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Questions and Answers
What is the primary action of Desmopressin in treating Diabetes Insipidus?
What is the primary action of Desmopressin in treating Diabetes Insipidus?
Which of the following is a consequence of excess Growth Hormone?
Which of the following is a consequence of excess Growth Hormone?
What is the mechanism of action of Octreotide in treating acromegaly?
What is the mechanism of action of Octreotide in treating acromegaly?
Which medication is indicated for treating Addison's Disease?
Which medication is indicated for treating Addison's Disease?
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What is a common adverse effect associated with Somatropin usage?
What is a common adverse effect associated with Somatropin usage?
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What is the key characteristic of Type I Diabetes Mellitus?
What is the key characteristic of Type I Diabetes Mellitus?
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Which insulin type is administered 30 minutes before a meal?
Which insulin type is administered 30 minutes before a meal?
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What is the duration of action for insulin glargine?
What is the duration of action for insulin glargine?
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What adverse effect is associated with the use of insulin?
What adverse effect is associated with the use of insulin?
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Which medication category works primarily by decreasing glucose production in the liver?
Which medication category works primarily by decreasing glucose production in the liver?
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In what situation is metformin primarily indicated?
In what situation is metformin primarily indicated?
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Which of the following is NOT a potential drug interaction with metformin?
Which of the following is NOT a potential drug interaction with metformin?
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When are short-duration rapid-acting insulins typically administered?
When are short-duration rapid-acting insulins typically administered?
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What is the mechanism of action (MOA) of glipizide?
What is the mechanism of action (MOA) of glipizide?
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Which of the following is NOT a side effect associated with thiazolidinediones like pioglitazone?
Which of the following is NOT a side effect associated with thiazolidinediones like pioglitazone?
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What adverse effect is associated with the use of Exenatide?
What adverse effect is associated with the use of Exenatide?
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Which medication requires monitoring of TSH levels during treatment?
Which medication requires monitoring of TSH levels during treatment?
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What is the primary indication for the use of methimazole?
What is the primary indication for the use of methimazole?
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Which of the following drug interactions is significant with levothyroxine?
Which of the following drug interactions is significant with levothyroxine?
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What is a common side effect of repaglinide?
What is a common side effect of repaglinide?
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Which medication is given to manage hyperthyroidism by destroying thyroid tissue?
Which medication is given to manage hyperthyroidism by destroying thyroid tissue?
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Study Notes
Diabetes Mellitus
- Definition: Impairment in glucose homeostasis leading to hyperglycemia (high blood sugar). This occurs due to lack or decreased production of insulin, OR, the produced insulin is ineffective.
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Types:
- Type I (IDDM) - Insulin-dependent diabetes mellitus: Characterized by the absence or decreased production of insulin due to a decrease in the number of beta cells in the pancreas.
- Type II (NIDDM) - Non-insulin-dependent diabetes mellitus: Here, the amount of insulin produced may be normal, increased, or decreased. However, tissue responsiveness to insulin is affected by defects at receptor sites or decreased receptor number, leading to insulin resistance.
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Medications:
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Insulin: Used for treatment of Type I and some Type II diabetics.
- Short Duration: Rapid Acting (e.g. insulin lispro/Humalog, insulin aspart/Novolog): Administered 5-10 minutes before meals or with meals. Effects last 3-5 hours. Often given at every meal, combined with intermediate-acting insulin for long-term control.
- Short Duration: Slower Acting (e.g. regular insulin/Humulin R, Novolin R): Administered 30 minutes before meals. Effects last 6-10 hours. Often combined with intermediate-acting insulin.
- Intermediate Acting (e.g. neutral protamine hagedorn insulin (NPH)/Humulin N, Novolin N): Used to control blood sugar between meals and overnight. Injected twice a day, often combined with short-acting insulin. Usually given at breakfast and dinner. Duration: 16-24 hours.
- Long Acting (e.g. insulin glargine/Lantus): Given once a day at bedtime. Duration: 24 hours. Subcutaneous (SQ) administration only, cannot be mixed with other insulin types.
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Insulin Administration & Dosing:
- Conventional schedule: 2 injections per day. One at breakfast and one at dinner. Both injections contain short-acting and intermediate-acting insulin, mixed in one syringe. Pre-mixed solutions (70/30) are available.
- Intensive conventional schedule: 4 injections per day. Short-acting insulin before each meal and long-acting at bedtime.
- Continuous infusion (pump): Delivers insulin continuously.
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Adverse effects:
- Hypoglycemia
- Lipodystrophy
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Oral Antidiabetic Agents: Used for Type II diabetics.
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Biguanide (e.g. Metformin/Glucophage):
- Mechanism of action: Lowers blood sugar by decreasing glucose production by the liver (suppresses gluconeogenesis), increases glucose uptake by muscles. Used for initial treatment.
- Administration: Twice daily with meals.
- Adverse Effects: Gastrointestinal issues, lactic acidosis.
- Drug Interactions: Alcohol
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Sulfonylureas:
- First generation: tolbutamide/Orinase, tolazamide/Tolinase, chlorpropamide/Diabinese
- Second generation: glipizide/Glucotrol, glyburide/Micronase, DiaBeta, glimepiride/Amaryl
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Glipizide/Glucotrol:
- Mechanism of action: Stimulates release of insulin from the pancreas.
- Administration: Given with breakfast.
- Adverse effects: Hypoglycemia, teratogenicity.
- Drug Interactions: Alcohol, beta blockers
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Meglitinides (e.g. Repaglinide/Prandin):
- Mechanism of action: Stimulates release of insulin from the pancreas. Short half-life, so take with every meal.
- Adverse effects: Hypoglycemia
- Drug Interactions: Gemfibrozil/Lopid, clopidogrel/Plavix
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Thiazolidinediones (e.g. Pioglitazone/Actos):
- Mechanism of action: Reduces insulin resistance by increasing glucose uptake by skeletal muscles and adipose cells. Also decreases glucose production by the liver.
- Administration: Once daily.
- Adverse effects: Headache, fluid retention, ovulation. High doses can increase bladder cancer risk and fracture risk.
- Drug Interactions: Insulin
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Biguanide (e.g. Metformin/Glucophage):
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Non-Insulin Injectables:
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Exenatide/Byetta - Glucagon-like Peptide Receptor Agonist:
- Mechanism of action: Activates GLP-1 receptors. These receptors produce similar effects to endogenous incretins which increase insulin release, slow gastric emptying, suppress appetite, and decrease glucagon release.
- Administration: Subcutaneously, twice a day, or extended release once weekly before meals.
- Indications: Type 2 diabetes.
- Adverse effects: Gastrointestinal: nausea, vomiting, diarrhea, pancreatitis. Renal impairment.
- Drug interactions: Sulfonylureas, some oral medications (antibiotics, oral contraceptives)
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Exenatide/Byetta - Glucagon-like Peptide Receptor Agonist:
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Insulin: Used for treatment of Type I and some Type II diabetics.
Thyroid Meds
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Hypothyroidism: A condition characterized by decreased production of thyroid hormone.
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Medications for Hypothyroidism: Hormone replacement
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Levothyroxine (T4)/Levothyroid, Synthroid:
- Mechanism of action: Synthetic preparation of thyroxine (T4). Taken orally once a day.
- Indications: All forms of hypothyroidism.
- Adverse effects: Rare at therapeutic levels. Toxic levels can lead to extreme hyperthyroidism (thyrotoxicosis).
- Drug Interactions: Iron, calcium supplements, warfarin, dilantin, rifampin, phenobarbital
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Levothyroxine (T4)/Levothyroid, Synthroid:
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Medications for Hypothyroidism: Hormone replacement
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Hyperthyroidism: A condition characterized by excessive thyroid hormone production.
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Types:
- Graves disease: Autoimmune disease where antibodies stimulate the thyroid.
- Toxic goiter: Thyroid cells or nodules function autonomously, secreting excess thyroid hormone.
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Medications for Hyperthyroidism:
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Methimazole/Northyx, Tapazole:
- Mechanism of action: Inhibits thyroid hormone synthesis by inhibiting the enzyme peroxidase.
- Indications: Graves disease.
- Adverse effects: Hypothyroidism, agranulocytosis.
- Contraindications: Pregnancy.
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Radioactive iodine/Iodotope:
- Mechanism of action: Destroys thyroid tissue by emitting beta particles.
- Indications: Graves disease, alternative to surgery.
- Adverse effects: Hypothyroidism.
- Non-radioactive iodine: Used as an alternative treatment.
- Beta-blockers: Used to manage symptoms related to excess thyroid hormone.
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Methimazole/Northyx, Tapazole:
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Types:
Anterior Pituitary Meds
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Growth Hormone Deficiency:
- Pathophysiology: Damage to the pituitary gland leads to decreased growth hormone (GH) production.
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Medications for Growth Hormone Deficiency:
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Somatropin/Humatrope, Genotropin:
- Mechanism of action: Form of GH. Given subcutaneously or intramuscularly.
- Indications: Pediatric growth hormone deficiency, pediatric non-growth hormone deficient short stature. Also indicated for wasting in patients with AIDS.
- Adverse effects: Hyperglycemia.
- Drug Interactions: Glucocorticoids.
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Somatropin/Humatrope, Genotropin:
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Excess Growth Hormone:
- Pathophysiology: Excess GH causes soft tissue and bony overgrowth (gigantism/acromegaly). Metabolic effects include hyperglycemia leading to diabetes mellitus.
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Medications for Excess GH:
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Octreotide/Sandostatin:
- Mechanism of action: Suppresses growth hormone release.
- Indications: Acromegaly.
- Adverse effects: Gastrointestinal: nausea, diarrhea, flatulence.
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Octreotide/Sandostatin:
Posterior Pituitary Meds
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ADH Deficiency - Diabetes Insipidus:
- Pathophysiology: Decreased production or action of antidiuretic hormone (ADH). Leads to the excretion of large amounts of dilute urine and excess thirst.
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Medications for DI:
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Desmopressin/DDAVP (oral or nasal spray):
- Mechanism of action: Structural analog of natural ADH. Promotes renal water conservation.
- Adverse effects: Water intoxication.
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Desmopressin/DDAVP (oral or nasal spray):
Adrenal Cortex Meds
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Adrenocortical Deficiency: Addison's Disease:
- Pathophysiology: Decreased synthesis of corticosteroids, resulting in elevated serum ACTH.
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Medications for Addison's Disease:
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Hydrocortisone:
- Mechanism of action: Synthetic steroid similar to cortisol.
- Indications: Addison's disease and all forms of adrenocortical insufficiency. Given orally or intravenously for adrenal crisis.
- Adverse effects: Well tolerated at therapeutic doses.
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Fludrocortisone/Florinef:
- Mechanism of action: Mineralocorticoid activity. Often used in combination with hydrocortisone.
- Indications: Addison's disease, hypoaldosteronism.
- Adverse effects: Water and sodium retention leading to hypertension, hypokalemia.
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Hydrocortisone:
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Description
This quiz covers essential information about Diabetes Mellitus, including its definition, types, and medications. Learn about Type I and Type II diabetes, their characteristics, and the role of insulin in treatment. Understand how glucose homeostasis is impacted and the importance of insulin in managing diabetes.
