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Fall 2020 - Pharmacology 2 > Endocrine Medications - Quiz 6 > Flashcards

Endocrine Medications - Quiz 6 Flashcards

1
Q

What meds cause Hyperglycemia?

A

Steroids

Antipsychotics

HIV Meds

Octreotide

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2
Q

What kind of stress causes Hyperglycemia?

A

Illness

Trauma

Pregnancy

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3
Q

How is Diabetes Diagnosed?

A

Fasting BS > 126

or

Random BS > 200

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4
Q

What is the advantage of using a Blood Glucose Monitor?

A

Portable, instant, and accurate using a tiny bit of blood

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5
Q

What is the disadvantage of obtaining Blood/Plasma Glucose?

A

Need a lot of blood & delay of results

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6
Q

What is the normal HgA1c?

A

4 - 6%

ADA recommends < 7-8.5% based on age

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7
Q

How does Insulin work?

A

Binds to Insulin receptors on the Plasma membrane to translocate Glucose Transporters

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8
Q

What do Glucose Transporters do?

A

Bring Glucose into Cells

Shift Metabolism to Glucose Storage

Electrolyte & Amino Acid Uptake

Protein Synthesis

Regulate Gene Expression

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9
Q

What happens with Insulin Resistance?

A

↓Glucose Transport Proteins

↓Glucose Uptake

Compensatory Hyperinsulinemia

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10
Q

Insulin receptor number is _______ related to the plasma concentration of insulin

A

Insulin receptor number is INVERSELY related to the plasma concentration of insulin

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11
Q

What is the half-life of IV Insulin?

A

5 - 10 minutes

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12
Q

Kidney Disease prolongs Elimination _______ than Liver Disease

A

Kidney Disease prolongs Elimination MORE than Liver Disease

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13
Q

How much Insulin is secreted by the Pancreas?

A

1 unit/hr

5-10x more w/ Food

40 units/day

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14
Q

Insulin response to glucose is ________ for Oral Ingestion than for IV Infusion

A

Insulin response to glucose is GREATER for Oral Ingestion than for IV Infusion

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15
Q

Which Insulin is Long Acting?

A

Degludec (2 Days)

&

Glargine (1 Day)

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16
Q

Which Insulin are Intermediate Acting?

A

NPH (18 Hrs)

&

Detemir (12 Hrs)

Given BID

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17
Q

Which Insulin have Short/Rapid acting onset?

A

Regular (30 min)

Aspart-Novolog (15 min)

Lispro (15 min)

Glulisine (15 min)

Aspart-Fiasp (15 min)

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18
Q

For Mixed Insulin, what does the larger number represent?

A

Intermediate Insulin

EX: Novolog Mix 70/30 = 70% Intermediate & 30% Rapid

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19
Q

Older Insulin come from animals. What is different about the Newer Insulin?

A

No more problems with allergy or immunoresistance from animal products

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20
Q

What are the side effects of Insulin?

A

Hypoglycemia - Most Serious

HypoK

HypoMag

HypoPhos

Refeeding Syndrome

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21
Q

What are the symptoms of Hypoglycemia?

A

Compensatory ↑Epinephrine

Diaphoresis

Tachycardia

HTN

Rebound Hyperglycemia

CNS Problems

Lipodystrophy

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22
Q

What can develop with Chronic use of NPH?

A

Protamine Antibodies

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23
Q

What constitutes as Insulin Resistance?

A

Pts. needing > 100 units/day

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24
Q

What can cause Insulin Resistance?

A

Trauma

Surgery

Infection

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25
What is Afreeza?
Rapid Acting Inhaled Insulin
26
How should Insulin Sliding Scales be managed?
Must give with Basal Glucose Control
27
What is the Peri-Operative Fasting Glucose Goal?
110 - 180 mg/dL \< 150 mg/dL for Joints
28
Which Insulin can be completely held Peri-Operatively with the Non-Tight Control Regimen?
Degludec
29
How do Sulfonylureas work?
Act on Pancreatic Beta Cells to release Insulin - given daily
30
What are the risks associated w/ Sulfonylureas?
**Hypoglycemia** (especially w/ Renal Failure) High Failure Rate Allergy
31
Which Sulfonyluria is the safest to use with Renal Failure?
Glipizide - no active metabolites
32
Which meds are 2nd Gen. Sulfonylureas?
**_GL_**yburide **_GL_**ipizide **_GL_**imepiride
33
Which Sulfonylurea has the most risk for Hypoglycemia?
Glyburide
34
Which meds are Alpha-Glucosidase Inhibitors?
Acarbose & Miglitol
35
How do Alpha-Glucosidase Inhibitors work?
↓Breakdown & Absorption of Carbs
36
Which meds are Meglitinides?
Repaglinide & Nateglinide
37
How do Meglitinides work?
Same as Sulfonylureas - Increase Insulin from Beta Cells, but faster onset & shorter duration
38
Meglitinides have ______ risk for Hypoglycemia than Sulfonylureas
Meglitinides have **LESS** risk for Hypoglycemia than Sulfonylureas
39
What are the advantages of using the Biguanide, Metformin?
Low Hypoglycemia Risk Positive Lipid Effects Weight Loss
40
How does Metformin work?
↓Liver Glucose Production ↓Glucose Absorption ↑Insulin Sensitivity Positive Changes in Gut Microbio
41
What are the side effects of Metformin?
**Significant GI Effects** - Anorexia, Nausea, Diarrhea & Lactic Acidosis
42
How should Metformin be managed Peri-Operatively and for IV Contrast?
Hold 48hrs before Surgery & IV Dye & 48hrs after IV Dye Monitor for Lactic Acidosis & Renal Function Avoid Hypovolemia & Hypoxemia
43
What are Contraindications to Metformin?
Creat \> 1.4 (f), 1.5(m) GFR \< 30 GFR \< 45 if never on therapy \> 80 y.o. Liver Dysfunction CHF
44
Which meds are Thiazolidinediones?
Rosiglitazone & Pioglitazone
45
How do Thiazolidinediones (TZDs) work?
Basal Meds ↓Insulin Resistance ↓Liver Glucose Production Needs Insulin for them to work
46
What are the side effects of Thiazolidinediones (TZDs)?
Weight Gain Liver Toxicity Peripheral Edema CHF Bone Fractures MI
47
Which meds are DPP-4 Inhibitors?
-gliptins
48
How do DDP-4 Inhibitors work?
Increase Insulin Secretion & Satiety & Decrease Gastric Emptying & Glucagon Secretion
49
What are the side effects of DDP-4 Inhibitors?
UTI URI Pancreatitis Angioedema Steven Johnson's Joint Pain Low Hypoglycemic Risk
50
Which Incretin Mimetics are GLP-1 Analogs and how do they work?
**Exanatide & -glutides -** Prolongs gastric emptying & reduces glucagon after meals
51
Which Incretin Mimetic is an Amylin Analog and how does it work?
**Pramlinide** ↑Insulin ↑Beta Cell Growth ↓Gastric Emptying ↓Appetite
52
What are the side effects of GLP-1 Analogs?
**_N/V/D_** Pancreatitis ARF Weight Loss
53
When should the Incretin Mimetic, Exanatide be avoided?
Renal Failure
54
When should the Incretin Mimetic, Liraglutide (Victoza) be avoided?
Thyroid Carcinoma
55
What is the Black Box Warning for Amylin Analogs?
Hypoglycemia, especially for DM1
56
What are the adverse effects of Amylin Analogs?
N/V Anorexia Headache **Gastroparesis**
57
Which meds are SGLT2 Inhibitors?
-Flozins
58
How do SGLT2 Inhibitors work?
↑Urinary Glucose Excretion
59
When are SGLT2 Inhibitors Contraindicated?
CrCL \< 30 & ESRD
60
What are Disadvantages to using SGLT2 Inhibitors?
Hypotension Risk of Toe Amputations Euglycemic Ketoacidosis Urinary Side Effects
61
What does the FDA recommend for managing SGLT2 Inhibitors Peri-Operatively?
Stop 3 Days before Surgery & May Restart when pt is eating again
62
What are the characteristics of Armour Thyroid?
Animal Thyroid 4:1 T4 to T3 Manufacturing Inaccuracies
63
What are the characteristics of Levothyroxine?
Contains only T4 Long Half-Life (7 Days)
64
Which Thyroid med only contains T3?
Liothyronine
65
How does Liothyyronine compare to Levothyroxine?
3x more potent w/ rapid onset & short duration
66
What is the Disadvantage of Liothyronine?
High Risk for CV Side Effects
67
What are some Anti-Thyroid Meds?
Proppylthiouracil (PTU) & Methimazole
68
How do Anti-Thyroids work?
Inhibits Thyroid Hormone formation using Iodine & Blocks conversion of T4 to T3 Needs few days for it to work
69
What are the Side Effects of Anti-Thyroids?
Leukopenia Rash Arthralgia Lupus Symptoms Fever Granulocytosis
70
What are some Iodines used for Hyperthyroidism?
Lugol's & Saturated KI
71
How do Iodines work as Anti-Thyroids?
Used w/ Propranolol to inhibit Thyroid Hormone Release

Fall 2020 - Pharmacology 2 (9 decks)

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