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NURS 424 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Type 1 DM

A

Age of onset: childhood and young adulthood

Cause: heredity, autoimmune response against insulin-producing beta cells

Endogenous insulin: secretion markedly diminished early in disease, can be totally absent later

Nutritional status: thin, catabolic state

Symptoms: polydipsia, polyphagia, polydipsia, fatigue, weight loss

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2
Q

Type 1 DM: treatment

A

Must include insulin

Diet and exercise help increase insulin sensitivity

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3
Q

Type 2 DM

A

Age of onset: adulthood

Cause: weight gain, age, inactivity, genetics

Endogenous insulin: low levels (insulin deficiency), normal, or high (insulin resistance)

Nutritional status: obesity common

Symptoms: asymptomatic; polydipsia or polyuria may be present

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4
Q

Type 2 DM: treatment

A

Combination of medications, diet, exercise, insulin

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5
Q

Insulin MOA (fivefold)

A

1) stimulates glucose entry into cells
2) increases storage of glucose as glycogen in muscle and liver cells
3) inhibits glucose production in liver and muscle cells
4) promotes protein synthesis by increasing amino acid transport into cells
5) enhances fat storage and prevents mobilization for fat for energy

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6
Q

Rapid-acting examples

A

Lispro (Humalog), aspart (NovoLog), glulisine (Apidra)

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7
Q

Rapid-acting: onset, peak, duration

A

Onset: 5 minutes
Peak: 1 hour
Duration: 4-5 hours

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8
Q

Short-acting examples

A

Regular (Humulin)

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9
Q

Short-acting: onset, peak, duration

A

Onset: 30-45 minutes before eating
Peak: 3-4 hours
Duration: 4-10 hours

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10
Q

Ideal BG parameters for fasting glucose and bedtime glucose

A

Fasting glucose: <126-130

Bedtime glucose: <140

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11
Q

Intermediate-acting examples

A

NPH

Looks cloudy and has to be mixed before its injected

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12
Q

Intermediate-acting: onset, peak, duration

A

Onset: 30 minutes - 1 hour
Peak: 4-10 hours
Duration: 12-24 hours

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13
Q

Long-acting examples

A

Glargine (Lantus), detemir (Levemir), degludec (Tresiba)

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14
Q

Long-acting: onset, peak, duration

A

Onset: 2-4 hours
Peak: peak less
Duration: 24 hours

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15
Q

Insulin: absorption

A

Abdominal site absorbs 50% more than other sites

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16
Q

Insulin: metabolism

A

Induces CYP1A2

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17
Q

Insulin: ADR

A

Hypoglycemia, diabetic ketoacidosis (breaks down muscle/fat for energy)

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18
Q

Insulin: patient education

A

Stop drinking alcohol –> increases hypoglycemia

Don’t take with beta blockers –> masks hypoglycemia symptoms (inhibit hepatic glucose production)

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19
Q

Which forms of insulin can pregnant women use?

A

Rapid and short-acting insulin (does not cross placenta)

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20
Q

How does hypothyroidism affect insulin production?

A

Delays insulin breakdown –> require less insulin units

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21
Q

How does hyperthyroidism affect insulin production?

A

Increases renal clearance –> require more insulin than baseline

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22
Q

What tests should be ordered to monitor insulin effectiveness?

A

Hgb A1C (glycohemoglobin), renal function (GFR), CBC

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23
Q

How often should A1C be drawn in patients who are meeting treatment goals and have stable glycemic control?

A

Twice a year

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24
Q

How often should A1C be drawn in patients whose treatment has changed/not meeting goals?

A

Quarterly

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25
Insulin: contraindications
Hepatic dysfunction, renal impairment Caution in pregnancy and hypo/hyperthyroidism
26
Glucagon: MOA
Accelerates liver glucogenolysis --> increased breakdown of glycogen to glucose and inhibition of glycogen synthesis --> elevated blood glucose levels
27
Glucagon: contraindications
Hypersensitivity to glucagon or lactose Avoid in insulinoma or pheochromocytoma
28
Metformin: classification
Biguanides
29
Metformin: MOA
Increases peripheral glucose uptake and utilization --> improve insulin sensitivity Decreases hepatic glucose production and intestinal absorption of glucose
30
Metformin: patient education
Does NOT stimulate insulin release, does NOT cause hypoglycemia Lowers postprandial and basal plasma glucose levels Hold 48 hours before and after radiologic studies with contrast
31
Metformin: contraindications
Avoid with GFR <30 (caution with GFR 30-45, requires close monitoring) Liver disease
32
True/False | Metformin is first-line therapy in pregnancy
False | Insulin is first line therapy, but Metformin can be considered by OB
33
Metformin: ADR
Lactic acidosis (death, hypothermia, HTN, resistance of bradyrhythmias) N/D, bloating, flatulence, HA, vitamin B12 deficiency
34
Which classification of diabetic medication would you prescribe for someone with tissue insensitivity to insulin?
Biguanides (ex Metformin), thiazolidinediones Improve insulin sensitivity
35
Pioglitazone (Actos): classification
Thiazolidinediones (TZD)
36
Pioglitazone (Actos): MOA
Enhances insulin sensitivity by improved insulin action in the cell --> increases utilization of available insulin by the liver and muscle cells Decreases hepatic glucose production
37
Pioglitazone (Actos): patient education
Does NOT cause hypoglycemia, increased bone fracture risk Avoid in pregnancy, lactation, and children younger than 18 years
38
Pioglitazone (Actos): contraindications
Avoid in NYHA class III and IV HF, patients with ALT >2.5, active or history of bladder cancer
39
Pioglitazone (Actos): ADR
Fluid retention, weight gain, HA, myalgia, HTN, URI
40
Which classification of diabetic medication would you prescribe for someone with insufficient production of endogenous insulin?
Sulfonylureas - cause an increase in insulin production
41
Glipizide, glyburide, glimepiride: classification
Sulfonylureas
42
Glipizide, glyburide, glimepiride: MOA
Increases endogenous insulin secretion by beta cells Reduce glucose release from liver
43
Glipizide, glyburide, glimepiride: contraindications
Avoid in elderly d/t hypoglycemia, in pregnancy/lactation and children, sulfa allergies, G6PD deficiency Caution in renal and hepatic impairment
44
Glipizide, glyburide, glimepiride: ADR
Hypoglycemia, weight gain, nausea, epigastric fullness, heartburn, rashes, pruritus, urticaria, agranulocytosis
45
Repaglinide (Prandin), nateglinide (Starlix): classification
Meglitinides
46
Which classification of diabetic medication would you prescribe for someone with an impaired response of beta cells?
Meglitinides - increases secretion of insulin
47
Repaglinide (Prandin), nateglinide (Starlix): MOA
Blocks ATP-dependent K channels, depolarizing the membrane and facilitates calcium entry through calcium channels Increased calcium stimulates insulin release from beta cells
48
True/False Short-acting insulin secretagogues (aka meglitinides) are the most effective agent at reducing postprandial blood glucose levels
True
49
Repaglinide (Prandin), nateglinide (Starlix): patient education
Take 30 minutes before meal If skipped meal, skip dose
50
Repaglinide (Prandin), nateglinide (Starlix): contraindication
Avoid in elderly d/t hypoglycemia, pregnancy/lactation and children Caution in renal and hepatic impairment
51
Repaglinide (Prandin), nateglinide (Starlix): ADR
Hypoglycemia, weight gain, HA, diarrhea, arthralgia, chest or back pain
52
Acarbose: classification
Alpha-glucosidase inhibitor
53
Which classification of diabetic medication would you prescribe for someone with excessive production of glucose by the liver?
Alpha-glucosidase inhibitors - inhibit absorption of carbohydrate in GI tract (starch busters) ALSO, metformin: improves hepatic response to elevated blood gas, decreases glucose production, and decrease GI absorption
54
Acarbose: MOA
Competitively inhibits absorption of complex carbohydrates from small bowel --> delays glucose absorption
55
Acarbose: ADR
Flatulence, diarrhea, abdominal pain, elevated serum transaminases
56
Acarbose: patient education
Difficult to tolerate d/t GI upset, typically an add-on to current therapy Works best for postprandial glucose elevation
57
Acarbose: contraindication
Avoid in bowel disease , predisposed to intestinal obstruction, pregnancy and lactation Caution in renal and hepatic impairment
58
True/False | Alpha-glucosidase inhibitors cause hypoglycemia
False
59
-flozins: classification
Selective sodium-glucose cotransporter 2 inhibitors (SGLT-2)
60
SGLT-2: MOA
Inhibits renal SGLT-2 in proximal tubule, blocks reabsorption of glucose in kidneys --> increased urinary glucose excretion and reduction of plasma glucose
61
SGLT-2: ADR
Hyperkalemia, GU fungal infection, UTI, renal insufficiency, urinary frequency, hypotension, urticaria
62
SGLT-2: patient education
Urinary frequency and hypotension caused by volume depletion Can cause weight loss, evidence of reducing ASCVD risk Add-on to current therapy
63
SGLT-2: contraindication
BLACK BOX: risk of Fournier's gangrene Avoid in GFR <30 (dose reduce if <60), pregnancy and lactation
64
SGLT-2: patient education
Increased risk for bone fractures, fall risk d/t hypovolemia
65
Which classification of diabetic medication would you prescribe for someone with impaired GLP-1 activity (rapid intestinal glucose dumping)?
Depeptidyl peptidase 4 (DPP-4) slow inactivation
66
-gliptins: classification
DPP-4
67
DPP-4: MOA
Inhibits DPP-4 enzyme, resulting in prolonged incretin (GLP-1 and GIP) hormone levels
68
DPP-4: contraindications
Avoid in pregnancy and lactation Caution in renal impairment (except linagliptin)
69
DPP-4: ADR
Hypersensitivity reactions, acute pancreatitis, arthralgia, hypoglycemia
70
-tides: classification
GLP-1
71
GLP-1 (-tides): MOA
Analog of incretin hormone GLP-1 which increases glucose dependent insulin secretion, decreases inappropriate glucagon secretion, slows gastric emptying
72
GLP-1 (-tides): ADR
N/V/D, injection site reaction, HA
73
GLP-1 (-tides): patient education
Promotes satiety and weight loss
74
GLP-1 (-tides): contraindications
Avoid in moderate to end stage renal disease, patients with severe GI disease BLACK BOX: risk of thyroid c-cell tumors
75
Levothyroxine (Synthroid): MOA
Synthetic form of T4 - endogenous hormone secreted by thyroid gland (T4 converts to T3) Bind to thyroid receptor proteins in cell nucleus and exert metabolic effects through control of DNA transcription and protein synthesis
76
Levothyroxine (Synthroid): patient education
Given on an empty stomach (30 minutes prior to meals) in morning Takes 6-8 weeks to reach steady state
77
Levothyroxine (Synthroid): contraindications
Avoid after recent MI Caution in patients with CVD, adrenal insufficiency
78
Levothyroxine (Synthroid): ADR
Tachycardia, HTN, anxiety, nervousness, insomnia, weight loss
79
Methimazole (Tapazole): MOA
Inhibits synthesis of thyroid hormones by blocking oxidation of iodine in thyroid gland Does NOT inactivate circulating T3 and T4
80
Methimazole (Tapazole): ADR
Drowsiness, HA, arthralgia, skin rash, urticaria, fever, agranulocytosis, hepatitis
81
Methimazole (Tapazole): contraindication
Avoid in first trimester of pregnancy, use in lowest dose in lactation Caution with other meds that suppress bone marrow
82
Methimazole (Tapazole): patient education
Long half-life and no risk for hepatic toxicity --> preferred over PTU Take PTU during first trimester, then start methimazole once second trimester occurs
83
PTU: MOA
Inhibits synthesis of thyroid hormones by blocking oxidation of iodine in thyroid gland Blocks conversion of T4 to T3 in peripheral tissue (dose NOT inactivate circulating T3 and T4)
84
PTU: ADR
Drowsiness, HA, arthralgia, skin rash, urticaria, fever, agranulocytosis, hepatitis
85
PTU: contraindications
BLACK BOX: hepatotoxicity Avoid in pediatrics; lowest dose in lactation Use cautiously with other meds that cause bone marrow suppression
86
PTU: patient education
Increased bleeding risk

NURS 424 (35 decks)

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