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NSG 533 > Exam 1- Endocrine > Flashcards

Exam 1- Endocrine Flashcards

1
Q

What is the first line medication for diabetes?

A
  • metformin
    - met Forman is strongly associated with improved long-term outcomes for adults with type two diabetes and should almost always be started first
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2
Q

What are some other options of medication to start after metformin?

A
  • sulfonylureas
  • thiazoldinediones
  • DPP4 inhibitors
  • SGLT2 inhibitors
  • injectables ( GLP 1 agonist)
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3
Q

What are examples of when another medication other than metformin should be started on diabetic patients?

A
  • if there is a contraindication to metformin like renal impairment or diabetic ketoacidosis
  • intolerance to metformin ( nauseous, vomiting, diarrhea, stomach pain)
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4
Q

What are the medications you would have to add as the second agent in diabetic patients with cardiovascular or kidney disease

A
  • semaglutide, empaglifozin, canagliflozin, dapagliflozin

( -glifozin = diabetic cardio patients)

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5
Q

When should insulin be added in conjunction with metformin?

A
  • insulin in conjunction with metformin should be initial therapy for patient with a very high A1c ( more than 9)
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6
Q

What is the major cause of morbidity in diabetic patients?

A

Cardiovascular disease

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7
Q

Medication management for diabetic patients with hypertension

A
  • different first line anti-hypertensive meds can be used like ACE inhibitors, ARBS, and calcium channel blockers
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8
Q

Oral anti-diabetic meds are just for which type of diabetes?

A
  • type 2!!

( type 1: insulin dependent so only get insulin

Type 2 : can be given insulin or oral antidiabetic agents)

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9
Q

What is a key side effect in a lot of oral anti diabetic medication

A

Hypoglycemia
( can go down too low)

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10
Q

What are examples of sulfonyuera medications? How does it work? Side effects and patient education?

A
  • glipizide, glyburide
  • brings blood sugar down by increasing release of insulin from pancrease
  • side effects: hypoglycemia ( blood sugar goes down too much)
  • take 30 min before meals
    Can cause photosensitivity- wear sunscreen when going outside
    • think glip = slide= going down ( BS down) . Slides are in the park outside = photosensitivity
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11
Q

Metglitinides ( example, side effects, education)

A
  • ex: repaglinide
  • helps increase insulin release from the pancreas
  • side effects: hypoglycemia, angina
  • education: take 3 times a day and eat within 30 min of taking med
    • think pag= pageant= pageant queen having angina
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12
Q

What medication class is metformin?

A

Biguanides

Bye guy, I’m taking metformin

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13
Q

Metformin ( how does it work, side effects, pt education)

A
  • decreases glucose production in the liver by increasing uptake of glucose in the body cells
  • side effects: GI upset, metallic taste, lactic acidosis ( dizziness, diarrhea, bradycardia, hypotension )
  • education: take with meals if procedure with contrast, diet or needs to be NPO= discontinue metformin 48 hours before procedure

• think metFORMIN= foreman= foreman going to construction site with a metal bottle, drinks it and has the metallic taste in mouth and starts to feel dizzy and have diarrhea 

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14
Q

What anti-diabetic meds can cause weight gain/ loss?

A
  • weight gain: insulin, sulfonlyureas ) glip, gly) thiazolodinediones ( TZD) ( ex. Pioglitazone, rosiglitazone)
  • weight loss: GLP1 receptors ( end in glutide) ( semaglutide aka ozempic), SGLT Inhibitors ( end in flozin. Ex: empagliflozin aka jardiance)
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15
Q

Which antidiabetic meds can cause hypoglycemia?

A
  • sulfonylureas ( glipizide, glyburide, glimepride)
  • meglitinides ( repaglinide, nateglinidine)
  • regular insulin, insulin lispro, insulin aspart
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16
Q

How does metformin work?

A

Decreases glucose production in the liver by increasing uptake of glucose by the body cells

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17
Q

Side effects of metformin?

A
  • GI upset, metallic taste, lactic acidosis ( dizziness, diarrhea, hypotension, bradycardia)
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18
Q

Metformin is contraindicated in patients with glomerular rates ( eGFR) less than…

A

30

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19
Q

Metformin should be avoided in patients with…

A

Liver disease

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20
Q

Differences in ADA/ AACE recommendations for glycemic targets

A

ADA : less than 7%
AACE: less than 6.5%

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21
Q

Why is metformin considered an essential component in type 2 diabetes?

A
  • because of its effectiveness, safety people, and long term beneficial effects
  • metformin doesn’t cause hypoglycemia
  • weight neutral
  • lowers A1C by 1-2% which is better than other oral anti-diabetic meds
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22
Q

Thiazolidinediones ( TZDs)
- medication examples,
- when to avoid TZDs

A
  • ex: pioglitazone, rosiglitazone ( end in litazone)
  • avoid in patients with cardiovascular disease!!! Associated with increased CV and edema. May provide fluid retention and edema
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23
Q

Incretin mimetics are associated with…

A
  • weight loss. ( May be desirable in obese patients)
  • incretin mimetics are agents that act like incretin hormones like GLP1 ( end in - tide)
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24
Q

When is metformin contraindicated?

A
  • renal impairment ( eGFR less than 30)
  • DKA
  • lactic acidosis ( any condition associated with increased risk of lactic acidosis like severe infection, shock, hypoxemia)
  • liver disease ( can increase risk of lactic acidosis)
  • heart failure
  • alcoholism
  • use in caution with older adults
25
Q

When should insulin be considered in type 2 diabetes?

A
  • when patients aren’t achieving their glycemic targets despite use of oral anti-diabetic medications or when there is a rapid and significant reduction in blood glucose levels
    -over time, patients with type 2 diabetes may need insulin to better control blood glucose
26
Q

DDP 4 inhibitors ( med examples?)

A
  • End in lipton ( ex sitaglipton, linaglipton)

Think DDP always has the tea( Lipton)

27
Q

How should insulin be initiated so the patient doesn’t experience hypoglycemia?

A
  • basal insulin should be initiated first ( usually 10 units once daily )
    - adjust the dose based on fasting blood glucose levels. Common titration strategy: increase the dose by 2-4 units every 3-7 days until the fasting blood glucose in the target range
  • discontinue oral secretagogues
  • start with long acting insulin if a basal is not used
28
Q

SGLT2 ( med examples)

A
  • end in flozin ( canagliflozin, dapagliflozin)
29
Q

What type medication would be good for a diabetic patient with cardiovascular problems?

A
  • SGLT2 inhibitors ( - flozin). SGLT2s regardless of type of heart failure. They are approved to include cardiovascular benefits.
30
Q

GLP 1 ( glucagon like peptide 1) med examples and good for weight…

A
  • weight loss ( part of incretins)
  • examples: end in tide
31
Q

Which med class would you NOT want to use in diabetic patients with heart failure?

A
  • thiazolidinediones ( TZD) ( ex pioglitazone/ actos)
    Can produce fluid retention and meds= contraindicated in heart failure. Can cause weight gain
32
Q

Cholesterol control in diabetic patients.. what type of meds should every diabetic patient be on

A
  • statin ( atorvastain, others that end in statin). Lowers cholesterol
33
Q

Cholesterol control in diabetic patients.. what type of meds should every diabetic patient be on

A
  • statin ( atorvastain, others that end in statin). Lowers cholesterol
34
Q

What kind of meds should a diabetic patient be on with hypertension?

A

-ACE ( - pril)
-ARBs ( end in sartan)
- calcium channel blockers
• ACE and ARB are also first line for patients with with renal or kidney disease

35
Q

Diabetic meds that cause weight gain

A
  • sulfonylureas ( glipizide, glyburide) and metglitinides ( repaglinide)
36
Q

SGLT2 side effects

A

( end in flozin)

  • side effects: UTI, fungal infections, hyperkalemia
37
Q

GLP1 side effects and contraindications

A

( end in tide)
- weight loss
- contraindications: hx of thyroid cancer, pancreatis

38
Q

Insulin ( how many non insulin options before switching to insulin?

A

3

39
Q

Starting insulin therapy, what meds to stop?

A

When you start with fast acting insulin, stop sulfonylureas ( metformin and GLP can continue)

40
Q

Insulin can cause weight…

A

Gain

41
Q

Hypothyroidism vs hyperthyroidism levels

A

T4 is what you should look at ( low= hypo). TSH is the opposite

  • hypothyroidism: low T4, high TSH
  • hyperthyroidism: high T4, low TSH
42
Q

TSH normal range

A

0.5-4.5

43
Q

What is the drug of choice for hypothyroidism?

A

Levothyoxine. Take in AM on empty stomach!!
( synthetic LT4- mimics the normal physiology of the thyroid gland. Stable and well tolerated)
Patients don’t need frequent monitoring since it’s stable, just need monitoring of TSH levels

44
Q

Hypothyroidism and pregnancy

A
  • hypothyroidism during pregnancy has a lot of adverse effects. Increased rate of miscarriage and decreased intelligence in baby
  • pregnant women need more levo, TSH levels need to be monitored every 4-6 weeks
45
Q

What’s the cause of hypothyroidism?

A
  • hashimotos
  • iodine deficiency or excess
46
Q

What’s the cause of hyperthyroidism?

A
  • Graves’ disease
  • hyperthyroidism: exophthalmus ( bulging eyes)
47
Q

What are the 4 types of insulin?

A
  • rapid acting
  • short acting
  • intermediate
  • long lasting
48
Q

What are the onset, peaks, and durations of the diff types of insulin?

A
  • rapid acting ( lispro, aspart) : onset 15 min, peak 1 hr, duration 2-4 hrs
  • short acting ( regular insulin Humulin R or novolin R): onset 30 min, peak 2-3 hrs, duration 3-6 hrs
  • intermediate ( NPH) onset 2-4 hrs, peak 4-12 hrs, duration 12-18 hrs
  • long acting ( glargine, determir) : onset 3-4 hrs, NO PEAK, Duration 24 hrs
49
Q

What’s example of rapid acting insulin ?

A

Insulin Lispro( humalog) and aspart ( novolog) . Onset 15 min, peak 1 hr, duration 2-4 hrs . Since its rapid onset, make sure their food is right in front of them

• think logs rolling rapidly down hill

50
Q

What’s examples of short acting insulin?

A

Regular insulin ( humulin R or Novolin R)

Onset: 30 min
Peak: 2-3 hrs
Duration: 3-6 hrs

51
Q

What’s an intermediate insulin?

A
  • NPH

onset: 2-4 hrs
Peak: 4-12 hrs
Duration: 12-18 hrs

• think of actor Neil Patrick Harris (NPH) , when you call him he will be on set in 2-4 hrs and stays for a duration up to 18 hrs

52
Q

What are examples of long lasting insulin?

A
  • glargine ( lantus) think large= long
  • determir ( levemir) think detemir lasts a year

Onset: 3-4 hrs
NO PEAK
Duration 24 hrs

Think of old guys= reached their peak (no peak) and don’t mix well ( don’t mix long lasting insulin)

53
Q

With insulin, draw up…

A

Clear before cloudy

54
Q

When should insulin in conjunction with metformin be considered as initial therapy?

A
  • When a patient has a very high A1C greater than 9%
  • usually basal insulin is the first insulin added
55
Q

What is thyrotoxicosis

A
  • signs and symptoms associated with high T3 and T4 that are excessive for the individual ( hyperthyroidism)
56
Q

What is the medication used for hyper thyroidism?

A
  • propylthiouracil ( PTU) and methimazole ( MMI)
57
Q

Graves’ disease and pregnancy medication dosage

A

Graves ( hyperthyroidism)
PTU at the lowest possible dose then switch to MMI for 2nd and 3rd trimester

58
Q

What is a serious adverse effect of hyperthyroid meds? ( PTU and MMI)

A

Agranulocytosis ( decrease in granulocytes which is a type of white blood cell)

59
Q

NTI ( narrow therapeutic index) and levo

A

Small NTI so small changes can result in significant change in hormone levels

NSG 533 (4 decks)

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