Pharm Exam 3

What is T4

90 percent of hormone produced

What is T3

10 perfect produced directly by the thyroid

What does T3 do

responsable for most of the metabolic effects

Does the thyroid release mainly t3 or t4

T4

How is T3 made

in peripheral tissues from T4 by deidinase enzymes

What does thyroid horomone do (t3)- Patho

speeds up basal metabolic rate by stimulating protein synth

What does thyroid horomone do (t3)- Physical effects

inc CO, simulate bone resorption, produce heat, activate SNS, flight-or-fight

Common causes hypothyroidism

hashimotos, iodine deficency

S/S hypothyroidism

fatigue, weight gain, consitpation, bradycardic,

Treatment hypothyroidism

replace thyroid hormone

Common causes hyperthyroid

graves, thyroiditis, excess hormone medication

S/S hyperthyroid

weight loss, heat intolerence, anxiety, tremor

Treatment hyperthyroid

reduce hormone effects/ synth or destroy overactive tissue

Clinical presentation hypothrydoidism

brittle hair, fatigue, intolerence to cold, consitpation

What is given for hypothyroidism

levothyroxine (T4)

What is levothyroxine

T4 replacement drug

What can affect levothyroxine

H2 receptor blockers, proton pump inhibitors,

Key considerations levothyroxine

separate medications 4 hours, many meds affect absorbtion

Levothyroixine + warfrain

warfarin dose needs to be reduced

Risks levothyroxine

arrhythmias

Excessive dosing s/s levothyroxine

tachy, hyperthermia, sweating, insomnia

What must happen if a thyroid hormone drug wants to be switched

retest serum TSH in 6 weeks and adjust as indicated

Dosing recs levothyroxine

start low and go slow

Pt. Education levothyroxine

take on empty stomach, careful to not take near a meal,

Causes thyrotoxic crisis (thyroid storm)

pt with thyrotoxicosis who undergo stress

S/S thyroid storm

105> fever, tachy, agitated, hypotension, HF, unconsious

Treatment thyroid storm

methimazole, BB, sedation/cooling/IV fluids

What class is methimazole

antithyroid

MOA methimazole

inhibits peroxidase (the enzyme that turns T3 to T4)

What does methimazole do

suppress synth of new thyroid hormones, no affect on those already made

Indications methimazole

first line treatment hyperthyroidism, priot to radiation treatment

Adverse effects methimazole

agranulocytosis, skin rash, hypothyroidsm, teratogenic

Can a pregnant women take methimazole

not in 1st trimester, but 2nd and 3rd ok

What class is propylthiouracil (PTU)

antithyroid drug

MOA propylthiouracil (PTU)

inhibits peroxidase in thyroid gland, and peripheral conversion of T4—> T3

What does propylthiouracil (PTU) do

prevents formation of thyroid hormones and reduces the amount of active thyroid hormone

What antithyroid drug is most effective for the treatment of thyroid storm

propylthiouracil (PTU)

Indications propylthiouracil (PTU)

intolerance of methimazole, pregnant in 1st trimester, thyroid storm

Adverse affects propylthiouracil (PTU)

Hepatic injury (boxed warning), ANCA-positive vascultiis

methimazole vs propylthiouracil (PTU)

methimazole 1st line and works quicker (once daily), propylthiouracil (PTU) for 1st trimester pregnancy and thryoid storm

Levels + S/S Level 1 Hypoglycemia

<70 - >54, possible neuro symptoms

Levels + S/S Level 2 Hypoglycemia

<54, neuro symptoms, CNS impairment, needs action

Levels + S/S Level 3 Hypoglycemia

severe event with altered mental or physical function, requires help at any level

How to prevent hypOglycemia

monitor BG frequently

What drug that treat diabetes can cause hypoglycemia

Insulin, glipizide (sulfonylureas), Repaglinide(glindes)

Type 1 DM meds, with blood glucose risks

when used alone, low hypoglycemia

What DM type is metformin

Type 1 DM meds, with blood glucose

What DM type is glitazones

Type 1 DM meds, with blood glucose

What DM type is incretin meds (GLP-1 agonists/ trizaptide)

Type 1 DM meds, with blood glucose

What DM type SGLT2 inhibitor

Type 1 DM meds, with blood glucose

What DM type is DPP-4

Type 1 DM meds, with blood glucose

What do type 2 DM meds do (glucose independent)

keeps lowering BG no matter what level

Risks type 2 DM meds do (glucose independent)

can cause hypoglycemia, higher in older and alc use

What DM type insulin

type 2 DM med (glucose independent)

What DM type sulfonylureas

type 2 DM med (glucose independent)

What DM type Meglitinides

type 2 DM med (glucose independent)

MOA insulin (natural)

peptide hormone produced by pancreatic beta cells, triggers glucose absorbtion, converts glucose to glycogen for storage

Patho goals of insulin therapy

mimicking endogenous insulin porduction, manage BG thought the day and with meals

Basal insulin is

long acting, continuous effects

Bolus insulin is

short acting, targets BG after meals, similar to natural body response

What is basal insulin order used for

background, covers glucose the liver releases even without food

Caveout with NPO and basal insulin order

give even if NPO (dose may be lower) NEVER hold in type 1 DM

What is prandial insulin order used for

food, coverse carbs during meal, hold if not eating

What is correction insulin order

fix, covers a high BG present before a meal, added to prandial

What type of insulin is regular insulin

short acting, prandial insulin

What type of insulin is Insulin lispro (Humalog)

Rapid acting, prandial insulin

What type of insulin is insulin lispro (Lyumjev)

Ultra rapid acting, prandial insulin

What type of insulin is NPH

intermediate acting, basal insulin

What is the only cloudy insulin

NPH

What type of insulin is Insulin glargine (lantus)

Long acting, basal insulin

What basal insulin CANNOT be mixed with another insulin

Insulin glargine (lantus)

What type of insulin is Insulin glargine U300 (toujeo)

ultra long acting, basal insulin

What type of insulin is degludec (tresiba)

ultra long acting, basal insulin

Uses NPH-Short Acting

multiple daily injection, acute for DKA

Onset NPH-Short Acting

30 min

Peak NPH-Short Acting

2-3hr

Duration NPH-Short Acting

6 hr

When to admin NPH-Short Acting (timing)

about 30 min before eating

When would U-500 NPH be given over U-100

Pts receiving high doses, >200 units/ day

Uses Insulin lispro (humalog)

multiple daily regimens, insulin pumps

Onset insulin lispro (humalog)

within 15 min

Peak insulin lispro (humalog)

2 hrs

Duration insulin lispro (humalog)

4-7 hrs

Time of admin insulin lispro (humalog)

right before eating

Uses insulin lispro (lyumjev)

multiple daily injections *insulin pump

Issues with insulin lispro (lyumjev)

Cost

Onset insulin lispro (lyumjev)

15-17min

Onset NPH-Intermediate acting

2-4hrs

Peak NPH-Intermediate acting

6-12hrs

Duration NPH-Intermediate acting

12-18hrs

Uses NPH-Intermediate acting

multiple daily injections, paired with rapid or regular to improve mealtime coverage

Uses for mixed insulin (intermediate + rapid)

two injections a day typically type 2 DM

Onset mixed insulin (intermediate + rapid)

15-30min

Peak mixed insulin (intermediate + rapid)

1-6.5hr

Duration mixed insulin (intermediate + rapid)

10-16hr

Uses Glargine (lantus)

multiple daily injections (basal insulin)

Onset Glargine (lantus)

204hrs

Peak Glargine (lantus)

none

Duration Glargine (lantus)

20-24hr

Degludec vs lantus

degludec quicker onset, longer acting