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Pharmo Unit 9

Endocrine Disorders: hypo/hyper-glycemia; hypo/hyper-thyroidism; adrenal insuff.

QuestionAnswer
What are the four functions of the thyroid gland? 1. stimulates enzymes involved in glucose oxidation-regulate basal metabolic rate2. increase cellular metabolism-increase body temp3. maintain blood pressure4. regulate growth and development
Path of the negative feedback system of the thyroid? Hypothalmus (TRH)-->Pituitary (TSH)-->Thyroid-->T3, T4--> Free Hormone/Bound hormone
Symptoms of hypothyroidism? decreased metabolism, general weakness, muscle cramps, dry skin, bradycardia, wt gain, cold intolerance, elevated TRH and TSH-->low T3 and T4
Symptoms of hyperthyroidism? increased metabolism, anxiety, increased muscle tone, tachycardia, wt loss, hyperthermia, exopthalmos, high TRH and TSH-->high T3 and T4
What hormones do the adrenal gland produce? corticosteroid hormones (from cholesterol), androgens (testosterone), aldosterone, *epinephrine/adrenaline and norepinephrine
What is Addison's disease? an autoimmune disorder-when adrenal glands don't produce enough cortisol hormone (due to dysfunction-secondary to pituitary/hypothalamus dysfunction)
Symptoms of Addison's disease? depression, fatigue, n/v, hyperpigmentation of skin, hypotension/shock w/stress, hyponatremia, hyperkalemia, loss of aldosterone/reduced excretion
How does the body respond to high glucose levels? -pancreas releases insulin-cells take up glucose from blood-liver produces glycogen-blood glucose falls
How does the body respond to low glucose levels? -pancreas releases glucagon-liver produces glycogen-blood glucose rises
Insulin affects? carbohydrate, lipid, and protein metabolism-assistes glucose transport (glucose cannot enter cells w/o insulin
-Blood glucose level greater than 126 mg/dl on 2 separate occasions? hyperglycemia
s/s of hyperglycemia? 3 P's: polyuria (excessive urination), polydipsia (excessive thirst), polyphagia (increased hunger)-glucosuria-wt loss, fatigue
Name it:an autoimmune disorder the results in destruction of beta cells responsible for insulin synthesis Type 1 diabetes
How do you treat type 1 diabetes? natural and/or modified insulins
Name it:insulin resistance and impaired insulin secretion Type 2 diabetes
What drugs stimulate the release of insulin? -Sulfonylureas (tolbutamide/Orinase and glyburide/Micronase)-Meglitinides (repannglinide/Prandin)
What drugs decrease production of glucose? metformin/glucophage
What drugs decrease insulin resistance (helps body utilize insulin)? Thiazolidinediones (Avandia and Actos)
What drug delays absorption of dietary carbohydrates? Acarbose
Can natural/modified insulins be used with Type 2 diabetes? Yes
Type 1 or 2? Hyperglycemia Type 1 and 2
Type 1 or 2? Diabetic Ketoacidosis Type 1
Type 1 or 2? Hyperglycemic Hyperosmolar Nonketotic Syndrome Type 2
Type 1 or 2? Hypoglycemia Type 1 and 2
Normal fasting glucose level? less than 100
Normal glucose levels 2 hours of eating? less than 140
Normal Hemoglobin A1C levels? less than 6%
HgB A1C levels measure over what length of time? 2-3 months
Onset? Peak? Duration?Rapid Acting: Lispro 15 min; 30 min; 4 hrs
Onset? Peak? Duration?Short Acting: Regular Insulin 30 min; 1 hr; 6 hrs
Onset? Peak? Duration?Intermediate Acting: NPH insulin 1 hr; 6 hrs; 16+ hrs
Onset? Peak? Duration?Long Acting: Lantus 70 min; NO Peak; 24 hrs
Which insulin has a cloudy appearance? NPH
Which insulin can be given IV? Short acting: regular insulin
Major side effect of Sulfonylureas (tolbutamide and glyburide)? hypoglycemia
Major side effect of Meglitinides (Prandin)? hypoglycemia
Major side effect of Biguanides (metformin/glucophage)? GI symptoms, decreased appetite, nausea, diarrhea, lactic acidosis (rare)
Major side effect of Thiazolidinediones (Avandia and Actos)? hypoglycemia (with excessive insulin)
Increase in exercise.... decrease glucose and insulin needs
Decreased caloric intake (NPO).... decrease glucose and insulin needs
Excessive alcohol consumption.... hypoglycemia (decrease glucose and insulin needs)
An infection... increase glucose and insulin needs
During times of stress.... increase glucose and insulin needs
Adolescent growth spurt.... increase glucose and insulin needs
Increased caloric intake... increase glucose and insulin needs
Glucocorticosteroid usage.... increase glucose and insulin needs
Regular insulin is compatible with which other insulins? All EXCEPT Lispro
Lispro is compatible with which other insulins? All EXCEPT Regular
NPH is compatible with which other insulins? Regular or Lispro
Lantus is compatible with which other insulins? NONE
Which insulin is normally given at bedtime? NPH (long acting insulin)
blood glucose below 50 mg/dl constitutes... hypoglycemia
rapid s/s of hypoglycemia... tachycardia, palpitations, sweating, nervousness
gradual s/s of hypoglycemia... headache, confusion, drowsiness, fatigue
severe s/s of hypoglycemia... convulsions, coma, death
conscious hypoglycemic tmt... oral sugar/glucose
Semi-unconscious hypoglycemic tmt... NPO, IV glucose (D50W), glucagon (IV preferred, IM, SC)
How do you mix insulins? 1)Inject air: NPH (long acting) 1st-->Regular 2nd2)Draw up: Regular (short acting) 1st-->NPH 2nd
Insulin absorption....Slow, faster, fastest... SC (slow), IM (faster), IV (fastest)
Factors that increase insulin absorption... localized heat, massage of area, and exercise of injected area
Insulin causes hypokalemia or hyperkalemia? hypokalemia (due to polyuria-excessive urination)
Which Sulfonyurea is very potent with a long duration? Glyburide
Glyburide is used to treat... Type 2 diabetes
Which drug class can cause a Disulfiram like reaction? (rash/red skin, itching) Sulfonyureas
Name the prototype drug for Meglitinides. Repanglinide (Prandin)
Prandin is used to treat... Type 2 diabetes
When is Prandin administered? 30 min before meals (AC) (must eat within 30 min)
Name the prototype drug for Biguanides? Metformin (Glucophage, Glucophage XR)
Metformin is used to treat... Type 2 diabetes
When is Metformin administered? PO bid w/meals
What is Metformin sometimes used for OTHER THAN decreasing glucose production? weight loss (decreased appetite, promotes nausea and diarrhea
Metformin decreased absorption of what vitamins? B12 and folic acid
What effect does Metformin/Glucophage have on insulin? NONE-it only decreases glucose production in the liver
What is the prototype drug for Thiazolidinediones ("Glitazones")? Pioglitazone (Actos) and Rosiglitazone (Avandia)
The Glitazones (Actos and Avandia) treat.... Type 2 diabetes
The Glitazones are administered.... PO 1-2x daily w/ or w/o food
What adverse effects do Actos and Avandia cause? -fluid retention-(*cautious w/CHF*)-Long term risk: liver failure (*baseline LFT-and then every 3-6 mths)-increases LDL and HDL, and triglycerides-NO hypoglycemia
What is the prototype drug for hypothyroidism? Levothyroxine (Synthroid)
What are the s/s of hypothyroidism? decreased metabolism, general weakness, muscle cramps, dry skin, bradycardia,wt gain, cold intolerance, ELEVATED TRH and TSH levels, LOW T3 and T4 levels
What is a "crisis" level of hypothyroidism? Myxedema Coma
What is the prototype drug for hyperthyroidism? Propyltiouracil (PTU): Iodine
What are the s/s of hyperthyroidism? increased metabolism, anxiety, increased muscle tone, tachycardia, wt loss, hyperthermia, exopthalmos, HIGH TRH and TSH levels, HIGH T3 and T4 levels
What is a "crisis" level of hyperthyroidism? Thyrotoxicosis/Thyroid Storm
How is Synthroid administered? PO qd acb-on an empty stomach; separate from other meds; lower dose w/warfarin; higher dose with phenytoin (seizures); highly protein bound; long half life
What is the MOA for Propylthiouracil (PTU)? blocks thyroid hormone synthesis-(*NO effect on existing stores)
How is PTU administered? PO-multiple daily doses (short half life)
What are some adverse effects of PTU? rash, (rare) agranulocytosis, hypothyroidism (w/overtreatment), use lowest effective dose w/pregnancy
Besides PTU, what other prototype drugs are used to treat hyperthyroidism? Nonradioactive Iodine (Lugol'solution), radioactive iodine (Iodine 131-Iodotope), and Beta blocker (Propanolol-Inderal)
What is the MOA for Lugol's Solution (strong Iodine)? decreases iodine uptake by thyroid and inhibits thyroid hormone synthesis and inhibits release of thyroid hormone in blood
How do you administer Lugol's solution? 2-6 drops tid (mix w/juice)
What are the adverse effects of Lugol's solution? brassy taste, burning sensation in mouth (d/c use)-OD-intense GI symptoms
Iodine 131 is used for treatment of.... thyroid cancer
Do not use Radioactive Iodine for... pregnancy and lactation
with high doses, adverse effects of radioactive iodine are.... radiation sickness, leukemia, and bone marrow suppression
Beta blockers are used w/ hyperthyroidism to... suppress tachycardia and s/s of Graves and thyrotoxic crisis (given IV)
s/s of Adrenal insufficiency.... depression, fatigue (hypoglycemia), anorexia/vomiting/diarrhea/nausea, hyperpigmentation of skin, sparse body hair in women, inability to respond to stress (causes hypotension/shock), low glucocorticoid levels and high ACTH and CRH, dec Na+, high K+
What is the prototype DOC for adrenal insufficiency? Hydrocortisone
Other treatments for adrenal insufficiency, besides hydrocortisone, include... restore fluid balance (IV), replacement of cortisol and aldosterone levels
What are the effects of glucocorticoids? decrease fluid volume (blood pressure and wt loss), decrease K+ and Na+, decrease immune response
How do you discontinue glucocorticoid drugs? taper off gradually
Do you increase or decrease dose of glucocorticoids under times of stress? increase
Created by: 1585575288
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