Chapter 13: Drug Therapy for Endocrine Problems
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Questions and Answers

What is the trigger for insulin secretion?

hyperglycemia

What hormones are produced in the pancreas?

insulin and glucagon

What cells produce insulin?

beta cells

What cells produce glucagon?

<p>alpha cells</p> Signup and view all the answers

What is the hormone of plenty?

<p>insulin</p> Signup and view all the answers

What is the important thing to remember about insulin?

<p>It's job is to lower blood glucose levels.</p> Signup and view all the answers

What is the trigger for glucagon secretion?

<p>hypoglycemia</p> Signup and view all the answers

What are symptoms of untreated diabetes?

<p>excessive hunger and eating, thirst, drinking more fluids throughout the day, urinating more, weight loss, and fatigue.</p> Signup and view all the answers

What is diabetes mellitus?

<p>a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both</p> Signup and view all the answers

What is Type 1 Diabetes?

<p>the body's immune system destroys cells in the pancreas that produce insulin</p> Signup and view all the answers

What is Type 2 Diabetes?

<p>It occurs when the body does not properly use insulin.</p> Signup and view all the answers

What type of DM is insulin dependent?

<p>Type 1</p> Signup and view all the answers

What is a byproduct of fat being used to make ATP?

<p>ketoacids</p> Signup and view all the answers

What is DKA?

<p>deficiency of body insulin resulting in hyperglycemia, formation of ketoacids, osmotic diuresis, and metabolic acidosis</p> Signup and view all the answers

How is DKA treated?

<p>Fluids, Insulin, Electrolyte therapy</p> Signup and view all the answers

Does blood become acidic or alkaline in DKA?

<p>acidic</p> Signup and view all the answers

What is a typical glucose reading if a patient is in DKA?

<p>500+</p> Signup and view all the answers

What are the long-term complications from untreated or poorly controlled DM?

<p>blindness, kidney failure, foot and leg amputations, HTN, increased risk for infection, heart attacks, and strokes</p> Signup and view all the answers

Is there a cure for DM?

<p>False</p> Signup and view all the answers

How are DM 1 and DM 2 alike?

<p>Each have many of the same symptoms and long-term complications are the same.</p> Signup and view all the answers

How are DM 1 and DM 2 different?

<p>onset and treatment</p> Signup and view all the answers

What type of DM is most common?

<p>Type 2</p> Signup and view all the answers

Why can't insulin be given PO?

<p>True</p> Signup and view all the answers

What can happen if you give insulin to the wrong patient?

<p>possible death to the 'wrong' patient and the patient that should have received their insulin</p> Signup and view all the answers

Should you hold long-acting insulin if BBG is low?

<p>False</p> Signup and view all the answers

How does Rapid-Acting Insulin work?

<p>15 minutes after injection -&gt; 1-3 hours to peak -&gt; lasts 3-5 hours</p> Signup and view all the answers

How does Short-Acting insulin work?

<p>30 minutes after injection -&gt; 2.5-5 hours to peak -&gt; lasts 8 hours</p> Signup and view all the answers

How does Intermediate-Acting insulin work?

<p>1.5 hours after injection -&gt; 4-12 hours to peak -&gt; lasts 10-16 hours (or longer)</p> Signup and view all the answers

How does Long-Acting Insulin work?

<p>2 hours after injection -&gt; no peak -&gt; lasts 24 hours</p> Signup and view all the answers

What are s/s of Hypoglycemia?

<p>anxiety, confusion, loss of consciousness; cool, clammy skin; h/a; hunger; increased sweating; rapid, pounding HR; shakiness, tremors</p> Signup and view all the answers

What are s/s of Hyperglycemia?

<p>weak, tired, polyuria, polydipsia, polyphagia, blurry vision, itchy dry skin, fruity-smelling breath</p> Signup and view all the answers

Hypoglycemia is aka

<p>insulin shock</p> Signup and view all the answers

What is the most commonly used preparation of insulin?

<p>U-100 (100 units per mL)</p> Signup and view all the answers

When should a patient eat a meal after receiving an insulin injection?

<p>15 minutes</p> Signup and view all the answers

Which insulin cannot be mixed with other solutions?

<p>Both A and B</p> Signup and view all the answers

What should you not do when injecting insulin?

<p>aspirate for blood or massage site</p> Signup and view all the answers

What is the treatment of choice for diabetes during pregnancy?

<p>insulin</p> Signup and view all the answers

During pregnancy, insulin may need to be increased during the last ___.

<p>6 months</p> Signup and view all the answers

What type of injection devices may an older adult benefit from when self-administering insulin? Why?

<p>prefilled syringes, cartridges, or pens due to vision loss; can feel/hear clicks of prefilled devices</p> Signup and view all the answers

How should insulin pens be stored?

<p>stood up straight with the needle up for up to 3 weeks</p> Signup and view all the answers

What are noninsulin antidiabetic drugs?

<p>hypoglycemic agents</p> Signup and view all the answers

How are drug dosages based for DM2?

<p>Patient's response to therapy</p> Signup and view all the answers

How many classes are there of noninsulin antidiabetic drugs?

<p>7 (seven)</p> Signup and view all the answers

Which age group is the most difficult to control DM1?

<p>children because of varying diet and exercise</p> Signup and view all the answers

What is the noninsulin diabetic drug that cannot be used for DM1?

<p>incretin mimetics (GLP1 agonists)</p> Signup and view all the answers

What is the MOA of insulin secretagogues?

<p>stimulate insulin secretion from the pancreatic beta cells to decrease postprandial blood glucose</p> Signup and view all the answers

What is the MOA of insulin sensitizers?

<p>do not act directly on beta cells of the pancreas; increase the sensitivity of insulin receptors and decrease liver glucose production without causing hypoglycemia</p> Signup and view all the answers

What is the MOA of incretin mimetics (GLP1 agonists)?

<p>They stimulate insulin secretion in a glucose-dependent manner, delay gastric emptying and suppress appetite.- should not be used for pts w/ DM1</p> Signup and view all the answers

What is the MOA of amylin analogs?

<p>Inhibit glucagon secretion much like physiological amylin to assist insulin in postprandial glucose control</p> Signup and view all the answers

What is the MOA of DPP-4 inhibitors?

<p>Increase incretin levels (GLP-1 and GIP), which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.</p> Signup and view all the answers

What is the MOA of sodium-glucose cotransport inhibitors?

<p>lowers blood glucose levels by preventing kidney reabsorption of glucose that was filtered from the blood into the urine</p> Signup and view all the answers

What drugs are insulin secretagogues?

<p>Sulfonylureas, Meglitinides</p> Signup and view all the answers

What drugs are insulin sensitizers?

<p>Biguanides, Thiazolidinediones</p> Signup and view all the answers

What drugs are alpha-glucosidase inhibitors?

<p>Acarbose, Miglitol</p> Signup and view all the answers

What drugs are incretin mimetics?

<p>Exenatide, Liraglutide</p> Signup and view all the answers

What drugs are amylin analogs?

<p>Pramlintide</p> Signup and view all the answers

What drugs are DPP-4 inhibitors?

<p>Sitagliptin, Saxagliptin, Linagliptin, Alogliptin</p> Signup and view all the answers

What drugs are sodium-glucose cotransport inhibitors?

<p>canagliflozin, dapagliflozin</p> Signup and view all the answers

What are common side effects to noninsulin antidiabetic drugs, amylin analogs, and incretin mimetics?

<p>n/v, diarrhea, and rashes</p> Signup and view all the answers

What additional side effects do DPP-4 inhibitors have?

<p>abd pain and increased evidence of respiratory infections</p> Signup and view all the answers

What additional side effects can sulfonylureas have?

<p>photosensitivity, blurred vision, fluid retention, and anemia</p> Signup and view all the answers

What additional side effects can meglitinides have?

<p>dizziness, back pain, upper respiratory infections, and flu-like achiness</p> Signup and view all the answers

What additional side effects can Metformin and alpha-glucosidase inhibitors have?

<p>bloating, flatulence, indigestion, abd pain, headaches</p> Signup and view all the answers

What additional side effects can Thiazolidinedione drugs have?

<p>upper respiratory infections, headaches, muscle aches, fluid retention, weight gain, and anemia</p> Signup and view all the answers

What noninsulin diabetic drug has a black box warning indicating that it should not be used for anyone at risk for HF?

<p>Rosiglitazone (Avandia), a Thiazolidinedione drug</p> Signup and view all the answers

What might a physician do if a patient is taking Metformin and needs surgery or a scan test w/ dye (contrast)? Why?

<p>Hold for 48 hours to reduce risk of kidney failure</p> Signup and view all the answers

When should you hold Metformin and notify the HCP?

<p>If serum creatinine is higher than 1.4 mg/dL for females or 1.5 mg/dL for males.</p> Signup and view all the answers

What should you assess for if patients are taking incretin mimetics or DPP-4 inhibitors?

<p>s/s of pancreatitis (severe epigastric pain, vomiting)</p> Signup and view all the answers

How would you educate a patient that is taking meglitinides and misses a meal?

<p>Do not take medication to prevent hypoglycemia</p> Signup and view all the answers

Should Metformin be taken with or without regard to meals?

<p>True</p> Signup and view all the answers

How do you teach patients to prevent lactic acidosis while taking Metformin?

<p>Drink plenty of water, avoid alcohol and dehydration</p> Signup and view all the answers

Are noninsulin drugs approved during pregnancy and breastfeeding?

<p>False</p> Signup and view all the answers

What are s/s of lactic acidosis?

<p>weakness, fatigue, lethargy, hyperventilation</p> Signup and view all the answers

What drug should not be mixed with insulin or injected within 2 inches of the site of an insulin injection?

<p>Pramlintide</p> Signup and view all the answers

How does insulin work?

<p>activates a process that allows glucose molecules to enter the cell</p> Signup and view all the answers

What is insulin used to control?

<p>DM1, DM2 when uncontrolled by diet, exercise, or weight reduction, severe DKA or diabetic coma, hyperkalemia in combo w/ glucose</p> Signup and view all the answers

What are the types of insulins?

<p>rapid, short, intermediate, long</p> Signup and view all the answers

What is Rapid-Acting Insulin?

<p>insulin Lispro-Humalog Insulin Aspart-Novolog</p> Signup and view all the answers

What is Short-Acting insulin?

<p>Regular Insulin-Humulin R. Regular insulin is the only one given IV. Concentrated insulin-Insulin U-500.</p> Signup and view all the answers

What is Intermediate-Acting insulin?

<p>NPH-Humulin N, Novolin R</p> Signup and view all the answers

What is Long-Acting insulin?

<p>Insulin Glargine-Lantus. Cannot mix with others. Insulin Detemir-Levemir</p> Signup and view all the answers

Study Notes

Insulin and Glucagon

  • Insulin secretion is triggered by hyperglycemia.
  • The pancreas produces insulin and glucagon.
  • Beta cells in the pancreas are responsible for insulin production.
  • Alpha cells in the pancreas produce glucagon.
  • Insulin is referred to as the hormone of plenty due to its role in lowering blood glucose levels.
  • Glucagon secretion is triggered by hypoglycemia.

Diabetes Mellitus

  • Diabetes mellitus encompasses metabolic diseases characterized by hyperglycemia, stemming from defects in insulin secretion or action.
  • Untreated diabetes presents symptoms such as polyphagia, polydipsia, polyuria, weight loss, fatigue, and potential glucose presence in urine.
  • Type 1 Diabetes occurs when the body's immune system destroys pancreatic beta cells; it is insulin-dependent.
  • Type 2 Diabetes arises when the body improperly uses insulin; it is the most common form of diabetes.

Diabetic Ketoacidosis (DKA)

  • DKA is marked by a deficiency of insulin, leading to hyperglycemia, ketoacid formation, osmotic diuresis, and metabolic acidosis.
  • Typical glucose readings in DKA exceed 500 mg/dL.
  • DKA treatment includes fluids, insulin, and electrolyte therapy.
  • During DKA, fat is broken down excessively, producing ketones and causing blood acidity.

Insulin Administration

  • Insulin cannot be administered orally due to gastrointestinal destruction.
  • Improper insulin administration to the wrong patient can result in severe harm or death.
  • Long-acting insulin should not be withheld even if blood glucose is low, as it has a delayed action.
  • Types of insulin include rapid, short, intermediate, and long-acting forms.

Symptoms and Management

  • Hypoglycemia presents with anxiety, confusion, sweating, shakiness, and cool skin—a condition also known as insulin shock.
  • Hyperglycemia shows symptoms like weakness, fatigue, dry skin, and fruity-smelling breath.
  • Noninsulin antidiabetic drugs are hypoglycemic agents used for managing diabetes, with their dosages based on patient response.

Noninsulin Antidiabetic Drugs

  • There are seven classes of noninsulin antidiabetic drugs.
  • Insulin secretagogues, insulin sensitizers, incretin mimetics, amylin analogs, DPP-4 inhibitors, and sodium-glucose cotransport inhibitors are key drug classes, each with specific mechanisms of action.
  • Common side effects among these drugs include nausea, vomiting, diarrhea, and skin rashes.

Special Considerations

  • Metformin use requires careful attention to renal function, with adjustments needed before surgery or diagnostic procedures involving contrast.
  • Clinical management of diabetes during pregnancy typically involves insulin therapy due to potential risks associated with other drugs.

Patient Education

  • Patients using incretin mimetics or DPP-4 inhibitors should be monitored for pancreatitis symptoms.
  • Mealtime considerations are critical for those on meglitinides; skipping meals necessitates skipping medication.
  • Patients should learn to prevent lactic acidosis while on Metformin by staying hydrated and avoiding alcohol.

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Explore key concepts related to drug therapy for endocrine disorders with this set of flashcards. Learn about insulin secretion triggers, pancreatic hormones, and the specific cells responsible for hormone production. Perfect for students preparing for exams in endocrinology.

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