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Pharmacy CPS Flashcards > ENDOCRINE: DIABETES, THYROID, > Flashcards

ENDOCRINE: DIABETES, THYROID, Flashcards

1
Q

drug causes dysglycemia

A 
glucocorticoids 
BB
atypical antipsychotics 
fluoroquinolone 
protease and calcineurin inhibitors 
statins ( HMG-CoA Reductase inhibitors)
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2
Q

the diagnosis of diabetes in Canada is established by

A

a random plasma glucose ≥11.1 mmol/L

a fasting plasma glucose (FPG) ≥7 mmol/L

2hPG in a 75-g OGTT ≥11.1 mmol/L

an HbA1c ≥6.5% (in adults)

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3
Q

what is the target for diabetes

A

FPG 4-7 mmol/L
2HPG 5-10 mmol/L OR 5-8 if A1C target not met

HBA1C <7% or <6.5% if patient has low hypoglycemia risk to reduce CKD & retinopathy

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4
Q

when is higher <8.5% A1C target indicated?

A

<8.5% in patient with history of severe hypoglycaemia, limited life expectancy, frail and/elderly with dementia

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5
Q

when is higher <8.0% A1C target indicated?

A

functionally dependent ( to avoid hypoglycaemia)

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6
Q

diabetes+ ASCVD ( acute MI, Coronary/ arterial vascularization, stroke, TIA, PAD)–> add?

A

GLP1 ( liraglutide, dulaglutide or SQ semaglutide)

SGLT2 ( empa, cana)

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7
Q

Diabetes + HF?

A

Dapa or empa

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8
Q

CKD+ DIABETES

A

SGLT 2 ( cana ( most evidence) then daga or empa)

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9
Q

ESRD + diabetes, what agent ??

A

ESRD < 15ml/min

DPP4 ( alogliptin, linagliptin, sitagliptin) or dulaglutide or repaglinide or SU (gliclazide) )insulin (low dose)

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10
Q

Which diabetes agent has benefit on weight loss

A

GLP1 and SGLT2I

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11
Q

which diabetes agent have reduce risk of hypoglycaemia

A

GLP1
SGLT2
acarbose or pioglitazone

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12
Q

when is appropriate to add insulin?

A

symptomatic hyperglycaemia, metabolic decompensation or antihyperglycemics insufficient
A1C >10%
Glucose >16.7 mmol/L

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13
Q

what is the recommended insulin basal starting dose

A

0.1-0.2 units/kg/day OR 5-10 units/ day , titrate 1 unit/day to taget BG ( FP <7 mmol/L

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14
Q

when it is appropriate to initiate bolus insulin?

how should bolus insulin be initiated?

A

BG not control despite being on basal + SGLT2 or GLP1 OR gylcemic values extremely high, may start basal/bolus right away

then add bolus

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15
Q

what is the renal cutoff in metformin, SGLT2-inhibitor

A

eGFR <30 ml/min

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16
Q

what is the MOA of biguanides and AE?

A

AI: increasing peripheral glucose uptake and insulin sensitivity and decreasing hepatic production

AE: upset stomach, N/V/, metallic taste, rhinitis, acidosis, B12 deficiency

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17
Q

MOA of a-glucosidase inhibitor and AE?

A

acarbose; inhibit a-glucosidase enzyme in SI, less glucose in absorbed since carbohydrates are B/D

AE: flatulence, diarrhea, abdominal pain ( dose related), hepatitis

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18
Q

sulfonylureas MOA and AE

A

gliclazide, glyburide, glimepiride, tobutamide

Meglitinides ( repaglnide)
depolarizes beta cells to stimulate insulin

hypoglycaemia ( higher with glyburide and eGFR <60 ml/min) 
weight gain 
headache 
dizziness 
GI effects
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19
Q

MOA of thiazolidinediones and AE

A

pioglitazone and rosiglitazone
increase PPAR-y sensitivity to insulin and decrease hepatic glucose production

ae: exacerbations/cause of HF, fluid retention, weight gain ( 2-2.5 kg), fractures, macular edema (rare), URI, headache

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20
Q

what are the CI of thiazolidinediones

A

HF, liver failure, bladder cancer( pioglitazone-rare), MI ( rosiglitazone- controversial)

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21
Q

DPP-4 inhibition MOA and adverse effects

A

“liptin” drug, sitagliptin, saxagliptin, linagliptin, alogliptin

DPP-4 inhibition leads to increase incretin levels

AE: headache, N/V/D, nasopharyngitis,

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22
Q

what should we be cautious of when initiating DPP-4 inhibition

A

**caution with history of pancreatitis or pancreatic cancer

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23
Q

what diabetic agent should we avoid in HF patient

A

DPP-4 I ( saxagliptin only)

thiazolidinediones,

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24
Q

what are the MOA of GLP-1 agonist and adverse effects

A

“tide drug”- exenatide, dulaglutide, liraglutide, lixisenatide, semaglutide

increased incretin concentrations

AE: N/V/D, weight loss
rare: acute pancreatitis, gallbladder

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25
GLP-1 agonist Contraindication
pregnancy, personal/family hx of MTC or MENS, caution with history of pancreatitis or pancreatic cancer **gastric emptying ( give agents requiring rapid GI absopr
26
what is the MOA of SGLT2 inhibitor and adverse effect
inhibits glucose reabsorption in the kidneys AE: UTI, yeast infection. hypotension, hyperkalemia and diabetic ketacidosis (rare)
27
what are the CI of SGLT2
``` bladder cancer ( dapagliflozin) EGFR < 30ML/MIN ```
28
Adverse effects of insulin
weight gain, hypoglycaemia, lipohypertrohy ( must rotate site)
29
what is a significant side effects of rosiglitazone
increased cardiovascular event risk, NEED WRITEN CONSENT FROM PATIENT
30
MOA of lipase inhibitor and AE
Orlistat ( decreases fat and breakdown and absorption by 30%) used as weight loss agent AE: N/V/D, increased bowel movement, flatulence
31
CI of lipase inhibitor
pregnancy, chronic malabsorption syndrome, cholestasis
32
what counselling point should be mentioned when taking meglitinides
take 15-30 mins prior to meals or right before, Delay or skip dose if delayed or skipped ** quicker onset compared to SU and less risk of hypoglycaemia
33
which class of diabetic meds can you NOT combine with GLP1 agonist
DPP 4 INHIBITOR
34
which diabetic class have weight gain potential
insulin, SU, meglitinides, TZD,
35
which insulin is basal ? | which is bolus
Insulin NPH, glargine 100u/ml + glargine 300 u/ml, degludec, determir bolus: insulin glulisine (apidra) , lispro ( humalog), aspart (novorapid) regular: Humulin-R, Entuzity
36
what is the difference between ultra-rapid analogues and regular insulin
ultra rapid has less hypoglycaemia than regular insulin, take right before eating (lispro, aspart, glulisine) Regular: take 30 min prior to eating (Novolin R)
37
basal insulin longest to shortest acting
degludec>glargine>determir/levemir> Humulin N, Novolin
38
Which insulin is cloudy
INTERMEDIATE BASAL NPH ( Humulin N,
39
drug of choice for pregnancy
rapid acting insulin or regular insulin, lisper and aspart have decreased risk of hypoglycaemia compared to regular insulin if Insulin is CI, metformin or glyburide can be used ( off labels)
40
is ACE, ARB or STATINS safe in pregnancy?
no
41
what are the recommended target for pregnancy?
FPG <5.3 2HRPG < 6.7 HBA1C: <6.5& OR <6.1% if safely achievable
42
what is the chronic adverse effect of metformin
vitamin B12 deficiency
43
What is the difference between dawn phenomenon and Somogyi effect?
If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon.
44
what is diabetic ketoacidosis? signs and symptoms? how to treat?
acute and fetal metabolic complication due to severe insulin deficiency. more common in type 1 - decreased consciousness - depleted Na+ K+ Cl- H2O - hospitalization - fluid
45
how to treat diabetic ketoacidosis
1. ICU 2. fluid resuscitation and K+ replacement 3. insulin and dextrose infusion (10u bolus IV until BG 5-7) 4. bicarbonate ( beneficial when pH <7)
46
what is consider mild and moderate to severe hypoglycaemia
mild <4 mmol/ L + autonomic symptoms: sweating, trembling, palpitations, anxiety, tingling, hunger moderate to severe <2.8 mmol + neuroglycopenic symptoms: LOC, drowsiness, confusion, weakness, visual disturbances, speech impairment
47
how to treat hypoglycaemia
15g of carbohydrate ( 4 glucose tabs OR 3 tsp of table sugar (15ml) or 1 tbsp of honey (15ml) ), check BG in 15 mins and if BG <4, 6 life savers repeat treatment
48
what is consider microvascular and macrovascular complications
macro: cerebrovascular, CAD, PVD micro: retinopathy, neuropath, nephropathy
49
symptoms of hyPOgylcemia and hyPERgylcemia
hypo: sweating, trembling, LOC, drowsiness, confusion, weakness hyper: polydipsia, polyuria, kussmaul breathing (hyper-ventilation), acetone breath
50
what is the most common cause of hyperthyroidism
graves disease ( thyroid-stimulating immunoglobulin stimulate TSH receptor on thyroid gland ** overproduction of thyroid hormone
51
clinical presentation of hyperthyroidism
nervousness, palpitation hand tremors, increased appetite, weight loss, goitre, nodules
52
which drug can cause hyper-t
levothyroxine ( over replacement , amiodarone, lithium ( rare), interferon, Tyrosine kinase inhibitors ( TKIs), SU (glyburide)
53
what are laboratory for hyper-t
increase RAIU, decreased TSH and increased FT4
54
What are treatment option for hyper-t
radioactive iodine methimazole propylthiouracil propanolol
55
what are the MOA of radioactive iodine? adverse effects? CI?
radioactive damages thyroid tissue N/V/D/ metallic taste, sore neck, worsen graves opthalmopathy CI: pregnancy and breastfeeding
56
important counselling point for radioactive iodine drug interaction?
wait at least 6 months before conceiving lithium prolongs RAI
57
1) MOA of methimazole? 2) ae? 3) CI
Blocks conversion of T4 to T3 arthralgia, rash, nausea, sore throat and fever GI rare: bone barrow suppression, agranulocytosis CI: 1st trimester of pregnancy ( MMI) ** d/c at least 5 days before diagnostic test
58
Propylthiouracil MOA, indication? adverse effects?
inhibits peripheral T4 to T3 conversion ae: same same as Methimazole + higher risk of hepatotoxicity and agranulocytosis with propythiouracil
59
significant DI between methimazole and propylthiouracil?
clozapine ( risk of agranulocytosis)
60
which agent can be used in children and which in pregnancy for hyperthyroid
methimazole: can be used in children propylthiouracil: preferred in 1st trimester of pregnancy, avoid in children due to risk of hepatotoxicity
61
what drug is used in management of severe hyper-t ( thyroid storm)
lug's solution
62
which disease is classified as primary hypo-t
hashimoto thyroiditis | autoimmune destruction of thyroid cells due to overproduction of antibodies against thyroid gland
63
laboratory for primary hypo-t, secondary and tertiary
primary: Increased TSH and decreased fT4 | 2 + 3: decreased TSH and decreased fT4
64
what the difference b/w 2 and 3 hypo-t
2: pituitary gland disorder ( neoplasm or trauma 3: hypothalamus disorder ( neoplasm or trauma
65
what value is subclinical hypo-t
increased TSH, normal T3T4
66
what are clinical presentation and symptoms of hypo-t
fatigue, cold intolerance, weight gain, bradycardia
67
is female at an increased risk of hypo-t
yes
68
what medication can cause hypo-
lithium, amiodarone, thionamides,
69
is there non-pharm therapy for hypo-t
no, thyroid hormone replacement is mainstay of therapy
70
pharmacotherapy for hypo-t
levothroxine (synthetic t4)- drug of choice liothyronine ( synthetic T3)- replaces endogenous T3 ( shorter acting)
71
AE of synthroid
symptoms of hyper-t and may worsen angina
72
dose of synthroid
1.6 mcg/kg/ day ( dose titration of 12.5-25 mcg q 4-8 weeks) PRN consider 12.5-25 mcg/day for elderly or those with cardiac disease
73
what are counselling points for synthroid
- take 1/2 hr before food | - space at least 4 hrs from calcium and iron containing products
74
what is the indication of liothronine
short term management in thyroid cancer patients off synthroid therapy
75
when should u check TSH after dose changes?
4 weeks
76
TSH is produced by
pituitary gland
77
Which compound is necessary for the production of T3 and T4?
iodine
78
Which of the following drugs may block the conversion of T4 to T3?
amiodaone and PTU
79
what is the role of beta blocker in thyroid disease
elieve the thyrotoxic symptoms such as palpitations, anxiety, tremor and heat intoleranc
80
what is the interaction b/w warfarin and synthroid ?
increases warfarin. ( decrease in the dose of anticoagulant may be warranted with correction of the hypothyroid state or when the levothyroxine sodium dose is increase)
81
The cause of the hyperthyroidism is the production of an antibody that does which of the following?
Activates the thyroid gland TSH receptor and stimulates thyroid hormone synthesis and release
82
Which of the following is a drug that is a useful adjuvant in the treatment of thyroid storm?
In thyroid storm, beta blockers such as propranolol are useful in controlling the tachycardia and other cardiac abnormalities, and propranbolol also inhibits peripheral conversion of T4 to T3.
83
What hormone is produced in the peripheral tissues when levothyroxine is administered?
T3
84
When should screening for type 2 diabetes using a fasting plasma glucose (FPG) be performed in the average adult patient?
Every 3 years for individuals ≥ 40 years.
85
which diabetic medication can prevent progression from prediabetes to diabetes
metformin + acarbose
86
when is ketone testing indicated
all individuals with type 1 diabetes during periods of acute illness accompanied by elevated BG, when preprandial BG levels remain elevated (>14.0 mmol/L), or when symptoms of diabetic ketoacidosis (DKA) (such as nausea, vomiting or abdominal pain) are present
87
when should SMBG be done in type 1 and type 2 diabetes
type 1: 3 times daily 2: once daily on basal + oral antihyperglycemic agents IF not on insulin- individualized (usually 1 to 2 times per week)
88
What is the duration of effect of long-acting basal insulin analogues?
42 hours ( degludec)
89
What is the recommended treatment of an unconscious patient with hypoglycemia?
1 mg glucagon SC or IM
90
Which of the following would be considered as alternatives to NPH insulin in someone prone to hypoglycemia?
Use of long-acting basal insulin analogues (insulin detemir, insulin glargine, insulin degludec) in those already on antihyperglycemic agents reduces the relative risk of symptomatic and nocturnal hypoglycemia compared to treatment with NPH insulin
91
When should you realistically expect to attain a target A1C in patients with type 2 diabetes who are using antihyperglycemic agents?
3-6 months
92
in DKA, is serum bicarb decreased or increased
decreased serum bicarbonate level
93
what are the common carbbohydrate ratio?
1:10 to 1:15 | 1 unit per 10 g CHO
94
when is post prandial BG testing done?
2 hours after a meal
95
what site is best for injecting bolus and basal insulin
bolus: abdomen for rapid reabsorption basal: abdomen or thigh or arms since rapid absorption is not critical ** note switching between sites will lead to variability in BG control.
96
Anatomical areas ranked in decreasing order of absorption rate are:
adomen, arm, thigh, buttock
97
how should patient administer insulin
hort term re-use of needles/syringes are not recommended (unless there is an emergency situation). Most patients should use a 90 degree angle (45 degrees is reserved for very thin people
98
which insulin can be mixed and which cannot
LANTUS CANNOT be mixed with other insulin regular short insulin can be mixed with NPH with no problem
99
rapid analogues have onset of?
Apidra / Humalog / NovRapid have onset of 10-15 minutes
100
NPH peak? | long acting insulin onset???
5- 8 hours 90 mins
101
when would insulin pump CSII be indicated for patient with type 1 diabetes
CSII can be considered in people with type 1 diabetes who do not reach glycemic targets despite optimized basal-bolus injection therapy, as well as in the following individuals: those with significant glucose variability; frequent severe hypoglycemia and/or hypoglycemia unawareness; significant “dawn phenomenon” with rise of blood glucose early in the morning;
102
increasing breakfast aspart dose will decrease the---- meal preprandial glucose readings, and increasing the lunchtime aspart dose will decrease the ---- r meal preprandial glucose readings.
lunch, dinner *** Adjustment of fast-acting insulin doses will affect the preprandial glucose levels at the following meal
103
which GLP1 is dose weekly
semaglutide, dulaglutide | exenatide 2mg
104
which GLP-1 RA what CV benefit
liraglutide

Pharmacy CPS Flashcards (27 decks)

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