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Pharm- Endocrine/cancer/RA > pharm-endocrine > Flashcards

pharm-endocrine Flashcards

1
Q

What happens when you have a decrease in blood glucose?

A
  • 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
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2
Q

type 1 DM

A

absolute deficiency of insulin production/secretion

  • Autoimmune; process of islet cells of pancreas
  • catabolic disorder
  • children/young adults
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3
Q

what are the signs of uncontrolled/untreated DM?

A

-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!!!!

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4
Q

type 2 DM

A
  • 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!!!
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5
Q

the 3 diagnostic values for DM

A
  • Fasting blood glucose > 126mg/dl
  • Two hour glucose tolerance test > 200
  • (Hb)Alc- glycosylated hemoglobin: 4-6% normal, recommended 7% or less
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6
Q

Hemoglobin Alc

A
  • 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
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7
Q

What are the ultra-rapid Action Insulin

A
  • Lispro, Aspart, Glulisine

- immediately before meals for postprandial glycemic control

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8
Q

Rapid insulin

A
  • Crystalline-zinc insulin
  • one hour or more before each meal
  • maintenance or with intermediate or prolonged acting
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9
Q

Intermediate onset & action

A

-Isophane Insulin suspension (NPH insulin) (low yield i think)

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10
Q

Very slow onset, prolonged action Insulin

A
  • ultralente insulin, insulin glargine, insulin detemir
  • 12 to 24 hr
  • may be supplemented by lispro or regular insulin
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11
Q

Manifestations of PNS & SNS hyperactivity from hypoglycemia

A
  • tachycardia, palpitations, sweating, tremors (SNS)

- nausea, hunger, confusion (PNS)

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12
Q

Drugs for diabetes

A
  • Amylinomimetic
  • incretin mimetics
  • insulins
  • oral hypoglycemics
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13
Q

Amylinomimetic

A

Amyline- co-secreted w/insulin form pancreatic b-cells; inhibits glucagon

  • Pramlintide (Symlin)
  • Synthetic amylin
  • inc peripheral glucose uptake
  • AE: Hypoglycemia (insulin)
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14
Q

incretin mimetics

A
  • Exenatide (Byetta); subcutaneous injection
  • Incretin secreted from GI in response to food
  • potentates insulin secretion
  • AE: hypoglycemia, GI disturbance
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15
Q

What is the Incretin effect?

A
  • 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
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16
Q

Oral Antidiabetic drug (T2DM): Insulin Secretagogues

A
  • sulfonylureas: Glyburide (Micronase), Glipizide (glucotrol)
  • increase insulin release (endogenous) decrease glucagon release
  • used with diet and exercise
  • hypoglycemia
17
Q

Oral Antidiabetic Drugs (T2DM): Thiazolidinediones

A
  • Rosiglitazone (Avandia); Actos

- inc glucose uptake, dec lipolysis (ketone production) and dec hepatic gluconeogenesis

18
Q

Oral Antidiabetic drugs (T2DM): Biguanides

A
  • Metformin (glucophage)
  • inc peripheral tissue insulin sensitivity
  • do not cause hypoglycemia!
19
Q

Hypoglycemia

A
  • 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
20
Q

What is lactic acidosis & Hyperglycemia

A

LA: impaired conversion of lactic acid to glucose, pH < 7.35

Hyperglycemia: >180-200; increased thirst & frequent urination

21
Q

Ketoacidosis (DKA)

A
  • 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
22
Q

Thyroid

A
  • primary hormones are T4, T3

- regulates metabolism

23
Q

T3

A
  • Triiodothryonine (Liothyronine)
  • secredted by throid gland
  • 10x more potent than T4
24
Q

T4

A
  • thyroxine
  • secreted by thyroid
  • converted to T3 in liver/kidneys
25
Q

Hyperthyroidism- Graves disease

A
  • 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
26
Q

Hyperthyrodism- Thioamides

A
  • Propylthiouracil (PTU) & Methimazole (Tapazole or Thiamazole)
  • inhibits conversion ot T4 to T3 & synthesis of thyroid hormone
  • AE- birth defects (Tapazole), rash, immune reactions
27
Q

Hyperthyroidism- Iodide Salts & Iodine

A
  • Iodid Salts: inhibit thyrod hormone release

- Radioactive Iodine: suppress conversion of T4 to T3

28
Q

Hypothyroid- Hashimotos Thyroiditis

A
  • inflammation of thyroid or inadequate stimulation from pituitary
  • slowing metabolism, weight gain
  • myalgias, trigger points, fatigue, cold intolerance,atherosclerosis
  • rhabdomylosis
29
Q

Hypothyroid- Pharmacology

A
  • Levothyroxine: synthetic T4 (most common)
  • Liothyronine: synthetic T3 (quicker, more $$)
  • AE: hyperthyroidism, stimulates heart in older/cardiac pts
30
Q

Glucocorticoids

A

-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
-

31
Q

Addisons Disease

A
  • Adrenal insufficiency; lack of cortisol and aldosterone release from adrenal gland
  • weakness, bone loss
  • Pharm: Cortisol (glucocorticoids), Fludocortisone (mineralocorticoid
32
Q

Cushing’s Syndrome

A
  • excessive cortisol release from the adrenal gland
  • hyperglycemia, hypertension, muscle wasting, steroidal diabetes, MOOON FACE :)
  • Pharm Tx- Corticosteriod antagonists–> Ketoconazole, Mifepristone

Pharm- Endocrine/cancer/RA (3 decks)

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