NCLEX Endocrine & Diabetes Pharmacology Flashcards

Vocabulary flashcards covering antidiabetic drugs, pituitary, thyroid, parathyroid, and adrenal cortical regulators along with NCLEX clinical rules from the endocrine pharmacology cheat sheet.

Clinical Criteria for Starting Oral Antidiabetics

Six criteria for Type 2 Diabetes patients: onset age 40+, diagnosed < 5 years, normal/overweight body profile, fasting blood glucose $\le 200\,\text{mg/dL}$, requiring < 40 units insulin/day, and normal renal and hepatic function.

Rapid-Acting Insulin

Class including Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra), and Inhaled (Afrezza). Onset: 15-30 min, Peak: 30-90 min, Duration: 3-5 hours (Inhaled: 2.5 hours). Must be administered ONLY when patient's food tray is present.

Short-Acting Insulin

Regular insulin (Humulin R, Novolin R). Onset: 30 min, Peak: 2.5-5 hours, Duration: 4-12 hours. It is the ONLY insulin formulation compatible with IV fluids and infusions.

Intermediate-Acting Insulin

Isophane NPH (Humulin N, Novolin N). Onset: 1-2 hours, Peak: 4-12 hours (avg 6 hours), Duration: 14-24 hours. Hypoglycemic risk is highest at its peak (~6 hours post-administration).

Long-Acting Insulin

Glargine (Lantus). Maintains background basal levels (Onset: 1-1.5 hours, Peak: None, Duration: 24 hours). Administered once daily at bedtime and must NEVER be mixed with other insulins.

Insulin Mixing Protocol

Procedure to always draw up Clear (Regular/Rapid) insulin before Cloudy (NPH) insulin to prevent contaminating the clear vial.

Sulfonylureas

Class exemplified by Glipizide (Glucotrol). Stimulates pancreatic beta cells to secrete insulin and increases peripheral receptor sensitivity. Administered once daily in the morning immediately before breakfast.

Biguanides

Class exemplified by Metformin (Glucophage). Decreases hepatic glucose production, reduces intestinal glucose absorption, and increases insulin receptor sensitivity. Must be held 48 hours before and after IV contrast dye procedures.

Alpha-Glucosidase Inhibitors

Class including Acarbose (Precose) and Miglitol (Glyset). Inhibits digestive enzymes in the small intestine to delay carbohydrate absorption; must be taken with the first bite of each main meal.

Thiazolidinediones

Class including Pioglitazone (Actos) and Rosiglitazone (Avandia). Improves insulin sensitivity by stimulating receptor sites. Absolutely contraindicated in patients with Class III or IV Heart Failure.

Meglitinides

Class including Repaglinide (Prandin) and Nateglinide (Starlix). Stimulates pancreatic beta cells to release insulin (rapid onset, short-acting). Contraindicated in liver dysfunction; skip dose if skipping a meal.

GLP-1 & DPP-4 Incretins

Class including Exenatide (subcutaneous) and Sitagliptin (oral). Enhances insulin secretion, suppresses glucagon, slows gastric emptying, and induces satiety. Requires monitoring for pancreatitis.

Amylin Analogue

Pramlintide (Symlin). Approved for BOTH Type 1 and Type 2 diabetes; suppresses glucagon secretion, slows gastric emptying, and modulates appetite. Administered subcutaneously before major meals.

Glucagon

Emergency hyperglycemic agent that stimulates hepatic glycogenolysis; used for acute insulin-induced hypoglycemia when IV access or oral route is unavailable.

Diazoxide (Proglycem)

Hyperglycemic agent that inhibits pancreatic beta cell insulin release; used for chronic hyperinsulinism rather than acute hypoglycemic reactions.

Somatropin

Anterior pituitary growth hormone (GH) replacement that stimulates skeletal muscle, connective tissue, and bone growth; requires monitoring for joint pain and glucose intolerance.

Cosyntropin

Diagnostic agent that stimulates cortisol release. A failure of cortisol levels to rise confirms primary adrenal insufficiency.

Desmopressin / Vasopressin

Posterior pituitary ADH replacements used for Diabetes Insipidus (ADH deficiency) to increase renal water reabsorption; requires strict monitoring for fluid overload and severe hyponatremia.

Demeclocycline / Vaptans

Agents (Demeclocycline, Conivaptan, Tolvaptan) used for posterior pituitary ADH excess (SIADH) that inhibit ADH action or block ADH receptors.

Levothyroxine Sodium (Synthroid)

Thyroid hormone replacement for hypothyroidism that increases metabolism and oxygen use. Must be taken on an empty stomach 30-60 minutes before breakfast.

Propylthiouracil (PTU)

Antithyroid agent that blocks iodine integration to inhibit hormone synthesis. Increases oral anticoagulant bleeding risk and decreases insulin efficacy.

Calcitriol

Vitamin D analogue for hypoparathyroidism that promotes GI calcium absorption and calcium mobilization into the blood.

Calcitonin-Salmon

Agent for hyperparathyroidism that inhibits osteoclast resorption and promotes renal excretion of calcium; contraindicated in pregnancy.

Prednisone Tapering Alert

Critical safety rule requiring systemic glucocorticoids to be tapered gradually over 1 to 2 weeks and NEVER stopped abruptly to prevent life-threatening acute adrenal crisis.

Fludrocortisone (Florinef)

Mineralocorticoid replacement that promotes renal sodium/water reabsorption and enhances potassium/hydrogen excretion; carries a high risk of hypokalemia.

Somogyi Effect

Hypoglycemia occurring between 0200-0400 followed by rebound morning hyperglycemia. Managed by checking 0300 blood glucose and reducing bedtime insulin or providing a protein snack.

Dawn Phenomenon

Morning hyperglycemia without overnight hypoglycemia. Managed by increasing the bedtime insulin dose.

Lipodystrophy

Atrophy or hypertrophy at the subcutaneous injection site, prevented by systematically rotating injection sites.