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NR565 - Advanced Pharmacology > Week 5 - Final Review > Flashcards

Week 5 - Final Review Flashcards

1
Q

What lab tests are used to diagnose hypothyroidism?

A
  • Serum TSH used to screen and diagnose hypothyroidism (Even with small T3 and T4 changes there will be an abnormally high level of TSH)
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2
Q

What are normal/hypo/hyper levels of TSH?

A
  • Hyperthyroid – under 0.3
  • Normal – 0.3-6
  • Hypothyroid – over 6
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3
Q

How long after initiation of treatment for hypothyroidism would you recheck labs?

A

Check TSH 6-8 weeks after initiating therapy and after any dosage change

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4
Q

What are the signs and symptoms of hypothyroidism?

A
  • face is pale, puffy, and expressionless
  • skin is cold and dry
  • hair is brittle, and hair loss occurs.
  • Heart rate and temperature are lowered.
  • lethargy, fatigue, and intolerance to cold.
  • Mentation may be impaired
  • Thyroid enlargement
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5
Q

What are the signs and symptoms of and hyperthyroidism?

A
  • Nervousness
  • Insomnia
  • rapid thought flow
  • rapid speech
  • Skeletal muscles may weaken and atrophy.
  • Metabolic rate is raised, resulting in increased heat production, increased body temperature, intolerance to heat, and skin that is warm and moist.
  • Appetite is increased, weight loss
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6
Q

How is a thyroid storm treated?

A

Using a combination of:

  • antithyroid drugs
  • corticosteroids
  • beta-blockers
  • iodine solution
  • supportive measures are needed

Can be a result of not treating hypothyroidism during pregnancy.

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7
Q

What medication is used to treat symptoms of hyperthyroidism?

A
  • Methimazole or propylthiouracil

These are antithyroid drugs which treat the symptoms but not the condition itself.

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8
Q

What medications reduce absorption of levothyroxine?

A
  • Histamine 2 (H2) receptor blockers (cimetidine)
  • Proton pump inhibitors (lansoprazole)
  • Sucralfate (Carafate)
  • Cholestyramine, Colestipol
  • Aluminum-containing antacids (-Maalox, Mylanta),
  • Calcium supplements (-Tums, Os-Cal)
  • Iron supplements (ferrous sulfate),
  • Magnesium salts
  • Orlistat (Xenical)
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9
Q

What drugs accelerate metabolism of levothyroxine?

A
  • phenytoin (Dilantin),
  • carbamazepine (Tegretol, Carbatrol),
  • rifampin (Rifadin),
  • sertraline (Zoloft), and
  • phenobarbital.
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10
Q

How do you confirm a diagnosis of diabetes?

A
  • Fasting glucose ≥ 126
  • Random glucose ≥200
  • Oral glucose tolerance test ≥200
  • HbA1c 6.5% or higher
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11
Q

What are the general goals for a1c when treating diabetics?

A

General goal: < 7%

Older Adult goal: < 8%

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12
Q

In what situations should insulin be used for treatment?

A
  • For all T1D
  • Gestational diabetes
  • Newly diagnosed diabetics with an A1C greater than 10% and a fasting glucose over 300
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13
Q

How often should an A1C be checked after beginning treatment for diabetes?

A

Every three months until it is less or equal to 7%
Then every 6 months thereafter

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14
Q

Name three actions of insulin

A
  • Promotes conservation of energy and buildup of energy stores (glycogen)
  • Stimulates cellular uptake of glucose, amino acids, neucleotides and potassium.
  • Promotes synthesis of complex organic molecules –> assembly of amino acids into proteins and fatty acids incorporated into triglycerides
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15
Q

What are contraindications for pioglitazone?

A
  • Patients with severe HF
  • Patient with bladder cancer or history of bladder cancer
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16
Q

GLP-1

A

Glucagon-like peptide-1 receptor agonists

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17
Q

TZD

A

Thiazolidinediones

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18
Q

DPP4-I

A

Dipeptidyl peptidase 4 Inhibitors

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19
Q

SGLT2i

A

Sodium-glucose Cotransporter 2 Inhibitors

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20
Q

Which drug class should be considered for diabetes prior to insulin?

A

Biguanides

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21
Q

Mechanism of action for GLP-1

A

Glucogon like peptide (non insulin injectable)

Augments the effects of the incretin hormone GLP-1 by:

  • activating receptors for GLP-1 to slow gastric emptying
  • stimulate release of insulin
  • inhibit postprandial release of glucagon
  • suppress appetite.

Thereby reducing glucose levels and inducing weight loss.

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22
Q

Mechanism of Action for TZD

A

Thiazolidinediones

Reduce glucose levels by decreasing insulin resistance

Activation of a PPAR receptor which turns on insulin-responsive genes resulting in:
- increased cellular uptake of glucose by the skeletal muscle and adipose cells

(Enhances response to insulin, therefore insulin needs to be present for the drug to work)

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23
Q

MOA for DPP-4i

A

Dipeptidyl peptidase 4 Inhibitors

Enhances the action of incretin hormones to:

  • stimulate release of insulin
  • suppress release of glucagon
  • keep blood glucose levels from climbing too high
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24
Q

Sulfonylureas

A

Stimulating the release of insulin from pancreatic islets (not for DM1) by binding with and blocking ATP sensitive potassium channels int eh cell membrane. The membrane then depolarizes permitting a Ca influx causing a release of insulin.

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25
Q

SGLT2i

A

Sodium-glucose Cotransporter 2 Inhibitors

Reduces the reabsorption of glucose thereby increasing urinary glucose excretion to improve glycemic control and weight loss

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26
Q

Which diabetic medication(s) come with a concern of hypoglycemia?

A
  • GLP-1 receptor agonists
  • Glinides
  • Thiazolidinediones
  • Sodium glucose cotransporter 2 inhibitors
  • Sulfonylureas
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27
Q

Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin

A

50:50

50% insulin for rapid acting
50% for basal

28
Q

Insulin to carbohydrate ratio when calculating basal insulin

A

1:10
1 unit of insulin to 10 grams of carbs

29
Q

What is wrong with this sentence?

A patients states that she will take her Insulin lispro 30-60 minutes before a meal.

A

A short duration: short acting insulin should be taken before a meal 15-30 min before a regular acting is 30-60 such as regular insulin that is not commonly used for meals.

30
Q

What is wrong with this sentence?

“As long as the short-acting insulin is drawn up first I can mix my insulin glargine with it.”

A

Of the long-acting medications, ONLY NPH the intermediate duration is suitable for mixing with the short action insulins.

31
Q

What is wrong with this sentence?

A patient states, “My sugars have been around 65-68 at times but I feel the medication is working.”

A

Patient can have hypoglycemia unawareness. Usually occurs with someone who is practicing tight glycemic control. Loosen tight control for a few weeks to regain hypoglycemic awareness.

32
Q

What is wrong with this sentence?

A women who is taking Pioglitazone states, “I’m glad that this medication promotes weight loss.”

A

First this medication promotes increase in LDL levels, which increases cardiovascular risk.

Also, she’s a female so speak about exercise and weight bearing exercise d/t possible increased risk for fractures.

33
Q

A female patient taking Canagliflozin comes in with a UTI and 6 months ago had a fungal infection. What are your next steps?

A

Discontinue and change medications

34
Q

A patient taking Sitagliptin reports abdominal pain with vomiting. What are your next steps?

A

Discontinue, meds he has pancreatitis.

35
Q

Who should not take metformin?

A
  • renal insufficiency due to risk of lactic acidosis
  • hx of lactic acidosis
  • HF
36
Q

Sulfonylureas should not be used during __________ or with _______ or _______ impairment.

A

Pregnancy
Hepatic
Renal

Biggest concern with sulfonylureas is hypoglycemia

37
Q

When is it appropriate to increase insulin need?

A

When using Pioglitazone

38
Q

What is the total daily dose of insulin for a person that weighs 70kg?

A

Total daily dose = weight in kg x 0.6.

50% should be short acting, 50% should be long acting.

In this example 21 basal, 21 bolus

39
Q

If a person is eating a 50 carb meal, how much short acting insulin will be needed based on the total daily dose of 42?

A

450 rule for regular insulin
500 rule for rapid acting

500/ total daily dose’

  • Example: 500/42 = 11.9 (rounded up to 12) gives you the carb to insulin ratio
  • Ratio equals 1:12
  • Meal is 50g carbs, 50/12= 4.1 units of insulin for rapid carbohydrate coverage
40
Q

A patient receives his first lab results showing an AIC of 7.2%. What is the diagnosis?

A

Recheck again for confirmation of diabetes over 6.5%

41
Q

An A1C of _________ is considered prediabetic?

A

5.7-6.4%

42
Q

A random glucose of ________ is considered diabetic

A

> 200

43
Q

A person with diabetes has recurrent severe hypoglycemia events. What should his A1C goal be?

A

Less stringent A1C goals (such as <8%) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal is difficult to achieve despite DS

44
Q

When is it okay for a patient to have an A1C goal of 6.5%?

A

When there are no hypoglycemic events and the patient can handle it.

45
Q

How often should an A1C be monitored when stable or when unstable?

A

Stable - every 6 months
Unstable - every 3 months

46
Q

A person comes in with an A1C of 10% and a fasting glucose of >300, what are the next steps for the provider?

A

Combination injectable therapy immediately. If over 9% can start at step 2 with dual therapy.

47
Q

Function of SLGT-2

A

Increase glucose excretion via the urine by inhibiting SLGT in the kidney tubules

48
Q

MOA of Biguanides

A
  • inhibits glucose production in the liver
  • reduces glucose reabsorption in the gut
  • sensitizes insulin receptors in target tissues to increase glucose uptake
49
Q

Function of TZD

A

Decreases insulin resistance and increase glucose uptake by muscle and adipose tissue

50
Q

Function of DPP-4

A

Enhance the activity of incretins and thereby increase insulin release, reduce glucagon release

51
Q

What are some food/supplement interactions that can occur with levothyroxine?

A

Antacids
Calcium
Iron

how to take it: (morning 30-60 min before eating on an empty stomach

52
Q

What labs would you order to help diagnosis thyroid conditions?

A

TSH, T3 free T4, anti TPO

53
Q

What is the role of Radioactive Iodine and what is a possible adverse effect?

A

To destroy thyroid tissue with those with hyperthyroidism and/or have not responded to therapy.

Possible hypothyroidism

54
Q

What adjunctive medication can be used for hyperthyroidism?

A

Beta blockers and non radioactive iodine

55
Q

Once a patient reaches a euthyroid state, how often should they be tested?

a. every 6 months
b. once a year
c. every 3 months
d. in 4-8 weeks

A

B - once a year

56
Q

A patient has a TSH of .28, a free T4 of 3, and a free T3 over 650. What medication should she be started on?

A

Methimazole, PTU, radioactive iodine. These labs indicate hyperthyroidism.

57
Q

Treatment for thyroid storm:

A

K iodide or strong iodine solution to suppress thyroid release. Methimazole to suppress thyroid synthesis.

58
Q

A patient is has just been prescribed levothyroxine. The NP put in a lab order to check TSH levels in:

a. 4-6 weeks
b. one week
c. 6-8 weeks
d. once a year

A

C - 6-8 weeks after initiating therapy

59
Q

A patient comes into the clinic complaining of sore throat and fever. She has recently started Methimazole in the last 4 weeks. What does this suggest?

A

Agranulocytosis. Must check CBC and LFTS for infection. Labs may not always catch in time since it progresses rapidly.

60
Q

Examples of biguanides

A
  • metformin
  • glucophage
  • fortamet
61
Q

Examples of sulfonylureas

A
  • glipizide
  • gliperamide
  • glyburide
62
Q

Examples of GLP-1

A
  • exanatide
  • liraglutide
  • dulaglutide
63
Q

Examples of TZD

A
  • pioglitazone
  • rosiglitazone
64
Q

Examples of DPP-4i

A
  • sitagliptin
  • saxagliptin
  • linagliptin
  • alogliptin
65
Q

Examaples of SGT2-i

A
  • canagliflozin
  • dapagliflozin
  • epaglifozin

NR565 - Advanced Pharmacology (13 decks)

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