Endocrinology Flashcards
diagnostic criteria for metabolic syndrome
Any 3 or the following:
- Abdominal obesity:
waist>40inches (male)
waist>35 (female) - TG>150 mg/dL
- HDL130/85 mmHg
- FSG> 100mg/dL (or 2hr post oral glucose>140mg/dL)
associated with stroke, other CV complications
diagnostic criteria for DM2
FSG>126
Random serum glucose 200
OGTT>200
HbA1C>6.5%
Metformin
decreases hepatic gluconeogenesis
no weight gain
no hypoglycemia
adverse effects:
GI disturbances
decreased B12 absorption
lactic acidosis (metabolized by kidney, and builds up with inadequate kidney function, heart failure etc would increase the changes of this happening)
how much do DM meds drop the A1C reading?
1-2% on average, per drug
more obvious effect if it starts higher
this might be a reason to start multiple drugs (one at a time)
sulfonylureas
glimepiride
glipizide
glyburide
stimulate insulin release from beta cells by activating potassium-ATP channel
caveat- requires functional pancreas, and puts patient at risk of hypoglycemia
use with caution in patients who have hepatic or renal insufficiency, can cause some weight gain
thiazolidinediones (TZD)
rosiglitazone
pioglitazone
decrease hepatic gluconeogenesis, increase insulin sensitivity
adverse effects: weight gain, fluid retention
pulmonary edema
CHF exacerbation
peripheral edema
use with caution in patients who have liver dysfunction
DPP-4 inhibitors
sitagliptin
saxagliptin
linagliptin
alogliptin
These drugs inhibit enzyme DPP-4.
The DPP-4 enzyme metabolizes GLP-1 (glucagon like peptide 1)
Endogenous GLP-1 decreases glucagon secretion, increases insulin secretion, and also delays gastric emptying
Not super effective (0.5% decrease in A1C), but advantage is that they don’t cause a lot of side effects, no hypoglycemia, no weightgain, and not many contraindications
GLP1 receptor agonists (incretin mimetics)
exenetide
liragletide
dulaglitide
Decrease glucagon secretion
Increase glucose- dependent insulin secretion
Delay gastric emptying
Exenatide- analog of exendin (Gila monster saliva), with similar effects to GLP-1
Liraglutide and dulaglutide are similar in effect, if not stronger, and are synthetic analogs of human GLP1
These are active peptides and must be injected
Adverse effect: nausea (slowed gastric effect), weightloss
SGLT-2 inhibitors
dapagliflozin
canagliflozin
empagliflozin
SGLT-2 transporters are found in the kidney, and they help with glucose reabsorption in the tubules.
These medications augment the inhibition of SGLT 2 receptors so that more glucose gets lost in the urine instead of being reabsorbed
similar effect to metformin
caveat- relies on functional kidneys
recurrent urinary tract infections and major mycotic infections
alpha- glucosidase inhibitor
acarbose
alpha-glucosidase enzyme is in the brush border of the intestines and breaks down complex carbohydrates into glucose so they can be absorbed
adverse effects:
- diarrhea
- flatulence
- abcominal cramping
acarbose- reactive hypoglycemia following gastric bypass surgery
Pramlintide
Amylin analog
Amylin hormone is released with insulin in response to food, and this is unique because it is the only non-insulin drug approved for type 1
injected TID
not popular
Meglitinides
nateglinide
rapaglinide
similar effect as sulfonylureas, but with shorter active time
lactic acidosis is a rare but worrisome side effect
metformin
most common side effect is hypoglycemia
sulfonylureas, meglitinides
oldest and cheapest of the oral agents
metformin, sulfonylureas (40years)
often used in combination with any of the other oral agents, first-line for 2DM
metformin
also helps lower TG and LDL cholesterol
metformin
not safe in settings of CHF
TZDs
should not be used in patients with elevated serum creatinine, or renal dysfunction
metformin, SGLT2 inhibitors
should not be used in patients with IBD
alpha- glucosideas inhibitors, GLP1 agonists, metformin
hepatic serum transaminase levels should be carefully monitored when using these agents
metformin, TZDs
not associated with weight gain, often used in overweight diabetic patients
metformin, DPP-2 inhibitors, GLP1 agonists, SGLT 2
metabolized by liver, acceptable choice in patients with mild to moderate renal disease
TZDs, DPP4 inhibitors
Hyperthyroid and palpation of single thyriod nodule
toxic thyroid adenoma
hyperthyroid and palpation of multiple thyroid nodules
multinodular goiter
hyperthyroid and recent study using IV contrast (iodine) in someone who was previously didn’t have enough iodine
Jod-Basedown phenomenon
hyperthyroid and recent eye changes including proprosis, edema, injection
Graves disease
History of thyroidectomy or radioablation of thyroid with hyperthyroid
excess thyroid hormone replacement
