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Pharmacology Exam 2 > Endocrine Pharmacology > Flashcards

Endocrine Pharmacology Flashcards

1
Q

PT considerations for endocrinological issues?

A

diabetes = chronic pain, loss of limbs, possible cardiac
thyroid probs = can lead to increased risk of general health deficits
osteoporosis = loss of bone density increases risk of fractures
exercise contraindicated in ketosis signs
may work with overweight pts

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2
Q

how does your body control glucose?

A
  • insulin secreted into blood from pancreas after eating and metabolize glucose
  • pancreas releases glucagon when glucose levels fall too low
    feedback loop
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3
Q

Type I Diabetes

A

Affects children and young adults
accounts for 5% of all diabetes cases
occurs when pancreas is unable to produce enough insulin

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4
Q

Type II Diabetes

A

adult onset
90-95% of all diabetes cases
occurs due to insulin resistance

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5
Q

gestational diabetes

A

10% of pregnant women
increases risk of developing TII diabetes later on

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6
Q

major T1 diabetes characteristics

A

occurs when pancreas is unable to produce enough insulin
requires insulin therapy
tends to develop at a young age

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7
Q

major T2 diabetes characteristics

A

occurs due to insulin resistance (when body doesn’t respond well to it)
can be managed with lifestyle mods if dx early
developed at an older age

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8
Q

Sx of both T1/T2?

A

frequent urination
increased thirst
extreme hunger
unintentional wt loss
fatigue
blurry vision
slow healing sores/wounds
tingling sensation in hands/feet

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9
Q

macrovascular complications from diabetes

A

MI
Stroke
PAD

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10
Q

microvascular complications from diabetes

A

foot ulcers (amputations)
retinopathy (vision loss)
neuropathy (chronic nerve pain)
nephropathy (dialysis)

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11
Q

how is diabetes managed?

A
  • A1c/BG = <7%
  • BP = <130/80
  • LDL = <70
  • Lifestyle mods
  • health / skin screenings
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12
Q

non-pharmacological management for diabetes

A
  • avoid/decrease alcohol (<1 drink/day women, <2 drinks/day men)
  • 150min/week mod intens aerobic, 75min/week vig intens aerobic, and/or resistance training ≥2-3 times/week
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13
Q

what are the 7 classes of diabetes meds?

A
  1. GLP-1 Receptor Agonists
  2. SGLT2 Inhibitors
  3. Biguanide
  4. Sulfonylureas
  5. Insulins
  6. DPP-4 Inhibitors
  7. Thiazolidinediones
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14
Q

which diabetes meds are taken orally?

A

metformin
DPP-4 Inhibitors
Sulfonylureas
SGLT2 Inhibitors
Combination

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15
Q

which diabetes meds are taken as injections?

A

insulins
GLP-1 agonists

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16
Q

goal for rapid acting insulin?

A

to mimic insulin release the pancreas would naturally do with injections

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17
Q

how do synthetic insulins help?

A

mimics differing individuals and reduces amount of insulin needed for injection
amino acids are changed for faster absorption
created slow-release formulations for longer lasting effects

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18
Q

types of insulin injections?

A
  • syringes = cheaper, pt does more steps
  • insulin pen = costly but easier to transport and dose
  • pump/pod = usually T1 DM, very expensive, lot of pt education, automates process
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19
Q

hypOglycemic symptoms

A

sweating
pallor
irritability
hunger
lack of coordination
sleepiness

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20
Q

hypERglycemic symptoms

A

dry mouth
increased thirst
weakness
HA
blurred vision
frequent urination

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21
Q

what can lead to hypOglycemia?

A
  • medications = taking too many or not on schedule
  • exercice can exacerbate but reversed by glucose intake
    *one of highest reasons elderly go to ER
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22
Q

what can lead to hypERglycemia?

A

nonadherence
non-optimized therapy

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23
Q

how to manage hypOglycemia?

A

glucose = <70 take a fast acting sugar source:
- 4oz fruit juice or soda
- 3-5 glucose tablets
- 6-7 lifesavers

test blood after 15min, if sugar still low then repeat until normal

24
Q

when to call 911 for blood glucose?

A

if pt is unconscious or blood glucose is <50 and glucagon (rescue medication) should be given immediately

25
is hyperglycemia dangerous?
no severe sx until serious probs develop over time
26
what is diabetic ketoacidosis (DKA)?
excessive blood sugar cannot be utilized due to complete lack of insulin (T1 and advance T2). Causes body to utilize fat stores as fuel. byproduct of fat breakdown = ketones, high levels = poisonous can lead to diabetic coma ***exercise contraindicated in patients showing signs of ketosis***
27
what is hypOthyroidism
underactive thyroid gland - not enough thyroid hormones produced (T3 & T4)
28
causes of hypOthyroidism
autoimmune dx such as hasimoto's thyroid surgery radiation certain meds iodine deficiency
29
what is hypERthyroidism
overactive thyroid gland producing too much thyroid hormones (T3 & T4), TSH lower than normal.
30
causes of hypER thyroidism
graves disease radiation certain meds
31
symptoms of hypOthydroidism?
cold intolerance wt gain constipation decreased sweating depression/irritability
32
symptoms of hypERthyroidism
wt loss or gain increased sweating nail thickening/flaking heat intolerance nervousness/anxiety racing heart diarrhea
33
symptoms that both hyper/hypothyroidism share?
fatigue insomnia hair loss
34
target range for T4, serum and TSH?
T4, serum = 4.5-11.2 mcg/dL TSH = 0.4 - 6.0 MIU/L
35
drug of choice for hypothyroidism?
levothyroxine
36
what is a thyroid storm?
decompensated hyperthyroid which can be life threatening caused by nonadherence, trauma, surgery, or infection high fever, agitation, derlirium, CHF, loss of consciousness
37
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treatment for thyroid storm?
beta-blockers steroids antithyroid meds + iodide therapy cooling blankets / ice and antipyretics
39
PT considerations for thyroid problems?
cardiovascular/respiratory dysfunction can be precipitated w/ exercise extended warm up / several minutes rest between resistive sets, 5min cool down to avoid hypotension *these patients are typically higher risk for osteoporosis*
40
what is osteoporosis
weakened bones that become fragile and more prone to fractures. loss of bone mass.
41
what causes osteoporosis
aging hormonal changes (esp. in post-menopausal women) insufficient calcium/vitamin D intake fam. history certain meds such as long-term corticosteroid use
42
2 ways to determine risk for osteoporosis
fracture risk assessment tool (FRAX) - identifies risk of osteoporotic fx over 10 yrs in postmenopaus. women & men >50yrs old Bone Mineral Density (BMD) scan - women >65 men >70. creates T score. *normal = >-1, osteopenia = -1 - -2.4, osteoporosis = < -2.5*
43
two supplements to help with osteoporosis
calcium & vitamin D
44
when is treatment initiated for osteoporosis
when T-score is < -2.5. can initiate when score is -1 - -2.4 and FRAX score is >20%
45
what are the 6 classes of osteoporosis meds
1. biphosphonates 2. estrogen agonists / antagonists products 3. calcitonin 4. parathyroid hormones 5. rankl inhibitor 6. romosozumab
46
PT considerations for osteoporosis?
higher risk of fractures wt bearing exercise can help strengthen/prevent falls orthostatic hypotension is a concern w/ several meds
47
MOA of Biguanides?
Lowers the glucose production of the liver and increases the body sensitivity to insulin and reduces absorption of glucose
48
MOA of DPP-4 INHIBITORS
Prevents dipeptidyl peptidase 4 enzyme from breaking down incretin hormones and GLP-1 and GIP which help to regulate blood glucose levels in increasing insulin release and decreasing glucagon release
49
MOA of SGLT2 INHBITORS
Kidneys reabsorb glucose, and by blocking these Sodium-Glucose Transporters 2 proteins, the body urinates out more glucose, reducing blood glucose concentration.
50
GLP-1 AGONISTS
Lowers glucagon release and slows gastric emptying, increasing satiety which can lead to weight loss.
51
INSULINS
Insulin is administered to mimic the normal physiological process of the pancreas controlling BG. The types of insulin vary depending on the length of time they last in the body (rapid to long-acting)
52
MOA of BISPHOSPONATES
Increase bone density by stopping osteoclast activity and reducing bone resorption.
53
MOA of CALCITONIN
Inhibits bone resorption by osteoclasts.
54
osteoblasts vs. clasts vs cytes
Osteoblasts: bone building cells Osteoclasts: bone-destroying cells responsible for bone resorption Osteocytes: mature bone cells

Pharmacology Exam 2 (6 decks)

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