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Module 11: Endocrine
Endocrine pharmacology
70
Pharmacology
Graduate
11/27/2016

Additional Pharmacology Flashcards

 


 

Cards

Term
True/False: Type I DM accounts for 10% of all diabetes and results from an autoimmune destruction of the beta cells of the islet of langerhans of the pancreas which leads to insulin deficiency.
Definition
True
Term
True/False: The pancreas is the major organ involved in Type I diabetes. In type II DM, the liver and endocrine system are the major players.
Definition
True
Term
What role does the GI system play in regulating the secretion of insulin (specifically GLP-1)?
Definition
GLP-1 is decreased following a meal
Term
True/False: A year of compensatory hyperinsulinemia may occur before the onset of clinic sx of Type II DM. Eventually the beta cell responsiveness to glucose stimulus diminishes and hyperglycemia prevails.
Definition
True
Term
What other d/o are a/w DM?
Definition
Hyperlipidemia, HTN, CAD
Term
How does insulin work to lower blood sugar?
Definition
  1. Stimulates peripheral glucose uptake
  2. Inhibits hepatic glucose production
  3. Inhibits lipolysis
  4. Inhibits proteolysis
  5. Enhances protein synthesis
  6. Acts on the liver to increase storage of glucose as glycogen
  7. Decreases urea production, protein catabolism, and CAMP in the liver
  8. Tryiglyceride synthesis
  9. Increases k+ and phosphate uptake by the liver
Term
First class used to treat type II DM
Definition
Sulfonylureas
Term
MOA of sulfonylureas
Definition
Increase endogenous insulin secretion by the beta cells
Term
Contraindications for sulfonylureas
Definition
  1. Ax to sulfonamids, thiazides
  2. Nursing mothers
  3. Type I DM
  4. DKA, uncontrolled infection, burns, trauma, pts w/ adrenal or pituitary insufficiency
Term
Glyburide is pregnancy category:
Definition
B
Term
S/E of sulfonylureas:
Definition
Hypoglycemia
Term
Example of biguanides:
Definition
Glucophage
Term
MOA of biguanides
Definition
  1. Increases peripheral glucose uptake and utilization
  2. Decreases hepatic glucose production
  3. Decreases intestinal absorption of glucose
  4. Does NOT stimulate insulin release from pancreatic beta cells so the risk for hypoglycemia is minimal **
Term
Precautions and contraindications of biguanides:
Definition
  1. Renal dz
  2. Metabolic acidosis
  3. Deyhdration
  4. Chronic alcoholism
  5. Lactic acidosis
Term
Biguanides may be used for prevention of ___ DM. May also lead to ____.
Definition
  1. Type I DM
  2. Weight loss
Term
Patient education on biguanides
Definition
  1. Warn about nausea & GI disturbance
  2. Warn about s/sx lactic acidosis
  3. Hypoglycemia NOT common
  4. Warn about potential metallic taste in mouth
Term
Examples of alpha-glucosidase inhbitors
Definition
  1. Acarbose (Precose)
  2. Miglitol (Glyset)
Term
MOA of alpha-glucosidase inhibitors
Definition

Inhibit and delay absorption of carbs from the small bowel

Term
Educate pt that while on alpha-glucosidase inhibitors, they may experience _____, but ____ is not an issue.
Definition
  1. Intestinal flatus & abd distention
  2. Hypoglycemia NOT issue.
Term
Metabolism of alpha-glucosidase inhibitors:
Definition
Metabolized exclusively by intestinal bacteria and digestive enzymes
Term
Precautions and contraindications of alpha-glucosidase inhibitors:
Definition

Do NOT use in pts w/ IBD, bowel obstruction, chronic intestinal dz

 

*Pregnancy cat B (but we never use in pregnancy)*

Term
Patient education with alpha-glucosidase inhibitors:
Definition
  1. Take w/ 1st bite of meal
  2. Usual tx for hypoglycemia DOES NOT work! (Treat w/ 8 oz milk or lactose tabs. If severe, tx w/ glucose or glucagon.)
Term
Main brand thiazolidinedione
Definition
Avandia
Term
MOA of thiazolidinediones (Avandia)
Definition
  1. Improve insulin action in cell which leads to increased utilization of available insulin
  2. Decrease hepatic glucose production
  3. No hypoglycemia
Term
Black box warning with Avandia:
Definition
Cardiotoxicity
Term
Avandia is pregancy category ___.
Definition
C
Term
Patient education w/ thiazolidinediones
Definition
  1. Advise pt to report STAT any s/sx hepatocellular injury: N/V, abd pain, fatigue, anorexia, jaundice, dark urine
  2. Advise about cardiac risk: CP, SOB, peripheral edema
  3. Females using OCP should use an additional form of BC, consider IUD, or increase their dose
Term
Brands of meglitinides
Definition
Prandin and Starlix
Term
MOA of meglitinides
Definition

Short acting insulin secretagogues

 

*Dosed TID no more than 20 mins before meals*

Term
Precautions with meglitinides
Definition
Not recommended in debilitated, malnourished pts at risk for hypoglycemia
Term
Drug interactions w/ meglitinides:
Definition
  1. Ketoconazole
  2. Miconazole
  3. EES
  4. Repaglinide

All increase risk of hypoglycemia

Term
Examples of dipeptidyl peptidase-4 inhibitors (gliptins)
Definition
Januvia and Onglyza
Term
Absorption of gliptins
Definition
Absorbed in GI tract. Don't have to take w/ food.
Term
Caution use of gliptins in:
Definition
Renal impairment
Term
Gliptins are pregnancy category _.
Definition
B
Term
Drug interactions with gliptins
Definition
Increased risk of angioedema w/ ACE-I
Term
Examples of glucagon-like peptide-1 agonists
Definition
Byetta, liraglutide (submitted for FDA approval)
Term
MOA of glucagon-like peptide-1 agonists
Definition
GLP-1 agonists directly bind to GLP-1 receptors in pancreatic beta cells and acts as incretin mimetic
Term
How is byetta (glucagon-like peptide-1 agonists) given?
Definition
Given IM BID
Term
Glucagon-like peptide-1 agonists are pregnancy category __.
Definition
C
Term
Example of amylin agonists
Definition
Pramlintide (Symlin)
Term
Precautions and contraindications of amylin agonists:
Definition
  1. Closely monitor older adults
  2. Risk for hypoglycemia increases if given with insulin
  3. Pregnancy category C
Term

Black box warning w/ amylin agonists:

 

Definition
Increased risk severe hypoglycemia when used w/ insulin
Term
Amylin agonists dosing w/ type I DM:
Definition

Start @ 15 mcg & go up 15 mcg increments as tol to 30 to 60 mcg

 

*If nausea: reduce back to 30 mcg*

Term
Amylin agonists dosing w/ Type II DM:
Definition
  1. Initiate @ 60 mcg
  2. Decrease dose of preprandial rapid acting or short acting insulin by 50%
  3. Increase to 120 mcg when no clinically sig. N/V has occurred for 3-7 days
Term
Patient education w/ amylin agonists:
Definition
  1. Administer SQ (NOT in the upper arm)
  2. Give STAT AC containing at least 250 kcal or @ least 30 grams carbs
  3. Can NOT be mixed w/ any form of insulin
  4. Admin @ least 2 inches from site where insulin is administered.
Term
Why would glucagon be administered? What route?
Definition
  1. Reverse hypoglycemia
  2. IM, IV, SQ
Term
Onset of action for lispro, aspart, glulisine:
Definition
5 to 15 minutes
Term
lispro, aspart, glulisine peak effect:
Definition
45 to 75 minutes
Term
Duration of action of lispro, aspart, glulisine:
Definition
2 to 4 hours
Term
onset of action of regular insulin
Definition
30 minutes
Term
peak effect of regular insulin
Definition
2 to 4 hours
Term
duration of action of regular insulin
Definition
5 to 8 hours
Term
onset of action of NPH
Definition
2 hours
Term
peak effect of NPH
Definition
4 to 12 hours
Term
duration of action of NPH
Definition
18 to 28 hours
Term
onset of action of insulin glargine
Definition
2 hours
Term
peak of action of insulin glargine
Definition
no peak
Term
duration of action of insulin glargine
Definition
20 to > 24 hours
Term
onset of action of insulin detemir
Definition
2 hours
Term
peak effect of insulin detemir
Definition
3 to 9 hours
Term
duration of action of insulin detemir
Definition
6 to 24 hours
Term
onset of action of NPL
Definition
2 hours
Term
peak effect of NPL
Definition
6 hours
Term
duration of action of NPL
Definition
15 hours
Term
What are the 3 main types of TRH?
Definition
  1. Levothyroxine (T4)
  2. Liothyronine (T3)
  3. Litri (4:1 mixture of T4)
Term
How much levothyroxine is absorbed after PO administration?
Definition
48-79%
Term
What increases absorption and when should levothyroxine be taken?
Definition
Fasting increases absorption and it should be taken prior to breakfast.
Term
When is thyroid replacement therapy contraindicated?
Definition
After recent MI or in thyrotoxicosis uncomplicated by hypothyroidism
Term
Long term levothyroxine therapy has been a/w what?
Definition
Decreased bone density in the hip and spine.
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