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APRN A. Pharm- Test 2 > Week 7- DM/ Thyroid > Flashcards

Week 7- DM/ Thyroid Flashcards

1
Q

What drug is in the biguanide class

A

metformin (glucophage)

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2
Q

what MoA is metformin

A

Decrease hepatic glucose production by decreasing gluconeogenesis
Causes an increase in peripheral glucose uptake + utilization (sensitivity)

(Reduces glucose uptake in GI tract)

Does not stimulate insulin release

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3
Q

what are the common uses for metformin

A

first line DM medication, initial monotherapy for adults/kids

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4
Q

black box warning of metformin

A

BOX WARNING: Rare but life-threatening lactic acidosis, hypothermia, hypotension, bradycardia death (50% fatality)

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5
Q

side effects of metformin

A

gas, diarrhea, weight loss, DOES NOT DIRECTLY C/ HYPOGLYCEMIA.. but it can still happen

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6
Q

contraindications of metformin

A

advanced renal disease, metabolic acidosis, monitor renal function

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7
Q

drug interactions of metformin

A

avoid iodine-based contrast (hold 48 hrs before/after imaging), watch drugs that use renal excretion too

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8
Q

what drugs are in the DPP-4 inhibitor class

A

linagliptin, saxagliptin, sitagliptin

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9
Q

MoA of gliptans

A

Acts on incretin system- stimulate insulin secretion from pancreatic beta cells

Slow gastric emptying by prolonging action of GLP-1 hormones

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10
Q

common uses of gliptins

A

DM-2
OK monotherapy—
Typically adjunct

Overweight & DM-2

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11
Q

side effects of gliptins

A

Arthralgia
Pancreatitis
Skin autoimmune issues
Rhabdo
Heart failure

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12
Q

drug interactions of gliptins

A

ACEI, DM drugs, Quinilones, Protease inhibitors: Higher risk hypoglycemia

Dig

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13
Q

GLP-1 receptor agonist drugs

A

dulaglutitide, exenatide, liraglutide

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14
Q

MoA of GLP-1 “glutides”

A

Acts on incretin system- stimulate insulin secretion from pancreatic beta cells and decrease glucagon release from alpha cells

(increases insulin secretion, lowers glucose levels, delays gastric emptying, induces weight loss)

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15
Q

GLP-1 Receptor Agonists

A

Combo w/ other meds for poorly controlled type 2 DM

& Obesity + CVD

NOT FOR DM-1

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16
Q

CI for all GLP 1 Receptor Agonists

A

GI disease (UC, crohn’s, gastroparesis, pancreatitis

also not recommends for people with renal impairment

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17
Q

side effects of GLP-1 receptor agonists

A

GI distubrances, pancreatic duct metaplasia, pancreatitis, thyroid tumors

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18
Q

black box warning GLP 1 Receptor
Agonists

A

thyroid C-Cell tumors and hyperplasia BOX WARNING

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19
Q

which GLP 1 agonists has the most nausea

A

exenatide

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20
Q

Dulaglutide can increase or decrease CV events

A

Decrease CV events

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21
Q

DDI of GLP 1

A

Most drug interactions tied to delayed gastric emptying & dual therapy hypoglycemia

ASA, salicylates, fibrates, MAOIs, sulfonamides, ARBs and ACEIs, beta blockers, contraceptives, Dig

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22
Q

which GLP 1 has the highest propensity for increased INR with warfarin

A

exenatide

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23
Q

which drugs are SGLT2 inhibitors

A

canaglifozin, dapagliflozin, empaglifozin “flozins”

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24
Q

what is the mechanism of action of flozins/ SGLT2 inhibitors

A

Inhibits SGLT2: blocks reabsorption of glucose in the kidneys & promotes excretion of glucose

No effect on natural insulin secretion

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25
Q

monotherapy of flozins

A

DM-2 (can be monotherapy)

Can be renal protective in pts w/ new dx DM-2

Reduce HF Hospitalizations

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26
Q

side effects of flozins

A

Hypotension (from volume loss)
Most common: Genital fungal infections, UTIs and increased urination

Increase LDL

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27
Q

side effects of canaglifozin

A

monitor for new pain, sores, or ulcers in lower limbs (D/C)

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28
Q

flozin contraindications

A

Contraindicated in renal impairment, ESRD

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29
Q

what drugs are in the sulfonylurea gland

A

glimepiride, glipizide, glyburdie

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30
Q

sulfonylureas mechanism of action

A

Stimulate insulin release from panc beta cells, suppression of glucose from liver

Oral Hypoglycemic

(Must have some endogenous insulin secretion)

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31
Q

uses of sulfonylurea

A

DM-2

Typically combo meds + 2nd line therapy

32
Q

side effects of sulfonylureas

A

Hypoglycemia: Avoid old ppl & High risk

Common: GI- N/D heartburn/ epigastric fullness.

Not for pregnancy: neonates born with severe hyperglycemia

Weight gain

SIADH

NeuroL Dizzy, nervous, HA, tremor

33
Q

black box warning for sulfonylureas

A

Box Warning: Increased CV mortality (based on 1st gen study from 1970’s but applied to all)

34
Q

which sulfonylurea has delayed absorption with food

A

Glipizide

35
Q

what drug class is pioglitazone

A

PRODRUG- thiazolidinediones

36
Q

how does pioglitazone work

A

Stimulating peroxisome proliferator-activated receptor gamma in cell nucleus

(this increases expression of proteins that improve insulin action)

(improves utilization of insulin on liver and muscle cells)

Depend on insulin for their action (so DM-2 only)

Reduce hepatic glucose production

Improve insulin sensitivity in DM-2

37
Q

how is pioglitazone used

A

DM-2
Typically with 2-3 other drugs
(can be monotherapy)

38
Q

side effects of pioglitazone

A

Weight gain

Edema

Serious: HF, elevated liver labs.

39
Q

contraindications of pioglitazone

A

Contraindications: Heart failure

Monitor liver function

40
Q

DDI with pioglitazones

A

CYP 450 inhibition

Do not use with contraceptives

Antiretrovirals: HLD

41
Q

which insulin is rapid acting

A

lispro, aspart, glulisine

42
Q

how does insulin work

A

binds to insulin receptors

43
Q

how quick is insulin (rapid acting)

A

effect within 15 minutes

44
Q

how is it usually given (rapid acting insulin)

A

premeal- immediate correction of hyperglycemia

45
Q

what is regular/short acting insulin called

A

humulin

46
Q

how is humulin usually given

A

Bolus to correct high
Meals
Effect within 30 min

DKA + HHS: infusion

Other: Hyperkalemia

Safe in pregnancy

IV/SC

47
Q

how is NPH intermediate

A

Delayed onset by combining insulin with protamine

48
Q

what are the timings of NPH

A

onset : 1-2 hrs
Duration 14-24 hrs

49
Q

which insulins are long acting

A

glargine, detemir, insulin degludec

50
Q

how do long acting insulins work differently than other insulins

A

Substituting glycine and arginine for other amino acids in human insulin

51
Q

timing of long acting insulins

A

24 hrs– no true peak, DM 1 and DM 2

52
Q

positive effects of long acting insulin

A

improved glycemic control w/ less variability

53
Q

side effects of insulin

A

Both up and down life threatening

Too Much insulin or exercise or not enough food: Hypoglycemia

Too Little insulin: DKA

Other: Lipodystrophy from not rotating sites can lead to infection/ abcess

54
Q

are different brands the same for insulin

A

no- not all brands are bioequivalent

55
Q

DDIs of insulin

A

ETOH.. honestly many drug interactions– making them too high or too low

56
Q

what drug class are synthyroid and levoxyl

A

levothyroxine

57
Q

difference between the two meds

A

these drugs are basically the same, but have dif inactive ingredients

58
Q

how does levothyroxine work

A

Synthetic hormone: providing your body with a man-made version of thyroxine (T4), a type of thyroid hormone

Most effects are exerted through control of DNA transcription and protein synthesis

59
Q

common uses for levothyroxine

A

hypothyroidism

60
Q

side effects of levothyroxine

A

Increased HR, decreased bone density, diarrhea, sweating, irritability, headache, SoB, heat intolerance

(Essentially mimic hyperthyroid symptoms)

61
Q

contraindications of levothyroxine

A

CAD may worsen when thyroid hormones, people with recent MI should avoid

62
Q

DDI of levothyroxine

A

Beta blockers, cholestyramine, digoxin, estrogens, glucocorticoids, iodides (like CONTRAST for scans!), DM medications, SSRIs, tricyclics and warfarin

63
Q

cytomel class

A

Liothyronine T3

64
Q

mechanism of action of cytomel

A

Triiodothyronine (T3) and L-thyroxine (T4) diffuse into the cell nucleus and bind to thyroid receptor proteins attached to DNA.

This hormone nuclear receptor complex activates gene transcription and synthesis of messenger RNA and cytoplasmic proteins

(Mimics normal physiology)

65
Q

what are cytomel common uses

A

Mild hypothyroidism, congenital hypothyroidism, simple nontoxic goiter, myxedema

-Second line tx when synthroid/ Levoxyl doesn’t work

66
Q

side effects of cytomel

A

Increased HR, decreased bone density Diarrhea, sweating, irritability, headache, SoB, heat intolerance

Teach patient how to measure pulse rate, and signs of OD, may experience hair loss

Cardiotoxicity risk: higher than synthroid

67
Q

risk for older adults and cytomel

A

Older adults have higher risk of developing A. Fib w/ this medication

68
Q

how are thyroid medications adjusted

A

Levels are monitored every 2-3 weeks throughout therapy, more often w/ adjustments and when starting… 2-4 weeks for adults, 4-8 weeks for older adults & CV risk ~low and slow~

69
Q

signs of hyperthyroidism (med OD)

A

increased HR, cardiac arrhythmias, chest pain, tremors, nervousness, insomnia, irritability, diarrhea, vomiting, weight loss, menstrual irregularities, heat intolerance

70
Q

what drugs are antithyroid agents

A

methimazole and propylthiouracil

71
Q

mechanism of action of antithryoid agents

A

inhibit synthesis of thyroid hormones,

Partially inhibits conversion of T4 to T3

Don’t inactivate existing thyroxine Triiodothyronine

72
Q

common uses for antithryoid agents

A

Adults & kids

Hyperthyroidism
(aka: Thyrotoxicosis)

Graves
Toxic goiter

73
Q

side effects of anti-thyroid agents

A

Agranulocytosis (watch for sore throat, bleeding, bruising) , aplastic anemia

Drug-induced hepatitis, abnormal hair loss, drowsiness, nausea, skin rash, drug induced hepatitis

74
Q

antithyroid agents notes/considerations

A

NO PREGNANT LADIES, levels are monitored every 2-3 weeks throughout therapy, more often w/ adjustments and when starting.. Also check WBC count

75
Q

administration of anti-thyroid meds

A

Administration: taken every 8 hrs, dose missed? Take as soon as remembered

76
Q

DDI for methimazole and PTU

A

Any bone marrow depression drugs, phenothiazines, potassium iodide, amiodarone, OTC cold meds that have iodine

APRN A. Pharm- Test 2 (3 decks)

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