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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
Q

What is Afreeza?

A

Rapid Acting Inhaled Insulin

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26
Q

How should Insulin Sliding Scales be managed?

A

Must give with Basal Glucose Control

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27
Q

What is the Peri-Operative Fasting Glucose Goal?

A

110 - 180 mg/dL

< 150 mg/dL for Joints

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28
Q

Which Insulin can be completely held Peri-Operatively with the Non-Tight Control Regimen?

A

Degludec

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29
Q

How do Sulfonylureas work?

A

Act on Pancreatic Beta Cells to release Insulin - given daily

30
Q

What are the risks associated w/ Sulfonylureas?

A

Hypoglycemia (especially w/ Renal Failure)

High Failure Rate

Allergy

31
Q

Which Sulfonyluria is the safest to use with Renal Failure?

A

Glipizide - no active metabolites

32
Q

Which meds are 2nd Gen. Sulfonylureas?

A

GLyburide

GLipizide

GLimepiride

33
Q

Which Sulfonylurea has the most risk for Hypoglycemia?

A

Glyburide

34
Q

Which meds are Alpha-Glucosidase Inhibitors?

A

Acarbose

&

Miglitol

35
Q

How do Alpha-Glucosidase Inhibitors work?

A

↓Breakdown & Absorption of Carbs

36
Q

Which meds are Meglitinides?

A

Repaglinide

&

Nateglinide

37
Q

How do Meglitinides work?

A

Same as Sulfonylureas - Increase Insulin from Beta Cells, but faster onset & shorter duration

38
Q

Meglitinides have ______ risk for Hypoglycemia than Sulfonylureas

A

Meglitinides have LESS risk for Hypoglycemia than Sulfonylureas

39
Q

What are the advantages of using the Biguanide, Metformin?

A

Low Hypoglycemia Risk

Positive Lipid Effects

Weight Loss

40
Q

How does Metformin work?

A

↓Liver Glucose Production

↓Glucose Absorption

↑Insulin Sensitivity

Positive Changes in Gut Microbio

41
Q

What are the side effects of Metformin?

A

Significant GI Effects - Anorexia, Nausea, Diarrhea

&

Lactic Acidosis

42
Q

How should Metformin be managed Peri-Operatively and for IV Contrast?

A

Hold 48hrs before Surgery & IV Dye & 48hrs after IV Dye

Monitor for Lactic Acidosis & Renal Function

Avoid Hypovolemia & Hypoxemia

43
Q

What are Contraindications to Metformin?

A

Creat > 1.4 (f), 1.5(m)

GFR < 30

GFR < 45 if never on therapy

> 80 y.o.

Liver Dysfunction

CHF

44
Q

Which meds are Thiazolidinediones?

A

Rosiglitazone

&

Pioglitazone

45
Q

How do Thiazolidinediones (TZDs) work?

A

Basal Meds

↓Insulin Resistance

↓Liver Glucose Production

Needs Insulin for them to work

46
Q

What are the side effects of Thiazolidinediones (TZDs)?

A

Weight Gain

Liver Toxicity

Peripheral Edema

CHF

Bone Fractures

MI

47
Q

Which meds are DPP-4 Inhibitors?

A

-gliptins

48
Q

How do DDP-4 Inhibitors work?

A

Increase Insulin Secretion & Satiety

&

Decrease Gastric Emptying & Glucagon Secretion

49
Q

What are the side effects of DDP-4 Inhibitors?

A

UTI

URI

Pancreatitis

Angioedema

Steven Johnson’s

Joint Pain

Low Hypoglycemic Risk

50
Q

Which Incretin Mimetics are GLP-1 Analogs and how do they work?

A

Exanatide & -glutides -

Prolongs gastric emptying & reduces glucagon after meals

51
Q

Which Incretin Mimetic is an Amylin Analog and how does it work?

A

Pramlinide

↑Insulin

↑Beta Cell Growth

↓Gastric Emptying

↓Appetite

52
Q

What are the side effects of GLP-1 Analogs?

A

N/V/D

Pancreatitis

ARF

Weight Loss

53
Q

When should the Incretin Mimetic, Exanatide be avoided?

A

Renal Failure

54
Q

When should the Incretin Mimetic, Liraglutide (Victoza) be avoided?

A

Thyroid Carcinoma

55
Q

What is the Black Box Warning for Amylin Analogs?

A

Hypoglycemia, especially for DM1

56
Q

What are the adverse effects of Amylin Analogs?

A

N/V

Anorexia

Headache

Gastroparesis

57
Q

Which meds are SGLT2 Inhibitors?

A

-Flozins

58
Q

How do SGLT2 Inhibitors work?

A

↑Urinary Glucose Excretion

59
Q

When are SGLT2 Inhibitors Contraindicated?

A

CrCL < 30

&

ESRD

60
Q

What are Disadvantages to using SGLT2 Inhibitors?

A

Hypotension

Risk of Toe Amputations

Euglycemic Ketoacidosis

Urinary Side Effects

61
Q

What does the FDA recommend for managing SGLT2 Inhibitors Peri-Operatively?

A

Stop 3 Days before Surgery

&

May Restart when pt is eating again

62
Q

What are the characteristics of Armour Thyroid?

A

Animal Thyroid

4:1 T4 to T3

Manufacturing Inaccuracies

63
Q

What are the characteristics of Levothyroxine?

A

Contains only T4

Long Half-Life (7 Days)

64
Q

Which Thyroid med only contains T3?

A

Liothyronine

65
Q

How does Liothyyronine compare to Levothyroxine?

A

3x more potent w/ rapid onset & short duration

66
Q

What is the Disadvantage of Liothyronine?

A

High Risk for CV Side Effects

67
Q

What are some Anti-Thyroid Meds?

A

Proppylthiouracil (PTU)

&

Methimazole

68
Q

How do Anti-Thyroids work?

A

Inhibits Thyroid Hormone formation using Iodine

&

Blocks conversion of T4 to T3

Needs few days for it to work

69
Q

What are the Side Effects of Anti-Thyroids?

A

Leukopenia

Rash

Arthralgia

Lupus Symptoms

Fever

Granulocytosis

70
Q

What are some Iodines used for Hyperthyroidism?

A

Lugol’s

&

Saturated KI

71
Q

How do Iodines work as Anti-Thyroids?

A

Used w/ Propranolol to inhibit Thyroid Hormone Release

Fall 2020 - Pharmacology 2 (9 decks)

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