Endocrine System 2 Flashcards
What causes Osteoporosis?
decreased osteoblast function
T/F: osteoporosis is more common in post-menopausal women?
TRUE
Types of Osteoporosis
1). primary 2). seconday
What causes primary osteoporosis?
1). idiopathic (unknown 2). increased age
what causes secondary osteoporosis?
1). underlying diseases 2). medications
Clinical manifestations for osteoporosis
1). sudden back pain (compression fx of vertebral body) 2). increased kyphosis of T spine 3). decreased height
Risk factors for developing osteoporosis (9)
1). decreased bone mass after 35 years old 2). female hormone changes 3). genetics 4). Caucasian 5). low physical activity 6). tobacco/alcohol use 7). medications 8). depression 9). diet/nutrition deficits
TX for osteoporosis?
1). calcium and Vitamin D 2). Bisphosphonates (most common tx) 3). Denosumab 4). Sclerostin Inhibitor 5). Teriparatide
AEs of calcium?
Consitipation
suffix for Bisphosphonates
-dronate
MOA of Bisphosphonates
binds key enzyme to inhibit natural bone turnover pathway >> increases osteoclast apoptosis which decreases bone turnover
Bisphosphoantes considerations
1). stay upright 2). take w/water 30-60 minutes before food
Bisphosphonates common AE
GI issues (increased if not upright)
Rare Bisphosphoantes AE
1). atypical femur fx 2). osteonecrosis of jaw (ONJ) - from IV use or long-term trx
Bisphosphonates contraindications
1). hypocalcemia 2). esophageal abnormalities 3). inability to remain upright
what type of drug is denosumab (Prolia)
Anti-RANKL
denosumab (Prolia) AEs
same as bisphospnates
denosumab (Prolia) considerations
administered in provider’s office
Sclerostin inhibitors MOA
increase bone formation
Sclerostin inhibitors common AE
arthraligia
Sclerostin inhibitors rare AEs
1). hypocalcemia (atypical) 2). femur fx 3). ONJ 4). increased risk of MI, stroke, or CV death
Synthetic PTH MOA
1). stimulate osteoblast function 2). increases GI calcium absorption 3). increase renal calcium absorption all this increases BMD
Synthetic PTH AEs
transient OH within 4 hours of dose
Drug name for Synthetic PTH
Teriparatide (Forteo)
Osteoporosis medication considerations
also given to pts with longterm steroid use and men receiving androgen deprivation therapy
Osteoporosis meds Therapeutic Concerns
1). excessive doses of Ca supplements can cause arrhythmias 2). utilize weight bearing activities to promote bone growth 3). avoid high impact activities for pts with osteroporosis
Types of Diabetes
Type 1 Type 2
Pathophysiology T1DM
selective beta cell destruction in the pancreas >> can’t produce insulin
what causes T1DM?
Autoimmune dysfunction, genetic, viral infections
What is T2DM?
1). moderate beta cell destruction that can become more severe 2). Insulin resistance
Which type of diabetes is more prevalent in youth?
T1DM
what is LADA?
latent autoimmune diabetes in adults (Type 1.5 >> requires insulin)
What type of diabetes can only be treated with insulin?
T1DM
Pathophysiology of T2DM?
Egregious Eleven
What are the egregious elevn
what is the overall result of the egregious eleven?
Hyperglycemia
TX options for T2DM?
1). diet 2). exercise 3). non-insulin meds 4). insulin
what are non-insulin meds that treat T2DM also called?
Antihyperglycemic Drug
List the classes of Antihyperglycemic Drugs (6)
1). Biguanide 2). Sulfonylureas 3). Thiazolidinedione (TZDs) 4). DPP-4 inhibitor 5). SGLT2 Inhibitor 6). GLP1 Receptor agonist
MOA for Biguanide
unclear, but it stops: 1). production of glucose 2). intestinal absorption of glucose also 3). increases insulin sensitivity in muscle and fat
AE of Biguanide
1). GI (N/V/cramps) 2). Vitamin B12 deficiency
how is vitamin B12 deficiency from Biguanide important?
it can be misdiagnosed as peripheral neuropathy
Biguanide boxed warnings
lactic acidosis
Sulfonylureas MOA
increase insulin release
Sulfonylureas AE
1). hypoglycemia 2). weight gain
AE from Sulfonylureas are increased in which populations?
1). elderly 2). individuals with renal dysfunction
T/F: some Sulfonylureas are on the Beer’s List?
TRUE
Thiazolidinedione (TZDs) MOA
increase insulin sensitivity in muscle and fat
Thiazolidinedione (TZDs) AE
1). edema 2). long-term increased risk of bone fractures
Thiazolidinedione (TZDs) boxed warnings
HF
What does DPP-4 inhibitor stand for?
Dipeptidyl peptidase 4 inhibitor
DPP-4 inhibitor MOA
inhibit breakdown of incretin => 1). increases insulin sensitivity and release 2). decreases glucagon secretion 3). decreases liver glucose production
DPP-4 inhibitor AE
very well tolerated
rare AE of DPP-4 inhibitor
1). arthraliga 2). increased risk of HF
SGLT-2 Inhibitor MOA
blocks glucose reabsorption in kidneys => increases urinary glucose excretion
SGLT2 inhibitor AE
1). volume depletion related 2). genitourinary infections 3). renal insufficiency
Rare SGLT2 inhibitors AE
euglycemic diabetic ketoacidosis
SGLT2 inhibitor boxed warnings
increased risk of bone fractures and lower limb amputations
GLP1 receptor agonist MOA
1). increase insulin secretion 2). decrease glucagon secretion 3). decrease gastric emptying (incretin hormones)
GLP1 receptor agonist AE
GI (nausea, bloating, diarrhea)
Sulfonylureas suffix
-ide
DPP-4 inhibitor suffix
-gliptin
SGLT2 inhibitor suffix
-flozin
GLP1 receptor agonist suffix
-tide
What are the symptoms of Diabetes? (10)
1). tired 2). always hungry 3). frequent urination 4). always thirsty 5). blurry vision 6). numb/tingling hands or feet 7). sexual problems 8). sudden weight loss 9). wounds that won’t heal 10). vaginal infections
MOA of Insulin
1). increase glucose uptake 2). inhibit glucose production
Types of Insulin
1). basal 2). bolus 3). Other
What are the “Other” types of insulin?
1). intermediate (NPH) 2). mixed 3). concentrated 4). U-500 5). inhaled regular insulin (afrezza)
how often is basal insulin injected?
normally only once daily, sometimes twice
types of bolus insulin
1). rapid 2). regular
onset for rapid bolus insulin
10-30 min lasts for 3-5 hours
onset for regular bolus insulin
~30 min lasts 4-12 hours
what type of insulin can be given as correction insulin?
rapid bolus insulin
Therapeutic considerations for DM?
1). exercise = good 2). monitor blood glucose 3). avoid heat/massage @ injection site 4). need good footwear 5). exercise after meals
if blood glucose is <100 mg/dL then _______
eat a snak
if blood glucose is >300 mg/dL then _______-
No PT
what are the signs of hypoglycemia?
1). shaky 2). sweaty 3). dizzy 4). confusion 5). difficulty speaking 6). weak/tired 7). HA 8). nervous/upset
_______ masks all the symptoms of hypoglycemia except ______
1). Beta blockers 2). sweating
Which Antihyperglycemic Drugs reduce the risk for hypoglycemia?
1). Biguanide 2). Thiazolidinedione (TZDs) 3). DPP-4 inhibitors
