week 8

What are the symptoms of hyperthyroidism? (5)

• hyperactivity

• insomnia

• heat intolerance

• fatigue

• increased appetite but weight loss

What are the symptoms of hypothyroidism? (5)

• hypothermia

• decreased appetite but weight gain

• dry skin + hair

• fatigue

• constipation

What is the pharmacologic treatment for hyperthyroidism? (2)

• Antithyroid medications

• Beta-blockers

What is the pharmacologic treatment for hypothyroidism?

Medications that replace thyroid hormone, like Levothyroxine

What is the treatment for thyroid storm?

thyroid storm = extreme case of hyperthyroidism

treatment = cooling, NO aspirin, fluid replacement

What is a goiter?

Enlarged thyroid gland

What is myxedema?

A life threatening complication of long untreated hypothyroidism

In primary thyroid disorders, what part is dysfunctional?

Thyroid

In secondary thyroid disorders, what part is dysfunctional?

Pituitary

In tertiary thyroid disorders, what part is dysfunctional?

Hypothalmus

What is the function of the pancreas?

Keeps blood glucose within normal range

What are the physiological actions of insulin? (3)

• Promotes entry of glucose into cells

• Provides storage of glucose

• Inhibits breakdown of fat and glycogen

What is the cause of type 1 diabetes mellitus?

Caused by absolute lack of insulin secretion due to autoimmune destruction of pancreatic islet cells

What type of insulin is rapid acting?

Lispro / Humalog

What type of insulin has prolonged action?

Glargine / Lantus

How long does it take for rapid acting insulin to take effect?

10 - 20 mins

How long does it take for long acting insulin to take effect?

30 mins - 4 hours

How long does rapid acting insulin last?

3 - 5 hours

How long does long acting insulin last?

16 - 24 hours

When is rapid acting insulin usually administered?

At the start of a meal

When is short acting insulin usually administered?

30 - 60 mins before a meal

What is the preferred site for insulin injection?

Abdomen

What type of insulin can be used intravenously?

Regular insulin

What is the safest way to give insulin?

Insulin pen

What are signs and symptoms of hypoglycemia? (5)

• sweating

• tachycardia

• confusion

• drowsiness

• convulsions

Which drugs can raise blood glucose levels? (4)

• Phenytoin

• NSAIDs

• Diuretics

• Corticosteroids

Which drugs can lower blood glucose levels? (3)

• Lithium

• ACE inhibitors

• Beta-blockers

What is type 2 diabetes?

Pancreas can secrete some insulin, but the insulin receptors have become resistant

How do oral anti-diabetic medications treat type 2 diabetes?

Lowers blood glucose

What are the classes of oral anti-diabetic drugs? (6)

• Sulfonylureas

• Biguanides

• Alpha-glucosidase inhibitors

• Thiazolidinediones

• Meglitinides

• Incretin enhancers

How do sulfonylureas treat type 2 diabetes?

stimulates the release of insulin from pancreatic islet cells

What are adverse effects of sulfonylureas? (3)

• Hypoglycemia

• Weight gain

• hepatotoxicity

Why are biguanides usually the first line of therapy for type 2 diabetes?

Do not cause weight gain and hypoglycemia

What is the only drug in the biguanide class?

Metformin

How do biguanides treat type 2 diabetes?

Decreases hepatic production of glucose and reduces insulin resistance

What are some side effects of biguanides? (2)

Usually GI related, like diarrhea and nausea

What is important to remember about biguanides?

Stop medication if getting IV dyes for radiological study

What is a rare and fatal adverse effect of biguanides?

Lactic acidosis

What is the onset of Metformin?

less than 1 hour

What is the duration of Metformin?

12 hours

How do alpha-glucosidase inhibitors treat type 2 diabetes?

Blocks enzymes in the small intestine that break down complex carbs

How do thiazolidinediones treat type 2 diabetes?

Reduce blood glucose by decreasing insulin resistance and inhibiting hepatic gluconeogenesis

How long does it take for thiazolidinediones to work optimally?

2-3 months

What are the common adverse effects of thiazolidinediones? (3)

• fluid retention

• headache

• weight gain

How do meglitinides treat type 2 diabetes?

act by stimulating the release of insulin from pancreatic islet cells

How long is the duration of action for meglitinides?

2 - 4 hours

What is the most common adverse effect for meglitinides?

Hypoglycemia

How do incretin enhancers treat type 2 diabetes?

Mimic effects of incretins- hormones released into the blood by intestine in response to food to signal insulin secretion and stop glucagon production