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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
Q

is hyperglycemia dangerous?

A

no severe sx until serious probs develop over time

26
Q

what is diabetic ketoacidosis (DKA)?

A

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
Q

what is hypOthyroidism

A

underactive thyroid gland - not enough thyroid hormones produced (T3 & T4)

28
Q

causes of hypOthyroidism

A

autoimmune dx such as hasimoto’s
thyroid surgery
radiation
certain meds
iodine deficiency

29
Q

what is hypERthyroidism

A

overactive thyroid gland producing too much thyroid hormones (T3 & T4), TSH lower than normal.

30
Q

causes of hypER thyroidism

A

graves disease
radiation
certain meds

31
Q

symptoms of hypOthydroidism?

A

cold intolerance
wt gain
constipation
decreased sweating
depression/irritability

32
Q

symptoms of hypERthyroidism

A

wt loss or gain
increased sweating
nail thickening/flaking
heat intolerance
nervousness/anxiety
racing heart
diarrhea

33
Q

symptoms that both hyper/hypothyroidism share?

A

fatigue
insomnia
hair loss

34
Q

target range for T4, serum and TSH?

A

T4, serum = 4.5-11.2 mcg/dL
TSH = 0.4 - 6.0 MIU/L

35
Q

drug of choice for hypothyroidism?

A

levothyroxine

36
Q

what is a thyroid storm?

A

decompensated hyperthyroid which can be life threatening
caused by nonadherence, trauma, surgery, or infection
high fever, agitation, derlirium, CHF, loss of consciousness

37
Q
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38
Q

treatment for thyroid storm?

A

beta-blockers
steroids
antithyroid meds + iodide therapy
cooling blankets / ice and antipyretics

39
Q

PT considerations for thyroid problems?

A

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
Q

what is osteoporosis

A

weakened bones that become fragile and more prone to fractures. loss of bone mass.

41
Q

what causes osteoporosis

A

aging
hormonal changes (esp. in post-menopausal women)
insufficient calcium/vitamin D intake
fam. history
certain meds such as long-term corticosteroid use

42
Q

2 ways to determine risk for osteoporosis

A

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
Q

two supplements to help with osteoporosis

A

calcium & vitamin D

44
Q

when is treatment initiated for osteoporosis

A

when T-score is < -2.5. can initiate when score is -1 - -2.4 and FRAX score is >20%

45
Q

what are the 6 classes of osteoporosis meds

A
  1. biphosphonates
  2. estrogen agonists / antagonists products
  3. calcitonin
  4. parathyroid hormones
  5. rankl inhibitor
  6. romosozumab
46
Q

PT considerations for osteoporosis?

A

higher risk of fractures
wt bearing exercise can help strengthen/prevent falls
orthostatic hypotension is a concern w/ several meds

47
Q

MOA of Biguanides?

A

Lowers the glucose production
of the liver and increases the
body sensitivity to insulin and
reduces absorption of glucose

48
Q

MOA of DPP-4 INHIBITORS

A

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
Q

MOA of SGLT2 INHBITORS

A

Kidneys reabsorb glucose, and by
blocking these Sodium-Glucose
Transporters 2 proteins, the body
urinates out more glucose, reducing
blood glucose concentration.

50
Q

GLP-1 AGONISTS

A

Lowers glucagon release and
slows gastric emptying,
increasing satiety which can
lead to weight loss.

51
Q

INSULINS

A

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
Q

MOA of BISPHOSPONATES

A

Increase bone density by stopping
osteoclast activity and reducing bone
resorption.

53
Q

MOA of CALCITONIN

A

Inhibits bone resorption by
osteoclasts.

54
Q

osteoblasts vs. clasts vs cytes

A

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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