Unit 10: Endocrine Flashcards
Normal fasting glucose
<100
Normal 2 hour post load glucose
<140
Normal HbA1C
<5.7%
Normal random plasma glucose
<200
Sulfonylureas
Oral hypoglycemics for type 2 DM
Bind to beta cell receptors causing ATP dependent K+ channels to close; Ca channels then open causing release of insulin
Second generation more potent
1st generation sulfonylureas
Tolbutamide, chlorpropamide, tolazamide
2nd generation sulfonylureas
glyburide, glipizide, glimepiride
Most important SE of sulfonylureas
Hypoglycemia
Biguanides
Metformin
Not considered hypoglycemic as it does not increase insulin secretion
Inhibits glucose production and improves sensitivity to insulin
Used in conjunction with diet as first line therapy
Does not cause hypoglycemia
Metformin CI in
renal issues, HF, pregnancy, alcoholics, >80 years old, children
Most common SE of metformin
GI upset
Thiazolidinediones
Rosiglitazone + Pioglitazone
Decrease insulin resistance at sites of insulin action
Bind to nuclear steroid hormone receptor and increase insulin sensitivity in skeletal muscle and fat
Alpha glucosidase inhibitors
Acarbose + Miglitol
Slows absorption of carbs from intestines, minimizing postprandial rise in blood sugar
Most useful in patients with post prandial hyperglycemia, very high HbA1c and poor diet adherence
Meglitinide analogs
Repaglinide + Nateglinide
Rapid acting insulin secretagogues that stimulate release of insulin from pancreas in response to a meal
Effective in patients who become hypoglycemic with sulfonylureas and have acceptable fpg levels but high postprandial blood glucose
Meglitinide analogs CI in
Type 1 DM, DKA, severe infection, surgery, trauma, pregnancy, BF
Dipeptidyl peptidase 4 inhibitors
-Gliptin
DPP4 usually inactivates GLP-1 so by inhibiting DPP4 there is an increase in amount of circulating GLP1
GLP-1 receptor agonists
-glutide
Used as adjunct therapy
Stimulates glucose dependent secretion of insulin from pancreatic beta cells while decreasing inappropriate release of glucagon from alpha cells
Also slows gastric emptying
Decreased postprandial and fasting glucose and avoids hypoglycemia
Dopamine receptor agonists
Bromcocriptine mesylate
Postprandial glucose levels are improved without increasing insulin concentrations
Amylin analog
Pramlintide
Delays gastric emptying, alters release of additional inappropriate glucagon by alpha cells, increases satiety
Sodium-glucose co-transporter 2 inhibitors
-gliflozin
Induces glycosuria through kidneys independent of insulin by inhibiting SGLT-2 transport system
Causes 60% excretion of glucose in urine
Roles of insulin
Rapid transport of glucose and amino acids intracellularly, promotes uptake and storage of glucose in liver, inhibits gluconeogenesis, and promotes conversion of excess glucose into fat
Very rapid acting insulin
Insulin analog
Short acting insulin
Regular insulin
Intermediate acting insulin
NPH
Long acting insulin
Glargine + Detemir
Recommended treatment for type 2 DM If entry HbA1C <7.5%
Monotherapy with oral agents– metformin, GLP-1, DPP4I, AGI
Second line–SGLT-2, TZD, SU/GLN
Recommended treatment for type 2 DM If entry HbA1C >7.5%
First line: metformin
Second line: combo of sulfonylureas + metformin, TZD or alpha glucosidase inhibitors
Recommended treatment for type 2 DM If entry HbA1C >9%
Consider insulin therapy
Drug therapy for hypothyroidism
Replacement with thyroid hormone in form of T4
Levothyroxine, liothyronine
3 main treatment options for hyperthyroidism
Antithyroid drugs, radioactive iodine, surgery
Antithyroid drugs
Methimazol + Propylthiouracil
Inhibits iodine organification, blocks conversion of T4 to T3 in periphery
Adjunct therapy for hyperthyroidism
Beta blockers (propranolol or atenolol), iodine containing compounds, lithium, glucocorticoids
Sulfonylureas should not be used in
Pregnant or breastfeeding women as it can cause severe hypoglycemia in fetus or infant
SE of biguanides
GI distress; lactic acidosis can occur with metformin
Biguanides CI in
patients with renal insufficiency of creatininine clearance, heart failure, pregnancy, children, alcoholics, those with dehydration
What needs to be monitored with thiazolidinediones
Liver function tests–may cause hepatic dysfunction
May exacerbate heart failure
Alpha glucosidase inhibitors CI in
patients with IBD, colon ulceration, obstructive bowel disorders, chronic intestinal disorders, liver disease, breastfeeding
