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PC707 Pharmacology > Module 10 - Endocrine > Flashcards

Module 10 - Endocrine Flashcards

1
Q

What is the preferred drug for managing diabetes during pregnancy?

A

Insulin

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2
Q

Symptoms of type 1 DM result from _____________ of insulin caused by ________________ destruction of __________________ ___________ cells.

A

absence; autoimmune; pancreatic beta cells

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3
Q

What cells are our physiologic source of insulin?

A

pancreatic beta cells

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4
Q

T/F

Type 2 DM results from insulin deficiency.

A

False; there is insulin but there is a resistance to insulin or decreased insulin receptor activity

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5
Q

Symptoms of Type 2 DM result primarily from _____________ ______________ to insulin’s actions.

A

cellular resistance

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6
Q

T/F

Type 1 and Type 2 DM share the same long-term complications.

A

True, but risk & severity are higher and tends to occur faster with Type 1

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7
Q

Complications of DM:

A

Hypertension, heart disease, stroke, blindness, renal failure, neuropathy, lower limb amputations, erectile dysfunction, and gastroparesis

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8
Q 
Labs dx of DM:
Fasting:
2hr:
Random:
HgbA1c:
A

Fasting: >/=126
2hr: >/= 200
Random: >/= 200 with sx of DM- polyuria, polydipsia, sudden wt loss
HgbA1c: >/= 6.5%

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9
Q

Standard method for daily monitoring of diabetes therapy?

A

SMBG - self monitoring of blood glucose

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10
Q

How often should HgbA1c be measured? What is the target value?

A

Every 3-6 months; 7% or lower

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11
Q

Insulin is an _________ hormone.

A

anabolic

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12
Q

Two basic effects of insulin:

A
  1. stimulates uptake of glucose, amino acids and potassium

2. promotes synthesis of complex organic molecules (glycogen, proteins, triglycerides)

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13
Q

Insulin deficiency promotes ______________ by increasing _______________ and ________________ and decreasing ______________ utilization.

A

hyperglycemia; glycogenesis; glucogenesis; glucose

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14
Q

How many types of insulin are used in the USA? List.

A

7; Regular insulin (human insulin), NPH, and 5 human insulin analogs- insulin lispro, insulin aspart, insulin glulisine, insulin detemir, and insulin glargine

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15
Q

T/F

All insulin used in the US is synthetic (produced in lab).

A

True

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16
Q

Which 3 types of insulin have VERY rapid onset and short duration?

A

Lispro, aspart & glulisine

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17
Q

Rapid Acting Insulin - onset /lasts

A

Onset: 10-30min; Lasts: 3-6hrs

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18
Q

Which type of insulin has moderately rapid onset and short duration? What is this called?

A

Regular Insulin; Short Acting Insulin

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19
Q

Short Acting Insulin - onset/lasts

A

Onset: 30-60min; Lasts: 6-10hrs

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20
Q

Which type of insulin has intermediate duration?

A

NPH

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21
Q

Intermediate Acting Insulin - onset/lasts

A

Onset: 1-2hrs; Lasts: up to 24hrs

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22
Q

Which 2 types of insulin are long acting?

A

glargine & detemir

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23
Q

Long Acting Insulin (basal) - onset/lasts

A

Onset: 1-2hr; Lasts: 24hrs

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24
Q

T/F

Tight insulin control can be achieved with 1-2 injections/day.

A

False

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25
Q

Glargine & detemir are given _______ daily.

A

once

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26
Q

Methods to achieve tight control include:

  1. An evening injection of _________ supplemented with mealtime injections of ___________, _______, __________, or _______; or
  2. Continuous subQ infusion of ___________, _________, ______, or ___________ supplemented with mealtime __________ doses.
A
  1. Glargine; regular, lispro, aspart, or glulisine; or

2. regular, lispro, aspart, or glulisine; bolus

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27
Q

What is the major risk of intensive glycemic control?

A

Increased risk for hypoglycemia

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28
Q

How often should blood glucose be measured on a person taking insulin?

A

3-5/day

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29
Q

____________ ______________ __________ carries a greater risk of hypoglycemia than __________ _____________ __________.

A

Intensive insulin therapy; conventional insulin therapy

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30
Q

Hypoglycemia is defined as :

A

blood glucose <50

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31
Q

Symptoms of hypoglycemia:

A

Tachycardia, palpitations, sweating, headache, confusion, drowsiness, and fatigue.

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32
Q

_________ ____________ can delay awareness of hypoglycemia by _________ hypoglycemia-induced signs that are caused by activation of the __________ nervous system.

A

Beta blockers; masking; sympathetic

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33
Q

Beta blockers __________ the breakdown of h.epatic ____________ to __________, which would help restore/normalize ___________ ______________ in the event of _______________.

A

inhibit; glycogen; glucose; blood glucose; hypoglycemia

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34
Q

MOA - oral

Stimulate pancreas to release insulin (2)

A

Sulfonylureas & meglitinides

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35
Q

MOA - oral

A

Biguanides & sulfonylureas

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36
Q

MOA - oral

Inhibit liver production of glucose (glucogenesis) and liver breakdown of glycogen into glucose (glycolysis). (1)

A

Biguanides

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37
Q

MOA- oral

Inhibit the enzyme alpha-glucosidase which causes a decrease in intestinal secretion of glucose (1)

A

Alpha glucosidase inhibitors

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38
Q

MOA- oral

Increase sensitivity to insulin in the skeletal muscle (1)

A

Thiazolidinediones

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39
Q

MOA- oral

Increase insulin release, reduce glucagon release, decrease hepatic glucose production (2)

A

Gliptins or DPP-4 Inhibitors

40
Q

What oral meds cannot cause hypoglycemia?

A

Biguanides

41
Q

Biguanide - MOA (3)

A
  1. Enhance receptor sensitivity to insulin in muscle and fat
  2. Inhibit glucogenesis and glycolysis; decreases hepatic glucose output; slows release from liver
  3. Slightly reduces glucose absorption in gut
42
Q

Biguanide - Side effects

A

Gi disturbance - diarrhea, N&V, gas, bloating - usually go away after 2wks

43
Q

How can side effects of metformin (biguanide) be minimized?

A

Take with a meal; usually at night

44
Q

Biguanide - Contraindications

A

Renal disease, liver disease, severe infection , excess ETOH, at risk for hypoxic episodes (COPD, HF).

45
Q

There is a small risk for __________ ____________ _____________ with metformin (biguanide)

A

fatal lactic acidosis

46
Q

Metformin (Biguanide) may cause _______________ anemia.

A

megaloblastic- affects folate and b12

47
Q

Metformin (Biguanide) should be stopped the day before diagnostic tests where _______________. When can it be restarted?

A

dye is injected; May be restarted in 48hrs if creatinine was WNL after test.

48
Q

What med is first line tx for DM 2 when diet & exercise modifications have failed?

A

Biguanide (metformin)

49
Q

What med is used off label to treat pre-diabetes and PCOS

A

Biguanide (metformin)

50
Q

In the elderly, check the drug resource for the acceptable level of ___________ before giving biguanide (metformin), because it may not be safe even if lab is WNL.

A

creatinine

51
Q

Sulfonylureas - MOA (2)

A
  1. Stimulate beta cells in pancreas to secrete insulin

2. Increase sensitivity of tissues to insulin

52
Q

Should 1st gen or 2nd gen sulfonylureas be used?

A

2nd generation

53
Q

What is the main side effect of sulfonylureas ?

A

Hypoglycemia - more often with Glyburide; wt gain; increased risk of CV mortality

54
Q

Are sulfonylureas safe in pregnancy

A

No longer contraindicated but should be used with caution; especially in 1st trimester and end or 3rd trimester. Category C.

55
Q

Sulfonylureas have a _____________ efficacy over time.

56
Q

Sulfonylureas are tier ______ due to _________cost and _____________.

A

one; low; efficacy

57
Q

NSAIDs, sulfa antibiotics and ______________ are all protein bound; the competetive binding causes an ___________ in the free drug available which _______________ risk for ______________.

A

Sulfonylureas; increase; increases; hypoglycemia

58
Q

Signs and symptoms of hypoglycemia may be masked in patients taking __________ ____________.

A

beta blockers.

59
Q

T/F

Sulfonylureas are contraindicated in pts with a sulfa allergy.

60
Q

___________ ,an oral DM med, may increase the risk of sudden cardiac death.

A

Sulfonylureas

61
Q

Gliptins (DPP-4 Inhibitors) - MOA (1)

A
  1. Inhibits degradation of endogenous incretins which increases insulin secretion, decreases glucagon secretion, and decreases hepatic glucose production.
62
Q

Gliptins - Side Effects

A

URI, UTI, headache. In one can cause increase in pancreatitis

63
Q

Gliptins - contraindications

A

Type 1 DM, hx of pancreatitis

64
Q

______________ are considered 3rd line therapy in pts with HgbA1c >9%

A

Gliptins (DPP-4 Inhibitors)

65
Q

Thiazolidinediones- MOA

A

Enhances insulin sensitivity in muscle and fat by increasing glucose transporter expression. **muscle uptake

66
Q

Thiazolidinediones - side effects

A

promote water retention; anemia, edema, headache; reversible increase in ALT; edema; increase LFTs

67
Q

Thiazolidinediones - contraindications

A

Children, ketoacidosis, active liver disease, caution with class III / IV HF. Oral contraceptives.

68
Q

Meglitinides - MOA

A

Stimulate insulin release from beta cells - different action than sulfonylureas. **increase pancreatic insulin release

69
Q

What oral DM med is known to lower triglycerides and increase HDL?

A

Thiazolidinediones

70
Q

What oral DM med is taken with meals? Who are these good for?

A

Meglitinides; good for pts with erratic schedules and those with normal Fasting but high PP.

71
Q

T/F

Meglitinides have an increased risk for hypoglycemia in comparison with other agents.

A

False; rapid onset and short half life so less hypoglycemia

72
Q

What medication is often used in combination with meglitinides?

73
Q

Gliptins (DPP-4 inhibitors) are weight ___________.

74
Q

Meglitinides - Side effects

A

hypoglycemia; wt gain; Bloating, abdominal cramping, diarrhea, and flatulence

75
Q

Meglitinides are recommended as add on therapy ia A1c is _____ to _______%.

76
Q

T/F

Meglitinides have multiple drug interactions.`

A

True; esp gemfibrozil, NSAIDs & anti-hypertensives

77
Q

What med can decrease triglycerides and LDL; also cause weight loss?

A

Metformin (biguanide)

78
Q

Alpha glucose inhibitors: MOA

A

Work in small intestine to prevent glucose absorption

79
Q

alpha glucose inhibitors: side effects

A

Increase LFT’s; flatulence

80
Q

GLP 1 agonist/incretin mimetics; MOA

A
  1. stimulates GLP a receptors which stimulates insulin release
  2. decreases pp glucagon secretion
  3. slows gastric emptying
81
Q

GLP 1 agonists are non insulin __________.

A

injectable

82
Q

GLP 1 agonist side effects

A

hypoglycemia, nausea; wt loss

83
Q

When should asa therapy be advised in DM? how much

A

Men >50, Women >60 with at least one other risk factor for CVD. Do NOT recommend for everyone. 75-162 mg

84
Q

How many times SBGM during preg?

85
Q

What is used to screen for osteoporosis?

86
Q

What BMD signifies osteopenia?

A

> -1 to -2.5

87
Q

What BMD signifies osteoporosis

88
Q

Who should be screened for osteoporosis?

A

women >65; younger or perimenopausal women or men with diseases assoc with bone loss (long term steroid, hyperparathyroid); any adult over 50 with fx

89
Q

Recommended Calcium supplementation: ________mg/day

90
Q

T/F

It is better to divide calcium doses rather than take in one dose.

91
Q

Biophosphonates ___________ bone resorption, cause ____ _________ and are contraindicated in ______________. Must be taken ____________ and then ________ for ______ min after.

A

decrease; GI upset; GERD. 30min before eating/drinking; stay upright; 30min

92
Q

SERMs ________ bone resorption, are _________. Added benefit: decrease ________ and __________.
May cause _______________

A

decrease; hormonal. total cholesterol and LDL. leg cramps and hot flashes.

93
Q

Which med increases bone formation?

A

Hormone modifier - Forteo

94
Q

Which osteoporosis med needs to be discontinued 72hr prior to surgery?

95
Q

Which osteoporosis med can cause issues with osteonecrosis of the jaw (no dental surgery!)

A

Biophosphonates

96
Q

Calcitonin inhibits action of __________. Not effective in ____________ women. Decreases risk of ___________ compression fx. Has an _________ effect. Comes in _________ and _________.

A

oseteoclasts; early postmenopausal. vertebral. analgesic. injectable and nasal spray

PC707 Pharmacology (5 decks)

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