Endocrine Deck 3 Flashcards
GLP-1 Agonists examples
Exenatide (Byetta) and others
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
GLP-1 Agonists precautions and contraindications
Acute pancreatitis noted in post-marketing surveillance
Severe GI disease (colitis, Crohn’s disease)
Pregnancy (check with specialists)
GLP-1 Agonists drug interacions
Increased international normalized ratio (INR) if administered with warfarin
Digoxin
GLP-1 Agonists Clinical use only for type 2 DM
Add-on therapy is typical
Combine with:
Metformin, sulfonylurea, others
GLP-1 Agonists monitoring
Glycemic control and GI distress
Potential site reactions
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
GLP-1 Agonists ADR
GI upset/nausea (major cause of noncompliance)
GLP-1 Agonists are
injectable and add on therapy, work on incretins and how they act.
GLP-1 Agonists
Extended-release forms
weekly injections
Works as well or better than rapid release on HgA1C and weight
GLP-1 Agonists ER GI issues are
GI issues more transient
Rapid and extended release have different impacts on postprandial vs fasting glucose levels
SGLT-2 Inhibitors examples
Canaglilozin, dapagliflozin
SGLT-2 Inhibitors MOA
Reduce blood glucose by blocking reabsorption of glucose in kidney
Also reduce BP and can lead to mild weight loss
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
SGLT-2 Inhibitors can cause
Can cause genital yeast infections which can trigger the rare Fournier’s gangrene
if it happens take them off
SGLT-2 Inhibitors sometimes linked to
Sometimes linked with increased K+, bladder cancer and increased lipid levels
do CMP and urinalysis
Glucagon is considered
an insulin antidote: used in patients with diabetes who experience hypoglycemia or insulin overdose
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.
Glucagon Pharmacokinetics
Well absorbed after parenteral administration
Extensively metabolized by the liver and kidneys
Glucagon
Precautions and contraindications
May be used with pregnant women and children
Administered cautiously to patients suspected of having pheochromocytoma or insulinoma
Glucagon ADR
nausea and vomiting, allergic reactions
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
