Endocrine Deck 3 Flashcards by Nathan Koranda

GLP-1 Agonists examples

Exenatide (Byetta) and others

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GLP-1 Agonists pharmacodynamics

Promote insulin release from pancreatic beta cells in the presence of elevated glucose
Mimic natural incretins
Slow glucose absorption from gut; promote satiety
Slow postparandial spikes

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GLP-1 Agonists precautions and contraindications

Acute pancreatitis noted in post-marketing surveillance
Severe GI disease (colitis, Crohn’s disease)
Pregnancy (check with specialists)

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GLP-1 Agonists drug interacions

Increased international normalized ratio (INR) if administered with warfarin
Digoxin

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GLP-1 Agonists Clinical use only for type 2 DM

Add-on therapy is typical
Combine with:
Metformin, sulfonylurea, others

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GLP-1 Agonists monitoring

Glycemic control and GI distress

Potential site reactions

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GLP-1 Agonists patient education

Administration of subcutaneous (SC) injection for rapid release
60 minutes before meals
Dosed 6 hours apart
If dose is missed, wait for next scheduled time

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GLP-1 Agonists ADR

GI upset/nausea (major cause of noncompliance)

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GLP-1 Agonists are

injectable and add on therapy, work on incretins and how they act.

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GLP-1 Agonists

Extended-release forms

weekly injections

Works as well or better than rapid release on HgA1C and weight

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GLP-1 Agonists ER GI issues are

GI issues more transient

Rapid and extended release have different impacts on postprandial vs fasting glucose levels

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SGLT-2 Inhibitors examples

Canaglilozin, dapagliflozin

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SGLT-2 Inhibitors MOA

Reduce blood glucose by blocking reabsorption of glucose in kidney
Also reduce BP and can lead to mild weight loss

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SGLT-2 Inhibitors first choice to add

if HgA1C is not at goal with metformin due to significant reduction of CV risk and progression of renal functional loss

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SGLT-2 Inhibitors can cause

Can cause genital yeast infections which can trigger the rare Fournier’s gangrene

if it happens take them off

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SGLT-2 Inhibitors sometimes linked to

Sometimes linked with increased K+, bladder cancer and increased lipid levels

do CMP and urinalysis

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Glucagon is considered

an insulin antidote: used in patients with diabetes who experience hypoglycemia or insulin overdose

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Glucagon Pharmacodynamics

Glucagon stimulates hepatic gluconeogenesis and glycogenolysis, raising BG levels.
BG concentration rises within 10 minutes of injection, and maximal concentrations are attained at approximately a half hour after injection.
Hepatic stores of glycogen are necessary for glucagon to produce an anti-hypoglycemic effect.

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Glucagon Pharmacokinetics

Well absorbed after parenteral administration

Extensively metabolized by the liver and kidneys

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Glucagon

Precautions and contraindications

May be used with pregnant women and children

Administered cautiously to patients suspected of having pheochromocytoma or insulinoma

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Glucagon ADR

nausea and vomiting, allergic reactions

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Glucagon

Drug interaction

Glucagon Clinical use and dosing

Reversal of hypoglycemia; prevention of low sugars for colonoscopy after 3-day preparations

Glucogon dose

In primary care setting: intramuscular (IM) dosing
Less than 20 kg weight: 0.5 mg or 20 to 30 mcg/kg/dose, repeat every 20 minutes
Less than 20 kg weight: adult dosing 1 mg/IM, may repeat in 20 minutes

Glucagon monitoring and patient education

Monitoring: BG levels immediately prior to and after injection Patient education Administration Educate family members and roommates on how to test BG and how to administer IM glucagon.

Glucagon depletes

glycogen stores; patient should be given supplemental carbohydrates as soon as he or she awakens and is able to swallow, especially children or adolescents.

Drugs affecting the hypothalamus-pituitary-adrenal (HPA) axis–endocrine system

Bisphosphonates (covered later in the course) Hypothalamic and pituitary hormones Thyroid and antithyroid agents Reproductive hormones (covered later in the course) Corticosteroid-related hormones (covered later in the course)

Human Growth Hormone name

Somatropin (genotropin)

Somatropin MOA

Recombinant DNA technology is true human factor | Stimulates the growth and metabolism of nearly every cell in the body

Somatropin Uses

short stature with or without normal GH levels

Somatropin contraindicated in

patients with closed epiphyses (don't used after finished growing)

Somatropin dosing

highly individualized on the basis of child’s growth rate and anticipated trajectory of genetic height

Somatropin pharmacodynamics

Initially there is insulin-like effect Simulates growth of linear bones, skeletal muscles, and organs Stimulates erythropoietin

Erythropoietin is a

hormone that is produced predominantly by specialised cells in the kidney. Once it is made, it acts on red blood cells to protect them against destruction. At the same time it stimulates stem cells of the bone marrow to increase the production of red blood cells.

Human Growth Hormone pharmacokinieitcs

intramuscular (IM) and subcutaneous (SC) drugs well-absorbed Metabolism: hepatic, renal 90% Excretion: renal

Human Growth Hormone | Adverse drug reactions (ADRs)

Antibody development Hyperglycemia, edema Hypothyroidism Arthralgia, headache, dizziness, flu-like symptoms

Human Growth Hormone patient education

Pediatric administration: total weekly dose (0.16 to 0.24 mg/kg) divided into 6 to 7 doses ADRs Lifestyle management and need to prevent abuse

HGH rational drug selection

NOT initiated by nurse practitioner in primary care practice; work with endocrinologist

HGH Monitoring

Hepatic/renal function: before and during treatment | TSH, glucose, glycohemoglobin, based on symptoms and prior illnesses

Thyroid hormones

Levothyroxine (T4), liothyronine (T3), and liotrix (a 4:1 mixture of T4 and T3)

Thyroid hormones produce the

same effects in the body as endogenous thyroid hormones.

Thyroid hormones also produce a

negative feedback loop to reduce further secretion of TSH and thyroid hormones.

t4 is the drug of choice for

thyroid replacement and suppression therapy because of its longer half-life

When do you take thyroid hormones

first thing in the morning on an empty stomach. Because they do not play with with other medications

Thyroid hormone absorption

Absorption: oral – erratic 40% to 80%; decreased by age, food, health of gastrointestinal (GI) tract; greater than 99% is protein bound

Thyroid hormone metabolism

liver, T4 is converted to T3 in the body; T4 produces both hormones

Thyroid hromone excreted

bile/feces

Thyroid Hormones | Precautions and contraindications

Contraindicated after acute myocardial infarction or thyrotoxicosis

Thyroid Hormones | Pregnancy risk

factor A, and safe with children

Thyroid hormones replacement is advised for

all pregnant women

thyroid hormone increased metabolic rate

during pregnancy may require higher dosing from baseline.

thyroid hormone is minimally

excreted in breast milk.

children with hypothyroidism

need treatment