pharm-endocrine Flashcards
What happens when you have a decrease in blood glucose?
- you have a dec in insulin and inc glucagon/glcuoneogensis
- which inc blood glucose
- which inc insulin release and dec glucagon
- which removes glucose from blood and dec hepatic glucose production
type 1 DM
absolute deficiency of insulin production/secretion
- Autoimmune; process of islet cells of pancreas
- catabolic disorder
- children/young adults
what are the signs of uncontrolled/untreated DM?
-polyuria, inc thirst, weight loss, ketosis, fatigue, blurred vision, Numbness.tingling in hands and feet (big one!!) Look at Chart slide 8, 12, 13, 15!!!!
type 2 DM
- insulin Resistance primary (skeletal mm, fat)
- secondary is inadequate compensatory secretion
- dec beta cell mass, cell exhaustion & apoptosis
- inc hepatic glucose formation
- Lifestyle is a major contributing factor!!!
the 3 diagnostic values for DM
- Fasting blood glucose > 126mg/dl
- Two hour glucose tolerance test > 200
- (Hb)Alc- glycosylated hemoglobin: 4-6% normal, recommended 7% or less
Hemoglobin Alc
- portion of hemoglobin found in a blood sample that is glycosylated
- avg over past 4 weeks
- gives best overall avg of blood-sugar levels for longest period of time
- value of >8% ADA recommends reeval of therapy
What are the ultra-rapid Action Insulin
- Lispro, Aspart, Glulisine
- immediately before meals for postprandial glycemic control
Rapid insulin
- Crystalline-zinc insulin
- one hour or more before each meal
- maintenance or with intermediate or prolonged acting
Intermediate onset & action
-Isophane Insulin suspension (NPH insulin) (low yield i think)
Very slow onset, prolonged action Insulin
- ultralente insulin, insulin glargine, insulin detemir
- 12 to 24 hr
- may be supplemented by lispro or regular insulin
Manifestations of PNS & SNS hyperactivity from hypoglycemia
- tachycardia, palpitations, sweating, tremors (SNS)
- nausea, hunger, confusion (PNS)
Drugs for diabetes
- Amylinomimetic
- incretin mimetics
- insulins
- oral hypoglycemics
Amylinomimetic
Amyline- co-secreted w/insulin form pancreatic b-cells; inhibits glucagon
- Pramlintide (Symlin)
- Synthetic amylin
- inc peripheral glucose uptake
- AE: Hypoglycemia (insulin)
incretin mimetics
- Exenatide (Byetta); subcutaneous injection
- Incretin secreted from GI in response to food
- potentates insulin secretion
- AE: hypoglycemia, GI disturbance
What is the Incretin effect?
- facilitates the responses of the pancreas and liver to plasma glucose fluctuations
- significantly greater insulin stimulatory effect evoked after an oral glucose due to incretin
- T2DM reduced effect
Oral Antidiabetic drug (T2DM): Insulin Secretagogues
- sulfonylureas: Glyburide (Micronase), Glipizide (glucotrol)
- increase insulin release (endogenous) decrease glucagon release
- used with diet and exercise
- hypoglycemia
Oral Antidiabetic Drugs (T2DM): Thiazolidinediones
- Rosiglitazone (Avandia); Actos
- inc glucose uptake, dec lipolysis (ketone production) and dec hepatic gluconeogenesis
Oral Antidiabetic drugs (T2DM): Biguanides
- Metformin (glucophage)
- inc peripheral tissue insulin sensitivity
- do not cause hypoglycemia!
Hypoglycemia
- glucose <70
- Insulin, Exenatide, Pramlinitide: can cause hypo
- Prevention: balanced meals, eat prior to exercise, monitor during
- symp: HA, confusion, dizziness, weakness, hunger, blurred vision
What is lactic acidosis & Hyperglycemia
LA: impaired conversion of lactic acid to glucose, pH < 7.35
Hyperglycemia: >180-200; increased thirst & frequent urination
Ketoacidosis (DKA)
- common in T1DM/low CHO diets
- release of ketons from oxidation of fats
- ph<7.35
- thirst, fruit breath, fatigue, confusion, N/V, polyuria, twitching cramps, convulsions
Thyroid
- primary hormones are T4, T3
- regulates metabolism
T3
- Triiodothryonine (Liothyronine)
- secredted by throid gland
- 10x more potent than T4
T4
- thyroxine
- secreted by thyroid
- converted to T3 in liver/kidneys
Hyperthyroidism- Graves disease
- autoimmune; excessive secretion; goiter
- high Ca levels, inc metabolism
- tachycardia, weight loss, heat intolerance, tremor, dyspnea, frozen should, protruding eyes
- proximal muscle weakness
- adhesive capsulitis
- inc in DTR
Hyperthyrodism- Thioamides
- Propylthiouracil (PTU) & Methimazole (Tapazole or Thiamazole)
- inhibits conversion ot T4 to T3 & synthesis of thyroid hormone
- AE- birth defects (Tapazole), rash, immune reactions
Hyperthyroidism- Iodide Salts & Iodine
- Iodid Salts: inhibit thyrod hormone release
- Radioactive Iodine: suppress conversion of T4 to T3
Hypothyroid- Hashimotos Thyroiditis
- inflammation of thyroid or inadequate stimulation from pituitary
- slowing metabolism, weight gain
- myalgias, trigger points, fatigue, cold intolerance,atherosclerosis
- rhabdomylosis
Hypothyroid- Pharmacology
- Levothyroxine: synthetic T4 (most common)
- Liothyronine: synthetic T3 (quicker, more $$)
- AE: hyperthyroidism, stimulates heart in older/cardiac pts
Glucocorticoids
-Cortisol, Prednizone, Dexamethasone Triamcinolone
-mimic endogenous production; used for anti-inflammatory
-used for Addisons, allergies, hematologic disorders, RA, skin diseases, neurological disorders
-SE- insulin resistance, muscle wasting, immunosuppression, AVN-HIP
-produced by adrenal glands
-
Addisons Disease
- Adrenal insufficiency; lack of cortisol and aldosterone release from adrenal gland
- weakness, bone loss
- Pharm: Cortisol (glucocorticoids), Fludocortisone (mineralocorticoid
Cushing’s Syndrome
- excessive cortisol release from the adrenal gland
- hyperglycemia, hypertension, muscle wasting, steroidal diabetes, MOOON FACE :)
- Pharm Tx- Corticosteriod antagonists–> Ketoconazole, Mifepristone
