Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology Final > Endocrine Drugs > Flashcards

Endocrine Drugs Flashcards

1
Q

Insulin

A

Action
same as physiologic insulin - facilitates the uptake and metabolism of glucose by insulin-dependent cells.

Broken down by GI tract so cannot be given po. Must be sc. Regular insulin can also be given IV or infused directly into the peritoneal cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lispro (Humalog)

A

Action: rapid
Onset 5-15 minutes
Peak 1-1.5 hr
Duration 3-4 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

aspart (Novalog)

A

Action: Rapid
Onset: 10-20 minutes
Peak: 1-3 hrs
Duration: 3-5 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Glulisine (Apidra)

A

Action: Rapid
Onset 5-30 minutes
Peak: 1 hr
Duration 3-4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Regular insulin

A

Action: short
Onset 1-2 hours
Peak 2-4 hours
Duration: 6-10 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

NPH insulin

A

Action: intermediate
Onset: 1-2 hrs
Peak: 6-14 hours
Duration: 16-24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

detemir (Levemir)

A

Action: Long
Onset: Gradual
Peak: 6-8 hours
Duration: up to 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

glargine (Lantus)

A

Action: very long
Onset: 1 hr
Peak: no peak
Duration; 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When are hypoglycemic episodes most likely to occur?

A

When the insulin peaks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Rapid acting insulin

A

Because of rapid onset and peak, it more closely mimics the dynamics of plasma insulin response to a meal in non-diabetics. Thus, pt can take shot 5-10 minutes before eating (or when beginning to eat), instead of 30 minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why should the nurse always use an insulin syringe for insulin?

A

Always use insulin syringe - no dead space. Regular syringes may trap as much as 10 u.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Absorption rates

A

Most rapid and predictable absorption takes place in:

a) abdomen – 50% of dose in 87 minutes
b) arms – 141 minutes
c) thighs – 164 minutes
d) buttocks – 155 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why should the nurse rotate sites?

A

ADA recommends rotate sites within one anatomic region to ↓ lipodystrophy and variation in daily absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Insulin adjustment

A 
Increased need:
body growth
hormonal changes [eg pregnancy]
increased food intake
stress
illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drastically impairs insulin absorption?

A

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What factors cause a decreased need for insulin?

A

exercise
decreased food intake
some disease states [eg end stage renal disease]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Time zone insulin adjustments

A

Going EAST - decrease dose by fraction of the day you lose.

Going WEST - increase by fraction of day you gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Side effects of insulin

A
  1. Allergic Responses
    a) local - burning, stinging, itching, erythema
    b) systemic - urticaria
  2. Insulin resistance
    develops IgG mediated antibodies to insulin. Pt needs high doses [>100u/day]
    RX: complex - may need special insulins
  3. Lipodystrophy
    a) atrophy
    b) hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Drugs which cause hyperglycemia

A

steroids
oral contraceptives
thyroid preparations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Drugs which cause hypoglycemia

A 
ETOH
anabolic steroids
MAOI
beta blockers
theophylline
salicylates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Mixing insulin

A
  1. withdraw short acting first
  2. Most solutions are stable. Can be stored in fridge for up to 3 months. Unrefrigerated can be stored for up to a month under ideal conditions. Store mixed insulins c needle up to prevent clogging.
  3. Reg is compatible c all others.
  4. Mixed insulins equilibrate c time. The shorter acting insulin binds with the longer acting –>different speed of action.

Teach pt to give all mixed doses within the same time frame - either always within 15 minutes or always longer than 15 minutes

**exception is reg/NPH mix - binds within 15 minutes. Binding is not clinically significant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Insulin Administration

A
  1. Do not aspirate
  2. Pt may reuse syringes.
  3. No need to use alcohol swabs
  4. Do not use if insulin is “frosted” Frosting indicates loss of potency.
  5. Do not shake - excess agitation causes frosting
  6. Rotate sites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Noninsulin Polypeptide Analogues

pramlintide [Symlin]

A

comes in vials or injector pen
synthetic analogue of amylin – hormone released by pancreas after eating. Released along with insulin and is synergistic to insulin.

Slows gastic emptying, suppresses release of glucagon, suppresses appetite because increases feeling of satiety.

b. By injection only.
Can be used for both type 1 & 2. But only for pts taking insulin.
Given: sc just before each meal. Use insulin syringes. Do NOT mix with insulin. Give in a different site. Usually reduce insulin dose at first.

Can cause severe hypoglycemia - may happen within 3 hrs of dose. (does not happen with Symlin alone, but c insulin it does); also N/V, HA, allergy, joint pain, cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ORAL HYPOGLYCEMICS

Primary failure

A

Primary failure = pt does not respond to therapy. Occurs in 20% of pts. Not known why.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

ORAL HYPOGLYCEMICS

secondary failure

A

Secondary failure = pt responds for a time, then, for reasons not known, no longer responds. Occurs in 5-10%. But about half of pts with secondary failure will respond to another drug.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Sulfonylureas: Action

A

Stimulate the pancreas to produce more insulin. This effect does not last. After a few months, insulin secretion levels drop to pretreatment levels, but blood sugar stays down. Increase sensitivity to insulin at the receptor. May increase the # of receptor sites for insulin & may potentiate insulin action on post-receptor phase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Sulfonylureas: Contraindications

A
  1. allergy to sulfa
  2. pt NPO
  3. pregnancy or lactation
  4. impaired hepatic or renal function.
28
Q

Sulfonylureas: Side effects

A

Hypoglycemia – may be long lasting,.
agranulocytosis, hemolytic anemia, thrombocytopenia, cholestatic jaundice. N/V, fullness, epigastric distress. Rash, photosensitivity.

29
Q

Sulfonylureas: Drugs

A
  1. chlorpropamide [Diabenase] - first generation – not widely used anymore
  2. glyburide [Micronase; Diabeta] - second generation
  3. glipizide [Glucotrol] - second gen
  4. Glimepiride [[Amaryl] -. Indicated as adjunct to diet and exercise for Type2. Can also be given in combo with insulin for pts whose hyperglycemia can’t be controlled by diet, exercise, and oral meds [still type 2]
30
Q

Advantages of second generation sulfonylureas

A

more potent so need smaller doses
can give once a day
fewer drug interactions

31
Q

sulfonylureas: drug/drug interactions

A

chlorpropamide [Diabenase] + ETOH will cause flushing, HA, light-headedness & wheezing, N/V. Caution pt c asthma. Sometimes 1 ASA 1 hr a ETOH can stop reaction.

32
Q

Biguanides: Metformin [Glucophage] : Action

A

metformin reduces glucose production by the liver and absorption in the intestine. It also enhances uptake of use of glucose by peripheral tissues. In other words, it helps body tissues better take up and use the insulin already available. It also reduces glucose production in the liver, thus lowering demand for insulin.

It does not stimulate insulin release – mechanism of action is independent of insulin release.

33
Q

Biguanides: Metformin [Glucophage] : Indication

A

Indicated for use with or without a sulfonylurea in pts with type 2 who can=t manage BS with diet alone. Works particularly well in obese pts.
Can promote weight loss. Uncoated pills have a bad smell – fish or dirty socks – could explain nausea.

34
Q

Biguanides: Metformin [Glucophage]

Side effects

A

N/V/D/A, bloating, unpleasant or metallic taste.
Lactic acidosis - can cause death.
Early sx’s: extreme weakness, fatigue or discomfort, unusual myalgia, unusual stomach discomfort, dizziness or lightheadedness, sudden slow or irregular pulse.
Teach pt to stop drug and call MD. Lactic acidosis requires emergency tx. Hemodialysis can help remove the drug. ETOH increases risk for lactic acidosis.

35
Q

Biguanides: Metformin [Glucophage]

Contraindications

A

renal disease or dysfunction; acute or chronic metabolic acidosis, including diabetic ketoacidosis, HF

36
Q

Meglitinides

A

basic action is stimulating release of insulin.

37
Q

Meglitinides; repaglinide [Prandin]

ACTION

A

seems to preserve glucose-stimulated proinsulin biosynthesis in islet cells. Binds to beta cells. Stimulates insulin secretion via inhibition of potassium channels in beta cells.

Very fast acting and quickly eliminated. ½ life = less than 1 hr. ½ life of glucose is very brief.

Take ac. Optimal timing is 15 minutes ac, but can be taken anywhere from immediately before to 30 minutes ac. Skip dose if pt misses a meal and add dose if pt adds a meal.

	Eliminated mostly in feces. Useful for pts with renal disease.
38
Q

Meglitinides: nateglinide – [Starlix]

A

nateglinide – [Starlix]
Dose: given TID, 1-30 minutes ac. Allows mealtime flexibility. Rapid and short-acting. Pt can skip pill if meal is missed.
Excreted by kidney so caution with renal disease.

SE(for class): hypoglycemia is most common SE but does not occur often.
Joint pain, upper resp infections, paresthesias.

39
Q

Thiazolidinediones

A

Indicated for type 2 DM, who have to take insulin, but still have inadequately controlled blood sugar levels. May reduce or eliminate dependence on insulin.

Action: improves body’s ability to use insulin. Reverse insulin resistance at cellular level by agonizing the receptors that regulate insulin- uptake. Also decrease hepatic glucose output. May take 3-4 months to get full effect.

Excretion: via bile and kidney
SE: infection, muscle pain, HA, edema, weight gain, increases in cholesterol.
Can be hepatotoxic. ,
cause or worsen HF,
can  inc risk of fractures in women, but not in men.

40
Q

Thiazolidinediones

Drugs

A

pioglitazone [Actos] – HF & MI Black Box warning
Actos may cause resumption of ovulation in anovulatory pts (pre-menopausal)

rosiglitazone [Avandia] – HF & MI Black Box warning

Lots of controversy in literature right now. Research has indicated higher risk of CV problems. Removed from market in Europe.

41
Q

Α-Glucosidase Inhibitors

Action

A

Α-Glucosidase Inhibitors
competitive, reversible inhibitor of pancreatic alpha-amylase, which hydrolyzes complex CHOs to oligosaccharides. By inhibiting this enzyme, acarbose delays digestion of starches. This results in a smaller rise in blood glucose concentrations following meals. In addition, the metabolism of sucrose to glucose and fructose is inhibited by acarbose.

42
Q

Α-Glucosidase Inhibitors

Side effects

A

intestinal gas, abd pain, distension, diarrhea, borborygmi - all these usually decrease with time. But get worse if pt does not eat correct diet.
Also can get elevated liver enzymes.

43
Q

Α-Glucosidase Inhibitors

Drugs

A

Acarbose [Precose] – Preg. Category B

Miglitol [Glyset] –

44
Q

Incretin Therapy

A

Incretins = hormones. Released by small intestine when we eat. There are 2 major ones: gastric inhibitory peptide [GIP]; and glucagon-like peptide [GLP-1].

45
Q

Incretin Therapy: Effects

A 
Effects:  
Increase amt of insulin secreted
Decrease amt of glucagon secreted
Delay gastric emptying
Increase feeling of satiety
These drugs work well to lower BS and have few SE. Do not cause hypoglycemia when used alone.
46
Q

Incretin Mimetic: Exenatide [Byetta]

A

Exenatide [Byetta]

a. glucagon-like peptide -1 receptor agonist. (GLP-1 receptor).
b. Used only for type 2 pts who are not controlled with other meds.
c. Given sc BID within 1 hr before breakfast and dinner – comes in a pen
d. Can  hypoglycemia when used with sulfonylureas, not when used alone. Also N/V, allergy, HA, dyspepsia, GERD, restlessness and jittery feeling.
e. Has been implicated in acute pancreatitis & kidney failure

47
Q

Incretin Mimetic: Liraglutide [Victoza]

A

Liraglutide [Victoza]

a. GLP-1 receptor agonist
b. Injection once a day
c. Brings down HA1C
d. Low risk of hypoglycemia
e. Greater wt loss
f. Rat studies = May be linked with thyroid C cell tumors but these are so infrequent in people that a study is impossible.

48
Q

DPP-4 Inhibitors aka Incretin enhancer

A

Action: prevents breakdown of incretins by inhibiting the enzyme that breaks them down and thus increase amt of insulin released after meals.

Because they work only in the presence high serum glucose levels, the risk of hypoglycemia is small – when used alone.

49
Q

DPP-4 Inhibitors

Sitagliptin [Januvia] (Janumet – fixed combination of Januvia and Metformin)

A 
Sitagliptin [Januvia]
PO. Once daily. 
Works only when BS is elevated. 
Increases satiety
SE:  HA, diarrhea, nasophyryngitis.
Interactions:  cocoa and rosemary may decrease effect.
50
Q

DPP-4 Inhibitors

Saxagliptin [Onglyza]

A

Saxagliptin [Onglyza]
SE: URI, UTI, HA, allergic-like reactions such as rash and hives
saxagliptin [Onglyza]

51
Q

Selective sodium-glucose cotransporter inhibitors

A

Action: prevents reabsorption of glucose in the kidneys – promotes excretion of glucose in the urine. Thus reduced high levels of blood sugar.
Works in a non-insulin dependent manner.

52
Q

Dapagliflozin

A

Dapagliflozin is the SGLT2 inhibitor with the most clinical data available to date, with other SGLT2 inhibitors currently in the developmental pipeline. Dapagliflozin has demonstrated sustained, dose-dependent glucosuria over 24 hours with once-daily dosing in clinical trials.

SE: increased risk of UTI and genital infections – reflects extra sugar eliminated in the urine.

53
Q

Glucagon

A
  1. Action
    increases BS through glycogenolysis and gluconeogenesis

Except during meals and extended fasting, glucagon is responsible for hepatic glucose production. Glucagon also increases the breakdown of protein and fat, which provides additional fuel for cellular metabolism.

  1. Cannot be taken po. Given sc, im, iv
54
Q

THYROID AGENTS: Action

A

same as natural hormones. Increase metabolic rate, stimulate heart and increase CO [may increase heart’s sensitivity to catecholamines and increase the number of beta receptors in the heart], increase oxygen consumption, body temp, blood volume, growth, and overall cellular growth.

55
Q

THYROID AGENTS: Uses, SE, Interactions

A
  1. Uses
    replacement therapy
  2. SE
    cardiac dysrhythmias; palpitations, diaphoresis, tachycardia, etc. and all other sx of hyperthyroidism.
  3. Interactions
    Increase effect of coumadin, etc. Increase BS so DM pts may need more insulin, etc.
56
Q

THYROID AGENTS: Drugs

A

Synthroid [levothyroxine or T4] - first choice drug.

Cytomel [liothyronine or T3] - rapid onset and short duration of action makes it choice for rapid effect.

Thyrolar [Liotrix] – T3 and T4

57
Q

THYROID AGENTS:

A

Nursing considerations
be careful if pt is elderly or has hx of heart disease - may aggravate angina and lead to MI.

Do not stop abruptly - may –> myxedema coma

Watch for signs of hyperthyroidism [overdose] : fatigue, breathlessness, heat intolerance, HA, palpitations, nervousness

58
Q

Antithyroid drugs; ACTION and USES

A
  1. Action
    inhibit hormone production by reducing the combination of iodide and tyrosine and the coupling of MIT and DIT. Also has immunosuppressant effects.

Iodine acts by overloading the thyroid with iodine so it stops making hormone. However, this effect is temporary [a few days].

2.Uses
to treat Grave=s disease. May remission. Also used to achieve euthyroid state preop

59
Q

Antithyroid drugs: SIDE EFFECTS

A

liver and bone marrow toxicity. Potentially fatal granulocytopenia [usu appears after 4-8 weeks of tx. Pt may start with a sore throat or fever]

Allergy [usu during first 3 weeks]

Vertigo, HA, neuritis, paresthesias.

Brassy taste and burning sensation in mouth, increased salivation.

SSKI can discolor teeth

60
Q

Antithyroid drugs:

PTU [propylthiouracil]

A

PTU [propylthiouracil]
contraindicated in pregnancy. – does not affect any T hormone already there. Only prevents new formation, so may not see response for several weeks.

61
Q

Antithyroid drugs:

Tapazole [methimazole]

A

Tapazole [methimazole]

contraindicated in third trimester

62
Q

Antithyroid drugs: potassium iodide

A

potassium iodide
[Lugol’s solution, SSKI] - used to prepare gland for surgery - reduces its vascularity. Also used as thyroid protectant in case of radiation exposure – must be taken a or within 3 hrs of exposure.

63
Q

Corticosteroids: Effects

A 
Effects of corticosteroids:
Anti-inflammatory
Suppress immune response
Suppress allergic response
Reduce cell reproduction
64
Q

Corticosteroids: facts

A

Corticosteroids are well absorbed po. can be given by many different routes. All non-po, non-parenteral routes limit systemic absorption – but do not do away with it entirely.

Highly plasma bound.
Cross placenta and breast milk.

65
Q

Corticosteroids: adverse effects

A 
Cushing’s syndrome
Adrenal atrophy
Osteoporosis
HTN 
susceptible to infection.
Delayed wound healing
Acne
Peptic ulcers
Obesity
Moon face, buffalo hump
Behavioral change
66
Q

Corticosteroids: more adverse effects

A 
Acne
Peptic ulcers
Obesity
Moon face, buffalo hump
Behavioral changes
Mask signs of infection
Cataracts and glaucoma
Metabolic changes
High serum glucose
Electrolyte imbalances
Hypocalcemia,
Hypokalemia
Hypernatremia
Fluid retention
Weight gain
Hypertension
Edema
67
Q

Mineralocorticoids:

Fludrocortisone

A

Fludrocortisone
Action:
Same actions as aldosterone. Promotes Na+ and water reabsorption and K+ excretion.

Uses:
Treat Addison’s disease, tx salt-losing adrenogenital syndrome

SE:
Fluid retention, edema, HTN, HF
Sx’s of hypokalemia

Pharmacology Final (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions