Module 8 Study Guide PDF

Module 8 Study Guide Module 8 Unit A 🍎 Type 1 Diabetes: 💉 Autoimmune induced pancreatic beta cell destruction. No insulin production. Typically occurs in people younger than 30. 🍬 Treatment: Life-long insulin therapy. Basal insulin and bol...

Module 8 Study Guide Module 8 Unit A 🍎 Type 1 Diabetes: 💉 Autoimmune induced pancreatic beta cell destruction. No insulin production. Typically occurs in people younger than 30. 🍬 Treatment: Life-long insulin therapy. Basal insulin and boluses of short acting insulin for coverage at meal times and snacks. 🍎 Type 2 Diabetes: 💉 Reduced tissue sensitivity to insulin, resulting in high blood sugar levels. After many years of elevated glucose levels and worsening insulin resistance, pancreatic beta cells become impaired and die off. 🍬 Treatment: Oral agents are first line use. Insulin is used in later stages. 🍎 Insulin types: 💉 Rapid acting: HumaLOG, NovoLOG 🍬 Onset: 15-30 min/10-20 min. 🍬 Peak: 0.5-2.5 hours/1-3 hours. 🍬 Duration: 3-6 hours/3-5 hours. 🍬 “15 minutes feels like 1 hour in 3 rapid responses” 💉 Short acting: Humulin R and Novolin R. 🍬 Onset: 30-60 min. 🍬 Peak: 1-5 hours. 🍬 Duration: 6-10 hours. 🍬 “ Short staffed nurses went from 30 patients 2 eight patients” 💉 Intermediate acting: Humulin N, Novolin N, NPH. 🍬 Onset: 60-120 min. 🍬 Peak: 6-14 hours. 🍬 Duration: 16-24 hours. 🍬 “Nurses play hero 2 eight 16 year olds.” 💉 Long acting: Glargine, Detemir. 🍬 Onset: 70 min/60-120 min. 🍬 Peak: none/12-24 hours. 🍬 Duration: 18-24 hours/varies. 🍬 “The 2 long nursing shifts never peaked, but lasted 24 hours” 🍎 Importance of insulin drug levels: 💉 Knowing the onset, peak, and duration of insulin allows the provider to adjust medication dosing with more accuracy. 🍬 It is important to remember that in type 1 diabetes, the patient does not produce endogenous insulin and can be very sensitive to insulin dosing adjustment. 🍎 Patient education: Insulin. 💉 Greatest risk is hypoglycemia. 🍬 Monitor blood glucose and signs of hypoglycemia 🍏 Tachycardia, palpitations, sweating, nervousness, convulsions, coma and death. 💉 D2D interactions, beta blockers and other hypoglycemic agents. 💉 Carry carb/protein snacks in case of hypoglycemia. 💉 Proper technique for injections, dosing, timing and rotation of sites. 🍎 Routes of insulin administration: 💉 Insulin can not be absorbed in the stomach, so needs to be given as an injection, intravenously or inhaled. 💉 Pump: Insulin is delivered via a steady, measured continuous dose (basal), paired with a surge(bolus) to cover meal time. Only 1 type of insulin is used. 🍬 Pros: more accurately mimics the body. 🍏 Eliminates multiple injections. 🍏 Delivers with greater accuracy. 🍏 Improves HgA1c levels. 🍏 Fewer blood glucose swings. 🍏 Allows for the patient to exercise without eating many carbs before. 🍬 Cons: 🍏 Contains insulin. 🍏 Causes weight gain. 🍏 Can cause DKA if catheter comes out. 🍏 Expensive. 💉 Inhaler: Delivers powdered form of insulin via inhaler to the lungs. More rapidly absorbed than injections, fast peak serum concentration and faster metabolism. 🍬 Cons: can cause acute bronchospasm in patients with asthma and COPD. (BBW). 🍎 Metformin monitoring: 💉 Metformin can decrease vitamin B12 and folic acid levels. 🍬 B12 levels should be periodically monitored, especially in those with anemia or peripheral neuropathy.  💉 Check renal function (eGFR) before therapy initiation and at least annually. More often in patients at risk for developing renal impairment. 🍎 Metformin-induced lactic acidosis: 💉 Increased risk when used with alcohol, topamax, IV contrast, patients greater than 65, surgery, hypoxic states (acute heart failure) and patients with hepatic or renal impairment. 🍎 Alpha-glucosidase inhibitors: The alpha-glucosidase inhibitors can cause a delay in carbohydrate digestion and absorption, as well as inhibit some of the enzymes that break down the carbohydrates. Can be used as an off-label adjunct therapy to insulin for T1DM or in the treatment of T2DM with exercise and diet changes. 💉 Because their action is primarily at the level of the gut and focused on altering absorption, the risk of GI upset (flatulence, cramping, distention, and borborygmus) is a higher risk. 🍎 Effectiveness of sulfonylureas: 💉 Sulfonylureas stimulate insulin secretion and increase tissue sensitivity to insulin. Require some insulin production for the drug to work. 🍬 As T2DM progresses and the pancreas stops working, the drug becomes less effective. 🍎 Sulfonylureas interactions: 💉 Alcohol: sulfonylureas can enhance the adverse/toxic effects of alcohol. 💉 Beta-adrenergic blockers: enhance the hypoglycemic effect of sulfonylureas. Mask tachycardia as an initial symptom of hypoglycemia. 💉 Tagamet: may increase serum concentration of sulfonylurea (glipizide) and risk for hypoglycemia. 🍎 Insulin and Sulfonylureas: 💉 Hypoglycemia is a risk with sulfonylureas. Initiating insulin increases the risk. 🍎 Diabetic medications effect on weight: 💉 Insulin and sulfonylureas can cause weight gain. 💉 Metformin, DPP-4 inhibitors, and GLP1 inhibitors can cause weight loss. 💉 Glipizide does not cause either weight loss or gain. 🍎 Treatment of type 2 diabetes: 💉 Sodium/glucose cotransporter 2 (SGLT2) inhibitors “Gliflozins”- Newest diabetes drug. Protects the heart and preserves kidneys in type 2 diabetes.  🍬 Approved to reduce risk of major CV events in adults with T2DM and established CV disease. 🍬 Used for patients with atherosclerotic CV heart disease risk factors, established HF, and/or diabetic kidney disease. 🍎 Glitazones warning 💉 May cause or exacerbate heart failure. 🍬 Severe liver injury with Rezulin(removed from market). Reversible when stopped. Newer agents have much lower incidence. Module 8 Unit B 🍆 Hyperthyroidism: 🔥 Treatment aims to normalize thyroid hormone production, minimize symptoms and decrease complications. 🍆 Hypothyroidism: 🔥 Treatment goal is to replace missing thyroid hormone. 🌟 Undertreatment: lethargy, fatigue, weight gain, skin changes, cold sensitivity, constipation, hyperlipidemia, bradycardia. 🌟 Overtreatment: Heart palpitations, elevated HR, trouble sleeping, sweating, anxiety, diarrhea, weight loss, bone loss. 🍆 Patient education: 🔥 Take at the same time everyday, first thing in the morning with water. 🔥 Do not eat or drink besides water for 30-60 minutes. 🔥 Can be taken 3-4 hours after eating the last meal. 🔥 Do not take within 4 hours of calcium or iron containing products or bile acid sequestrants. 🍆 Lab monitoring: 🔥 TSH 6-8 weeks after therapy initiation, and after dosage change. 🔥 TSH 6 month and 12 month intervals after serum TSH is stabilized. 🍆 Thyroid disorders in pregnancy: 🔥 Thyroid hormones are crucial for normal development of the fetal brain and nervous system. 🌟 Dosage should be significantly increased during pregnancy and regular monitoring of TSH is necessary. 🍆 Special populations: 🔥 Dosages in the elderly should be 75% or less than the adult dose. 🌟 Synthroid is associated with accelerated bone loss and increased risk for AFIB. 🍆 D2D Interactions: 🔥 Warfarin- synthroid increases the effects of warfarin. Warfarin dose may need to be reduced. 🔥 Synthroid can increase the requirements of insulin and digoxin. 🔥 Proton pump inhibitors, calcium and iron supplements and aluminum-containing antacids can reduce the absorption of synthroid. 🔥 Lithium, amiodarone and interferon can cause thyroid dysfunction. 🍆 Propranolol and hyperthyroidism: 🔥 Treats symptoms of tachycardia, tremor and anxiety while the euthyroid state is being reached. 🌟 Symptom treatment only, does not treat disease. 🍆 Radioactive dye and hyperthyroidism: 🔥 Used to destroy thyroid tissue and decrease production of thyroid hormone. 🍆 Testosterone therapy adverse effects: 🔥 Worsening sleep apnea, gynecomastia, acne, accelerated male pattern baldness. 🔥 Erythrocytosis, prostate carcinoma, metastatic prostate cancer progression, decreased spermatogenesis and fertility, increased risk for CV events. 🍆 BBW: Testosterone. 🔥 Secondary exposure to topical gel and solution can cause virilization in children. Possible increase in CV events and serious pulmonary micro embolism reactions. 🍆 Testosterone deficiency: 🔥 Indications: male hypogonadism, replacement therapy, delayed puberty, therapy in menopausal women, cachexia, anemias, transgender therapy. 🔥 Precautions: Long term use, greater than 10 years, can increase risk of breast cancer. Testosterone may alter serum lipid profiles, so use caution with a history of myocardial infarction within the last three months or in those with coronary artery disease. Testosterone therapy should not be used in patients with a history of cardiovascular disease. It may increase the risk of gynecomastia, benign prostatic hyperplasia (BPH), prostate cancer, and venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolisms.  🍆 PDE-5 inhibitors: Education. 🔥 take 1 hour before intercourse and no more than once daily. 🔥 Medication may be more effective when combined with testosterone therapy, if levels are low. 🍆 PDE-5 Contraindications: 🔥 Concurrent use of nitrates. 🍆 BPH: Alpha-1 blockers. 🔥 Relax the muscles of the bladder neck and prostate to allow easier urine flow. 🔥 Relief will be retained for up to 4 years, alpha-blockers do not shrink the prostate or slow the progression. 🍆 BPH: 5-alpha-reductase inhibitors. 🔥 Shrink the prostate and increase urine flow. 🔥 Can take 3-6 months to work. Module 8 Unit C 🦴 Bisphosphonates: 💀 Patient education: 💪 Take with calcium and vitamin D for maximum effectiveness. 💪 Remain upright for 30-60 minutes after dosing. Take with a full glass of water. 1. Possible damage to the upper gastrointestinal tract, throat and esophagus can occur. Esophagus may swell if not taken with a full glass of water. 💪 Inform the dentist that you are taking the medication. 💀 Contraindications: 💪 If a patient cannot sit upright, suffers from esophageal motility disorders, or has poor renal function. 🦴 Monoclonal antibodies: 💀 Inhibits osteoclasts’ formation, function and survival. Results in decreased bone resorption and increased bone mass and strength. 💀 Serious Side effects: 💪 serious infections of the abdomen, urinary tract and ear. Dermatologic reactions, back and musculoskeletal pain, atypical femur fractures, hypocalcemia. 🦴 SERM raloxifene- BBW: 💀 Thromboembolic events.  🦴 Hormone replacement therapy: 💀 Contraindications: History of venous thromboembolism. Module 8 Unit D 💊 Corticosteroids- treatment of RA. 💥 RA is an autoimmune, inflammatory disorder. 💫 Corticosteroids produce anti-inflammatory and immunosuppressive effects. 💊 HPA suppression: 💥 Occurs when high levels of cortisol or other hormones disrupt normal feedback for endogenous hormone production. 💫 Glucocorticoids for 7 days or more can cause the hypothalamus to decrease or halt production. 1. To lessen risk, withdrawal and d/c of corticosteroids should be done slowly and carefully. a. Use the lowest possible dose required for management. 💊 Systemic corticosteroids: 💥 Taper is not indicated when steroids are given for less than 5 days at doses of less than 40mg/day. 💊 Long term use of corticosteroids: 💥 Can result in hypothalamic pituitary adrenal axis suppression, cushing's syndrome, osteoporosis, immunosuppression, skin changes. 💊 Corticosteroid impact on blood sugar: 💥 Impact glucose metabolism, production and utilization. Causes hyperglycemia. 💊 Systemic corticosteroids effect on immune response: 💥 Suppress the immune response, can increase rates of infection. 💊 Methotrexate: RA treatment. 💥 Decreases inflammation caused by by-products of cell degradation. 💥 Contraindications: Pregnancy, breastfeeding and leukopenia. 💊 BBW- Remicade: 💥 Serious infections and malignancy.  💊 BBW- Leflunomide: 💥 Embryo-fetal toxicity and hepatotoxicity. 💊 Plaquenil- QT interval: 💥 Prolongs the QT interval. 💊 BBW- Tumor necrosis factor inhibitors: 💥 Increased risk of serious infections and malignancies. Module 8 Unit E ✨ Stimulants for weight loss: ❗ Can lead to insomnia, increased BP, elevated HR, restlessness, drug dependence and withdrawal symptoms. ✨ Orlistat (Alli): ❗ Deficiencies in fat soluble vitamins (ADEK) can occur d/t the decreased absorption of fats in the GI tract. ❗ Contraindications: Pregnancy, malabsorption syndrome and cholestasis. ✨ Contrave: Weight loss drug that affects neurotransmitters. ❗ MOA: hypothesized to decrease appetite by inhibiting the reward system and regulating appetite in the hypothalamus. 🌀 Can cause opioid withdrawal and elevated BP and HR. Increased risk for neuropsychiatric effects. 🌀 BBW: Suicidal thinking. ✨ Saxenda: ❗ MOA: Slows gastric emptying, decreased food intake and increases beta-cell growth and replication. ❗ Side effects: Increased HR, headache, hypoglycemia, GI distress. ❗ BBW: Risk of medullary thyroid cancer. ✨ Bariatric surgery: ❗ Altered absorption of oral medication. ✨ Pregnancy considerations: ❗ Weight loss drugs are not recommended during pregnancy.