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NAPLEX Chapter Reviews > Endocrine: DM, Thyroid, Steroids, Autoimmune > Flashcards

Endocrine: DM, Thyroid, Steroids, Autoimmune Flashcards

1
Q

Repaglinide

A

(Prandin)

secretagogue, can cause hypoglycemia and weight gain

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2
Q

Hypoglycemia

A

< 70

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3
Q

Glucagon secreted by

A

alpha cells

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4
Q

Insulin secreted by

A

beta cells

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5
Q

TZDs

A

Thiazolidinediones are PPAR gamma agonists that improve peripheral insulin sensitivity (increase uptake and utilization of glucose); improve insulin sensitivity in muscle cells

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6
Q

Glucagon injection kit

A

Glucagon is used when a patient is unconscious. Glucagon is available as a SC injection kit, reconstituted solution for injection and nasal spray. The kit includes a vial and a syringe that contains the reconstitution liquid.

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7
Q

DM + albuminuria

A

According to the ADA, any patient with diabetes and albuminuria [defined as a urinary albumin excretion of 30 mg/24 hours or greater or a urine albumin-to-creatinine ratio (UACR) of 30 mg/g or greater] should receive an ACE inhibitor or ARB, but not both together. This is true whether the patient has hypertension or not.

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8
Q

DM drugs w/ cancer risk

A

Actos (pioglitazone), dapagliflozin - bladder cancer. GLP1-RAs (thyroid, medullary thyroid CA)

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9
Q

Insulin adjustment when pramlintide started- protocol

A

Mealtime insulins need to be reduced by 50% when starting pramlintide

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10
Q

Miglitol

A

Glycet- Miglitol is an alpha-glucosidase inhibitor. Another agent in the class is acarbose. These drugs should be taken with the first bite of each meal. Hypoglycemia cannot be treated with sucrose.

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11
Q

Pramlintide slows gastric emptying and is contraindicated

A

in patients with gastroparesis. MOA- an injectable, under GLPRA1s, amylin analog, slowing gastric emptying and increasing satiety

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12
Q

Glucose at home testing instructions

A

Hands should be washed first to clean the testing site. The hands should be dry, as water will dilute the blood sample. The finger pads should not be used as a testing site. A new test strip should be used for each test. Alternate testing sites are not recommended when blood glucose is changing or when hypoglycemia is suspected because alternate sites can give a test result that is 20 - 30 minutes old.

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13
Q

Insulin use in the hospital

A

Sliding scale insulins alone are no longer recommended to manage hyperglycemia in hospitalized patients. Per the ADA guidelines, in patients with poor oral intake (this patient is not eating a regular diet until later in the day after her CT scan), a basal insulin regimen with bolus correction doses (aka sliding scale insulin) is recommended. Short- or rapid-acting insulins and agents that cause hypoglycemia (such as sulfonylureas) should not be scheduled in a patient that is not eating regular meals.

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14
Q

Hospitalized patients should have their BG maintained between

A

140-180 mg/dL

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15
Q

The ADA treatment goals for patients with type 2 diabetes are preprandial blood glucose ____ and peak postprandial blood glucose _____

A

80-130 mg/dL; < 180 mg/dL

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16
Q

Insulin should be considered initially in patients with severe hyperglycemia, defined as an _____

A

A1C > 10%

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17
Q

Diabetes diagnostic criteria: A1c, FPG, PPG

A

A1c >/= 6.5, FBG >/= 126, PPG >/= 200

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18
Q

Pre-diabetes diagnostic criteria: A1c, FPG, PPG

A

A1c >/= 5.7, FBG 100-125, PPG 140-199

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19
Q

Diabetes treatment goals, not pregnant: A1c, preprandial, PPG

A

<7, FBG 80-130, PPG < 180

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20
Q

Diabetes treatment goals, pregnant: A1c, preprandial, PPG

A

FBG = 95, 1 hr PPG = 140, 2hr PPG = 120 (stricter)

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21
Q

Actos

A

pioglitazone, TZD

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22
Q

Janumet

A

metformin + januvia (sitagliptin, a DPP4i)

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23
Q

Invokanamet

A

invokana (canagliflozin, SGLT2i) + metformin

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24
Q

Avandia

A

rosiglitazone, TZD

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25
Q

Jardiance

A

empagliflozin, SGLT2

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26
Q

Weight loss

A

metformin, GLP1, SGLT2

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27
Q

Little/no hypoglycemia risk

A

metformin, DPP4, SGLT2, TZD, GLP1

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28
Q

Weight gain

A

insulin, TZD, SUs, meglitinides

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29
Q

Januvia

A

sitagliptin

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30
Q

Tradjenta

A

linagliptin

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31
Q

DPP4s CI with what class DM meds?

A

GLP1s (-glutides), similar moa

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32
Q

Do NOT use ___ in NYHF class 3-4

A

TZDs; can cause or worsen HF

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33
Q

Glucotrol, Glucotrol XL

A

glipizide

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34
Q

Glumetza

A

metformin

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35
Q

Fortamet

A

Metformin

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36
Q

Glucophage

A

metformin

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37
Q

Do not start metformin with eGFR __-__

A

30-45

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38
Q

Beers criteria- dont use ___ in elderly. Highest risk med is ____.

A

SUs; glyburide (Glynase)

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39
Q

Glynase

A

glyburide

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40
Q

Amaryl

A

glimepiride

41
Q

Take ____ 30 mins PO ac

A

Glucotrol (glipizide)

42
Q

meglitinides

A

repaglinide, nateglinide; can cause weight gain, hypoglycemia - if you skip a meal, skip dose d/t risk of hypoglycemia. Do NOT use with insulin or SU, same MOA (increase insulin secretion)

43
Q

Starlix

A

nateglinide (meglitinide)

44
Q

Victoza

A

liraglutide

45
Q

Trulicity

A

dulaglutide

46
Q

GLP1 RA that also comes in PO form

A

semaglutide PO = Rybelsus , SC = ozempic

47
Q

GLP RA

A

incretin mimetics; decrease dose with renal impairment

48
Q

Byetta

A

exenatide, GLP1 RA

49
Q

Bydureon

A

exenatide ER, GLP1 RA

50
Q

1-2/day GLP-RAs - need to give needles

A

Byetta, Victoza [once a day], Adlyxin (exenatide, liraglutide, lixisenatide)

51
Q

Adlyxin

A

lixisenatide, GLP1 RA

52
Q

GLP RAs - give without regard to meals EXCEPT ____ and ___. Give those ___ mins ___ meals.

A

Byetta and Adlyxin (exenatide and lixisenatide); give 60 mins prior to meals.

53
Q

Bydureon serious reaction injection site reaction risk of ____.

A

Skin nodules. Bydureon = exenatide ER

54
Q

GLPs have risk of _____

A

pancreatitis

55
Q

Synthetic analog of amylin

A

Pramlintide

56
Q

SymlinPen 60, 120

A

Pramlintide; synthetic amylin analog, can be used in both type 1 and 2 DM. CI is gastroparesis as its MOA is already slowing gastric emptying and increasing satiety.

BOXED warning: severe hypogylcemia when used with insulin

57
Q

DM drugs with hypoglycemia risk

A

insulin, pramlintide (when used with insulin), SUs, meglitinides (when dose is given but meal is skipped)

58
Q

gastroparesis, GI disorders

A

GLP RAs, pramlintide

59
Q

Genital infection/UTI

A

SGLT2 (-flozins)

60
Q

HF

A

TZDs, alogliptin, saxagliptin

61
Q

hepatotoxicity

A

TZDs, alogliptin

62
Q

hyperkalemia

A

invokana (canag)

63
Q

hypokalemia

A

insulin

64
Q

ketoacidosis

A

SGLT2

65
Q

lactic acidosis

A

metformin, do not use if GFR < 30

66
Q

osteopenia, osteporosis

A

TZDs (fractures), invokana (canag, decreases BMD and risk of fractures)

67
Q

RA insulin

A

aspart, lispro (Novo, Huma)

68
Q

SA insulin

A

= regular insulin. Humulin R, Novolin R

69
Q

Intermediate acting insulin

A

NPH (N), cloudy, RX and OTC

70
Q

____ insulin preferred in IV

A

regular (N)

71
Q

LA insulin

A

det, lev (Lantus, Toujeo, Basaglar)

72
Q

Converting BID NPH to Lantus or Basaglar; use __% of NPH dose

A

80%

73
Q

Converting Toujeo to Lantus or Basaglar; use __% of Toujeo dose

A

80%

74
Q

Starting a basal-bolus insulin dose

A

1/2 of TBW is the TDD needed. divide that in 1.2 and that is your basal TDD units. the other half, divide by 3 and that is your units per meal. To check your work: add all total units, that should be half of the patient’s TBW.

75
Q

Insulin stability at room temp: 28 days

A

Humalog vial, pen, cartridges, humalog mixes: vials only. Glargine, glulisine (Apidra). Novolog vial, pen, cartridge. Lantus vial pen

76
Q

Insulin stability at room temp: 10 days

A

Humalog MIXES pens (vials are 28 days)

77
Q

Drugs that cause hyperglycemia** +++ (12)

A

Beta blockers, quinolones, thiazide and loops, tacrolimus, cyclosporine, PIs, antipsychotics (ex: olanzapine, quetiapine), statins, niacin, systemic steroids, cough syrups

78
Q

Insulin stability at room temp: 28 days

A

Humalog vial, pen, cartridges, humalog mixes: vials only. Glargine, glulisine (Apidra). Novolog vial, pen and cartridge. Lantus (vial and pen)

79
Q

Drugs that cause hypoglycemia*** - - - (6)

A

beta blockers, quinolones, linezolid, lorcaserin (Belviq), pentamidine, tramadol

80
Q

HHS

A

HHS is predominantly a complication of type 2 diabetes (rarely type 1) in which high BG can cause severe dehydration and increases in osmolarity. The condition is a medical emergency

81
Q

How are DPP4s and GLP1s similar?

A

Januvia is sitagliptin, a DPP-4 inhibitor. Medications in this class prevent the breakdown of incretin hormones [like glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)] thereby increasing insulin release and decreasing glucagon secretion. This ultimately decreases glucose production.

82
Q

treating hypoglycemia

A

15-20 grams of carbohydrates are recommended for treating hypoglycemia which includes 8 oz of milk, 3-4 glucose tabs, non-diet soda (4 oz), 1 tablespoon of honey and other items. Be sure to retest in 15 minutes and have the patient eat a small amount of food to prevent recurrence

83
Q

Meds that interact with levothyroxine

A

Some medications can bind levothyroxine and decrease its absorption, such as antacids (containing aluminum, magnesium or calcium), bile acid sequestrants (e.g., cholestyramine), potassium binding resins (e.g., sodium polystyrene sulfonate), phosphate binders (e.g., sevelamer), iron, orlistat and sucralfate. The administration of these drugs should be separated from levothyroxine.

84
Q

PTU has a boxed warning for ?

A

PTU has a boxed warning for severe liver injury, which can come on suddenly, even after long-term use. Both methimazole and PTU can cause rash and agranulocytosis (a form of bone marrow suppression).

85
Q

___ is used in the first trimester of pregnancy because of the fetal risk associated with ___. ___ can be used in the 2nd and 3rd trimesters.

A

PTU is used in the first trimester of pregnancy because of the fetal risk associated with methimazole. Methimazole can be used in the 2nd and 3rd trimesters.

86
Q

T3 vs T4 ; __ is more potent that __.

A

T3 is much more potent than T4.

87
Q

Patients with known ___ should be started at __-__ mcg/day of levothyroxine.

A

Patients with known CAD should be started at 12.5-25 mcg/day of levothyroxine.

88
Q

Levothyroxine pill colors

A

12 strengths

Orangutans will vomit on you right before they become large proud giants

orange
white
violet
olive
yellow
red
brown
turquoise
blue
lilac
pink
green
25
50
75
88
100
112
125
137
150
175
200
300
89
Q

PTU and methimazole can cause ____, which presents as a syndrome with symptoms such as ____ (6)

A

Both PTU and methimazole can cause drug-induced lupus erythematosus (DILE), which presents as a syndrome with symptoms such as muscle/joint pain, malar (butterfly) rash, weight loss, photosensitivity, fatigue and depression.

90
Q

Drugs that can cause hyPOthyroidism

A

I A T L C (i always think long & confused; hypo)

Interferons, * (both hypo and hyper)
Amiodarone, * (both hypo and hyper)
Tyrosine kinase inhibitors (sunitinib, etc),
Lithium, 
Carbamazepine
91
Q

Treating thyroid storm

A

In addition to PTU, patients with thyroid storm should be treated with SSKI or Lugol’s solution, a beta-blocker, a corticosteroid and acetaminophen.

92
Q

Treating thyroid storm

A

In addition to PTU, patients with thyroid storm should be treated with SSKI or Lugol’s solution, a beta-blocker, a corticosteroid and acetaminophen.

93
Q

Drugs that can cause hyPERthyroidism

A

Interferons, * (both hypo and hyper)
Amiodarone, * (both hypo and hyper)
Iodine

94
Q

Drugs that can cause hyPERthyroidism

A

Interferons, * (both hypo and hyper)
Amiodarone, * (both hypo and hyper)
Iodine

95
Q

RA sx

A

all over, bilateral, morning stiffness, bone deformity

96
Q

RA meds

A

MTX, HCQ, Leflunomide (Arava)

97
Q

Arava, toxicities, MOA

A

leflunomide, hepatotoxic.

CI in pregnancy, need a negative pregnancy test and 2 forms of BC. If pregnancy desired, patient must wait 2 years of being off this med OR accelerated drug elimination option

MOA: inhibits pyrimidine synthesis, reducing proliferation (why its CI in preg) and inflammation

98
Q

MTX boxed warnings are

A

pregnancy (inhibits folate synthesis), hepatotoxic, myelosuppression, mucositis/stomatitis

99
Q

MTX is dosage forms and dosing

A

PO, IM, SC. PO = TREXall, SC = oTREXup, Rasuvo.

Dosed once weekly, never given daily (reports of adverse events like GI bleed, liver issues, mouth sores). 7.5-20 mg / week.

NAPLEX Chapter Reviews (13 decks)

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