Endocrine Drugs

Question 0

Type I - IDDM

Answer 0

Insulin production is decreased or absent due to decrease in number of B-cells in pancreas. Needs insulin replacement

Question 1

Diabetes Mellitus

Answer 1

Abnormalities in glucose homeostasis leads to Hyperglycemia. Lack or decrease in insulin production, or the insulin produced is ineffective,

Question 2

Type II - NIDDM

Answer 2

Amount of insulin produced may be normal, increased, or decreased. Decreased tissue responsiveness to insulin because of defects at receptor sites, decreased number of sites or problem with post-receptor sites.

Question 3

Clinical manifestations of Type I IDDM

Answer 3

Three P’s: Polyuria, Polydipsia, and Polyphagia.
Weight loss of underweight status
Ketosis
Fatigue

Question 4

Clinical manifestations of Type II NIDDM

Answer 4

Three P's may or may not be present.
OBESITY
Fatigue
RECURRENT INFECTIONS
GENITAL PRURITIS
VISUAL CHANGES

Question 5

Short Duration: Rapid acting insulin

Answer 5

Ex) insulin Lispro/ Humalog, insulin aspart/ Novolog

Given 5-10 min before eating or with meal (sq). Effects last 3-5 hours, given at every meal, combined with intermediate acting for long term control.

Question 6

Short Duration: Slower acting

Answer 6

Ex) Regular insulin/ Humalin R, Novolin R
Given 30 minutes before meal. Effects last 6-10 hours, combined with intermediate acting. Given sq, inhalation (Exubra), infusion pump, IV

Question 7

Intermediate acting Insulin

Answer 7

Ex) Neutral Protamine Hagedorn Insulin (NPH)/ Humalin N, Novolin N
Used to control blood sugar between meals and during night. Injected twice daily, can be mixed with short duration insulins. Usually given at breakfast and dinner, DURATION IS 16-24 Hours

Question 8

Long Acting Insulin

Answer 8

Ex) Insulin Glargine/ Lantus

Given once per day at bedtime. Duration is 24 hours. SQ only, CAN’T BE MIXED

Question 9

Tolbutamide/ Orinase

Answer 9

Sulfonylureas: Oral Hypoglycemic agents

MOA: Stimulates release of insulin, given before meals - 2x/day
IND: Type II Diabetics Taken po
AE: Hypoglycemia, Teratogenic
DI: Alcohol, Beta Blockers

Question 10

Metformin/ Glucophage

Answer 10

Biguanide

MOA: Lowers blood sugar by decreasing production of glucose by liver, suppresses gluconeogenesis. Also increases glucose uptake by muscles

AE: GI, Lactic Acidosis

DI: Alcohol

Question 11

Rosiglitazone/ Avandia

Answer 11

Thiazolidinesdiones: Glitazones

MOA: Reduces insulin resistance by increasing target cells response to insulin. Taken with Glucophage and or Sulfonylurea.

AE: Well tolerated except does cause slight increase in fluid retention

DI: Insulin, gemfibrozil/ Lopid

Question 12

Hypothyroidism: Hormone Replacement

Levothyroxine (T4)/ Levothyroid, Synthyroid

Answer 12

MOA: Synthetic preparation of thyroxine -T4. Taken po once a day
IND: All forms of hypothyroidism
AE: Rare at therapeutic levels.
Toxic Levels: Extreme hyperthyroidism - thyrotoxicosis
DI: Iron, Calcium supplements, Warfarin, dilantin, rifampin, phenobarbitol
NURS: Monitor TSH levels

Question 13

Hyperthyroidism

Answer 13

Patho: Increased synthesis and release of TH
Graves Disease: Autoimmune disease, stimulates thyroid (Protrusion of Eyeballs)

 Toxic Goiter: Cells or nodules function autonomously, secrete TH

Clinical Man: Nervousness, tremors, weight loss despite increased appetite, Inc HR, Palpitations, SOB, Heat intolerance, Inc GI Motility

Question 14

Methimazole/Northyx

Answer 14

MOA: Inhibits thyroid hormone synthesis, inhibits an enzyme (Perioxidase)

IND: Graves Disease

AE: Hypothyroidism, agranulocytosis

CI: Pregnancy, Lactation

Question 15

Radioactive iodine/ Iodotope

Answer 15

MOA: Destroys thyroid tissue by emission of beta particles (radiation)

IND: Graves, Alternative to surgery

AE: Hypothyroidism

Question 16

Meds for Growth Hormone deficiency

Answer 16

Somatropin/ Humatrope, Genotropin

MOA: Form of GH given sq or IM

IND: Pediatric GH Deficiency
Pediatric non-growth hormone deficient short stature
Adults: waisting in AIDS patients

AE: Hyperglycemia

DI: Glucocorticoids

Question 17

Meds for excess growth hormone

Answer 17

Octreotide/ Sandostatin

MOA: Mimics action of somatostatin on pituitary and suppresses GH release.

IND: Acromegaly

AE: GI- Nausea, diarrhea, flatulance

Question 18

Posterior pituitary

Answer 18

Releases ADH: Promotes renal conservation of water, collecting ducts are more permeable.

Question 19

ADH Deficiency:

Answer 19

Diabetes Incipidous: DI

Patho: Decreased ADH or Decreased action. Leads to excretion of large amounts of dilute urine and excess thirst.

Question 20

Desmopressin/ DDAVP (po/nasal spray)

Answer 20

Meds for DI:

MOA: Structural analog of natural ADH. Promotes renal conservation of water.

AE: Water intoxication

Question 21

Glucocorticoids

Answer 21

Affect glucose metabolism, plays role in response to stress (Cortisol).
Functions: Increase conversion of protein and fat to glucose in the liver, increases breakdown of body protein and increases use of fatty acids for energy.

Question 22

Mineralocorticoids

Answer 22

Maintenance of fluid and e-lyte balance, Aldosterone

Question 23

Androgens

Answer 23

Sex steroids

Question 24

Adrenocorticol Deficiency: Addisons disease

Answer 24

Patho: Insufficient adrenocorticol function, elevated serum ACTH but inadequate synthesis of hormones. Autoimmune Disorder

Question 25

Hydrocortisone

Answer 25

Meds for Addison’s Disease
MOA: Synthetic steroid similar to cortisol

IND: Addison’s Disease and all forms of adrenocorticol insufficiency (po)
Adrenal crisis given IV
AE: Well tolerated

Question 26

Fludorcortisone/ Florinef

Answer 26

MOA: Mineralocorticoid activity. Used on combo with Hydrocortisone.

IND: Addison’s Disease, Hypoaldosteronism.

AE: Water and sodium retention –> hypertension
Hypokalemia