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Med surg > Endocrine pharm > Flashcards

Endocrine pharm Flashcards

1
Q

what are the 6 different types of oral hypoglycemics

A
  1. sulfonylureas
  2. Meglitinides
  3. Biguanides
  4. Thiazolidinediones
  5. Alpha-glycosidase inhibitors
  6. Gliptins
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2
Q

what are the 3 types of injectable hypoglycemics

A
  1. Insulin
  2. Amylin mimetics
  3. Incretin mimetics
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3
Q

what are the different types of insulin

A
  1. rapid acting (-log)
  2. short acting (regular)
  3. NPH
  4. Long acting (Lantus)
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4
Q

what are the onset, peak, and duration of rapid acting

A

onset-15 to 30 mins
peak-30 mins to 2.5 hours
duration 3-6 hours

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5
Q

what are the onset, peak, and duration of short acting

A

onset 30-1 hour
peak 1-5 hours
duration 6-10 hours

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6
Q

what are the onset, peak, and duration of NPH

A

onset 1-2 hours
peak 6-14 hours
duration 16-24 hours

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7
Q

what are the onset, peak, and duration of long acting

A

onset-70 mins
peak-none
duration-24 hours

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8
Q

side effects of insulin

A
  1. hypoglycemia
  2. hypokalemia
  3. lipohypertrophy
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9
Q

insulin interventions

A
  1. hypoglycemia
    - abrupt onset of tachycardia, diaphoresis, tremors
    - gradual onset: headache, tremors, weakness
  2. give 15-20g of carbs of hypoglycemia occurs
    - 4 oz fruit juice/1 tbsp honey
    - if unconscious give glucagon or glucose IV
  3. Rotate injection sites to avoid lipohypertrophy
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10
Q

insulin admin

A
  1. for insulin suspensions, gently rotate vial between palms
  2. draw up short acting before long acting
  3. do not mix insulin glargine or detemir with other insulins
  4. store vials in use at room temp for up to one month and refrigerate unopened vials
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11
Q

patient teaching insulin

A
  1. do not inject cold insulin
  2. carry carbohydrate snacks
  3. wear a medical alert bracelet
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12
Q

insulin interactions

A
  1. sulfonylureas, meglitinides, bblockers, salicylates, and alcohol increase hypoglycemic effects
  2. thiazide and loop diuretics, sympathomimetics, thyroid hormones, and glucocorticoids increase blood glucose levels these patients need larger doses
  3. bblockers mask manifestations of hypoglycemia (tachycardia and tremors)
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13
Q

amylin mimetics prototype

A

Pramlintide

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14
Q

amylin mimetic action

A 
mimics action of naturally occuring peptide hormone produced by the pancreas, amylin
producing
1.lower blood glucose
2.slowing gastric emptying
3.inhibiting secretion of glucagon
4.increasing feeling of satiety
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15
Q

amylin mimetics SE

A
  1. severe hypoglycemia (r/t decreased gastric emptying)
  2. nausea (very common)
  3. injection site reactions
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16
Q

amylin mimetics interventions

A
  1. recommend a lower insulin dosage until response to drug is seen
  2. monitor for n/v
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17
Q

amylin mimetics admin

A
  1. do not mix with insulin in the same syringe
  2. give with meal with atleast 30 grams of carbs
  3. peak action on stomach 20 mins after dosing, peak risk for hypoglycemia at 3 hours.
  4. store at room temperature for up to a month and refrigerate unopened vials
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18
Q

amylin mimetics teaching

A

1.watch for hypoglycemia especially 3 hours after dosing

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19
Q

amylin mimetics contraindications

A
  1. renal failure
  2. hemodialysis
  3. poor insulin regimen adherence
  4. A1c above 9%
  5. gastroparesis (slowed gastric emptying)
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20
Q

amylin mimetics interactions

A

1.slows absorption of oral drugs therefore take other oral drugs 1 hour before or 2 hours after

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21
Q

incretin mimetics uses

A
  1. a supplement to sulfonylureas or metformin (glucophage)
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22
Q

incretin mimetics prototypes

A

exenatide (byetta)

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23
Q

incretin mimetic action

A

is a synthetic peptide (GLP-1) similar to glucagon which
activates GLP-1 receptors after a meal
1.slowing gastric emptying
2.stimulating the release of insulin in the presence of glucose
3.decreases secretion of glucagon
4.increases feeling of satiety

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24
Q

incretin mimetics SE

A
  1. hypoglycemia
  2. N/v, diarrhea (very common)
  3. pancreatitis
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25
Q

incretin mimetics interventions

A
  1. monitor for pancreatitis

- severe, persistant abdominal pain

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26
Q

incretin mimetics admin

A
  1. give 60 mins prior to morning and evening meals

2. peak action =2hours

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27
Q

incretin mimetics contraindications

A
  1. renal failure
  2. type 1 DM
  3. DKA
  4. ulcerative colitis
  5. crohns disease
  6. gastroparesis
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28
Q

incretin mimetics interactions

A
  1. sulfonylureas increase the risk for hypoglycemia
  2. slows the absorption of oral drugs, especially oral contracepties and antibiotics so patients should take these other drugs 1 hour before or two hours after
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29
Q

sulfonylureas prototypes

A

Glipizide (glucotrol)-second generation (stronger and have fewer drug interactions) Tolbutamide (orinase)

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30
Q

Sulfonylureas uses

31
Q

Sulfonylureas action

A

Stimulates the release of insulin but patients must have a functioning pancreas

32
Q

Sulfonylureas SEs

A
  1. mild hypoglycemia

2. n/v/d

33
Q

sulfonylureas interventions

A
  1. hypoglycemia
    - diaphoresis, tachycardia, fatigue, hunger, tremors
    - give 15-20 grams of carbs
34
Q

sulfonylureas admin

A
  1. give orally 30 mins before meal

2. pregnant patients should stop taking 48 hours prior to giving birth

35
Q

sulfonylureas contraindications

A
  1. DKA

2. pregnancy/ lactation

36
Q

sulfonylureas interactions

A
  1. alcohol can cause a disulfiram (antabuse) like reaction such as n/v, palpitations, flushing
  2. alcohol also increases hypoglycemic effect
  3. sulfonamide antibiotics, NSAIDS, oral anticoagulants, salicylates, MOAIs, Cimetidine increase hypoglycemic effect
  4. thiazides counteract hypoglycemic effect
  5. beta blockers mask hypoglycemia
37
Q

meglitinide uses

38
Q

meglitinide prototypes

A

Repaglinide (prandin) Nateglinide (starlix)

39
Q

meglitinides action

A

similar to sulfonylureas, patients who do not respond to sulfonylureas will not respond to meglitinides

40
Q

meglitinides SEs

A

everything is same as sulfonylureas

41
Q

Meglitinide interactions

A
  1. gemfibrozil, erythromycin, ketoconazole, grapefruit juice (more then 1L/day), ginseng, and garlic increase hypoglycemic effect
  2. barbiturates, carbamazepine, rifampin counteract the hypoglycemic effect
42
Q

Biguanides uses

A

first drug for patients newly diagnosed with DM 2

43
Q

biguanides action

A
  1. decreases absorption of glucose from the intestine
  2. decreases synthesis of glucose by the liver
  3. increases sensitivity of insulin receptors
44
Q

biguanides prototypes

45
Q

biguanide SEs

A
  1. n/v/d, anorexia
  2. B12 and folic acid defiency
  3. Lactic acidosis (changes mitochrondrial oxidation of lactic acid)
46
Q

biguanides interventions

A
  1. Lactic acidosis
    - weakness, fatigue, lethargy, hyperventilation
    - severe acidosis requires hemodialysis
  2. monitor I and O
  3. monitor for n/v/d
  4. monitor for b12 or folic acid deficiency
47
Q

biguanides admin

A

give with morning and evening meals

48
Q

biguanides teaching

A
  1. avoid alcohol as it can increase chances of lactic acidosis
  2. report weakness, fatigue, lethargy, or hyperventilation
  3. Vitamin deficiency
    - weakness, fatigue, pallor
  4. GI effects will diminish
49
Q

biguanides contraindication

A

all contraindications are r/t increase risk for lactic acidosis

  1. DKA
  2. cardiopulmonary, hepatic, or renal insufficiency
  3. alcoholism
  4. HF
  5. severe infection
  6. shock
  7. acute MI
  8. hypoxemia
  9. lactic acidosis
50
Q

biguanides interactions

A
  1. alcohol and cimetidine increase risk of lactic acidosis
  2. any contrast medium containing iodine increases risk for acute renal failure thus increasing risk for lactic acidosis
  3. ginseng and garlic increase hypoglycemic effect
  4. captopril, nifedipine, furosemide, morphine, rantidine, antifungals also increase hypoglycemic effect.
51
Q

thiazolidinediones uses

52
Q

glitazones prototype

A

Pioglitazone (actos)

53
Q

glitazones action

A

reduce insulin resistance but insulin must be available for this to occur therefore concurrent admin of metformin or insulin may be needed

54
Q

glitazone SEs

A
  1. fluid retention (be careful for HF)
  2. hepatotoxicity
  3. increased serum lipid levels (HDL, LDL and triglycerides)
55
Q

glitazone interventions

A
  1. monitor for HF
    - edema, weight gain (1-2 lb in a day or 3-5 in a week)
  2. hepatotoxicity
    - obtain baseline ALT then every 3-6 months
    - report jaundice, dark urine, abdominal pain, vomiting, fatigue
  3. watch lipid panels
56
Q

glitazone contraindications

A
  1. CVD including HTN
  2. HF
  3. active haptic disease
57
Q

glitazone interactions

A
  1. insulin increases the risk of HF and edema
  2. Gemfibrozil and ketoconazole increase hypoglycemic effect
  3. green tea and herbal ginseng and garlic increase hypoglycemic effects
58
Q

Alpha-glucosidase inhibitors uses

59
Q

Alpha glucosidase inhibitors prototype

A

acarbose (precose)

miglitol (glyset)

60
Q

alpha glucosidase inhibitors action

A

alpha-glucosidase is an enzyme that breaks down carbohydrates in the intestine. therefore blocking this enzyme

  • slows absorption of carbs after a meal
  • reduces sudden rise in postprandial blood glucose
61
Q

alpha glucosidase inhibitors SEs

A
  1. GI -secondary to fermentation by left over bacteria
    - distention, flatus, hyperactive bowel sounds, diarrhea
  2. Hypoglycemia (its hard to treat b/c they cannot absorb the glucose)(give dextrose, which is pure form of glucose)
  3. Liver dysfunction
  4. Anemia
62
Q

alpha-glucosidase inhibitors interventions

A
  1. GI (very common)
    - hyperactive bowel, distention, diarrhea
  2. Hypoglycemia
    - treat with 4 g dextrose
  3. Liver dysfunction
  4. Anemia
    - monitor CBC and recommend iron rich food
63
Q

alpha glucosidase inhibitors admin

A

give with meal always and always before the first bite or the carbs will be broken down and absorbed

64
Q

alpha glucosidase inhibitors contraindications

A

GI disorders

65
Q

Alpha glucosidase inhibitors interactions

A
  1. insulin, sulfonylureas, gingseng increase the risk for hypoglycemia
  2. metformin worsens gastrointestinal effects
  3. Estrogens, thiazides, corticosteroids phenothiazines, isoniazid, and phenytoin counteract the hypoglycemic effect
66
Q

Gliptins prototypes

A

Sitagliptin (Januvia)

67
Q

Gliptins actions

A

augments naturally occurring incretin hormones by inhibiting the enzyme that inactivates them
1.promotes release of insulin
2.decrease secretion of glucagon
3lower fasting and postprandial blood glucose

68
Q

Gliptins SEs

A
  1. Upper respiratory tract infection and inflamed nasal passages (rare)
  2. headache
  3. Pancreatitis
69
Q

Gliptins interventions

A
  1. Upper respiratory tract infections
    - monitor temp and lungs
  2. monitor for headaches
  3. reduce dosage for patients who have severe renal impairment or low creatinine clearance
70
Q

thyroid replacement prototypes

A

levothyroxine (synthroid) liothyronine (cytomel) liotrix (thyrolar) thyroid (thyroid USP)

71
Q

thyroid replacement interventions

A

1.hyperthyroidism

72
Q

thyroid replacement contraindications

A
  1. thyrotoxicosis

2. recent MI

73
Q

thyroid replacement interventions

A
  1. monitor for hyperthyroidism
  2. myxedema coma
    - may cause hyponatremia and hypoglycemia so be prepared to treat that
74
Q

thyroid replacement interactions

A
  1. cholestryamine, antacids, iron and calcium supplements, and sucraflfate reduce absorption
  2. food reduces absorption
  3. many antiseizure meds and antidepressants including carbamazepine, phenytoin, phenobarbital, and sertraline decrease levels
  4. anticoagulants effects of warfarin increase
  5. catecholamine sensitivity increases

Med surg (35 decks)

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