Term
| Hormones of the posterior pituitary |
|
Definition
| Desmopressin, oxytocin, Vasopressin (ADH) |
|
|
Term
| hormones of the hypothalamis |
|
Definition
| Corticotropin (ACTH), Gonadotropin-releasing hormone, Growth Hormone releasing hormone, Leteinizing hormone releasing, somatostatin, Somatoropin |
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|
Term
| Hypothalamic hormones are clinically used for? |
|
Definition
| diagnostic purposes to determine the response of the pituitary gland to physiologic stimuli |
|
|
Term
ACTH (corticotropin) released from where?
target organ?
stimulates the release of what? |
|
Definition
anterior Pituitary
Adrenal Gland
stimulate synthesis of glucocorticoids, mineralcorticoids, and androgens |
|
|
Term
| most potent glucocorticoid produced by adrenals. synthesized from cholesterol,peak levels are found in the morning |
|
Definition
|
|
Term
| Cosyntropin used for diagnosis of |
|
Definition
Adrenal insufficiency acts like ACTH
.25mg will stimulate adrenal to max=25 units of natural ACTH |
|
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Term
| dz of ACTH hypersecretion |
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Definition
|
|
Term
| which is a condition in which the adrenal glands suddenly stop working the way they should |
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Definition
|
|
Term
| Pharmacologic test to distinguish primary or secondary adrenal failure |
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Definition
|
|
Term
| is caused by too low a level of ACTH in a damaged adrenal gland |
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Definition
|
|
Term
| is caused by having too high a level of ACTH |
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Definition
|
|
Term
| which is a decrease in activity of the pituitary gland |
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Definition
|
|
Term
| an abnormal growth in the pituitary gland |
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Definition
|
|
Term
| A sluggish or no response to the ACTH test indicates what? |
|
Definition
|
|
Term
| A rise of greater that 20 mcg/dl on day 4 of an ACTH test indicates |
|
Definition
| ACTH deficiency (not adrenal insufficiency) |
|
|
Term
| During an ACTH test A >20 mcg/dl rise in cortisol is considered |
|
Definition
| normal: check levels before and 30 minutes after dose |
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Term
| Growth Hormones release in response to GHRH from the hypothalamus stimulates? |
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Definition
| Stimulates protein synthesis,cell proliferation (increases the number and size of muscle cells), and linear bone growth, cartilage synthesis |
|
|
Term
Somatropin and Somatrem are?
Primary action? |
|
Definition
Growth Hormone derived from recombinant DNA technology
stimulation of linear growth |
|
|
Term
| Treatment with growth hormone increases the _______ and _______ of muscle cells |
|
Definition
number, size
[Remember: Growth Hormone is NOT specific in its action on just certain tissues ie. Muscle tissue] Growth hormone influences internal organ size and increases red cell mass. |
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Term
| Direct effects of Growth hormone? |
|
Definition
| binds receptors on adipocytes: stimulates them to break down triglyceride and supresses their ability to take up and accumulate circulating lipids. |
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Term
|
Definition
Stimulation of Insulin-like Growth Factor-1 (IGF-1) [somatomedin] from liver
IGF-1 stimulates proliferation of chondrocytes (cartilage cells), resulting in bone growth.
differentiation and proliferation of myoblasts
amino acid uptake and protein synthesis in muscle and other tissues. |
|
|
Term
| growth hormone is modulated by |
|
Definition
| including stress, exercise, nutrition, sleep and growth hormone itself |
|
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Term
| Primary Controllers of GH release? |
|
Definition
GHRH (hypothalmic)
Somatostatin (hypothalmic)
Ghrelin (major source is epi cells in stomach_effects appetite and NRG balance |
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Term
| Treatment of growth failure: For the long-term treatment of children who have growth failure caused by a lack of adequate endogenous growth hormone secretion |
|
Definition
| SOMATREM-Protropin Genentech |
|
|
Term
| Indications for GH supplementation |
|
Definition
Growth Failure (GH deficiency or child with Chronic Renal insufficiency)
Turner syndrome short stature
AIDs waisting
Elderly decrease fat to lean ration increase skin thickness |
|
|
Term
| Somatostatin- GHIH does what? |
|
Definition
| inhibits the release of Human GH and is found in the hypothalmus, intesting and pancreas |
|
|
Term
Octreotide Acetate (Sandostatin) is indicated for:
initial dose? |
|
Definition
Somatostatin analog (GH inhibitor)
Achromegaly, caused by GH secreting tumors
Also for secretory diarrhea associated with vasoactive intestional peptide (VIP) secreting tumors, GI fistula, Pancreatic fistula
50mcg 2 or 3 times daily |
|
|
Term
| Name the 2 Gonadotropins? |
|
Definition
LH (ovulation induction):
FSH (follicle stimulation) |
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Term
| a preparation of highly purified follicle-stimulating hormone (FSH) extracted from the urine of postmenopausal women. |
|
Definition
| urofollitropin (Fertinex) |
|
|
Term
are human FSH preparations of recombinant DNA origin
stimulate ovarian follicular growth in women who do not have primary ovarian failure
These medications should only be used by physicians who are thoroughly familiar with infertility problems and their management. Mild to severe adverse reactions do occur. |
|
Definition
Follitropin alfa [Gonal\NF] -
Follitropin beta [Follistim] |
|
|
Term
| In order to effect ovulation in the absence of endogenous LH surge,________________ must be given following the administration of urofollitropin, follitropin alfa and beta when clinical and laboratory assessment of the patient indicate that sufficient follicular maturation has occurred. |
|
Definition
| human chorionic gonadotropin (hCG) |
|
|
Term
hMG (Human Menopausal Gonadotropin represent?
hCG (human Chorionic gonadotropin) represents? |
|
Definition
FSH and LH activity
only LH activity |
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|
Term
| medicine is used to treat advanced prostate cancer when orchiectomy (castration) or estrogen administration is either not indicated or unacceptable to the patient. It is also used to treat breast cancer, endometriosis, percocious puberty, uterine leiomyomata (fibroids)and to thin the endometrium. |
|
Definition
GnRH/LHRH
controls the release of FSH and LH from pituitary
stimulates gonadal hormone production in hypogonadism
These analogs when given
Act as inhibitors of GnRH via negative feedback mechanism
Inhibit LH/FSH release to reduce hormonal stimulation |
|
|
Term
| Leuprolide Acetate (LUPRON)is what kind of drug? |
|
Definition
|
|
Term
Use is in obstetrics to stimulate uterine contraction
Potential AEs :hypertensive crisis, uterine rupture, water retention, fetal death have been reported with use.
has vasopressive and antidiuretic effects as well |
|
Definition
Cuddle Hormone:
Oxytocin: Pitocin and Syntocinon |
|
|
Term
What hormone am I?
promotes water resorption at the renal tubular epithelium
Tx of Diabetes Insipidus (central/neurogenic type)
smooth muscle contraction throughout the vascular bed (vasopressor effects) |
|
Definition
|
|
Term
| disorder of water metabolism that results from a partial or complete deficiency in the production and secretion of vasopressin from the neurohypophysis |
|
Definition
Neurogenic or Central diabetes insipidus
Vasopression and its synthetic analogs DO work here!!!!! |
|
|
Term
| disorder results from an insensitivity of the renal tubules to the action of antidiuretic hormone |
|
Definition
Nephrogenic or peripheral diabetes insipidus
Vasopression or its synthetic analogs do not work here!!!! |
|
|
Term
DDAVP (1-Deamino-8-D-Arginine Vasopressin)
Diabetes Insipidus
Nocturnal Enuresis
Hemophilia A von Wilebrand's disease (type1)
No vasopressor effect
Administered intranasally |
|
Definition
|
|
Term
what type of hormone?
Facilitate normal growth and maturation by maintaining the level of metabolism in the tissues. |
|
Definition
Thyroid Hormones
two major types
Throxine= T4
Triiodothyronine= T3 |
|
|
Term
| . TSH action is mediated by CAMP and leads to stimulation of _________ uptake |
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Definition
|
|
Term
Most sensitive index for hyper/hypothyroidism and replacement therapy
stimulated by TRH from hypothalamus
released from anterior pituitary |
|
Definition
|
|
Term
| TSH secretion is suppressed physiologically by __________, which antagonizes the stimulatory effects of TRH. |
|
Definition
dopamine
Therefore, dopaminergic agonists and antagonists can alter TSH secretion. |
|
|
Term
PEARLS
TSH Screening Indications |
|
Definition
1-All elderly with depression
2-All elderly entering long term care
3-All patients on therapy for PD with dopamine agonists (more dopaminergic activity will suppress TSH secretion……hypothyroidism)
Normal Levels: 0.5- 4.7 mIU/L |
|
|
Term
| as chronic lymphocytic thyroiditis, your immune system attacks your thyroid gland. The resulting inflammation often leads to an underactive thyroid gland (hypothyroidism). |
|
Definition
|
|
Term
| The primary effect of the thyroid hormones is the result of (T3, T4) activity. Under normal circumstances, the ratio of T4 to T3 released from the thyroid gland is __:__. |
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Definition
|
|
Term
| is the thyroid replacement of choice. |
|
Definition
| Levothyroxine (levothyroid) long half life 7 days absorption: 60min before meal Generic and branded levothyroxine are not interchangeable. |
|
|
Term
| drug not recommended for routine thyroid hormone replacement because of the problems identified earlier with T3 administration. Because T3 is absorbed more rapidly than T4, supraphysiologic elevations in plasma T3 levels occur after oral ingestion, which can produce mild thyrotoxic symptoms in some patients |
|
Definition
Triiodothyronine (cytomel)
relatively short half-life (1.5 days)
multiple daily dosing |
|
|
Term
this exogenous thyroid replacement has
a very "narrow therapeutic index" drug
differing by as little as 10% can have a major negative clinical impact
Contraindications:
Acute myocardial infarction and thyrotoxicosis uncomplicated by hypothyroidism |
|
Definition
|
|
Term
Drug interactions of Thyroid Hormones:
1. Anticoagulants
2. Beta blockers
3. Digitalis
4. Theophyllines |
|
Definition
1. increase anticoagulation
2. decreased efficacy
3. digitalis levels are reduced
4. decreased theophylline |
|
|
Term
| Rules to thyroid replacement |
|
Definition
Replacement therapy is to be taken for life
Take as a single daily dose, preferably at bedtime (Clin. Endocrin & Arch of IM 2010)
Do not change from one brand of this drug to another
Do not discontinue medication
Not for use as primary or adjunctive therapy in a weight control program. |
|
|
Term
what kind of disease?
Grave's Disease (Most Common Cause)
Subacute Thyroiditis
Acute Thyroiditis (Bacterial infection)
Toxic Multinodular Goiter
Toxic Thyroid Adenoma
Thyroid Storm
Postpartum Thyroiditis
Pituitary TSH-secreting tumor |
|
Definition
| Hyperthyroid [Thyrotoxicosis |
|
|
Term
| used for treatment of hyperthyroidism. |
|
Definition
Sodium Iodide
Indications:
Thyroid carcinoma
Hyperthyroidism
Pregnancy is absolute contraindication |
|
|
Term
Preferred for children, pregnant women, and young adults
Leaves the thyroid gland intact
In Graves to control symptoms until remission occurs (25-30% of cases)
Given before RAI therapy to deplete the gland of hormone to prevent thyroid storm
Therapy given for 18 months or longer |
|
Definition
Thionamides: PTU and Methimazole
PTU and Methimazole inhibit thyroidal peroxidase.
PTU also inhibits peripheral conversion of T4 to T3 |
|
|
Term
| The onset of action of PTU (propylthiouracil) is more rapid than methimazole because PTU has an additional mechanisms of action to inhibit the peripheral conversion of T4 to T3. Therefore, PTU is the thionamide of choice in thyroid storm. PTU also is the drug of choice during breast-feeding because it is secreted in breast milk. Otherwise, methimazole is preferred over PTU to enhance compliance because it can be administered once daily, whereas PTU must be given two to three times daily. no contraindication in liver dz |
|
Definition
| Hyperthyroidism Drug Therapy: Thionamides |
|
|
Term
| may be used to ameliorate hyperthyroidism in preparation for subtotal thyroidectomy or radioactive iodine therapy. It is also used when thyroidectomy is contraindicated or not advisable. |
|
Definition
Methimazole (Tapazole)
Advantages over Propylthiouracil (PTU)
Once daily dosing
Decreases T4 and T3 levels
Lower risk of Agranulocytosis at moderate doses |
|
|
Term
| Drug-Induced Agranulocytosis (more common with PTU) presents as |
|
Definition
Infection (e.g. Pharyngitis)
Course
Resolves within 2-3 weeks after drug stopped |
|
|
Term
Life-threatening medical emergency
Exaggerated form of thyrotoxicosis
S/S: fever, tachycardia, tachypnea, and other CNS & CV manifestations
Htn,shock,tremors,psychosis
Manifests in 2% to 8% hyperthyroid patients
Increased adrenal and sympathetic output |
|
Definition
|
|
Term
| Treatment of Thyroid Storm |
|
Definition
Decrease synthesis and release of hormone:
High doses of thioamides + iodides
PTU 600-1200 mg QD
Methimazole 60-120 mg/QD
hydrocortisone 100 to 200 mg should be given IV every 6 hours
Reverse peripheral effects of hormones and catecholamines
Beta blockers (propranalol)
Blocks adrenergic stimulation & peripheral T4 to T3 conversion
Supportive treatment |
|
|
Term
| Drug-Induced Thyroid Diseases |
|
Definition
Lithium
Chronic therapy inhibits the release of thyroid hormone from the gland
Occurs in approximately 19% of patients
Amiodarone
High iodine content (12 mg/dose)
Occurs in 6% to 10% of patients |
|
|
Term
| inhibits Growth Hormone and Inhibits TSH |
|
Definition
| Somatostatin (Octreotide): |
|
|
Term
| syndrome that is caused by a relative or an absolute lack of insulin. Clinically, it is characterized by symptomatic glucose intolerance as well as alterations in lipid and protein metabolism. |
|
Definition
|
|
Term
| does not require insulin for glucose transport, but insulin facilitates the conversion of glucose to glycogen and free fatty acids. The latter are esterified to triglycerides, which are transported by very-low-density lipoproteins (VLDL) to adipose and muscle tissue. |
|
Definition
|
|
Term
Homeostatic mechanism maintains glucose between?
CNS requires________ of Glucose as primary energy source- independent of insulin |
|
Definition
55-140 mg/dl
40-60 mg/dl
Muscle & fat use glucose as major energy source- require insulin |
|
|
Term
| Two key factors that lead to type 2 diabetes |
|
Definition
| are increased insulin resistance and decreased beta-cell function. Both contribute to increased blood glucose levels. |
|
|
Term
| Classic signs and symptoms of diabetes |
|
Definition
1. polyuria, polydipsia, ketonuria, and rapid weight loss) combined with a random plasma glucose >200 mg/dL.
2. . A fasting plasma glucose (FPG) > 126 mg/dL.
3. Following a standard oral glucose challenge (75 g glucose for an adult or 1.75 g/kg for a child), the venous plasma glucose concentration is >200 mg/dL at 2 hours and >200 mg/dL at least one other time during the test (0.5, 1, 1.5 hours); this is the oral glucose tolerance test (OGTT). |
|
|
Term
|
Definition
|
|
Term
| There are three major components to the treatment of diabetes? |
|
Definition
| diet, drugs (insulin and oral hypoglycemic or antihy¬perglycemic agents), and exercise |
|
|
Term
| All insulin products have a _______ pH, except for __________ which has a pH of 4.0 |
|
Definition
neutral
insulin glargine (lantus) |
|
|
Term
| Ultra short acting insulin |
|
Definition
Insulin Lispro or Insulin Aspart (Novolog)
onset 15min-30min
duration: <5hours |
|
|
Term
Regular insulin:
onset of action
durationof action |
|
Definition
onset: 30-60 min
duration: 5-10 hours |
|
|
Term
NPH and Lente
onset of action
duration of action |
|
Definition
Intermediate acting insulins
onset: 2-3hours
duration: 16-24 hours |
|
|
Term
| premixed insulins include: |
|
Definition
NPH/Reg (70:30)
NPH/Lispro (50:50)
NPH/aspart (75:25) |
|
|
Term
| Insulin that cannot be mixed: |
|
Definition
|
|
Term
| typical starting point for insulin dosing? |
|
Definition
1 unit of insulin for every 15 grams of CHO:
1 startch, 1 fruit, 1 milk |
|
|
Term
| Insulin for once-daily SC administration in the treatment of adult and pediatric patients (>6 years) with type 1 diabetes mellitus or adult patients with type 2 diabetes who require basal (long-acting) insulin for the control of hyperglycemia." once injected this clear solution with a pH of 4.0) precipitates at physiologic pH forming a depot that releases insulin slowly over 24 hours. Do not mix |
|
Definition
| Insulin Glargine (Lantus) |
|
|
Term
long-acting basal insulin analog, with up to 24 hours duration of action, produced by a process that includes expression of recombinant DNA in Saccharomyces cerevisiae followed by chemical modification.
once-daily, the dose should be administered with the evening meal or at bedtime.
twice-daily dosing for effective blood glucose control, the evening dose can be administered either with the evening meal, at bedtime, or 12 hours after the morning dose. |
|
Definition
| Insulin Detemir (Levemir) |
|
|
Term
inserted into the inhaler, the patient pumps the handle of the inhaler and then presses a button, causing the blister to be pierced.
¡will not replace the need for injections |
|
Definition
|
|
Term
Type 1 Diabetes daily Insulin requirements
Initial dose?
Honeymoon phase?
with ketosis, during illnes, growth |
|
Definition
initial: .5-.8 U/kg
Honey: .2- .5 U/kg
ketosis: 1.0-1.5 U/kg |
|
|
Term
Type 2 diabetes: total daily insulin requirements
with insulin resistance: |
|
Definition
|
|
Term
Estimated basal requirements for insulin:
what is the range |
|
Definition
.3-1.4 U/hr
or approximately 50% total daily dose
or approximately .7 U/hr for 70kg person |
|
|
Term
What rule am I?
estimates the number of grams of carbohydrate (CHO) that will be covered by 1 unit of rapid-acing insulin.
what about regular insulin? |
|
Definition
500 rule: 500/TDD (total daily dose)
450 rule: 450/TDD
500/50= 10: 10g of CHO covered by 1U insulin |
|
|
Term
| factor determines how far the blood glucose drops per unit of insulin |
|
Definition
Correction factor:
1800 rule: rapid insulin
1500 rule: regular insulin
So if patient TDD is 30u than 1800/30= 60mg/dl drop in glucose per unit insulin |
|
|
Term
just read:
Some endocrinologists prefer to begin with NPH, optimize the NPH doses, and then add rapid or short-acting insulin if needed later. The total daily dose of NPH is split initially intp two doses: two-thirds in the morning and one-third before dinner. Insulin glargine Lantus) is superior to NPH or Ultralente with a reduction in the incidence of hypoglycemia |
|
Definition
|
|
Term
| What is the initial goal of insulin therapy? |
|
Definition
| The initial goal of therapy is to achieve preprandial blood glucose concentrations of <180 mg/dL and to eliminate symptoms of hyperglycemia. |
|
|
Term
What is going on here?
normoglycemia at bedtime
low blood glucose concentrations at 0300 hrs
symptoms of nocturnal hypoglycemia
nightmares, sweating, hunger, morning headache
secondary to an excessive increase in glucose production by the liver |
|
Definition
| Somogyi Effect or Rebound Hyperglycemia |
|
|
Term
a potentially life-threatening condition, requires prompt diagnosis and treatment.
Hyperglucagonemia, hyperglycemia
may result from stress, illness, or insulin omission or may develop slowly after a long period of insulin control. |
|
Definition
|
|
Term
| How to treat Ketoacidosis? |
|
Definition
When you get them in hospital you have to push fluids to dilute the blood sugar and give IV insulin to get the blood sugar down. When it gets down you replace the normal saline to D5W for the brain.
IV insulin infusion (Regular) is given. LD is 0.15 U/kg/hr with maintenance infusion of 0.1 U/kg/hr |
|
|
Term
first in a new class of injected antihyperglycemic medications for use in patients with type 2 or type 1 diabetes treated with insulin.
neuroendocrine hormone synthesized from pancreatic beta cells that contributes to glucose control during the postprandial period
When used with insulin, can achieve imporved glycemic control. |
|
Definition
Symlin (Pramlintide) like amylin
You can’t mix symlin with insulin in the same dose you have to give it in separate syringe
Dosed subcu |
|
|
Term
| How does Symlin (pramlintide) work? |
|
Definition
regulates nutrient delivery to the stomach,slows gastric emptying
suppresses glucagon secretion (not normalized by insulin alone), which leads to suppression of endogenous glucose output from the liver. Regulates food intake due to centrally-mediated modulation of appetite.
Symlin also suppresses the appetite center in the brain, and a very significant finding
This finding is truly unique because normally, when blood sugar control is improved with pills and/or insulin, weight gain is inevitable because the fat and muscle cells of the body are now properly utilizing all of the sugar that was spilling out in the urine |
|
|
Term
|
Definition
dose is always adminstered as separate injections:
should not be mixed with any type of insulin
if dose is missed do not give an additional injection
use a new syringe and needle to give symlin and insulin injections
60microg SC immediately prior to meals
reduce preprandial rapic or short acting or mix insulin dose by 50%
than increase to 120microg after 3-7 days if no nausea
Can cause nausea bc of decreased gastric emptying. |
|
|
Term
| Name 4 classes of Type 2 oral drugs: |
|
Definition
Biguanides
Alpha-glucosidase inhibitors
Insulin Secretagogues
thiazolidinediones |
|
|
Term
oral glucose drug:
reduce insulin resistance primarily by decreasing hepatic glucose production. |
|
Definition
|
|
Term
oral drug:
reduce insulin resistance primarily stimulating glucose uptake in muscle and fat cells. |
|
Definition
|
|
Term
oral drug diabetes
acarbose delay the absorption of carbohydrates in the gut. |
|
Definition
| Alpha-glucosidase Inhibitor |
|
|
Term
oral diabetes hypoglycemic control:
what drug:
1-stimulate insulin release from B cells
2-reduce serum glucagon levels
3-increase binding of insulin to receptors (enhance beta cell sensitivity to glucose) |
|
Definition
|
|
Term
| contraindication of sulfonylureas? |
|
Definition
pregnancy and type 1 DM
also renal or liver deficiency |
|
|
Term
| 1st line treatment of type 2 diabetes? |
|
Definition
diet and excercise
reduction of body weight can improve glycemic control significantly. Physical exercise is also known to increase insulin sensitivity. |
|
|
Term
what type 2 diabetes drug am I?
Does not stimulate insulin secretion- is not a secretagogue
Does not cause hypoglycemia in non-diabetic individuals
Acts mainly to decrease hepatic glucose output (gluconeogenesis)
Improves peripheral sensitivity to insulin
reduces LDL and VLDL/ incr. HDL |
|
Definition
Metformin (Glucophage) (2nd generation) Biguanides
rare SE: lactic acidosis |
|
|
Term
availabe in liquid form, tablets and extended release: drug of choice for diabetic 2: keeps blood sugar down, has good lipid benefits, very effective in polycystic ovary diseases
inhibits gluconeogenesis |
|
Definition
|
|
Term
Titrate dose from 500 mg QD- BID to 850 mg TID (max dose 2550 mg/QD)
Lowers FPG by 50 to 70 mg/dL
Can reduce A1C by 1.5% to 1.7% from baseline
Preferred as initial therapy in Type 2 DM because it rarely causes hypoglycemia ans has equal efficacy in lowering FPG as does the sulfonylureas |
|
Definition
|
|
Term
| Name 2 Glucosidase Inhibitors: |
|
Definition
Acarbose and Migitol
Have no effect on weight or lipid profiles
Both can be used as monotherapy or combination
Dose: 25 mg TID with meals (start of each meal) (max 100mg TID)
Cause liver enzymes to increase
Tolerance is the biggest problem with this drug |
|
|
Term
| Name two non-sulfonylurea secretagogues |
|
Definition
Repaglinide (prandin) and Natelinide (starlix)
In combination with metformin to lower blood glucose in patients whose hyperglycemia cannot be controlled by exercise, diet and either agent alone.
Rapid onset and shorter DOA than sulfonyureas
taken within 15 minutes of the meal, but time may vary from immediately preceding the meal to as long as 30 minutes before the meal.
Can be given alone but mostly in combination |
|
|
Term
| What oral diabetic drug am I? MOA: stimulates pancreatic islet beta cell insulin release Give 30 mins ac (skip if no meal) Dose: 60-120mg TID ac Can cause hypoglycemia, nausea, dyspepsia, diarrhea Metabolized by liver (monitor LFT’s periodically) |
|
Definition
Nateglinide (nonsulfonylureas) you give it before you eat more flexibility
With Sulfoylureas you take 1-2 times a day and you have to eat at that TIME |
|
|
Term
is indicated as monotherapy for type 2 diabetes, or as an adjunct to diet and exercise, to improve glycemic control in type 2 diabetes patients.
should be added to, rather than substituted for, sulfonylurea or metformin in patients who have not achieved glycemic control with maximum-dose sulfonylurea or metformin. |
|
Definition
Thiazolininediones:
Rosiglitazone (Avandia) |
|
|
Term
| Name 2 Thiazolininediones: |
|
Definition
Rosiglitazone (Avandia)
Pioglitazone (Actos)
Liver function testing should be done before initiation of therapy with rosiglitazone or pioglitazone. If ALT levels are greater than 2.5x the upper limit of normal, these agents should not be initiated. |
|
|
Term
| Thiazolininediones and the liver? |
|
Definition
Liver function testing should be done before initiation of therapy with rosiglitazone or pioglitazone. If ALT levels are greater than 2.5x the upper limit of normal, these agents should not be initiated.
Once therapy has begun with these agents, liver function testing should be conducted every two months for the first year of treatment, and periodically thereafter.
If ALT levels fall in the range of 1.0 to 2.5 times the upper limit of normal, either at baseline or during therapy, the cause of the elevation should be determined.
Treatment should be discontinued if the ALT becomes greater than three times the upper limit of normal or if jaundice develops. If at any time ALT levels increase to greater than three times the upper limit of normal, liver enzyme levels should be rechecked as soon as possible. |
|
|
Term
inhibitors that improves blood sugar control in patients with type 2 diabetes.
enhances a natural body system called the incretin system, which helps to regulate glucose by affecting the beta cells and alpha cells in the pancreas.
works only when blood sugar is elevated to address diminished insulin due to beta-cell dysfunction and uncontrolled production of glucose by the liver due to alpha-cell and beta-cell dysfunction |
|
Definition
Sitagliptin (Januvia): dipeptidyl peptidase-4 (DPP-4) inhibitors
JANUVIA is 100 mg once daily. JANUVIA should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings. |
|
|
Term
Blocks DPP-4 enzyme that breaks down the gut hormone incretin that is released in response to the ingestion of food
¡Incretins enhance glucose-stimulated insulin secretion from the pancreas and decrease the release of glucagon from the pancreatic alpha cells |
|
Definition
|
|
Term
just read:
JANUVIA addresses two of the three key defects that cause poor glucose control: diminished insulin release due to beta-cell dysfunction and uncontrolled production of glucose by the liver due to alpha-cell and beta-cell dysfunction. By adding JANUVIA to the insulin sensitizers metformin or pioglitazone (a TZD), the three key defects of type 2 diabetes can be addressed: insulin resistance, beta-cell dysfunction (decreased insulin release), and alpha-cell dysfunction (unsuppressed hepatic glucose production). |
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Definition
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Term
injectable medicine used to improve glucose control in adults with type 2 diabetes.
It can be used with metformin, a sulfonylurea, or a thiazolidinedione.
enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying |
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Definition
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| ADverse Effects of Byetta |
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Definition
Hypoglycemia
Decreased appetite, food intake and body weight
Mild to moderate nausea (most frequently reported SE) decreased over time
incidence of withdrawal due to adverse events was 7% |
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Term
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Definition
| 5 mcg twice daily (BID) for 1 month followed by 10 mcg BID for 6 months before the morning and evening meals. Each dose of BYETTA should be administered as a SC injection in the thigh, abdomen, or upper arm at any time within the 60-minute period before the morning and evening meals (or before the two main meals of the day, approximately 6 hours or more apart). BYETTA should not be administered after a meal. If a dose is missed, the treatment regimen should be resumed as prescribed with the next scheduled dose. |
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| Insulin statements, choose the true statement |
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Definition
o How insulin is administered: IV, IM, SC for Regular; most others SC
o MOA of insulin: promote uptake of Glucose, fatty acids, aminoacids and converts them to storage form |
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| • Hormone secretion from anterior vs posterior pituitary: |
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Definition
| posterior Oxytocin and ADH |
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| synthetic T4; drug of choice in Hypothyroidism, Stable and well-absorbed |
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Definition
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What dz can all these drugs treat
Lugos solution
propranolol
potasium iodide
corticosteroids |
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Definition
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| Used to promote spermatogenesis in infertile men? |
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Definition
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Hormone synthesized in cells located in the anterior pituitary?
pick one: CRH, Oxytocin, Vasopressin, TRH, LH |
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Definition
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| important difference in leuprolide and ganirelix? |
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Definition
| Ganirelix immediately reduces gonadotropin secretion |
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Term
| A protein synthesized in the thyroid gland; its tyrosine residues are used to form thyroid hormone |
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Definition
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| What drug is associated with lupus erythromatous like syndrome and agranulocytosis? |
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Definition
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| to reduce the size of a thyroid gland and vascularity use? |
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Definition
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| Methimazole reduces serum concentration of T3 primarily by: |
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Definition
| preventing the addition of iodine to tyrosine residues on thyroglobulin |
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Term
| In neurogenic Diabetes Insipidus there is a deficiency in production and secretion of ADH causing nocturnal enueresis so you should use? |
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Definition
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Definition
| 500BID titrate to 850 TID |
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Term
| Sulfonylureas end in -ides |
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Definition
| acetohexamide, chlorpropamide, Tolazamide, tolbutamide, glipizide, glyburide, glimepiride |
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Term
| Enlarged thyroid means what? |
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Definition
hypothyroidism
increase TSH decrease thyroid hormone
intolerant to cold |
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Term
| man tachycardic and intolerant to heat? |
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Definition
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Term
| inhibits glucosidase enzyme present in the brush border of intestine and delays the digestion of ingested carbs= smaller rise in blood glucose conc following meals |
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Definition
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| side effect seen in patients undergoing GH therapy esp in paients w renal/endocrine probs or disorders |
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Definition
| SCFE split capped femoral |
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Term
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Definition
T4 Thyroxine is storage
T3 triiodothyronine is active |
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Term
| long term administration of Glucocorticoids? |
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Definition
decrease ACTH stores
chauses changes in morphology of pituitary
absence of ACTH causes adrenal cortex atrophy |
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Term
| Metformin is metabolized where? |
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Definition
| in the liver so anything else metab by liver will increase its efficacy |
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