoms

20
Q

Pregant women insulin

A

can use rapid- or short-acting insulin; does not cross placenta
Insulin aspart, insulin glargine, and insulin glulisine

21
Q

insulin and hypothyroidism

A

delays insulin breakdown; therefore may require less insulin units

22
Q

insulin and hyperthyroidism

A

increases renal clearance, requiring more insulin than baseline

23
Q

Insulin monitoring

A

Glycohemoglobin, renal function, CBC
A1C test twice a year in patients who are meeting treatment goals and have stable glycemic controls
A1C test quarterly in patients whose treatment has changed/not meeting goals
Point-of-care testing for A1C allows for timely decisions on treatments changes

24
Q

A1C as an average of the patients glucose in the last

A

90 days and comes in a percentage

25
Q

goal for A1C for most nonpregnant adults

A

less than 7%

26
Q

insulin patient education

A

Individualized goals for older adults with long-time diagnoses
Administration, understanding types of insulin
Glucose monitoring frequency and recording
Emergency plan for glucose readings and “flu”
Lifestyle management, diet, exercise
Injection site selection

27
Q

Look at insulin peak, onset, duration, and names

A

chat in book

28
Q

Insulin is dosed on a

A

total daily insulin need. Calculation is done that gives you a total daily dose. 50% goes into the short acting pool. That is divided between the three meals a day. The remainder is given as a long acting.

29
Q

Insufficient production of endogenous insulin

A

Sulfonylureas: cause an increase in insulin production

30
Q

Tissue insensitivity to insulin

A

Thiazolidinediones: improve insulin sensitivity
Biguanides: do the same

31
Q

Impaired response of beta cells

A

Meglitinides: increase secretion of insulin

32
Q

Excessive production of glucose by the liver drugs and MOA

A

Metformin: improves hepatic response to elevated blood glucose (BG), decreases glucose production, and decreases GI absorption
Alpha-glucosidase inhibitors: inhibit absorption of carbohydrate in GI tract

33
Q

Impaired glucagon-like peptide-1 (GLP-1) activity: rapid intestinal glucose dumping

A

Use of dipeptidyl peptidase 4 (DPP-4) medications to slow inactivation

34
Q

Continuous weight gain

A

DPP-4 may stop it or be weight neutral

35
Q

Sulfonylureas examples

A

Glipizide (Glucotrol), glyburide (Diabeta), glimepiride (Amaryl)

36
Q

Sulfonylureas

A

All stimulate insulin release from beta cells
All potentiate effects of antidiuretic hormone
Hypoglycemia is major side effect

37
Q

Sulfonylureas Precautions and contraindications

A

Cross-sensitivity with sulfonamides or thiazide diuretics
Avoid in pregnant women
Older adults more sensitive to hypoglycemia events
Pediatric: use in children 10 to 18 years, but it is unlabeled

38
Q

Sulfonylureas ADRs

A

Hypoglycemia, GI, dermatological rashes, syndrome of inappropriate antidiuretic hormone secretion, hemolytic anemia, leukopenia, thrombocytopenia, weight gain

39
Q

Sulfonylureas Drug Interactions

A

many may increase or decrease hypoglycemic effect

40
Q

Sulfonylureas Clinical use and dosing

A

Use second-generation agents most of the time.
Individualized dose progression is based on response.
Start with lowest dose and increase every 4 to 7 days.

41
Q

Sulfonylureas neurogenic diabetes insipidus

A

Chlorpropamide is used off-label.

42
Q

Sulfonylureas rational drug selection dosing

A

Age: chlorpropamide and glyburide used in older adults (use short-acting glipizide)
Cost: many generics available
Concurrent renal disease
Glipizide or tolbutamide, or glyburide
Concurrent insulin: only glimepiride FDA labeled for co-administration, but most second-generation agents used

43
Q

Monitoring Sulfonylurea

A

HgA1C: baseline, then every 3 months while adjusting, then every 6 months
CBC at onset, then annual unless more if symptoms

44
Q

Patient Education

A

Administration
ADR
Lifestyle managment

Pharmacology for Advanced Practice Nurses (50 decks)

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