EXAM 3 Flashcards
Hormone that increases blood glucose levels:
Glucagon
Secreted by the pancreas.
Production of glycogen from glucose in the liver:
Glycogenesis
Hormone that decreases blood glucose levels:
Insulin
Glycogen broken down to release glucose into the bloodstream:
Glycogenolysis
Production of glycogen from glucose in the liver:
Glycogenesis
The most common endocrine disorder:
Diabetes
Three types of diabetes:
Type I, Type II, Gestational
Production of glucose from non-carbohydrate sources:
Gluconeogenesis
Production of glucose from amino acids and/or glycol
This type of diabetes is from the absence of insulin:
Type I
Due to the beta cells being attacked in the pancreas and no longer able to synthesize insulin. Autoimmune disorder.
5-10% of all cases
This disorder results from the absence of, deficiency of, or resistance to insulin leading to hyperglycemia:
Diabetes
Excessive amounts of urine:
Polyuria
Excessive thirst:
Polydipsia
This gland lies on both sides of the trachea and secretes hormones that have a profound effect on metabolism, GI function, cardiac function, and growth and development:
Thyroid gland
Tri-iodothyronine (T3)
and
Thyroxine (T4)
Majority of the hormone is in the T4 form and is in circulating mode… Once it enters the peripheral tissues it converts to T3. This is the ACTIVE form.
Feedback loop for thyroid gland:
Starts in the Hypothalamus which releases TRH (thyrotropic releasing hormone which travels to the anterior pituitary)
Anterior pituitary receives the TRH which stimulates the release of the TSH (thyroid stimulating hormone).
This travels to the thyroid gland which secretes thyroxine (T4).
Once the “loop” receives negative feedback that homeostasis has been reestablished, the hypothalamus acts on this and stops releasing TRH, stopping the loop.
This cause of Hypothyroidism is an autoimmune thyroiditis:
Hashimoto’s thyroiditis
This prototype is identical to endogenous insulin. It is used to decrease blood glucose levels by transporting glucose into the cell (gatekeeper):
Human Regular Insulin (Humulin R) - prototype
Administered subcutaneously or IV
Via insulin syringe, Opticlick pen, or insulin pump.
Used to decrease blood glucose levels by transporting glucose into the cell “gatekeeper”.
Both Humulin R and Novlin R are used for short duration insulin therapy.
Time at which a physiological response happens:
Onset
Time at which the max effect of drug happens:
Peak
Total length of time for physiologic response:
Duration
Adverse effects of insulin administration:
Hypoglycemia
Insulin shock
Requires immediate treatment with glucose:
Hypoglycemia
This prototype is used in the emergency treatment of hypoglycemia:
Glucagon (GlucaGen)
Used when the patient is unconscious or unable to eat/drink.
It stimulates the breakdown of stored glycogen (glycogenolysis).
It increases glyconeogenesis.
Given by IV, IM, SQ
Adverse effects: nausea/vomiting, hyperglycemia
Every type of insulin has a clear appearance, except one. Which one?
Isophane insuline (NPH, Humulin N)
This is the only intermediate timed insulin.
1 - 1.5 hr onset/ 6 - 10 hr peak/ 14 -16 hr duration
How long is the onset and duration of Humulin N?
Onset: 1-1.5 hours
Peak: 6-10 hours
Duration: 14-16 hours
Which insulins are short durations?
lispro (Humalog) 5-15 min onset/20-90 min peak/3-4 hr duration
aspart (Novolog) 10-20 min onset/1-3 hr peak/3-5 hr duration
regular (Humulin R) 30-45 min onset/2-4 hrs peak/5-6 hr duration
What is the name of the only long duration insulin?
Insulin glargine (Lantus)
1 - 2 hr onset
No peak
21 - 24 hr duration
Gestational diabetes is intolerance to what?
Glucose
Typical lab values for fasting plasma levels: 60 - 100 mg/dL
Prediabetes: 100-125 mg/dL
126 = diabetes
What is the name of the anti-diabetic drug from the mm class?
(Januvia)
Name of test measured over 2-3 months:
HbA1C
greater than 6.5% = diabetes
Which class does Metformin (Glucophage) belong to?
Biguanides
Metformin (Glucophage): prototype: Very common anti-diabetic drug.
Reduces gluconeogenesis
Decreases reabsorption of glucose in GI tract
Adverse effects: decreased appetite, decreased reabsorption of B12 and folic acid
Rarely causes hypoglycemia
Contraindicated in patients with renal impairment (can build up to a toxic level), IV contrast dye (time-frame: they have to wait 2 days prior to dye and 2 days after receiving the dye to receive drug
Which class does Repaglinide (Prandin) belong to?
Meglitinides
Repaglinide (Prandin): prototype: Stimulates the pancreas to produce more insulin (beta cells)
Adverse effects: Hypoglycemia
Which class does Rosiglitazone (Avandia) belong to?
Thiazolidinediones (TZDs)
Rosiglitazone (Avandia): prototype: Increases cellular sensitivity to insulin (decreases insulin resistance)
Decreases gluconeogenesis
Adverse effects: edema, macular edema, increased lipid levels (so have to be careful with patients with high cholesterol or high triglycerides already)
Which class does Acarbose (Precose) belong to?
Alpha-Glucosidase Inhibitors
Acarbose (Precose): prototype: delays absorption of dietary carbohydrates in the GI tract
Adverse effects: diarrhea, flatulence, abdominal distention.
Which class does Sitagliptin (Januvia) belong to?
Incretin Enhancers
Sitagliptin (Januvia): Inhibits enzyme DPP-4 from breaking down incretins (the hormone released by the small intestine in response to meals)
Increased levels of incretin = decreased blood glucose levels
newer type drug
Adverse effects: may increase digoxin levels (ppl who are taking digoxin for heart may not be able to take this)
Which class does Sitagliptin (Januvia) belong to?
Incretin Enhancers
What is T4 synthesized from?
Tyrosine and iodine
And excess of Levothyroxine (Levothroid, Synthroid) can have what adverse effects?
Tachycardia palpitations nervousness tremors insomnia
What is the Proto type drug for graves disease?
Propylthiouracil (PTU)
Inhibits first step in the synthesis of thyroid hormone, suppresses the conversion of T4 to T3, therapeutic effects are delayed 3 to 12 weeks.
Adverse affects: Agranulocytosis (leukopenia or decreased white blood cell count), hypothyroidism, Parethesia’s.
What is the sensation of pins and needles called?
Paresthesia
Diaphoresis, pallor, shaking, and confusion are all signs of what?
Possible insulin shock, or hypoglycemia.
Severe: sleepiness then lethargy, coma, death
Hypo-under 60
