Master Module 4 Pharm

Synthetic insulin

Lab-produced insulin that replaces insulin patients cannot naturally produce.

Liver glucose

Continuous basal glucose produced by the liver throughout the day.

Meal-time glucose

Glucose entering the bloodstream after eating, causing postprandial peaks.

Sliding scale insulin

Insulin dosing based on pre-meal blood glucose (e.g., 10 units for a glucose of 350 mg/dL).

HbA1c goal

General target is <7%, representing average blood glucose over the previous 3 months.

Type 2 diabetes

Results from both insulin resistance and insulin deficiency.

DKA

Characterized by extreme hyperglycemia, ketones, and electrolyte imbalance.

Macrovascular diabetic complications

Coronary artery disease, stroke, hypertension, peripheral vascular disease.

Microvascular diabetic complications

Nephropathy, retinopathy, neuropathy.

Metformin maximum dose

Typically titrated to a maximum tolerated dose of 2,500 mg/day.

Thiazolidinediones (TZDs)

Increase insulin sensitivity but may cause or worsen heart failure.

DPP-4 inhibitors

Prevent breakdown of incretin hormones, reducing fasting and postprandial glucose.

Amylin agonists

Slow gastric emptying, suppress glucagon, and increase satiety.

Pramlintide (Symlin)

First non-insulin medication approved for Type 1 diabetes.

Incretin mimetics

Stimulate insulin secretion and slow gastric emptying; used only in Type 2 diabetes.

Endocrine system

Network of glands that maintain homeostasis through hormone release.

Anterior pituitary hormones

ACTH, FSH, GH, LH, Prolactin, TSH.

Posterior pituitary hormones

ADH and oxytocin.

Somatropin

Mimics growth hormone to promote linear growth in children with GH deficiency.

Octreotide

inhibits GH release; also treats severe watery diarrhea from certain tumors.

Vasopressin

ADH analog that increases water reabsorption and is also a potent vasoconstrictor.

Desmopressin

used to treat certain blood disorders.

Thyroid hormones

T4 (thyroxine) and T3 (triiodothyronine) regulate metabolism.

Hypothyroidism

High TSH, cold intolerance, weight gain, depression.

Hyperthyroidism

Excess T3/T4 causing increased metabolism, diarrhea, heat intolerance, flushing, palpitations.

Propylthiouracil (PTU)

Inhibits thyroid hormone synthesis; Preferred during first trimester of pregnancy and for thyroid storm.

Methimazole

First-line antithyroid medication for most patients.

Glucocorticoids

Cortisol-like hormones that stimulate gluconeogenesis and protein catabolism while reducing inflammation.

Mineralocorticoids

Aldosterone-like hormones regulating sodium, potassium, water, and blood pressure.

Addison disease

Deficiency of glucocorticoids.

Cushing disease

Excess glucocorticoids.

Fludrocortisone

Mineralocorticoid used to treat Addison disease.

Steroid psychosis

Mood/personality changes and insomnia associated with prolonged high-dose corticosteroid use.

Gonadotropin-releasing hormone (GnRH)

Hypothalamic hormone stimulating FSH and LH release.

Oral contraceptive mechanism

Exogenous estrogen and progesterone suppress FSH and LH, preventing ovulation.

Insulin

Secreted by pancreatic beta cells in response to elevated blood glucose.

Glucagon

Secreted by pancreatic alpha cells; converts liver glycogen into glucose.

Vasopressin clinical use

Useful for hypotensive crisis, not hypertensive emergency.

Thyroid hormones released

T3, T4, and calcitonin.

Levothyroxine

Synthetic T4. Should not be taken without food.

Hyperthyroidism treatment after thyroidectomy

Lifelong levothyroxine replacement is required.

Adrenal glands

Located on the superior surface of each kidney.

Glucocorticoid anti-inflammatory mechanism

Alters gene transcription by increasing anti-inflammatory proteins and suppressing pro-inflammatory proteins.

Long-term corticosteroid adverse effects

Obesity, diabetes, muscle wasting, osteoporosis, growth suppression.

Prednisone

Should never be stopped abruptly after prolonged therapy.

Levothyroxine administration

Should not be taken without regard to food (best on an empty stomach).

Oral contraceptive adverse effects

Nausea, irritability, weight gain.

Oral contraceptives

Must be taken consistently; missing doses reduces effectiveness.

Type 2 diabetes at diagnosis

Most patients are obese.

Diabetes diagnosis/Hyperglycemia

Fasting blood glucose >126 mg/dL.

Typical 2-hour post-meal glucose goal in diabetes

<180 mg/dL.

Sulfonylureas

Oldest class of oral antidiabetic medications.

Sulfonylureas adverse effect

Hypoglycemia.

Metformin adverse effect

GI upset minimized by gradual dose titration and taking with food.

Dulaglutide

Given once weekly, not daily.

Physiologic insulin regimen

Four injections/day (one long-acting plus rapid-acting before meals); some patients avoid it because of regimen complexity.

Rapid-acting insulin examples

Humalog (lispro), Novolog (aspart), Apidra (glulisine).

Intermediate-acting insulin example

NPH.

Short-acting insulin example

Humulin R (regular insulin).

Long-acting insulin examples

Lantus (glargine), Levemir (detemir).

Pituitary gland

Known as the master gland.

Examples of endocrine glands

Pituitary, pineal, adrenal, pancreas.

Pituitary gland anatomy

Has two lobes: anterior and posterior.

ACTH target organ

Adrenal cortex.

TSH target organ

Thyroid.

LH target organ

Ovaries.

ADH target organ

Kidneys.

Thyroid negative feedback loop

Pituitary releases TSH

Pituitary gland location

Located in the region of the forebrain near the hypothalamus.

Pituitary gland primary function

Releases hormones that regulate other endocrine glands through a negative feedback loop.

Negative feedback loop

A hormone released by the pituitary stimulates another endocrine gland, and the resulting hormone signals the pituitary to decrease hormone release.

Anterior pituitary hormones

ACTH, FSH, GH, LH, Prolactin, TSH.

Posterior pituitary hormones

ADH and Oxytocin.

Hypothyroidism

Decreased production of thyroid hormones (T3 and T4), resulting in slowed metabolism.

Hyperthyroidism

Excess production of thyroid hormones (T3 and T4), resulting in increased metabolism.

Hypothyroidism symptoms

Cold intolerance, weight gain, fatigue, depression, dry brittle hair and nails.

Hyperthyroidism symptoms

Heat intolerance, increased appetite, diarrhea, palpitations, irritability, nervousness, flushing, muscle weakness, fatigue, altered menstrual flow.

Hypothyroidism TSH level

Increased because the pituitary attempts to stimulate thyroid hormone production.

Hyperthyroidism TSH level

Decreased because elevated thyroid hormones suppress pituitary TSH release.

Surgical removal of the thyroid gland

Results in hypothyroidism requiring lifelong thyroid hormone replacement.

Adrenal gland location

Located on the upper surface of each kidney.

Two parts of the adrenal gland

Adrenal medulla (inner) and adrenal cortex (outer).

Two corticosteroid classes

Glucocorticoids and mineralocorticoids.

Primary endogenous glucocorticoid

Cortisol.

Inactive glucocorticoid converted in the body

Cortisone.

Primary mineralocorticoid

Aldosterone.

Aldosterone function

Regulates sodium, potassium, extracellular water, and blood pressure.

Addison disease

Deficiency of glucocorticoids.

Cushing disease

Excess production of glucocorticoids.

Why glucocorticoids reduce inflammation

They activate anti-inflammatory protein production and inhibit pro-inflammatory protein production.

Why glucocorticoids have widespread effects

Nearly every cell contains glucocorticoid receptors.

Typical glucocorticoid adverse effects

Increased appetite, weight gain, indigestion, and restlessness.

Serious long-term glucocorticoid complications

Obesity, diabetes, muscle wasting, osteoporosis, thinning skin, decreased wound healing, increased infections, decreased growth in children.

Steroid psychosis

Mood changes, personality changes, and insomnia associated with long-term high-dose corticosteroid use.

Stopping long-term corticosteroids

Must be tapered gradually to prevent withdrawal and severe depression.

Oral contraceptive mechanism

Exogenous estrogen and progesterone suppress FSH and LH, preventing ovulation and altering the endometrium to prevent implantation.

Standard oral contraceptive schedule

One active pill daily for 3 weeks followed by one week of placebo pills.

Major cardiovascular risks of estrogen-containing contraceptives

Blood clots, stroke, and myocardial infarction.

Pancreatic beta cells

Secrete insulin.

Pancreatic alpha cells

Secrete glucagon.