Term
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Definition
| Pituitary, adrenals, thyroid, pancreas |
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Term
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Definition
| master gland, regulates function of other glands; controlled by hypothalamus; Anterior and postier |
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Term
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Definition
Growth Hormone;
Target: liver and adipose
Action: promotes growth (indirectly), control of protein, lipid & carbohydrate metabolism;
From: anterior pituitary |
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Term
| Thyroid Stimulating Hormone |
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Definition
TSH
Target: thyroid
Action: stimulate secretion of thyroid hormones
From: anterior pituitary |
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Term
| Adrenocorticotropin Hormone |
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Definition
ACTH
Target: Adrenal gland (cortex)
Action: stimulate secretion of glucocorticoids
From: anterior pituitary |
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Term
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Definition
PL
Target: mammary glands
Action: milk production
From: anterior pituitary |
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Term
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Definition
LH
Target: Ovary/Testis
Action: reproductive function
From: anterior pituitary |
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Term
| follicle stimulating hormone |
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Definition
FSH
Target: Ovaries/Testes
Action: reproductive functions
From: anterior pituitary |
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Term
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Definition
ADH
Target: Kidney
Action: Conservation of body water
Posterior Pituitary |
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Term
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Definition
Target: mammary glands, uterus
Action: milk ejection, uterine contraction
From: Posterior Pituitary
Synthetic - given IV in labor induction; nasal spray for milk production,
Adverse Effects: hypertensive crisis, uterine rupture, water retention, fetal death
Adverse effects are rare with proper use
Contraindications: abnormal fetal presentation, fetal distress, premature births |
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Term
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Definition
| Excessive secretion of growth hormone in adults, usually the result of benign pituitary tumors. The onset of this disorder is typically insideous (over several years). Clinical signs include overgrowth of extremities, soft-tissue swelling, abnormalities in jaw structure and cardiac disease |
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Term
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Definition
| Excessive growth hormone secretion that begins in pediatrics |
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Term
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Definition
created in the hypothalamus;
Target: anterior pituitary
Action: Growth Hormone Inhibiting Hormone |
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Term
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Definition
synthetic somatostatin; Has a longer T 1/2;
Treatment: acromegaly, secretory diarrhea from VIPomas |
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Term
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Definition
| variceal bleeding, given as IV to prevent bleeding from esophageal varcies, reduction of pressure in the portal circulation (& possible splachnic vessles) |
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Term
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Definition
| Releasing hormone from hypothalamus; secreted in response to stress - "stress management" of glucocorticoids; ACTH is secreted in response |
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Term
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Definition
| synthetic corticotropin used for diagnosis of adrenal insufficiency |
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Term
| Therapeutic use corticotropin |
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Definition
| used diagnostically to differentiate between primary & secondary adrenal insufficiency |
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Term
| Adverse effect of corticotropin |
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Definition
Glucocorticoid-like effects (osteoporosis, cushing like syndrome (puffy face, increased body hair growth, acne, insomnia, increased appetite), elevate blood glucose, salt/water retention)
Allergic reactions: especially if animal source |
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Term
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Definition
| major prolactin-inhibitor; from the hypothalamus |
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Term
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Definition
Hyperprolactinemia-excessive secretion of prolactin (numerous causes, including prolactin-secreting tumors & medications)
Manifestations-amenorrhea & galactorrhea
Treatment: Dopamine-2 Receptor Agonist
Bromocriptine: treatment of galactorrhea, prolactinomas |
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Term
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Definition
failure of gonadal function; causes include FSH or LH insufficiency
Males: below normal sperm count
Females: cessation of reproductive cycle |
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Term
| Gonadotropin Releasing Hormone |
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Definition
GnRH
Target: anterior pituitary
Action: secretion of FSH/LH |
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Term
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Definition
Synthetic:
Leuprolide (Lupron®), Goserelin, Nafarelin, Histrelin
Suppression of gonadal hormones: useful in the treatment of prostate cancer, endometriosis, precocious puberty
Adverse Effects
Hypersensitivity, dermititis, headache, hot flashes, sweating, decreased libido, depression, ovarian cysts, gynecomastia (males) |
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Term
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Definition
Hypothalamic ("central") diabetes insipidus-deficiency in secretion of ADH from the posterior pituitary (Causes of this disease include head trauma, & infections or tumors involving the hypothalamus)
Nephrogenic diabetes insipidus occurs when the kidney is unable to respond to ADH; usually resulting from renal disease |
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Term
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Definition
ADH
Effects: Vasopressor effects (vasoconstriction) on vascular smooth muscle
Antidiuretic effects on renal collecting ducts, causing reabsorption of water
Therapeutic Uses: Diabetes Insipidus
ACLS (for vasopressive effects)
Bleeding esophageal varices
Causes vasoconstrictive effects on vascular smooth muscle
Adverse Effects: Hyponatremia, water overload, Heart Attack |
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Term
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Definition
| T3; more potent, shorter t1/2, shorter duration of action |
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Term
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Definition
| more dominant circulating form, may be converted to more active form (T3) in peripheral tissues |
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Term
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Definition
| Stimulation of energy use, stimulation of heart, promotion of growth & development |
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Term
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Definition
Symptoms:Cold interolerance, weakness, stiffness, lethargy, fatigue
Pediatrics: growth & mental retardation
Signs: Dry skin, course hair, weight gain, constipation, slowed & hoarse speech, bradycardia, periorbital puffiness, slow DTRs |
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Term
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Definition
Emergency hypothyroid condition
Spontaneous onset or precipitated by cold exposure, infection, analgesics, sedative drug use, respiratory or other severe illnesses
Signs/Symptoms: Coma, seizures, hypotension, hypoventilation
Treatment: IV Thyroid hormone (levothyroxine), steroid (cortisone), mechanical ventilation |
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Term
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Definition
(Synthroid®, Levothyroid, L-thyroxine)
Drug of choice for hypothyroidism |
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Term
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Definition
Thyroid USP--Dessicated thyroid
Animal derived; less predictable response; risk of allergic reaction |
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Term
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Definition
Synthetic T3
Higher incidence of cardiac adverse effects |
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Term
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Definition
T4:T3 in ratio of 2.5:1
More expensive, unlikely clinical benefit
Animal derived (allergenicity) |
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Term
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Definition
T4:T3 ratio of 4:1
Good medication, but the body converts T4:T3 peripherally (so probably isn’t a significant benefit for most patients) |
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Term
| Adverse Effects of Thyroid Hormone Replacement |
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Definition
Adverse Effects (similar to symptoms of hyperthyroidism)
Nervousness, palpitations, tachycardia, heat intolerance, weight loss
Excessive doses of thyroid hormone may lead to
Heart failure, Angina, MI,↓ Bone mineral density |
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Term
| Drug Interactions with thyroid replacement |
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Definition
Impaired absorption of thyroid hormone replacement
Thyroid hormone medications easily bind to certain foods & drug:
Iron, Aluminum, Calcium, fiber supplements & various other prescription and OTC medications/supplements
↑ T4 clearance (CYP 450 inducers):
Rifampin, carbamazepine, phenytoin
Block conversion of T4-->T3: Amiodarone (Antiarrhythmic) |
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Term
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Definition
Symptoms: Nervousness, easy fatigability, heat intolerance, weight loss with ↑ appetite, ↑ BMs, palpitations, proximal muscle weakness, scanty or irregular menses
Signs: Warm/smooth/moist skin, unusually fine hair, retraction of eyelids, lid lag, tachycardia, systolic ejection murmur, gynecomastia (in men), fine tremor (of protruded tongue & outstreched hands, hyperactive DTRs)
Treatment: Thioureas/Thionamides, Iodides, Radioactive Iodide, Adrengeric Blockers, Thyroidectomy |
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Term
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Definition
Treatment for Hyperthyroidism
MOA-Block thyroid hormone synthesis by inhibiting peroxidase enzyme system of the thyroid gland
Pharmacokinetics-Orally active, takes 3-4 weeks for full effect
Propylthiouracil (PTU): Also inhibits peripheral T4-->T3
Due to inhibition of conversion of T4-->T3, PTU may have a more rapid onset of action
Preferred in pregnancy because less drug crosses the placenta
Methimazole (Tapazole®):
often used prior to radioactive iodide |
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Term
| Side effects of thionamides |
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Definition
Major/Serious: Agranulocytosis, aplastic anemia, lupus-like syndrome, polymyositis, heptotoxicity, hypothrombinemia
Agranulocytosis: most likely within 3 months of start
Minor: Pruritic maculopapular rashes, arthralgias, fever, benign transient leukopenia |
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Term
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Definition
Method Of Action: block thyroid hormone release, inhibits thyroid hormone biosynthesis, ↓ size & vascularity of gland
Use: adjunctive therapy with surgery to acutely inhibit thyroid hormone release, quickly attain euthyroid in severly thyrotoxic patients, inhibit thyroid hormone release after RAI therapy
Medications: Potassium Iodide (SSKI drops, Lugol’s solution)
SE: Hypersensitivity reactions, salivary gland swelling, iodism (metallic taste, burning mouth, sore gingiva, gynecomastia) |
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Term
| Radioactive Iodides for Hyperthyroidism |
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Definition
Sodium Iodide 131
Method of Action: PO liquid that concentrates in thyroid & disrupts thyroid hormone synthesis by incorporating into thyroid hormones & thyroglobulin
Over weeks, the follicles that uptake RAI develop necrosis & fibrosis of interstitial tissue
Contraindication: Pregnancy
Beta Blockers are used adjunctively for symptoms (no compromise of RAI therapy)
Elderly & cardiac disease patients are usually given thioureas prior to RAI because pre-formed thyroid hormone will be released after RAI
Anti-thyroid medications are usually not given after RAI, if iodides are given, wait at least 3-7 days to prevent interference
A 2nd dose is given if still hyperthyroid after 6 months
Hypothyroidism is common (usually months to years after) |
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Term
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Definition
Beta-blockers to ameliorate thyrotoxic symptoms: Palpitations, anxiety, & tremor
Used adjunctively with other anti-thyroid medications
Do Not reduce thyroid antibodies or prevent thyroid storm
Propranolol & nadolol : minor effect of inhibiting conversion of T4-->T3
Contraindications: severe/unstable CHF, cardiomyopathy, asthma
SE: Bradycardia, dizziness, hypotension
Alternative to BBs: Centrally acting sympathomimetics (clonidine),
Calcium Channel Blockers (CCBs) |
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Term
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Definition
Medical Emergency - extreme hyperthyroidism
Signs/Symptoms: High fever, dehydration, arrhythmias, cardiac failure, coma
Treatment: Beta Blockers—Propranolol due to control of sympathetic stimulation & also weak antithyroid effects (inhibition of peripheral conversion), IV fluids
PTU:give PTU before iodides (initially iodides may cause the formation of more thyroid hormone, PTU blocks this reaction)
Iodides: rapid feedback suppression of thyroid hormone, prevents the release of thyroid hormone, given after PTU
General/Supportive:
Antipyretic (acetaminophen- preferred), Fluid/electrolyte management, Sedatives, Antiarrhythmics |
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Term
| impaired glucose tolerance |
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Definition
GTT: 2 Hour BG 140-200 mg/dL
FBS: 110-126 mg/dL |
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Term
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Definition
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Term
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Definition
| Oral Glucose Tolerance Test |
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Term
| Lab values for diabetes mellitus |
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Definition
Random Blood Glucose (RBG) > 200 mg/dL
Fasting Blood Glucose (FBG) > 126 mg/dL
2 Hour BG > 200 mg/dL during an OGTT |
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Term
Type 1 Diabetes Mellitus
Age of onset |
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Definition
| Usually childhood or puberty |
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Term
Type 1 Diabetes Mellitus
Nutritional status at onset |
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Definition
| Frequently undernourished |
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Term
Type 1 Diabetes Mellitus
Prevalence |
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Definition
| 5-10% of diagnosed diabetics |
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Term
Type 1 Diabetes Mellitus
Genetic Predisposition |
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Definition
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Term
Type 1 Diabetes Mellitus
Defect or Deficiency |
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Definition
| Beta cells are destroyed, eliminating the production of insulin |
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Term
Type 2 Diabetes Mellitus
Age of onset |
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Definition
| Frequently over 35 years old |
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Term
Type 2 Diabetes Mellitus
Nutritional status at onset |
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Definition
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Term
Type 2 Diabetes Mellitus
Genetic predisposition |
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Definition
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Term
Type 2 Diabetes Mellitus
Defect or disability |
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Definition
| Inability of Beta cells to produce appropriate quantities of insulin; insulin resistance; other defects |
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Term
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Definition
Ultra-short acting
Short-acting (Regular Insulin)
Intermediate-acting
Long-acting |
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Term
Lispro (Humalog®)
Aspart (Novolog®)
Glulisine (Apidra®) |
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Definition
Ultra short-Acting: More rapid onset & shorter duration than regular insulin
Glulisine- should be given no earlier than 15mins before meal or later than 20 mins after starting meal |
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Term
| Humulin R, Novolin R, Velosulin |
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Definition
Short-Acting: Regular Insulin
Can give IV |
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Term
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Definition
| buffered regular insulin approved for use in insulin pump, less likely to lead to clogging of tubing of insulin pump |
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Term
NPH (Humulin N, Novolin N)
Lente (Humulin L, Novolin L) |
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Definition
| Intermediate-acting insulin; Lente may be cloudy in appearance |
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Term
Ultralente (Humulin U)
Glargine (Lantus®)
Detemir (Levemir®) |
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Definition
Long-acting insulin
-some U insulins have been discontinued, ultralente is also cloudy in appearance |
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Term
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Definition
Lantus (trade name); long-acting insulin
Peakless
Less nocturnal hypoglycemia than NPH
Protamine is attached |
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Term
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Definition
Levemir (trade name)
Long-acting basal insulin analog, with up to 24 h duration of action |
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Term
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Definition
NPH & Regular: Draw up regular insulin first then the NPH & the insulins do not have to be “mixed” in the syringe. The insulins should be given immediately after loading syringe.
Lispro & NPH (or ultralente) |
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Term
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Definition
Pre-mixed Insulin
70% Aspart protamine (Intermediate)
30% Aspart (ultra short)
Aspart protamine: intermediate action |
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Term
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Definition
Pre-mixed Insulin
70% NPH (intermediate)
30% Regular (short) |
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Term
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Definition
Pre-mixed Insulin
70% NPH (intermediate)
30% Regular (short) |
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Term
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Definition
Pre-mixed Insulin
75% NPL (intermediate)
25% Lispro (ultra short)
NPL: natural protamine lispro (similar in action to NPH)
Given within 15 minutes of meal |
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Term
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Definition
Pre-mixed Insulin
50% NPH
50% Regular |
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Term
| Standard Treatment of Insulin |
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Definition
2 injections daily
Less control over blood glucose levels
increased risk of complications associated with DM
decreased risk of hypoglycemia & adverse effects of insulin |
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Term
| Intensive Treatment of Insulin |
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Definition
Normalize blood glucose
More frequent blood glucose checks
More frequent injections or insulin pump
Decrease risk of complications from diabetes
Increase risk of adverse effects from insulin (hypoglycemia, etc.) |
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Term
| Regular Sliding Scale Insulin (RSSI) |
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Definition
Patients vary in degree of insulin sensitivity & adjustments will need to be made based on patient response/history.
Prolonged use of RSSI as sole form of insulin coverage is highly discouraged
More useful when added to long/intermediate insulin regimen for tighter BG control.
Not really for maintenance - more for better control |
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Term
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Definition
Palpitations
Diaphoresis
Tremor
Confusion
Syncope/presyncope |
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Term
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Definition
| hypoglycemia, Weight gain, Lipodystrophy (degeneration of adipose tissue), Allergic reactions, Local injection site reactions |
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Term
| treatment of hypoglycemia |
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Definition
Glucose tablets 10-15 g PO
Dextrose IV 25 g IV (1 ampule of D50)
Glucagon IM
If patient is alert & cooperative give 15-30 g carbohydrates (15 g carbs will ↑ BG 25-50)
8 oz juice/soda: 30 g |
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Term
| Oral Agents (Classes) for DM 2 |
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Definition
Sulfonylureas
Meglitinides
Biguanides
Glitazones
Alpha-glucosidase inhibitors
Pancreatic Islet Peptide |
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Term
| Non-insulin Injectables DM 2 |
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Definition
Incretin Mimetics
Help their body secrete more insulin (to overcome resistance) or force tissues to use glucose more appropriately |
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Term
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Definition
MoA: Binds to sulfonylurea receptors on B-cells & stimulates pancreatic secretion of insulin
Block ATPase-sensitive K channels resulting in depolarization & Ca influx (causing release of preformed insulin)
Secondary actions
Reduction of serum glucagon
SE: Hypoglycemia, weight gain, rash, hemolytic anemia, GI upset
Dosing: Start at lower doses in elderly (or those who may have compromised renal or hepatic function)
Doses can be titrated every 1-2 weeks
Kinetics: Orally active, Protein-binding, Liver metabolism |
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Term
| 1st generation sulfonylureas |
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Definition
Chlorpropamide (Diabinese®): longer t ½, causes more hypoglycemia
Tolbutamide: short t ½ , causes less hypoglycemia, but has more drug interactions
Others: acetohexamide, tolazamide
Not used as much; must be careful in someone with impaired liver function; won't work with patients with too high glucose levels |
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Term
| 2nd generation sulfonylureas |
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Definition
Glyburide (DiaBeta, Micronase®)
Liver metabolism, renal excretion
Glipizide (Glucotrol®)
Given 30 minutes before meal(s)
Shorter t ½ :slightly less likely to cause hypoglycemia than glyburide
Liver metabolism, renal excretion
Glimepiride (Amaryl®)
Liver metabolism (possibly safer in patients with kidney dysfunction) |
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Term
| Drug Interactions with sulfonylureas |
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Definition
Phenylbutazone, salicylates, sulfonamides: displace sulfonylureas from plasma proteins
allopruinal, probenecid: decrease urinary excretion of sulfonylureas or metabolites;
dicumarol, chloramphenicol, MOI, Phenylbutazone: reduce hepatic metabolism;
causes too much active sulfonylurea to be active in the blood (hypoglycemia risk) |
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Term
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Definition
Short-acting insulin secretagogues
MoA: Bind to receptors on B-cells & lowers glucose by stimulating pancreatic insulin secretion
Produces more physiologic insulin release after a meal & better postprandial BG lowering
Kinetics:Orally active, rapid onset, short duration
CYP 450 metabolism, excreted in bile
Administered before each meal:
If the meal is skipped, the medication should also be skipped
Medications:
Regalinide (Prandin®)
Nateglinide (Starlix®)
SE: hypoglycemia (less than sulfonylureas), weight gain
Cautions:
Hepatic impairment
Drug Interactions
CYP 450 Inhibitors increase risk of hypoglycemia
CYP 450 Inhibitors: Antifungals, macrolide antibiotics
CYP 450 Inducers may decrease effectiveness of meglitinides
CYP 450 Inducers: phenytion, phenobarbital, rifampin
More appropriate if pt is close to normal weight |
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Term
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Definition
Very common
MoA: ↓ hepatic glucose production
↑ peripheral glucose utilization
Insulin must be present for med to work
Other use-PCOS (↓ insulin resistance & increases probability of ovulation)
SE
↓ appetite (may cause modest weight loss), favorable effect on lipid profile
N/V/D, & metallic taste are the most common SE
Lactic acidosis: minimize use in renal insufficiency, CHF
*Avoid if SCr > 1.5 in males & 1.4 in females
Does NOT induce hypoglycemia when used as monotherapy
GI SE can be minimized by taking with food & titrating the dose slowly
Should be discontinued 2 days prior to IV contrast studies & restarted once documentation normal Cr is done
Medications-Metformin (Glucophage®)
Use for obese patients- titrate to 2000 mg/day |
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Term
| Glitazones (Thiazolidinediones) -TZDs |
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Definition
MoA: Activate PPAR gamma receptor to reduce peripheral insulin resistance (sensitize muscle & fat to effects of insulin)
Insulin must be present for medication to work
May take 3 months for full effect
SE: Edema & weight gain (Caution in CHF/edematous states), Mixed effects on lipids (↓TG, ↑HDL, but negative effect on LDL)
Liver dysfunction (trioglitazone)
LFTs need to be periodically monitored-discontinue with abnormal LFTs or signs/symptoms of liver injury
Medications: Pioglitazone (Actos®)
Rosiglitazone (Avandia®)* has black box (cardiac)
Must do LFTs before and while on drug
Use in pts intolerant or contraindicated for metformin |
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Term
| Alpha-Glucosidase Inhibitors |
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Definition
MoA: Prevent breakdown of sucrose & complex carbohydrates in the small intestine, prolonging the absorption of carbohydrates
Net effect: ↓ postprandial glucose, fasting BG is relatively unchanged
SE:
GI Side effects: diarrhea, abdominal cramps, flatulance
Hypoglycemia usually only occurs if the medication is used in combination with a hypoglycemic (secretagogue or insulin)
If hypoglycemia occurs PO or parenteral glucose (dextrose) or glucagon MUST be given– the medication will inhibit the breakdown of more complex sugar molecules (sucrose)
GI SE can be minimized by slow dose titrations
Alpha-glucosidase inhibitors are weight neutral
Medications: Acarbose (Precose®)
Miglitol (Glyset®)
Use for pts at risk for hypoglycemia |
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Term
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Definition
| Group of GI hormones (gut derived peptides) that increase postprandial insulin secretion, slow the rate of absorption of nutrients from GI tract, inhibit glucagon release |
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Term
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Definition
acts like incretins; pancreatic islet cell peptide.
slows the absorption of nutrients (slows gastric emptying time) |
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Term
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Definition
Incretin Mimetic
MoA: Incretin mimetic
Glucose-depended stimulation of insulin release, suppression of glucagon, slows gastric emptying; may preserv B-cell function (useful in early disease);
Non-insulin injection
May be used in combination therapy (biguanides, sulfonylureas)
SE: Nausea, vomiting, weight loss, injection-site irritation.
Patients don't like it b/c they vomit (take 30 mins before meals) |
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Term
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Definition
Amylin analgog
MoA-Pancreatic islet peptide that decreases postprandial hyperglycemia
Synthetic Amylin analog
Suppresses glucagon secretion
Delays gastric emptying
Promotion of satiety
Non-insulin injection
Use: Type I & Type II (on insulin)
SE: nausea & vomiting, weight loss, hypoglycemia
Can give regardless of kidney/liver function; must time oral meds due to delayed stomach emptying; do not mix in syringe with insulin; may decrease amount of bolus insulin |
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Term
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Definition
Dipeptidyl peptidase 4-inhibitor
MoA: DDP-4 Inhibitor-slows the inactivation of incretin hormones (works similar to incretin mimetic)
By increasing and prolonging active incretin levels, it increases insulin release and decreases glucagon levels in the circulation in a glucose-dependent manner
Use: indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
PO tablet
SE: URI, nasopharyngitis and headache
Hypoglycemia (reported in patients treated with the combination of JANUVIA and sulfonylurea) |
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Term
| DM microvascular complaints; Nephropathy |
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Definition
Glucose & BP control are most important for prevention (BP control also slows progression)
Angiotensin-converting Enzyme Inhibitors (ACEI)
Initial recommended treatment
Angiotensin receptor Blockers
May also have a protective effect
Diuretics may be necessary for volume-expanded patients |
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Term
| DM microvascular complains; Coronary Heart Disease |
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Definition
ACEI: 1st line therapy for HTN in DM patients
Diuretics, CCBs, & BBs: are also used
BBs may ↓ risk from CHD events but may also mask hypoglycemic symptoms
Thiazide diuretics may increase BG |
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Term
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Definition
| unpleasant subjective sensory & emotional experience associated with actual or potential tissue damage |
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