Endocrine Module 1 Flashcards
Alpha-Glucosidase inhibitor
Delays carbohydrate digestion and absorption
Biquanides
Reduce hepatic glucose production Increases insulin sensitivity to muscle and fat cells Reduce insulin resistance Decrease weight Improve lipid levels
Meglitinides
Stimulate insulin release from the pancreas
Thiazolidinediones
Decrease insulin resistance Increase insulin sensitivity
Dipeptidyl peptidase-4 inhibitor
Inhibits breakdown of increntin hormone
Increntin mimetic
Increase insulin secretions from beta cells Suppress glucagon secretion Slow gastric emptying
Amylinomimetic / amylin analogue
Slows the movement of food through the stomach
Sulfonylureas
Stimulate the beta cells to release insulin 30min b4 breakfast Check allergy to sulfa She’ll in stool
Acrabose (precose)
Alpha-Glucosidase inhibitor (Maltase)
Metformin (glucophage)
Biquanide
Miglitol (glyset)
Alpha-Glucosidase inhibitor (Maltase)
Glimepiride (amaryl)
Sulfonylureas
Glyburide (micronase)
2nd gen Sulfonylureas
Tolburamide (Orinase)
Sulfonylureas 1st gen
Pioglitazone (actos) Rosiglitazone (avandia)
Thiazolidinediones
Exenatide (byetta)
Increasing mimetic
Nateglinide (starlix) Repaglinide (prandin)
Meglitinide
Sitagliptin (januvia) Saxagliptin (onglyza)
Dipeptidyl peptidase 4 inhibitor
Pramlintide acetate (symlin)
Amylin analogue
Glipizide (glucotrol)
Sulfonylureas 2nd gen
Chloropropamide (diabenese)
1st gen sulfonylureas
Tolazamide (tolinase)
Sulfonylureas 1st gen
Sulfonylureas
Oral hypoglycemics Type 2 Stimulate beta cells to release insulin- effective but decreases effectiveness overtime Administer 30 min before breakfast Chlorpropamide (Diabimese) 100-250mg / day Glyburide (micronase) (diabeta) 2.5 mg- 20mg / day Glimepiride (amany) 1-8mg/day Side effects Hypoglycemia N+V, anorexia Weight gain Photo sensitivity Weakness Nephrotoxicity Hepatotoxicity (jaundice, pruitis) Interaction: sulfa, Asa, NSAID, phenytoin, Allopurinol, betablockers, maoi, antifungals, fluroquinolones Might find shell in stool
Alpha Glucosidase inhibitors
Oral H- type 2Carb blockers- delays carbohydrate digestion and absorption Aka Maltese- acts on maltose food products Only taken if they can eat- work in GI blocking digestion and absorption of carbs Take after the first bite Acarbose (precose) 25 100mg TID Side effects Abdominal pain Diarrhea / bloating Upset stomach Hypoglycemia Flatulence (gas) Treat with glucose tablet or glucose gel not w. food cause its not going to work Caution- liver and bowel disease
Biquanides
O. H Type 2 Reduce hepatic glucose production Decrease weight Increase insulin sensitivity to muscle and fat cell Decrease resistance Improve lipid levels Once or twice per day (10am or 10am and 6pm) Met forming (glucophAge) 500-1000mg Side effects Metallic taste Diarrhea Hypoglycemia and lactic acidosis (Rarf) N-v Bloating- cramping Decrease lipid levels Caution- liver and kidney disease- excessive alcohol
Thiazolidinediones
Oh type 2 Decrease insulin resistance Increase sensitivity Decrease hepatic glucose production Similar actions to biquanides Without regards to meals Once or twice a day Pioglitazome (actos) 20-40mg / day Rosiglitazone (avandia) 4-8mg 1 or 2 times a day (black box warning ) Side effects Increase urti Sinusitis Headache back pain Diarrhea CHF (look for edema v/s)
Depeptidyl peptidase 4 inhibitor
Oh type 2 Inihibits breakdown of intention (aids in absorption of glucose) hormones Helps release insulin Suppresses glucagon release Not used alone poly therapy Sitagliptin (januvia) 100mg daily (works in gut) Side effects Increase respiratory infections (assess temp NBC lung sounds)Adjuvant to diet and exercise
Amylin Analogue
O h Type 1 Mimic amylin (hormone in our body) Released by beta cells pancreas Usually work w insulin to lower blood sugar level Doses in mcg Based on patient 30 min before meals.
Meglititinies
Oh Type 2 Stimulates Insulin release From the pancreas (beta cells in pancreas) 15-30 min before meal Repaglinide (prandin) 1/2mg-4mg 2-3x daily Side effects Hypoglycemics Back pain Hepatotoxic (monitor liver profile) Urt 1 Bronchitis Rhinitis
Increntin mimetic
Oh type 2 Increase insulin secretion from beta cells Slows gastric emptying Suppresses glucagon Found in gi tract Exenatide (byetta) sub q 5mcg 2x daily Side effects Gastrotoxicity (nv,abdominal pain) Hypoglycemia
Hyperglycemia (diabetic coma/ ketoacidosis)
High blood sugar > 150 Keatons -glucose cannot be used so fats are used for metabolism Cause Too little insulin Mixed dose Too much food StressAlcohol consumption Illness (nvd) S/S N-V anorexia irritable abdominal pain and distension skin flushed- got dry mouth increase urine output decrease body fluid decrease BP increase HR Fruity odor to breath Kussmal breathing/ respiration ( Air hunger) (rapid deep breathing)
Diabetes Mellitus
Insufficient insulin production. Defective insulin production Chronic: no cure Type 1- insulin dependent Requires insulin administration Little to no insulin produced Rapid onset and more severe Type 2 Non insulin dependent Decrease production of insulin Decrease cell sensitivity to insulin Onset is insidious( they don’t realize) Treat w po drugs S/s Increase urine Dehydration Wounds slow to heal
Insulin
Hormones that regulates glucose metabolism and transporting of glucose across the cell membrane Controls use of protein fat glucose Inhibits glucose production by the liver Forms of insulin Animal Porcine-pork source (consider allergies and religion) Bovine- beef source Human Synthetic- humulin (yeast) (more cheap) Semisynthetic -novilin (genes) Syringes: u100, u50, u30, u500 (very rare) Insulin pen Route : always sub q Only regular insulin can be given IV 2 inches away from umbilicus Abdomen #1 spot (fast absorption) Rotate site (diff site diff day) 1 inch apart Pinch skin Done aspirate for insulin/ heparin Don’t massage- dont excersise (increase absorption) Sub q 90- back arm, thigh, too of butt (fatty portion) Profilled multidisciplinary pen syringes are for single patient use only Insulin pump- a monitor *only human insulin Basil Bolis Protein-decrease rate of absorption Zinc-modify onset of duration Assessment prior to insulin administration Blood glucose 1/2 hour ac+hs Urine glucose- not the 1st void Use the next void Np0 6 hours q finger stick
Hypoglycemia (insulin reaction/ shock)
Low blood sugar <60 repeat process Once in normal range give complex carb Skin milk, crackers 1/2 sandwiches Give within a hour 10-15gran of simple carb 6oz fruit juice regular soda 2-3 sugar cubes Honey/ corn syrup 5-6 hand candy Meds ^ sugar blood levels Glucagon (hormone produces by pancreas/ alpha cells (non beta) 1mg dose -sub IM IV Cannot be mixed with other things in syringe Can not be mixed with 0.9% NS Dextrose 50% (d 50) iv push followed by infusion
Diabetes Mellitus
Chronic Insufficient insulin production Defective Insulin production Two types
Type 1 diabetes
Little to no insulin producedRapid onset and more severe Requires insulin administration
Type 2 diabetes
Decreased production of insulin Decreased cell sensitivity to insulin Onset insidious Treat with oral drug
Insulin
Hormone produced by beta cells of the pancreas Controls use of glucose protein and fat Aids in transportation of glucose across cell membrane Inhibits glucose production by the liver
Synthetic insulin
Humulin
Semisynthetic insulin
Novolin
Insulin strength
u 100 and u 500
Insulin is classified as
Rapid Short Intermediate Long acting and mixed insulins
Protein does what to insulin
Decreases the rate of absorption
Zinc does what to insulin
Modifies the onset and duration
Signs and symptoms of hypoglycemia
N & V diarrhea hunger inability to concentrate confusion. Nervousness anxiety tremors tachycardia Pale cold clang skin Tired drowsy lethargic coma
Cause of hypoglycemia
Too much insulin or wrong type Delay or omission of food Too much excersise Illness Diarrhea vomiting
In someone who is hypoglycemia their sugar keytones are
Negative
How to treat hypoglycemia
10-15 grand of simple cho -6oz fruit juice, non diet soda Cube sugar honey or corn syrup 5-6 life savers 2-3 glucose tabs or gel Followed by complex CHO with 1 hour skim milk crackers or meal
Hyperglycemia signs and symptoms
N and v abdominal pain dissension anorexia dry mouth irritability got flushed skin fruity odor to breath kussmauls respiration increase urinalysis output
Wgst causes hyper glycemis
Too little insulin Misses dose Unregulated or extra meals Stress Increase alcohol consumption N and v diarrhea infection
When mixing insulin what should you do
Roll vial in palm of your hands do not shake
Air –> Cloudy –> then clear
Med –> clear –> then cloudy
Where should insulin be stored
unopened in the refrigerator.
opened insulin should be stored at room temp for 30 days.
if the exp. date is less than 30 days then keep it until exp. date
Lypodystrophy
destruction of fatty tissue.
rotate sites when giving cold insulin to prevent lypodystrophy
Hyperglycemia (Diabetic Coma / Ketoacidosis) Signs and Symptoms
N&V, Abdominal Pain, Anorexia, Irritable, SKIN HOT AND FLUSH, Dry mouth, FRUITY ODOR to the breath, Kussmaul’s Respirations. increased URINE OUTPUT, DECREASED B/P, INCREASED HEART RATE
Causes of hyperglycemia
Too little insulin or missed dose. Too much food, unregulated meals. stress. alcohol consumption, illness
Sulfonylureas
stimulate the beta cells to release insulin. effective but decreased effectiveness overtime. Take a.c. of the day
Examples of Sulfonylureas
Diabinese, Micronase, Glucotrol
Alpha Glucosidase Inhibitor
(Maltase) A Carb blocker. Delays carbohydrate digestion + absorption. Helps LOWER B/P Take with 1st bite of meal
Biguanides
Metformin (Glucophage) Reduce hepatic glucose production
Increases insulin sensitivity to muscle fat cells
Reduce insulin resistance
Decrease weight
improve lipid levels
Increntin Mimetic
INCREASE INSULIN SECRETIONS from beta cells
suppress glucagon secretion
slow gastric empyting
Examples of Incretin Mimetics
Exenatide (Byetta)
Dipeptidyl Peptidase 4 Inhibitor
acts in absorbing glucose,
inhibit the breakdown of incretin hormones
adjuvant to diet and exercise
Examples of Dipeptidyl Peptidase 4 Inhibitors
Stagliptin (Januvia)
Saxagliptin (Onglyza)
Amylin Analogue
Amylinomimetic
Slows the movement of food through the stomach
Adult 1 + 2 diabetes that need blood sugar coults
MUST BE GIVEN WITH INSULIN
example of an amylin analogue
zamlintide duclate (symlin)
Combination Drug : Metaglip
Metformin , Glipizide
Combination Drug : Avandamet
Metformin , Avandia
Combination Drug : Glucovance
Metformin , Glipizide
Combination Drug : Actoplus met
Pioglitazone , Metformin
Combination Drug : Ductact
Pioglitazone , Glimepiride
Combination Drug : Glucorana
Rosiglitazone , Metformin
Adrenocorticotropic Hormone
Anterior lobe stimulates the adrenal cortex to produce glucocorticoids.
Used to diagnose adrenocortical functions, multiple sclerosis
Meglitinides
Stimulates insulin release from the pancreas
Examples of Meglitinides
Nateglinide , Repaglinide
Thiazolidinediones
decreased hepatic glucose production
decreased sugar released by the liver
decreases insulin resistance
increases insulin sensitivity
Examples of thiazolidinediones
Pioglitazone (actos)
Rosiglitazone (Avandia)
Synthroid
Thyroid Replacement Drug. Increases metabolic rate by replacing thyroid hormone t3 and t4 replacement therapy in hyperthyroidism
Drugs used in thyroid replacement
Levothyroxine (Synthroid) t4
Liothyroxine Na (cytomel) t3
Liotrix (Euthyroid) t3 or t4
Thyroglobulin (Proloid) t3 or y4
How to store thyroid replacement drugs
Store in a DARK bottle
Replace after 3 months
Avoid iodide, salt, MVI on skin
Maintain and record apical pulse
Thiouracils
Return to euthyroid state
inhibit synthesis and release of the thyroid hormone
prevent the CONVERSION OF t4 to t3 IN PERIPHERAL CIRCULATION
Iodides
Anthyroid medication Reduces size and vascularity of the thyroid gland
Example of Iodide (Potassium Iodide)
Thryosafe , Thyroshield
Radioactive Iodine
antithyroid drug Emits beta rays which destroy hyperactive thyroid cells
Parathyroid Agents
Calcitonin (used to treat hyperthyroidism)
Hypoparathyroid drugs (hypo secretion)
Calcium Carbonate
Calcium Gluconate
Parathyroid Extract
Calcitriol (Rocaltrol)
Glyburdie
Micronase/DIA Beta
Used with diet and exercise to help control blood sugar in patients with type 2 diabetes.
Brand names: Micronase, DiaBeta, Glynase
Drug class: Sulfonylurea
Vasopressin
Pitressin
One of the most important roles of AVP is to regulate the body’s retention of water; it is released when the body is dehydrated and causes the kidneys to conserve water, thus concentrating the urine and reducing urine volume. At high concentrations, it also raises blood pressure by inducing moderate vasoconstriction.
Levothyroxine
Synthroid
Treats hypothyroidism. Also treats an enlarged thyroid gland (goiter) and thyroid cancer.
Brand names: Tirosint, Synthroid, Levothroid, Unithroid, Levoxyl, Novothyrox
Propylthiouracil
(PTU)
Treats Graves’ disease and hyperthyroidism (too much thyroid hormone from the thyroid gland) in patients who have already been treated with other medicines (such as methimazole) that did not work well.
Drug class: Thyroid Hormone Synthesis Inhibitor
Other drugs in same class: Methimazole
May treat: Hyperthyroidism, Enlarged thyroid, Thyrotoxic crisis
Calcitriol
Rocaltrol
Treats low blood calcium in kidney dialysis patients and other patients. Calcitriol is a form of vitamin D.
Drug class: Vitamin D3 Analog
Brand names: Rocaltrol, Vectical, Calcijex
Potassium Iodide
SSKI
123456789
Desmopressin
DDAVP
Prevents or controls thirst and frequent urination caused by diabetes insipidus and certain brain injuries.
May treat: Diabetes insipidus, Bleeding, Enuresis, Thrombocytopenia
Drug classes: Vasopressin analogue, Factor VIII Activator
Calcitonin
Calcimar
acts to reduce blood calcium (Ca2+), opposing the effects of parathyroid hormone
Salmon calcitonin is used for the treatment of: Postmenopausal osteoporosis Hypercalcaemia Paget's disease Bone metastases Phantom limb pain[15]
Metformin HCL
Glucophage
Glucophage and Glucophage XR (metformin hydrochloride) are oral antihyperglycemic drugs used to treat type 2 diabetes.
Acarbose
Precose
Helps control blood sugar in patients who have diabetes mellitus.
Drug class: Alpha-glucosidase inhibitor
Other drugs in same class: Miglitol
May treat: Type 2 diabetes mellitus
Brand name: Precose
Chlorpromide
Diabenese Treats diabetes mellitus. Belongs to a class of drugs called sulfonylureas.
Glimepiride
Amaryl
Treats type 2 diabetes. Used together with a proper diet and exercise to help control high blood sugar. This medicine is a sulfonylurea.
Brand name: Amaryl
Drug class: Sulfonylurea
Other drugs in same class: Glibenclamide, Glipizide, Tolbutamide
Sitagliptin
Januvia
Treats type 2 diabetes. Used together with proper diet and exercise to help control high blood sugar.
Brand name: Januvia
Drug class: Dipeptidyl peptidase-4 inhibitor
Humalog Novolog and Apidra are all examples of
Rapid Acting Insulin
Humulin R and Novolin R are examples of
Short acting Insulin
Humulin N and Novolin N are examples of
Intermediate Insulin
Levemir and Lantus are examples of
Long Lasting Insulin
