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Endo pancreas pharm

Disorders & Tumors of the Endocrine Pancrease Pharmacology

QuestionAnswer
Management of severe hypoglycemia related to high insulin levels from insulinoma (pancreatic islet cell adenoma) Rapid restoration of blood glucose to prevent brain damage (I.V. concentrated solution of Dextrose); Maintain normal blood glucose (lower Dextrose concentration); Discover and reverse cause of increased insulin (drugs, resection of tumor); Follow-up
Reactive hypoglycemia Person has inherited or acquired insulin resistance; When they eat carbs their body has exaggerated insulin secretion; This leads to hypoglycemia and adrenergic response
Management of Reactive Hypoglycemia Diet-decrease carb challenge; Alpha-glucosidase inhibitors (inhibit the breakdown of carbs, thus they can't be absorved); Parenteral glucagon (Increase hepatic glucose release); Insulin secretion antagonists
Symptoms/Findings of gastrinoma/Zollinger-Ellison Syndrome Prominent gastric folds and multiple ulcers in upper G.I., and diarrhea due to gastrin secreting tumor in the pancreas. Could be part of MEN-1 and have symptoms indicative of parathyroid or pitiutary tumors as well.
Treatment for Gastrinoma Surgical resection & proton pump inhibitors (PPIs) to treat excessive acid production. Lansoprazole (Prevacid), Omeprazole (Prilosec), Esomeprazole Magnesium (Nexium), etc.
Treatment of DKA: Immediate Action Insulin replacement w/ ultra-rapid or fast-acting insulin, and fluid & sodium replacement with isotonic saline. After plasma glucose and ketone bodies decrease add 5% glucose (prevent hypoglycemia) & hypotonic saline
Treatment of DKA: Non-immediate Action Reduction of blood pH and restoration of bicarbonate; Potassium replacement
Treatment goals for Metabolic Syndrome Decrease risk factors, which are: Truncal Obesity (Diet & Exercise), Increased TGs, Increased LDL, Hypertension, Increased fasting glucose
Metabolic Syndrome: Lipid Therapy Decrease LDL with statins, or bile acid sequestrants, Ezetmibe, or fibrates; Increase HDL with Niacin or Fibrates; Decrease VLDL-TG with diet and/or statins, or fibrates.
Statins MOA Inhibit HMG-CoA reductase, the rate-limiting enzyme needed to form cholesterol
Niacin MOA Reduce hepatic LDL & VLDL production, inhibit lipolysis, decrease TG esterifiction, increase lipoprotein lipase activity, participate in tissue respiration oxidation-reduction reactions
Fibrates MOA Inhibit TG synthesis and stimulate catabolism of TG-rich lipoproteins.
Metabolic Syndrome: Antihypertensive Therapy Thiazide diuretics, but since it may cause loss of K+ then may need combination of thiazide-spironalactone (aldosterone antagonist), K+ supplement, combine with K-sparing diuretic (Amiloride). Also ACE inhibitors, ARBs, Ca-channel blockers, beta blockers
Metabolic Syndrome: Antithrombotic Therapy Counteract prothrombotic state by using aspirin (aspirin + Dipyridamole is better), Clopidogrel, aspirin + Clopidogrel (increased bleeding though). Counteract procoagulant state with warfarin, or LMWH, or Heparin.
Dipyridamole An antiplatelet drug that inhibits platelet adhesion, and dilates coronary arteries.
Clopidogrel An antiplatelet drug that inhibits ADR-induced platelet aggregation. ADR=adrenaline/epinephrine
Created by: MarcoB78
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