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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
monotherapy of flozins
DM-2 (can be monotherapy) Can be renal protective in pts w/ new dx DM-2 Reduce HF Hospitalizations
26
side effects of flozins
Hypotension (from volume loss) Most common: Genital fungal infections, UTIs and increased urination Increase LDL
27
side effects of canaglifozin
monitor for new pain, sores, or ulcers in lower limbs (D/C)
28
flozin contraindications
Contraindicated in renal impairment, ESRD
29
what drugs are in the sulfonylurea gland
glimepiride, glipizide, glyburdie
30
sulfonylureas mechanism of action
Stimulate insulin release from panc beta cells, suppression of glucose from liver Oral Hypoglycemic (Must have some endogenous insulin secretion)
31
uses of sulfonylurea
DM-2 Typically combo meds + 2nd line therapy
32
side effects of sulfonylureas
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
black box warning for sulfonylureas
Box Warning: Increased CV mortality (based on 1st gen study from 1970’s but applied to all)
34
which sulfonylurea has delayed absorption with food
Glipizide
35
what drug class is pioglitazone
PRODRUG- thiazolidinediones
36
how does pioglitazone work
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
how is pioglitazone used
DM-2 Typically with 2-3 other drugs (can be monotherapy)
38
side effects of pioglitazone
Weight gain Edema Serious: HF, elevated liver labs.
39
contraindications of pioglitazone
Contraindications: Heart failure Monitor liver function
40
DDI with pioglitazones
CYP 450 inhibition Do not use with contraceptives Antiretrovirals: HLD
41
which insulin is rapid acting
lispro, aspart, glulisine
42
how does insulin work
binds to insulin receptors
43
how quick is insulin (rapid acting)
effect within 15 minutes
44
how is it usually given (rapid acting insulin)
premeal- immediate correction of hyperglycemia
45
what is regular/short acting insulin called
humulin
46
how is humulin usually given
Bolus to correct high Meals Effect within 30 min DKA + HHS: infusion Other: Hyperkalemia Safe in pregnancy IV/SC
47
how is NPH intermediate
Delayed onset by combining insulin with protamine
48
what are the timings of NPH
onset : 1-2 hrs Duration 14-24 hrs
49
which insulins are long acting
glargine, detemir, insulin degludec
50
how do long acting insulins work differently than other insulins
Substituting glycine and arginine for other amino acids in human insulin
51
timing of long acting insulins
24 hrs-- no true peak, DM 1 and DM 2
52
positive effects of long acting insulin
improved glycemic control w/ less variability
53
side effects of insulin
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
are different brands the same for insulin
no- not all brands are bioequivalent
55
DDIs of insulin
ETOH.. honestly many drug interactions-- making them too high or too low
56
what drug class are synthyroid and levoxyl
levothyroxine
57
difference between the two meds
these drugs are basically the same, but have dif inactive ingredients
58
how does levothyroxine work
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
common uses for levothyroxine
hypothyroidism
60
side effects of levothyroxine
Increased HR, decreased bone density, diarrhea, sweating, irritability, headache, SoB, heat intolerance (Essentially mimic hyperthyroid symptoms)
61
contraindications of levothyroxine
CAD may worsen when thyroid hormones, people with recent MI should avoid
62
DDI of levothyroxine
Beta blockers, cholestyramine, digoxin, estrogens, glucocorticoids, iodides (like CONTRAST for scans!), DM medications, SSRIs, tricyclics and warfarin
63
cytomel class
Liothyronine T3
64
mechanism of action of cytomel
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
what are cytomel common uses
Mild hypothyroidism, congenital hypothyroidism, simple nontoxic goiter, myxedema -Second line tx when synthroid/ Levoxyl doesn't work
66
side effects of cytomel
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
risk for older adults and cytomel
Older adults have higher risk of developing A. Fib w/ this medication
68
how are thyroid medications adjusted
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
signs of hyperthyroidism (med OD)
increased HR, cardiac arrhythmias, chest pain, tremors, nervousness, insomnia, irritability, diarrhea, vomiting, weight loss, menstrual irregularities, heat intolerance
70
what drugs are antithyroid agents
methimazole and propylthiouracil
71
mechanism of action of antithryoid agents
inhibit synthesis of thyroid hormones, Partially inhibits conversion of T4 to T3 Don't inactivate existing thyroxine Triiodothyronine
72
common uses for antithryoid agents
Adults & kids Hyperthyroidism (aka: Thyrotoxicosis) Graves Toxic goiter
73
side effects of anti-thyroid agents
Agranulocytosis (watch for sore throat, bleeding, bruising) , aplastic anemia Drug-induced hepatitis, abnormal hair loss, drowsiness, nausea, skin rash, *drug induced hepatitis*
74
antithyroid agents notes/considerations
NO PREGNANT LADIES, levels are monitored every 2-3 weeks throughout therapy, more often w/ adjustments and when starting.. Also check WBC count
75
administration of anti-thyroid meds
Administration: taken every 8 hrs, dose missed? Take as soon as remembered
76
DDI for methimazole and PTU
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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