Endocrine Medications

Question 1

metformin dosing

Answer 1

500-2000 mg daily

Question 2

metformin AEs

Answer 2

GI - consider XR formulation

Question 3

metformin dosing adjustment

Answer 3

do not initiate if gfr <45

hold 48h before/after contrast

Question 4

glupizide, glimepride, glyburide class

Answer 4

sulfonylureas

Question 5

sulfonylureas AEs

Answer 5

hypoglc, wt gain, insulin dependence

Question 6

sulfonylureas dosing adjustment

Answer 6

glupizide preferred for renal impairment

sulfa allergy hypersensitivity

Question 7

AE of SGLT-2 inhibitors

Answer 7

genital mycotic infections, UTIs, dehydration, hypotension

Question 8

canagliflozin, empagloflozin, dapagliflozin class

Answer 8

SGLT-2 inhibitors

Question 9

sitagliptin, saxagliptin, linagliptin, alogliptin class

Answer 9

DPP-IV inhibitors

Question 10

which DPP-IV inhibitor does not require renal dosing?

Answer 10

linagliptin

Question 11

exenatide, semaglutide, iraglutide, dulaglutide class

Answer 11

GLP-1 agonists

Question 12

AEs of GLP-1 agonists

Answer 12

GI, injection site rxns (Exenatide)
BBW for pancreatitis and thyroid C-cell tumors
wt loss (semaglutide)

Question 13

dosing adjustment for GLP-1 agonists

Answer 13

do not use exenatide w gfr <45

Question 14

semaglutide precautions

Answer 14

may increase absorption of levothyroxine
no renal dosing adjustment needed :))))
take 30 min before/after meals d/t peak 1h

Question 15

degludec PK

Answer 15

very long acting - >40 h
good for pts that may miss dose

(hours)
onset - 1-2
peak - none
duration - >40

Question 16

glargine PK

Answer 16

(hours)
onset - 3-4
peak - none
duration - 22-24

Question 17

NPH PK

Answer 17

(hours)
onset - 2-4
peak - 4-8
duration - 8-18

dose BID

Question 18

regular insulin PK

Answer 18

onset - 30-60 min
peak - 1-3 h
duration - 5-10 h

Question 19

rapid acting insulin PK

Answer 19

(min)
onset - 5-30
peak - 30-90
duration - 184-313

Question 20

thyroid hormones/origins

Answer 20

hypothalamus - thyroid releasing hormone
pituitary - thyroid stimulating hormone
thyroid - gland - T3 and T4
T3 and T4 negative feedback decreases TSH secretion

Question 21

free T4 normal range

Answer 21

0.8-1.5

unbound and active

Question 22

TSH normal range

Answer 22

0.25-6.7

INVERSE of thyroid hormone levels

Question 23

hypothyroidism hormonal change and treatmen

Answer 23

deficient T3 and T4

supplement with T4: levothyroxine

Question 24

levothyroxine dosing, admin, interactions

Answer 24

1.6 mcg/kg/day IBW
empiric dosing 50 mcg/day

daily dosing

half-life 7 days, takes 6-8 weeks to reach steady-state

take on empty stomach x2h, separate from other meds 4h

many drug interactions

Question 25

liothyronine

Answer 25

T3 shorter half life than levothyroxine, BID/TID admin

Question 26

thyroid replacement combo products

Answer 26

liotrix - 4:1 levothyroxine:liothyronine dessicated thyroid - variable potency & unstable shelf life

Question 27

levothyroxine interactions

Answer 27

WARFARIN - separate doses to prevent bleeding, estrogens/contraceptives, androgens, cholestyramine, phenytoin, phenobarb, rifampin, sertraline

Question 28

hyperthyroid treatment

Answer 28

thionamides (methimazole, propylthiouracil, iodides) radioactive iodine beta blockers - adjunct therapy

Question 29

thionamides MOA

Answer 29

inhibit thyroid peroxidase - diverts iodine away from receptor sites of TG - blocks thyroid hormone synthesis

Question 30

thionamides PK

Answer 30

short half life 1-2.5 h, quick onset clinical improvement seen in 4-8 weeks remission likely

Question 31

thionamides AEs

Answer 31

pruritic maculopapular rashes benign transient leukopenia arthralgias, myangias severe - agranulocytosis (s/s of infection), hepatic toxicity PTU>hepatic tox than methimazole PTU preferred for first trimester of pregnancy

Question 32

iodides MOA

Answer 32

acutely blocks thyroid hormone synthesis and release, reduces size and vascularity quick symptom resolution (2-7 d), but not for long term therapy

Question 33

iodides AEs

Answer 33

hypersensitivity, iodism - metallic, burning taste, sore teeth/gums, "head cold", Gi disturbance, skin lesions

Question 34

radioactive iodine indication

Answer 34

treatment htat ablates thyroid gland - but often causes hypothyroid for patients who have adverse rxns to other meds NO USE IN PREGNANCY

Question 35

adjunct therapy for hyperthyroid

Answer 35

beta blockers - propranolol 20-40 mg crosses BBB corticosteroids, cholestyramine, rituximab

Question 36

regular insulin U-500 dosing

Answer 36

TID or BID before eating w/o other insulin

Question 37

contraindication for pioglitazone

Answer 37

NYHA class 3 HF

Question 38

approved insulin for gestational DM

Answer 38

detemir, lispro, aspart

Question 39

MOA of empagliflozin

Answer 39

inhibits sodium-glucose cotransporter 2

Question 40

meglitinides MOA

Answer 40

stimulates pancreatic beta cells to secrete insulin in a non-glucose dependent manner

Question 41

which DPP-4 inhibitor can decrease hospitalizations in HF

Answer 41

saxagliptin

Question 42

GLP-1 receptor agonists MOA

Answer 42

glucagon suppression, increased beta cell insulin secretion after meals, slowed gastric emptying, increased satiety

Question 43

Afrezza duration

Answer 43

ultra-rapid