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Pharm Exam 5 > Unit X Endocrine, Chapters 48 & 49 > Flashcards

Unit X Endocrine, Chapters 48 & 49 Flashcards

1
Q

How is T2D Diagnosed (labs)

A

Hbg A1C 6.5% or higher
Fasting Blood glucose > 126
Random Blood Glucose or OGTT > 200

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2
Q

Tx for T2D: Step 1

A

Metformin and lifestyle changes

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3
Q

Tx for T2D: Step 2

A

Maintain Step 1 (Metformin & Lifestyle)

Add second Drug
TZD (Actos)
DPP-4 Inhibitor (Januvia)

SGLT-2 Inhibitor (Conagliflozin)
GLP-1 Receptor Agonist (Exenatide)

*Can try Sulfonylurea or basal insulin if do not achieve blood glucose goal with these options.

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4
Q

Tx for T2D: Step 3

A

Maintain Step 2 (Metformin & Lifestyle + additional drug)

Add third Drug (Can consider possible basal insulin)

TZD (Pioglitazon, Actose, Avandia)
DPP-4 Inhibitor (Sitagliptin)

SGLT-2 Inhibitor (Conagliflozin)
GLP-1 Receptor Agonist (Exenatide)

Drug choice depends on step 2 choices and independent patient factors

*As with step 2, a drug listed above can be replaced with a sulfonylurea or basal insulin if goal is not been reached with current regimen.

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5
Q

Tx for T2D: Step 4

A

If 3 drug combo that includes basal insulin fail (after 3-6 months), proceeded to combo injectable including insulin and GLP-1 Receptor Agonist

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6
Q

What T2D treatment step is the starting point for an Hbg A1C >9%

A

Step 2

Metformin & Lifestlye + Additional Drug

TZD (Proglitazone, Actose, Avandia)
DPP-4 Inhibitor (Sitagliptin)

SGLT-2 Inhibitor (Conagliflozin)
GLP-1 Receptor Agonist (Exenatide)

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7
Q

What is the starting treatment for a pt diagnosed with T2D with a Hbg A1C of 10% or greater, a fasting blood glucose of 300 or more, or are markedly symptomatic?

A

Combination injectable therapy

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8
Q

Where is insulin synthesized and what does it do?

A

Synthesized by beta cells in the pancreas and is normally secreted in response to a rise in glucose levels

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9
Q

What duration of action is (Insulin):
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Adipra)

A

Short duration/RAPID-acting

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10
Q

How are short duration/rapid acting insulins administered in relation to meals?

A

GIVEN WITH MEALS (15-20 min before eating)

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11
Q

What duration of action is (Insulin):

Regular (Humulin/NovolinR)

A

Short Duration/SHORT acting

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12
Q

How are short-duration/short-acting insulins administered in relation to meals?

A

GIVEN WITH MEALS

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13
Q

Which insulins are considered short-duration/RAPID acting?

A

Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)

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14
Q

Which insulins are considered short-duration/SHORT acting?

A

Regular Insulin (Humulin/NovolinR)

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15
Q

What duration of action (Insulin) is Humulin/NovolinN?

A

Intermediate (NPH)

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16
Q

Which Insulin(s) are Intermediate Acting?

A

NPH (Humulin/NovolinN)

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17
Q

How is Humulin/NovolinN administered in relation to meals?

A

Not given with meals

Regularly dosed 2-3 times per day

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18
Q

What is the ONLY insulin that can be mixed with short-duration insulins?

A

Intermediate (Humulin/NovolinN)

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19
Q

Which insulins are considered Long Duration?

A

“Basal Insulin”
Glargine (Lantus)
Detemir (Levemir)

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20
Q

What duration of action (Insulin) are Glargine (Lantus) and Detemir (Levemir)

A

Long Duration

*also referred to as ‘basal insulin’

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21
Q

How are Long Duration Insulins dosed?

A

Once a day, taken at night

24 hour duration

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22
Q

Which insulins are considered Ultra-Long Duration?

A

Glargine (Toujeo)

Degludec (Tresiba)

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23
Q

What duration of action (Insulin) are Glargine (Toujeo) & Dejludec (Tresibia)

A

Ultra-long duration

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24
Q

When is the use of Ultra-Long Duration insulin indicated?

A

When diabetes is very difficult to control

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25
Q

What is the major concern/risk factor for patients taking insulin?

A

Hypoglycemia

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26
Q

How is hypoglycemia managed in patients taking insulin?

A

Educate pt on s/s of hypoglycemia

Pt. should always carry something with them to bring a quick rise in blood glucose if needed.

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27
Q

s/s of a RAPID drop in blood glucose?

A

tachycardia, palpitations, sweating, and nervousness

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28
Q

s/s of a GRADUAL drop in blood glucose?

A

HA, confusion, drowsiness, and fatigue

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29
Q

Insulin drug interactions?

A

Hypoglycemic agents : (sulfonylureas, glinides, ETOH)

Hyperglycemic agents: (thiazide diuretics, glucocorticoids sympathomimetics)

Beta Blockers: Mask s/s of hypoglycemia

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30
Q

Name a drug that is a Biguanide

A

Metformin

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31
Q

What drug class is Metformin?

A

Biguanide (noninsulin med for diabetes)

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32
Q

MOA of Biguanides?

A

1) Prevent a rise in glucose levels after eating (keeps existing levels from rising, doesn’t drop existing levels)
2) Decreases glucose production in liver

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33
Q

Benefit of Biguanide (Metformin) MOA?

A

Little to no risk of hypoglycemia

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34
Q

Indication for Biguanides?

A

Prevention of hyperglycemia with no risk of hypoglycemia in diabetic patients

Prevention/delay of T2D in high risk individuals

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35
Q

Common adverse reactions of biguanides?

A 
Mostly GI (nausea, weight loss), can be controlled by titrating dose.
lactic acidosis (s/s:  hyperventilation. myalgia, malaise and somnolence)
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36
Q

Contraindications for use of biguanides (2)?

A

Heart Failure

Renal Failure (BLACK BOX): Metformin is excreted UNCHANGED by kidneys. Significant kidney impairment causes metformin toxicity and metabolic acidosis.

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37
Q

What patient population do biguanides work especially well for?

A

Those with odd eating schedules/meal skippers

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38
Q

Give examples of Sulfonylureas

A

Glipizide

Glyburide

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39
Q

What drug class are Glipizide & Glyburide?

A

Sulfonylureas

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40
Q

MAO of Sulfonylureas?

A

Increase insulin release by the beta cells within the pancreas (regardless of food)

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41
Q

Why are sulfonylureas ineffective to treat T1D?

A

Because of the mechanism of action–it increases insulin release by beta cells within the pancreas. In T1D, the beta cells have been destroyed

**Pancreas must be functioning for these drugs to work.

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42
Q

What is a significant risk for patients taking Sulfonylureas?

A

Hypoglycemia (because of MOA and release of insulin not being in relation to food intake)

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43
Q

Contraindications for Sulfonylureas?

A

Pregnancy

Breastfeeding

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44
Q

Cautions with Sulfonylureas adverse reaction, not hypoglycemia?

A

Hepatic and renal dysfunction

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45
Q

Adverse reactions with Sulfonylureas?

A

HYPOGLYCEMIA

Weight Gain

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46
Q

Examples of Glinides/Meglitinides

A

Starlix

Prandin

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47
Q

What drug class are Starlix & Prandin?

A

Glinides/Meglitinides

48
Q

MOA of Glinides?

A

Act like Sulfonylureas–promote insulin release from the pancreas.

49
Q

How are the MOA of Sulfonylureas and Glinides different?

A

Glinides have a much shorter duration of action than Sulfonylureas.

Glinides MUST BE TAKEN WITH MEALS (MUST eat within 30 min of dosing) to prevent severe hypoglycemia.

50
Q

If patients are unresponsive to sulfonylureas, what other during class will be ineffective for these patients?

A

Glinides (r/t to same MOA)

51
Q

How are Glinides taken in relation to meals?

A

MUST eat within 30 min of taking Glinides to prevent severe hypoglycemia.

52
Q

Give examples of Thiazolidinediones (TZD)/Glitazones

A

Actos

Avandia

53
Q

What drug class are Actos and Avandia?

A

Thiazolidinediones (TZD/Glitazones)

54
Q

MAO of Thiazolidinediones (TZD)/Glitazones?

A

Decrease Insulin Resistance

55
Q

What is a risk of Thiazolidinediones (TZD)/Glitazones?

A

Promote fluid retention that can cause heart failure in those predisposed due to underlying CVD (Black Box).

56
Q

What is the black box warning for Thiazolidinediones (TZD)/Glitazones?

A

Risk for heart failure due to fluid retention

57
Q

Adverse Reactions to Thiazolidinediones (TZD)/Glitazones (5)?

A 
Hypoglycemia
HF (Black Box) 
Increase fractures (women only)
Ovulation resulting unintended pregnancy
Bladder Cancer
58
Q

Contraindications for Thiazolidinediones (TZD)/Glitazones?

A

Absolute: Bladder cancer or history of bladder cancer

Osteoporosis and high fall risk

59
Q

Monitoring requirements for Thiazolidinediones (TZD)/Glitazones?

A

ALT at baseline and every 3-6 months

60
Q

Give examples of Alpha-Glucosidase Inhibitors

A

Precose

Glyset

61
Q

What drug class are Precose & Glyset?

A

Alpha-Glucosidase Inhibitors

62
Q

MOA of Alpha-Glucosidase Inhibitors?

A

Delay absorption of carbohydrates

63
Q

What is limiting for the frequent use of Alpha-Glucosidase Inhibitors?

A

Significant GI side effects (gas, bloating, ‘not feeling well’)

64
Q

Adverse Effects of Alpha-Glucosidase Inhibitors?

A

Significant GI Effects (gas, bloating, and ‘not feeling well’)

65
Q

Give examples of Dipeptidyl Peptidase-4 Inhibitors (DPP-4)/Gliptins

A

Tradjenta

Januvia

66
Q

What drug class are Tradjenta & Januvia?

A

Dipeptidyl Peptidase-4 Inhibitors (DPP-4)/Gliptins

67
Q

MOA of Dipeptidyl Peptidase-4 Inhibitors (DPP-4)/Gliptins?

A

Enhance the action of INCRETIN HORMONES

group of hormones that their sole function-through various functions) is to decrease blood glucose

68
Q

What is the action of INCRETIN HORMONES?

A

Through various functions, decrease blood glucose

69
Q

Are Dipeptidyl Peptidase-4 Inhibitors (DPP-4)/Gliptins approved for monotherapy or adjunct therapy

A

Adjunct ONLY

70
Q

Adverse Reactions to Dipeptidyl Peptidase-4 Inhibitors (DPP-4)/Gliptins

A

Pancreatitis

Hypersensitivity (angioedema, SJS)

71
Q

Use of Dipeptidyl Peptidase-4 Inhibitors (DPP-4)/Gliptins should be used with care in which patients?

A

Hx of Pancreatitis

Elevated triglyceride levels (Increased triglycerides are a common cause of pancreatitis).

72
Q

Give examples of Sodium Glucose Co-Transporter 2 Inhibitors

A

Invokana

73
Q

What drug class does Invokana belong to?

A

Sodium Glucose Co-Transporter 2 Inhibitors

74
Q

MOA of Sodium Glucose Co-Transporter 2 Inhibitors

A

Decreased reabsorption of filtered glucose so, glucose is excreted through the urine

75
Q

Adverse Effects of Sodium Co-Transporter 2 Inhibitors

A

Increase UTIs and genital yeast infections r/t increased glucose in urine.

76
Q

Give examples of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

A

Byetta

77
Q

What class of drug does Byetta belong to?

A

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist

78
Q

MOA of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists?

A

INCRETIN MIMETICS

Act like incretin hormones. So, these drugs stimulate incretin mechanisms to decrease glucose levels

79
Q

Adverse Effects of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists?

A 
GI Upset (weight loss)
Hypoglycemia (mild)
Renal Impairment (monitor)
80
Q

Monitoring requirements of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists?

A

Renal function r/t risk of renal impairment

81
Q

How do thyroid hormone needs change with

pregnancy?

A

Need to increase dosage by 30% once pregnancy confirmed (if had hypothyroidism prior to conception)

82
Q

What are the effects of untreated hypothyroidism on a

baby born to a mom with hypothyroidism?

A

Developmental delays

83
Q

Is hypothyroidism in infants transient or permanent?

A

Either

84
Q

What is the importance of early hypothyroidism in infants?

A

Early detection and treatment (within the first few days of life) physical and mental development will be normal

85
Q

Explain how hypothyroidism in babies is determined to be transient or permanent?

A

If baby has hypothyroidism, treat for three years.
Stop treatment for 4 weeks.
Retest.
If the retest is normal, hypothyroidism was transient, no further treatment needed. If restest still shows hypothyroidism, it is permanent and lifelong replacement therapy is necessary.

86
Q

What is the clinical name for HYPERthyroidism?

A

Graves’ Disease

87
Q

Treatment for Grave’s Disease?

A

Surgical removal of thyroid
Destruction of Thyroid with radioactive iodine
Suppression of thyroid hormone synthesis with antithyroid drug

88
Q

Give examples of Thionamides?

A

Methimazole

Propylthiouracil (PTU)

89
Q

Methimazole & PTU belong to what class of drugs?

A

Thionamides (anti-thyroid medications)

90
Q

What drugs are adjunct therapy to drug therapy for HYPERthyroidism and what do they do?

A

Beta blockers (suppress tachycardia)

Non-radioactive Iodine (inhibit synthesis and release of thyroid hormone)

91
Q

s/s of Thyrotoxic Crisis (Thyroid Storm)

A 
Profound hyperthermia (105 or greater)
severe tachycardia
Restlessness
Agitation
Tremor
92
Q

Causes of Thyrotoxic Crisis (Thyroid Storm)

A

Major Surgery

Severe Infection/Sepsis

93
Q

Are synthetic or natural drugs for HYPOthyroidism preferred?

A

Synthetic (more stable/consistent dosing)

94
Q

What drug is used to treat Hypothyroidism?

A

Levothyroxine (T4)/Synthroid

95
Q

How is Levothyroxine (T4)/Syntrhroid administered in relation to
food

A

Should be taken on an empty stomach 30-60 min before breakfast. CONSISTENTLY.

96
Q

Levothyroxine (T4)/Synthroid half-life long or short?

A

Long (approximately 7 days), contributes to sustained thyroid levels over time (but also takes a long time to reach therapeutic effect)

97
Q

How long does it take to reach normal plasma thyroid levels/full effects after starting Levothyroxine (T4)/Synthroid?

A

Approximately one month (4 half-lives)

98
Q

What is important to teach about thyroid supplement prescriptions (can it be easily substituted)?

A

Make sure that formulation/manufacturer/drug company doesn’t change—it can affect the concentration of the drug and impact the effect on thyroid levels.

**If a change is made, retest serum level in 6 weeks and make necessary adjusments

99
Q

Monitoring parameters for Thyroid replacement

A

Upon initiation of drug therapy, check levels every 6 weeks

Once stable, retest every 6-12 months

100
Q

Adverse Effects of Levothyroxine (T4)/Synthroid?

A 
Acute OD (thyrotoxicosis)
s/s include:
Tachycardia
Angina
Tremor
Nervousness
Insomnia
Hyperthermia
Heat intolerance and sweating
Hyperthyroidism
101
Q

Levothyroxine (T4)/Synthroid Drug Reactions (7)?

A

All Heartburn Meds (take 4 hours after Levothyroxine if needed)
Seizure meds (Dilantin, Phenobarb, Tegretol)
Zoloft
Warfarin
Catecholamines
Insulin
Digoxin

102
Q

Indications for use for Thionamides?

A

HYPERthyroidism-
Graves’ disease
Adjunct to radiation
Thyrotoxic Crisis (Thyroid Storm)

*Usually short term until a decision about long term treatment can be made (surgery or radioactive iodine)

103
Q

Which Thionamide is first-line indication for HYPERthryroidism? What are exceptions?

A

Methimazole (Tapazole)
EXCEPT pregnant women and breastfeeding

EXCEPT THYROTOXIC CRISIS– PTU works faster

104
Q

How long does it take to reach the therapeutic effects (euthyroid state) of Methimalzoe?

A

3-12 weeks

105
Q

Adverse Effects of Methimazole?

A

1) Agranulocytosis
s/s include:
sore throat and fever

Typically within the first 2 months of initiating treatment

2) Hypothryroidism

106
Q

What is typical dosing for Methimazole?

A

ONCE DAILY

107
Q

When is PTU preferred over Methimazole?

A

Pregnancy
Breastfeeding
Thyrotoxic Crisis (works more quickly than Methimazole)

108
Q

Radioactive Iodine Indications for use

A

ADULTS ONLY

Used as bridge/prep to having thyroid removed

109
Q

Contraindications for Radioactive Iodine?

A

Children
Pregnancy
Lactation

110
Q

What is a consistent adverse effect of radioactive iodine?

A

Hypothyroidism-almost always requires supplementation

111
Q

What is dosing for PTU (initial and maintenance)?

A

3-4 times a day initially

2-3 times a day for maintenance

112
Q

How long does it take to achieve the full effect of Radioactive Iodine?

A

2-3 months (may take multiple rounds of treatment)

113
Q

What drugs REDUCE Levothyroxine absorption and need to have administration separated by at least 4 hours?

A 
H2 Receptor Blockers (Tagament, etc)
Proton Pump Inhibitors (Pepcid, etc)
Aluminum Containing Antacids
Calcium Containing Supplements
Iron Supplements
114
Q

What drugs ACCELERATE Levothyroxine absorption and may require an increase in levothyroxine dosing?

A

Antiepiletics (Dilantin, Carbamazepine, Phenobarbital)
Rifampin
Zoloft

115
Q

What drugs have ACCELERATED DEGREDATION from levothyroxine (drug effects are enhanced by Levothyroxine) and may require reduced dosages of these drugs?

A

Warfarin

Catecholamines (Increases cardiac responsiveness and can cause cardiac dysrhythmias)

116
Q

What drugs have INCREASED REQUIREMENTS when taken with Levothyroxine?

A

Insulin

Digoxin

Pharm Exam 5 (5 decks)

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