Diabetic Medications and Insulin Therapy
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Questions and Answers

What is the anticipated initial dose of levothyroxine for an adult?

  • 50-75 mcg
  • 125-175 mcg
  • 100-150 mcg
  • 75-125 mcg (correct)

    • Which medication can induce thyroid dysfunction?

  • Metformin
  • Amlodipine
  • Ibuprofen
  • Amiodarone (correct)

    • What is a symptom of hypothyroidism?

  • Increased heart rate
  • Hyperactivity
  • Bradycardia (correct)
  • Weight loss

    • What condition may occur postpartum and is characterized by a severe increase in thyroid hormone levels?

    <p>Postpartum thyroiditis (A)</p> Signup and view all the answers

    What is the recommended testing interval post-adjustment for levothyroxine dosage changes?

    <p>6-8 weeks (D)</p> Signup and view all the answers

    Which of the following can reduce levothyroxine absorption?

    <p>Calcium supplements (A)</p> Signup and view all the answers

    Why is T3 supplementation usually unnecessary in most patients taking levothyroxine?

    <p>Levothyroxine is converted to T3 in the body. (D)</p> Signup and view all the answers

    What dosage adjustment is generally recommended for elderly patients starting levothyroxine?

    <p>Start low and go slow, 75% or less than the adult dose (D)</p> Signup and view all the answers

    What is the recommended first-line treatment for hypothyroidism during pregnancy?

    <p>Levothyroxine (Synthroid) (A)</p> Signup and view all the answers

    What should be monitored regularly in pregnant women taking thyroid hormone replacement therapy?

    <p>Serum TSH (B)</p> Signup and view all the answers

    What common complication can arise if hypothyroidism is left untreated during pregnancy?

    <p>Anemia (B)</p> Signup and view all the answers

    Which of the following statements regarding propylthiouracil (PTU) is accurate?

    <p>PTU has a lower risk of fetal drug transfer. (D)</p> Signup and view all the answers

    Which symptom is commonly associated with untreated hyperthyroidism during pregnancy?

    <p>Preeclampsia (D)</p> Signup and view all the answers

    What is the relationship between testosterone deficiency and age in the male population?

    <p>It becomes more common as men age. (A)</p> Signup and view all the answers

    What is a potential fetal effect of hypothyroidism during early pregnancy?

    <p>Compromised brain development (D)</p> Signup and view all the answers

    What distinguishes primary testosterone deficiency from secondary deficiency?

    <p>Primary deficiency is testicular in origin. (D)</p> Signup and view all the answers

    What might be necessary when starting levothyroxine therapy in a patient taking warfarin?

    <p>Reduce the warfarin dose (D)</p> Signup and view all the answers

    Which symptom is NOT associated with thyroid hormone over-replacement?

    <p>Weight gain (D)</p> Signup and view all the answers

    What is a significant concern when using triiodothyronine (T3) as a replacement therapy?

    <p>It can cause symptoms of hyperthyroidism due to fluctuation levels (D)</p> Signup and view all the answers

    During which trimester is the fetus solely dependent on maternal thyroid hormones?

    <p>First trimester (C)</p> Signup and view all the answers

    Why might patients on levothyroxine experience increased insulin requirements?

    <p>Levothyroxine accelerates metabolism leading to more glucose use (B)</p> Signup and view all the answers

    Which factor can lead to elevated thyroid hormone levels during pregnancy?

    <p>Elevated levels of human chorionic gonadotropin (hCG) (B)</p> Signup and view all the answers

    What is the primary reason for only prescribing T4 in most cases of hypothyroidism?

    <p>T4 has a longer half-life and more stable levels (D)</p> Signup and view all the answers

    What is the risk associated with using thyroid hormones for weight loss?

    <p>It can lead to over-replacement and toxicity (A)</p> Signup and view all the answers

    Flashcards

    Levothyroxine effect on Warfarin

    Levothyroxine accelerates the breakdown of Vitamin K-dependent clotting factors, potentially increasing the effectiveness of warfarin. This means warfarin dosage may need adjustment if levothyroxine is started.

    Levothyroxine and Insulin/Digoxin

    Levothyroxine can increase the required dosage of insulin and/or digoxin in some patients.

    Hyperthyroidism Symptoms

    Symptoms from increased thyroid hormone. Examples include: heart palpitations, trouble sleeping, jitters, sweating, anxiety, diarrhea, weight loss, and bone loss.

    T3 vs T4 Thyroid Replacement

    While hypothyroidism results from low T3 and T4, T4 is typically prescribed as the primary treatment. T3 is sometimes added to help resolve symptoms when T4 alone is insufficient.

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    T3 Short Lifespan

    Triiodothyronine (T3) has a short lifespan, requiring multiple daily doses and leading to fluctuating blood levels.

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    T3 Use Specialist

    Patients requiring T3 treatment in addition to T4 are typically managed by a thyroid specialist due to the challenges in maintaining stable blood levels.

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    Thyroid Hormone and Weight Loss

    Thyroid hormones should not be used to treat obesity or weight loss. Dosing within normal ranges is ineffective and higher doses can be dangerous.

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    Fetal Thyroid Development

    During pregnancy, the baby initially relies on the mother's thyroid hormone, but the fetus's thyroid starts functioning independently by about 12 weeks. Sufficient fetal hormone production starts at around 18-20 weeks.

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    Postpartum thyroiditis

    Thyroid inflammation occurring after pregnancy, marked by fluctuating thyroid hormone levels.

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    Hypothyroidism

    A condition where the thyroid gland doesn't produce enough hormones, leading to a slower metabolism.

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    Levothyroxine (Synthroid)

    A synthetic thyroid hormone replacement medication (T4).

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    Thyroid-stimulating hormone (TSH)

    A hormone that regulates thyroid hormone production.

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    Low-iodine diet

    A diet limiting iodine intake, potentially causing thyroid dysfunction.

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    Initial Levothyroxine dose (adult)

    Typically 75-125 mcg, but can vary.

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    Factors reducing Levothyroxine absorption

    Proton pump inhibitors, calcium/iron supplements, and aluminum-containing antacids.

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    Monitoring after Levothyroxine dose change

    TSH levels checked 6-8 weeks after a dose change.

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    Potential pregnancy complications from hypothyroidism

    Untreated hypothyroidism in pregnancy can lead to preeclampsia, anemia, miscarriage, low birth weight (LBW), and congestive heart failure (CHF).

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    Fetal thyroid reliance

    The fetus relies on the mother for thyroid hormone until after the first trimester.

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    Hypothyroidism dosage in pregnancy

    Dosage requirements for levothyroxine increase significantly during pregnancy, requiring regular TSH monitoring.

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    Hyperthyroidism medication in pregnancy

    Propylthiouracil (PTU) is often preferred over methimazole due to less placental transfer; both are Category D.

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    Postpartum thyroid screening

    Checking TSH levels is important if a woman develops postpartum depression or has thyroid symptoms.

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    Primary testosterone deficiency

    Testosterone deficiency originating from the testicles.

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    Secondary testosterone deficiency

    Testosterone deficiency due to hypothalamus-pituitary dysfunction.

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    Study Notes

    Diabetic Medications

    • Two main types: Type 1 and Type 2
    • Type 1: Autoimmune destruction of insulin-producing beta cells; requires lifelong insulin therapy.
    • Type 1 symptoms: Involuntary weight loss, polyuria, polydipsia, polyphagia, diabetic ketoacidosis (dehydration, abdominal pain, vomiting, decreased consciousness).
    • Type 2: Genetic predisposition plus environmental factors (genetics loads the gun, environment pulls the trigger); insulin resistance and eventual beta cell impairment.
    • Type 2 treatment: Healthy diet, regular exercise, and stress management; eventually insulin therapy might be necessary.

    Insulin

    • Protein, must be injected/infused.
    • Subcutaneous (SC) injection or intravenous infusion, rotation and consistency of sites is important.
    • Abdomen is most common injection site; other options include back of arms, thighs, and buttocks.
    • Several types, classified by duration of action:
      • Rapid-acting (lispro, aspart): Immediate treatment of blood glucose, often in insulin pumps.
      • Short-acting (Regular): Short-acting insulin
      • Intermediate-acting(NPH): Intermediate-acting insulin
      • Long-acting (basal) (glargine, detemir): Coverage for 24 hours; not to be mixed with other insulins in the same syringe.
      • Premixed combinations: Mixtures of different types of insulin (e.g., Novolog Mix 70/30).
    • Insulin Pumps: Continuous delivery of insulin, useful for type 1 diabetes.
    • Insulin inhaler: Powdered form inhaled into lungs; risk of acute bronchospasm in asthma/COPD patients.

    Type 2 Diabetes Medications

    • Sulfonylureas: Stimulate insulin secretion, enhance tissue sensitivity, require some insulin production. Longer-acting versions can result in risks of hypoglycemia.
    • Biguanides (e.g., metformin): Preferred initial treatment; inhibits liver glucose production, reduces gut glucose absorption, improves insulin receptor sensitivity; does not cause weight gain or hypoglycemia; important to check for potential lactic acidosis reactions.
    • Meglitinides: Stimulate insulin release, often used with erratic meal schedules.
    • Alpha-glucosidase inhibitors: Delay carbohydrate digestion.
    • Thiazolidinediones: Increase insulin sensitivity in skeletal muscle.
    • Gliptins (DPP-4 inhibitors): Increase insulin release, reduce glucagon levels, and decrease hepatic glucose production.
    • SGLT2 inhibitors: Prevent kidneys from re-absorbing glucose and increase urinary glucose excretion (newest class). Reduces risk of major cardiovascular events and protect kidneys. Risk of lower limb amputations and diabetic ketoacidosis.
    • GLP-1 receptor agonists (incretin mimetics): Mimic incretin hormones, slow gastric emptying, and decrease food intake; often used for weight management as well as diabetes.

    Thyroid Disorders

    • Hyperthyroidism: Overactive thyroid gland, can be Grave's Disease (caused by autoimmune antibodies) or Toxic Nodular Goiter(hyperfunctioning nodule). Symptoms: Tremors, tachycardia, tachypnea, heat intolerance, exophthalmos, and pretibial edema.
    • Hypothyroidism: Underactive thyroid gland, most common cause is Hashimoto's thyroiditis (autoimmune). Symptoms: Lethargy, fatigue, weight gain, cold sensitivity, constipation, hyperlipidemia, and bradycardia.

    Benign Prostatic Hyperplasia (BPH)

    • Alpha-blockers: Relax bladder and prostate muscles for easier urination.
    • 5-alpha-reductase inhibitors: Shrink prostate, increase urine flow.
    • Lifestyle modifications, surgery are additional treatments.

    Osteoporosis

    • Disease characterized by low bone density and increased risk of fractures.
    • Bisphosphonates: Inhibit osteoclast activity, preventing bone loss.
    • Parathyroid Hormone Analogs (teriparatide): Stimulate bone formation.
    • Selective Estrogen Receptor Modulators (SERMs): Reduce bone resorption, potentially lower breast cancer risk.
    • Hormone Replacement Therapy (HRT): May reduce fracture risk, but with increased cardiovascular risks and other side effects.
    • Lifestyle modifications are often foundational treatments.

    Rheumatoid Arthritis

    • Chronic, autoimmune disease, causing inflammation in joints and potentially other parts of the body.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs): Symptom relief, many side effects
    • Glucocorticoids (corticosteroids): Powerful anti-inflammatory, but many potential long-term adverse effects.
    • Disease-modifying antirheumatic drugs (DMARDs): Suppress immune response, some examples: methotrexate, infliximab, leflunomide, and hydroxychloroquine.

    Obesity

    • Chronic condition of excess body fat, measured by BMI.
    • Diet, exercise, and behavioral modification are fundamental treatments.
    • Medications (e.g., naltrexone/bupropion, lorcaserin, phentermine/topiramate) can augment lifestyle changes.
    • Bariatric surgery may be an option for severe cases.

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    Description

    This quiz covers the essential aspects of diabetic medications, focusing on Type 1 and Type 2 diabetes. It discusses the importance of insulin therapy, including the methods of administration and the various types of insulin available. Test your knowledge on symptoms, treatments, and management strategies for diabetes.

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