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Pharmacology > Endocrine - hypo/hyperthyroidism, diabetes > Flashcards

Endocrine - hypo/hyperthyroidism, diabetes Flashcards

1
Q

describe the general flow of thyroid hormones

A

TRH (thyrotropin releasing hormone) from Hypothalamus acts on the anterior pituitary gland, which releases TSH (thyroid stimulating hormone) which stimulates the thyroid gland to produce T4 and T3
Iodine needed for production of T3 and T4

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2
Q

Thyroid tests to determine levels

A

TSH high + T4 low = HYPOthyroidism

TSH low + T4 high = HYPERthyroidism

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3
Q

describe hyperthyroidism

A

thyroid gland produces too much thyroid hormone, causes hypermetabolic syndrome that affects females more than males

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4
Q

Hyperthyroidism causes

A
  1. Grave’s disease - characterized by a goiter, ‘orange-peel’ skin. caused by an antibody-mediated auto-immune reaction that binds to the TSH receptor and chronically stimulates it
  2. thyroiditis
  3. excess ingestion of thyroid hormone
  4. drug-induced - Aminodarone
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5
Q

signs and symptoms of hyperthyroidism

A

intolerance to heat, facial flushing
fine, straight hair, bulging eyes, finger clubbing
tachycardia, tremors, increased systolic BP
diarrhea, weight loss, amenorrhea, edema

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6
Q

hyperthyroidism diagnosis

A

decreased thyroid stimulating hormone and increased thyroid hormones (T3 & T4)

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7
Q

complications associated with hyperthyroidism

A
  1. increased HR, heart failure, muslce wasting, osteopoposis
  2. Thyroid ‘storm’ - rapid onset with high temp, extreme exhaustion, rapid HR, delerium
  3. Death
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8
Q

drug therapy for hyperthyroidism

A 
Drug Therapy:
-Methimazole
-Propylthiouracil (PTU)
-Radioactive Iodine
Adjunctive Therapy:
-Beta-blockers
-corticosteroids
Surgery:
-Thyroidectomy
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9
Q

what are the main anti-thyroid drugs and describe

A

Propythiouricil and methimazole
These two drugs block the binding of iodine, therfore prevents the formation of thyroid hormones.
Note: may take weeks to see full effect

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10
Q

A/E to PTU and methimazole

A

granulocytopenia (decrease WBC’s)
rash
peripheral neuritis

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11
Q

common adjuncts (add-ons) to propylthiouracil and methimazole

A

propranolol to supress tachycardia

corticosteroids to reduce immune respose

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12
Q

radioactive iodine and hyperthyroidism

A

suitable for most patients, although some prefer to use mainly for older Pt’s
-used when failed medical therapy or surgery
-medical/surgical therapy is contraindicated
NOTE: contraindicated with PREGNANCY and has high incidence to cause hypothyroidism

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13
Q

describe Iodine-131

A

-radioactive isotope
-concentrates in the thyroid gland
-destruction of thyroid tissue via beta emissions
-reduces thyroid function gradual
Full effects in 2 weeks to 3 months

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14
Q

describe hypothyroidism

A

deficiency of thyroid hormone or decreased activity of the thyroid gland. affects women more than men

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15
Q

Causes of hypothyroidism

A
  1. Hashimoto’s thyroiditis - autoimmune disease where the body’s own antibodies attack the cells of the thyroid
  2. destruction of thyroid gland (trauma)
  3. lack of dietary iodine
  4. drug induced - amiodarone, lithium, interferon-alpha, over-treatment with anti-hyperthyroid drugs
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16
Q

hypothyroidism diagnosis

A

clinical sign and symptoms
increased TSH
T3/T4 is usually low

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17
Q

signs and symptoms of hypothyroidism

A

intolerance to cold, receding hairline, facial and eye-lid edema, thick tongue/slow speech
apathy, lethargy, dull-blank expression, extreme fatigue
dry skin, muscle aches, anorexia,
constipation, menstrual disturbances
ADVANCED: bradycardia, wieght gain, decreased LOC, cardiac complications

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18
Q

Thyroid hormone drug therapy

A 
LEVOTHYROXINE (T4 analogue)
-Synthroid
-Eltroxin
LIOTHYRONINE (T3 analogue)
Dosage:
usually start 50-75 mcg/day, increasing dose by 25-50mcg in 6-8 week intervals. 
Usual dose ~ 75-150mcg/day
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19
Q

A/E to thyroid hormone therapy

A

headache, palpations (atrial fibrillation), chest pain, heat intolerance, sweating
monitor clinical status of Pt for 6-8 weeks (TSH, T3, T4)

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20
Q

diseases associated with cortisol

A

too much = Cushing’s Syndrome/Disease

too little = Addison’s disease

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21
Q

what does cortisol do

A

-controls water and sodium balance
-regulates carbohydrate, fat and protein metabolism
-production increases during stress
produced by the adrenal gland, mostly in the a.m. (20mg/day)

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22
Q

describe the cortisol loop

A

hippocampus gets the hypothalamus to release CRH (corticotropin releasing hormone) and acts on the anterior pituitary that then releases ACTH (Adrenocorticotropin hormone) that acts on the adrenal gland to produce more cortisol.
Negative feedback loop. once cortisol levels rise, the hippocampus will not stimulate hypothalamus any further

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23
Q

describe Cushings syndrome/disease

A

too much cortisol produced as a result of too much ACTH released from pituitary gland.
Pituitary tumor = Cushing’s disease
Adrenal tumor = Cushing’s syndrome

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24
Q

signs/symptoms of Cushing’s syndrome/disease

A 
moon face, Na+ and fluid retention
hyperglycemia, personality changes
males may develop breasts (gynecomastia)
females may have amenorrhea, hirsutism
thin skin, purple striae, osteoporosis, fat deposits on back
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25
treatment for cushings syndrome/disease
1. reverse the underlying cause 2. if tumor is identified then it may be removed via surgery. steroid replacement afterwards. 3. if surgery not suitable, several drugs have been found to inhibit cortisol synthesis (Ketoconazole, antifungal that reduces cortisol production)
26
Describe Addison's disease
Too little cortisol produced when cortex of adrenal gland is damaged, most commonly found by the body attacking itself (autoimmune disease)
27
other causes for adrenal gland failure
- tuberculosis - other infections of the adrenal gland - spread of cancer to the adrenal glands - bleeding into the adrenal glands
28
secondary causes for adrenal insufficiencies
- pituitary gland diseased - inadequate production of ACTH can lead to insufficient production of hormones produced by the adrenal gland - when Pt's treating chronic conditions, such as asthma or arthritis, suddenly stop taking corticosteroids
29
signs and symptoms for Addison's disease (too little cortisol)
bronze pigmentation of skin hyopglycemia, postural hypotension, weight loss changes in distribution of body hair, weakness Adrenal CRISIS: profound fatigue, dehydration, vascular collapse (BP), renal shut down, decreased serum Na+, increased Serum K+ (electrolyte imbalance)
30
treatments for Addison's disease
Hydrocortisone Cortisone Fludrocortisone
31
what is type 1 diabetes
onset usually at a young age no production of insulin: islet cells of pancreas not working oral meds are ineffective Glucose enters the bloodstream, there is little to no insulin in the blood to breakdown the glucose to it build up in the blood stream leading to hyperglycemia
32
what is type 2 diabetes
onset in adulthood, usually secondary to obesity insulin resistance and relative insulin deficiency Oral meds usually work **too much fat, not enough exercise, and inherited genes. leads to overwieght and body becomes insulin resistance.. Fatty deposits in pancreas cause damage and prevent insulin from being produced = type 2 diabetes. Insulin produced is resistant to effective use and can't push the glucose into the interstitial space, resulting in increased glucose in the blood stream
33
signs and symptoms of diabetes
``` tired, thirsty, increased urination, increased hunger change in body weight (+/-) blurred vision vaginal infections in women balantitis in uncircumcised men tingling/numbness in hands/feet ```
34
risk factors for type 1 diabetes
generally young not usually overweight may not have a family history prone to developing Ketosis (ketone - fruity breath)
35
risk factors for type 2 diabetes
``` prediabetes sedentary lifestyle overweight/obese hypertension dyslipidemia (high cholesterol) 40 years old or higher close relative who has type 2 member of high risk population heart disease women who have had gestational diabetes mellitus ```
36
common diagnosis tools for diabetes
FPG - Fasting plasma Glucose - >7.0mmol/L (8 hours w/o caloric intake) OR Casual PG - plasma glucose - >11.1mmol/L (taken at any point during the day) must present with signs of diabetes OR 75g 2hPG OGTT - Oral glucose tolerance test. Used by specialists who administer the FPG then person drinks a glucose sol'n and waits for 2hours and result >11.1mmol/L
37
blood glucose targets for adults
A1C (glycosylated hemoglobin) gives average of BG level for last 120days. A1C <6.0 (normal range) FPG preprandial PG = 4.0-7.0 (diabetic), or 4.0-6.0 (normal range) 2hPG postprandial(after food) = 5.0-10.0 (diabetic), or 5.0-8.0 (normal range)
38
major diabetic compications
cerebrovascular disease retinopathy (blindness) Coronary heart disease nephropathy (kidney) Peripheral neuropathy and vascular disease Diabetic foot ulcerations and amputations
39
Management of diabetes type 2
non-pharmacological therapy (exercise, diet) achieve desired blood glucose asap (within 6 mos.) Medications
40
medications for type 2 diabetes
- Secretagogues (Sulfonylureas, Meglitidines) - Biguanide - Alpha-glucosidase inhibitor - Thiazolidinediones (TZD) - Incretin agents (DPP-4 inhibitors) - Insulin
41
Biguanides and thiazolidinediones mechanisms of action
reduce glucose production in Liver | reduce insulin resistance in skeletal muscle and adipose tissue
42
insulin secretagogue (sulphonylureas & Meglitinides)
increase insulin production in Pancreas
43
Alpha-glucosidase inhibitor mechanism of action
slows the absorption of sucrose and starch in the small intestine
44
sulfonylureas generic names, dose, and risk of hypoglycemia
GLYBURIDE - 2.5-5mg at breakfast, MAX 20mg (10mg BID)/day. signficant risk for hypoglycemia GLICLAZIDE - 40-80mg daily, MAX 320mg (180mg BID). Minimul to moderate risk for hypoglycemia GLICLAZIDE MR - start 30mg/day, MAX 120mg once daily. minimul/moderate risk for hypoglycemia GLIMEPIRIDE - 1-2mg daily, MAX 8mg/day at breakfast, moderate risk for hypoglycemia
45
Meglitidine generic names, dose, and risk of hypoglycemia
NATEGLINIDE - 120mg w/ each meal. max dose 540mg (180mg TID). minimal to moderate risk for hypoglycemia REPAGLINIDE - start w/0.5mg at each meal if A1C 8%. Max dose 4mg per meal up to QID. NOTE:: if meals are skipped these can be used because they can be skipped as well
46
Biguanides generic names, dose, and risk of hypoglycemia and A/E.
METFORMIN - 250mg 1-2x/day MAX=2500mg/day. negligible risk for hypoglycemia METFORMIN HCl - once daily 500mg. Max=2000mg A/E: abdominal cramping
47
Alpha-glucosidase inhibitors generic names, dose, and risk of hypoglycemia and A/E
ACARBOSE - start 25-50mg each meal. MAX = 300mg (100mg TID). negligible risk if used as monotherapy. MUST be taken with first bite of food A/E - abdominal gas
48
Thiazolidinediones (TZD) generic names, dose, and risk of hypoglycemia and A/E
PIOGLITAZONE - start w/ 15mg/daily. MAX=45mg once daily. negligible risk for hypoglycemia ROSIGLITAZONE - start w/ 4mg/day. MAX = 8mg (4mgBID). negligible risk for hypoglycemia A/E: weight gain, may induce edema and/or heart failure not indicated for use with insulin
49
DPP-4 inhibitors generic names, dose, and risk of hypoglycemia and A/E
SITAGLIPTIN - start w/ 100mg once daily. Negligible risk for hypoglycemia when used as monotherapy. A/E: improves postprandial PG, weight neutral, occasionally associated with increased rates of minor infection
50
what is insulin
a hormone produced by the pancreas to control the amount of glucose in the blood
51
insulin use in type 1 and type 2 diabetes
Type 1 - drug of choice! Type 2 - may be used in cases of marked hyperglycemia (A1C >9%). May also be used initially or after oral medications deemed ineffective
52
effects of insulin on glucose uptake and metabolism
insulin binds to the receptor then 1. starts many activation cascades 2. influx of glucose 3. glycogen synthesis 4. glycolysis 5. and fatty acid synthesis
53
types of insulin
Prandial (bolus) insulins - rapid/short acting (CLEAR!!!) Basal insulins - intermediate acting (CLOUDY!!!) Basal insulins - Long acting (CLEAR!!!) Pre-mixed insulins - regular and long acting (CLOUDY!!!) "R" = Clear "N" = Cloudy
54
Rapid acting (Prandial) insulin meds and onset/duration
``` Insulin Aspart (10-15min / 3-5hrs) Insulin Lispro (10-15min / 3-5hrs) Insulin Glulisine (10-15min / 3-5hrs) Humulin R (30min / 6.5hrs) Novolin ge Toronto (30min / 6.5hrs) ```
55
Intermediate acting (Basal) insulins
``` Humulin N (1-3hr / up to 18hr) Novolin NPH (1-3hr / up to 18hr) ```
56
long acting (basal) insulins
``` Insulin Determir (1.5hr. / 16-24hr) Insulin Glargine (1.5hr. / 16-24hr) ```
57
premixed insulins (NPH - cloudy)
Humulin 30/70 (rapid-short acting % / intermediate acting %) | Novolin 30/70, 40/60, 50/50
58
insulin storage guidlines
30 days at room temp once opened | 90 days if refridgerated (once opened)
59
insulin A/E
HYPOglycemia weight gain Lipohypertrophy at injection site (fat nodules) allergic reactions (rare)
60
insulin monitoring guidelines
Blood glucose A1C Hyperglycemia Hypoglycemia (very important to discuss with diabetic Pt's)
61
treatment for hypoglycemia
mild to moderate: oral ingestion of 15g of carbs (juice, honey, sugar) wait 15 minutes - admin second 15g prn severe hypoglycemia: 20g of carbs, wait 15 minutes -admin second 15g prn if <4.0mmol/L severe (unconscious) hypoglycemia: glucagon 1mg SC or IM injection, call for emergency sevices. If IV access: 10-25g glucose admin over 1-3 minutes
62
symptoms of hypoglycemia
shaking, sweating, anxious, dizziness, fast heaertbeat, impaired vision, weakness/fatigue, headache

Pharmacology (7 decks)

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