Endocrine Pharm Flashcards by Eli Woodard

What measurement is used to dose TH replacement

microgram (mcg)
because small changes have big impact

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How long does it take TH replacements to work

2 weeks to help symptoms
6 weeks to help labs
Cig smoking can alter timing

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When to take thyroid meds

On empty stomach and no food, drink, or meds for next 30-60 mins

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Meds taht induce CYP450 increasing conversion of T4 to T3

Rifampin
Phenobarbital
Carbamezepine
Phenytoin
Tyrosine
Kinase inhibitors
Helpful side effect if treating hyperthyroidism

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GLUT-1

Glucose transporter that does constant uptake of glucose in brain

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GLUT-2

GLucose transporter that does constant uptake of glucose in beta cells of pancreas and in liver.
Insulin has direct effect to increase activity of GLUT-2

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GLUT4

Glucose transporter
Insulin moves it to surface of cell
Found on skeletal muscle, cardiac muscle, and fat
Also moved to surface from muscle contraction (so exercise after food is good)

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What is the principal tissue for insulin-stimulated glucose disposal

Skeletal muscle

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Most common formula for insulin

U-100
(100 units/mL)

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Why do we give insulin SQ

Its a polypeptide that would break down in the gut

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What shape does insulin naturally make

Hexamer
Use multi-hexamer for slow release
Monomer is very fast action

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How to prepare vial of insulin combining NPH and another insulin

INsert air into NPH then air into other sinsulin.
Draw out insulin then draw out NPH.
NPH must be last

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Non-pharm ways to fix hypoglycemia

Give 15g of carbs

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Levothyroxine

Syntetic T4

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Liothyroine

Synthetic T3
Short half life
Cardiotoxicity

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Natural desiccated thyroid

Porcine T3 and T4

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Beta blockers

-lol
Prevent T4–>T3

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Thioamides

Methimazole and PTU
Inhibit TPO from converting iodide to iodine
PTU inhibits deiodination of T4 and T3.

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What thioamide to use in first trimester of preg

PTU

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What thioamide has shorter half life

PTU
Dosed Q6-8 hrs.
Methimazole is QD

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Radioactive iodine-131 MOA

Enters follicular cells via NIS and gamma rays destroy thyroid gland cells.
Stay 6 ft away from others for 3-11 days

Potassium iodide solution

Increased iodide causes NIS pump to fail leading to less TH formation.
NOT for preg
Used in preparation of thyroidectomy

Glucocorticoids

Hydrocortisone and dexmethasone
Suppress T4–>T3
Help with inflammation and pain in thyroiditis

Cholestyramine

Binds excess TH in intestine inceasing fecal excretion.
Can cause constipation and diarrhea

Teprotumumab

Treats thyroid eye disease Binds IGF-1 receptor to block activatoin. 8 infusions over 8 months

Teplizumab

Delays onset of stage 3 T1DM Binds to CD3 protein on T cells preventing activation

Ultra rapid acting insulin

Prandial 15 minutes before aspart lispro-aabc inhaled (afrezza) glulisine

Short acting insulin

Regular human insulin Prandial 30 mins before meal

Intermediate acting insulin

Basal Isophane suspension ONset is 1-2 hours duration is 24 hours SQ

Long acting insuline

Glargine (forms precipitate for slow release) Detemir No true peak onset 1-1.5 hours SQ

Ultra-long acting insulin

Degludec No true peak Onset 1-1.5 hours SQ lasts 42 hours

Afrezza

Inhaled rapid insulin Onset is 12 mins Duration is 1.5-3 hrs

baqsimi

Nasal glucagon 3mg for everyone over 4 yo

Gvoke hypopen

Pre-filled glucagon pen. Dose is weight dependent

Sulfonylurea

-ide NOT -tide Blocks ATP K channel in beta cells causing influx of Ca and insuline secretion. Glucose independent so can cause hypoglycemia

What sulfonylurea is preferred

glipizide bc of short half life

Glinides

-glinide Bind to ATP K channel in beta cells Glucose independent so can cause hypoglycemia

GLP-1 receptor agonist

Exenatide and -glutide Glucose dependent. Stimulate insulin secretion and inhibit glucagon after meals C-cell tumor risk

Tirzepatide

GLP-1/GIP receptor agonist. Glucose dependent Stumulates insulin release, increases insulin sensitivity, slows gastric emptying, inhibits glucagon Zepbound for weightloss Drops A1C 2+ C-cell tumor risk

DPP-4 inhibitors

-gliptin Slows breakdown of GLP-1 indirectly stimulating insulin release 0.5-0.8 A1C decrease

Biguanide (metformin)

Decreases hepatic production of glucose. Decreases glucose absorption in gut. INcreases insulin sensitivity of muscle and fat. Weight neutral Oral 1-1.5 A!C decrease

Thiazolidenediones

-glitazone Activate PPAR-gamma causing expression of genes for glucose and lipid metabolism and insulin signal transduction 1-1.5 A!C decrease causes weight gain. Not for youth CHF

Alpha-glucosidase inhibitor

Delays absorption of carbs. Don't use if they have IBS or any obstruction

SGLT-2 inhibitors

-flozin Block Na-glucose transporter causing glucosuria. Can cause UTI Don't start if GFR<30 0.5-1 A1C decrease

Pramlintide

Amylin analog Increases satiety Deceases postprandial glucagon secretion

Sympathomimetics

Phentermine and diethylpropion. CNS stimulant that cuases release of norepi and dopa to reduce apetite

Phentermine/topiramate

Phent causes release of norepi and dopa and topiramate blocs glutamate receptor decreaseing apetite and enhances activity at gaba for satiety. TERATOGENIC

Naltrexone/bupropion

Enhances productoin of melanocyte stimulating hormone. Reduces apetite

Orliastat

Lipase inhibitor causing fatty stools. Weight loss drug. Take ADEK multivatamine >2hrs after

First choice weight loss med for pts with without CVD

Tirzepatide (GLP-1/GIP)